Arteriovenous grafts remain crucial for hemodialysis access despite the risk of perigraft seromas (PSs)-sterile fluid collections causing graft compression, thrombosis, and dysfunction. Current treatments (surgical drainage and compression therapy) show high recurrence rates. We describe a novel occlusion-reopening technique for refractory PSs in 5 patients receiving hemodialysis (mean age, 62.6 years) with expanded polytetrafluoroethylene AVGs. All seromas developed at arterial anastomoses (143 days after placement) and recurred after conventional therapies. Our protocol involved (1) intentional graft occlusion via manual compression to induce thrombosis, (2) complete surgical seroma evacuation with pseudocapsule preservation, and (3) percutaneous transluminal angioplasty using 6-mm balloons for graft reopening (see Fig 1 for details). Technical success was achieved in all cases, with immediate restoration of thrill/bruit and mean post-percutaneous transluminal angioplasty flow of 1320 mL/min. No seroma recurrences occurred during follow-up, and all AVGs remained functional. The occlusionreopening technique addresses PS pathophysiology by eliminating fluid production through temporary thrombosis while preserving graft architecture. This approach demonstrates 100% efficacy in our series for recurrent PSs unresponsive to standard therapies, offering a reproducible solution with durable outcomes.

Background Arteriovenous fistula (AVF) dysfunction remains a major barrier to adequate dialysis delivery in patients undergoing maintenance hemodialysis (MHD), frequently resulting in repeated interventions and increased healthcare burden. Although chronic inflammation and mineral metabolism abnormalities are both implicated in vascular remodeling, their integrated clinical significance in AVF stenosis has not been well defined. Leveraging large-scale real-world data, this cross-sectional study aimed to comprehensively evaluate the associations of inflammatory indices and calcium–phosphate metabolism parameters with AVF stenosis and repeated percutaneous transluminal angioplasty (PTA). Methods In this single-center cross-sectional study, 683 MHD patients with AVF stenosis requiring PTA were enrolled as the case group, while 255 contemporaneous patients with normally functioning AVFs served as controls. Demographic characteristics, comorbidities, dialysis vintage, laboratory measurements, mineral metabolism markers, and inflammatory indices were collected. Inflammatory markers—including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to–high-density lipoprotein ratio (NHR), and systemic immune-inflammation index (SII)—were derived from peripheral blood counts. Multivariable logistic regression analyses were conducted to identify variables independently associated with AVF stenosis and repeated PTA within 12 months. Discriminatory performance was evaluated using receiver operating characteristic (ROC) curves, with subgroup analyses performed according to diabetes status and sex. Results Patients with AVF stenosis exhibited significantly higher serum phosphorus, intact parathyroid hormone (iPTH), calcium–phosphate product, NLR, PLR, and SII levels, alongside lower LMR and lymphocyte counts (all P < 0.05). Elevated iPTH, NLR, SII, calcium–phosphate product, and diabetes were independently associated with AVF stenosis. Among patients with established stenosis, higher NLR, diabetes, longer dialysis vintage, female sex, and lower serum albumin were independently associated with repeated PTA. Subgroup analyses suggested stronger associations with repeated interventions among diabetic and female patients. Notably, prediction models integrating inflammatory and mineral metabolism markers demonstrated superior discriminatory capacity compared with individual parameters. Conclusion Systemic inflammation and disordered mineral metabolism are both significantly associated with AVF stenosis in MHD patients, whereas inflammatory burden appears more closely linked to repeated interventions. A multidimensional risk assessment strategy incorporating these markers may improve early identification of high-risk patients and support more targeted vascular access management.

BACKGROUND:The transradial approach (TRA) is a critical access method for percutaneous transluminal angioplasty (PTA) in hemodialysis (HD) patients with arteriovenous fistula (AVF) dysfunction, yet its technical challenges remain unaddressed. Currently, no predictive tools exist to assess TRA feasibility. This study aimed to identify risk factors for difficult TRA and develop a predictive nomogram. METHODS:We retrospectively analyzed 160 HD patients undergoing ultrasound-guided TRA-PTA across three Chinese hospitals (May 2022-May 2024). A training cohort (n = 110) and validation cohort (n = 50) were established. Independent risk factors were identified via univariate and multivariate logistic regression. A nomogram was constructed and validated using ROC curves, calibration plots, and decision curve analysis (DCA). RESULTS:The cohort had a mean age of 59.7 ± 12.9 years, with 36.9% (59/160) experiencing difficult TRA. Radial artery diameter (OR = 2.1, p = 0.003), calcification (OR = 3.4, p < 0.001), and tortuosity (OR = 2.8, p = 0.002) were independent predictors. The nomogram demonstrated strong discrimination (AUC: 0.902), with sensitivity = 0.907 and specificity = 0.806 at a cutoff of 0.416. Calibration showed excellent agreement (mean absolute error = 0.022), and DCA confirmed clinical utility across threshold probabilities of 0.2-0.8. CONCLUSION:This nomogram demonstrates that for optimal puncture feasibility, the radial artery diameter should be ≥ 3 mm when both calcification and tortuosity are present, > 2.2 mm if either condition is present, and > 1.5 mm if neither is present. The nomogram effectively predicts difficult TRA during AVF-PTA in HD patients, offering clinicians a practical tool to preoperatively assess procedural feasibility and optimize vascular access planning.

