Cubital Vein Research Articles

Forearm Cephalic Vein Graft for Short, "Middle"-Flow, Internal Maxillary Artery to Middle Cerebral Artery Bypass.

The cervical carotid system has been used as a source of donor vessels for radial artery or saphenous vein grafts in cerebral bypass. Recently, internal maxillary artery to middle cerebral artery bypass has been described as an alternative, with reduction of graft length potentially correlating with improved patency. To describe our experience using the forearm cephalic vein grafts for short segment internal maxillary artery to middle cerebral artery bypasses. All vein grafts were harvested from the volar forearm between the proximal cubital fossa where the median cubital vein is confluent with the cephalic vein and the distal wrist. Six patients were treated with internal maxillary artery to middle cerebral artery bypass. In 4, the cephalic vein was used. Postoperative angiography demonstrated good filling of the grafts with robust distal flow. There were no upper extremity vascular complications. All but 1 patient (mortality) tolerated the procedure well. The other 3 patients returned to their neurological baseline with no new neurological deficit during follow-up. The internal maxillary artery to middle cerebral artery "middle" flow bypass allows for shorter graft length with both the proximal and distal anastomoses within the same microsurgical field. These unique variable flow grafts represent an ideal opportunity for use of the cephalic vein of the forearm, which is more easily harvested than the wider saphenous vein graft and which has good match size to the M1/M2 segments of the middle cerebral artery. The vessel wall is supple, which facilitates handling during anastomosis. There is lower morbidity potential than utilization of the radial artery. Going forward, the cephalic vein will be our preferred choice for external carotid-internal carotid transplanted conduit bypass.

Small-Diameter Implant Treatment Plan Revision: Management of Complications.

Small-Diameter Implant Treatment Plan Revision: Management of Complications.

Chemokine (C-X-C motif) ligand 11 levels predict survival in cirrhotic patients with transjugular intrahepatic portosystemic shunt.

Chemokines, such as CXCR3-ligands, have been identified to play an important role during hepatic injury, inflammation and fibrosis. While CXCL9 is associated with survival in patients receiving transjugular intrahepatic portosystemic shunt (TIPS), the role of CXCL11 in severe portal hypertension remains unknown. CXCL11-levels were measured in 136 patients with liver diseases, and 63 healthy controls. In further 47 cirrhotic patients receiving TIPS, CXCL11 levels were measured in portal and hepatic veins at TIPS insertion by cytometric bead array. CXCL11-levels were measured in 23 patients in cubital vein and right atrium, whereas in 24 patients in portal and hepatic blood at an invasive reevaluation. CXCL11-levels were increased with the severity of liver fibrosis. CXCL11-levels from portal, hepatic and cubital veins and right atrium showed a highly significant correlation among each other in these patients. Furthermore, levels of CXCL11 from the right atrium were significantly higher than those from cubital vein. Interestingly, patients with alcoholic cirrhosis had significantly lower CXCL11-levels, than other aetiologies of cirrhosis. After TIPS, CXCL11 levels correlated with the degree of portal pressure and patients with higher CXCL11-levels in portal and hepatic veins showed higher mortality. Multivariate analysis revealed hepatic CXCL11-levels before TIPS, creatinine and age as independent predictors for survival in TIPS patients, whereas MELD score and low portal CXCL11-levels after TIPS predicted long-term survival. CXCL11 levels are mainly increased in patients with non-alcoholic cirrhosis and high portal pressure. Moreover, levels of CXCL11 might predict long-time survival of cirrhotic patients bearing TIPS.

Oxidative stress impact on growth hormone secretion in the eye.

