Atherosclerotic Risk Factors Among Ankle-Brachial Index and Toe-Brachial Index in Peritoneal Dialysis Patients

Background. Atherosclerotic vascular change affecting the lower extremities is the most common peripheral vascular disease. Ankle-brachial index (ABI) and toe-brachial index (TBI) are common, non-invasive diagnostic tests for atherosclerosis in the lower extremities. Peritoneum is a vascular-based structure. The use of glucose-based hyperosmolar solutions for PD patients results in a significant increase in blood glucose load and can be considered atherogenic. The association between ABI or TBI values and peritoneal function in patients undergoing peritoneal dialysis remains unclear. We presumed that the risk factors for atherosclerosis in large and small vessels may differ. Methods. A total of 146 peritoneal dialysis patients, 41 males and 105 females (119 without diabetes and 27 with diabetes), received peritoneal dialysis for more than four months. Patients who had dialysis-related peritonitis within six months prior to this study were excluded. The ABI or TBI was determined using an automated, non-invasive, waveform analysis device. Results. The ABI value correlated positively with mean arterial pressure and TBI value. The TBI value correlated positively with ABI value and inversely with fasting serum glucose and serum total cholesterol concentrations. Peritoneal function was not correlated with ABI or TBI. Conclusion. This cross-sectional study demonstrated that risk factors in peritoneal dialysis patients for atherosclerosis in large vessels and small vessels differed. Interestingly, peritoneal function test is not associated with ABI or TBI value. However, further investigation of the association between ABI or TBI value and cardiovascular events is required for this patient group.     

Assessment of Peripheral Arterial Disease of Lower Limbs with Ultrasonography and Ankle Brachial Index at the Initiation of Hemodialysis

Aim.?Peripheral arterial disease (PAD) of the lower limbs carries high risks of leg amputation, quality of life deterioration, and death in hemodialysis (HD) patients. However, the frequency of PAD at the initiation of HD has not been adequately documented. In addition, the applicability of ultrasonography to diagnosing PAD is not yet clear in HD patients. Methods. Twenty-seven patients within three months after HD initiation were enrolled. Ultrasonography was performed regardless of ischemic symptoms. Significant stenosis or obstruction of lower limb arteries on ultrasonography was diagnosed as PAD.?Results. Sixteen of the 27 (59.3%) showed PAD on echography. On the other hand, only six of the 27 (22.2%) had an ABI < 0.9. Sixteen patients had a total of 37 lesions revealed by ultrasonography, and the average number of PAD lesions was 2.3 per patient. The numbers of PAD lesions on ultrasonography were as follows: iliac artery, 7; femoral-popliteal artery, 15; and infra-popliteal artery, 15. The ABI was 0.95 ± 0.29 in PAD and 1.23 ± 0.13 in non-PAD patients (p = 0.005). Conclusions.?A high prevalence of PAD at HD initiation was demonstrated. PAD may be missed using only the ABI (ankle brachial index). Ultrasonography is a reliable and non-invasive examination for detecting PAD.     

颈动脉超声检查和ABI测定对缺血性脑卒中的临床价值

目的探讨颈动脉超声和踝臂指数(ABI)对缺血性脑卒中的临床价值。方法选取缺血性脑卒中50例患者为研究组,50例体检者为对照组。安静状态下采用二维超声及彩色多普勒超声检查颈总动脉(CCA)、颈动脉分叉处、颈内动脉(ICA)颅外段等,检查双侧颈动脉有无斑块、狭窄及闭塞;测量颈动脉内径、内-中膜厚度(IMT),进行多普勒频谱定量分析,记录阻力指数(RI)及搏动指数(PI),同时检测ABI。结果研究组斑块检出率、狭窄率、闭塞率显著高于对照组(P0.05);与对照组比较,研究组颈动脉管腔内径减小,IMT增厚,RI、PI增高,ABI降低,差异有统计学意义(P0.05)。结论颈动脉超声检查技术及ABI测定为无创检查手段,可为缺血性脑卒中的诊断提供重要参考依据。     

Retrosigmoid Craniotomy for Auditory Brainstem Implantation in Adult Patients with Neurofibromatosis Type 2