Background: To explore the trends of venous diameter and brachial artery volume flow (VF) in 12 weeks after arteriovenous fistula (AVF) and the influence of preoperative arterial diameter on this trend. Our goal was to clarify the maturation process within 12 weeks after AVF surgery. Methods: Clinical data of 257 patients with end-stage renal disease who had their first radial- cephalic AVF established at our institution from February 1, 2023, to February 1, 2024, were included. The patients were divided into group A (radial artery diameter <1.5 mm), group B (radial artery diameter 1.5-2.0 mm), and group C (radial artery diameter >2.0 mm) according to the preoperative radial artery diameter. After AVF surgery, the artery and vein diameter and brachial artery VF were recorded at 1 day, 2 weeks, 4 weeks, 6 weeks, 8 weeks, 10 weeks, and 12 weeks. Results: The venous diameter and brachial artery VF of AVF showed an upward trend and increased significantly in 1 day-6 weeks postoperatively (P < 0.05), especially between 1 day and 2 weeks, while no significant difference in the increases at 6-12 weeks. Groups B and C were in line with the above trend, whereas the patients in group A showed best growth in 2-4 weeks postoperatively. The natural maturation rates of AVF in groups B and C were significantly better than that of group A at all postoperative time (P<0.05). Conclusions: The AVF was in a developmentally dominant stage at 6 weeks postoperatively, with 1 day-2 weeks being particularly prominent. The postoperative natural maturation rate of AVF with arteries diameter of <1.5 mm was low; the direct use of such arteries to establish AVF needs careful consideration.

OBJECTIVE:To investigate the current status of vascular access in hemodialysis patients and the surgical capabilities of hospitals at all levels in Sichuan Province. METHODS:A cross-sectional survey using a questionnaire method was conducted, involving 228 hospitals and 30,067 hemodialysis patients. The current status of hemodialysis vascular access and hospital surgical capabilities were statistically analyzed, and differences in surgical capabilities across hospital levels were compared. RESULTS:The primary first-time vascular access in Sichuan Province was non-cuffed catheters (NCC, 57.42%), with the femoral vein (68.04%) being the main site for initial NCC placement. Notably, 69.3% of patients had indwelling times exceeding 1 month, and 15.79% exceeded 2 months, this phenomenon particularly prominent in prefectural and county-level hospitals (79.73% and 72.86%, respectively), which was significantly influenced by physicians' surgical capabilities (aOR = 10.23, 95% CI 1.42-73.43, p = 0.021). For long-term hemodialysis access, autogenous arteriovenous fistulas (AVF) were the most common (85.36%), followed by tunnel-cuffed catheters (TCC, 12.59%), with arteriovenous grafts (AVG) accounting for only 1.42%. Vascular access surgeries in Sichuan Province were predominantly performed by nephrologists (78.00% for open surgery, 55.79% for interventional surgery), with stronger open surgical capabilities compared to interventional capabilities (80.18% vs 38.16%). However, only 17.54% of hospitals could perform AVG surgeries. CONCLUSION:The primary first-time vascular access in Sichuan Province is NCC with prolonged indwelling times, while AVF is the main long-term access. The low proportion of AVG and weak surgical capabilities highlight the need to strengthen access planning and management for end-stage chronic kidney disease patients in hospitals at all levels, particularly improving physicians' capabilities in AVG and interventional access surgeries.

