Successful pAVFs with proximal radial artery inflow were created with excellent initial results regarding technical success, patency, and safety. Advantages include avoidance of a surgical incision, short procedure times, good acceptance by patients, prompt access maturation, moderate flow, and low-pressure access, with possible reduction of risk for ischemic complications. Avoidance of vessel manipulation and side branch ligation might reduce risk of thrombosis and improve long-term patency and reduce need for further interventions. These early findings need to be confirmed in larger and longer follow-up studies.

The results of this study indicate that the GABA(B[1]) polymorphism (G1465A) confers a highly increased susceptibility to TLE. Moreover, it seems to influence the severity of this common epileptic disorder.

Objective: The aim of this study was to report our midterm results of percutaneous arteriovenous fistula (pAVF) creation using the Ellipsys (Avenu Medical, San Juan Capistrano, Calif) device and to present technical recommendations and our algorithm of pAVF maintenance.Methods: A single-center comprehensive database of all consecutive predialysis and end-stage renal disease patients who had a pAVF creation with the Ellipsys device was reviewed retrospectively. Study end points included technical success, maturation, functional patency, and required interventions.Results: Between May 2017 and July 2019, there were 234 patients (mean age, 64 years; 148 male [63%]) who had a pAVF created. Technical success was achieved in 232 individuals (99%), and average duration of the procedure was 15 minutes (7-35 minutes). Average follow-up was 252 days (range, 83-696 days). The 1-year primary, primary assisted, and secondary patency rates were 54%, 85%, and 96%, respectively. Average pAVF flow was 923 mL/min (range, 425-1440 mL/min). There were no significant adverse events related to the procedure. Only three patients (1%) required a later conversion of the pAVF anastomosis to a surgical fistula. Twenty-four (10%) patients required superficialization of deep outflow veins because of difficult cannulation. Average maturation time was 4 weeks (range, 1-12 weeks). Fourteen patients (6%) had early (<2 weeks after creation) cannulation of the pAVF. Conclusions:The Ellipsys pAVF device allows the rapid and safe creation of a reliable autogenous access. Rates of technical success, patency, and maturation were excellent. For patients unsuited for a distal radiocephalic arteriovenous fistula, it should be considered the next preferred access option.

Twenty-six lactating Holstein cows (90 d of lactation) were blocked according to milk production, parity, and days of lactation for assignment to one of two dietary treatments. Diets included a control diet with no supplemental niacin and a diet supplemented with increasing concentrations of niacin (12, 24, or 36 g/d per cow over three consecutive 17-d periods. Cows were housed in a covered free-stall barn and were fed and milked twice daily. Mean maximum air temperatures and temperature-humidity indexes were 28.5, 31.4, and 25.2 degrees C and 79.6, 85.1, and 75, respectively, for the three periods. Rectal temperature was measured with a rectal probe, tail and rump temperatures by infrared thermometry, and respiratory rate by visual observation. Measurements were made daily at 0800, 1600, and 2200 h. Rectal temperature was not affected by treatment. Comparison of skin temperatures for control cows and cows fed niacin showed higher temperatures at the tail (34.0 vs. 33.7 degrees C at 0800 h; 35.1 vs. 34.8 degrees C at 1600 h, respectively) and rump (34.1 vs. 33.7 degrees C at 0800 h; 35.3 vs. 35.0 degrees C at 1600 h, respectively) for control cows during period 1. No differences in thermal responses were observed during period 3. Niacin did not significantly increase milk production but decreased skin temperatures during periods of mild or severe heat stress.

The endovascular management of TRAS is safe and presents a high rate of technical success with low morbidity. Its impact on serum creatinine levels is significant in our experience. However, the blood pressure items do not seem to improve postoperatively.

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