Objective To observe the effect of high flux hemodialysis (HFHD) combined with artificial kidney on fibroblast growth factor-23 (FGF-23) in patients with maintenance hemodialysis (MHD). Methods Eighty cases who regularly carried out long-term HFHD in nephrology blood purification center of NO.85 Hospital of PLA were enrolled. All the patients firstly received HFHD alone for 1 month, and then according to random principle, they could receive HFHD followed by hemoperfusion (HP) for treatment (HFHD+HP group) or HP followed by HFHD for treatment (HP+HFHD group). These two types of treatment were respectively carried out for 3 months, and then exchanged to proceed the procedure, the interval of exchange being 1 month (in this month, the two groups of patients all underwent simple HFHD treatment). The therapeutic course was 8 months including 2 cycles. The serum samples were taken from patients undergoing simple HFHD before and after the first month of blood purification, and patients in HFHD+HP group and HP+HFHD group before and after the last month for determination of serum creatinine (SCr), calcium, phosphorus, parathyroid hormone (iPTH), FGF-23 levels. Results The SCr level in HFHD + HP group before hemodialysis was significantly lower than that in simple HFHD group (μmol/L:773.45±212.23 vs. 803.27±192.47, P<0.05), there were no significant differences in blood calcium and phosphorus before hemodialysis between HFHD+HP group and HP+HFHD group (all P>0.05). After hemodialysis, the serum iPTH, FGF-23 were dropped significantly in HFHD + HP and HP + HFHD groups compared with those in simple HFHD group (P < 0.05 or P < 0.01). After hemodialysis, there were no statistically significant differences in SCr and calcium levels between the above two groups (both P>0.05). But the levels of serum phosphorus, iPTH, and FGF-23 in HFHD+HP group were significantly lower than those of HP+HFHD group [serum phosphorus (mmol/L):1.47±0.22 vs. 1.60±0.23, iPTH (μg/L):490.12±145.23 vs. 516.34±165.75, FGF-23 (μg/L): 802.11±92.58 vs. 822.39±107.23, P < 0.05 or P < 0.01]. Conclusions In the aspect of elimination of large and medium sized molecules, the effect of combined artificial kidney is much better than that of simple HFHD. The rates of toxin elimination in different types of combined artificial kidney treatment are different, and the HFHD+HP type has greater effect than HP+HFHD type on elimination of toxins with large or medium sized molecules such as iPTH, FGF-23, etc.

Objective To study the disease chart among pre-hospital first aid in Tangshan people'hospital.Methods Prospectively collecting data of pre-hospital first aid 2580 patients from 2006 to 2007,analyzing the data,sex,age,visitingtime,emergency diagnosisand results,etc.Results Among pre-hospital first aid 2580 patients,traf-rice diseases,neurosystem diseases,cerebral infarction,coronary heart disease are the first three diseases.The highest times of pre-hospital first aid are 8:00～10:00,14:00～16:00 and 20:00～22:00.The admission rate is 44.46%.Conclusion Pre-hospital first aid should be based on the data,age,visiting time of the disease,scientifically arranging pre-hospital,training for pre-hospital first aid staff,so,the patients will be the fast and best pre-hospital flint aid.

Objective To evaluate the therapeutic effects of noninvasive bi-level positive airway pressure (BiPAP) ventilation after extubation in chronic obstructive pulmonary disease (COPD) complicated with type Ⅱ respiratory failure.Methods Forty-one intubated COPD eases with severe respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study.At the time of pulmonary infection control (PIC) window,the extubation was conducted and followed by BiPAP ventilation in 21 cases (the experimental group),while the other 20 COPD cases with similar clinical characteristics,as the control group,who continuously received invasive mechanical ventilation after PIC window.Outcomes including the duration of invasive ventilation,the total duration of ventilation support,success rate,the incidence of ventilator associated pneumonia (VAP) and mortality rate were observed and compared between the two groups.Results The two groups had similar clinical characteristics and gas exchange at the time of PIC window (P ＞ 0.05 ).Compared with the control group,the experimental group had shorter duration of invasive mechanical ventilation (6.9±3.0) d vs.(13.1 ±4.3) d,t=5.38,P＜0.001),lower rate of VAP (1/20 vs.8/20,x2 =5.51,P=0.02) andhigher extubation rate (20/21 vs.13/20,x2 =4.19,P =0.04).Conclusion In COPD patients with intubation and mechanical ventilation for respiratory failure,BiPAP ventilation after extubation at the point of PIC window may improve patients' prognosis.