BackgroundCognitive function impairment (CFI) is common in patients with chronic kidney disease (CKD) and significantly impacts treatment adherence and quality of life. This study aims to create a simplified nomogram for early CFI risk detection.MethodsData were obtained from the National Health and Nutrition Examination Survey cycles spanning from 1999 to 2002 and again from 2011 to 2014. Stepwise logistic regression was used to select variables and construct a CFI risk prediction model. Furthermore, C-statistic and Brier Score (BS) assessed model performance. Additionally, Kaplan–Meier survival curves were utilised to assess risk group-death prognosis relationships.ResultsOf the 545 participants in the CKD model development cohort, a total of 146 (26.8%) had CFI. The final model included the variables of age, race, education, annual family income, body mass index, estimated glomerular filtration rate, serum albumin and uric acid. The model had a C-statistic of 0.808 (95% confidence interval (CI): 0.769–0.847) and a BS of 0.149. Furthermore, the 5-fold cross-validation internal C-statistic was 0.764 (interquartile range: 0.763–0.807) and BS was 0.154. Upon external validation, the model's C-statistic decreased to 0.752 (95% CI: 0.654–0.850) and its BS increased to 0.182. The Kaplan–Meier survival curves demonstrated that intermediate-to-high-risk participants had shorter overall survival time than low-risk participants (log-rank test: p = 0.00042).ConclusionsThis study established an effective nomogram for predicting CFI in patients with CKD, which can be used for the early detection of CFI and guide the treatment of patients with CKD.

ObjectiveThe aim of this study was to investigate the timing of assessing the maturation of arteriovenous fistula (AVF) and the diagnostic efficacy of two ultrasound assessment criteria in determining the maturation of AVF.MethodsWe collected clinical data on 227 patients with end-stage renal disease who were first diagnosed at our institution between February 1, 2023 and February 1, 2024, and were followed up regularly for 12 weeks post-AVF creation, with the diameter of the draining vein and the brachial artery volume flow (VF) recorded at 1 day, 2, 4, 6, 8, 10, and 12 weeks post-operation. We focused on the time of AVF maturation, and ultrasonographic diagnostic criteria 1 (the vein diameter was ≥4 mm, and the brachial artery VF was >500 mL/min, referred to as the "Rule of 4") and ultrasonographic diagnostic criteria 2 (the vein diameter was ≥5 mm, and the brachial artery VF was> 500 mL/min, referred to as the "Rule of 5") were used to evaluate the maturation of AVF. And compared with clinically maturation criteria to understand the correlation, consistency, and diagnostic efficacy.Results1. The venous diameter and brachial artery VF of AVF showed an upward trend, and increased significantly in 1 day to 6 weeks postoperatively (p < .05),especially between 1 day and 2 weeks, while no significant difference in the increases at 6-12 weeks; 2. Logistic regression analysis showed that venous diameter (OR = 19.589 , 95% CI 1.560-245.979, p = .021) and brachial artery VF (OR = 1.024 , 95% CI 1.005-1.042, p = .011) at 6 weeks were the independent correlates affecting AVF maturation; and the optimal thresholds were 4.08 mm (sensitivity 88.10%, specificity 70.00%) and 472.50 mL/min (sensitivity 93.20%, specificity 84.00%), respectively; 3. Compared with clinical maturation, the two ultrasonographic diagnostic criteria at 6 weeks postoperatively were correlated with clinical maturation, and the specificity of both was 100%, with "Rule of 4" having a sensitivity of 79.66%, an accuracy of 84.14%, and a concordance kappa = 0.633, while "Rule of 5″ had a sensitivity of 31.63%, an accuracy of 46.69%, and a concordance kappa = 0.169; and the area under the ROC curve (AUC) for "Rule of 4″ was higher than that for "Rule of 5" (0.898 vs. 0.658, p < .001).ConclusionSix weeks postoperatively may be the best timing for an ultrasound assessment of AVF maturation, and the "Rule of 4" ultrasound assessment criteria was more suitable for clinical judgment of AVF maturation.

Abstract Background Cognitive impairment (CoI), chronic kidney disease (CKD), and depression are prevalent among older adults and are interrelated, imposing a significant disease burden. This study evaluates the association of CKD and depression with CoI and explores their potential interactions. Method Data for this study were sourced from the 2011–2014 National Health and Nutritional Examination Survey (NHANES). Multiple binary logistic regression models assessed the relationship between CKD, depression, and CoI while controlling for confounders. The interactions were measured using the relative excess risk of interaction (RERI), the attributable proportion of interaction (AP), and the synergy index (S). Results A total of 2,666 participants (weighted n = 49,251,515) were included in the study, of which 700 (16.00%) had CoI. After adjusting for confounding factors, the risk of CoI was higher in patients with CKD compared to non-CKD participants (odds ratio [OR] = 1.49, 95% confidence interval [CI]:1.12–1.99). The risk of CoI was significantly increased in patients with depression compared to those without (OR = 2.29, 95% CI: 1.73–3.03). Furthermore, there was a significant additive interaction between CKD and depression in terms of the increased risk of CoI (adjusted RERI = 2.01, [95% CI: 0.31–3.71], adjusted AP = 0.50 [95% CI: 0.25–0.75], adjusted S = 2.97 [95% CI: 1.27–6.92]). Conclusion CKD and depression synergistically affect CoI, particularly when moderate-to-severe depression co-occurs with CKD. Clinicians should be mindful of the combined impact on patients with CoI. Further research is needed to elucidate the underlying mechanisms and assess the effects specific to different CKD stages.

