Objective To investigate and compare relative blood volume (RBV) changes in dialysis-symptomatic hypotension and dialysis-refractory hypertension during hemodialysis. Methods Fifteen patients with dialysis-symptomatic hypotension (SH group) and thirteen patients with dialysis refractory hypertension (RH group) on chronic haemodialysis were enrolled in this study. RBV, blood pressure, heart rate and ultrafiltration volume (UV) were measured before hemodialysis and at 1 hour intervals during hemodialysis. Total of 149 and 146 five-hour hemodialysis sessions were performed separately. RBV was assessed using Automatic Blood Volume Monitor. Results RBV changes were significantly higher in SH group than in RH group (P

ObjectiveTo evaluate the influence on left ventricular(LV) twist,and the relationship between LV twist and function in the rabbits with ventricular aneurysm formed after myocardial infarction by two-dimensional ultrasound speckle tracking imaging.MethodsTwenty-six healthy rabbits were divided into two groups,six as control group,twenty as experimental group.The model of myocardial infarction and ventricular aneurysm were established by ligaturing left anterior descending coronary artery and left circumflex artery.After four weeks,according to the pathological examination of whether ventricular aneurysm formed or not,the experimental group was divided into myocardial infarct group and ventricular aneurysm group.Echocardiography was performed to measure rotations (at the levels of mitral annulus and apex in LV short-axis view),LV twist,left ventricular cavity size and function.ResultsCompared with the myocardial infarct group,LV end-diastolic diameter(LVEDD) and LV end-diastolic volume(LVEDV) were larger in the ventricular aneurysm group,but LV ejection fraction (LVEF),LV fractional shortening (LVFS),apical rotation and LV twist were lower in the ventricular aneurysm group than the myocardial infarct group.Both apical rotation and LV twist had shown a great correlation with LVEF.The conclusion was also shown in the ROC curve that sensitivity and specificity of diagnosis cardiac dysfunction were 76.9％ and 80.0％ respectively when the apical rotation was 1.21°.Conclusions There was a closely relationship between the change of apical rotation and the LV systolic function.When the apical rotation dropped to 1.21°,an apparent decline of LV systolic function was implied.

Objective To investigate the prevalence of glomerular microthrombosis in lupus nephritis (LN) and the significance of antibodies to anti-coagulation related factors and anti-phospholipid antibodies in glomerular microthrombosis (GMT).Methods Kidney biopsy specimens and plasma samples were obtained consecutively from 124 patients with LN. Kidney biopsy specimens were examined for the presence of glomerular microthrombi.Plasma samples from 25 LN patients with GMT (LN-GMT group) and 99 LN patients without GMT (LN-non-GMT group) were tested for lupus anticoagnlant (LA) and antibodies to cardiolipin (ACL),β2 glycoprotein I (β2GP I ),plasmin,thrombin,tissue plasminogen activator (t-PA) and Annexin A II.Results The prevalence of GMT in LN patients was about 20.2%.Compared to LN-non-GMT group,LN-GMT group had elevated SLE disease activity indices (SLEDAI),elevated activity and chronicity indices of kidney tissue injury,and elevated serum creatinine,blood urea nitrogen and proteinuria levels,and also had a higher frequency of hypertension (P＜0.01).The positive rates of LA,IgG class anti-β2GP I and anti-thrombin antibodies were higher in LN-GMT group than in LN-non-GMT group (P＜0.05).The positive rates of IgG class antibodies to ACL,plasmin,t-PA and Annexin A II in LN-GMT group were not statistically different from those in LN-non-GMT group (P＞0.05).No difference was found in the positive rate of any IgM class antibody between the two groups (P＞0.05).Conclusion This study has shown that GMT occurs approximately in 20.2% of the LN patients.Patients with GMT have more severe kidney tissue injury and more poor renal outcomes than patients without GMT.LA and antibodies to β2GP I and thrombin play a role in glomerular microthrombosis in lupus nephritis.

Objective To investigate the long-term prognosis and possible risk factors of acute kidney injury(AKI)following cardiac surgeries. Methods Clinical data of 941 patients undergoing open heart surgery from January 2004 to June 2007 were retrospectively analyzed.Survival and renal function of above patients were informed through telephone or clinic follow-up till February 2010.Long-term survival was analyzed using risk-adjusted Cox proportional hazards regression model. Results Of the 941 patients after cardiac surgery,275(29.2%)developed AKI and 666(70.8%)did not.Survival was worse in patients with AKI(67.8%vs 85.6%,P<0.01)and was proportional to its severity (AKIN 1,2 and 3 stages:70.7%,62.3%and 58.6%,P<0.01).Although 90.5% of patients had complete renal recovery after AKI at discharge of hospital,they still had an increased risk for death during follow-up compared with patients without AKI (69.6% vs 85.6%,P<0.01).In the Cox proportional hazards regression model,age(HR=2.238),anemia (HR=1.625),prolonged operation time (HR=1.153),AKI severity (HR=1.473)were independent risk factors for long-term prognosis after cardiac surgery.At the end of the follow-up,patients with AKI had statistically higher Scr than non-AKI patients(107.6 μmol/L vs 83.0 μmol/L,P=0.014),and among those AKI patients,34.0%progressed into CKD 3-5 stages,34.8%developed double serum creatinine. Conclusions AKI is a risk factor for the long-term prognosis of cardiac surgery.Patients with complete renal recovery after AKI still has an increased risk for death and poor renal function compared with patients without AKI.

