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Objective:To investigate the impacts of hierarchical management based on medical alliance on the patency of arteriovenous graft (AVG),and provide a basis for further exploration of optimal AVG management.Methods:In this retrospective cohort study, clinical and follow-up data of patients with AVG established in the First Affiliated Hospital of Zhengzhou University from January 1, 2018 to December 31, 2021 were analyzed. Patients were divided into medical alliance group and non-medical alliance group according to whether they were under hierarchical management model, and the patency rate of AVGs and the incidence of clinical events were compared between the two groups.Results:A total of 328 AVGs were included in this study, which were from 151 hemodialysis centers, including 189 AVGs (57.6%) from 72 centers in medical alliance group, and 139 AVGs (42.4%) from 79 centers in non-medical alliance group. The age of the patients was (55.57±11.80) years, among whom 130 (39.6%) were males and 126 (38.4%) were diabetic. The follow-up time of AVGs in this cohort was 15.5 (9.5, 26.2) months, with 15.4 (9.8, 25.2) months in medical alliance group and 15.5 (9.2, 27.3) months in non-medical alliance group. The incidence of thrombosis or occlusion (0.328 times/patient-year), graft dissection (0.007 times/patient-year), graft infection (0.030 times/patient-year), and catheter utilization (0.043 times/patient-year) in the medical alliance group were lower than those in the non-medical alliance group (0.589 times/patient-year, 0.040 times/patient-year, 0.054 times/patient-year and 0.147 times/patient-year, respectively), and there was no significant difference in clinic follow-up rates between the two group (1.91 times/patient-year vs. 1.94 times/patient-year). The median primary patency time was 17.4 (95% CI 11.3-23.5) months, the median primary assisted patency time was 32.6 (95% CI 25.0-40.2) months, and the median secondary patency time was 47.9 (95% CI 40.0-55.8) months in the medical alliance group, compared with 12.3 (95% CI 9.4-15.2) months, 19.4 (95% CI 14.3-24.5) months, and 34.6 (95% CI 29.3-39.9) months in the non-medical alliance group, respectively. Primary patency were significantly higher in the medical alliance group (77.4%, 62.2%, 39.9%, and 26.6%) than those in the non-medical alliance group (71.1%, 50.1%, 30.6%, and 13.4%) at 6, 12, 24, and 36 months (Log-rank test, χ2=4.504, P=0.034). Primary assisted patency were significantly higher in the medical alliance group (90.9%, 84.3%, 67.1%, and 46.1%) than those in the non-medical alliance group (89.2%, 75.7%, 42.0%, and 16.6%) at 6, 12, 24, and 36 months (Log-rank test, χ2=10.655, P=0.001). Secondary patency were significantly higher in the medical alliance group (96.8%, 91.8%, 84.2%, and 74.0%) than those in the non-medical alliance group (89.9%, 85.8%, 69.3%, and 47.5%) at 6, 12, 24, and 36 months (Log-rank test, χ2=11.634, P=0.001). Multivariate Cox regression analysis showed that it was a protective factor for primary patency ( HR=0.708, 95% CI 0.512-0.980, P=0.037), primary assisted patency ( HR=0.506, 95% CI 0.342-0.749, P=0.001) and secondary patency ( HR=0.432, 95% CI 0.261-0.716, P=0.001) under the medical alliance model. Conclusion:The hierarchical management based on medical alliances can improve the patency of AVGs and reduce the incidence of clinical events.
