Oxidative stress plays a key role in acute kidney injury (AKI). 8-Oxo-7,8-dihydroguanosine (8-oxo-Gsn) can reflect the overall level of oxidative stress in the body. The levels of urinary 8-oxo-Gsn and renal function-related indicators in 62 patients who underwent video-assisted thoracic surgery (VATS) or open-chest surgery were measured during the perioperative period. The results showed that urinary 8-oxo-Gsn increased 24 hours after surgery and decreased 48 hours after surgery as the condition improved. In 10 patients with severe complications, urinary 8-oxo-Gsn continued to rise. The level of urinary 8-oxo-Gsn in the VATS group recovered faster than that in the open-chest surgery group ( P<0.05). There was a certain correlation between the level of urinary 8-oxo-Gsn and postoperative renal injury in thoracic surgery, suggesting that RNA oxidative stress may play an important role in the pathogenesis of surgery-related AKI.

Objective:To compare the performance of 11 glomerular filtration rate(GFR)equations in Chinese elderly hospitalized patients using dynamic renal imaging as the reference standard.Methods:The retrospective study involved patients aged 60 years and older who were admitted to Beijing Hospital between January, 2017, and January 2020.Glomerular filtration rate(GFR)was assessed through dynamic renal imaging for all participants.Estimated GFR(eGFR)was calculated using various equations based on serum creatinine and/or cystatin C levels, including All Age Spectrum(FAS), Berlin Initiative Study(BIS), Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI), Modification of Diet in Renal Disease Study(MDRD), MDRD in China(MDRDc), and Xiangya..Results:A total of 691 patients, of which 383 were males, with an age range of 60 to 90 years(mean age 71.9±7.7 years), were included in the study.Among the different equations used to estimate glomerular filtration rate(GFR)in ml·min -1·1.73m -2, the smallest deviations were observed with FAScys(2.48), FAScr-cys(3.07), CKD-EPIcys(4.20), and BIScr-cys(7.42).Conversely, the most accurate estimations were found with BIScr-cys(10.38), FAScr-cys(11.94), FAScys(12.08), CKD-EPIcr-cys(13.21), and CKD-EPIcys(13.51).The highest P30 values, indicating the proportion of estimates within 30% of the true GFR, were achieved by FAScr-cys(68.97%), FAScys(68.96%), CKD-EPIcys(63.22%), and BIScr-cys(61.67%).The equations with the lowest root mean square errors were BIScr-cys(9.73), CKD-EPIcr-cys(10.98), FAScr-cys(11.27), CKD-EPIcys(11.52), and FAScys(11.53).Specifically, the FAS equation showed higher accuracy in men, while BIScr-cys and CKD-EPIcys were more accurate in women.Among patients with chronic kidney disease(CKD), the P30 values for BIScr-cys, FAScys, and FAScr-cys were 86.96%, 83.33%, and 80.95% respectively.Notably, for patients with mGFR ≥ 30 ml/min, MDRDc overestimated GFR the most, whereas for patients with mGFR<30 ml/min, Xiangya exhibited the most significant overestimation of GFR. Conclusions:Among the equations tested, BIScr-cys, FAScys, and FAScr-cys demonstrated the highest accuracy and are therefore recommended for use in Chinese elderly hospitalized patients.

Objective:To systematically integrate qualitative research on the decision-making experience of fertility preservation in cancer patients of childbearing age, so as to provide evidence-based basis for improving patients' fertility preservation decision-making ability and formulating targeted intervention plans.Methods:Qualitative research on the decision-making experience of fertility preservation in cancer patients of childbearing age was systematically searched on PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI) , Wanfang Database, VIP and China Biology Medicine disc. The search period was from database establishment to December 2, 2022. The quality of literature was evaluated using the quality evaluation criteria for qualitative research of the Australia Joanna Briggs Institute Evidence-Based Health Care Center. The results were integrated using the Meta-synthesis method.Results:A total of 11 articles were included, 28 results were extracted, summarized into 6 categories, and formed 3 integrated results. The integration results included the challenges and opportunities faced by fertility preservation decision-making, fertility preservation decision-making was influenced by individual, family and social factors, and lack of sufficient decision-making support.Conclusions:Cancer patients of childbearing age lack decision-making support for fertility preservation and face decision-making difficulties. Medical and nursing staff should comprehensively evaluate the fertility needs of cancer patients of childbearing age, pay attention to their cognition and experience, provide professional fertility counseling, and help patients make high-quality decision-making.

