Objective:To explore risk factors of skin pruritus in peritoneal dialysis patients and the effect of individualized care intervention, to provide guidance for clinical practice.Methods:The total of 87 patients with peritoneal dialysis who were followed-up with pruritus in the Beijing Anzhen Hospital from January 2017 to June 2020 were selected. The Visual Analogue Scale (VAS) was used to evaluate the degree of pruritus, and the patients were divided into two groups: mild-to-moderate skin pruritus group (VAS≤6 points) and severe skin pruritus group (VAS>6 points). The risk factors of severe skin pruritus were analyzed by single factor and multivariate Logistic regression. The improvement of skin pruritus after 3 months of individualized nursing intervention was observed.Results:Among the 87 patients, the mild-to-moderate skin pruritus group and the severe skin pruritus group accounted for 64.4%(56/87) and 35.6%(31/87), respectively. Single factor analysis showed that the age, prevalence of diabetes, serum albumin, serum phosphorus, intact parathyroid hormone and C-reactive protein levels were (61.8 ± 11.5) years old, 33.3%(19/56), (36.3 ± 5.3) g/L, (1.6 ± 0.5) mmol/L, 328.4(144.9, 494.5) ng/L, 2.8(0.6, 8.3) ng/L in the mild-to-moderate skin pruritus group, and (67.0 ± 9.2) years old, 61.1%(19/31), (33.9 ± 4.8) g/L, (1.9 ± 0.3) mmol/L, 397.0(300.0,758.6) ng/L, 7.2(2.6, 17.2) mg/L in the severe skin pruritus group, the differences were significant between the two groups ( t values were -2.17, 2.14, -2.32, Z values were -2.28, -2.90, χ 2 value was 6.07, P<0.05). Logistic multivariate regression analysis showed that low albumin, high blood phosphorus and high C-reactive protein were independent risk factors for severe skin pruritus in peritoneal dialysis patients ( P<0.05). After 3 months of individualized care,18.4% (16/87) patients had complete remission,19.5% (17/87) patients significantly relieved, 55.2% (48/87) relieved, 6.9% (6/87) were ineffective, and the total response rate was 93.1%(81/87). Conclusions:More than one-third of peritoneal dialysis patients with pruritus are severe. Lower serum albumin, higher serum phosphorus and higher C-reactive protein are independent risk factors for severe pruritus in peritoneal dialysis patients. Individualized care can effectively improve pruritus in peritoneal dialysis patients.

Objective To evaluate the effects of intrathecal low-dose naloxone,morphine and fentanyl on the expression of motilin (MTL) in the spinal cord in rats with incisional pain.Methods Seventy-two healthy male Sprague-Dawley rats,weighing 180-220 g,in which intrathecal catheters were successfully implanted,were randomly divided into 6 groups (n =12 each) using a random number table:normal saline group (NS group),morphine + fentanyl group (MF group),incisional pain group (P group),naloxone + incisional pain group (NP group),morphine + fentanyl + incisional pain group (MFP group),and morphine + fentanyl + naloxone +incisional pain group (MFNP group).Incisional pain was induced by an incision made into the plantar surface of the right hindpaw.At 20 min before induction of incisional pain,the mixture of morphine 5 μg/kg and fentanyl 0.25 μg/kg was injected intrathecally in MF,MFP and MFNP groups,and naloxone 1 ng/kg was given in NP and MFNP groups.Six rats from each group were randomly chosen,and paw withdrawal threshold to mechanical stimulation (PWMT) and paw withdrawal latency to thermal stimuli (PWTL) were measured before intrathecal catheterization (T0,baseline),at 24 h before induction of incisional pain (T1),and at 1,3 and 6 h after induction of incisional pain (T2-4).The left 6 rats from each group were chosen and sacrificed and the spinal cord were removed at 6 h after operation for detection of MTL content in the spinal cord,body of the stomach and duodeum tissues (by ELISA).Results Compared with the baseline value at T0,PWMT was significantly increased at T3,and PWTL was prolonged at T2-4 in MF group,PWMT was decreased and PWTL was shortened at T2-4 in P group and at T3,4 in NP group,PWMT was increased at T2,3 in MFP group,and PWMT was increased and PWTL was prolonged at T2 in MFNP group (P ＜ 0.05).Compared with NS group,MTL contents in spinal cord and body of the stomach were significantly decreased in MF and NP groups,MTL cortent in duodeum was decreased in group MF,while increased in group NP and MTL content in spinal cord was increased,and MTL content in body of the stomach was decreased in P and MFP groups,MTL content in duodeum was increased in group P,while decreased in group MFP(P ＜ 0.05),however,no significant change was found in MTL content in MFNP group (P ＞ 0.05).Conclusion Intrathecal low-dose naloxone combined with morphine and fentanyl can inhibit up-regulation of the expression of MTL in the spinal cord in rats with incisional pain and is involved in the maintenance of stable gastrointestinal motility.

