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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 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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Background: Assessments of genetic diversity are essential for germplasm characterization and exploitation. Molecular markers are valuable tools for exploring genetic variation and identifying germplasm. They play key roles in a Xanthoceras sorbifolia breeding program. Results: We analyzed the genetic diversity of populations of this species using 23 simple sequence repeat (SSR) loci and data on kernel oil content. The 11 populations included in the study were distributed across a large geographic range in China. The kernel oil content differed significantly among populations. The SSR marker analysis detected high genetic diversity among the populations. All SSRs were polymorphic, and we identified 80 alleles across the populations. The number of alleles at each locus ranged from two to six, averaging 3.48 per primer pair. The polymorphism information content values ranged from 0.35 to 0.70, averaging 0.51. Expected heterozygosity, observed heterozygosity, and Shannon's information index calculations detected large genetic variations among populations of different provenance. The high average number of alleles per locus and the allelic diversity observed in the set of genotypes analyzed indicated that the genetic base of this species was relatively wide. The statistically significant positive correlation between genetic and geographic distances suggested adaptations to local conditions. Conclusions: Microsatellite markers can be used to efficiently distinguish X. sorbifolia populations and assess their genetic diversity. The information we have provided will contribute to the conservation and management of this important plant genetic resource.
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Genetic Variation , Microsatellite Repeats , Sapindaceae/genetics , Phenotype , Polymorphism, Genetic , Seeds/genetics , Plant Oils , Genetic Markers , China , Polymerase Chain Reaction , DNA, PlantABSTRACT
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.