Objective To evaluate the efficacy of case-based learning(CBL)-problem-based learning(PBL)-evidence-based medicine(EBM)integrated teaching method in the standardized training of nephrology resident physicians.Methods Sixty internal medicine trainees who were on a 2-month rotation in the Department of Nephrology between February 1st,2023 and August 31st,2023,were recruited and randomized 1∶1 into the CBL-PBL-EBM group and the CBL group.The scores of the two groups in the theoretical assessment,case analysis,and general skills were compared at the end of the rotation.Results There was no significant difference between experimental group and control group(45.21±3.67 vs 44.02±4.90,P＞0.05).The test scores of test groups were higher than those of control group(42.48±2.35 vs 38.45±3.24,P＜0.05),and the comprehensive scores were higher than those of control group(92.24±1.69 vs 89.21±1.56,P＜0.05).At the same time,the scores of the experimental group in independent learning,literature query ability,critical thinking,and induction and summary ability were al-so significantly better than those of the control group,with statistical significance(P＜0.05).Conclusion The CBL-PBL-EBM teaching method is better than the CBL teaching method,which can effectively achieve the training goals and enhance the overall competence of nephrology trainees.

Objective To evaluate the efficacy of case-based learning(CBL)-problem-based learning(PBL)-evidence-based medicine(EBM)integrated teaching method in the standardized training of nephrology resident physicians.Methods Sixty internal medicine trainees who were on a 2-month rotation in the Department of Nephrology between February 1st,2023 and August 31st,2023,were recruited and randomized 1∶1 into the CBL-PBL-EBM group and the CBL group.The scores of the two groups in the theoretical assessment,case analysis,and general skills were compared at the end of the rotation.Results There was no significant difference between experimental group and control group(45.21±3.67 vs 44.02±4.90,P＞0.05).The test scores of test groups were higher than those of control group(42.48±2.35 vs 38.45±3.24,P＜0.05),and the comprehensive scores were higher than those of control group(92.24±1.69 vs 89.21±1.56,P＜0.05).At the same time,the scores of the experimental group in independent learning,literature query ability,critical thinking,and induction and summary ability were al-so significantly better than those of the control group,with statistical significance(P＜0.05).Conclusion The CBL-PBL-EBM teaching method is better than the CBL teaching method,which can effectively achieve the training goals and enhance the overall competence of nephrology trainees.

Objective:To explore the influencing factors of hemodialysis (HD) initiation in non-diabetic kidney disease (NDKD) patients with predialysis arteriovenous fistula (AVF) creation.Methods:This was a single-center prospective cohort study. The NDKD patients undergoing predialysis AVF creation were enrolled at the First Affiliated Hospital of Xi'an Jiaotong University from 2015 to 2018. According to the estimated glomerular filtration rate (eGFR, the Chronic Kidney Disease Epidemiology Collaboration equation) and age, patients were divided into different subgroups, eGFR: group 1 [eGFR<10 ml·min -1·(1.73 m 2) -1], group 2 [ eGFR between 10 to 15 ml·min -1·(1.73 m 2) -1], and group 3 [eGFR > 15 ml·min -1·(1.73 m 2) -1]; age: age ≥65 years group and age <65 years group. The primary outcome was defined as the initiation of HD within 1 year after AVF surgery. The second outcome was the use of AVF access at the time of HD initiation. Cox proportional hazard regression was performed to identify which demographic and clinical factors were associated with the initiation of HD after AVF surgery. Logistic regression analysis was performed to investigate factors associated with AVF use at the initiation of HD. Results:A total of 220 patients were enrolled, with age of (48.1±16.2) years, of which 143(65.0%) were males. Overall, the clinical parameters of eGFR, cystatin C, serum albumin, 24h-Urine protein, serum phosphorus were as follows respectively, 7.7 (6.6,9.2) ml·min -1·(1.73 m 2) -1, (3.93±1.12) mg/L, (36.0±4.0) g/L, (2.22±1.36) g, (1.71±0.53) mmol/L. The proportion of patients initiating HD within 6 months ( Fisher=6.832, P=0.020) and the level of hemoglobin ( F=3.112, P=0.047) were higher in group 3 compared to the other two eGFR groups. While the median time interval between AVF creation and HD initiation ( H=6.295, P=0.043) was shorter in group 1. In age <65 years group, the level of serum albumin ( t=2.076, P=0.039), triglyceride ( t=1.995, P=0.048) were higher compared with age ≥65 years group; interestingly, the proportion of patients initiated HD within 3 months ( χ2=4.033, P=0.045) and 6 months ( χ2=5.012, P=0.025) were lower in age <65 years group. The median time interval between AVF creation and HD initiation among these patients was 84 (49,174) days. The patients initiating HD within 3 months, 6 months, and 1 year after AVF creation were 112 (50.9%), 152 (69.1%), and 202 (91.8%), respectively. Multivariate Cox regression analysis indicated that higher cystatin C level ( HR=1.283, 95% CI 1.121-1.469, P<0.001) was associated with earlier HD initiation within 1 year of AVF surgery in NDKD patients. AVF usage was accomplished in 64.3% of patients who initiated HD within 90 days, the ratio was 100.0% in those initiated HD between 91 to 180 days, and 88.0% in those ≥181 days after AVF surgery. No factor was independently associated with AVF use at HD initiation identified by multivariate logistic regression analyses in patients with NDKD. Conclusion:Serum cystatin C level is associated with HD initiation within 1 year of the predialysis AVF creation in NDKD patients.

