There are 275,000 new cases of oral cancer (OC) per year, making it the sixth most common cancer in the world. Severe adverse effects, including loss of function, deformity, and systemic toxicity, are familiar with traditional therapies such as radiation, chemotherapy, and surgery; due to their unique properties, nanoparticles (NPs) have emerged as a superior alternative over chemo/radiotherapy and surgery due to their targeting capability, bioavailability, compatibility, and high solubility. Due to their unique properties, metallic NPs have garnered significant attention in OC control. In addition to the fact that metal NPs may be harmful to human cells, the reactive chemicals used to make them pose the same risk, which limits their use in medicine. Green synthesis (GS) is a novel strategy that uses biological materials like yeast, bacteria, fungi, and plant extracts. Compared to more traditional chemical synthesis processes, these are more environmentally benign and manageable for living organisms. This article summarises the GS of NPs made of metals and metal oxides and their anticancer effects on OC. The method's potential benefits and drawbacks in advancing metallic NPs' GS and shaping OC therapy's future were also discussed.

The highly prevalent cognitive impairment in hemodialysis patients is associated with all-cause mortality; however, the role of different cognitive domain impairments in this association is still not clarified. Our objective was to determine the association between cognitive domain impairment and all-cause mortality in elderly adult patients undergoing hemodialysis. We conducted a prospective cohort study including patients from 11 hemodialysis centers in Beijing. Baseline data were collected, and a series of neuropsychological batteries covering 5 domains of cognitive function were included for the assessment of cognitive function. According to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-V), the patients were classified as normal, mild, and major cognitive impairment for global and domain cognitive function, then followed up for 1 year. Kaplan–Meier survival analysis was used to compare the difference in the cumulative survival rate in different cognitive domains. A multivariate Cox proportional hazards regression analysis was used to determine the association between global or domain cognitive impairment and all-cause mortality. A total of 613 patients were enrolled, the mean age was 63.82 ± 7.14 years old, and 42.1% were women. After 49.53 ± 8.42 weeks of follow-up, 69 deaths occurred. Kaplan–Meier plots demonstrated a significant association of cognitive impairment in memory, executive function, attention, and language domains with all-cause death. Multivariate Cox regression analysis showed that mild and major impairment of global cognition (HR = 2.89 (95% CI, 1.01–8.34), p = 0.049 and HR = 4.35 (95% CI, 1.55–12.16), p = 0.005, respectively), executive cognitive domain (HR = 2.51 (95% CI, 1.20–5.24), p = 0.014; HR = 3.91 (95% CI, 1.70–9.03), p = 0.001, respectively), and memory cognitive domain (HR = 2.13 (95% CI, 1.07–4.24), p = 0.031; HR = 3.67 (95% CI, 1.71–7.92), p = 0.001, respectively) were associated with all-cause mortality. Combined impairment of 3, 4, and 5 cognitive domains was associated with all-cause mortality [HR = 5.75 (95% CI, 1.88–17.57), p = 0.002; HR = 12.42 (95% CI, 3.69–41.80), p < 0.001; HR = 13.48 (95% CI, 3.38–53.73), p < 0.001, respectively]. We demonstrate an association between the executive and memory cognitive domain impairment and all-cause mortality in hemodialysis patients. Our data suggest that the impairments in these cognitive domains might help in the early identification of hemodialysis patients at risk of death.

Background Lack of accurate and effective assessment tools of fluid status is one of the major challenges to reach proper dry weight (DW) in chronic hemodialysis (HD) population. The aim of this randomized study was to evaluate the effect of bioimpedance guided DW assessment on long-term outcomes in Chinese HD patients. Eligible patients were randomly assigned (1:1) to two groups in each center, the control group and body composition monitor (BCM) group. In the BCM group, DW has been evaluated by bioimpedance technic every 2 months during follow-up. The primary composite endpoint consisted of death, acute myocardial infarction, cerebral infarction, cerebral hemorrhage, and peripheral vascular disease. Methods A total of 445 patients were recruited from 11 hemodialysis centers from Beijing, Tianjin and Shijiazhuang cities from Jan 1, 2013 to Dec 31, 2014. They were randomized into either BCM group or control group. All patients have been followed up for 1 year or until Dec 31, 2014 or censoring. Results At baseline, there were no significant differences between two groups in terms of demographic parameters, dialysis vintage, percentage of vascular access, and comorbid conditions. At the end of the study, 18 (4.04%) patients had died (11 in control group and 7 in BCM group). Kaplan-Meier survival analysis showed no significant difference in survival rates between two groups (log-rank test P = 0.07). However, there was an increasing trend of survival rates in BCM group compared to the control group. In the multivariable Cox analysis, there was a nonsignificant trend toward less primary composite end points in the BCM group in the adjusted analysis, the hazard ratio was impressive (0.487, 95% CI 0.217–1.091, P = 0.08). Conclusion Bioimpedance technic has been applied to assess fluid status for decades and has been proved to be a promising tool for clinical practice. Although short-term outcomes were not improved in the randomized, controlled trial, the ascending trend in survival has been observed. Further studies are needed to investigate the survival benefit of bioimpedance method in DW assessment in a larger sample with longer follow-up period. Trial registration ClinicalTrials.org, NCT01509937 . Registered 13 January 2012,

