Analysis of patency rates and factors associated with arteriovenous fistula in maintenance hemodialysis patients followed for 10 years.

OBJECTIVE: This study analyzed the long-term arteriovenous fistula (AVF) patency rate and its determinants in patients undergoing maintenance hemodialysis. METHODS: General data and laboratory examinations of hemodialysis patients were collected retrospectively. The primary patency time, primary functional patency time, cumulative patency time, cumulative functional patency time, and temporary central venous catheterization (CVC) time were counted. Cox regression was used to analyze the relationships between different factors and AVF survival time. Kaplan-Meier survival analysis was used to analyze the primary patency, primary functional patency, cumulative patency, and cumulative functional patency rates between different groups. RESULTS: A total of 174 patients were included (mean age 58.38 ± 15.35 years), 57 women (32.76%) and 68 diabetics (39.08%). Univariate and multivariate Cox regression showed a correlation between UCR and AVF primary patency time, primary functional patency time, cumulative patency time, and cumulative functional patency time (HR 1.127, 1.116, 1.127, 1.115, 1.088, 1.075, 1.087, 1.013; 95%CI 1.055-1.204, 1.043-1.194, 1.055-1.204, 1.042-1.194, 1.022-1.158, 1.006-1.149, 1.021-1.157, 1.004-1.147; p < 0.001, 0.001, <0.001, 0.002, 0.008, 0.033, 0.009, 0.039, respectively). Duration of temporary CVC was also correlated (HR 1.013, 1.013, 1.013, 1.014, 1.008, 1.008, 1.008, 1.008; 95%CI 1.007-1.018, 1.008-1.019, 1.008-1.019, 1.009-1.020, 1.004-1.012, 1.004-1.012, 1.004-1.012, 1.004-1.012; p < 0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, respectively). Female sex was correlated with the primary patency time and the primary functional patency time (HR 1.755, 1.765, 1.767; 95%CI 1.028-2.997, 1.034-3.014, 1.021-3.057; p = 0.039, 0.037, 0.042, respectively), but not with the cumulative patency time and the cumulative functional patency time, the primary patency rate and primary functional patency rate of AVF were higher in male than in female patients (χ2 = 4.439, 4.531; p = 0.035, 0.033, respectively). The primary patency rate, primary functional patency rate, cumulative patency rate, and cumulative functional patency rate of AVF with UCR > 10.11 group are lower than those with UCR ≤ 10.11 (χ2 = 10.745, 10.712, 4.605, 4.472; p = 0.001, 0.001, 0.032, 0.034, respectively). The group of DTCP ≤ 42 days is better than DTCP > 42 days (χ2 = 6.014, 6.055, 8.572, 8.461; p = 0.014, 0.014, 0.003, 0.004, respectively). CONCLUSION: Women with high UCR values at the beginning of dialysis and a long duration of temporary CVC have a poor long-term survival rate of AVF. Therefore, UCR can be used as an indicator to predict the long-term survival rate of AVF. Simultaneously, clinicians should remove the temporary catheter as early as possible if conditions permit it.

Efficacy of ginseng and its ingredients as adjuvants to chemotherapy in non-small cell lung cancer.

Chemotherapy is applied to treat non-small cell lung cancer (NSCLC), but often limited due to its unstable therapeutic effects and adverse reactions (ADRs). Ginseng and its main ingredients (ginsenosides and polysaccharides) have been clinically used as adjuvants to chemotherapy. However, their efficacies were based on individual trials with relatively small sample sizes, and it is difficult to draw a valid conclusion. In this study, eligible randomized controlled trials (RCTs) were searched in six international and Chinese databases (PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chinese VIP Information and Wanfang). The outcomes of the objective response rate (ORR), disease control rate (DCR), ADRs, quality of life (QOL), survival rates and immunity were extracted using standard data extraction forms. The efficacies of ginseng and its ingredients as adjuvants to chemotherapy in NSCLC were investigated and compared by meta-analysis and subgroup meta-analysis, respectively. A total of 28 RCTs including 2503 subjects were enrolled, and most of the eligible studies were of low-to-moderate quality. For the evaluation of ginseng and its ingredients as adjuvants to chemotherapy, the risk ratio (RR) or standardized mean difference (SMD) and 95% confidence intervals (CI) of the ORR, DCR, leucopenia, thrombocytopenia, myelosuppression, hepatotoxicity, nausea and vomiting, diarrhea, CD4+/CD8+ and one- and two-year survival rates, and QOL were 1.35 (1.21,1.50), 1.20 (1.14,1.28), 0.59 (0.50, 0.70), 0.53 (0.37, 0.76), 0.30 (0.17, 0.53), 0.67 (0.52, 0.87), 0.67 (0.53, 0.86), 0.42 (0.19, 0.96), 1.39 (0.63, 2.16), 1.35 (1.13, 1.60), 3.21 (1.51, 6.81) and 1.31 (1.22, 1.41) with significant differences. Subgroup analysis showed that ginseng enhanced nausea and vomiting and QOL, ginsenosides increased ORR, DCR, QOL, leucopenia, thrombocytopenia, myelosuppression, hepatotoxicity, diarrhea, CD4+/CD8+, and one- and two-year survival rates, while polysaccharides improved ORR, DCR, leucopenia, thrombocytopenia, myelosuppression, hepatotoxicity and nausea and vomiting during chemotherapy. In conclusion, ginseng and its ingredients facilitated the therapeutic effects of chemotherapy on NSCLC patients. Ginseng had beneficial effects on alleviating ADRs and enhancing QOL, ginsenosides demonstrated beneficial effects on enhancing therapeutic effects, reducing ADRs, improving immunity, prolonging survival rates and promoting QOL, while polysaccharides showed beneficial effects on promoting therapeutic effects and reducing ADRs.

