Objective To investigate the clinical efficacy of total parathyroidectomy and autologous transplantation(PTX+ AT) for treating secondary hyperparathyroidism(SHPT) in the patients with uremic maintenance hemodialysis and postoperative calcium supplementation.Methods The clinical data in 57 patients with SHPT treated with PTX+ AT in the urology department of the First Affiliated Hospital of Nanjing Medical University from March 2015 to August 2015 were retrospectively analyzed.The changes of serum intact parathyroid hormone(iPTH),calcium and clinical symptoms were observed before and after operation.Results Serum iPTH levels at different time points of immediately after operation,postoperative 20 min,2 d,4 d were(288.57 ±194.71),(185.00±99.28),(83.83 ± 58.26),(17.91± 15.60) pg/mL respectively,which were significantly decreased compared with (2395.80 ± 829.04) pg/mL before operation (P＜ 0.05);blood calcium at postoperative 4,8,24,72 h was (2.34 ± 0.32),(2.16±0.37),(2.16±0.27),(2.25±0.25) mmol/L respectively,which were significantly decreased compared with(2.61±0.25)mmol/L before operation(P＜0.05);the symptoms such as bone pain,skin itching and so on were significantly improved.Conclusion PTX+AT can effectively treat uremic SHPT,and postoperative timely calcium supplementation can reduce the occurrence of hypocalcemia.

The microscopic identification technique plays an important role in quality standard of Chinese herbal medicines. It has been adopted as a routine identification method in the major pharmacopoeias due to its accurate, simple, speedy, inexpensive, feasible as well as environmentally friendly properties. In this article, the theoretical principles of microscopic identification, the stability and specificity of microscopic characters, are firstly discussed. The applications of microscopic identification in ChP, USP, Ph. Eur. and JP are listed and typically compared. A protocol for microscopic identification is thus proposed based on our previous investigations. Finally, some challenges facing modernizaiton of Chinese herbal medicines are also outlined.

Objective:To observe volt-ampere characteristic of Acupoint Neiguan (PC 6) on patients with hyper-thyroidism for probing into the actions of acupoints and change of qi and blood of human body as well as the relationship between the action of acupoint and the metabolism of energy. Methods:A self-made high-sensitive apparatus was applied to detect volt-ampere curves of Acupoint Neiguan(PC 6)and its control point on 33 patients with hyperthyroidism and 30 healthy people.Results:In patients,the volt-ampere areas (VAA)of both ampere.Increasing scan(AIS)and ampere—decreasing Scan(ADS)as well as the inertia areas (IS) of both side Neiguan(PC 6)were significantly smaller than the control points(P<0.05 or P<0.0 1).In healthy people.The VAA of the AIS/ADS of both side and me IA of right Neiguan(PC 6)were significantly smaller than those of the comparison points (P<0.05 or P<0.01).The comparison on volt-ampere characteristicsof the acupoints having same names on right and left side showed that the inertia areas ofNeiguan(PC 6)on patients with hyperthyroidism on the right side were significantly larger than those on the left side (P<0.05).There was no significant difference between the patients and healthy people on the VAA of both AIS/ADS/IA of the right and left Neiguan(PC 6)(P>0.05).Conclusion:The volt-ampere characteristics of theright and left Neiguan(PC 61 on patients with hyperthyroidism are in imbalance.Hyperthyroidism exerts certaininfluenceontheheartfunction.