随着放射诊断技术和介入治疗在心脑血管疾病中的广泛应用,作为心脑血管疾病的高危人群,越来越多的慢性肾脏病患者可能会接受造影剂检查.而肾功能不全是发生碘造影剂不良反应的主要危险因素.造影剂脑病(contrast-induced encephalopathy,CIE)是心、脑血管造影术后可能发生的一种罕见并发症,临床上可出现一过性皮质盲、偏瘫、失语、震颤麻痹、意识障碍、癫痫等症状,需要与很多临床疾病作鉴别,如缺血性或出血性脑卒中、代谢性脑病等[1-2].本文报道1例维持性血液透析患者行冠状动脉介入术(percutaneous coronary intervention,PCI)后发生CIE.

Objective To explore the significance of early detection of renal tubular markers in the high risk population with chronic kidney diseases（CKD）, and analyze the influencing factors of abnormal increase of renal tubular injury markers. Methods According to the inclusion and exclusion criteria, 266 subjects were included in the study. The general clinical data, biochemical blood parameters, urine microalbumin-creatinine ratio（ACR）, renal tubular injury indices\[including Beta2-Microglobulin（β2-MG）, Alpha1-microglobulin（α1-MG）, Retinol Binding Protein（RBP）\] were recorded. The subjects were divided into positive and negative groups based on urinary ACR. The significance of early detection of renal tubular injury markers and the related influencing factors were analyzed. Results The positive rate of renal tubular injury in the urine ACR positive group was 86.36%, higher than that in the urine ACR negative group. However, in the urine ACR negative, 48.72% of patients had abnormal increase of renal tubular injury markers. Abnormal amplitude and abnormal item number of renal tubular injury markers in the urine ACR positive group were significantly higher than those in the negative group, with statistically significant difference（P<0.05）. The ages of patients in the positive group were significantly higher than that in the negative group, with statistically significant difference（P<0.05）. Multivariate stepwise regression analysis suggested that blood uric acid（OR=0.992, P=0.009） was a correlative factor for abnormal increase of renal tubular injury markers. Conclusions The detection of renal tubular protein has high clinical application value for the detection of early renal injury.

Objective To compare the high cut-off hemodialysis with high flux hemodialysis for free light chain removal,and to review literatures concerned.Methods A male aged 59 was admitted due to "fatigue more than one year,aggravated two days".He felt fatigue one year ago and was diagnosed as multiple myeloma by bone marrow biopsy and increased free light chain.Then partial remission was achieved by thalidomide,adriamcin and dexamethasone.One week before,he felt weakness and chest pain,then a decrease in hemoglobin and acute renal failure were found,which was considered the recurrence of multiple myeloma.Cyclophosphamide,doxorubicin and dexamethasone chemotherapy was started.When the creatinine up to 611 μmol/L,the hemodialysis treatment began.He received two times high flux hemodialysis (Fresenius FX60) first,then three times high cut-off hemodialysis (HCO2100).Time was four h and ultrafiltration was set at 0.5 kg.Human albumin 10 g was replenished at high flux hemodialysis for 3.5 h.The levels of serum FLCλ were detected by particle enhanced turbidimetric immunoassay,and those of serum albumin by automatic biochemical immunoassay before and after treatment.Results After two times high flux hemodialysis,serum levels of FLCλ were decreased from 45.9 to 36.4 mg/L,and those of albumin changed from 31.9 to 32.7 mg/L respectively.After three times high cut-off hemodialysis,serum levels of FLC λ decreased from 42.3 to 32.1 mg/L,and those of albumin were decreased from 33 to 28 mg/L (10 g albumin was added in each high cut-off hemodialysis).Conclusions We didn't find the superiority of high cut-off hemodialysis over high flux hemodialysis for serum FLC removal in multiple myeloma on renal replacement therapy.During four hours of high cut-off hemodialysis,albumin loss can be effectively prevented by intravenous administration of 10 g albumin.

