Objective To explore the effects of residual renal function (RRF) on quality of life (QOL) in patients with continuous ambulatory peritoneal dialysis (CAPD),and analyze the factors influencing QOL.Methods One hundred and eighteen patients treated with CAPD for at least 3 months in No.455 Hospital of People's Liberation Army were enrolled.All patients were divided into two groups according to residual glomerular filtration rate (rGFR):the group with RRF [rGFR≥ 1 ml·min-1 · (1.73 m2)-1],and the group without RRF [rGFR ＜ 1ml · min-1 · (1.73 m2)-1].The demographic characteristics,laboratory data,cardiothoracic ratio,dialysis adequacy parameters,rGFR,blood pressure,urine volume,ultrafiltration volume and dialysis prescription were investigated.Patient's QOL was evaluated by Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36).Results There was no significant differences between the groups with and without RRF in the age,gender,causes of disease,complication,body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),haemoglobin (Hb),cholesterol,triglyceride,high-density lipoprotein,low-density lipoprotein,normalized protein catabolic rate (nPCR) and cardiothoracic ratio (all P ＞ 0.05).Compared with the patients with RRF,PD duration,ultrafiltration volume,serum creatinine (Scr),calcium,phosphorus,C-reactive protein (CRP),parathyroid hormone (PTH) and peritoneal dialysis dose in the patients without RRF were significantly higher,and urine volume,serum albumin (Alb),potassium,and urea total Kt/V were significantly lower (all P ＜ 0.05).The patients without RRF had a significantly lower score in physical function and physical component summary as compared to the patients with RRF (all P ＜ 0.05).There was no significant differences in role physical,bodily pain,general health,vitality,social function,role emotional,mental health,mental component summary and SF-36 scores (all P ＞ 0.05).Simple linear regression showed that there was no correlation between rGFR and SF-36 scores (β=1.330,P=0.070).Multiple linear regression revealed that SF-36 scores were correlated with CRP (β=-0.477,P ＜ 0.001),Scr (β=0.020,P ＜ 0.001),cardiothoracic ratio (β=-57.823,P=0.004),Alb (β=0.772,P=0.016) and ultrafiltration volume (β=-0.006,P=0.031),but not correlated with rGFR (β=0.099,P=0.302).Conclusions PD patients without and with RRF perceived different scores in physical health,but their scores were similar in mental health and QOL.RRF was no related to QOL in PD patients.Chronic inflammation,fluid overload and malnutrition were the main factors that affect QOL.

BACKGROUND:The validity of stem celltransplantation for acute kidney injury has been verified by many studies. However, the mechanism of repair of tubular epithelial cellinjury remains unclear. OBJECTIVE:To investigate protective effects and mechanisms of adipose-derived stem cells cultured with astragaloside on the apoptosis of renal tubular epithelial cells induced by cisplatin. METHODS:There were four groups. Renal tubular epithelial cells were induced by 2.5μmol/L cisplatin for 24 hours. Models of renal tubular cellinjury were established in the cisplatin group. Adipose-derived stem cells were cocultured with renal tubular epithelial cells of injured kidney in the adipose-derived stem cells+renal tubular epithelial cells group. Using Transwel chamber, adipose-derived stem cells were incubated with 20 mg/L astragaloside for 48 hours, and then cocultured with renal tubular epithelial cells in the astragaloside-incubated adipose-derived stem cells+renal tubular epithelial cells group. Normal renal tubular epithelial cells served as controls (normal control group). RESULTS AND CONCLUSION:Compared with renal tubular epithelial cellinjury group, AV/PI and TUNEL results demonstrated that the apoptotic rate and number of renal tubular epithelial cells were apparently reduced in the adipose-derived stem cells+renal tubular epithelial cells group and 20 mg/L astragaloside-incubated adipose-derived stem cells+renal tubular epithelial cells group. ELISA results displayed that insulin-like growth factor-1 levels were significantly elevated in the 20 mg/L astragaloside-incubated adipose-derived stem cells+renal tubular epithelial cells group (P<0.05). Western blot assay results exhibited that caspase-3 protein levels were noticeably diminished, but Bcl-2 expression was significantly increased in the 20 mg/L astragaloside-incubated adipose-derived stem cells+renal tubular epithelial cells group (P<0.05). Results suggested that astragaloside-incubated human adipose-derived stem cells suppressed the apoptosis of renal tubular epithelial cells induced by cisplatin, which contributes to the early recovery of injured renal tubule. Its protective mechanism was probably associated with the secretion of insulin-like growth factor-1, inhibition of caspase-3 expression and upregulation of Bcl-2 levels.

