Arterial problems associated with dysfunctional hemodialysis grafts: evaluation of patients at high risk for arterial disease

PURPOSE: To retrospectively review the incidence and types of arterial problems associated with dysfunctional hemodialysis grafts in patients who are at high risk for peripheral arterial disease. MATERIALS AND METHODS: During the 1-year period from February 2001 to February 2002, 40 patients with polytetrafluoroethylene hemodialysis grafts underwent upper extremity arteriography to evaluate arterial inflow to the vascular access. The indication for arteriography was based on the presence of at least two of the following risk factors for peripheral vascular disease: diabetes mellitus, hypertension, and age greater than 65 years. Thirty-three of the 40 patients were women and the median age was 65 years. Thirty-three patients had forearm loop-configuration grafts and seven had upper-arm grafts. RESULTS: Upper extremity arteriography revealed 13 arterial inflow lesions in 11 of the 40 patients (28%). Ten patients had stenoses at the arterial anastomosis. Two of these patients also had stenoses in the brachial artery. One patient had a single stenosis in the brachial artery. Eight of the 11 patients (73%) underwent angioplasty of seven arterial anastomotic stenoses and three brachial artery stenoses. Comparative analysis revealed that the presence of risk factors for atherosclerotic disease did not correlate with an increased incidence of arterial inflow problems. Surprisingly, patients with diabetes mellitus had a decreased likelihood (P =.03) of having an arterial abnormality. CONCLUSION: Although the incidence of arterial anastomotic stenoses in our study group was higher than previously reported, patients undergoing hemodialysis who have risk factors for peripheral vascular disease do not have a high prevalence of native arterial lesions.     

Singapore First Aid Guidelines 2021

The Singapore Resuscitation and First Aid Council is updating the guidelines for first aid based on the latest evidence-based review from the International First Aid Taskforce Consensus on Science with Treatment Recommendations published in 2020. This is part of the regular updating of standards of care and training for first aid. This article presents some of the updated evidence-based approaches to first aid treatments in common emergencies such as asthma, chronic bronchitis, anaphylaxis, shock, unresponsiveness, seizure, heat disorders, ingested poisons, bleeding, head and spinal injury, bites and dental injuries. These updated treatments will be incorporated into the Standard and Child First Aid course syllabus in Singapore.     

Activity-Dependent Cleavage of the K-Cl Cotransporter KCC2 Mediated by Calcium-Activated Protease Calpain

The K-Cl cotransporter KCC2 plays a crucial role in neuronal chloride regulation. In mature central neurons, KCC2 is responsible for the low intracellular Cl(-) concentration ([Cl(-)](i)) that forms the basis for hyperpolarizing GABA(A) receptor-mediated responses. Fast changes in KCC2 function and expression have been observed under various physiological and pathophysiological conditions. Here, we show that the application of protein synthesis inhibitors cycloheximide and emetine to acute rat hippocampal slices have no effect on total KCC2 protein level and K-Cl cotransporter function. Furthermore, blocking constitutive lysosomal degradation with leupeptin did not induce significant changes in KCC2 protein levels. These findings indicate a low basal turnover rate of the total KCC2 protein pool. In the presence of the glutamate receptor agonist NMDA, the total KCC2 protein level decreased to about 30% within 4 h, and this effect was blocked by calpeptin and MDL-28170, inhibitors of the calcium-activated protease calpain. Interictal-like activity induced by incubation of hippocampal slices in an Mg(2+)-free solution led to a fast reduction in KCC2-mediated Cl(-) transport efficacy in CA1 pyramidal neurons, which was paralleled by a decrease in both total and plasmalemmal KCC2 protein. These effects were blocked by the calpain inhibitor MDL-28170. Taken together, these findings show that calpain activation leads to cleavage of KCC2, thereby modulating GABAergic signaling.     

Training by the Numbers: A Survey-Based Analysis of the Number of Positions Available in New Interventional Radiology Training Pathways

ObjectiveAs of June 30, 2020, interventional radiology (IR) fellowships will cease to exist and will be replaced by the integrated IR, independent IR, and early specialization in IR (ESIR) pathways. The objective of this study is to determine the alignment in the number of available positions between the ESIR and independent IR pathways.MethodsAn analysis was performed of 150 residency programs offering at least 1 of the 3 IR training pathways. Information regarding the most up-to-date list for integrated IR, independent IR, ESIR, and IR fellowship programs were obtained from the Society of Interventional Radiology (SIR), the Electronic Residency Application Service (ERAS), and the Accreditation Council for Graduate Medical Education (ACGME) websites. A 4-question survey was distributed to residency program directors and residency program coordinators to confirm the number of positions offered in each of the training pathways at their institution.ResultsNinety-nine of 113 ESIR programs (87.6% response rate) reported a total of 176 approved ESIR positions. One hundred and eleven fellowship programs in the United States currently offer a total of 331 positions. Seventy-seven integrated IR programs and 48 independent IR programs offer 150 and 133 positions, respectively, for a total of 283 advanced IR training positions.DiscussionA substantial discrepancy currently exists with IR training pathways, as the number of available ESIR positions far outnumbers the available independent IR pathway positions. There is a continuing need for communication with residency programs and frequent reevaluation of the various IR training pathways to maintain the most accurate database.     

Neurosurgical research in Pakistan: trends of publication and quality of evidence

Objective

To analyze the output and quality of neurosurgical research published from Pakistan in indexed peer reviewed journals.

Methods

Indexed peer reviewed publications from 2003 to 2008 were searched for neurosurgical contributions from Pakistan. The retrieved articles were evaluated to analyze the trends of publication and quality of evidence.

Results

Sixty-two neurosurgical research papers (10.3 per year, range 8-13) were published from Pakistan during the study period. Twenty-four (38.7%) publications were the contribution of just four primary authors; 25 (45.3%) of the publications were original research articles and 30 (48.4%) were either case reports or case series; and 38 (61.3%) of all the publications were from just three institutions in the country. Majority of publications were pertaining to neurooncology (n = 23, 37.1%) and neurosurgical trauma (n = 16, 25.8%). Overall, 48 (77.4%) papers were published in local indexed journals and only 14 (22.6%) in international journals. There were no basic science studies, and no papers offering level 1 or 2 evidence were published during the study period.

Conclusion

Neurosurgical research in Pakistan over the past six years has been unsatisfactory, both in terms of number and quality of publications. Analysis of six year publications also did not show any significant improvement in research trends.     

Gender effect on clinical features of achalasia: a prospective study

Background  

Achalasia is a well-characterized esophageal motor disorder but the rarity of the disease limits performing large studies on its demographic and clinical features.     

Lipoblastomas and liposarcomas in paediatric patients: A case series

Lipoblastomas and liposarcomas are rare causes of soft tissue masses in paediatric patients. In this retrospective clinical case series we identified 11 patients from our paediatric database (10 with a lipoblastoma and one with a liposarcoma) who had attended our hospital between 1998 and 2019. The median age of patients with lipoblastoma was 29 months. All lipoblastoma cases were managed with surgical excision and histological examination. The 18-year old patient with liposarcoma presented with a metastatic and unresectable tumour that was unresponsive to chemotherapy and radiation. Our experience demonstrates the importance of differentiating the type of soft tissue mass in children.