Objective To investigate the correlation between serum uric acid level and heart-ankle vascular index (CAVI) in type 2 diabetic patients. Methods 135 patients with type 2 diabetes and without diabetic nephropathy were enrolled. We recorded the general clinical data, blood biochemical indicators, and CAVI. The patients were divided into four groups according to CAVI quartile. The relationship between CAVI and serum uric acid and the correlation between CAVI and CAVI were analyzed. Result ①CAVI median 9.45, according to CAVI quartile patients were divided into four groups, respectively: Q1≤8.2, 36 cases; Q2: 8.2~9.45, 34 cases; Q3:9.45~10.45, 33 cases ; Q4≥10.45, 32 cases. There were significant differences in age, body mass index (BMI), low density lipoprotein cholesterol (LDL-C), estimated glomerular filtration rate (eGFR) between the four groups (P<0.05). ②SUA level was higher than that of Q1, Q2 and Q3 groups (P<0.05). There was a positive correlation between serum uric acid and CAVI in patients with diabetes mellitus (r=0.365, P<0.01). ③The level of CAVI was positively correlated with age and negatively correlated with eGFR (r=-0.215, P<0.05). Conclusion Serum uric acid has a certain effect on arteriosclerosis in type 2 diabetes mellitus patients. Decreased early eGFR in diabetic patients with normal serum creatinine may be one of the risk factors of atherosclerosis.

Background: We investigated the relationship between plasminogen activator inhibitor-1 (PAI-1) 4G/5G insertion/deletion polymorphism and prevalence of diabetic nephropathy (DN) in Chinese patients. Methods: A total of 107 patients with type 2 diabetes were randomly recruited in the study, and 102 healthy subjects were selected as Control. Patients were divided into three groups according to their urinary albumin-creatinine ratio (UACR). Group A (n=44), had patients without DN (serum creatinine <106 mu mol/L and UACR <30 mu g/mg); Group B (n=30), had patients with micro-albuminuria (UACR 30-299 mu g/mg), and Group C (n=33), had patients with macro-albuminuria (UACR 300 mu g/mg and creatinine <200 mu mol/L). Plasma level of PAI-1 was measured by ELISA. PAI-1 polymorphism was determined by a polymerase chain reaction (PCR) method and DNA sequencing. Results: (1) The plasma PAI-1 levels of group A (60.39 +/- 17.01ng/L), group B (68.76 +/- 17.81ng/L) and group C and (68.63 +/- 18.30ng/L) are higher than that of controls (46.26 +/- 26.04ng/L); (2) Patients with genotype 4G/4G tended to exhibit higher PAI-1 level; (3) The distribution frequency of genotype 4G/4G in group C was significantly higher than in group A (42.4% vs. 28.7%, p<0.05) and (4) In type 2 diabetic patients, the occurrence of diabetes nephropathy in genotype 4G/4G, 4G/5G and 5G/5G is 35.0%, 30.2% and 21.4%, respectively. Conclusions: (1) Plasma PAI-1 level was elevated in Type 2 diabetic patients; (2) The level of plasma PAI-1 is closely related to PAI-1 gene 4G/5G polymorphism and (3) PAI-1 4G/5G polymorphism is associated with the development and progression of predominant proteinuria diabetes nephropathy.