Objective To investigate the role of human adipose-derived mesenchymal stem cells (ADSC) cultured with astragaloside Ⅳ(Ast) on renal tubular epithelial cells line (HKC) induced by cisplatin in vitro.Methods HKC was divided into four groups:(1) normal control group; (2)cisplatin group; (3) ADSC and HKC group; (4) ADSC cultured with Ast and HKC group.After coincubated with ADSC,the apoptosis index and proliferation of HKC were detected respectively.The levels of interleukin-6 (IL-6),regulated upon activation normal T cell expressed and secreted (RANTES),erythropoietin (EPO) and insulin like growth factor 1 (IGF-1) were detected by ELISA.Transwell culture system were used to test the migration effect of ADSC.Results Compared with cisplatin group,the apoptotic rates of HKC were decreased and the cell number increased obviously (P ＜ 0.05) in ADSC and HKC group and ADSC cultured with Ast and HKC group.Compared with cisplatin group,the expression of IL-6 and RANTES were lower (P ＜ 0.05),and the level of EPO and IGF-1 increased significantly (P ＜ 0.05),in ADSC cultured with Ast and HKC group.Crystal violet staining showed that ADSC cultured with Ast and HKC group migration index was higher than the other three groups (P ＜ 0.05).Conclusion The intervention of Ast may stimulate paracrine effect and migration of ADSC,so as to reduce apoptosis of HKC.

Objective To investigate the expression and significance of γH2AX in cervical squamous carcinoma.Methods Firstly,DNA were extracted from 74 cervical squamous carcinoma samples and PCR were tested for HPV infection.Secondly,formalin-fixed paraffin-embedded tissue sections (4 μm)were stained with H&E method to detect cervical lesions grading.Thirdly,HPV16 DNA were examined by in situ hybridization(ISH) and γH2AX,p16 were examined by immunohistochemical (IHC) staining.Then,30 cases typical tissue sections in which including the normal cervical tissue,cervical intraepithelial neoplasia and cervical carcinoma in situ were selected for comparing the HPV DNA loading,and the γH2AX and,pl6 expression.Finally,the feasibility of γH2AX serving as a biomarks in HPV infection-related cervical carcinogenesis were analyzed.Results In this study,HPV infection ratio is 98.65％,and HPV16 is the most common type with 74.32％ infection.In situ hybridization showed no HPV16 DNA exist in normal cervical tissues and CINI.In CIN Ⅱ HPV DNA exist mainly as episomal DNA.With the increasing of cervical lesions grade,HPV DNA was integrated into chromosome steadily.The expression of γH2AX and pl6 were positively associated with grading of cervical lesions.HPV DNA and γH2AX protein co-exist primarily in the prickle cell layer and the granular cell layer.The HPV DNA and p16 protein exist in different cell layer.Conclusion γH2AX may be employed as a biomarker for HPV positive cervical carcinogenesis.

Objective To construct vector expressing soluble mPDL1-hIgGFc and study its effect on the proliferation and apeptosis of cells in vitro. Methods The extrncellular domain of mPDL1 gene was amplified from pmPDL1 vector by PCR and inserted into phIgGFc vector. The recombinant pmPDL1-hIgGFc was transfected into CHO cells by LipofectAMINETM2000, and the transfected cells were named as CHOp. The expression of mPDL1-hIgGFc in the culture supernatants of CHOp was assayed by ELISA and Western blot. The effects of CHOp culture supernatants on mixed lymphocyte culture(MLC) was analysed by Flowm-etry. Results The extracellular domain of mPDL1 gene were obtained from PCR. DNA sequencing and the identification of digestion by HindⅢ and KpnⅠ indicated the recombinant plasmid pmPDL1-hIgGFc was suc-cessfully constructed. ELISA and Western blot analysis proved that the CHOp could express mPDL1-hIgG-Fc. CHOp culture supernatants could inhibit lymphocyte proliferation and induce the apoptosis of the activa-ted T cells in MLC in vitro in a dose-dependent manner. Conclusion The mPDL1-hIgGFc protein could in-hibit lymphocyte proliferation and induce the apoptosis of the activated T cells.

