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Objective:To investigate the effect of improved partial graft excision (iPGE) in the treatment of infected arteriovenous grafts (AVG).Methods:It was a single-center retrospective study. A cohort database study of patients who underwent surgery for infected AVG from January 2019 to July 2022 was conducted. The cases were divided into total graft excision (TGE) group and iPGE group, and the postoperative reinfection rate and surgery-related complications, such as bleeding, nerve injury and limb ischemia, in the two groups were analyzed. The primary patency rate and the secondary patency rate at 3 months and 6 months after the surgery in the iPGE group were analyzed.Results:(1) General information: A total of 47 cases were included in the study. Among these 47 cases, 14 cases had undergone iPGE of infected AVG, and 33 cases had undergone TGE. The study population was of an average age of 59 years (21-81 years), including 18 males and 29 females. Dialysis age was 36 (14, 72) months. AVG age was 18 (4, 36) months. The shortest AVG age was half a month, and the longest AVG age was 72 months. (2)Comparative analysis of the two groups: The reinfection rate of the iPGE group was 21.4% (3/14), and the reinfection rate of the TGE group was 0 (0/33). The reinfection rate of the iPGE group was higher than that of the TGE group, and the difference was statistically significant (Fisher exact test, P=0.022). For 11 patients in the iPGE group (excluding 3 cases with reinfection), the shortest follow-up period was 5 months and the longest follow-up period was 18 months. In the iPGE group, the primary patency rate at 3 months was 72.7% (8/11), and the primary patency rate at 6 months was 72.7% (8/11); the secondary patency rate at 3 months was 100% (11/11) and the secondary patency rate at 6 months was 90.9% (10/11). There was no brachial artery rupture, nerve injury or limb ischemia in the iPGE group. In the TGE group, 1 case underwent secondary repair of brachial artery due to brachial artery rupture, and there was no nerve injury or limb ischemia in other cases. Conclusions:During the treatment of infected AVG, iPGE can preserve the original fistula, and avoid central venous catheterization. At the same time, the operation difficulty and risk are relatively low. Although the reinfection rate of iPGE is slightly higher than that of TGE in this study, the reinfection rate of iPGE is lower than that reported in the previous study. The key to prevent reinfection is to grasp the reasonable surgical adaptation signs in preoperative evaluation, perform intraoperative reevaluation and control surgical operation details. The iPGE represents an acceptable method for the treatment of some particular patients with infected AVG.
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Objective:To analyze the predictive factors of autogenous arteriovenous fistula (AVF) maturation and tentatively discuss the intervention timing of assisted maturation.Methods:It was a retrospective study. The data of patients with newly established AVF and regular follow-up in Haidian Hospital, the Third Hospital of Peking University from August 1, 2018 to March 31, 2022 were analyzed. The patients were divided into mature group and immature group based on whether they met clinical maturity or ultrasonic maturity criteria 3 months after AVF establishment.The general data, preoperative laboratory examination and postoperative ultrasonic examination parameters were compared between the two groups. Logistic regression analysis model was used to analyze the related factors of AVF maturation, and receiver operating characteristic curve (ROC curve) was drawn to evaluate the predictive value of each factor for AVF maturation and intervention timing.Results:A total of 568 patients were included, with age of (56.86±13.82) years old, 339 males (59.68%), and 229 females (40.32%). There were 380 patients in the maturation group and 188 patients in the immature group. The total rate of AVF maturation was 66.90% (380/568). The anastomosis diameter ( t=9.732, P < 0.001), ln(anastomosis artery diameter)( t=10.116, P < 0.001), anastomosis vein diameter ( t=13.961, P < 0.001), ln(brachial artery diameter)( t=9.362, P < 0.001) and brachial artery blood flow ( t=16.542, P < 0.001) of postoperation one month, and anastomosis diameter ( t=7.356, P < 0.001), anastomosis artery diameter ( t=11.117, P < 0.001), anastomosis vein diameter ( t=12.332, P < 0.001), ln(brachial artery