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1.
Comparative outcomes of vascular access in patients older than 70 years with end-stage renal disease
Deokbi Hwang Sujin Park Hyung-Kee Kim Seung Huh 《Journal of vascular surgery》2019,69(4):1196-1206.e5
Objective
The advantage of arteriovenous fistulas (AVFs) in older patients requiring dialysis is controversial. We reviewed our vascular access experience in patients ≥70 years of age (older group) compared with younger patients.Methods
We analyzed consecutive patients who underwent access surgery between 2013 and 2016. Primary success (PS) and primary patency (PP) data were analyzed between the older and younger groups before and after propensity score matching of the patients' characteristics and access composition. PS was defined as the achievement of access function that was amenable to two sessions of successful cannulation without early occlusion or maturation failure requiring revision. PP was defined as the time with uninterrupted patency without intervention.Results
A total of 594 consecutive accesses were created among 563 patients, of whom 119 were allocated into each group after propensity score matching. In the whole cohort, 193 accesses (32.5%) were performed in older patients. AVFs were performed in 130 (67.4%) older patients and 293 (73.1%) younger patients. Regarding AVFs, the PS rate (83.6% in the older group vs 94.3% in the younger group; P = .001) and the overall PP at 6 and 12 months (73.1% and 57.1%, respectively, in the older group vs 86.7% and 77.7%, respectively, in the younger group; P = .009) were lower in the older group than in the younger group. However, no differences were found in the PS and PP rates for arteriovenous grafts between groups. Regarding the AVF location, the PS rate for forearm AVFs was significantly lower in the older group than in the younger group (76% vs 93%; P < .001); however, the PS rate of the upper arm was not different between the groups (94% vs 97%; P = .425). In the patients with PS, the PP rate of AVFs was similar between the two groups. In the older group with forearm AVFs, the median diameter of the radial artery was larger in the patients with PS than in the patients without PS (2.20 mm with PS vs 2.00 mm without PS; P = .008). The propensity score matching results demonstrated similar trends for the whole cohort, with lower PS (P = .042) and PP rates (P = .023) for AVF in the older group.Conclusions
The outcomes after AVF were poorer in the older group than in the younger group, which was primarily due to unsatisfactory outcomes in patients with forearm AVFs. Thus, stricter criteria, especially regarding the radial artery diameter, should be applied for forearm AVFs in older patients, and additional research is necessary to delineate the risk factors for primary failure. 相似文献2.
目的:探究超脉冲CO2点阵激光联合富血小板血浆(PRP)治疗面部痤疮凹陷性瘢痕的疗效。方法:72例面部痤疮凹陷性瘢痕患者,随机分为观察组(36例)和对照组(36例)。对照组采用超脉冲CO2点阵激光治疗,观察组采用超脉冲CO2点阵激光联合PRP治疗。比较两组患者的灰度差异、时间指标、瘢痕程度、疼痛、不良反应及视觉评估。结果:观察组的并发症发生率为11.11%,低于对照组的36.11%,差异具有统计学意义(P<0.05)。治疗后,两组患者的灰度差异率均减小,且观察组患者的灰度差异率显著低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的炎性渗出时间、红肿时间、愈合时间、停工时间及瘢痕程度评分均低于对照组,差异均具有统计学意义(P<0.05);但疼痛度评分组间比较,差异无统计学意义(P>0.05)。结论:超脉冲CO2点阵激光联合PRP治疗面部痤疮凹陷性瘢痕效果较好,可有效降低瘢痕程度,减少治疗时间及并发症的发生,帮助患者迅速回归正常工作与生活,值得临床推广使用。 相似文献
3.
目的:探究金水宝片联合依诺肝素对维持性血液透析患者血脂代谢的影响。方法:选取2018年12月至2019年3月马鞍山十七冶医院血液净化中心进行透析的患者154例作为研究对象,根据用药不同分为对照组和观察组,每组77例。对照组常规应用依诺肝素抗凝,观察组在对照组抗凝基础上加用金水宝片,各组均干预3个月,比较2组患者血脂变化及持续血液透析并发症发生情况。结果:治疗后,观察组患者三酰甘油、总胆固醇及低密度脂蛋白胆固醇水平下降,高密度脂蛋白胆固醇升高,与治疗前比较差异均有统计学意义(P<0.05),与对照组治疗后比较,差异有统计学意义(P<0.05);观察组总并发症发生率明显低于对照组,2组比较差异有统计学意义(P<0.05);2组患者维持性血液透析不良反应发生率均较低,组间比较差异无统计学意义(P>0.05)。结论:金水宝片联合依诺肝素有助于改善维持性血液透析患者血脂代谢水平,降低维持性血液透析相关并发症,值得临床推广应用。 相似文献
4.
药物依赖心理治疗的基本技术——动机强化治疗的理论与技术 总被引:3,自引:1,他引:2
赵敏 《中国药物滥用防治杂志》2006,12(6):311-314
现代科学证实,药物依赖(吸毒)是一种慢性复发性脑疾病,具有复杂的心理学、生物学与社会学病因机制,应采取躯体、心理、社会康复等综合治疗的模式来治疗药物依赖导致的各种相关问题,对药物依赖的治疗过程是一个长期的、复杂的过程。脱毒只是戒毒治疗的前提,除海洛因等阿片类药物 相似文献
5.