Objective To discuss and evaluate the dosimetric characteristics of different plans implementing stereotactic radiotherapy(SRT)for intracranial tumors using Fixed and Iris collimators of CyberKnife VSI.Methods Twenty patients with intracranial tumors were selected and divided into group A with a small target volume(≤30 cm3)and group B with a large target volume(≥30 cm3). There were 10 patients in each group,and the prescribed dose to the target was 21 Gy in 3 fractions. For each patient, two treatment plans were designed using Fixed and Iris collimators. By analyzing the dosimetric parameters such as conformity index(CI),homogeneity index(HI), gradient index(GI), gradient score index(GSI), and organs at risk (OAR),the quality and efficiency of the plans were evaluated in order to discuss the beam characteristics for two sets of collimators. The difference was analyzed with the paired t-test. Results The mean time of Iris plan for delivering was significantly less than that of Fixed plan(group A:P=0.001;group B:P=0.000). In group B,the peripheral dose(20% and 10% of the prescribed dose)volumes of Fixed plan were significantly less than those of Iris plan(P=0.001 and 0.009). For OAR,D minof the visual pathway and D meanor D minof the eyeball in group B were significantly different between Fixed and Iris plans(all P<0.05), while in group A, only D minof the optic chiasm was significantly different between the two plans(P=0.043). For the other parameters of targets,there were no significant differences between Fixed and Iris plans in both groups(all P>0.05). Conclusions Apart from less treatment time in the Iris plan, there are no significant dosimetric differences between the two collimator plans of CyberKnife VSI in treating small intracranial tumor. For the large and complex tumor,although Iris plan meets the requirement for OAR dose constraints,its low-dose volumes are larger than those of Fixed plan. Further studies of the dosimetric characteristics in CyberKnife should be done.

Objective To determine the factors that influence the development of abnormal thyrotropin (TSH) level in an euthyroid population.Methods We conducted a follow-up study in 3 communities with different iodine status.Of the 3403 euthyroid subjects at baseline screened in 1999,80.1% ( n = 2727 ) was visited and sampled in 2004 for measuring TSH,thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb).Results Iodine status in the 3 communities were stable.Decreased TSH level( <0.3 mU/L) developed in 2.5% (n =68) of sampled subjects,while raised TSH level( > 4.8 mU/L) in 2.4% (n = 64).A logistic analysis showed that risk factors for developing decreased TSH level included positive conversion of TPOAb (OR = 5.5 ),positive TPOAb both in 1999 and in 2004 ( OR = 4.0),positive TgAb in 2004 ( OR = 3.7) and TSH < 1.0 mU/L in 1999 ( OR = 2.6).Risk factors involved in developing raised TSH level included iodine status of Zhangwu community ( OR = 4.1 ),iodine status of Huanghua community ( OR = 3.9),positive TgAb in 2004 ( OR = 3.7 ),positive TPOAb both in 1999 and 2004 (OR =3.6),positive conversion of TPOAb (OR =2.7) and TSH > 1.9 mU/L in 1999 (OR = 2.6 ).Conclusions Exposure to long-term iodine excess imposes danger of developing hypothyroidism.The risk will be even higher when exposing to iodine adequacy after correction of iodine deficiency.An interval between 1.0 and 1.9 mU/L of TSH level was optimul with the least probability of developing abnormal TSH level.

Objective To study the prevalence,treatment policy and control of hypertension in patients with maintenance hemodialysis, and to analyze the influencing factors of hypertension control.Methods We studied the current status of 1382 patients with maintenance hemodialysis in 11 dialysis centers in Shanghai, among them 809 were male, and 573 were female.Hypertension was defined as systolic blood pressure(SBP) ≥ 140 and/or diastolic blood pressure (DBP) ≥90 mm Hg ( 1 mm Hg = 0.133 kPa).Those who had a history of hypertension and requiring antihypertensive therapy were also diagnosed as hypertension though their blood pressure was within normal range during the survey.Hypertension control was defined as blood pressure ＜ 140/90 mm Hg before each dialysis session.Results The prevalence of hypertension in the hemodialysis patients was 86.3%.The treatment rate and control rate in those patients were 96.8% and 25.5% respectively.More than half (50.4% ) of patients were treated with only one kind of anti-hypertensive drug, and 34.4% with 2 kinds, 14.2% with 3 kinds, 1.0% with 4 kinds or more.Calcium channel blocker (CCB) was the most frequently prescribed drug (61.0%), followed by angiotensin Ⅱ receptor blockers ( 56.4% ), centrally acting anti-hypertensive agent ( 26.4% ), beta blockers and alpha, beta-blockers( 14.0% ).The control rate of hypertension in those hemodialysis people was aggravated by the existence of coronary artery disease.The patients who need more kinds of antihypertensive agents have a poorer control rate of hypertension.The hypertension control rate elevated significantly with the adequate hemodialysis.Conclusions There is a very high prevalence of hypertension in maintenance hemodialysis patients.Although the treatment rate is high, the control rate is unsatisfactory.So the control of hypertension in hemodialysis patient is still a clinical challenge.Appropriate dialysis adequacy, reasonable use of erythropoietin, treatment of heart disease and judicious use of antihypertensive drugs may be helpful to improve the clinical outcome.

