Cheekbendtsen3437

Cardiovascular diseases are an important cause of mortality in end-stage renal disease (ESRD) and increased arterial stiffness and autonomic dysfunction have been proposed to explain part of this excess cardiovascular risk. This prospective study was designed with the aim of noninvasive assessment of the vascular function, i.e., arterial stiffness in the form of pulse wave velocity (PWV) and autonomic function in the form of baroreflex sensitivity (BRS) in ESRD patients before renal transplantation (RT) and three and six months after RT. check details The study was conducted in 64 patients of ESRD slated for RT in the Department of Nephrology and was being followed up during all three visits (pretransplant, three-, and six-month posttransplant). The period of patient recruitment and data collection lasted for approximately 1½ years. Although PWV did not show a significant change, the change in PWV was negatively correlated with baseline PWV, and it was statistically significant. The BRS after RT had a significant improvement as early as three months. The correlation between change in PWV and change in BRS postrenal transplant was not seen. RT improves BRS, but it is still unknown that it is through amelioration of arterial properties or neural components or/and a relative contribution of both. We suggest that the improvement in BRS postrenal transplant is probably because of the improvement in autonomic neural functions rather than the improvement in compliance of barosensitive regions of large arteries.The most common cause of mortality in chronic kidney disease patients is cardiovascular events. Cardiovascular autonomic dysfunction is likely to contribute high incidence of cardiovascular mortality, and in addition to adrenergic overdrive in these patients, there is the presence of impaired reflex control of both sympathetic and parasympathetic outflow to the heart and vasculature. Very few studies are available which show that renal transplantation (RT) improves the baroreflex function along with improvement in cardiovascular variability parameters. This prospective study was designed for the assessment of the autonomic function, i.e., heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity (BRS) in end-stage renal disease (ESRD) patients before RT and three and six months after RT and to study the effects of RT on cardiac and vascular autonomic tone and on BRS. We studied 81 ESRD patients prospectively slated for RT but only 64 patients (mean age 33 years) completed both three and six months visits after RT for autonomic function study. Patients were evaluated in detail clinically as well as routine biochemical parameters were done on every three visits. Baroreflex function was quantified by the sequence method. Assessment of short-term HRV and BPV were done using power spectrum analysis of RR intervals and systolic BP by frequency domain analysis. The parameters of HRV after RT showed significant changes in high-frequency domain measures six months post-RT but not in low frequency. HRV in total power was also statistically significant as early as three months postrenal transplant and remained at six months. The favorable effect of RT on decreasing BPV and improving BRS is seen by as early as three months.This study aimed to evaluate the clinical characteristics and antihypertensive medications affecting elderly hemodialysis (HD) patient mortality. This retrospective cohort study enrolled patients (≥18 years old) discharged from 15 tertiary general hospitals in China between January 1, 2009, and December 31, 2011. The characteristics of elderly HD patients (≥60 years old) and antihypertensive medications for mortality were analyzed. A total of 7135 patients on maintenance HD, including 2738 elderly patients, were enrolled in this study. The mean levels of hemoglobin, albumin, serum calcium, phosphorus, and parathyroid hormone in elderly group were lower than the younger group (P 0.05). CVD and infection were the most common causes of hospitalization and/or mortality in elderly HD patients. Age, anemia and malnutrition, use of CVCs, and low level of serum uric acid are the risk factors for mortality in elderly maintenance HD patients. Renin-angiotensin system blockade might provide a benefit in protecting elderly maintenance HD patients from mortality.In renal transplantation (RT), human leukocyte antigens (HLA) expressed on donor cells are the principal targets of the recipient's immune system. In addition to classical HLA-alloantibodies, the importance of non-HLA antibodies (Abs) in RT is being increasingly recognized. The majority of non-HLA Abs are considered as autoantibodies as they are directed against cryptic autoantigens of vascular endothelium, which express following tissue (graft) injury. The mechanisms by which these Abs are produced and induce rejection are not fully understood. This review discusses the spectrum of non-HLA Abs, their putative pathogenetic mechanisms, clinical relevance, and their relationship with graft survival and rejection in RT.Metabolic syndromes are considered a significant risk factor for renal impairment in renal transplant patients. However, the impact of metabolic syndrome on long-term kidney function is still unclear. This study aims to review the medical literature to investigate the long-term impact of metabolic syndrome on renal impairment in kidney donors. The literature was evaluated through PubMed, Embase, Cochrane, and CINAHL databases in the duration between 1990 and May 2019. Searching terms included synonyms and components for "metabolic syndrome," "renal impairment," "kidney donors," combined with the operators "OR" and "AND." Following this, results were refined to include only original research articles evaluating the long-term effects of kidney donation on kidney function in donors with metabolic syndrome. Eligible trials mentioned the exact duration of follow-up. A total of 820 articles were recovered. After the exclusion of articles on animals and including only analyses on humans, 38 studies appeared. A total of eight studies were considered eligible, covering a total of 1574 living donors with metabolic syndrome. Two studies were observational cohort, while three studies were retrospective and three randomized controlled studies. Living donors with metabolic syndrome are at risk of reduced renal functions of the remaining kidney after donation, with obesity appearing to be the significant contributor. Further randomized controlled studies with a longer follow-up duration are required.

