Balloon angioplasty versus Viabahn stent graft for treatment of failing or thrombosed prosthetic hemodialysis grafts

ObjectiveTo compare the results of stent graft placement to balloon angioplasty for the treatment of stenosis at the venous anastomosis of failing and thrombosed prosthetic hemodialysis grafts.MethodsThis prospective, multicenter trial included 293 patients randomized (1:1) to the stent graft (n = 145) or balloon angioplasty (n = 148) group for treatment of stenosis at the venous anastomosis of dysfunctional (n = 164) or thrombosed (n = 129) hemodialysis grafts. The primary study end point was target lesion primary patency at 6 months; participants were followed for up to 24 months. Primary patency of the access circuit was a secondary end point. Statistical analysis of effectiveness was performed using both the intent-to-treat population and the effectiveness-per-protocol (EPP) populations for primary patency end points. Statistical analysis of additional effectiveness end points was performed using the EPP population.ResultsThe 6-month target lesion primary patency was statistically greater in the stent graft group than the balloon angioplasty group (intent-to-treat, 51.6% vs 34.2% [P = .006]; EPP, 52.9% vs 35.5% [P = .008]). Compared with the angioplasty group, the stent graft group increased the median time from the index procedure to the next intervention on the target lesion by 95 days (203 vs 108 days). Patients with dysfunctional (stenotic) grafts had higher target lesion primary patency compared with patients with thrombosed grafts regardless of treatment (EPP, stent graft, 64.6% vs 36.1% and balloon angioplasty, 45.8% vs 23.5%). When compared with angioplasty, using a stent graft for treatment of a venous anastomotic stenosis of a thrombosed graft increased the 6-month target lesion primary patency by 53.6% (EPP, 36.1% vs 23.5%).ConclusionsWhen compared with balloon angioplasty, a stent graft provided superior target lesion primary patency at 6 months for treatment of venous anastomotic stenoses of dysfunctional and thrombosed prosthetic hemodialysis grafts

RELASI PANDEMI TERHADAP IKLIM BUMI DAN PANDANGAN TEKS SUCI

Tulisan ini mencoba memaparkan jejak kemunculan Covid-19 yang kini menjadi pandemi, dengan menitikberatkan pembahasan pada rusaknya ekosistem sebagai tempat tinggal satwa liaryang menjadi inang bagi virus. Krisis ekologi menjadi gerbang utama awal mula perubahan yang drastis terhadap iklim bumi. Iklim bumi sendiri mengalami perubahan signifikan yang tidak bisa dihindari akibat pemanasan global dan diyakini akan berdampak luas terhadap berbagai aspek kehidupan. Hal ini menjadi sebab utama merebaknya berbagai virus bahkan menyebabkan virus-virus tersebut bermutasi,yang tentunya menjadikan virus lebih kuat dan kebal terhadap berbagai vaksin.Selain dengan penjabaran yang mampu penulis suguhkan dengan berberapa sudut pandang keilmuan, keberadaan teks-teks suci juga mengingatkan danmenawarkannilai-nilai kehidupan yang oleh sebagian besar manusia mulai meninggalkannya. Penulis berupaya menyajikan prinsip-prinsip yang terkandung dalam ayat-ayat al-Quran sebagai upayaturutandil dalam mengedukasi masyarakat. Penulis juga berharap manusia menjadi khalifahsepenuhnya yang tentunya arif dan sadar akan tanggungjawab dalam menjaga, merawat, mengelola serta melestarikan segala potensi yang telah disediakan oleh Allah Swt di muka bumi

Developing Rigorous Mathematical Thinking Approach-Based Learning Materials for Sequences and Series Concept at High School Level in Tanjungpinang

Mathematics encourages logical reasoning and critical thinking. Rigorous thinking helps in analysing problems to decision-making and ensures that solutions are accurate and reliable. Prior research indicated students’ lack of those abilities when learning the concept of sequences and series. Therefore, this research aims to develop learning materials for the concept of sequences and series based on rigorous mathematical thinking (RMT) approach. The learning materials developed with the ADDIE model include mobile learning, student worksheets, and test instruments, which provide clear explanations, examples, problem-solving activities with RMT approach, and assessments enabling teachers to evaluate students’ understanding of mathematics concepts of the sequences and series. The learning materials were validated using a questionnaire by mathematics experts. The quantitative and qualitative data results show that the mobile learning, student worksheets, and test instruments are valid. Mobile learning that was developed and tested valid entails that the study can add to a new learning strategy that proposes technology and digital tools to engage students in the learning process and promote RMT

Early Vascular Access Blood Flow as a Predictor of Long-term Vascular Access Patency in Incident Hemodialysis Patients

