Abstract： Objective To investigate the extracellular matrix （ECM） gene expression profile of saphenous vein （SV） in end-stage renal disease （ESRD） patients undergoing coronary artery bypass grafting （CABG）. Methods Sixty-eight patients who were diagnosed as coronary artery disease by coronary angiography and admitted to Department of Cardiovascular Surgery，Zhongshan Hospital of Fudan University from July 2004 to December 2010 were enrolled in this study. According to whether or not they had preoperative ESRD history，all the 68 patients were divided into 2 groups，the ESRD group with 30 ESRD patients who needed maintenance hemodialysis，and the control group with 38 patients without preoperative renal disease. Preoperative clinical data of all the patients were collected in detail. SV samples were obtained at the time of CABG. Microarray，immunohistochemistry and Western blotting were used to investigate the expression profile of ECM genes of SV in ESRD patients undergoing CABG. Results There was no statistical difference in preoperative clinical variables between the 2 groups except the variables which were directly related to their kidney disease （P＞0.05）. There were 16 genes that were up-regulated at least 3-fold and 3 genes that were down-regulated at least 3-fold in the ECM gene expression profile of SV in the ESRD group patients before CABG. The expressions of matrix metalloproteinases-2 （MMP-2） and matrix metalloproteinases-9 （MMP-9） of the ESRD group were significantly higher than those of the control group （2.60±0.50 vs. 0.70±0.16，1.80±0.40 vs. 0.60±0.15，P＜0.01）. The expressions of tissue inhibitor of metalloproteinase-2 （TIMP-2） and tissue inhibitor of metalloproteinase-3 （TIMP-3） of the ESRD group were significantly lower than those of the control group （0.60±0.19 vs. 2.20±0.30，0.90±0.28 vs. 2.40±0.70，P＜ 0.05）. Conclusion A variety of ESRD-related risk factors of cardiovascular diseases may severely influence on the balance of ECM gene expression of SV before CABG，and the resulting imbalance is a risk factor to aggravate SV graft disease after CABG.
Abstract: Objective To evaluate the clinical effects and health economics of lung volume reduction surgery（LVRS）, single lung transplantation（SLTx） and bilateral lung transplantation（BLTx） for patients with end-stage emphysema. Methods A total of 61 patients with end-stage emphysema, including 39 patients who underwent LVRS（LVRS group）, 14 patients who underwent SLTx（SLTx group）, and 8 patients who underwent BLTx（BLTx group） from September 2002 to August 2008 in Wuxi People’s Hospital, were analyzed retrospectively. Lung function, arterial blood gas analysis and 6-minute walk distance（6-MWD）were assessed before their surgery and 6 months, 1-year and 3-year after their surgery respectively. Their 1-year and 3-year survival rates were observed. Cost-effectiveness analyses were made from a health economics perspective. Results Compared with their preoperative results, their mean forced expiratory volume in 1 second（FEV1.0）in LVRS group increased by 75%, 83% and 49% at 6 months, 1-year and 3-year postoperatively, by 176%, 162% and 100% in SLTx group, and by 260%, 280% and 198% in BLTx group respectively. Their mean forced vital capacity（FVC）in LVRS group increased by 21%, 41% and 40% at 6 months, 1-year and 3-year postoperatively, by 68% , 73% and 55% in SLTx group, and by 82%, 79% and 89% in BLTx group respectively. Their exercise endurance as measured by 6-MWD increased by 75%, 136% and 111% in LVRS group at 6 months, 1-year and 3-year postoperatively, by 513%, 677% and 608% in SLTx group, and by 762%, 880% and 741% in BLTx group respectively. The 1-year and 3-year survival rates after operation were 74.40% and 58.90% in LVRS group, 85.80% and 64.30% in SLTxgroup, and 62.50% and 50.00% in BLTx group respectively. The three years’ cost utility of SLTx group was significantly higher than that of BLTx group（1 668.00 vs.1 168.55, P＜ 0.05）and LVRS group （1 668.00 vs. 549.46, P＜ 0.05）. Conclusion SLTx and BLTx are better than LVRS in improving patients’ lung function and exercise endurance for end-stage emphysema patients. LVRS is more cost-effective than SLTx and BLTx in the early postoperative period. With the development of medical technology and decreased expenses of lung transplantation and immunosuppressive agents, lung transplantation will become the first surgical choice for end-stage emphysema patients.