Abstract Recent studies have suggested a potential link between COVID-19 and the initiation or exacerbation of membranous nephropathy (MN) caused by the SARS-CoV-2 virus. However, a causal relationship between COVID-19 and MN remains unconfirmed. Here, we used the Mendelian randomization (MR) approach to investigate whether this causal relationship exists. We utilized data from the COVID-19 Host Genetics Initiative, comprising the largest available genome-wide association study (GWAS) datasets from European and East Asian populations. For MN, we used the largest literature-reported GWAS dataset. We selected single nucleotide polymorphisms as instrumental variables and used the inverse variance weighted (IVW) method, supplemented with MR Egger, weighted median, and mode methods. The MR-Egger intercept test and the MR-PRESSO global test were applied to assess horizontal pleiotropy. The robustness of the MR findings was evaluated using Cochran’s Q test and leave-one-out analysis. In both cohorts, MR methods showed SARS-CoV-2 infection, hospitalization, and severe COVID-19 did not increase the risk of MN. Conversely, MN potentially increased the risk of COVID-19-related hospitalization in Europeans, supported by the IVW and other methods. In East Asians, MR Egger suggested an increased risk of severe COVID-19 associated with MN, but other MR methods did not support this. No significant evidence of horizontal pleiotropy was detected. Cochran’s Q test showed no heterogeneity, and leave-one-out analysis confirmed the MR findings' reliability. The bidirectional MR analysis confirmed that COVID-19 did not increase MN risk, but MN might increase the risk of COVID-19-related hospitalization in Europeans, indicating a potential causal relationship.

目的 调查四川省东北部地区血液透析患者血管通路使用情况,了解维持性血液透析(maintenance hemodialysis,MHD)患者血管通路现状.方法 随机抽样调查四川省东北部地区 18 个血液透析中心(每个中心 40 例)共 720 例 MHD患者血管通路情况,分析该区域MHD患者的通路现状.结果 MHD患者在用血管通路以自体动静脉内瘘(arteriovenous fistula,AVF)为主(654 例,90.83%),其次为带隧道和涤纶套的透析导管(36 例,5.00%),移植物动静脉内瘘(arterio-venous graft,AVG)最少(30 例,4.17%).首次透析使用血管通路以无隧道和涤纶套的透析导管(non-cuffed catheter,NCC)为主(438 例,60.83%),且股静脉NCC高于颈内静脉,其次为AVF(244 例,33.89%).在用AVF以区域穿刺为主要穿刺方式(356 例,54.43%),其次为绳梯穿刺(258 例,39.50%),其中 14.37%(94/654)的患者有透析穿刺困难.肘部AVF区域穿刺及穿刺困难发生率较腕部桡侧AVF、前臂中段AVF及AVG高,差异有统计学意义(P＜0.05).结论 四川省东北部地区终末期肾病患者血管通路管理及MHD患者内瘘穿刺管理均需进一步加强,以改善首次透析内瘘使用率及区域穿刺问题.

Background: Bloodstream infection (BSI) is a prevalent cause of admission in hemodialysis (HD) patients and is associated with increased morbidity and mortality. This study aimed to establish a diagnostic, predictive model for the early identification of BSI in HD patients.Methods: HD patients who underwent blood culture testing between August 2018 and March 2022 were enrolled in this study. Machine learning algorithms, including stepwise logistic regression (SLR), Lasso logistic regression (LLR), support vector machine (SVM), decision tree, random forest (RF), and gradient boosting machine (XGboost), were used to predict the risk of developing BSI from the patient's clinical data. The accuracy (ACC) and area under the subject working curve (AUC) were used to evaluate the performance of such models. The Shapley Additive Explanation (SHAP) values were used to explain each feature's predictive value on the models' output. Finally, a simplified nomogram for predicting BSI was devised. Results: A total of 391 HD patients were enrolled in this study, of whom 74 (18.9%) were diag-nosed with BSI. The XGboost model achieved the highest AUC (0.914, 95% confidence interval [CI]: 0.861-0.964) and ACC (86.3%) for BSI prediction. The four most significant co-variables in both the significance matrix plot of the XGboost model variables and the SHAP summary plot were body temperature, dialysis access via a non-arteriovenous fistula (non-AVF), the procalci-tonin levels (PCT), and neutrophil-lymphocyte ratio (NLR). Conclusions: This study created an effective machine-learning model for predicting BSI in HD patients. The model could be used to detect BSI at an early stage and hence guide antibiotic treatment in HD patients.

