Objective To investigate the relationship between preoperative serum homocysteine (Hcy) level and acute kidney injury (AKI) after cardiac valve replacement surgery. Methods The data of the inpatients who accepted cardiac valve replacement surgery, age≥18 years, no renal replacement therapy before surgery, non - renal decompensation and preoperative serum creatinine (Scr)＜178 μmol/L, survival within 48 h after surgery, and with preoperative serum Hcy data in the First Affiliated Hospital of Guangxi Medical University from January 1, 2015 to December 31, 2017 was retrospectively analyzed. AKI was diagnosed in patients whose Scr increased more than 26.5 μmol/L (0.3 mg/dl) within 48 hours or 1.5 times higher than baseline within 7 days after surgery. According to this, patients were divided into AKI group and non-AKI group, and the affecting factors for AKI were compared between the two groups. Multivariate logistic regression was used to analyze the independent influencing factors of AKI. The relationship between serum Hcy level and AKI incidence was analyzed by Spearman correlation analysis. Whether the AKI occurred and serum Hcy levels were used as variables to map the receiver operating characteristic curve (ROC), and was used to assess the value of preoperative serum Hcy level for predicting AKI after cardiac valve replacement surgery. Results A total of 810 subjects were included in the study, including 375 males and 435 females. They were (50±11) years old (19-78 years old). Among them, 329 patients with AKI occurred within 7 days after heart valve replacement, and the incidence rate was 40.6% (male 45.9%, female 36.1%). The serum Hcy level in the AKI group was higher than that in the non-AKI group [(15.74±4.55) μmol/L vs (13.87 ± 3.85) μmol/L, t=6.106, P＜0.01]. Multivariate logistic regression analysis showed age (OR=1.030, 95% CI 1.014-1.045, P＜0.001), extracorporeal circulation time (OR=1.011, 95% CI 1.007-1.016, P＜0.001), Scr (OR=1.014, 95%CI 1.005-1.023, P=0.002), serum Hcy (OR=1.059, 95% CI 1.017-1.103, P=0.006), high level of Hcy (＞13.64 μmol/L) (OR=1.465, 95%CI 1.059-2.027, P=0.021) and moderate to severe hyperhomocystinemia (16≤Hcy≤100 μmol/L) [with normal HHcy (Hcy＜10 μmol/L) as reference, OR=2.180, 95% CI 1.245-3.816, P=0.006] were independent influencing factors of AKI after cardiac valve replacement surgery. Spearman correlation analysis showed that the incidence of postoperative AKI increased with the increase of preoperative serum Hcy level (rs=0.927, P＜0.001). The results of ROC curve showed that the area under the curve of the preoperative serum Hcy level predicting AKI after heart valve replacement was 0.701, and the cutoff value was 13.64 μmol/L, with the sensitivity 61.3%, specificity 70.9%. Conclusions Preoperative serum Hcy level is an influencing factor for AKI after cardiac valve replacement surgery. The higher the level of preoperative serum Hcy, the higher the incidence of AKI after cardiac valve replacement surgery. Patients with preoperative serum Hcy levels＞13.64 μmol/L have an increased risk of AKI after cardiac valve replacement surgery.

Objective:To investigate the risk factors of acute kidney injury (AKI) in patients undergoing cardiopulmonary bypass (CPB) during cardiac surgery, and to determine the relationship between preoperative biochemical examination and intraoperative CPB time and the incidence of AKI.Methods:From October 2017 to October 2018, the clinical data of cardiopulmonary bypass patients admitted to the First Affiliated Hospital of Guangxi Medical University were analyzed retrospectively.Logistic regression was used to analyze the influence of patients′ basic diseases, preoperative biochemical examination and cardiopulmonary bypass time on postoperative AKI.At the same time, the changes of serum creatinine in patients with AKI 7 days after operation were analyzed to provide help for the early diagnosis of AKI after operation.Results:A total of 370 patients with cardiopulmonary bypass were included.Logistic regression analysis results: diabetes basic history( OR=5.226, 95% CI: 1.084-25.191, P=0.039), the increase of age ( OR=1.041, 95% CI: 1.018-1.065, P<0.001), BMI ( OR=1.127, 95% CI: 1.043-1.218, P=0.003), urea nitrogen ( OR=1.211, 95% CI: 1.077-1.360, P=0.001), and CPB time ( OR=1.013, 95% CI: 1.006-1.020, P<0.001) were the risk factors of postoperative AKI in patients with cardiopulmonary bypass.The detection rate of AKI was 4.19%(9/215), 51.63%(111/215), 87.91%(189/215), 97.67%(210/215), 99.07%(213/215), 100%(215/215) and 100%(215/215) on the first day, the third day, the fourth day, the fifth day, the seventh day, respectively. Conclusion:Diabetes history, age, BMI, Urea nitrogen and CPB times are risk factors of AKI patients after CPB.In order to reduce the rate of misdiagnosis, creatinine should be detected for at least 4 consecutive days in clinical observation of post-operative serum creatinine.