Objective To compare different equations for estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD).Methods Hospitalized patients with CKD from the nephrology department of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) were recruited between December 2014 and May 2015.The calculations of eGFR and 24 h creatinine clearance rate (Ccr) were accomplished in three days after admission.The eGFRs were calculated separately using the 24 h creatinine clearance rate adjusted by the standard body surface area (Ccr_BSA),Cockcroft-Gault equation adjusted by the standard body surface area (eCcr_BSA),CKD-EPI creatinine equation (EPI_Cr),CKD-EPI cystatin C equation (EPI_CysC),CKDEPI creatinine-cystatin C equation (EPI_Cr_CysC),simplified MDRD (MDRD) and China MDRD equations.The EPI_Cr_CysC equation was used as the standard and the precision and accuracy of the other six equations were compared and analyzed.Results A total of 403 CKD participants were enrolled in the study,with 228 male patients and a mean age of (54.9± 18.4) years.The main primary diseases were chronic glomerulonephritis (43.7％) and diabetic nephropathy (13.2％).The median concentration of serum creatinine and cystatin C were 117.5 (69.7,242.4) μmol/L and 1.80 (1.13,3.31) mg/L,respectively.The median values of Ccr_BSA,eCcr_BSA,MDRD,China MDRD,EPI_Cr,EPI_CysC and EPI_Cr_CysC equations were 50.8 (21.1,96.2),51.9 (23.3,93.2),53.6 (23.0,97.4),52.2(22.4,94.1),53.2 (22.1,97.3),35.1 (15.4,67.0) and 49.1 (22.8,82.3) ml · min-1 · (1.73 m2)-1,respectively.There was well agreement among MDRD,China MDRD and EPI_Cr equations,while there were large differences between equations derived from CysC (EPI_Cr_CysC and EPI_CysC) and equations derived only from creatinine (EPI_Cr,MDRD,China MDRD,eCcr_BSA,Ccr_BSA equations).Compared with EPI_Cr_CysC equation (the reference equation),EPI_Cr equation showed the highest accuracy [percentage of other eGFR equation calculations that were ＞ 30％ of the reference equation calculations (1-P30),30.8％] while Ccr_BSA equation showed the lowest (1-P30,42.4％).EPI_CysC equation showed the highest precision [inter-quartile range (IQR) of the difference,11.7 ml·min-1 · (1.73 m2)-1] while Ccr_BSA equation showed the lowest [IQR of the difference,22.8 ml· min-1 ·(1.73 m2)-1].Conclusions The agreement among equations derived only from creatinine is better;while it exhibits some differences between equations with cystatin C and equations derived only from creatinine.The accuracy of EPI_Cr equation is second only to EPI_Cr_CysC equation and it is currently the most suitable eGFR equation for clinical popularization of renal glomerular function assessment.

Objective:To gain an insight into the immunological mechanism of tuberculosis by observing the variation of T lymphocyte subgroups in endobronchial tuberculosis(EBTB) patients.Methods:The variation of T lymphocyte subgroups was determined by flow cytometry in 23 EBTB patients and 25 physical examinees and results were compared.Results:The value of CD8 T lymphocytes was significantly lower in the EBTB patients than in healthy controls(P0.05).Conclusion:The pathogenesis of tuberculosis is associated with the changes in the immune system.CD4 and CD8 T lymphocytes play an important role in the cell-mediated immune response.

Objective To explore the effects of partial body weight support treadmill training (PBWSTT) combined with brain function therapy on walking ability of stroke patients. Methods 112 stroke patients with hemiplegia were randomly allocated into treatment group (n=57) and control group (n=55). The control group received routine rehabilitation training, while the treatment group received PBWSTT combined with brain function therapy in addition. They were assessed with lower limb's movement and balance function assessment of the Fugl-Meyer Assessment (FMA), Functional Ambulation Category (FAC), and Modified Barthel Index (MBI) before and after the treatment. Results The scores of FMA, FAC, and MBI improved more in treatment group than in control group after treatment (P<0.05). Conclusion Based on the conventional rehabilitation, PBWSTT combined with brain function therapy may improve the motor function of lower limb, balance function，walking ability, and ADL more significantly in stroke patients with hemiplegia.

Objective To observe the effect of Zhenganxifeng decoction and Buyanghuanwu decoction on the early rehabilitation of the stroke.Methods 101 cases with acute stroke were randomly divided into the treatment group(n=51) and control group(n=50).All patients were treated with routine medical therapy,physiotherapy and electric stimulation for a month.The treatment group was treated with Zhenganxifeng decoction while the control group with Buyanghuanwu decoction in addition.Results The motor function and Activities of Daily Living(ADL) in both groups were improved after treatment,but were better in treatment group than in control group(P<0.01).Conclusion It is better to use Zhenganxifeng decoction in the early rehabilitation of the stroke than Buyanghuanwu decoction.