Management of Residual and Recurrent Aneurysms After Clipping or Coiling: Clinical Characteristics, Treatments, and Follow-Up Outcomes.

BACKGROUND: Recurrent intracranial aneurysms (RAs) remain a daunting challenge for neurosurgeons. This study aimed to explore a potential optimal management strategy of RAs by reviewing the characteristics and management outcomes of 117 RAs. METHODS: A total of 117 patients with RAs were treated in a single neurosurgical center from January 2011 to January 2017. The demographic and angiographic characteristics of the patients, treatment approaches, and follow-up outcomes were evaluated. RESULTS: Of the 117 patients with RAs, 16 (13.7%) and 101 (86.3%) initially underwent microsurgical clipping and endovascular coiling, respectively. Coil embolization was used in 75 cases, microsurgical clipping was used in 32 cases, and conservative treatment occurred in 10 cases. Complete clipping was achieved in all 32 aneurysms by microsurgery, and remnants were observed in 25 aneurysms after coiling (33.3%, P < 0.001). Operation-related cerebral infarction occurred in 4 cases (12.5%) with complex and large RA in the clipping group and in 1.3% (1/75) of patients treated with coiling (P = 0.027). Follow-up found similar favorable outcomes in patients after coiling, clipping, and conservative treatment (90.3% vs. 86.7% vs. 80%, respectively; P = 0.711). Follow-up rates of recurrence were significantly higher in the coiling group than the clipping group (26% vs. 0%, respectively; P = 0.003). CONCLUSIONS: The follow-up outcomes appeared to be acceptable and comparable between the 2 groups. However, in large or giant recurrent aneurysms, sound judgment and the careful selection of treatment are strongly suggested because direct microsurgery has a higher morbidity, even in experienced hands, whereas endovascular coiling is complicated with a higher incomplete occlusion rate.

Ginseng alleviates cyclophosphamide-induced hepatotoxicity via reversing disordered homeostasis of glutathione and bile acid.

Cyclophosphamide (CP), a chemotherapeutic agent, is restricted due to its side effects, especially hepatotoxicity. Ginseng has often been clinically used with CP in China, but whether and how ginseng reduces the hepatotoxicity is unknown. In this study, the hepatoprotective effects and mechanisms under the combined usage were investigated. It was found that ginseng could ameliorate CP-induced elevations of ALP, ALT, ALS, MDA and hepatic deterioration, enhance antioxidant enzymes' activities and GSH's level. Metabolomics study revealed that 33 endogenous metabolites were changed by CP, 19 of which were reversed when ginseng was co-administrated via two main pathways, i.e., GSH metabolism and primary bile acids synthesis. Furthermore, ginseng could induce expression of GCLC, GCLM, GS and GST, which associate with the disposition of GSH, and expression of FXR, CYP7A1, NTCP and MRP 3, which play important roles in the synthesis and transport of bile acids. In addition, NRF 2, one of regulatory elements on the expression of GCLC, GCLM, GS, GST, NTCP and MRP3, was up-regulated when ginseng was co-administrated. In conclusion, ginseng could alleviate CP-induced hepatotoxicity via modulating the disordered homeostasis of GSH and bile acid, which might be mediated by inducing the expression of NRF 2 in liver.

Comparison of gene expression profiles in BALB/c 3T3 transformed foci exposed to tumor promoting agents.

Identification of specific etiological carcinogens is one of the most important issues in environmental-toxicology studies. In this study, cDNA microarrays were used to analyze gene expression and discern chemical-associated profiles induced by a variety of tumor promoting agents in transformed cells. Two-stage transformation model of BALB/c 3T3 cells was established with MNNG as initiator, and 12-O-tetradecanoylphorbol-13-acetate (TPA), okadaic acid (OA), or cadmium chloride (CdCl(2)) as tumor promoters. Nine morphologically transformed foci were isolated and the anchorage-independent growth of transformed cells was verified. The gene expression alterations in foci were evaluated using cDNA microarray with 1796 mouse genes. Unsupervised hierarchical clustering analysis revealed that the nine foci were classified into three groups in concordance with the promoters used to induce them and characteristic clusters of genes were identified. In these clusters, genes associated with oxidative stress were specially upregulated following distinct promoter exposure. Moreover, common gene expression alterations were also observed in foci, including upregulated genes associated with cell proliferation and downregulated genes associated with extracellular matrix. Our results demonstrate the presence of unique gene expression profiles in transformed cells which reflect the etiological chemicals and indicate the importance of characteristic molecular alterations as potential biomarkers of exposure to tumor promoters.

[Medical devices adverse events and its preventive measures].

The text analyzes the reasons of medical devices adverse events occurrence from manufacturers, medical institutions and patients. To guard against the events, the medical institutions should put emphasis on check of purchasing, informed consent, technical permission, SOP performing, the safe of medical and enhance monitoring etc.