Objective To compare the differences of the four estimating equations about MDRD,CKD-EPI eGFRcr,CKD-EPI eGFRcys,and eGFRcr-cysin evaluating the renal function of kidney transplant recipients,and explore the optimal equations to estimate the renal allograft function.Method Between January 2000 to March 2015,a total of 213 renal transplant recipients with data integrity were enrolled.eGFR was calculated using the equations:Modification of Diet in Renal Dis-ease [eGFR (MDRD),the creatinine-based equation (CKD-EPI eGFRcr),the CKD EPI cystatin C equation (CKD-EPI eGFRcys),and CKD EPI creatinine + cystatin C equation (CKD-EPI eGFRcr-cys) drafted by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) in 2009 and 2012.We assessed the performance of these four eGFR equations by Pearson correlation analysis,Bland-Altman plot,and Cox regression analysis.Result The incidence of reduced kidney function was 49.3％ using MDRD,43.7％ using eGFRcr,49.8％ using eGFRcys,and 52.1％ using eGFRcr-cys,respectively.In recipients with eGFR ≥60 ml·min· 1.73 m2 estimated by MDRD,19.5％ and 11％ had eGFR ＜60 ml·min·1.73 m2 re-estimated by eGFRcys and eGFRcr-cys respectively.Serum cystatin C was significantly correlated with serum creatinine,MDRD,eGFRcr,eGFRcr-cys with the correlation coefficient being 0.67,0.61,0.65,and 0.77 respectively.Only the CKD staging based on eGFRcr,and eGFRcr-cys was positively related to renal graft loss risk.eGFRcr,and eGFRcr-cys could not be replaced each other,and only eGFRcr-cys showed strong correlation with the other three equations.Conclusion As compared with others,eGFR (CKD-EPI-Creat + CysC) is more precise in estimating GFR and evaluating the renal graft loss risk.

Objective To explore the mechanism of gene Nelin on the differentiation of vascular smooth muscle cells(VSMC).Methods Human VSMCs were stably infected with over-express lentiviral vector [Nelin-VSMC] and interference lentiviral vector [LV-Nelin-SiRNA-VSMC] by Western blotting and RT-PCR.The effect of Nelin expression on phenotypic transition of VSMCs was observed and the mechanism involved was explored.Results The Nelin-VSMC cells take on the contractile phenotype of long slender cells possessing hill-valley characteristics.Overexpression of Nelin can enhance SMoα-actin expression with the increase of total RhoA and nuclear serum response factor(SRF) expression.Treated with a selective Rho kinase inhibitor Y-27632,the expression of SMα-actin and nuclear SRF protein induced by Nelin was effectively reduced.Meanwhile,the opposite results were observed in the Nelin-depression VSMC.Conclusions Nelin can enhance the expression of SMα-actin and carry a pivotal role in the process of VSMCs differentiation and phenotype modulation by activating Rho and SRF.

Objective To investigate the practice status of the newNursing practice standards for intravenous therapy in secondary and above hospitals in Shandong province. Methods Self-designed questionnaire was used to investigate 3051 nurses from 129 hospitals in 17 cities in Shandong province. Results Nurses′ awareness rate of the new Nursing practice standards for intravenous therapy was 92.69%(2828/3051);92.13%(2811/3051) nurses reported that their hospitals used the new standard, 65.78%(2007/3051) nurses reported that their hospitals had applied the standard since the second half of 2014; 92.92% (2835/3051) nurses reported that their hospitals had revised their practice rules according to the new standard;93.54%(2854/3051) nurses reported that their hospitals had revised the related nursing process; 50.08% (1528/3051) nurses thought the new standard helpful to clinical practice;22.98%(701/3051) nurses knew well about the new standard;53.85%(1643/3051) nurses thought the standard applicable to clinical practice. Conclusions As nurses do not master the Nursing practice standards for intravenous therapy well, they need strengthened training. Hospitals should fresh their rules, protocolsand supply training program to improve nurses′ knowledge and skill. Meanwhile, Nursing practice standards for intravenous therapyalso needs to be revised and improved according to nurses feedback.

