bluuebunny/crossref_metadata_2025 huggingface dataset:
Sero-Prevalence of Rubella Virus among Pregnant Women in Kaduna State Nigeria 2015
Authors: Gubio Aishatu , Olonitola Steve , Jattau Edward , Mukhtar Maryam
Published: May 2017

ObjectiveTo determine the IgM and IgG antibodies of rubella viruscirculating among pregnant women in Kaduna State Nigeria.IntroductionRubella virus causes -“German measles,” also known as “three-daymeasles.” This is usually a milder disease than red measles. Red/Hardmeasles or just measles is caused by Rubeola virus. The result of acuteinfection of the virus is a benign systematic rash which is significantlypathogenic to humans. This virus is a, positive-strand RNA virus thatreplicates in the cytoplasm of the infected cell.(Brooks et al., 2007).If placental infection of the virus spread during 8-10 weeks gestationit causes a chronic infection of the fetus leading to the developmentof congenital rubella syndrome (CRS) (Matthewset al., 2011) Theeffect of the infection of the several organ systems which include theeyes, ears, heart, brain, and endocrine system is known as congenitalrubella infection (CRI) (Chantleret, al.,2001)Rubella is endemic in Nigeria. Studies among women of childbearing age in Nigeria put seroprevalence at 66.6% in Imo, 77% inLagos and 93.5% in Oyo (8-10). Thus as part of the control measure,the availability of an effective vaccine to prevent Rubella infectionand therefore CRS, is necessary to evaluate the burden of disease ina country where MMR vaccine is not covered in the immunizationschedule or in vaccination strategyMethodsA cross-sectional study carried out on pregnant women attendingante-natal clinic from the three different senatorial district in Kadunastate. Blood samples were screened for rubella IgM & IgG antibodyusing commercially produced enzyme linked immunosorbent assay(ELISA), Questionnaires were administered to obtain demographicinformation and possible risk factors associated with rubella virus.Data was analzyed using Epi Info 6 Version 3.5.3.ResultsOf the 900 pregnant women screened, 572(63.3%) were positivefor rubella IgG. The prevalence of rubella IgG was highest among theage group 21-25 with 198(34.6%) and IgM was highest among theage group 21-25(51.3%). The IgG test results shows that 317 (66.0%)pregnant women tested positive for their first trimester, while the IgMpositive results shows 17(33.3%) for their first trimester. Although thesouthern senatorial district had the highest seroprevalence 14(35.9%)among the three centres, the differences were not statisticallysignificant (p>0.05). Only 3 people claimed to have been vaccinatedagainst rubella virus. Acquisition of primary education and being ahouse wife were insignificantly associated with raised titres. (p>0.05).ConclusionsThe serological evidence of rubella virus found in pregnant womenamong age group & their first trimester in this study is an indicationthat rubella is prevalent in Nigeria. It is however still necessary toimmunize seronegative women against rubella before they getpregnant.
The Factors That Affect To Attract Deposits in Palestinian Islamic Banks
Authors: Jaber Amer Saadi , Manasrah Mohammed Shuaib
Published: May 2017

This study aims to identify the factors that affect to attract deposits in Palestinian Islamic banks. The researcher used the descriptive approach to reach the results and recommendations of the study. The study society is a branches manager of Islamic banks operating in Palestine. The sample was the Sam of study society; because the small size of study society. It found that there is a relation between the geographical location of the branches of Islamic banks, advertising campaigns and promotion, diversification, development of services, experience of bank staff, and attracting deposits in Islamic banks in Palestine.The study recommended that the Islamic banks in Palestine continuously provide savings campaigns to increase deposits, and must choose locations based on the recommendations of branch managers and the involvement of marketing departments. In addition, they should increase investment in human resources in terms of training, qualification. And work to provide them with the necessary skills to attract customers.
Workplace Safety and Health Conditions and Facilities in Small Industries in Jeddah, Saudi Arabia
Authors: Ahmad Ijaz , Balkhyour Mansour A. , Abokhashabah Tariq M. , Ismail Iqbal M. , Rehan Mohammad
Published: May 2017

A lot of attention has been paid to improving occupational safety and health (OSH) in small scale industries all over the globe. This study describes the outcomes of a preliminary OSH status assessment in small scale industries of motor vehicle repair workshops (MVRW) in Jeddah, Kingdom of Saudi Arabia (KSA). An inspection tool composed of 10 OSH elements and 62 items employed walk-through survey, observations and interviews. The mean positive responses for different OSH elements surveyed were as follows; personal protective equipment (PPEs) (43%), emergency preparedness (49%), fire protection (60%), facilities (80%), general workshop safety (43%), housekeeping (17%), chemical exposure (12%), services and maintenance (57%), mechanical handling (81%) and tool safety (63%). However, special concerns were found for OSH elements including; use of PPE’s, emergency preparedness, general workshops safety, housekeeping and exposures to chemicals as having safety score less than 50%. OSH elements with lower positive responses at surveyed workshops would be addressed through further monitoring and training of technical and administrative staff. This preliminary survey will form the basis of a more comprehensive study for evaluation of an accurate representative OSH status in small scale industries in KSA.
Contact Patch to Rim Distance: The Quintessential Tool for Metal-On-Metal Bearing in Vivo Performance Analysis – a Review
Authors: Le Duff Michel J. , Ebramzadeh Edward , Amstutz Harlan C.
Published: May 2017

