Hyperkalemia is one of the common ion metabolism disorders in clinical practice. Hyperkalemia is defined as serum potassium higher than 5.0 mmol/L according to the guidelines at home and abroad. Acute severe hyperkalemia can cause serious consequences, such as flaccid paralysis, fatal arrhythmia, and even cardiac arrest. The use of renin-angiotensin- aldosterone system inhibitors, β-blockers and diuretics, low-sodium and high-potassium diets, and the presence of related comorbidities increase the occurrence of hyperkalemia. Hyperkalemia risk exist in all clinical departments, but there is a lack of a standardization in the management of multi- department cooperation in hospital. Therefore, a number of domestic nephrology and cardiology department experts have discussed a management model for multi-department cooperation in hyperkalemia, formulating the management standard on hospital evaluation, early warning, diagnosis and treatment, and process. This can promote each department to more effectively participate in nosocomial hyperkalemia diagnosis and treatment, as well as the long-term management of chronic hyperkalemia, improving the quality of hyperkalemia management in hospital.

Renal biopsy has been an essential part of the diagnosis and management of kidney disease. In recent years, the rapid development of artificial intelligence (AI) technology based on convolutional neural networks has significantly facilitated its utilization in nephrology. This article focuses on the research of AI in the recognition of tissue structure and pathological diagnosis of kidney biopsy. It elaborates on the identification and segmentation of kidney tissue structure and pathological features, as well as its auxiliary role in disease diagnosis across three dimensions: light microscopy, immunofluorescence, and electron microscopy. The aim is to provide a reference for the application of AI in renal pathology research and precision medicine.

Objective:The exact biological mechanism whereby exposure to ambient ozone(O3)may contribute to clinical onset of cardiovascular events remains unclear.In this study,we aim to examine the impacts of O3 exposure on cardiac arrhythmias and potential pathways involved through autonomic dysfunction and myocardial injury.Methods:Seventy-three non-smoking healthy adults were followed with 4 repeated measurements of 24-hour ambulatory arrhythmias,heart rate variability,ST-segment deviation,and blood pressure(BP)in Beijing,China,2014-2016.Generalized additive mixed models coupled with distributed lag nonlinear models were constructed to evaluate the associations and potential interlinks between O3 exposure and outcome measurements.Results:During the study period,24-hour average concentrations of ambient O3 were 47.4 μg/m3(ranging from 1.0 to 165.9 μg/m3).Increased risks of premature ventricular contraction and ventricular tachycardia were associated with interquartile range increases in O3 exposure during the last 5 days before each participant's clinic visit,with relative risks of 2.14(95％confidence interval[CI]:1.95 to 2.32)and 5.47(95％CI:3.51 to 7.43),respectively.Mediation analyses further showed that sympathetic activation,parasympathetic inhibition,and elevated BP levels,as well as heightened risks of ST-segment depression could mediate up to 47.74％of the risks of arrhythmias attributable to O3 exposure.Conclusion:Our results suggest that short-term exposure to ambient O3 could prompt the genesis of arrhythmias partially through worsening autonomic function and myocardial burden.

Objective:Evidence on potential cardiovascular benefits of personal-level intervention among the elderly exposed to high levels of particulate matter(PM)remains limited.We aimed to assess improvements in surrogate markers of cardiovascular injury in vulnerable populations at risks by using indoor air filtration units.Methods:We conducted a randomized crossover trial for 2 separate 2-week air filtration interventions in 20 households of patients with stable chronic obstructive pulmonary disease and their partners in the winter of 2013,with concurrent measurements of indoor PM.The changes in biomarkers indicative of cardiac injury,atherosclerosis progression and systemic inflammation following intervention were evaluated using linear mixed-effect models.Results:In the analysis,average levels of indoor PM with aerodynamic diameters＜2.5 μm(PM2.5)decreased significantly by 59.2％(from 59.6 to 24.3 μg/m3,P＜0.001)during the active air filtration.The reduction was accompanied by improvements in levels of high-sensitivity cardiac troponin I by-84.6％(95％confidence interval[CI]:-90.7 to-78.6),growth differentiation factor-15 by-48.1％(95％CI:-31.2 to-25.6),osteoprotegerin by-65.4％(95％CI:-56.5 to-18.7),interleukin-4 by-46.6％(95％CI:-62.3 to-31.0)and myeloperoxidase by-60.3％(95％CI:-83.7 to-3.0),respectively.Conclusion:Indoor air filtration intervention may provide potential cardiovascular benefits in vulnerable popu-lations at risks.

