bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethnographic perspectives on the mediation of informality between people and plans in urbanising China
Authors: Smart Alan
Published: January 2018

In this introduction to some of the themes of this special issue on People and plans in urbanising China, I draw on Herbert Gans’ prescient comments about the importance of informality in mediating between plans and the various groups of people, users and planners, who shape their formation and implementation. Informality is even more important in the governance of cities in China. Comparing contemporary Chinese cities with Hong Kong, I suggest that informal responses, both in society and within government, can produce significant changes in plans that may increase the effectiveness or appropriateness of urban governance. Careful ethnographic research is required, however, in order to access the subtle and non-public nature of such interactions and their consequences. This commentary draws out some of the themes from articles included in this special issue, and highlights how informality intersects with plans and the people who create them and are influenced by them.
The ideological alignment of smart urbanism in Singapore: Critical reflections on a political paradox
Authors: Kong Lily , Woods Orlando
Published: January 2018

Over the past decade, much has been written about the potential of smart urbanism to bring about various and lasting forms of betterment. The embedding of digital technologies within urban infrastructures has been well documented, and the efficiencies of smart models of urban governance and management have been lauded. More recently, however, the discourse has been labelled ‘hegemonic’, and accused of developing a view of smart technology that is blinkered by its failure to critique its socio-political effects. By focusing on the case of Singapore’s ‘Smart Nation’ initiative, this paper embraces the paradoxes at the heart of smart urbanism and, in doing so, interrogates the tension between ideology and praxis, efficiency and control, access and choice, and smart governance and smart citizenship. It also demonstrates how such tensions are (re)produced through ‘fourthspace’ – the digitally enabled spaces of urbanism that are co-created, and that contribute to an expansion and diffusion of social and political responsibility. It ends by suggesting how such spaces have the potential to radically transform not just the urban environment, but also the role of government and citizens in designing urban futures.
Everything That Is Old Is New Again—Old Again—New Again . . .
Authors: Paparozzi Mario A. , Guy Roger
Published: January 2018

Since the decade of the 1970s, the policies and practices in probation, parole, and community corrections have vacillated between an emphasis on rehabilitation and enforcement, and most recently back to rehabilitation. While these paradigmatic shifts in ideology are driven by top management, generally at the behest of elected officials who are concerned with burgeoning costs and the desire not to appear soft on crime, it is what is done in everyday practice at the “street level” that determines if change actually occurs and is interpreted. This essay discusses probation and parole practices with regard to fluctuations in emphasis on the offender rehabilitation and law enforcement functions of probation and parole officers.
“I Never Would Have Caught That Before”: Pharmacist Perceptions of Using Clinical Decision Support for Antimicrobial Stewardship in the United States
Authors: Giuliano Christopher A. , Binienda Juliann , Kale-Pradhan Pramodini B. , Fakih Mohamad G.
Published: January 2018

To systematically improve the appropriateness of antibiotic prescribing, antimicrobial stewardship programs have been developed. There is a paucity of literature examining how pharmacists perform antimicrobial stewardship using a clinical decision support system in a hospital setting. The purpose of this qualitative study was to develop a model exploring how pharmacists perform antimicrobial stewardship to identify areas for programmatic improvement. Semistructured interviews were conducted across a health care system until saturation of themes was reached. Pharmacists identified that self-efficacy and time were vital for antimicrobial stewardship to be performed, while culture of the hospital and attitude facilitated the process of stewardship. Antimicrobial stewardship programs using clinical decision support tools should ensure pharmacists have adequate time to address rules, provide easy-to-use resources and training to support self-efficacy, and engage influential physicians to support a culture of collaboration.
When Family Gets in the Way of Recovery
Authors: Belmontes Kelly C.
Published: January 2018

Alcohol and substance use often results in the individual experiencing social and interpersonal problems. Among many of the factors that impact alcohol and substance use, relationships can be part of the problem or the solution. Support systems are considered to be a key ingredient of effective treatment. Unfortunately, the individual’s social system may not be, either intentionally or unintentionally, supportive of the individual’s recovery. In an effort to address this challenge to an individual’s recovery, motivational interviewing principles and practices can be applied to families and other social systems that are ambivalent to changing problematic behaviors that may be negatively impacting the individual’s recovery or substance use cessation goals.
The Ash Split Cath™ as Long-Term IJ Access: Hydraulic Performance and Longevity
Authors: Ash S.R. , Mankus R.A. , Sutton J.M. , Spray M.
Published: January 2018

A prospective observational study was performed to determine the duration of use of the Ash Split Cath placed as primary or bridge access in ESRD patients; 164 ESRD patients received a Split Cath in the IJ location, with transcutaneous placement guided by ultrasound. Mean follow-up time was 19.3 months (maximum up to 48 months). During the follow-up, there were 36 catheter failures resulting in removal, 53% due to infection and the others due to outflow failure or break (leak) of the catheter. By Kaplan-Maier analysis 82% of placed catheters were functional at 12 months and half-life of catheter duration was 26 months. Blood flow rates during dialysis were not distinguishable between IJ catheter patients and those with functioning grafts or fistulas. Function, safety and duration of use of the Split Cath in the IJ location all compare favorably to AV grafts.
Are Ambulatory Femoral Catheters for Hemodialysis a Safe Vascular Access?
Authors: Gerasimovska V. , Oncevski A. , Dejanov P. , Polenakovic M.
Published: January 2018

