A Review of Patients with Renal Disease Undergoing Vascular Access Surgery: Is Gray-scale Ultrasound Enough?

Background An adequate fistula or graft is essential to long-term survival and quality of life for patients with end-stage renal disease (ESRD) who are receiving hemodialysis because of its lower complication rates, lower costs, and prolonged patency. Use of duplex ultrasound for preoperative planning is currently recommended by the Kidney Disease Outcomes Quality Initiative for patients with ESRD with prior fistulas or grafts, central lines, pacemakers, and prior chest or arm surgery. The preoperative evaluation consisted of gray-scale ultrasound and physical examination in all patients with ESRD in this study. The current study determined the baseline data, including the type of vascular access, functional patency of access, associated morbidity, and preoperative demographics and comorbidities, including prior dialysis access. The primary objective was to determine the frequency of revision surgery, to identify the potential cases that may indicate the need for better assessments (eg, duplex ultrasound), and to improve fistula and graft success rates. Materials and methods A retrospective chart review of patients with ESRD who underwent native fistula or graft access creation in a 13-month time period from 2010 to 2011 was completed. Seventy-six surgical procedures were performed on 53 subjects. Included variables were age, race, gender, smoking status, body mass index, stage of chronic kidney disease at referral, previous central lines/pacemakers, fistulas, or grafts. Comorbidities identified included diabetes mellitus (DM), hypertension (HTN), and coronary artery disease (CAD). The types of access, location, maturation, infection, failure, or revision were noted. Continuous variables are shown in frequencies and mean. Categoric data were compared using chi-square analysis. Results During the 13-month study period, 76 surgical procedures were performed in 53 patients, with 39.6% of patients undergoing multiple surgical procedures. The majority of patients were male (98%) and white (58.5%), with a history of HTN (96.2%) and DM (64.2%). The mean age was 68 years, with most patients presenting in stage 5 chronic kidney disease (92.5%). Some 67.9% of patients had prior central lines or pacemakers; of those, 56.6% had previous fistulas or grafts. Negative significance was determined between the comorbidities DM/HTN/CAD alone or grouped as a cohort and multiple surgeries. Positive significance was found between multiple surgical procedures and those with prior access/ pacemaker/central line (chi-square [1, N = 53] = exact P = .04). Conclusions Patients with ESRD undergoing access creation presenting with prior central lines, pacemakers, or arm surgery (fistulas or grafts) were more likely to undergo multiple surgeries to obtain a functional graft or fistula for hemodialysis use than those patients with ESRD without prior central lines, pacemakers, or arm surgery (fistulas or grafts). Color duplex ultrasound should be considered as a standard for preoperative assessment in an effort to improve fistula or graft success rates

Determination of water and lipid-soluble arsenic compounds in the commercial edible seaweed Hijiki (Hizikia fusiforme)

Se presentan los resultados obtenidos en los estudios de especiación de arsénico realizados sobre el alga comestible Hijiki. Los análisis se realizaron a través de métodos analíticos desarrollados en la UPM (España) y en la Universidad de Graz (Austria). La determinación de especies hidrosolubles se realizó mediante HPLC-(UV)-HG-AFS, previa extracción mediante MAE con agua desionizada. Por otro lado, la identificación y cuantificación de arsenolípidos se llevó a cabo mediante HPLC-ICPMS/ESMS, previa extracción con cloroformo:metanol y purificación mediante SPE

Rituximab efficacy in pediatric patients with refractory nephrotic syndrome

Background: Nephrotic syndrome (NS) in children is a disease of glomerular filtration barrier failure, manifesting with severe proteinuria leading to hypoalbuminemia, hypercholesterolemia, and generalized edema. it could be primary or secondary. In primary NS, also known as idiopathic NS, the histological findings of Primary NS include minimal change disease which mainly respond to steroids (steroid sensitive NS), focal segmental glomerulosclerosis which are usually steroid resistant or membranous nephropathy. Rituximab has been shown to be effective for patients with complicated FRNS/SDNS and refractory SRNS. While the incidence of nephrotic syndrome (NS) is increasing, the morbidity of difficult-to-treat NS is significant.Methods: This is a retrospective cohort study that took place in King Abdulaziz University Hospital from 2012 to 2016. Patients included: Any patient under 18 years, and diagnosed with steroid resistant and dependent nephrotic syndrome. Patients excluded: Any patient above 18 years, and known to have secondary Nephrotic Syndrome.Results: Present study consists of 24 children with nephrotic syndrome (NS) were recruited in the study. In the population 8 patients (33.33 %) were diagnosed with SDNS, while the other 16 patients (66.67%) were diagnosed SRNS. Also, patients who were treated with Rituximab we found that (the mean) number of relapses per year before rituximab was about 2.67±1.49 (standard deviation 1.49), while patient who relapsed after rituximab was about 1.09±1.38 (standard deviation 1.38).Conclusions: Rituximab is a biological agent that started to be widely used in difficult nephrotic syndrome cases. The effectiveness of rituximab is most observed in steroid depended nephrotic syndrome patients since it decreases the frequency of relapses and steroid dependency. However, it has been shown that it is less effective in steroid resistant nephrotic syndrome cases and was associated with significant numbers of relapses

European Journal of Neurology / Healthier rhythm, healthier brain? : Integrity of circadian melatonin and temperature rhythms relates to the clinical state of braininjured patients

Background Healthy circadian rhythmicity has been suggested to relate to a better state of braininjured patients and to support the emergence of consciousness in patient groups characterized by a relative instability thereof such as patients with disorders of consciousness (DOC). Methods Going beyond earlier studies, a systemslevel perspective was adopted and, using multilevel modelling, the joint predictive value of three indices of circadian rhythm integrity derived from skin temperature variations, melatoninsulfate secretion, and physical activity (wrist actigraphy) patterns was evaluated for the behaviourally assessed state [Coma Recovery Scale Revised (CRSR) score] of DOC patients [13 unresponsive wakefulness syndrome; seven minimally conscious (exit) state]. Additionally, it was assessed in a subset of 16 patients whether patients behavioural repertoire (CRSR score) varied (i) with time of day or (ii) offset from the body temperature maximum (BTmax), i.e. when cognitive performance is expected to peak. Results The results reveal that better integrity of circadian melatoninsulfate and temperature rhythms relate to a richer behavioural repertoire. Moreover, higher CRSR scores are, by trend, related to assessments taking place at a later daytime or deviating less from the prespecified time of occurrence of BTmax. Conclusions In conclusion, the results suggest that therapeutic approaches aimed at improving circadian rhythms in braininjured patients are promising and should be implemented in hospitals or nursing homes. Beyond this, it might be helpful to schedule diagnostic procedures and therapies around the (preassessed) BTmax (4 pm in healthy individuals) as this is when patients should be most responsive.W 1223G16Y00777(VLID)354656