Objective To explore the clinical effect of hemodialysis combined with hemoperfusion in treatment of secondary hyperparathyroidism. Methods 32 patients with secondary hyperparathyroidism were selected and randomly divided into two groups:the observation group(16 cases) and the control group(16 cases). The patients in the observation group were treated with hemodialysis combined with hemoperfusion, and in the control group, the patients were treated with conventional hemodialysis. Then the levels of serum phosphorus, serum calcium, serum intact parathyroid hormone(iPTH) and skin itching,and weakness and so on were compared. Results After treatment,the level of iPTH in the observation group decreased significantly(P ＜ 0.05) ,but in control group it decreased not obviously, and compared with it before treatment there was no significant difference. After treatment, in the two groups the level of serum phosphorus was significantly lower(P ＜0.05) ,and the level of serum calcium was significantly higher (P ＜ 0.05), and the level of serum phosphorus and iPTH had significant differences between the two groups (P ＜0. 05) ,while no significant difference in serum calcium. In the observation group,skin itching,muscle weakness and other symptoms were improved significantly compared with those in the control group (P ＜ 0.05). Conclusion Hemodialysis combined with hemoperfusion in treatment of secondary hyperparathyroidism was very effective.

Objective To investigate and analyze the effect of serum micro inflammatory and nutritional indexes of psychological intervention combined with enalapril maleate tablets on the treatment of the patients with maintenance hemodialysis. Methods 100 patients with chronic renal failure in Jiande the first people's hospital from February 2015 to August 2016 were selected as the subjects, and randomly divided into the control group and the experimental group. The control group and the experimental group were given enalapril maleate tablets, at the same time, the experimental group were received psychological intervention. The changes of serum micro inflammation indexes and nutritional indexes in the the two groups were compared and analyzed. Results The HsCRP, TNF alpha levels in the experimental group decreased significantly than those in the control group, the differences had statistical significant (P<0.05). The levels of prealbumin and plasma albumin in the experimental group were significantly higher than those in the control group (P<0.05). After treatment, the SAS score in the experimental group was (42.3±5.2) points, and the SDS score was (40.1±5.9) points. The SAS score in the control group was (60.9±9.2) points, and the SDS score was (59.1±7.4) points. The scores of depression and anxiety in the experimental group were significantly lower than those in the control group (P<0.05). Conclusion Psychological intervention combined with enalapril maleate tablets used in maintenance hemodialysis patients, which can significantly improve patients' serum inflammation index, restore the nutritional status of patients, eliminate the negative emotion of patients, with further clinical promotion and application significance.

Objective: To establish the quality standard for Erxiaqingxin Tablets(Cordyceps, Rhizoma Pinelliae, Radix Puerariae, Caulis Bambusae in Taenia, Fructus Aurantii Immaturus, Pericarpium Citri Reticulatae, etc.). Methods:TLC was performed to identify Pericarpium Citri Reticulatae, Fructus Aurantii Immaturus and Radix Puerariae. HPLC was used to determine the content of puerarin. Results:The study on the quality control showed that the characteristic of identification by TLC was distinct and hightly specific. The quantification method had the linear range of 0.04092～2.4552?g. The average recovery was 99.36% and RSD was 2.32%. Conclusion:The method for identification and quantification was simple, realizable and reproducible. It can be used effectively for the quality control of Erxiaqingxin Tablets.

Objective To investigate the role of N-acetylcysteine as a protective agent in rifampicin-induced hepatic injury of mice. Methods Thirth-two Kunming mice were randomly divided into four groups(n=8 each).The mice in each group were injected intraperitoneally with 0.9% sodium chloride solution (control), N-acetylcysteine (NAC), combination of rifampicin (R), or NAC and R (NAC+R) once every day.After 14 days, the liver index (LI), alanine aminotransferase (ALT) and aspartate aminotransferase ( AST) activity in serum, and the level of malondialdehyde( MDA) ,superoxide dismutase( SOD) activity in liver tissues were measured respectively.Hepatic tissue morphology was observed under light microscope. Results Macroscopic analysis revealed that rifampicin led to severe liver tissue injury,including a wide range of hepatocellular vascular congestion,fatty change and local necrosis, whereas the administrationof NAC produced a significant reduction of rifampicin-induced hepatotoxicity .LI,ALT and AST activities in R or NAC+R group were significantly elevated as compared with the control group(P<0.01) .LI, activities of ALT and AST in serum,and MDA levels in liver tissues in NAC+R group were significantly lower than those in R group ( P<0.01) ,but the SOD activity in NAC+R group was increased significantly in comparison with R group (P<0.01). Conclusion Rifampicin was able to cause severe hepatic injury.Pre-administration of NAC reduced the side-effect induced by the treatment with the rifampicin.

