Hyponatremia is the most common electrolyte imbalance.Other than neurological complications,other complications of hyponatremia have not received due attention.Mild,chronic hyponatremia can result in subtle symptoms such as gait disturbance and falls,and increase the risks of osteoporosis and fractures.This paper reviewed the emerging relationship between hyponatremia and bone metabolism,its possible mechanisms and clinical implications.

Objective To observe the effect of adenosine A1 receptor (A1AR) on the megalin defect in type 1 diabetic mice with early kidney disease.Methods 7-8 week-old,baseline body weight and fasting blood glucose matched wild type (WT) C57BL/6J mice were selected,and randomly divided into two groups:control group (n=6) and WT DM group (n=6).In the same way,male A1AR knock-out C57BL/6J mice were selected as A1AR-/-DM group (n=6).DM model was established by intraperitoneal injection of streptozocin.The blood glucose (BG),body weight (BW),kidney weight (KW),24 h proteinuria (24hUP) and albumin creatine ratio (ACR) were measured at 4 weeks.The renal pathological lesion was observed and the expression of megalin in proximal tubules was examined by immunohistochemistry.The expression of caspase-1,IL-18 and A1AR were detected by Western blotting.Results At 4th week,compared with WT control mice,the BG,BW,KW and 24hUP of WT DM mice were increased significantly (n=6,P ＜ 0.01),with the pathological glomerular enlargement,mesangial cell proliferation,extracellular matrix accumulation and renal tubule hypertrophy being observed.Immunohistochemistry revealed decreased expression of megalin,an important multiligand protein receptor on the brush border of proximal tubular epithelial cells in WT DM mice,which was correlated with 24hUP (r=-0.645,P ＜ 0.01).Compared with the control mice,the expressions of caspase-1,IL-18 and A1AR were significantly increased in WT DM mice (P ＜ 0.05).For A1AR-/-DM mice,more serious pathological lesion and megalin defect,together with increasing of casapase-1 and heavier proteinuria were observed than those in WT DM mice.Conclusion A1AR may play a protective role in megalin expression of diabetic mice with early kidney disease,in which the mechanism may be associated with caspase-1 related pyroptosis pathway.The details need further exploration.

Objective Our retrospective study was aimed to analyze the clinical value of serum CEA and CA19-9 in patients with chole-lithiasis.Methods The clinical data of 98 patients with cholelithiasis and 44 patients with inguinal hernia received treatment in our hospital from February 2011 to February 2015 were retrospectively analyzed.The expressive levels of CEA and CA19-9 of the patients were detected and compared.The important roles of CEA and CA19-9 in the patients with cholelithiasis were analyzed.Results The levels of CEA,CA19-9 and inflammatory factors in normal group and control group had no statistical differences (P>0.05).The levels of CEA,CA19-9 and inflam-matory factors in rising group were higher than those in control group (P<0.05).The levels of CEA,CA19-9,inflammatory factors before and after the treatment had no statistical differences (P>0.05),but the levels of CEA,CA19-9,inflammatory factors in rising group were obvi-ously decreased( P<0.05) .Conclusion The levels of CEA and CA19-9 in patients with cholelithiasis had correlation with inflammation of biliary tract,which will increased by severe choleithiasis.

Objective To explore the hearing screening, and the change and outcome of hearing impairment of high risk infants. Meth-ods From March, 2015 to March, 2016, 336 high risk infants were screened with otoacoustic emissions (OAE), auditory brainstem response (ABR) and brainstem auditory evoked-potential (BAEP) 0-1, 3, 6, 12 months after born, respectively. Results Among the 336 high risk in-fants, 29 failed the examinations within the 1st month, 37 cases failed in the 3rd month, 27 cases recovered in the 9th month, and 7 cases re-covered in the 12th month, 3 cases were finally diagnosed as deafness (0.89%). Conclusion OAE, ABR combining with BAEP examination may obtain comprehensive diagnosis of hearing impairment for high risk infants, continuous listening comprehension monitoring can effec-tively dynamically observe the hearing impairment, changes and outcome of high risk infants.

