Association of access blood flow with patency loss of arteriovenous fistula in maintenance hemodialysis patients: ultrasound dilution versus color Doppler ultrasound / 中华肾脏病杂志

Objective:To explore the association of access blood flow measured by ultrasound dilution and color Doppler ultrasound with patency loss of arteriovenous fistula (AVF).Methods:This was a bidirectional cohort study. The adult patients who underwent maintenance hemodialysis (MHD) with AVF in Peking University First Hospital from January 1, 2018 to July 31, 2020 were enrolled. AVF blood flow was measured by ultrasonic dilution method (Qa), and color Doppler ultrasound in cephalic vein and brachial artery. Patients were divided into low Qa (<500 ml/min), normal Qa (500-1 500 ml/min) and high Qa (>1 500 ml/min) groups according to baseline AVF blood flow measured by ultrasonic dilution method. Qa was monitored every 3 months within the first year. The endpoint events of follow-up were defined as AVF patency loss or death. The deadline of the follow-up was July 31, 2022. Linear regression analysis was used to assess the change trend of Qa. Fine and Gray competitive risk model was used to evaluate the cumulative incidence of AVF patency loss. The Cox proportional hazards regression model was used to evaluate the association between access AVF blood flow and patency loss.Results:A total of 163 patients were enrolled, with age of (57.0±13.7) years old and 110 males (67.5%). The median follow-up time was 45(22, 53) months. Forty-four patients (27.0%) had AVF failure, and 29 patients (17.8%) died. The cumulative incidence rates of AVF patency loss in patients with low Qa, low blood flow of brachial artery and cephalic vein (<500 ml/min), and in those with a downward trend of Qa were higher than those in patients with normal or high blood flow, and in those with a upward trend of Qa (Gray′s test, all P<0.05). After adjusted for age, sex, age of fistula, diabetes and vascular stenosis, multivariable Cox regression analysis results showed that baseline Qa<500 ml/min ( HR=3.508, 95% CI 1.382-8.905, P=0.008), baseline brachial artery flow<500 ml/min ( HR=2.413, 95% CI 1.058-5.503, P=0.036) and a downward trend of Qa ( HR=2.498, 95% CI 1.241-5.027, P=0.010) were independently associated with AVF patency loss. Conclusions:Patients with low baseline value or downward trend of AVF blood flow are at significantly higher risk of patency loss. The brachial artery measurement of AVF blood flow is the preference location for color Doppler ultrasonic.

Inhibitory molecules expressed in T lymphocytes in patients with lung cancer before and after chemotherapy / 中国肿瘤临床

Objective:The tumorigenesis, progression, and metastasis of lung cancer are mostly governed by the immunosuppres-sive profile. This study aimed to explore the levels of various immunosuppressive inhibitory molecules in lung-cancer patients subject-ed to different chemotherapy cycles. Methods:Thirty-three patients with advanced lung cancer (ALC;stages III-IV) without receiving prior chemotherapy and 23 healthy subjects were enrolled in our study. Peripheral blood samples were collected from the patients be-fore each chemotherapy cycle. The inhibitory markers expressed in T cells such as TIM3, PD-1, and CTLA4 were analyzed by flow cy-tometry. Results:The percentages of CD4+TIM3+, CD8+TIM3+, CD4+PD-1+, CD8+PD-1+, CD4+CTLA-4+, and CD8+CTLA-4+T cells in the peripheral blood of the ALC patients were significantly higher compared to the controls. The percentage of CD4+TIM3+, CD8+TIM3+, CD4+PD-1+, and CD8+PD-1+T lymphocytes in the peripheral blood of patients (n=19) who achieved PR or SD significantly de-creased after five cycles of chemotherapy (P<0.05). Similarly, the percentages of CD4+CTLA-4+and CD8+CTLA-4+T cells in the pa-tients also decreased after five cycles of treatment. Conclusion:The immune status of ALC patients was evidently suppressed. Effec-tive chemotherapy successfully potentiated effective immune responses by downregulating inhibitory molecules in T cells.

A Prospective Study of the Effect of Smoking and Body Mass Index on the Risk of Lung Cancer in Male Workers of Beijing Steel Industry / 中国慢性病预防与控制