Objective To identify the best therapy regime for dyspnea in an end-stage cancer patient.Method We searched The Cochrane Library (Issue 2, 2006), SUMsearch (1978 to 2006) and MEDLINE (1978 to 2006), and identified 4 systematic reviews and 28 randomised controlled trials. We critically assessed the quality of these studies. Result Evidence supported the use of breathing exercise, desensitisation, oral or parenteral opioids and antianxiety drugs to pall iate breathlessness. Patients with hypoxemia were found to benefit from oxygen therapy. Conclusions Physiotherapy, psychotherapy, oxygen therapy, opioids and antianxiety drugs can be considered in treating cancer patients with dyspnea.
Cirrhosis is an end stage of condition of various liver diseases with specific clinic and pathologic process. The incidence is high and it seriously affects the quality of life for patients. In order to obtain the best prevention and treatment for end-stage cirrhosis, we searched The Cochrane Library (Issue 3, 2004), SUMsearch (1981~2004) and MEDLINE (1981~2004), and identified 15 systematic reviews and 65 randomized controlled trials. We critically assessed the quality of studies. The results showed the principal treatment of cirrhosis was to deal with complications, such as the prevention and treatment of variceal bleeding, the treatment of ascites etc.
Objective To assess the cost-utility study of renal transplantation compared with nemodialysis (HD) and peritoneal dialysis (PD). Methods A prospective study of end-stage renal disease patients was followed up for 3 months after renal replacement therapy. The study population included 196 patients (renal transplant [RT] n=63, hemodialysis [HD] n=82 and continious ambulatory peritoneal dialysis [CAPD] n=51) from 6 hospitals of Sichuan province. Health-related quality of life was assessed by using the WHOQOL-BRIEF questionnaire. Utility scores were obtained so as to conduct CUA (cost-utility analysis). Costs were collected from financial department and by patient interview. Results The utility values were 0.539 9± 0.013 for RT, 0.450 8± 0.014 for HD, 0.512 2±0.099 for CAPD, respectively. The mean direct cost of the first three months of renal transplant was significantly higher than dialysis (RT and CAPD). Over 3 months, the average cost per quality-adjusted life year (QALY) for patients after CAPD was lower than HD and RT. Compared to HD, incremental cost analysis showed that CAPD was more ecnomical than RT. Sensitive analysis showed that CAPD was more effective than RT when ΔQALY varied in the limit of 95% confidence interval. However, the cost-utility of RT vs HD and CAPD vs HD was varied with ΔQALY level. Conclusions Cost-utility analysis showed that CAPD was a more favorable cost-utility ratio when compared to RT at early stage RT vs HD and CAPD vs HD, but which cost-utility ratio is better, we can not draw a certain conclusion.
ObjectiveTo explore the practice effect of the combination management of tertiary hospital and community hospital for home peritoneal dialysis patients. MethodsA total of 50 patients of end-stage renal disease from December 2012 to May 2013 were involved in this study, including 26 males, and 24 females with the average age of 47.1±13.9. The patients were randomly divided into hospital group (30 patients) and combination group (20 patients). For the patients in the hospital group, the specialists take care of them with regular outpatient service and follow-up; for the patients in the combination group, they were taken care by doctors from both tertiary hospital and community hospital, while the community general practitioners were trained by the tertiary hospital regularly with peritoneal dialysis basic treatment and standardization management and communication. All the patients were managed for 9 months. ResultsAt the end of the observation,the dialysis adequacy success rate, hemoglobin, blood potassium, phosphorus, calcium, albumin, CO2CP, blood pressure success rate, the incidence of peritonitis, and average monthly medical treatment expense between the two groups were not statistically different (P>0.05); the difference in cost of transportation was statistically significant (P<0.05). ConclusionThe standardization manage of combination of tertiary hospital and community for patients with home peritoneal dialysis may reduces the patients' expense in transportation, and improve the community general practitioners' level of basic knowledge and indication of peritoneal dialysis.
ObjectiveTo explore the impact of continuous quality improvement on the quality of life and complications in end-stage hemodialysis patients. MethodWe reviewed the clinical data of 128 end-stage renal disease patients undergoing hemodialysis from January 2013 to January 2014. The patients were divided into observation group and control group randomly with 64 patients in each. Patients in the control group received routine nursing only during hemodialysis, while those in the observation group received extra continuous quality improvement nursing on the basis of routine one. Quality of life of the two groups of patients was evaluated by World Health Organization Quality of Life Scale-brief before and after intervention. Adverse reactions during hemodialysis were also observed in these two groups. ResultsThe incidences of hypotension, malnutrition, thrombosis, infection and arrhythmia in the observation group were significantly lower than those in the control group (P<0.05). Psychological dimension, social dimension, physiological adaptability and total scales of quality of life in the observation group were significantly better than those in the control group (P<0.05). ConclusionsContinuous quality improvement of nursing reduces the rates of complications and improves patients' quality of life.