Objective:To systematically evaluate the disease experience of patients with gestational hypertension, provide targeted care support for patients with gestational hypertension and promote their physical and mental health.Methods:This study is a Meta-synthesis. Qualitative studies on the experience of hypertensive patients during pregnancy were searched through PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Database, VIP and China Biology Medicine disc. The retrieval time limit was from the establishment of the databases to May 8, 2022. The quality of the studies were evaluated using the quality evaluation criteria for qualitative research of the Australian Joanna Briggs Institute Evidence-Based Health Care Center, and the results were integrated by the pooled integration method.Results:A total of 13 studies were included, 55 complete research results were extracted, 9 new categories were summarized and 3 integrated results were synthesized. Integration result 1 was the physical, psychological and behavioral changes that occurred in patients with gestational hypertension after diagnosis of the disease. Integration result 2 was that patients with gestational hypertension had coping deficits and hoped to receive support from multiple sources. Integration result 3 was the current and future challenges for patients with gestational hypertension.Conclusions:Gestational hypertension will bring many impacts to the patients, which needs support from many aspects. There are many challenges for disease management in the future. Medical staff should fully understand the experience of patients with gestational hypertension, give guidance and support to the most authentic feelings and experiences of the patients and encourage them to actively deal with the disease. At the same time, an effective and comprehensive support system should be built to help them better manage the disease.

Objective:To analyze the association of clinical characteristics and laboratory indicators at initial maintenance hemodialysis(MHD)with long-term prognosis in advance-aged patients, and to find influencing factors for the prognosis in advance-aged MHD patients.Methods:This retrospective study was conducted at the Nephrology Department of Beijing Hospital between April 2007 and January 2018.A total of 61 patients receiving first-time hemodialysis at ≥ 80 years of age and undergone regular dialysis for 3 months or longer were enrolled.All patients were followed-up until death or the end of July 1, 2018.Patients were divided into the survivor and non-survivor groups, and differences in clinical characteristics and laboratory indicator values were compared between the two groups.Influencing factors for prognosis in advance-aged MHD patients were analyzed by using multivariate Cox regression.Results:For the 61 subjects, the median follow-up time was 25.8 months.During the follow-up, 32 patients died(52.5%). The main death causes were infectious diseases(40.6%, n=13)and cardiovascular and cerebrovascular diseases(37.5%, n=12). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 75.4%(46/61), 54.1%(33/61), 37.7%(23/61), 22.9%(14/61)and 16.4%(10/61), respectively.The median survival time was 25.8 months for all patients, 27.5 months for patients aged 80-84 years, and 14.9 months for patients aged 85 years and over.The non-survivor group had a higher male ratio(65.6% or 21/32 vs.37.9% or 11/29, χ2=4.678, P=0.031)and lower levels of hemoglobin(85.4±13.0 vs.95.0±17.6 g/L, t=2.867, P=0.019)and albumin(30.3±5.0 vs.34.6±4.8 g/L, t=3.039, P=0.001)than the survivor group.Kaplan-Meier curves indicated that the survival rate decreased with age, and subjects aged less than 85 years had a higher survival rate than subjects aged 85 years and older(the median survival time: 14.9 months vs.27.5 months, Log Rank P=0.006); patients who received continuous renal replacement therapy(CRRT)before dialysis had lower survival rates than patients who did not receive CRRT(the median survival time: 7.8 months vs.29.2 months, Log Rank P=0.002); patients with high serum levels of albumin(≥33 g/L)had higher survival rates than patients with low serum levels of albumin(<33 g/L)(the median survival time: 29.2 months vs.18.9 months, Log Rank P=0.003). Multivariate Cox regression analysis showed that age at initial dialysis( HR=1.136, 95% CI: 1.005-1.285, P=0.041), female( HR=0.409; 95% CI: 0.169-0.994, P=0.048), serum albumin level( HR=0.836, 95% CI: 0.772-0.906, P<0.001)and CRRT before dialysis( HR=6.161, 95% CI: 1.848-20.538, P=0.003)were independent predictors of all-cause mortality in advance-aged patients. Conclusions:Advance-aged patients undergoing hemodialysis have complicated clinical conditions and poor prognosis.Age, gender and serum albumin level at initial dialysis and CRRT before dialysis are independent predictors of prognosis in these patients.

