Analysis of predictive factors of thrombosis in autogenous arteriovenous fistula.

PURPOSE: To investigate the predictors of early diagnosis of thrombus of autogenous arteriovenous fistula (aAVF). METHODS: The included patients were divided into the thrombus group with aAVF failure or thrombosis and the control group with good internal fistula function. The general data of the patients, including age, sex, diabetes mellitus, were collected. Platelets (PLT), platelet crit (P-LCR), platelet distribution width (PDW), mean platelet volume (MPV), homocysteine (HCY), and other biochemical data were collected. The predictors of thrombus of aAVF were obtained by the t test and logistic regression analysis, and receiver operating characteristic (ROC) curve analysis was used to compare the area under the ROC curve (AUC) between the combined predictors and the original indicators. The optimal critical value was determined when the Youden index reached its maximum value, and the sensitivity, specificity, accuracy, diagnostic index, and so on were calculated. Finally, prediction was performed by substituting each value in individually. RESULTS: PLT, PDW, P-LCR, MPV, and HCY showed significant differences between two groups (p < 0.05). Logistic regression analysis showed that, for PLT (OR = 1.014, 95% CI 1.006-1.022, p = 0.01), PDW (OR = 1.295, 95% CI 1.009-1.661, p = 0.042), P-LCR (OR = 1.230, 95% CI 1.089-1.389, p = 0.001), MPV (OR = 1.696, 95% CI 1.101-2.613, p = 0.017), and HCY (OR = 1.332, 95% CI 1.182-1.502, p = 0.01), the difference was significant; PLT, PDW, P-LCR, MPV, and HCY were positively correlated with thrombogenesis (p < 0.05). By logistic regression, a group of the five predictors of PLT, PDW, P-LCR, MPV, and HCY was obtained, and the combined predictors were 0.014*PLT + 0.258*PDW + 0.207*P-LCR + 0.528*MPV + 0.287*HCY. The area under the curve of the combined predictor was 0.933, the sensitivity was 92.4%, the specificity was 81.2%, the maximum diagnostic index was 0.736, the diagnostic cutoff point was 21.790, and the accuracy rate was 87%. CONCLUSION: PLT, PDW, P-LCR, MPV, and HCY are predictors of thrombus of aAVF. They can better predict thrombus of aAVF, and the combination of these five indicators is better than a single indicator.

Minimally invasive 'pull technique' for peritoneal dialysis catheter removal.

A simple, noninvasive method for removing peritoneal dialysis (PD) catheters, called the "pull technique," has become popular in recent years. Physicians still worry, however, about the range of its application and possible complications such as infection of the retained cuff and breakage. We, therefore, applied this technique in patients and enriched its administration for removing PD catheters. Altogether, 24 PD catheter removals in 24 patients were reviewed during the period from July 2018 to October 2019 in our hospital. Using the pull technique, the PD catheter's superficial cuff was dissected using an electronic knife, and the deep cuff was retained. All patients' catheters were successfully removed with no breakage. No incision or retained cuff was infected during the follow-up period (1.1-15.6 months). The appropriate peak force of pull traction was approximately 12-13 pounds, not very different from the mean maximum tensile force of 21.48 pounds for silicone tube breakage. The use of intermittent (rather than sustained) traction may reduce the breakage risk of the silicone tube. This method is a safe, practical, minimally invasive method for removing PD catheters, and it is suitable for application on special patients with peritonitis or who are on an immunosuppressant.

[Impact of advanced glycosylation end products-modified human serum albumin on migration of epidermal keratinocytes: an in vitro experiment].

OBJECTIVE: To explore the impact of advanced glycosylation end products (AGE)-modified human serum albumin (AGE-HSA) on keratinocyte migration and the mechanism thereof. METHODS: AGE-HSA was prepared in vitro. Epidermal keratinocytes from Sprague-Dawley rats' back were cultured and treated with AGE-HSA of the terminal concentrations of 0, 30, 60, 90, 120, and 150 microg/ml for 1, 3, 5, and 7 days respectively. MTT method was used to detect the keratinocyte adhesion rate, expressed by absorbance. Keratinocyte migration ability was assessed by scratch wound healing assay and Transwell assay. Expression of integrin alpha3 was determined by flow cytometry. Scanning electron and inverted microscopes were used to observe the pseudopodium and microfilament of the keratinocytes. Immunofluorescence staining was used to detect the form of F-actin in the cells. RESULTS: The adhesion rates of the keratinocyte cultured with AGE-HSA for 12 and 24 hours were (0.112 +/- 0.022) and (0.173 +/- 0.012) respectively, both significantly lower than those of the control group [(0.122 +/- 0.004) and (0.267 +/- 0.024) respectively, both P < 0.05)]. Scratch wound healing assay showed that the amount of migrating cells in the AGE-HSA group was (7 +/- 4)/HP, significantly less than that of the control group [(61 +/- 11)/HP, P < 0.05)], and Transwell assay showed that the amount of migrating cells in the AGE-HSA group was (72 +/- 18)/HP, significantly less than that of the control group [(288 +/- 52)/HP, P < 0.05]. The expression rate of keratinocyte integrin alpha3 in the AGE-HSA group was (3.2 +/- 1.2)%, significantly lower than that in the control group [(36.6 +/- 11.2)%, P < 0.05]. The spreading of cell body, and the formation of pseudopodium and microfilament of the AGE-HSA group were all depressed in comparison with the control group. CONCLUSION: Keratinocyte migration is inhibited by AGE accumulation in high glucose condition. The mechanism may be the abnormality in the integrin inside-out signaling pathway and AGE-RAGE signaling pathway.

