Cephalic Vein Research Articles

Avaliação do uso de nanoemulsão de clorexidina a 0,25% na antissepsia da pele de gatos

ABSTRACT: This study evaluated the antiseptic effect of 0.25% chlorhexidine nanoemulsion (NM-Cl) on cat skin and compare its effect with that of 2.0% chlorhexidine digluconate (CS-Cl). NM-Cl was synthesized using the spontaneous emulsification method, and physical and chemical properties were analyzed. The antiseptic effects of NM-Cl and CS-Cl were randomly tested on the thoracic limbs of 10 healthy male cats. After a wide trichotomy of the thoracic limbs, NM-Cl was randomly applied to the trichotomy area of the right (n = 5) or left (n = 5) thoracic limbs. Then, a catheter was inserted aseptically in the cephalic vein. Subsequently, the same procedure was performed using CS-Cl on the contralateral limb. Cutaneous microbiota swab samples were obtained before antisepsis (Tpre); immediately after antisepsis (Tpost); and 4, 8, and 24 h after antisepsis. The collected samples were immediately inoculated on blood agar plates and incubated at 35 ºC ± 2 ºC in aerobiosis. Colony-forming units (CFUs) were manually counted after 24 h of inoculation. The Kruskal-Wallis and Mann-Whitney U tests were performed between groups and within the same group at different sample times, respectively. The NM-Cl and CS-Cl groups showed a reduction in CFUs between Tpre and Tpost in all animals (P < 0.001). Both formulations presented an antiseptic effect 24 h of antisepsis (P < 0.05), and no difference was observed between formulations at different times (P < 0.05). With a lower concentration of chlorhexidine than CS-Cl, NM-Cl presents effective antiseptic action and prolonged residual effect in antisepsis for cat venipuncture.

Comparison of Blood Biomarkers in Systemic Blood and Varicose Veins: A Cross-sectional Study

Introduction: Varicose Veins (VV) are enlarged, convoluted, and elongated veins that primarily affect the superficial veins in the lower limbs and are one of the most prevalent indications of vascular diseases. The reasons for elevated venous pressure are understood, but the inflammatory cytokines that initiate the ultimate pathways of tissue destruction and are in charge of the clinical characteristics of Chronic Venous Insufficiency (CVI) are yet unknown. Although inflammation plays a crucial role in the process of tissue apoptosis, it also plays a crucial role in tissue repair and regeneration. Aim: To investigate changes in blood markers of varicose vein inflammation and endothelial damage and compare them with systemic markers in VV patients and conclude that they are increased in VV blood. Materials and Methods: The comparative cross-sectional study was conducted in the Department of Biochemistry on 70 patients with primary VV who were scheduled for Outpatient Sclerotherapy at Nootan Medical College and Research Centre, Sankalcahnd Patel Vidyadham in Visnagar, Gujarat, India from April 2021 to June 2023. Chronic lower extremity Venous Disease (CVD) was categorised using the Clinical Aetiology Anatomy Pathophysiology (CEAP) classification method. Blood samples were obtained above the knee from the tortuous and dilated varicose tributaries of the great saphenous vein (local) and from the antecubital (systemic) vein by standard venipuncture. Erythrocytes, leukocytes, platelets, haemoglobin, and haematocrit were determined using an automatic haematology analyser. D-dimer and High sensitivity C-reactive Protein (hsCRP) were determined by an immune turbidimetric assay. IL-6 and von Willebrand factor (vWF) were measured by Enzyme Linked Immunosorbent Assay (ELISA) using commercially available kits according to the manufacturers’ instructions. An Independent samples t-test was used to compare group difference, and p-value ≤0.05 were considered significant in all two-sided statistical tests. Results: Basic haematologic test results {systemic versus (vs) varicose blood samples} were comparable. In VV, the following parameters were significantly increased compared to systemic blood: Haemoglobin (12.85±1.81 g/dL vs. 15.82±1.57 g/ dL, p<0.001), hsCRP (1.34±1.01 mg/L vs. 3.78±1.67 mg/L, p<0.001), IL-6 (2.65±1.07 pg/mL vs. 4.17±1.51 pg/mL, p<0.001), vWF (90.73±16.72% vs. 127.30±19.92, p<0.001). D-dimer was also substantially higher in samples extracted from leg VV than in systemic blood (105.87±17.72 ng/mL vs. 85.61±18.18 ng/mL, p<0.001). Conclusion: Blood from VV has shown a higher level of several inflammatory markers and signs of endothelial dysfunction. This is most likely the result of worsening venous pressure and dilated, convoluted superficial veins that restrict blood flow. The procoagulant qualities of the local blood and damage to the venous wall, leading to a chronic inflammatory response, may accelerate the disease’s progression and thrombotic consequences.

