Objective To investigate the quality of life (QOL) of maintenance hemodialysis (MHD) patients and its influencing factors.Methods A total of 257 MHD patients in our hospital were recruited in this study.Clinical data of the patients were collected,and the QOL was assessed by MOS 36 item short form health survey(SF-36).Nutritional status of patients was evaluated by modified quantitative subjective global assessment (MQSGA).Univariate analysis of variance,pearson correlation analysis and multiple linear stepwise regression analysis were performed to determine the effect of related factors on QOL scores.Results The scores of all scales of SF-36 evaluation in MHD patients were relatively lower than that of general population as reported before.Their physiological component summary (PCS) score decreased gradually as age grew,nevertheless,the mental component summary (MCS) score was highest in the group aged 41-60.The score was lower in patients with moderate to severe malnutrition or diabetic nephropathy when compared with other patients.Univariate analysis of variance also revealed that high SF-36 scores associated with higher education or income.Multivariate analysis indicated that PCS score and total SF-36 score of MHD patients were positively correlated with body mass index (BMI) and cholesterol,but negatively correlated with diabetic nephropathy,pulmonary artery systolic pressure and MQSGA score (all P ＜ 0.05).There was positive correlation between MCS score and income,yet negative correlation between MCS score and MQSGA score (all P ＜ 0.05).Conclusion MHD patients had relatively poor QOL.Primary diseases and nutritional status were probably the main influencing factors.Age,educated level,family income and pulmonary artery systolic pressure might also have effects on their QOL.

Objective To explore the prevalence and the correlative factors of restless legs syndrome (RLS) in maintenance hemodialysis (MHD) patients.Methods The basic information and clinical laboratory results of 307 MHD patients were collected.The international RLS study group (IRLSSG) diagnostic criteria were applied to assess the presence and the severity of RLS.Binary logistic analysis was used for exploring correlative factors of RLS.Results The prevalence of RLS was 12.1％ in the MHD patients,with 73.0％ patients having mild-to-moderate symptoms and 83.8％ having chronic RLS.There was no significant difference between MHD patients with and without RLS in age,gender,dialysis age,daily urine,Kt/V,history of smoking,drinking,hemoglobin,serum creatinine,urea nitrogen,uric acid,calcium,phosphorus,magnesium,potassium,intact parathyroid hormone (iPTH),prealbumin,albumin and alkaline phosphatase.But the frequency of daily exercise in RLS group is significantly lower than that in non-RLS group (Z=-4.114,P ＜ 0.001).Logistic regression analysis showed that daily exercise was a correlative factor of RLS (B=-2.203,OR=0.111,95％CI 0.033-0.371,P ＜ 0.001).Conclusions RLS is a common complication in MHD patients,with chronic state and mild-to-moderate symptoms.RLS is correlated with daily exercise,which may be a scientific approach to treat or prevent this disease.

Objective To understand the incidence and clinical characteristics of scabies-associated glomerulonephritis and to investigate its pathogenesis.Methods The patients with scabies from Qijiang District People's Hospital.were collected from the outpatient department and divided into the simple scabies group (A) and glomerulonephritis group (B) according to whether complicating glomerulonephritis.The general clinical indicators and serum C-reactive protein(CRP),complement components C3 and C4,immunoglobulin,TNF-α,IL-6,IL-1β and IL-18 in the early stage of the disease were determined and compared between the two groups.The differences of above indicators were collected and compared between before and after clinical cure in the patients with scabies-associated glomerulonephritis.Results Among 376 cases of scabies,16 cases developed glomerulonephritis.The clinical manifestations included glomerular hematuria and/or mild-moderate proteinuria.The kidney injury manifestations in 12 cases were completely disappeared at 2-6 months after scabies cure.The levels of serum CRP,IgG,TNF-α,IL-6,and IL-18 in the group B were significantly increased and the serum C3 level was significantly decreased compared with the group A,the differences were statistically significant(P＜0.05).The levels of serum IgG,hs-CRP,TNF-α,IL-6 and IL-18 after cure in 12 cases of clinically cured scabies-associated glomerulonephritis were significantly decreased and the serum C3 level was significantly increased,and the difference was statistically significant compared with the early onset stage(P＜0.05).Conclusion The majority of prognosis in scabies-associated glomerulonephritis is good.Its occurrence is closely correlated with immune and inflammatory reactions induced by sarcoptes mites irffection.

ovel GCK-E339K mutation might be linked to this MODY2 pedigree.

