Objective
To compare the mortality of different vascular access types in hemodialysis patients by using systematic review and meta-analysis of observational research.
Methods
Through a systematic literature search in PubMed and Embase databases, the English publications that directly compared the mortality of vascular access types in hemodialysis patients from 2000 to 2022 were determined. The outcomes of this study are based on the mortality hazard ratio (HR) of vascular access types. Moreover, using a random-effects model to calculate the pooled HR [95% CI] and I2 to show the heterogeneity among the included studies.
Results
Of the 4,802 studies screened, 19 studies involving 575,109 patients met the inclusion criteria and were included in the analysis. Meta-analyses revealed the significant difference for the adjusted HR of death among various vascular access types. The results of meta-analysis showed that the mortality of using central venous catheter (CVC) for hemodialysis patients was higher than using arteriovenous fistula (AVF) (pooled HR = 1.85; 95% CI, 1.55–2.22). Further, the mortality of patients with arteriovenous graft (AVG) was higher than patients with AVF (pooled HR = 1.24; 95% CI, 1.12–1.36), while the mortality have no statistically significant difference between CVC use and AVG use was found (pooled HR = 1.41; 95% CI, 1.31–1.52; P > 0.05).
Conclusions
The mortality of patients with CVC was higher than those with AVF for hemodialysis, while patients using AVG had higher mortality than those using AVF.
Background
Colonization of gut microorganism is related to maturation of B cells in peripheral immune organs. This study aims to investigate the effect of intestinal microflora in Germ-free (GF), Specific Pathogen-free (SPF) and Clean (CL) BALB/C mice to small intestine total B-cell and memory B-cell receptor (BCR) complementary-determining region 3 (CDR3) repertoire.
Results
The composition and characteristics of intestinal microflora were analyzed by 16S rDNA sequencing. Genomic DNA extracted from small intestine tissue and memory B-cells of GF, SPF and CL mice were conducted via high-throughput DNA sequencing methods. As expected, significant differences of gut microflora diversity were observed in the three mice groups. CL group showed the most diversity, followed by SPF group, and GF group had the lowest diversity. Moreover, anormogenesis of intestinal lymphoid tissue were observed in GF mice. Diversity of the BCR heavy chain CDR3 repertoire in memory B cells were significant difference among three groups, but not in total B cells. The nucleotide polymorphism, usage frequency of gene segments (V, D, J, V–J gene segments) and amino acid of total B cells and memory B cells CDR3 were comparable among three mice groups, and there was significant difference between CL and GF mice groups.
Conclusions
The results of this study advocate that the colonization of intestinal microorganisms affect the diversity of B cells CDR3 repertoire. Elucidating mechanism of microbiome participated in the function of intestinal mucosal immune system may have positive effects on human health, and it requires further investigation.
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