A Single-Centre Experience of an Anesthesia-Led Pediatric Peripherally Inserted Central Catheter Service at a Specialized Cancer Institute

Introduction: To report our experience of establishing a pediatric peripherally inserted central catheter (PICC) line procedure led by the anesthesia department of a tertiary care cancer center. Materials / Patients and Methods: A retrospective review was conducted over a period of 28 months. Variables such as demographic data, indications, the number of days the line remained in situ, and the frequency of adverse events were considered. Results A total of 112 patients between the ages of one and fourteen years who had PICC lines inserted were included. All procedures were done under general anesthesia by two separate anesthesia teams with established protocols. Insertion was guided by ultrasonography through the basilic (n = 84, 75%), median cubital (n = 12, 10.7%), femoral (n=1, 0.9%), or cephalic (n=15, 13.39%) veins in the non-dominant arm. The insertion success rate was 97.3% while the unsuccessful in 2.7%. The 4Fr (French number) PICC line was used in 95 (84.82%) patients and 5F in 17 (15.17%) patients. The PICC line was used for an average of 85.47 days (ranging from 0 to 350 days). Chemotherapy (n = 89, 78.47%), difficult Intravenous (IV) access (n=15, 13.39%), and palliative care (n=8 7.14%) patients require long-term venous access. 38 (33.92%) patients had completed treatment with PICC line while 4 (3.57%) patients lost follow-up. Conclusion: PICC - lines are an essential element of cancer treatment in children. Anesthesia-led PICC line service is a reliable option. They maintain operating room, PICC line sterility during insertion, and complications comparable to follow the recommended precautions.

Exploring the Dynamics of Sleep Deprivation: Insights into Complete Blood Count and Coagulation Parameters in a Case-Control Study.

The lack of preceding research in Sudan emphasizes the importance of this study, which contributes critical data to the global understanding of sleep-related health effects. This study investigates the complex relationship between sleep deprivation and blood-related factors, particularly focusing on full blood count and coagulation parameters. From January to March 2022, a case-control study was conducted in Kosti, Sudan. A control group of 11 healthy 23-33-year-olds (6 men and 5 women) had regular sleep patterns. Six men and five women ages 23-33 were chosen for this sleep-deprived case study. The case group was deprived of sleep from 7:00 p.m. to 7:00 a.m. for three days and allowed to sleep normally during the day. Daily at 7:00 a.m., antecubital vein blood was drawn. The ACL 7000 coagulation analyzer and Sysmex fully automated hematology analyzers were used for coagulation and whole blood count analysis. Data analysis included descriptive and inferential approaches like the Mann-Whitney U test for group comparisons. The study found no significant differences in total white blood cell counts reported between case and control groups (p=0.898). The case group had a substantial drop in lymphocyte counts on day 3 (p=0.016). The third day showed significant differences in neutrophil and eosinophil levels (p=0.003 and 0.000, respectively). The difference in hemoglobin and hematocrit on day 3 was statistically significant (p=0.023). Platelet counts were stable. Both groups' prothrombin times were unaffected. On all three days, groups had significant differences in activated partial thromboplastin time (APTT) (p=0.004). Therefore, the intrinsic coagulation system may have changed. This study demonstrates the complex link between sleep deprivation, coagulation indicators, and complete blood count. Monitoring blood indicators in poor sleep helps explain fundamental mechanisms and medicinal implications.

Deformation analysis of forearm soft tissues surrounding the cephalic vein under shear on the skin surface using ultrasound video images

Deformation analysis of forearm soft tissues surrounding the cephalic vein under shear on the skin surface using ultrasound video images

НАРУШЕНИЕ ПРОХОДИМОСТИ ВЕН ВЕРХНИХ КОНЕЧНОСТЕЙ У ПАЦИЕНТКИ С ПОКАЗАНИЯМИ К ИМПЛАНТАЦИИ ЭЛЕКТРОКАРДИОСТИМУЛЯТОРА (КЛИНИЧЕСКИЙ СЛУЧАЙ)