With metal-on-metal (MoM) bearings, fluid film lubrication is disrupted when the contact patch area between the femoral head and the cup is close to the edge of the acetabular component, making the calculation of the contact patch to rim (CPR) distance a key variable in the study of the performance of MoM bearings. A few research centers have used models of varying complexity to calculate the CPR distance and determine its relationship with assessments of component wear. In this review, we aimed to summarise the current knowledge related to the application of CPR distance calculations in the study of in vivo performance of MoM bearings. Our systematic search of the US National Library of Medicine yielded 9 relevant publications in which 3 different models were used for the computation of the CPR distance. The 3 models show different levels of complexity and their use is mainly dependent upon the size of the subject sample and the nature of the data collected as a dependent variable. The studies reviewed consistently showed a strong inverse correlation between CPR distance and wear or metal ion levels suggesting that any study aiming to determine the risk factors for MoM hip devices needs to include an assessment of CPR distance. Cup anteversion can be measured reliably with various tools and should not be an obstacle to the use of this essential variable that is CPR distance.
Effects of Fecal Sampling on Preanalytical and Analytical Phases in Quantitative Fecal Immunochemical Tests for Hemoglobin
Authors: Rapi Stefano , Berardi Margherita , Cellai Filippo , Ciattini Samuele , Chelazzi Laura , Ognibene Agostino , Rubeca Tiziana
Published: May 2017

Background

Information on preanalytical variability is mandatory to bring laboratories up to ISO 15189 requirements. Fecal sampling is greatly affected by lack of harmonization in laboratory medicine. The aims of this study were to obtain information on the devices used for fecal sampling and to explore the effect of different amounts of feces on the results from the fecal immunochemical test for hemoglobin (FIT-Hb).

Methods

Four commercial sample collection devices for quantitative FIT-Hb measurements were investigated. The volume of interest (VOI) of the probes was measured from diameter and geometry. Quantitative measurements of the mass of feces were carried out by gravimetry. The effects of an increased amount of feces on the analytical environment were investigated measuring the Hb values with a single analytical method.

Results

VOI was 8.22, 7.1 and 9.44 mm3 for probes that collected a target of 10 mg of feces, and 3.08 mm3 for one probe that targeted 2 mg of feces. The ratio between recovered and target amounts of devices ranged from 56% to 121%. Different changes in the measured Hb values were observed, in adding increasing amounts of feces in commercial buffers.

Conclusions

The amounts of collected materials are related to the design of probes. Three out 4 manufacturers declare the same target amount using different sampling volumes and obtaining different amounts of collected materials. The introduction of a standard probes to reduce preanalytical variability could be an useful step for fecal test harmonization and to fulfill the ISO 15189 requirements.
Clinical, Biomechanical and Morphological Assessment of Anterior Cruciate Ligament Kevlar®-Based Artificial Prosthesis in Rabbit Model
Authors: de la Garza-Castro Santiago , González-Rivera Carlos E. , Vílchez-Cavazos Félix , Morales-Avalos Rodolfo , Barrera-Flores Francisco J. , Elizondo-Omaña Rodrigo E. , Soto-Dominguez Adolfo , Acosta-Olivo Carlos , Mendoza-Lemus Oscar F.
Published: May 2017

Background

The aim of this study was to evaluate the clinical, biomechanical and morphological characteristics of a Kevlar®-based prosthetic ligament as a synthetic graft of the anterior cruciate ligament (ACL) in an experimental animal model in rabbits.

Methods

A total of 27 knees of rabbits randomly divided into 3 groups (control, ACL excision and ACL replacement with a Kevlar® prosthesis) were analyzed using clinical, biomechanical and morphological tests at 6, 12 and 18 weeks postprocedure.

Results

The mean displacement in mechanical testing was 0.73 ± 0.06 mm, 1.58 ± 0.19 mm and 0.94 ± 0.20 mm for the control, ACL excision and ACL replacement with synthetic prosthesis groups, respectively. The results showed an improvement in the stability of the knee with the use of the Kevlar® synthetic prosthesis in the biomechanical testing (p<0.05) compared with rabbits that underwent ACL excision, in addition to displacements that were larger but comparable to that in the control group (p>0.05), between the replacement group and the control group. The histological study revealed a good morphological adaptation of the synthetic material to the knee.

Conclusions

This study proposes a new animal model for the placement and evaluation of Kevlar®-based synthetic ACL implants. The studied prosthesis showed promising behavior in the clinical and biomechanical tests and in the histological analysis. This study lays the foundation for further basic and clinical studies of artificial ACL prostheses using this material.
Effects of Surfactants on the Preparation of MnO2 and its Capacitive Performance
Authors: Sun Yin , Dang Hangfei , Huang Naibao , Wang Dongchao , Liang Chenghao
Published: May 2017