Esophageal squamous cell carcinoma (ESCC) is the main prevalent histological type of esophageal cancer worldwide, with a high mortality and poor prognosis due to advanced stage at diagnosis. Surgical resection after neoadjuvant therapy is the main treatment for ESCC. With the rise of immunotherapy, immunotherapy on ESCC has been shown to improve outcomes, especially the immune checkpoint inhibitors (ICIs). As the efficacy of immunotherapy for ESCC is limited, it is helpful to screen patients who may benefit from immunotherapy by looking for predictive biomarkers of efficacy of immunotherapy. In this paper, based on the current literature on immunotherapy and related biomarkers, we review the research progress on predictive markers of ICIs for ESCC, in hopes of providing assistances for the precise treatment and prognosis determination.

Objective: To evaluate the efficacy and safety of oseltamivir in the treatment of suspected influenza in children. Method: A multicenter, randomized and open-label trial was conducted among 229 individuals with suspected influenza which were collected from the clinic of 5 hospitals in Guangdong province (Guangzhou Women and Children′s Medical Center, Shenzhen Baoan District Maternity and Child Care Service Center, the Second Affiliated Hospital of Shantou University Medical College, Dongguan Maternity and Child Care Service Centre, Yuexiu District Children′s Hospital of Guangzhou) from April to July 2015. They were randomized either to oseltamivir group (oseltamivir 30-75 mg, twice daily for 5 days) or control group who were given symptom relief medicines for 5 days. Result: No significant difference was found between two groups in influenza symptoms of the patients before the treatment(P>0.05). Altogether 229 individuals (114 in oseltamivir group, 115 in control group) were analyzed for efficacy, in which 73 individuals (42 oseltamivir, 31 control), 31.9%, were identified as influenza-infected through laboratory test. No significant difference was found between the two groups in the duration of fever although shortened. In the 229 individuals , the cumulative alleviation proportion between oseltamivir and control group was not significantly different (P>0.05): the median duration of illness was 69.9 hours (95% CI 65.3-91.5) in oseltamivir group and 75.4 hours (95%CI 63.9-91. 7) in control group; the median duration of fever was 40.4 hours (95%CI 31.5-53.4) in oseltamivir group and 44.0 hours (95%CI 33.2-50.0) in control group. In the 73 individuals, the cumulative alleviation proportion between oseltamivir and control group was significantly different (P<0.05). The median duration of illness was 61.2 hours (95%CI 48.0-121. 0) in oseltamivir group, being significantly shorter than that of 116.0 hours (95%CI 91.5-175.0) in control group. But it was not significantly different that the median duration of fever was 32.8 hours (95%CI 24.0-47.0 ) in oseltamivir group and 55.8 hours (95%CI 43.6-78.3 ) in control group (P>0.05). And the median duration of fever in 60 individuals (38 oseltamivir, 22 control) was significantly different between two groups(P<0.05), who had finished a course of taking oseltamivir in the 73 individuals, 34.8 hours (95%CI 24.0-48.5 ) in oseltamivir group being significantly shorter than that of 53.3 hours (95%CI 43.6-104.0 ) in control group. There was certain difference in side effects rate between the two groups (oseltamivir 10%, control 2%, P<0.05). The main side-effects were gastrointestinal symptoms (stomachache, diarrhea, poor appetite, vomiting). Conclusion The duration of illness and fever in suspected influenza patients treated with oseltamivir was shorter than those in the patients treated with no oseltamivir, the difference was not statistically significant, when 31.9% was confirmed with positive result of virus test in suspected influenza in children. But in these patients with positive result of virus test, the duration of illness was significantly shortened with treatment with oseltamivir as compared with no treatment with oseltamivir, and it would be better if full oseltamivir course was completed for reducing the duration of fever. Oseltamivir treatment was safe with mild side effects.

Objective To observe the clinical effects and safety degree of treating children's cough variant asthma for mite allergy with Montelukast sodium combined with Flixotide. Methods Forty cases of infant patients with cough variant asthma for mite allergy in Guangzhou Women and Children's Medical Center from February 2012 to Octo-ber 2013 were taken as research subjects and randomly divided into treatment group and control group,each group 20 cases. The control group was treated with Flixotide aerosol;the treatment group took extra medicine Montelukast sodium chewable tablets. The treatment period covered half a year. After treatment both groups were observed for 3 months. During the treatment period the recovery process of clinical symptoms and adverse reaction of all the infant patients were observed and recorded. The data was analyzed with statistical software SPSS 17. 0. Results The duration of cough im-proved and solved in treatment group in the acute phase was(5. 82 ± 0. 90)d,much shorter than that of the control group[(6. 54 ± 1. 30)d],and the difference was of statistical significance(P ﹤ 0. 05). In the procedure,4 times of cough scores of treatment group[(3. 90 ± 0. 90)scores,(0. 90 ± 0. 30)scores,(0. 70 ± 0. 30)scores,(1. 90 ± 0. 70) scores]declined apparently more than those of control group[(4. 10 ± 0. 70)scores,(1. 20 ± 0. 40)scores,(1. 30 ± 0. 50)scores,(2. 40 ± 0. 80)scores];the difference was of statistical significance(all P ﹤ 0. 05);and the both were rebounded after 3 months without medicine. In terms of pulmonary function PD20,the patients in treatment group [(0. 46 ± 0. 08)mg vs(1. 76 ± 0. 07)mg]showed better improvement than those in control group[(0. 46 ± 0. 07) mg vs(1. 70 ± 0. 07)mg],and the difference was of statistical significance(P ﹤ 0. 05). Conclusions Treating chil-dren's cough variant asthma for mite allergy with Montelukast sodium combined with Flixotide is of good therapy effect in the acute phase and the control phase,worthy of further clinical application.

