A time-saving method of creating AVF buttonholes: indwelling trocar technique.

AIMS AND OBJECTIVES: This study aims to explore the convenience and practicality of the method of establishing buttonholes with indwelling trocars. BACKGROUND: Compared with rope-ladder technique, buttonhole cannulation has better applicability for haemodialysis patients, and the method of buttonhole establishment is particularly important. DESIGN: Prospective, observational and cohort study. METHODS: We conducted a 12-month observational study on 30 patients who used sharp needles to establish buttonholes and 33 patients who used indwelling trocars to establish buttonholes, and compared the differences between the two groups in the buttonhole formation time, patient-reported cannulation pain, buttonhole success rate, AVF-related infection and patency of AVF. The study adhered to STROBE guidelines. RESULTS: The buttonhole formation time of the indwelling trocar group is less than that of the sharp needle group (5.48 ± 0.51 vs. 23.23 ± 3.07, p < .01). When the buttonhole was used for the first time, the cannulation pain of the indwelling trocar group was less than that of the sharp needle group (4.94 ± 1.50 vs. 6.03 ± 1.13, p = .002), but there was no significant difference in this result after 1 month (sharp needle group with 4.50 ± 0.94 vs. indwelling trocar group with 4.12 ± 1.19, p = .169). Compared with all the buttonholes in the indwelling trocar group were established successfully, there were 5 unsuccessful buttonholes in the sharp needle group (p = .02). Three cases of unsuccessful buttonhole patients in the sharp needle group developed AVF-related infection, this result did not appear in the indwelling trocar group (p = .102). The difference in arterial pressure and venous pressure between the two groups was not significant (p = .061, p = .222). CONCLUSIONS: Our new method can help buttonhole patients get less track formation time, less cannulation pain, and less fistula infection, thereby bringing them a more comfortable dialysis experience. RELEVANCE TO CLINICAL PRACTICE: The new method used in this study not only meets the needs of patients to protect AVF, but also provides convenience for clinical work. In addition, this study analyzed the causes of the AVF infection in buttonhole patients, and provided directions for future research.

Implementation and effectiveness of an intensive education program on phosphate control among hemodialysis patients: a non-randomized, single-arm, single-center trial.

BACKGROUND: Hyperphosphatemia is a common complication in patients on maintenance hemodialysis. Patients' adherence to phosphorus control can be improved by consistent education. However, few studies have focused on the model construction and effects of health education on phosphate control for hemodialysis patients. OBJECTIVE: To develop an intensive education program focusing on phosphate control among hemodialysis patients and to analyze the effectiveness of this program. DESIGN: A non-randomized, single-arm, single-center trial lasting for 6 months. SETTING: This program was conducted in a hemodialysis center in a teaching hospital in Zhuhai, China. PARTICIPANTS: Patients on maintenance hemodialysis with hyperphosphatemia. METHODS: An intensive hyperphosphatemia control education program lasting for 6 months was conducted among 366 hemodialysis patients applying the First Principles of Instruction model, which focused on mastering four stages: (a) activation of prior experience, (b) demonstration of skills, (c) application of skills and (d) integration of these skills into real-world activities. The controlled percentage of serum phosphorus, knowledge of hyperphosphatemia, and adherence to phosphate binders before and after the education program were assessed. RESULTS: The proportion of controlled serum phosphorus was significantly increased from 43.5 to 54.9% (P<0.001). The scores on the knowledge of phosphate control were improved significantly from 59.0 ± 18.9 to 80.6 ± 12.4 (P < 0.001). The proportion of high adherence to phosphate binders was increased dramatically from 21.9 to 44.5% (P < 0.001). CONCLUSION: The intensive education program can effectively improve serum phosphorus, knowledge of hyperphosphatemia, and adherence to phosphate binders among hemodialysis patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2100042017 . Retrospectively registered January 12th, 2021.

A nomogram for predicting the HER2 status of circulating tumor cells and survival analysis in HER2-negative breast cancer.