Amorphous hydrated manganese dioxide (MnO2) was prepared as an electrode material for supercapacitors by liquid co-precipitation in the presence of polyvinylpyrrolidone (PVP), polyethylene glycol (PEG) and sodium dodecylbenzenesulfonate (SDBS) respectively. The obtained samples were characterized by x-ray diffraction (XRD), field emission scanning electron microscopy (FE-SEM), high-resolution transmission electron microscopy (HRTEM), and electrochemical methods. Physical characterizations confirmed that the addition of surfactants played an important role in the preparation of MnO2. The specific surface areas of MnO2 with the addition of PEG, SDBS and PVP were 169.92 m2/g, 137.40 m2/g and 196.64 m2/g, respectively, and the corresponding capacitances were 207.9 F/g, 187.5 F/g and 238.7 F/g. Compared with the sample without surfactants, the specific surface area and capacitance of the sample with the addition of PVP were improved by 92.2% and 53.1%, respectively. Moreover, the electrode showed good cycle stability at the current density of 120 mA/g, and 91.1% of its specific capacitance still remained after 500 cycles. It was concluded that this performance improvement was attributed to the electrostatic stabilization of the multivariate alkyl residue and cyano group (—NCO) as anchoring group, as well as the steric hindrance effect from lateral polarity groups of pentabasic ring in PVP structure.
Use of a Combination of CEA and Tumor Budding to Identify High-risk Patients with Stage II Colon Cancer
Authors: Du Changzheng , Xue Weicheng , Dou Fangyuan , Peng Yifan , Yao Yunfeng , Zhao Jun , Gu Jin
Published: May 2017

Background

High-risk patients with stage II colon cancer may benefit from adjuvant chemotherapy, but identifying this patient population can be difficult. We assessed the prognosis value for predicting tumor progression in patients with stage II colon cancer, of a panel of 2 biomarkers for colon cancer: tumor budding and preoperative carcinoembryonic antigen (CEA).

Methods

Consecutive patients (N = 134) with stage II colon cancer who underwent curative surgery from 2000 to 2007 were included. Multivariate analysis was used to evaluate the association of CEA and tumor budding grade with 5-year disease-free survival (DFS). The prognostic accuracy of CEA, tumor budding grade and the combination of both (CEA-budding panel) was determined.

Results

The study found that both CEA and tumor budding grade were associated with 5-year DFS. The prognostic accuracy for disease progression was higher for the CEA-budding panel (82.1%) than either CEA (70.9%) or tumor budding grade (72.4%) alone.

Conclusions

The findings indicate that the combination of CEA levels and tumor budding grade has greater prognostic value for identifying patients with stage II colon cancer who are at high-risk for disease progression, than either marker alone.
Trigger Point Injections for Pelvic Floor Myofascial Spasm Refractive to Primary Therapy
Authors: Fouad Lina S. , Pettit Paul D. , Threadcraft Marcus , Wells Ali , Micallef Audrey , Chen Anita H.
Published: May 2017

Introduction

A retrospective chart review was conducted of visual analog scale (VAS) scores completed before and after trigger point injections (TPIs) for pelvic floor myofascial spasm to evaluate response.

Methods

Sixty-eight female patients who underwent TPIs from October 9, 2007 to March 12, 2015 were included. The primary end point was the difference between scores. Secondary analyses were conducted for patients who needed repeat TPIs. Descriptive and paired t test analyses were used.

Results

The key result was an improvement in VAS scores for 65% (44/68) of patients (p<0.0001). The median pre-injection VAS score was 7 (1 to 10), (mean 6.3). The median post-injection VAS score was 4 (0 to 9), (mean 4.3). The median difference between scores in patients who improved was 3 (1 to 8), (mean 3.6). Seventeen of 68 (25%) patients needed repeat TPI, and the median time between injections was 1.5 months (1 to 7 months), (mean 2.2 months). When analyzing pre-injection VAS scores in patients who underwent subsequent repeat injection when compared to patients who did not require repeat injection, there was no difference (p = 0.32). In addition, the differences between pre- and post-injection VAS scores in the patients who underwent repeat injection and those who did not was not significant (p = 0.26).

Conclusions

We report on 68 women who underwent TPIs, with an improvement in VAS pain scores in 65%. It appears that TPIs for pelvic floor myofascial spasm are successful in reducing pain scores for patients who are refractory to primary therapy.
Frequency, Complications and Outcomes of Myomectomy in Reproductive Age Women: Retrospective Analysis and Expert Opinion
Authors: Popov Alexander A. , Fedorov Anton A. , Loginova Ekaterina A.
Published: May 2017

The incidence of uterine fibroid in the general female population is estimated at 20%-25%. In 2008, a study involving 145 gynecologists from a few large Russian cities demonstrated that the majority of the respondents had to handle from 10 to 30 (mean 20) women with fibroid every month. Only 28.8% of the patients had newly diagnosed uterine fibroids. Surgical treatment was recommended to 29.8% of the women. A few variants of myoma treatment are distinguished. Fortunately, over 40% of these tumors are asymptomatic. We performed a retrospective analysis of 218 patients submitted to myomectomy in our medical center between 2011 and 2013. In 149 cases (68%) myomectomy was conducted as a step of preparation for pregnancy. The pregnancy rate was 51.6%. A single (1.3%) complication in the form of uterine scar rupture was documented in week 34 of pregnancy. In our opinion, myomectomy is a high-technology operation that must be performed strictly based on the principle of “best” surgery for the “best” patient.
Managing Systemic Sclerosis-Related Interstitial Lung Disease in the Modern Treatment Era
Authors: Volkmann Elizabeth R. , Chung Augustine , Tashkin Donald P.
Published: May 2017

