Objective To explore risk factors for cardiac valve calcification (CVC) in maintenance hemodialysis (MHD) patients and evaluate its impact on cardiovascular events and mortality. Methods Retrospective selection of 223 patients with MHD admitted to the Department of Nephrology of Jinshan Hospital, Fudan University from June 30, 2019 to June 30, 2024, and enrollment completed within one week of June 30, 2019. Patients were divided into CVC and non-CVC groups. Baseline data and 5-year follow-up data were collected. The binary logistic regression analysis was performed to explore the risk factors for CVC. Kaplan-Meier survival curve was used to analyze the survival rate of patients. Cox proportional hazard regression model was applied to evaluate the impact of CVC on the survival rates of MHD patients. Results Totally, 223 MHD patients with an average age of (58.4±13.5) years and an average dialysis duration of (64.0±55.4) months were involved. Among them, 136(61.0%) were males, 117(52.5%) were complicated with CVC. Age, dialysis duration, diabetic kidney disease (DKD), the serum corrected total calcium and phosphate, intact parathyroid hormone (iPTH), high-sensitive C-reactive protein (hsCRP), and homocysteine (Hcy) were independent related factors for CVC (P＜0.05). Both all-cause mortality (46.6% vs 28.7%) and cardiovascular mortality (33.3% vs 16.0%) were significantly higher in the CVC group than those in the non-CVC group (P＜0.01). Conclusions Age, dialysis duration, the primary disease, calcium and phosphate, and inflammation- and nutrition-related serum indicators are associated with CVC in MHD patients. CVC significantly increases mortality risk of MHD patients.

Objective To explore the correlation between serum fibroblast growth factor-23(FGF23),Klotho protein levels and cardiac valve calcification(CVC)in patients with maintenance hemodialysis(MHD).Methods A total of 169 MHD patients in the Blood Purification Center of Jinshan Hospital,Fudan University from January 2022 to January 2023 were selected.The patients'CVC status was examined by color Doppler echocardiography.Results There were 111 CVC cases,accounting for 65.68%.Compared with the non-CVC group,the CVC group had significantly higher levels of FGF23,β2-microglobulin,brain natriuretic peptide(BNP),age,and the proportion of male,while significantly lower levels of Klotho,predialysis creatinine,hemoglobin,plasma albumin and iPTH(P＜0.05).Pearson/Spearman correlation coefficient analysis showed that FGF23,age,β2-microglobulin and BNP were significantly positively correlated with CVC(r=0.20,0.41,0.15,0.28,0.12),while Klotho,predialysis creatinine,hemoglobin,plasma albumin and iPTH were significantly negatively correlated with CVC(r=﹣0.16,﹣0.17,﹣0.16,﹣0.17,﹣0.16).Unconditioned binary logistic regression analysis showed that FGF23,Klotho,age and β2-microglobulin were independent risk factors for CVC in MHD patients.Conclusions MHD patients are prone to CVC.Serum FGF23 protein level is significantly positively correlated with CVC,while Klotho protein level is significantly negatively correlated with CVC.FGF23,Klotho,age and β2-microglobulin are independent risk factors for CVC in MHD patients.

Objective To analyze the role of telehealth?based dialysis registration systems in real?time and dynamic reflection of renal anemia in hemodialysis (HD) patients, and discuss the prospect of its application in dialysis registration management. Methods The Red China project was to build up a dialysis registration system based on the WeChat mobile terminal platform. Demographic and baseline laboratory parameters such as age, gender, primary disease, dialysis age, creatinine were recorded in this system. Hemoglobin (Hb) level was monthly recorded. The platform generated Hb statistics report for each HD center monthly, including the detection rate, target rate and the distribution level of Hb, and released it to physicians through the WeChat terminal of mobile phone. After that, physicians could change the treatment of anemia individually on basis of this report. Here the demographic and baseline laboratory parameters, the detection rate, target rate, the average level and the distribution of Hb from June 2015 to October 2017 after the project launched were analyzed. Results From June 2015 to October 2017, 8392 maintenance HD patients from 28 HD centers in Shanghai were enrolled, of whom 5059(60.3％) were male.The average rate age was (60.5 ± 13.7) years old. Baseline average Hb was (108.3±16.0) g/L. Baseline detection rate and target rate were 54.2％and 47.5％, respectively. After 28 months follow?up, the detection rate of Hb increased from 54.2％ to 73.6％ (P<0.001), the target rate of Hb increased from 47.5％ to 56.1％ (P<0.001), and the level of average Hb rose from (108.3±16.0) g/L to (110.7±16.0) g/L. The difference between average Hb in two consecutive months was less than 1.3 g/L. Conclusions The telehealth?based dialysis registration system can timely report the anemia situation of HD patients, which may improve the awareness rate of anemia, the degree of attention and the compliance of anemia monitoring, so as to improve the detection rate and target rate of Hb and reduce the fluctuation of Hb, which helps to maintain the HD patients to correct anemia in a timely, stable and long?term way. The telehealth?based dialysis registration system, as an improved mode of dialysis registration is a promising way for long?term management of renal anemia in dialysis patients.

