Objective To explore the effect of shifting the little finger abductor muscle and cutting open the metatarsophalangeal joint dorsal articular capsule to improve the appearance and function of reconstructed thumb.Methods From August 2007 to May 2012,twelve cases of Ⅳ°or Ⅴ°defect of thumb were repaired by free transplantation of the second toes with metatarsophalangeal joint.During operation,using the abductor muscle of little finger to reconstruct palmar opposition function,cutting open the joint capsule of metatarsophalangeal joint,adjusting the tension of the joint by the little finger abductor muscle and toe short extensor muscles,which were used to improve the appearance and function of reconstructed thumb.Results Twelve reconstructed thumbs all survived.Followed up from 6 to 24 months,the appearance and function were improved obviously.According to the evaluation trial standards,nine cases were optimal and 3 cases were good.Conclusion The shift of the little finger abductor muscle could reconstruct palmar opposition function,combined with metatarsophalangeal joint dorsal articular capsule incision and adjusting joint tension,could improve the appearance and function of reconstructed thumb.The effect of operation was satisfied.

Objective To assess the risk factors of intradialytic-hypotension (IDH) among maintaining hemodialysis (MHD) patients and to explore the relation between NT-proBNP and IDH,thus to provide clinical evidence for the prevention and treatment of IDH.Methods A total of 202 MHD patients during March 2009 to May 2009 in our dialysis center were enrolled in the study.Intradialytic blood pressure (BP) was measured during a 3-month period.IDH was defined as an event characterized by a sudden drop in systolic BP more than 20 mm Hg or in mean artery pressure (MAP) more than l0 mm Hg.Logistic regression analysis was used to assess the risk factors of IDH.ROC curve was used to evaluate the diagnostic efficacy of serum NT-proBNP.Results The incidence of IDH was 42.1％.One hundred and seventeen patients with no-IDH (＜1/10 hypotensive events per 3 months) were served as controls.Fifty-five patients with o-IDH (≥ 1/ 10 but ≤1/3 hypotensive events per 3 months) and 30 patients with f-IDH (＞1/3 hypotensive events per 3 months) were identified among 202 patients.Multivariate regression analysis showed that age,gender,ultrafiltration rate,serum NT-proBNP,serum albumin,aortic root dimension (AoRD) were associated with IDH among MHD patients.Serum NT-proBNP was positively correlated with IDH.The area under the ROC curve (AUC) of NT-proBNP was 0.76 (95％ CI 0.69 to 0.83,P＜0.01).The cut-off value of serum NT-proBNP for IDH was 1746.5 ng/L,with a sensitivity of 88.61％ and a specificity of 51.10％.Furthermore,the AUC of NT-proBNP for f-IDH was 0.65 (95％ CI 0.53 to 0.763,P＜0.01).The cut-off value of serum NT-proBNP for f-IDH was 8208.0 ng/L,with a sensitivity of 33.33％ and a specificity of 91.30％.Conclusions Elderly,female,high ultrafiltration rate,high level of serum NT-proBNP,hypoalbuminemia,shorter AoRD are independent risk factors of IDH among MHD patients.Serum NT-proBNP can be used as a predictor of IDH.

Objective To summarize the clinical experience of ESWL under B ultrasound guidance in treatment of urinary stones.Methods The clinical data of 20 625 patients who underwent B ultrasound-guided ESWL between August 1995 and July 2011 were retrospectively analyzed.Of the stones,8659cases were in the kidney,11 712 cases were in the ureter,and 254 cases were in the bladder.And 1965stones were radioparent.Results The stone fragmentation rates of the kidney,ureter and bladder stones were 96.27％ ( 8336/8659),97.56％ ( 1 1 426/1 1 712) and 99.21％ ( 252/254),respectively.The total stone fragmentation rate was 97.04％ (20 014/20 625 ).The 3-month stone-free rates of the kidney,ureter and bladder stones were 86.63％ (7501/8659),95.32％ ( 11 164/11 712) and 97.24％ (247/254),respectively.The total 3-month stone-free rate was 91.69％ (18 912/20 625).The stone fragmentation rate of radioparent stones was 97.91％ ( 1924/1965 ),and the 3-month stone-free rate was 94.40％ ( 1855/1965).Conclusion B ultrasound-guided ESWL is safe and effective in the treatment of urinary stones.

