Objective To evaluate the association between methylenetetrahydrofolate reductase gene (MTHFR) C677T polymorphism and diabetic kidney disease in Chinese population.Methods After searching the related literatures from PubMed,Medline,EMBASE databases and common Chinese journal literature databases,meta-analysis was performed to assess the association of MTHFR C677T polymorphism with diabetic kidney disease according to the principles of systematic review based on the recessive model and dominant model respectively.Fixed effect model (M-H) was used to pool odd ratio (OR) after heterogeneity test.The Begg and Egger analysis were conducted to evaluate the publication bias.Results 10 literatures including a total of 2018 cases were included in the metaanalysis.No significant heterogeneity was detected.Data were pooled by fixed effect model.The total OR was 2.41 (95％CI=1.85～3.13) and 2.33 (95％CI=1.82～2.98) in recessive and dominant models respectively.No obvious publication bias was observed by Begg and Egger analysis.Conclusions The T allele of C677T polymorphism in MTHFR gene is positively associated with diabetic kidney disease in Chinese population.

Objective:To analyze the association of clinical characteristics and laboratory indicators at initial maintenance hemodialysis(MHD)with long-term prognosis in advance-aged patients, and to find influencing factors for the prognosis in advance-aged MHD patients.Methods:This retrospective study was conducted at the Nephrology Department of Beijing Hospital between April 2007 and January 2018.A total of 61 patients receiving first-time hemodialysis at ≥ 80 years of age and undergone regular dialysis for 3 months or longer were enrolled.All patients were followed-up until death or the end of July 1, 2018.Patients were divided into the survivor and non-survivor groups, and differences in clinical characteristics and laboratory indicator values were compared between the two groups.Influencing factors for prognosis in advance-aged MHD patients were analyzed by using multivariate Cox regression.Results:For the 61 subjects, the median follow-up time was 25.8 months.During the follow-up, 32 patients died(52.5%). The main death causes were infectious diseases(40.6%, n=13)and cardiovascular and cerebrovascular diseases(37.5%, n=12). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 75.4%(46/61), 54.1%(33/61), 37.7%(23/61), 22.9%(14/61)and 16.4%(10/61), respectively.The median survival time was 25.8 months for all patients, 27.5 months for patients aged 80-84 years, and 14.9 months for patients aged 85 years and over.The non-survivor group had a higher male ratio(65.6% or 21/32 vs.37.9% or 11/29, χ2=4.678, P=0.031)and lower levels of hemoglobin(85.4±13.0 vs.95.0±17.6 g/L, t=2.867, P=0.019)and albumin(30.3±5.0 vs.34.6±4.8 g/L, t=3.039, P=0.001)than the survivor group.Kaplan-Meier curves indicated that the survival rate decreased with age, and subjects aged less than 85 years had a higher survival rate than subjects aged 85 years and older(the median survival time: 14.9 months vs.27.5 months, Log Rank P=0.006); patients who received continuous renal replacement therapy(CRRT)before dialysis had lower survival rates than patients who did not receive CRRT(the median survival time: 7.8 months vs.29.2 months, Log Rank P=0.002); patients with high serum levels of albumin(≥33 g/L)had higher survival rates than patients with low serum levels of albumin(<33 g/L)(the median survival time: 29.2 months vs.18.9 months, Log Rank P=0.003). Multivariate Cox regression analysis showed that age at initial dialysis( HR=1.136, 95% CI: 1.005-1.285, P=0.041), female( HR=0.409; 95% CI: 0.169-0.994, P=0.048), serum albumin level( HR=0.836, 95% CI: 0.772-0.906, P<0.001)and CRRT before dialysis( HR=6.161, 95% CI: 1.848-20.538, P=0.003)were independent predictors of all-cause mortality in advance-aged patients. Conclusions:Advance-aged patients undergoing hemodialysis have complicated clinical conditions and poor prognosis.Age, gender and serum albumin level at initial dialysis and CRRT before dialysis are independent predictors of prognosis in these patients.

