Objective To investigate the serum cystatin C (CysC) level and explore its relationship with cytokines and atherosclerosis (AS) in maintenance hemodialysis (MHD) patients.Methods A total of 110 stable MHD patients undergoing hemodialysis for at least six months and 60 healthy control people were enrolled in the study.Serum levels of CysC and high-sensitivity Creactive protein (hsCRP) were measured by immunoturbidimetry.The serum levels of total homocysteine (tHcy),IL-1β,IL-6 and TNF-α were determined by ELISA.Prevalence of atherosclerosis was detected by carotid ultrasonography.The relationship of CysC level and cardiac geometry incidence in MHD patients was analyzed by Logistic regression model.Results The serum CysC level was significantly higher in MHD patients as compared with healthy controls [(6.19±0.95) mg/L vs (0.76±0.21) mg/L,P＜0.01],and the serum levels of hsCRP,tHcy,IL-1β,IL-6,TNF-α were significantly higher in MHD patients than those in healthy control group (P＜0.05 or P＜0.01).The serum CysC level was higher in MHD patients with carotid artery atherosclerosis compared to patients without carotid artery atherosclerosis (P＜0.05).CysC was positively correlated with hsCRP,tHcy,IL-1β,IL-6,TNF-α respectively (P＜0.05 or P＜O.01),and was positively correlated with carotid intimal medial thickness (IMT) and AS.Besides,a negative correlation was found between the serum CysC level and the serum albumin level (P＜0.05),while CysC was positively correlated with dialysis duration,systolic pressure and iPTH (P ＜0.05).Conclusion Serum CysC level is significantly higher in MHD patients and is correlated with hsCRP,tHcy,IL-1β,IL-6,TNF-α as well as carotid artery atherosclerosis,which indicates that CysC is an independent risk factor of AS in MHD patients.

Objective To investigate the effect of L-carnitine on pathological changes of myocardium and the underlying mechanism in chronic renal failure rats (CRF). Methods A total of 55 male SD rats were randomly divided into sham group (n=10),model group (n=15),low dose (300 mg/kg),medium dose (600 mg/kg) and high dose (900 mg/kg) L-carnitine group(n=10,each).5/6 subtotal nephrectomy was performed in these rats without sham group.One week after the operation,normal saline or corresponding dose L-carnitine were intragastrically administrated to sham and model group or L-carnitine groups for 17 weeks.Transthoracic echocardiography,mean arterial pressure (MAP),heart rate (HR) and heart weight/body weight were assessed.Moreover,24h urine protein,renal function,SOD,MDA,IL-6,ATP,ADP were measured at the end of the study.Additionally,pathological changes in myocardium were detected by light microscope and transmission electron microscope. Results (1) ATP (μmol/g·wt)in L-carnitine groups (2.35±0.24,3.59±0.28,3.78±0.25) was significantly higher than that in model group (1.61±0.12) (all P＜0.01).(2) Thickness of posterior wall of left ventricle (mm) in high dose L-carnitine group was thinner than that in model group (3.74±0.23 vs 4.18±0.48,P＜0.05). (3) The ratios of heart weight to body weight in both medium dose and high dose L-carnitine groups (3.92±0.27,3.65±0.2) were significantly lower compared to model group (3.99±0.27) (all P＜0.01). (4) Under light microscopy,disarrangement and hypertrophy of cardiac myocytes,increased myocardial fibrosis were observed in model group, while these changes and the pathological scores were significantly improved in both medium dose and high dose L-carnitine groups (7.14±1.07,6.13±0.99),as compared with model group (9.88±1.13) (all P＜0.01).Under electron microscopy,typical changes in cardiac hypertrophy were observed,including dissolution of myocardial fibers,increasing and swelling of mitochondria,membrane rupture as well as matrix increase in model group,while these changes were ameliorated by L-carnitine in a dose-dependent manner. (5) Seventeen weeks after the treatment,both IL-6 and MDA were decreased in all L-carnitine-treated groups than those in model group [IL-6 (ng/L):261.86±13.18,240.12±18.7,233.34±36.88 vs 596.64±81.41; MDA (nmol/L):15.23±2.01,12.41±0.6.10.97±1.9 vs 21.84±2.71).Whereas,SOD (U/ml) were increased in L-carnitine-treated groups (51.2±6.11,58.51±5.52,60.63±6.94) than that in model group(32.01 ±5.69 )(all P＜0.05).(6) No significant differences of systolic,diastolic blood pressure or MAP were found among groups. Conclusion L-carnitine can improve energy metabolism,micro-inflammation and oxidative stress in myocardium of CRF rats,which may be associated with the amelioration of cardiac hypertrophy and fibrosis.