To explore early prevention and control of coronavirus disease 2019 （COVID-19） outbreak based on system dynamics model analysis. The data of early outbreak of COVID-19 were collected from the World Health Organization，covering countries of the China，United States，United Kingdom，Australia，Serbia and Italy. The susceptible-exposed-infected-recovered （SEIR） model was generalized and then its parameters were optimized. According to the parameters in the basic infection number expression，the sensitivity in the system dynamics model was used to quantitatively analyze the influence of the protection rate，infection rate and average quarantine time on the early spread of the outbreak. Based on the analysis results，targeted prevention and control measures for the early outbreak of COVID-19 were proposed. The generalized SEIR model had a good fit for the early prediction and evaluation of COVID-19 outbreaks in six countries. The spread of COVID-19 was mainly affected by the protection rate，infection rate and average quarantine time. The improvement of the protection rate in the first ays was the most important:the greater the protection rate，the fewer the number of confirmed cases. The infection rate in the first 5 days was the most critical:the smaller the infection rate，the fewer the number of confirmed cases. The average quarantine time in the first 5 days was very important:the shorter the average quarantine time，the fewer the number of confirmed cases. Through the comparison of key parameters of six countries，Australia and China had implemented strict epidemic prevention policies，which had resulted in good epidemic prevention effects. In the early stage of the outbreak，it is necessary to improve the protection rate，shorten the average quarantine time，and implement strict isolation policies to curb the spread of COVID-19.
COVID-19 ; China/epidemiology* ; Disease Outbreaks ; Humans ; Quarantine ; SARS-CoV-2

Objective To investigate the effect and safety of comprehensive therapy based on femoral head arthroplasty in treating old femoral neck fracture in the elderly complicated with other severe basic medical conditions.Methods Thirty-six elderly patients with old femoral neck fracture were treated with femoral head arthroplasty.Mean age of the patients was 78.2 years, and mean duration since injury was 13.7 months.All the patients had at least one severe basic medical problem.Perioperative complications were retrospectively analyzed, and function of hip joint was evaluated 6 months after operation.Results One patient died because of severe pulmonary infection, while 16 electrolyte imbalance, 7 hypotension, 4 arrhythmia, 2 acute heart failure and 1 acute kidney injury were cured in the rest 35 patients.Harris hip score of the 35 patients increased from (22.0 ± 6.8) points pre-operatively to (69.2 ± 10.8) points 6 months post-operatively (P ＜ 0.01).Conclusions Comprehensive therapy based on femoral head arthroplasty is effective for old femoral neck fracture in the elderly suffering severe underlying diseases.Early treatment, perfect pre-operative preparation, correct manipulation and appropriate perioperative management play important roles.

Speech evoked brainstem responses (s-ABRs) elicited by a speech syllable /da/ are composed of four parts: onset response (OR), transitional response, frequency following response (FFR) and offset response. FFR elicited by periodic events behaves like a quasi-periodic waveform corresponding to the stimulus sounds. The fast Fourier transform based spectra are commonly used to exam the characteristics of s-ABR in practice, which is, however, unable to trace the occurrence of the main components of s-ABR. The FFR is usually not obvious in the original individual s-ABR waveform. In this paper, we proposed a novel approach to observe the FFR by an instantaneous energy spectrum performed on the intrinsic mode functions (IMFs) after empirical mode decomposition (EMD) of the s-ABR. We demonstrated that the FFR is most pronounced on the second layer of IMFs. This finding suggests a new way which may be available to characterize and to detect the FFR better. This will benefit the clinic applications of s-ABRs.
Adult ; Brain Stem ; physiology ; Evoked Potentials, Auditory, Brain Stem ; physiology ; Female ; Fourier Analysis ; Humans ; Male ; Speech ; Speech Perception ; physiology ; Young Adult