目的:探讨维持性血液透析患者血清可溶性肿瘤坏死因子样凋亡微弱诱导剂(sTWEAK)水平与冠状动脉钙化的关系.方法:选择维持性血液透析患者60例和健康对照组30例,采用双抗体夹心酶联免疫吸附技术测定其血清sTWEAK水平,采用多层螺旋CT(MSCT)测定其冠状动脉钙化积分(CACs),比较两组的血清sTWEAK水平、CACs,并分析二者的相关性及血液透析患者冠状动脉钙化的危险因素.结果:血液透析患者血清sTWEAK水平显著低于正常对照组,分别为186.23(148.35,220.74)pg/mL和265.13(210.91,298.22)pg/mL,差异有统计学意义(P＜0.01).CACs＞400的血液透析患者血清sTWEAK水平显著高于CACs≤ 400者,分别为220.73(189.70,251.67)pg/mL和146.07(138.43,180.11)pg/mL,差异有统计学意义(P＜0.01).Spearman等级相关分析显示血液透析患者的血清sTWEAK水平与患者的CACs呈明显正相关(r=0.482,P＜0.01).多因素逐步回归分析显示影响血液透析患者CACs严重程度的因素有血清sTWEAK水平、年龄、透析龄、糖尿病(P＜0.05).结论:维持性血液透析患者血清sTWEAK水平较正常人降低,但在血液透析患者sTWEAK范围内,高水平的血清sTWEAK水平与重度冠状动脉钙化相关;血清sTWEAK可能参与了血液透析患者冠状动脉钙化的发生、发展.

Background/Aim: Vascular calcification is common and contributes to increased cardiovascular mortality in hemodialysis (HD) patients. In this prospective study, we aimed to investigate the associations of serum S100A12 in the presence of severe coronary artery calcification (CAC) and the progression of CAC in HD patients. Methods: Sixty maintenance HD patients and 30 controls were enrolled. Serum S100A12 levels were measured using ELISA. CAC scores (CACs) were measured twice at a 4-year interval using multislice spiral CT. The HD patients were classified as rapid progressors or slow progressors according to the change in the CACs across these 2 measurements (ΔCACs). Results: The incidences of rapid progression of CAC in patients with baseline CACs ≤10, CACs >10 and CACs >400 were 12.5, 40.0 and 64.3%, respectively. Both baseline and 4-year serum S100A12 levels were significantly higher in the rapid progressors than in the slow progressors (medians of 45.6 vs. 30.2 ng/ml, p < 0.001 and 62.3 vs. 39.4 ng/ml, p = 0.002, respectively). The serum S100A12 levels were significantly correlated with baseline CACs (r = 0.466, p < 0.001), 4-year CACs (r = 0.440, p < 0.001) and ΔCACs (r = 0.392, p < 0.001). Importantly, the ΔCACs were significantly correlated with ΔS100A12 levels (r = 0.396, p < 0.001). Logistic regression analysis revealed that the serum S100A12 level was as an independent determinant of the presence of severe CAC and that the increment in the serum S100A12 level was a factor that was significantly independently associated with the progression of CAC. Conclusions: Serum S100A12 levels were significantly associated with the presence of severe CAC, and the increment in serum S100A12 levels was an independent determinant of the progression of CAC.

Objective To observe the level of coronary artery calcification in maintain hemodialysis( MHD) patients and explore the relationship between calcium and phosphorus metabolism, fibroblast growth factor 23(FGF23), fetuin-A and coronary artery calcification. Methods Fifty-four MHD patients were enrolled in this study. Phosphate, calcium in their serum were determined. The level of FGF23 and fetuin-A in serum were detected by the method of ELISA. The degree of coronary artery calcification was detected by 64 slice spiral CT and the coronary artery calcium score(CCS) was calculated. The patients were divided into CCS≤400 group and CAC>400 group according to the CCS. Results (1) The mean CCS in 54 MHD patients is 826(P25 ~P75 is 144~2044). The patients of more than 0 points accounted for 94. 44%, more than 100 points accounted for 79. 63%, more than 400 points accounted for 59. 26%. (2) The FGF23 and age in CCS≤400 group was lower than CCS>400 group. The proportion of coronary disease in group CCS≤400 is lower than that in group CCS>400. The duration of dialysis, calcium, phosphorous, uric acid, albumin, parathyroid hormone, fetuin-A has no significant difference between the two groups. ( 3 ) Logistic regression analysis revealed that the level of FGF23 and age was the influencing factor of coronary artery calcification in MHD patients. Conclusion The degree of coronary artery calcification in MHD patients is serious, and the elevation of FGF23 is relevant to the coronary artery calcification.