Interstitial lung disease (ILD) affects the majority of patients with systemic sclerosis (SSc) and is the leading cause of death in SSc. Traditionally, treatments for SSc-ILD have targeted broad suppression of the immune system with agents such as cyclophosphamide and mycophenolate. The recently published Scleroderma Lung Study (SLS) II demonstrated that treatment with either oral cyclophosphamide or mycophenolate led to similar improvement in lung function, dyspnea and radiographic extent of fibrosis. However, with the emergence of anti-fibrotic therapy for the treatment of idiopathic pulmonary fibrosis, the repurposing of biologic agents used to treat other connective tissue diseases, and the introduction of hematopoetic stem-cell transplantation for patients with early diffuse SSc, options for managing SSc-ILD have increased. For the first time ever, patients and physicians have choices for how to treat SSc-ILD. At the same time, the study and administration of these novel therapeutic agents have raised important clinical research questions that warrant further investigation. This review describes the current and experimental therapies available for SSc-ILD. This review also explores unanswered questions directly relevant to patient care and future research efforts in this area, including questions on indications for initiation of SSc-ILD therapy, the use of maintenance SSc-ILD therapy and the duration of SSc-ILD therapy. Conducting studies designed to answer these important questions is central to advancing SSc-ILD research and improving outcomes for patients with this devastating disease.
Initiation of antiplatelet medication after surgical thrombectomy jeopardized arteriovenous graft longevity
Authors: Yeh Chi-Hsiao , Huang Ting-Shuo , Wang Yao-Chang , Huang Pin-Fu , Huang Tzu-Yen , Chen Tzu-Ping , Yin Shun-Ying
Published: May 2017

Introduction

The efficacy of antiplatelet agents in preventing thrombosis in newly formed arteriovenous graft (AVG) in hemodialysis (HD) patients has been extensively examined. The aim of this study was to investigate the possible effect of initiation of antiplatelet medications on preventing AVG thrombosis recurrence after surgical thrombectomy for acute occlusion in HD patients. Whether post-operatively antiplatelet medications have protective effects on the patency or longevity of AVG after surgical thrombectomy in HD patients has not been investigated.

Methods

We conducted a 4-year quasi-randomized study of the unassisted patency and AVG longevity for 213 HD patients with or without initiating antiplatelet drugs after receiving surgical thrombectomy for first episode of acute AVG thrombosis.

Results

From the propensity-score-matched quasi-randomized study, initiation of antiplatelet drugs after first surgical thrombectomy in HD patients did not prevent the recurrence of surgical thrombectomy (log-rank p = 0.81), but significantly decreased the longevity of the access (log-rank p = 0.034). Multivariate Cox model demonstrated that prescription of antiplatelet drugs significantly increased the risk of graft failure (adjusted hazard ratio 2.13, p = 0.025).

Conclusions

Adjunctive prescription with antiplatelet medications in HD patients after surgical thrombectomy did not prevent recurrent thrombosis of AV access, but significantly jeopardized the longevity of AVG after surgical thrombectomy.
Regional versus local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis
Authors: Ismail Ammar , Abushouk Abdelrahman Ibrahim , Bekhet Amira H. , Abunar Osama , Hassan Omar , Khamis Ahmed A. , Al-sayed Mohamed , Elgebaly Ahmed
Published: May 2017

There is a consensus in the literature that regional anesthesia (RA) improves local hemodynamic parameters in comparison to local anesthesia (LA) during arteriovenous fistula (AVF) surgical construction. However, the effects of both techniques on fistula patency and failure rates are still controversial. The aim of this meta-analysis is to synthesize evidence from published randomized trials and observational studies regarding the safety and efficacy of RA versus LA in AVF surgical construction. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central retrieved six randomized trials (462 patients) and one retrospective study (408 patients). Pooling data using RevMan software (version 5.3) showed that RA was superior to LA in terms of primary fistula patency rate (RR = 1.22, 95% CI [1.08, 1.37], p = 0.0010); however, both types were comparable in terms of primary fistula failure rate (RR = 0.81, 95% CI [0.47, 1.40], p = 0.46). In comparison to LA, RA was associated with improved hemodynamic parameters including fistula blood flow (MD = 25.08, 95% CI [19.40, 30.76], p<0.00001), brachial artery diameter (SMD = 2.63, 95% CI [2.17, 3.08], p<0.00001), and outflow venous diameter (SMD = 0.93, 95% CI [0.30, 1.75], p = 0.004). Postoperative complications were comparable between both groups (OR = 0.23, 95% CI [0.05, 0.97], p = 0.05). In conclusion, RA was associated with higher primary patency rates of AVF and improved local blood flow in comparison to LA; however, both procedures were comparable in terms of primary failure rates and postoperative complications. Larger well-designed trials with longer follow-up periods should compare both techniques in terms of long-term patency rates and safety outcomes.
Primary and secondary patencies of transposed femoral vein fistulas are significantly greater than with the HeRO graft
Authors: Ladenheim Eric D. , Lulic Dzenan , Lum Craig , Agrawal Sid
Published: May 2017

Introduction

For access-challenged patients with bilateral upper extremity central venous stenosis, solutions include the Hemodialysis Reliable Outflow (HeRO) device or an autogenous AV fistula in the lower limb. We evaluated HeRO grafts and transpositions of the femoral vein in maintaining primary and secondary patency.

Methods

We retrospectively analyzed 40 patients with a HeRO device and 18 patients with superficial femoral artery to transposed femoral vein autogenous arteriovenous fistula (SFA-tFV). All patients had bilateral central venous obstruction. All procedures were outpatient performed by a single surgeon at one center between 2009-2015. Operative details, intraoperative flows, and flows at the first-week postoperative visit were analyzed, as were primary and secondary patency and intervention rates. Complications were compared between groups.