AimTo evaluate the influence of oxidative stress on extrapituitary growth hormone (GH) secretion in the eye and to analyze the interdependence between eye and serum GH levels under normal and hypoxic conditions.MethodsPars plana vitrectomy (PPV) was performed in 32 patients with developed proliferative diabetic retinopathy (PDR) and 49 non-diabetic controls, both of whom required this procedure as part of their regular treatment in the period from April 2013 to December 2014. During PPV, vitreous samples were taken and blood was simultaneously collected from the cubital vein. GH levels in serum and vitreous samples were measured by electrochemical luminescence assay. Oxidative stress was measured by enzyme-linked immunosorbent assay of advanced oxidation protein products (AOPP) and lipid hydroperoxide (LPO) in serum and vitreous.ResultsSerum AOPP levels were significantly higher than vitreous levels in both groups (P < 0.001 for each group) and LPO levels were significantly higher only in PDR group (P < 0.001). There was a significant positive correlation between serum and vitreous LPO levels in PDR group (r = 0.909; P < 0.001). Serum GH levels were significantly higher than vitreous levels in both groups (P < 0.001 for each group). Serum GH levels were significantly higher in PDR group than in controls (P = 0.012). Vitreous GH values were slightly higher in PDR group, but the difference was not significant.ConclusionOur study confirms that GH production in the eye is autonomous and independent of oxidative stress or pituitary GH influence.

Use of blind placements of peripherally inserted central catheters in burn patients: A retrospective analysis

IntroductionSafe and reliable vascular access is essential for the treatment and care of burn patients. Peripherally inserted central catheters (PICCs) are widely used for various groups of critically and chronically ill patients. However, the information about PICC use and management for burn patients is limited. MethodsThe Institutional Review Board approved retrospective cohort chart review included all burn patients at a single center who received one or more PICCs (n=106). Blind PICCs were placed by an intravenous clinical nurse specialist (IV CNS). Data were collected from PICC records and included general demographics, as well as PICC insertions, management, and removals. ResultsAbout 42% of cases were in the cubital vein, 39% in the basilar, 14% in the cephalic, and 3% in the brachial veins. In 75% of the cases, gauze dressing was identified as the primary form of routine PICC nursing care. About 62% of all patients had their dressings changed every 48h and 37.5% had dressings changed daily. The average length of time each PICC remained in place was 18.5 days. About 16% of the cases were identified as having PICC-related complications, including one infection, two occlusions (2%), one edema at insertion place (1%), and 12 cases of mechanical phlebitis. ConclusionAlthough PICCs are adequate for burn patient care, there are no protocols or guidelines covering rational and safe usage of PICCs. Standard guidelines on PICC placement and management specifically for burn patient should be developed.

Comparison of Pain Tolerance Thresholds of Upper Limb to Identify the Most Appropriate Venipuncture Site

Venipuncture is often accompanied by pain, which can compromise dental care and foment distrust toward dental care providers. The aim of the present study was to identify sites on the forearm and hand that have the greatest pain tolerance threshold (PTT) during venipuncture. The PTT was estimated in 20 healthy volunteers using a noninvasive nerve conduction threshold device. The subjects self-stimulated 5 sites (median cubital vein, cephalic vein at the cubitus, basilic vein, cephalic vein at the carpus, and superficial dorsal vein) at 2 kHz, 250 Hz, and 5 Hz. We measured the stimulation intensity before the subject deactivated the device. Differences in the average PTT values at each site were compared using the Kruskal-Wallis and Scheffé tests. P <.05 was considered to indicate statistical significance. The PTT was significantly greater at the superficial dorsal vein than at the basilic vein for all 3 noninvasive nerve conduction threshold frequencies (P < .05). The estimated PTT was significantly greater at the superficial dorsal vein than at the median cubital vein and cephalic vein at the carpus in response to 250-Hz stimulation (P < .05). The greater PTT of the superficial dorsal vein suggests that venipuncture at this site should result in the lowest pain intensity among all upper limb sites.