Neetu Radhakrishnan M.D. Chong. H. Park M.D. Barry M. Kaplan M.D. F.A.C.C. Rajiv Jauhar M.D. F.A.C.C. 《The International journal of angiology》2006,15(1):37-42
A 65-year-old man developed acute limb ischemia, severe abdominal wall and lower limb livedo reticularis following a coronary
angiogram. The differential diagnoses of acute limb ischemia and multiple cholesterol emboli syndrome (MCES) are discussed.
This work was performed at Long Island Jewish Medical Center, 270-05, 76th Avenue, New Hyde Park, NY 11040. 相似文献
6.
Jin Hwan Ahn Joon Ho Wang Jae Chul Yoo Sung Kon Kim Jung Ho Park Jong Woong Park 《Knee surgery, sports traumatology, arthroscopy》2006,14(12):1288-1291
This article describes a modified suture technique designed for the vertical repair of the anterior horn of the meniscus after arthroscopic decompression of a large meniscal cyst. This procedure comprises of three steps: first, the meniscus was pierced vertically using a suture hook and a No. 0 PDS suture. Second, both ends of the No. 0 PDS on the femoral and tibial surfaces of the meniscus were pulled to the outside of the joint capsule using a spinal needle preloaded with suture material. Finally, a skin incision was made adjacent to the suture materials, and both ends were tied. We recommend this technique not only for the vertical repair of the anterior horn of the meniscus after decompression of large meniscal cyst, but also to repair a longitudinal tear of the meniscus. 相似文献
7.
Eun Sang Park Jung Im Na Seon Ok Kim Chang Hun Huh Sang Woong Youn Kyoung Chan Park 《Skin research and technology》2006,12(4):298-302
Background/purpose: Vitiligo and nevus depigmentosus (ND) present similar hypopigmented macules with significantly different prognoses. Although the distinction between the two diseases is important, differential diagnosis relies on medical history and physical examination, which is far from decisive in some cases. The Mexameter® is an objective skin color-measuring device, and has been reported to provide a reproducible and sensitive means of quantifying small skin color differences. In this study, we investigated the usefulness of a Mexameter® for discriminating these diseases.
Methods: A selection of 202 hypopigmented skin lesions (182 from vitiligo and 20 from ND) were the objects of this study. Using a Mexameter, MIs were obtained from lesions and symmetrically located control skin. RMIs, ratios of the MIs of lesional skins to control skins, were calculated.
Results: The mean MIs and RMIs were significantly different for vitiligo and ND. The mean RMI of ND lesions was 74±13, which was significantly higher than that of vitiligo lesions (50±24). No ND lesion had an RMI of <50%.
Conclusion: This study shows that the Mexameter® , an objective pigment-measuring device, can be used to achieve a more accurate diagnosis of hypopigmentary disorders, and that the relative melanin index (RMI), which represents the relative pigment levels, might be a more effective parameter than the melanin index (MI) itself for comparing pigmentation differences. 相似文献
Methods: A selection of 202 hypopigmented skin lesions (182 from vitiligo and 20 from ND) were the objects of this study. Using a Mexameter, MIs were obtained from lesions and symmetrically located control skin. RMIs, ratios of the MIs of lesional skins to control skins, were calculated.
Results: The mean MIs and RMIs were significantly different for vitiligo and ND. The mean RMI of ND lesions was 74±13, which was significantly higher than that of vitiligo lesions (50±24). No ND lesion had an RMI of <50%.
Conclusion: This study shows that the Mexameter
8.
9.
Vincent Chung Liang Liu Zhaoxiang Bian Zhongzhen Zhao Wai Leuk Fong Wan Fung Kum Jing Gao Min Li 《Movement disorders》2006,21(10):1709-1715
The objective of this study is to assess the efficacy and safety of herbal medicines (HMs), as a monotherapy or adjunct therapy, compared to placebo or conventional approaches in the treatment of idiopathic Parkinson's disease (PD). We conducted a systematic review of randomized controlled trials from both conventional and alternative medicine sources. Outcome measures were overall improvement, quality of life, reduction of levodopa dose, and adverse events. Nine studies were included, each testing a different HM. Six of the trials had limited internal validity due to major flaws in design, including the lack of proper randomization; insufficient blinding; unclear inclusive criteria in terms of diagnostic criteria, baseline staging, and duration of disease; lack of proper sample size calculation; and insufficient data analysis. Imbalances in gender and ethnicity among the patients in the included trials were observed. No major adverse events emerged, and no specific pattern was detected from the trials describing such data. In addition to major methodological defects, heterogeneity in (1) HM tested, (2) control treatment, and (3) outcome measure hindered in-depth data analysis and synthesis. Current evidence is insufficient to evaluate the efficacy and safety of various HMs. Further studies with improved trial design and reporting, with assessment on cost-effectiveness, quality of life, and qualitative data are warranted. 相似文献
10.