This study aimed to examine the associations of adverse adulthood experiences (AAEs) with advanced cardiovascular-kidney-metabolic (CKM) syndrome. In addition, we conducted a cross-sectional mediation analysis and a joint analysis to examine the associations of depressive symptoms with advanced CKM syndrome. AAEs were determined by five questionnaire indicators. The evaluation of depressive symptoms utilized the 10-item Center for Epidemiologic Studies Depression Scale. Advanced CKM syndrome refers to stages 3 and 4 of CKM syndrome. Logistic regression, cross-sectional mediation analysis, joint analysis, subgroup analysis and sensitivity analyses were applied in this study. This study included 5601 participants drawn from the China Health and Retirement Longitudinal Study (CHARLS). The average prevalence of advanced CKM syndrome was 34.87%. After adjusting for all covariates, compared to low AAEs, the risk of advanced CKM syndrome was 1.83 [95% confidence interval (CI): 1.26–2.67, P = 0.002] for high AAEs. In joint analysis, compared with the group with no depressive symptoms and low AAEs, the presence of depressive symptoms and high AAEs showed a higher risk of advanced CKM syndrome [odds ratio (OR) = 2.49, 95% CI: 1.87–3.32, P<0.001]. Depressive symptoms showed a possible association in the relationship between AAEs and advanced CKM syndrome. Compared to low AAEs, the ORs for medium and high AAEs were 1.011 (95% CI: 1.007–1.020, P < 0.001) and 1.024 (95% CI: 1.014–1.030, P < 0.001), respectively. Our study found AAEs were associated with an increased risk of advanced CKM syndrome. The findings are driven primarily by the psychosocial AAEs, while health-related items likely reflect disease-related factors. Besides, depressive symptoms showed a potential cross-sectional association with the relationship between AAEs and CKM syndrome. In addition, an combined association was noted between AAEs and depressive symptoms concerning advanced CKM syndrome.

There is limited research to investigate the relationship between blood urea nitrogen (BUN) levels and gout, especially there was no study to establish a causal relationship. The aim of our study is to explore the associations between BUN levels and gout risk using observational and Mendelian randomization (MR) analyses. In the observational analyses, we used data from the 2007 to 2018 survey cycles of the National Health and Nutrition Examination Survey (NHANES) and recruited 31,245 participants aged ≥ 20 years. Logistic regression, subgroup analyses, restricted cubic spline (RCS), and the 2-sample MR analysis were used to examine the association between BUN levels with gout. Our cross-sectional study found that each standard deviation increase in BUN was linked to an elevated risk of gout after adjusting for covariates (odds ratio [OR] = 1.02, 95% confidence intervals [CI] = 1.01-1.03, P < .001). In subgroup analyses, stronger associations between BUN and gout were identified in female, hypertension, diabetes, and chronic kidney disease (CKD) (all P < .05). In addition, the RCS revealed positive non-linear relationship between BUN and gout. The 2-sample MR analyses results suggested that there were positive causal relationships between BUN and gout using the Inverse variance weighted (IVW) method (OR = 9.12, 95% CI = 2.00-41.52], P = .0042), (OR = 5.98, 95% CI = 2.15-16.62, P = .0006]), and (OR = 1.43, 95% CI = 1.02-1.92], P = .0367). Our study found the robust and causal relationship between BUN levels and the risk of gout. These results suggest that BUN can be used as a feasible indicator for predicting gout.