English

Anomalies of upper limb arteries have got clinical implications for nursing staff, surgeons and medical practitioners. Here we have found superficial ulnar artery arising from brachial artery in the middle 1/3rd of the arm in the Right upper limb. This anomaly was found during routine dissection in the Anatomy Department, Andhra Medical College. Its frequency varies from 0.7% to 7%. Its clinical significance is discussed. INTRODUCTION: Ulnar artery is the larger terminal branch of brachial artery in the cubital fossa 1. It passes downwards, medially and leaves the cubital fossa deep to the ulnar head of pronator teres which separates the artery from the median nerve.2 In the present case the ulnar artery is taking origin from the brachial artery in the middle third of the arm and is running a superficial course. It is passing superficial to the bicipital aponeurosis in the cubital fossa and subjacent to the median cubital vein. It is then passing just lateral to the medial epicondyle of humerus and running superficial to the common flexor origin. Hence it has been named as Superficial Ulnar artery (SUA). CASE REPORT: During routine dissection for the under-graduate students we have come across this anomaly. In the Right upper limb we have noticed that the superficial ulnar artery (SUA) has taken origin from the middle third of the brachial artery in the arm at a distance of 12.3cms from the acromian process of scapula. (Photograph 1) At its origin in the Arm: The SUA along with its venae comitantes is lying lateral to the median nerve. The later on it is crossing to the medial side and comes to lie subjacent to the median nerve. There after it ran a superficial course in the arm, passes just lateral to the medial epicondyle of humerus and superficial to the common flexor origin to enter the cubital fossa. In the cubital Fossa: The SUA is present superficial to the bicipital aponeurosis and subjacent to the median cubital vein where it is most vulnerable to injury while attempting for intra- venous injections and cannulations. In the Forearm: The SUA passed superficial to the flexor muscles of the forearm. It passed superficial to the pronator teres muscle and then ran downwards and medially to run lateral to the ulnar nerve. Both the SUA and ulnar nerve are present lateral to the flexor carpi ulnaris muscle. The SUA has not given any significant branches throughout its course in the arm and the forearm.

Monitoring recovery from iron deficiency using total hemoglobin mass.

Using hemoglobin concentration ([Hb]) to diagnose borderline iron deficiency and monitor the progress of its treatment is difficult because of the confounding effects of plasma volume. Because hemoglobin mass (Hbmass) is not affected by plasma volume, it may be a more sensitive parameter. The aim of this study was to monitor Hbmass, iron storage, and maximal oxygen consumption (V˙O2max) during and after oral iron therapy in subjects with severe and moderate iron deficiency. Three groups of female recreational athletes were monitored for at least 22 wk, as follows: 1) severe iron deficiency group (SID) (n = 8; ferritin, ≤12 ng·mL), 2) moderate iron deficiency group (MID) (n = 14; ferritin, ≤25 ng·mL), and 3) control group (n = 8; ferritin, >25 ng·mL). Hbmass and iron status were determined before, during, and up to 12 wk after at least 10 wk of oral iron supplementation. In total, five V˙O2max tests were performed before, during, and after the supplementation period. Hbmass increased markedly in the SID group (15.6% ± 11.0%, P < 0.001) and slightly in the MID group (2.2% ± 3.7%, P < 0.05) by the end of the supplementation period and remained at this level for the following 12 wk. [Hb] and Hbmass were similarly affected, but Hbmass was more closely related to mean corpuscular volume and mean corpuscular hemoglobin than [Hb]. The SID group incorporated 534 ± 127 mg of iron into ferritin and hemoglobin, whereas the MID group incorporated 282 ± 68 mg of iron. V˙O2max increased only in the SID group by 0.20 ± 0.18 L·min (P < 0.05) and was closely related to Hbmass (P < 0.01). Hbmass is a sensitive tool for monitoring recovery from iron deficiency anemia and assessing the effectiveness of iron supplementation in individuals with severe or moderate iron deficiency.

Evolutionary gain of male secondary sexual structures in the widespread Neotropical montane genus Lathecla (Lepidoptera, Lycaenidae, Eumaeini)