Objective To examine the association between residual renal function at initiation of dialysis and prognosis in maintenance dialysis patients.Methods Incident patients with end-stage renal diseases initiating dialysis between 1 January 2005 and 30 September 2009,followed up to 31 March 2010 were enrolled in this study.Residual renal function was evaluated using eGFR estimated by the abbreviated MDRD equation.Patients were classified into four groups according to eGFR of ≥10.5,8 to ＜10.5,6 to ＜8,＜6 ml·min-1·(1.73 m2)-1.The outcome was all-cause and cardiocerebral vascular mortality.Results (1) A total of 562 patients were included.The median eGFR at initiation of dialysis was 5.60 (2.26-12.62) ml·min-1·(1.73 m2)-1.The median follow-up time was 17 (0-58) months from initiation of dialysis and 141 patients died within this period.The median survival time was 45.48 (43.05-47.90) months.With eGFR declined,Scr,BUN,serum uric acid,serum prealbumin,phosphorus,calcium and phosphate product,iPTH,mean arterial pressure (MAP) at initiation of dialysis increased (P＜0.05),and hemoglobin,proportion of male,proportion of diabetes comorbidity,proportion of the Charlson comorbidity index ≥5 decreased (P＜0.05).Though there was no significant difference among the four groups,the proportion of left ventricular hypertrophy comorbidity increased when eGFR declined.(2) There was no significant difference of all-cause mortality among four groups using Kaplan-Meire survival curve.Cox regression model indicated no significant difference of all-cause mortality in levels of eGFR (HR=1.012,95％CI 0.961-1.065,P=0.654).Without patients died in the first 3 months,the multivariate Cox regression model indicated eGFR at initiation of dialysis was the protective factor to 1 year survival (HR=0.791,95％CI 0.669-0.935,P＜0.01).(3) The multivariate Cox regression model indicated the risk of overall and 1 year cardiocerebral vascular death decreased with eGFR at initiation of dialysis increased (HR=0.868,95％CI 0.777-0.971,P＜0.05; HR=0.937,95％CI 0.851-0.992,P＜0.05,respectively).(4) The multivariate Cox regression model indicated eGFR at initiation of dialysis was benefit to survival of patients treated by peritoneal dialysis,with all-cause death risk decreased by 10％ when eGFR increased by 1 ml·min-1·(1.73 m2)-1 (HR=0.90,95％CI 0.81-0.99,P＜0.05).In hemodialysis patients,Kaplan-Meire survival curve was significantly different among the four groups (Log-rank test,P=0.047); the survival of the group of 8 to ＜10.5 ml·min-1·(1.73 m2)-1 was lower as compared to the groups of 6 to ＜8 (Log-rank test,P=0.033) and ＜6 ml·min-1(1.73 m2)-1 (Log-rank test,P=0.005); but the multivariate Cox regression model indicated no relationship between survival and eGFR.In the subgroup of chronic glomerulonephritis as primary renal disease,the eGFR at initiation of dialysis was the benefit factor,with all-cause death risk decreased by 16.6％ (HR=0.834,95％CI 0.736-0.946,P＜0.01) and cardiocerebral vascular death risk decreased by 18.2％ (HR=0.818,95％CI 0.669-0.999,P＜0.05) when eGFR increased by 1 ml ·min-1 ·(1.73 m2)-1.In the subgroup of chronic glomerulonephritis treated by peritoneal dialysis,the all-cause death risk decreased by 32.1％ with eGFR increased by 1 ml·min 1·(1.73 m2)-1 (HR=0.679,95％CI 0.535-0.862,P＜0.01).Conclusions Early initiation of dialysis may not be associated with improved overall survival,but may reduce cardiocerebral vascular and 1 year all-cause mortality,improve the survival of chronic glomerulonephritis patients and peritoneal dialysis patients.