Femoral catheterization is fast and simple and associated with a low risk of complications. Those which occur can usually be managed easily. Femoral catheters are usually kept in place for a short period of a few days. We, instead, used femoral catheters (FC) as a temporary vascular access for a longer period of time (until the permanent vascular access matured) in inpatients and in outpatients on regular ambulatory hemodialysis who had a problem with their permanent access. We analyzed 59 patients with end-stage renal disease treated with hemodialysis (HD), divided into two groups. Of the group that started with hemodialysis (group I), only 16 patients were hospitalized during the maturation of native arterio-venous fistula (AVF). Duration time of the catheters was 15–47 days (average 32 days). The second group (group II) comprised 43 patients going on regular ambulatory hemodialysis who were discharged from hospital with femoral catheters. Duration time of catheters in this group was 13–183 days (average 44.2 days). Catheters were removed when AVF matured, or if a significant complication occured. We took blood culture from peripheral vein (BCP) and from catheter (BCC) on removal of the catheter, or when we suspected infection. Catheter tips (CT) were also sent for microbiological analysis. We monitored the clinical signs of infection. We compared microbiological results of BCP, BCC and CT from the two groups using chi-square test and we did not find any significant difference among the three types of findings (p<0.05). The FC was removed from one patient only from group II because of suspicion of catheter-related infection. Two pts were treated with antibiotics (AB) systemically and locally (AB was “locked” in the catheter) because of febricity. When the catheters were removed the microbiological findings were sterile. We concluded that FC can be used without any problem for a longer period of time for ambulatory HD, with the provision of permanent care from a team specially trained for vascular access.
Diagnosis of Intra Vascular Catheter-Related Infection
Authors: Cicalini S. , Palmieri F. , Noto P. , Boumis E. , Petrosillo N.
Published: January 2018

The use of central vascular catheters (CVC) is associated with a substantial number of complications, amongst which infections predominate. A diagnosis of CVC-related infection usually requires catheter removal for culture. Semiquantitative (roll-plate method) and quantitative methods (flush, vortex, centrifugation or sonication methods) are the most reliable diagnostic methodologies requiring catheter removal, because of their greater specificity. The roll-plate method is the simplest and most commonly used technique. This method only samples the external surface of the catheter, and is particularly indicated for recently inserted catheters in which extraluminal colonisation is the primary mechanism of infection. Luminal culture techniques, such as the quantitative methods, may be more relevant for catheters that have been in place for a long period of time. However, in up to 85% of removed CVC the culture is negative, and other diagnostic techniques that do not require catheter removal have been proposed, including paired quantitative blood cultures, endoluminal brushing, and differential time to positivity (DTP) of paired blood cultures. DTP, that compares the time to positivity for qualitative cultures of blood samples simultaneously drawn from the CVC and a peripheral vein, appears to be the most reliable in the routine clinical practice since many hospitals use automatic devices for qualitative blood culture positivity detection. More recently catheter-sparing direct diagnostic methods, which include Gram stain and acridin-orange leucocyte cytospin (AOLC) test, appeared to be especially useful because of the rapidity of results and the ability to distinguish different microorganisms, allowing early targeted antimicrobial therapy.
Roman Tunnelling Tool
Authors: Canzi M. , De Baz H. , Roman F.
Published: January 2018

The aim of this paper is to present an instrument that helps to create a subcutaneous path for central catheters used for hemodialysis, as well as a non traumatic internal introduction of Tesio's catheters and other systems (Dacron cap). We have designed a tunneling tool which consists of a solid but light weight hand set, connected to an extension that ends with an olive shape dilator to be connected to a trocar. Thus, precise tunneling is guaranteed through a non traumatic procedure, allowing exact anchorage of catheters.
Vascular Screening Prior to Placement of Tunnelled and Cuffed Hemodialysis Catheters
Authors: Falk A. , Lookstein R. , Uribarri J. , Shen C. , Teodorescu V. , Vassalotti J.A.
Published: January 2018

Purpose

To demonstrate the importance of venous vascular screening before the placement of tunneled and cuffed hemodialysis catheters in patients requiring hemodialysis prior to placement and/or maturation of an arteriovenous fistula (AVF) or graft (AVG).

Methods

Between October 1998 and March 2000, all patients requiring hemodialysis access placement were prospectively evaluated with duplex ultrasound for status of upper extremity vessels and central veins prior to selection of a permanent access site. When interim tunneled and cuffed hemodialysis catheters were required, they were placed on the side contralateral to proposed AVF/AVG placement. No catheters were placed without initial vascular screening. The study group was compared to historical controls during a similar period (April 1997 through September 1998) when no vascular screening was performed.