Objective To investigate the clinical characteristics of twice-weekly hemodialysis patients.Methods Data were collected from Shanghai Renal Registry.A total of 1288 patients undergoing regular hemodialysis (HD) with dialysis adequacy index and other biochemical parameters in Shanghai in January 2007 were enrolled into the cohort study with 2 years follow-up.Clinical characteristics and outcome of twice-weekly HD patients were analyzed as compared with thrice-weekly HD patients.Results Compared with patients on thrice-weekly HD,the twice-weekly HD patients were significantly younger and had significantly shorter HD vintage,smaller body surface area,longer HD session time,higher single-pool Kt/V (spKt/V) and serum albumin but lower weekly Kt/V (P＜0.05).There was no statistical difference in ultrafiltration volume between two groups.Kaplan-Meier survival analysis indicated that both groups had similar two-year survival.Multivariate Cox regression analysis showed that age,body mass index,serum albumin and weekly Kt/V were predictors of patient mortality.Conclusion It is acceptable for some hemodialys patients with twice-weekly HD,and close monitor of dialysis adequacy and volume status is necessary for this therapy model.

Synchronous multiple primary carcinomas refers to 2 or more than 2 kinds of different primary malignant tumors develop synchronously or in 6 months.The incidence of synchronous multiple primary carcinoma is low.A patient with esophageal basaloid squamous cell carcinoma (BSCC) and gastric adenocarcinoma was admitted to the First People's Hospital of Lianyungang in October 2011.The main symptom of this patient was dysphagia,and multiple lesions were found in esophagus,cardia and stomach fundus by gastroscopy respectively.On computed tomography image,eminence lesion in esophageal midpiece and wall thickening from esophagus-cardia to stomach fundus were displayed and were both enhanced slightly by enhancement scanning.The esophageal and cardia tumors were resected via left thoracic approach,and postoperative pathological examination revealed esophageal BSCC and moderately differentiated adenocarcinoma of cardia respectively.Comedo necrosis and red basal membrane material were seen under light microscope.The expressions of cytokeratin 5/6 and P63 were positive,the expression of cytokeratin L was weak positive and the expressions of synaptophysin,chromogranin A and CD117 were negative.The patient suffered from pleural effusion and multiple liver metastases after 4 months follow-up and died of liver metastases in May 2012.Multiple primary carcinomas including esophageal BSCC and gastric adenocarcinoma are rarely seen in clinical practice.Their diagnosis and differential diagnosis mainly depend on histological morphology and immunohistochemical method.Surgical resection combined with postoperative radiotherapy and chemotherapy is selectable,but the prognosis is poor.

Objective To evaluate the safety and efficacy of laparoscopy-assisted total gastrectomy (LATG) for gastric cancer by systematic review and meta-analysis.Methods The literature database before February,2012 was extensively searched to retrieve the comparative studies of LATG and open total gastrectomy(OTG) with a relevance of study goal.The inclusion and exclusion criteria were formulated.Aftera quality evaluation,the data was extracted.The Cochrane collaboration RevMan 5.1 version software was used for meta-analysis.Results There are ten studies meeting the inclusion criteria for meta-analysis.The total sample size of these studies was 942 cases.Compared to OTG,LATG experienced longer operation time [weighted mean difference(WMD) =41.12 min,95％ confidence interval(CI):20.62-61.63,P ＜0.01)],less blood loss(WMD =-198.36 ml,95％ CI:-300.94--95.78,P ＜ 0.01),earlier time to flatus(WMD =-0.80 days,95％ CI:-1.17--0.42,P＜0.01),shorter hospital stay(WMD =-4.02days,95％ CI:-6.03--2.01,P ＜ 0.01) and decrease in overall complications [relative risk (RR) =0.55,95％ CI:0.40-0.76,P ＜ 0.01)].The number of dissected lymph nodes,proximal or distal resection margin and mortality were similar between the two groups.Conclusions Laparoscopy-assisted total gastrectomy is a safe and feasible procedure with less blood loss,less overall complications and quick recovery.