Today, permanent cardiac pacing is the most effective way to correct bradyarrhythmia. Most pacemaker leads are implanted through the veins of the upper extremities. Common vein access involves either a cephalic vein cutdown or a puncture of the subclavian or axillary veins. Implantation of leads may become technically difficult or unfeasible if there is an anomaly in the structure of the veins or, more often, occlusion/stenosis of the veins of the upper extremities after thrombosis. The article presents It is illustrated with the case of a 75-year-old patient with indications for pacemaker implantation presented by the article. The first implantation attempt was unsuccessful: extensive occlusion of the left subclavian vein (SCV) and stenosis of the right SCV were detected. The venous obstruction was asymptomatic. The patient underwent venography and was diagnosed with up to 90% luminal narrowing of the right SCV. Percutaneous transluminal angioplasty of the right SCV was performed; the residual stenosis was 50%. Subsequently, a dual-chamber pacemaker was successfully implanted into the patient; the postoperative period was uneventful. The vein obstruction could be related to a history of malignant neoplasm of the uterus. A brief literature review of various types of vascular access for pacemaker implantation and alternative implantation options complements the case report. Keywords: Pacemaker, venous thromboembolic complications, deep vein thrombosis, deep vein stenosis, angioplasty.

Superficialization of the Basilic Vein in Brachiobasilic Arteriovenous Fistula: An Alternative Vascular Access for Hemodialysis- A Single Center Experience

Introduction: The use of basilic vein to create brachiobasilic arteriovenous fistula (BBAVF) is the vascular access option of choice for hemodialysis when cephalic veins are not available. To create BBAVF, the basilic vein should be superficialized and lateralized. The study aims to highlight the outcome and morbidity of BBAVF at the tertiary referral center and aims to improve the results of the procedure in patients with chronic renal failure.Materials and Methods: This is prospective, descriptive study conducted at College of Medical Sciences Teaching Hospital from January 2019 to December 2022.The demographic data, morbidities, results were analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0 (SPSS).Results: We evaluated outcome of total forty patients who underwent BBAVF with transposition of basilic vein. The mean age of patients was 61 ± 10.85 years and male:female ratio was 2.07:1. The mean size of basilic vein was 3.05 ± 0.84mm and brachial artery was 4.11 ± 0.99mm. The most common co-morbidities in this study was Diabetes Mellitus and hypertension both was present in 52.5% of patients, only hypertension in 27.5%, only Diabetes Mellitus in 5%, HTN with PVD in 2.5% and HTN, Diabetes Mellitus with PVD in 2.5% of patients. The postoperative complications were bleeding in 25% (10), infection 10% (4), primary failure 7.5% (3), pseudoaneurysm 5% (2), and oedema 7.5% (3).Total 82.5% (33) of cases were able to start dialysis in 45 days. The failure rate was 12.5% (5) due to thrombosis and pseudoaneurysm.Conclusion: BBAVF is a suitable option for vascular access in patients with failed previous AVF or patients with small cephalic vein. Relocation of basilic vein for AVF is feasible, safe and with good patency and complication rates are acceptable.

Assessment of Lipid Profiles among Athletes and Non-Athletes in Kalar City

Regular and professional physical activity has a significant impact on general health, lipid status, and body composition., Lipid profiles and anthropometric measures are considered the main indicators for understanding body composition and cardiovascular risk factors among both athletes and non-athletes. The aim of this study was to assess the body composition and lipid profile of athletes and non-athlete college students at the University of Garmian. This study used a cross-sectional design and was conducted on 45 endurance athletes and 30 sedentary male and female individuals. It took venous blood samples from the antecubital vein. Total blood cholesterol (TC), triglycerides (TG), high-dense lipoprotein cholesterol (HDL), Low-dense lipoprotein cholesterol (LDL), and very low lipoprotein cholesterol (VLDL) were determined by standard methods. It was found a significant difference in lipid profile and body mass index (BMI) between athletic and non-athletic individuals at different ages. A significant reduction in TC, TG, LDL, and VLDL concentrations was observed in athletes as compared to the control group. However, the HDL cholesterol and BMI of athletes were not significantly different when compared to the control group. Among athletes, BMI had a significant correlation with age, TC, and VLDL, but the same correlation was not significant in non-athletes. TG had a significant correlation with VLDL in athletes but not in non-athletes. According to this study, athletes had a better lipid profile than non-athletes, despite the slight difference in BMI, and this achieves one of the sustainable development goals of the United Nations in Iraq which is (Good Health). The significant correlations of body composition (BMI) and age with body lipid profiles in athletes may be useful for assessing body health.

A dose characterization study evaluating the pharmacodynamics and safety of a concentrated alfaxalone solution (4%) as an intramuscular sedative in dogs.

