Objective To evaluate the safety and possibility of coronary intervention in uremic patients on dialysis. Methods Three uremic patients with unstable angina pectoris were treated successfully with percutaneous transluminal coronary angioplasty and stenting. In order to minimize the adverse effect on kidney due to contrast, non-ionic and low osmolar contrast medium was used and coronary angiography and intervention therapy were performed separately. Further protection of the renal function was effected by more frequent dialysis and increasing fluid administration. Results Coronary contrary shows the stenosis of multiple vessels in one patient, unique vessel lesion in two patients. One to four stents were placed. Clinical follow-up period of 12-18 months after procedure, angina pectoris disappeared in all three patients and no deterioration of renal function was noted. Conclusion It is possible to perform coronary angiography and stenting in uremic patients on hemodialysis successfully and safely, provided due attention was paid to the choice of contrast medium and protective measures for renal function.

Objective To summarize the age-related changes and the risk factors of renal tubular function in the elderly male cases.Methods Totally 229 cases without chronic kidney disease were divided into two groups:group aged ＜80 years and group aged ≥80 years.We measured the urine routine,serum creatine,serum urea,urine β2-microglobin (β2-MG),urine α1-microglobin (α1-MG)and calculated the eGFR based on Cockcroft-Gault equation.Logistic regression was used to analyze the risk factors which may accelerate the progression of the renal tubular impairment.Results The average age of 229 cases was (76±10)years.There were 142 cases in the group of ＜80 years old and 87 cases in the group of ≥80 years old.The level of eGFR in the group of ≥80 years old was (55.0±12.7) ml/min,which was lower than that of the group of ＜ 80 years old (80.3 ± 18.0 ml/min) (t =9.882,P＜0.01).The level of urine SG was decreased in the group of ≥80 years old versus in the group of ＜80 years old(1.016±0.006 vs.1.013±0.006).The value changes of urine pH,urine β2-MG and urine α1-MG were of statistical differences between the two groups [(6.2±0.8) vs.(6.6±0.8),(0.96±1.02)mg/L vs.(2.08 ±3.56)mg/L,(6.67±3.57) mg/L vs.(8.71±6.59)mg/L].The correlation analysis showed that age correlated negatively with eGFR and urine SG(r =-0.692and r=-0.280,both P＜0.01)and positively with urine pH(r=0.255),urine β2 MG(r=0.262),urine α1-MG(r=0.228)(all P＜0.01).The Logistic regression analysis showed that coronary heart disease was an independent risk factor for the progression of renal tubular impairment (OR=4.251,P=0.002).Conclusions Renal tubular functions is decreased with ageing age in the elderly male,especially in the advanced elderly.The coronary heart disease is an independent risk factor of the progression of renal tubular impairment.

Objective To investigate the change of renal tubular function in elderly patients after use of β lactam antibiotic. Methods The elderly patients with pulmonary infection were treated with β lactam antibiotic,the dosage was 50%-70% of normal use. The renal tubular function indicated by urine α1-MG, β2-MG, pro/Cre, NAG/Cre and glomerulus function marked by eGFR, serum creatinine (Cre)), cystatin C were detected during drugs treatment and 7 days after stopping medications. Results The infection was controlled well in 3-7 days after treatment. Urine α1-MG, β2-MG, pro/Cre and NAG/Cre were abnormal before treatment, were elevated in 3, 14 days after using antibiotic, and came down to the level before treatment on 7 days after stopping treatment. The level of Cre and eGFR was (89.0±25.97) μmol/L and (26.39±8.17) ml/min before treatment, then elevated and decreased in 14 days after treatment, respectively, and down to the level before treatment on 7 days after stopping of antibiotic. Cystatin c was abnormal before treatment and did not change significantly after treatment and after stopping antibiotic. Conclusions It is important to protect renal tubular function and to adjust antibiotic dosage according to eGFR during using antibiotic in elderly patients to control infection.