diameter) ( t=7.956, P < 0.001) and brachial artery blood flow ( t=13.803, P < 0.001) of postoperation three months in the mature group were significantly higher than those in the immature group. Logistic regression analysis models showed anastomosis vein diameter at 1 month after surgery ( OR=0.577, 95% CI 0.342-0.975, P=0.040), brachial arterial blood flow at 1 month after surgery ( OR=0.988, 95% CI 0.996-1.000, P=0.043) and brachial arterial blood flow at 3 months after surgery ( OR=0.997, 95% CI 0.995-0.999, P=0.002) were the independent relevant factors of AVF maturation. When the anastomosis vein diameter ≥ 3.90 mm at 1 month after AVF surgery ( AUC=0.842, 95% CI 0.809-0.871, P < 0.001), the blood flow of brachial artery ≥ 446.90 ml/min at 1 month after AVF surgery ( AUC=0.880, 95% CI 0.850-0.906, P < 0.001), the critical value of the combined index of anastomotic vein diameter and blood flow of brachial artery at 1 month after fitting ≥ 0.44 ( AUC=0.889, 95% CI 0.860-0.914, P < 0.001) and brachial arterial blood flow ≥ 595.00 ml/min ( AUC=0.857, 95% CI 0.822-0.888, P < 0.001), the unassisted maturation of AVF could be predicted. Conclusions:The anastomosis vein diameter ≥ 3.90 mm at 1 month after AVF surgery, and the blood flow of brachial artery ≥ 446.90 ml/min at 3 months after AVF surgery, or the critical value of combined index of both after fitting ≥ 0.44 can predict the unassisted maturation of AVF, and one month after surgery may be the opportunity for early intervention to promote maturation.
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Objective:To investigate the association between cognitive impairment and all-cause mortality in middle and elderly adult patients undergoing maintenance hemodialysis (HD).Methods:A prospective cohort study was conducted. Patients from 11 HD centers in Beijing between April and June 2017 were enrolled. Baseline data were collected, and a series of neuropsychological batteries covered 5 domains of cognitive function were applied for the assessment of cognitive function. The patients were then classified as normal and cognitive impairment groups according to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-V) and followed-up until June 2018. The clinical characteristics of the two groups of patients were compared. Kaplan-Meier survival analysis was used to compare the difference in the cumulative survival rate between the two groups. Multivariate Cox regression model was used to analyze the independent influencing factors of all-cause mortality, to determine the relationship between cognitive impairment and different cognitive domain impairments and all-cause death.Results:A total of 613 patients were enrolled, of which 496(80.91%) patients had cognitive impairment. Compared with the normal cognitive function group, the patients in the cognitive impairment group tended to be older, longer dialysis vintage, a higher proportion of diabetes, hypertension, and stroke, increased serum iPTH level, and lower education level and urea clearance index (Kt/V) (all P<0.05). After (49.53±8.42) weeks of follow-up, Kaplan-Meier survival analysis showed that the cumulative survival rate of cognitive impairment group was significantly lower than that of cognitive normal group (Log-rank χ2=8.610, P=0.003). Multivariate Cox regression analysis showed that history of diabetes ( HR=2.742, 95% CI 1.598-4.723, P<0.001), coronary heart disease ( HR=1.906, 95% CI 1.169-3.108, P=0.010), dialysis vintage (every increase of 1 month, HR=1.007, 95% CI 1.003-1.011, P=0.001), serum level of albumin (every increase of 1 g/L, HR=0.859, 95% CI 0.809-0.912, P<0.001), cognitive impairment ( HR=2.719, 95% CI 1.088-6.194, P=0.032) were independently associated with all-cause mortality. Multivariate Cox regression analysis on different cognitive domains also indicated that memory impairment ( HR=2.571, 95% CI 1.442-4.584, P<0.001), executive function impairment ( HR=3.311, 95% CI 1.843-5.949, P=0.001) and three, four, five domains combined impairment ( HR=5.746, 95% CI 1.880-17.565, P=0.002; HR=12.420, 95% CI 3.690-41.802, P<0.001; HR=13.478, 95% CI 3.381-53.728, P<0.001) were independently related to all-cause mortality. Conclusions:Cognitive impairment is an independent risk factor of all-cause mortality in middle and elderly adult patients undergoing maintenance hemodialysis, and the risk is significantly increased in patients with the impairment of the domains of memory, executive function, or in the combination of three to five cognitive domains.