Alfaxalone is a commonly employed veterinary anaesthetic induction and sedation agent. A 4% w/v preserved, aqueous formulation of alfaxalone 'RD0387' (A4%) has recently been developed. To evaluate the sedative effects of A4%, three doses, 5 mg kg-1 (A5); 7.5 mg kg-1 (A7.5) and 10 mg kg-1 (A10) were administered intramuscularly into the epaxial musculature of six healthy adult mixed-breed dogs in an experimental, randomized, blinded, crossover study. Sedation time variables, quality of sedation (including onset of sedation and recovery), physiological variables, response to cephalic vein catheterization and frequency of undesirable events were recorded. Continuous variables were analysed between treatments (one-way ANOVA or restricted maximum likelihood modelling) and within treatments compared with baseline (Tukey's test). Categorical data were analysed between treatments (Kruskal-Wallis' test) and within treatments from baseline (Dunn's test). Significance was set at p < .05. All dogs became sedated (laterally recumbent) and sedation onset was significantly faster in groups A7.5 (9.8 ± 5.3 min) and A10 (9.1 ± 5.6 min) compared to A5 (25.6 ± 16.1 min) (p = .033, p = .027, respectively). Duration of sedation was significantly longer in A10 (168.5 ± 70.6 min) and A7.5 (143.8 ± 58 min) compared to A5 (63.8 ± 28.2 min) (p = .005 and p = .003, respectively). Dogs in A10 had a superior quality of onset of sedation compared to A5 (p = .028). Sedation scores and quality of recovery from sedation were not significantly different between doses. Two dogs (2/6) in A5 were insufficiently sedated for cephalic catheterization. Ataxia was the most frequently observed undesirable event with an overall frequency of 78% (14/18) and 89% (16/18) during sedation onset and recovery, respectively. Overall, A4% administered IM in dogs at 7.5 and 10 mg kg-1 resulted in sufficient sedation for IV catheterization in dogs. To improve the speed and quality of the sedation, it is recommended that future research focuses on combining A4% with other sedative or analgesic drugs.

Salvage of Mega-fistula with Nezakatgoo Technique

Introduction: Mega-fistula is understood as an arteriovenous fistula that is very dilated throughout its course, tortuous, sometimes aneurysmal, and that presents flows above 2L/min; this carries the risk of generating multiple complications (from aneurysmal rupture, recirculation, and heart failure due to overload, among others). Its usual treatment is ligation or prosthetic replacement. Material and methods: The technique described by Nezakatgoo et al. was performed on three patients with mega fistulas (operated between 2020 and 2023) in whom salvage surgery and recovery of the entire fistula was performed. Complete dissection of the fistula from its anastomosis to the arch of the cephalic vein is performed, the vein is calibrated with a 24-34 Fr chest tube, and the excess of the mega-fistula and aneurysms are resected. In the case of stenotic areas, these are enlarged, or new anastomoses are made, and in the case of stenosis of the arch, a new anastomosis is made in the axillary vein. Results: The first case describes a left humerocephalic fistula made in 2011, which, after the plastic surgery, required two angioplasties due to stenosis in the middle third (at 125 and 236 days after the plastic surgery). It remains patent, with a total patency of 156 months since its initial confection and 36 months since the plastic. The second patient presents a mega-fistula performed in April 2019, which, after plastic surgery, required angioplasty for stenosis at one time at 509 days and continues to be permeable to date, with a total patency of 56 months and 30 months since plastic. The third fistula was operated in the context of total fistula thrombosis and required, in the first instance, a thrombectomy prior to reconstruction. It evolved in two episodes (at months 2 and 5), with stage IIb steal treated by banding (Miller technique) on both occasions. It presents a total patency of 57 m and 18 m from the plastic. All patients remain on dialysis to date due to the reconstructed fistula. Conclusions: Salvage of mega-fistula is a valid procedure to continue the useful life of native fistulas in the short and medium term; if necessary, complementary procedures are required to solve problems similar to those of other fistulas.

Clinical anatomy of the lateral antebrachial cutaneous nerve: Is there any safe zone for interventional approach?