目的 探究靶向抑制血管紧张素Ⅱ1型受体(angiotensinⅡtype 1 receptor,AGTR1)对血管紧张素Ⅱ诱导的高血压肾病中肾脏纤维化和足细胞损伤的影响.方法 将40只健康小鼠按随机数字表法分成正常对照组、生理盐水组、模型组和药物组,每组10只小鼠,正常对照组不进行处理,生理盐水组进行单侧肾切除并用微渗泵灌注生理盐水,模型组进行单侧肾切除并用微渗透泵灌注血管紧张素Ⅱ,药物组在进行单侧肾切除并用微渗透泵灌注血管紧张素Ⅱ前30 min腹腔注射50 mg/kg氯沙坦,用动物血压仪检测造模前及造模后2周、4周各组小鼠血压,造模后4周,酶联免疫法检测24 h尿蛋白定量(24 h urinary protein,24 h UP)、血肌酐(serum creatinine,Scr)和尿素氮(urea nitrogen,BUN),HE染色观察肾组织病理形态学,Masson染色检测肾组织纤维化,透射电镜观察足细胞超微结构变化,免疫荧光染色检测肾组织足细胞裂孔膜蛋白(nephrin)表达,蛋白质印迹法检测肾组织内α-平滑肌肌动蛋白(α-smooth muscle actin,α-SMA)、I型胶原蛋白(collagen-Ⅰ)、Ⅲ型胶原蛋白(collagen-Ⅲ)、nephrin、膜蛋白(podocin)以及突触足蛋白(synaptopodin)表达.结果 模型组相较于正常对照组,造模后小鼠血压升高[造模2周:(148.92±12.56)mmHg比(109.18±9.43)mmHg;造模4周:(150.92±13.74)mmHg比(117.68±10.73)mmHg,(1 mmHg=0.133 kPa)],生理盐水组和模型组24 h UP[(2.02±0.18)mg/24h比(3.88±0.34)mg/24h比(0.37±0.02)mg/24h]、Scr[(11.34±0.97)μmol/L比(13.92±1.16)μmol/L比(9.18±0.87)μmol/L]、BUN[(11.34±1.09)mmol/L比(14.55±1.30)mmol/L比(7.71±0.73)mmol/L]水平均升高,肾组织内肾小管出现萎缩、坏死,空泡变性,上皮细胞脱落,炎性细胞大量浸润,伴随明显的纤维化,足细胞足突增粗、融合,裂孔膜消失,nephrin荧光强度减弱,α-SMA、collagen-Ⅰ、collagen-Ⅲ的蛋白表达水平均升高,nephrin、podocin、syn-aptopodin的蛋白表达水平均下降(P<0.01);与模型组相比,药物组小鼠血压下降[造模2周:(125.08±10.79)mmHg比(148.92±12.56)mmHg;造模4周:(122.78±10.07)mmHg比(150.92±13.74)mmHg],24 h UP[(1.25±0.11)mg/24 h比(3.88±0.34)mg/24 h]、Scr[(10.33±0.84)μmol/L比(13.92±1.16)μmol/L]、BUN[(8.96±0.81)mmol/L比(14.55±1.30)mmol/L]水平均降低,肾小管萎缩、坏死以及空泡变性等现象减轻,有少量炎性细胞浸润,纤维化程度减轻,足细胞足突增粗、融合现象得到改善,同时,nephrin荧光强度增强,α-SMA、collagen-Ⅰ、collagen-Ⅲ的蛋白表达水平均下降,nephrin、podocin、synaptopodin的蛋白表达水平均升高(P<0.01).结论 抑制AGTR1可减轻血管紧张素Ⅱ诱导的高血压肾病小鼠模型中肾脏纤维化,同时减轻足细胞损伤.

