Objective To investigate the correlation of vascular endothelial growth factor (VEGF)-634G/C gene polymorphism to diabetic nephropathy in type 2 diabetes mellitus. Methods VEGF genotype was determined by PCR-RFLP in 98 healthy controls and 216 patients with type 2 diabetes including 104 cases without nephropathy and 112 cases with nephropathy. VEGF genotype and allele frequencies were compared among these groups.Results (1)Individuals with CC genotype had higher serum VEGF level than those with CG and GG groups. (2)The genotype CC distribution and C allele frequency in diabetic nephropathy were significantly higher than those in cases without nephropathy group and in controls. (3)Compared with genotype GG and CG class, the morbidity of diabetic nephropathy in genotype CC class was significantly increased. (4) Logistic regression analysis revealed that serum VEGF level and its CC genotype, SBP, HbA1C, LDL-C and BMI were important risk factors of type 2 diabetic nephropathy. Conclusions VEGF -634G/C polymorphism is associated with the development of type 2 diabetic nephropathy. C allele is probably a susceptible gene of type 2 diabetic nephropathy.

Objective To investigate the association of serum leptin(LEP),adiponectin(ADPN)and leptin-to-adiponectin(L/A)ratio with cardio ankle vascular index(CAVI)in the patients maintaining hemodialysis(MHD).Methods Sixty MHD patients and thirty healthy volunteers were involved in the study.The levels of LEP and ADPN were determined by ELISA.Atherosclerosis was evaluated by the cardio ankle vascular index which was measured by using a VaSera VS-1000 machine.Results The levels of serum LEP and ADPN in hemodialysis patients were significantly higher than those in healthy controls([7.99 ± 1.21]μg/L vs.[4.18 ± 1.10]pg/L)and([15.12 ± 4.68]mg/L vs.[8.58 ± 2.23]mg/L),respectively,P ＜ 0.01].With the progression of atherosclerosis,the levels of serum LEP increased significantly,while the levels of serum ADPN decreased significantly.The L/A ratio was dramatically increased in patients with atherosclerosis.Multiple stepwise regression analysis showed that independent risk factors associated with CAVI include age,diabetes,levels of LEP and L/A ratio.Conclusion The increased serum LEP level and decreased serum ADPN level may be involved in the progression of atherosclerosis in MHD patients.The L/A ratio may be a powerful independentpredictor for CAVI in MHD patients.

Objective To investigate the clinical significance of body composition monitor (BCM) in evaluating the dry weight of hemodialysis patients.Methods Fifty-four hemodialysis patients who reached the dry weight according to clinical assessment were enrolled.The volume load was measured with BCM,and the pre-dialysis blood pressure,plasma B type natriuretic peptide (BNP) and echocardiogram parameters were recorded.Results BCM results showed that,in 54 hemodialysis patients,15 patients presented overhydration and 13 patients underhydration.According to the results of BCM,all of the 15 overhydration patients and some of the 13 underhydration patients adjusted their dry weight.According to the BCM results and the pre-dialysis blood pressure,the patients were divided into 4 groups:group A (without overhydration,the pre-dialysis blood pressure ＜ 150 mmHg,1 mmHg =0.133 kPa),23 cases;group B (without overhydration,pre-dialysis blood pressure ≥ 150 mmHg),16 cases;group C (overhydration,pre-dialysis blood pressure ＜ 150 mmHg),7 cases;and group D (overhydration,pre-dialysis blood pressure ≥ 150 mmHg),8 cases.There were no significant differences in pre-dialysis,plasma BNP and the echocardiographic parameters among the 4 groups (P ＞ 0.05).Conclusions BCM is a simple and convenient tool to evaluate the volume status of hemodialysis patients,It can give guidance of dry weight regulation.Compared with the other clinical assessment methods such as pedal edema,the blood pressure and plasma BNP,it is more accurate and practical.

Objective To investigate the relations between serum adiponectin and coronary artery calcification score (CACS) and to find the risk factors for coronary artery calcification in maintenance hemodialysis(MHD) patients.Methods Twenty-seven MHD patients(MHD group) and 13 healthy persons (control group) were enrolled in this study.The serum adiponectin was measured by enzyme-linked immunosorbent assay method.CACS was calculated by multi-row spiral CT.The circulating parameters such as hemoglobin (Hb),calcium,phosphate,calcium-phosphate product,intact parathyroid hormone (iPTH),total cholesterol (TC),low density lipoprotein cholesterol (LDL-C),albumin (Alb),high sensitive C-reactive protein (hs-CRP),and so on were detected.Results The level of serum adiponectin in MHD group [(15.00 ± 7.47) mg/L] was significantly higher than that in control group [(2.07 ± 0.83) mg/L],and there was significant difference (P＜ 0.01).Coronary artery calcification(CACS ＞ 0 score) was observed in 88.9％ (24/27) in MHD group and 10/13 in control group.The mean CACS in MHD group was significantly higher than that in control group [655 (0-3 570) scores vs.126 (0-731)scores],and there was significant difference (P ＜ 0.05).Eleven MHD patients and 1 healthy person had severe coronary artery calcifications,(CACS ≥ 400 scores).There was significan t difference in dialysis duration,diastolic pressure,phosphate calcium-phosphate product and adiponectin (P ＜ 0.05 or ＜ 0.01).Spearman analysis showed that CACS of MHD patients was positively correlated with dialysis duration,phosphate,calcium-phosphate product,serum creatinine and adiponectin (P ＜ 0.01 or ＜ 0.05).Only calcium-phosphate product remained as independent predictor of CACS in multivariate analysis (P ＜0.01).Conclusion Coronary artery calcification is common in MHD patients and which is correlated with dialysis duration,serum phosphate,calcium-phosphate product,serum creatinine and adiponectin.