Lathecla is a widespread, primarily montane, Neotropical genus. It consists of seven species that have a relatively uniform adult wing pattern coupled with a diverse set of male secondary sexual structures. Taxonomically, we describe five species — Lathecla mitzi Robbins new species, Lathecla fernandezi Robbins &amp; Busby new species, Lathecla vichai Robbins &amp; Busby new species, Lathecla carolyna Busby new species and Lathecla winnie Robbins &amp; Busby new species and remove one name from synonymy — Thecla mimula Draudt, revised status. Evidence is presented for transferring Lathecla from the Thestius Section of the Eumaeini to the Micandra section, next to Podanotum. Topology of an inferred phylogenetic tree for Lathecla is stable when male secondary sexual characters are omitted or under a variety of implied weighting options. A scent patch on the cubital vein of the dorsal surface of the forewing is unique to Lathecla and evolved (and was not lost) in the ancestor of a four-species lineage. Its sister lineage contains two species. A scent patch on the ventral surface of the forewing evolved (and was not lost) in the ancestor of a six-species lineage in Lathecla. Its sister lineage contains one species. These results, along with previous data, show the viability for the Eumaeini of the hypothesis that the evolutionary gain of a male secondary sexual organ increases the rate of species diversification.

The difference between the subjective and objective evaluation of oxaliplatin-induced vascular pain due to administer chemotherapy via peripheral vein.

651 Background: We have reported the safety and effectiveness of chemotherapy via median cubital vein for metastatic colorectal cancer without implantation of a central venous port. However, vascular pain (VP) occasionally requires switching of the drip infusion route during chemotherapy for the administration of oxaliplatin via the peripheral vein. VP and phlebitis induced by intravenous infusion of antineoplastic agents reduces the rate of completion or continuation of chemotherapy. We also reported that addition of dexamethasone to oxaliplatin drip infusion controlled the vascular pain caused by administration of oxaliplatin via the peripheral vein (ASCO-GI2012). Pain is currently evaluated using subjective methods such as the visual analog scale (VAS). However, because the assessment of pain can greatly vary depending on the mood and physical state of the patient at the time of assessment, it is best to objectively evaluate pain. Pain Vision PS-2100 (PV) is an analytical instrument that was designed to quantitatively and objectively assess sense perception and nociception in a patient. Although it is used in the field of anesthesiology, there have been no reports concerning it for the assessment of oxaliplatin-induced VP. Methods: The present study examined the correlation of subjective and objective assessment results using VAS and PV, respectively, for cases of oxaliplatin-induced VP. Subjects comprised 57 patients with colorectal cancer who underwent chemotherapy at the Fukuoka University. Results: Both VAS and PV assessments of PN were performed 162 times in total, and partial correlation coefficient analysis adjusted by subject and gender. The VAS and PV mean values of VP were 24.8 (0–100) and 44.5 (0–596), respectively. The partial correlation coefficient was 0.350 (p= 0.0002). Conclusions: Although both assessments evaluated the same events, no strong correlation was observed between the results and a weak correlation was observed between VAS and PV. These results suggest that because VAS and PV each measure different factors, both subjective and objective assessments of drugs designed to ameliorate oxaliplatin-induced VP are necessary.

Variations of the cubital superficial vein investigated by using the intravenous illuminator.

The purpose of this study was to report variations of the cubital superficial vein patterns in the Korean subjects, which was investigated by using venous illuminator, AccuVein. The 200 Korean subjects were randomly chosen from the patients and staff of the Keimyung University Dongsan Medical Center in Daegu, Korea. After excluding the inappropriate cases for detecting venous pattern, we collected 174 cases of right upper limbs and 179 cases of left upper limbs. The superficial veins of the cubital fossa were detected and classified into four types according to the presence of the median cubital vein (MCV) or median antebrachial vein. The type II, presenting the both cephalic and basilic vein connected by the MCV, was most common (177 upper limbs, 50.1%). Although the most common type in male and female was different as type I (108 upper limbs, 49.3%) and type II (75 upper limbs, 56.0%), respectively, statistical significance was not detected (P=0.241). The frequency of the each types between right and left upper limbs was also not different (P=0.973). Among 154 subjects who were observed the venous pattern in the both upper limbs, 76 subjects (49.3%) had the same venous pattern. Using AccuVein to investigate the venous pattern has an advantage of lager scale examination compared to the cadaver study. Our results might be helpful for medical practitioner to be aware of the variation of the superficial cubital superficial vein.

Comparative study of various subpopulations of cytotoxic cells in blood and ascites from patients with ovarian carcinoma.