Objective:To compare the application of three different glomerular filtration rate(eGFR)-estimating equations in the elderly aged 60 years and over.Methods:The patients aged ≥ 60 years in our hospital from January 2012 to October 2017 were included as research subjects who underwent three GFR detection(as measured GFR i. e.mGFR)of serum creatinine(Scr), serum cystatin C(sCysC)and GFR by 99mTc-DTPA renal dynamic imaging.The advantages and disadvantages of each GFR-estimating(eGFR)equation in the elderly patients were compared.Results:A total of 122 patients were enrolled, including 90 males(73.8%), with a median age of 77 years.The median Scr and sCysC were 109 μmol/L and 1.39 mg/L, respectively, with their average of mGFR being(45.70±18.91)ml·min -1·1.73m -2.Overall, each eGFR-Scr equation over-estimated the GFR in varying degrees.In eGFR-Scr, full age spectrum equation(FAS)-Scr had the smallest bias(2.34)and the best accuracy(P30 75.4%), followed by Berlin Initiative Study(BIS)-Scr(P30 71.3%). In eGFR-CysC, the P30 of FAS-CysC and chronic kidney disease(CKD)-Epidemiology Collaboration(EPI)-CysC were 75.4% and 71.3%, respectively, and the accuracy of eGFR-CysC was comparable to that of BIS-Scr and FAS-Scr.In eGFR-combi, the bias of FAS-combi was the smallest(1.10), and the accuracy of FAS-combi, BIS-combi and CKD-EPI-combi was comparable, the P30 was 81.1%, 79.5% and 74.6%, respectively, and the P30 of FAS-combi and BIS-combi was higher than that of eGFR-Scr and eGFR-CysC.In the 60-80 age group, the accuracy of FAS-combi and BIS-combi was the best, P30 was 77.8% and 76.4% respectively, while, the accuracy of other equations were poor.In patients ≥ 80 years old, except for the modification of diet in renal disease(MDRD)equations and CKD-EPI-scr equation, the accuracy of other equations was acceptable, among which the accuracy of eGFR-combi equation was the best, and the P30 of FAS-combi, BIS-combi and CKD-EPI-combi were 86.0%, 84.0% and 80.0%, respectively. Conclusions:In elderly patients aged 60 years and over, the application of eGFR-combi equation is better than that of the respective eGFR-Scr and eGFR-CysC equations.The FAS equation has the best bias and accuracy, followed by the BIS equation.