Objective To investigate the pathological characteristics of lymph nodes,liver and bone morrow in adult-onset still' s disease (AOSD).Methods The clinical data of three AOSD patients were collected and their biopsy of enlarged lymph nodes,liver and bone marrow were analyzed by histology and immunohistochemistry.Results In AOSD lymphadenopathy,there were high lymph node hyperplasia,partial architecture damage and an intense paracortical hyperplasia along with diffused infiltration of large immunoblasts,activated lymphocytes,Langerhans cells,histocytes,neutrophils and chronic inflammatory cells.Bone marrow biopsy showed a significant increase in the proportion of granulocytes and erythrocytes,with apparently increased segmented neutrophils.Hepatic biopsy showed hepatocellular spotty necrosis.Meanwhile,there was some infiltration of lymphocytes and neutrophils in the periportal fibrosis area.Immunohistochemical staining showed CD21 expression in lymphoid follicle remnants and B cell markers with few T markers in most of immunoblasts.Conclusion The pathological characterizations of lymph nodes,liver and bone marrow provide important clues to the diagnosis of AOSD as well as its differential diagnosis.

Objective To investigate the effects of vitamin E (VE) on renal ischemia/reperfusion (I/R) injury of rats.Methods A total of 18 male Wistar rats were randomly divided into sham-operated group,I/R group,VE + I/R group,and each group of 6 rats.All the animals were killed at the end of 24 h of reperfusion.Nephridial tissue were examined by light microscopy,and the level of blood urea nitrogen(BUN) and serum creatinine (SCr) were measured.The protein expressions of tumor necrosis factor α (TNF-α) were detected by Western blotting.Results Compared with sham-operated group,tubulointerstitial pathological injury in I/R group was significantly aggravated,which was shown by HE and PAS stain.Compared with I/R group,the degree of morphological changes as well as renal dysfunction in VE + I/R group were obviously lessened.Meanwhile,the levels of BUN,SCr in I/R group,VE + I/R group were (10.13 ± 2.14) mmol/L and (7.67 ± 1.63) mmol/L,(80.33 ±7.15) μmol/L and (63.67 ±5.40) μ mol/L,significantly higher than those in shamed-operated group ((3.85 ± 0.21) mmol/L,(48.67 ± 3.61) μmol/L;P ＜ 0.05).And the level of BUN and SCr in VE + I/R group were significant lower than those in I/R group(P ＜0.05).Western Blotting showed that the protein expressions of TNF-α in VE + I/R group were obviously lower compared with those in group of I/R without VE treatment (P ＜ 0.05).Conclusion Vitamin E can attenuate over-expressions of TNF-α in kidney following I/R,thus protect against structural damages and renal dysfunction in I/R rat models.

Objective To raise the awareness of acute kidney injury (AKI) and improve the level of diagnosis.Methods All the hospitalized adult patients in the Affiliated People's Hospital of Shanxi Medical University from January 2012 to July 2013 were screened.Those patients diagnosed as AKI were retrospectively analyzed in terms of incidence,the rate of missed diagnosis,etiology,distribution and prognosis of AKI.Results (1) The incidence of AKI in the patients was 0.67％ (381/56 835),the ratio of male to female was 1.91 ∶ 1,and the average age was (63.45±16.95) years.(2)There were 321 cases diagnosed as pre-renal AKI (84.25％),42 cases diagnosed as renal AKI (11.02％) and 18 cases diagnosed as post-renal AKI (4.72％).(3)There were 189 cases(49.61％) missed diagnosed among all the screened cases.The rates of missed diagnosis in neurosurgery,general surgery and cardiac surgery department was 62.96％,59.09％ and 50.00％,in cardiology,respiratory and neurology department was 50.00％,50.00％ and 45.45％ respectively.(4) Multivariate Logistic regression analysis showed that hypertension [odds ratio(OR)=1.631],renal replacement therapy(RRT)(OR=23.256) and oliguria history (OR=1.936) were independent risk factors of missed AKI diagnosis.Conclusion The missed diagnosis rate of AKI is high and has certain characteristics in different departments.Hypertension,RRT and oliguria history are independent impact factors of missed AKI diagnosis.