Objective To construct a practical and scientific evaluation system for the quality of anesthesia nursing.Methods From January to June 2015, the contents and important observation indicators of anesthesia nursing quality evaluation was reviewed in a hospital in the 2014. Based on the 2013 International Guidelines for Anesthesia, a questionnaire based on Donabedian's theory was formed by literature review and semi-structured interviews. Experts from 22 ClassⅢ Grade A hospitals and 5 universities in 7 different provinces and cities were selected for research. Delphi expert inquiry method was used to determine the items and contents of the evaluation system. Then, a preliminary evaluation system was formed.Results A total of 27 experts were included in the questionnaire consultation. The recovery rate of the first round of questionnaire was 90.0％ and that of the second round was 100.0％. The first and second rounds of expert authority coefficients was 0.874 and 0.879 respectively, and the coordination coefficients of the first and second indicators were 0.810 and 0.862 respectively. The differences in coordination coefficients were statistical significant (P<0.05), and the coefficient of variation was 0.090-0.130. Finally, an evaluation system of anesthesia nursing quality was formed, including 8 first-level indicators and 20 second-level indicators.Conclusions The index system constructed in this study has certain reference significance for perioperative anesthesia nursing quality evaluation, but there are still some limitations,which still need to be further tested for reliability and validity.

Objective To construct nursing postgraduates' professional ability questionnaire and examine its reliability and validity,in order to provide a reliable and valid measure of professional ability.Methods After extensive studies on contemporary literature and interview,theory framework of professional ability was concluded and items pool was set up. Expert consultation was applied to evaluate the questionnaire and its items and pretesting questionnaire was formed. Pretesting questionnaires filled out by 122 nursing postgraduates were used to do the items analysis and exploratory factor analysis. A total of 176 nursing postgraduates were recruited to examine its validity,reliability and the confirmatory factor analysis. Results The nursing postgraduates' professional ability questionnaire included 5 subscales (27 items):planning and learning ability,self-management ability,ability to complete the task,social and communication skills,and professional ability. The Cronbach's α of total scale was 0.885,and subscales were 0.704-0.822. Retest reliability was 0.899. Correlation coefficients of total scale scores and each factor were 0.789-0.896 (P<0.01). The correlation coefficients among factors were 0.465-0.714 (P<0.01). According to the results of confirmatory factor analysis,x2/df<5,NFI,RFI,IFI,TLI,CFI were all close to or larger than 0.90,RMSEA< 0.06,with PNFI and PCFI both greater than 0.5.Conclusions With good validity and reliability,the nursing postgraduates' professional ability questionnaire could be used as a measure of nursing postgraduates' professional ability.

OBJECTIVETo study the baseline distribution of polymorphisms in the promoter of peroxisome proliferators activated receptor co-activator 1 (PPARGC1A) gene in ethnic Hans from Beijing, and to assess their association with type 2 diabetes (T2DM).

METHODSA 2-stage study was designed. Firstly, the promoter region of PPAGC1A gene was screened with PCRRFLP in a small population (n=216, T2DM/control: 104/112), which was followed by a replication study of a larger group (n=1546, T2DM/control: 732/814). Fasting plasma glucose, insulin, blood lipid, height, weight, waist circumference, and blood pressure were measured in all subjects. Potential association was assessed by logistic regression. Linkage disequilibrium and haplotype analysis were conducted with Haploview software.

RESULTSFive polymorphisms were identified with Sanger sequencing, among which T-2120C (rs3755857), -1999C/G (rs2946386) and -1437T/C (rs2970870) were included for genotypic analysis based on their moderate levels of heterozygosity. No significant difference was found between the two groups. When adjusted for age and gender confounding, we have combined the OR values from population 1 and population 2 based on Mantel-Haenszel fixed model, and recognized a mild contribution of C allele of -1999C/G (rs2946386) to the 1.18-fold risk of T2DM (P=0.03, OR=118). No haplotype was associated with T2DM after permutation correction.

