Metanephric adenoma is a rare renal epithelial tumor with a low incidence and lack of specific clinical manifestations，resulting in a lack of uniformity in clinical understanding and treatment. Its etiology and pathogenesis are still unclear，and it may be related to the abnormal number and structure of chromosomes 2，7，and 17，as well as mutations in genes such as BRAF V600E，NF1，and NOTCH1，etc. There may be a transformed relationship between this tumor and Wilms’ tumor and papillary renal cell carcinoma. For diagnosis，it has diverse but non-specific clinical manifestations，and it is difficult to accurately differentiate it from other tumors in the imaging examination，and the confirmation of diagnosis relies on pathological and immunohistochemical staining. Treatment is mainly based on surgery to preserve the renal unit，such as partial nephrectomy，etc.，but the difficulty of preoperative diagnosis often leads to over-treatment，and there is a lack of standardized treatment protocols for metastatic posterior renal adenoma. The aim of this article is to provide a reference for the in-depth understanding of posterior renal adenomas and to optimize the clinical diagnosis and treatment strategies.

Metanephric adenoma is a rare renal epithelial tumor with a low incidence and lack of specific clinical manifestations，resulting in a lack of uniformity in clinical understanding and treatment. Its etiology and pathogenesis are still unclear，and it may be related to the abnormal number and structure of chromosomes 2，7，and 17，as well as mutations in genes such as BRAF V600E，NF1，and NOTCH1，etc. There may be a transformed relationship between this tumor and Wilms’ tumor and papillary renal cell carcinoma. For diagnosis，it has diverse but non-specific clinical manifestations，and it is difficult to accurately differentiate it from other tumors in the imaging examination，and the confirmation of diagnosis relies on pathological and immunohistochemical staining. Treatment is mainly based on surgery to preserve the renal unit，such as partial nephrectomy，etc.，but the difficulty of preoperative diagnosis often leads to over-treatment，and there is a lack of standardized treatment protocols for metastatic posterior renal adenoma. The aim of this article is to provide a reference for the in-depth understanding of posterior renal adenomas and to optimize the clinical diagnosis and treatment strategies.

This paper summarises the nursing care in an ischemia-free liver transplantation combined with islet transplantation of a patient with hepatocellular cancer,hepatic cirrhosis and Type Ⅱ diabetes.The key measures of nursing care include postoperative observations and cares to prevent thrombosis and bleeding,monitoring the functions of transplanted liver and islet to avoid an immune rejection,and application of a scientific and effective nutritional management.After 17 days of treatment and nursing care,the patient was discharged.

This paper summarises the nursing care in an ischemia-free liver transplantation combined with islet transplantation of a patient with hepatocellular cancer,hepatic cirrhosis and Type Ⅱ diabetes.The key measures of nursing care include postoperative observations and cares to prevent thrombosis and bleeding,monitoring the functions of transplanted liver and islet to avoid an immune rejection,and application of a scientific and effective nutritional management.After 17 days of treatment and nursing care,the patient was discharged.

Objective:To investigate the clinical features and associated influencing factors of cognitive impairment in middle-aged and elderly Chinese adult patients undergoing maintenance hemodialysis (HD).Methods:A cross-sectional study was conducted among HD patients from 11 centers in Beijing city from April 2017 to June 2017. A neuropsychological battery covering domains of attention/processing speed, executive function, memory, language, and visuospatial function was applied in cognitive function assessment. Patients were classified as normal cognitive function group and cognitive impairment group according to the fifth version of the diagnostic and statistical manual of mental disorders criteria (DSM-V). Multivariate binary logistic regression was used to analyze the independent influencing factors of cognitive impairment. Results:A total of 613 HD patients were included in the study, and the prevalence of cognitive impairment was 80.91% (496/613). Attention impairment (81.05%) and memory impairment (63.51%) were the most common impaired domains, and 79.23% was concomitant impairment across two or more cognitive domains among those with cognitive impairment. Compared with the patients in the normal cognitive function group, the patients in the cognitive impairment group had senior age, longer dialysis vintage, higher proportion of diabetes, hypertension, and stroke, higher level of serum intact parathyroid hormone (iPTH), lower education level, and lower urea clearance index (Kt/V) (all P<0.05). Factors were independently associated with cognitive impairment including increasing age ( OR=1.110, 95% CI 1.072-1.150, P<0.001), education time>12 years (with education time<6 years as reference, OR=0.323, 95% CI 0.115-0.909, P=0.032), history of diabetes ( OR=2.151, 95% CI 1.272-3.636, P=0.004), history of stroke ( OR=2.546, 95% CI 1.244-5.210, P=0.011), increased dialysis vintage ( OR=1.016, 95% CI 1.010-1.022, P<0.001), reduced Kt/V( OR=0.008, 95% CI 0.002-0.035, P<0.001), and increased iPTH level ( OR=1.002, 95% CI 1.002-1.003, P=0.012). Conclusions:The prevalence of cognitive impairment in middle-aged and elderly adult Chinese patients undergoing HD is high. Memory and attention are the most commonly impaired domains. Increasing age, low education level, history of diabetes and stroke, increased dialysis vintage, reduced Kt/V and increased serum iPTH are the independent influencing factors associated with cognitive impairment.