Results

During the study period, 234 screening duplex ultrasound examinations were performed in 244 patients. Ten patients required no screening prior to access site placement. Overall, 353 catheters were placed, 243 (69%) on the right side and 110 (31%) on the left side. During the control period, 394 catheters were placed in 255 patients, 306 (78%) right-sided and 88 (22%) left-sided. The increase in left-sided catheters with ultrasound screening and careful planning for future access sites was significant (p<0.01).

Conclusion

Vascular-screening-directed catheter placement significantly alters the side of catheter placement when compared to a management protocol without prior screening. Such screening helps identify the side of permanent access placement, while directing interim catheters to the contralateral side such that central veins may be preserved for permanent access.
Steal Syndrome after Brachiocephalic Fistula for Vascular Access: Correction with a New Simple Surgical Technique
Authors: Henriksson A.E. , Bergqvist D.
Published: January 2018

Purpose

Steal syndrome is the condition of arterial insufficiency distal to a permanent haemodialysis fistula. Three treatment options have been recommended: ligation of the fistula, banding of the fistula, and distal revascularization. We report an alternative simple surgical technique for correction of steal syndrome.

Methods

Two patients were treated for steal syndrome after brachiocephalic fistula operation. The treatment of the steal syndrome was done by interponating an ePTFE graft loop tunnelated subcutaneously in the upper arm.

Results

At follow-up one year later both fistula were patent without any reoperation and with normal flow at haemodialysis. There were no symptoms of steal.

Conclusion

This new method for correction of steal syndrome seems to be an attractive alternative.
ProCol® Vascular Bioprosthesis for Vascular Access: Midterm Results
Authors: Hatzibaloglou A. , Velissaris I. , Kaitzis D. , Grekas D. , Avdelidou A. , Kiskinis D.
Published: January 2018

Background/Aims

This study aimed to evaluate the safety and efficacy of the ProCol, vascular bioprostheses as vascular access (VA) material, especially in patients with a history of prior failed access.

Methods

During a 20-month period, 25 arteriovenous (AV) bovine vein grafts were placed in 24 hemodialysis (HD) patients for VA. All patients presented with failed autologous access sites.

Results

Graft placement was successful in all patients with no procedure-related complications. Follow-up from 6–26 months gave primary 6-month, 12-month and 24-month patency rates of, respectively, 90%, 80% and 70%. Graft characteristics in cannulation and hemostasis were very satisfying.

Conclusion

Our midterm results demonstrated that the ProCol, vascular bioprosthesis was a promising material for VA with good patency and low complication rates.
New Graft for Low Friction Tunneling in Vascular Access Surgery
Authors: Schild A.F. , Baltodano N.M. , Alfieri K. , Livingstone J. , Raines J.K.
Published: January 2018

Purpose

Prosthetic accesses of the upper extremity have been in use for more than 25 years. Many different conduits have been employed; investigators have continually searched for a graft with superior properties.

Methods

We describe a prospective randomized study comparing the new Slider Graft (Atrium) with the Hybrid PTFE Graft (Atrium); the latter has been used for a number of years. The Slider Graft is also made of PTFE. For this study, both grafts were 6 mm in diameter and 40 cm in length. The Slider Graft has a low friction polyethylene sheath over its entire length. This sheath expedites the passage of the graft through the tunnel. At one end, the graft and the polyethylene sheath are attached to a metal tip. This tip has male threads, which may be inserted firmly into a Kelly Wyck, Atrium, or any standard non-sheath tunneling system. This alleviates graft separation, turning, and slipping during tunneling. The primary objective of this trial was to determine the safety and efficacy of the Slider Graft as compared to the Hybrid Graft in vascular access surgery. The secondary objective was to evaluate how tunneling effects graft performance. We randomized 60 subjects for this study with two equal arms. During surgery we measured various parameters including ease of tunneling, tunnel bleeding, anastomotic bleeding, graft sweating, and immediate patency. To assess arm edema we measured circumference 7.5 cm and 20 cm above the wrist, prior to surgery and in follow-up visits at 1 week, 1 month, and 3 months. Primary patency was also assessed at these visits and at 6, 9, and 12 months.

Results

Our results show tunneling with the Slider Graft is easier to accomplish (p = 0.0001) with reduced tunnel bleeding (p = 0.0047) and anastomotic bleeding (p = 0.042). Further, the Slider Graft virtually eliminated the complication of graft sweating and seroma development (p = 0.0005). This may be due to reduced stretching and graft wetting during insertion. At 180 days the Slider Graft demonstrated improved primary patency, which was statistically significant (p = 0.047). At 360 and 720 days the Slider Graft continued to demonstrate a trend toward improved primary patency (p = 0.160).

Conclusions

This study suggests the Slider Graft has significant advantages when compared to the Hybrid Graft and highlights the importance of tunneling in creating prosthetic accesses.
Salvage Insertion of Tunneled Central Venous Catheters in the Internal Jugular Vein after Accidental Catheter Removal
Authors: Bellasi A. , Brancaccio D. , Maggioni M. , Chiarelli G. , Gallieni M.
Published: January 2018

Purpose

Tunneled catheters are widely used for intermediate to long-term hemodialysis (HD) access, but are prone to several complications that can require catheter replacement. Replacing malfunctioning catheters with a new line, placed in a different access site, can lead to problems with multiple vein occlusions. This has led many nephrologists to continue using the same vein as long as possible by guidewire catheter exchanges, to preserve other veins for future use. We describe a guidewire exchange technique for the Ash-Split catheter in the internal jugular vein.

