Peritoneal dialysis catheter insertion using a very-low-site approach: a 5-year experience.

PURPOSE: Peritoneal dialysis (PD) catheter tip migration accounts for the majority of cases of PD catheter malfunction. In this case series, we described our experiences of using a modified PD catheter implantation approach through a site that is lower than the site that is conventionally used, to reduce catheter malfunction. METHODS: We retrospectively identified 76 patients who received PD catheter implantation at the Affiliated Wujin Hospital of Jiangsu University, among whom 39 received the traditional approach of low-site insertion and 37 received a modified approach of very-low-site insertion. All participants were followed up for at least 2 years after PD catheter implantation, and the development of catheter dysfunction or death during this period was monitored. RESULTS: We found that the survival rate of the initially inserted catheter was 75.68% among the very-low-site group. This survival rate was significantly better than that observed among the low-site group (48.72%; p = 0.029). Kaplan-Meier curves of the initial catheter survival also showed that the catheter survival was significantly higher in the patients in the very-low-site group than those in the low-site group (log rank p = 0.012). Complications, such as catheter tip migration, were not observed in the very-low-site group, while tip migration occurred in 15.38% of the patients in the low-site group (very-low-site group vs low-site group: p = 0.039). CONCLUSIONS: A safe and simple PD catheter implantation can be performed either through the low-site approach or the very-low-site approach.

[The study of hBMP-4 gene modified tissue-engineered bone].

OBJECTIVE: Bone marrow stromal cells (bMSCs) of rabbits transferred with mammalian hBMP-4 expression plasmid were used to construct tissue-engineered bone. Gene therapy combined with tissue-engineering technique was explored to further improve osteogenesis. METHODS: pEGFP-hBMP-4 plasmid was constructed by subcloning technique. bMSCs were then transferred with either pEGFP-hBMP-4, pEGFP plasmid by lipofectamine or left uninfected in vitro. The cells from the 3 groups were combined with natural non-organic bone (NNB) to construct tissue-engineered bones, which were subcutaneously implanted into nude mice (6 implants per group) for 4 weeks. Specimens were evaluated through histological and computerized new bone formation analysis. RESULTS: pEGFP-hBMP-4 plasmid was successfully constructed. bMSCs could attach and proliferate on the surface on NNB. In vivo experiment showed that new bone formation in pEGFP-hBMP-4 group was higher than those of the control groups. CONCLUSIONS: Tissue-engineered bone using hBMP-4 gene modified bMSCs might be an ideal alternative for the repair of bone.