Objective To study the prognostic value of soluble CD146（sCD146） level in maintenance peritoneal dialysis patients.Methods A total of 50 peritoneal dialysis patients hospitalized in the Department of Nephrology, the First Affiliated Hospital of Zhengzhou University from December 2018 to June 2019 were included, of which 4 patients were lost to follow-up and 2 patients had incomplete information. Finally, 44 patients were included. The laboratory data of blood routine and blood biochemistry were collected and the sCD146 level was measured. The new or aggravated heart failure, ischemic cardiomyopathy, arrhythmia, cerebrovascular accident, and death were taken as the composite endpoints to observe the prognosis of peritoneal dialysis patients.Results The patients were followed up for 24 months. Among the peritoneal dialysis patients, 27 cases continued peritoneal dialysis, 10 cases were converted to hemodialysis, 4 cases underwent kidney transplantation, 3 cases died, and 18 cases had adverse events, including 3 deaths, 11 cases of heart failure, 2 cases of acute cerebral infarction and 2 cases of unstable angina pectoris. COX regression analysis was used to analyze the adverse events during the follow-up of patients. Multivariate Cox regression analysis showed that sCD146 and body mass index（BMI） were independent risk factors for adverse events（P＜0.05）. Peritoneal dialysis patients were divided into a high-concentration group and a low-concentration group according to the median level of sCD146. Kaplan-Meier survival curve showed that there was no statistical difference in adverse event-free survival rate between the two groups（P＞0.05）.Conclusion The concentration of sCD146 is an independent risk factor for cardiovascular and cerebrovascular adverse events in peritoneal dialysis patients, and sCD146 may be used as a related index to evaluate the prognosis of peritoneal dialysis patients. Paying attention to the volume management of dialysis patients can reduce the occurrence of cardiovascular and cerebrovascular adverse events and improve the survival rate without adverse events.

Objective:To analyze the molecular characteristics of papillary thyroid carcinoma tissue samples and explore the correlation between gene mutation spectrum and clinical features.Methods:A total of 79 fresh tumor tissue samples were collected from 71 patients with thyroid papillary carcinoma who underwent surgery in the Second Affiliated Hospital of Soochow University from July 2020 to May 2021. Fisher’s precision probability test was used to analyze its correlation with clinicopathological features.Results:Different pathological mutations or fusions were detected in 95% of fresh tumor tissue samples, and at least two different pathological gene co-mutations or fusions were found in 15% of fresh tumor tissue samples. Among patients with papillary thyroid carcinoma, the rate of central lymph node metastasis in patients with pathological mutation or fusion was significantly higher than that in patients without pathological mutation or fusion (62.7% to 0, P<0.05). Conclusion:Thyroid papillary carcinoma patients with pathological gene mutation or fusion are more prone to the central lymph node metastasis, hereby we think preoperative tumor tissues for next-generation sequencing analysis is helpful to accurately judge the central lymph node metastasis and convenient making precise surgical plan.

Objective:To compare the efficacy of robot assisted laparoscopic radical prostatectomy (RALRP) and traditional laparoscopic radical prostatectomy (LRP).Methods:The clinical data of 49 cases of radical prostatectomy performed by the same surgeon from August 2017 to March 2019 were analyzed retrospectively (RALRP: n=23; LRP: n=26). There was no statistical difference in age, prostate specific antigen level, Gleason score of prostate biopsy specimens, prostate volume between the two groups ( P>0.05). The perioperative and postoperative recovery indexes were compared and analyzed between the two groups by using the software of SPSS 20.0, and significant statistic difference was valued as P<0.05. Results:There was no significant difference between the two groups in terms of operation time ( t=0.95, P>0.05), intraoperative bleeding volume ( t=1.68, P>0.05), margin positive rate ( χ2=0.02, P>0.05), ventilation time ( t=0.22, P>0.05), drainage tube removal time ( t=1.59, P>0.05), perioperative complications rate ( χ2=0.00, P>0.05), biochemical recurrence rate ( χ2=0.08, P>0.05), and urine control rate at 6th month after operation ( χ2=0.08, P>0.05). However, there were significant differences between the two groups as follows: the cervix vesicae-urethra anastomosis time in RALRP group was shorter than that in LRP group [(14.26±2.38) min and (18.46±2.40) min respectively, t=6.14, P<0.01], and removal of urinary catheter in RALRP group was earlier than that in LRP group [(15.48±2.11) d and (17.69±2.33) d respectively, t=3.47, P<0.01]. Moreover, the rate of urinary continence at 3rd month after operation was significantly higher in RALRP group than in LRP group (82.61% vs. 53.85%, χ2=4.59, P<0.05), and RALRP group provided significantly better penile erectile recovery than LRP group (78.26% vs. 50.00%, χ2=4.19, P<0.05). Conclusion:RALRP is a safe and effective surgical treatment, which can ensure satisfactory tumor control and reduce the risk of postoperative urinary incontinence and penile erectile dysfunction, and has unique advantages in anastomotic reconstruction.