The long-term clinical benefits of vascular access blood flow (VABF) measurements in hemodialysis (HD) patients have been controversial. We evaluated whether early VABF may predict long-term vascular access (VA) patency in incident HD patients. We enrolled 57 patients, of whom 27 were starting HD with arteriovenous fistulas (AVFs) and 30 with arteriovenous grafts (AVGs). The patients' VABF was measured monthly with the ultrasound dilution technique over the course of the first six months after the VA operation. During the 20.4-month observational period, a total of 40 VA events in 23 patients were documented. The new VA events included 13 cases of stenosis and 10 thrombotic events. The lowest quartile of average early VABF was related to the new VA events. After adjusting for covariates such as gender, age, hypertension, diabetes, VA type, hemoglobin levels, body mass index, parathyroid hormone, and calcium-phosphorus product levels, the hazard ratio of VABF (defined as <853 mL/min in AVF or <830 mL/min in AVG) to incident VA was 3.077 (95% confidence interval, 1.127-8.395; P=0.028). There were no significant relationships between early VABF parameters and VA thrombosis. It is concluded that early VABF may predict long-term VA patency, particularly VA stenosis

Kesejahteraan Psikologis pada Guru PAUD laki-laki (Sebuah Pemaknaan diri sebagai Figur Ayah)

Guru PAUD Laki-laki memiliki peran penting dalam pendidikan, namun faktanya jumlahnya sangat sedikit. Salah satu faktornya adalah kurangnya perhatian terhadap kesejahteraan psikologis guru PAUD. Peneliti melakukan studi awal  dengan wawancara singkat dan survei dengan skala kesejahteraan psikologis terhadap guru PAUD laki-laki, dan keduanya menunjukkan hasil yang berbeda. Penelitian ini bertujuan mengkaji Kesejahteraan Psikologis guru PAUD laki-laki dengan pendekatan kualitatif fenomenologis. wawancara mendalam semi-terstruktur dan observasi dilakukan terhadap tujuh Informan yang memenuhi kriteria, Teknik analisis dengan Interpretative Phenomenological Analysis (IPA), dan uji keabsahan data dengan Triangulasi sumber, triangulasi teknik dan member check. Hasil penelitian menunjukkan Kesejahteraan Psikologis guru PAUD laki-laki sangat baik yang ditandai adanya sikap penerimaan diri yang baik, peningkatan pribadi yang positif, memiliki hubungan positif dengan orang lain dan lingkungannya, mampu mengatur hidupnya sendiri, memiliki tujuan hidup yang berorientasi pada akhirat dan memaknai dirinya sebagai figur ayah di Sekolah

Relasi Pandemi terhadap Iklim Bumi dan Pandangan Teks Suci

Tulisan ini mencoba memaparkan jejak kemunculan Covid-19 yang kini menjadi pandemi, dengan menitikberatkan pembahasan pada rusaknya ekosistem sebagai tempat tinggal satwa liaryang menjadi inang bagi virus. Krisis ekologi menjadi gerbang utama awal mula Perubahan yang drastis terhadap iklim bumi. Iklim bumi sendiri mengalami Perubahan signifikan yang tidak bisa dihindari akibat pemanasan global dan diyakini akan berdampak luas terhadap berbagai aspek kehidupan. Hal ini menjadi sebab utama merebaknya berbagai virus bahkan menyebabkan virus-virus tersebut bermutasi,yang tentunya menjadikan virus lebih kuat dan kebal terhadap berbagai vaksin.Selain dengan penjabaran yang mampu penulis suguhkan dengan berberapa sudut pandang keilmuan, keberadaan teks-teks suci juga mengingatkan danmenawarkannilai-nilai kehidupan yang oleh sebagian besar manusia mulai meninggalkannya. Penulis berupaya menyajikan prinsip-prinsip yang terkandung dalam ayat-ayat al-Quran sebagai upayaturutandil dalam mengedukasi masyarakat. Penulis juga berharap manusia menjadi khalifahsepenuhnya yang tentunya arif dan sadar akan tanggungjawab dalam menjaga, merawat, mengelola serta melestarikan segala potensi yang telah disediakan oleh Allah Swt di muka bumi

In-Vitro model for evaluation of the effects of supercooling and re-warming on vascular cells

Peripheral vascular disease can be treated by transluminal balloon angioplasty when lesions are favorable. However, the initial technical success rates are complicated by restenosis in which both endothelial cells and smooth muscle cells play a critical role. Cryoplasty, a novel form of treatment combining dilatational forces with the delivery of cold temperature to the vessel wall, has been shown to reduce the rate of restenosis. However, the underlying mechanism and the cellular response to supercooling are still poorly understood. In this study, an in vitro model was developed to examine the effect of supercooling and re-warming on cultured endothelial cell survival. Our results demonstrate that apoptosis of endothelial cells, expressed as the percentage of TUNEL-positive cells, was induced by cooling and increased during the re-warming phase.link_to_subscribed_fulltex