Results

The one-year cumulative primary patency was 30% for HeRO grafts and 79% for SFA-tFV fistulas (p = 0.0001); secondary patency was 71% for HeRO grafts and 93% for SFA-tFV fistulas (p = 0.03). To maintain patency, HeRO patients required a mean 2.1 interventions per year and thigh fistula patients required a mean 0.4 interventions per year. Thirty-seven percent of thigh fistula patients had a hematoma or seroma versus 5% of HeRO patients and 17% of thigh fistula patients experienced delayed wound healing versus 2.5% of HeRO patients (p<0.05). None of the thigh fistula patients had distal ischemia.

Conclusions

HeRO patients had lower primary and secondary patency rates versus thigh fistula patients and HeRO grafts required five-fold more interventions to maintain secondary patency. However, patients with thigh fistulas had significantly more wound healing problems. Thus, the SFA-tFV has become our access of choice for patients with bilateral central venous stenosis.
The hemostatic efficacy of chitosan-pads in hemodialysis patients with significant bleeding tendency
Authors: Misgav Mudi , Lubetszki Ahron , Brutman-Barazani Tami , Martinowitz Uri , Kenet Gili
Published: May 2017

Background

Patients on chronic hemodialysis often have acquired coagulopathy that can aggravate bleeding from puncture site after needle extraction. Chitosan-based pads have been reported to accelerate hemostasis even in the presence of coagulopathy. The aim of this study was to evaluate the hemostatic efficacy of the chitosan pads compared to gauze pads, applied for local hemostasis.

Methods

A crossover study in a cohort of patients on hemodialysis with extended time to hemostasis after needle extraction. At the end of each dialysis, either gauze or chitosan pad was applied on both access points (arterial and venous). The type of pad was changed in the next dialysis all together 5 times in each patient (10 applications per patient for every pad).

Results

A total of 288 applications, 144 for each type of pad, were performed in 15 patients. The average time to hemostasis for the entire group was significantly shorter with the chitosan pads compared to the regular gauze pads (“arterial” point 3 vs. 18.5 min, p<0.001 “venous” access 2.8 vs. 13.2 min, p<0.001, respectively).

Conclusions

Chitosan pads significantly reduce time to hemostasis and should be considered for the treatment of accessible bleeds in patients with coagulopathy.
Advanced age is not a barrier to creating a functional arteriovenous fistula: a retrospective study
Authors: Beaulieu Monica C. , Dumaine Chance S. , Romann Alexandra , Kiaii Mercedeh
Published: May 2017

Introduction

Arteriovenous fistulas (AVFs) are the recommended form of vascular access for hemodialysis. However, controversy exists regarding whether AVFs are suitable for elderly patients.

Methods

Single-center retrospective review to investigate the impact of age on AVF outcomes. Five hundred and twenty-five patients with AVF creation were stratified based on age <65, 65-75, and >75 years. AVF outcomes including primary failure, AVF patency (primary, secondary, and functional), and AVF complications were studied for 3 years following AVF creation.

Results

The cohort was 63% male, 44% Caucasian, and 55% had diabetes or cardiovascular disease. 39% were aged <65 years, 33% 65-75 years, and 28% were aged >75 years. No differences in rates of primary failure, loss of primary patency, complications, or need for intervention were observed between age groups. There was a significant association of age with secondary patency and functional patency, with age >75 being an independent risk factor for shortened lifespan of the fistula. For patients aged >75 years, secondary patency at 3 years was 64% compared to 75%-78% for younger patients. Functional patency at 2 years was 69% for those aged >75 years compared to 78%-81% for younger patients.

Conclusions

We found no difference in AVF maturation, primary patency, complications, or interventions in those over the age of 75 compared to younger counterparts. While secondary and functional patency rates were significantly lower in those aged >75 years, the magnitude of difference is likely not clinically relevant. Therefore, we recommend that advanced age alone should not preclude patients from AVF creation.
Ultrasound-Guided Costoclavicular Approach Infraclavicular Brachial Plexus Block for Vascular Access Surgery
Authors: Beh Zhi Yuen , Hasan Mohd Shahnaz
Published: May 2017

Introduction

We report the use of a newly described regional technique, ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for surgical anesthesia in two high-risk patients undergoing 2nd stage transposition of basilic vein fistula.

Methods

Both patients had features of difficult airway, American Society of Anesthesiologists (ASA) physical status class III and central venous occlusive disease. The common approach, i.e., ultrasound-guided supraclavicular brachial plexus block was technically difficult with inherent risk of vascular puncture due to dilated venous collaterals at the supraclavicular area possibly compromising block quality. The risk of general anesthesia (GA) was significant as patients were morbidly obese with possible risk of obstructive sleep apnea postoperatively. As an alternative, we performed the ultrasound-guided costoclavicular approach infraclavicular brachial plexus block with 20 mL local anesthetic (LA) ropivacaine 0.5% delivered at the identified costoclavicular space using in-plane needling technique. Another 10 mL of LA was infiltrated along the subcutaneous fascia of the proximal medial aspect of arm.

Results

Both surgeries of >2 hours’ duration were successful, without the need of further local infiltration at surgical site or conversion to GA.

Conclusions

Ultrasound-guided costoclavicular approach can be an alternative way of providing effective analgesia and safe anesthesia for vascular access surgery of the upper limb.
Persistent Left Superior Vena Cava and Partially Left Inferior Vena Cava: A Case Report of a Dangerous Central Venous Catheterization
Authors: Ricciardi Biagio , Ricciardi Carlo Alberto , Lacquaniti Antonio , Carella Giuseppe , Puzzolo Domenico , Pisani Antonina , Di Mauro Debora , Micali Antonio
Published: May 2017

Background

The coexistence of a double superior vena cava (SVC) and a partially left inferior vena cava (PLIVC) with a circumaortic collar, associated with other congenital malformations, was not described previously.

