Arteriovenous fistula outcomes in the elderly

OBJECTIVE: Over several decades, there has been an increase in the number of elderly patients requiring hemodialysis. These older patients typically have an increased incidence of comorbidities including diabetes, hypertension, and peripheral vascular disease. We undertook a systematic review of the current literature to assess outcomes of arteriovenous fistula (AVF) formation in the elderly and to compare the results of radiocephalic AVFs vs brachiocephalic AVFs in older patients.

METHODS: A literature search was performed using MEDLINE, Embase, PubMed, and the Cochrane Library. All retrieved articles published before December 31, 2014 (and in English) primarily describing the creation of hemodialysis vascular access for elderly patients were considered for inclusion. We report pooled AVF patency rates and a comparison of radiocephalic vs brachiocephalic AVF patency rates using odds ratios (ORs).

RESULTS: Of 199 relevant articles reviewed, 15 were deemed eligible for the review. The pooled 12-month primary and secondary AVF patency rates were 53.6% (95% confidence interval [CI], 47.3-59.9) and 71.6% (95% CI, 59.2-82.7), respectively. Comparison of radiocephalic vs brachiocephalic AVF patency rates demonstrated that radiocephalic AVFs have inferior primary (OR, 0.72; 95% CI, 0.55-0.93; P = .01) and secondary (OR, 0.76; 95% CI, 0.58-1.00; P = .05) patency rates.

CONCLUSIONS: This meta-analysis confirms that adequate 12-month primary and secondary AVF patency rates can be achieved in elderly patients. Brachiocephalic AVFs have both superior primary and secondary patency rates at 12 months compared with radiocephalic AVFs. These important data can inform clinicians' and patients' decision-making about suitability of attempting AVF formation in older persons.

Investigating clinical predictors of arteriovenous fistula functional patency in a European cohort

Background: Arteriovenous fistula (AVF) failure to mature (FTM) rates contribute to excessive dependence on central venous catheters for haemodialysis. Choosing the most appropriate vascular access site for an individual patient is guided largely by their age, co-morbidities and clinical examination. We investigated the clinical predictors of AVF FTM in a European cohort of patients and applied an existing clinical risk prediction model for AVF FTM to this population.
Methods: A prospective cohort study was designed that included all patients undergoing AVF creation between January 2009 and December 2014 in a single centre (Belfast City Hospital) who had a functional AVF outcome observed by March 2015.
Results: A total of 525 patients had a functional AVF outcome recorded and were included in the FTM analysis. In this cohort, 309 (59%) patients achieved functional AVF patency and 216 (41%) patients had FTM. Female gender [P < 0.001, odds ratio (OR) 2.03 (CI 1.37–3.02)] and lower-arm AVF [P < 0.001, OR 4.07 (CI 2.77–5.92)] were associated with AVF FTM. The Lok model did not predict FTM outcomes based on the associated risk stratification in our population.
Conclusions: In this European study, female gender was associated with twice the risk of AVF FTM and a lower-arm AVF with four times the risk of FTM. The FTM risk prediction model was not found to be discriminative in this population. Clinical risk factors for AVF FTM vary between populations;we would recommend that units investigate their own clinical predictors of FTM to maximize AVF functional patency and ultimately survival in dialysis patients. Clinical predictors of AVF FTM may not be sufficient on their own to improve vascular access functional patency rates.

Preoperative radial artery volume flow is predictive of arteriovenous fistula outcomes

Objective: Guidelines recommend the creation of a wrist radiocephalic arteriovenous fistula (RAVF) as initial hemodialysis vascular access. This study explored the potential of preoperative ultrasound vessel measurements to predict AVF failure to mature (FTM) in a cohort of patients with end-stage renal disease in Northern Ireland

.Methods: A retrospective analysis was performed of all patients who had preoperative ultrasound mapping of upper limb blood vessels carried out from August 2011 to December 2014 and whose AVF reached a functional outcome by March 2015.

Results: There were 152 patients (97% white) who had ultrasound mapping andan AVF functional outcome recorded; 80 (54%) had an upper arm AVF created, and 69 (46%) had a RAVF formed. Logistic regression revealed that female gender (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.12-5.55; P = .025), minimum venous diameter (OR, 0.6; 95% CI, 0.39-0.95; P = .029), and RAVF (OR, 0.4; 95% CI, 0.18-0.89; P = .026) were associated with FTM. On subgroup analysis of the RAVF group, RAVFs with an arterial volume flow <50 mL/min were seven times as likely to fail as RAVFs with higher volume flows (OR, 7.0; 95% CI, 2.35-20.87; P < .001).

Conclusions: In this cohort, a radial artery flow rate <50 mL/min was associated with a sevenfold increased risk of FTM in RAVF, which to our knowledge has not been previously reported in the literature. Preoperative ultrasound mapping adds objective assessment in the clinical prediction of AVF FTM.

