Objective:To investigate the effects of peritoneal dialysis combined with hemodialysis on improving cardiac and renal function, peritoneal function, and nutritional status, and reducing complications in patients with end-stage renal disease.Methods:A total of 90 patients with end-stage renal disease who received treatment at Lishui Municipal Central Hospital and Lishui People's Hospital from January 2019 to May 2022 were retrospectively included in this study. The patients were divided into a control group and an observation group, with 45 patients in each group, based on the treatment methods used. The control group received peritoneal dialysis treatment, while the observation group received a combination of peritoneal dialysis and hemodialysis treatment. The changes in cardiac and renal function, peritoneal function, nutritional status, and the occurrence of complications were observed in both groups.Results:After treatment, the observation group showed significantly lower values in the cardiothoracic ratio [(57.02 ± 3.35)%], brain natriuretic peptide [(8 849.34 ± 124.65) ng/L], left ventricular mass index [(181.32 ± 8.56) g/m2], blood urea nitrogen [(14.04 ± 1.94) mmol/L], and serum creatinine [(181.47 ± 27.06) μmol/L] compared with the control group [(58.92 ± 3.11)%, (15 126.39 ± 322.82) ng/L, (187.28 ± 8.95) g/m2, (18.49 ± 2.82) mmol/L, (196.56 ± 31.07) μmol/L, t = 2.79, 121.68, 3.23, 8.72, 2.46, all P < 0.05]. Additionally, the observation group had significantly higher levels of ejection fraction [(63.47 ± 5.23)%], albumin [(52.98 ± 6.37) g/L], and hemoglobin [(114.94 ± 13.61) g/L] compared with the control group [(60.46 ± 5.18)%, (47.01 ± 6.04) g/L, (98.04 ± 10.93) g/L, t = -2.74, -4.52, -6.49, all P < 0.05]. The observation group also exhibited a significantly lower dialysate/plasma creatinine ratio [(0.56 ± 0.09)] and a lower level of β 2-microglobulin [(18 032.29 ± 718.11) mg/L] compared with the control group [(0.61 ± 0.07), (18 424.42 ± 736.43) mg/L, t = 2.54, 2.06, both P < 0.05]. The incidence of complications in the observation group was 11.11% (5/45), which was significantly lower than that in the control group [31.11% (14/45), χ2 = 4.27, P < 0.05]. Conclusion:Peritoneal dialysis combined with hemodialysis can improve cardiac and renal function, peritoneal function, and nutritional status and decrease the incidence of complications in patients with end-stage renal disease. This approach deserves to be clinically promoted. The findings of this study are of significant innovation and scientific value.

Rejection after lung transplantation, including acute rejection (AR) and chronic rejection manifested with chronic lung allograft dysfunction (CLAD), is the main factor affecting the long-term survival of allografts. Exosome, a type of extracellular nanovesicle for intercellular communication among eukaryotic cells, could carry complex biological information and participate in various physiological and pathological processes. Exosome has become a critical immune medium in rejection, regulates the incidence and development of rejection through multiple pathways, and also plays a key role in the monitoring and management of rejection. In this article, the type of rejection after lung transplantation, the mechanism underlying the role of exosome in regulating rejection, exosome acting as biomarkers and the application in rejection treatment were reviewed, aiming to provide a novel direction for comprehensive diagnosis and treatment of rejection following lung transplantation.

Objective To improve the surgical efficacy of bilateral lung transplantation for pediatric cystic fibrosis through multi-disciplinary team (MDT). Methods Preoperative MDT consultation was delivered for a 10-year-old child with rare end-stage cystic fibrosis to establish the corresponding treatment protocol. Results The child was diagnosed with cystic fibrosis for 5 years, and the indication of lung transplantation were confirmed. After preoperative MDT consultation, bilateral lung transplantation via a Clam-shell incision was determined. The vital signs were maintained stable during operation. Postoperatively, ventilator-assisted ventilation, anti-infection, immunosuppression, acid suppression, prevention of stress ulceration and other treatments were delivered. Individualized treatment was given according to the characteristics of the child, and the child was well recovered. Conclusions Through preoperative MDT consultation, lung transplantation yields satisfactory surgical efficacy in treating pediatric cystic fibrosis and lowers the risk of postoperative complications, which deserves application in clinical practice.

