Aneurysms in Vascular Access: State of the Art and Future Developments

2017 ◽  
Vol 18 (6) ◽  
pp. 464-472 ◽  
Author(s):  
Nicholas Inston ◽  
Hiren Mistry ◽  
James Gilbert ◽  
David Kingsmore ◽  
Zahid Raza ◽  
...  
Keyword(s):  
Vascular Access ◽  
Audience Participation ◽  
Short Term ◽  
Cross Sectional ◽  
Av Fistula ◽  
Active Audience ◽  
Cross Sectional Imaging ◽  
History Of ◽  
Definition Of

A master class was held at the Vascular Access at Charing Cross (VA@CX2017) conference in April 2017 with invited experts and active audience participation to discuss arteriovenous (AV) vascular access aneurysms, a serious and common complication of vascular access (VA). The natural history of aneurysms in VA is poorly defined, and although classifications exist they are not uniformly applied in studies or clinical practice. True and pseudo aneurysms of AV access occur. Whilst an AV fistula by definition is an abnormal dilatation of a blood vessel, an agreed definition of 18 mm, or 3 times accepted maturation diameter, is proposed. The mechanism of aneurysmal dilatation is unknown but appears to be a combination of excessive external remodeling, wall changes due to injury, and obstruction of outflow. Diagnosis of AV aneurysms is based on physical examination and ultrasound. Venography and cross-sectional imaging may assist and be required for the investigation of outflow stenosis. Treatment of pseudo aneurysms and true aneurysms of VA (AVA) is not evidence-based, but relies on clinical experience and available facilities. In many AVA, a conservative approach with surveillance is suitable, although intervals and modalities are unclear. Avoidance of rupture is imperative and preemptive treatment should aim for access preservation, ideally with avoidance of prosthetic materials. Different techniques of aneurysmorrhaphy are described with good results in published series. Although endovascular approaches and stenting are described with good short-term results, issues with cannulation of stented areas occur and, while possible, this is not recommended, and long-term access revision is recommended.

MO783CENTRAL VEIN STENOSIS IN HEMODIALYSIS PATIENTS WITH PAST CENTRAL VEIN MANIPULATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Pedro Reis Pereira ◽  
Círia Sousa ◽  
Natalia Silva ◽  
Jose Francisco ◽  
Mónica Fructuoso ◽  
...  
Keyword(s):  
Vascular Access ◽  
Significant Proportion ◽  
Previous History ◽  
Hemodialysis Patients ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Central Venous ◽  
Short Term ◽  
History Of

Abstract Background and Aims Central vein stenosis (CVS) is frequently observed in hemodialysis patients. Risk factors for CVS include prior ipsilateral central venous catheterization (CVC) and cardiac rhythm device (CRD) insertions. Though it may have clinical manifestations, CVS is often asymptomatic and, therefore, not diagnosed. The aim of this work was to evaluate the prevalence of CVS in a population of hemodialysis patients, as well as underlying risk factors, clinical manifestations and impact in patients’ vascular access. Method We retrospectively evaluated all venous angiographies of prevalent patients in our hemodialysis units from 2013 to 2018. In patients with proved CVS, we evaluated history of prior short term and long term upper ipsilateral CVC and CRD insertions. We also analyzed symptoms associated CVS as well as the rate of loss of vascular access for hemodialysis related to the presence of CVS. Results The prevalence of CVS in prevalent patients in hemodialysis during the period of our study (n=209) was 14%. We identified 31 upper CVS in 29 patients undergoing venous angiography. Left brachiocephalic vein was the most commonly affected site (45.1% of cases), followed by the right brachiocephalic vein (19.3%), left subclavian vein (16.1%), right subclavian vein (12.9%) and superior vena cava (6.4%). The majority of patients with CVS (95%) had previous history of ipsilateral CVC (previous short-term CVC in 40%, pervious short term and long-term CVC in 27% and previous long-term CVC in 33%). Loss of vascular access for hemodialysis due do CVS was observed in 26% of patients with CVS. Conclusion A significant proportion of patients in hemodialysis presents CVS. The majority of patients with CVS had a previous history of ipsilateral central venous catherization. A significant proportion of patients with CVS had a previous history central venous catherization uniquely with short term CVC, highlighting the importance of the risk of vascular lesion, even during short periods of catherization. The presence of CVS is associated with a significant rate of loss hemodialysis vascular access.

Determinants of Anthropometric Failure Among Tribal Children Younger than 5 Years of Age in Palghar, Maharashtra, India

2021 ◽  
Vol 42 (1) ◽  
pp. 55-64
Author(s):  
Angeline Jeyakumar ◽  
Swapnil Godbharle ◽  
Bibek Raj Giri
Keyword(s):  
Odds Ratio ◽  
Composite Index ◽  
Z Score ◽  
Short Term ◽  
Cross Sectional Survey ◽  
Crude Odds Ratio ◽  
Cross Sectional ◽  
Independent Variables ◽  
Child Undernutrition

Background: Measuring undernutrition using composite index of anthropometric failure (CIAF) and identifying its determinants in tribal regions is essential to recognize the true burden of undernutrition in these settings. Objective: To determine anthropometric failure and its determinants among tribal children younger than 5 years in Palghar, Maharashtra, India. Methods: A cross-sectional survey employing CIAF was performed in children <5 years to estimate undernutrition in the tribal district of Palghar in Maharashtra, India. Anthropometric measurements, maternal and child characteristics were recorded from 577 mother–child pairs in 9 villages. Results: As per Z score, prevalence of stunting, wasting, and underweight were 48%, 13%, and 43%, respectively. According to CIAF, 66% of children had at least one manifestation of undernutrition and 40% had more than one manifestation of undernutrition. Odds of anthropometric failure were 1.5 times higher among children of mothers who were illiterate (adjusted odds ratio [AOR] =1.57, 95% CI: 1.0-2.3), children who had birth weight >2.5 kg had lesser odds (AOR: 0.63, 95% CI: 0.4-0.9) of anthropometric failure, and children who had initiated early breastfeeding had 1.5 times higher odds of anthropometric failure (crude odds ratio: 1.5, 95% CI: 1.0-2.1). However, when adjusted for other independent variables, the results were not significant. Conclusion: The alarming proportion of anthropometric failure among tribal children calls for urgent short-term interventions to correct undernutrition and long-term interventions to improve maternal literacy and awareness to prevent and manage child undernutrition.

Systemic arteriopulmonary venous fistula (APVF): case presentation of an asymptomatic individual and a review of the literature

2021 ◽  
Vol 14 (7) ◽  
pp. e241644
Author(s):  
Paul Jenkins ◽  
Prageeth Dissanayake ◽  
Richard Riordan
Keyword(s):  
Chest Radiograph ◽  
Cardiovascular Health ◽  
Incidental Finding ◽  
Chest Radiographs ◽  
Cross Sectional ◽  
Arterial Circulation ◽  
Cross Sectional Imaging ◽  
Venous Fistula ◽  
The Right

Abnormal communications between the systemic and pulmonary venous systems are rare but can present as a opacity on chest radiograph. A solitary vessel communicating as a fistula directly between the systemic arterial circulation and the pulmonary venous system is not widely described. These may have significant implications in the long-term cardiovascular health of an individual acting as a left to right shunt. There is no clear consensus as to the management, but surgical management and endovascular embolisation have been successfully used. We present a case where a systemic arteriaopulmonary fistula originating from the abdominal aorta and connecting to the right inferior pulmonary vein manifested as an incidental finding on a chest radiograph and was further evaluated on cross-sectional imaging in a young patient. Chest radiographs are non-specific and it is important to be aware of the less frequent but important pathologies that can be picked up on plain chest radiographs, which inturn should warrant further investigation. This is presented in conjunction with a review of the available literature along with a discussion regarding the differential diagnosis and management applicable to the general clinician.

scholarly journals When is a Learning Object not an Object: A first step towards a theory of learning objects

2002 ◽  
Vol 3 (2) ◽  
Author(s):  
Mike Sosteric ◽  
Susan Hesemeier
Keyword(s):  
Economies Of Scale ◽  
Learning Objects ◽  
Short Term ◽  
Object A ◽  
Smart Learning ◽  
Smart Learning Environments ◽  
Adequate Definition ◽  
Definition Of ◽  
Conceptual Confusion

<p> For some, “learning objects" are the “next big thing” in distance education promising smart learning environments, fantastic economies of scale, and the power to tap into expanding educational markets. While learning objects may be revolutionary in the long term, in the short term, definitional problems and conceptual confusion undermine our ability to understand and critically evaluate the emerging field. This article is an attempt to provide an adequate definition of learning objects by (a) jettisoning useless theoretical links hitherto invoked to theorize learning objects, and (b) reducing the definition of learning objects to the bare essentials. The article closes with suggestions for further research and further refinement of the definition of learning objects. </P>

scholarly journals Rheumatoid arthritis onset after COVID-19 infection: a case report

