Association of arterial calcification with chronic limb ischemia in patients with peripheral artery disease

Objective

Arterial calcification is associated with an increased risk of limb events, including amputation. The association between calcification in lower extremity arteries and the severity of ischemia, however, has not been assessed. We thus sought to determine whether the extent of peripheral artery calcification (PAC) was correlated with Rutherford chronic ischemia categories and hypothesized that it could independently contribute to worsening limb status.

Low total psoas area as scored in the clinic setting independently predicts midterm mortality after endovascular aneurysm repair in male patients

Objective

Preoperative sarcopenia is an established risk factor for poor outcomes after surgery. Methods for assessing sarcopenia are either complex, time consuming, or poorly validated. We aimed to assess the interobserver reliability of scoring psoas area at the level of the L3 vertebra and to evaluate whether sarcopenia scored by this simple and rapid method correlated with other fitness scoring methods or impacted on mortality and duration of stay for patients undergoing endovascular aneurysm repair (EVAR).

Tissue expander-stimulated lengthening of arteries for the treatment of midaortic syndrome in children

Background

Midaortic syndrome (MAS) is a rare condition characterized by stenosis of the abdominal aorta. Patients with disease refractory to medical management will usually require either endovascular therapy or surgery with use of prosthetic graft material for bypass or patch angioplasty. We report our early experience with a novel approach using a tissue expander (TE) to lengthen the normal native arteries in children with MAS, allowing primary aortic repair without the need for prosthetic graft material.

A novel modification of the Thrombelastograph assay, isolating platelet function, correlates with optical platelet aggregation

Flow cytometry, singlet platelet counting, and optical aggregation have been used to monitor clopidogrel and glycoprotein IIb/IIIa (GPIIb/IIIa) platelet antagonists. Optical aggregation is considered the gold standard, but neither it nor flow cytometry is convenient in larger-scale clinical studies or point-of-care systems. Singlet platelet counting, a point-of-care assay correlated with optical platelet aggregation, only provides a measurement of platelet function at a single point in time. The Thrombelastograph is used to assay whole blood for thrombin-generated maximal clot-shear elasticity, referred to as the maximal amplitude (MA). Although platelet dysfunction, thrombocytopenia, and the in vitro effect of strong inhibitors such as IIb/IIIa antagonists can be observed, with thrombin generation milder platelet inhibitors cannot be assessed. We modified the Thromboelastograph assay, using reptilase and factor XIIIa, to form a clot, without thrombin generation, in heparinized whole blood. The resulting clot MA is dependent on added platelet agonists such as ADP or arachidonic acid, is sensitive to platelet antagonists, and provides a continuous measure of platelet function more analogous and better correlated with optical aggregation. This novel modification of the Thromboelastograph assay should prove to be a useful point-of-care whole-blood assay with which to monitor the effects of GPIIb/IIIa, ADP, and thromboxane A(2)-receptor-inhibiting drugs in patients.     

IA和MA方案治疗急性髓系白血病临床观察

目的 评价IA和MA方案在治疗急性髓系白血病(AML)中的临床价值。方法 用t检验和卡方检验比较两组治疗方案的疗效及不良反应。结果 ①IA和MA方案的完全缓解 (CR)率分别为84.2 %和61.9 %,有显著性差异 (p<0.05) ;②两组方案治疗早期死亡率分别为7.9 %和9.5 %,无显著性差异 ( p>0.05) ;③IA方案达CR平均疗程为1.2较MA方案1.5疗程短 ;④两组方案治疗后不良反应有所差异 ,但均可耐受。结论 在AML治疗中 ,IA方案优于MA方案 ,值得临床选用。     

Enzymic determination of urinary free l-fucose

Conditions necessary for the precise measurement of free l-fucose in urine by an enzymic method using l-fucose dehydrogenase have been studied. The normal urinary levels of l-fucose were 16.4 ± 9.1 μg/ml in children (22.2 ±6.5 μg/mg of creatinine) and 17.7 ± 8.5 μg/ml in adults (16.6 ± 5.7 μg/mg of creatinine). There was a close correlation between the concentration of free l-fucose and that of creatinine. A close correlation was also found between the concentration of free l-fucose and α-l-fucosidase activity. Thus, it was suggested that the free l-fucose in urine reflected the metabolism of l-fucose or l-fucose-containing glycoconjugates.In a preliminary screening test, several urine samples which showed high concentrations of free l-fucose, namely cases of “fucosuria” were found.     

Is social support associated with post-transplant medication adherence and outcomes? A systematic review and meta-analysis

Although social support is used to determine transplant eligibility, the relationship between social support, medication adherence, and survival among transplant recipients remains unclear. We estimated the relationship between social support and post-transplant medication adherence and outcomes using 10 electronic databases from inception to January 2016. Study quality was assessed and all review stages were conducted independently by 2 reviewers. Systematic review and meta-analysis were conducted. Thirty-two studies (9102 participants) met inclusion criteria: 21 assessed medication adherence (5197 participants), and 13 assessed clinical outcomes (3905 participants). Among high quality studies, neither social support nor marital status was predictive of medication adherence or post-transplant outcomes. Social support was not associated with medication adherence. It was associated with superior post-transplant outcomes, but the relationship was not significant among high quality studies. Compared to unmarried recipients, married recipients were more likely to adhere to medication post-transplant, but this relationship was not significant among high quality studies. Marital status was not significantly associated with transplant success. Social support is weakly and inconsistently associated with post-transplant adherence and outcomes. Larger prospective studies using consistent and validated measures are needed to justify the use of inadequate social support as a contraindication to transplantation.