Methods

In three patients, the exchange was performed because of partial catheter removal, as evidenced by the outward dislocation of the Dacron cuff. In these patients, the guidewire was inserted through the catheter. In two additional patients, the catheter had been completely removed by accident: the replacement of the dislodged tunneled venous catheters was attempted 5 hr and 1 day after accidental removal. In these patients, the guidewire was inserted through the previous tunnel. After guidewire placement, a skin incision was made in the supraclavicular region. The metal guidewire was easily located inside the fibrous structure that had previously surrounded the catheter. The guidewire was then extracted from the subcutaneous tunnel and used to insert a new catheter safely and easily after creating a new tunnel. Patients were routinely given antibiotic prophylaxis (1 g of cefazolin) immediately before the procedure. A strict aseptic technique was used, including several sterile glove changes.

Results

No infections developed following this procedure, which has the potential for bacterial contamination. All procedures were successful. Only in one patient did we have to convert to a different catheter: it was not possible to replace the old Ash-Split catheter with the same dual-lumen catheter because of difficulties in inserting the peel away introducer-catheter complex. In this patient, rather than forcing it with larger dilators or trying to disrupt the fibrin sheath with balloon dilatation, a single lumen Tesio catheter was successfully placed. In both patients who completely lost the previous catheter, the guidewire was readily reinserted through the subcutaneous tunnel into the vein. Catheter function was excellent in all patients, with a test blood flow rate on the 1st catheter use >350 ml/min.

Conclusions

We described a new method for catheter exchange, which allows the easy insertion of a new catheter and the creation of a new and safer subcutaneous tunnel. In addition, we demonstrated that in cases of complete catheter removal, it is possible to reinsert a catheter in the same vein through a guidewire, even when reinsertion was attempted up to 1 day later.
In vitro and in vivo hemocompatibility evaluation of graphite coated polyester vascular grafts
Authors: Arabi H. , Mirzadeh H. , Ahmadi S.H. , Amanpour S. , Rabbani S. , Abdi A.
Published: January 2018

Attempts have been made in this study to prepare a homogeneous and stable coating of graphite on polyester vascular grafts (GPVG) using an electrophoresis method to evaluate thromboresistant and blood compatibility of GPVG in comparison to non-coated PVG and InterGard (collagen sealed PVG) as control.

Lactate dehydrogenase (LDH) activity measurement was carried out on all PVG types to evaluate platelet adhesion. To examine tissue reaction GPVG and non-coated sheets of knitted polyester fabric were implanted simultaneously in the dorsal flank of rats subcutaneously. The GPVG, non-coated and control were implanted in descending aorta as end-to-end or end-to-side implantation substitution in 25 sheep for 4–60 weeks.

Results showed that the graphite coating on polyester vascular grafts reduced the number of adherent platelets and prevent platelet activation and spreading on the surface in comparison with non-coated and control. Pathological investigation showed inflammatory reactions were totally resolved after 12 weeks and there was no difference in the tissue reaction between graphite coated, non-coated and control patches. All grafts remained patent and there was no significant difference in patency rate between these three types of PVG. We found that GPVG has no need for pre-clotting and it showed lower platelet aggregation, thinner capsule formation and lower calcification after 15 months. However, suturing of GPVG was more difficult in comparison with the other types.
Right Atrial Thrombi Complicating use of Central venous Catheters in Hemodialysis
Authors: Shah A. , Murray M. , Nzerue C.
Published: January 2018

Background

There has been an increase in the use of central venous catheters for temporary hemodialysis access. In this report, we describe a case series of 12 patients on hemodialysis who developed intracardiac clots associated with the use of central venous catheters, their outcomes and review the literature on this syndrome.

Methods

Retrospective, single-center case series of 12 patients with right atrial thrombi associated with central venous catheter use for dialysis vascular access. These patients were treated between June 1, 2001 and June 30th 2002 at the three University of Rochester affiliated dialysis clinics. The medical records of these patients were reviewed to obtain information concerning demographics, dialysis history, dates of catheter insertion, catheter complications, identification and dimensions of intracardiac thrombi, echocardiographic data, and outcome of anticoagulant therapy.

Results

Right heart thrombi were identified in 12 patients in our hemodialysis population over the study interval. Anticoagulation for 6 months led to clot resolution in more than 50% of our patients. Bacteremia recurred in 6 patients (50%), in spite of catheter replacement. There was zero mortality related to presence of clots in the short term. One patient with non-bacteremic right atrial thrombus suffered sudden cardiac arrest, but was successfully resuscitated.

