Wall shear stress in the stented superficial femoral artery in peripheral arterial disease

Objective

Local changes in wall shear stress (WSS) contribute to vascular wall thickening and subsequent stenosis. Restenosis after stenting is a major concern, especially in the superficial femoral artery (SFA) of patients with peripheral arterial disease (PAD). Local alterations in WSS after stenting might contribute to restenosis/reocclusion. To test the hypothesis that WSS is impaired along the stented SFA segment, we studied the profile of WSS along the femoro-popliteal axis after stent placement in a cross-sectional design.

Methods

Eighty-seven patients with PAD (89 limbs) were included one day after stenting of the SFA. Flow velocities (peak and mean) and vessel diameter were measured by duplex ultrasound in five predefined segments along the femoro-popliteal axis, at rest and after exercise (30 toe raises); WSS (peak and mean) was calculated from flow velocities, vessel diameter and whole blood viscosity.

Results

WSS progressively declined along the stented segment at rest (peak WSS, p < 0.0001; mean WSS, p < 0.05); after exercise, WSS increased in all segments (all p < 0.001), but, again, progressively declined along the stent (peak WSS, p < 0.0001; mean WSS, p < 0.05). The internal vessel diameter remained unchanged after exercise in the stented and in the non-stented parts of the femoro-popliteal axis (all p > 0.05).

Conclusion

In PAD patients with SFA stenting WSS is impaired along the femoro-popliteal axis. The consequences of this finding in terms of local effects on the vessel wall that might favor restenosis/reocclusion needs further investigation.     

Low-grade albuminuria is associated with peripheral artery disease in Chinese diabetic patients

Background

Increasing studies have suggested that albuminuria might be an important risk factor for peripheral artery disease (PAD). However, studies focusing on the association between low-grade albuminuria and PAD are limited. It would be of great interest to elucidate the association between low-grade albuminuria and PAD in diabetic subjects.

Methods

A cross-sectional study was conducted in 1386 diabetic subjects (age ≥ 40 years) with normal urinary albumin levels from Shanghai, China. A first voided early morning spot urine sample was obtained for urinary albumin and creatinine measurements. Subjects were divided into three groups according to sex-specific cutoff points of urinary albumin–creatinine ratio (UACR) tertiles. Subjects in the upper tertile of UACR were classified as having low-grade albuminuria. PAD was defined by ankle–brachial index (ABI) <0.9 or >1.4.

Results

Overall, 106 (7.7%) of the study population had PAD. The prevalence of PAD in tertile 3 of UACR was higher than the prevalence in tertile 2 and tertile 1 (10.2%, 6.4% and 6.4%, respectively; P < 0.05). A fully adjusted logistic regression analysis revealed that compared with subjects in tertile 1 of normal UACR, those in tertile 3 had 1.7-fold increased risk for the presence of PAD.

Conclusions

In diabetic patients, high normal UACR level, which is below the current cutoff point of microalbuminuria, was associated with the increased prevalence of PAD. It suggested that low-grade albuminuria might be an early marker for the detection of PAD in diabetic patients.     

血清淀粉样蛋白A与2型糖尿病肾病患者颈动脉内膜中层厚度的相关性研究

目的 探讨血清淀粉样蛋白A （SAA）在2型糖尿病肾病（DN）的改变及与颈动脉内膜中层厚度（CIMT）的相关性.方法 根据24h尿微量白蛋白排泄率（UAER）将75例2型糖尿病患者分为2组：单纯糖尿病组（SDM组,39例）和早期糖尿病肾病组（EDA组,36例）,同时以35例健康人作为正常对照组（NC组）.用ELISA法检测各组空腹血清SAA浓度,同时测定各组的肌酐（Cr）、尿素氮（BUN）、血糖血脂、胰岛素抵抗指数（HOMA-IR）、超敏C反应蛋白（Hs-CRP）、CIMT等指标,并分析血清SAA与CIMT及其他指标的相关性.结果 EDA组和SDM组SAA水平明显高于NC组[分别为（7.98±0.63 vs.6.09 ±0.72vs.2.75 ±0.30 mg/L）,P＜0.05或P＜0.01];EDA组、SDM组和NC组CIMT值组间比较均有统计学差异[分别为（1.07±0.13vs.0.86 ±0.22 vs.0.72±0.13mm）,P＜0.05或P＜0.01].SAA水平与Hs-CRP、IL-6、FBG、HOMA-IR、CIMT、颈动脉斑块数量和UAER成明显正相关,与HDL-C成明显负相关（P＜0.05或P ＜0.01）.EDN组双侧斑块数量≥2个的患者SAA水平显著高于斑块只有1个或无斑块的患者（P＜0.01）,与斑块厚度呈正相关（r=0.409,P ＜0.05）.UAER、HOMA-IR、CIMT和Hs-CRP是影响DN患者SAA水平的独立影响因素.结论 联合检测SAA和CIMT可推断SAA对动脉粥样硬化的影响,全面的评价早期糖尿病肾损害,提示临床应早期干预血浆SAA水平防治DN及其他微血管和大血管病变.     

Diabetic foot ulcers treated with hyperbaric oxygen therapy: a review of the literature

Hyperbaric oxygen therapy (HBO) has been used as an adjunct for healing diabetic foot ulcers (DFUs) for decades. However, its use remains controversial. A literature search was conducted to locate clinical studies and assess the available evidence. Ten prospective and seven retrospective studies evaluating HBO for DFUs were located. These were reviewed and the outcomes were discussed. One study reported no difference in outcomes between patients receiving hyperbaric oxygen and the control group. However, their regime differed from all other studies in that the patients received hyperbaric oxygen twice rather than once daily. Reduced amputation rates and improved healing were the most common outcomes observed.     

