ABSTRACT
Objective: By applying the proteomic method, to analyze differences of protein expressions and signal pathways in veins at arteriovenous fistula in chronic kidney disease stage 5 (CKD5) patients with or without diabetes so as to explore the pathogenesis of high incidence of arteriovenous fistula functional incapacitation in CKD5 patients with diabetes. Methods: The protein expression RAW datasets of vascular access from CKD5 patients with or without diabetes in Proteomexchange Database were screened out and downloaded. Then the identified features were searched from UniProt/SwisssProt human proteins database through the software ProteomeDiscovery (PD). Then, the PD generated a file of quantitative proteins data. The significantly different proteins between two groups were screened out and analyzed by T-test or Adj T-test depending on homogeneity of variance. These significantly different proteins were enriched into different biological pathways through IPA analysis, GO enrichment analysis, and KEGG pathway analysis, which signifies these biological pathways are significantly different. Ultimately, the correlation of proteins in different biological pathway was analyzed by Spearman correlation test. Results: TheiTRAQ labeled proteins RAW datasets comparing the vessels from CKD5 patients with diabetes and without diabetes (PXD010883) were collected at first. After searching identified features again and disposing the data, a total of 120 significantly different proteins including 89 up-regulated proteins and 31 down-regulated proteins were screened out finally. Through GO, KEGG and IPA analyses, there were two significantly different biological pathways. On the one hand, the purine nucleoside monophosphate metabolic change and the ratio of ATP/AMP decrease were reflected in oxidative phosphorylation receding and AMP metabolism enhancing in CKD5 patients with diabetes. On the other hand, the muscle system process which played a vital role in VSM cells receded in CKD5 patients with diabetes. It was specific in the decrease of MYH11, CNN1 and so on. Excitingly, the significantly differential genes in the two pathway had a strong correlation. The results explained why CKD5 patients with diabetes always have cardiovascular disease. Conclusion: The ratio of ATP/AMP reduction caused by diabetes led to muscle function disorder of VSM cells, which explains the reason for the internal fistula functional incapacitation in CKD5 patients with diabetes.
ABSTRACT
The emerging endoscopic technologies are proved to be effective treatments for obesity in selected patients and to offer the potential advantages of reduced invasiveness, reversibility and repeatability. From the view of operation principle, endoscopic technologies can be classified as restrictive procedure, malabsorption procedure and endoscopic revision of gastric bypass. Restrictive procedures include intragastric balloon, aspiration therapy, endoscopic sleeve gastroplasty (ESG) and transoral gastroplasty. Intragastric balloon employs space occupying, volume restriction and satiety mechanisms, which is superior to drugs and lifestyle change, but shorter than sleeve and bypass surgery. Aspiration therapy is similar to standard percutaneous endoscopic gastrostomy, while there are no available data regarding the obesity and metabolic improvement. Compared with traditional bariatric surgery, ESG does not excise gastric tissue with less complications and without weight regain, but it can not be used as an independent operation still now. Transoral gastroplasty is rarely applied clinically whose efficacy and long-term complications need further studies. Malabsorption surgery includes endoscopic duodenojejunal bypass sleeve (EDJBS) and endoscopic gastroduodenojejunal bypass sleeve(EGDJBS). EDJBS may have the similar mechanism like bypass reducing the blood glucose. Even with obvious effect of weight loss, EDJBS has high morbidity of complications and requirements of the skilled operators. EGDJBS, which imitates bypass anatomy changes and belongs to the mixed operation, should be superior to the above procedures in reducing weight theoretically, but due to the lack of clinical data, its short-term and long-term efficacy still need further clinical observation. As compared to the complexity and risks associated with telescopic surgical revision, endoscopic suturing has been confirmed as less invasive and safer for stomal revisions, while its long-term efficacy of reducing weight and improvement of diabetes are not yet clear. Even if long-term efficacy of reducing weight and morbidity of complication in endoscopic bariatric surgery are still indefinite, and clinical trial researches of large sample and long-term follow-up are absent, with the development of endoscopic skill and the gradual clinical application, endoscopic bariatric surgery will provide a new option for the patients of obesity and metabolic diseases.