ObjecfiveTo investigate clinical features and imaging manifestation in patients with posterior reversible eneephalopathy syndrome (PRES) to improve its recognition.MethodsSix patients with PRES were enrolled,four women with history of end-stage renal disease,kidney transplantation,eclampsia,or systemic lupus erythematosus (SLE) and two men with history of chemotherapy or hypertension.All of them underwent multi-serial MR imaging (T1 WI,T2 WI,FLAIR) and post-contrast T1 WI.Three cases also underwent CT scan and gadolinium enhancement. ResultsAll the six cases of PRES had different inducing causes such as acute hypertension,preeclampsia or eclampsia, taking immunosuppressive agents or steroids.and their clinical symptoms were characterized by sudden occurrence of headache,eclampsia or seizure of epilepsy,altered melltal status,visual disturbances.Clinical symptoms were died out in about one week after prompt and appropriate treatments for high blood pressure.or removal of precipitating factors,or treatment for epileptic seizures or status epilepticus.MRI and CT scanning demonstrated multifocal subcortical white lesions in bilateral parieto-occipital lobes (six cases), bilateralfrontal lobes (two cases),bilateral post temporal lobes (two cases) and left cerebellum (one cases).and cortical involvement (two cases).All lesions appeared unenhanced with gadolinium enhancement. FoHow-up by MRI showed decreased abnormal signs and small infarct foci were left in the cortex-subeortex of one case.ConclusionsPRES is a clinico-neuroradiologieal transient condition, usually benign and reversible in nature.Completely clinical and radiographic recovery Can be achieved with prompt antihypertensive treatment or removal of precipitating factors and supportive care,but delayed diagnosis and therapy Can result in cerebral infarct with neurological sequelae.

Objective To investigate the dynamic changes of interleukin-1 receptor-associated kinases (IRAK-4) in hypoxic neurons and explore their role in regulation of inflammatory reaction. Methods The B35 cells exposed to hypoxia of 3% O2,5% CO2 and 92% N2 were cultured for 1,3,6, 12,24,48,72 and 96 hours respectively. Then, mRNA and protein expressions of IRAK-4 were detected by RT-PCR and Western blot, the expression of IRAK-4 in the cells were observed by laser scanning con-focal microscope (LSCM), and the concentration of IL-6 was measured by ELISA method. Results After hypoxia, the mRNA and protein expressions of IRAK-4 were increased at one hour, reached the peak at six hours (P<0.05), kept at a high level at 12 hours (P<0.05) , but decreased gradually to the normal oxygen level at 24 hours (P < 0.05) and to below the normal oxygen level at 48 hours (P < 0.05). Immunofluorescence results showed that the fluorescence intensity of IRAK-4 was gradually increased with time. The changes of IL-6 in the supernatant were positively correlated with protein expression of IRAK-4 (r =0.84, P < 0.05 ). Conclusions Hypoxia can increase the expression of IRAK-4 at transcription and translation levels in a certain period of time, which may participate in down-stream inflammatory reaction and lead to increase of IL-6 expression.

ObjectiveTo analyze the clinical characteristics of inflammatory bowel disease (IBD) in neonates.MethodsFrom July 2010 to July 2015, seven neonates were diagnosed with IBD in Affiliated BaYi Children's Hospital, Clinical Medical College in Chinese People's Liberation Army General Hospital, Southern Medical University. The data regarding these neonatal cases were analyzed and compared with 45 children with IBD from literature. Thet-test andChi-square test were used for statistical analysis of the data.ResultsSix cases had ulcerative colitis, and one case had Crohn's disease, both occurred 2-20 days after birth, and were characterized by diarrhea, no increase in body weight, anemia and intermittent higher hypersensitive C-reactive protein. Compared with IBD in children, abdominal pain and abdominal mass were rarer, while anemia was more common in neonatal IBD. All fecal cultures and blood cultures in the seven cases of neonatal IBD were negative. Abdominal X-ray revealed intestinal wall thickening in four cases. Multiple ulcers were observed from the cecum to the rectum by colonoscopy. Chronic intestinal mucosal inflammation associated with acute inflammation were found on pathological examination. Six infants received treatment with 5-aminosalicylic acid (combined with glucocorticoid in four cases), and one received glucocorticoid treatment only. One infant was started on infliximab treatment from two years old. One of these seven cases died one month after discharge due to refusal to continue treatment, and the disease was controlled in the other six cases. After treatment, one infant was lost to follow-up six months after discharge, two were cured at six and 12 months old without further treatment, and three improved and continued treatment.ConclusionsIn neonates with diarrhea, anemia and no increase in body weight, especially when antibiotic treatment is ineffective, colonoscopy should be performed to facilitate early diagnosis of IBD. Standard treatments result in good outcomes.