ObjectiveTo explore the safety and efficacy of patients with dialysis-dependent end-stage renal disease who underwent coronary artery bypass grafting (CABG). Methods We retrospectively analyzed the data of 40 dialysis-dependent patients who underwent CABG in Beijing Anzhen Hospital between January 1, 2006 and August 20, 2013. There were 27 male and 13 female patients at mean age of 63.52±9.17 years. Of them, 33 patients underwent off-pump CABG were in the off-pump CABG group, while 7 patients underwent on-pump CABG were in the on-pump CABG group. ResultsThe average number of the grafts is 2.27±0.68. In the off-pump CABG group, 1 patient died from perioperative myocardial infarction with mortality of 3.0%.In the on-pump CABG group, the operative mortality was 28.6%, with 1 death because of serious infection and secondary multi-organ failure 15 days after the operation, and another death because of ventricular fibrillation 4 days after the operation. The follow-up rate was 100.00%. Overall mean follow-up time was 4.3±2.1 years. During the follow-up, the overall survival rate at 1 year, 3 years, and 5 years was 92.68%, 89.43%, and 82.04% respectively. ConclusionCABG can be performed in the patients with dialysis-dependent end-stage renal disease who also suffered with severe coronary artery disease, despite higher mortality. Surgeons should carefully select patients for the operation. Through optimal way of revascularization, and reasonable perioperative therapy, especially more actively use of continues renal replacement therapy, good results could be got in those kinds of patients.
ObjectiveTo explore the effectiveness and safety of sevelamer carbonate (Renvela) for hyperphosphatemia in patients with end-stage renal disease (ESRD). MethodsESRD patients undergoing renal replacement therapy with hyperphosphatemia in the East District of Qingdao Municipal Hospital from June to November 2013 were randomly divided into two groups. For eight-week treatment course, the trial group was treated with Renvela (initial dose of 800 mg, tid), and the control group was treated with calcium acetate (initial dose of 667 mg, tid). The dose was adjusted every two weeks to achieve serum phosphorus control. Serum levels of phosphorus, adjusted serum calcium, calcium-phosphorus products, intact parathyroid hormone (iPTH), low density lipoprotein cholesterol (LDL-C) and bicarbonate were recorded. Statistical analysis was conducted using SAS 8.2. ResultsA total of 68 ESRD patients were included, 34 patients in each group. After 8-week treatment, serum phosphorus and calcium-phosphorus products significantly decreased in both groups (P < 0.05). There was no significant difference between the Renvela group and the calcium acetate group in the achievement rate of serum phosphorus (43.33% vs. 36.67%), the incidence of hypercalcaemic events (6.67% vs. 13.33%), and the change of serum iPTH content (-0.88±10.34 pg/mL vs.-0.76±19.14 pg/mL), with no significant difference. However, the Renvela group showed significant advantages in the change of serum phosphorus content (-0.65±0.26 mmol/L vs.-0.53±0.22 mmol/L), the change of adjusted serum calcium content (0.01±0.05 vs. 0.09±0.06 mmol/L), the change of calcium-phosphorus products (-1.45±0.61 mmol2/L2 vs.-0.97±0.47 mmol2/L2), the change of LDL-C content (-0.46±0.10 mmol/L vs. 0.02±0.12 mmol/L), and the change of serum bicarbonate content (-1.00±0.29 mmol/L vs. 0.01±0.18 mmol/L), with significant differences. There was no significant difference in the incidence of adverse reactions (14.71% vs. 11.76%) between the two groups (P=1.00), and the main adverse reaction was gastrointestinal reaction. ConclusionRenvela is relatively effective and safe for hyperphosphatemia in ESRD patients.
Patients undergoing maintenance hemodialysis are characterized with lower cardiorespiratory capacity and muscle atrophy, thus easily leading to a sedentary lifestyle. These patients are usually associated with lower quality of life and worse prognosis. Evidence indicates appropriate exercise rehabilitation plan could help maintenance hemodialysis patients achieve better health outcomes. However, there is still a lack of evidence data to precisely recommend exercise type, intensity, frequency and timing specially designed for maintenance hemodialysis patients. This article aims to summarize the existing expert consensus on exercise rehabilitation for maintenance hemodialysis patients, important considerations in the implementation process, factors that affect exercise rehabilitation, with a view to encouraging maintenance hemodialysis patients to participate in the development of appropriate exercise rehabilitation plan and maximize health benefits.