Nephrology is a frontier discipline with interdisciplinary integration. The pathogenesis of kidney disease is complex and diverse. The progress of its clinical diagnosis and treatment needs to be promoted by scientific research achievements. In the standardized training of nephrology residents, higher requirements are put forward for the scientific research ability of the trainees. However, due to the busy clinical work, many of the trainees lack sufficient time and energy to participate in the systematic scientific research training. Based on the characteristics of nephrology, this paper discussed how to improve the scientific research ability of the trainees from the aspects of raising clinical problems, cultivating scientific research thinking, strengthening basic scientific research practice, changing teaching methods, and carrying out academic exchange activities.

Objective:To perform a bibliometric analysis of research on artificial kidney for the purpose of exploring the status and trend of research in this field.Methods:From the web of science core collection (WoSCC), artificial kidney-related literature from 2000 to 2022 were taken as samples, and the CiteSpace and VOSviewer softwares were applied to statistically analyze the number of publications, as well as country, institution, author, journal, and key words, etc.Results:A total of 382 articles related to artificial kidney were obtained after screening and de-duplication. The United States was the country with the largest contribution, and University of Twente was the leading institution. Artificial Organs was the most active journal in this field. Claudio Ronco was the author with the highest number of publications and ranked first among co-cited authors. Wearable artificial kidney, hemodialysis, peritoneal dialysis, and bioartificial kidney were the keywords that appeared with high frequency. Adsorption and removal were the main burst key words.Conclusion:Annual publications related to artificial kidney have been increasing year by year for the last two decades. Wearable artificial kidney and bioartificial kidney were continuously popular research directions. The recent high interest in the function of artificial kidney to adsorb and remove metabolites suggested that it may be recent hotspots in this field.

目的 对比分别使用高浓度次氯酸钠与过氧乙酸消毒、每日夜间无消毒液浸泡,与低浓度次氯酸钠与过氧乙酸夜间浸泡消毒,2种不同消毒方式的有效性与安全性,分析夜间低浓度消毒液浸泡法用于中央透析液供应系统(central dialysis fluid delivery system,CDDS)消毒的优势.方法 2017年11月～2019年11月,中国人民解放军总医院第一医学中心CDDS系统分别使用2种不同消毒方式各12个月.对比2种消毒方式下,中央透析液供应系统不同采样点细菌、内毒素水平以及消毒液夜间浸泡中浓度变化情况,评价有效性.检测2种低浓度消毒剂冲洗至安全残留浓度的时间,评价该消毒方式的安全性.结果 与高浓度冲洗消毒相比,夜间低浓度浸泡消毒后透析液供给装置出口细菌菌落数(Z=-2.041,P=0.041)、内毒素(t=4.761,P=0.032)、系统管道末端细菌菌落数(Z=-2.178,P=0.029)、内毒素(t=5.405,P=0.027)均明显降低.2种消毒方式下透析机出口细菌水平(Z=-1.069,P=0.285)、内毒素水平(t=2.621,P=0.086)无统计学差异.经过夜间管道滞留,次氯酸酸钠有效浓度下降15.78％,过氧乙酸下降5.88％,浓度保持43mg/L,160mg/L;2种消毒液分别冲洗14min、16min后,残留浓度达安全水平.结论 夜间低浓度消毒液浸泡法用于中央透析液供应系统消毒安全、有效,可应用于临床.

人工肾发展源于肾脏替代治疗的研究,期待能造福尿毒症群体.其方向逐渐突破血液净化常规思维,迈向更全面、更多样的血液净化理念.本文介绍了多种便携式血液净化单元原理及多项研究成果,并详细介绍了细胞工程技术、芯片技术、3D打印技术及异种移植方面的人工肾研究最新进展.