Objective To observe the efficacy, safety and feasibility of the four kinds of anticoagulation method in hemodialysis patients with high risk of hemorrhage. Methods 128 patients with high risk of hemorrhage who had undergone hemodialysis were randomly divided into four groups. In group A, 68patients were resorted with 30% regional sodium citrate anticoagulation(RCA). In group B, 60 patients were treated with local heparin anticoagulation. In group C, 64 patients were treated with low molecular weight heparin (LMWH). In group D, 66 patients received no heparinization hemodialysis. The changes of bleeding, clotting function, adverse effect and nursing strategies were studied. Results All patients of group A completed regular hemodialysis with satisfactory indices, 6 cases with bleeding and primary bleeding aggravated in group B, 8 cases with bleeding and primary bleeding aggravated in group C, 8 cases occurred grade three coagulation and finished dialysis in group D. 3 cases in group A and 2 cases in group B occurred adverse reaction, but no adverse reaction was seen in group C and D. Conclusions RCA is safe,effective and can be easily handled in regular hemodialysis. It is an ideal dialysate for hemodialysis in patients with high risk of hemorrhage.

Objective To investigate the serum level of free fatty acid (FFA) and explore its relationship with cytokines and atherosclerosis (AS) in chronic kidney disease (CKD).Methods The serum level of FFA was determined with enzymatic colorimetry.IL-1 β, IL-6 and TNFα were determined with ELISA.High-sensitivity C-reactive protein (hsCRP) was measured with immunoturbidimetry.Prevalence of atherosclerosis was detected with carotid ultrasonography.We evaluated the relationship between serum levels of FFA and IL-1β,IL-6, TNFα, hsCRP as well as the renal function in 130 adult patients with CKD, stratified according to the GFR ( based on the National Kidney Foundation/Kidney Dialysis Outcomes Quality Initiatives) and in 58 hemodialytic (HD) patients.The relationship between FFA level and cardiac geometry incidence in CKD patients was analyzed with logistic regression model.Results The serum level of FFA was significantly higher in CKD patients as compared with that in the healthy controls [(492.63 ± 143.59)vs (302.65 ± 142.18) μ mol/L, P ＜ 0.01], even in the early stage of CKD.The level of FFA increased with the progression of renal dysfunction.In the non-dialytic CKD group, the level of FFA was negatively related to GFR and positively related to the proteinuria (P ＜ 0.05), while in the HD group, it was positively correlated with dialysis duration ( P ＜ 0.05 ).The serum levels of FFA were higher in CKD patients with carotid artery atherosclerosis than those in patients without ( P ＜ 0.05 or ＜ 0.01 ).However, in both groups with impairment of renal function, the levels of FFA were positively correlated with hsCRP, IL-1 β, IL-6,TNFα and TG( all P ＜ 0.05 ).A positive correlation between the level of FFA and the clinical manifestations such as carotid intimal medial thickness (IMT) and AS was also found.A negative correlation was found between the level of FFA and the serum level of albumin and GFR( P ＜ 0.05).Conclusion Serum levels of FFA are significantly higher either in non-dialytic CKD or in HD patients and it is related with hsCRP, IL-1 β, IL-6, TNFα as well as carotid artery atherosclerosis, indicating that FFA is an independent risk factor of AS in CKD.

Objective To investigate the effects of levocarnitine combined with urimetazidine on left ventricular remodeling in maintenance hemodialysis(MHD)patients.Methods All of 86 MHD patients and 40 healthy volunteers(health control group)were involved in the study.all of 86 MHD patients were randomly divided into two groups,disease treatment group(46 cases)and disease control group(40 cases),who had undergone hemodialysis for at least 3 months before the study and were in a stable clinical status without signs of infection or disease activity.In disease treatment group,1.0 g of levocarnitine was infused at the end of each dialysis treatment and 20 mg of trimetazidine was taken orally 3 times each day for 6 months,while the parameters for free fatty acid(FFA),free carnitine(FC),inflammation and oxidative stress were studied before and after the treatmenL In disease control group these two drugs were not used.The left ventricular end-diastolic diameter(LVDd),left ventricuhr end-systolic diameter(LVDs),left atrial diameter (LAD),left ventricular posterior wall thickness(LVPWT),interventricular septal thickness(IVST)and left ventricular ejection fraction(LVEF)were detected by ultrasonic cardiography.Results Before treatment,the serum levels of FFA,high-sensitivity C-reactive protein(hs-CRP),intedeukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-αand malondialdehyde(MDA)were higher in disease treatment group and disease control group than those in health control group(P<0.05 or<0.01),while the serum levels of FC,glutathione peroxidase(GSHPx)and superoxide dismutase(SOD)were lower in disease treatment group and disease control group than those in health control group(P<0.05 or<0.01).Compared with those before treatment,the serum levels of FFA,hs-CRP,IL-1β,IL-6,TNF-α,MDA were decreased(P<0.05 or<0.01),FC,GSHPx,SOD were increased(P<0.05 or<0101),the scores of LVDd,LAD,IVST,LVPWT,LVMI were also decreased significantly(P<0.05),while LVEF increased markedly after treatmem in disease treatment group(P<0.05).There were significant differences in all indexes between disease treatment group and disease control group(P<0.05 or<0.01).Conclusion Supplements of levocarnitine combined with trimetazidine in MHD patients appear to be associated with an improvement of left ventricular remodeling.