IntroductionThe lateral antebrachial cutaneous nerve (LACN) is a somatosensory nerve coursing in the lateral portion of the forearm. The nerve is located in a close proximity to the cephalic vein (CV) all along its course with a danger of being injured during venipuncture. The LACN also overlaps and communicates with the superficial branch of the radial nerve (SBRN) in the distal forearm and hand, making the awareness of their relationship of great importance in the treatment of neuroma. The aim of the study was to observe the relationship of the LACN to surrounding structures as well as its branching pattern and distribution. Materials and methodsNinety-three cadaveric forearms embalmed in formaldehyde were dissected. The relationship of the LACN to surrounding structures was noted and photographed, and distances between the structures were measured with a digital caliper. The cross-sectional relationships of the LACN and SBRN to the CV were described using heatmaps. ResultsThe emerging point of the LACN was found distally, proximally or at the level of the interepicondylar line (IEL). The LACN branched in 76 cases (81.7 %) into an anterior and posterior branch at mean distance of 47.8 ± 34.2 mm distal to the IEL. The sensory distribution was described according to the relationship of the LACN branches to the medial border of the brachioradialis muscle. The LACN supplying the dorsum of the hand was observed in 39.8 % of cases. The LACN and the SBRN intersected in 86 % of upper limbs with communications noticed in 71 % of forearms. The LACN was stated as the most frequent donor of the communicating branch resulting in neuroma located distal to the communication and being fed from the LACN. The relationship of the LACN and the CV showed that the IEL is the most appropriate place for the venipuncture due to maximal calibers of the CV and deep position of the LACN. The LACN was adjacent to the cubital perforating vein and the radial artery in all cases. The medial border of the brachioradialis muscle was observed less than 1.8 mm from the LACN. ConclusionThe study provides morphological data on the LACN distribution, branching pattern and relationship to surrounding structures in a context of clinical use in different spheres of medicine. The branching pattern of the LACN appears to be more constant compared to data provided by previous authors. We emphasized the meaning of cross-sectional relationship of the LACN to the CV to avoid venipuncture outside the cubital fossa if possible. The posterior branch of the LACN was predicted as appropriate donor of the graft for a digital nerve. The LACN appeared to be in a close proximity within the whole length of the brachioradialis muscle what the orthopedic surgeons must be concerned of. The meaning of the donor-nerve of the communicating branch in neuroma treatment was also introduced.

Subclinical hypothyroidism and anti-thyroid peroxidase antibodies in primary open-angle glaucoma: A case-control study.

To evaluate the association among subclinical hypothyroidism, anti-thyroid peroxidase (anti-TPO) antibody, and primary open-angle glaucoma (POAG). Case-control study. The cases consisted of patients with POAG and controls were age- and sex-matched patients from the general eye clinic with no history of glaucoma. Blood samples were taken from the participants' antecubital veins and sent for measurement of thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), and anti-thyroid peroxidase (anti-TPO) antibody. Data was analyzed using the Mann-Whitney U test and the Chi-square test. Odds ratio with 95% confidence interval (CI) was calculated. A two-tailed P value less than 0.05 was considered for statistical significance. There were a total of 63 cases and 63 controls. Subclinical hypothyroidism was present in 20.6% of patients in the glaucoma group and 4.8% of patients in the control group ( P < 0.01). The odds of subclinical hypothyroidism in patients with POAG compared to controls was 5.2 (95% CI 1.7-22). Anti-TPO antibody positivity was higher in the glaucoma group (22.2%) than in the control group (14.3%), but this did not reach statistical significance ( P = 0.25). This study suggests an association between POAG and subclinical hypothyroidism. Further research is needed to establish the cause-and-effect relationship between these two conditions.

Serum Vitamin Levels, Cardiovascular Disease Risk Factors, and Their Association with Depression in Korean Women: A Cross-Sectional Study of a Nationally Representative Sample.

Background and Objectives: Serum vitamin levels, cardiovascular disease risk factors, and their association with depression is a complex issue that has been the subject of much research. Therefore, we investigated the relationship between vitamin A, B9, and E levels, cardiovascular risk factors, and depression in premenopausal and menopausal South Korean women. Materials and Methods: This cross-sectional study used the 2016-2018 Korea National Health and Nutrition Examination Survey data. Depression was assessed using a questionnaire to check for symptoms of depression or the Patient Health Questionnaire-9. Blood samples were collected from the antecubital vein in the morning after an overnight fast. Covariates were defined as self-reported physician diagnoses. Well-trained medical staff performed the standard procedures. Statistical analysis was performed using the complex sample analysis method of SPSS, using two separate logistic regression models (model 1: adjusted for age; model 2: adjusted for age, marital status, smoking, and alcohol consumption). Results: A total of 3313 women aged over 20 years were enrolled. The association between vitamin A levels and depression was as follows: lower levels of vitamin A were associated with an increased risk of depression in premenopausal women in model 1 and model 2. The levels of serum vitamins E and B9 were not correlated with depression in premenopausal and postmenopausal women. In the premenopausal group, depression increased in the obesity (model 1: p = 0.037; model 2: p = 0.047) and diabetes mellitus (model 1: p = 0.010; model 2: p = 0.009) groups. The menopausal group with depression had higher rates of stroke (model 1: p = 0.017; model 2: p = 0.039) and myocardial infarction (model 1: p = 0.004; model 2: p = 0.008) than the group without depression. Conclusions: Depression is correlated with lower blood levels of vitamin A in premenopausal women. Vitamin B9 and E levels were not associated with depression independent of menopausal status. Depression is associated with obesity and diabetes mellitus in premenopausal women and with stroke and myocardial infarction in postmenopausal women.

