Endovascular treatment of iatrogenic central vein stenosis and occlusion in patients undergoing haemodialysis : a two-year follow-up

Objectives: The objective of our report was to present the results of two-year follow-up of endovascular treatment of central venous occlusive disease in haemodialysis patients. Material and methods: Eighty-one consecutive patients with central venous occlusive disease, were included into the study group. There were 81 lesions treated (42 stenosis and 39 occlusions). Percutaneous transluminal angioplasty (PTA) or percutaneous transluminal angioplasty with stenting (PTS) was committed. There was no randomisation. Stent implantation was avoided in vessels with a foreign body inside (catheter or electrode). Diagnostic phlebographies were performed after 12 and 24 months or if symptoms recurred. The follow-up period lasted for 24 months. There were 26 (70%) patients with primary stenosis and 11 (29%) with occlusion in the group with PTA therapy and 13 (38%) and 21 (61%) in the group with PTS therapy. Procedure was successful in all cases of stenosis, unsuccessful in 10 cases of occlusions. Seventeen patients died during first year of observation, 9 during the second. Two patients were lost to follow up. No serious adverse events were observed. Results: Primary patency (PP) after 12 and 24 months was 50% and 26% after PTS, 33% and 21% after PTA respectively. Primary assisted patency (PAP) was 70% and 52% in PTS group while 86% and 92% in PTA group. Secondary patency (SP) 70% and 52% after PTS to 93% and 92% after PTA. Conclusions: Both methods are safe and mildly effective in the treatment of central veins in haemodialysis patients. Both techniques should be applicable in specific clinical settings according to patient status and operator experience

Increased activity of lipoprotein-associated phospholipase A2 in non-severe asthma

Background Given increased risk of cardiovascular events in asthma we hypothesized that lipoprotein-associated phospholipase A2 (Lp-PLA2), an enzyme involved in atherosclerosis, is associated with proinflammatory and prothrombotic blood alterations in this disease. Methods In 164 adult asthmatics (63 with severe asthma) we measured plasma Lp-PLA2 activity using the PLAC test. We determined its relations to inflammation and prothrombotic blood alterations. Results In asthma, Lp-PLA2 was inversely related to the age (β = −0.1 [−0.18 to −0.02]) and was lower in women (n = 122 [74%], 205 [182–242] vs. 243 [203–262] nmol/min/ml, p = 0.001). Interestingly, Lp-PLA2 correlated negatively with the asthma severity score (β = −0.15 [−0.23 to −0.07]), being 10.3% higher in those with non-severe (mild or moderate) asthma (n = 101, 62%) as compared to the severe disease subtype (224 [191–261] vs. 203 [181–229], p = 0.006 after adjustment for potential confounders). Lp-PLA2 activity was positively related to the levels of low-density lipoprotein (β = 0.1 [0.02–0.18]), triglycerides (β = 0.11 [0.03–0.19]) and glucose (β = 0.1 [0.02–0.18]) and inversely to the tumor necrosis factor α (β = −0.27 [−0.35 to −0.2]), high sensitivity C-reactive protein (β = −0.1 [−0.19 to −0.02]) and fibrinogen (β = −0.12 [−0.21 to −0.03]), as well as prothrombin (β = −0.16 [−0.24 to −0.08]), and parameters describing thrombin generation potential, such as endogenous thrombin potential (β = −0.14 [−0.21 to −0.06]) and peak thrombin generated (β = −0.2 [−0.28 to −0.12]). Conclusions Elevated Lp-PLA2 activity in non-severe asthmatics suggests increased atherosclerotic risk in this group. Lower Lp-PLA2 activity accompanied by its inverse relationship to inflammatory or prothrombotic blood biomarkers observed in turn in severe asthmatics might be related to the pathogenesis of more severe asthma phenotype

Państwo i Społeczeństwo 2020, nr 4 Medycyna i zdrowie publiczne

Z wprowadzenia: "Z wielką przyjemnością oddaję w Państwa ręce kolejny numer „Państwa i Społeczeństwa” poświęcony medycynie i zdrowiu publicznemu. Niektórzy autorzy i recenzenci bieżącego numeru pisali swoje teksty wykorzystując kwarantannę lub – jak niżej podpisany – izolację związaną z zakażeniem COVID-19. W ten sposób można przewrotnie powiedzieć, że środowisko akademickie nie tylko nie poddaje się epidemii, ale wręcz wykorzystuje ją do działań zmierzających do rozwijania nauki, nie tylko tej związanej bezpośrednio z zagadnieniami wirusologicznymi."(...