Objective:To investigate the relationship between arteriosclerosis and inflammatory status and adiponectin (ADPN) in peritoneal dialysis patients.Methods:A total of 48 stable peritoneal dialysis patients were enrolled,and C reactive protein (CRP)and ADPN in the serum were measured.Arteriosclerosis (AS)was detected by vascular ultrasound.Then the relation-ships between them were analyzed.Results:Compared with the no-AS group,the AS group had significant lower level of AD-PN (P <0.01)and significant higher level of CRP (P <0.01).The level of ADPN was lower in the high CRP group than that in the normal CRP (P <0.01).Pearson correlation analysis showed that CRP had a significant negative correlation with ADPN (P <0.01).Conclusions:Low serum ADPN level in peritoneal dialysis patients can aggravate inflammatory staus,and promote arteriosclerosis.

Objective:To explore the efficacy of traditional chinese medicine Danhong on renal pathological lesions of rats with early chronic kidney disease (CKD) and the role of transforming growth factorβ1(TGF‐β1) in it .Methods:Thirty male SD rats were divided into three groups :the early CKD group (model group) ,the sham‐operated group (control group) and Danhong treated group (treated group) ,with 10 in each group .Rats in the three groups were treated by uninephrectomy for building up early CKD model ,sham‐operation (separating tissues to renal capsule without kidney excision) ,and Danhong treatment after building up model ,respectively .Renal pathological lesions ,24 h urine protein excretion and renal function were observed .The concentration of TGF‐β1 in renal cortex and overall expression of TGF‐β1 in renal tissue was examined by enzyme‐linked immune‐sorbent assay (ELISA) and immunohistochemistry ,respectively .Results:Mild to moderate proliferation of glomeruli mesangial cells accompanied by broadened mesangium matrix ,glomeruli capsule wall adhesion and change of capillary wall , interstitial fibrosis and inflammatory monocytes infiltration was found in the model group other than the control group .Renal lesions were alleviated dramatically in treated group ,while compared to that in model group .The gross renal pathological score in model group was higher than that in control group (P<0 .05) ,however ,the score in treated group was lower than that in model group (P<0 .05) .The 24 h urinary protein excretion in model group and treated group was higher than that in control group (P<0 .01) ,while the 24 h urinary protein excretion in treated group was lower than that in model group (P<0 .01) . There was no significant difference among the three groups regarding blood creatinine level and urea level .Serum CysC levels in model group and treated group increased significantly than that in control group (P<0 .05) .The concentration of TGF‐β1 in renal cortex and overall expression of TGF‐β1 in renal tissue were higher in model group than those in control group(P<0 .05) ,while those in treated group were lower than those in model group (P<0 .05) .TGF‐β1 expression level in renal tissues was significantly associated with both the urinary protein excretion and the total renal pathological scores ( P< 0 .01 ) . Conclusions:Danhong alleviated renal pathological lesions by down‐regulating TGF‐β1 expression .

