Objective:To investigate the incidence, risk factors and prognosis of acute renal injury(AKI)in elderly patients with respiratory distress syndrome(ARDS).Methods:The elderly patients with ARDS treated in the Department of Respiratory Medicine, Emergency Department and Geriatrics of the Second People's Hospital of Lianyungang from July 2016 to July 2019 were divided into AKI group and non-AKl group according to KDIGO diagnostic criteria.The clinical data and the differences were compared and analyzed between the two groups.Binary Logistic regression was used to analyze Risk factors for AKI.Kaplan-Meier cure was used to analyze the influence of different stages of AKI on the prognosis of ARDS patients.The Cox proportional hazards model was used to analysis risk factors for AKI and ARDS on elderly patients＇prognosis.Results:A total of 432 elderly patients with ARDS were enrolled in the study, in which the mean age was 74.7 ± 8.8 years, and AKI occurred in 129 cases(29.9%). Compared with non-AKI group, AKI group showed older age, and higher proportion of the incidences of hypertension, diabetes, atrial fibrillation, consciousness disturbance, mechanical ventilation and a low mean arterial pressure(all P<0.05). The incidence of AKI was increased significantly in patients with moderate to severe ARDS( P< 0.001). The levels of basal creatinine, AST and NT-proBNP were significantly higher in AKI Group than in non-AKI Group( P= 0.001, P< 0.001, P< 0.001). AKI Group patients had the more elevated inflammatory marker level of neutrophil / lymphocyte ratio(NLR)( P= 0.003)and D-dimer( P< 0.001), and the level of high-sensitivity c-reactive protein(hsCRP)( P=0.040). AKI group showed the increased incidence of urine protein( P< 0.001), low ejection fraction( P= 0.040), and positive rate of pleural effusion( P= 0.003). Logistic Regression analysis showed the following independent risk factors for the development of ARDS-associated AKI, included hypertension( OR: 1.789, 95%, CI: 1.105-2.894, P=0.018), diabetes( OR: 1.976, 95% CI: 1.076-3.628, P=0.028), consciousness disturbance( OR: 2.531, 95% CI: 1.203-5.251, P=0.014), mechanical ventilation( OR: 3.421, 95% CI: 1.521-7.694, P=0.003), AST>40 U/L( OR: 2.495, 95% CI: 1.431-4.348, P=0.001), increased basal creatinine levels( OR: 1.014, 95% CI: 1.002-1.027, P=0.024), and NLR( OR: 1.015, 95% CI: 1.001-1.029, P=0.042). Kaplan-Meier survival curve showed that there was a significant difference in the prognosis between patients with different AKI stages( χ2=19.790, P<0.001), and there was no significant difference in the prognosis between stage 1-AKI and non-AKI( χ2=2.188, P=0.139). The risk of poor prognosis was higher in AKI(stage 2-3)group( χ2=18.268, P<0.001; χ2=6.347, P=0.012)than in patients without AKI or stage 1 AKI.Multivariate Cox Proportional Hazard Model Analysis elucidated that AKI( HR: 1.858, 95% CI: 1.207-2.861, P= 0.005)and moderate-severe ARDS( HR: 1.815, 95% CI: 1.167-2.822, P=0.008)were independent risk factors for poor prognosis of ARDS in the elderly. Conclusions:Hypertension, diabetes, disturbance of consciousness, mechanical ventilation, AST>40 U/L, elevated levels of basal creatinine and NLR are independent risk factors for ARDS-associated AKI in elderly patients with ARDS.Patients with moderate-severe ARDS and AKI(2-3 phases)have the increased risk of poor prognosis.