Factors influencing nurse compliance in maintaining aseptic technique in the insertion of peripheral intravenous access in neonates

BackgroundAseptic technique is the foundation for preventing bloodstream infections due to peripheral intravenous access insertion. This study aims at identifying the factors influencing nurse compliance in maintaining aseptic technique in the insertion of a peripheral intravenous catheter (PIVC).MethodologyThe research method is cross-sectional with 160 nurses. The related variables measured were repeated insertion, infant care (incubator or radiation warmer), age of nurse, working experience, level of education of nurses, level of knowledge, work schedule, and number of teams on duty. The nurse's knowledge was measured using a modified questionnaire, and the level of compliance was measured by an observation sheet.ResultsHigher age and education level of nurses were significantly associated with an increase in the level of nurse compliance (β = 0.053–1.22; p < 0.001; <0.015). Working experience, the number of insertions, the level of knowledge of nurses about PIVC, and the place of care in the radiant warmer were associated negatively with a decrease in the level of nurse compliance in the use of aseptic PIVC techniques (β = −0.011; - 0.152; p < 0.001).ConclusionAge and educational qualifications should be considered for the potential contributing to nurses' compliance with the aseptic protocol in the neonatal care unit.     

Psychometrics evaluation of Charcot‐Marie‐Tooth Neuropathy Score (CMTNSv2) second version,using Rasch analysis

Charcot‐Marie‐Tooth Neuropathy Score second version (CMTNSv2) is a validated clinical outcome measure developed for use in clinical trials to monitor disease impairment and progression in affected CMT patients. Currently, all items of CMTNSv2 have identical contribution to the total score. We used Rasch analysis to further explore psychometric properties of CMTNSv2, and in particular, category response functioning, and their weight on the overall disease progression. Weighted category responses represent a more accurate estimate of actual values measuring disease severity and therefore could potentially be used in improving the current version. Copyright © 2014 John Wiley & Sons, Ltd.     

Serotonin syndrome in patients with peripheral neuropathy: a diagnostic challenge

According to the Hunter Serotonin Toxicity Criteria, the presence of either clonus or hyperreflexia is a must for making a diagnosis of serotonin syndrome (SS). We report five patients with SS who had areflexia because of associated polyneuropathy. None of the patients fulfilled the Hunter criteria for SS. However, all five patients had features suggestive of neuromuscular hyperactivity, autonomic hyperactivity and altered mental status and fulfilled the Sternbach criteria for SS. All patients responded to cyproheptadine within 5 days to 2 weeks duration. These cases highlight the limitations of the Hunter criteria for SS in patients with associated polyneuropathy.     

Hemolyzed Laboratory Specimens in the Emergency Department: An Underappreciated,but Frequent Problem

IntroductionHemolysis of blood samples from emergency department (ED) patients leads to delays in treatment and disposition. The aim of this study is to determine the frequency of hemolysis and variables predictive of hemolysis.MethodsThis observational cohort study was conducted among three institutions: academic tertiary care center and two suburban community EDs, with an annual census of over 270,000 ED visits. Data were obtained from the electronic health record. Adults requiring laboratory analysis with at least one peripheral intravenous catheter (PIVC) inserted within the ED were eligible. Primary outcome was hemolysis of lab samples and secondary outcomes included variables related to PIVC failure.ResultsBetween January 8, 2021 and May 9, 2022, 141,609 patient encounters met inclusion criteria. The average age was 55.5 and 57.5% of patients were female. Hemolysis occurred in 24,359 (17.2%) samples. In a multivariate analysis, when compared to 20-gauge catheters, smaller 22-gauge catheters had an increased odds of hemolysis (OR 1.78, 95% confidence interval (CI) 1.65-1.91; P < .001), while larger 18-gauge catheters had a lower odds of hemolysis (OR 0.94; 95% CI 0.90-0.98; P = .0046). Additionally, when compared to antecubital placement, hand/wrist placement demonstrated increased odds of hemolysis (OR 2.06; 95% CI 1.97-2.15; P < .001). Finally, hemolysis was associated with a higher rate of PIVC failure (OR 1.06; 95%CI 1.00-1.13; P = 0.043).DiscussionThis large observational analysis demonstrates that lab hemolysis of is a frequent occurrence among ED patients. Given the added risk of hemolysis with certain placement variables, clinicians should consider catheter gauge/placement location to avoid hemolysis that may result in patient care delays and prolonged hospital stays.     

Relationship between E - cadherin and diabetic nephropathy

Objective To identify novel biomarker for diabetic nephropathy (DN) by urinary proteomic methods, and to detect the expression of E-cadherin in urine and renal tissue of patients with DN. Methods Urine samples were collected from 12 cases of type 1 diabetic nephropathy patients (T1DN), 12 cases of type 2 diabetic nephropathy patients (T2DN), 12 cases of nephritic syndrome patients (NS), and 12 cases of healthy Controls. Comparative proteomic approach of two-dimensional gel electrophoresis (2-DE) and mass spectrometry (MS) were employed to identify DN-related biomarker in urine samples. The differential expression of the identified biomarker in urine samples and renal biopsy specimens were detected by Western blotting and immunohistochemistry method. Results E-cadherin was identified by 2DE/MS, which was significantly up-regulated in T1DN and T2DN groups (all P＜ 0.01). Western blotting confirmed the expression of E-cadherin was significantly higher in T1DN and T2DN groups than in NS and Control groups (all P＜0.01). Immunohistochemical stain showed E-cadherin was mainly expressed in the membrane and cytoplasm of renal tubular epithelial cell, and its expression was markedly decreased in DN kidneys compared with healthy Controls (P＜0.05). Conclusions E-cadherin is identified as a novel DN-related biomarker, which is specifically increased in urine of DN patients.