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Objective:To investigate the patency rates and risk factors of arteriovenous graft (AVG), and provide a clinical guidance for further optimization of vascular access selection and improvement of dialysis quality.Methods:This was a retrospective study. The clinical and follow-up data of patients who received AVG in the Blood Purification Center, First Affiliated Hospital of Zhengzhou University from January 1, 2017 to December 31, 2021 were selected. Kaplan-Meier curve and Cox regression model were used to analyze the patency rates and risk factors of AVG.Results:A total of 381 cases with AVG were included, with 154 cases (40.4%) of males, age of (55.5±11.8) years old, and 140 cases (36.7%) of diabetes. The median time of primary patency was 377.00(95% CI 314.26-439.74) days, and the primary patency rates at 1, 2, and 3 years were 51.0%, 30.7%, and 15.4%, respectively. The median time of primary assisted patency was 839.00(95% CI 668.89-1 009.11) days, and the primary assisted patency rates at 1, 2, and 3 years were 78.3%, 56.4%, and 39.1%, respectively. The secondary patency rates at 1, 2, and 3 years were 96.7%, 90.1%, and 78.5%, respectively. Multivariate Cox regression analysis results showed that anastomotic vein types of basilic vein and cephalic vein (median cubital vein as a reference, HR=1.869, 95% CI 1.124-3.107, P=0.016; HR=2.110, 95% CI 1.176-3.786, P=0.012) and the diameter of anastomotic vein<3.5 mm ( HR=1.411, 95% CI 1.020-1.952, P=0.037) were the independent influencing factors for abnormal primary patency of AVG. Males ( HR=1.680, 95% CI 1.127-2.503, P=0.011), mean arterial pressure<70 mmHg ( HR=3.228, 95% CI 1.109-9.394, P=0.032), Acuseal graft type (Intering as a reference, HR=1.884, 95% CI 1.185-2.994, P=0.007), anastomotic vein type of cephalic vein (median cubital vein as a reference, HR=2.817, 95% CI 1.328-5.977, P=0.007), the diameter of anastomotic vein<3.5 mm ( HR=1.555, 95% CI 1.048-2.306, P=0.028), serum phosphorus ≤1.78 mmol/L (1.13-1.78 mmol/L />1.78 mmol/L, HR=1.737, 95% CI 1.111-2.716, P=0.015;<1.13 mmol/L />1.78 mmol/L, HR=2.162, 95% CI 1.072- 4.362, P=0.031), and ferritin<200 μg/L ( HR=1.850, 95% CI 1.231-2.780, P=0.003) were the independent influencing factors for abnormal primary assisted patency of AVG. Serum albumin<40 g/L ( HR=2.165, 95% CI 1.096-4.275, P=0.026) was an independent influencing factor for abnormal secondary patency of AVG. Conclusions:The primary patency rates of AVG at 1, 2, and 3 years were 51.0%, 30.7%, and 15.4%, respectively. The secondary patency rates of AVG at 1, 2, and 3 years were 96.7%, 90.1%, and 78.5%, respectively. Anastomotic vein types of cephalic vein and basilic vein, and internal diameter<3.5 mm are the independent risk factors for abnormal primary patency of AVG. Anastomotic vein type of cephalic vein and internal diameter<3.5 mm are the independent risk factors for abnormal assisted primary patency of AVG. Serum albumin<40 g/L is an independent risk factor for abnormal secondary patency of AVG. It is suggested that systematic preoperative evaluation and good nutritional status of patients are important to maintain long-term patency of the AVG.
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OBJECTIVE：To study influential factors for medication compliance of phosphate binder in patients with maintenance hemodialysis and the effects of pharmacist intervention ，and to improve medication compliance and the effects of disease control. METHODS ：The patients with maintenance hemodialysis who were treated in the blood purification center of our hospital from Jun. to Dec. ，2019 were selected for questionnaire survey. The questionnaires involved general information ， medication compliance of phosphate binder ，disease and medicine related knowledge ，social support ，self-efficacy. The t-test，χ2 test and multivariate Logistic regression analysis were used to analyze influential factors for medication compliance. The patients were randomly divided into pharmaceutical intervention group and non-intervention group. Intervention group were provided with pharmaceutical care for 3 months according to risk factors. Blood phosphorus level and medication compliance was compared between 2 groups. RESULTS ：Totally 298 patients completed the survey （effective recovery rate of 96.1％）. Among them ，163 patients（54.7％）had good adherence to phosphate binder ，while 135 patients（45.3％）had poor compliance. Results of single factor analysis showed that medication compliance of phosphate binder was closely associated with age ，dialysis duration ， parathyroid hormone levels ，total daily dose ，daily dose of phosphate binder ，disease and medicine related knowledge scores ， social support ，self-efficacy（P＜0.05）. Results of multivariate Logistic regression analysis showed that total daily dose ，daily dose of phosphate binder ，disease and medicine related knowledge scores ，social support and self-efficacy were the influential factors for medication compliance （P＜0.05 or P＜0.01）. Medication compliance ，disease control status ，disease and medicine related knowledge score ， social support and self-efficacy in pharmaceutical intervention group were significant improved ， blood phosphorus level was significant lower ，compared with non-intervention group （P＜0.05）. CONCLUSIONS ：Independent risk factors influencing medication compliance of phosphate binder include total daily dose ，daily dose of phosphate binder ，disease and medicine related knowledge scores ，social support and self-efficacy. The patients with maintenance hemodialysis have poor compliance to phosphate binder. Pharmacists should take individualized and targeted intervention measures for the above risk factors，which can effectively improve the medication compliance and disease prognosis of patients.
