How to carry out monthly blood flow surveillance of fistula in large-scale hemodialysis units: A cross-sectional study.

BACKGROUND: The important effect of regular blood flow surveillance on arteriovenous fistula maintenance is emphasized. The ultrasonic dilution technique for blood flow surveillance can be performed during hemodialysis, but there are some limitations. Blood flow is traditionally measured by duplex Doppler ultrasound during the nondialysis period. However, the surveillance workload for arteriovenous fistula has increased with the rapid increase in the hemodialysis population size. Efficient methods for blood flow surveillance during hemodialysis are needed. METHODS: Eighty-four hemodialysis patients with a forearm radiocephalic arteriovenous fistula were enrolled in this cross-sectional study. Each received blood flow measurements using ultrasonic dilution technique and duplex Doppler ultrasound during hemodialysis. Duplex Doppler ultrasound measurements included the blood flow of the brachial artery and radial artery. The correlations between these variables were analyzed. RESULTS: The correlation coefficients (r) between flow measured by ultrasonic dilution technique and brachial artery flow measured by duplex Doppler ultrasound, between flow measured by ultrasonic dilution technique and radial artery flow measured by duplex Doppler ultrasound, and between brachial artery flow and radial artery flow measured by duplex Doppler ultrasound were 0.724, 0.784, and 0.749, respectively (all p < 0.001). CONCLUSION: Blood flow measured by ultrasonic dilution technique was positively correlated with blood flow measured by duplex Doppler ultrasound during hemodialysis, suggesting that duplex Doppler ultrasound can be used to monitor the trends in the blood flow of the brachial artery and radial artery for timely intervention to improve patency during hemodialysis.

Can the fistula arm be used to lift heavy items? Six-pound dumbbells versus handgrip exercise in a 6-month follow-up secondary analysis of a randomized controlled trial.

INTRODUCTION: Patients with arteriovenous fistulas are advised to avoid carrying heavy objects draped over the fistula arm. Awareness gradually leads to overprotection and a reduction in the use of the fistula arm. However, restricting motion in the fistula arm leads to decreased quality of life and diminished muscle strength. The current safety recommendations regarding lifting heavy items with the fistula arm are primarily based on experience. Few studies have provided evidence clarifying the scope of safe activity and the influence of load bearing on the continued patency of arteriovenous fistulas. METHODS: This prospective observation was based on a long-term follow-up study in which 86 hemodialysis recipients with arteriovenous fistulas were randomized into either a dumbbell group or a handgrip group. The dumbbell group exercised with 6-lb dumbbells, while the handgrip group squeezed rubber balls. Postintervention primary patency and adverse events at the 6-month follow-up were analyzed. RESULTS: No significant difference in postintervention primary patency was observed between the dumbbell group and the handgrip group at 6 months (97.4% vs 95.0%). There were two participants with high-flow fistulas in the dumbbell group and three in the handgrip group, with no significant difference between the two groups (5.3% vs 7.5%). In both groups, there were no other adverse events reported regarding cardiac failure, aneurysm, puncture site hematoma, or hemorrhage. CONCLUSION: Hemodialysis patients can safely use their fistula arm to lift objects weighing less than 6 lb, which encourages increased motion and helps preserve the functionality of the fistula arm.

Chronic asthma-induced behavioral and hippocampal neuronal morphological changes are concurrent with BDNF, cofilin1 and Cdc42/RhoA alterations in immature mice.

INTRODUCTION: Recent studies have found that persistent hypoxia caused by chronic asthma, especially during childhood, affects the development and function of the brain, but the mechanism is unclear. In the present study, BDNF and its signal pathway was investigated in mediating chronic asthma induced-neuronal changes that lead to behavior alterations. METHODS: The chronic asthma model was induced by sensitization with ovalbumin for more than 9 weeks in immature mice. Morris water maze test (MWMT), open field test (OFT) and elevated plus maze test (EPMT) were used to conduct behavioral evaluation. Neuronal morphology in hippocampal CA1, CA3 and DG was assessed using ImageJ's Sholl plugin and RESCONSTRUCT software. BDNF signaling pathway related molecules was determined by Western blotting. RESULTS: Chronic asthma does affect the behavioral performances of immature mice evaluated in MWMT, OFT, and EPMT. The analysis by three-dimensional reconstruction software found that following the behavioral alteration of asthmatic mice, dendritic changes also occurred in hippocampal neurons, including shortened dendrite length, significantly reduced number of dendritic branches, decreased density of dendritic spines, and reduced percentage of functional dendritic spine types. At the same time, by immunofluorescence and western blotting, we also found that alterations in dendritic morphology were consistent with activation of cofilin1 and changes in BDNF-Cdc42/RhoA levels. Some of the changes mentioned above can be alleviated by intranasal administration of budesonide. CONCLUSION: Our data suggest that response similar to nicotine withdrawal or/and hypoxia induced by childhood chronic asthma enhances the BDNF-Cdc42/RhoA signaling pathway and activates cofilin1, leading to the remodeling of actin, causing the loss of dendritic spines and atrophy of dendrites, eventually resulting in behavioral alterations.