Aim of the studyA number of observations have indicated that the immune system plays a significant role in patients with epithelial ovarian cancer (EOC). In cases of EOC, the prognostic significance of tumour infiltrating lymphocytes has not been clearly explained yet. The aim is to determine the phenotype and activation molecules of cytotoxic T cell and NK cell subpopulations and to compare their representation in malignant ascites and peripheral blood in patients with ovarian cancer.Material and methodsCytotoxic cells taken from blood samples of the cubital vein and malignant ascites were obtained from 53 patients with EOC. Their surface and activation characteristics were determined by means of a flow cytometer. Immunophenotype multiparametric analysis of peripheral blood lymphocytes (PBLs) and tumour infiltrating lymphocytes (TILs) was carried out.ResultsCD3+ T lymphocytes were the main population of TILs (75.9%) and PBLs (70.9%). The number of activating T cells was significantly higher in TILs: CD3+/69+ 6.7% vs. 0.8% (p < 0.001). The representation of (CD3–/16+56+) NK cells in TILs was significantly higher: 11.0% vs. 5.6% (p = 0.041); likewise CD56bright and CD–56bright from CD56+ cells were higher in TILs (both p < 0.001). The activation receptor NKG2D was present in 45.1% of TILs vs. 32.3% of PBLs (p = 0.034), but we did not find a significant difference in the numbers of CD56+/NKG2D+ in TILs and PBLs.ConclusionsThese results prove that the characteristics and intensity of anti-tumour responses are different in compared compartments (ascites/PBLs). The knowledge of phenotype and functions of effector cells is the basic precondition for understanding the anti-tumour immune response.

The Ultrasound Characteristics of the Changes in the Venous System of the Intravenous Drug Users

1 , T.V. VATOLINA 2 *, A.V. TSYPLYASHCHUK 3 Aim — the objective of the present study was to elucidate specific ultrasound characteristics of the changes in the venous system of the opiate drug users. Material and methods. A total of 150 patients with the history of intravenous drug (ID) abuse were avail- able for the examination. They were divided into two groups. Group 1 was comprised of the subjects who had used drugs up the onset of the study (n=40; 23 men and 17 women aged from 21 to 44 (mean 31) years). Group 2 consisted of 110 subjects in the state of remission from the drug dependence (24 men and 86 women at the age from 24 to 59 (mean 37) years). All the patients were involved in the ultrasound study of the internal organs and the peripheral vascular bed. Results. It was shown that the patients using the intravenous drugs during a period up to 2 years do not suffer vein deformation with the exception of the narrowing of the left median cubital vein. Venous deformation in the form of a strand of beads develops after 2—5 years of drug abuse and is sometimes irreversible. Venous thrombosis and chronic venous insufficiency only rarely occur in the subjects using opiate drugs during 2—5 years. The patients ceasing to use a drug experience normalization of the narrowed vein lumen within 5—10 years after the onset of remission. At the same time, the majority of the patients using ID during 5 to 10 years or longer suffer the irrevers- ible changes in the lymphovenous system that clinically manifest themselves as puffy hand syndrome. Supravenous «pothole» deformations are formed as soon as 1—2 years after the onset of ID abuse. The use of intravenous dugs during 10 years or longer results in persistent irreversible hyperplasia of the lymph nodes. Vemous obstruction most frequently occurs in the patients using intravenous oiates during 10 years or more. Conclusion. The majority of the patients using intravenous opiate drugs develop a combination of pathological changes in the venous system.

Peripheral venous access in the obese patient.