Objective To investigate the clinical value of neutrophil/lymphocyte ratio (NLR) and neutrophil/high-density lipoprotein cholesterol ratio (NHR) for carotid atherosclerosis (CAS) in patients with end-stage renal disease (ESRD). Methods A total of 220 ESRD patients [glomerular filtration rate < 15 mL/(min·1.73 m2)] admitted in our department from January 2017 to January 2021 were recruited in this study. According to the results of neck color Doppler ultrasound, they were divided into CAS group (n=80) and non-CAS group (n=140). Their general data, results of blood routine test, biochemical indexes and hs-CRP level were collected, and then NLR, NHR, monocyte to high-density lipoprotein cholesterol ratio (MHR), and platelet to lymphocyte ratio (PLR) were calculated. Results The CAS group had significant older age, higher NLR, NHR, PLR and MHR, and lower hemoglobin, albumin and HDL levels when compared with the non-CAS group (P < 0.05). Multivariate logistic regression analysis showed that older age (OR=1.067, 95%CI: 1.035~1.099, P < 0.001), elevated NLR (OR=1.295, 95%CI: 1.066~1.574, P=0.009), and increased NHR (OR=2.143, 95%CI: 1.620~2.834, P < 0.001) were risk factors for CAS, and risen hemoglobin (OR=0.945, 95%CI: 0.923~0.967, P < 0.001) were protective factors for CAS in ESRD patients. ROC curve analysis indicated that NLR (AUC=0.759, 95%CI: 0.696~0.82, P < 0.000 1), NHR (AUC=0.755, 95%CI: 0.691~0.820, P < 0.000 1) and their combination (AUC=0.793, 95%CI: 0.733~0.853, P < 0.000 1) had certain predictive values for CAS in ESRD patients. Conclusion NLR and NHR, as inflammatory indexes, are independent risk factors for CAS in ESRD patients. Their combination might have better predictive value for CAS in these patients.

ObjectiveTo explore the effect of targeted inhibition of angiotensin Ⅱ type 1 receptor （AGTR1） on renal fibrosis and podocyte damage in angiotensin Ⅱ-induced hypertensive nephropathy.MethodsThe murine experimental groups include normal control group，normal saline group，model group and drug group （n=10 each）.Normal control group was not treated，normal saline group underwent unilateral nephrectomy plus microosmotic pump infusion of normal saline，model group unilateral nephrectomy plus micro-osmotic pump perfusion with angiotensin Ⅱ，drug group unilateral nephrectomy plus an intraperitoneal injection of 50 mg/kg of Losartan 30 min before perfusion of angiotensin Ⅱ with a micro-osmotic pump.Blood pressures were measured for each group at pre-modeling and 2/4 weeks post-modeling.At 4 weeks post-modeling，enzyme-linked immunosorbent assay was employed for detecting 24 h urinary protein （24 h UP），serum creatinine （Scr） and urea nitrogen （BUN）； hematoxylin-eosin （HE） staining for observing the pathological morphology of kidney tissue； Masson staining for detecting renal tissue fibrosis，observing the ultrastructural changes of podocytes with transmission electron microscope，immunofluorescent staining for detecting the expression of nephrin in podocytes of renal tissue，Western blot for detecting the expressions of α-smooth muscle actin （α-SMA），type Ⅰ/Ⅲ collagen （collagen-Ⅰ/Ⅲ），nephrin，podocin and synaptopodin.ResultsCompared with normal control group，blood pressure rose after modeling ［modeling for 2 weeks：（148.92±12.56） mmHg vs （109.18±9.43） mmHg； modeling for 4 weeks：（150.92±13.74） mmHg vs （117.68±10.73） mmHg，1 mmHg = 0.133 kPa］ and 24 h UP ［（2.02±0.18） mg/24h vs （3.88±0.34） mg/24h vs （0.37±0.02） mg/24h］，Scr ［（11.34±0.97） μmol/L vs（13.92±1.16） μmol/L vs （9.18±0.87） μmol/L］ and BUN ［（11.34±1.09） mmol/L vs （14.55±1.30） mmol/L vs （7.71±0.73） mmol/L］ spiked in normal saline and model groups，renal tubules appeared atrophic and necrotic with vacuolar degeneration，and epithelial cells sloughed off，heavy infiltrate of inflammatory cells，accompanied by obvious fibrosis，podocyte foot process thickened and merged，slit membrane disappeared，fluorescent intensity of nephrin declined，protein expression levels of α-SMA and collagen-Ⅰ/Ⅲ spiked while protein expression levels of nephrin，podocin and synaptopodin declined （P<0.01）.Compared with model group，blood pressure of drug group dropped ［2 weeks of modeling：（125.08±10.79） mmHg vs （148.92±12.56） mmHg； 4 weeks of modeling：（122.78±10.07） mmHg vs（150.92±13.74） mmHg］，24 h UP ［（1.25±0.11） mg/24h vs （3.88±0.34） mg/24h］，Scr ［（10.33±0.84） μmol/L vs （13.92±1.16） μmol/L］ and BUN ［（8.96±0.81） mmol/L vs （14.55±1.30） mmol/L］ decreased，renal tubular atrophy，necrosis and vacuolar degeneration were alleviated，minimal infiltration of inflammatory cell，degree of fibrosis lessened，foot process thickened and fusion phenomenon improved.At the same time，fluorescent intensity of nephrin increased，rotein expression levels of α-SMA and collagen-Ⅰ/Ⅲ dropped while protein expression levels of nephrin，podocin and synaptopodin spiked （P<0.01）.ConclusionInhibition of AGTR1 may reduce renal fibrosis in a murine model of hypertensive nephropathy induced by angiotensinⅡand at the same time reduce podocyte damage.