Novel antidepressant effects of Paeonol alleviate neuronal injury with concomitant alterations in BDNF, Rac1 and RhoA levels in chronic unpredictable mild stress rats.

RATIONALE: Increasing evidence has suggested that major depressive disorder (MDD) is highly associated with brain-derived neurotrophic factor (BDNF) levels, dendrites atrophy, and loss of dendritic spines, especially in emotion-associated brain regions including the hippocampus. Paeonol is a kind of polyphenols natural product with a variety of therapeutic effects. Recent studies have reported its antidepressant effects. However, it is unclear what signaling pathways contribute to improve MDD. OBJECTIVE: The present study investigated the effect of Paeonol on hippocampal neuronal morphology and its possible signaling pathways in chronic unpredictable mild stress (CUMS) rat model. METHODS: Using CUMS rat model, the antidepressant-like effect of Paeonol was validated via depression-related behavioral tests. Neuronal morphology in hippocampal CA1 and DG was assessed using ImageJ's Sholl plugin and RESCONSTRUCT software. BDNF signaling pathway-related molecules was determined by Western blotting. RESULTS: Paeonol attenuated CUMS-induced depression-like behaviors, which were accompanied by hippocampal neuronal morphological alterations. After Paeonol treatment for 4 weeks, the dendritic length and complexity and the density of dendritic spines markedly increased in the hippocampal CA1 and the dentate gyrus (DG). However, CUMS or Paeonol treatment does not selectively affect dendritic spine types. Simultaneously, administration of Paeonol deterred CUMS-induced cofilin1 activation that is essential for remolding of dendritic spines. The induction of CUMS downregulated BDNF levels and upregulated Rac1/RhoA levels; however, the tendency of these was inhibited by treatment with Paeonol. CONCLUSION: Our data suggest that BDNF-Rac1/RhoA pathway may be involved in attenuation of CUMS-induced behavioral and neuronal damage by Paeonol that may represent a novel therapeutic agent for depression.

Novel derivative of Paeonol, Paeononlsilatie sodium, alleviates behavioral damage and hippocampal dendritic injury in Alzheimer's disease concurrent with cofilin1/phosphorylated-cofilin1 and RAC1/CDC42 alterations in rats.

Alzheimer's disease (AD) is a typical hippocampal amnesia and the most common senile dementia. Many studies suggest that cognitive impairments are more closely correlated with synaptic loss than the burden of amyloid deposits in AD progression. To date, there is no effective treatment for this disease. Paeonol has been widely employed in traditional Chinese medicine. This compound improves learning behavior in an animal model; however, the mechanism remains unclear. In this study, Paeononlsilatie sodium (Pa), a derivative of Paeonol, attenuated D-galactose (D-gal) and AlCl3-induced behavioral damages in rats based on evaluations of the open field test (OFT), elevated plus maze test (EPMT), and Morris water maze test (MWMT). Pa increased the dendritic complexity and the density of dendritic spines. Correlation analysis indicated that morphological changes in neuronal dendrites are closely correlated with behavioral changes. Pa treatment reduced the production of Aß, affected the phosphorylation and redistribution of cofilin1 and inhibited rod-like formation in hippocampal neurons. The induction of D-gal and AlCl3 promoted the expression of RAC1/CDC42 expression; however, the tendency of gene expression was inhibited by pretreatment with Pa. Taken together, our results suggest that Pa may represent a novel therapeutic agent for the improvement of cognitive and emotional behaviors and dendritic morphology in an AD animal model.

A polyoxometalate-organic supramolecular nanotube with high chemical stability and proton-conducting properties.

The use of 1H-1,2,4-triazole-3-thiol (H2trzS) has led to a rare inorganic-organic hybrid supramolecular nanotube built from novel Ni5-substituted polyoxotungstates, which presents interesting structural characteristics, high chemical stability, and proton-conducting properties.

Simultaneous modulated accelerated radiation therapy for esophageal cancer: a feasibility study.

