Arterio-Venous Fistula Using Nonpenetrating Titanium Clips (VCS)

Rezumat Fistulã arterio-venoasã cu clipuri metalice nepenetrante Accesul vascular la hemodializã este însoåit în continuare de o morbiditate foarte mare. Tromboza datoratã hiperplaziei neointimale este una din principalele cauze de nefuncåionalitate a accesului vascular. Scopul lucrãrii este de a prezenta tehnica realizãrii anastomozei arterio-venoase folosind clipurile de titan nepenetrante(VCS) şi rezultatul acesteia. Material şi metodã: Pacientului K.L. de 47 ani aflat în evidenåa Clinicii de Nefrologie din 2005 pentru insuficienåã renalã cronicã i s-a efectuat în octombrie 2006 o fistulã arteriovenoasã clasicã între artera radial şi vena cefalicã a antebraåului. Aceastã fistulã nu a funcåionat motiv pentru care în ianuarie 2007 s-a efectuat anastomoza arterio-venoasã cu clipuri de titan nepenetrante între artera brahialã şi vena medianã a antebraåului. Rezultate: Anastomoza a fost realizatã în 17 minute. Dupã declamparea arterelor s-a obåinut puls şi tril la nivelul venei mediane a antebraåului şi la nivelul venei cefalice. Nu au fost complicaåii intraoperatorii şi postoperatorii imediate. La 5 sãptãmâni postoperator s-a efectuat prima hemodializã. Fistula este funcåionalã la 58 de luni de la efectuarea ei. Concluzii: Realizarea anastomozelor arterio-venoase pentru acces la hemodializã cronicã cu material nepenetrant poate fi o soluåie de reducere a complicaåiilor postoperatorii şi de prelungire a patenåei fistulelor. Cuvinte cheie: hemodializã, fistulã arterio-venoasã, clipuri de titan nepenetrante Abstract Vascular access in haemodialysis is still accompanied by a high morbidityrate. Neointimal hyperplasia due to thrombosis is one of the main causes of vascular access failure. The purpose of this paper is to present the use of non-penetrating titanium clips (VCS) forthe creation of an arteriovenous fistula and its outcome. Materials and Methods: A male patient, 47 years old, with end-stage renal disease -ESRD -(2005) was addressed to our service, for a vascular access reintervention, after a failed forearm radio-cephalic fistula performed 3 months before. In January 2007, an arteriovenousfistula between thebrachial artery and themedian cubital vein using non-penetratingtitanium clips (Anastoclip VCS) was created. Results: The vascular anastomosis was performed in 17 min. After unclamping the artery, a solid pulse and consistent thrill were obtained at the level of the cubital fossa. The postoperative course was uneventful. The arteriovenous fistula remains functional 60 months post-surgery. Conclusions: The Anastoclip VCS system is versatile, safe to manipulate and enables fast anastomosis. Arteriovenous anastomosis performed with non-penetrating clips may be a solution with the potential to reduce postoperative complications and extend arteriovenous fistula patency in ESRD

A Signal Processing Method for Assessing Ankle Torque with a Custom-Made Electronic Dynamometer in Participants Affected by Diabetic Peripheral Neuropathy

Portable, custom-made electronic dynamometry for the foot and ankle is a promising assessment method that enables foot and ankle muscle function to be established in healthy participants and those affected by chronic conditions. Diabetic peripheral neuropathy (DPN) can alter foot and ankle muscle function. This study assessed ankle toque in participants with diabetic peripheral neuropathy and healthy participants, with the aim of developing an algorithm for optimizing the precision of data processing and interpretation of the results and to define a reference frame for ankle torque measurement in both healthy participants and those affected by DPN. This paper discloses the software chain and the signal processing methods used for voltage—torque conversion, filtering, offset detection and the muscle effort type identification, which further allowed for a primary statistical report. The full description of the signal processing methods will make our research reproducible. The applied algorithm for signal processing is proposed as a reference frame for ankle torque assessment when using a custom-made electronic dynamometer. While evaluating multiple measurements, our algorithm permits for a more detailed parametrization of the ankle torque results in healthy participants and those affected by DPN

Acute effects of sedentary behavior on ankle torque assessed with a custom-made electronic dynamometer

Inactivity negatively influences general health, and sedentary behaviour is known to impact the musculoskeletal system. The aim of the study was to assess the impact of time spent in active and sedentary behaviour on foot muscle strength. In this observational study, we compared the acute effects of one day of prolonged sitting and one day of low-to-moderate level of activity on ankle torque in one group of eight healthy participants. Peak ankle torque was measured using a portable custom-made electronic dynamometer. Three consecutive maximal voluntary isometric contractions for bilateral plantar flexor and dorsiflexor muscles were captured at different moments in time. The average peak torque significant statistically decreased at 6 h (p = 0.019) in both static and active behaviours, with a higher average peak torque in the active behaviour (p < 0.001). Age, gender, body mass index and average steps did not have any significant influence on the average value of maximal voluntary isometric contraction. The more time participants maintained either static or active behaviour, the less force was observed during ankle torque testation. The static behaviour represented by the sitting position was associated with a higher reduction in the average peak ankle torque during a maximal voluntary isometric contraction when compared to the active behaviour

The additional value of patient-reported health status in predicting 1-year mortality after invasive coronary procedures: A report from the Euro Heart Survey on Coronary Revascularisation

Objective: Self-perceived health status may be helpful in identifying patients at high risk for adverse outcomes. The Euro Heart Survey on Coronary Revascularization (EHS-CR) provided an opportunity to explore whether impaired health status was a predictor of 1-year mortality in patients with coronary artery disease (CAD) undergoing angiographic procedures. Methods: Data from the EHS-CR that included 5619 patients from 31 member countries of the European Society of Cardiology were used. Inclusion criteria for the current study were completion of a self-report measure of health status, the EuroQol Questionnaire (EQ-5D) at discharge and information on 1-year follow-up, resulting in a study population of 3786 patients. Results: The 1-year mortality was 3.2% (n = 120). Survivors reported fewer problems on the five dimensions of the EQ-5D as compared with non-survivors. A broad range of potential confounders were adjusted for, which reached a p<0.10 in the unadjusted analyses. In the adjusted analyses, problems with self-care (OR 3.45; 95% CI 2.14 to 5.59) and a low rating (≤ 60) on health status (OR 2.41; 95% CI 1.47 to 3.94) were the most powerful independent predictors of mortality, among the 22 clinical variables included in the analysis. Furthermore, patients who reported no problems on all five dimensions had significantly lower 1-year mortality rates (OR 0.47; 95% CI 0.28 to 0.81). Conclusions: This analysis shows that impaired health status is associated with a 2-3-fold increased risk of all-cause mortality in patients with CAD, independent of other conventional risk factors. These results highlight the importance of including patients' subjective experience of their own health status in the evaluation strategy to optimise risk stratification and management in clinical practice

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P &lt;.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes