Objective To analyze the expression and regulation of components of intrarenal renin-angiotensin system (RAS) and the correlation between intrarenal angiotensin Ⅱ (Ang Ⅱ) expression and clinicopathological injury index in primary IgA nephropathy patients. Methods Expressions of intrarenal RAS components were assessed by immunohistochemistry staining (IHCS). Correlation among intrarenal RAS components and of intrarenal Ang Ⅱ expression with blood pressure, estimated glomerular filtration rate (eGFR), 24-h urinary protein and Katafuchi score in 36 primary IgA nephropathy patients were examined. Results There were positive correlations between positive IHCS area of intrarenal renin and Ang Ⅱ (r=0.43, P＜0.01), angiotensiongen and Ang Ⅱ (r=0.34, P＜0.05). There was negative correlation between positive IHCS area of intrarenal Ang Ⅱ and eGFR (r=-0.61, P＜0.01). There was positive correlation between positive IHCS area of intrarenal Ang Ⅱ and pathological chronicity index (ρ=0.39, P＜0.05), index of interstitial cell infiltration (ρ =0.52, P ＜0.05). Conclusion Expression of intrarenal Ang Ⅱ is positively correlated with expression of intrarenal renin and angiotensinogen, and plays an important role in kidney fibrosis in primary IgA nephropathy.

Objective To analyze the correlation of urinary angiotensinogen (AGT) with clinical index of kidney injury and intrarenal renin-angiotensin system (RAS) activity in chronic kidney disease (CKD) patients. Methods Urinary or plasma renin activity, AGT, angiotensin Ⅱ (Ang Ⅱ ), aldosterone were measured by RIA or ELISA in 129 CKD patients. Expression of intrarenal renin, AGT, Ang Ⅱ and angiotensinⅡ receptor was examined by immunohistochemistry staining (IHCS) in 73 CKD patients undergoing renal biopsy. Correlation of urinary AGT with other indexes was performed. Results Average urinary AGT in 129 CKD patients was (159.08 ± 125.18) μg/g Cr, Scr was (113.20± 105.05)μmol/L, and urinary AGT was positively correlated with Scr (r=0.51, P<0.01). Average estimated glomerular filtration rate (eGFR) was (58.52±27.15) ml·min-1·(1.73 m2)-1, which was negatively correlated with urinary AGT (r=-0.55, P<0.01). Average urinary protein was (2.03±2.65) g/24 h, which was positively correlated with urinary AGT (r=0.30, P<0.01). Average urinary Ang Ⅱ was (164.71 ±139.25) ng/g Cr, which was positively correlated with urinary AGT (r=0.20, P<0.05). Average urinary type Ⅳ collagen was (447.60± 800.66) μg/g Cr, which was positively correlated with urinary AGT (r=0.47, P<0.01). Average urinary soduim was (162.17±81.61) mmol/24 h, which was negatively correlated with urinary AGT (r=-0.20, P<0.05). Multiple regression analysis indicated that low eGFR (P<0.01), high Scr (P< 0.01), high urinary protein (P<0.05), high urinary Ang Ⅱ (P<0.05) and high urinary type Ⅲ collagen (P<0.01) were significantly correlated with high urinary AGT. In renal tissues of CKD patients, there was positive correlation of urinary AGT with positive IHCS area of AGT (r=0.45, P< 0.01), Ang Ⅱ (r=0.52, P<0.01) and angiotensin Ⅱ type 1 receptor (r =0.28, P <0.05). Conclusions Urinary AGT level may indicate the kidney injury severity, especially in chronic kidney injury, and may be used as a non-invasive marker of intrarenal Ang Ⅱ activity in CKD patients.