Objective To assess the effect of smoking and body mass index(BMI) on lung cancer incidence density in male workers.Methods Risk factors of cardiovascular diseases in baseline were surveyed in 1974,1979 and 1980 for 5 137 men aged more than 18 years old from Beijing Capital Steel and Iron Company.Follow-up was carried out to 2001;all diseases were identified by uniform standard.Cox proportional hazards model was used to analyze the relationship between smoking,BMI and lung cancer.Results During mean follow-ups of 20.8 years,106 cases of lung cancer occurred.The crude incident rates of lung cancer were 102.2 cases per 100 000 person-years.After adjustment for age,BMI and other established risk factors,cigarettes consumption of greater than 20 cigarettes/day versus no smoking was associated with a relative risk of lung cancer of 3.45(95% confidence interval(CI): 1.58～7.53).In categories of BMI of less than 18.5(underweight),18.5～24.9(normal weight) and more than 25 kg/m2(overweight and obesity),adjusting for age and other covariables,all workers and smoking workers both showed decreasing tendencies in relative risks of lung cancer in higher BMI groups.The pattern was similar after excluding the early 5-year lung cancer patients.Grouping in smoking and BMI levels,compared with underweight smokers,the relative risks for lung cancer of normal-weight nonsmokers and nonsmokers with overweight and obesity,as well as smokers with overweight and obesity were 0.25(95% CI: 0.08～0.84),0.16(95% CI: 0.04～0.74) and 0.23(95% CI: 0.07～0.77),respectively.Smokers with underweight had higher risk for lung cancer.Conclusion Smoking and underweight increased the risk of lung cancer.Keeping normal weight and giving up tobacco were important for the prevention of lung cancer.

Effects of health promotion for eight years on knowledge, attitude and behavior of cardiovascular diseases in rural Fangshan District, Beijing / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the effects of health promotion for eight years on cardiovascular diseases based on the changes in knowledge (K), attitude (A) and behavior (B) (KAB) before and after intervention in rural population of Fangshan, Beijing.</p><p><b>METHODS</b>Five townships in Fangshan District, Beijing were divided into intervention and control communities with cluster sampling. Totally 772 farmers were selected randomly for interviews with a questionnaire of KAB, including 424 in the intervention communities (IC) and 348 in the control communities (CC) in 1992. After community-based health promotion and education on cardiovascular prevention for eight years, 895 farmers, including 431 in IC and 464 in CC, were selected randomly again in 1999 to be interviewed with the same questionnaire of KAB used in 1992.</p><p><b>RESULTS</b>From 1992 to 1999, knowledge of cardiovascular diseases was significantly improved in residents of IC (P < 0.01) and CC. Compared to the residents in CC, there was a net increase in knowledge in residents of IC. Significant improvement was found in 10 and 11 of the 18 items of knowledge in males and females (P < 0.01), respectively. Level of knowledge in cardiovascular diseases was significantly higher in the residents of IC than those of CC in 1999. Proportions of those with positive attitudes and appropriate behaviors were significantly elevated in the residents of IC (P < 0.01), as well as prevalence of smoking and alcohol drinking decreased. However, as compared to CC, attitude and behavior in most aspects in the residents of IC changed positively, but in few aspects changed negatively. It suggested knowledge improved better than attitude and behavior changed.</p><p><b>CONCLUSIONS</b>Community-based health promotion and education for a longer term had obvious effects on improvement of knowledge in cardiovascular disease for rural population, but slower effects on changes in attitude and behavior, which suggested there still existed certain barriers to transform knowledge into healthy behavior.</p>

Prevalence and Relevant Risk Factors of Low Blood Pressure in China / 中华高血压杂志

Objective　 To study the prevalence and relevant risk factors of low blood pressure and its influence on cardiovascular diseases in China. Methods　A cross-sectional study for low blood pressure was conducted using the data of the third national survey of blood pressure in 1991. Low blood pressure was defined for systolic (SBP) and diastolic (DBP) pressure less than the tenth percentile for the sample (SBP≤98mmHg and DBP≤60mmHg). Results　The prevalence of low blood pressure for males and females were 2.7% and 7.4%, respectively. The prevalence of low blood pressure for females was higher than that of males (P<0.01). Prevalence of low blood pressure was 7.62%, 6.97%, 4.40%, 3.22%, 2.65%, 1.94% for age groups 15～, 25～, 35～, 45～, 55～, 65～, respectively. The prevalence of low blood pressure was gradually declined with aging. There was large variation in the prevalence of low blood pressure for different minorities. The prevalence of low blood pressure was higher in the southern rather than the northern part of China. Logistic regression showed that the age (OR 0.97, 95%CI 0.97～0.98, per 10 mmHg), BMI (OR 0.80, 95%CI 0.80～0.81), drinking (OR 0.89, 95%CI 0.86～0.93) and heart rate (OR 0.981, 95%CI 0.980～0.982) had reverse relationship with low blood pressure. The sex had a positive relationship with low blood pressure. The prevalence of stroke and myocardial infarction in the population with low blood pressure was lower than that of normal pressure or hypertension (P<0.01). Conclusion　The prevalence and relevant risk factors of low blood pressure in China were various. We speculate that low blood pressure in Chinese population appears to be a normal state of physiology.The difinite influence in health needs cohort studies to confirm.