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Objective:To explore the puncture management in hemodialysis patients with difficult new arteriovenous fistula based on the finest evidence-based best practice evidence and evaluate the clinical effects.Methods:A team was formed, according to theoretical framework basing on the evidence of continuous quality improvement model, the best evidence-based interventions were obtained by adopting evidence-based practice. Formulated review indicators, evaluated obstacles and promoting factors in the process of practice, and took corresponding action strategies. From February 2020 to June 2020, 30 patients admitted to the dialysis center of Sir Run Run Shaw Hospital of Zhejiang University were recruited in the baseline review group by convenience sampling method. From September 2020 to January 2021, 30 patients from September 2020 to January 2021 were recruited in the after-effect evaluation group. The baseline review group adopted the original difficult new arteriovenous fistula puncture management scheme, and the after-effect evaluation group adopted the difficult autologous new internal fistula puncture management scheme based on the best evidence. The success rate of one puncture of fistula, the incidence rate of hematoma during puncture and dialysis, the incidence rate of discontinuation of treatment and the compliance with examination indexes were compared in the patients before and after applying for the evidences.Results:Compared with the baseline review group, the success rate of one-time puncture of internal fistula in the aftereffect evaluation group increased from 36.7% (11/30) to 73.3% (22/30), the incidence rate of hematoma during puncture and dialysis were decreased from 33.3%(10/30) to 6.67%(2/30) and 40%(12/30) to 0, the incidence rate of discontinuation of treatment were decreased from 40%(12/30) to3.33% (1/30), the difference was statistically significant ( χ2 values were 6.67-11.88, P<0.05). The implementation rate of review indexes in the aftereffect evaluation group was higher than that in the baseline review group, and the difference was statistically significant ( P<0.05). Conclusions:Evidence-based practice can improve the success rate of difficult new arteriovenous fistula, and reduce the incidence of arteriovenous fistula hematoma, reduce treatment interruption, and better maintain the lifeline of patients.
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Objective To preliminarily investigate the methods,safety and short to medium-term effectiveness of the interventional ultrasound applying in the hybrid procedure to treat the thrombosis of arteriovenous graft(AVG).Methods Twenty patients with the thrombosis of AVG,who received the hybrid procedure defined as Fogarty catheter thrombectomy and percutaneous transluminal angioplasty (PTA) guided by the ultrasonography,were retrospectively investigated. The display effects of the ultrasonography were observed.The technical and clinical success rates were evaluated.All the cases were followed up every 3 months for at least 1 year to evaluate the post-interventional assisted primary patency and the post-interventional secondary patency.Results All the processes were clearly displayed and well guided by the interventional ultrasound during the procedure.The technical and the clinical success rates were both 100%.No major complications were recorded.The post-intervention assisted primary patency rate was 100%,92.9%,85.7%,71 .4% at 3,6,9,12 months,respectively.The post-intervention secondary patency was 100%,100%,89.5%,89.5% at the correspondent months.Conclusions This pilot research shows the hybrid procedure guided by the interventional ultrasound to treat the thrombosis of AVG has high success rate and satisfied patency in short to medium-term.The interventional ultrasound is an effective, safe and convenient guiding method to the hybrid procedure,and has the value for clinical application.
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Objective:To investigate the effects of epidermal growth factor (EGF)on cell cycle and cell cycle-related regulatory factors of human esophageal squamous cell carcinoma (ESCC) cell line Eca109.Methods: Serum starved Eca109 cells were treated with 20 ng/ml recombinant human EGF(rhEGF)for 24 h.The cell cycle phase distribution was detected by flow cytometry.The mRNA and protein expression levels of p21CIP1/WAF1(p21) and p27KIP1(p27) were detected by real-time quantitative reverse transcription polymerase chain reaction(qRT-PCR)and Western blot,respectively.Results: The proportions of G1 phase cells in EGF group and control group were ( 54.90 ±0.82 )% and ( 65.94 ±0.74 )%.The mRNA and protein expression levels of p 21 in EGF group was significantly higher ,and p27 was significantly lower than that in control group ( P<0.01 ) .Conclusion: EGF facilitates G1-S phase transition,and promotes the proliferation of Eca 109 cells,which may be associated with the up-regulation of p21 and down-regulation of p27.
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Objective To investigate the expression of Nek8 in esophageal squamous cell carcinoma(ESCC) tissues and cell line , and to evaluate its correlation with the clinicopathological features of ESCC and the survival rate of ESCC patients after operation . Methods The expression of Nek8 mRNA in human ESCC Eca109 cell line and two pairs of ESCC tissues and adjacent normal e‐sophageal mucosal epithelium were detected by semi‐quantitative reverse transcription polymerase chain reaction (RT‐PCR) .Immu‐nohistochemistry and tissue microarray technique were used to examine the expression of Nek 8 protein in ESCC tissues and tumor‐adjacent tissues .The correlation between Nek8 expression and clinicopathological features of ESCC and survival rate of ESCC pa‐tients was then analyzed .Results The expression of Nek8 mRNA was positive in Eca109 cells and two cases of ESCC tissue ,and it was negative in paired normal esophageal mucosal epithelium specimens .In tissue microarray ,the expression of Nek8 protein in ES‐CC tissues ,which was mainly in the cytoplasm ,was significantly higher than that in tumor‐adjacent tissues(P= 2 .16E‐13) .The high expression of Nek8 was associated with tumor size (P=0 .008) ,but not with sex ,age ,histological grade ,infiltration degree , lymph node metastasis ,and the survival rate(P>0 .05) .Conclusion The expression of Nek8 is up‐regulated in ESCC tissues and cell line ,and may be involved in tumorigenesis and development of ESCC .Nek8 could act as a potential biomarker for ESCC diag‐nose and target for therapy .