Objective To evaluate the effects of intrathecal low-dose naloxone,morphine and fentanyl on the expression of motillin (MTL) in the hippocampus of rats with incisional pain.Methods Seventy-two healthy male Sprague-Dawley rats,weighing 180-220 g,aged 6-8 weeks,in which intrathecal catheters were successfully implanted,were randomly divided into 6 groups (n =12 each) using a random number table:normal saline group (NS group),incisional pain group (P group),morphine + fentanyl + incisional pain group (MFP group),and naloxone (0.2,1.0 and 5.0 ng/kg) + morphine + fentanyl groups (MFPN1,MFPN2 and MFPN3 groups).Incisional pain was induced by an incision made into the plantar surface of the right hindpaw.At 20 min before induction of incisional pain,the mixture of morphine 5 μg/kg and fentanyl 0.25 mg/kg was injected intrathecally in group MFP,and the mixture of naloxone 0.2,1.0 and 5.0 ng/kg,morphine and fentanyl were injected intrathecally in MFPN1,MFPN2 and MF-PN3 groups,respectively.Six rats in each group were selected,and the mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 24 h before intrathecal catheterization (T0,baseline),at 24 h before induction of incisional pain (T1),and at 1,3 and 6 h after operation (T2-4).The left 6 rats in each group were selected and sacrificed at 6 h after operation,and the hippocampi,body of the stomach and duodenum were removed for detection of MTL content by enzyme-linked immunosorbent assay.Results Compared with group NS,the MWT was significantly decreased,and the TWL was shortened at T2-4 in P and MFPN3 groups,the MWT was significantly decreased,and the TWL was shortened at T4 in group MFPN1,and the TWL was prolonged at T2 in group MFPN2,the MTL contents in hippocampus and body of the stomach were significantly decreased in P,MFP,MFPN1 and MF-PN3 groups,the MTL contents in duodenum were increased in P and MFPN3 groups,and the MTL contents in duodenum were decreased in MFP and MFPN1 groups (P＜0.05),and no significant change was found in the parameters mentioned above in group MFPN2 (P＞0.05).Conclusion Intrathecal naloxone 1.0 ng/kg combined with morphine and fentanyl can inhibit up-regulation of the expression of MTL in the hippocampus of rats with incisional pain,and then is involved in the maintenance of stable gastrointestinal motility.

Objective To investigate the cell survival of the combination of fibrin glue and adiposederived stem cells (ADSCs) in rats when implanted into ischemic myocardium and the improvement of heart function.Methods The rat ADSCs were isolated from the subcutaneous adipose tissues.The surface phenotype of these cells was analyzed by flow cytometry.Myocardial infarction was induced in female rats using coronary artery ligation.One week after MI,surviving rats were randomized (random nuber) into 4 groups,control group (n =10),fibrin group (n =10),cell group (n =10) and combination group (n =10).100 μl of PBS was injected into the ischemic myocardium in control group.100 μl of Fibrin glue were injected into ischemic myocardium in fibrin group.100 μl of ADSCs labeled with DAPI were injected into the infract along the border zone in cell group.ADSCs in 100 μl of fibrin glue were injected into the infract in combination group.Four weeks after the injection the surviving rats underwent examination of heart functions by the Hemodynamics.The rats were killed and their hearts were taken out to undergo immunohistochemistry with 4,6-diamidino-2-phenylindole (DAPI) and actin and factor Ⅶ to measure the area of cardiac infarction and the capillary density.The heart infarcted size was calculated by masson trichrome staining.All data was analyzed by software SPSS 15.0,ANOVA comparison tests and the student t test were used,and P ＜ 0.05 was considered as statistically significant.Results Four weeks after the cells were transplanted,LVSP and + dp/dtmax of combination group were highest among all groups.The heart infarcted size of the combination group was (28.5 ± 3.6) ％,significantly less than those of the cell group (33.33 ± 2.3) ％ and fibrin group (35.96 ± 2.11) ％,both P ＜ 0.05.The capillary density of the combination group was (108.7 ± 11.38) /mm2,significantly greater than those of the cell group and that of the fibrin group,and greater than that of the control group.DAPI and actin double staining detected a varied increase in the number of surviving cardiomyoctyes at the heart infarcted area.Conclusions Transplantation of ADSCs with fibrin glue brings better improvement in cell survival and in restoration of heart function than either cellular or fibrin therapy alone.