目的 观察维持性血液透析(MHD)患者心脏瓣膜钙化及冠状动脉钙化情况,探讨用超声心动图检测心脏瓣膜钙化是否可以预测MHD患者冠状动脉钙化程度. 方法 选取MHD患者61例,测定血清甲状旁腺激素(PTH)、血钙(Ca2+)、血磷(P3-)、血脂等指标.应用超声心动图检测心脏瓣膜是否存在钙化,应用64层螺旋CT检查冠状动脉钙化积分(CAC)情况. 结果 ①无瓣膜钙化组CAC中位数为524分、一个瓣膜钙化组CAC中位数为1006.5分,二个瓣膜钙化组CAC中位数为2094.5分.②根据是否存在瓣膜钙化分组后,钙化组年龄(73.36±9.28岁)明显大于无钙化组(61.60±14.87岁),钙化组CAC(1765分)明显高于无钙化组(524分),P＜0.05.③低密度脂蛋白与CAC呈正相关(r=0.308,P=0.016).④心脏瓣膜钙化者更可能出现CAC＞1000分(OR值为4.995,95％可信区间0.877～28.445). 结论 MHD患者心血管钙化严重,应用超声心动图检查瓣膜钙化可以预测冠状动脉钙化程度.

目的 探讨维持性血液透析(MHD)患者血清Klotho蛋白水平及影响因素.方法 选择本院病情稳定的MHD患者46例,年龄匹配的健康体检者10例作为对照组.采用酶联免疫吸附技术测定血清Klotho蛋白水平;检测血清成纤维细胞生长因子23(FGF23)、全段甲状旁腺激素(iPTH)、血钙、血磷、白蛋白(Alb)、血色素(Hb)、肌酐(SCr)、尿素氮(BUN)等指标,收集并计算患者平均每日元素钙和活性维生素D摄入量.结果 MHD组血清Klotho蛋白水平为(283.3±219.1) ng/L,明显低于对照组(1 125.5±127.0) ng/L(P＜0.01).pearson相关分析显示,Klotho蛋白水平与FGF23(r=-0.929,P＜0.01)、SCr(r=-0.393,P＜0.01)、BUN(r=-0.429,P＜0.01)、血钙(r=-0.325,P＜0.05)、血磷(r=-0.687,P＜0.01)、平均每日元素钙摄入量(r=-0.411,P＜0.01)和平均每日活性维生素D摄入量(r=-0.354,P＜0.05)呈负相关.多元逐步回归分析显示FGF23是血清Klotho蛋白水平的影响因素.结论 血液透析患者血清Klotho蛋白水平明显降低,血清FGF23是影响血清Klotho蛋白水平的因素.

目的 检测维持性血液透析(maintenance hemodialysis,MHD)患者血清成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)和Klotho蛋白水平,探讨它们与左心室肥厚之间的关系. 方法 选取首都医科大学附属复兴医院病情稳定的MHD患者46例.采用酶联免疫吸附技术测定血清FGF23和Klotho蛋白水平.其他指标有血清全段甲状旁腺激素(iPTH)、血钙、血磷、白蛋白、B型脑钠肽、血红蛋白、肾功能等,并进行超声心动检测,根据Devereux公式计算左室质量指数(LVMI). 结果 ①MHD患者血清FGF23水平为(1829.29±1947.05)ng/L,明显高于正常人水平(10.48±8.93)ng/L,差异有统计学意义(P＜0.01).,MHD患者血清Klotho水平为(283.26±219.06)ng/L,明显低于同年龄正常人血清Klotho水平(1125.50±126.96) ng/L,差异有统计学意义(P＜0.01).②Pearson相关分析显示,MHD患者Log Klotho与Log FGF23呈负相关(r=-0.929,P＜0.01).Log Klotho和Log FGF23与超声心动图检测的各项指标无相关关系.③MHD患者左心室肥厚的发生率为61％,LVMI与收缩压、B型脑钠肽呈正相关(P＜0.01).多元逐步回归分析显示,B型脑钠肽是影响左心室肥厚的独立危险因素.结论 ①MHD患者血清FGF23水平明显升高,血清Klotho水平明显降低.②MHD患者左心室肥厚的发生率高,B型脑钠肽是影响左心室肥厚的独立危险因素,未发现血清FGF23和Klotho水平与左心室肥厚有相关关系.