Objective To study the influence of pulmonary artery hypertension (PAH) on survival of patients with advanced chronic obstructive pulmonary disease (COPD) on the waiting list of lung transplantation.Methods The characteristics of 143 patients with COPD receiving lung transplantation evaluation from January 2014 to August 2016 were queried.Mild PAH was defined as mean pulmonary artery pressure (mPAP) ≥25 mmHg and severe ≥35 mrnHg by right heart catheterization measurements.The incidence of PAH was studied,and the patients were divided to different groups to determine the effect of PAH on survival prior to transplantation on the basis of different definitions of PAH.Kaplan Meier method was used to draw survival curves,and a log-rank test was used to analyze the effect of PAH on survival of COPD patients on the waiting list of pulmonary transplantation.Univariate and multivariate Cox proportional hazard models were performed to test the relationship between each main covariate and the hazard of mortality.The waiting time was tracked from wait list entry date until death or censoring,and the censoring issues were as follows:receiving lung transplantation,removing from the waiting list without transplant,and still wating for donor until the last follow-up day (2016-08-30).Results Of 143 COPD patients,there were 119 males and 24 males,with mean age of 61.73 years old;46 patients received lung transplantation,and the remaining 97 not;50 had mPAP ≥25 mmHg and 21 had mPAP ≥35 mmHg.A total of 23 cases (22.88％) died on the waiting list.Thirty-eight patients were removed from the list prior to transplantation,and 36 were still on the waiting list.Kaplan-Meier survival function showed suvival of patients with mild PAH or severe PAH was significantly shorter than that of patients without PAH (P＜0.001).Using Cox proportional hazards models,univariate analysis revealed significant differences in survival for mild PAH (HR =2.147,95％CI 1.429-3.157,P＜ 0.001) and severe PAH (HR =3.458,95 ％ CI 2.518-4.859,P＜0.001).Multivariate Cox models identified significant risk for death for mild PAH (HR=2.518,95％CI 1.728-3.364,P＜0.001) and severePAH HR=4.027,95％ CI 3.257-4.703,P＜0.001).Conclusion The incidence of PAH among COPD patients waiting for lung transplantation was high.PAH is associated with significantly increased risk of death among COPD patients waiting for lung transplantation.

Objective To investigate the safety and efficacy of microwave ablation guided with laparoscopy and transvaginal ultrasound in the treatment of adenomyosis.Methods Seventy patients with 89 lesions of adenomyosis were treated with laparoscopy and transvaginal ultrasound guided microwave ablation.Intraoperative and postoperative complications were observed.The differences in dysmenorrhea score,menstrual flow and dysmenorrhea time before and after treatment were compared.Ultrasound examinations were performed 1,3 and 6 months after treatment to measure the volumes of uterus and adenomyosis lesions.Results Outflow liquid from vagina 1-3 days after treatment was found in 1 patient,and mild vaginal bleeding was found in 3 patients.No serious complication occurred in the other 66 patients.Compared with preoperation,the dysmenorrhea score,menstrual flow and dysmenorrhea time decreased in all patients after treatment (all P＜0.01).The volumes of uterus and adenomyosis lesions 1,3 and 6 months after treatment were significantly less than those before treatment (all P＜0.01).Conclusion Laparoscopy and transvaginal ultrasound guided microwave ablation is a safe and efficient therapy for adenomyosis.

Purpose To explore the short-term clinical efficacy and application value of transvaginal sonography-guided laparoscopic percutaneous microwave coagulation therapy in the treatment of uterine adenomyoma.Materials and Methods Forty patients with uterine adenomyoma who visited the Central Hospital of Wuhan from October 2015 to October 2016 were selected in this study.These patients were invalid in traditional treatment for severe dysmenorrheal,but still unwilling to excise uterus.Microwave needles were placed into uterine adenomyoma to conduct percutaneous microwave coagulation therapy under the whole-process monitoring and guidance of laparoscope and transvaginal ultrasonography.Results All of 64 nidi in the 40 patients were ablated successfully,and none had damage to peripheral vital organs or vessels.Intraoperative hemorrhagic volume was extremely small.Postoperative menstrual blood volume and dysmenorrheal severity were improved notably,but none had obvious recurrence until now.The uterine volumes at postoperative one,three and six months as well as one year were (135.0±73.2) cm3,(108.2 ± 62.9) cm3,(91.4 ± 58.4) cm3,and (84.8 ± 50.0) cm3,respectively,all were evidently smaller than the (207.2± 97.4) cm3 before operation (P＜0.01).The n idus sizes at postoperative one,three and six months as well as one year were (42.3±34.2) cm3,(30.6±27.4) cm3,(24.7±23.0) cm3 and (23.0± 19.4) cm3,respectively,all were evidently smaller than the (67.9±48.2) cm3 before operation (P＜0.01).There were also significant differences in laboratory examinations of CA125 and CA199 before and after operation (P＜0.01).Conclusion Percutaneous microwave coagulation therapy as a non-invasive technique that can both maintain patients' uteruses and resolve their pain,is more safe and real-time under the monitoring of laparoscope,thus being promising as a new routine for the treatment of uterine adenomyoma.