Conclusion

Right atrial thrombi may occur in hemodialysis patients who use central venous catheters for dialysis access. These clots are frequently found in the right atrium or right atrial-superior vena caval junction. Ten of 12 patients (83%), had catheter-associated bacteremia, but the precise relationship between bacteremia and intracardiac clots is unclear. Chronic anticoagulation for 6 months lead to resolution of these clots in more than 50% of patients in our series.
Tunneled Double-Lumen Silicone Hemodialysis Catheter Placement in Three Patients with Permanent Pacemaker Wires: A Case Study
Authors: Sombolos K.I. , Christidou F.N. , Bamichas G.I. , Anagnostopoulos T.C. , Rudenko I.I. , Gionanlis L.C. , Natse T.A.
Published: January 2018

Permanent pacemaker wires have been described as a cause of central vein stenosis. Furthermore, in hemodialysis (HD) patients with transvenous pacemakers, permanent vascular access (VA) created at the ipsilateral arm is not always successful. We report the use of tunneled double-lumen silicone HD catheters, as permanent VA in three HD patients wearing permanent transvenous pacemakers. In one patient, the catheter was inserted ipsilateral to the pacemaker site. Catheter-related infections were the most significant complications.
Continuous low volume delivery of intravenous treprostinil via a central venous catheter with a miniature pump in a conscious dog model
Authors: Laliberte K. , Jerat S. , Tenneson K. , Wade M. , Zaccardelli D.
Published: January 2018

Purpose

Two animal studies were conducted to determine the feasibility of infusing treprostinil via a central venous catheter at an infusion rate of 0.1 mL/hour. Currently treprostinil is administered intravenously at infusion rates of approximately 1.0 to 2.0 mL/hour to patients with pulmonary arterial hypertension, which reflects standard clinical practice to ensure line patency with continuous intravenous administration via a central venous catheter.

Methods

In a pilot study three male beagle dogs were administered 50 ng/kg/min of treprostinil continuously at an infusion rate of 0.1 mL/hr via the MiniMed 407C infusion pump for 21 days. In a definitive study, six male beagle dogs were administered 50 ng/kg/min of treprostinil continuously at an infusion rate of 0.1 mL/hr via the MiniMed 407C infusion pump for 60 days. In both studies “no delivery” pump alarms were documented throughout the study in addition to pharmacokinetic data at specified time points.

Results

There were no documented occlusions in the 21-day pilot study. In the 60-day study one animal had a documented catheter occlusion after 16 days of therapy. Following re-implantation with a new catheter this animal did not have any additional occlusions for 40 days. No other animals in this study had any significant problems. In both studies, pharmacokinetic data were similar to that observed in previous animal studies evaluating treprostinil administration at the same dose and at higher infusion rates.

Conclusion

These animal data support the evaluation of administering treprostinil at a low infusion rate via the MiniMed 407C infusion pump in patients with pulmonary arterial hypertension.
Needle stick injuries: How can we minimise our risk?
Authors: Gabriel J.
Published: January 2018

In the United Kingdom (UK) there is inequity in health care workers access to safer sharps and needle free systems. The availability of safer sharps and needle free systems is dependent on the budget manager authorising the purchase of these devices within individual hospitals. This can mean that within the same organisation one department can be using safer sharps and needle free systems, while another department is denied access to such equipment. This is partly due to competing priorities for scarce health care resources, which is becoming more acute, and lack of national guidance to employers to provide such safety equipment for their employees. At the current time the UK does not have a mandatory reporting system for sharps injuries, so the true extend of the problem is not fully understood.
Ultrasound Guided Brachial Arterial Angioplasty during the Creation of a Radio-Cephalic Arteriovenous Fistula: A Case Report
Authors: Napoli M. , Montinaro A. , Russo F. , Valletta A. , De Pascalis A. , Proia S. , Aprile M. , Alfonso L. , Patruno P. , Buongiorno E.
Published: January 2018

To prevent arteriovenous fistula (AVF) early failure, due to radial or brachial artery stenosis, ultrasound guided angioplasty performed while surgically creating the AVF could be an effective procedure.

Case report

A 76-year-old diabetic male patient, on hemodialysis (HD) for 15 months, presented extensive thrombosis of the radio-cephalic AVF at the right arm, which had lasted for about 10 days. Ultrasound examination showed a 40% brachial artery stenosis with eccentric calcified plaque. The stenosis was localized about 1.5 cm before the artery bifurcation. The brachial artery diameter was 0.45 cm before and 0.26 cm at the level of the stenosis, the latter being 0.45 cm long. At the left wrist, under local anesthesia, the radial artery and the cephalic vein were exposed; the radial artery was then longitudinally incised for 7–8 mm in the area selected to create the AVF. A 6 Fr introducer, a metallic guide wire and a catheter for angioplasty were inserted one after the other in the radial artery. When the correct position of the angioplasty catheter in the stenotic area was established by ultrasound examination, the balloon was blown up to 13 atm for 35 sec, reducing the stenosis from 40–20%. Finally, a side-to-side radio-cephalic fistula was created, legating the distal vein. The AVF was used for HD after 3 weeks. The follow-up at 6 months demonstrated fair access performance and it was used without problems. Our satisfactory experience suggests that ultrasound guided angioplasty of brachial artery stenosis, performed simultaneously with surgical AVF creation, is possibly a successful procedure. This technique reduces the risk of early AVF failure and also allows, when required, stent implantation.
Comparison of access blood flow and venous pressure measurements as predictors of arteriovenous graft thrombosis
Authors: Singh N. , Ahmad S. , Wienckowski J.R. , Murray B.M.
Published: January 2018

Purpose

The purpose of the present study was to prospectively compare the predictive accuracy of static venous pressure (SVP); dynamic venous pressure (DVP) and access blood flow (ABF) in determining subsequent graft thrombosis and/or failure.