Objective To study interdialytic body weight gain(IBWG)in maintenance hemodialysis(MHD)patients,and to analyze the associated factors. Methods A total of 269 patients undergoing maintenance hemodialysis were enrolled in this cross-sectional study.The patients were divided into two groups according to the percentage of IBWG(PIBWG:interdialytic body weight gain/dry weight×100%):PIBWG＞3.50%(190 cases)and PIBWG≤3.50%(79 cases).Associated factors of IBWG were analyzed. Results The average IBWG of 269 MHD patients was(2.42±1.01)kg(0-6.33 kg),and PIBWG was(4.25±1.79)%.In male patients,IBWG was (2.45±1.09)kg,and PIBWG was(3.99±1.79)%.In female patients,IBWG was(2.39±0.85)kg,and PIBWG was(4.64±1.74)%which was significantly higher compared to males(P＜0.01).Patients with PIBWG＜3.00%accounted for 20%,with PIBWG≥3.00%to＜5.00%accounted for 50%,with PIBWG≥5.00%accounted for 30%.Compared to patients with PIBWG＞3.50%,those with PIBWG≤3.50%were characterized by elder age(year)(60.50 ±14.49 vs 54.07±13.78),more males(70.88%vs 54.74%),shorter dialysis duration(month)(41.03±41.92 vs 58.83±43.57),larger BMI(kg/m2)(22.67±3.36 vs 20.91±3.25)and less dry weight(kg)(56.69±10.94 vs 62.82±10.97),more residual urine(ml,In)(6.19±0.94 vs 5.48±0.8),lower predialysis serum β2MG(mmol/L)(31.61±9.82 vs 38.54±10.38)and phosphorus(mmol/L)(1.92±0.66 vs 2.15±0.58).Correlation analysis revealed that PIBWG was positively correlated with dialysis duration,Scr,BUN,β2-MG,phosphorus,decrease and decrease percentage of BP during hemodialysis,and negatively correlated with age,dry weight,BMI,residual urine,and pre-dialysis SBP,MAP. Conclusions PIBWG of about 70%of our patients was below 5%.Young.female.low BMI and dry body weight,long dialysis duration,low residual urine,chronic glomerulonephritis and diabetic nephropathy are associated with more IBWG,which may lead to greater intradialytic BP fluctuation.

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.

Objective To study the urea rebound after hemodialysis in maintenance hemodialysis (MHD) patients and its impact factors. Methods From 124 stable MHD patients, blood samples were collected at the beginning, immediate post-hemodialysis, 15 minutes and 30 minutes after hemodialysis. The urea rebound was quantified, and its effect on URR and spKt/V was investigated. The impact factors on urea rebound were analyzed. Results In this group of patients, average post-hemodialytic urea rebound was 13.6%, leading to over-estimation of URR and spKt/V of 0.04 and 0.14, respectively. Hemodialysis efficiency expressed as K/V determined urea rebound most significantly. Other impact factors included higher hemoglobin, higher relative ultrafiltration, arteriovenous access, and male patients. Conclusions Urea rebound is common after the hemodialysis. For specific patients and hemodialysis sessions, ignoring it would result in significant over-estimation of delivered hemodialysis dose.