Sir, Intravenous (IV) cannulation, a common procedure in anaesthetic practice, can at times be difficult and frustrating. We report a 46-year-old male, 109 kg, who was scheduled for repair of incisional hernia (related to previous right nephrolithotomy via a subcostal incision) in whom establishing peripheral IV access proved difficult. The patient had undergone several previous surgeries for genitourinary and kidney-related complaints. No peripheral veins were visible or palpable in the extremities. Venous cut-downs had been done in both lower limbs during previous surgeries. The right cephalic vein was visible in the delto-pectoral groove and was successfully cannulated. After establishing standard monitoring, anaesthesia was induced with fentanyl and thiopentone. Tracheal intubation was facilitated with rocuronium. The patient was positioned in left lateral position for surgery. This resulted in positional slowing of the crystalloid infusion rate. The operation table was tilted ≈20° head-down (to make neck veins prominent), and the right external jugular vein was cannulated. The surgery lasted 3 h and the recovery and post-operative course were uneventful. Predictive factors for difficult venous access include obesity, chronic illness, hypovolaemia, history of IV drug abuse, vasculopathy,[1,2,3] oedema, chemotherapy, diabetes and multiple prior hospitalizations.[4] Obtaining IV access can be tedious and time-consuming procedure in the obese. The veins on the dorsum of the hand and the deep brachial vein may be neither visible nor palpable in the obese patient. However, veins on the volar aspect of the wrist may be used for venous cannulation. The external jugular vein is another option but may be difficult to find in the short, thick neck of the obese patient. Placing the obese patient in Trendelenburg position (to make the vein prominent) may not be tolerated because of respiratory embarrassment. The cephalic vein crosses the surface of the anatomical snuff box, superficial to the radial styloid. This vein is referred to as the ‘houseman's friend’ because of its consistent location at this site and its straight course that allows placement of a large bore IV cannula.[5] It communicates with the basilic vein via the median cubital vein at the elbow. Superiorly, the cephalic vein passes between the deltoid and the pectoralis major muscles before it empties into the axillary vein. The cephalic vein is often visible through the skin in the deltopectoral groove and is a potential site for venous access in the obese [Figure 1]. This vein is worth looking for in an obese patient with a difficult peripheral venous access. Loukas et al.,[6] in a cadaveric study, found that the cephalic vein was found emerging superficially in the lateral portion of the deltopectoral triangle in 80% of specimens. In the remaining 20% cases, the cephalic vein was located deep to the deltopectoral fascia and fat. The length of the cephalic vein within the deltopectoral triangle ranged from 3.5 to 8.2 cm (mean 4.8 ± 0.7 cm). The morphometric analysis revealed a mean cephalic vein diameter of 0.8 ± 0.1 cm (range 0.1–1.2 cm).[6] Ultrasound-guided peripheral venous access is also a valuable aid in patients with a known difficult venous access. Nevertheless, knowledge of the potential sites for IV access can improve the success rate for IV line placement in the obese. Figure 1 The cephalic vein (in the deltopectoral groove) and the external jugular vein cannulated (18 gauge cannula) in an obese patient

The Reverse Brachio-Cephalic Arteriovenous Fistula for Hemodialysis Access

Objective: Many modifications have been designed for patients in whom unsatisfactory for fistula formation. Among these modified arteriovenous fistula (AVF), the reverse brachiocephalic fistula (rBC), in which the median cubital vein is isolated as close to the basilic vein as possible, then anastomosed end to side to the brachial artery. The result of rBC AVF are assessed in this retrospective series. Methods: During the period January 2003 to December 2013, a retrospective review of 49 cases undergoing rBC AVF in department of surgery in Soonchunhyang University Hospital were performed. Data collected included demographics, postoperative complications. Results: Primary patency of rBC AVF was 76%, 62.5%, and 50% at 1, 3, and 5 years, respectively. Secondary patency was 100%, 96.8%, and 89.2%, at 1, 3, and 5 years, respectively. Thirty one postoperative complications were developed in 25 patients (65 cases). Conclusion: Available techniques for creating rBC AVF are associated with good patency rate. End‐stage renal disease with hemodialysis patients might benefit from rBC AVF, because of long patency, less radiologic procedure, and less infection rate. Key words: Reverse brachiocephalic arteriovenous fistula; Renal dialysis; Vascular access

Abstract 18368: Evidence for Activation of Cerebral Autonomic Center in Response to Cardiac Electrical Stimulation in Humans -A New Finding of Cardio-Cerebral Connection