Objective To investigate the relationship between the resting heart rate (RHR) and target organ damage (TOD) in elderly patients with metabolic syndrome(MS). Methods 264 elderly patients with MS were divided into four groups according to the level of RHR: RHR1 group, RHR<65 beats/minute (bpm) (46 cases) ;RHR2 group, 65≤RHR<75 bpm (77 cases);RHR3 group, 75 bpm≤RHR<85 bpm (89 cases);RHR4 group, RHR≥85 bpm (52 cases).Electrocardiography, echocardiography, carotid uhrasonography, crcatinine clearance rate (Ccr) and quantitative assay of 24 hours' albuminuria were performed. Results (1) Compared with RHR1, RHR2 and RHR3 groups, RHR4 group showed higher levels of carotid intima-medial thickness (IMT), carotid arterial diameter (CAD), left ventricular mass index (LVMI) and albuminuria(P< 0.05 or P<0.01), and lower levels of left ventricular ejection fraction (LVEF) and Ccr (all P< 0.01). (2) The IMT, CAD, LVMI and albuminuria were positively correlated with RHR (r=0.33, 0.23, 0.61, 0.58, respectively, all P<0.01). However, the LVEF and Ccr were negatively correlated with RHR (r=-0.59, -0.51, all P<0.01). (3) Logistic multivariate analysis showed that RHR and pulse pressure (PP) had effects on myocardial hypertrophy, coronary heart disease, heart failure, cerebral stroke and renal dysfunction(P<0.05 or P<0.01). Except heart failure, PP played a more important role than RHR. Coneinsions RHR may be an independent risk factors for TOD in elderly patients with MS,and RHR regulation is important for the development of MS in the elderly.

In the present study, the fluoro-gold(FG) and horseradish peroxidase(HRP) combined tracing method was used to investigate the localization of parasympathetic preganglionic neurons and ascending projection neurons in lumbosacral spinal cord of the rat. FG was injected into the lateral parabrachial nucleus(PBL) or into Barrington's nucleus on one side, and HRP was applied to the contralateral pelvic nerve. The retrogradely FG-labeled neurons were found in bilateral "visceral field" at segments L_5-S_2, and the majority of them were concentrated in the intermediolateral nucleus (IML), and the dorsal commissural nucleus (DCN). In addition to these areas, some labeled neurons were also observed in bilateral lamina I and lateral spinal nucleus (LSN). The parasympathetic preganglionic neurons labeled with HRP were seen in the IML at segments L_6-S_1, occasionally appeared in the intercalated nucleus. In the IML area, HRP-labeled parasympathetic preganglionic neurons were located in its ventral part, however, the localization of FG-labeled neurons projected to the PBL and Barrington's nucleus were mainly found in the dorsal and dorsomedial part of the IML, and a few FG-labeled cells were scattered among HRP-labeled cells. Based on the present and other investigations, the nomenclature, organization and function of the IML and the composition of the LSN were discussed.

ObjectiveTo investigate the effects of acupuncture on neuromuscular block of vecuronium and analgesia under general anesthesia.MethodsNinety ASA Ⅰ or Ⅱ patients,aged 29-80 yr,weighing 50-80kg,scheduled for laparoscopic chotecystectomy,were randomly divided into 3 groups (n =30 each):acupuncture at acupoints combined with general anesthesia group (group A),acupuncture at non-acupoints combined with general anesthesia group (group B) and general anesthesia group (group C).Bilateral Hegu (LI4),Neiguan (PC6),Zusanli (ST36),yanglingquan (GB34),and Quchi (LI11) acupoints were selected in group A.In group B,the points adopted were the midpoints between the meridians in which the acupoints were selected in group A and the adjacent meridians on the lateral side,at the level of selected meridian points correspondingly.Electric stimulation was started from 15-30 min before anesthesia induction and continued until the end of operation.Anesthesia was induced with iv injection of fentanyl,propofol and vecuronium and maintained with intermittent iv boluses of fentanyl and vecuronium.All the patients received patient-controlled intravenous analgesia after operation.The effect time,onset time,clinical duration and recovery index of vecuronium,consumption of anesthetics during operation,and consumption of fentanyl for postoperative analgesia and postoperative adverse reactions were recorded.Results Compared with group C,the elinical duration was significantly prolonged,the consumption of anesthetics during operation and consumption of fentanyl for postoperative analgesia were significantly reduced,and the incidence of nausea was significantly decreased ( P ＜ 0.05 ),while no significant changed was found in the effect time,onset time,and recovery index in group A ( P ＞ 0.05).Compared with group B,the amount of fentanyl consumed during and after operation was significantly reduced in group A ( P ＜ 0.05 ).ConclusionAcupuncture can prolong the clinical duration of vecuronium,and enhance the analgesic efficacy during and after operation under general anesthesia.