Objective To investigate the correlation between plasma pentraxin 3 (PTX3)and cardiovascular disease(CVD) in maintenance hemodialysis(MHD) patients.Methods Plasma was obtained from 98 MHD patients before and after a session of HD and 50 age-matched healthy subjects.Plasma PTX3 was measured by enzyme-linked immunosorbant assay (ELISA).Spearman correlation and linear regression were used to examine the correlation between plasma PTX3 level and other laboratory parameters.Binary Logistic regression was used to assess the correlation between plasma PTX3 level and CVD.Receiver operator characteristic (ROC) curve was used to analyze the correlation among PTX3, high sensitive C-reactive protein(hsCRP) and CVD.Results Plasma PTX3 level was significantly higher in MHD patients compared to healthy controls [1.87 (1.34-2.50) μg/L vs 1.11(0.86-1.51) μg/L, P＜0.01], and increased after a single HD session[post-HD 2.18(1.80-3.14) μg/L vs pre-HD 1.87(1.34-2.50) μg/L, P＜0.01].Patients with CVD had higher concentrations of PTX3 than those without CVD[2.18 (1.48-2.74) μg/L vs 1.76 (1.25-2.26) μg/L, P＜0.05].High plasma PTX3 (＞1.87 μg/L) was positively and independently associated with CVD[OR=3.15, 95％CI(1.17-8.50), P＜0.05].ROC curve analysis showed the PTX3 was more closely correlated to CVD than hsCRP in MHD patients with hsCRP ＞3 mg/L, and the area under the curve of PTX3 and hsCRP was 0.655 ±0.083(P＜0.05) and 0.562±0.083(P＞0.05) respectively.Plasma PTX3 level was negatively correlated with body mass index (ρ=-0.248,P＜0.05), pre-albumin(ρ=-0.218, P＜0.05), total cholesterol(ρ=-0.265, P＜0.01), triglyceride (ρ=-0.246, P＜0.05), LDL-cholesterol (ρ=-0.254, P＜0.05), hemoglobin (ρ=-0.212, P＜0.05), and positively with erythropoietin dose per week(ρ=0.184, P＜0.01), cardiac troponin T (ρ=0.287,P＜0.01), carotid artery intima-media thickness (ρ=0.294, P＜0.05).Conclusions PTX3 level ismarkedly elevated in HD patients.HD procedure induces PTX3 elevation.Plasma PTX3 could be auseful marker of CVD risk factors in MHD patients.

Objective To investigate the effects of repeated low dose intravenous infusion of low molecular weight iron dextran and iron sucrose on oxidative stress in chronic renal failure (CRF) rats. Methods CRF model was established by 5/6 subtotal nephrectomy (5/6 Nx). Four weeks after removing the right kidney, successful rats were randomly divided into low molecular weight iron dextran group, sucrose iron group and CRF control group. The sham group was established simultaneously. The dose of iron administrated in each rat was similar in iron dextran group and sucrose iron group. There were 6 rats in each group. Animals were observed for 6weeks, then the blood, urine and renal tissue samples were collected, and indexes of renal function,anemia, iron status and oxidative stress were investigated. Results The hemoglobulin (Hb) level in iron groups was significantly higher as compared to control group (P＜0.05) but was not significantly different between two iron groups. The levels of serum iron, ferritin and saturation rate of transferring (TS) were obviously lower in control group as compared to sham group (P＜0.05).Levels of above 3 indexes were significantly higher in two iron groups as compared to control group (P＜0.05), but were not significantly different between two iron groups. Concentration of plasma advanced oxidation protein products (AOPP) was obviously higher in two iron groups than that in control group [(127.84±21.19) μmol/L, (134.21±29.38) μmol/L vs (81.83±19.93) μmol/L, P＜0.05]. Plasma malonaldehyde (MDA) was significantly higher in iron sucrose group than that in iron dextran group [(6.06±0.73) nmol/L vs (4.99i0.80) nmol/L, P＜0.05]. Serum levels of superoxide dismutase (SOD) and total anti-oxidant capacity (TAOC) had no significant differences among three CRF groups. Concentration of plasma glutathione peroxidase (GSH-Px) was significantly decreased in three CRF groups as compared to sham group (P＜0.05), while plasma GSH-Px was significantly lower in sucrose iron group than that in iron dextran group and control group [(2123.11±74.78)nmol ·ml-1 ·min-1 vs (2352.84±163.90) nmol· ml-1 ·min-1, (2310.23±125.99) nmol ·ml-1 ·min-1, P＜0.05]. Conclusions Injection of intravenous iron can partially improve the anemia and the iron status indexes in 5/6 Nx CRF rats. Repeated low dose intravenous infusion of iron dextran and iron sucrose can aggravate the oxidative stress state in CRF rats, and the iron sucrose is worst.