The effects of health education and exercise style changes on the maturation of autologous arteriovenous fistula in hemodialysis patients: A randomized controlled trial.

Upper limb exercise has long been considered to be the main means to promote autogenous arteriovenous fistula (AVF) maturation, but in practice exercise intensity and compliance are both typically lacking. Several randomized controlled trials (RCTs) have demonstrated the good effects of functional resistance or pressure exercise in patients with AVF. However, many patients' have difficulty complying with upper limb exercise programs without systematic health education. Therefore, we argue that resistance and pressure exercise supported by health education is actually the most beneficial for AVF patients. We randomly divided 114 patients into a control group and an experimental group of 57 patients each. In the control group, conventional care was used, and in the experimental group, online health education based on the IMB (Information-Motivation-Behavior skills) model and functional resistance and pressure upper limb exercises was implemented with the AVF side arm. The failure rate of AVF maturation, clinical maturation time, cephalic venous blood flow, vessel diameter, and vessel skin thickness were compared between the two groups. Fifty-five cases were included for each in the final study. The primary outcome of this study was the failure rate of AVF maturation. Secondary outcomes included clinical maturation time, cephalic vein flow, vessel diameter, and vessel thickness. The failure rate of AVF maturation in the experimental group was significantly lower than that in the control group, and the clinical maturation time in the experimental group was significantly shorter than that in the control group. For the remaining three indicators, there were between-group effects, time effects, and interaction effects in both groups. Comparison between groups showed that there was no statistical difference in the observed indicators of cephalic vein flow, vessel diameter, or vessel thickness between the two groups before the intervention but that there was a statistical difference at the end of the 4th, 8th, and 12th weeks of the intervention. A 2 × 2 comparison also showed that there was a statistical difference between the three indicators at each time point within the two groups. IMB model-based online health education combined with functional resistance and pressure exercises can improve AVF maturation status and accelerate AVF maturation within 12 weeks of surgery.

Dual outflow upper arm arteriovenous fistula: An effective technique to prevent cephalic arch stenosis.

Cephalic arch stenosis (CAS) is critical point to maintain functional arteriovenous fistula (AVF) in patients undergoing hemodialysis with brachio-cephalic AVFs. In this study, we aimed to determine the effectiveness of dual outflow (cephalic and basilic veins) as a surgical method to prevent CAS. Between July 2016 and December 2019, 369 patients underwent upper arm AVF creation. Among them the 251 patients were enrolled in this retrospective study. Two hundred seven underwent brachio-cephalic arteriovenous fistula (BCAVF) and 44 underwent brachio-cephalicbasilic arteriovenous fistula (BCBAVF). From the 251 patients, diabetes mellitus (66.7% vs 36.4%, P < .001) and hypertension (91.3% vs 75%, P = .002) were more common in the patient group who underwent BCAVF surgery; however, the difference in volume flow to the fistula did not differ between the 2 groups. CAS (30.4% vs 9.1%, P = .004) and fistula occlusion (15.9% vs 4.5%, P = .048) were likely to occur in the BCAVF group. The primary patency rates at 12 months were 74.3% and 86.4% for the BCAVFs and BCBAVFs, respectively (P = .075). The primary-assisted patency rates at 12 months were 87.0% for BCAVFs and 93.2% for BCBAVFs, respectively (P = .145). Secondary patency rates at 12 months were 92.2% for BCAVFs and 93.2% for BCBAVFs, respectively (P = .023). Compared to BCAVF, traditional upper arm AVF, upper arm AVF with cephalic and basilic vein dual drainage can be optimal surgical method to preventing CAS.