ObjectiveTo evaluate the clinical effect and reliability of basiliximab as immune inducer combined with classic triad resisting immune rejection scheme in preventing immune rejection after heart transplant.MethodsWe continuously collected the clinical information of 214 patients undergoing heart transplantation from June 2004 to January 2011.Basiliximab was used at 1st h before heart transplant and 4 days after the operation by 20 mg each time.Triad resisting immune rejection scheme included methylprednisone,cyclosporine A and mycophenolate mofetil.The endocardial biopsy was done to diagnose rejection postoperatively,and the severity of acute rejection was graded according to the standardized criteria of the International Society for Heart and Lung Transplantation (ISHLT).The recipients were followed up for 1year after the surgery,the data of the endocardial biopsy and rejection were collected,and the postoperative complications and deaths were observed.Results The first time of recipients to accept the endocardial biopsy was 20.1±7.3 days postoperatively,including 63 (29.4％) cases of Grade Ⅰ A,8 (3.7％) cases of grade Ⅰ B,and 12 (5.6％) cases of grade Ⅱ.One year after operation,143 recipients accepted the endocardial biopsy,including 29 (20.3％) cases of grade Ⅰ A,1(0.7％) case of grade Ⅰ B,12 (7.7％) cases of grade Ⅱ.During hospitalization,5 recipients died,including 3 cases due to transplant heart failure,1case due to multiple organ failure and 1due to sudden death.One year after discharge,there were 2 deaths,including one case of serious rejection and 1case of multiple organ failure One month after operation,infection occurred in 7 cases (3.3％),and acute renal insufficiency in 11cases (5.1％).ConclusionCombined use of Basiliximab with triad resisting immune rejection scheme was a kind of safe and effective therapy to prevent early acute rejection after heart transplantation.

Objective To investigate whether and how murine double minute 2(MDM2) was involved in aldosterone (ALD)-induced human mesangial cells line (HMCLs) proliferation. Methods RT-PCR and immunofluorescence were used to confirm the expression of MDM2 in HMCLs. Western blotting was used to estimate the relationship between ALD dose and MDM2 expression. Spironolactone, a mineralocorticoid receptor (MR) blocker, was used to estimate the role of MR on the up-regulation of MDM2 induced by ALD. Cycloheximide (CHX), a protein synthesis inhibitor, was used to estimate whether the rapid nongenomic mechanism was involved in the upregulation. To confirm the relationship among ALD, MDM2 expression and proliferation of HMCLs, small interference RNA of MDM2 was applied. Results Both MR and 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) mRNAs were detected in HMCLs. MDM2 protein expression was also detected in both the nucleus and the cytoplasm. ALD significantly stimulated MDM2 expression, which implied that MDM2 was a novel mineralocorticoid-responsive gene in HMCLs. MR was involved in this process as spironolactone did not promote the expression of MDM2 mRNA or protein. ALD with CHX did not increase the expression of MDM2 protein, which indicated it was not directly regulated by the rapid nongenomic mechanisms. MDM2 protein was decreased by using the transfection of MDM2 siRNA and ALD did not promote the cell proliferation of HMCLs under the same conditions. All of which implied that MDM2 participated in ALQ-induced HMCLs proliferation. Conclusions MDM2 is a novel mineralocorticoid-responsive gene in HMCLs. MR is involved in ALD-induced MDM2 expression which is inhibited by spironolactone. The increased expression of MDM2 protein induced by ALD is not directly regulated by the rapid nongenomic mechanisms. MDM2 participates in ALD induced HMCLs proliferation.

Objective To evaluate the short and mid-term effects of fixing comminuted posterior acetabular wall fractures with structural autologous iliac bone graft combined with mini screws.Methods From January 2010 to January 2014,29 patients with comminuted posterior acetabular wall fracture were treated by structural autologous iliac bone graf combined with mini screws.They were 21 males and 8 females,with a mean age of 44.2 years (range,from 22 to 58 years).The mean time form injury to operation was 7.8 days (range,from 1 to 25 days).The operations were performed through the Kocher-Langenbeck approach,with the patients in the lying position on the uninjured side.The fragments were reduced and fixed by mini screws and the ischemic ones were removed.Structural autologous iliac bone graft was used to reconstruct the posterior wall of acetabulum before a reconstruction plate was applied to compress and maintain it.The functional outcomes were evaluated by the modified Merle d'Aubigne and Postel clinical grading system at the last follow-ups.The radiographs were graded according to the Matta criteria.Results By the Matta criteria,10 cases achieved excellent reduction,16 good reduction,and 3 poor reduction,giving a good to excellent rate of 89.7％.Of this series,29 patients were followed up for 31.5 months on average (range,from 12 to 48 months).By the modified Merle d'Aubigne and Postel criteria,the functional recovery was rated as excellent in 16 cases,good in 9,fair in 3 and poor in one,giving a good to excellent rate of 86.2％.Two cases developed femoral head necrosis according to the magnetic resonance imaging 18 months postoperation.Three patients developed traumatic arthritis two years postoperation.Five patients developed heterotopic ossification postoperation,with no obvious clinical symptoms.Two patient with injury to the sciatic nerve recovered 4 months postoperation.Conclusions Structural autologous iliac graft combined with mini screws can reconstruct the integrity and stability of the fractured acetabular posterior wall,avoiding osteonecrosis of the acetabulum.This surgical technique is effective and safe in treatment of comminuted fracture of the acetabular posterior wall.

