Objective To evaluate the efficacy of imipenem-cilastin sodium as subsequent therapy on peritoneal dialysis(PD)-related peritonitis.Methods From January 2007 to December 2010,44 PD-related peritonitis patients in our hospital were enrolled in the study.These patients presented cloudy fluid after 3 days initial treatment,and bacterial culture was Gram-negative bacteria or negative.Thirteen peritonitis episodes were treated with ceftazidime,while 36 episodes with imipenem-cilastin sodium.Efficacy,outcome,pathogen and drug-resistance were analyzed retrospectively.Results The effective rates 2 d later of ceftazidime and imipenem-cilastin sodium were 23.1％ and 72.2％ respectively with significant difference (P＜0.05).Gram-negative bacteria of ceftazidime and imipenem-cilastin sodium groups were 69.4％ and 65.2％ respectively without significant difference (P＞0.05).The cure rates 3 weeks later of ceftazidime and imipenemcilastin sodium groups were 23.1％ and 72.2％ respectively with significant difference (P＜0.05).Conclusion As subsequent therapy for PD-related peritonitis,imipenem-cilastin sodium can improve the cure rate.

BACKGROUND: Carotid-femoral pulse wave velocity in hemodialysis patients is influenced by multiple factors.OBJECTIVE: To explore the carotid-femoral pulse wave velocity (PWVcf) changes and related factors in maintenance hemodialysis (MHD) patients.DESIGN, TIME AND SETTING: Non-randomized control experiment was performed at the Third Hospital of Peking University from January to August 2006.PARTICIPANTS: A total of 66 MHD patients were selected from Third Hospital of Peking University.METHODS: General clinical conditions, biochemical indexes, PWVcf and subjective nutritional state were evaluated. MHD patients were divided into two groups according to the state of nutrition evaluated with SGA: non-malnutrition (n=49), malnutrition group (n=17). The PWVcf of two groups was compared, and one-way and multiple regression analyses were performed to explore PWVcf-relatest factors.MAIN OUTCOME MEASURES: PWVcf, blood albumin and parathyroid hormone.RESULTS: PWVcf was significantly positively correlated with age (r= 0.284, P< 0.05), systolic blood pressure (r= 0.468, P<0. 001), and pulse pressure (r=0.451, P< 0.001), while negatively correlated with prealbumin (r=0.318, P< 0. 05),plasma-albumin (r=0.263, P< 0.05), parathyroid hormone (r=0.167, P< 0.05), serum creatinine (r=0.347, P= 0.004)and transferring (r=0.284, P < 0.05) before dialysis. Multiple regression analysis demonstrated that pulse pressure and parathyroid hormone were independently related with PWVcf. The PWVcf was significantly increased in malnutrition group compared with non-malnutrition group (P < 0.05). CONCLUSION: Pulse pressure is the major clinical determinants of arterial stiffness in patients with MHD independent of conventional risk factors for cardiovascular disease; Malnutrition and atherosclerosis are common complications of MHD,showing close relationship. The PWVcf was significantly increased in malnutrition patients.

Aim To explore the interaction between nitric oxide( NO) and hydrogen sulfide(H 2S) on the relaxation reactivity of pulmonary arteries in rats.Methods Seven male healthy rats were anaesthesed with chloral hydrate; the pulmonary artery of each rat was removed for the study. Th e reactivities of pulmonary artery rings in response to different doses of NO do nar-sodium nitroprusside(SNP) and H 2S donar-NaHS were measured in vitro.DL-propargylglycine(PPG)and N?-nitor-L-methyl ester(L-NAME) were provided to pulmonary artery, respectively;the relaxation reactivities of pulmonary artery were observed.Results The relaxation reactivities of pulmonary arteries showed a dose-dependent increase in response to different doses of SNP and H 2S.The relaxation reactivity to SNP decreased by PPG. The relaxation reactivity to H 2S decreased by L-NAME.Conclusion H 2S acted as a vasorelaxator either independently or accompanied with NO, SNP acted as a vasorelaxator either independently or accompanied with H 2S;the networ k of gastransmitter played an important role in the relaxation of pulmonary arte ries.

Objective To explore the effect of hemeoxygenease/carbon monoxide system on hypoxic pulumonary vascular structural remodeling. Methods Twenty six Wister rats were randomly divided into four groups:control groups( n =6),hypoxia group( n =7),hypxia+ZnPP group( n =6) and hypoxia+CO group( n =7).Pulmonary artery mean pressure(mPAP) of each rat was elaluated by using right cardiac catheterization,the ultrastructaral changes in intra acinar pulmonary muscularized arteries were observed. Results mPAP was significantly increased in hypoxic rats(22?2 31?mmHg)as compared with that of normal controls(16 57?2 51mmHg)( P

BACKGROUND:Little data have been available concerning function features of arterial elasticity in patients with chronic kidney disease at 2-5 stage not undergoing dialysis.Studies have demonstrated that carotid-femoral pulse wave velocity(PWVcf) can be used to evaluate arterial elasticity.OBJECTIVE:To explore the changes and influential factors of PWVcf in patients with chronic kidney disease.DESIGN,TIME AND SETTING:A non-randomized controlled experiment was performed at the Department of Nephrology,Peking University Third Hospital from January to August 2006.PARTICIPANTS:166 patients with chronic kidney disease and 28 health persons were selected from Peking University Third Hospital.METHODS:The patients were divided into 3 groups based on the Kidney/Dialysis Outcomes Quality Initiative(K/DOQI) guideline for chronic kidney disease:mild group(at stage 1 to 2),moderate group(at stage 3) and severe group(at stage 4 to 5);the healthy people served as control.Body mass,blood pressure,PWVcf and biochemical indicators were determined to calculate glomerular filtration rate and compare the differences.One-way and multiple regression analyses were used to explore related factors of PWVcf.MAIN OUTCOME MEASURES:PWVcf and influential factors.RESULTS:Compared with control group,the patients had significantly higher levels of systolic blood pressure,diastolic blood pressure,pulse pressure and PWVcf(P