Objective To evaluate the effect of oxidative injury induced by peroxide oxidase on Klotho expression in mouse renal tubular epithelial cells (TCMK-1) and to explore the possible pathway.Methods TCMK-1 cells were exposed to H2O2 of different concentrations.Reactive oxygen species (ROS) was examined byflow cytometrry.Cell viability was assessed by CCK-8.Cell apoptosis was evaluated by flow cytometry and Hoechst 33258 staining.The expression of Klotho,apoptosis-associated proteins and anti-oxidant enzymes were determined by Western blotting.Results Compared with control group,after H2O2 stimulating TCMK-1 cell,ROS was dramatically elevated (all P ＜ 0.05) and the expression of anti-oxidant enzymes,SOD2 and CAT went down (all P ＜ 0.05);the expression of Klotho was inhibited (all P ＜ 0.05);cell viability of TCMK-1 cells was decreased (all P ＜ 0.05) in a dose-dependent manner (0.3 to 0.9 mmol/L);cell apoptosis was significantly increased in TCMK-1 cells following the concentration of H2O2 (all P ＜ 0.05);Bax/Bcl-2 and the phosphororation of JNK and p38 were obviously elevated in TCMK-1 by H2O2 induction (all P ＜ 0.05).Conclusion Oxidative injuries induced by H2O2 significantly suppresses the expression of Klotho in TCMK-1 cells.And cell apoptosis was increased,p38 and JNK pathway was activated.

Objective To compare the RIFLE and AKIN diagnosis criteria for acute kidney injury ( AKI) in patients undergoing cardiac surgery. Methods Patients undergoing cardiac surgery from January 2004 to June 2007 were retrospectively evaluated. RIFLE and AKIN criteria were employed for the diagnosis and staging of AKI which occurred 7 d after cardiac surgery. The diagnosis sensitivity and precision for prediction of hospital mortality were compared between these two criteria. Results One thousand and fifty-six patients were included in this study. There was no significant difference between the prevalence of AKI after cardiac surgery diagnosed by RIFLE criteria and that diagnosed by AKIN criteria (29.55% vs 31.06%, P>0.05). There was no significant difference between the total hospital mortality and the hospital mortality of each stage of AKI diagnosed by RIFLE criteria and those diagnosed by AKIN criteria ( P > 0. 05). Logistic regression analysis suggested that the relative risk of hospital mortality for AKI was similar between patients diagnosed by AKIN criteria and those diagnosed by RIFLE criteria. The area under the ROC curve for hospital mortality was 0. 856 for RIFLE and 0.865 for AKIN in all patients (P<0.001). Conclusion Compared to RIFLE criteria, AKIN criteria do not improve the sensitivity of diagnosis and predictive ability of hospital mortality of AKI after cardiac surgery.

Objective To investigate the markers in early diagnosis of acute kidney injury (AKI) in patients undergoing heart surgery.Methods Markers included serum cystatin C (CyC),and urinary neutrophil gelatinase-associated lipocalin(NGAL),interleukin 18(IL-18),retinol binding protein(RBP)and N-acetyl-β-D-glucosaminidase(NAG).Twenty-nine cardiac surgical patients hospitalized were enrolled in the study.Serial blood and urine samples were collected immediately before incision and at various time intervals after surgery.The primary outcome measure was AKI.defined as a 50%increase in Scr from baseline. Results The cohort consisted of 29 patients aged(62.9±13.7)years,and baseline Scr was(73.2±11.9)μmol/L.There were no significant differences in demographics between cases and controls,while the aortic clamp time was predictably longer in AKI cases as compared to controls[(60.63±13.92)vs(43.00±9.20)rain,P<0.05].Each biomarker difiered significantly between cases and controls at least one timepoint.Optimal AUCs were for CyC at 10 houm with sensitivity (ST)0.71,specificity(SP)0.92,AUC=0.83(0.67-1.00),cut-off(CO)1.31 mg/L;NGAL at 0 hour with ST 0.84,SP 0.80,Auc=0.85(0.70-1.00),CO 49.15 μg/g Ucr;IL-18 at 2 hours with ST 0.85,SP 0.73,AUC=0.81(0.64-0.97),CO 285.65 ng/g Ucr;RBP at 0 hour with ST 0.75,SP 0.67,AUC=0.77(0.60-0.95),CO 2934.65μg/g Ucr and NAG at 4 hours with ST 0.86,SP 0.67,AUC=0.72(0.53-O.92),CO 37.05 U/mg Ucr.Using a combination of all the 5 biomarkers analyzed at the optimal time-point as above,an AUC of 0.98(0.93-1.02)(P<0.01)in this limited sample was able to obtain. Conclusions Application of serum and urinary biomarkers for the prediction of AKI in patients undergoing cardiac surgery is highly dependent on the sampling time.Of the evaluated markers,uNGAL has the best predictive profile.uRBP also shows similar predictive power.Combining all the five above biomarkers is able to predict significantly more cases,suggesting that the use of more than one marker may be beneficial clinically.