Objective :To observe the effect of active vitamin D3 on renal tubulointerstitial fibrosis and its possible mechanism . Methods : Forty male SD rats were randomly divided into four groups :sham operation group(Sham group ,n= 10) ,unilateral ureteral obstruction (UUO) model group (UUO group ,n= 10) ,UUO model treated with low dose of active vitamin D3 group (LV group ,n= 10) ,and UUO model treated with high dose of active vitamin D3 group (HV group ,n= 10) .UUO model was estabished by ligating the left ureter .The left ureter was only dissociated without ligation in Sham group .LV group and HV group were given active vitamin D3 (dissolved in peanut oil) at a dose of 0 .03 μg/(kg ? d) and 0 .06 μg/(kg ? d) ,respectively , by intraperitoneal injection .Sham group and UUO group were given the same volume of peanut oil by intraperitoneal injection . Rats were killed 14 days after surgery .Blood and kidney samples were collected .And serum calcium ,phosphorus ,creatinine (SCr) ,and parathyroid hormone (PT H ) were detected . The kidney pathological changes involving renal tubulointerstitial injury and fibrosis ,were observed after H-E and Masson staining with optical microscope .The expressions of α-smooth muscle actin (α-SMA ) 、E-cadherin , and transforming grow factor β (TGF-β) in renal tubulointerstitial tissues were detected by immunohistochemistry .Results :Compared with those in UUO group ,the SCr level ([39 .0 ± 1 .83] μmol/L ,[36 .0 ± 2 .11]μmol/L vs .[43 .1 ± 5 .55] μmol/L) ,tubulointerstitial fibrosis index (2 .00 ± 0 .12 ,1 .70 ± 0 .10 vs .2 .80 ± 0 .11) ,expression of α-SMA (0 .22 ± 0 .02 ,0 .20 ± 0 .03 vs .0 .24 ± 0 .02) ,and expression of TGF-β (0 .26 ± 0 .03 ,0 .25 ± 0 .03 vs .0 .32 ± 0 .04) in LV group and HV group decreased significantly (P< 0 .05) ,while the expression of E-cadherin (0 .30 ± 0 .08 ,0 .34 ± 0 .11 vs .0 .22 ± 0 .07 ) increased . Compared with those in LV group , the SCr level , tubulointerstitial fibrosis index , tubulointerstitial injury index ,expression of α-SMA ,and expression of TGF-β ,in HV group decreased significantly ( P <0 .05) ,while the expression of E-cadherin increased (P< 0 .05) .Correlation analysis showed that the expressions of TGF-β andα-SMA were positively correlated with tubulointerstitial fibrosis index . E-cadherin was negatively correlated with tubulointerstitial fibrosis index .TGF-β was positively correlated with α-SMA .E-cadherin was negatively correlated with TGF-β .α-SMA was negatively correlated with E-cadherin .Conclusions : Active vitamin D3 can relieve renal tubulointerstitial fibrosis in UUO rats .Its possible mechanism is that the tubular epithelial-myofibroblast transdifferentiation (EM T ) is suppressed by inhibiting the over expression of TGF-β so as to relieve the renal tubulointerstitial fibrosis .The effect of the high dose of active vitamin D3 for relieving renal tubulointerstitial fibrosis is superior to that of low dose of active vitamin D3 .

Objective To evaluate the characteristics of brachyfacial types in adolescents with class Ⅱ~1 division 1 malocclusions by comparing with normal patterns.Methods 32 parameters were evaluated in pretreatment lateral cephalograms of 60 brachyfacial type adolescents,including 30 boys and 30 girls,aged from 11 to 13 years,with class Ⅱ~1 division 1 malocclusions(distal moral relationship,ANB＞5°,Go-Gn-SN＞28°).Results There was a remarkable increase in SNA,ANB,upper incisor inclination (U1-NA),U1-L1/N-Me and Me-L1/N-Me,so was lip protrusion of soft tissue facial profile(NB-Pg'-Ls);the lower sulcus depth(Si-Pg'-Ls)and the lower lip thickness(Li-L1).Mandibular plane(Go-Gn-SN),OP-MP,OP-FH,U1-L1,anterior lower facial height(ANS-Me),anterior lower facial height/anterior facial height(ANS-Me/N-Me),anterior lower facial height/posterior lower facial height (ALFH/PLFH)and mandibular length(B'-J')were significantly decreased.Conslusions Brachyfacial type in adolescents with class Ⅱ'division 1 malocclusions is characterized by decreased anterior lower facial height,increased posterior lower facial height,clockwise rotation of the palatal plane,anticlockwise rotation of the occlusion plane and mandibular plane,deepen overbite,soft tissue protrusive profiles with upper lip protrusion,crimpled lower lip and retracted chin.