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Objective:To investigate the clinical features and associated influencing factors of cognitive impairment in middle-aged and elderly Chinese adult patients undergoing maintenance hemodialysis (HD).Methods:A cross-sectional study was conducted among HD patients from 11 centers in Beijing city from April 2017 to June 2017. A neuropsychological battery covering domains of attention/processing speed, executive function, memory, language, and visuospatial function was applied in cognitive function assessment. Patients were classified as normal cognitive function group and cognitive impairment group according to the fifth version of the diagnostic and statistical manual of mental disorders criteria (DSM-V). Multivariate binary logistic regression was used to analyze the independent influencing factors of cognitive impairment. Results:A total of 613 HD patients were included in the study, and the prevalence of cognitive impairment was 80.91% (496/613). Attention impairment (81.05%) and memory impairment (63.51%) were the most common impaired domains, and 79.23% was concomitant impairment across two or more cognitive domains among those with cognitive impairment. Compared with the patients in the normal cognitive function group, the patients in the cognitive impairment group had senior age, longer dialysis vintage, higher proportion of diabetes, hypertension, and stroke, higher level of serum intact parathyroid hormone (iPTH), lower education level, and lower urea clearance index (Kt/V) (all P<0.05). Factors were independently associated with cognitive impairment including increasing age ( OR=1.110, 95% CI 1.072-1.150, P<0.001), education time>12 years (with education time<6 years as reference, OR=0.323, 95% CI 0.115-0.909, P=0.032), history of diabetes ( OR=2.151, 95% CI 1.272-3.636, P=0.004), history of stroke ( OR=2.546, 95% CI 1.244-5.210, P=0.011), increased dialysis vintage ( OR=1.016, 95% CI 1.010-1.022, P<0.001), reduced Kt/V( OR=0.008, 95% CI 0.002-0.035, P<0.001), and increased iPTH level ( OR=1.002, 95% CI 1.002-1.003, P=0.012). Conclusions:The prevalence of cognitive impairment in middle-aged and elderly adult Chinese patients undergoing HD is high. Memory and attention are the most commonly impaired domains. Increasing age, low education level, history of diabetes and stroke, increased dialysis vintage, reduced Kt/V and increased serum iPTH are the independent influencing factors associated with cognitive impairment.
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Objective:To explore the relationship between high sensitivity C-reactive protein (hs-CRP) and vascular access failure in hemodialysis patients.Methods:From July 2017 to June 2018, 105 patients with regular hemodialysis were selected from the blood purification center of Beijing Haidian hospital.According to the presence or absence of VAF, the patients were divided into two groups: VAF+ group and VAF - group.The difference of hs CRP level between the two groups was compared.Results:During the 12-month follow-up, 17 patients had more than one event of vascular failure.The total protein level of VAF+ group was significantly lower than that of VAF-Group((65.61±4.01) g/L and( 68.98±5.66) g/L, P=0.021). The male proportion of VAF+ group was lower than that of VAF-group (29.41% vs 53.41%, P=0.07), but the difference was not statistically significant.There was no significant difference in the annual change level of hs CRP between VAF + group and VAF Group((0.33±5.49) mg/L and(0.57±4.45) mg/L, P=0.840). The level of total protein was the independent protective factor of VAF( OR=0.889, 95% CI 0.797-0.991, P=0.034). The level of hs CRP was not significantly correlated with vascular access events( OR=1.018, 95% CI 0.926-1.119, P=0.713). Conclusion:There is no correlation between hs CRP and VAF.The exact mechanism of inflammation in intimal hyperplasia needs further study.