Objective To explore the clinical characteristics and prevention management of death events caused by infections in end-stage renal disease (ESRD)patients undergoing hemodialysis. Methods Clinical data of ESRD patients undergoing hemodialysis in Nephrology Department of Zhongshan Hospital from 1998 to 2008 were retrospectively studied.Death causes,primary diseases,complications,infections,and survival time were analyzed. Results A total of 252 patients died including 162 males(64.29%)and 90 females(35.71%).Average death age was (63.48±14.77)years.In death events,emergency dialysis accounted for 59.52%,and primary glomerular disease was the major primary diseases(27.23%),then diabetic nephropathy(16.90%)and hypertensive nephrosclerosis (14.55%).34.8%death was caused by infections or promoted by infections,secondly by cerebrovascular events(23.6%).The elderly accounted for the majority of infection-associated deaths.48.15%and 38.71%patients with deaths caused or promoted by infections respectively had shorter dialysis duration(<3 months),whose percentage was much higher than those with non-infection-associated deaths (30.34%).Primary infection was still pulmonary infection(77.59%),then blood infection(10.34%)and catheter-associated infection(5.17%).58.62%infection-associated deaths had positive microbiologic test results,and gram negative bacillus accounted for 38.24%.50% of patients with positive test was complicated with fungal infection. Conclusions Infection is a main cause and a critical promotion to death in ESRD hemodialysis patients,besides it is the main cause of death in the elderly (>75 years)and hemodialysis duration within 3 months,which may result in shorter survival.Pulmonary infection and gram negative bacillus combined with fungal infection should be considered in the treatment.Prophylaxis of nosocomial infection and pulmonary infection in hemodialysis patients should be more emphasized.

ObjectiveTo explore the epidemiologic feature of maternal syphilis and the status of prevention and control of the disease in Baoshan District. Methods Syphilis monitoring data of pregnant women were analyzed retrospectively in Baoshan district of Shanghai from 2004 to 2009. Results The positive rate of syphilis in pregnant women was 0.31％ ( 195/63 227 ).Among them,residing and migratory pregnant women accounted for 0.17％ (37/22 287) and 0.39％ (158/40 940) respectively (X2 =22.699,P ＜0.01 ). A total of 145 cases received the examination of treponema pallidum particle agglutination (TPPA).And 136 cases were positive.The positive rate of rapid plasma reagin test (RPR) was 51.35％(19/37) in residing early pregnant women and 24.68％ (39/158) in migratory counterparts (X2 =22.192,P =0.000).And 152 cases were followed up to record pregnancy outcomes,including normal delivery of live births ( n =146 ),artificial termination of pregnancy ( n =3 ),stillbirth and spontaneous abortion ( n =3). Forty-three cases became lost. And the rate of loss was 22.78％(36/158) in migratory pregnant women and 18.92％(7/37) in residing counterparts. Conclusions It is imperative to improve the prevention and control mechanisms of pregnancy syphilis and the model of consulting services. We should also pay more attention to screening and follow-up work in migratory pregnant women.