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OBJECTIVE：To provide referenc e for developing pharmaceutical care of chronic kidney disease （CKD）by clinical pharmacists. METHODS ：During 1st，Jan. to 30th，Sept. in 2019，inpatients diagnosed as CKD admitted or transferred to nephrology department of our hospital were selected. Medication reconciliation was conducted by clinical pharmacists after pharmaceutical consultation ，reviewing medical records ，analyzing and summarizing drug-related problem （DRP）. Medication reconciliation recommendations were proposed to physician. Subsequently ，drug list and medical education were provided to patients by clinical pharmacists. RESULTS & CONCLUSIONS ：The medication information of 130 patients was collected ，and 85 of them were provided with medication reconciliation by clinical pharmacist ，with a reconciliation rate of 65.38％. There were 193 medical orders involved 85 patients. Among all the DRP ，the top three of proportion in medical orders were improper drug usage and dosage （41.96％），drug interactions （18.13％）and improper drug selection （14.51％）. Among drugs related to medication reconciliation，top three types were cardiovascular system drugs （26.94％），drug correcting mineral and bone metabolism disorder （22.28％）and antibacterial drugs （16.02％）. The main plans of medication reconciliation were drug change （71 cases，36.78％）， drug withdrawal （42 cases，21.76％），drug supplement （35 cases，18.13％），followed by change of medication time and dosage adjustment. The majority （88.08％）of the recommendations were accepted by physician and patients. Clinical pharmacists can reduce the occurrence of DRP by medication reconciliation. The majority of patients with CKD were elderly and complicated with multiple diseases and took various drugs ，and part of drugs required dose adjustment due to the change of kidney function ，therefor clinical pharmacists implementing medication reconciliation to CKD ，should pay attention to drug usage and dosage ，especially disorder，and assist physicians to ensure safety of drug use in
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@#The signal transducer and activator of transcription(STAT)proteins, which can transmit signals from extracellular to nucleus, play important roles in biological processes. The abnormal activation of STAT3 signaling pathway usually results in many malignant diseases such as tumors(leukemias, lymphomas, breast cancer and lung cancer), inflammation or immune and rheumatoid arthritis. Numerous studies have demonstrated that the activation of STAT3, which means the phosphorylation of the residue 705, can inhibit apoptosis, induce cell proliferation and angiogenesis and finally lead to malignant diseases mentioned above. In this review, the biological functions of STAT family proteins and the related diseases of STAT3 are introduced, and the inhibitors of STAT3 are summarized simply. Further development of STATs is also proposed.
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Objective To explore the teaching effect ofOrgan-system-based curriculum in-tegrated model on clinical graduation field work. Method 150 clinical medical undergraduates of Grade 2009 from Shenyang Medical College selected, were randomly divided into the experimental group (75 persons) and the control group (75 persons). The experimental group adopted the means of the Organ-system-based curriculum integrated model, namely practicing according to human organ-system and the control group accepted the traditional pattern of discipline centered practice during the clinical graduation internship. The two groups of students carried out questionnaire survey and comprehend examinations when the practice ended, and then statistics analysis (the chi square test, t test) was done by the SPSS 19.0 software between the two groups in order to explore the teaching effect. Result The students' satisfaction degree from six aspects of the questionnaire survey showed in the experimental group was significantly higher than that in the control group (the degree of recognition of practicing pattern: χ2=11.437, P=0.003; the architectonic integrality: χ2=9.881, P=0.007; the im-provement of the autonomic learning ability χ2=9.643, P=0.008; the teaching method and means: χ2=11.006, P=0.004; motivating learning interest: χ2=13.550, P=0.001; increasing the ability of clinical thinking: χ2=13.309, P=0.001), and the average test scores of students from three parts of examination results showed by comprehend examinations (speculative knowledge examination: t=2.768, P=0.006;technical skill examination: t=2.212, P=0.029; clinical capability examination: t=5.015, P=0.000) in the experimental group was obviously higher than that in the control group and the difference was sig-nificant. Conclusion Organ-system-based curriculum integrated model on clinical graduation in-ternship is generally approved by the students, which has significantly improved the students' clinical thinking ability, and the quality of graduation internship teaching.
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Objective To examine the status of self-perceived burden in patients with continuous ambulatory peritoneal dialysis and explore the relationships among social support,coping styles and self-perceived burden.Methods 103 elderly patients with peritoneal dialysis of outpatient follow-up were recruited.They were investigated using Self-Perceived Burden Scale,Social Support Rating Scale,and Simplified Coping Style Questionnaire.Results The total score of self-perceived burden was at a moderate level and the average score was (36.67±3.67).The total score of social support,the average score of positive coping and negative coping were (40.27±5.83),(1.69±0.26),(1.80±0.40),then the difference was statistically significant when compared with domestic norm (34.56±3.73),(1.78±0.52),(1.59±0.66) (P＜0.05).The analysis found that self-perceived burden was negatively correlated with positive coping styles,social support and each dimension (r =-0.239,-0.668,-0.725,-0.252,-0.647,P＜0.05).Conclusions Medical personnel should inspire elderly patients to make full use of social resources and guide them to take positive attitude to deal with dialysis event.It would help them maintain well psychological condition for a long time and reduce the self-perceived burden of patients.