Methods

This study included 43 patients with functional arteriovenous grafts (AVG's) who underwent monthly serial measurements of SVP, DVP and ABF for 3 consecutive months. Patients were then followed for an additional 6 months. The primary end point was graft thrombosis.

Results

Six patients were excluded from the final analysis. Of the 37 patients completing the study, 7 episodes of graft thrombosis occurred within 6 months of follow up. Neither SVP nor DVP exhibited satisfactory sensitivity or specificity for graft thrombosis. Ten patients either began with or developed an ABF < 600 during the 3 months of measurements, but only 5 clotted. Δ ABF of >20% provided the best combination of sensitivity (86%) and specificity (90%) for graft thrombosis. In AVG's that have an ABF<600, it is those grafts with falling ABF that appear most likely to clot in the short term.

Conclusion

The study supports the concept that it is a falling level of access flow rather than the absolute level that is the most potent predictor of graft thrombosis.
The brachio-brachial arteriovenous fistula: a new method in patients without a superficial venous system in the upper limb
Authors: Dorobantu L.F. , Stiru O. , Iliescu V.A. , Novelli E.
Published: January 2018

Purpose

This study aimed to report our experience in the creation of brachio-brachial arteriovenous fistulas (AVFs) in patients without adequate superficial venous circulation at the upper limb.

Methods

A retrospective study of 33 patients, operated on between 2004–2005, in whom we created a brachio-brachial fistula between the brachial artery and the brachial vein. After dissection and adequate mobilization, the brachial vein was anastomized to the brachial artery in an end-to-side fashion. After the maturation period (1 month) the brachial vein was transposed into the subcutaneous tissue.

Results

Thirty-three patients underwent 33 brachio-brachial fistula constructions. Primary patency was achieved in all patients. After 1 month, 27 fistulas (81.8%) were functional. Six patients developed fistula occlusion. The 27 remaining patients had subsequently good fistulas for hemodialysis (HD) afterwards. Discrete edema of the forearm was noted in 12 patients (36%); in one of these patients the edema was extended to the entire arm. No other complications were noted. A follow-up study, extended from 3–26 months (mean 14 ± 6.6 months), was performed. The overall patency rate of the brachio-brachial fistula at the end of the follow-up was 85.2%.

Conclusions

The brachio-brachial fistula can represent a viable choice in patients with an inadequate superficial venous system in the upper limb.
Median nerve bisection: a morbid complication of a peripherally inserted central catheter
Authors: Alomari A.I. , Falk A.
Published: January 2018

Considering the reported safety, efficiency, and low cost of peripherally inserted central catheters (PICCs), they are increasingly preferred to central venous catheters for short-term delivery of medical therapies. Here, we report a case of severe median nerve bisection during PICC placement via a brachial vein. While such nerve damage is uncommon, the case indicates that when the brachial vein is selected as an access site over the basilic and cephalic veins, caution should be exercised during PICC placement since the brachial vein traverses in close proximity to the median nerve.
Implementing a Health Home: Michigan’s Experience
Authors: Prokop Jackie , LaPres Marie , Barron Brad , Villasurda Jon
Published: January 2018

As the number of individuals in the United States with chronic conditions and the associated costs in caring for these individuals continues to rise, there is a need to transform how health care services are delivered. Under Section 2703 of the Affordable Care Act of 2010, the federal government provides state Medicaid programs the opportunity to improve care coordination for people with chronic conditions in a person-centered approach through the establishment of health homes. Given the complexity of care for Medicaid beneficiaries with chronic conditions, addressing the social determinants of health and providing integrated care are central to effectively improving health outcomes and generating cost-savings. Although launching a health home model is a step toward improving care coordination and care management for high-risk individuals, there are myriad components to implementing such a program. The purpose of this article is to explain the process that Michigan policymakers undertook to implement its Section 2703 Medicaid health home initiative, named the MI Care Team. The authors present lessons learned for policymakers and stakeholders in other states seeking to implement a Medicaid health home and explain how the nursing profession is integral for health homes.
Strength analysis and tooth shape optimization for involute gear with a few teeth
Authors: Sun Qiang , Sun Yuehai , Li Lun
Published: January 2018