Cobalt is a prevalent environmental metal with known toxicological potential. Inflammation plays a key role in the pathophysiology of cardiovascular disease (CVD) and chronic kidney disease (CKD). However, the relationships between blood cobalt concentrations, inflammatory indicators, and their roles in CVD and CKD remain inadequately characterized. This study aimed to evaluate the associations between blood cobalt concentrations and the prevalence of CVD and CKD and to explore the mediating role of inflammatory indicators in these associations. Data from 6689 participants were obtained from the National Health and Nutrition Examination Survey 2015–2018. Restricted cubic splines and multivariate logistic regression models were used to assess the associations between blood cobalt exposure, CVD, CKD, and inflammatory markers. Generalized additive models were applied to investigate potential nonlinear relationships. The receiver operating characteristic analysis assessed the discriminatory ability of blood cobalt levels for CVD and CKD. Mediation analysis was conducted to examine whether inflammatory indicators mediate the association between blood cobalt and CVD/CKD. Multivariate logistic regression analysis showed that higher blood cobalt levels (OR = 1.50, 95

Abstract Introduction: To investigate the association of a decreased estimated glomerular filtration rate (eGFR) with urolithiasis risk. This study aimed to investigate the association between eGFR and the risk of urolithiasis formation in the general population. Methods This is a prospective cohort study. We included 426,866 community-dwelling participants (39 to 73 years old) from the UK Biobank. Participants joined the study from 2006 to 2010 and were followed up until 2021. We used the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula based on cystatin C to calculate eGFR. Cox proportional hazards regression models were used to evaluate the association between eGFR and the risk of urolithiasis formation. Results The mean age of all participants was 56 years, of which 231,509 were female (54%) and 403,214 (94%) were White. During a mean follow-up of 12.4 years, 5,176 participants (1%) developed incident urolithiasis. We found that participants were 3% (adjusted hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01–1.06, p = 0.01) more likely to develop urolithiasis for every 10 mL/min/1.73 m2 decrease in eGFR. Compared to those with eGFR between 90–104 mL/min/1.73 m2, the HRs (95% CIs) for the eGFR < 60, 60 ≤ eGFR < 75, 75 ≤ eGFR < 89 and eGFR ≥ 105 mL/min/1.73 m2 groups were 1.19 (1.02–1.38), 1.07 (0,96–1.18), 1.02 (0.94–1.11), and 0.93 (0.83–1.04), respectively. Conclusion A lower eGFR is associated with higher risk of urolithiasis formation in the general population.

Purpose: Benign prostatic hyperplasia (BPH) describes common noncancerous prostate enlargement. BPH is usually associated with lower urinary tract symptoms and an increased risk of cerebrovascular diseases, such as stroke and its recurrence. White matter hyperintensities (WMHs), markers of cerebral injury, increase the risk of stroke, cognitive impairment, dementia, and death. The relationship between BPH and WMHs remains unclear. This study aimed to determine the association between BPH and WMHs. Methods: A total of 788 male patients from the First Affiliated Hospital of Kunming Medical University from July 2019 to September 2021 were enrolled in this cross-sectional study. BPH was assessed by abdominal ultrasound, and three independent neuroradiologists rated the presence or absence of WMHs. Multiple imputations of chained equations were used to handle missing data. Logistic regression was used to assess the relationship between BPH and WMHs. Results: Patients with BPH presented an increased risk of WMHs with a crude odds ratio (OR) of 2.76 (95% CI, 2.02-3.79) and an adjusted OR of 1.75 (95% CI, 1.24-2.48) after controlling for potential confounding factors in the multivariate logistic regression. Conclusion: We found that BPH was closely associated with WMHs in male Chinese individuals.