Anti-proliferative effect of rhein, an anthraquinone isolated from Cassia species, on Caco-2 human adenocarcinoma cells

Objective: In recent years the use of anthraquinone laxatives, in particular senna, has been associated with damage to the intestinal epithelial layer and an increased risk of developing colorectal cancer. In the present study we evaluated the cytotoxicity of rhein, the active metabolite of senna, on human colon adenocarcinoma cells (Caco-2) and its effect on cell proliferation. Methods: Cytotoxicity studies were performed using MTT, NR and TEER assays whereas 3H-thymidine incorporation and western blot analysis were used to evaluate the effect of rhein on cell proliferation. Moreover, for genoprotection studies Comet assay and oxidative biomarkers measurement (malondialdehyde and reactive oxygen species) were used. Results: Rhein (0.1-10μg/ml) had no significant cytotoxic effect on proliferating and differentiated Caco-2 cells. Rhein (0.1 and 1 μg/ml) significantly reduced cell proliferation as well as MAP kinase activation; by contrast, at the high concentration (10μg/ml) rhein significantly increased cell proliferation and ERK phosphorylation. Moreover, rhein (0.1-10μg/ml) (i) did not adversely affect the integrity of tight junctions and hence epithelial barrier function, (ii) did not induce DNA damage rather it was able to reduce H2O2-induced DNA damage and (iii) significantly inhibited the increase in malondialdehyde and ROS levels induced by H2O2/Fe2+. Conclusions: Rhein, was devoid of cytotoxic and genotoxic effects in colon adenocarcinoma cells. Moreover, at concentrations present in the colon after a human therapeutic dosage of senna, rhein inhibited cell proliferation via a mechanism which seems to involve directly the MAP kinase pathway. Finally, rhein prevents the DNA damage probably via an anti-oxidant mechanism.

Right coronary artery fistula to the coronary sinus and right atrium associated with giant right coronary enlargement detected by transthoracic echocardiography

We present the case of a 54-year-old female with a previous history of lung fibrosis secondary to methotrexate used for rheumatoid arthritis who was referred to cardiology evaluation due to precordial pain. Echocardiography showed biatrial enlargement with an enlarged coronary sinus and tubular image posterior to the heart. On the coronary angiogram, the right coronary artery was enlarged, and a distal fistula was identified. The patient underwent a contrast enhanced cardiac computed tomography which demonstrated an aneurysmatic right coronary artery with a distal fistula to the right atrium and coronary sinus. As the chest pain did not recur and there was a high risk of the intervention to correct coronary fistula, the patient remained on conservative treatment.

Competition of sicklepod, cassia obtusifolia l., densities on soybean, glycine max (l.) merr., at variable row distance

Competition studies with soybeans, Glycine max (L.) Merr. "Bragg." and sicklepod, Cassia obtusifolia L., were conducted at the Agricultural Research and Education Center of the University of Florida in Quincy, Florida. Two field experiments were established, one on May 22, 1975. and the other four weeks later, on June 19, 1975, to determine the competitive effects of various sicklepod densities and the influences of soybean row distances on weed dry matter, soybear plant characteristics, yield components and seed yield, and on soil nutrient content. Control, low, medium, and high sicklepod densities in the first experiment were O, 25,000, 53,000, and 77,000 p1ants/ha, respectively; while the second experiment presented control, low, medium, and high sicklepod densities of O, 36,000, 68,000, and 122,000 plants/ha, respectively. Three soybean row distance treatments were tested using a constant pattern of 90-, 60-, and 45-cm widths throughout the growing season. Three other treatments, evaluated in a variable patern, were initially seeded in 30-cm row widths. Five weeks after planting, an appropriate number of soybean rows were harvested from the 30"cm pattern to establish row distances of 90, 60, and 30-60 cm for the remainder of the season. ln the greenhouse a test was conducted to evaluate the effects af those variables on seed germination and seedling vigor for the next soybean generation. As a result of full-season sicklepod competition, soybean plants were less branched, set fewer leaves, and presented thinner stems as compared to the control. However, height of soybean plants was not affected by the presence of sicklepod. ln one of the two experiments, number of nodes decreased for soybeans under weed campetition. The yield components--number of pods; number of seeds, and seed yield per soybean plant--were all similarly reduced due to weed competition. Seeds per pod were decreased to a lesser extent. Soybean seed yields per unit area were significantly diminished by increasing levels af sicklepod ínfestation. While the control produced 3120 kg/ha, the sicklepod densities of 25,000, 53,000, and 77,000 plants/ha reduced seed yíelds 47, 65, and 73%, respectively. As soybean row distances decreased, number of branches, number of leaves, and stem diameter of soybeans decreased. However, the height of soybean plants increased with narrwing of row width. The components of seed yield--number of pods, number of seeds, and seed yield per soybean plant--diminished as row spacing was reduced. Maximum difference between row distances for these attributes was attained for soybean plants under weed-free conditions. Generally, as row width decreased, soybean seed yield per unit area increased. Specifically, soybear.s in 90-cm rows, either in constant or variable row pattern, yielded less than soybeans in 60- and 30-60-cm rows in the variable pattern. Soil contents of phosphorus, potassium, calcium, and magnesium were not affected by the various levels of sicklepod and soybean populalions. Neither the sicklepod densities nor the soybean row distances influenced seed germination and seedling vigor in the next soybean generation. Sicklepod was a strong competitor with soybeans at all density ranges investigated. Because sicklepod grows taller than soybeans during the reproductive stages of the crop, limited success can be reached by varying row spacing alone. However, this practice is considered an integral measure to complement other methods of sicklepod control. Compared to constant rows, the soybean cropping system using variable row spacings presents the choice of planting soybeans at close row spacings to provide early competition with weeds and the possibility of obtaining a forage crop after the first month of growth, without any decreases on the final seed yields.