As a result of the inadequate carrying capacity and poor meshing performance of gears with a few teeth, the reasonable and optimal choice of parameters is a key step in design. Aiming at this problem, the stress equation for gear pairs with a few teeth was derived and it is discovered that the main failure mode of gears with a few teeth is pitting on contacting surface. At the same time, the results of theoretic analysis were also verified by strength test. A new optimization method of parameters which aimed at minimizing the contact stress was presented based on equal bending fatigue life at the tooth root of pinion and gear. The equation was solved by the genetic algorithm and reasonable design parameters are obtained. Tooth contact analysis based on finite element method is carried out and the results demonstrated that the method presented was an effective way to enhance the carrying capacity and meshing performance of gear pair with a few teeth. The study in this article laid a solid foundation for the further promotion of gear transmission with a few teeth.
Serum Levels of Leptin in Multiple Myeloma Patients and Its Relation to Angiogenic and Inflammatory Cytokines
Authors: Alexandrakis M.G. , Passam F.H. , Sfiridaki A. , Pappa C.A. , Moschandrea J.A. , Kandidaki E. , Tsirakis G. , Kyriakou D.S.
Published: January 2018

Background

Leptin, apart from the regulation of food intake, has been implicated in hematopoiesis, the immune response and angiogenesis. Leptin has been found to be decreased in various hematological malignancies. In the present study leptin was measured in multiple myeloma (MM) patients before and after treatment and correlated with other angiogenic molecules and markers of disease activity.

Methods

Serum leptin, vascular endothelial growth factor (VEGF), basic fibroblast growth factor (b-FGF), interleukin-1 beta (IL-1β), beta 2 microglobulin (β2M) and C-reactive protein (CRP) were measured in 62 newly diagnosed MM patients, 22 of whom obtaining disease stabilization after treatment. The same parameters were measured in 20 healthy controls. Disease stage was defined according to the Durie-Salmon criteria.

Results

Leptin, VEGF, b-FGF, IL-1β, and β2M were significantly higher in newly diagnosed MM patients than in controls (p<0.05). VEGF, b-FGF, IL-1β, β2M, CRP but not leptin increased with advancing stage of disease (p<0.01). All parameters decreased significantly following treatment (p<0.001). Although IL-1β correlated positively with VEGF, β2M, b-FGF and CRP, leptin did not correlate with any of the measured parameters.

Conclusion

Leptin serum levels do not reflect disease severity in MM. However, there seems to be a decrease in leptin following treatment, which may be associated with an alteration in the metabolic state or the chemokine milieu.
High Levels of Urinary Vascular Endothelial Growth Factor in Women with Severe Preeclampsia
Authors: Roes E.M. , Steegers E.A.P. , Thomas C.M.G. , Geurts-Moespot A. , Raijmakers M.T.M. , Peters W.H.M. , Sweep C.G.J.
Published: January 2018

Elevated plasma VEGF concentrations in preeclampsia are associated with local placental ischemia and endothelial dysfunction. We investigated the urinary VEGF excretion in women with severe preeclampsia (n=37) and its relation with proteinuria compared to that in healthy pregnant (n=32) and non-pregnant women (n=30). In women with severe preeclampsia VEGF levels were 54.0 (19.9–192.4) ng/mmol creatinine, significantly (p<0.0001) higher than levels in pregnant controls (28.2 (6.7–63.0) ng/mmol creatinine) and non-pregnant controls (29.5 (10.1–59.1) ng/mmol creatinine). Proteinuria was not significantly correlated with urinary VEGF levels. In conclusion, high urinary VEGF concentrations in severe preeclampsia might reflect increased renal production of VEGF rather than elevated VEGF levels in the systemic circulation.
Serum Levels of Tumor Necrosis Factor Alpha Correlate with Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer
Authors: Berberoglu U. , Yildirim E. , Celen O.
Published: January 2018

It has been shown that serum levels of tumor necrosis factor alpha (TNF-α) are increased in breast cancer patients. There are few data available on the reduction of serum levels of this cytokine following chemotherapy. The aim of this study was to determine the effect of neoadjuvant chemotherapy on serum concentrations of TNF-α and the relation to response rates in locally advanced breast cancer. Twenty consecutive patients with non-inflammatory stage III-B breast cancer achieving a partial or complete clinical response to three courses of neoadjuvant chemotherapy followed by modified radical mastectomy were prospectively included in the study and evaluated. Sera were collected before the start and after the termination of chemotherapy. Serum concentrations of TNF-α were measured by an ELISA method. The pathological response rates were also evaluated and recorded. The control group consisted of 12 healthy age-matched women. The mean pre-treatment TNF-α value of breast cancer patients was 15.9±0.9 pg/mL while it was 5.8±1.7 pg/mL in the control group; the difference was statistically significant (p<0.0001). The serum levels of TNF-α were markedly decreased in patients with partial and complete responses compared to pre-treatment values (p<0.0001). There was also a difference in TNF-α levels in patients with partial vs complete responses (p<0.0001). The relative change between pre- and post-treatment values correlated significantly with the type of response (p=0.004). These results suggest that the serum concentration of TNF-α can be an indicator of response and could be used in clinical decision-making for patients with locally advanced breast cancer.
Possible Involvement of Prolactin in Endocrine-Resistant Metastatic Prostate Cancer
Authors: Lissoni P. , Bignami A. , Frontini L. , Manganini V. , Dapretto E. , Gardani G.S. , Viganò P. , Strada G.
Published: January 2018

