NCT02001844.

The toe-brachial index (TBI) is used as an adjunct to the ankle-brachial index (ABI) for non-invasive lower limb vascular screening. With increasing evidence suggesting limitations of the ABI for diagnosis of vascular complications, particularly in specific populations including diabetes cohorts, the TBI is being used more widely. The aim of this review was to determine the sensitivity and specificity of the TBI for detecting peripheral artery disease (PAD) in populations at risk of this disease. A database search was conducted to identify current work relating to the sensitivity and specificity of toe-brachial indices up to July 2015. Only studies using valid diagnostic imaging as a reference standard were included. The QUADAS-2 tool was used to critically appraise included articles. Seven studies met the inclusion criteria. Sensitivity of the TBI for PAD was reported in all seven studies and ranged from 45% to 100%; specificity was reported by five studies only and ranged from 16% to 100%. In conclusion, this review suggests that the TBI has variable diagnostic accuracy for the presence of PAD in specific populations at risk of developing the disease. There was a notable lack of large-scale diagnostic accuracy studies determining the diagnostic accuracy of the TBI in detecting PAD in different at-risk cohorts. However, standardised normal values need to be established for the TBI to conclusively determine the diagnostic accuracy of this test.

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BackgroundThe objevctive of the present study was to explore the potential influence of blood markers and patient factors such as risk factors, kidney function profile, coagulation profile, lipid profile, body mass index, blood pressure, and vein diameter on the maturation of arteriovenous fistula (AVF) in patients with end-stage renal disease.MethodsRetrospective data from 300 patients who had undergone AVF creation at the Royal Infirmary of Edinburgh were examined. A predictive logistic regression model was developed using a backward stepwise procedure. Model performance, discrimination, and calibration were assessed using the receiver operating characteristic (ROC) curve and Hosmer–Lemeshow goodness-of-fit test. The final model was externally validated by 100 prospective patients who received a new fistula at the Royal Infirmary of Edinburgh.ResultsA total of 400 (300 retrospective and 100 prospective) patients were recruited for this study, with a mean age of 60.14 ± 15.9 years (development set) and 58 ± 15 years (validation set), respectively (P = 0.208). Study results showed that males were twice as likely to undergo fistula maturation as females, while patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula and a preoperative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation as compared with a vein size of less than 2.5 mm. The model for fistula maturation had fair discrimination, as indicated by the area under the ROC curve (0.68), but good calibration as indicated by the Hosmer–Lemeshow test (P = 0.79). The area under the receiver operating curve for the validation model in the validation set was 0.59. Similarly, in the validation set, the Hosmer–Lemeshow statistic indicated an agreement between the observed and predicted probabilities of maturation (P > 0.05).ConclusionGender, PVD, and vein size are independent predictors of AVF maturation. The clinical utility of these risk categories in the maturation of AVF requires further evaluation in longer follow-up.

Background: Children and adolescents with Juvenile Idiopathic Arthritis (JIA) typically have reduced physical activity level and impaired aerobic and anaerobic exercise capacity when compared to their non-JIA counterparts. Low intensity exercise regimens appear to be safe in children with JIA and may results in improvements in overall physical function. Poor adherence to paediatric rheumatology treatment may lead to negative clinical outcomes and possibly increased disease activity. This includes symptoms such as pain, fatigue, quality of life, longer term outcomes including joint damage, as well as increase of healthcare associated costs. Low adherence to medications such as methotrexate and biological-drugs remains a significant issue for paediatric rheumatologists, with alarming reports that less than half of the children with JIA are compliant to drug-therapy. Main body: The recent advances in interactive technology resulting in a variety of wearable user-friendly smart devices may become a key solution to address important questions in JIA clinical management. Fully understanding the impact that arthritis and treatment complications have upon individual children and their families has long been a challenge for clinicians. Modern interactive technologies can be customised and accessed directly in the hands or wrists of children with JIA. These secured networks could be accessible 'live' at anytime and anywhere by the child, parents and clinicians. Multidisciplinary teams in paediatric rheumatology may benefit from adopting these technologies to better understand domains such as patient biological parameters, symptoms progression, adherence to drug-therapy, quality of life, and participation in physical activities. Most importantly the use of smart devices technologies may also facilitate more timely clinical decisions, improve self-management and parents awareness in the progression of their child's disease. Paediatric rheumatology research could also benefit from the use of these smart devices, as they would allow real-time access to meaningful data to thoroughly understand the disease-patterns of JIA, such as pain and physical activity outcomes. Data collection that typically occurs once every 1 or 3 months in the clinical setting could instead be gathered every week, day, minute or virtually live online. Arguably, few limitations in wearing such interactive technologies still exist and require further developments. Conclusion: Finally, by embracing and adapting these new and now highly accessible interactive technologies, clinical management and research in paediatric rheumatology may be greatly advanced.

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Life expectancy in patient with established kidney failure is considerably shortened with worsening quality of life. Through the provision of renal replacement therapy, survival and quality of life of advanced renal disease patients can be markedly improved. Haemodialysis and peritoneal dialysis are the treatment modalities in patients with end-stage renal disease. The efficiency of haemodialysis treatment relies on the functional status of vascular access. Vascular access and its related problems represent the main factors that determine a rise in the rate of incidence of the disease among haemodialysis patients and, consequently, a rise in the healthcare expenses. Arteriovenous fistula is the most efficient method, as it has a low risk of infection and mortality, and can ensure long-term functional access. However, maturation of an arteriovenous fistula is a complex process and is not well understood; significant numbers of arteriovenous fistula fail to develop sufficiently prior to their use for haemodialysis due to either lack of vessel maturation or spontaneous thrombosis. There are multiple blood markers and human factors that contribute to the maturation of fistula. Endothelial function is one of the most important determinants of arteriovenous fistula maturation. Early fistula failure is usually due to thrombosis which can be triggered by haematoma, by low flow rates resulting from low blood pressure, or by a hypercoagulable state. Impairment of endothelial function is associated with decreased arterial remodelling and final venous lumen diameter. Arteriovenous fistula anastomoses need early proliferation of endothelial cells to restore the barrier, permeability, and biochemical monitoring roles of endothelial cells in managing vascular repair, local thrombosis, neointimal hyperplasia, and inflammation. The purpose of this review was to discuss the maturation of AVF and endothelial dysfunction.

An intermetatarsal neuroma is a plantar digital neuritis causing metatarsalgia of the affected inter-metatarsal space. At present the evidence to support the management of the condition is poor with only some quality evidence supporting the short-term management of intermetatarsal neuromas using steroid injections. Some authors have supported the use of alcohol sclerosing intra-lesional injections to treat intermetatarsal neuromas. Following a search of the evidence 11 articles were identified. The systematic review found that alcohol injections appear to be safe although some papers report a short-term side effect of a flogistic reaction and there are variances in the alcohol concentration used and guiding verses not guiding the injection using ultrasound imaging. Some of the evidence may suggest a sclerosing histological effect of the nerve. However, all the studies reviewed present a research design offering a low level of evidence that is open to methodological biases and interpretation. Thus, this review found insufficient high-quality research evidence to afford conclusions on the management of intermetatarsal neuromas with alcohol sclerosing agent injections.