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Objective@#To explore the relationship between high sensitivity C-reactive protein (hs-CRP) and vascular access failure in hemodialysis patients.@*Methods@#From July 2017 to June 2018, 105 patients with regular hemodialysis were selected from the blood purification center of Beijing Haidian hospital.According to the presence or absence of VAF, the patients were divided into two groups: VAF+ group and VAF - group.The difference of hs CRP level between the two groups was compared.@*Results@#During the 12-month follow-up, 17 patients had more than one event of vascular failure.The total protein level of VAF+ group was significantly lower than that of VAF-Group((65.61±4.01) g/L and( 68.98±5.66) g/L, P=0.021). The male proportion of VAF+ group was lower than that of VAF-group (29.41% vs 53.41%, P=0.07), but the difference was not statistically significant.There was no significant difference in the annual change level of hs CRP between VAF + group and VAF Group((0.33±5.49) mg/L and(0.57±4.45) mg/L, P=0.840). The level of total protein was the independent protective factor of VAF(OR=0.889, 95%CI 0.797-0.991, P=0.034). The level of hs CRP was not significantly correlated with vascular access events(OR=1.018, 95%CI 0.926-1.119, P=0.713).@*Conclusion@#There is no correlation between hs CRP and VAF.The exact mechanism of inflammation in intimal hyperplasia needs further study.
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Objective To analyze the effect of interventional treatment in patients with swelling hand syndrome.Methods 100 patients with maintained hemodialysis were enrolled in this study (49 male,51 female).Upper limb swelling involved the dialysis was examined with a course of 1 week to 36 months.Before intervention treatment,stenosis or occlusion of the brachiocephalic vein or subclavian vein were found in 95 patients diagnosed by CTA.Angiography was performed through the affected side of the upper limb.Then a balloon pre-dilatation of the stenosis or occlusion was performed,followed by balloon dilatation or stent molding treatment through the femoral vein.Results Percutaneous transluminal angioplasty or stent angioplasty was performed in 87 patients without severe complications,while treatment was failed in 13 cases.Swelling was gone in 85 patients 2-5 days after surgery,and persistent symptom was observed in 2 cases.All the 87 patients were followed up from 2 to 46 months after interventional treatment,one patient died of cancer after 14 months.Relapsed symptom of swelling hands was found in 20 patients and interventional therapy was performed again.Conclusion Swelling hand syndrome is common in maintained hemodialysis patients due to the stenosis or occlusion of central vein involved the dialysis side.Interventional treatment is a safe and effective procedure.
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Objective To explore the clinical application value for calculating the volume of splenic embolization by splenic artery branch diameter ratio method.Methods Data of 20 patients with cirrhosis and hypersplenism who underwent partial operation of splenic artery embolization were retrospectively analyzed.Based on the angiography of splenic artery during operation,the diameter of branch vessels of splenic artery was measured and the percentage of embolism volume in spleen was calculated.CT scans were performed on all patients after one month of the operations.Based on VR reconstruction image,the percentage of embolism volume in the spleen was calculated.Postoperative complications and adverse responses were observed.Peripheral blood red cells,white blood cells and platelets were tested repetitively three days before the operation,and a week,a month,three months after the operation.Moreover,the statistical analysis was performed.Results The difference between the percentage of embolism volume in the spleen calculated by splenic artery branch diameter ratio method ([52.15±3.29]％) and calculated by CT ([49.99±6.02]％) was not statistical (t=-1.630,P=0.120).All the patients had moderate or below moderate pain on left upper quadrant,and had symptoms of nausea,vomiting and fever after the operation.They all got better after symptomatic treatment.Peripheral blood red cells,white blood cells and platelets all had significant differences among three days before the operation,a week,a month and three months after the operation (all P＜0.001).Conclusion During the partial splenic embolization,the application of ratio method on branch vessels of splenic artery to measure the volume of embolism in the spleen is convenient,prompt and relatively accurate.It is worthy to be expanded in clinic.