Adsorption technology is one of the working principles of blood purification. It can be used independently or as a composite component of common materials for blood purification. It has been widely used in the adjuvant treatment of kidney diseases, as well as severe diseases besides nephrology such as autoimmune diseases and poisoning, etc. This article briefly reviewed the preparation requirements of adsorbent materials, currently commonly-used adsorbent materials, and related technologies.

With the continuous development of blood purification technology, the membrane material of dialyzer is one of the most important factors affecting the quality of dialysis. The exploration of membrane materials and preparation technology is an important part of the development of clinical blood purification technology. This paper introduced the history and clinical requirements of blood purification membrane materials, and summarized the main development direction: to improve the clinical outcome of patients with end-stage renal failure by increasing the removal of toxins of large molecular weight, improve biocompatibility, and reduce coagulation. A number of new membrane materials and their advantages were listed.

Objective To explore the clinical strategies and safety of different urokinase thrombolytic methods in the treatment of dysfunction of central venous catheter with polyester sleeve. Methods 30 patients who had had dysfunction of central venous catheter with polyester sleeve (≥1 time/week, altogetrher more than 2 times) in our hospital from January 1, 2018 to September 1, 2019 were selected. All the patients were given regular dialysis 3 times/week, and randomly divided into three groups A, B, and C according to the random number method, with 10 patients each. Another 10 patients who had had a good function of the central venous catheter with polyester sleeve were also enrolled. Group A were given urokinase (100, 000 units) in normal saline (10 ml) that was continuously pumped at a drip speed of 1 ml/h from the arteriovenous end of the catheter, and the last 2 ml was injected into the catheter on the day before dialysis once a week. Group B were given urokinase (100, 000 units) in normal saline (100 ml) that was continuously pumped at a drip speed of 5 ml/min on the day of dialysis once a week; In group C, urokinase (100, 000 units) in normal saline (4 ml) was given to the arteriovenous end of the catheter for thrombolysis in sealing the tube, and a suction was given after 20 minutes on the day of dialysis once a week. One month later, the changes of blood flow and pressure and the occurrence of bleeding events in each group were observed. Results After the thrombolytic therapies, the catheter function was improved in all the three groups. The blood flow volume of group A was greater than those of groups B and C (P<0.01), and the arteriovenous pressure of group A could meet the clinical needs. Conclusion The long-term effect of continuous pumping of small dose of urokinase was better in the treatment of catheter dysfunction. Key words: Urokinase; Thrombolysis therapy; Central venous catheter with polyester sleeve; Hemodialysis

目的 探讨全自动预冲与手动生理盐水密闭式预冲法在血液透析管路预冲中洁净度的效果观察.方法 使用3种进口品牌的透析器在两种不同型号血液透析机上进行管路安装及预冲,观察组采用全自动超纯透析液预冲法,对照组采用手动生理盐水密闭式预冲法,两组分别预冲至500 ml、800 ml、1000 ml、1500 ml、2000 ml、2500 ml、3000 ml、3500 ml、4000 ml时用无热源试管采集预冲废液,采用酶标仪来检测预冲废液中的吸光度值和甘油残余量比较两种方法预冲中的洁净度.结果 两组预冲废液吸光度值与甘油残余量在预冲至500 ml时下降不明显,预冲至800 ml时,手动预冲法甘油残余量为326 mg/dl,全自动预冲甘油残留量为32 mg/dl,两组洁净度比值有明显差异(P＜0.05).结论 全自动预冲法相比手动生理盐水密闭式预冲法有更大的优越性,中央透析液供应系统(central dialysis delivery system,CDDS)中全自动预冲方式不仅洁净度高,而且可减轻医务人员负担,缩短准备预冲的操作时间,提高护士的工作效率.

