Objective To investigate the therapeutic effect of gabapentin combined with hemoperfusion on skin pruritus in the patients on maintenance hemodialysis(MHD).Methods A total of 72 patients with MHD complicating moderate to severe skin itching treated in Lianyungang Municipal Oriental Hospital from January 2023 to March 2024 were selected as the study subjects and divided into the observation group and control group by the random number table method,36 cases in each group.On the basis of symptomatic treat-ment,the control group was given hemodialysis 3 times a week and hemoperfusion twice a month;on the basis of the control group,the observation group orally took 1 gabapentin capsule every night,and the patients in the two groups continued to be treated for 12 weeks.The visual analogue scale(VAS)score,Pittsburgh Sleep Quality Index(PSQI)score,molecular toxin level and calcium and phosphorus metabolism were evaluated be-fore treatment,in 4,12 weeks after treatment respectively,and the occurrence of adverse reactions during treatment in the two groups was observed.Results After 4 weeks and 12 weeks of treatment,the VAS and PSQI scores of the observation group were decreased compared with those before treatment,moreover the scores of the observation group were lower than those of the control group in the same period,and the differ-ences were statistically significant(P<0.05);the VAS and PSQI scores after 4 weeks of treatment in the control group were decreased compared with those before treatment,but the difference was not statistically significant(P>0.05);and the VAS and PSQI scores after 12 weeks of treatment in the control group were decreased compared with before treatment,and the difference was statistically significant(P<0.05).After 4 weeks of treatment,the levels of Scr,BUN and β2-MG in the two groups were decreased compared with those before treatment,but the differences were not statistically significant(P>0.05);after 12 weeks of treatment,the levels of Scr,BUN and β2-MG in the two groups were decreased compared with those before treatment and after 4 weeks of treatment,and the differences were statistically significant(P<0.05),but there was no sta-tistically significant difference between the two groups(P>0.05).After 4 weeks of treatment,there was no statistically significant difference in the levels of blood Ca,P and iPTH between the two groups compared with before treatment(P>0.05);after 12 weeks of treatment,except for blood Ca,the levels of blood P and iPTH in the two groups were decreased compared with those before treatment and in 4 weeks of treatment(P<0.05),and the differences were statistically significant(P<0.05),but there was no statistical difference be-tween the two groups(P>0.05).There were no adverse reactions in the control group,and there were 3 cases of drowsiness,1 case of fatigue and 1 case of dizziness at the beginning of treatment in the observation group.The symptoms were mild without treatment and spontaneously relieved in about 1 week.Conclusion Gabap-entin combined with hemoperfusion could quickly and effectively alleviate the itchy symptoms of skin,improve the sleep quality,reduce the uremic toxin levels,and improve the calcium and phosphorus metabolism in MHD patients,with few adverse reactions,and the patients are easy to tolerate.

Objective To analyze the expression levels of serum GINS complex 4(GINS4)and PD-1 in patients with gastric cancer before surgery and to explore the relationship between these two factors and the clinicopathological characteristics and prognosis of these patients.Methods A total of 95 patients with gastric cancer treated at the First People's Hospital of Nanyang between August 2016 and August 2018 were included in this study.The patients were followed-up for 5 years and divided into survival and death groups based on their survival at the end of the follow-up.A total of 95 healthy individuals in the same period were selected as the control group.The serum PD-1 levels before surgery were measured using an enzyme-linked immunosorbent assay(ELISA).The level of serum GINS4 mRNA before surgery was detected with real-time quantitative PCR.The relationship between serum GINS4 mRNA and PD-1 levels prior to surgery and the 5-year survival rate in the patients with gastric cancer were analyzed using the Kaplan-Meier method.Cox regression was used to analyze the factors affecting gastric cancer prognosis.Results The serum levels of GINS4 mRNA and PD-1 were significantly higher in the patients with gastric cancer than in the healty controls(P＜0.05).The serum levels of GINS4 mRNA and PD-1 in patients with poorly differentiated tissues in TNM stages Ⅲ and Ⅳ,and lymph node metastasis were significantly higher than those in patients with moderately/highly differentiated tissues,in TNM stage Ⅱ,and no lymph node metastasis(P＜0.05).The serum levels of GINS4 mRNA and PD-1,proportio of patients with TNM stages Ⅲ and Ⅳ,and the proportion of patients with lymph node metastasis in the death group were significantly higher than those in the survival group(P＜0.05).According to the results of Kaplan-Meier analysis,the 5-year survival rate of patients with gastric cancer with high serum expression levels of GINS4 mRNA and PD-1 was lower than that of patients with low expression levels of GINS4 mRNA and PD-1(P＜0.05).GINS4 mRNA and PD-1 levels were independent risk factors for death in patients with gastric cancer(P＜0.05).Conclusion The expression levels of serum GINS4 mRNA and PD-1 in patients with gastric cancer were higher than those of the controls,which were related to tissue differentiation,TNM staging,lymph node metastasis,and prognosis.