Comparison of structural, mechanical, and histochemical characteristics of L-PRF and T-PRF membranes using different centrifugation protocols – An ex-vivo observational study

ObjectivesMany investigators are looking into the possibility of using platelet-rich. hemoderivatives as a source of the protein structures and cytokines necessary for. periodontal healing of wounds. The objective of the study was to evaluate and. compare the structural, mechanical, and histochemical characteristics of L-PRF and TPRF. membranes prepared by using three different centrifugation protocols. MethodsThirty participants around the ages of 20 and 35 who were in good overall. health had their antecubital veins pricked for ten milliliters of the blood. Venous blood. was centrifuged immediately after collection in silica-coated glass tubes and titaniumcoated. tubes utilizing the APRF machine. The mechanical properties of PRF. membranes (n = 30) for L-PRF and T-PRF each protocol) were assessed using a. desktop universal testing machine. ResultsThe forces around 700 g (3200 rpm, 15 min) yielded a PRF membrane with. desirable mechano-degradation characteristics for its clinical application. Histochemical examination revealed mixed inflammatory infiltrate with predominantly. platelets followed by lymphocytes, neutrophils& monocytes in T-PRF. Whereas, in. LPRF thin strands of mixed inflammatory infiltrate predominantly neutrophils &. monocytes are seen in the connective tissue stroma. ConclusionThis study demonstrated that centrifugation speed, force, and time. influenced the structural, and mechanical properties of PRF membranes prepared with. various protocols. This is the first study to reveal the marked impact of glass and. titanium-reinforced centrifugation tubes on the final production of PRF. It was further. found that a significant difference was observed between L-PRF and T-PRF at. 3200 rpm and 2700 rpm protocols.

Variations in Glycosylated Haemoglobin (Hba1c) Levels of Obese Women Resident in Rivers State, Nigeria

Globally, the incidence of obesity is known to be linked to a number of other riskfactors such as diabetes, cardiovascular disease, amongst others, however, there are population specific variance and severity. Therefore, this study t investigated the possible variations in glycosylated haemoglobin (HbA1c) levels of obese women resident in Rivers State, Nigeria. Precisely, 334 obese and non-obese women within the ages of 18 and 65 years with no obvious health challenge and resident in Upland and Riverine areas of Rivers State were actually surveyed by the present study. A multistage sampling technique was adopted, and subjects were surveyed across the upland and riverine locations of the State. These subjects were evenly drawn from the multi-ethnic residents of the state. Anthropometric (body mass index- BMI) data and blood sample (via antecubital vein following standard procedures) were obtained from the consenting subjects. After laboratory analyses, the quantitative data got were subjected to statistical analyses using the statistical package for social sciences (SPSS) version 21.0. One-way analysis of variance (ANOVA) and independent t-test with a p&lt; 0.05 considered statistically significant were determined. The result also revealed that all obese subjects as well as their UPL and RVR subgroups had significantly (P&lt;0.05) elevated HbA1c compared to their respective non-obese groups and these increases were both graded and marked (P&lt;0.05) with increasing BMI. It is also important to note that the non- obese and obese class III of the RVR subjects had markedly (P&lt;0.05) higher levels when compared to those of their UPL counterparts.The finding of this study on the changes in HbA1c levels of obese women resident in UPL and RVR residents revealed significant (P&lt;0.05) rising percentages of HbA-1c with increasing BMI. It can thus be concluded that the incidence of obesity and associated comorbidities are substantially linked to sex, ethnic/culture and socioeconomic status.

An experimental study of consecutive administration of ropinirole and apomorphine for emesis induction in dogs.

To study the safety and effectiveness of consecutively administered ropinirole and apomorphine (both dopamine 2-like receptor agonists) for emesis induction in dogs. Prospective, crossover study design. Institutional animal research facility. Six healthy male purpose-bred Beagle dogs. Each dog received 4 treatments:(1) apomorphine infusion (21μg/kg) over 30minutes+ropinirole eye drops (3.75mg/m2 );(2) ropinirole infusion (108μg/m2 ) over 30minutes+apomorphine SC (100μg/kg);(3) apomorphine SC (100μg/kg)+ropinirole eye drops (7.5mg/m2 ) after 30minutes; and (4) ropinirole eye drops (7.5mg/m2 )+apomorphine SC (100μg/kg) after 30minutes.Infusions were administered via a catheter instrumented in the cephalic vein. Eye drops and SC injections were administered as described in the product inserts. Blood samples were taken for ropinirole and apomorphine concentration analysis before dosing and periodically following administrations. The washout period between the treatments was 5-7days. Number of vomits and clinical signs were recorded. Alertness and heart rate were monitored in conjunction with blood sampling. The average number of vomits varied between 4.3 and 8.8 (range 1-16) following treatments. Signs of nausea, vomiting, and lethargy were seen in all individuals without significant differences between treatments. Moderate to marked, transient increase in heart rates was detected in all treatments. Infrequent noted side effects included ocular hyperemia, blepharospasms, and muscle tremors. Prior treatment with apomorphine significantly decreased the absorption of ropinirole eye drops. The safety and efficacy profiles of this experimental study support that ropinirole and apomorphine could be administered consecutively in cases where the treatment using 1 substance has resulted in an incomplete evacuation of the stomach contents, and the attending veterinarian considers the use of a different agent to have benefits that outweigh the risks.

