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Objective: To explore risk factors for hyperkalemia in hemodialysis (HD) patients, and establish and verify a risk assessment model of hyperkalemia in HD patients. Methods: The clinical data of HD patients who were admitted to the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University between April 2020 and January 2021 were retrospectively collected and divided into training dataset and validation dataset by using the conversion-random number generator. In the training dataset, multivariate logistic regression analysis was used to screen the risk factors for hyperkalemia in HD patients and the factors were scored to establish the risk assessment model. The validation dataset was substituted into the model and the receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to verify the effectiveness of the risk prediction model in predicting hyperkalemia. Results: A total of 502 HD patients were enrolled and further divided into training dataset ( n =372) and validation dataset ( n =130). There were 268 males and 234 females, with a mean age of (54±13) years. Multivariate logistic regression analysis showed that metabolic acidosis, high potassium diet, history of hyperkalemia, the change of electrocardiogram (ECG), disfunction of vascular access and time interval from last dialysis were risk factors for causing hyperkalemia in patients undergoing HD. Risk assessment model was established based on these risk factors. The AUC of the ROC curve was 0.799. Using 5 as the cut-off value, the sensitivity and specificity for predicting hyperkalemia events was 61.4% and 86.3%, respectively. Conclusion: The current study preliminarily established a risk assessment model for hyperkalemia in HD patients, which can help clinicians manage the potassium level of HD patients.

Objective: To study the surgical treatment of chronic type B dissection with aortic arch involvement using Sun's procedure. Methods: Between February 2009 and December 2015, 29 patients [20 males, 9 females, with a mean age of (41±12) years, range 24-64 years] with type B dissection with aortic arch involvement underwent Sun's procedure. Sixteen patient had a history of hypertension. Marfan syndrome was observed in 9 cases, coronary artery disease in 3 cases, mitral regurgitation in 3 patients, cerebrovascular disease in one patient. Twenty-two patients suffered proximal aortic arch disease, 4 cases experienced history of aortic root procedure and 2 subjects had history of pregnancy. Four patients had aortic arch malformation. Results: One case suffered from massive cerebral infarction after surgery and died in another hospital. Concomitant procedures included mitral valve replacement in 3 cases, coronary artery bypass grafting in 3 patients, reconstruction of the right aberrant subclavian artery in one patient. Ventilator support exceeding 24 hours obseved in 2 patients. One of them recieved continuous renal replacement therapy and recovered before discharge. Spinal cord injury was obseved in one case, brain infarction in one patient and pericardial drainage in one case. Two patients required tracheotomy. During 12-94 (43±23) months' follow-up, thoracoabdominal aortic replacment was performed in 4 patients, thoracic endovascular aortic repair (TEVAR) in 2 subjects and repair of perivalvular leakage in one patient. Conclusions: Sun's procedure obtained satisfactory results in patients with chronic type B dissection with aortic arch involvement. Concomitant repair of proximal aortic arch lesions and distal type B dissection can be adopted using Sun's procedure.

Objective: To analyze whether isolated hypertension and metabolic syndrome ( Based on the 2005 IDF criteria) have equal risk on stroke in Chinese adults., Methods: 25194 subjects (25-75 years old) from Chinese National Health and Nutrition Survey in 2002 were divided into control group, isolated hypertension ( i-HTN) group, metabolic syndrome (MS) without hypertension ( non-HTN/MS) group , MS with hypertension (HTN/MS) group. The clinical features and risk for stroke ( using multiple logistic stepwise regression analysis) were compared among 4 groups., Results: (1) The clinic features in the i-HTN group was non-central obesity, and its plasma glucose, triglyceride 9TG), high density lipoprotein cholesterol ( HDL-C) levels were normal . (2) The prevalence of stroke in control group , i-HTN group, non-HTN/MS group and HTN/MS group was 0.14%, 1.27%, 1.19% and 2.14%, respectively. (3) After adjustment for age, sex, smoking, low density lipoprotein cholesterol level, logistic regression analysis showed that the i-HTN group, non-HTN/MS group and HTN/MS group had higher risk of stroke compared with the controls, the odd ratio (OR) were 4.18, 8.00, 8.69 (P < 0.01), respectively. Compared with i-HTN group, OR in HTN/MS group was 2.05, while no difference was found between i-HTN group and non-HTN/MS group ( P>0.05). (4) Among different components of the MS, hypertension (OR 2.33), central obesity (OR 2.09), low HDL-C (OR 1.69), hyperglycemia (OR 1.66) except hypertriglyceridemia were all significantly related to stroke (P < 0.01)., Conclusion: (1) MS and hypertension were an independent risk factor for the development of stroke in Chinese adults. (2) Though there was no clinical features of insulin resistance in i-HTN group, it was observed that the i-HTN and non-HTN/MS had equal contribution to stroke. The risk of stroke will be further increased if hypertension included in the MS.