[ ABSTRACT] AIM: To explore whether autophagy is involved in the excessive death of renal tubular epithelial cells in subtotal nephrectomy ( SNx) rats and the relationship between autophagy and necroptosis in the kidney of SNx rats. METHODS:Male Sprague-Dawley rats were randomly assigned to control group ( n=6 ) and SNx group ( n=42 ) .The rats in SNx group were subjected to SNx.Sham surgery was performed in the rats in control group.The rats in SNx group were divided into subgroups at 0, 4, 8 and 12 weeks ( n=6) and the other rats in SNx group were divided into SNx+vehi-cle group, SNx+necrostatin-1 (Nec-1) group and SNx+3-methyladenine (3-MA) group.The expression of RIP1, RIP3, LC3 and beclin-1 at mRNA and protein levels was measured at 0, 4, 8 and 12 weeks by qPCR and immunohistochemistry. The effects of Nec-1 or 3-MA on the protein expression of LC3-I, LC3-II and beclin-1, and production of reactive oxygen species ( ROS) in the rat kidney were determined by Western blot and DCFH-DA staining.The death of renal tubular epi-thelial cells in the SNx rats was observed by TUNEL staining and electron microscopy.Finally, the effects of Nec-1 and 3-MA on blood urea nitrogen ( BUN) , serum creatinine ( SCr) and the pathological changes of the renal tissues were ana-lyzed.RESULTS:The highest mRNA and protein levels of RIP1, RIP3, LC3 and beclin-1 appeared at the 8th week after SNx (P<0.01).Compared with the rats in SNx+vehicle group, the protein over-expression of LC3-II/I and beclin-1, re-nal tubular epithelial cells with typical morphological features of necroptotic cell death and TUNEL-positive renal tubular
cells were decreased in the SNx rats treated with Nec-1 and 3-MA (P<0.01), but 3-MA did not reduce the increased con-centration of ROS.In addition, treatment with Nec-1 and 3-MA obviously reduced BUN, SCr (P<0.05), glomeruloscle-rosis index and tubulointerstitial injury score (P<0.01).CONCLUSION:Autophagy participates in the excessive death of renal tubular epithelial cells in SNx rats.Inhibition of autograph prevents necroptotic cell death of renal tubular cells, and alleviates chronic renal injury in SNx rats.

Objective: To compare the clinical characteristics and plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) between the patients with hypertensive hypertrophic cardiomyopathy in elder age (HHCME) and the patients with hypertensive left ventricular hypertrophy (HTN-LVH).
Methods: Our work included 2 groups, HHCME group,n=47 and HTN-LVH group,n=44. Duplex Doppler echocardiography was performed to determine left atrial diameter (LAd), left ventricular end-diastolic dimension (LVEDd), interventricular septal thickness (IVST), left ventricular ejection fraction (LVEF), velocity of early diastolic period (VE) and velocity of end-diastolic period (VA) in mitral valve oriifce. Plasma level of NT-proBNP was measured by ELISA. The above indexes were compared between 2 groups.
Results:①Compared with HTN-LVH group, HHCME group presented decreased LVEDd and increased IVST, LVEF, allP<0.001. There were no signiifcant differences in VE/VA ratio and LAd between 2 groups, allP>0.05.②Plasma level of NT-proBNP was higher in HHCME group,P<0.01. With the adjusted age, gender, history of hypertension, LAd, IVST, left ventricular systolic and diastolic function, the level of NT-proBNP in HHCME group (1317.19 fmol/ml) was still signiifcantly higher than that in HTN-LVH group (526.19fmol/ml),P<0.01.
Conclusion: The plasma NT-proBNP level was higher in HHCME patients than that in HTN-LVH patients which indicated that HHCME patients may have worse prognosis. NT-proBNP might be helpful for differencing HHCME.

Objective To investigate the effect and significance of microglia/macrophage activation prior to cerebral ischemic preconditioning (CIP) in regulating toll-like receptors 2 (TLR2)/nuclear factor-kappa B (NF-κB) inflammatory signaling pathway in early stage after ischemic brain injury in rats.Methods Thirty healthy male SD rats were selected and divided into normal control group,sham operation group,ischemia group,intervention group and treatment group according to random number table,with six rats per group.A rat model of focal permanent cerebral infarct was established by occlusion of middle cerebral artery (MCAO).CIP was performed by local ischemia-reperfusion.Minocycline was used to inhibit microglia/macrophage activation after CIP.Features of microglia/macrophage activation after CIP were detected by immunofluorescence; mRNA expressions of predominant factors (NF-κB inhibitor α,IκB-α;tumor necrosis factor α,TNF-α) of TLR2/NF-κB inflammatory signaling pathway in parietal cerebral cortex by in situ hybridization method; death rate by Kaplan-meier survival curves; neurological deficits by a 5-point neurological scale; brain infarct size by triphenyl tetrazolium chloride (TTC) staining.Results Microglia/macrophage started activation at one hour after cerebral ischemic injury in preconditioning group and presented a significant increase at 12 hours.Speed and range of activation were higher in preconditioning group than in ischemic group.IκB-α mRNA in preconditioning group started expression at one hour.TNF-α mRNA in preconditioning group remained a low expression in 12 hours and had a significantly lower peak value as compared with that in ischemic group (P ＜ 0.05).CIP increased rat survival rate significantly,improved nerve function and reduced infarction size when compared with the ischemia group (P ＜ 0.05).Minocycline inhibited nerve protection by CIP significantly (P ＜0.05).Conclusion CIP induces rapid activation of microglia/macrophage in early period of rat cerebral ischemic injury and provides brain protection probably via inhibition of TLR2/NF-κB activity and inflammatory overreaction to cerebral ischemia.