Aim: This study evaluated, using thrombo-elastography (TEG), the efficacy of antiplatelet therapies in retired Chinese officers and explored the factors influencing the efficacy of antiplatelet therapies. Methods: Niue hundred and fifty-five retired male Chinese officers (>= 60 years old), who had undergone TEG between June and August 2015 at the Chinese People's Liberation Army General Hospital (PLAGH), were enrolled in this study. The subjects were divided into four groups according to the antiplatelet drug(s) that they were administered: aspirin. clopidogrel, dual drugs (combination of aspirin and clopicloud) and no antiplatelet drug. TEG was used to evaluate the efficacy of antiplatelet therapy in the four groups. Results: The inhibition of platelet aggregation induced by arachidonic acid (AA%) was 48.0 +/- 19.3% in the aspirin group, and the inhibition induced by adenosine diphosphate (ADP%) was 63.0 +/- 18.2% in the clopidogrel group. The AA% and ADP% in the dual-drug group were 51.0 +/- 16.5 and 46.0 +/- 15.3%, respectively. The total efficacy of antiplatelet therapy was 45.9% in the aspirin group, 51.2% in the clopidogrel group and 81.4% in the dual-drug group. A multivariate logistic regression analysis of the maximum amplitude of ADP-induced platelet fibrin clot strength (MA-ADP) indicated that in the population with MA-ADP < 31 mm. an increased white blood cell count (OR = 1.262, p < 0.001) was a risk factor, while an increased platelet count (OR = 0.995. p = 0.013) was a protective factor for bleeding. In the population with MA-ADP > 47 mm, increased platelet count (OR = 1.006, p < 0.001). estimated glomerular filtration rate (eGER, OR = 1.016. p = 0.013) and glycated haemoglobin levels (HbA(1c), OR = 1.358, p = 0.011) were risk factors for thrombosis. Conclusion: This quality-controlled TEG procedure was an efficient method to evaluate the efficacy of antiplatelet therapies in the clinic. White blood cell and platelet counts. and eGFR and HbA(1c) levels may influence the efficacy of an antiplatelet therapy.

Objective :To explore therapeutic effect of single and double stent implantation on coronary bifurcation le-sions.Methods : Clinical data of 455 patients with coronary bifurcation lesions , who received drug-eluting stent (DES) implantation in General Hospital of PLA from Jan 2014 to Oct 2016 ,were retrospectively analyzed .Accord-ing to interventional strategy ,patients were divided into single stent group (n＝235) and double stent group (n＝220).The lesion distribution ,lesion features of proximal ,distal and bifurcation ,stent implantation ,surgical selec- tion ,postoperative instant blood flow ,clinical adverse events were observed and compared between two groups .Re-sults :There were no significant difference in general data ,lesion distribution suggested by coronary angiography ,le-sion feature of proximal ,distal and bifurcation between two groups , P＞0. 05 all.All patients used Cross-over tech-nique in single stent group ,while double stent group used Crush (46.81%) ,Culotte (37.73%) ,T-stent and V-stent surgery .There were no significant difference in postoperative instant TIMI blood flow grade 3 rate of main vessel and side branch between two groups , P＞0. 05 both .During hospitalization ,incidence rate of nonfatal myocardial infarction in double stent group was significantly higher than that of single stent group (7.27% vs.2.98%) , P＝0.037. During 12-month follow-up ,compared with single stent group ,there was significant reduction in restenosis rate (5.53% vs.1.36%) , and significant rise in incidence rate of nonfatal myocardial infarction (2.55% vs. 6.82%) in double stent group ,P＝0.016 ,0.030 respectively .Conclusion :The therapeutic effect between single and double stent implantation treating coronary bifurcation lesions is no significant ,but restenosis rate of double stent group significantly reduces and incidence rate of nonfatal myocardial infarction significantly rises .