Background: Chronic kidney disease (CKD) is very common now and associates with high overall and cardio-vascular mortality. Numerous studies have reported that Heart rate variability (HRV) could also be used to detect cardiovascular autonomic dysfunction (CAD). We investigated the association of electrochemical skin conduc-tance (ESC) of EZSCAN results with HRV in non-dialysis CKD patients.Methods: In a cross-sectional study, we enrolled 248 prevalent non-dialysis CKD patients. Patients underwent a 24-h Holter (CB-2302-A, Bio Instrument, China). A time domain analysis of HRV was performed, and the following parameters were obtained: SDNN, SDANN, rMSSD, pNN50. EZSCAN device (Impeto Medical, Paris, France) measures ESC values of each participants. Mean global skin conductance computed as 0.5 * (reflecting (right + left hand)/2 + (right and left foot)/2). Log transforms data into a normal distribution for statistical analysis.Results: There were 142 males and 106 females included in the present study. Patients' age was 56.6 +/- 17.08 years. Logarithm(Log) (global ESC) was independently predicted by age (P<0.01), hypertension history, esti-mated Glomerular filtration rate (eGFR) and log SDNN (P<0.05). While log SDANN, rMSSD and pNN50 were not independent predictors for log (global ESC).Conclusion: Increased global ESC significantly associated with elevated HRV, specifically SDNN in non-dialysis CKD patients. This suggested that global ESC may appear to be an important predictor of CAD, and even could be used as a cardiovascular risk factor in non-dialysis CKD patients.

Background: Diabetic microvascular complications, including diabetic kidney disease (DKD), retinopathy (DR), and neuropathy (DN), were major causes of morbidity and mortality in diabetic patients worldwide. It has been suggested that urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) were not the only indicators of renal function impairment in DKD and that they were also associated with diabetic peripheral neuropathy (DPN) which might affect nerve conduction velocity (NCV). As 30-40% of DPN patients had no subjective symptoms, while current perception threshold (CPT) could detect sensory nerve damage at an early stage. As a result, we aimed to investigate correlation between UACR, eGFR and CPT in DKD patients. Methods: A total of 273 DKD patients from the First Affiliated Hospital of Kunming Medical University from January 2018 to June 2020 were enrolled to complete the CPT test. CPT values of the bilateral median nerve and superficial and deep peroneal nerves at 2000 Hz, 250 Hz, and 5 Hz were collected. Results: In normoesthesia and hypaesthesia patients with DKD, MDRD-eGFR correlated negatively with TC (r =-0.135, P = 0.037), left superficial peroneal and deep peroneal nerve 2000 Hz CPT (r =-0.205, P = 0.001) and right superficial peroneal and deep peroneal nerve 2000 Hz CPT (r =-0.154, P = 0.017). Besides, left and right superficial peroneal and deep peroneal nerve 2000 Hz CPT correlated with CKD-EPI-eGFR and UACR. Multivariate logistic regression analysis found left superficial peroneal and deep peroneal nerve 2000 Hz CPT was independently associated with both MDRD-eGFR and CKD-EPI-eGFR. Conclusion: Decreased MDRD-eGFR and CKD-EPI-eGFR were expected to be a predictor of peripheral nerve injury in normoesthesia and hypaesthesia patients with DKD.

目的 探讨慢性肾脏病3期(CKD3)患者体质指数(BMI)与肺通气功能障碍指标的关系及在临床预测中的作用.方法 回顾性选取2015年1月至2019年10月在昆明医科大学第一附属医院完成肺功能检查的CKD3患者250例.根据是否合并肺通气功能障碍分为肺通气功能正常组(正常组,n=119)和合并肺通气功能障碍组(合并组,n=131).分别比较两组患者的临床资料,采用Pearson及Spearman相关分析第1秒用力呼气容积占预计值百分比(FEV1％pred)与BMI及其他指标的关系,ROC曲线评估BMI对CKD3期患者合并肺通气功能障碍的预测价值.进一步将合并组患者分为轻中度障碍组(50％≤FEV1％pred＜80％,n=80)、重度及以上障碍组(FEV1％pred＜50％,n=51),与正常组(FEV1％pred≥80％,n=119)一起比较三组的临床资料,采用多元Logistic回归分析肺通气功能障碍加重的危险因素.结果 两组患者性别、年龄、吸烟史、慢性支气管炎病史比较差异有统计学意义(P＜0.05),正常组患者BMI高于合并组,差异有统计学意义(P＜0.05).FEV1％pred 与 BMI 呈正相关(r=0.217,P＜0.05).BMI 的 AUC 为 0.686(95％CI:0.607～0.765,P＜0.01),截断值为23.45,预测CKD3期患者发生肺通气功能障碍的灵敏度为66.8％,特异度为62.8％.在轻中度障碍组、重度及以上障碍组年龄大于正常组(P＜0.05),但在有障碍的两组比较差异无统计学意义(P＞0.05);三组有慢性支气管炎病史的患者比例为重度及以上障碍组＞轻中度障碍组＞正常组(P＜0.05);随病情加重,BMI逐渐下降,在三组间比较差异有统计学意义(P＜0.05).多元Logistic回归模型显示BMI(OR=0.898,95％CI:0.822～0.981,P＜0.05)及慢性支气管炎病史(OR=0.130,95％CI:0.052～0.324,P＜0.01)是CKD3患者肺通气功能障碍加重的独立危险因素.结论 BMI对CKD3患者发生肺通气功能障碍有一定的临床预测价值,对疾病的发展及预后有一定的临床指导意义.

