Vascular access is the dialysis patient's lifeline. Lower extremity arteriovenous accesses are a potential vascular access option in hemodialysis patients who have exhausted all upper-limb sites.The lower extremity options are including autogenous and prosthetic arteriovenous accesses.Numerous challenges including patency rates and complications are encountered in the lower extremities that are not seen in the upper extremities.In this review,we focus on the advances in lower extremity accesses.

Objective To study the protective function and the mechanism of Shenqi Dihuang decoction on the kidney of type 2 diabetes melltuds rats. Methods Type 2 diabetes mellitus rat models were set up by injection of small dose of streptozotocin (STZ). The SD rats were randomized into a control group, a model group and a treatment group. The treatment group was given Shenqi Dihuang decoction. The control group and the model group were given the same amount of water. After 24 weeks, renal morphology examination and biochemical indicator were examined. The levels of Ang-Ⅱ and endothelin (ET) in senum were tested by radioimmunoassay and the level of transforming growth factorβ1 (TGF-β1) in renal cortex were determined by immunohistochemistry. Results The kidney function and kidney lesions were significantly improved in the treatment group than in the model group. Ang-Ⅱ And ET levels in serum and renal cortex was reduced, and the expression of TGF-β1 in the treatment group was decreased. Conclusion Shenqi Dihuang Decoction has protective effect on the kidney of diabetic rats, the mechanism may be related to its inhibition on the over expression of Ang- Ⅱ, ET and TGF-β1.

BACKGROUND:Acellular vascular matrix as vascular scaffold has following advantages:acellular vascular matrix possesses complicated three-dimensional structure of natural blood vessels. Growth factor and structural domain on the surface of acellular matrix helps for cell adhesion and infiltration.OBJECTIVE:To prepare acellular vascular matrix material and to evaluate its biocompatibility in vivo and in vitro.METHODS:Trypsin and Triton X-100 were used to gradually dispose pig carotid artery and to prepare acellular vascular matrix. The biocompstibility of the material was evaluated by implantation in muscle, acute toxicity experiment and cytotoxicity test in vitro.RESULTS AND CONCLUSION:The acallular vascular matrix material possessed good chemical stability and did not release harmful factors that produced destruction and dissolution in erythrocytes, without acute hemolytic reaction or toxic effects on cell growth. The acellular vascular matrix material showed lots of inflammatory cell infiltration in eady stage of implantation, and no significant inflammatory cell infiltration in late stage of observation. Fibroblasts were visible in the acellular matrix. In addition, the acellular matrix material did not exhibit toxic effects on surrounding tissues,showing wound stage I healing.Simultaneously,histological sections demonstrated that there were good compatibility of scaffold material and surrounding tissues, without rejection.These indicated that acellular matrix material presented good biocompatibility in animals.

Objective To study the influencing factors,treatment and prevention of venous thromboembolic (VTE) in elderly patients with malignant tumor.Methods The clinical findings in forty elderly patients with malignant tumor combined with VTE from our hospital within 5 years were analyzed retrospectively.The risk,site,time,prevention and treatment of VTE in these tumor patients were analyzed and summarized.Results After active treatment,the positive efficacy response was obtained in 26 cases (65.0％),no-response in 14 cases (35.0％).Specifically,14 cases died,7 cases cured,and 19 cases were improved.Besides cancer and aging,the elderly tumor patients were considered as the high-risk group because of the risk factors including hypertension,diabetes,hyperlipidemia,pulmonary infection,surgery,radiation,chemotherapy and so on.D-dimer level was significantly increased in elderly malignant tumor patients with VTE.Venous thrombosis could occur at any stage.Venous thrombosis was found before tumor in 1 case.The most common site of DVT was the lower limbs,especially the left lower extremities (14 cases,35％).Most of internal carotid vein and upper limb vein thrombosis were associated with peripherally inserted central catheter (PICC) Conclusions The elderly patients with malignant tumor is the extremely high risk groups for venous thrombosis,and their quality of life and survival will be seriously impacted.Anticoagulant therapy through the whole process of treatment in patients with VTE is beneficial.The prevention and treatment of VTE play an important role in the tumor patients with risk factors such as chronic diseases,high D dimer level,radiation and chemotherapy,which should attract the attention of clinicians.