Objective To observe the clinical efficacy of Jiangshabanxia nano-paste on nausea and vomiting in end-stage patients and its effect on the quality-of-life (QOL) in cancer patients. Methods 120 end-stage patients with nausea and vomiting symptoms above grade III were randomly divided into observation group and control group. They were treated with Jiangshabanxia nano-paste and placebo paste respectively. The paste patch was changed every 24 hours and used continuously for 7 days. The nausea and vomiting symptom score, the quality-of-life measurement score and KPS score of cancer patients in the two groups were observed to evaluate the curative effect. Results After 7 days of treatment, the symptom scores of nausea and vomiting in the observation group decreased significantly, the KPS score of the observation group increased, and the effective rate was higher than that in the control group. The score of QOL measurement showed that after treatment, the score of main symptom areas and other symptom areas (except external dyspnea, diarrhea and economic difficulties) in the observation group decreased, and the score of overall health area increased. After treatment, the score of main symptom areas and other symptom areas (except external dyspnea, diarrhea and economic difficulties) in the observation group was lower than that in the control group, and the scores of overall health area in the observation group were higher than those in the control group. Conclusion Jiangshabanxia nano-paste has a good clinical efficacy nausea and vomiting in end-stage patients, it also can improve the quality of life end-stage cancer patients.

It was a retrospective study. The patients with type 2 diabetes mellitus (T2DM) who underwent renal biopsy in the Department of Nephrology, the First Affiliated Hospital of Xi'an Jiaotong University from 2015 to 2021 were enrolled to analyze the pathological and clinical manifestations of kidney. There were 483 patients enrolled, including 136 patients who had no history of diabetes mellitus, newly diagnosed as T2DM according to an oral glucose tolerance test. The age was (52.80±13.13) years old. There were 337 males (69.77%). Based on the renal biopsy, the patients were classified as diabetic kidney disease (DKD, 22.15%, 107/483), DKD+non-diabetic kidney disease (NDKD)(6.63%, 32/483), and NDKD (71.22%, 344/483). Membranous nephropathy was the most common pathology in patients with NDKD (40.41%, 139/344) and DKD+NDKD (34.38%, 11/32). In the 136 newly diagnosed T2DM patients, there were 3 patients (2.21%) with DKD, 2 patients (1.47%) with DKD+NDKD, and 131 patients with NDKD (96.32%). The proportions of DKD in patients with diabetes history ≤3 months, 3-12 months, 1-5 years, 5-10 years and ≥10 years were 10.53% (6/57), 25.00% (16/64), 26.53% (26/98), 41.56% (32/77) and 47.06% (24/51), respectively. The proportions of DKD+NDKD in patients with diabetes history ≤3 months, 3-12 months, 1-5 years, 5-10 years and ≥10 years were 3.51% (2/57), 3.13% (2/64), 10.20% (10/98), 9.09% (7/77) and 17.65% (9/51), respectively. Multivariate logistic regression analysis results showed that, the duration of diabetes history ( OR=1.130, 95% CI 1.057-1.208, P<0.001), diabetes retinopathy ( OR=12.185, 95% CI 5.331-27.849, P<0.001), urinary red blood cell count ( OR=0.987, 95% CI 0.974-0.999, P=0.039), glycosylated hemoglobin ( OR=1.482, 95% CI 1.119-1.961, P=0.006) as well as hemoglobin ( OR=0.973, 95% CI 0.957-0.990, P=0.001) were independently correlated with DKD. The proportions of DKD and DKD+NDKD increase with the prolongation of diabetes history. Membranous nephropathy is the most common pathology in NDKD and DKD+NDKD patients. Even in patients newly diagnosed with T2DM, it is necessary to screen for DKD. The duration of diabetes history, diabetes retinopathy, urinary red blood cell count, glycosylated hemoglobin and hemoglobin may be used to identify DKD from NDKD.