近年来,随着医疗技术的飞速发展,彩色超声多普勒技术水平及临床应用也得到长足发展,其中肾动脉阻力指数(RRI)已成为诊断多种疾病和评估病情的重要手段.测定RRI不仅在肾损伤的风险预测、严重程度评估等方面有重要临床价值,并且具有无创、床旁、廉价、可重复等优点.本文就目前RRI在临床上的应用作一简单概述.

目的 探讨磷脂酰肌醇3-激酶(PI3K)/蛋白激酶B(AKT)/生存素(Survivin)信号通路在腹膜间皮细胞上皮-间充质转分化(EMT)中的作用.方法 20只雄性SD大鼠随机分为模型组和对照组,模型组每天给予42.5 g/L葡萄糖腹膜透析液(100 mL/kg)腹腔注射建立大鼠腹膜间皮细胞EMT模型,对照组在相同条件下予等量的生理盐水腹腔注射.两组大鼠于4周末次腹膜透析后,留取腹膜组织,采用HE和Masson染色,观察腹膜组织形态学变化并测量腹膜组织厚度,采用实时定量PCR、Western印迹和免疫组化等方法检测腹膜组织p-AKT、AKT、Survivin的表达及EMT相关蛋白和mRNA的表达[紧密连接蛋白(ZO-1)、神经-钙黏素(N-cadherin)].结果 成功建立大鼠腹膜间皮细胞EMT模型,与对照组相比,模型组小鼠腹膜组织明显增厚,上皮细胞标志物ZO-1 mRNA及蛋白表达降低,间充质细胞标志物N-cadherin mRNA及蛋白表达升高,p-AKT、Survivin蛋白也明显升高(P<0.05),AKT蛋白表达无明显变化(P>0.05).结论 PI3K/AKT/Survivin信号通路参与腹膜间皮细胞EMT的发生与发展.

在经济全球化的背景下,培养留学生成为很多国家培养人才、实现国际间交流的重要方式.本文主要探讨国内现有的留学生教学方法及其在肾脏内科临床教学中的应用,探讨不同教学方式对课堂教学效果的影响,选择最有益于教学效果的教学方式,以实现MBBS项目的进步与发展.

Chronic kidney disease (CKD) is very common now and is associated with high overall and cardiovascular mortality. Numerous studies have reported that elevated heart rate (HR) is a risk factor for cardiovascular mortality. We investigated the link between serum endocan and circadian heart rate variability in non-dialysis stage 5 CKD patients.

Chronic kidney disease (CKD) is very common now and is associated with high overall and cardiovascular mortality. Numerous studies have reported that abdominal obesity is a risk factor for cardiovascular mortality. We investigated the link between sagittal abdominal diameter (SAD) and Framingham risk score in non-dialysis CKD patients.

为了激发医学本科生科研兴趣,提高其整体科研活动参与率,解决学生科研动机不足的问题,文章借鉴国外研究型大学有益经验,从组织前提及实施方法两方面探讨了如何对医学本科生实施科研激励.