Objective To evaluate the regulatory role of acetylcholine receptor in muramyl dipeptide (MDP)-induced activation of Nod-like receptor 2/receptor-interacting protein 2 (2NLR2/RIP2) pathway in macrophages of mice.Methods RAW264.7 cells at the logarithmic growth phase were seeded in 12-well plates (density 1 × 106 cells/ml,2 ml/well),a total of 108 wells.The cells were randomly divided into 3 groups (n =36 each) using a random number table:control group (group C),MDP group (group M),and GTS-21 (a7nAChR specific agonist) group (group G).The cells were routinely cultured in group C.MDP with the final concentration of 10 μg/ml was added to the culture medium in group M.MDP with the final concentration of 10μg/ml and GTS21 with the final concentration of 50 μg/ml were added to the culture medium in group G.The cells were incubated for 24 h.At 1,6 and 24 h of incubation with MDP,12 wells were chosen and the cell suspension was obtained for measurement of NLR2 mRNA expression (by real-time fluorescent quantitative PCR),RIP2 expression (by Western blot),and concentrations of tumor necrosis factor-alpha (TNF-α) and high mobility group box-1 (HMGB1) in the culture media (by ELISA).Results Compared with group C,the levels of NLR2 mRNA,RIP2,TNFα and HMGB1 were significantly increased at each time point in group M (P ＜ 0.05).Compared with group M,the levels of NLR2 mRNA,RIP2,TNF-α and HMGB1 were significantly decreased at each time point in group G (P ＜ 0.05).Conclusion Acetylcholine receptor can suppress MDP-induced transduction of NLR2/RIP2 pathway in macrophages of mice.

Objective To explore the effects of atorvastatin and valsartan on high glucose-induced human umbilical vein endothelial cells (HUVECs) injury.Methods Cultured HUVECs were divided and assigned to 9 groups:normal control group,mannitol control group,high glucose group,low dose atorvastatin group (0.1 μ mol/L),medium dose atorvastatin group (1 μmol/L),high dose atorvastatin group (10 μ mol/L),low dose valsartan group (0.1 μmol/L),medium dose valsartan group (1 μmol/L),and high dose valsartan group (10 μmol/L).H UVECs were pretreated with or without 30 mmol/L glucose plus various concentrations of atorvastatin and valsartan (0.1,1,10 μmol/L) for 16 hours and then incubated with 5.5 mmol/L glucose for 6 days.The levels of vascular cell adhesion molecule 1 (VCAM-1),monocyte chemotactic protein 1 (MCP-1),and plasminogen activator inhibitor 1 (PAI-1) in the culture supernatant were measured by enzyme-linked immunosorbent assay.Results Compared with normal glucose group,hyperglycemia memory increased the levels of VCAM-1,MCP-1,and PAI-1 (all P＜0.05),which were still maintained at high levels even after withdrawal of high glucose.Atorvastatin and valsartan treatment decreased the levels of VCAM-1,MCP-1,and PAI-1 (all P＜0.05).Conclusion Atorvastatin and valsartan may lower the secretion of VCAM-1,MCP-1,and PAI-1,and prevent high glucose memory-induced injury to endothelial cell.