Objective To report our technique and experience using a retrosigmoid craniotomy approach for auditory brainstem implantation (ABI) placement in adult neurofibromatosis type 2 (NF2) patients. Design Retrospective case series. Setting Single-center study, Boston, Massachusetts, United States. Participants All NF2 patients who underwent evaluation at Massachusetts Eye and Ear Infirmary and surgery at Massachusetts General Hospital from 2009 to 2013 were reviewed. Six cases of retrosigmoid craniotomy for ABI surgery in five adult NF2 patients were identified. The clinical history, operative course, and outcomes in these patients were reviewed. Main Outcome Measures Postoperative complications and audiological outcomes. Results Indications for ABI surgery were profound hearing loss associated with growth or treatment of bilateral vestibular schwannomas. In all cases, a retrosigmoid craniotomy was performed for tumor resection and ABI placement without complication. Electrode placement was confirmed intraoperatively using electrical-evoked auditory brainstem responses. The ABI was activated in the awake patient 4 to 6 weeks postoperatively. Audiological testing was used to evaluate sound detection and speech perception with the ABI. There were no cases of cerebrospinal fluid leak. Conclusion Retrosigmoid craniotomy is a safe and effective means to provide access to the cochlear nucleus for ABI placement following tumor resection in the adult NF2 patient. Preliminary data indicate that this approach has few complications while offering benefits for hearing. The retrosigmoid craniotomy should be considered a reasonable alternative to the traditional translabyrinthine approach for placement of the ABI in deaf patients who are not candidates for the cochlear implant.     

下肢动脉闭塞患者的彩色多普勒超声检查特征及其与ABI相关性分析

研究彩色多普勒超声检测下肢动脉闭塞患者的临床意义,下肢动脉闭塞病变的超声检测特征、与踝臂指数检测（ankle arm index, ABI）结果的一致性。方法前瞻性分析2010年1月～2012年12月间就诊的30例下肢动脉闭塞患者的彩色多普勒超声检测结果,测量内中膜厚度,并且分析病变特点、及超声检测与ABI检测结果的比较观察。同期正常健康体检者作为对照组。结果彩色多普勒超声可提示动脉内中膜增厚,局部斑块形态多样,血流改变,与ABI异常一致性高。与健康对照组相比,下肢动脉硬化组动脉中层厚度（media thickness） MT〉1.0mm的患者明显增多,差异有统计学意义（P〈0.05）。结论彩色多普勒超声无创检测下肢动脉闭塞症,可显示病变特征,早期发现MT增高的患者,与ABI的检测结果一致性高,具有重要的临床意义。     

TCD、PWV和ABI联合检测在脑卒中早期诊断中的应用效果观察

目的探讨应用经颅多普勒超声(TCD)、脉搏波传导速度(PWV)、踝臂指数(ABI)联合检测对脑卒中患者进行早期诊断的效果。方法选择52例脑卒中患者作为研究观察组,52例健康体检人群为对照组。比较TCD单独检测与联合检测的确诊率。结果观察组患者的PWV明显高于对照组,而ABI则明显低于对照组,差异均有统计学意义(P0.05);应用TCD对脑卒中患者进行检测的确诊率为82.69%,同时应用以上三种检查进行检测的确诊率达到98.08%,联合检测的确诊率明显高于单纯TCD检测(P0.05)。结论联合应用TCD、PWV和ABI于早期进行联合检测可以更加全面地评估脑卒中患者情况,提高确诊率,同时也可以对患者的预后进行预测,并为后续临床治疗提供指导,具有较大的临床价值,值得推广。     

12-Month Results From the First-in-Human Randomized Study of the Ranger Paclitaxel-Coated Balloon for Femoropopliteal Treatment

Objectives

The authors sought to evaluate the performance of the Ranger paclitaxel-coated balloon versus uncoated balloon angioplasty for femoropopliteal lesions at 12 months.

A Factor Analysis of Functional Independence and Functional Assessment Measure Scores Among Focal and Diffuse Brain Injury Patients: The Importance of Bifactor Models

Objective

To explore the factor structure of the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM) among focal and diffuse acquired brain injury patients.