Objective:To explore the influencing factors of continuous renal replacement therapy(CRRT)after heart transplantation(HT).Methods:For this retrospective cohort study, the relevant clinical data were retrospectively reviewed for 145 recipients undergoing HT at No.7 Municipal People's Hospital from April 2018 to December 2022.They were assigned into two groups of non-CRRT(n=124)and CRRT(n=21). And t, χ2or rank-sum test was utilized for comparing baseline data, intraoperative and postoperative general conditions of two groups.Variables with P<0.05 in univariate analysis and significant indicators in previous studies were included in multivariate logistic regression analysis to analyze the influencing factors of CRRT post-HT.Receiver operating characteristic curve(ROC)was utilized for selecting the optimal predictive cut-off value. Results:Among them, 66 cases(45.52%)developed AKI and 21(14.48%)required CRRT.Through univariate analysis, preoperative estimated glomerular filtration rate(eGFR), erythrocyte count, platelet, hemoglobin, total bilirubin, intraoperative volume of blood loss, volume of blood transfusion, urine volume, operative duration, cardiopulmonary bypass time, postoperative mechanical ventilation time, ICU stay and postoperative acute kidney injury were compared.The inter-group differences were statistically significant( P<0.05). Further multivariate logistic regression analysis revealed that preoperative hemoglobin level( OR=0.869, 95% CI: 0.770-0.980, P=0.022), preoperative platelet count( OR=0.959, 95% CI: 0.925-0.993, P=0.019), intraoperative volume of hemorrhage( OR=1.004, 95% CI: 1.000-1.009, P=0.049), intraoperative urine volume( OR=0.997, 95% CI: 0.993-1.000, P=0.035), operative duration( OR=1.022, 95% CI: 1.000-1.044, P=0.047)and mechanical ventilation time( OR=1.036, 95% CI: 1.005-1.069, P=0.024)were the independent influencing factors of CRRT post-HT.ROC curve results indicated that area under curve(AUC)of operative duration, mechanical ventilation time and intraoperative volume of hemorrhage were 0.745(95% CI: 0.636-0.855), 0.835(95% CI: 0.735-0.934)and 0.669(95% CI: 0.506-0.830)with a sensitivity of 0.714, 0.857, 0.571 and a specificity of 0.710, 0.685, 0.895.And the cut-off values were 283.5 min, 25.46 h and 825 ml respectively. Conclusions:Hemoglobin level, preoperative platelet count, intraoperative volume of hemorrhage, urine volume, operative duration, mechanical ventilation time and intraoperative urine volume are independent influencing factors of CRRT post-HT.Operative duration >283 min, mechanical ventilation time >25.46 h and intraoperative volume of hemorrhage >825 ml have some predictive values for CRRT post-HT.

Objective To compare the difference of all-cause mortality between diabetic and non-diabetic transplant recipients.Methods This population cohort study included all primary kidneyonly transplant recipients with data integrity between Jan.2000 and May 2017,the deadline date of follow-up was May 2018,and median follow-up period was 5.9 (range 1.1 to 17.1) years.According to whether the recipients had diabetes,they were divided into type 2 diabetes group (DM group),and no diabetes group (non-DM group).The clinical data of the two groups including recipients and donors were collected.The all-cause mortality and difference in dead causes were analyzed.Results Mortality was higher in DM group than in non-DM group.Compared with non-DM group,the relative risk(RR) for all-cause mortality in DM group was 2.25 (95％ CI:1.23-4.12).The cumulative survival rate in non-DM group was significantly higher than that in DM group(Log Rank P =0.035).The DM group aged younger than 40 years had the highest risk (RR 4.50),but there was no significant difference between the two groups at the age of ≥40 years.Compared with living donor and cadaveric donor renal transplantation,the relative mortality risk in DM group in DCD donor renal transplantation was highest (RR 2.68).The transplantation time did not change the multiple risk of death in both groups (adjusted RR 2.13).The first cause of death in two groups was infection (50％ in DM group vs.53.3％ in non-DM group).The difference was not statistically significant.Conclusion Kidney transplant recipients with type 2 diabetes had higher all-cause mortality than in those without diabetes.Compared with non-diabetic recipients,the age ＜40 years and receiving DCD for kidneys had a greater impact on the all-cause mortality of diabetic recipients.Infection was the leading cause of death in both groups.