PBL教学模式是一种医学教育的新模式,在医学教育领域得到了广泛认可.微信平台可实现文字、图片、语音、视频信息的全方位沟通互动,可成为PBL教学法的实时互动平台,进行“以问题为基础的学习”,提高见习教学效果.

目的:探讨在慢性肾脏病患者中人体肥胖指数评价肥胖的可行性,以及肥胖指数、体重指数与糖尿病的相关性.方法:采用病例对照研究方法,选取昆明医科大学第一附属医院肾内科患者作为研究对象,其中符合糖尿病患者38例作为观察组,非糖尿病患者115例作为对照组.结果:BMI、BAI呈显著正相关(P＜ 0.001),观察组中BMI高于对照组,差异有统计学意义(P＜0.001),BAI在组间差异无统计意义.

随着肾脏多普勒超声在临床上成为一种常规检查方法,越来越多医务人员关注到肾动脉阻力指数(renal resistive index,RRI或RI)临床价值上来.目前RI已应用于高血压、糖尿病肾病、肾移植术后以及梗阻性肾病等人群,但关于其临床应用的有效性尚有争议.本文将就目前肾动脉阻力指数在慢性肾脏病领域的临床应用及研究现状作一简单概述.

BACKGROUND:Chronic kidney disease (CKD) is associated with high overall and cardiovascular mortality. Numerous studies have reported that increased heart rate is a risk factor for all-cause mortality. We investigated the link between sleep heart rate and artery stiffness in CKD patients.METHODS:In a cross-sectional study, we enrolled 100 prevalent Chinese CKD patients (55 males, aged 52.5 ± 16.40 years). Heart rate was measured with an automatic system. Arterial stiffness was evaluated by using a calibrated tonometer.RESULTS:Large artery elasticity index (LAEI) was positively correlated with body mass index and hemoglobin but negatively associated with age and systolic blood pressure. Furthermore, LAEI was negatively associated with glomerular filtration rate (GFR) and sleep heart rate. In multivariate regression, LAEI was independently predicted by SBP, BMI, age, sleep heart rate, and gender. Adjusted R (2) of the model was 0.486.CONCLUSION:Elevated sleep heart rate is significantly associated with increased arterial stiffness in CKD patients. Further investigation is needed to explore the potential benefits of sleep heart rate lowering therapy in this patient group.

Background: Patients with chronic kidney disease (CKD) have an unacceptably high risk of death, primarily as a result of cardiovascular disease (CVD). The ‘hypertriglyceridemic waist' phenotype has been proposed as a simple and strong predictor of CVD risk. Therefore, we investigated the relationship between the hypertriglyceridemic waist phenotype and carotid atherosclerosis in CKD patients. Methods: In a cross-sectional study, we enrolled 785 prevalent CKD patients [416 males, aged 44.6 years (21.7-69.4), glomerular filtration rate 52.5 ml/min/1.73 m2 (5.3-119.4)]. We divided the patients into three groups: group 1: waist circumference >90 cm in men or >85 cm in women and triglycerides ≥2 mmol/l (n = 109); group 3: waist circumference ≤90 cm in men or ≤85 cm in women and triglycerides <2 mmol/l (n = 379), and group 2: the remaining patients (n = 297). Routine biochemical parameters and carotid artery intima-media thickness (IMT) were measured. Results: The prevalence of the hypertriglyceridemic waist phenotypes was 13.8% in the CKD patients. Triglyceride, total cholesterol, HDL-cholesterol and LDL-cholesterol concentrations in group 1 were significantly higher than those in group 3. Carotid artery IMT of the hypertriglyceridemic waist group was the highest. Conclusion: The hypertriglyceridemic waist phenotype was associated with worse carotid atherosclerosis in CKD patients. This suggests that the hypertriglyceridemic waist phenotype may be useful for predicting CVD risk in CKD patients.