目的:观察沙库巴曲/缬沙坦(SV)治疗对维持性血液透析(MHD)高血压患者的疗效及安全性.方法:采用自身对照研究,选取郑州大学第一附属医院血液净化中心MHD合并高血压接受SV治疗的患者31例,包括难治性高血压患者21例.其中11例将血管紧张素Ⅱ受体拮抗剂(ARB)换为SV.分析治疗前后血压、血常规、血生化等相关指标变化.结果:31例患者治疗后4周、12周透析前收缩压较治疗前下降,治疗后1周、4周、12周透析中收缩压与透析后收缩压均较治疗前下降,治疗后12周透析前舒张压较治疗前下降,治疗后1周、4周、12周透析中舒张压与透析后舒张压均较治疗前下降(P＜0.05).治疗后患者服用其他降压药限定日剂量下降[2.49±1.58 vs 3.42±1.81,P＜0.05].将ARB换为SV的11例患者在治疗后1周、4周、12周透析前、透析中、透析后血压同样较治疗前降低.用药期间未发现与SV相关的不良反应.结论:SV联合使用可有效控制MHD患者高血压,且安全性较好.

本研究旨在探讨可溶性CD146(sCD146)浓度与血液透析(HD)患者水负荷的关系及其在评估水负荷状态中的作用。筛选郑州大学第一附属医院血液净化中心长期血液透析的患者49例,收集患者临床相关资料；透析前后采血,利用酶联免疫分析法测血浆sCD146浓度；测生物电阻抗,计算体内多余水量(MEXF)。据透前MEXF分为水负荷过多组(36例)和水负荷正常组(13例)。筛选郑州大学校医院体检健康的研究对象(10例),晨起空腹采血。比较组间基线及临床资料,受试者工作特征曲线(ROC)评价透前sCD146诊断HD患者水负荷过多(OH)的价值,Logistic回归法分析sCD146升高的影响因素。结果发现,水负荷过多组患者年龄、透前细胞外液量(ECV)、MEXF、左心房内径及sCD146均高于水负荷正常组(P<0.05)。HD患者血浆sCD146浓度高于健康人(P<0.05)。透前sCD146浓度诊断OH的ROC曲线下面积为0.780(95%CI 0.622～0.938,P=0.003),最佳截断值为288.85 μg/L(敏感度69.4%,特异度92.3%)。Logistic回归分析结果显示,MEXF是sCD146升高(>288.85 μg/L)的独立影响因素(OR=1.987,95%CI 1.287～3.066,P<0.005)。作者认为sCD146有可能作为HD患者水负荷状态评估的新指标。

目的 分析感染性休克患者发生急性肾损伤(AKI)的危险因素,为临床预防AKI的发生提供理论依据.方法 随机选取2014年8月至2017年8月该院重症监护病房(ICU)收治的98例感染性休克患者作为研究对象,并依据是否发生AKI及AKI分级标准分为未发生AKI(NAKI)组、AKI 1级组、AKI 2级组、AKI 3级组共4组,对比分析各组间相关指标的变化.结果 感染性休克患者中AKI的发生率为63.3％.AKI 1～3级各组ICU住院时间、急性生理学及慢性健康状况评分量表(APACHEⅡ)评分、器官衰竭个数、机械通气占比均显著高于NAKI组,差异均有统计学意义(P<0.05),且随着AKI分级增加各指标水平均逐渐增加,AKI 3级组以上各指标显著高于AKI 2级组和AKI 1级组,差异均有统计学意义(P<0.05);AKI 3级组和AKI 2级组血清CRP水平均显著高于AKI 1级组和NAKI组,差异均有统计学意义(P<0.05);AKI 1～3级各组6 h补液量均显著高于NAKI组,差异均有统计学意义(P<0.05).多因素logis-tic回归分析显示,APATHEⅡ评分、器官衰竭个数、应用机械通气是影响感染性休克患者发生AKI的独立危险因素(P<0.05),其风险比值分别为1.576、1.863、1.176.结论 AKI是感染性休克的常见并发症.ICU住院时间、APACHEⅡ评分、器官衰竭个数、应用机械通气、炎症指标和6 h补液量等与AKI的发生密切相关,其中APATHEⅡ评分、器官衰竭个数、应用机械通气是感染性休克患者发生AKI的独立危险因素.在临床治疗中应密切监测、及时干预,以降低AKI的发生率,改善患者预后.