Objective:To explore the practical effect of PICC catheterization in breast cancer patients by a multidisciplinary team led by specialist nurses.Methods:Choose Affiliated Tumor Hospital, Xinjiang Medical University in March 2018 to January 2020, 120 cases of breast cancer patients undergoing chemotherapy, according to the random number method, 60 cases were divided into control group and test group, control group given routine nursing care, experimental group on the basis of conventional nursing to the specialist nurses as the leading multidisciplinary team management mode to compare two groups of patients with a success rate of puncture complications patients satisfaction and unscheduled decannulation rate before and after the implementation of the multidisciplinary model nurse satisfaction.Results:The one-time puncture success rate, unplanned extubation rate, incidence of mechanical phlebitis, medical adhesion-related skin injury, puncture point infection, and catheter blockage rate were 98.3% (59/60), 10.0% (6/60), 8.3% (5/60), 1.7% (1/60), 10.0% (6/60), and 10.0% (6/60), respectively. The control group was 88.3% (53/60), 20.0% (12/60), 20.0% (12/60), 13.3% (8/60), 18.3% (11/60) and 21.7% (13/60), respectively. The difference was statistically significant ( χ 2 values were 4.821-14.911, P<0.05). The satisfaction scores of patients in the experimental group were (17.05±1.43), (17.13±1.28) and (4.38±0.56) points respectively in the three dimensions of nurse skill level, nursing service experience and health education guidance, while those in the control group were (14.53±2.10), (15.03±1.38) and (3.10±0.75) points respectively, the difference was statistically significant ( t values were 0.576, 0.623, 0.699, P<0.001). Nurse satisfaction after the implementation of the multidisciplinary model on the professional ability, job security, teamwork, self-assessment score four dimensions, respectively (12.73±1.02), (24.00±3.52), (16.42±2.06), (13.00±1.83) points, not the implementation of the multidisciplinary model its satisfaction each dimension score (9.69±1.49), (7.88±2.07), (11.92±1.32), (8.88±1.18) points, improved from the previous implementation, the difference was statistically significant ( t values were 0.576-0.798, P<0.001). Conclusions:The multidisciplinary team management model led by specialist nurses is applied to the PICC management of breast cancer patients, which not only reduces the incidence of catheter complications, but also improves the quality control level of PICC and the satisfaction of patients and nurses, in order to further promote intravenous treatment. Specialized development provides guidance.

OBJECTIVETo review the current evidence about the prevalence of obstructive sleep apnea in patients with Marfan's syndrome, and discuss some proposed potential mechanisms for this relationship.

DATA SOURCESThe data in this review were mainly from Medline and PubMed articles published in English from 1990 to 2013. The search term was "Marfan's syndrome and sleep apnea".

STUDY SELECTIONClinical evidence about the epidemiology of obstructive sleep apnea in patients with Marfan's syndrome; the mechanism that causes obstructive sleep apnea; interventional therapy for patients with Marfan's syndrome, and coexisting obstructive sleep apnea.

RESULTSA high prevalence of obstructive sleep apnea exists in patients with Marfan's syndrome. The potential reasons are craniofacial abnormalities and lax upper airway muscles, which lead to high nasal airway resistance and upper airway collapse. Obstructive sleep apnea mechanically deteriorates aortic dilatation and accelerates progression of aortic aneurysms. The condition is reversible and rapid maxillary expansion and adequate continuous positive airway pressure therapy are possible effective therapies to delay the expansion of aortic diameter in patients with Marfan's syndrome.

CONCLUSIONSObstructive sleep apnea is strongly associated with Marfan's syndrome. Craniofacial abnormalities and lax upper airway are the main mechanisms. Untreated obstructive sleep apnea accelerates progression of aortic dissection and rupture. Effective therapies for obstructive sleep apnea could postpone the aortic dilatation in patients with Marfan's syndrome.

Humans ; Marfan Syndrome ; epidemiology ; etiology ; Prevalence ; Sleep Apnea, Obstructive ; complications ; epidemiology