Objective To study the prevalence,treatment policy and control of hypertension in patients with maintenance hemodialysis, and to analyze the influencing factors of hypertension control.Methods We studied the current status of 1382 patients with maintenance hemodialysis in 11 dialysis centers in Shanghai, among them 809 were male, and 573 were female.Hypertension was defined as systolic blood pressure(SBP) ≥ 140 and/or diastolic blood pressure (DBP) ≥90 mm Hg ( 1 mm Hg = 0.133 kPa).Those who had a history of hypertension and requiring antihypertensive therapy were also diagnosed as hypertension though their blood pressure was within normal range during the survey.Hypertension control was defined as blood pressure ＜ 140/90 mm Hg before each dialysis session.Results The prevalence of hypertension in the hemodialysis patients was 86.3%.The treatment rate and control rate in those patients were 96.8% and 25.5% respectively.More than half (50.4% ) of patients were treated with only one kind of anti-hypertensive drug, and 34.4% with 2 kinds, 14.2% with 3 kinds, 1.0% with 4 kinds or more.Calcium channel blocker (CCB) was the most frequently prescribed drug (61.0%), followed by angiotensin Ⅱ receptor blockers ( 56.4% ), centrally acting anti-hypertensive agent ( 26.4% ), beta blockers and alpha, beta-blockers( 14.0% ).The control rate of hypertension in those hemodialysis people was aggravated by the existence of coronary artery disease.The patients who need more kinds of antihypertensive agents have a poorer control rate of hypertension.The hypertension control rate elevated significantly with the adequate hemodialysis.Conclusions There is a very high prevalence of hypertension in maintenance hemodialysis patients.Although the treatment rate is high, the control rate is unsatisfactory.So the control of hypertension in hemodialysis patient is still a clinical challenge.Appropriate dialysis adequacy, reasonable use of erythropoietin, treatment of heart disease and judicious use of antihypertensive drugs may be helpful to improve the clinical outcome.

BACKGROUND: Orthodontic tooth movement is dependent on reconstruction of periodontium. Osteoclastic bone resorption is the first step of tooth movement. The present study hotspots focus on signal transduction pathway regarding osteoclast differentiation and functional development under stress and on the relationship between periodontal ligament cells and osteoclasts. OBJECTIVE: To set up a simple method to in vitro culture human osteoclast-like cells and to observe the effects of bone resorption-stimulating factors on differentiation, proliferation, and function of osteoclast-like cells, DESIGN, TIME AND STTING: A cytological in vitro controUod observation was performed at the Central Laboratory,Stomatology Hospital, Xi'an Jiaotong University between October 2007 and May 2008. MATERIALS: Umbilical cord blood was sourced from the healthy puerperae who had not suffered from high-risk pregnancy. Freshly prepared fetal femur provided by Laboratory Animal Center, Xi'an Jiaotong University and were used for preparation of bone flaps at 100-200 μm thickness. 1α ,25-(OH)2D3, macrophage colony-stimulating factor (M-CSF), prostaglandin E2 were purchased from Sigma Company, USA.METHODS: Under aseptic condition, umbilical cord blood was collected. Following Ficoll solution separation and centrifugation, supematant was discarded. Umbilical cord blood-derived mononuclear cells were suspended with o -modified minimal essential medium (α-MEM) solution and then inoculated into a 24-well culture plate, in which, coverslips and femoral slices were pre-placed, at a density of 1×109/L, 1.0 mL per well. Five groups were set, blank control, 108 mol/L 1α ,25-(OH)2D3, 10-7 mol/L 1α ,25-(OH)2D3, macrophage colony stimulating factor (M-CSF), and 1α ,25-(OH)2D3+prostaglandin E2 (PGE2). Each group was cultured for 7 days. MAIN OUTCOME MEASURES: Cellular growth morphology was observed under an inverted microscope; osteoclast-like celt formation was examined by tartrate-resistant acid phosphatase (TRAP) staining; and osteoclastic Howship's lacuna was detected by toluidine blue staining. Any cell with TRAP-positive staining and more than two nuclei was considered osteoclast-like cell and counted. RESULTS: After 3 days of culture, cells from the blank control group did not exhibit apparent changes in morphology and quantity. In the remaining groups, mononuclear cells appeared with confluent tendency. After 7 days of culture, a small number of osteoclast- like cells with 2-3 nuclei were found in the blank control group; a great many of multinucleated osteoclast- like cells with 3-20 nuclei were present in the remaining groups. Through the use of optical microscope, osteoclast-like cells could be found for the presence of red cytoplasm, bright yellow nuclei, and TRAP-positive staining in each inducing factor-treated group, in particular in the 108 mol/L 1α ,25-(OH)2D3 group, which displayed osteoclast- like cells exhibiting 14 nuclei, strong TRAP-positive staining, and a relatively big cell body. But no osteoclastic Howship's lacuna was found in any group. Compared to the blank control group, the numbers of osteoclast-like cells were greater in each inducing factor-treated group (F = 9.78, P < 0.01). There was no significant difference in the numbers of osteoclast-like cells between the 108 mol/L 1α ,25-(OH)2D3 and the 10-7 mol/L 1 a ,25-(OH)2D3 groups (P0.05). The M-CSF group and the 1α ,25-(OH)2D3+PGE2 group exhibited significantly less numbers of osteoclast-like cells than the 108 mol/L 1α ,25-(OH)2D3 group (F= 7.46, P< 0.01). CONCLUSION: After in vitro culture of 1α ,25-(OH)2D3, M-CSF, and PGE2, umbilical cord blood-derived mononuclear cells can differentiate into TRAP-positive multinucleated osteoclast-like cells, the 10-8 mol/L 1α ,25-(OH)2D3 being the most effective.