目的 比较药物洗脱支架(DES)再置入与药物涂层球囊(DCB)扩张治疗药物洗脱支架内再狭窄(IRS)的安全性和疗效.方法 选取于2015年8月～2017年3月于解放军总医院心血管内科就诊的DES治疗的IRS患者共171例,分别接受紫杉醇涂层球囊(PCB)治疗(PCB group,n=75)和第二代DES(G2-DES)治疗(G2-DES group,n=96),对两组临床基线特征及冠脉造影结果进行分析,并随访一年后冠状动脉(冠脉)造影(CAG)资料(病变血管、支架特征、平均扩张压、扩张时间、支架内与节段内再狭窄率、最小管腔支架等)及主要不良心血管事件(MACE,晚期管腔丢失、二次再狭窄率、全因死亡、ST段抬高型心肌梗死、靶血管血运重建).结果 两组患者基线资料及术前冠脉造影结果无统计学差异(P>0.05).两组患者进行经皮冠状动脉介入治疗(PCI)在使用器械上(支架长度、直径)无统计学差异(P>0.05).PCI后,PCB组的平均扩张压力更低(P<0.001),扩张时间更长(P<0.001),另外PCI后,PCB组支架内管腔狭窄率更高(P=0.001),支架内最小管腔直径更低(P=0.035);且术后节段内管腔狭窄率更高(P=0.002),但是节段内最小管腔直径无统计学差异(P=0.086).随访分析发现两组患者的CAG特征及MACE上无统计学差异(P>0.05).结论 紫杉醇药物涂层球囊治疗IRS安全有效,与第二代DES治疗IRS无显著差异.

Objective To assess the application of thrombelastography (TEG) in assessing the effect of antiptatelet therapy and analyze its related factors.Methods Nine hundred and fifty-five retired male officer aged ≥60 years admitted to our hospital for TEG from June 2015 to August 2015 were divided into aspirin treatment group (n=368),clopidogrel treatment group (n=115),double antiplatelet drug treatment group (n=43),and non-antiplatelet drug treatment group (n=429) according to the antiplatelet drugs they used.The effect of antiplatelet drugs was assessed by TEG.The related factors influencing the effect of antiplatelet therapy were analyzed by multivariate logistic regression analysis.Results The inhibition rate of platelets in AA pathway and ADP pathway was 48 ％ ±19.3 ％ in aspirin treatment group,63.0 ％ ±-18.2 ％ in clopidogrel treatment group,51.0％ ± 16.5％ and 46.0％ ± 15.3％ respectively in double antiplatelet drug treatment group.No significant difference was found in the inhibition rate of platelets in AA pathway and ADP pathway in aspirin treatment group and clopidogrel treatment group (45.80％ vs 51.16％,76.52％ vs 67.44％,P＞0.05).Multivariate logistic regression analysis showed that the number of WBC and eGFR were the risk factors for bleeding (OR=0.891,P=0.001;OR=1.016,P=0.013).The number of platelets and HbA1c were the risk factors for thrombosis (OR =1.026,P=0.000;OR =1.358,P =0.011).Conclusion TEG is one of the effective means in assessing the effect of antiplatelet therapy in clinical practice.

目的 探讨三段式教育模式对血液透析患者疾病知识掌握、自我护理能力及生化指标的影响.方法 选取该院2015年3月~2016年3月收治的血液透析患者130例为研究对象,随机分为研究组和对照组各65例,对照组采用常规护理干预,研究组则在对照组的基础上加用三段式教育模式,干预前及干预后6个月比较两组患者疾病知识掌握、自我管理行为情况,测定患者肌酐(Cr)、尿素氮(BUN)、血红蛋白(Hb)等生化指标.结果 干预后,研究组患者的知识掌握情况得分为(40.2±1.4)分,明显高于对照组的(28.5±2.3)分(P<0.05);研究组患者自我管理行为得分为(70.5±2.2)分,明显高于对照组的(63.7±4.1)分(P<0.05);研究组患者Cr、BUN、Hb指标均优于对照组(均P<0.05).结论 三段式教育模式能有效提高血液透析患者对自身疾病知识的掌握度,改善患者自我管理行为及生化指标,有利于促进患者疾病的康复.

