Impact of stage-specific limb function exercises guided by a selfmanagement education model on arteriovenous fistula maturation status

BACKGROUND The exercise of limb function is the most economical and safe method to promote the maturation of arteriovenous fistula(AVF).However,due to the lack of a uni-fied exercise standard in China,many patients have insufficient awareness of the importance of AVF,leading to poor effectiveness of limb function exercise.The self-management education model can effectively promote patients to take pro-active health-related actions.This study focuses on the characteristics of patients during the peri-AVF period and conducts a phased limb function exercise under the guidance of the self-management education model to observe changes in fac-tors such as the maturity of AVF.AIM To assess the impact of stage-specific limb function exercises,directed by a self-management education model,on the maturation status of AVFs.METHODS This study is a randomized controlled trial involving 74 patients with forearm AVFs from the Nephrology Department of a tertiary hospital in Sichuan Province,China.Patients were randomly divided into an observation group and a control group using a random number table method.The observation group underwent tailored stage-specific limb func-tion exercises,informed by a self-management education model which took into account the unique features of AVF at various stages,in conjunction with routine care.Conversely,the control group was given standard limb function exercises along with routine care.The assessment involves the maturity of AVFs post-intervention,post-operative complications,and the self-management level of the fistula in both groups patients.Analyses were conducted using SPSS version 23.0.Count data were represented by frequency and percentage and subjected to chi-square test comparisons.Measurement data adhering to a normal distribution were presented as mean±SD.The independent samples t-test was utilized for inter-group comparisons,while the paired t-test was used for intra-group comparisons.For measurement data not fitting a normal distribution,the median and interquartile range were presented and analyzed using the Wilcoxon rank sum test.RESULTS At the 8-wk postoperative mark,the observation group demonstrated significantly higher scores in AVF symptom recognition,symptom prevention,and self-management compared to the control group(P<0.05).However,the variance in symptom management scores between the observation and control groups lacked statistical signi-ficance(P>0.05).At 4 wk after the operation,the observation group displayed a superior vessel diameter and depth from the skin of the drainage vessels in comparison to the control group(P<0.05).While the observation group did manifest elevated blood flow rates in the drainage vessels relative to the control group,this distinction was not statistically significant(P>0.05).By the 8-wk postoperative interval,the observation group outperformed the control group with notable enhancements in blood flow rates,vessel diameter,and depth from the skin of drainage vessels(P<0.01).Seven days following the procedure,the observation group manifested significantly diminished limb swelling and an overall reduced complication rate in contrast to the control group(P<0.05).The evaluation of infection,thrombosis,embolism,arterial aneurysm stenosis,and incision bleeding showed no notable differences between the two groups(P>0.05).By the 4-wk postoperative juncture,complications between the observation and control groups were statistically indistinguishable(P>0.05).CONCLUSION Stage-specific limb function exercises,under the guidance of a self-management education model,amplify the capacity of AVF patients to discern and prevent symptoms.Additionally,they expedite AVF maturation and miti-gate postoperative limb edema,underscoring their efficacy as a valuable method for the care and upkeep of AVF in hemodialysis patients.

Loss-of-function CFTR p.G970D missense mutation might cause congenital bilateral absence of the vas deferens and be associated with impaired spermatogenesis

Congenital bilateral absence of the vas deferens(CBAVD)is observed in 1%–2%of males presenting with infertility and is clearly associated with cystic fibrosis transmembrane conductance regulator(CFTR)mutations.CFTR is one of the most well-known genes related to male fertility.The frequency of CFTR mutations or impaired CFTR expression is increased in men with nonobstructive azoospermia(NOA).CFTR mutations are highly polymorphic and have established ethnic specificity.Compared with F508Del in Caucasians,the p.G970D mutation is reported to be the most frequent CFTR mutation in Chinese patients with cystic fibrosis.However,whether p.G970D participates in male infertility remains unknown.Herein,a loss-of-function CFTR p.G970D missense mutation was identified in a patient with CBAVD and NOA.Subsequent retrospective analysis of 122 Chinese patients with CBAVD showed that the mutation is a common pathogenic mutation(4.1%,5/122),excluding polymorphic sites.Furthermore,we generated model cell lines derived from mouse testes harboring the homozygous Cftr p.G965D mutation equivalent to the CFTR variant in patients.The Cftr p.G965D mutation may be lethal in spermatogonial stem cells and spermatogonia and affect the proliferation of spermatocytes and Sertoli cells.In spermatocyte GC-2(spd)ts(GC2)Cftr p.G965D cells,RNA splicing variants were detected and CFTR expression decreased,which may contribute to the phenotypes associated with impaired spermatogenesis.Thus,this study indicated that the CFTR p.G970D missense mutation might be a pathogenic mutation for CBAVD in Chinese males and associated with impaired spermatogenesis by affecting the proliferation of germ cells.

Clinical observations of osteoporotic vertebral compression fractures by using mineralized collagen modified polymethylmethacrylate bone cement

To investigate the clinical outcomes of the treatment of osteoporotic vertebral compression fractures(OVCFs)by using mineralized collagen(MC)modified polymethylmethacrylate(PMMA)bone cement.52 cases(52 vertebras)who sustained OVCF treated with MC modified PMMA bone cement from July 2014 to December 2015 were reviewed retrospectively.All the cases(52 patients,52 vertebras)included 8 males and 44 females with an average age of 74.83(ranging from 57-to 90-years old).The visual analogue scale(VAS),vertebral body height,Cobb angle,CT values preand post-operation as well as incidence of complications were used to be observed.All the patients underwent the surgery were successfully followed-up with an average period of 13.54 months(ranging from 6 to 23 months).The patients can ambulate at the second day after the operation.The VAS scores 2 days after the operation and during the last follow-up were significantly decreased compared with that before the operation(P<0.05);the average vertebral height and local Cobb angle had significant recovery(P<0.05);the CT value of the treated vertebra significantly increased compared with that before the operation(P<0.05).MC with good osteogenic activity and degradation properties can effectively improve the mechanical properties and biocompatibility of the PMMA bone cement,thus obtain better clinical results.

Clinical observation of mineralized collagen bone grafting after curettage of benign bone tumors

Curettage of benign bone tumor is a common cause for bone defect.For such bone defect repair,autogenous bone,allogeneic bone and traditional artificial bone graft substitutes have many disadvantages.In recent years,a biomimetic mineralized collagen(MC)with similar composition and microstructures to the natural bone matrix was developed and used for treating various bone defects.In this work,a retrospective study analyzed clinical outcomes of patients treated with curettage of benign bone tumors and bone grafting with MC,in comparison to another group treated with the same surgical method and autogenous bone.Lane-Sandhu X-ray score of the autogenous bone group was superior to the MC group at 1 month after the operation,but the two groups had no statistical difference at 6 and 12 months.The MC group was better in Musculoskeletal Tumor Society scoring at 1 and 6 months after the operation,and the two groups had no statistical difference at 12 month.Therefore,the MC performed not as good as autogenous bone in early stage of bone healing but achieved comparable outcomes in long-term follow-ups.Moreover,the MC has advantages in function recovery and avoided potential complications induced by harvesting autogenous bone.