A new approach in the treatment of high flow native AV fistula: the open-pore external scaffolding prosthesis

Objective: The vascular access steal syndrome is a complication occurring in 1-6% after native arterio-venous (AV) fistulas, often due to huge diameter of the vein. This results in very high flow, which could also be responsible for cardiac overload. The aim of this study is to evaluate the efficiency of a new approach in the treatment of this pathology using open-pore external scaffolding prosthesis.Methods: This a retrospective review of all patients presenting symptomatic high flow after native AV fistula between January 2007 and December 2009 in 3 vascular centers. Pre-operative duplex exam confirmed the diagnosis of high flow. The operation consisted in preparation of the whole fistula, measurement of the flow and section on the venous side. The vein was wrapped with this 6 to 8 mm open-pore external scaffolding prosthesis (ProVena, BBraun, Germany) according to its diameter and to the flow and then sutured. Measurement of the flow was repeated. Patients were followed by duplex exam at 1 week and at 1, 3, 6 and 12 months. Procedural success was defined as complete implantation of the prosthesis and reduction of the flow. Primary outcomes were reduction of the flow and recovery of the symptoms and secondary endpoint was patency of the fistula.Results: During the study period, 14 patients, with a mean age of 65・8 years old, have been operated with this technique.There were 2 native forearmfistulas and 12 on the armwith a mean pre-operative flow of 2600 ml/min (1800-3800). The mode of presentation was pain in 6 patients, neurological disorders in 10 and necrosis in 4. Moreover, 3 patients had cardiac insufficiency due to high flow in the fistula. The procedure was technically successful in 100% of cases. Re-intervention was necessary in 2 patients due to hematoma. Recovery of the initial symptoms occurred in 13 patients (93%). The mean flow reduction was 1200 ml/min (600-2000). In 1 patient, a persistent steal syndrome despite flow reduction to 1400 ml/min resulted in fistula closure 2 months later. At a mean follow-up of 22 months (4-35), all remaining patients (13/14) presented a patent fistula without recurrence.Conclusion: This new approach seems to be safe and effective in the treatment of symptomatic high flow native AV fistulas by significantly reducing the flow and avoiding closure of the vascular access. Longer follow-up with more patients are necessary to evaluate the risk of recurrence.

Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure.

Context Heart failure (HF) is the most common complication of infective endocarditis. However, clinical characteristics of HF in patients with infective endocarditis, use of surgical therapy, and their associations with patient outcome are not well described.Objectives To determine the clinical, echocardiographic, and microbiological variables associated with HF in patients with definite infective endocarditis and to examine variables independently associated with in-hospital and 1-year mortality for patients with infective endocarditis and HF, including the use and association of surgery with outcome.Design, Setting, and Patients The International Collaboration on Endocarditis-Prospective Cohort Study, a prospective, multicenter study enrolling 4166 patients with definite native- or prosthetic-valve infective endocarditis from 61 centers in 28 countries between June 2000 and December 2006.Main Outcome Measures In-hospital and 1-year mortality.Results Of 4075 patients with infective endocarditis and known HF status enrolled, 1359 (33.4% [95% CI, 31.9%-34.8%]) had HF, and 906 (66.7% [95% CI, 64.2%-69.2%]) were classified as having New York Heart Association class III or IV symptom status. Within the subset with HF, 839 (61.7% [95% CI, 59.2%-64.3%]) underwent valvular surgery during the index hospitalization. In-hospital mortality was 29.7% (95% CI, 27.2%-32.1%) for the entire HF cohort, with lower mortality observed in patients undergoing valvular surgery compared with medical therapy alone (20.6% [95% CI, 17.9%-23.4%] vs 44.8% [95% CI, 40.4%-49.0%], respectively; P < .001). One-year mortality was 29.1% (95% CI, 26.0%-32.2%) in patients undergoing valvular surgery vs 58.4% (95% CI, 54.1%-62.6%) in those not undergoing surgery (P < .001). Cox proportional hazards modeling with propensity score adjustment for surgery showed that advanced age, diabetes mellitus, health care-associated infection, causative microorganism (Staphylococcus aureus or fungi), severe HF (New York Heart Association class III or IV), stroke, and paravalvular complications were independently associated with 1-year mortality, whereas valvular surgery during the initial hospitalization was associated with lower mortality.Conclusion In this cohort of patients with infective endocarditis complicated by HF, severity of HF was strongly associated with surgical therapy and subsequent mortality, whereas valvular surgery was associated with lower in-hospital and 1-year mortality.