2021 ◽  
Vol 9 (12) ◽  
pp. 3713
Author(s):  
Thafar S. A. Safar ◽  
Karmen B. Katay ◽  
Reem H. Khamis
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Pathological Condition ◽  
Primary Health Care Centre ◽  
Short Term ◽  
Health Care Centre ◽  
Immune Mediated ◽  
Small Hand ◽  
History Of

At the end of 2019, coronavirus disease (COVID-19) outbreak is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Worldwide researchers and physician try to explore the mechanisms of damage induced by virus, they focus on the short-term and long-term immune-mediated consequences induced by the virus infection. Every day discover a new pathological condition induced by virus and new symptoms and disease may occur after recovery from disease. Our case report is 41 years old, Indian lady who presented to our primary health care centre complaining of multiple small hand joints pain, both elbows and knees pain with swelling of them and prolonged morning stiffness, diagnosed seropositive rheumatoid arthritis (RA) (arthritis, positive rheumatoid factor (RF), and X-ray changes) after 1 month recovery from COVID-19 infection. She did not have any joint pain and she had negative RF before COVID-19 infection with no family history of RA.

scholarly journals Journal of the History of Economic Thought Preprints - Limits to Arbitrage and Interest Rates: A Debate Between Keynes, Hawtrey and Hicks

2018 ◽  
Author(s):  
Lucy BRILLANT
Keyword(s):  
Business Cycle ◽  
Central Bank ◽  
Interest Rates ◽  
Economic Thought ◽  
History Of Economic Thought ◽  
Short Term ◽  
Limits To Arbitrage ◽  
History Of ◽  
The Business Cycle

This paper deals with a debate between Hawtrey, Hicks and Keynes concerning the capacity of the central bank to influence the short-term and the long-term rates of interest. Both Hawtrey and Keynes considered the central bank’s ability to influence short-term rates of interest. However, they do not put the same emphasis on the study of the long-term rates of interest. According to Keynes, long-term rates are influenced by future expected short-term rates (1930, 1936), whereas for Hawtrey (1932, 1937, 1938), long-term rates are more dependent on the business cycle. Short-term rates do not have much effect on long-term rates according to Hawtrey. In 1939, Hicks enters the controversy, giving credit to both Hawtrey’s and Keynes’s theories, and also introducing limits to the operations of arbitrage. He thus presented a nuanced view.

scholarly journals Association Between Past Oral Contraceptive Use and the Prevalence of Hypertension in Postmenopausal Women: The Fifth (2010–2012) Korea National Health and Nutrition Examination Survey (KNHANES V)

2021 ◽  
Author(s):  
JungJu Lee ◽  
Hyunsuk Jeong ◽  
Joo Hee Yoon ◽  
Hyeon Woo Yim
Keyword(s):  
Postmenopausal Women ◽  
National Health ◽  
Contraceptive Use ◽  
Confounding Factors ◽  
Nutrition Examination Survey ◽  
Short Term ◽  
Multivariable Logistic Regression Model ◽  
Cross Sectional ◽  
Health And Nutrition

Abstract Background: There is little evidence as to whether the use of oral contraceptives(OC) during the fertile years affects the development of postmenopausal hypertension. This study aimed to evaluate the effects of past use of OC on the development of hypertension in postmenopausal women. Methods: This was a cross-sectional study conducted using data from the Fifth Korea National Health and Nutrition Examination Survey of postmenopausal women. Subjects were classified into three groups based on past OC use duration: nonusers, short-term users(0–30months), and long-term users(≥30 months). We evaluated the development of hypertension in women after menopause. A multivariable logistic regression model was used to identify the association between the use of OC during the fertile years and the prevalence of hypertension after menopause following adjustment for potential confounding factors. Results: Of the 3,386 postmenopausal women, 2,713 were nonusers of OC, 489 were short-term users, and 184 were long-term users. Women who had used OC for 30 months or more had a significantly greater prevalence of hypertension after menopause than those who had never taken OC. The association between taking OC for 30 months or more during the fertile years and the prevalence of hypertension after menopause was significant following adjustment for potential confounding factors (aOR:1.92; 95%CI:1.22–3.00). Conclusion: This study identified an association between past OC use and an increased prevalence of hypertension in postmenopausal women. Our results suggest that long-term use of OC during the fertile years can be an important risk factor for subsequent hypertension after menopause.