Objective:To compare the advantages and disadvantages of several formulas for estimated glomerular filtration rate (eGFR) based on serum creatinine in elderly patients with chronic kidney disease (CKD) over 60 years old.Methods:CKD patients aged≥60 years old in Beijing Hospital from January 2012 to October 2017 were selected as subjects. Measured glomerular filtration rate (mGFR) was detected by 99mTc-DTPA renal dynamic imaging and used as a reference standard. According to the mGFR value, the patients were divided into 4 groups: mGFR<30 ml·min -1·(1.73 m 2) -1 group, 30≤mGFR<45 ml·min -1·(1.73 m 2) -1 group, 45≤mGFR<60 ml·min -1·(1.73 m 2) -1 group and mGFR≥60 ml·min -1·(1.73 m 2) -1 group. The deviation of each formula was compared by Bland-Altman scatter chart, and the accuracy of each formula was evaluated by the proportion of eGFR within mGFR (1±30%) ( P30) and root mean square error ( RMSE). Wilcoxon paired rank sum test was used to compare the deviation of each formula, and McNemar test was used to compare the difference of P30 among these formulas. Results:A total of 628 patients with CKD were enrolled in this study. The median age was 76.0(71.0, 81.0) years old. The median serum creatinine and mGFR were 110.0(86.0, 152.0) μmol/L and 42.90(29.88, 55.68) ml·min -1·(1.73 m 2) -1, respectively. Each eGFR formula based on serum creatinine overestimated glomerular filtration rate in varying degrees. Among them, the accuracy of Berlin Initiative Study (BIS) formula and full age spectrum (FAS) formula was the best ( P30 were 68.3% and 68.0% respectively), followed by the Chinese race coefficient of Chronic Kidney Disease Epidemiology Collaboration (C-CKD-EPI) formula ( P30 was 65.4%). The accuracy of the other formulas was poor. In terms of deviation, C-CKD-EPI formula was the best (0.27). In the group of mGFR<30 ml·min -1·(1.73 m 2) -1, the accuracy of all formulas was poor, and the accuracy of FAS formula was slightly better than that of other formulas ( P30 was 51.0%). In the group of 30≤mGFR<45 ml·min -1·(1.73 m 2) -1, the deviation of C-CKD-EPI formula was the smallest (3.11). In terms of accuracy, BIS and FAS formulas were better than others, and the P30 were 64.6% and 63.0% respectively. In the group of 45≤mGFR<60 ml·min -1·(1.73 m 2) -1, the deviation of C-CKD-EPI formula was also the smallest (0.72), and the accuracy of BIS formula was the best ( P30 was 82.5%), followed by FAS formula ( P30 was 79.7%). In the group of mGFR≥60 ml·min -1·(1.73 m 2) -1, the deviation and accuracy of Xiangya formula were the best (the deviation and P30 were -0.53 and 96.5% respectively), and the P30 of BIS and C-CKD-EPI formulas were 87.6% and 87.6%, respectively. Conclusions:In the elderly patients with CKD over 60 years old, the accuracy of eGFR based on serum creatinine increases with the increase of mGFR. BIS and FAS formulas are recommended first. The accuracy of each formula is poor in patients with severe renal insufficiency.

Objective:To compare death causes and the survival time in elderly patients undergoing hemodialysis versus peritoneal dialysis in the nephrology department of Beijing Hospital in the last 10 years.Methods:This was a retrospective study.Patients aged more than 60 years who had undergone dialysis and died in the dialysis center of Beijing Hospital between January 2010 and January 2019 were enrolled.A detailed medical history including gender, age, primary diseases, diabetes mellitus, time of dialysis initiation, time of death and direct cause of death were recorded.Results:A total of 153 elderly dialysis patients were enrolled, with a mean age of 76.6±7.7 years, a median dialysis vintage of 54.1(26.9, 86.4)months, including 83(54.2%)cases with diabetes.Patients were divided into the hemodialysis group(HD, n=114)and the peritoneal dialysis group(PD, n=39)according to the dialysis method.The mean ages of patients in the HD and PD groups were 77.1±7.9 and 75.0±7.0 years, and the median dialysis vintages were 56.5(27.4, 104.2)and 48.3(26.3, 66.6)months, respectively.The primary diseases of patients undergoing HD and PD were diabetic nephropathy(DN, 32.5% vs.48.7%), chronic glomerulonephritis(29.8% vs.17.9%)and hypertensive renal damage(21.1% vs.10.3%). The top three causes of mortality in patients undergoing HD and PD were cardiovascular diseases(32.4% vs.43.6%), infections(29.8% vs.28.2%)and cerebrovascular diseases(11.4% vs.15.4%). The compositions of primary diseases and death causes were similar between the two groups, with no significant difference.Kaplan-Meier curves indicated that the survival time of dialysis patients with diabetes mellitus was shorter than that of patients without diabetes mellitus(chi-square value was 12.829, P<0.001), and the survival time of HD patients was longer than that of PD patients(chi-square value was 8.161, P=0.004). In patients without diabetes mellitus, the survival time of HD patients was longer than that of PD patients( Z=-2.716, P=0.007). In patients with diabetes mellitus, HD and PD had similar survival outcomes( Z=-0.581, P=0.561). Conclusions:The proportion of patients with diabetic nephropathy is high in elderly dialysis patients.Cardiovascular and cerebrovascular diseases and infections are the main causes of death in elderly dialysis patients.The survival time is longer in HD patients than in PD patients.