Objective To determine the serum level of fibroblast growth factor 23（PGF23） in chronic kidney disease（CKD） patients and explore the relationship between FGF23 and valvular calcificatioa Methods eighty-nine CKD patients and twenty-eight people（control group） whose renal functions were normal were enrolled in this study.The patients in CKD were divided into CKD 1-2 group（16 patients）,CKD 3-4 group（20 patients）,CKD 5 group（16 patients） and CKD 5D（37 patients）.Phosphate,calcium,triacylglycerol,total cholesterol.Low density lipoprotein cholesterol high density lipoprotein cholesterol,parathyroid hormone and FGF23 in their serum were determined.The level of FGF23 in serum were detected by the method of ELISA.All the peoples were divided to VC group and non-VC group according to echocardiogram.Results（1）The Log iPTH,Log FGF23 and valvular calcification in CKD 5D group was much higher than other groups.（2）The Log FGF23 and Dialysis proportion in VC group was much higher than non-VC group.（3） Logistic regression analysis revealed that the level of Log FGF23,age,Hypercholesterolemia and history of diabetes mellitus was the influencing factor of CKD patients.Conclusions The serum level of FGF23 in CKD patients is higher.With the worsening of renal function,FGF23 increased,and the elevation of FGF23 is relative to the valvular calcificatioa

Objective To investigate the clinical significance of body composition monitor (BCM) in evaluating the dry weight of hemodialysis patients.Methods Fifty-four hemodialysis patients who reached the dry weight according to clinical assessment were enrolled.The volume load was measured with BCM,and the pre-dialysis blood pressure,plasma B type natriuretic peptide (BNP) and echocardiogram parameters were recorded.Results BCM results showed that,in 54 hemodialysis patients,15 patients presented overhydration and 13 patients underhydration.According to the results of BCM,all of the 15 overhydration patients and some of the 13 underhydration patients adjusted their dry weight.According to the BCM results and the pre-dialysis blood pressure,the patients were divided into 4 groups:group A (without overhydration,the pre-dialysis blood pressure ＜ 150 mmHg,1 mmHg =0.133 kPa),23 cases;group B (without overhydration,pre-dialysis blood pressure ≥ 150 mmHg),16 cases;group C (overhydration,pre-dialysis blood pressure ＜ 150 mmHg),7 cases;and group D (overhydration,pre-dialysis blood pressure ≥ 150 mmHg),8 cases.There were no significant differences in pre-dialysis,plasma BNP and the echocardiographic parameters among the 4 groups (P ＞ 0.05).Conclusions BCM is a simple and convenient tool to evaluate the volume status of hemodialysis patients,It can give guidance of dry weight regulation.Compared with the other clinical assessment methods such as pedal edema,the blood pressure and plasma BNP,it is more accurate and practical.

Objective To investigate the correlation between hemoglobin variability with hospitalizations/mortality of maintenance hemodialysis(MHD) patients.Methods In a retrospective study,we analyzed the hemoglobin variability and hospitalization and mortality of MHD patients from June,2012 to June,2014.Data of normal distribution were performed by analysis of variance.The X~2test with Yates correction and Fisher’s exact test were used for no-numerical date.Correlations between hemoglobin variability and age,dialysis age and mean hemoglobin were analyzed with Spearman’s correlation test.To predict the hospitalizations/mortality,logistic regression analysis was performed.Results In a total of 105 MHD patients,mean hemoglobin was(108.39±8.81)g/L,mean hemoglobin SD was(11.43±4.62)g/L.95.24%of patients had a high fluctation of hemoglobin.All the patients were divided into outpatients group(42 patients),in the hospital group(45 patients)and dead group(18 patients).The age of three groups were(64.02±13.02)years,(69.44± 13.47)years and(81.44±10.15)years respectively.The dialysis age of three groups were(9.23±6.42)years,(6.80±4.47)years and(4.98±3.00)years.The mean hemoglobin were(110.46±7.12)g/L,(108.51±8.12)g/L and(103.29±12.00)g/L respectively.Hemoglobin SD were(9.96±3.74)g/L,(11.98 ± 5.29)and(13.47 ± 3.73)g/L.The differences between three groups had statistically significance.Hemoglobin variability was significantly correlatied with the erythropoietin adjustments(r= 0.209,P = 0.032).Logistic regression analysis revealed that the dialysis age and hemoglobin SD were the influencing factors of hospitalizations/mortality.Conclusions Hemoglobin variability is common in MHD patients.High hemoglobin fluctuation is the risk factor predicting hospitalizations and mortality.