目的 分析法舒地尔对尿毒症动静脉内瘘成形术后患者凝血功能、血管内皮功能及内瘘通畅率的影响.方法 选取2018年6月—2020年6月我院行动静脉内瘘成形术治疗的95例尿毒症,根据术后治疗方式的不同分为研究组50例和对照组45例,研究组和对照组分别在动静脉内瘘成形术后应用法舒地尔、阿司匹林治疗7 d.比较2组内瘘成熟率,凝血功能指标[血小板计数(PLT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)及D-二聚体(D-D)],血管内皮功能指标[血管血流量、壁厚、内径及一氧化氮(NO)、内皮素-1(ET-1)],透析血流量、内瘘成熟后初次透析时间、内瘘通畅率.结果 研究组内瘘成熟率明显高于对照组(P<0.01).治疗后2组PLT水平升高、D-D水平降低,以研究组为甚(P<0.05,P<0.01);治疗后,研究组PT、FIB、APTT较前无明显变化(P>0.05),对照组PT、FIB、APTT较前缩短或降低,且研究组上述指标高于或长于对照组(P<0.05).治疗后,2组血管血流量、壁厚、内径及NO、ET-1水平均明显改善,且研究组血管血流量、壁厚、内径及NO水平更高,ET-1水平更低(P<0.05,P<0.01).研究组透析血流量、初次透析时间及内瘘通畅率明显优于对照组(P<0.01).治疗过程中2组均未出现严重不良反应.结论 尿毒症动静脉内瘘成形术后患者予法舒地尔干预,可有效促进内瘘成熟,且在不明显影响凝血功能基础上,对血管内皮起调节作用,提高内瘘通畅率.

The aim of this study was to investigate the protective effects of lycopene from tomato pomace on renal injury in diabetic rats. Lycopene was extracted from tomato pomace. The rats were divided into control, model and 10, 20 and mg/kg lycopene groups. The diabetic nephropathy model was constructed in the latter four groups. Then, the latter three groups were treated with 10, 20 and mg/kg lycopene, respectively. After four weeks of treatment, compared with the model group, in 20 and 40 mg/kg lycopene groups the serum fasting plasma glucose level was decreased (P < 0.05), the fasting insulin level was increased (P < 0.05), the renal index and 24-h urinary protein level were decreased (P < 0.05), the blood urea nitrogen and serum creatinine levels were decreased (P < 0.05), the renal tissue superoxide dismutase and glutathione peroxidase levels were increased (P < 0.05), the renal tissue malondialdehyde level was decreased (P < 0.05), and the serum tumor necrosis factor alpha, interleukin 6 and hypersensitive C-reactive protein levels were decreased (P < 0.05). In conclusion, lycopene from tomato pomace can alleviate renal injury in diabetic rats. The mechanism may be related to the resistance of oxidative stress and inflammatory response.

目的 探究抑制P2X7受体(R)表达对高糖诱导的肾间质成纤维细胞转化生长因子(TGF)-β1/p38丝裂原活化蛋白激酶(MAPK)信号通路的影响.方法 设计、合成P2X7R序列并制备慢病毒悬液,分离肾间质成纤维细胞,分为空白组、高糖组、过表达组、沉默组,空白组细胞使用DMEM完全培养液+5.5 mmol/L葡萄糖培养;高糖组使用DMEM完全培养液+25 mmol/L葡萄糖培养;过表达组细胞使用2 ml按照1:1比例混合的siNC P2X7R慢病毒悬液和DMEM培养液+25 mmol/L葡萄糖培养;沉默组细胞使用2 ml按照1:1比例所混合的siRNA P2X7R慢病毒悬液和DMEM培养液+25 mmol/L葡萄糖培养.对比4组细胞增殖、凋亡能力、丙二醛(MDA)、超氧化物歧化酶(SOD)水平及TGF-β1/p38MAPK信号通路因子表达量.结果 沉默组细胞增殖率低于过表达组,细胞凋亡率高于过表达组,具有统计学差异(P<0.05).沉默组MDA水平低于过表达组,SOD水平高于过表达组,具有统计学差异(P<0.05).沉默组TGF-β1、p38MAPK、Caspase-3 mRNA表达量均低于过表达组,具有统计学差异(P<0.05).结论 抑制P2X7受体表达可经影响高糖诱导的肾间质成纤维细胞TGF-β1/p38MAPK信号通路,抑制氧化应激及增殖,促进凋亡,进而减轻肾损伤.