Objective: To assess the value of different equations for estimating glomerular filtration rate (GFR) for evaluating renal function in people aged 70 years and older. Methods: A retrospective study was conducted involving 11 966 elderly people aged 70 years and older, including 5 741 males (48.0%), who underwent routine physical examinations in Beijing Hospital from January 2012 to December 2014 and were followed up for 3 years.Baseline data, including the age, gender, and serum creatinine, were recorded. Results: function was assessed using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD) Study, Chinese Modification of Diet in Renal Disease (MDRD) Study, full age spectrum (FAS) equation and Berlin Initiative Study (BIS) equation, respectively.Results The serum creatinine level increased with age in male and female subjects, and the standard deviation also increased with age, indicating greater variability of serum creatinine in the elderly.Of all equations, the FAS and BIS equations had the lowest GFR estimates.The five equations showed good consistency.In males, the Kendall's W coefficient was 0.796 (P = 0.000); the female Kendall's W coefficient was 0.715 (P = 0.000). Based on three ranges of serum creatinine (<88.4 μmol/L, ≥88.4 μmol/L and <132.6 μmol/L, ≥132.6 μmol/L), all patients were divided into three groups.The BIS, MDRD, MDRDc and FAS equations were all consistent in staging CKD at any creatinine level; however, the CKD-EPI equation significantly overestimated renal function at higher levels of serum creatinine.There was no clear age-related trend when each of the five equations was used to calculate the average 3-year eGFR rate. Conclusions The CKD-EPI, MDRD, MDRDc, FAS and BIS equations can be used to assess renal function, but the results vary among different populations.Which equation has the best accuracy for the elderly in China remains inconclusive and further research is urgently needed.

Objective To assess the predictive value of serum fibroblast growth factor(FGF)23 level and carotid intima-media thickness (CIMT)for the long-term outcome in maintenance hemodialysis(MHD)patients.Methods A total of 88 MHD patients were enrolled,with a median follow-up of 73.2 months(a range from 11.5 to 75.7 months).CIMT and atherosclerotic plaques were measured by Bmode Doppler ultrasound at baseline by an experienced sonographer.Blood samples were collected and stored in the-80℃ refrigerator for measuring serum FGF23 levels.Results The 88 patients were aged(64.2±11.5)years,with 52 males and 36 females,and the mean CIMT was (1.34±0.38)mm.Carotid artery atherosclerotic plaque was detected in 72(81.8％)subjects.Carotid artery atherosclerotic plaques (CASP)were found in 58 (65.9％)patients aged 60 years and over.Compared with non-elderly patients,elderly patients had the characteristics of high incidence of cardiovascular disease and poor nutritional status.During the follow up period,34 patients died and 23 (67.6％) patients died of cardiovascular disease.Kaplan-Meier curves showed that cardiovascular disease-free survival rate was higher in the normal CIMT group than in thickening CIMT group(Log Rank P=0.003).And subjects with low level of FGF23 had a better survival rate than those with moderate to high level of FGF23(Log Rank P =0.043).Multivariate COX regression analysis showed that FGF23(HR=1.056,95％CI:1.007-1.108,P=0.026)and CIMT(HR=1.165,95％CI:1.032 1.315,P =0.013)were independent predictors for cardiovascular mortality.Multivariate COX regression analysis showed that serum calcium (HR =0.022,95％ CI:0.001-0.489,P =0.016),hemoglobin(HR =0.966,95％CI:0.937-0.997,P =0.033),FGF23 (HR =1.071,95％ CI:1.017-1.128,P =0.010) and CIMT (HR =1.202,95％ CI:1.049-1.377,P =0.008) were independent predictors for cardiovascular mortality in elderly MHD patients.Conclusions Serum level of FGF23 and CIMT are the important predictors for cardiovascular mortality in MHD patients.The proportion of elderly patients with cardiovascular disease is higher,in which the factors affecting prognosis are more complex.