Objective To investigate the effects of high-fat diet induced insulin resistance on fibroblast growth factor-21 (FGF-21) and its receptors expression in ApoE~(-/-) mice. Method Male ApoE~(-/-) mice were randomly divided into normal-chow group(NF,n=20)and high-fat fed group(HF,n=20) and fed for 16 weeks. The insulin sensitivity and glucose-lipid metabolism in awake mice were evaluated by hyperinsulinemic-euglycemic clamp technique combined with 3-[~3H]-glucose as a tracer. The Mrna expressions of FGF-21,β-klotho, and FGFR1-4 were measured by quantitative real-time PCR. FGF-21 protein levels were determined by Western blot. Results Fasting blood glucose, plasma insulin and free fatty acids, triglycerides, free fatty acids, and cholesterols were significantly elevated in HF group compared with NF group(all P<0.01). During the steady-state of clamp, plasma insulin was significantly higher in HF group than that in NF group(P<0.01), and glucose infusion rate was also significantly decreased(P<0.01). At the end of insulin clamp, glucose disappearance rate was significantly lower in HF group than that in NF groups(P<0.01). Hepatic glucose production in NF group was suppressed by 70% ,while in HF group it was suppressed by 51%. The FGF-21 Mrna expressions of hepatic and adipose tissues in HF group were significantly increased compared with NF group(both P<0.01), and β-klotho Mrna expressions increased(P<0. 05). In hepatic and adipose tissues, FGFRI, Mrna expressions were higher in HF group than those in NF group(both P<0.01) ,and FGFR3 Mrna increased(P<0.01 and P<0.05, respectively). In hepatic tissue,FGFR4 Mrna levels were significantly up-regulated in HF group(P<0. 05). Plasma FGF-21 levels were elevated in HF group compared with NF group(P<0.01) ,and FGF-21 protein expressions of hepatic and adipose tissues were also increased(both P<0.05). Conclusion FGF-21, β-klotho, FGFR1, and FGFR3 were significantly up-regulated in ApoE~(-/-) mice fed by high-fat diet, and they might be the targets in regulating glucose-lipid metabolism by FGF-21.

Objective:The present study aimed to conduct a clinical analysis of nosocomial infections in hospitalized cancer pa-tients and propose effective precautionary measures. Methods:We retrospectively analyzed 56,430 cases of discharges from the Cancer Institute and Hospital of Tianjin Medical University between January and December 2012. Results:Among 825 cases, the rate of noso-comial infections was 1.46%;46.42%of the patients aged>60 years. The highest infection rate was observed in the Medical Depart-ment of Stomach Cancer. The highest composing rate was recorded in the Department of Hepatobiliary Cancer. The major pathogenic bacteria were Gram-negative bacilli;fungal infections were relatively rare. The most vulnerable body parts were the abdomen and diges-tive tract, which were mainly infected by pathogenic Escherichia coli. Conclusion:Healthcare workers should consider the importance of influencing factors and take precautionary measures to reduce the rate of nosocomial infections in cancer patients.

A rapid analytical method was developed for the determination of N-methylcarbamoyl adduct in Hemoglobin of workers exposed to N,N-dimethylformamide by ultra high performance liquid chromatography-mass spectrometry ( UPLC/MS/MS). About 0. 1 g of hemoglobin sample, 40 μmol/L of 3-methyl-5-isopropylhydantoin (MIH) as the internal standard and 4. 75 mL of HCl-acetic acid (2∶1, V/V) were added in the centrifuge tube, and mixed for 3 min. Then the tube was heated in boiling water bath for 1h. After cooling down, 200 μL of the mixture and 600 μL of formic acid-acetonitrile (1%) were added into 96-well extract plate. The vacuum pump pressure was controlled to make the sample collection elute within 2-4 min.The purified collection was transferred into the sample vial, and 3-methyl-5-isopropylhydantoin ( MVH ) as degration product of N-methylcarbamoyl adduct was quantified by UPLC/MS/MS in multiple reaction monitoring ( MRM ) by internal standard method. A good linear relationship was obtained in the MVH concentration range of 0 . 01-1 . 0 μmol/L with the correlation coefficient of 0 . 999 . The recovery of added MVH in the blank sample was 97 . 3% and the relative standard deviation was 1 . 7%. The limit of detection (LOD) was 0. 01 μmol/g. This method was proved to be fast and efficient.