Objective To summarize the lung transplant program using donation after death of citizens (DCD).Methods Retrospective characteristics of 242 patients with end-stage lung diseases receiving lung transplantation in our hospital were reviewed between January 2015 and December 2016.The data about evaluation and collection of all donors were analyzed.The survival rate,causes of deaths,and postoperative complications were reviewed.Kaplan Meier survival curves and a logrank test of differences in survival functions were used to assess the effect of lung transplant type and extracorporeal membrane oxygenation (ECMO) on survival post transplant.Results A total of 231 patients donated their lungs,including China type three (135 cases),China type two (19 cases),and China type one (77 cases).242 lung transplantations were successfully performed.The 3-month,6-month and 1-year survival rate after lung transplantation was 80.6％,80.6％,and 77.8％,respectively.There were 47 deaths during perioperative period,including 22 cases of primary graft dysfunction,14 cases of sepsis,6 cases of multiple organ failure,3 cases of heart failure,and 2 cases of stomal leak.One hundred and thirty-two patients received bilateral lung transplantation,with 3-month,6-month,and 1-year survival rate being 78.6％,78.6％,and 75.6％ respectively.110 underwent single lung transplantation with 3-month,6-month,and 1-year survival rate being 82.7 ％,82.7 ％,and 80.1％,respectively.No significant difference in survival rate was observed between single and bilateral lung transplantation (P＞0.05).One hundred and twenty-nine cases of lung transplants were conducted under ECMO support,with the 3-month,6-month and 1-year survival rate being 72.5％,72.5％,and 70.5％ respectively,which was significantly higher in those without ECMO with the 3-month,6-month and 1-year survival rate being 90.2％,90.2％ and 86.6％ respectively (n =113) (P ＜ 0.05).Conclusion DCD may facilitate the development of lung transplantation in China with long-term survival.

Objective To investigate the selection of recipients,operative technique,and perioperative management of lung transplantation for chronic thromboembolic pulmonary hypertension.Methods This article reviews the clinical data of 6 patients with chronic thromboembolic pulmonary hypertension receiving lung transplantation from January 2012 to June 2016.From January 2012 to June 2016,6 patients with chronic thromboembolic pulmonary hypertension underwent lung transplantation at Department of Thoracic Surgery,Affiliated Wuxi People's Hospital,Nanjing Medical University.There were 4 male and 2 female patients aged from 34 to 59 years.Chest enhancement of CT or CTPA in 6 patients prior to transplantation suggests a different degree of pulmonary embolism.The mean pulmonary artery pressure (mPAP) was＞30 mmHg,NYHA 11Ⅰ or Ⅳ.Four patients received bilateral sequence lung transplantation (BSLT) under extracorporeal membrane oxygenation (ECMO) support.Two patients received single lung transplantation (SLT).We analyzed the differences of oxygenation index,pulmonary systolic pressure,pulmonary artery diastolic pressure,mean pulmonary arterial pressure,and central venous pressure before and after treatment.Using paired t test to compare these indicators,P＜0.05 was considered statistically significant.Results The oxygenation index increased from (195 ± 85) to (440 ± 140) mmHg after treatment,the difference was statistically significant (P＜0.05).the The systolic pressure of pulmonary artery was decreased from (108 ± 28) mmHg to (56 ± 16) mmHg,and the difference was statistically significant (P＜0.05).the The diastolic pressure of pulmonary artery was decreased from (72 ± 18) mmHg to (25 ± 10) mmHg,and the difference was statistically significant (P＜0.05).the The mean pulmonary artery pressure was decreased from (84 ± 27) mmHg to (36 ± 10) mmHg,and the difference was statistically significant (P＜0.05).the The central venous pressure was decreased from (17.5 ± 4.5) mmHg to (8.5 ± 1.5) mmHg,and the difference was statistically significant (P＜0.05).Finally,5 patients were discharged from the hospital,and the pulmonary valve? functioned? well.1 patients died of shock and systemic failure 3 days after operation.Conclusion Lung transplantation is effective in the treatment of chronic thromboembolic pulmonary hypertension,and long-term survival requires further investigations.