Objective:To investigate the association between cognitive impairment and all-cause mortality in middle and elderly adult patients undergoing maintenance hemodialysis (HD).Methods:A prospective cohort study was conducted. Patients from 11 HD centers in Beijing between April and June 2017 were enrolled. Baseline data were collected, and a series of neuropsychological batteries covered 5 domains of cognitive function were applied for the assessment of cognitive function. The patients were then classified as normal and cognitive impairment groups according to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-V) and followed-up until June 2018. The clinical characteristics of the two groups of patients were compared. Kaplan-Meier survival analysis was used to compare the difference in the cumulative survival rate between the two groups. Multivariate Cox regression model was used to analyze the independent influencing factors of all-cause mortality, to determine the relationship between cognitive impairment and different cognitive domain impairments and all-cause death.Results:A total of 613 patients were enrolled, of which 496(80.91%) patients had cognitive impairment. Compared with the normal cognitive function group, the patients in the cognitive impairment group tended to be older, longer dialysis vintage, a higher proportion of diabetes, hypertension, and stroke, increased serum iPTH level, and lower education level and urea clearance index (Kt/V) (all P<0.05). After (49.53±8.42) weeks of follow-up, Kaplan-Meier survival analysis showed that the cumulative survival rate of cognitive impairment group was significantly lower than that of cognitive normal group (Log-rank χ2=8.610, P=0.003). Multivariate Cox regression analysis showed that history of diabetes ( HR=2.742, 95% CI 1.598-4.723, P<0.001), coronary heart disease ( HR=1.906, 95% CI 1.169-3.108, P=0.010), dialysis vintage (every increase of 1 month, HR=1.007, 95% CI 1.003-1.011, P=0.001), serum level of albumin (every increase of 1 g/L, HR=0.859, 95% CI 0.809-0.912, P<0.001), cognitive impairment ( HR=2.719, 95% CI 1.088-6.194, P=0.032) were independently associated with all-cause mortality. Multivariate Cox regression analysis on different cognitive domains also indicated that memory impairment ( HR=2.571, 95% CI 1.442-4.584, P<0.001), executive function impairment ( HR=3.311, 95% CI 1.843-5.949, P=0.001) and three, four, five domains combined impairment ( HR=5.746, 95% CI 1.880-17.565, P=0.002; HR=12.420, 95% CI 3.690-41.802, P<0.001; HR=13.478, 95% CI 3.381-53.728, P<0.001) were independently related to all-cause mortality. Conclusions:Cognitive impairment is an independent risk factor of all-cause mortality in middle and elderly adult patients undergoing maintenance hemodialysis, and the risk is significantly increased in patients with the impairment of the domains of memory, executive function, or in the combination of three to five cognitive domains.

Objective To summarize the perioperative nursing care of a patient with ischemia-free liver transplantation. Methods The nursing measures were developed according to the characteristics of the disease and the individual conditions of the patients: including preoperative psychological care;preoperative preparation; prevention of postoperative infection; meticulous observation of the patient′s conditions, transplanted liver function and postoperative complications; the early guidance of rehabilitation activity, nutritional support treatment and the care of water and electrolyte balance. Results The patient recovered well with careful nursing care and no nursing-related complications occurred, and he was discharged successfully on the 18th day after surgery. Conclusion According to the patient's condition and individual situation, the development of nursing measures can effectively prevent the potential infection, timely discover the changes of the patient′s condition, understand the recovery of the transplanted liver function and observe the related postoperative complications, and help to promote the early recovery of patients.

Exploratory experiment is the key to the experimental physiology,which is universally applicable training of innovative talents.More importantly,it is an important way to cultivate innovative talents of medicine.On the basis of the original multi-subject evaluation system,we have formed a comprehensive evaluation system through refining the scoring item for teachers and students,enriching the forms of student evaluation,and building the student self-assessment.This comprehensive evaluation system is set to promote the development of experimental physiology,especially the exploratory experiments.The practice of this evaluation system effectively improve the objectivity of the evaluation,provide a basis for reform of exploratory experiment,and then promote the training of innovative talents.

Objective To investigate the nursing points of pancreatic leakage after upper abdominal multiple organ transplantation. Methods A retrospective study was conducted on the nursing experience of two patients with end-stage liver disease and type 2 diabetes mellitus who were complicated with pancreatic leakage after upper abdominal multiple organ transplantation from March 2009 to July 2015. Results The blood glucose of these patients returned to normal level within 1 week after operation and insulin was discontinued. Pancreatic leakage was occurred in the two patients at 14 and 21 days after operation, respectively. They were both successfully discharged after active treatments and nursing cares including completely drainage, the application of drugs that inhibited the secretion of pancreatic enzymes and digestive tract glands, strengthening infection control, nutritional support and other conservative treatments. Conclusions It is the key to improve the recovery of pancreatic leakage after upper abdominal multiple organ transplantation with careful observation of abdominal signs and abdominal drainage tube, accurate use of somatostatin, nutritional support, maintenance of water and electrolyte balance, and psychological intervention.

Objective To investigate the nursing of the adult recipients who accept children organ donations after cardiac death(DCD)complicated with portal venous thrombosis after liver transplantation. Methods We retrospectively analyzed 1 case completed in 2015 related to the adult recipients who accept children organ donations after cardiac death with portal venous thrombosis after liver transplantation in clinical situation,in view of the portal vein thrombosis of portal vein catheter thrombolysis,portal vein carotid stenting, close observation and nursing are used for patients′condition change. Results After positive clinical therapy and careful nursing,portal venous thrombolysis effect is good, and portal venous blood flowing after carotid stenting,clinical symptoms were alleviated. The liver function recovered well after surgery, and the patient discharged successfully,followed by regular visits from the hospital. Conclusions Children organ donations after cardiac death for liver can be successfully applied in the adult recipients,but the understanding of related complications after surgery need to be strengthened.The symptom observation,early detection,active nursing intervention,are conducive to the prognosis of patients.