【Objective】 To study the effects of miR-30e-5p from bone marrow mesenchymal stem cell-derived exosomes(BMSC-exos) on high glucose (HG)-induced HK-2 cell pyroptosis and explore an alternative strategy to manage diabetic kidney disease (DKD). 【Methods】 BMSC-exos were isolated and internalized into HK-2 cells treated with HG to measure viability and cytotoxicity. The secretion of IL-1β and IL-18 was measured by ELISA. Pyroptosis was assessed by flow cytometry. The levels of miR-30e-5p, IL-1β, and IL-18 were measured. The expression of pyroptosis-associated cytokine proteins was determined. 【Results】 BMSC-exos decreased LDH, IL-1β, and IL-18 secretion and inhibited the expression of the pyroptosis-related factors (IL-1β, caspase-1, GSDMD-N, and NLRP3) in HG-induced HK-2 cells. Moreover, miR-30e-5p depletion in BMSC-exos promoted HK-2 cell pyroptosis. 【Conclusion】 BMSC-derived exosomal miR-30e-5p inhibits caspase-1-mediated pyroptosis in HG-induced HK-2 cells, which might provide a new strategy for treating DKD.

Peritoneal dialysis (PD) catheter-related infections are important risk factors for catheter loss and peritonitis. 2023 International Society for Peritoneal Dialysis (ISPD) catheter-related infection recommendations have revised and clarified definitions and classifications of exit site infection and tunnel infection, such as cause-specific catheter-related infection, culture-negative catheter-related infection, refractory catheter-related infection, and infection- related catheter removal. A new target for the exit site infection rate should not exceed 0.40 episodes per year at risk. The recommendation about topical antibiotic cream or ointment to catheter exit site has been downgraded. New recommendations for exit site infection include clarified suggestion of exit site dressing cover and revised topical antibacterial agents as well as antibiotics treatment duration. In addition to catheter removal and reinsertion, new salvage options for catheter are suggested. The paper outlines the updated main content of the guide.

Objective:To investigate the efficiency and safety of peritoneal dialysis (PD) in pediatric patients with acute kidney injury (AKI).Method:A retrospective study of children who underwent PD for AKI in the First Affiliated Hospital of Xi’an Jiaotong University from 2003 to 2013 was performed, and the laboratory examinations, the causes, the complication, the prognosis and the risk factors were evaluated.Results:The study included 48 children, with the age of (67.6±51.7) months (ranging from 3 months to 15 years old), including 31 males (64.6%) and 34 co-infections (70.8%). Primary glomerulonephritis (27.1%) was the most common cause of AKI, followed by the hemolytic uremic syndrome (18.7%) and drug induced AKI (18.7%). Peritoneal dialysis was performed manually using percutaneous or adapted catheters. The duration of PD during hospitalization was 11(7,14) days. PD treatment was highly effective in attenuation of toxics retention and correction of electrolyte disturbances (all P<0.05). There were 3 cases of PD-related complications, including 1 case of peritonitis, 1 case of catheter outflow obstruction, 1 case of catheter exit site hematoma, and no child patient died of PD complications. Among the AKI children, 37 cases (77.1%) recovered with the PD treatment and had the catheter successfully removed till discharge, 7 cases (14.6%) needed further peritoneal dialysis and 4 cases (8.3%) died. The serum albumin level was significantly higher in patients who got recovered with PD treatment than other unrecovered cases [(32.6±6.7) g/L vs (23.2±4.3) g/L, t=-3.994, P<0.001]. Conclusions:PD can be safely and efficiently performed for the treatment of pediatric AKI. Low albumin level may be related to poor prognosis of AKI.