Objective:To resolve the issue of poor automatic segmentation of the bowel in women with pelvic tumors, a Dense V-Network model was established, trained and evaluated to accurately and automatically delineate the bowel of female patients with pelvic tumors.Methods:Dense Net and V-Net network models were combined to develop a Dense V-Network algorithm for automatic segmentation of 3D CT images. CT data were collected from 160 patients with cervical cancer, 130 of which were randomly selected as the training set to adjust the model parameters, and the remaining 30 were used as test set to evaluate the effect of automatic segmentation.Results:Eight parameters including Dice similarity coefficient (DSC) were utilized to quantitatively evaluate the segmentation effect. The DSC value, JD, ΔV, SI, IncI, HD (cm), MDA (mm), and DC (mm) of the small intestine were 0.86±0.03, 0.25±0.04, 0.10±0.07, 0.88±0.05, 0.85±0.05, 2.98±0.61, 2.40±0.45 and 4.13±1.74, which were better than those of any other single algorithm.Conclusion:Dense V-Network algorithm proposed in this paper can deliver accurate segmentation of the bowel organs. It can be applied in clinical practice after slight revision by physicians.

Objective: To evaluate the efficacy and safety of DCV-based DAAs therapy for chronic HCV infected Chinese patients. Methods: An open-label, non-randomized, prospective study was designed. Fifty-two patients with chronic HCV infection were enrolled. Among them, there was one patient after liver transplantation, 2 patients after kidney transplantation, 3 patients with hepatocellular carcinoma, and 4 patients with HBV infection. Thirteen cases with chronic hepatitis C (one compensated cirrhosis) who were negative for resistance-related variants [NS5A RAS (-)] of gene 1b and NS5A were treated with daclatasvir (DCV) + asunaprevir (ASV) for 24 weeks. Twenty-five cases of CHC (six compensated cirrhosis) with GT 1b, 2a, 3a, 3b, 6a were treated with DCV + SOF ± RBV for 24 weeks. 8 cases with decompensated cirrhosis of gene 1b and NS5A RAS(-) were given DCV + SOF + RBV regimen for 12 weeks. Six cases with decompensated cirrhosis, of gene 2a, 1b, 2a, 3a, 3b, were given DCV + SOF + RBV regimen for 24 weeks. HCV RNA, blood routine test, liver and kidney function, and upper abdominal ultrasound/MRI were measured at baseline, 4 weeks of treatment, end of treatment, and 12 weeks of follow-up. The incidence of adverse events and laboratory abnormalities during treatment were recorded. A t-test was used to compare the measurement data between two groups, and analysis of variance was used to compare the measurement data between multiple groups. Results: Sixteen patients (100%) achieved SVR12 after treatment, with 0% recurrence rate. Rapid virological response (RVR) of the four treatment regimens were 76.92%, 54.17%, 87.50%, and 83.33%, respectively, and 32 patients achieved 100% virological response after the completion of treatment. The incidence of adverse events of chronic hepatitis C with cirrhosis and decompensated cirrhosis was 62.5% and 64.29%, respectively. The most common adverse event was fatigue in CHC (25.00%), and elevated indirect bilirubin in decompensated cirrhosis (42.86%). No serious adverse drug events, deaths or adverse reactions occurred. Conclusion DCV-based DAAs regimen is promising option for the treatment of HCV genotypes, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and HCV infection after liver/kidney transplantation in china. Above all, it has high SVR12 with good tolerability and safety profile.