Iowa Commission on the Status of African Americans Agency Performance Plan, 2007

Agency Performance Plan

Iowa Commission on the Status of Women Agency Performance Plan, 2007

Agency Performance Plan

Les endocardites dues aux germes du groupe HACEK. A propos d'un cas d'endocardite native a Kingella kingae. [Endocarditis due to HACEK bacteria. A case report of endocarditis due to Kingella kingae]

Endocarditis is a common disease in hospital practice. Identification of the microorganism responsible for the valvular damage is essential to establish the prognosis and to determine the optimal antibiotic treatment. In some cases of endocarditis the diagnosis is laborious, especially when the responsible microorganism is difficult to detect using standard culture techniques. Here we report a case of native aortic valve endocarditis due to Kingella kingae, a Gram negative organism of the HACEK group. In addition we review 6 other cases of endocarditis caused by organism belonging to this group, treated in our hospital between 1983 and 1999. Epidemiological studies show that less than 5% of all cases of endocarditis are caused by organisms of the HACEK group. The diagnosis is often delayed because their slow growth on a standard culture medium. We describe clinical and microbiological characteristics of this group of endocarditis.

New data on the distribution and conservation status of some angiosperms of the Cape Verde Islands, W Africa

New data on the distributibn and conservation status of some angiosperms of the Cape Verde Islands, W Africa Intensive field work aud analysis of the state of biodiversity ou all islands during the years iYY.3 lo IYYY Icd lo lhc publication ol’several contributions lo the flora and vegelalion of the archipclago of Cabo Verde (Brochniann & al. 1997, Gornes & Vera-Cruz 1993. Gonles & al. I9YSa-h. 1998, Games 1997. Kilian & Leyens 1994, Leyens 1998. Leyens & Lobin 1995, Lobin & al. 1995) as well as to the compilation of the First Red Data List for the Cape Verde Islnuds (Lcyrus & Lobin 1996). the elaboration of the National Strategy for Biodiversity Conservation (SIPA 19YY) and ! compilation of all areas in urgent need of protection (Leyens unpubl. diplonla thc.\is IYYJ. Gwnes & al. iu prep.). As part UC the activities of the lnstituto National de Invcstig;u$o c Dcscnvolvitucnto Agriirio (INIDA) and the Dcpurtamcnto de GeociSncias do Institute Supcriot de Educ;u$o t ISE) iutcnsive t’icld studies were conducted PI many diffcrctu localilics OII xcvcr;~I islands. resulting in a thesis tGo~nes IY97) and several terminal study papers (Luz IYYY. Cosi;t 1994. Gonsalvez 1999). The results show that the vegetation and flora of the islands arc still IWI fully known and much more field work is needed. hllhot~gh Sanliiqw is one of lhc islands whcrc lhc firs1 holanicill iIlVcxligilliollx wcrr c:crriul WI (Wcbh 1x49. Schruidt 1x52. Chcvalicr IY35) and where uu~ny intensive field studirs wcrc

The presence of a CD4+ CD25high CD45RO+ CD127high T-cell population correlates with the clinical status of kidney transplant recipients

Background: Recent data have suggested that a population of CD4+ CD25high T cells, phenotypically characterized by the expression of CD45RO and CD127, is significantly expanded in stable liver and kidney transplant recipients and represents alloreactive T cells. We analyzed this putative new alloreactive cellular marker in various groups of kidney transplant recipients. Patients and methods: Flow cytometry was used to analyze the expression of CD25, CD45RO and CD127 on peripheral CD4+ T cells. Of 73 kidney recipients, 59 had a stable graft function under standard immunosuppressive therapy (IS), 5 had biopsy-proven chronic humoral rejection (CHR), 8 were stable under minimal IS and one was an operationally "tolerant" patient who had discontinued IS for more than 3 years. Sixty-six healthy subjects (HS) were studied as controls. Results: Overall, the alloreactive T cell population was found to be significantly increased in the 73 kidney recipients (mean ± SE: 15.03 ± 1.04% of CD4+ CD25high T cells) compared to HS (5.93 ± 0.39%) (p <0.001). In the 5 patients with CHR, this population was highly expanded (31.33 ± 4.16%), whereas it was comparable to HS in the 8 stable recipients receiving minimal IS (6.12 ± 0.86%), in 4 patients who had been switched to sirolimus (4.21 ± 0.53%) as well as in the unique "tolerant" recipient (4.69%). Intermediate levels (15.84 ± 0.93%) were found in the 55 recipients with stable graft function on standard CNI-based IS. Regulatory T cells, defined as CD4+ CD25high FoxP3+ CD127low, were found to be significantly reduced in all recipients except in those with minimal or no IS, and this reduction was particularly striking in recipients with CHR. Conclusion: After kidney transplantation, an alloreactive T cell population was found to be significantly expanded and it correlates with the clinical status of the recipients. Interestingly, in stable patients with minimal (or no) IS as well as in patients on sirolimus, alloreactive T cells were comparable the healthy controls. Measuring circulating CD4+ CD25high CD45RO+ CD127high T cells may become a useful monitoring tool after transplantation.