Objective To analyze the rationality of antihyperuricemic drugs application and HLA-B*5801 alleles detection in patients with chronic kidney diseases complicated by hyperuricemia. Methods The medical records of patients with chronic kidney diseases complicated by hyperuricemia in the First Affiliated Hospital of Xi′an Jiaotong University from July 2015 to June 2017,whose HLA-B*5801 alleles were detected and who were treated with benzbromarone,allopurinol,or febuxostat,were collected and analyzed retrospectively. The evaluation criteria of rationality of 3 antihyperuricemic drugs application and gene detection were constituted according to the related guidelines,expert consensuses,and drug labels. It was judged as irrational use of benzbromarone in patients with estimating glomerular filtration rate (eGFR)< 30 ml/(min · 1. 73 m2 ),excessive uric acid production,acute gout attack,urinary calculi,or undetermined uric acid excretion type. It was judged as irrational use of allopurinol in patients whose eGFR were < 15 ml/(min·1. 73 m2 )but without dialysis or in patients with positive HLA-B*5801 alleles. It was judged as irrational use of gene detection in patients who had underwent gene detection but were not suitable for allopurinol treatment after initial assessment,and in patients who finally were not given allopurinol though they were suitable for allopurinol treatment after initial assessment and with negative HLA-B*5801 alleles. Results A total of 201 patients enrolled in the study. There were 57,103,and 41 patients receiving benzbromarone,allopurinol,and febuxostat,respectively. There were 24 (11. 9％)patients with positive HLA-B*5801 alleles and 177 (88. 1％)with negative one. The percentages of patients with rational use of benzbromarone,allopurinol,and febuxostat were 40. 4％ (23/ 57),76. 7％ (79/ 103)and 100％ (41/ 41), respectively. The percentage of patients with rational use of HLA-B*5801 alleles detection was 50. 2％(101 / 201). There were 100 patients with irrational use of HLA-B*5801 alleles detection,including 34 patients who underwent gene detection but were not suitable for allopurinol treatment [their eGFRs were <15 ml/(min·1. 73 m2 )but they did not conduct dialysis],and 66 patients who were not given allopurinol despite that they were suitable for allopurinol treatment with negative HLA-B*5801 alleles. Conclusions There are irrational use of both antihyperuricemic drugs and HLA-B*5801 alleles detection in patients with chronic kidney diseases complicated by hyperuricemia in our hospital. Irrational use of benzbromarone is more serious in antihyperuricemic drugs. Clinicians should pay attention to the irrational use of antihyperuricemic drugs.

Objective To analyze the rationality of antihyperuricemic drugs application and HLA-B*5801 alleles detection in patients with chronic kidney diseases complicated by hyperuricemia. Methods The medical records of patients with chronic kidney diseases complicated by hyperuricemia in the First Affiliated Hospital of Xi′an Jiaotong University from July 2015 to June 2017,whose HLA-B*5801 alleles were detected and who were treated with benzbromarone,allopurinol,or febuxostat,were collected and analyzed retrospectively. The evaluation criteria of rationality of 3 antihyperuricemic drugs application and gene detection were constituted according to the related guidelines,expert consensuses,and drug labels. It was judged as irrational use of benzbromarone in patients with estimating glomerular filtration rate (eGFR)< 30 ml/(min · 1. 73 m2 ),excessive uric acid production,acute gout attack,urinary calculi,or undetermined uric acid excretion type. It was judged as irrational use of allopurinol in patients whose eGFR were < 15 ml/(min·1. 73 m2 )but without dialysis or in patients with positive HLA-B*5801 alleles. It was judged as irrational use of gene detection in patients who had underwent gene detection but were not suitable for allopurinol treatment after initial assessment,and in patients who finally were not given allopurinol though they were suitable for allopurinol treatment after initial assessment and with negative HLA-B*5801 alleles. Results A total of 201 patients enrolled in the study. There were 57,103,and 41 patients receiving benzbromarone,allopurinol,and febuxostat,respectively. There were 24 (11. 9％)patients with positive HLA-B*5801 alleles and 177 (88. 1％)with negative one. The percentages of patients with rational use of benzbromarone,allopurinol,and febuxostat were 40. 4％ (23/ 57),76. 7％ (79/ 103)and 100％ (41/ 41), respectively. The percentage of patients with rational use of HLA-B*5801 alleles detection was 50. 2％(101 / 201). There were 100 patients with irrational use of HLA-B*5801 alleles detection,including 34 patients who underwent gene detection but were not suitable for allopurinol treatment [their eGFRs were <15 ml/(min·1. 73 m2 )but they did not conduct dialysis],and 66 patients who were not given allopurinol despite that they were suitable for allopurinol treatment with negative HLA-B*5801 alleles. Conclusions There are irrational use of both antihyperuricemic drugs and HLA-B*5801 alleles detection in patients with chronic kidney diseases complicated by hyperuricemia in our hospital. Irrational use of benzbromarone is more serious in antihyperuricemic drugs. Clinicians should pay attention to the irrational use of antihyperuricemic drugs.