高迁移率族蛋白B1(high mobility group box-1 protein,HMGB1)是一种多功能的核相关蛋白,自噬是一种程序性细胞生存方式.目前多项研究发现,HMGB1与自噬存在复杂的关系.在组织与细胞中,HMGB1可以作为重要的介质通过一系列信号通路、在不同水平上调控自噬,进一步引起细胞相应的功能和结构改变.本文就HMGB1与自噬的关系进行简要论述.

Objective To investigate the current application and effectiveness of antiplatelet drugs in elderly people taking physical examination.Methods A total of 955 elderly patients (≥60 years old) who taking physical examination in our hospital from June to August 2015 were enrolled in this cross-sectional study .They were divided into 4 groups by treatment scheme , that is, aspirin group (n=368), clopidogrel group (n=115), dual-drug group (aspirin+clopidogrel, n=43), and non-drug group (n=429).Their baseline clinical data and the results of thrombelastography (TEG) were collected.The application and effectiveness of the antiplatelet agents were analyzed , and the related clinical indicators influencing drug efficacy were investigated .Results Significant differences were found in the age distribution, proportions of smokers, and those with the medical history of stroke, coronary heart disease,diabetes mellitus, hyperlipidemia, as well as white blood cell count (WBC), platelet count (PLT), total cholesterol, low-density lipoprotein cholesterol ( LDL-C ) , fasting blood glucose ( FBG ) , creatinine , estimated glomerular filtration rate ( eGFR ) and glycosylated hemoglobin (HbA1c) (P<0.05), but not in the blood coagulation index (P>0.05).In aspirin group, the arachidonic acid (AA) pathway was nearly effective .The adenosine diphosphate ( ADP ) pathway was within the scope of effectiveness in the clopidogrel group.The ADP and AA pathway were both effective in the dual-drug group.The effectiveness was more significant in the clopidogrel group than in the aspirin group (76.52% vs 45.92%, P<0.05).Logistic regression analysis found that WBC , PLT, LDL-C and activated partial thromboplastin time ( APTT) increased the risk of bleeding , while age, PLT, eGFR, HbA1c, and APTT increased the risk of thrombus .Conclusion The current application of antiplatelet agents is satisfying , which can bring benefit to the elderly .

炎性作用在心血管疾病中的作用越来越重要,尤其是炎性标记物与冠心病之间的相互作用及关系,近年来被广泛研究,大多研究结果呈现一致性.中性粒细胞与淋巴细胞比值是近些年新兴的炎症标记物,其简易、普及、易获取的特点受到了广泛学者的肯定.NLR与动脉粥样硬化相关,相关研究显示动脉僵硬度、钙化积分与NLR密切相关,另外,高NLR者更易发现易损斑块.NLR可预测急性冠脉综合征的短期及长期心血管事件发生率及死亡率,以及预测稳定性心绞痛预后情况及侧支循环是否丰富.在冠脉造影的应用中,发现NLR不仅与冠脉病变严重程度密切相关,能预测完全闭塞病变的发生,及预测无复流的发生.在已有心血管危险因素的基础上,NLR可作为新成员,为冠心病的发现及其预后的风险评价提供依据.

Platelet function is closely associated with cardiovascular diseases .With the increased awareness of the diseases , there are more and more methods for platelet function test developed .Since the invention of light transmission aggregometry ( LTA) , it has been thought to be the golden standard of platelet function testing .In recent years ,various test methods have been developed with the increasing awareness of disease and treatment as well as technological advances .However, despite the gold standard or the latest methods, they have more or less flaws and some aspects of advantage .In this article, we introduced and summarized currently available methods of measuring platelet function .