Objective To investigate the injuries caused by cholesterol to the vascular endothelial cells (VECs). Methods Different dosage of cholesterol (6.25,12.5,25.0,50.0 mg/L) was used on human umbilical endothelial cell line,ECV304,respectively. LDH activity,nitric oxide and the nitric oxide synthetase activity in the supernatant of cell culture were detected. The concentration of MCP-1 protein in cell culture was detected by ELISA. Results As compared with the normal control cells,a significant increase of LDH activity was found in the cells treated with 50.0 mg/L cholesterol. The NO level decreased in the cells treated by 25.0 or 50.0 mg/L cholesterol. When treated by cholesterol at dose of 6.25,12.5,25.0 or 50.0 mg/L respectively,the NOS activity was greatly decreased and MCP-1 protein was significantly increased in a dose-dependent manner. Conclusion Cholesterol of high concentration could directly injure the structure and partial function of VECs.

Objective:To observe the serum level of fibroblast growth factor-23(FGF-23) in patients with end stage renal disease (ESRD) and study its association with phosphorus and vitamin D metabolism.Methods: Serum FGF-23 level was determined by enzyme-linked immunosorbent assay (ELISA) in ESRD patients undergoing haemodialysis (HD, n=50) and peritoneal dialysis (PD, n=24) and in twenty healthy controls (control group,n=20).Serum level of 1,25-(OH) 2VitD was measured by enzyme immunoassay(EIA).Serum intact parathyroid hormone (PTH), creatinine, and calcium and phosphorus were also measured.Results: Serum FGF-23 was obviously higher in HD group([88.51?35.01] ng/L vs [11.76?3.63] ng/L)and PD group([87.85?33.65] ng/L vs [11.76?3.63] ng/L)than in control group. Moreover, the serum level of 1,25-(OH)2VitD was lower in HD and PD groups than in control group ([19.82?4.99] pmol/L vs [48.37?3.47] pmol/L; [24.31?7.11] pmol/L vs [48.37?3.47] pmol/L ), and the level of 1,25-(OH)2VitD was much lower in HD group than in PD group. Pearson relativity analysis showed that serum FGF-23 level was positively correlated with serum creatinine, phosphorus, intact PTH and duration of dialysis(P

Objective:To investigate the changes of adrenomedullin(ADM) and adrenotensin(ADT) in hemodialysis patients. Methods:The plasma concentrations of ADM and ADT were measured by radioimmunoassay. Results:Plasma ADM was significantly higher in the hypertensive group(P

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 explore the effect of psychological intervention of the patients with acute stroke in pre-hospital first aid. Methods 148 patients with acute stroke who had been treated by psychology in pre-hospital first aid were chosen and interviewed, comparing with 100 patients with acute stroke in hospital in same state. Results There was a significant difference between two groups about realization to disease, attitude to disease, mental reaction, treating confidence, compliance, and so on. Conclusion Psychological intervention can improve the patients with acute stroke in pre-hospital first aid effectly in the realization about disease, correct attitude about disease, capability of fighting diseases, confidence for recovery from the illness and compliance.

Objective To explore the effects of family member's behaviors on outcome of patients with acute cerebral infarction. Methods 160 cases with acute cerebral infarction were investigated with 9 kinds of family member's behavior. Results 9 kinds of family member's behavior were all closely related to the outcome of patients with acute cerebral infarction. Conclusion Family member's behavior was closely related to the patients with acute cerebral infarction

Objective To investigate the frequencies of genotype and allele distribution of IL-12A gene single nucleo?tide polymorphisms (SNP) rs568408 and IL-12B gene SNP rs3212227 in Zhuang populations in Guangxi, and to compare the distribution of IL-12A and IL-12B polymorphisms among different races. Methods The IL-12A SNP rs568408 and IL-12B SNP rs3212227 were detected by SNaPshot SNP genotyping technique in 165 Zhuang people in Guangxi, frequen?cies of genotype and allele of IL-12A gene rs568408 and IL-12B rs3212227 polymorphisms were analyzed in Zhuang popu?lations compared with the other four populations(HapMap-HCB, HapMap-JPT, HapMap-YRI, HapMap-TSI)from Hap?Map database. Results There were polimorphisms of IL-12A and IL-12B gene in Zhuang populations in Guangxi. The fre?quencies of allele and genotype distribution of IL-12A gene rs568408 polymorphisms were not significantly differenct com?pared with HapMap-HCB, HapMap-JPT and HapMap-TSI(P>0.05), but were significantly different compared with Hap?Map-YRI(P<0.01);The frequencies of allele and genotype distribution of IL-12B rs3212227 polymorphisms were not sig?nificantly differenct compared with HapMap-HCB and HapMap-JPT(P>0.05), but were significantly different compared with HapMap-YRI and HapMap-TSI(P<0.01). Conclusion There are significant differences in the frequencies of allele and genotype distribution of IL-12A gene rs568408 and IL-12B gene rs3212227 between Zhuang populations and other eth?nic populations, and this variation might contribute to a variety of clinical manifestation and morbidity of some IL-12 related diseases.