The feasibility and safety of sharp recanalization for superior vena cava occlusion in hemodialysis patients: A retrospective cohort study

Introduction: Hemodialysis catheter‐related superior vena cava (SVC) occlusions can cause considerable morbidity for patients and be challenging to treat if refractory to conventional guide wire transversal. This pilot study assessed the feasibility and safety of sharp recanalization of SVC occlusion in hemodialysis patients.Methods: This study retrospectively enrolled hemodialysis patients treated in West China Hospital diagnosed with SVC occlusion who failed traditional guide wire transversal from January 2014 to November 2017. In brief, a guide wire from the femoral approach was advanced to the lower end of the obstructive lesion to act as a target, while the stiff end of hydrophilic wire was advanced though a jugular approach. Under fluoroscopic guidance in biplane imaging, the occlusive SVC lesion was penetrated with the stiff wire that was snared and pulled through. Graded dilation of the SVC and subsequent tunneled‐cuffed catheter implantation were performed. Demographic information and clinical outcomes were recorded and evaluated.Findings: Sixteen patients with a mean age of 62 ± 13 years (13 females and 3 males) who received SVC sharp recanalization were included in this study. The sharp recanalization procedure was successfully performed in 14 patients (87.5%). Two patients were complicated with SVC laceration and hemopericardium but remained asymptomatic and required no surgical repair. One patient suffered ventricular fibrillation during procedure. Despite the return of spontaneous circulation, the patient unfortunately died of gastrointestinal tract bleeding after 3 days in ICU. Follow‐up suggested the 6‐month catheter patency to be 92.85% and 12‐month catheter patency to be 58.33%. No long‐term procedure‐related complications were recorded.Discussion: Sharp recanalization might be a feasible strategy in managing SVC occlusion in hemodialysis patients. The potential life‐threatening complications (cardiac arrhythmia and SVC laceration) necessitate strict eligibility screening, skillful operation, and avoidance of over‐dilation of SVC.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153765/1/hdi12804.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153765/2/hdi12804_am.pd

Multidimensional Feature Optimization Based Eye Blink Detection Under Epileptiform Discharges

Objectives: Eye blink artifact detection in scalp electroencephalogram (EEG) of epilepsy patients is challenging due to its similar waveforms to epileptiform discharges. Developing an accurate detection method is urgent and critical. Methods: In this paper, we proposed a novel multi-dimensional feature optimization based eye blink artifact detection algorithm for EEGs containing rich epileptiform discharges. An unsupervised clustering algorithm based on smoothed nonlinear energy operator (SNEO) and variational mode extraction (VME) is proposed to detect epileptiform discharges in the frontal leads. Then, multi-dimensional time/frequency EEG features extracted from forehead electrodes (FP1 and FP2 channels) combining with the improved VME (IVME) threshold are derived for EEG representation. A variance filtering method is further applied for discriminative feature selection and a machine learning model is finally learned to perform detection. Results: Experiments on EEGs of 16 subjects from the Children’s Hospital of Zhejiang University School of Medicine (CHZU) show that our method achieves the highest average sensitivity, specificity and accuracy of 95.04, 89.52, and 93.01, respectively. That outperforms 5 recent and state-of-the-art (SOTA) eye blink detection algorithms. Significance: The proposed method is robust in eye blink artifact detection for EEGs containing high-frequency epileptiform discharges. It is also effective in dealing with individual differences in EEGs, which is usually ignored in conventional methods

Kidney health in the COVID-19 pandemic: An umbrella review of meta-analyses and systematic reviews

BackgroundThis umbrella review aims to consolidate evidence from systematic reviews and meta-analyses investigating the impact of the coronavirus disease-2019 (COVID-19) on kidney health, and the associations between kidney diseases and clinical outcomes in COVID-19 patients.MethodsFive databases, namely, EMBASE, PubMed, Web of Science, the Cochrane Database of Systematic Reviews and Ovid Medline, were searched for meta-analyses and systematic reviews from January 1, 2020 to June 2, 2022. Two reviewers independently selected reviews, identified reviews for inclusion and extracted data. Disagreements were resolved by group discussions. Two reviewers independently assessed the methodological quality of all included reviews using ROBIS tool. A narrative synthesis was conducted. The characteristics and major findings of the included reviews are presented using tables and forest plots. The included meta-analyses were updated when necessary. The review protocol was prospectively registered in PROSPERO (CRD42021266300).ResultsA total of 103 reviews were identified. Using ROBIS, 30 reviews were rated as low risk of bias. Data from these 30 reviews were included in the narrative synthesis. Ten meta-analyses were updated by incorporating 119 newly available cohort studies. Hospitalized COVID-19 patients had a notable acute kidney injury (AKI) incidence of 27.17%. AKI was significantly associated with mortality (pooled OR: 5.24) and severe conditions in COVID-19 patients (OR: 14.94). The pooled prevalence of CKD in COVID-19 patients was 5.7%. Pre-existing CKD was associated with a higher risk of death (pooled OR: 2.21) and disease severity (pooled OR: 1.87). Kidney transplant recipients were susceptible to SARS-CoV-2 infection (incidence: 23 per 10,000 person-weeks) with a pooled mortality of 18%.ConclusionKidney disease such as CKD or recipients of kidney transplants were at increased risk of contracting COVID-19. Persons with COVID-19 also had a notable AKI incidence. AKI, the need for RRT, pre-existing CKD and a history of kidney transplantation are associated with adverse outcomes in COVID-19.Systematic review registrationwww.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021266300, identifier: CRD42021266300

Involvement of inflammation-related miR-155 and miR-146a in diabetic nephropathy: implications for glomerular endothelial injury

BACKGROUND: MicroRNAs have been demonstrated to play an important role in the pathogenesis of diabetic nephropathy (DN). In this study, we investigated both the repertoire of miRNAs in the kidneys of patients with DN and their potential regulatory role in inflammation-mediated glomerular endothelial injury. METHODS: The miRNA expression profiling of the renal biopsy samples was performed by a microarray analysis; then, in situ hybridization and real-time polymerase chain reaction (PCR) were used to determine the localization and expression of two of the miRNAs significantly up-regulated in human DN kidney samples, miR-155 and miR-146a, in the kidney tissues from type 1 and type 2 DN rat models. Human renal glomerular endothelial cells (HRGECs) cultured under high-glucose conditions were transfected with miR-155 and miR-146a mimics, and the transforming growth factor (TGF)-β1, tumor necrosis factor (TNF)-α, and nuclear factor (NF)-κB expressions were examined by western blot, real-time PCR, and an electrophoresis mobility shift assay. RESULTS: The expression of both miR-155 and miR-146a was increased more than fivefold in the kidney samples of the DN patients compared with the controls, and the miR-155 expression was closely correlated with the serum creatinine levels (R = 0.95, P = 0.004). During the induction and progression of the disease in type 1 and type 2 DN rat models, miR-155 and miR-146a were demonstrated to increase gradually. In vitro, high glucose induced the over-expression of miR-155 and miR-146a in the HRGECs, which, in turn, increased the TNF-α, TGF-β1, and NF-κB expression. CONCLUSIONS: Taken together, these findings indicate that the increased expression of miR-155 and miR-146a in the DN patients and in the experimental DN animal models was found to contribute to inflammation-mediated glomerular endothelial injury