Objective To evaluate the safety and feasibility of injection test which is used to locate esophageal balloon catheter.Methods A prospective study was conducted. The patients undergoing invasive mechanical ventilation (MV) admitted to general intensive care unit (ICU) of Beijing Tiantan Hospital Affiliated to Capital Medical University from May 2015 and March 2017 were enrolled. The commercially available esophageal balloon catheter was modified to perform injection test. The catheter was withdrawn step by step and the injection test was repeated until the presence disturbance wave presented, which indicated that the balloon had just entered the esophagus. The position where disturbance wave appears was named 0 cm. End-expiratory occlusions were performed at the positions of+15,+10,+5, 0, -5, -10 and -15 cm, respectively, and the changes of esophageal pressure (Pes) and airway pressures (Paw) were measured in the spontaneous breathing and passive ventilation, and the ratio between the changes (ΔPes/ΔPaw) was calculated.Results A total of 20 patients were enrolled, of which 15 patients finished both the spontaneous and the passive ventilation parts, and 2 patients finished only the spontaneous part and 3 patients finished only passive part. ① Disturbance waves could be induced by injection test in all patients. The average depth of disturbance wave in spontaneous breathing was deeper than that in passive ventilation (cm: 42.4±3.8 vs. 41.8±3.3), but there was no significant difference between the two ventilation settings (P = 0.132). No adverse events occurred during the study period. ② Pes increased with the stepwise withdraw of esophageal catheter, reached the maximal value at+5 cm, and then decreased when the catheter was further withdrawn, no matter in the spontaneous or the passive ventilation. In spontaneous breathing, the ΔPes/ΔPaw was within the ideal range (0.8-1.2) at the positions of 0, -5 and -10 cm. The ΔPes/ΔPaw was closest to unity at the positions of 0 cm (0.98±0.15). The ΔPes/ΔPaw at -15 cm (0.66±0.26) was significantly lower than that at 0 cm (P < 0.05). For passive ventilation, the ΔPes/ΔPaw was within the ideal range at the positions of -5 cm and -10 cm, and the ΔPes/ΔPaw was closest to unity at the positions of-10 cm (0.94±0.12). The ΔPes/ΔPaw at 0 cm and -5 cm was significantly higher than that at -10 cm (1.43±0.31 and 1.12±0.14, respectively); while the ΔPes/ΔPaw at -15 cm (0.68±0.23) was significantly lower than that at -10 cm (allP < 0.01).Conclusions Ideal position of the esophageal balloon catheter could be determined quickly and easily by using injection test. The method is safe and clinically feasible.Clinical Trial Registration Clinical Trials, NCT02446938.

Case analysis method,which was a new teaching mode,was proposed for some problems in current traditional teaching mode.The concrete operation content of case analysis method in lemological teaching was described.The results of the survey analysis showed that the teaching effectiveness of the new teaching mode was obviously better than that of traditional teaching mode.

Objective The objective of this study was to explore the construction of a comprehensive and systematic quality management system for pharmacy intravenous admixture service (PIVAS) and form quality management method and model reflecting distinct gradations,specific responsibility and all staff participation,so that we can provide safe and effective intravenous solutions for the patients and guarantee the quality and safety of intravenous infusion and improve management quality.Methods According to Quality Management Standards of PIVAS published by Ministry of Public Health and JCI Standard,with the theory and methods of feed forward control and delicacy management,by establishing and completing three-grade-quality management organization,defining the quality control indicators,selecting and demonstrating with the application of expert meeting method and Delphi method,a scientific quality control system was formed.Statistics on unreasonable prescriptions,adverse drug reaction of intravenous infusion,defect of pharmacy intravenous admixture and satisfaction of medical staff and patients were compiled and evaluated throughout the implementation of the practice changes in 38 wards.Results Significant differences were observed in various indicators,comparing statistics collected during 6 months of the same season throughout the implementation of the practice changes.x2 value was 160.54,21.39 and 10.29 by comparison of unreasonable prescriptions,adverse drug reaction and number of drug preparation errors.The satisfaction degree of medical staff and patients improved evidently,x2 value was 14.34 and 26.76.Conclusions The construction and implementation of three-grade-quality management system adapt to high-risk,high strength,high sense of responsibility,process-oriented and intensive management of PIVAS.The impact on the continuous improvement PIVAS quality and assurance in safety of intravenous infusion is remarkable.

CD4(+)CD25(+)CD127(dim/-) regulatory T cells (Tregs) have been implicated in suppressing T cell immune responses to hepatitis B virus (HBV), but the inhibition mechanism has not being clear yet. This study investigated the effects of soluble FGL2 (sFGL2) secreted by Tregs on immune suppression in chronic HBV-infected patients. We verified that sFGL2 protein and mRNA were highly expressed in Tregs. The separated Tregs by using magnetic beads from peripheral blood mononuclear cells (PBMCs) in 20 patients with chronic hepatitis B were co-cultured with PBMCs at a ratio of 1:3 with anti-CD3 stimulating antibody or FGL2 blocking antibody. The proliferation index of CD8(+)T cells after blocking FGL2 was higher than that in blank group (3.58±0.18 vs. 3.28±0.17, P=0.034) in 18 of 20 samples, and lower than that in CD3 stimulation group (3.82±0.19, P=0.026) in 16 of 20 samples. The IFN-γ secreted in the mixed culture in the absence of Tregs was higher than that in the culture in the presence of Tregs, but it could be abolished by FGL2 blocking antibody. These results suggest that sFGL2 protein secreted by Tregs suppresses the proliferation and function of CD8(+) T cells in chronic hepatitis B.