Objective:To explore the safety and effectiveness of modified lower costa surgical approach (mLS) for transversus abdominis plane block (TAPB) combined with rectus sheath block (RSB) in surgical incision peritoneal dialysis catheterization (PDC).Methods:Forty chronic kidney disease of stage 5 patients scheduled for PDC from January to December 2018 in Huadu District People′s Hospital of Guangzhou City were selected. The patients were divided into 3 groups by random digits table method, among whom 13 cases used mLS for TAPB combined with RSB (TAPB combined with RSB group), 13 cases used lateral approach combined with hip approach for TAPB (TAPB group), and 14 cases used local anesthesia (LA group). The mean arterial pressure, heart rate and pain visual analogue score (VAS) at skin incision (T 0), separation of rectus abdominis (T 1), peritoneal dialysis catheter placement (T 2) and suture of skin and subcutaneous tunnel (T 3) were recorded; and the total operation and anesthesia time, cases of rescue anesthesia, surgeon′s satisfaction with anesthesia, surgical and anesthesia related complication were recorded. Results:The VAS from T 0 to T 3 in TAPB combined with RSB group and TAPB group was significantly lower than that in LA group: (1.92 ± 0.95) and (3.00 ± 1.08) scores vs. (5.07 ± 0.62) scores, (1.31 ± 0.63) and (2.54 ± 0.66) scores vs. (3.86 ± 0.77) scores, (0.85 ± 0.69) and (1.77 ± 0.93) scores vs. (3.71 ± 0.61) scores, (1.38 ± 0.77) and (1.38 ± 0.87) scores vs. (3.64 ± 0.17) scores, the VAS of T 1 in TAPB combined with RSB group was significantly lower than that in TAPB group, and there were statistical differences ( P<0.05). There were no statistical differences in mean arterial pressure and heart rate among 3 groups ( P>0.05). The surgeon′s satisfaction with anesthesia from T 0 to T 3 in TAPB combined with RSB group and TAPB group were significantly higher than that in LA group: (3.12 ± 0.76) and (3.11 ± 0.65) scores vs. (2.09 ± 0.61) scores, (3.09 ± 0.82) and (2.68 ± 0.75) scores vs. (1.99 ± 0.66) scores, (3.35 ± 0.82) and (3.31 ± 0.75) scores vs. (2.37 ± 0.73) scores, (3.02 ± 0.82) and (3.01 ± 0.75) scores vs. (2.35 ± 0.63) scores, surgeon′s satisfaction with anesthesia of T 1 in TAPB combined with RSB group was significantly higher than that in TAPB group, and there were statistical differences ( P<0.05). The rescue anesthesia in LA group was in 2 cases. The total operation and anesthesia time in TAPB combined with RSB group was significantly shorter than that in TAPB group and LA group: (45.08 ± 9.62) min vs. (74.46 ± 7.29) and (69.71 ± 13.25) min, that in LA group was significantly shorter than that in TAPB group, and there were statistical differences ( P<0.05). The patients of 3 groups had no surgical and anesthesia related complication. Conclusions:In surgical incision PDC with mLS for TAPB combined with RSB, the effectiveness of intraoperative anesthesia is accurate, the operation time is short, the surgeon′s satisfaction with anesthesia is high, the blood pressure and heart rate are stable, and the security is high.

Objective To study the effect of aralia total saponins on renal function of type 2 diabetic mice, and its effect on the Bax and Bcl-2 protein in renal tissues, in order to provide some references for the development of aralia total saponins. Methods The mice were divided into the normal group, model group, positive control group, low, medium and high dose aralia total saponins group by random number method. Except the normal group, the others were received with high-fat diet for one month+one-time large dose of streptozotocin (STZ) to induce type 2 diabetic model, and then the mice in the normal group and the model group were intragastrically administered with the same volume of normal saline, and the mice in the positive control group was given 1 mg/kg of benazepril solution, and the low, medium and high dose groups were given 30, 60, 120 mg/kg aralia total saponins. The body weight of 1 ml/kg mice was intragastrically administered once a day. After treatment for 6 weeks they were sacrificed, and the serum insulin, and SOD and MDA levels were measured, the urine creatinine (Cr), urea nitrogen (UN), and uric acid (UA) levels were also measured. The immunohistochemistry and Western blot were used to detect the Bax and Bcl-2 protein expression in kidney tissues. Results Compared with the model group, the blood glucose and insulin resistance index in the low, medium and high doses aralia total saponins group were significantly decreased (P<0.05); the levels of urine UN, Cr and UA significantly decreased (P<0.05); The serum SOD level increased and the MDA level significantly decreased (P<0.05). The average gray value of Bcl-2 increased (92.26 ± 11.36, 107.17 ± 9.26, 132.65 ± 8.45 vs. 56.42 ± 16.24) in kidney tissue. The average gray value of Bax (152.62 ± 9.86, 124.48 ± 10.36, 92.29 ± 10.10 vs. 171.38 ± 15.18) significantly decreased ( P<0.05); Bax protein (0.81 ± 0.06, 0.75 ± 0.07, 0.52 ± 0.09 vs. 2.02 ± 0.09) significantly decreased, but Bcl-2 protein (0.92 ± 0.08, 0.94 ± 0.12, 1.27 ± 0.07 vs. 0.30 ± 0.09) significantly increased (P<0.05). Conclusions The aralia total saponins can reduce blood sugar levels, meanwhile improve renal function in type 2 diabetic mice. The mechanism may be may be that aralia total saponins could improve the antioxidant capacity and inhibition of renal cell apoptosis.

Objective:To investigate the characteristics of cardiac structure and function changes in maintenance hemodialysis (MHD) patients.Methods:The information of 363 MHD patients with dialysis age ≥3 months who were registered in Huadu District People′s Hospital of Guangzhou City before January 2020 was collected, and the echocardiographic screening was performed to analyze the changes in cardiac structure and function.Results:The most common abnormal changes of heart structure and function in MHD patients were valve regentation (69.7%), left ventricular hypertrophy (LVH) (51.8%), left ventricular diastolic dysfunction (29.8%), valve calcification (11.6%), and left ventricular systolic dysfunction (10.2%). With the increase of age, the left ventricular ejection fraction of MHD patients decreased, and the proportion of left ventricular diastolic dysfunction, left atrial enlargement and pulmonary hypertension increased (all P<0.05). Among 363 MHD patients, 188(51.8%) had LVH. It was found that LVH patients had higher average single ultrafiltration volume, higher brain natriuretic peptide (BNP) level, more type 2 diabetes, lower left ventricular ejection fraction (all P<0.05), and were more prone to chest tightness, chest pain, post activity shortness of breath, heart failure and other symptoms compared with the non-LVH patients (all P<0.05). Conclusions:Most MHD patients have different degrees of cardiac structural changes. Early intervention, reduction of single ultrafiltration volume and control of blood glucose are beneficial to improve the dialysis quality of MHD patients and reduce the occurrence of cardiovascular events.