Objective:To explore the effects of hyperbaric oxygen-assisted hemoperfusion on renal function and immune inflammatory cytokines in patients with end-stage diabetic nephropathy (ESDN).Methods:A total of 92 patients with ESDN admitted to the Department of Nephrology of the Second People’s Hospital of Lianyungang from June 2016 to December 2017 were randomly divided into control group ( n=46) and observation group ( n=46). The control group was given conventional treatment and the combination of hemodialysis with hemoperfusion, while the observation group was treated with hyperbaric oxygen on the basis of the treatments of the control group. The levels of fasting blood glucose (FBG), 24-hour urinary protein (24 h Upro), blood urea nitrogen, creatinine (Cr), uric acid and albumin (ALB), and the contents of immune inflammatory cytokines such as interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-17 (IL-17), monocyte chemoattractant protein-1 (MCP-1), and hypersensitive C-reactive protein (hs-CRP) were compared between the two groups before and after treatment. Results:After treatment, the levels of FBG, renal function indicators, and the contents of immune inflammatory cytokines in the two groups were significantly improved in comparison with those before treatment ( P<0.05). The levels of Cr, 24 h Upro, and ALB in the observation group were (482.54±166.46) μmol/L, (1 095.34±154.78) mg, and (33.04±3.91) g/L, respectively, which were significantly better than those in the control group ( P<0.05). The improvements in IL-6, IL-10, IL-17, MCP-1, and hs-CRP contents in the observation group were significantly better than those in the control group ( P<0.05). The incidences of complications such as hypoglycemia, hypoxemia, hypotension, infection, and cardio-cerebrovascular events in the observation group were also significantly lower than those in the control group ( P<0.05). Conclusion:Hyperbaric oxygen-assisted hemoperfusion can effectively inhibit vascular endothelial injury due to inflammatory irritation and restore renal microvascular circulation to improve renal function by reducing the contents of IL-6, IL-17, MCP-1, and hs-CRP, and increasing IL-10 content in ESDN patients.

Objective:To explore the effects of hyperbaric oxygen-assisted hemoperfusion on renal function and immune inflammatory cytokines in patients with end-stage diabetic nephropathy (ESDN).Methods:A total of 92 patients with ESDN admitted to the Department of Nephrology of the Second People’s Hospital of Lianyungang from June 2016 to December 2017 were randomly divided into control group ( n=46) and observation group ( n=46). The control group was given conventional treatment and the combination of hemodialysis with hemoperfusion, while the observation group was treated with hyperbaric oxygen on the basis of the treatments of the control group. The levels of fasting blood glucose (FBG), 24-hour urinary protein (24 h Upro), blood urea nitrogen, creatinine (Cr), uric acid and albumin (ALB), and the contents of immune inflammatory cytokines such as interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-17 (IL-17), monocyte chemoattractant protein-1 (MCP-1), and hypersensitive C-reactive protein (hs-CRP) were compared between the two groups before and after treatment. Results:After treatment, the levels of FBG, renal function indicators, and the contents of immune inflammatory cytokines in the two groups were significantly improved in comparison with those before treatment ( P<0.05). The levels of Cr, 24 h Upro, and ALB in the observation group were (482.54±166.46) μmol/L, (1 095.34±154.78) mg, and (33.04±3.91) g/L, respectively, which were significantly better than those in the control group ( P<0.05). The improvements in IL-6, IL-10, IL-17, MCP-1, and hs-CRP contents in the observation group were significantly better than those in the control group ( P<0.05). The incidences of complications such as hypoglycemia, hypoxemia, hypotension, infection, and cardio-cerebrovascular events in the observation group were also significantly lower than those in the control group ( P<0.05). Conclusion:Hyperbaric oxygen-assisted hemoperfusion can effectively inhibit vascular endothelial injury due to inflammatory irritation and restore renal microvascular circulation to improve renal function by reducing the contents of IL-6, IL-17, MCP-1, and hs-CRP, and increasing IL-10 content in ESDN patients.

This study examined the effect of insulin on the expression of very low density lipoprotein receptor (VLDLR) subtypes of SGC7901 cells and discussed its biological implication. In vitro, moderately or poorly-differentiated human gastric adenocarcinoma cell line SGC7901 was incubated with insulin for different lengths of time, and then the expression of protein and RNA level in VLDLR subtypes were detected by Western blotting and real-time PCR, respectively. The results showed that, at certain time interval, insulin could down-regulate expression of type I VLDLR and up-regulate the expression of type II VLDLR in SGC7901 cells, at both protein and RNA level. We are led to conclude that insulin serves as a regulator in maintaining the balance between glucose and lipid metabolism in vivo, possibly through its effect on the differential expression of VLDLR subtypes.

This study examined the effect of insulin on the expression of very low density lipoprotein receptor (VLDLR) subtypes of SGC7901 cells and discussed its biological implication. In vitro,moderately or poorly-differentiated human gastric adenocarcinoma cell line SGC7901 was incubated with insulin for different lengths of time, and then the expression of protein and RNA level in VLDLR subtypes were detected by Western blotting and real-time PCR, respectively. The results showed that, at certain time interval, insulin could down-regulate expression of type Ⅰ VLDLR and up-regulate the expression of type Ⅱ VLDLR in SGC7901 cells, at both protein and RNA level.We are led to conclude that insulin serves as a regulator in maintaining the balance between glucose and lipid metabolism in vivo, possibly through its effect on the differential expression of VLDLR subtypes.