Objective:To evaluate the effect and safety of different heating methods in continuous renal replacement therapy (CRRT) treatment.Methods:One-hundred and twenty critical patients, who hospitalized in the department of ICU of Nanjing University of TCM affiliated Hospital from Nov. 2018 to Aug. 2020, were enrolled in this study and divided randomly and equally into four groups: control group (heated by Prismaflex′s blood warming equipment), group A (heated by spiral-wound case blood warming equipment), group B (heated by 3M Bair Hugger warming carpet) and group C (heated by 3M displacement liquid warming equipment). All the patients were monitored levels of rectal temperature, forehead temperature, and temperatures of CRRT′s arterial and venous ends in 12 hours after CRRT treatment. The rates of low or high temperature and max fluctuation range of temperature were recorded.Results:The highest temperatures of rectal, arterial and venous ends of CRRT in three groups were (37.20±0.23)℃, (37.15±0.35)℃, (37.16±0.24)℃, (37.21±0.35)℃, (37.15±0.31)℃, (37.19±0.23)℃ and (36.49±0.52)℃, (36.36±0.46)℃, (36.68±0.22)℃, respectively. After CRRT treatment, the highest temperatures of rectal in each group were (36.85±0.31)℃, (36.75±0.35)℃ and (36.96±0.21)℃, respectively. The highest temperatures of arterial and venous ends of CRRT in each group were (36.81±0.32)℃, (36.65±0.31)℃, (36.99±0.20)℃, (36.34±0.41)℃, (36.20±0.42)℃ and (36.30±0.28)℃, respectively. The highest temperatures of rectal, arterial and venous ends of CRRT in Group A and C were higher than those in control group. The highest temperatures of rectal and arterial ends of CRRT in Group A and B were lower than those in Group C ( t values were 2.037-4.559, P<0.05). After CRRT treatment, the lowest rectal temperatures in three groups were (36.85±0.31)℃, (36.75±0.35)℃ and (36.96±0.21)℃, respectively. The lowest temperatures of arterial and venous ends of CRRT in three groups were (36.81±0.32)℃, (36.65±0.31)℃, (36.99±0.20)℃, (36.34±0.41)℃, (36.20±0.42)℃ and (36.30±0.28)℃, respectively. The lowest temperatures of rectal, arterial and venous ends of CRRT in Group A and C were higher than those in control group. The lowest temperatures of rectal and arterial ends of CRRT in Group A and B were lower than those in Group C ( t values were 2.032-6.194, P<0.05). After CRRT treatment, the fluctuation of rectal temperatures in three groups were (0.34±0.11)℃, (0.38±0.15)℃ and (0.26±0.11)℃, respectively. The fluctuation of arterial and venous ends of CRRT temperatures in three groups were (0.30±0.14)℃, (0.35±0.23)℃, (0.22±0.14)℃, (0.33±0.16)℃, (0.39±0.23)℃ and (0.26±0.09)℃, respectively. The fluctuation levels of rectal, arterial and venous ends of CRRT in Group A and C were higher than those in control group. The fluctuation levels of rectal and arterial ends of CRRT in Group A and B were lower than those in Group C ( t values were 2.032-6.194, P<0.05). After CRRT treatment, the fluctuation of △RBC in three groups were 0.11±0.07, 0.11±0.06 and 0.09±0.06, respectively. The fluctuation of △Fib in three groups were 0.83±0.32, 0.84±0.28 and 0.60±0.31, respectively. Correlation analysis showed C methods was most related with the fluctuation temperatures of venous ends of CRRT. Conclusion:Heating replacement fluid by 3M blood warming device is proved to be the best way to prevent heat loss in CRRT treatment.

Objective:To explore the association rules of personality traits and health-promoting lifestyle in patients with primary angle closure glaucoma, so as to provide advice for the synthetical treatment.Methods:From July to November 2021, a total of 117 primary angle closure glaucoma patients(acute patients n=89, chronic patients n=28) in ophthalmology department of five hospitals in Nanjing were investigated with type A behavior pattern scale, health-promoting lifestyle scale Ⅱ and general information questionnaire.Based on Weka 3.8.5, algorithm of Apriori was used to mine its association relationship. Results:(1) The total scores of type A behavior pattern scale for patients with acute and chronic types of primary angle closure glaucoma were (32.48±6.43) and (27.54±6.49) respectively.The total scores of health-promoting lifestyle scale Ⅱ were (101.69±11.83) and (97.79±7.78) respectively.(2) There were positive associations among patients with acute primary angle closure glaucoma, type A/A-personality (including impatience and hostility) and health-promoting lifestyle (including stress management disorder, interpersonal relationship management disorder, well sense of health responsibility and adequate dietary nutrition intake)(all support>0.1, confidence >0.6, lift >1.0). And patients with chronic primary angle closure glaucoma were associated with B/B-personality (including patience and mild), health-promoting lifestyle (including stress management disorder, interpersonal relationship management disorder, well sense of health responsibility and adequate dietary nutrition intake)(all support>0.1, confidence >0.6, lift >1.0).Conclusion:Primary angle closure glaucoma is strongly related with personality traits and health-promoting lifestyle.Its synthetical treatment plan should take both physical and mental measures, and classified health management for patients with different disease types.

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.