目的 调查川东北地区社区居民的肥胖现状及对肥胖相关性肾病(ORG)的认知情况,并分析相关影响因素.方法 采用分层随机抽样法选取2018年7月—9月川东北5个地区18岁及以上的1905名居民为调查对象.采用问卷进行调查,问卷内容包括基本信息、健康检查、ORG相关知识三个方面.结果 川东北地区居民的肥胖率为11.8％,超重率为35.9％,居民对ORG的认知率为13.4％.单因素分析结果提示,文化程度、年龄和是否体检是居民ORG知晓率的影响因素,差异有统计学意义(P＜0.05).多因素分析结果提示,文化程度、年龄和是否体检是居民ORG认知度的影响因素,差异有统计学意义(P＜0.05).结论 川东北地区居民超重、肥胖率较高,对ORG认知率低,应加强健康教育宣传,提升居民自我健康管理意识,并提高大众对ORG的知晓率.

目的探讨中性粒细胞/淋巴细胞比值（NLR）与免疫球蛋白A（IgA）肾病Lee氏分级、牛津分型的相关性。方法选取80例IgA肾病患者的临床和病理资料,根据IgA肾病病理Lee氏分级及牛津分型间质纤维化与肾小管萎缩（T）分级分组,根据牛津分型新月体（C）分级分为2组。检测NLR、超敏C反应蛋白（hsCRP）、血肌酐（SCr）、尿素氮（BUN）、24 h尿蛋白水平,采用肾脏病饮食改良公式估算肾小球滤过率（eGFR）,分析NLR与IgAN病理Lee氏分级、牛津分型及肾功能临床指标相关性。结果在Lee氏分级和牛津分型中,伴随肾脏病理损伤程度加重,NLR、SCr、BUN、24 h尿蛋白水平逐渐加重,eGFR下降（P＜0.05）。NLR与Lee氏分级及牛津分型中T、C分级呈正相关（P＜0.05）,与SCr、BUN、24 h尿蛋白水平呈正相关（P＜0.05）,与eGFR呈负相关（P＜0.05）。结论 NLR能反映IgA肾病患者疾病炎症状态及活动性,且与病理损害程度及肾脏功能有较好的相关性,对评估IgA肾病肾脏损伤程度及预后有一定价值。

Objective To investigate the clinical value of procalcitonin(PCT) and white blood cell count(WBC) in diagnosis of complicated pulmonary infection in patients with maintenance hemodialysis.Methods A total of 87 patients were selected as the infection group,who underwent maintenance hemodialysis(MHD) in Blood Purification Centre,Affiliated Hospital of North Sichuan Medical College from June 2017 to December 2018,and complied with diagnosis criteria of pulmonary infection in clinical examinations,imaging examinations and laboratory tests.A total of 75 MHD patients without pulmonary infection or other site infection in the same period were selected as the non-infection group.General data and clinical examination data of all the above patients were collected,including age,sex,body mass index,primary disease,blood routine,blood biochemistry,parathyroid hormone,C-reactive protein(CRP),PCT and so on.Retrospective analysis was done on the data after enrollment.Results(1) Compared with the non-infection group,the levels of albumin and total cholesterol in the infection group were significantly lower,while the levels of WBC,neutrophil percentage,PCT and CRP were significantly higher(P<0.05).(2) Multivariate Logistic regression analysis showed that PCT(OR=70.625,95%CI 13.783～361.891,P<0.05) and WBC(OR=1.435,95%CI 1.133～1.817,P<0.05) were independent risk factors for pulmonary infection in MHD patients.(3) The areas under the receiver operating characteristic curve of PCT,WBC and PCT+WBC for the combined diagnosis of maintenance hemodialysis patients with pulmonary infection were 0.880(0.828～0.932),0.717(0.638～0.797) and 0.905(0.859～0.951)(P<0.05),respectively.Conclusions PCT and WBC are independent risk factors of pulmonary infection in MHD patients.The combined detection of PCT and WBC is more effective in the diagnosis of pulmonary infection in MHD patients.