Objective: To examine the alteration of pathologic structure and endogenous hydrogen sulfide pathway in rats with pulmonary hypertension induced by high pulmonary blood flow. Methods: Sixteen SD rats were randomly divided into shunting group and control group. An 11 week aortocaval shunting was produced in rats of shunting group, and pulmonary artery mean pressure (mPAP) was evaluated using right cardiac catheterization. The ratios of right ventricular mass to body weight (RV/BW) and right ventricular mass to left ventricular plus septal mass[RV/(LV+S)] were also detected. Pulmonary vascular micro and ultra structures were examined. Meanwhile the concentration of plasma hydrogen sulfide (H 2S) was measured by spectrophotography. The gene expression of cystathionine ? lyase (CSE)was detected by in situ hybridization, and the activity of CSE in lung tissues was measured by H 2S production according to chemical analysis. Results: After 11 weeks of aortocaval shunting, pulmonary artery mean pressure was significantly increased. Muscularization of small pulmonary vessels and relative medial thickness of pulmonary arteries were obviously increased in shunting rats compared with controls. Ultrastructure of intrapulmonary arteries changed obviously in shunting rats. Meanwhile, plasma H 2S concentration was decreased and the activity of CSE (according to H 2S production) in lung tissues decreased in shunting rats. CSEmRNA expression by pulmonary arteries was significantly suppressed. Conclusion: Pulmonary vascular structural remodeling is the important pathologic basis for pulmonary hypertension induced by high pulmonary blood flow. The down regula tion of endogenous H 2S pathway might play an im portant role in the development of high pulmonary blood flow induced pulmonary hypertension.

Objective:This study aims to determine the efficacy of chemotherapy and to identify potential chemotherapy agents for advanced primary duodenal carcinoma (PDC). Methods:Fifty-six patients with advanced PDC, who did and did not receive chemo-therapy, were involved in this study. Response rates (RR), disease control rates (DCR), progression-free survival (PFS), and overall sur-vival (OS) were analyzed. Results:The overall RR and DCR of 43 patients were 19.04%and 71.42%, respectively. The patients who re-ceived chemotherapy agents fluorourzcil and oxaliplatin exhibited higher RR compared with patients who received other chemotherapy combinations (35.29%vs. 7.69%, P=0.010 9). Palliative chemotherapy improved the OS of patients with advanced PDC compared with patients who did not receive chemotherapy (13.35 months vs. 5.65 months, HR=0.203, 95%CI:0.083 to 0.497, P=0.000 5). Compared with the use of other chemotherapy regimens, treatment with a fluorourzcil-based chemotherapy agent resulted in a longer PFS (5.08 months vs. 1.08 months, HR=0.004, 95%CI:0.000 to 0.315, P=0.013 2). Multivariate analysis indicated mucinous histology and lymph mode metastasis as factors predictive of poor prognosis in patients with advanced PDC. Conclusion:Palliative chemotherapy may im-prove the OS of patients with advanced PDC.

Objective:This retrospective study aims to determine the efficacy of chemotherapy and improve a salvage chemother-apy agent for metastatic colorectal cancer (MCRC) after failure of treatment with irinotecan and oxaliplatin. Methods:Between Janu-ary 2002 and March 2013, 37 patients with metastatic MCRC who had progressed after treatment with irinotecan and oxaliplatin were analyzed for their response rate (RR) and progression-free survival (PFS). Results:The overall RR of the 37 patients was 13.51%, with 5 cases of partial response (PR), 12 cases of disease stabilization (SD), and 20 cases of progression (PD). Compared with other chemo-therapy regimens, treatment with a pemetrexed-based chemotherapy agent had a higher RR (17.64%vs. 10.00%, P=0.64) without a lon-ger PFS (2.00 months vs. 1.63 months, HR=0.79, 95%, CI:0.35 to 1.78, P=0.58). Compared with other chemotherapy regimens, treat-ment with a raltirexed-based chemotherapy agent had a higher RR (16.67%vs. 12.00%, P=0.34) without a longer PFS (1.58 months vs. 1.90 months, HR=2.24, 95%, CI:0.98 to 5.12, P=0.06).Conclusion:In patients with MCRC after failure of treatment with irinotecan and oxaliplatin, a pemetrexed-based or raltirexed-based chemotherapy agent may beneficial during salvage treatment and is therefore worthy of further study.

Clinical teaching is the critical stage for medical students turning to qualified doctor.In order to overcome the objective problems of insufficient clinical case resources,using the electronic medical record system to collect cases,the real case library of kidney disease was initially constructed,which was presented in the form of network resources.This case database was applied to assist teaching in the probation of eight year medical students at the undergraduate stage,and the application of the case database was evaluated in the form of questionnaire.It is found that case database is helpful to students' clinical learning,and has the necessity of further improvement and good prospects for popularization.It provides a new idea for clinical teaching.