Objective To investigate the relation between serum adiponectin and coronary artery calcification score (CACS), and find the risk factors for CACS in patients with chronic kidney disease (CKD). Methods Twenty-nine patients with 3-5 stage CKD were selected. The serum adiponectin was measured by enzyme linked immunosorbent assay. The heart was scanned by 64-row spiral CT, and the CACS was calculated. The blood calcium, phosphorus, intact parathyroid hormone, total cholesterol, low density lipoprotein cholesterol, albumin, urea nitrogen, creatinine, uric acid and high sensitive C reactive protein levels were measured, and the calcium-phosphorus product and estimation glomerular filtration rate were calculated. Results In 29 patients with CKD, 24 cases (83%) had coronary artery calcification with different degree (CACS>0 score), and the average CACS was 508 (0-3 363) scores. There were statistical differences in systolic blood pressure, urea nitrogen and estimation glomerular filtration rate between CKD patients with CACS≥100 scores (15 cases) and CKD patients with CACS<100 scores (14 cases):(146.00± 13.00) mmHg (1 mmHg=0.133 kPa) vs. (123.00±9.00) mmHg, (15.44±8.36) mmol/L vs. (9.71±2.52) mmol/L and (21.77 ±11.81) ml/ (min·1.73 m2) vs. (38.71 ±11.56) ml/ (min·1.73 m2), P<0.01 or <0.05. Pearson correlation analysis results showed that CACS had positive correlation with systolic blood pressure, creatinine and uric acid, and negative correlation with albumin and estimation glomerular filtration rate. Mult-stepwise regression analysis results showed that systolic blood pressure and estimation glomerular filtration rate were the independent risk factors of CACS. Conclusions The patients with 3-5 stage CKD have severe coronary artery calcification. The systolic blood pressure and estimation glomerular filtration rate are the independent risk factors of coronary artery calcification.

Objective To detect the level of serum Klotho in chronic kidney disease (CKD) 3-5 stage patients and explore its relationship with the progress of renal function.Methods Twenty-nine patients with CKD 3-5 stage (CKD group) and 10 cases of age-matched non-CKD patients (control group) were enrolled in the study.The level of serum Klotho and fibroblast growth factor 23 (FGF23) were measured by enzyme-linked immunosorbent assay.Results The level of serum Klotho in CKD group was significantly lower than that in control group [(670.07 ± 146.22) ng/L vs.(1 125.50 ± 126.96) ng/L] (P ＜ 0.01).The level of serum FGF23 in CKD group was significantly higher than that in control group[(48.89 ± 44.28) ng/L vs.(10.48 ± 8.93) ng/L] (P ＜ 0.01).Pearson correlation analysis showed that the level of Klotho in CKD patients was positively correlated with estimated glomerular filtration rate (eGFR) and hemoglobin,and Klotho was negatively correlated with log urea nitrogen,log serum creatinine,log FGF23 and phosphate.Multiple regression analysis showed that log FGF23 and serum phosphorus were independent factors for serum Klotho level in patients with CKD.CKD patients were divided into rapid progression of renal function group (10 cases) and renal stability group (19 cases) according to annual rate of eGFR dechne.The patients in rapid progression of renal function group with lower serum Klotho [(580.27 ± 162.15) ng/L vs.(717.33 ± 115.22) ng/L],higher uric acid and more severe proteinuria [(448.00 ±65.21) mmol/L vs.(368.32 ±78.80) mmol/L,(1.99 ± 1.57) g/d vs.(0.60 ± 1.00) g/d] (P ＜0.05).Conclusions Serum Klotho level of CKD 3-5 stage patients decreases with the decline in renal function.Serum phosphate and FGF23 are the independent factors for serum Klotho.Serum Klotho may become the prediction index of renal function progress for patients with CKD.

目的:探讨PBL结合CBL教学法对参加住院医师规范化培训第一阶段住院医师临床能力影响.方法:采用自身对照研究,比较参加住院医师临床一阶段培训的住院医师PBL+ CBL教学前后临床考核成绩.结果:实施PBL+ CBL教学法前后,参加临床一阶段培训的住院医师临床考核成绩有显著提高(P＜0.01).结论:PBL +CBL教学法可提高住院医师的临床考核成绩,同时提高自主学习及临床思维能力.