Diet therapy is considered as the basic treatment of chronic kidney disease (CKD),and its primary goals are improving metabolic disorder,relieving symptoms and prevent complications,hence to retard renal function lost of CKD patients.However,there have been controversies about the results of clinical studies on nutritional treatment for CKD.This article reviews the effectiveness,safety and compliance of low-protein diet (LPD) for CKD patients,and related clinical management strategies.The article also recommends the feasible diet scheme to provide a reference of clinical LPD therapy for patients with CKD.

Objective To discuss the feature of the ultrasonic image and the clinical value of this test way.Methods six Cases of hypoplastie cartilage from 30 thousand fetus were detected.Results Shortened and widened long bone in four limbs,betl shape in chest,enlarged head and inflated abdomen are the main features of the ultrasonic image.Conclusion Ultrasound is superior to other methods in diagnosing fetus'hypoplastic cartilage.

Objective:To explore the effect of integrated treatment of Chinese and western medicine on muhiple organ dysfunction syndrome (MODS).Methods:129 cases of MODS were treated by syndrome differentiation of TCM with the“four syndrome and four methods”based on the routine western medicine treatment from 1997 to 2003,and their therapeutic effects were evaluated. Results:Of the 129 cases,75 were cured and 54 died,the mortality being 41.9%.After treatment of TCM,the state of illness of the patients were ameliorated,the level of blood endotoxin decreased and the clinical syndrome improved.Conclusion:Integrated with western medicine,the“four syndrome and four methods”has obvious therapeutic effect.

Objective To investigate the treatment of elderly dialysis patients with refractory hypertension.Methods Sixty-six patients were randomly divided into two groups of A group and B group,with 33 cases in each group.Patients in A group were treated by routine hemodialysis 3 times per week and hemoperfusion 1 time every 2 weeks.Patients in B group were treated by routine hemodialysis 2 times per week and hemodiafiltration 1 time per week plus hemoperfusion 1 time every 2 weeks.The levels of blood pressure,plasma endothelin (ET),angiotensin-Ⅱ (AT Ⅱ),renin (RA),parathyroid hormone (PTH) in two groups before and after treatment were compared.Results Before and after treatment,the levels of blood pressure,ET,AT Ⅱ,RA and PTH in A group were (183.42 ± 16.20)/(109.15 ± 7.69) and (151.45 ± 3.31)/(88.71 ±4.95) mmHg(1 mmHg =0.133 kPa),(173.45 ±41.25) and (160.38 ±25.31) ng/L,(69.21 ± 18.47)and(57.25 ± 23.34) ng/L,(1.21 ± 0.15) and (0.87 ± 0.14) μ g/L,(530.27 ± 43.28) and (272.43 ± 34.19) ng/Lrespectively.Before and after treatment,the levels of blood pressure,ET,AT Ⅱ,RA and PTH in B group were (185.34 ± 12.26)/ (112.38 ± 6.24) and (141.59 ± 4.15)/ (80.39 ± 2.73) mmHg,(178.21 ± 34.35) and (149.12 ±21.34) ng/L,(68.38 ±23.57) and (47.17 ± 15.61) ng/L,(1.19 ±0.29) and (0.69 ±0.41) μg/L,(528.62 ± 42.53) and (253.15 ± 31.62) ng/L respectively.The levels of blood pressure,ET,AT Ⅱ,RA and PTH in two groups after treatment were significantly decreased compared with those before treatment (P ＜0.05),and there were significant differences between two groups (P ＜ 0.05).Conclusion Combined with hemoperfusion in the treatment of elderly hemodialysis patients with refractory hypertension,the effect of combined hemodiafiltration is significant,and it is worthy of promotion.

Objective To observe the influence of Xuebijing injection on apoptosis, apoptotic related gene mRNA levels and activity of caspase3 in activated T lymphocyte. Methods The T lymphocytes were obtained from the spleens of BALB/c mice and be induced to be activated and apoptotic by cultured with Con A + IL-2. Apoptosis was investigated by flow cytometry. RT-PCR was used to detect the expression of Fas, FasL, Bcl-2, Bax, IL-2 mRNA, and the activity of caspase3 in T lymphocyte was also detected by spectrophotometric method. In the mean time, the effect of Xuebijing injection on those parameters was observed. Results After the induction, T lymphocyte apoptosis raised at 18 h. At 6 h after the induction, there was no expression of FasL, Bax mRNA, and no change in the expression of Fas and Bcl-2 mRNA. At 18 h, the expressions of Fas, FasL, Bax mRNA rised and the expression of Bcl-2 mRNA lessened. The activity of caspase3 also ascended. Xuebijing injection can cut down the apoptosis induced by induction, make the expression of Fas, FasL, Bax mRNA decreased and Bcl-2 mRNA improved. The activity of caspase3 also fallen after the Xuebijing injection treated. It can promote the expressions of IL-2 mRNA at early phase of AICD (6 h) and depress the expressions at the late period (18 h). Conclusion The apoptosis of T lymphocyte induced by activation was regulated by the change of Fas, FasL, Bcl-2, Bax mRNA expression. Xuebijing injection can ameliorate the apoptosis through regulating the expression of IL-2 and apoptotic related gene mRNA, improve the proliferation activity of T lymphocyte.