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Objective To explore the in vitro spermostatic effects and the mechanisms of ceritinib,a novel candidate from the active compound pools previously screened for the regulation of sperm function.Methods The vigor sperm of human and mouse were incubated with ceritinib for 20seconds,and the sperm motility was evaluated by computer assistant sperm analysis (CASA).The integrity of the sperm plasma membrane and the survival ratio of sperm was assessed by hypo-osmotic swelling (HOS) assay and SYBR-14/PI staining.The damage of sperm plasma membrane was detected by electron microscope.The cytotoxicity of ceritinib to VK2/E6E7,End1/E6E7 and Ect1/E6E7 cells was measured by CCK-8 assay and fluorescent staining.Results The minimal effective concentration (MEC) of ceritinib to (5-10) × 106/mL human sperm within 20 seconds was (74.87 ± 31.46)μmol/L,which was significantly lower than the MEC of nonoxynol-9 (219.75 ± 20.89) μmol/L measured in the same condition.The time-dose related spermostatic effects of ceritinib were measured by CASA system.Ceritinib was able to damage sperm membrane and caused sperm death with HOS and SYBR-14/PI staining.With electron microscopy,the sperm membrane was observed to be ruptured,and the heads and tails of sperm were separated by ceritinib.Ceritinib was also able to damage the epithelial cells.Conclusions Ceritinib has acute spermostatic effects and potential contraceptive effects.
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Ginsenoside Rg1 (Rg1), the major effective component of ginseng, has been shown to have multiple bioactivities, but low oral bioavailability. The aim of this study was to develop a simple, sensitive and rapid high performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) method, which could be used to validate and quantify the concentrations of Rg1 and its metabolites in Sprague-Dawley rat bile, urine, and feces after oral administration (25 mg/kg). Calibration curves offered satisfactory linearity (>0.995) within the determined ranges. Both intra-day and inter-day variances were less than 15%, and the accuracy was within 80-120%. The excretion recoveries of Rg1, ginsenoside Rh1 (Rh1), and protopanaxatriol (Ppt) in bile, urine, and feces combined were all greater than 70%. The fecal excretion recoveries of Rg1, Rh1, and Ppt were 40.11%, 22.19%, and 22.88%, respectively, whereas 6.88% of Rg1 and 0.09% of Rh1 were excreted in bile. Urinary excretion accounted for only 0.04% of Rg1. In conclusion, the observed excretion profiles for Rg1 and its metabolites after oral administration are helpful for understanding the poor oral bioavailability of Rg1 and will aid further investigations of Rg1 as a pharmacologically active component.
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It has long been concerned about the mechanism , pathology and toxicology of anaesthetic involving drug addiction and its influence on human body .In recent years , as a short non-coding RNA negatively regulating the genes in cells , MicroRNAs (miRNAs) may turn out to be a focus issue which is related to apoptosis , metabolism, inflammation, and tumorigenesis.This article illuminates the influence on gene expression introduced by common anaesthetics and the interaction between gene and its target site . Analyzing the potential medical applications of miRNA , this article reviews the correlation between miRNAs and anaesthetic to provide new evidences in this emerging field .
