[Objective] To explore the counteractive mechanism of Tongmai Injection (IT) for excitotoxicity in rats with cerebral ischemia/reperfusion by observing the glutamic acid (Glu) content and N-methyl-D-aspartate (NMDA) receptor activity in rats cortex. [ Methods ] Rat models with cerebral ischemia/reperfusion were established by four-vessel occlusion. Glu content and NMDA receptor activity were examined by radioimmunoassay and the effects of TI on Glu and NMDA receptor were also observed. [ Results ] Glu content and NMDA receptor activity were both increased in the model group and TI could counteract the above changes. [Conclusion] Cerebral ischemia/reperfusion can induce excitotoxicity and TI can protect the cerebral cortex.

ObjectiveTo investigate the clinical effect of the double stapling technique for anus-preserved (Dixon) and Miles procedure of rectal carcinoma. MethodsFifty-eight cases were divided into 29 cases as control group and 29 cases as observation group by digital table method. The distance of their carcinoma was 4-7 cm to anus. The control group was treated with Miles procedure of rectal carcinoma, the observation group was treated with double stapling technique for Dixon. ResultsThe operation time of observation group was ( 180 ± 56) min, the control group was (240 ± 73)min(P ＜ 0.05). Five-year survival rate of observation group was 77.9％, the control group was 79.3％ (P ＞0.05);the recurrence rate of observation group was 6.9％(2/29),the control group was 6.9％(2/29) (P ＞ 0.05). In the observation group,nobody suffered encopresis after 1 year,postoperative stool frequency was ≤5 times/d,while the control group occurred encopresis gradually. ConclusionIf the distance of carcinoma is 4-7 cm to anus, the way of the double stapling technique for Dixon can get the similar short term effect with the way of Miles, and can get more ability to control it.

Objective:To construct a mutant D314A of Escherichia coli cytosine deaminase (EC-CD, substitution of an alanine (A) for the aspartic acid (D) at position 314 of cytosine deaminase) and investigate its antitumor effect. Methods: Eukaryotic expression plasmid containing EC-CD gene (pcDNA3.1-CD~(wt)) was constructed, and the mutant pcDNA3.1-CD~(D314A) plasmid, with aspartic acid (D) at position 314 of EC-CD gene substituted by alanine (A) (EC-CD~(D314A)), was established by site-directed mutation. EC-CD~(wt) and EC-CD~(D314A) were transfected into human colon cancer cell line LoVo via Lipofectamine~(tm) 2000, and positive LoVo-CD~(wt) and LoVo-CD~(D314A) cells stably expressing corresponding genes were selected by G418. The cytotoxicity and bystander effects of EC-CD and EC-CD~(D314A) genes on LoVo cells were e-valuated by MTT assay. Results: The mutant D314A was confirmed by sequence analysis. EC-CD and EC-CD~(D314A) mRNA were expressed after transfected into LoVo cells. The IC_(50) of Lovo-CD~(D314A) cells was (85.13±0.60) mmol/L, which was significantly lower than that of LoVo-CD~(wt) cells ([689.76±0.45] μmol/L, P=0.000). Bystander effect assay showed that, when at the ratio of 30%, the survival rates of LoVo-CD~(wt) cells and Lovo-CD~(D314A) cells were (48.5±0.49)% and (17.3±0.40) % (P = 0.000), respectively. Conclusion: Mutatant EC-CD gene (EC-CD~(D314A)) has a significantly in-creased antitumor effect on LoVo cells compared with wild type EG-CD gene, and it may become a new candidate gene for tumor gene therapy.

Objective:To construct a simple model of arteriovenous fistula classification,and to achieve the classification of arteriovenous fistula in hemodialysis patients.Methods:The study was a retrospective analysis, a total of 304 hemodialysis patients with internal fistula in People′s Hospital of Deyang City from January 2016 to January 2021 were selected by convenience sampling method,depending on whether the internal fistula was dysfunctional, patients were divided into 64 in the internal fistula failure group and 240 in the internal fistula patency group. Independent influence factors and their regression coefficient were obtained by single-factor analysis and logistic regression analysis, The risk score formula was established based on the regression coefficient to form a simple model of internal fistula classification.The model was evaluated by receiver operating characteristic curve and the scoring criteria for internal fistula classification was determined.Results:Logistic regression analysis showed that diabetes mellitus, hypotension, age≥60 years old, compression time≥30 min, blood phosphorus>1.78 mmol/L, triglyceride>1.71 mmol/L and fibrinogen>4 g/L were independent influencing factors of internal fistula failure (all P<0.05).The area under the receiver operating characteristic curve was 0.858(95% CI 0.789-0.928, P<0.01), and the best critical value of the internal fistula classification was 7.5, the sensitivity was 80.4% and the specificity was 84.8%. Conclusions:By obtaining the predictors of internal fistula failure, conducted the risk score, and constructed a simple model of internal fistula classification, which can effectively predicted the risk of internal fistula failure. It is conducive to the implementation of internal fistula classification management and the puncture of corresponding grade, to ensure the pathway safety of patients.