Objective To investigate the impact of relevant factors in mechanical ventilation on intraabdominal pressure in patients with ALI/ARDS by continuous monitoring of intra-abdominal pressure.Methods A total of 116 ALI/ARDS patients treated with mechanical ventilation in ICU were enrolled in this study.Intra-abdominal pressure (IAP) was recorded continuously.Meanwhile ventilator parameters, arterial blood gas analysis, hemodynamic variables, and as well as the levels of IL-4, IL-8 and TNF-α in blood and bronchial alveolar lavage fluid (BALF) were determined and recorded.The detection of risk factors for intra-abdomen hypertension (IAH) were carried out using multivariate stepwise logistic regression.ROC curve analysis used to estimate the diagnostic performance of these parameters for IAH.Results The oxygenation index (PaO2/FiO2) in patients with IAH after 2 hours' mechanical ventilation was significantly lower than that in patients with normal intra-abdomen pressure (IAP) (P ＜ 0.01);PEEP and RR in mechanical ventilation were higher in IAH group (P ＜ 0.01 or P =0.001);Mean artery pressure (MAP), ejection time percent (ET), stroke volume (SV), cardiac index (CI) were lower in IAH group than those in normal IAP group (P ＜ 0.01);the levels of IL-4, IL-8 and TNF-α in blood and bronchial alveolar lavage fluid were higher in IAH group than those in normal IAP group (P ＜ 0.01);IAH patients have a higher mortality on 28 d (Log rank test, P =0.023).Poor oxygenation index (PaO2/ FiO2) after 2 hours' ventilation, high PEEP setting, low MAP, ET, SV, CI and elevated IL-4 in the BALF were resulted in increasing risk of IAH for ARDS patients under mechanical ventilation support.Conclusions The monitoring of intra-abdominal pressure should be emphasized for ALI/ARDS patients when mechanical ventilation was employed.PaO2/FiO2, SV and IL-4 in BALF might be the independent risk factors of IAH.