Objective To investigate the effects of trimetazidine on the oxidative stress in maintenance he-modialysis (MHD) patients. Methods Eighty-six MHD patients and 30 healthy volunteers were recruited in the study. The activity of glutathione peroxidase (GSHPx) was measured by colorimetry and superoxide dismutase (SOD) in serum was measured by hydroxylamine method. The levels of serum malondialdehyde (MDA) were meas-ured by thiobarbituric acid reaction. Serum advanced oxidation protein products (AOPP) levels were measured by enzyme-linked immunosorbent assay (ELISA). All MHD patients were randomly divided into two groups, treatment group (n = 46) and control group (n = 40), who had undergone hemodialysis for at least three months before the study and were in a stable clinic status without signs of infection or disease activity. In the treatment group,20 mg of trimetazidine was taken orally three times each day for twenty-four weeks, when the parameters for oxidative stress were studied. The levels of GSHPx. SOD, MDA and AOPP in serum were measured before and after the treat-ment. Results At the initiation of the investigation, the serum levels of GSHPx [(584.37±215.70) μmol/L, (580.87±309.12) μmol/L vs (769.06±302.46) μmol/L] and SOD [(347.87±82.09) kU/L, (348.16±75.33) kU/L vs (428.34±15.23)kU/L] in the M HD patients were significantly lower than those in the normal eontrol group (P < 0.01), whereas the content of MDA [(4.94±1.32) nmol/L, (4.97±1.61) nmol/L vs (3.56±0.46)nmol/L] and AOPP [(120.95±59.24) μg/L,(121.76±69.12) μg/L vs (47.69±20.15) μg/L] in MHD patients was higher than those in the control group( P < 0.05 and P <0.01, respectively). After treatment for twelve weeks, the scores of GSHPx and SOD were significantly increased in the treatment group compared to that before treatment (P <0.01). However, the contents of the MDA and AOPP decreased. There were significant differences in the levels of GSHPx, SOD,MDA and AOPP between the two groups of MHD patients after the treatment with trim-etazidine. Conclusions Trimetazidine in maintenance hemodialysis patients appears to be associated with an im-provement of oxidative stress.

ced glutathione in MHD patients appears to be associated with an improvement of oxidative stress.

Objective To investigate the effects of parathyroid hormone(PTH)on microinflammatory and nutritional status in maintenance hemodialysis(MHD)patients.Methods Ninety-eight MHD patients were selected,who hod undergone hemodialysis for at least three months before the study and were in a stable clinical status without signs of infection or disease activity.The serum level of intact PTH was measured by electrochemiluminescence immunoassay(ECLIA),while the serum levels of interleukin(IL)-1β,IL-6,IL-8 and tumor necrosis factor-α(TNF-α)were detected by enzyme-linked immunosorbent assay(ELISA).The levels of C-reactive protein(CRP),albumin(Alb),pre-albumin(PA),hemoglobin(Hb)and lipids were measured.Body measurement and modified quantitative subjective global assessment(MQSGA)was done simultaneously.Correlation analysis between serum PTH level and the parameters for inflammation and nutrition Was performed.Results The serum levels of intact PTH in MHD patients[(353.46±102.41)ng/L]were significantly higher than those in the control people[(57.45±5.76)ng/L,P<0.01],and the serum levels of IL-1β,IL-6,IL-8,TNF-α and CRP were significantly higher in MHD patients than those in the control people(P<0.01 or <0.05).Relative body weight(RBW),triceps skin fold thickness(TSF),mid-arm circumference(MAC)and mid-arm muscle circumference(MAMC)in MHD patients decreased significantly(P<0.05 or <0.01),while the score of MQSGA increased markedly(P<0.01).The levels of intact PTH showed significantly positive correlations with the levels of CRP,IL-1β, IL-6,TNF-α, lipoprotein(a) [Lp(a)] , serum phosphorus and ages of MHD(P<0.05 or <0.01 ).The levels of intact PTH showed significantly negative correlations with RBW, MAC, MAMC, Alb, Hb and total cholesterol(TC) in MHD patients (P<0.01 or <0.05) . And there was also significantly positive correlation between PTH and MQSGA in MHD patients (P<0.05). Conclusion PTH is probably involved in the presence and the progression of malnutrition-inflammation-atherosclerosis syndrome in MHD patients.