Objective To investigate the long-term prognostic factors and the significance of serum cardiac troponin T (cTnT) and C-reactive protein (CRP) in maintenance hemodialysis (MHD) patients.Methods Clinical data of 76 MHD patients in our hospital from January 2002 to January 2003 were retrospectively analyzed.Time and cause of death in the next 10 years were recorded.Survival rate was calculated by Kaplan-Meier and impact factors of long-term prognosis were explored.Significance of cTnT and CRP was elucidated by COX regression analysis.Results CRP was positive in 28 cases (36.8％) and cTnT was positive in 22 cases (28.9％) among 76 patients.The median survival time was 37.9 months,2-year survival rate was 65.9％ and 10-year survival rate was 24.2％.Univariate analysis found positive CRP,positive cTnT,old age,diabetes,cardiocerebrovascular disease,anemia,low serum albumin,Kt/V decline were associated with long-term prognosis.Multivariate analysis showed that increased age (P =0.010),cardiocerebrovascular disease (P =0.048),positive cTnT (P =0.036),positive CRP (P =0.009) were independent risk factors of the 10-year survival of MHD patients.Ten-year mortality of cardiocerebrovascular diseases in positive cTnT group was not significantly different as compared with negative cTnT group (50.0％ vs 35.4％,P =0.248).But the positive cTnT group had higher 2-year mortality than negative cTnT group (40.9％ vs 14.6％,P =0.015).Mortality of cardiocerebrovascular disease was higher in positive CRP group as compared to negative CRP group at both 2-year and 10-year time (48.1％ vs 7.0％,P =0.000; 66.7％ vs 23.3％,P =0.000).Compared with both negative cTnT and CRP group,both positive cTnT and CRP group had much higher all-cause mortality (92.9％ vs 55.6％,P =0.030),higher mortality of cardiocerebrovascular disease at 10-year (64.3％ vs 25.0％,P =0.009),and higher mortality of cardiocerebrovascular disease at 2-year (57.1％ vs 5.6％,P =0.000).Conclusions Aging,cardiocerebrovascular disease,positive cTnT and positive CRP are independent risk factors of long-term prognosis for MHD patients.Positive cTnT can predict cardiocerebrovascular mortality of MHD patients in 2 years,while positive CRP can predict short-and long-term cardiocerebrovascular mortality.Positive cTnT combined with positive CRP may be more valuable in predicting the poor prognosis of MHD patients.

Objective To explore the clinical efficacy of Naikan cognitive therapy(NCT) for alcohol dependent patients.Methods 64 cases of alcohol-dependent patients were randomly assigned to the study group (32 cases) and the control group (32 cases).The study group was treated with NCT for successive 7 days on the basis of taking original drugs; and the control group was only given the original drug therapy.The obsessive compulsive drinking scale (OCDS),self-report symptom inventory(SCL-90),nurses observation scale for inpatient evaluation(NOSIE) were administered to all subjects at pre-and post-treatment.Results ①After the treatments,the scores of OCDS in study group (49.51 ± 1.63) were lower than that in control group(53.92 ± 1.82),and the statistical difference had the significance (P ＜ 0.01).②After the treatments,the total scores and some factor scores of SCL-90 in study group were lower than in control group (t =-2.413,P =0.019 ; t =-2.033,P =0.047 ; t =-2.065,P =0.044 ; t =-2.038,0.046),and the difference was statistically significant.③After the treatments,in the study group,the scores of the total estimated factor and total positive factor(187.10 ± 18.80;78.51 ±12.22) were higher than in control group (175.51 ± 11.71 ; 68.22 ± 11.87),total negative factor score (15.55 ±9.46) were lower than in control group (20.51 ± 9.33),and the difference was statistically significant.Conclusion NCT can effectively inhibit alcohol craving,and reduce the drinking wine relevant questions.It can help to improve psychological symptoms in patients with alcohol dependence,especially depression and anxious symptoms.

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 investigate the bacteria distribution and antibiotic resistance in urinary tract infection in 2004.METHODS During Jan 1st 2004 to Dec 31st 2004,1007 urine specimens were collected from inpatient and outpatient departments of Beijing Hospital.Totally 632 strains of pathogens were identified and the drug resistance was(performed.) RESULTS Among pathogens of urinary tract infection in 2004,Escherichia coli rated the first(38.29%),(followed) by Enterococcus(18.67%),fungi(17.41%),Streptococcus(8.07%),Proteus(3.4%),Staphylococcus(3.95%),Pseudomonas aeruginosa(3.17%) and Klebsiella pneumoniae(2.37%).Enterobacteriaceae were sensitive to imipenem(100%).(G~+) cocci were sensitive to nitrofurantoin and vancomycin(nearly to 100%).Compared to pathogens of UTI in 2001,fungi showed obviously increasing trend.CONCLUSIONS In 2004,(Enterobacteriaceae)(mostly E.coli) are the major pathogens in urinary tract infection.Fungi infection in(urinary) tract has an obviously increasing tendency and should be carefully treated.