Introduction: Anterior cingulate cortex (ACC) is one of the cortical receptive fields of afferent nerves innervating the visceral organs and modulates autonomic nervous system in collaboration with hypothalamus and brainstem. Cardiac afferent nerves are associated with not only chest pain but also sympathetic arousal in heart failure, in which ACC could be involved. However, the cortical receptive fields of cardiac afferent nerves still remain to be elucidated. Hypothesis: We thus investigated whether ACC is activated in response to cardiac electrical stimulation in humans. Methods: We studied 10 patients (74.7±1.9 yrs, M/F 9/1) with cardiac pacemaker implantation. Before the measurement, mode of cardiac pacemaker was changed to VVI 80-90 bpm with 1.5V intensity. Cerebral blood flow (CBF) was measured using [15O]H2O positron emission tomography (PET) during sham stimulation (1.5V) and intense stimulation (7.5-8V). The CBF images of intense stimulation were compared with those of sham stimulation using SPM8, a common analysis tool for neuroimages. Cardiac sensation was evaluated with an ordinate scale after CBF measurements. Blood samples were obtained from the cubital vein before and after CBF measurements for plasma catecholamine levels (one patient was excluded for the analysis due to urination before the last blood sampling). Results: Intense stimulation did not induce cardiac sensation but significantly increased plasma adrenaline levels as compared with sham stimulation (intense, 6.1±1.8 vs. sham, 0.1±3.0 pg/ml, P=0.031, n=9 each). CBF in ACC was significantly increased in response to intense stimulation as compared with sham stimulation (intense, 64.6±0.7 vs. sham, 61.0±1.3 ml/100g/min, P=0.008, n=10 each) ( Figure, yellow arrowhead ). Conclusions: This study demonstrates for the first time that ACC could be the cortical receptive field of cardiac afferent nerves associated with sympathetic arousal in humans.

Effects of radiofrequency catheter ablation of atrial fibrillation on soluble P-selectin, von Willebrand factor and IL-6 in the peripheral and cardiac circulation.

BackgroundCatheter ablation (CA) of atrial fibrillation (AF) is associated with inflammatory response, endothelial damage and with increased risk of thrombosis. However, whether these processes differ in peripheral and cardiac circulation is unknown.MethodsPlasma markers (von Willebrand factor (vWf), soluble P-selectin (sPsel) and interleukin-6 (IL-6)) were measured by ELISA at three time points in 80 patients (62±10 years, 63% males, 41% paroxysmal AF) undergoing CA. These were at baseline – from femoral vein (FV) and left atrium (LA) before ablation; directly after ablation – from the pulmonary vein (PV), LA and FV; and 24 hours after procedure – from a cubital vein (CV).ResultsThe levels of vWF and IL6 – but not sP-sel – increased significantly 24h after procedure (p<0.001). Baseline vWF was significantly associated with persistent AF (Beta = .303, p = 0.006 and Beta = .300, p = 0.006 for peripheral and cardiac levels, respectively), while persistent AF (Beta = .250, p = 0.031) and LAA flow pattern (Beta = .386, p<0.001) remained associated with vWF in cardiac blood after ablation. Advanced age was significantly associated with IL6 levels at baseline and after ablation in peripheral and cardiac blood. There were no clinical, procedural or anti-coagulation characteristics associated with sP-sel levels in cardiac blood, while peripheral sP-sel levels were associated with hypertension before (Beta = −.307, p = 0.007) and with persistent AF after ablation (Beta = −.262, p = 0.020).ConclusionsvWF levels are higher in persistent AF and are associated with LAA rheological pattern after AF ablation. Increase of peripheral vWF and IL6 levels after procedure supports current AF ablation management with careful control of post-procedural anticoagulation to avoid ablation-related thromboembolism.

Simultaneous bilateral magnetic resonance angiography to evaluate thoracic outlet syndrome.