Objective To analyze the relationship between insulin resistance (IR) and left ventricular hypertrophy ( LVH ) in patients with early chronic kidney disease ( CKD ). Methods Homeostatic model method was used for detecting insulin resistance index (Homa-IR) in 108 patients with early CKD and 25 normal healthy cases, and the other clinical data such as Hb, creatinine clearance rate (Ccr) , parathyroid hormone (PTH) , ambulatory blood pressure monitoring ( ABPM ) data, including day average systolic blood pressure (dSBP), day average diastolic blood pressure (dDBP), night average systolic blood pressure ( nSBP) , night average diastolic blood pressure ( nDBP) , 24-hour mean systolic blood pressure (mSBP), 24-hour mean diastolic blood pressure (mDBP), decline in the percentage of diastolic blood pressure at night (nDPD) and decline in the percentage of systolic blood pressure at night (nDPS) were also measured. Echocardiography was used for measuring LVH relevant data, and left ventricular mass index (LVMI) was calculated. Then, the relationship between LVH and IR and other clinical data were analyzed retrospectively. Results IR existed in early CKD patients. With the decline of Ccr, both the value of Homa-IR and the incidence of IR increased significantly (both P < 0. 05). LVH existed in early CKD patients and with the decline of Ccr, both LVMI value and the incidence of LVH increased significantly (both P <0. 01). Compared with the non-IR group, the IR group had higher LVMI value (P<0. 05) and higher incidence of LVH (P<0. 01). Compared with the non-LVH group, the LVH group had higher levels of Fins, 2hPG, Homa-IR (all P <0. 05), and higher incidence of IR (P <0. 01). The LVH group had significant lower levels of Ccr, Hb and nDPD (all P <0. 05) , higher levels of dSBP, dDBP, nSBP, nDBP, mSBP, mDBP and PTH (all P<0.05) than the non-LVH group. LVMI had significant positive correlations with 2hPG, Fins, Homa-IR, dSBP, nSBP, mSBP and PTH (r = 0.255, 0.373, 0.376,0.222,0.199,0.225,0.221,0.246, respectively; all P<0.05), but significant negative correlations with Hb and Ccr (r = -0.588,-0.313, respectively; both P<0.01). Multi-factor regression analysis showed that Hb, Homa-IR, and Ccr entered the regression equation (y = 167. 106 - 0. 755x_1 + 0. 250x_2 +0.322x_3, y = LVMI; 167. 106 = constant, t = 12. 138, P =0.000; x_1 =Hb, t= -6.800, P = 0. 000; x_2 = Homa-IR, t = 3. 229, P = 0. 002; x_3 = Ccr, t = 2. 898, P = 0. 005). Conclusion IR existed in early CKD patients and become more severe with the decline of renal function. IR had a significant correlation with LVH, and it may be an important risk factor for the development of LVH. Besides, both anemia and decline of renal function are also associated with LVH.