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Objective To investigate the clinical characteristics and summarize the experiences on the diagnosis and treatment of gastritis cystica profunda (GCP).Methods Clinical data of 15 GCP patients,who were treated in the First and Second Affiliated Hospital of Zhengzhou University from January 2006 to January 2013,were retrospectively analyzed.Results GCP may present clinically as abdominal pain,bloating,emaciation,and GI bleeding.CT,electronic gastroscope,or ultrasonic endoscope shows that GCP consists of multiple cysts within a thickened submucosal layer.The submucosal pathological features can not be obtained by ordinary biopsy and snares.Of the 15 cases,proximal gastrectomy was performed in 4 cases,distal subtotal gastrectomy in 3 cases,1 case was treated with gastric wedge resection,and total gastrectomy was performed in 7 cases.Postoperative recovery was uneventful.13 cases were followed up for 2 years,and there was no evidence of recurrence.Conclusions GCP is an uncommon disease with unknown origin,and has no clinical characteristics,and has malignant potential.Postoperative prognosis is satisfactory.
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Objective To investigate p16 promoter methylation in premature rats with chronic lung disease induced by hyperoxia. Methods Eighty premature Wistar rats were randomly divided into two groups: hyperoxia group (fraction of inspiratory oxygen) 0. 90 and control group (fraction of inspiratory oxygen 0. 21), 40 rats for each group. Semi-nested methylation specific polymerase chain reaction and methylation specific polymerase chain reaction were applied respectively to detect p16 promoter methylation in lung tissues. Additionally, p16 mRNA and protein expressions in lung tissue were detected by reverse transcription- polymerase chain reaction, Western blot and immunohistochemistry method. Results The methylation was not found in control group by seminested methylation specific polymerase chain reaction and methylation specific polymerase chain reaction, while was found in different aged rats of the hyperoxia group. The methylation detection rate was higher by using the semi-nested methylation-specific polymerase chain reaction (52.5%, 21/40) than that by methylation specific polymerase chain reaction (42.5%, 17/40) in the hyperoxia group,but there was no statistically significant difference between the two methods. The p16 mRNA in the hyperoxia group were significantly lower than in the control group at day 7, 14 and 21(1.73 ± 0.40 vs 2.11±0. 37,1.29±0. 19 vs 1.60±0. 27,0. 95±0.25 vs 1.72±0. 34, t=2.19, 2.95 and 10. 43,P＜0. 05). The p16 protein expressions by western blot in the hyperoxia group were significantly lower than in the control group at day 7, 14 and 21 also (88. 1±8. 7 vs 95.0±4.1,65.7±4.5 vs 83. 5±13.6 and 50.4±4.9 vs 86.7±11.9, t=2.27,3.95 and 13.40,P＜0.05). The expression of p16 mRNA (1.06±0.61) and protein (62.32±25.65) in lung tissues of rats with methylation was lower than that without methylation (1.63±0.62 and 94.93±22.21, respectively) (t=2.95, OR=0. 86;t=4.28, OR=0. 85,P＜0.01, respectively). Conclusions Exposure to hyperoxia might induce p16 promoter methylation in lung tissues in premature rats. Methylation risk increases as exposure time extends. p16 promoter methylation induced by hyperoxia might participate in the mechanism of lowering p16 mRNA and protein expression, but might not result in p16 gene silence.
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Objective: To observe the effects of Chinese nutgalls ex tr acts on the secretion of IL-6 from monocytes induced by lipopolysaccharide (LPS ) of Porphyromonas gingivalis (Pg). Methods:Monocytes ob tained by separating human blood cells were stimulated with LPS of Pg at 25 ?g/ml, radioimmunoassay (RIA) was used to examine the effect of Chinese nutgal ls extracts at the concentrations of 6.25-100 ?g/ml on the secretion of IL-6 in the supernatant of the cell culture. Results:Chinese nutgalls extracts at the concentrations(?g/ml) of 6.25,12.50, 25.00 ,50.00 and 100.00 inhibited IL-6 secretion from monocytes by(%) 34.6,46.4,48.5,52.7 and 54.9 res pectively.Conclusions:Extracts from Chinese nutgalls may inhibit the secretion of IL-6 from monocyte induced by LPS of Pg in a dose-depend ent manner.
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Objective:To observe the effects of gallnut water extract on the vitality of plaque biofilms.Methods:The oral plaque biofilms were obtained through bonding the enamel fragments to the bucca of the mindibular first molar for 24 h.The two groups of the biofilms were treated by gallnut water extract at 6 mg/ml and saline(control) for three minutes respectively.The effect of gallnut water extract on the vitality of plaque biofilms was observed by Ethidium bromide/Fluorescein diacetate (EB/FDA) staining and confocal laser scan microscope(CLSM).Results:All specimens had early biofilm formed,The percent vitality of the plaque biofilms treated with gallnut water extract and the control was 37.10?9.63 and 60.78?7.60 respectively(P