Objective To investigate the incidence and risk factors of acute kidney injury(AKI)after different types of cardiac valve replacement surgery. Methods A single cohort of 1113 patients who received cardiac valve replacement surgery from April 2009 to March 2010 in Zhongshan Hospital,Fudan University were prospectively analyzed.Multivariate Logistic regression analysis was used to evaluate possible risk factors associated with post-operative AKI.Akl was defined as a relative 50% increase or an absolute increment of 26.4 μmol/L in Scr within 48 hours and/or urine volume <0.5ml·kg-1·h-1 up to 6h.Results Of the 1113 patients, the incidence of AKI was 33.24%.In-hospital mortality of AKI patients was 6.49%,which was 5.373 times higher than that of non-AKI patients(P<0.01).The incidence of AKI in patients who simultaneously received cardiac valve replacement and coronary artery bypass grafting was 75.00%,which was significantly higher as compared to other types of valve replacement surgery(P<0.01).Unconditional multivariate Logistic regression analysis revealed that male,old age,long extracorpeal circulation (CPB)time(≥120 min)and combined with coronary artery bypass grafting surgery were the independent predictors of AKI episodes,and the corresponding OR values were 1.455,2.110,1.768 and 2.994 respectively. Conclusions AKI is a common and serious complication after cardiac valve replacement surgery.Patients who received combined cardiac surgery as valve replacement and coronary artery bypass grafting have higher incidence of AKI.Old age,male,long CPB time(≥120 min)and combined with coronary artery bypass grafting surgery are the independent risk factors of post-operative AKI for patients undergoing cardiac valve replacement surgery.

Objective To explore the potential risk factors for aortic and mitral valve calcification in maintenance hemodialysis(MHD)patients. Methods Patients on MHD for at least 6 months.aged≥1 8 years without history of surgery or catheter for heart valve disease were enrolled in the study.Echocardiographic examination was performed to detect the calcification.The risk factors for aortic and mitral valve calcification were analyzed by Logistic regression. Results One hundred and eighty-one MHD patients(98 men and 83 women)were enrolled in the study.Of all the patients,aortic or mitral valve calcification was found in 94 patients(5 1.9%),aortic valve calcification in 90 patients(49.7%),mitral valve calcification in 30 patients(16.6%),aortic and valve calcification in 26 patients(14.4%).Multivariate Logistic regression showed that age(β=5.52,P=0.007),dialysis duration(β=6.99,P=0.039)and pre-albumin(β=-12.616,P=0.004)were independently correlated with aortic valve calcification.Mitral valve calcification was independently correlated with dialysis duration(β=6.057,P=0.002),history of primary hypertension(β=3.054,P=0.008),hemoglobin(β=-0.061,P=0.035)and β2 microglobulin(β=7.63,P=0.01).While the correlation between mitral valve calcification and age was borderline significant(β=0.085,P=0.05).Conclusions Valve calcification is prevalent in MHD patients,and aortic valve calcification is more common than mitral valve calcification.Age,dialysis duration and low serum pre-albumin are independent risk factors for aortic valve calcification.The risk factors for mitral valve calcification include age,dialysis duration,history of primary hypertension,anemia and high serum β2 microglobulin.

Objective To identify the efficacy and safety of aspirin in reducing the serum high sensitivity C reactive protein(hsCRP)level and preventing the internal arteriovenous fistulas(AVF)embolism in maintenance hemodialysis patients. Methods One hundred and ten hemodialysis patients using AVF more than 3 months were randomly divided into 2 groups,the intervention group(n=55,received aspirin 100 mg/d)and the control group(n=55).Examinations were performed at baseline and 6-month after treatment.Serum hsCRP level,platelet aggregates ratio(PAR),coagulation and inflammation indicators were measured.AVF embolism and the adverse events were monitored. Results Six months later.PAR and hsCRP level of the intervention group patients aged≤60 years decreased significantly [(68.14±8.45)%vs (82.37±9.12)%;(4.79±4.81)mg/L vs(6.94±10.26)mg/L,all P＜0.05],and were significantly lower as compared to.the control group[(68.14±8.45)%vs(74.7±11.50)%,(4.79±4.81)mg/L vs(5.12±9.25)mg/L,all P＜0.05].There were 2 cases of AVF embolism occured in both groups,which showed no statistical difierence (P=0.676).The incidence of adverse effeets was higher in the intervention group than that in the control group but no statistical significance was found (20.0%vs 7.2%,P=0.052),while the mortality rate had no difference between 2 groups (3.6%vs 0,P=0.495).Conclusion Use of aspirin 100 mg/d for 6 months can significantly reduce the serum hsCRP level and PAR in hemodialysis patients under 60-year-old without serious adverse reactions.