Objective To analyze the characteristics of lethal peritoneal dialysis related peritonitis and to define the risk factors.Methods All patients who developed PD related peritonitis between Jan.1999 and May 2015 in PUMCH were included.Clinical profiles were collected.Patients were divided into mortality group(n=16) and non-mortality group(n=182) according to whether peritonitis causing mortality.Baseline clinical profiles were compared between two groups.Cox regression analysis was used to define the risk factors for mortality.Results White blood cells [(10.2±6.3)×109/L vs (5.8±1.8)×109/L,P<0.05] increased,but serum albumin[(25.2±8.5)g/L vs (34.0±6.3)g/L,P<0.05] and potassium concentration [(3.5±0.9)mmol/L vs (4.5±1.0)mmol/L,P<0.05] decreased at the time of lethal peritonitis bacteria and fungus cultures were positive in half of the patients as bacteria (31.2%),fungus (12.5%)and mycobacterium tuberculosis (6.25%).Multiple cox regression analysis identified cardiovascular disease as the independent risk factor for peritonitis related mortality (HR 9.318,95% CI 1.875~46.305,P<0.01).Conclusions Peritonitis of patients with cardiovascular disease may cause death.

Objective To observe the clinical parameters, self-management, and compliance in peritoneal dialysis (PD) patients before and during Spring Festival, and to describe holiday syndrome in PD patients.Methods We prospectively observed PD patients with regular follow-up in our center before Chinese Spring Festival (January 8-February 7, 2016) and during Chinese Spring Festival (February 8-March 8, 2016).Demographic and clinical characteristics, self-management, and compliance with its influencing factors were collected by face-to-face method in outpatient care.Results Totally 130 PD patients were enrolled.The average age was (58.5±15.4) years, and women accounted for 53.1％.The primary diagnosis was diabetic kidney disease (32.3％), followed by primary glomerulonephritis (26.2％).Fourteen patients (10.8％) received automated peritoneal dialysis (APD), and most of the remaining patients chose continuous ambulatory peritoneal dialysis (CAPD,73.8％), with a median dialysis age of 34 months.During the 4-week followed-up, the appetite was stable, while the serum phosphate and pre-albumin increased [(1.5±0.4)mmol/L vs.(1.6±0.4)mmol/L, P=0.025;325.3 (272.2,355.1)mmol/L vs.326.0(284.2,376.5)mmol/L, P<0.01, respectively].No difference was observed in edema, dyspnea, and nighttime lying flat.However, the weight elevated significantly [(61.3±13.9)kg vs.(63.4±13.0)kg, P=0.002], with the median peritoneal ultrafiltration volume increased from 783.3 ml to 900.0 ml (P=0.005).During the holiday, the incidences of dialysis-related infections were unchanged, while the incidences of digestive system comorbidities increased significantly (5.4％ vs.13.8％, P=0.021).As for the compliance, 8 patients reduced their PD cycles during the holiday, which was more frequent than before holiday (P=0.018).One patient changed his PD pattern, and 6 patients did not follow the medication orders.Demographic characteristics such as gender, age, and marriage conditions were not associated with the compliance.Conclusions Holiday syndrome remarkably affects PD patient''s volume load, metabolism, and compliance.Poor self-management of PD patients during holidays needs further concern.

The aberrant activities or overexpression of kinases have been closely linked to the development of many diseases, including liver fibrosis, and kinases have become important therapeutic targets for these diseases. Protein kinases, including tyrosine kinases and serine/threonines protein kinases, and phosphoinositide 3-kinase(PI3K)are involved in the development of liver fibrosis through direct and indirect mechanisms, such as regulating the activation of hepatic stellate cells and intrahepatic angiogenesis. Recent studies have shown that small molecule kinase inhibitors(SMKIs)manifest great potential for treating liver fibrosis by inhibiting cell proliferation and angiogenesis. The present review summarizes the activities of tyrosine kinase, serine/threonine kinase and PI3K in liver fibrosis, as well as the pathway they involved in during the development of liver fibrosis, and the recently reported antifibrotic effects of various SMKIs both on preclinical animal models and on patients with liver fibrosis in clinical trials.
10.11665/j.issn.1000-5048.20180203