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Objective To evaluate cardiac biomarkers as biological risk factors for cardiovascular and all-cause motality in HD patients.In addition,a multimarker approach including inflammatory index was performed to improve the cardiovascular and all-canse risk assessment of these patients.Methods The author measured Troponin-T (TnT),N-terminal pro brain natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (HsCRP),collected the clinical data at baseline (January 2012) in 229 HD patients in three hemodialysis centers in Haidian District of Beijing,recorded time and cause of death in the next 1000 days.Kaplan-Meier was used to calculate survival rate and impact factors of prognosis.Cox proportional hazard model was used to estimate significance of =TnT,NT-proBNP and HsCRP and adjusted hazard ratios (HRs) of death.Results During the followup,37 patients died,mainly from cardiac cause (54.05％,20/37).Univariate analysis found old age,diabetes,cardiovascular disease,low serum albumin,CRP≥3 mg/L,TnT≥0.1 mg/L,NT-proBNP≥ 4381 ng/L were associated with prognosis.Elevated cTnT,NT-proBNP or HsCRP were all associated with increased cardiovascular and all-cause motality.Moreover,the combination of all parameters (NTproBNP≥4381 ng/L and TnT≥0.1 mg/L and HsCRP≥3 mg/L) were dramatically associated with increased cardiovascular cause mortality (HR=25.25,P ＜ 0.01) and all-cause mortality (HR=27.33,P ＜ 0.01).The association were significant even after full adjustment for cardiovascular (HR=14.33,P ＜ 0.01) and all-cause mortality (HR=1 1.54,P ＜ 0.01) respectively.Conclusions A combined index of cardiovascular risk factors could provide supplementary risk stratification in HD patients for cardiovascular mortality and all-cause mortality,strongly supporting the annual routine determination of these biomarkers.
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Objective To approach the alleviating effect of medicative diet for food therapy on hepatic function of patients with gastric cancer and adjuvant chemotherapy after operation and supply references for effective treatment and nursing. Methods We divided 123 patients with gastric cancer after operation into the test group (65 cases) and the control group (58 cases).The control group adopted routine treatment project while the test group received medieative diet for food therapy based on routine treatment project. The changes in hepatic functions were compared between the two groups. Results The changes in hepatic functions of the test group were better than those of the control group (P<0.01 ). Conclusion Medicative diet for food therapy could significantly restore the seriously damaged hepatic function after chemotherapy.
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Objective To observe the therapeutic effect of Chinese medicine in treating elderly herpes zoster, and study the clinical evaluation of the treatment with Chinese medicine from evidence-based medicine (EBM) view. Methods All the 156 elderly patients diagnosed with herpes zoster were randomly divided into treatment group (78) and control group (78). The former group was administered with Chinese medicine by oral administration and topical application, while the latter took aciclovir alone. All the case were treated for 10 days. Results The overall response rates of Chinese medicine and aciclovir in treatment herpes zoster were respectively 98.70% and 84.62% (P
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Aim To elucidate the biochemical mechanism of gossypol in inducing the decline of sperm quality.Methods Gossypol was administered orally at the dose of 50 mg?kg-1/2 d for two weeks.Then,the sperm was collected from the left caudal epididymis and was analysed by CASA.The morphological changeand the concentration of nitric oxide(NO)in testes as well as the level of hormone〔follicle-stimulating hormone(FSH)〕,luteotrophic hormone(LH),testosterone(T)in serum were assayed.Results Gossypol could induce the decrease of sperm number and sperm quality.The concentration of NO in testes increased significantly.Among the three kind of hormone,only the concentration of T showed decrease after the oral administration of gossypol.NA1108 could antagonize the decline of sperm quality damaged by gossypol and decrease the content of NO in testes.Conclusions The concentration of NO in testes beyond normal value was one of the toxic mechanism of gossypol that contributed to the inhibition of spermatogenesis.Some drugs with the ability to reduce NO content in testes could also increase sperm quality.
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Objective To alleviate the side effects of glucocorticoid, we established a new procedure - intra - renal adipose capsule injection therapy to treat chronic glomerulonephritis. Methylprednisolone was injected into human renal adipose capsules of patients to treat primary glomerulonephritis. Methods 21 patients were diagnosed as primary glomerulonephritis by renal biopsies. Under the guide of sonograph,40mg methylprednisolone was injected into each renal adipose capsule of the patients twice a week, and each one of them was totally given ten times of the treatment. The urinary protein,plasma albumin, serum creatinine and blood pressure before and after the treatment were measured. Results The condition of most patients had been improved after the treatments. The excretion of urinary protein in 18 of 21 patients (85.1% ) had significantly been decreased (P