Objective To explore the role of remote ischemic preconditioning(RIPC)in prevention of contrast -induced nephropathy(CIN)in elderly patients undergoing coronary artery angiography(CAA).Methods 106 elderly patients were enrolled in this randomized control trial.According to random number table,the patients were randomized into control group (n =53)and RIPC group(n =53).All of the patients received 1 000mL of 0.9% sodium chloride injection before CAA.The RIPC group patients underwent RIPC in their right arms with sphygmomanometer cuff infla-tion for 5 minutes prior to the CAA,three cycles were repeated.Serum creatinine was detected before and 48 hours after CAA.Results CIN was reported in 10 cases in the control group and 3 cases in the RIPC group(χ2 =4.30, P =0.04).The levels of serum creatinine were increased[(96.38 ±9.50)μmol/L vs (88.87 ±10.24)μmol/L] after CAA in the control group(t =2.28,P =0.03),and there was no difference in the RIPC group(t =1.17,P =0.24).Conclusion RIPC has a protective effect on CIN in elderly patients in our study.Since this method is harm-less and cost effective,further studies is required to popularize PIPC to our clinical practice for prevention of CIN.

Objective To investigate the risk factors and improvement measures of thrombosis in internal arteriovenous fistula in maintenance hemodialysis patients .Methods Case control studies were performed in this study . Totals of 100 maintenance hemodialysis patients with thrombosis in internal arteriovenous fistula from January 2009 to June 2015 in Lishui Central Hospital were included in observation group, while another 100 patients with maintenance hemodialysis who did not have thrombosis in internal arteriovenous fistula were involved as control group .The related clinical and nursing data were collected , and the correlation between the thrombosis in internal arteriovenous fistula and related factors were analyzed to improve targeted nursing .Results Prevalence of diabetes , puncture failure rate , hematoma occurrence rate , high intensity in site-directed oppression , tightly binding after hemodialysis rate , oppression time longer than 30 min after hemodialysis rate, ultrafiltration rate, hemoglobin, high-sensitivity C-reactive protein, fasting blood glucose, total cholesterol, low density lipoprotein cholesterol , calcium-phosphorus product and D-dimer in observation group were higher than those in control group .The differences were statistically significant ( P<0.05 ) .There were statistically significant differences in the systolic pressure and low molecular weight heparin usage between two groups (P<0.05).The multi-factor logistic regression analysis showed that the diabetes[OR=1.417, 95%CI (1.196 -1.803), P =0.001], puncture failure[OR=1.393, 95%CI (1.185 -1.638), P =0.000], tightly binding after hemodialysis [OR=1.249, 95%CI (1.101-1.416), P=0.001], oppression time longer than 30 min after hemodialysis[OR=8.369, 95%CI (1.725 -40.596), P=0.008], systolic pressure[OR=1.031, 95%CI (1.001 -1.061), P =0.040], ultrafiltration rate[OR =1.490, 95%CI (1.146-1.937), P=0.003], high-sensitivity C-reactive protein[OR=1.594, 95%CI(1.085-2.342), P=0.017], low-density lipoprotein cholesterol [OR=9.456, 95%CI (2.534 -55.040), P=0.007] and D-dimer[OR=11.711, 95%CI (5.310-69.231), P=0.005] were independent risk factors for thrombosis in internal arteriovenous fistula in maintenance hemodialysis patients .Usage of low molecular weight heparin [ OR=0.101, 95%CI (0.017 -0.590), P=0.011] was protective factor.Conclusions Thrombosis in internal arteriovenous fistula in patients with maintenance hemodialysis is not only related to metabolic factors , but also related to nursing factors .We should strictly control the ultrafiltration rate , improve puncture success rate , strengthen the health education and nursing observation post operation so as to early spot and prevent the thrombosis in internal arteriovenous fistula .