Objective To observe the possible relationship of cardiac troponin T (cTnT) with cardiac disease and death events in hemodialysis patients Methods The cTnT was measured with dry chemical method in 57 hemodialysis patients The patients were followed up for one year Results The concentration of cTnT was more than 0 10 ?g/L in 12 of the 57 unselected hemodialysis patients 8 in the 12 patients were diagnosed as diabetes mellitus 7 of 12 patients died and the death reason was acute left ventricular failure(33 3%) in 4 patients In other 45 patients with normal cTnT, 3 died and only 1 died of heart failure(2 22%) The cTnT concentrations of pre-and post-hemodialysis were measured in 24 patients The concentration was more than 0 1 ?g/L in 6 patients before dialysis Post-dialysis concentration was increased in 5 patients', the value was decreased in the other one Conclusions In hemodialysis patients without acute myocardial infarction, mortality and cardiovascular events are closely correlated with the increase of cTnT concentration. Patients with diabetes mellitus have higher incidence in the abnormality of cTnT concentration.The process of hemodialysis does not affect the concentration of cTnT.

Objective To evaluate the effect and safety of anticoagulant citrate dextrose solution A (ACD-A ) in continuous blood purification (CBP) for patients at high risk of bleeding with ARF. Methods Twelve patients at high risk of bleeding, treated with continuous venovenous hemofiltration(CVVH), were divided into regional citrate anticoagulant (RCA) group and control group. In the former, ACD-A solution was delivered, pre-filter , with the rate adjusted to maintain a postfilter ionized calcium (iCa2+) level between 0.30-0.40 mmol/L. Before the extracorporeal blood returned to the patient, 10% calcium gluconate was infused to maintain a systemic iCa2+ level between 0.90-1.20 mmol/L. In control group, CVVH were performed either with low dose of heparin LMW sodium (1700-2500 IU/12 h-24 h)or without anticoagulant. The life span of each hemofilter was recorded. In RCA group, prothrombin time (PT), activated partial thromboplastin time (APTT) , acid-base changes, serum sodium and iCa2+ were monitored pre- and during CVVH. Result In the whole duration 1192.5 hours of CVVH in RCA group and 596 hours in control group, 62 and 42 hemofilters were used, respectively. Filter survival was 65.3% at 24 h and 24.5% at 48 h in RCA group,while 14.5% and 0 in control group. The mean life span of filter in RCA group was significantly longer than that in control group[(29.4?21.0) (1.5-71.5)h vs( 14.2?8.2) (4.5-40)h, P

Objective To investigate serum cardiac troponin T(cTnT) and C-reactive protein (CRP) levels and assess the prognostic values of cTnT and CRP of mortality and cardiovascular events in maintenance hemodialysis (MHD) patients. Methods One hundred and six MHD patients were enrolled in this study. Serum cTnT, CRP, creatinine, albumin were measured in pre-hemodialysis at the beginning of the study. The mortality and cardiovascular events were recorded during the period of follow up. Results At the initiation of the study,28 patients (26.42%) were recorded with positive cTnT level, 32(30.19%) with positive CRP and 16 (15.09%) with positive cTnT and CRP. Logistic regression analysis showed a significant correlation between serum cTnT and serum CRP and Scr. Patients with positive cTnT and CRP levels had higher mortality and more cardiovascular events than those with negative levels. Kaplan-Meier survival analysis showed a significant difference between patients with normal and abnormal cTnT and CRP levels. Conclusions Some MHD patients have elevated serum cTnT level. Serum cTnT level is correlated with serum CRP and creatinine level. Patients with positive cTnT and CRP levels have higher mortality and more cardiovascular events than those with negative levels.