Objective To explore the risk factors for renal anemia in hemodialysis patients with end-stage kidney disease (ESKD). Methods A total of 48 ESKD patients undergoing hemodialysis in our hospital from December 2021 to December 2022 were selected as study objects. They were divided into renal anemia group (86 cases) and non-anemia group (62 cases) based on hemoglobin (Hb) levels and diagnostic criteria for renal anemia. Clinical data between the two groups were compared. Random forest algorithm and multivariate Logistic regression analysis were used to screen for factors influencing renal anemia, and a multivariate Logistic regression model was established. Cross-validation was also employed to verify the stability of the model. A risk stratification system was developed, and patients were stratified based on cut-off values obtained from X-Tile software. The areas under the receiver operating characteristic (ROC) curves were used to evaluate the discrimination ability of the multivariate Logistic regression model and the risk stratification system. Results Among 148 ESKD patients, the incidence of renal anemia was 58.11% (86/148). Hypertension, increased neutrophil-to-lymphocyte ratio (NLR), elevated C-reactive protein (CRP), increased serum ferritin (SF), and elevated intact parathyroid hormone (iPTH) were identified as risk factors for renal anemia (P < 0.05). Administration of α-calcidol, increased erythropoietin (EPO), elevated triglyceride (TG), and increased serum albumin (ALB) were protective factors (P < 0.05). The goodness-of-fit test for the multivariate Logistic regression model showed a Nagelkerke R2 of 0.593. Based on the cut-off values for risk scores obtained from X-Tile software, patients were stratified into low-risk group (< 4 points, 29 cases), medium-risk group (4 to < 7 points, 64 cases), and high-risk group (≥7 points, 55 cases), with renal anemia incidence rates of 24.14%, 57.81%, and 76.36%, respectively. The difference in renal anemia incidence rates among the three groups was statistically significant (P < 0.001). In the training set, the areas under the ROC curves for the multivariate Logistic regression model and the risk stratification system were 0.826 and 0.811, respectively, and were 0.804 and 0.789, respectively in the validation set. Conclusion The occurrence of renal anemia in hemodialysis patients with ESKD is influenced by various factors, including hypertension, NLR, CRP, etc.

Objective To retrieve,evaluate and summarize the relevant evidence on malnutrition management among maintenance hemodialysis(MHD)patients to provide clinical medical staff with evidence-based guidelines for managing malnutrition in MHD patients.Methods Using the"6S"pyramid model of evidence,We searched UpToDate,BMJ best clinical practice,the Australian JBI evidence-based health care centre database(JBI),Medive,the International Guidelines Collaborative Network(GIN),Agency for Healthcare Research and Quality Network,the UK National Institute of Clinical Medicine Guidance Library(NICE),Scottish Inter-College Guide Collaboration network,the Ontario Registered Nurses Association(RNAO),Guidelines Network of International Society of Nephrology,American Nephrology Foundation Guidenet,British Nephrology Society,Society of Nephrology,Chinese Medical Association,Improving Kidney Disease Outcomes Worldwide,International Society of Renal Nutrition and Metabolism,American Society for Parenteral Enteral Nutrition,European Society for Clinical Nutrition and Metabolism,Chinese Nutrition Society,PubMed,Web of Science,Embase,Cochrane Library,CNKI,Wanfang,VIP and CBM,to collect relevant guidelines,expert consensus,clinical decision,evidence summary,recommended practice,best practice,systematic evaluation and clinical practice,from the establishment to the date of April 10th,2023,for literature on malnutrition management of MHD patients.The literature included guidelines,expert consensuses,clinical decision-making studies,evidence summaries,recommended practices,best practices,and systematic reviews.Two researchers independently evaluated,extracted,and integrated the evidence.The evidence was graded by the evidence pre-grading system of the Evidence-based Healthcare Center of Joanna Briggs Institute(JBI).Results A total of 16 articles were included and summarized,comprising 5 guidelines,3 expert consensuses,1 clinical decision-making study,1 evidence summary,and 6 systematic reviews.Thirty-nine pieces of the best evidence were integrated,covering 5 key aspects(39 evidences):screening and assessment,nutritional requirements,nutritional supplement,other interventions,and monitoring and education.Conclusions The best evidence summary of malnutrition management among MHD patients in this study is scientifically rigorous and systematic.Clinical medical staff can use the best evidence to develop personalized malnutrition management programs for MHD patients.