Background: In breast cancer patients with HER2-negative tumors (tHER2-), HER2-positive CTCs (cHER2+) were associated with promising efficacy of HER2-targeted therapy, but controversy has persisted over its prognostic effect. We developed a model including clinicopathologic parameters/blood test variables to predict cHER2 status and evaluated the prognostic value of cHER2+ in tHER2- patients. Methods: cHER2+ was detected, blood test results and clinicopathological characteristics were combined, and a nomogram was constructed to predict cHER2 status in tHER2- patients according to logistic regression analysis. The nomogram was evaluated by C-index values and calibration curve. Kaplan-Meier curves, log-rank tests, and Cox regression analyses were performed to evaluate the prognostic value of cHER2 status. Results: TNM stage, white blood cells (WBCs), neutrophils (NEUs), uric acid (UA), De Ritis ratio [aspartate transaminase (AST)/alanine transaminase (ALT)], and high-density lipoprotein (HDL) were found to be associated with cHER2 status in tHER2- patients in univariate logistic regression analysis, in which UA and De Ritis ratio remained significant in multivariate logistic regression analysis. A model combining these six variables was constructed, the C-index was 0.745 (95% CI: 0.630-0.860), and the calibration curve presented a perfect predictive consistency. In survival analysis, patients of the subgroups "with cHER2+/UA-low" (p = 0.015) and "with cHER2+/De Ritis ratio - high" (p = 0.006) had a significantly decreased disease-free survival (DFS). Conclusions: Our nomogram, based on TNM stage, WBC, NEU, UA, De Ritis ratio, and HDL, may excellently predict the cHER2 status of tHER2- patients. Incorporation with UA and De Ritis ratio may enhance the prognostic value of cHER2 status.

Integrated management is effective in the prevention and control of COVID-19 in the blood purification center: joint efforts from multiple departments.

BACKGROUND: During the outbreak of new coronavirus pneumonia, many hospitals in China became the designated hospitals for the treatment of new coronavirus pneumonia. The goal was to develop rapid and effective prevention and control methods for blood purification centers. RESEARCH DESIGN AND METHODS: The medical department, hospital department, nursing department, and blood purification center jointly set up a multi-department integrated COVID-19 prevention and control management team to manage the blood purification center. The efforts included the establishment of the continuous renal replacement therapy (CRRT) team for COVID-19, the integrated training and assessment of medical personnel, the integrated education of patients and their families, and the integrated management of the workflow of the hemodialysis room. RESULTS: No infected persons, including medical staff, patients, and their families, have been found in the dialysis center. After multi-departmental integrated training, the theoretical performance of medical staff in our dialysis center has increased from 82.36 ± 8.10 to 95.29 ± 4.95 (p < 0.05), and the unqualified rate dropped from 23.21 to 1.78% (p < 0.05). In addition, the three operational skills evaluation scores have also been significantly improved, from 86.00 ± 4.02, 88.01 ± 6.20, 92.01 ± 2.46 to 95.90 ± 0.30, 97.21 ± 0.87, 96.00 ± 1.00 (p < 0.01), and the passing rate from 80.36 to 100% (p < 0.05). CONCLUSION: Medical staff's knowledge of novel coronavirus pneumonia prevention and control can be improved by multi-sectoral integrated management, and CRRT treatment of COVID-19 patients is effective.

Tumor-Infiltrating Cytotoxic T Cells and Tumor-Associated Macrophages Correlate With the Outcomes of Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer.

BACKGROUND: Tumor-infiltrating immune cells (TIICs) play a key role in immunoregulatory networks and are related to tumor development. Emerging evidence shows that these cells are associated with sensitivity to chemotherapy and radiotherapy. However, the predictive role of TIICs in the outcomes of neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer (LARC) is unclear. METHODS: Imaging mass cytometry (IMC) was performed to comprehensively assess the immune status before nCRT in 6 patients with LARC (3 achieved pathological complete response (pCR), 3 did not) with matched clinicopathological parameters. Immunohistochemistry (IHC) for CD8, CD163 and Foxp3 on biopsy samples from 70 patients prior to nCRT and logistic regression analysis were combined to further evaluate its predictive value for treatment responses in an independent validation group. RESULTS: A trend of increased CD8+ cytotoxic T lymphocytes (CTLs) and decreased CD163+ tumor-associated macrophages (TAMs) and Foxp3+ regulatory T cells (Tregs) in the pCR group was revealed by IMC. In the validation group, CTLs and TAMs were strong predictors of the clinical response to nCRT. High levels of CTLs were positively associated with the pCR ratio (OR=1.042; 95% CI: 1.015~1.070, p=0.002), whereas TAMs were correlated with a poor response (OR=0.969; 95% CI: 0.941~0.998, p=0.036). A high density of TAMs was also associated with an advanced cN stage. CONCLUSION: CTLs in the tumor microenvironment (TME) may improve the response to nCRT, whereas TAMs have the opposite effect. These results suggest that these cells might be potential markers for the clinical outcomes of nCRT and aid in the clinical decision-making of LARC for improved clinical outcomes.