Objective To study the feasibility of the acute gastrointestinal injury (AGI) classification standard for evaluation of gastrointestinal function in intensive care unit (ICU) patients,and to discuss its value in administration of early enteral nutrition (EN).Methods A perspective study was conducted.85 patients with AGI admitted to ICU of Tianjin First Center Hospital from January 2013 to June 2013 were enrolled.EN was conducted after ICU admission or within 12-24 hours after high catabolic state.The patients were divided into four groups according to the AGI classification,i.e.grade Ⅰ,Ⅱ,Ⅲ,and Ⅳ,and they were treated according to the treatment procedure for AGI.The primary end points were 7-day rate of intake of standard EN,the degree of disease and nutrition,and their correlation with AGI classification.Secondary endpoint was rate of giving EN within 48 hours.Results Gastrointestinal dysfunction patients accounted for 49.42％ (85/172) of the ICU patients,and number of patients in grade Ⅰ,Ⅱ,Ⅲ,Ⅳ were 29,28,19,9 respectively.On the first day of ICU stay,there were no statistical differences in age,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,serum albumin (ALB) and prealbumin (PA) among four groups,and it was demonstrated that the baseline data were comparable.APACHE Ⅱ score on the seventh day of ICU stay was significantly lower than that on the first day in grade Ⅰ,Ⅱ and Ⅲ patients (grade Ⅰ:20.48 ± 2.45 vs.22.59 ± 2.06,t=-3.120,P=0.031 ; grade Ⅱ:19.34 ± 1.80 vs.21.65 ± 2.22,t=-4.316,P=0.012; grade Ⅲ:20.63 ± 1.34 vs.23.31 ± 1.70,t=-5.640,P=0.000),and serum PA (g/L) was significantly increased (grade Ⅰ:24.37 ± 6.54 vs.10.62 ± 7.24,t=-4.866,P=0.000; grade Ⅱ:19.79± 12.48 vs.11.57±8.94,t=-2.116,P=0.031; grade Ⅲ:19.15±8.43 vs.13.78 ± 6.59,t=-3.601,P=0.000).On the seventh day ofICU stay,the APACHE Ⅱ score was higher in grade Ⅳ than that in grade Ⅰ,Ⅱ and Ⅲ patients (22.87 ± 3.31 vs.20.48 ± 2.45,19.34 ± 1.80,20.63 ± 1.34,P＜0.05 or P＜0.01),and PA was obviously lower in grade Ⅳ than that in grade Ⅰ,Ⅱ and Ⅲ patients (g/L:14.02 ± 8.70 vs.24.37 ± 6.54,19.79 ±12.48,19.15 ± 8.43,P＜0.05 or P＜0.01).There was no statistically significant difference among four groups in respect of serum ALB (F=0.454,P=0.722).The rate of giving EN in 24 hours in grade Ⅰ,Ⅱ,Ⅲ,Ⅳ patients was 95.4％,72.1％,52.0％ and 0,respectively (x2=8.310,P=0.016),and in 48 hours it was 100.0％,83.0％,76.0％,and 0 (x2=5.470,P=0.025).7-day standard EN intake rate was 100.0％,88.7％,84.0％ and 34.0％ respectively in grade Ⅰ,Ⅱ,Ⅲ,Ⅳ patients (x2 =0.720,P=0.017).Correlation analysis showed that there was a negative correlation between AGI classification and rate of giving EN in 1 day (r=-0.62,P=0.04) and 7-day standard EN intake rate (r=-0.76,P=0.02).Conclusions AGI classification can be used to estimate the gastrointestinal function of patients with critical illness,and it has a significant correlation with early EN support.An early goal achieving intervention based on the AGI classification can improve the nutritional status and the general state of the patients.

Objective To investigate the correlation between Bispectral index (BIS) value and the prognosis of patients with coma in ICU.Methods A total of 208 patients with coma in ICU were divided into 4 groups according to the BIS value.In group I,BIS value was 0 to 20; groupⅡ,BIS value 21 to 40; group Ⅲ,BIS value 41 to 60; and group Ⅳ,BIS value greater than 60.Comparison of the difference in BIS value with the differences in prognosis of patients with coma was carried out between four groups,and the prognosis of patients with coma was stratified into consciousness,coma,vegetative state,and brain death.Subsequently,the best cutoff score of BIS value calculated for determining the correlation between BIS and mental state was proposed.Results There are no significant differences in the age and APACHE Ⅱ scores between four groups (P ＞ 0.05).It was inverse correlation between BIS value and mental state (r =-0.749,P =0.00).According to the ROC curve,as BIS value was greater than 42.5,there were higher sensitivity and specificity in Conscious-Coma patients.Conclusions BIS value is correlated with the prognosis of patients with coma in ICU,and BIS value can be a useful marker for estimating the prognosis of comatose patients.

Objective To study the quality and effect of root cause analysis (RCA) on long-range video EEG monitoring on epilepsy patients.Methods The process of RCA long-range video EEG monitoring on patients with epilepsy was investigated to find out the root causes for quality of epilepsy capturing from pseudo differential of EEG and video effects.Then the measures were taken to improve the quality of monitoring.Result After the intervention,except canmera not clear enough,the incidences were significantly decreased compared with pre-intervention (all P ＜ 0.001).Conclusions Root cause analysis is effective in improving the quality of long-range video EEG monitoring on epilepsy patients.It is worth clinically promoting.

SUMMARY Mercury intoxication is a rare cause of severe hypertension. A case of mercury intoxication presented with severe hypertension and erythromelalgia was reported. A 10-year-and-5-month-old girl presented with recurrent rash and painful hands for 2 months, with seizure attack and episodic loss of consciousness for one hand half months. The girl was found to have red painful hands, a blood pressure 170/120 mm Hg(1 mm Hg=0.133 kPa), tachycardia and hypokalemia (2.83-3.25 mmol/L, reference value 3.5-5.5 mmol/L). An extensive investigation ensued. Elevated renin-angiotensin and aldosterone were demonstrated in plasma. Cranial MRI T2 weighed images showed widespread white matter signal abnormalities, which particularly involved parietal, occipital and frontal lobes. With hypertension controlled, white matter signal abnormalities weakened. Other symptoms included insomnia, nausea and paroxysmal abdominal pain. The girl was found to have a raised concentration of mercury in urine (0.171 mg/L, reference value