Proliferation hemangiomas formation through dual mechanism of vascular endothelial growth factor mediated endothelial progenitor cells proliferation and mobilization through matrix metalloproteinases 9.

Infantile hemangioma is the most common tumor of infancy and the mechanism leading to proliferation hemangiomas formation is poorly understood and currently no successful treatment modality exists. We hypothesize that EPCs formed during proliferation hemangiomas, as the result of vascular endothelial growth factor (VEGF) stimulation through MMP9, play the major role in the control of cell proliferation and capillary-like vessels production. Accepting the hypothesis to be correct, a therapy that inhibits EPC mobilization and proliferation can be used to prevent the proliferation hemangiomas formation. Current therapies are only partially effective and safe because they could not eliminate all the relative factors of proliferation hemangiomas formation at all, such as: EPCs in the peripheral blood, and at the same time inducing death (apoptosis and necrosis) of other normal cells. A more efficient prevention of proliferation hemangiomas could be achieved using specific drugs or biologic methods that inhibit EPC mobilization and proliferation. Therapy based on gene therapy, capable to specifically inhibit VEGF and MMP9 expression in gene level, can be possibly effective.

[Clinical analysis of abdominal compartment syndrome in patients with serious burn injury].

OBJECTIVE: To summarize the clinical management of abdominal compartment syndrome (ACS) in burn patients with severe burn injury. METHODS: Twelve serious burn patients with abdominal compartment syndrome hospitalized in our center from January 2001 to April 2005 were enrolled in the study. Among them 3 patients were treated with conservative method, 4 with escharectomy of abdominal wall, 5 with laparotomy for decompression. The clinical results were analyzed statistically. Bladder pressure, central venous pressure, systolic blood pressure and arterial blood oxygen partial pressure (PaO2 ) were measured and compared before and after operation. RESULTS: Among these 12 patients, 5 died with the overall mortality of 41.67%. But only 3 died among 9 patients undergone operation. Most of patients were oliguric,with abnormal bladder pressure, central venous pressure, and systolic blood pressure 24 hours before operation. But these parameters were significantly improved after operation ( P <0. 01). CONCLUSION: Early abdominal escharectomy and timely abdominal decompression are vital for the management of ACS in burn patients.

[The influence of dermal template application on the p53 gene expression and apoptosis during wound repairing in burn patients].

OBJECTIVE: To observe dynamically the influence of the application of dermal template on the p53 gene expression and apoptosis during wound repairing in burn patients. METHODS: Twenty burn patients were enrolled in the study and were divided into experiment (E, n = 11) and control (C, n = 9) groups. The escharectomy wounds in patients with 3rd degree burn in E group were covered with dermal template overlain with thin split-thickness autograft, while those in C group were covered with thin split-thickness autograft only. Specimens were harvested from wounds of both groups at 1st, 2nd, 3rd, 4th and 5th post operative week (POW). The P53 expression and the apoptosis were assessed respectively by immunohistochemistry and by TUNEL kit. The change in cell number was observed after HE staining. RESULTS: The P53 expression increased gradually along with the wound healing process from 1st to 4th POW, which was significantly higher than that in C group at 2nd, 3rd, and 4th POW (P < 0.05), and it reached the peak at 4th POW. Fibroblasts underwent apoptosis at 1st POW in E group, while apoptosis of the endothelial cells occurred mainly at 2nd and 3rd POW. There was obvious difference in the rate of apoptosis between the two groups in 3rd and 4th POW (P < 0.05). The numbers of fibroblasts and vascular endothelial cells in E group were smaller than those in C group. CONCLUSION: Application of dermal template overlain with thin split-thickness autograft to wounds could induce P53 expression and cell apoptosis, thereby reduce scar formation, resulting in improvement of the quality of wound healing.