AIM: To establish the feasibility of simultaneous modulated accelerated radiation therapy (SMART) in esophageal cancer (EC). METHODS: Computed tomography (CT) datasets of 10 patients with upper or middle thoracic squamous cell EC undergoing chemoradiotherapy were used to generate SMART, conventionally-fractionated three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiation therapy (cf-IMRT) plans, respectively. The gross target volume (GTV) of the esophagus, positive regional lymph nodes (LN), and suspected lymph nodes (LN ±) were contoured for each patient. The clinical target volume (CTV) was delineated with 2-cm longitudinal and 0.5- to 1.0-cm radial margins with respect to the GTV and with 0.5-cm uniform margins for LN and LN(±). For the SMART plans, there were two planning target volumes (PTVs): PTV66 = (GTV + LN) + 0.5 cm and PTV54 = CTV + 0.5 cm. For the 3DCRT and cf-IMRT plans, there was only a single PTV: PTV60 = CTV + 0.5 cm. The prescribed dose for the SMART plans was 66 Gy/30 F to PTV66 and 54 Gy/30 F to PTV54. The dose prescription to the PTV60 for both the 3DCRT and cf-IMRT plans was set to 60 Gy/30 F. All the plans were generated on the Eclipse 10.0 treatment planning system. Fulfillment of the dose criteria for the PTVs received the highest priority, followed by the spinal cord, heart, and lungs. The dose-volume histograms were compared. RESULTS: Clinically acceptable plans were achieved for all the SMART, cf-IMRT, and 3DCRT plans. Compared with the 3DCRT plans, the SMART plans increased the dose delivered to the primary tumor (66 Gy vs 60 Gy), with improved sparing of normal tissues in all patients. The Dmax of the spinal cord, V20 of the lungs, and Dmean and V50 of the heart for the SMART and 3DCRT plans were as follows: 38.5 ± 2.0 vs 44.7 ± 0.8 (P = 0.002), 17.1 ± 4.0 vs 25.8 ± 5.0 (P = 0.000), 14.4 ± 7.5 vs 21.4 ± 11.1 (P = 0.000), and 4.9 ± 3.4 vs 12.9 ± 7.6 (P = 0.000), respectively. In contrast to the cf-IMRT plans, the SMART plans permitted a simultaneous dose escalation (6 Gy) to the primary tumor while demonstrating a significant trend of a lower irradiation dose to all organs at risk except the spinal cord, for which no significant difference was found. CONCLUSION: SMART offers the potential for a 6 Gy simultaneous escalation in the irradiation dose delivered to the primary tumor of EC and improves the sparing of normal tissues.

Sequential chemoradiotherapy with accelerated hypofractionated radiotherapy compared to concurrent chemoradiotherapy with standard radiotherapy for locally advanced non-small cell lung cancer.

To compare the outcomes and treatment-related toxicities of two chemoradiotherapy schedules given to the patients with unresectable locally advanced non-small cell lung cancer (NSCLC): sequential chemotherapy with accelerated hypofractionated radiotherapy (SCRT), and concurrent chemotherapy with standard radiotherapy (CCRT), 68 patients from two prospective clinical trials were included. Thirty-four patients were treated with SCRT using an accelerated hypofractionated radiation schedule, 34 patients received CCRT with standard radiation. Between the two treatment groups there were no significant differences in terms of overall survival, progression-free survival (PFS), locoregional-PFS or distant metastasis-PFS. For the SCRT group, the median survival time and 2- and 4-year overall survival rates were 19 months, 38.2%, and 23.5%, respectively, and for the CCRT group these were 19 months, 44.1%, and 19.6%. Esophageal and constitutional toxicities were more pronounced in the CCRT group, while there was no significant difference in pulmonary toxicities. The results suggest that for unresectable stage III NSCLC, the outcomes of SCRT with accelerated hypofractionated radiotherapy and CCRT with standard radiotherapy are similar, but the toxicities associated with treatment are less in the SCRT group.

Adsorption of nitrosamines by mesoporous zeolite.

On the basis of a study of the adsorption of zeolite and mesoporous silica, we attempted to create a hierarchical structure in the new nitrosamines trapper. Thus, mesoporous HZSM-5 zeolite was fabricated through impregnating a structure-directing agent into the as-synthesized MCM-41 followed by dry-gel conversion to transform amorphous silica to zeolite crystal. The texture of mesoporous ZSM-5 was tailored by adjusting the Si/Al ratio in the MCM-41 source and the thermal treatment time. The resulting samples were characterized by N(2) adsorption to evaluate their textural properties. One volatile nitrosamine, N-nitrosopyrrolidine (NPYR), was used as probe molecule in instantaneous adsorption to survey the function of the resulting composites. Adsorptions of N'-nitrosonornicotine (NNN) in dichloromethane solution and tobacco-specific nitrosamines (TSNA) in tobacco-extract solution were also utilized for the same purpose. As expected, mesoporous zeolite exhibits a good adsorption capacity in laboratory tests, superior to either microporous zeolite or mesoporous silica, providing a valuable candidate for controlling nitrosamines in the environment.