目的 探讨急性冠状动脉综合征(acute coronary syndrome,ACS)病人中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)与冠状动脉血管完全闭塞病变及左心室功能的关系.方法 2013年我院诊断为ACS且行冠状动脉造影检查患者中随机筛选出120例,记录其基线及临床资料,并分为NLR≤2.73组和NLR＞2.73组,分析NLR与慢性完全闭塞病变及左心室功能的相关性.结果 两组在慢性完全闭塞病变、左心室射血分数(left ventricular ejection fraction,LVEF)、肌酐、脂蛋白(a)差异有统计学意义.结论 高NLR与损伤的左心室功能、慢性完全闭塞病变密切相关,NLR可用于心血管危险分层.

目的 研究丙酮酸乙酯(ethyl pyruvate,EP)对氧化型低密度脂蛋白(oxidized low-density lipoprotein,ox-LDL)作用下巨噬细胞炎性因子白介素1 β (interleukin-1 β,IL-1 β)表达的影响.方法 THP-1细胞经佛波酯(100 ng/ml)诱导分化为巨噬细胞,分别与人ox-LDL(50 mg/L)及ox-LDL(50 mg/L)+ EP(5 mmol/L)共培养6h、12h、24 h、48 h后提取细胞RNA,实时qPCR检测高迁移率族蛋白1(high mobility group box-1 protein,HMGBl)、Toll样受体4(toll-like receptor 4,TLR4)、IL-1β的表达水平.结果 HMGB1及TLR4在ox-LDL刺激后12h开始升高,12h、24 h、48 h刺激组HMGB1表达量分别是对照组的3.23、6.95、8.96倍.12h、24h、48 h刺激组TLR4表达量分别是对照组的3.35、5.65、5.98倍.丙酮酸乙酯能显著抑制ox-LDL刺激下巨噬细胞HMGB1、TLR4表达.12 h、24 h、48 h丙酮酸乙酯处理组相比刺激组HMGB1表达抑制率分别为64.4％、83.8％、77.5％.12h、24 h、48 h丙酮酸乙酯处理组相比刺激组TLR4表达抑制率分别为54.9％、42.6％、65.6％.IL-1 β在ox-LDL刺激下6h开始升高,随着时间增长表达量升高.6h、12h、24 h、48 h刺激组IL-1 β表达量分别是对照组的2.24、2.88、3.36、3.73倍.6h、12 h、24 h、48 h丙酮酸乙酯处理组相比刺激组IL-1 β表达抑制率分别为31.6％、48.6％、49.3％、51.2％.结论 丙酮酸乙酯能够通过抑制ox-LDL刺激下巨噬细胞HMGB1及其受体TLR4的表达而抑制炎性因子IL-1 β的表达.

目的:探讨急性冠脉综合征(acute coronary syndrome,ACS)患者发生冠脉血管完全闭塞病变的影响因素.方法:从2013年在我院诊断为ACS且行冠状动脉造影检查患者中随机筛选出120例患者为研究对象,记录其基线及临床资料,回顾其造影图像,计算SYNTAX积分,根据是否存在完全闭塞病变分组,分析慢性完全闭塞病变的影响因素.结果:与不完全闭塞病变组相比,完全闭塞病变组吸烟(61.1％,P=0.041)、糖尿病(35.2％,P=0.025)、高脂血症(55.6％,P=0.033)发生率高,入院静息心率(77.07±11.99,P=0.023)高,中性粒细胞/淋巴细胞比值Neutrophil-to-Lymphocyte Ratio,NLR)水平(8.69±9.46,P＜0.001)显著升高,左室射血分数(left ventricular ejection fraction,LVEF)(50.39±8.36,P=0.001)显著降低.多因素分析显示年龄(P=0.043)、急性心梗(acute myocardial infarction,AMI)的发生(P=0.003)、LVEF(P=0.002)、NLR(P=0.002)、脂蛋白(a)(P=0.039)、SYNTAX积分(P=0.002)和完全闭塞病变独立正相关.结论:ACS患者发生慢性完全闭塞病变与年龄、静息心率、吸烟史、高脂血症相关,与冠脉病变复杂程度、左室功能下降密切相关.NLR作为新型炎症标志之一,可预测ACS患者完全闭塞病变.