Objective:To investigate the predictive value of postoperative C-reactive protein for serious complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 298 patients with advanced gastric cancer who underwent Da Vinci robotic surgical system radical gastrectomy in the 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from January 2017 to June 2019 were collected. There were 253 males and 45 females, aged from 24 to 86 years, with a median age of 60 years. Of the 298 patients, 275 cases underwent no serious postoperative complications and 23 cases underwent serious postoperative complications. Observation indicators: (1) serious postoperative complications; (2) analysis of risk factors for serious postoperative complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer; (3) performance evaluation of the predictive indicators. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the rank sum test. Univariate analysis was conducted using the chi-square test. Multivariate analysis was conducted using Logistic regression model. The receiver operating characteristic curve was drawn and the area under curve (AUC) was used to compare and estimate the efficiency of diagnostic criteria. The value of Youden index was used to determine the optimal cut-off point. Results:(1) Serious postoperative complications: of the 298 patients, 23 cases underwent complications classified ≥grade Ⅲa of Clavien-Dindo classifica-tion, including 10 cases with grade Ⅲa complications, 7 cases with grade Ⅲb complications, 4 cases with grade Ⅳa complications, 1 case with grade Ⅳb complications and 1 case with grade Ⅴ complications. (2) Analysis of risk factors for serious postoperative complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer. Results of univariate analysis showed that operation time, indicators of C-reactive protein concentration and neutrophil count at post-operative day 1, and indicators of C-reactive protein concentration, white blood cells count, neutrophil count and platelet count at postoperative day 3 and pathological stage were related factors affecting serious complications for advanced gastric cancer after Da Vinci robotic surgical system radical gastrectomy ( χ2=7.671, 4.504, 5.045, 48.293, 9.575, 15.436, 13.731, 9.537, P<0.05). Results of multivariate analysis showed that the operation time ≥250 minutes, the concentration of C-reactive protein at postoperative day 3 ≥16.65 mg/dL, the neutrophil count at postoperative day 3 ≥8.167×10 9/L, the platelet count at postoperative day 3 ≥218×10 9/L and the pathological stage of tumor as stage Ⅱ and stage Ⅲ were independent risk factors affecting serious complications for advanced gastric cancer after Da Vinci robotic surgical system radical gastrectomy ( odds ratio=3.721, 16.084, 6.056, 6.893, 12.455, 95% confidence interval: 1.032-13.421, 4.657-55.547, 1.073-34.163, 1.798-26.423, 1.338-115.930, P<0.05). (3) Performance evaluation of the predictive indicators: the C-reactive protein concentration at postoperative day 3 was a high-performance predictor with the AUC as 0.851 (95% c onfidence interval: 0.780-0.921, P<0.05) and neutrophil count and platelet count at postoperative day 3 were low-performance predictors with the AUC as 0.659 and 0.666 (95% confidence interval: 0.570-0.748 and 0.581-0.750, P<0.05). Conclusion:The C-reactive protein concentration ≥16.65 mg/dL at postoperative day 3 is a high performance predictive indicator for serious complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer.

Objective:To explore the value of apparent diffusion coefficient (ADC) and renal volume in assessing fetal kidney development and disease.Methods:From January 2016 to October 2020, 84 fetuses with congenital anomalies of the kidney and urinary tract (CAKUT) were identified with MRI (CAKUT group), and 97 fetuses with no significant abnormalities on MRI or postnatal follow-up (control group) from the Obstetrics and Gynecology Hospital of Fudan University were enrolled and analyzed retrospectively. ADC value and renal volume were measured to compare the two groups, and the relationship was analyzed between these two parameters in the control group with gestational age, location (left or right kidney), and fetal gender. Two independent or paired sample t-tests, and linear correlation analyses, were adopted for the statistical analysis. Results:(1) There were 84 pregnant women in the CAKUT group, including a twin pregnancy, with an average age of (29±4) years old, ranging from 21 to 39 years old. The gestational age at MRI was (26±4) weeks with a range of 21-34 weeks. Of the 85 fetuses, 52 were male (61.2%), and 33 were female (38.8%). The polycystic dysplastic kidney was found in 32 cases (37.6%), hydronephrosis in 29 cases (34.1%), and an isolated kidney in 24 cases (28.2%). There were 97 singleton pregnancies in the control group, including 45 (46.4%) male and 52 (53.6%) female fetuses. The average maternal age was (30±5) years old, with a range of 19-41 years old, and the gestational week at MRI was (27±4) weeks, with a range of 21-34 weeks. (2) In the control group, the mean ADC value and renal volume were (1.255±0.112)×10 －3 mm2/s and (4 747±2 479) mm 3, which were negatively ( R 2=0.30, P<0.01) and positively correlated ( R 2=0.80, P<0.01) with the gestational age, respectively. There was no significant difference between ADC value and renal volume between different fetal gender in the control group. (3) The ADC value and the renal volume of fetuses with polycystic dysplastic kidney [(1.720±0.200) ×10 －3 mm2/s and (8 154±8 337) mm 3] were higher than those in the control group ( t=－13.11 and－3.08, P<0.001 and P=0.004). Compared with the control group, ADC of fetuses with hydronephrosis [(1.333±0.171) ×10 －3 mm2/s] was higher ( t=－3.90, P<0.001); and the renal volume [(7 201±4 460) mm 3] was larger but without statistical significance. The fetuses with an isolated kidney had an increasing trend in renal volume [(5 239±4 244) mm 3] and a decreasing trend in the ADC value [(1.239±0.125) ×10 －3 mm2/s] when compared with the normal fetuses, but neither difference was significant. Conclusions:In normal fetuses, the ADC value decreases, and the renal volume increases with the gestational age. Fetuses with CAKUT may have a larger kidney than normal.