Objective To investigate whether the JAK2/STAT3 signaling pathway is involved in the epithelial-mesenchymal transition (EMT) of peritoneal mesothelial cells in uremic peritoneal dialysis (PD) rats.Methods A total of 48 male Sprague-Dawley (SD) rats were randomly separated into six groups:normal control group (NC group,n=8),sham group (n=8),uremic group (n=8),PD group (n=8),S3I-201 control group (n=8) and S3I-201 group (n=8).Uremic model generated by 5/6 nephrectomy surgery in rats was established.The rats of PD group,S3I-201 control group and S3I-201 group received daily infusion of 4.25％ glucose-based peritoneal dialysate fluid (3 ml/100 g) from PD catheters for 28 days.Rats of S3I-201 group were injected with STAT3 inhibitor S3I-201 (2.5 mg/kg) solution from the catheters every other day;the same dose of the solvent of S3I-201 was simultaneously given to S3I-201 control group rats.After PD for 28 days,peritoneal function,pathologic changes,and microvessel density (MVD) were evaluated.Creatinine,urea nitrogen and interleukin-6 (IL-6) concentration in blood and dialysate,and protein and mRNA levels of phospho-JAK2 (p-JAK2),phospho-STAT3 (p-STAT3),E-cadherin,alpha-smooth muscle actin (α-SMA) and vascular endothelial growth factor (VEGF) in peritoneum were determined.Results Uremia and peritoneal dialysate could aggravate the peritoneal function and elevate peritoneal thickness and MVD.They could also increased the concentration of IL-6 in blood and dialysate and the expression levels of α-SMA,VEGF,p-JAK2 and p-STAT3 in peritoneum,while lowering E-cadherin expression in peritoneum.These manifestations were even more remarkable in PD group compared to those in uremic group.There was no statistical difference between the S3I-201 control group and the PD group as regards all the index (all P ＞ 0.05).Compared with the S3I-201 control group,the rats treated with S3I-201 showed better peritoneal function.S3I-201 could reduce peritoneal thickness (P＜0.05),MVD (P＜0.05),the concentration of IL-6 in blood and dialysate,the mRNA and protein expression of α-SMA,VEGF,p-JAK2 and p-STAT3 (all P ＜ 0.05),while enhance the mRNA and protein expression of E-cadherin (all P ＜ 0.05).Conclusions After STAT3 is inhibited,the peritoneal thickness,MVD and IL-6 concentration in PD rats are decreased,and EMT is also inhibited,while peritoneal function is improved.The JAK2/STAT3 signaling pathway may thus be involved in the process of EMT of peritoneum in uremic peritoneal dialysis rats by regulating the expression of IL-6.

Objective To investigate the association of red cell distribution width（RDW）with all-cause and cardiovascular disease（CVD）-related mortality in patients undergoing continuous ambulatory peritoneal dialysis（CAPD）.Methods A retrospective analysis was performed on 207 patients who initiated CAPD for more than3 months between July 2005 and March 2016 in the First