CONCLUSIONThe C allele of -1999C/G ( rs2946386) in the promoter region of the PPARGC1A gene is mildly associated with T2DM. Variations in the promoter region of the PPARGC1A gene seem not to confer the risk of T2DM in our population.

Adult ; Aged ; Asian Continental Ancestry Group ; ethnology ; genetics ; Blood Glucose ; metabolism ; Case-Control Studies ; China ; ethnology ; Diabetes Mellitus, Type 2 ; blood ; ethnology ; genetics ; Ethnic Groups ; genetics ; Female ; Genetic Variation ; Humans ; Lipids ; blood ; Male ; Middle Aged ; Peroxisome Proliferator-Activated Receptor Gamma Coactivator 1-alpha ; Polymorphism, Single Nucleotide ; Promoter Regions, Genetic ; Transcription Factors ; genetics

Objective:To compare death causes and the survival time in elderly patients undergoing hemodialysis versus peritoneal dialysis in the nephrology department of Beijing Hospital in the last 10 years.Methods:This was a retrospective study.Patients aged more than 60 years who had undergone dialysis and died in the dialysis center of Beijing Hospital between January 2010 and January 2019 were enrolled.A detailed medical history including gender, age, primary diseases, diabetes mellitus, time of dialysis initiation, time of death and direct cause of death were recorded.Results:A total of 153 elderly dialysis patients were enrolled, with a mean age of 76.6±7.7 years, a median dialysis vintage of 54.1(26.9, 86.4)months, including 83(54.2%)cases with diabetes.Patients were divided into the hemodialysis group(HD, n=114)and the peritoneal dialysis group(PD, n=39)according to the dialysis method.The mean ages of patients in the HD and PD groups were 77.1±7.9 and 75.0±7.0 years, and the median dialysis vintages were 56.5(27.4, 104.2)and 48.3(26.3, 66.6)months, respectively.The primary diseases of patients undergoing HD and PD were diabetic nephropathy(DN, 32.5% vs.48.7%), chronic glomerulonephritis(29.8% vs.17.9%)and hypertensive renal damage(21.1% vs.10.3%). The top three causes of mortality in patients undergoing HD and PD were cardiovascular diseases(32.4% vs.43.6%), infections(29.8% vs.28.2%)and cerebrovascular diseases(11.4% vs.15.4%). The compositions of primary diseases and death causes were similar between the two groups, with no significant difference.Kaplan-Meier curves indicated that the survival time of dialysis patients with diabetes mellitus was shorter than that of patients without diabetes mellitus(chi-square value was 12.829, P<0.001), and the survival time of HD patients was longer than that of PD patients(chi-square value was 8.161, P=0.004). In patients without diabetes mellitus, the survival time of HD patients was longer than that of PD patients( Z=-2.716, P=0.007). In patients with diabetes mellitus, HD and PD had similar survival outcomes( Z=-0.581, P=0.561). Conclusions:The proportion of patients with diabetic nephropathy is high in elderly dialysis patients.Cardiovascular and cerebrovascular diseases and infections are the main causes of death in elderly dialysis patients.The survival time is longer in HD patients than in PD patients.

A 65-year-old male was admitted because of anorexia, gross hematuria, skin purpura and acute renal insufficiency. Cardiovascular interventional examination was performed in other hospital 3 months before admission. During hospitalization, multiple blood cultures suggested positive Streptococcus gordonii, decreased blood complement and increased rheumatoid factor. Echocardiography revealed mitral valve vegetations (4 mm), and renal biopsy revealed endocapillary proliferative glomerulonephritis, diagnosed as infective endocarditis-associated glomerulonephritis. The combination of effective antibiotics and plasma exchange therapy significantly improved clinical symptoms and acute renal failure. The case suggests that plasma exchange is effective and safe in the treatment of immune complex-mediated glomerulonephritis caused by infective endocarditis, providing a new option for the treatment of such diseases.