Case Description

We present a 33-year-old woman in hemodialysis with complete exhaustion of the brachial routes for vascular access, admitted to our Nephrology Unit for a long-term central venous catheter (CVC) implant, usually by us performed under EchoScopic Technique (EST), an echographic venipuncture followed by continuous radioscopic control of guidewire and catheter in all the steps of implant. An intraoperative venography showed a complete stop of right internal jugular vein, a right SVC, a persistent left SVC, a left inferior vena cava in the iliac and subrenal tracts, a circumaortic venous collar in the renal tract, and normal right suprarenal and hepatic tracts.

Conclusions

The double SVC was related to the persistence of the caudal part of the anterior cardinal veins. As to the PLIVC, the iliac and subrenal parts of the inferior vena cava can be related to the persistent left supracardinal vein, while the circumaortic venous collar to the persistent intersupracardinal and left subsupracardinal anastomoses. All invasive procedures, and particularly those potentially complicated, must be performed under EST, now considered a mandatory tool for CVC implants, owing to the hypothesis of possible venous congenital anomalies.
A prospective comparison of the performance and survival of two different tunnelled haemodialysis catheters: SplitCath® versus DuraMax®
Authors: McGarry James G. , Given Mark F. , Whelan Adrian , O'Kelly Patrick , Connaughton Derval , McGrath Frank P. , Keeling Aoife N. , Conlon Peter J. , Lee Michael J.
Published: May 2017

Background

Despite their well-recognised shortcomings, haemodialysis catheters (HDCs) remain an important form of haemodialysis access for many patients. There are several HDCs commercially available, each differing considerably in design, which is known to significantly influence performance and survival. We sought to determine which of two tunnelled HDCs, DuraMax® (Angiodynamics, NY, USA) or SplitCath® (MedComp, PA, USA) delivers the best performance, safety and reliability for dialysis patients.

Methods

Eighty-six patients were prospectively randomised to receive either DuraMax® (DM) or SplitCath® (SC). Outcomes included: (i) mean flow rates (mL/min) averaged over the first 10 weeks of dialysis, and urea reduction ratio (URR); and (ii) long-term catheter survival with appraisal of any events leading to catheter dysfunction and early removal.

Results

Median flow rates (interquartile range) in the DM and SC groups were 321 (309-343) and 309 (294-322) mL/min, respectively (p = 0.002). URR values for the DM and SC groups were 71 (65-76) and 74 (70-78), respectively, (p = 0.094). There was no significant difference in long-term survival or frequency of incidents that required early HDC removal (9/43 in the DM group, 5/43 patients SC). A slightly higher incidence of HDC dislodgement was noted in the DM group, although this study was not statistically powered to determine its significance.

Conclusions

We conclude that DM yields slightly higher flow rates in the first 10 weeks of dialysis, and a similar low incidence of complications and long-term survival for both DM and SC HDCs.
Novel use of infrared thermal imaging to predict arteriovenous fistula patency and maturation
Authors: Al Shakarchi Julien , Hodson James , Field Melanie , Inston Nicholas
Published: May 2017

Objective

The arteriovenous fistula (AVF) is the preferred method of long-term haemodialysis. However, it has been shown to have a substantial rate of maturation failure. The formation of an AVF creates haemodynamic changes to blood flow in the arm with diversion of blood away from the distal circulation into the low pressure venous system, in turn, leading to thermal changes distally. In this study, we aimed to assess the novel use of infrared thermal imaging as a predictor of arteriovenous maturation.

Methods

A prospective cohort study was conducted on 100 consecutive patients who had AVF formation from December 2015 to June 2016. Infrared thermal imaging was undertaken pre- and post-operatively on the day of surgery to assess thermal changes to the arms and to assess them as predictors of clinical patency and functional maturation.

Results

For clinical patency, infrared thermal imaging was found to have a positive predictive value of 88% and a negative predictive value of 86%. For functional maturation, it was found to have a positive predictive value of 84%, a negative predictive value of 95%. In addition, it was shown to have superiority to the commonly used intra-operative predictor of thrill as well as other independent pre-operative patient factors.

Conclusions

Infrared thermal imaging has been found to be a very useful tool in accurately predicting fistula patency and maturation.
Perioperative ultrasound: a critical element in diagnosis and salvage of complex vascular access dysfunction
Authors: Mallios Alexandros , Hebibi Hadia , Jennings William
Published: May 2017

Background

Perioperative ultrasound performed by the operative surgeon can improve outcomes of vascular access surgery. We present the case of a patient referred for dysfunctional vascular access with two separate and patent right arm arteriovenous fistulas (AVF). Pre-operative ultrasound vessel mapping defined the complex anatomy and intraoperative ultrasound allowed the optimal surgical approach for access salvage while avoiding the need for catheter placement.

