血液透析是肾衰竭最常见的治疗方式,几乎90％的患者选择血液透析,功能正常的血管通路是提供充分血液透析治疗的关键[1].维持血管通路通畅对血液透析患者来说是一个巨大的挑战,"天然"动静脉内瘘( arteriovenous fistula,AVF)目前被推荐为主要血管通路[2,3].新生内膜增生引起的内膜狭窄是血管通路功能障碍的最常见原因.传统球囊血管成形术对于内膜增生型狭窄即时效果差,远期通畅率低[4,5].

Background To observe and explore the effect of metformin on the migration and proliferation of bladder cancer T24 and 5637 cells in vitro . Methods Bladder cancer T24 and 5637 cell lines were cultured in vitro, and were divided into group A (blank control group) and group B (metformin group: 5, 10, 15, and 20 mmol/L); both groups were plated on 6-well plates at the same time. Culture in 24-well plates was used for wound healing assays and in 96-well plates for Transwell migration and invasion, and Cell Counting Kit-8 proliferation experiments. We observed and detected the cell migration and proliferation ability of each group at 48 h, and calculated the cell migration area and survival rate. Flow cytometry was used to detect cell apoptosis in the groups. The apoptosis-related proteins, cleaved-caspase 3, cleaved-PARP, and the PI3K/AKT/mTOR signaling pathway member proteins PI3K, phosphorylated (p)-PI3K, AKT, p-AKT, mTOR, and p-mTOR were detected using western blotting. Results After 48 h of treatment with different concentrations of metformin, the cell migration and proliferation capabilities were significantly lower than those in the blank control group. The proliferation and migration abilities of T24 and 5637 cells decreased in a metformin concentration-dependent manner ( P < 0.05). The apoptosis rate under different concentrations of metformin, as detected by flow cytometry, showed a significantly higher rate in the metformin group than in the control group ( P < 0.05). Compared with that in the control group, the level of cleaved-caspase 3 and cleaved-PARP protein in the metformin group was increased in each treatment group, and the levels of p-mTOR, p-AKT, and p-PI3K decreased significantly compared with those in the control group ( P < 0.05). Conclusion Metformin inhibited bladder cancer T24 and 5637 cell migration and proliferation, and induced their apoptosis. The mechanism might involve inhibition of the activation of the PI3K/AKT/mTOR signaling pathway.

BACKGROUND:Conventional recanalization techniques may fail in patients with completely occluded superior vena cava (SVC).AIM:To analyze the effectiveness and complications of sharp recanalization for completely occluded SVC.METHODS:This was a retrospective study of patients that underwent puncture and recanalization of the SVC between January 2016 and December 2017 at our hospital. Sharp recanalization was performed using the RUPS-100 system. The patients were followed for 12 mo. The main outcomes were the patency rate of SVC and arteriovenous fistula flow during dialysis.RESULTS:The procedure was successful in all 14 patients (100%). Blood pressure in the distal SVC decreased in all 14 cases (100%) from 26.4 ± 2.7 cmH2O to 14.7 ± 1.3 cmH2O (P < 0.05). The first patency rates of the SVC at 24 h and at 3, 6, 9 and 12 mo after sharp recanalization were 100%, 92.9%, 85.7%, 78.6% and 71.4%, respectively. There were two (14.3%) severe, one (7.1%) moderate and one (7.1%) minor complication. The severe complications included one case of pericardial tamponade and one case of hemothorax.CONCLUSION:The results suggest that sharp recanalization can be an additional tool to extend or renew the use of an occluded upper extremity access for hemodialysis. This could be of use in patients with long-term maintenance hemodialysis in whom the maintenance of central venous access is often a challenge.

Objective: To investigate the effects of normobaric hyperoxia intervention on renal ischemia-reperfusion injury in rats and its possible mechanism. Methods: Twenty-one adult male SD rats were enrolled and their right kidneys were excised. After two weeks, they were randomly assigned to 3 groups, with 7 rats in each group, namely sham-operated group (Group S), ischemia-reperfusion group (Group I/R), and normobaric hyperoxia+ischemia-reperfusion group (Group NBHO+I/R). In group S, only the left renal pedicle was isolated, but no ischemic treatment was performed. However, in group I/R and group NBHO+I/R, left renal pedicles were separated and left renal ischemia was induced by noninvasive arterial clamp for 45 min, and after 24 h of reperfusion, rats in group S and group I/R inhaled regular concentration of oxygen (21%), while rats in group NBHO+I/R inhaled high concentration of oxygen (60%), 2 h at each time, once a day for 7 days. On the 7th day after surgery, blood urea nitrogen (BUN) and creatinine (Cr) levels were measured by taking blood from the orbital veins of rats. The content of malondialdehyde (MDA) and superoxide dismutase (SOD) was detected from the left kidney tissues. The mRNA and protein contents of Keap1 and Nrf2 gene in kidney tissues were determined by qPCR and Western Blotting, respectively. Hematoxylin-eosin staining (HE) was employed to observe the pathological changes of kidney tissue. Immunohistochemical staining was used to measure the protein expression of Keap1 and Nrf2 in kidney tissues. Results: Compared with group S, the serum BUN [(10.7±1.7) mmol/L, (8.4±1.0) mmol/L vs (6.1±1.3) mmol/L, both P<0.05] and Cr [(81.0±3.7) μmol/L, (62.9±3.4) μmol/L vs (48.3±2.9) μmol/L, both P<0.05] levels of rats in the group I/R and group NBHO+I/R increased, and the I/R group had the most significant increase. Compared with group S, the MDA content of kidney tissue in the rats of group I/R and NBHO+I/R increased [(10.5±1.0) μmol/L, (8.6±0.8) μmol/L vs (6.5±0.5) μmol/L, both P<0.05], but the MDA content in group NBHO+I/R was lower than that of group I/R (P<0.05). Compared with group S, the SOD content in the kidney tissues of rats in both group I/R and group NBHO+I/R decreased. However, the SOD content of group NBHO+I/R was higher than that of group I/R (P<0.05). Compared with group S, the mRNA and protein contents of Keap1 gene in kidney tissues of group I/R and group NBHO+I/R decreased, and group NBHO+I/R had the most significant decrease (P<0.05). However, compared with group S, mRNA and protein expressions of Nrf2 gene increased in kidney tissues of group I/R and group NBHO+I/R, and NBHO+I/R group had the most significant increase (P<0.05). Postoperative pathological results suggested that compared with group S, the pathological damage of kidney tissues in group I/R and group NBHO+I/R increased, but the degree of damage in group NBHO+I/R was lower than that in group I/R. Conclusion: Normobaric hyperoxia intervention may have protective effects on renal ischemia-reperfusion injury in rats by activating Keap1-Nrf2 signaling pathway.