The hormone resistance of prostate cancer has been proved to depend at least in part on enhanced neuroendocrine activity and the resultant increase in blood concentrations of chromogranin A. Other experimental observations have suggested the involvement of prolactin (PRL), which appears to be a potential growth factor for prostate cancer. Abnormally high levels of PRL have been detected in metastatic prostate cancer, but the clinical significance of this finding has still to be clarified. In an attempt to explain the prognostic significance of serum PRL levels in prostate cancer, in this preliminary study we have analyzed the PRL levels in a group of metastatic prostate cancer patients with hormone-dependent or hormone-resistant cancer. The study included 50 patients with metastatic prostate cancer, 15 of whom had hormone-resistant tumors. The serum levels of PRL were measured by the RIA method. Abnormally high concentrations of PRL were found in 11/50 (22%) patients. Moreover, the percent of patients with cancer-related hyperprolactinemia was significantly higher in the hormone-resistant group than in the hormone-dependent group (8/15 vs 3/35, p<0.01). This study confirms the possible existence of a hyperprolactinemic state in metastatic prostate cancer, as previously reported by other authors. Moreover, it appears to demonstrate that the occurrence of hyperprolactinemia is more frequent in hormone-resistant neoplasms, suggesting the possible involvement of PRL in hormone independence. Further studies concomitantly evaluating PRL and chromogranin A blood concentrations will be necessary to establish whether the hyperprolactinemia precedes and promotes the onset of hormone resistance in prostate cancer, or whether it is simply a consequence of the hormone independence.
Usefulness of Prostate-Specific Antigen Nadir as Predictor of Androgen-Independent Progression of Metastatic Prostate Cancer
Authors: Morote J. , Esquena S. , Abascal J.M. , Trilla E. , Cecchini L. , Raventós C.X. , Orsola A. , Planas J. , Catalín R. , Reventós J.
Published: January 2018

The objective of this study was to analyze the value of the nadir level of prostate-specific antigen (PSA) to predict androgen-independent progression (AIP) in metastatic prostate cancer patients after androgen deprivation therapy. In a group of 185 metastatic prostate cancer patients who received androgen deprivation therapy serum PSA was determined every three months until AIP occurred. Multiple regression analysis was performed to define independent clinical and PSA-related predictors of AIP. AIP was assumed to be present after two consecutive increases in serum PSA after the PSA nadir. Independent predictors of the duration of AIP-free survival (less than 12 months versus more than 12 months) were the extent of bone involvement (six or fewer hot spots versus more than six) with an odds ratio (O.R.) of 3.95, Gleason score (7 or less versus more than 7) with an O.R. of 3.47, and PSA nadir (2 μg/L or less versus more than 2 μg/L) with an O.R. of 14.63. AIP was independently predicted by the extent of bone involvement with an O.R. of 1.72, Gleason score with an O.R. of 1.74, PSA nadir with an O.R. of 3.22, and time to reach the PSA nadir (9 months or less versus more than 9 months) with an O.R. of 2.84. When patients were stratified according to these predictors, those with three good prognostic factors had a median AIP-free survival of 58 months while those with two, one or no good prognostic factors had a median AIP-free survival of 19 months, 12 months and 7 months, respectively. We conclude that the PSA nadir seems to be a good predictor of AIP in patients with metastatic prostate cancer after androgen deprivation therapy. Time to PSA nadir, extent of bone involvement and Gleason score are also independent predictors. The combination of these prognostic factors allows to stratify metastatic prostate cancer patients for the prediction of AIP.
Highly Conserved Sequence of Exon 15 BRAF Gene and KRAS Codon 12 Mutation among Greek Patients with Colorectal Cancer
Authors: Symvoulakis E.K. , Zaravinos A. , Panutsopulos D. , Zoras O. , Papalambros E. , Sigala F. , Spandidos D.A.
Published: January 2018

Background

The RAS/RAF/MEK/MAP kinase pathway is essential to intracellular signaling transduction regulating cell proliferation, differentiation and death. We investigated the occurrence of exon 15 BRAF and KRAS codon 12 mutations among Greek patients with colorectal cancer.

Methods

Sixty-one samples from patients with sporadic colorectal adenocarcinomas were studied for exon 15 BRAF mutations. DNA from surgically resected specimens was analyzed by a combination of polymerase chain reaction and direct sequencing. KRAS codon 12 mutational analysis was technically possible in 58 samples (58/61) by a combination of polymerase chain reaction and restriction fragment length polymorphism.

Results

No exon 15 BRAF mutations were detected in any of the colon cancer specimens. The frequency of KRAS codon 12 mutations was 29.3% (17/58). Patients aged <70 years more frequently presented carcinomas harboring KRAS codon 12 mutations than patients aged >70 years (p=0.028). Patients between 61 and 70 years of age were more likely to be carriers of this mutation (p=0.040).

Conclusions

Despite the limited study sample, our data suggest that BRAF mutations might be present less frequently than KRAS mutations in Greek patients with colorectal carcinomas. Further research involving larger patient series will be necessary to confirm these findings and to assess possible ethnic, environmental and lifestyle influences on BRAF and KRAS mutagenesis.