The effects of tumor suppressor in lung cancer-1(TSLC1)upregulation on gene expressions involved in glucose and lipid metabolism in Hepa1-6 cells were investigated.The results showed that TSLC1 overexpression decreased fatty acid synthase and acetyl CoA carboxylase expressions(P<0.05 or P<0.01),increased adipose triglyceride lipase expression(P<0.05),and did not change hormone-sensitive lipase,glucose transporter (GLUT)1,and GLUT4 expressions.These results suggest that TSLC1 overexpression may promote lipolysis and inhibit adipogenesis in liver cells.

Objective To investigate the role of endometrial and subendometrial blood flows measured by transvaginal three-dimensional(3D) power Doppler ultrasound in the prediction of endometrial receptivity during in vitro fertilization-embryo transfer (IVF-ET) cycles. Methods One hundred and twenty patients undergoing IVF-ET cycles were enrolled in this study. Transvaginal 3D power Doppler ultrasound examination was performed on the day of human chorionic gonadotropin injection to determine endometrial thickness,endometrial volume, vascularization index(VI), flow index(FI) and vascularization flow index (VFI) of endometrial and subendometrial regions by experienced sonograpbers. The patients were divided into pregnant group and non-pregnant group according to pregnant outcome. The data between the two groups were compared and analysed. Results There were no significant differences( P ＞0.05) between the pregnant group and non-pregnant group in endometrial thickness, endometrial volume. Endometrial and subendometrial VI,FI, VFI were higher in the pregnant group than those in the non-pregnant group, and statistical comparison had significant difference( P ＜0.05). Conclusions Endometrial and subendometrial blood flows measured by transvaginal 3D power Doppler ultrasound can be as a reliable indicator to assess endometrial receptivity and to predict the pregnancy outcome.

Objective To observe the effects of JAZF1 (Juxtaposed with another zinc finger gene 1 ) overexpression on glucose and lipid metabolism in 3T3-L1 adipocytes. Methods The tissue distribution of JAZF1 in healthy C57BL/6J mice was detected by real-time quantitative PCR( RT-QPCR). Expression vector for JAZF1 gene was constructed and transfected into 3T3-L1 adipocytes. The mRNA levels of JAZF1, GLUT1, GLUT4, FAS, ACC, SREBP1, ATGL, and HSL implicated in glucose and lipid metabolism were determined by RT-QPCR; JAZF1 protein level was measured by Western blot. Intracelluar lipid accumulation were measured by oil red O staining method. Results In JAZF1-transfected adipocytes, JAZF1 mRNA and protein levels were significantly higher than control cells after 48 h. The mRNA level of HSL was increased significantly (P<0. 05) in JAZF1 transfection group compared with negative control and empty vector group, and the expressions of FAS, ACC, SREBP1 mRNA were decreased significantly(all P<0.01). However, the mRNA levels of ATGL, GLUT1, GLUT4 were not changed. Intracelluar lipid accumulation was decreased significantly (P<0.05 ) by oil red O staining and colorimetric in JAZF1 -transfected cells compared with negative control and empty vector group. Conclusions There was an extensive expression of JAZF1 in various tissues of C57BL/6J mice,indicating that JAZF1 might play a role in maintaining normal physiological function. These results show that overexpression of JAZF1 in 3T3-L1 cells can reduce lipid synthesis, increase lipolysis, and improve lipid accumulation. JAZF1 might provide a new potential therapeutic target for obesity and diabetes.