Objective To elucidate the clinicopathological characteristic, differential diagnosis, treatment and prognosis of systemic amyloidosis. Methods An inpatient diagnosed as systemic amyloidosis was analyzed for clinical and pathological features as well as laboratory findings. The related literature was reviewed. Results The patient was confirmed to have amyloidosis of the muscle. Muscle involvement was the most prominent and first manifestation, and the patient had widespread visceral involvements, which included cardiovascular system, kidney, respiratory as well as gastrointestinal tracts and tongue. The biopsy of the muscle, mucosa of stomach and intestine, and cutaneous tissue revealed amyloid material deposited in the skeletal and smooth muscle as well as vessel walls. Conclusion Amyloid myopathy is a rare manifestation in systemic amyloidosis. Skeletal muscle weakness and stiffening may be an important clue to the diagnosis of systemic amyloidosis.

Summary: The levels of serum TNF-α and IL-8 in the patients with allergic asthma during acute attack period and remission period, and the effects of glucocorticoid (GC) on them were investigated. By using ELISA, the levels of TNF-α and IL-8 were detected in the healthy volunteers (group C, n=40), the patients with allergic asthma (n=40) during acute attack period (group A) and remission period (group B) and those taking GC for a week (n=28). The results were compared among them. It was found that the levels of TNF-α and IL-8 in group A were higher than in group B and group C. In the patients subject to GC therapy, the levels of TNF-α and IL-8 were decreased as compared with those in group A. In group B, the level of TNF-α was higher than in group C, but there was no significant difference in the level of IL-8 between group B and group C. It was concluded that the inflammatory cytokines, TNF-α and IL-8, played important roles in the bronchus allergic inflammation. GC could reduce the levels of serum TNF-α and IL-8 to exert the anti-inflammatory effects.

Objective:To evaluate the reliability of several formulae for estimating the quantity of glucose absorption of peritoneal dialysate (GA).Methods:Forty-four patients receiving continuous ambulatory peritoneal dialysis (CAPD) were enrolled in this study. The quantities of GA obtained from actual measurement and estimation were compared to judge whether there was statistical difference between them.Results:The GA quantities estimated by Grodstein formula, Bodnar formula, K/DOQI formula, empirical method A (based on 60% absorption rate) and empirical method B (based on 50% absorption rate in daytime and 80% absorption rate in night) were as follows: 81.3 (64.2, 118.0) g, (97.8±19.7) g, (94.1±25.8) g, 87.1 (76.2, 109.0) g and (89.5±16.0) g, respectively; the actually measured GA quantity was [94.2 (77.5, 111.6)] g. Wilcoxon signed rank test of paired samples showed that only the results of Bodnar formula and K/DOQI formula did not present statistical differences from actually measured result.Conclusion:It can be considered to use Bodnar formula and K/DOQI formula to roughly estimate the GA quantity of CAPD patients, but to accurately understand the individual GA value, actual measurement is still required.

Objective To investigate insulin sensitivity and beta cell function in female systemic lupus erythematosus (SLE) patients with different glucose tolerances. Methods Insulin sensitivity and beta cell function were compared between SLE patients and non-SLE subjects in the states of normal glucose tolerance (NGT), impaired glucose tolerance (IGT)and diabetes mellitus (DM) respectively.Furthermore, risk factors for insulin sensitivity and beta cell function in SLE patients were analysed by linear regression. Results In NGT state, insulin sensitivity and beta cell function of newly diagnosed SLE patients without glucocorticoids treatment were not significantly different from those of normal control group ( P ＜0. 05). Compared with newly diagnosed SLE patients without glucocorticoids treatment and normal control group, HOMA insulin resistance index (HOMA-IR) , In (HOMA-β), In (early phase insulin secretion index, EISI ) and In ( late phase insulin secretion index, LISI ) of SLE patients with glucocorticoids treatment were significantly higher( 1.91 ± 1.04 vs 0. 81 ±0. 75,0. 94 ±0. 27;5.05 ±0. 65 vs 4. 01 ±0. 63,4. 23 ±0.47;3. 14±0.81 vs 2.42 ±0.39,2.50±0.65;2.30 ±0.55 vs 1.62 ±0.57,1.56 ±0.43;P ＜0.05),while In ( Matsuda index, MI ) was significantly lower ( 4. 53 ± 0. 54 vs 5. 27 ± 0. 68,5. 18 ± 0. 38; P ＜0. 05). In IGT and DM state, HOMA-IR (2. 84 ± 1. 87 vs 1.82 ± 1.22, 3. 18 ±2. 29 vs 2. 94 ±2. 26) and In (HOMA-β) (5. 18 ±0. 93 vs 4. 06 ±0. 58, 3. 99 ± 1.04 vs 3.43 ±0. 83) were significantly higher in SLE patients with glucocorticoids treatment than those of non-SLE subjects ( P ＜ 0. 05 ) respectively. BMI and In (daily glucocorticords doses) were independent risk factors for insulin sensitivity, and age, the SLE disease activity index(SLEDAI) and In(daily glucocorticords doses) were related factors beta cell function.Conclusion In NGT, IGT and DM state,SLE female patients with glucocorticoids treatment have reduced insulin sensitivity and increased beta cell function, these changes are related to the use of glucocorticoids.