Percutaneous transhepatic biliary drainage (PTBD) and EUS-guided choledochoduodenostomy (EUS-CD) are alternate therapies to endoscopic retrograde cholangiopancreatography with stent placement for biliary decompression. The primary outcome of this study is to compare the technical and clinical success of PTBD to EUS-CD in patients with distal biliary obstruction. Secondary outcomes were adverse events (AEs), need for reintervention, and survival.

A multicenter retrospective cohort study from three different centers was performed. Cox regression was used to compare time to reintervention and survival and logistic regression to compare technical and clinical success and AE rates. Subgroup analysis was performed in patients with malignant biliary obstruction (MBO).

A total of 86 patients (58 PTBD and 28 EUS-CD) were included. The two groups were similar with respect to age, gender, and cause of biliary obstruction, with malignancy being the most common etiology (80.2%). EUS-CD utilized lumen-apposing metal nce end-of-life quality in patients with MBO and expected survival longer than 50 days.

EUS-CD is a technically and clinically highly successful procedure with a trend toward lower AEs compared to PTBD. EUS-CD minimizes the need for reintervention, which may enhance end-of-life quality in patients with MBO and expected survival longer than 50 days.

EUS-guided drainage of pancreatic fluid collections (PFCs) has been increasingly performed using lumen-apposing metal stents (LAMS). However, recent data have suggested higher adverse event rates with LAMS compared to double pigtail plastic stents (DPS) alone. To decrease risks, there has been anecdotal use of placing DPS through the LAMS. We aimed to determine whether the placement of DPS through cautery-enhanced LAMS at time of initial placement decreases adverse events or need for reintervention.

We performed a multicenter retrospective study between January 2015 and October 2017 examining patients who underwent EUS-guided drainage of pseudocysts (PP), walled-off necrosis (WON), and postsurgical fluid collection using a cautery enhanced LAMS with and without DPS.

There were 68 patients identified at 3 US tertiary referral centers 44 PP (65%), 17 WON (25%), and 7 PFSC (10%). There were 35 patients with DPS placed through LAMS (Group 1) and 33 with LAMS alone (Group 2). Overall technical success was 100%, clinical success was 94%, and adverse events (bleeding, perforation, stent occlusion, and stent migration) occurred in 28% of patients. Subgroup analysis compared specific types of PFCs and occurrence of adverse events between each group with no significant difference detected in adverse event or reintervention rates.

This multicenter study of various types of PFCs requiring EUS-guided drainage demonstrates that deployment of DPS across cautery-enhanced LAMS at the time of initial drainage does not have a significant effect on clinical outcomes, adverse events, or need for reinterventions.

This multicenter study of various types of PFCs requiring EUS-guided drainage demonstrates that deployment of DPS across cautery-enhanced LAMS at the time of initial drainage does not have a significant effect on clinical outcomes, adverse events, or need for reinterventions.Numerous genes have been associated with multiple morphological abnormalities of the sperm flagella (MMAF), which cause severe asthenozoospermia and lead to male infertility, while the causes of approximately 50% of MMAF cases remain unclear. To reveal the genetic causes of MMAF in an infertile patient, whole-exome sequencing was performed to screen for pathogenic genes, and electron microscope was used to reveal the sperm flagellar ultrastructure. A novel heterozygous missense mutation in the outer dense fiber protein 2 (ODF2) gene was detected, which was inherited from the patient's mother and predicted to be potentially damaging. Transmission electron microscopy revealed that the outer dense fibers were defective in the patient's sperm tail, which was similar to that of the reported heterozygous Odf2 mutation mouse. Immunostaining of ODF2 showed severe ODF2 expression defects in the patient's sperm. Therefore, it was concluded that the heterozygous mutation in ODF2 caused MMAF in this case. To evaluate the possibility of assisted reproductive technology (ART) treatment for this patient, intracytoplasmic sperm injection (ICSI) was performed, with the help of a hypo-osmotic swelling test and laser-assisted immotile sperm selection (LAISS) for available sperm screening, and artificial oocyte activation with ionomycin was applied to improve the fertilization rate. Four ICSI cycles were performed, and live birth was achieved in the LAISS-applied cycle, suggesting that LAISS would be valuable in ART treatment for MMAF.