Status of Young Women in the Juvenile Justice System Preliminary Data, 2007

Young women involved in the juvenile justice system present with characteristics and experiences that differentiate them from their male counterparts. As such, the juvenile justice system in Iowa must consider these factors if it is to effectively and efficiently impact recidivism and rehabilitation.

Interference of Native Language in English Language Acquisition in Santa Cruz and Calheta Secondary schools

This study analyzes the interference of native language when students are learning a foreign language, in this case English. According to this study, interferences from the native language such as lexical-semantic and phonological are not infrequent. It is one of the main barriers that create difficulties when learning English. The outcome of this study is presented at the end of the Monografia: to provide English-language teachers and students the most significant linguistic interferences that occur during the learning process of English language. Furthermore, some teaching strategies are discussed to avoid the biases that appear due to the interferences of the native language. As a result of this study, I hope to contribute to the learning success among English-language students.

Checklist of aedine mosquito species (Diptera, Culicidae, Aedini) occurring in Middle and South America (south of the United States) reflecting current generic and subgeneric status

A list of species of tribe Aedini from Middle and South American, south of the United States, with their current generic combinations is provided. Its purpose is to enable entomologists, public health personnel and mosquito control workers to more quickly become familiar with recent formal taxonomic changes within the tribe.

Stroke initial severity and outcome relative to insurance status in a universal health care system in Switzerland.

BACKGROUND:  Socioeconomic status is thought to have a significant influence on stroke incidence, risk factors and outcome. Its influence on acute stroke severity, stroke mechanisms, and acute recanalisation treatment is less known. METHODS:  Over a 4-year period, all ischaemic stroke patients admitted within 24 h were entered prospectively in a stroke registry. Data included insurance status, demographics, risk factors, time to hospital arrival, initial stroke severity (NIHSS), etiology, use of acute treatments, short-term outcome (modified Rankin Scale, mRS). Private insured patients (PI) were compared with basic insured patients (BI). RESULTS:  Of 1062 consecutive acute ischaemic stroke patients, 203 had PI and 859 had BI. They were 585 men and 477 women. Both populations were similar in age, cardiovascular risk factors and preventive medications. The onset to admission time, thrombolysis rate, and stroke etiology according to TOAST classification were not different between PI and BI. Mean NIHSS at admission was significantly higher for BI. Good outcome (mRS ≤ 2) at 7 days and 3 months was more frequent in PI than in BI. CONCLUSION:  We found better outcome and lesser stroke severity on admission in patients with higher socioeconomic status in an acute stroke population. The reason for milder strokes in patients with better socioeconomic status in a universal health care system needs to be explained.

Status of Females in the Juvenile Justice System, 2007

On October 12th 2007, the inaugural Girls’ Summit on females in the juvenile justice system was held. This Summit brought together key decision makers in an exploration of research and data. Those who attended were also asked to make recommendations regarding a course of action. This report represents an effort to improve our response to these young women in Iowa. It highlights pertinent information covered at the Summit as well as resulting conclusions and recommendations. On behalf of the Iowa Gender Specific Services Task Force and the participants of the Girls’ Summit, it is my hope that this report will serve as a road map for necessary improvements as well as a means to reinforce the effective tools that are already in place. There are differences that exist between young women and young men in the juvenile justice system and the efficacy of professionals rests heavily on a better understanding of these differences and how they impact the justice system response.

Midwest Regional Rail Passenger Initiative and Passenger Rail Service in Iowa Status Report

This report is submitted as required per Iowa Code section 327J.3(5), "The director shall report annually to the general assembly concerning the development and operation of the midwest regional rail system and the state's passenger rail service."

Iowa Commission on the Status of Women: 35th Annual Report - 2006

Iowa Commission on the Status of Women: 35th Annual Report - 2006 The ICSW is proud of the past year’s achievements, and pleased to present to you our 35th Annual Report. The following pages detail the activities and programs that were carried out in 2006. The ICSW celebrates the progress in women’s rights that has been made in Iowa, and continues to address inequities, advocating for full participation by women in the economic, social, and political life of the state. In this advocacy role, as mandated by the Code of Iowa, we educate, inform, and develop new ideas to bring a fresh viewpoint to bear on the issues facing Iowa women and their families.