Case report

A 45-year-old male patient of African descent presented with a malfunctioning right forearm AVF and aneurysm formation in the arm. Clinical examination revealed a soft, low-flow forearm fistula merging into a high-flow and pulsatile AVF outflow aneurysm in the arm. Multiple well healed surgical incisions were present. Ultrasound examination revealed two separate AVFs. One was a low-flow radiocephalic AVF at the wrist that was used routinely for cannulation in the forearm, although with some difficulty due to low inflow pressure. The second AVF, a brachiocephalic anastomosis, was pulsatile, aneurysmal, and not in use. Blood flow in the proximal brachial artery was 3.0 L/min. Surgeon-performed ultrasound (SP-US) was used perioperatively to plan the surgical approach and incision, closing the existing brachial anastomosis and creating a veno-venous anastomosis between both outflow veins, establishing a mature and undisturbed cannulation conduit from the wrist through the arm. The revised AVF was immediately usable for hemodialysis with restored normal AVF flow in the forearm and appropriately reduced flow in the arm. Importantly, dialysis catheter placement was avoided.
The role of MRI in predicting Ki-67 in breast cancer: preliminary results from a prospective study
Authors: Caiazzo Corrado , Di Micco Rosa , Esposito Emanuela , Sollazzo Viviana , Cervotti Maria , Varelli Carlo , Forestieri Pietro , Limite Gennaro
Published: May 2017

Purpose:

In the last decade contrast-enhanced magnetic resonance imaging (MRI) has gained a growing role as a complementary tool for breast cancer diagnosis. Currently the relationship between the kinetic features of a breast lesion and pathologic prognostic factors has become a popular field of research. Our aim is to verify whether breast MRI could be considered a useful tool to predict Ki-67 score, thus resulting as a breast cancer prognosis indicator.

Methods:

From June to December 2014, we enrolled patients with breast cancer who underwent preoperative dynamic contrast-enhanced MRI at the local health agency. We analyzed the time-signal intensity curves calculating the mean values of the following parameters: the basal enhancement (Ebase), the enhancement ratio (ENHratio), the maximum enhancement (Emax), and the steepest slope of the contrast enhancement curve (Smax). Scatterplots and Pearson correlation test were used to investigate the eventual associations among these parameters.

Results:

A total of 27 patients underwent breast MRI during the study period. The mean ± SD Ki-67 percentage was 27.03 ± 16.8; the mean Emax, Smax, Ebase, and ENHratio were 433.9 ± 120.2, 267.3 ± 96.8, 165.5 ± 77.1, and 187.1 ± 94.8, respectively. Scatterplots suggest a positive correlation between Ki-67 and both Emax and Smax. The correlation tests between Ki-67 and Emax, Ki-67 and Smax showed statistical significance.

Conclusions:

Our preliminary data suggest that enhancement pattern is closely linked to breast cancer proliferation, thus proving the relationship between more proliferating tumors and more rapidly enhanced lesions. This is hypothesis-generating for further studies aimed at promoting breast MRI in the early estimation of cancer prognosis and tumor in vivo response to chemotherapy.
A Supportive Care in Cancer Unit Reduces Costs and Hospitalizations for Transfusions in a Comprehensive Cancer Center
Authors: Ripamonti Carla Ida , Molani Pietro , Desti Cinzia , Boscagli Giacomo , Ravagnani Fernando , Arienti Flavio , Di Cristo Clementina
Published: May 2017

Purpose

Among patients with solid or hematologic malignancies undergoing oncologic therapies, blood product transfusions (BPT) are a relevant reason for planned/unplanned hospitalizations, as well as a possible cause of delay in administration of the oncologic therapies. Furthermore, they create additional costs for the healthcare system (HCS). The aim of this study was to compare the costs of performing BPT (erythrocytes and platelets) in medical units/wards to the costs derived from the administration of BPT in a dedicated outpatient supportive care in cancer unit (SCCU).

Methods

Costs were analyzed from June 3, 2009 (when the SCCU started), until December 2013. Four inpatient oncologic units (bone marrow transplantation, radiotherapy, medical oncology I and II) were compared to the SCCU. Data regarding the transfusions performed by the SCCU of the patients who were previously hospitalized for transfusions were extracted, checked, and analyzed through a cross-check on the tax codes. Therefore, patients were considered suitable for the analysis if they had received BPT in the SCCU after a previous hospitalization for transfusion in one of the 4 units/wards. The average daily cost deriving from blood product units and from the hospitalization in each ward (irrespective of pharmaceutical expenses) was compared with the average daily cost deriving from blood product units and from the management of patients in the SCCU.

Results

We analyzed 227 patients (112 female) with a mean age of 60 years (range 20-90) with hematologic malignancies in 79% of cases. The number of transfusions performed by the SCCU has grown constantly and consistently over the years, reaching 1,402 transfusions in 2013, thus exceeding the other considered units. The total savings for the HCS was €282.204.71, €151.182.85 in 2013 only. We saved €124.319,26 for each patient transfused at the SCCU.

Conclusions

A dedicated outpatient SCCU, aimed at monitoring and treating cancer therapy-related toxicities and comorbidities and in which it is also possible to perform BPT promptly and effectively, reduces the number of hospitalizations and provides an economical benefit for HCS.
FNA and CNB in the Diagnosis of Pulmonary Lesions: A Single-center Experience on 665 Patients, Comparison between Two Periods
Authors: Marchianò Alfonso Vittorio , Cosentino Maria , Di Tolla Giuseppe , Greco Francesca Gabriella , Silva Mario , Sverzellati Nicola , Fabbri Alessandra , Tamborini Elena , Russo Giuseppe Lo , Mariani Luigi , Lalli Luca , Pastorino Ugo
Published: May 2017

Purpose

To evaluate the diagnostic yield and complication rate of 2 different biopsy techniques (fine-needle aspiration, FNA, and core-needle biopsy, CNB) in the diagnosis of pulmonary lesions in 2 distinct periods, 2010-2012 and 2013-2015.