Objective To investigate the mechanism of phenylethanoid glycosides of pedicularis muscicola Maxim ameliorating high altitude memory impairmentby activating mTOR signal pathway.Methods 60 clean male Wistar rats were randomly divided into normoxic control group, hypoxia group, PhGs low, medium and high dose groups(50, 200, 400 mg/kg by oral administration).Normoxic control and hypoxia groups were administered with sterile injection water for 7 days.On the fourth day of drug treatment, hypoxia and PhGs groups were exposed to a specially designed animal decompression chamber, which simulated 7 500 m high altitude environment.The expression levels of mTOR, P70S6K and 4E-BP1 mRNA in hippocampus were detected by SYBR Green real-time PCR.The expression levels of p-mTOR, p-P70S6k and p-4E-BP1 protein in hippocampus were detected by Western blot.Results For hypoxia group rats, mTORand P70S6k mRNA repression, p-mTOR and p-P70S6K protein repression were respectively decreased by 22.50%, 26.00%, 42.28% and 11.70%(P<0.05, P<0.01), 4E-BP1 mRNA repression and p-4E-BP1 protein repression were respectively increased by 41.28%, 111.86%(P<0.01) in comparison tonormoxic control group.Compared with hypoxia group,for PhGs low dose group rats, 4E-BP1 mRNA repression and p-4E-BP1 protein repression were respectively decreased by 77.33% and 82.4%(P<0.01), p-P70S6K protein repression was increased by 32.53%(P<0.01).For PhGs medium, high dose groups, mTOR and P70S6k mRNA repression,p-mTOR and p-P70S6K protein repression were respectively increased by 64.56%, 60.76%;14.86%, 20.27%;65.12%, 94.17% and 56.63%, 78.31%(P<0.01), 4E-BP1 mRNA repression and p-4E-BP1 protein repression were respectively decreased by 72.67%, 71.57% and 57.6%, 40%(P<0.01).Conclusion Phenylethanoid glycosides of Pedicularis muscicola Maxim can ameliorate high altitude-induced memory impairment.This protective mechanism may due to the activation of mTOR signal pathway.

Objective To explore the factors influencing the efficacy of conventional Western medicine treatment for patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to provide a basis for individualized clinical treatment.Methods 100 patients with AECOPD were prospectively included in this study,and all of them were given standard treatment plans according to the guidelines.After 3 months of follow-up observation,53 cases were evaluated as effective and included in the effective group;47 cases were evaluated as having no significant effect and included in the ineffective group.Differences in basic characteristics between the two groups in terms of age,duration of COPD,respiratory rate,lung function and consolidated malignancy were compared,and pre-treatment laboratory test indexes and blood gas analysis data were collected for comparison.Results There were significant differences between the two groups in terms of age,duration of COPD,respiratory rate,ratio of forced expiratory volume in one second to forced vital capacity(FEV1/FVC%),consolidated malignancy,hemoglobin,lymphocytes,C-reactive protein,glutamic-pyruvic transaminase and PaCO2(P<0.05).Univariate logistic regression analysis showed that older age,prolonged COPD duration,increased respiratory rate,decreased FEV1/FVC%,consolidated malignancy,decreased hemoglobin,decreased lymphocyte count,increased C-reactive protein,increased glutamic-pyruvic transaminase,increased lactate,and increased PaCO2 were risk factors for poor treatment outcome in AECOPD.Further multifactorial logistic regression analysis showed that age(P=0.007,OR=1.240),FEV1/FVC%(P=0.014,OR=0.757),hemoglobin(P=0.038,OR=0.954),lymphocyte count(P=0.007,OR=0.488),and lactate(P=0.002 OR=9.964)were independent risk factors affecting the efficacy of AECOPD treatment.ROC curve analysis showed that the AUCs for age,FEV1/FVC%,hemoglobin,lymphocyte count and lactate were 0.728[95%CI(0.627,0.829)],0.681[95%CI(0.576,0.785)],0.686[95%CI(0.582,0.790)],0.629[95%CI(0.520,0.737)]and 0.823[95%CI(0.744,0.902)],respectively,and the combined AUC of the five risk factors for predicting a poor AECOPD treatment outcome was 0.957[95%CI(0.923,0.991).Conclusion Age,FEV1/FVC%,hemoglobin,lymphocyte count and lactate are independent risk factors that influence the treatment outcome of AECOPD patients.The comprehensive analysis of these risk factors can predict the treatment effect of AECOPD more accurately,help clinicians adjust the treatment plan in time,and improve the treatment effect and prognosis.