Objective To analyze the expression levels of serum GINS complex 4(GINS4)and PD-1 in patients with gastric cancer before surgery and to explore the relationship between these two factors and the clinicopathological characteristics and prognosis of these patients.Methods A total of 95 patients with gastric cancer treated at the First People's Hospital of Nanyang between August 2016 and August 2018 were included in this study.The patients were followed-up for 5 years and divided into survival and death groups based on their survival at the end of the follow-up.A total of 95 healthy individuals in the same period were selected as the control group.The serum PD-1 levels before surgery were measured using an enzyme-linked immunosorbent assay(ELISA).The level of serum GINS4 mRNA before surgery was detected with real-time quantitative PCR.The relationship between serum GINS4 mRNA and PD-1 levels prior to surgery and the 5-year survival rate in the patients with gastric cancer were analyzed using the Kaplan-Meier method.Cox regression was used to analyze the factors affecting gastric cancer prognosis.Results The serum levels of GINS4 mRNA and PD-1 were significantly higher in the patients with gastric cancer than in the healty controls(P＜0.05).The serum levels of GINS4 mRNA and PD-1 in patients with poorly differentiated tissues in TNM stages Ⅲ and Ⅳ,and lymph node metastasis were significantly higher than those in patients with moderately/highly differentiated tissues,in TNM stage Ⅱ,and no lymph node metastasis(P＜0.05).The serum levels of GINS4 mRNA and PD-1,proportio of patients with TNM stages Ⅲ and Ⅳ,and the proportion of patients with lymph node metastasis in the death group were significantly higher than those in the survival group(P＜0.05).According to the results of Kaplan-Meier analysis,the 5-year survival rate of patients with gastric cancer with high serum expression levels of GINS4 mRNA and PD-1 was lower than that of patients with low expression levels of GINS4 mRNA and PD-1(P＜0.05).GINS4 mRNA and PD-1 levels were independent risk factors for death in patients with gastric cancer(P＜0.05).Conclusion The expression levels of serum GINS4 mRNA and PD-1 in patients with gastric cancer were higher than those of the controls,which were related to tissue differentiation,TNM staging,lymph node metastasis,and prognosis.

Objective:To observe heart rate circadian rhythm in patients with chronic kidney disease (CKD) stage 5 and to analyze the effects of parathyroidectomy (PTX) on heart rate circadian rhythm in severe secondary hyperparathyroidism (SHPT) patients.Methods:A cross-sectional observation was performed in 213 patients with CKD stage 5 and 96 controls, and the patients were divided into those with severe SHPT (PTX group, n=70) and without severe SHPT (non-PTX group, n=143). Forty-six PTX patients were followed up prospectively. The baseline data were compared among these groups. Holter electrocardiogram was performed for each participant. Non-dipping heart rate was defined as night/day heart rate ratio greater than 0.9. Multiple linear regression analysis was used to analyze the related factors of heart rate circadian rhythm in patients with CKD stage 5. Results:The 24-hour, daytime and nighttime mean heart rate in patients with CKD stage 5 were all higher than those in controls, especially in PTX group (all P<0.05). The night/day heart rate ratios of controls and CKD stage 5 patients were (0.81±0.08) and (0.91±0.08) respectively ( P<0.01). Correlation analysis showed 24-hour and daytime or nighttime mean heart rate in patients with CKD stage 5 were positively correlated with serum levels of phosphorus and ln(alkaline phosphatase), while nighttime mean heart rate and night/day heart rate ratio were positively related with serum intact parathyroid hormone level. After adjusting with postoperative follow-up period (median time: 10.9 months), 24-hour and nighttime mean heart rate, and night/day heart rate ratio in PTX patients all decreased significantly (all P<0.01). Conclusions:Heart rate is increased and circadian rhythm is abnormal in patients with CKD stage 5, which are related with mineral and bone disorder. PTX significantly decreases 24-hour and nighttime mean heart rate in severe SHPT patients, and improves the heart rate circadian rhythm.