scholarly journals Systema Temporis: A Time-Based Dimensional Framework for Consciousness and Cognition

2019 ◽  
Author(s):  
Lachlan Kent ◽  
George Van Doorn ◽  
Britt Klein
Keyword(s):  
Time Perception ◽  
Dimensional Structure ◽  
Two Dimensional ◽  
Dimensional Approach ◽  
Short Term ◽  
Hierarchical Framework ◽  
Time Consciousness ◽  
Emotion And Memory ◽  
Definition Of

This study uses a combined categorical-dimensional approach to depict a hierarchical framework for consciousness similar to, and contiguous with, factorial models of cognition (cf., intelligence). On the basis of the longstanding definition of time consciousness, the analysis employs a dimension of temporal extension, in the same manner that psychology has temporally organised memory (i.e., short-term, long-term, and long-lasting memories). By defining temporal extension in terms of the structure of time perception at short timescales (&lt; 100 s), memory and time consciousness are proposed to fit along the same logarithmic dimension. This suggests that different forms of time consciousness (e.g., experience, wakefulness, and self-consciousness) are embedded within, or supported by, the ascending timescales of different modes of memory (i.e., short-term, long-term, etc.). A secondary dimension is also proposed to integrate higher-order forms of consciousness/emotion and memory/cognition. The resulting two-dimensional structure accords with existing theories of cognitive and emotional intelligence.

scholarly journals Esports Clubs’ Work in Media Spaces: Distinctive Features

2020 ◽  
pp. 28-42
Author(s):  
Oleksandr Petryk ◽  
Alexander Meleshchenko ◽  
Anastasiia Volobuieva
Keyword(s):  
Late 20Th Century ◽  
Distinctive Features ◽  
Sports Clubs ◽  
Active Audience ◽  
Media Component ◽  
History Of ◽  
Computer Based ◽  
The Media ◽  
Definition Of ◽  
Development Prospects

On 7 May 2015, the term “esports” was officially added to one of the most extensive online English dictionaries “Dictionary.com.” The dictionary gives the following definition of the term “esports”: “competitive tournaments of video games, especially among professional gamers” (IGN, 2015). The history of esports began in the late 20th century with the game Quake, which allowed users to play together through a LAN or internet network. Since then, a tremendous number of new esports leagues have emerged. Every year, game publishers promote esports disciplines; create a media space around them, and make competitively oriented games, creating an active audience. The popularity of computer-based esports grows each year at an increasing speed. Therefore, it is not surprising that the traditional for typical sports (football, basketball, volleyball, etc.) model of interaction between professional players (esports athletes) and sports clubs (esports organizations) emerged quite rapidly. This interaction aims to optimize the training process to increase athletic achievements and develop the media component for players and clubs. This article analyzes how esports clubs function in media spaces: their goals, tools, strategies, results, and development prospects on the examples and experience of professional esports organizations in Germany, Finland, and China.

scholarly journals Management Guidelines for Pancreatic Cystic Lesions: Should we Adopt or Adapt the Current Roadmaps?

2019 ◽  
Vol 28 (4) ◽  
pp. 495-501 ◽  
Author(s):  
Filipe Vilas-Boas ◽  
Guilherme Macedo
Keyword(s):  
Needle Aspiration ◽  
Pancreatic Cysts ◽  
Cystic Lesions ◽  
International Consensus ◽  
Cross Sectional ◽  
Fluid Analysis ◽  
Mucinous Neoplasms ◽  
Cross Sectional Imaging ◽  
History Of ◽  
International Consensus Guidelines

Pancreatic cystic lesions are very prevalent, especially in elderly patients and are increasingly being diagnosed because of the massive use of cross sectional imaging. Our knowledge about the natural history of these lesions is limited, especially in the case of intraductal papillary mucinous neoplasms. This fact explains why scientific societies guidelines statements are based on evidence graded as very low quality and helps the understanding of some of the different guidelines recommendations. Several guidelines have been recently revised to incorporate the new evidence published in the literature with the aim to help clinicians make the best decisions. American Gastroenterological Association guidelines, a revision of the International Consensus Guidelines, the American College of Gastroenterology and the European Study Group guidelines are the most recent. Herein we review the current guidelines on pancreatic cysts and focus our discussion on controversies and updates about the best imaging modalities, the indications for endoscopic ultrasound guided fine needle aspiration, cyst fluid analysis, indications for resection and surveillance strategies.

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