Objective:To investigate the efficacy and safety of plasma exchange (PE) combined with plasma perfusion (PP) in treatment of liver failure and the influence on inflammatory factors and liver function.Methods:98 patients with liver failure in our hospital from February 2014 to February 2016 were selected as the subjectswere,and they were randomly divided into experimental group and control group,and each group was 49 cases.The experimental group was treated with PE combined with PP,and the control group was received PE alone.The liver function before and after treatment was detected by automatic biochemical analyzer.The serum levels of C-reactive protein (CRP),tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were determined by enzyme-linked immunosorbent assay (ELISA).The total effective rate,the incidence of side effects,the levels of liver function and inflammatory factors before and after treatment were compared between the two groups.Results:The clinical effective rate in the experimental group (91.84％) was significantly higher than that in the control group (73.47％),the difference was statistically significant (P＜0.05).The incidence of adverse reactions in the experimental group (10.20％) was significantly lower than that in the control group (38.78％),the difference was statistically significant (P＜0.05).The levels of serum alanine aminotransferase (ALT),total bilirubin (TBIL) and blood ammonia (NH3) were significantly decreased in both groups after treatment (all P＜0.05).Albumin (ALB) and thrombin activity (PTA) were significantly increased in both groups after treatment (both P＜0.05).After treatment,the serum levels of ALT,TBIL and NH3 in the experimental group were lower than those in the control group (all P＜0.05),the levels of ALB and PTA were higher than those of the control group,the difference was statistically significant (both P＜0.05).After treatment,the serum levels ofCRP,TNF-α and IL-6 were lower than those before treatment,and the serum levels of CRP,TNF-α and IL-6 in the experimental group were lower than those in the control group (all P＜0.05).Conclusion:The combination of plasma exchange and plasma perfusion has a good effect in the treatment of liver failure,and the incidence of adverse reactions is low.It can effectively remove inflammatory factors,improve liver function and improve the quality of life of patients.

Objective To determine the effects of trimetazidine (TMZ) on pathology and energy metabolism of myocardium in chronic renal failure(CRF) rats.Methods CRF models were built in Sprague-Dawley (SD) rats with 5/6 subtotal nephrectomy, and animals were randomyly divided into sham group, control group and three groups treated with different doses of TMZ (3 mg/kg,6 mg/kg or 9 mg/kg).TMZ was intragastrically administrated to CRF rats for 17 weeks, while physiologicalsalinewasusedascontrol. Transthoracicechocardiographywasperformedand myocardial morphosis was observed.Left ventricular weight/body weight(LVW/BW) and heart weight/body weight (HW/BW) were measured, and heart rate, and mean arterial pressure (MAP)were detected at the end of the study, while several parameters were detected, including urea nitrogen (BUN), creatinine(Scr), triphosaden(ATP), adenosine diphosphate(ADP), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α).Results (l)Left ventricle end-systolic dimensions, anterior wall end-diastolic and end-systolic thicknesses, and posterior wall end-diastolic thickness were significantly lower in rats treated with either medium dose or high dose of TMZ, as compared with control group(P＜0.05).(2)LVW/BW and HW/BW in rats treated with either medium dose or high dose of TMZ were significantly lower than those in control group(P＜0.05). (3)Various pathological changes were observed in control group, such as irregular arrangement and hypertrophy of the cardiomyocytes, myocardial fibrosis,mitochondrial swelling, focal muscle fiber dissolution, etc.However, all these pathological changes were apparently ameliorated in TMZ-treated groups, while the beneficial effects of TMZ therapy were dose-dependent. (4)No difference was observed in heart rate among all the groups.Although no difference existed in all the CRF rats, concerning on the systolic/diastolic blood pressure and mean arterial pressure (P＞0.05), these parameters were elevated in CRF rats, as compared with sham-operated group(P＜0.01). (5)ATP and ADP in TMZ-treated rats were significantly higher as compared with control(P＜0.05), moreover, medium dose and high dose of TMZ were superior to low dose (P＜0.05).(6)SOD was significantly increased in TMZ-treated rats (P＜0.05), while IL-6,TNF-α and MDA were significantly decreased in medium dose and high dose of TMZ, as compared with control(P＜0.05).Conclusion TMZ may prevent myocardial fibrosis and left ventricular hypertrophy in chronic renal failure via ameliorating myocardial energy metabolism and alleviating inflammatory reaction and oxidative stress.