Traditional Tibetan medicine nature theory was the core of Tibetan medicine. This study was aimed to understand the scientific values of Tibetan medicine correctly and catch its unique advantages accurately. The history origin, nature and taste, target, effect, the relationship between diseases and Tibetan medicine and other aspects of traditional Tibetan medicine nature theory were discussed in this paper. Several points were put forward, which included the research of Tibetan medicine nature theory was the premise to maintain and develop Tibetan medicine; it was necessary to carry out literature research, definite and improve the nature theory; the data mining technology and systems biology should be applied to the theory research to elucidate the rules and scientific connotation of Tibetan medicine nature; building the model of experimental study with clinical research to determine its clinical values forward during the development of Tibetan medicine nature theory research.

Objective To study the effects of bioartificial kidney(BAK)treatment on cytokines interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α),biochemistry indexes,and survival time in acute uremic pigs with multiple organ dysfunction syndrome(MODS).Method Pigs with MODS and acute renal failure(ARF)were treated with BAK(group A,n = 6)or sham BAK containing no cells(group B,n = 6)or received no treatment(group C,n = 5).Data on blood pressure,hepatic and renal functions,serum IL-10 and TNF-α levels,arterial blood gas and survival time of all the pigs were recorded.Comparisons of values were done using Student's t-test or repeated-measures analysis of variance(ANOVA).ResultsMean arterial pressure(MAP,mmHg)responsed more rapidly and reached higher values in group A (91.82±5.73)compared with group B and C at 24 hours(P＜0.01).The peak level of serum EL-10(pg/mL)ingroupA(249.57±43.51)was significantly higher than that in group B and C(132.06± 17.53,104.25 ±13.42,P＜0.01).Serum TNF-a level(pg/mL)in group A dropped gradually to(402.91 ± 32.47)at 24 hours,and had significant discrepancy compared with that before the treatment(537.16 ± 38.45)and that in groupB(P＜0.05).The average survival time(hours)in group A(113.01 ± 14.32)was significantly longer than that in the group B and C(P＜0.01),which was prolonged by 35.93%and 63.90%,respectively.ConclusionsTreatment with BAK can prolong the survival time of uremic pigs with MODS,possibly through ameliorating the MAP,increasing the level of IL-10 and reducing the concentration of TNF-α.

Objective Acute kidney injury (AKI) is common but usually under-diagnosed in hospitalized patients,of the impact of which on patients is still unclear.The paper was aimed to investigate the impact of delayed recognition of AKI on short-time prognosis of patients through a propensity score matched study.Methods From Oct 2013 to Sep 2014,1401 adult hospitalized patients with AKI in the First Affiliated Hospital of Nanjing Medical University were divided into delayed recognition group and timely-diagnosed group according to propensity score matching (1∶ 1) without replacement method.Primary endpoint was 30-day all-cause mortality,and secondary endpoints included recovery of kidney at discharge,length of hospitalization,length of intensive care unit stay and hospital costs.Results There were significant differences in age,department distribution,complications,stage of AKI,Charlson index,APACHE Ⅱ score,SOFA score between the two groups before matching.After matching,there were no significant difference in demographic data,department distribution,complications,stage of AKI,Charlson index,APACHE Ⅱ score,SOFA score between the two groups except in blood urea nitrogen (P=0.039) and use of diuretics (P=0.018).Delayed recognition of acute kidney injury was not associated with 30-day all-cause mortality in univariate (P=0.711) and multivariate Logistic regression analyses.The secondary endpoints did not differ in two groups.Conclusion Delayed acute kidney injury recognition did not associate with poor short-term outcomes in adult hospitalized patients.