Entomofauna visitante das flores de Cassia spectabilis (L.) D C. (Leguminosae)

Realizaram-se estudos sobre sistemas de reprodução de Cassia spectabilis (L.) D C. (Leguminosae) observando-se a diversidade, freqüência e constância dos insetos visitantes em diferentes horários. Também testou-se a influência dos fatores ambientais em relação às visitas. Os resultados de polinização manual sugerem que C. spectabilis é autocompatível, porém, a xenogamia é o sistema de reprodução predominante. As inflorescências foram visitadas por uma grande quantidade de insetos, havendo predominância de abelhas. O horário de maior ocorrência dos insetos nas flores de C. spectabilis foi das 8 às 14 h e de menor ocorrência entre 7 e 8 h e das 17 às 18 h. Quanto ao comportamento dos insetos em relação à flor de C. spectabilis, observou-se que Xylocopa frontalis Olivier, X. suspecta Camargo & Moure, Bombus morio Swederus e Centris scopipes Friese possuem comportamento e morfologia adequados aos polinizadores legítimos; C. similis F., Oxaea flavescens Klug e Epicharis rustica flava Cockerell foram considerados polinizadores ocasionais. Pseudaugochloropsis graminea (F.), Tetragonisca angustula Latreille e A. mellifera L. foram considerados pilhadores. A polinização por vibração é o método usado pelas abelhas para coleta de pólen.

Acquired vesicovaginal fistula secondary to ovariohysterectomy in a bitch: a case report

Uma cadela de sete anos de idade foi trazida ao hospital veterinário Governador Laudo Natel pois apresentava estrangúria há dois meses. Os sinais clínicos desenvolveram-se dois dias após ovário-histerectomia de eleição. Exames radiográficos e ultrasonográficos sugeriram piometra de coto ou granuloma cervical e fistula vesicovaginal. Duas laparotomias foram realizadas para desfazer as adesões, mas não houve melhora nos sinais clínicos observados. Iniciou-se tratamento médico e oito meses depois o animal, novamente avaliado, apresentava-se sadio porém ainda com sinais de estrangúria.

Método de colheita e superação de dormência na qualidade fisiológica de sementes de Cassia ferruginea

The harvesting method of fruits of tree species should be adequate to obtain seeds of maximum physiological quality. When present, the dormancy of Cassia ferruginea seeds is due to seed coat impermeability to water. This research work viewed to find the best methods both for the harvesting and for the breaking of dormancy of seeds of that species. The experiment was conducted during two years. In the first, fruits shed from the mother plant and laying on the ground were picked and their seeds submitted to the following treatments: 1. control, 2. mechanical scarification of the seeds with sandpaper no. 220, 3. hot water for 5 minutes (initial and final temperatures of 82 and 69 degrees C, respectively), 4. hot water for 15 minutes (initial and final temperatures of 82 and 51 degrees C, respectively), 5. chemical scarification with H2SO4 (95%) for 20, 30, 40, 50, 60, 70, and 80 minutes. In the second year, seeds were submitted to treatments 2, 3, and 4 whereas acid scarification was applied for 30, 45, and 60 minutes. The results showed that seeds picked from the ground and those taken directly from the mother plant differ in their response to the dormancy breaking procedure. The results also showed that the seeds picked from the ground are better than those harvested directly from the plant and that, when dormant, the best results are attained when seeds are either submitted to mechanical scarification or chemical scarification with sulfuric acid for periods between 30 and 60 minutes.

Saphenofemoral arteriovenous fistula as hemodialysis access

Background: An upper limb arteriovenous (AV) fistula is the access of choice for haemodialysis (HD). There have been few reports of saphenofemoral AV fistulas (SFAVF) over the last 10-20 years because of previous suggestions of poor patencies and needling difficulties. Here, we describe our clinical experience with SFAVF.Methods: SFAVFs were evaluated using the following variables: immediate results, early and late complications, intraoperative and postoperative complications (up to day 30), efficiency of the fistula after the onset of needling and complications associated to its use.Results: Fifty-six SFAVF fistulas were created in 48 patients. Eight patients had two fistulas: 8 patent (16%), 10 transplanted (20%), 12 deaths (24%), 1 low flow (2%) and 20 thrombosis (39%) (first two months of preparation). One patient had severe hypotension during surgery, which caused thrombosis of the fistula, which was successfully thrombectomised, four thrombosed fistulae were successfully thrombectomised and revised on the first postoperative day. After 59 months of follow-up, primary patency was 44%.Conclusion: SFAVF is an adequate alternative for patients without the possibility for other access in the upper limbs, allowing efficient dialysis with good long-term patency with a low complication rate.