Objective:To investigate the predictive value of abnormal heart rate circadian rhythm for all-cause mortality in stage 5 chronic kidney disease (CKD 5) patients.Methods:The retrospective study was performed in CKD 5 patients enrolled from the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) and the Affiliated BenQ Hospital of Nanjing Medical University from February, 2011 to December, 2019. A total of 159 healthy volunteers were enrolled as the healthy control group during the same period. The circadian rhythm of heart rate was monitored by 24-hour Holter. Related indices (including 24-hour, daytime and nighttime mean heart rate, night/day heart rate ratio, 24-hour maximum heart rate, 24-hour minimum heart rate and difference between maximum and minimum of 24-hour heart rate) were calculated. Non-dipping heart rate was defined as night/day heart rate ratio greater than 0.9. Cox regression model was used to analyze the risk factors of all-cause mortality in CKD 5 patients. Kaplan-Meier survival curve and Log-rank test were used to compare the differences of cumulative mortality between high ratio group (night/day heart rate ratio>0.91) and low ratio group (night/day heart rate ratio≤0.91). The nonlinear relationship between night/day heart rate ratio and all-cause mortality was analyzed by restricted cubic spline plot. Time-dependent receiver operating characteristic (ROC) curve was used to analyze the predictive value of night/day heart rate ratio for all-cause mortality in CKD 5 patients.Results:A total of 159 healthy volunteers and 221 CKD 5 patients were included in this study. There were 123 males (55.66%) and the age was (52.72±13.13) years old in CKD 5 patients. The total median follow-up time was 50.0 months. Compared with controls, 24-hour, nighttime mean heart rate, 24-hour minimum heart rate in CKD 5 patients were increased (all P<0.05), furthermore, the night/day heart rate ratio was higher [(0.91±0.09) vs (0.81±0.08), P<0.001], showing "non-dipping heart rate". However, the 24-hour maximum heart rate and the difference between maximum and minimum of 24-hour heart rate in CKD 5 patients were lower than controls (both P<0.05). Multivariate Cox regression analysis showed that the increased night/day heart rate ratio (per 0.1 increase, HR=1.557, 95% CI 1.073-2.258, P=0.020) was an independent influencing factor for all-cause mortality in CKD 5 patients. Kaplan-Meier survival curve analysis showed that the cumulative mortality of the high ratio group was significantly increased than that of the low ratio group (Log-rank test χ 2=7.232, P=0.007). From the restricted cubic spline plot, there was a linear effect between night/day heart rate ratio and all-cause mortality ( P=0.141), and when night/day heart rate ratio was above 0.91, the risk of all-cause mortality was significantly increased in CKD 5 patients. According to time-dependent ROC curve, the accuracy of night/day heart rate ratio in predicting all-cause mortality was 70.90% even when the survival time was up to 70.0 months. Conclusions:The circadian rhythm of heart rate in CKD 5 patients displays "non-dipping" state. High night/day heart rate ratio is an independent influencing factor for all-cause mortality in CKD 5 patients.

Objective To investigate the effect ofdiammonium glycyrrhizinate on neurovascular units in rats after cerebral ischemia reperfusion (IR) injury.Methods Two hundred and forty health SD rats were randomly assigned into normal control group (n=30),sham-operated group (n=30),IR group (n=90) and diammonium glycyrrhizinate group (DG,n=90).The rats in the IR group and DG group were divided into 2,6 and 12 h subgroups after modeling,respectively (n=30).The rats in the IR group and DG group were induced middle cerebral artery occlusion (MCAO) models,and after the models were successfully established,9.11 mL DG sodium chloride injection was given to DG group,while equal saline to normal group,sham-operated group and IR group via the tail vein.The brain tissues of each group were harvested 2,6 and 12 h,resperctively,after modeling.The infraction rate was measured by TTC staining;immunohistochemistry was employed to detect the expresions of Claudin-5 and vessel endothelium (VE)-Cadherin;Western blotting was used to detect the protein expression levels of Rac-1 and Claudin-5.Results The DG group had signficantly lower infarction rate than IR group 2,6 and 12 h after modeling (P＜0.05).The Claudin-5 expression rates in the 6 h and 12 h DG subgroups were signficantly higher than those in the 6 h and 12 h IR subgroups (P＜0.05).The VE-Cadherin expression rates in the DG group were significantly higher than that in IR group at 2,6 and 12 h after modeling (P＜0.05).Samely,the Claudin-5 relative quantity in DG group was significantly higher than that in IR group at 2,6 and 12 h after modeling (P＜0.05).The Rac-1 quantity in DG group was only statistically higher than IR group at 2 h after modeling (P＜0.05).Conclusion The DG can upregulate the Rac-1,VE-Cadherin and Claduin-5 expressions in neurovascutar units,and partly protect neurovascular units after cere bral acute IR injury.

Objective To evaluate the efficacy and safety of endovascular mechanical thrombectomy in patients with anterior circulation stroke. Methods PubMed, EMBASE, Cochrane database, Clinical Trials and the related supplement resources were retrieved. The randomized controled trials for comparing intravenous thrombolysis and endovascular mechanical thrombectomy in patients with anterior circulation stroke were selected. The bias risk assessment was performed. The basic characteristics of studies and the clinical outcome data at day 90, including good outcome (defined as the modified Rankin scale score 0-2), death and symptomatic intracranial hemorrhage (sICH) were extracted. Review Manager 5.3 software was used to conduct the statistical analysis. Results A total of 10 articles were enroled, including 1 557 patients in the endovascular mechanical thrombectomy group and 1 359 in the intravenous thrombolysis group. The overal quality of the included trials was higher. The risk of bias was lower. The good outcome rate in the endovascular mechanical thrombectomy group was significantly higher than that in the intravenous thrombolysis group (odds ratio [ OR] 2. 15, 95% confidence interval [ CI] 1. 34-3. 46; P < 0. 01). The death risk at day 90 was significantly lower than that in the intravenous thrombolysis group (OR 0. 86, 95% CI 0. 69-1. 06; P = 0. 16), and there was borderline statistical significance for the risk of sICH (OR 1. 35, 95% CI 1. 00- 1. 84; P = 0. 05 ). Conclusions The effectiveness of the endovascular mechanical thrombectomy is superior to the intravenous thrombolysis in patients with anterior circulation stroke;however, in terms of safety, further evaluation is needed.