Eliminating carcinogenic pollutants in environment: reducing the tobacco specific nitrosamines level of smoke by zeolite-like calcosilicate.

Trapping carcinogens such as tobacco-specific nitrosamines (TSNA) in environmental tobacco smoke (ETS) is a challenge for the application of zeolite in environment protection because most TSNA exist in the particles whose size exceed the micropores of zeolites. In this paper, a new strategy to intercept the particles and to trap the TSNA in smoke by use of the porous calcosilicate material with fiber-like morphology plus two-dimensional eight-ring channel system is depicted and assessed. Owing to the specific fiber-like morphology and chemical composition, zeolite-like calcosilicate CAS-1 can effectively intercept the particles and thus reduces the TSNA level of mainstream smoke in the range of 30-60% once it is added into the cigarette filter, which is superior to zeolite NaA additive with the same amount. Moreover, the importance of morphology of zeolite-like porous materials on the adsorption of nitrosamines in smoke is reported for the first time.

Adsorption of nitrogen oxides by the moisture-saturated zeolites in gas stream.

This investigation examined the instantaneous adsorption of NO(x) by moisture-saturated zeolites at ambient temperature. Among the zeolites studied, Faujasite exhibited the highest adsorption capacity owing to its relatively large pore size. Besides, the influence of cation was demonstrated by comparing the adsorption of zeolites with different cation densities (NaX vs. NaY, mesoporous silica MCM-48-like vs. Faujasite) and treatments (ion exchange of NaY with Cu(2+)). For the adsorption of NO, the effects of gas flow rates and pre-adsorbed hydrocarbons such as benzene, acetaldehyde or 1,3-butadiene were evaluated. It was proven that zeolite could efficiently capture nitrogen oxides in gas stream even it had been saturated by moisture, which will be valuable for the protection of environment and public health.

[Efficacy of chemotherapy combined hyperfractionated accelerated radiotherapy on limited small cell lung cancer].

BACKGROUND & OBJECTIVE: Limited small cell lung cancer (SCLC) is sensitive to both radiotherapy and chemotherapy. Radiotherapy can enhance survival rate and reduce the local/regional recurrence rate of limited SCLC. This study was to analyze the efficacy of chemotherapy combined hyperfractionated accelerated radiotherapy (HART) on limited SCLC, observe treatment-related adverse events and summarize the treatment failure patterns. METHODS: A total of 55 limited SCLC patients were treated with EP regimen as induction chemotherapy, then received radiotherapy, followed with EP regimen as consolidation chemotherapy. Prophylactic cranial irradiation (PCI) was given to those patients who had achieved complete remission (CR) after chemoradiotherapy. As treatment was completed, patients were followed up, the efficacy and toxicities were evaluated. RESULTS: At the end of chemoradiotherapy, the overall response rate was 87.3%. The 1-, 3-, and 5-year overall survival rates were 79.1%, 40.3% and 16.1%, respectively, with the median survival time of 18.7 months. Grade III and IV hematologic toxicities were observed in 23 (41.8%) and 16 (29.1%) patients, respectively. Grade I and II radiation-induced pneumonitis occurred in 21 (38.2%) and 2 (3.6%) patients, respectively. Grade I and II radiation-induced esophagitis occurred in 29 (52.7%) and 12 (21.8%) patients, respectively. No grade III/IV non-hematologic toxicity was observed. Grade I and II pulmonary fibrosis occurred in 11 (20.0%) and 5 (9.1%) patients, respectively. Grade I esophageal stricture was observed in 2 (3.6%) patients. Of the 55 patients, 16 (29.1%) had local/regional recurrence, 21 (38.2%) suffered from distant metastasis. CONCLUSIONS: The toxicities of EP regimen chemotherapy combined with HART are mild to moderate and are tolerable by patients. Local/regional recurrence and distant metastasis are the main reasons of treatment failure.

Improving MCM-41 as a nitrosamines trap through a one-pot synthesis.

Copper oxide was incorporated into MCM-41 by a one-pot synthesis under acidic conditions to prepare a new mesoporous nitrosamines trap for protection of the environment. The resulting composites were characterized by XRD, N2 adsorption-desorption, and H2 temperature-programmed reduction techniques, and their adsorption capabilities were assessed in the gaseous adsorption of N-nitrosopyrrolidine (NPYR). The adsorption isotherms were consistent with the Freundlich equation. The copper salt was deposited onto MCM-41 during the evaporation stage and was fixed on the host in the calcination process that followed. MCM-41 was able to capture NPYR in air below 373 K but not at 453 K. Loading of copper oxide on MCM-41 greatly improved its adsorption capability at elevated temperatures. The influence of the incorporation of copper into MCM-41 samples and the adsorption behavior of these samples are discussed in detail.