Vascular access in cardiac implantable electronic devices: a systematic review and network meta-analysis

Abstract Background Despite the increasing number of cardiac implantable electronic devices (CIED) implantations worldwide, gaps in the evidence base on the optimal venous access to perform the procedure still exist and direct comparisons of different techniques are lacking. Purpose The aim of this study was to compare the acute and long-term safety and efficacy of the three main vascular access modalities (i.e. subclavian vein puncture [SVP], cephalic vein cut-down [CVC], axillary vein puncture [AVP]) used during CIEDs implantations. Methods A systematic review of the literature and network meta-analysis were performed searching Pubmed/MEDLINE databases for relevant articles using the following search strategy, without language restrictions: ((cardiac implantable device) OR (pacemaker) OR (ppm) OR (defibrillator) OR (icd) OR (resynchronization) OR (crt)) AND ((venous access) OR (subclavian) OR (axillary) OR (cephalic)). Randomized and non-randomized studies comparing one or more of the outcomes of interest, between at least two discernible groups (SVP, CVC and AVP), were included in the present analysis and SVP competitive arm was used as the reference group. The primary endpoints were safety outcomes, which included: 1) pneumothorax, 2) pocket haematoma, 3) lead failure, including both acute (dislodgment) and chronic (fracture, subclavian crush syndrome) events, 4) infective complications. Success rate, defined either by successful cannulation of the vein or by successful lead placement was a secondary outcome. Results Forty studies (33, 83% non-randomized) were selected and a total of 166782 patients (median age 69.2 years, 65.2% males) followed up for a median of 18 months (IQR 11-51) were included. Both AVP and CVC showed a significant reduction in the risk of pneumothorax compared to SVP (AVP: OR 0.12, 95% CI 0.05-0.28; CVC: OR 0.18, 95% CI 0.15-0.22) but no significant differences between treatment arms concerning bleedings (AVP: OR 1.11, 95% CI 0.52; 2.37; CVC OR 1.16, 95% CI 0.60; 1.88) or infective complications (AVP: OR 1.00, 95% CI 0.47- 2.14; CVC OR 0.67, 95% CI 0.31-1.44) were observed. Compared to SVP, AVP was significantly superior concerning the risk of lead failure (OR 0.42, 95% CI 0.27-0.67) while CVC showed a nearly statistically significant reduction in risk of lead complications (OR 0.73, 95% CI 0.52-1.02), see figure 1. Success rate did not differ significantly between treatments arms albeit CVC showed a trend towards a higher risk of need for alternate venous access compared to AVP (3.56, 95% CI 0.89-14.21). Conclusions Considering the lower risk of pneumothorax and lead failure, AVP and CVC should be preferred over SVP to achieve venous access during CIEDs implantation taking into account the higher success rates associated with AVP.Figure 1

Autologous forearm arteriovenous loop vascular access, an option to be considered

Background: Autologous arteriovenous fistula is usually the vascular access of choice for hemodialysis in patients with chronic kidney disease. Autologous forearm loops with cephalic or basilic vein are an alternative in those cases with a suitable forearm vein but with an unsuitable radial artery; however they are rarely used and there is little reported evidence of their usefulness. Our objective is to report our results on the creation of autogenous forearm loops as vascular access for hemodialysis. Methods: We present a prospective cohort study of autogenous forearm loop arteriovenous fistula created between 2010 and 2022, in patients with stage 4–5 chronic kidney disease. Demographic data, surgical details, vein used, follow up to 24 months, maturation, utilization, primary, assisted, and secondary patency estimations with Kaplan-Meier curves, as well as complications during follow-up, were recorded. Results: During the study period, 22 autologous forearm loops were created, 14 of them with cephalic, and 8 with basilic vein. Most (59%) of the patients were men, 19 were already on dialysis and the rest started during follow-up. Sixteen patients had previous vascular accesses. One patient was lost during follow-up. Six-week maturation rate was 61.9% and utilization rate was 57.1%. 6, 12, and 24 months primary and secondary patencies were 75.4%, 59.2%, 41.5% and 85.0%, 69.5%, 56.9% respectively. In five patients an access-induced distal ischemia was diagnosed, four successfully treated and only one patient lost the access. No cases of infection or other major complications were reported. Conclusion: Autologous forearm loops have acceptable maturation (61.9%) and patency rates at follow-up (56.9% 2-years secondary patency). Although rarely used, they are a vascular access alternative that should be considered to preserve the proximal vasculature of the arm for future accesses.