目的 观察花虫酊局部外用联合远红外线在自体动静脉内瘘局部血管狭窄经皮腔内血管成形术后的临床效果.方法 将内瘘局部血管狭窄患者,随机分为对照组、远红外线组、花虫酊+远红外线组,每组各30例.观察各组术前、术后1月、3月、6月、12月狭窄血管管径、透析时血流量、静脉压及术后内瘘通畅率情况.结果 术后可见各组血管内径增宽、血流量增加、静脉压下降;随着时间推移,血管内径、血流量呈变窄、减少,静脉压上升趋势;与对照组、远红外线组比较,术后12月花虫酊+远红外线组血管管腔直径较大,差异有统计学意义(P<0.05),术后6月、12月花虫酊+远红外线组血流量大,差异有统计学意义(P<0.05);与对照组比较,远红外线组及花虫酊+远红外线组术后6月、12月透析时静脉压低,差异有统计学意义(P<0.05).结论 中药复方花虫酊局部擦洗、按摩联合远红外线治疗,可有效延缓经皮腔内血管成形术后内瘘内膜增生速度,延长患者再次球囊扩张时间,无明显过敏反应,安全性高,可进一步应用于临床.

目的 探讨C形臂CT导引上腔静脉直接穿刺置管术治疗血液透析外周通路耗竭患者的临床效果.方法 选取2016年10月至2017年12月收治的10例中心静脉造影明确上腔静脉、无名静脉完全闭塞患者.采用C形臂CT成像技术经皮直接穿刺上腔静脉,观察穿刺针路径及其与定位单弯导管位置关系,明确无邻近重要脏器和组织损伤后留置带隧道和涤纶套血液透析导管.结果 术后患者胸闷、呼吸困难症状较前缓解,部分患者内瘘结扎后颜面部、手臂部肿胀消失,胸壁曲张静脉部分塌陷;血液透析过程中血流量均可达250 mL/min,静脉压较术前明显下降;心脏超声房室结构和射血分数均得到改善.结论 对慢性肾脏病5期外周血管通路耗竭且不能建立其它血管通路的上腔静脉、无名静脉慢性闭塞患者,采用C形臂CT导引上腔静脉近心端直接穿刺留置带涤纶套和隧道血液透析导管效果良好.

目的 观察超声引导联合介入技术在血液透析患者动静脉内瘘狭窄中的临床应用效果.方法 60例血液透析患者作为研究对象,随机分成对照组与观察组,各30例.对照组应用介入技术(经皮腔内血管成形术)治疗,观察组应用超声引导联合介入技术治疗,对比两组穿刺时间、手术时间、穿刺并发症发生率、术后瘘口血流量等指标.结果 观察组穿刺时间、手术时间分别为(5.19±1.93)、(61.05±13.56)min,均短于对照组的(8.41±5.65)、(71.62±17.83)min,差异具有统计学意义(P<0.05).观察组穿刺并发症发生率为3.33％,低于对照组的20.00％,差异具有统计学意义(P<0.05).观察组内瘘口血流量为(538.02±32.98)ml/min,高于对照组的(518.36±36.01)ml/min,差异具有统计学意义(t=2.2052,P<0.05).结论 超声引导联合介入技术在血液透析患者动静脉内瘘狭窄中的临床应用效果较好,可以缩短穿刺和手术时间,减少并发症的发生,值得临床推广应用.

慢性肾脏病(CKD)目前已成为全球威胁人类健康的公共卫生问题,我国成年人群中CKD的患病率为10.8％,CKD的知晓率仅为12.5％.而CKD进行性发展最终会进入终末期肾病.因此,加强对CKD的防治,已成为不可忽视的公共卫生问题之一.故早期发现、早期诊断、早期治疗、早期人为干预,延缓CKD进程就显得尤其重要.导师经过临床观察发现焦虑状态与CKD进展有关联性,有研究指出,CKD患者较正常人群更易发生焦虑;因此,对情绪因素的治疗应该成为CKD治疗的一个重要的组成部分.笔者通过探索性临床研究,初步观察精神、情绪因素(焦虑状态)在CKD慢性进程中的作用及其与CKD患者病情进展的相关性.为后续大规模的临床验证研究奠定基础,为临床制定针对CKD患者的心理健康管理策略提供依据.并以此课题引起医务工作人员对CKD患者心理健康方面的重视,对患者进行早期心理干预,以达到延缓CKD进展,改善CKD患者的生活质量的目的.