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One hundred patients with acute ischemic stroke were enrolled in the study as the trial group, and 20 healthy individuals as control group. Intima-media thickness and plaque of the carotis were detected by carotid ultrasonography, cerebral infarction was detected by CT/MRI, and serum concentrations of sCD40L were measured by enzyme-linked immunosorbent assay. Neurologie impairment score was evaluated in all patients. The results showed that in patients with acute ischemic stroke the serum concentrations of sCD40L in plaques group were significantly higher than those in no plaque group. The levels of serum sCD40L of infarction group (diameter>1.5 cm) were higher than those of lacunar infarction group ( diameter<1.5 cm ) and temporary ischemic attack ( TIA ) group. The levels of serum sD40L in trial group were all higher than those in control group. In the trial group, serum concentrations of sCD40L were correlated with neurologic impairment score. The results indicate that CD40/CD40L signaling pathway may be involved in the carotid atherosclerosis formation and the rupture of plaques, and the increase of serum CD40L levels might be a risk factor for acute ischemic cerebrovascular diseases.
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Objective:To study the relation between conserved motif of sphingosine 1-phosphate receptor type 1(S1P1) and FTY720-induced internalization.Methods:With HA-S1P1(WT)-Myc-EGFP-N1 fusion vector as template,HA-S1P1(R142N)-Myc-EGFP-N1 fusion vector was constructed by overlap PCR.The conserved ERY motif of wild type S1P1 was mutated into ENY.The recombinant vectors were confirmed by sequencing,then they were transfected into HEK293 cells by Polyfect.The transfected HEK293 cells were selected with G418.Cells were incubated for 3,6,12 hours in the absence or presence of 100 nmol/L FTY720,then S1P1 gene expression was analyzed by fluorescence microscopy.Results:Sequencing confirmed HA-S1P1(R142N)-Myc-EGFP-N1 vectors was successfully constructed.S1P1(WT) protein and S1P1(R142N) protein were expressed on the stably transfected-HEK293 cell surface.FTY720 induced S1P1(WT) internalization,but not S1P1(R142N).Conclusion:FTY720-induced S1P1 internalization is related with conserved ERY motif.
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Objective To study the effect and safety of radiofrequency ablation (RFA) in the treatment of liver cancer.Methods The clinical data of prospectively and non-randomly selected 102 liver cancer patients were analysed. Results 102 patients with a total of 216 tumors were found in this series, the size of hepatomas were 1.5 to 14*!cm in diameter (average 4.9*!cm in diameter). In 67 of primary liver hepatocellular carcinoma, the tumors' size were smaller than 5*!cm in diameter in 21 cases; 35 with secondary liver tumors. RFA were performed under the guidance of ultrasonography in 43 cases, under CT in 50, under laparoscopy in 3, and 6 were performed during open surgery. All patients received ultrasonography and CT scanning of liver one month after the ablaton. The echoes of the tumors were stronger, and the area of the echo reached was larger than pre-ablation; blood flow in the tumor obviously reduced and even disappeared in sonography; CT showed that the shadow density in the tumor was diminished. Of the 102 patients, 14 underwent 18-FDG-PET imaging 30 days after the ablation, of them, 11 showed defect of radiation in the tumor, 3 showed residual locus in the tumor. 2 of the 3 cases underwent RFA again and the residual was disappeared completely, the another subject to ethanol injection because of advanced age. All the patients were followed up for 3-18 months. Except 6 patients with late metastastic liver cancer died within 1 year after RFA, the other 96 cases remained alive now, the 1-year survival rate was 94.1%. Conclusions RFA is a new ideal therapy for liver cancer. It is safe, effective, and good tolerance with little trauma.
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Objective To investigate the effect of radiofrequency ablation(RFA) in the treatment of small liver cancer.Methods In recent 6 years,130 patients with primary or secondary liver cancer(≤5cm in diameter)were treated by RFA,among which 86 cases were primary,and 44 cases were secondary liver cancer.Among the 130 cases,18 received RFA plus TAEC,and 20 had RFA combined with PEI.Results Overall 1-and 3-year survival rate was 91.3% and 77.7% respectively.Complications occurred in 7 cases,including biliary fistula,intestinal fistula,and slight burn of skin.There was no death in this series.Conclusions RFA is an effective and safe therapeutic approach for small liver cancer ≤5cm in diameter.Its effect may be similar to that of surgical resection.