This paper presents a new magnetic resonance angiography (MRA) protocol for the evaluation of thoracic outlet syndrome (TOS) that allows for a separate assessment of veins and arteries while using a single, simultaneous and bilateral (SB-MRA) single contrast injection, valid for both abduction and adduction acquisitions. From 2009 to 2013 we performed 38 MRA studies for clinically suspected TOS (13 M, 25 F; mean age, 35.9years; σ=11.13). Twin peripheral 20G intravenous catheters were placed in a cubital vein in both arms and connected to a single power injector by two lines joined with a connector. A 3T MR system with a wide gantry was used. Two groups of four radiologists assessed all the images. Group A judged the full examinations, Group B had only the late acquisitions. Differences were evaluated using the Chi square test. TOS was confirmed only after integration with the clinical history. Seventeen (45%) patients were diagnosed with predominant venous TOS (VTOS), nine (24%) with predominant arterial TOS (ATOS) and 12 (32%) had an indeterminate or nonvascular condition. Group A radiologists identified significantly more VTOS than group B (p=0.049). Interobserver agreement was very high. SB-MRA is a safe and reliable protocol for the study of TOS. It provides a supplementary early acquisition that allows for separate assessment of veins and arteries, permits the investigation of the collateral venous flow with a single injection of contrast material and provides a higher diagnostic power for VTOS. SB-MRA is helpful for the diagnosis of TOS of vascular origin.

CXCL9 is a prognostic marker in patients with liver cirrhosis receiving transjugular intrahepatic portosystemic shunt

Inflammation, collagen deposition and tissue remodelling are involved in the pathogenesis and complications of cirrhosis with portal hypertension. CXCL9 and other chemokines play an important role in these processes and have been associated with liver injury and complications of liver disease in humans. However, their predictive value in patients with cirrhosis and portal hypertension remains to be established. 103 patients with liver cirrhosis who had received TIPS (transjugular intrahepatic portosystemic shunt) were included into this study. The TIPS indication was either refractory ascites or recurrent bleeding. Before and after the TIPS procedure portal and hepatic venous blood samples were obtained in 78 patients. In 25 patients blood samples were obtained from the portal vein, hepatic vein, right atrium and cubital vein at TIPS insertion. Serum levels of CXCL9 were measured by cytometric bead array and correlated with clinical parameters and overall outcome. Portal venous levels of CXCL9 decreased after TIPS. Child-Pugh score, refractory ascites, renal dysfunction and alcoholic aetiology of cirrhosis were associated with increased CXCL9 levels. Importantly, low levels of CXCL9 in portal and hepatic vein samples were prognostic factors for the survival of patients receiving TIPS during long-time follow-up. The CXCR3 ligand CXCL9 affects the liver and/or is released by the liver and thereby might contribute to hepatic and extrahepatic organ dysfunction. Elevated levels of CXCL9 are associated with shorter survival in cirrhotic patients with severe portal hypertension receiving TIPS. This chemokine should be further evaluated as a novel biomarker for the outcome in patients with cirrhosis and portal hypertension and its modulation as a new therapeutic strategy.

人造血管在血液透析造瘘的应用及护理

Objective: To study the application of artificial blood vessels to build alternative standard arteriovenous fistula blood vessels for hemodialysis maintenance nursing. Methods: 17 cases of patients underwent artificial blood vessel transplantation, material for ptfe (PTEE), 30 cm in length, inner diameter 5mm, from 2012 to 2013 in Jinan military region general hospital. Artificial blood vessel transplantation is more operated on brachial vein, cephalic vein, median cubital vein and basilic vein. When the anastomosis among artificial blood vessels and brachial artery and vein anastomosis was established, the arterial end was on the inner side. When the anastomosis among brachial vein, median cubital vein and basilic vein was established, the arterial end was on the outside for the extension of vascular access. Results: 15 cases have hemodialysis after two months’ treatment, 1 case have artificial blood vessel fistula after swelling for 4 months, infection of thrombosis occurred one month after the operation in 1 case. Conclusion: Artificial blood vessel show good biocompatibility, high long-term patency rate, blood flow, and convenient puncture point. It builds the “lifeline” for the patients who are unable to establish a good vascular access. It is of great significance to improve the management of artificial blood vessel fistula for maintenance hemodialysis patients.