Methods

We retrospectively analyzed the results of 691 CT-guided lung biopsies in 665 patients who were divided into 2 groups: cohort 1 (January 2010 to December 2012) was composed of 271 consecutive patients with 284 procedures either by FNA or CNB; cohort 2 (January 2013 to December 2015) was composed of 394 patients with 407 CNBs. Univariate and multivariate logistic regression modeling was used for selected outcomes including diagnostic yield, bleeding and pneumothorax.

Results

Cohort 1 comprised 165 men and 106 women (mean age 68.5 years) with 180 FNAs and 104 CNBs; cohort 2 comprised 229 men and 165 women (mean age 66.4 years) with 407 CNBs. The diagnostic yield increased in cohort 2 with respect to cohort 1. There was a slight increase in CT procedure complications (pneumothorax and bleeding) from cohort 1 to cohort 2. The overall risk of complications was greater for lesions <20 mm and for lesions at >20 mm distance from the pleura.

Conclusions

CT-guided CNB had a higher diagnostic yield than discretional use of either FNA or CNB; there was a slight but acceptable increase in complication rates.
Unmet needs of Italian cancer patients in different stages of the disease and care process
Authors: Bonacchi Andrea , Di Miceli Stefania , Lippi Donatella , Muraca Maria Grazia , Miccinesi Guido
Published: May 2017

Purpose:

Assessing patients’ unmet supportive care needs is essential in order to prioritize areas of cancer care that require improvement. The aim of the present cross-sectional study was to compare the unmet needs of cancer patients in different stages of the disease and care process (diagnosis, treatments following diagnosis, follow-up and/or rehabilitation, relapse/recurrence, progression of the disease, and palliative care).

Methods:

The research focused on patients from 7 oncology units of the same geographic region (Tuscany, a region of central Italy) in the same period of time regardless of primary tumor site. A total of 752 patients filled in the Needs Evaluation Questionnaire and the Psychological Distress Inventory.

Results:

We observed high rates of cancer patients who expressed unmet needs, especially in the areas of information and relational and material needs. The multiple regression models showed a direct correlation between psychological distress and extent of unmet needs. Individual unmet needs had significantly different entities at diverse phases.

Conclusions:

The present study confirmed the dynamic nature of needs of cancer patients, highlighting some critical aspects in different stages of the care process on which to concentrate attention and resources and suggesting the usefulness of periodic and repeated assessments of principal needs.
Comunicação interna: uma análise do caso MCL Peças Agrícolas Ltda., de Palotina, PR
Authors: Silva Bastos Cristiane , Wenningkamp Keila Raquel , Willers Ednilse Maria
Published: May 2017

Este estudo teve por objetivo levantar informações sobre o processo da comunicação interna da empresa MCL Peças Agrícolas a fim de propor ações para a melhoria dessas práticas na organização. Em termos metodológicos, tratou-se de um estudo de caso com abordagem qualitativa. Como técnicas de coleta de dados, utilizou-se o questionário, aplicado aos colaboradores do setor administrativo da empresa e a entrevista, realizada com o sócio-administrador. Ambos aplicados com o intuito de melhor compreender o processo de comunicação interna e identificar possíveis dificuldades ou falhas existentes. Com base nos dados observados, desenvolveu-se algumas estratégias para melhorar o processo de comunicação interna, o que envolveu ações para a maior eficácia da comunicação entre os colaboradores e, também, entre colaboradores e superiores, buscando auxiliar na distribuição, clareza e objetividade das informações. Acredita-se que as estratégias de comunicação interna desenvolvidas possam aprimorar e promover mudanças significativas no ambiente interno da MCL Peças Agrícolas Ltda. e, dessa forma, favorecer a melhoria da gestão e dos procedimentos administrativos.
Effect of Gum Arabic as Dietary Supplement for Type II Diabetes in Jabir Abu Aliz Diabetic Center- (Khartoum State)
Authors: Ibrahim Niama Mirghani , Ali Almahdi Mohammed , Rahim Khogali Nadia Abdel , Bashir Hiba Shawgi
Published: May 2017

BACKGROUND: Gum Arabic (Acacia Senegal) is a water-soluble dietary fiber considered to be safe by the United States Food and Drug Administration since the 1970s.Recent studies showed the therapeutic action of Gum Arabic.METHODS: It was Quasi-experimental study design. The objective of this study was to determine the effects of regular Gum Arabic ingestion as dietary supplement on accumulative blood glucose (HbA1c) and body mass index (BMI) among type II diabetes in Jabir Abu Aliz Diabetic Center in Khartoum. 49 type II diabetes were provided with Gum Arabic at the beginning of the trial and educated to add 60 g/day (divided into two portions 30 gm) to their meals for three months. Food consumption, BMI, and HbA1C were assessed for all the patients before and after the consumption of Gum Arabic for three months. Data was processed using SPSS version (20) and paired t- test was used to determine the effect of Gum Arabic on studied parameters.RESULTS: It showed that regular intake of 60 g/day of Gum Arabic for three months showed slight reduction in BMI for diabetes (no significant difference), and slight change in HbA1c (no significant difference). This may be due to the fact that majority of the respondents (60%) increased their carbohydrates intake in their daily meals because of winter, also respondents did not abide fully () to consumption of Gum Arabic, where only (32%) of the patients were fully committed to the consumption of Gum Arabic.