Objective To investigate the role of STAT3 transcription factor in IL-6 inducing epithelial mesenchymal transition (EMT) of human peritoneal mesothelial cells (HPMCs).Methods HPMCs were cultured in vitro and grouped.(1) According to the stimulation time with 50 μg/L IL-6,HPMCs were divided into 24,48,72 h groups.(2) HPMCs were grouped 50,100 μg/L according to IL-6 concentration.(3) HPMCs were respectively divided into control group,IL-6 group,empty vector group,empty vector+IL-6 group,virus infecting group and virus infecting+IL-6 group,as lenti-virus vector mediating RNA interference targeting STAT3 was applied.The mRNA expressions of E-cadherin,α-smooth muscle actin (α-SMA) and vascular endothelial growth factor (VEGF) were detected by real time PCR;their protein expressions and the phosphorylation of JAK2 and STAT3 were detected by Western blotting;the expressions and distribution of E-cadherin and α-SMA were observed by immunofluorescence.Results Compared with those in control group,the expression of E-cadherin decreased remarkably (P ＜ 0.05),while the expressions of VEGF and α-SMA and the ratio of phosphorylated (p)-JAK2/JAK2 and p-STAT3/STAT3 increased significantly in IL-6 concentration groups and stimulation time groups (all P ＜ 0.05),which had been dose and time dependent.Compared with empty vector+IL-6 group,virus infecting+IL-6 group had decreased expressions of VEGF and α-SMA,while increased expressions of E-cadherin (all P ＜ 0.05).Conclusions IL-6 can promote VEGF and α-SMA gene expression and prevent E-cadherin gene expression by STAT3,which involves in EMT of peritoneum fibrosis.While STAT3 gene is knocked-down,EMT is inhibited in HPMCs.

Long-term peritoneal dialysis (PD) therapy results in functional and structural alteration of the peritoneal membrane, including epithelial-to-mesenchymal transition (EMT). Interleukin 6 (IL-6) is a local pleiotropic cytokine, hypothesized to play an important role in EMT. This study was designed to investigate the role of IL-6 in EMT and peritoneal membrane dysfunction in long-term PD patients by assessing the level of IL-6 in dialysate and exploring the relationship between IL-6, the related signaling pathway JAK2/STAT3, and EMT, using in vitro cellular and molecular techniques. Plasma and dialysate levels of IL-6 were significantly higher in PD ultrafiltration failure patients compared with patients without ultrafiltration failure and were negatively correlated with measures of PD adequacy. In vitro IL-6 treatment changed human peritoneal mesothelial cell phenotype from a typical cobblestone-like to a fibroblast-like appearance and increased cell viability. IL-6 treatment increased α-smooth muscle actin and vascular endothelial growth factor expression but decreased E-cadherin expression. IL-6 treatment activated the JAK/STAT signaling pathway. However, the JAK2/STAT3 inhibitor WP1066 prevented IL-6-induced activation of the JAK2/STAT3 pathway and EMT. We conclude that IL-6 promotes the EMT process, possibly by activating the JAK2/STAT3 signaling pathway. IL-6 may serve as a novel therapeutic target for preventing EMT, and preservation of the peritoneal membrane may arise from these studies.

Objective To explore the clinical curative effect of Bailing Capsules combined with tacrolimus in treatment of lupus nephritis. Methods Patients (118 cases) with lupus nephritis in the First Affiliated Hospital of Zhengzhou University from November 2014 to February 2016 were randomly divided into control and treatment groups, and each group had 59 cases. Patients in the control group were fasting po administered with Tacrolimus Capsules, the initial dosage was 0.1 mg/(kg·d), twice daily, the blood concentration was maintained at 5 — 15 μg/L after treatment for 3 d. Patients in the treatment group were po administered with Bailing Capsules on the basis of the control group, 1 g/time, three times daily. Patients in two groups were treated for 12 months. After treatment, clinical efficacy, SLEDAI scores, hematuria index, and adverse reaction in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 69.49% and 88.14%, respectively, and there was difference between two groups (P < 0.05). After treatment for 6 and 12 months, the SLEDAI scores in two groups significantly decreased (P < 0.05). And the SLEDAI scores in treatment group were significantly lower than those in the same period in the control group (P < 0.05). After treatment for 6 and 12 months, the ALB and C3 in two groups were significantly increased (P <0.05), while Scr, TP/24 h and RBC levels were significantly decreased (P < 0.05). Compared with those after treatment for 6 months, ALB, C3, Scr, TP/24 h and RBC levels in two groups were significantly improved after treatment for 12 months (P < 0.05). And after treatment for 6 and 12 months, ALB, TP/24 h and RBC levels in the treatment group were significantly better than those in the same period in the control group (P < 0.05). After treatment for 12 months, C3 levels in the treatment group were significantly higher than those in the same period in the control group (P < 0.05). After treatment, the adverse reaction rate in the control group was 47.46%, which were significantly higher than 27.12% in the treatment group, and there were differences between two groups (P < 0.05). Conclusion Bailing Capsules combined with tacrolimus can effectively improve the clinical therapeutic effect in treatment of lupus nephritis, which has a certain clinical application value.