Aim. To establish the practical value of studying ultrasound markers of atherosclerosis for assessing cardiovascular risk as a part of screening of the population based on lean technologies.Material and methods. The study included 305 patients. The age of participants ranged from 31 to 84 years, the median age was 61,0 years. The object of study was 1830 extracranial vessels, including common carotid arteries, internal carotid arteries, subclavian arteries. Duplex ultrasound was using an Acuson 2000 ultrasound system with a frequency of 3-9 MHz. An abbreviated ultrasound protocol was used. The obtained data were processed using the software package Statistica 12.0 (StatSoft, USA).Results. As a result of lean technology application, the duration of procedure was significantly reduced, and the process was improved by 6 times. Changes in intimamedia thickness (IMT) were detected in 42,6% of cases, and significantly more changes in IMT were found in women (48,1%) than in men (25,0%), p=0,0005. Atherosclerotic plaques (ASP) were detected in 53,4% of cases (men — 68,1%; women — 48,9%), p=0,0043. In men <50 years of age, a more intense increase in ASP prevalence than in women was recorded. Starting from 50 years old, ASP prevalence has leveled off. The prevalence of carotid atherosclerosis at any age was higher in men. From the age of 50, sex differences had no significance, p=0,133. In 87,1% of cases, ASP was located within the bifurcation. In the studied groups, obstruction to 50% were more common (46,2%, p=0,0005). Questioning revealed that over the past three years, duplex ultrasound was performed in 21% of patients. Satisfaction with the quality of the procedure was 57,0% (174/305).Conclusion. The results of the study indicate the high practical value of ultrasonic markers of atherosclerosis using abbreviated ultrasound protocol as a part of screening of the population. The inclusion of noninvasive vascular imaging data in screening programs will help to achieve targets for reducing cardiovascular mortality and personalize the assessment of cardiovascular risk.
Introduction: Vascular access (VA) for hemodialysis is essential for kidney patients because of its associated morbidity and mortality as well as for its impact on quality of life. Thrombosis is the main complication of an arteriovenous fistula (AVF). The main cause is the previous stenosis, which occurs due to the hyperplasia of the neointima of the vessel, that conditions the appearance of thrombosis. The efficacy of different approaches has been studied to reduce the incidence of thrombosis in AVFs and increase their survival. We determine those factors involved in vascular access thrombosis for hemodialysis. Methods: This is a cross-sectional descriptive study. We include all the AVFs performed in our center during the period between 2000 and 2020. Demographic variables (age, sex), CKD etiology and associated comorbidity factors were collected. We determine the factors involved in thrombosis of AVFs. The statistical analysis was executed with SPSS 25.0. The categorical variables are expressed as percentages and were compared using the Chi2 test. The quantitative variables are expressed as mean +/-standard deviation, and the T-Student or U Mann Whitney were used to compare them. We performed multivariate analysis using logistic regression. We establish statistical significance for a value of p <0.05. Results: We include 622 AVFs performed in 482 patients. 86.8% were autologous. 66.6% were male, with an average age of 65.4 AE 14 years. The most frequent CKD etiology were diabetic nephropathy (30.2%), unknown etiology (18%), and glomerular etiology (16.6%). 91.2% had high blood pressure (HBP) and 47.9% diabetes mellitus (DM). 48.7% received antiplatelet therapy and 15.6% anticoagulation prior to the creation of the AVF. VA thrombosis was documented in 23%. The univariate analysis showed statistical significance for ischemic heart disease (p = 0.05), peripheral vascular disease (p = 0.05), antiplatelet therapy (p = 0.038), high phosphorous levels (p = 0.033), high PTH levels (p = 0.024) and C-reactive protein (p = 0.021). When performing the multivariate analysis using logistic regression, antiplatelet therapy (OR: 0.62 95% CI 0.41-0.93 p = 0.023), and statin treatment (OR: 0.58 95% CI 0.36-0, 93 p = 0.025) are protective factors for VA thrombosis. Conclusions: In our study, antiplatelet therapy prior to the creation of the VA decreased the probability of AVF thrombosis by 38% and the statin treatment decreased the probability of AVF thrombosis by 42%.
Тульский государственный университет, медицинский институт, Тула Освещено применение новых оральных антикоагулянтов при фибрилляции предсердий (ФП) ,а также способность препаратов данной группы снижать риск тромбоэмболический осложнений после ФП. В настоящее время как в России так и за рубежом распространенна стратегия профилактики инсульта с использованием варфарина, однако его применение нередко вызывают ряд побочных реакций, в связи с этим в клиническую практику все чаще внедряется применение новых оральных антикоагулянтов. В данной статье освещены результаты их использования в терапии тромбоэмболических осложнений.
Background and Aims The aim of study was to compare the lung ultrasound (LUS) and bioimpedance analysis (BIA) as methods to assess the hydration (fluid) status in maintenance hemodialysis (MHD) patients. Method The comparative analysis was performed in 87 MHD patients aged 24 to 82 years (43 women, and 44 men). Patients with cardiac pacemakers and permanent catheters as vascular access were excluded from the study. Extravascular lung water (EVLW) in MHD patients was assessed simultaneously by LUS (Acuson X150 ultrasound system with a CH5-2 curvilinear transducer, Siemens) and by the bioimpedance spectroscopy (BIS) (Bodystat Multiscan 5000) with frequency range of 5-1000K Hz. Both LUS and BIS were performed before and 30 minutes after the hemodialysis (HD) session in the second and third sessions of the week. Ultrasonic measurements were performed by summing LUS comets or B-lines along four anatomical lines (parasternal, mid-clavicular, anterior, middle, and posterior axillary lines) from II to V intercostal spaces on the right and from the II to IV intercostal spaces on the left. The quantitative assessment of B-lines (B-lines score, BLS) was performed according to Picano E. et al. [2006]: normohydration – zero degree (<4 B lines) with the absence of EVLW, overhydration (OH) – 1st degree (5-14 BLS), 2nd degree OH (15-30 BLS), and 3d degree OH – >30 BLS with an insignificant, moderate and severe amount of EVLW, respectively. The body hydration status assessment technique by BIS was based on the overhydration (OH) index, the total body water volume, extra- and intracellular water, and the body composition. Patient's fluid status classified as normohydration (1.0-1.0 L), moderate OH (>1.0-<2.5 L), and severeOH (>2.5 L), and dehydration (<1.0 L) [Henry C. Lukaski et al., 2019]. The LUS do not allow assessing the state of dehydration, therefore, the normohydration by LUS was the sum of normo- and dehydration by BIS. We used SPSS Statistics 21.0 software for statistical processing of the data. To assess the correlation between BLS and OH indicators, we used Spearman's rank correlation coefficient. The statistical significance level was assumed to be 0.05. Results Data of the body fluid status using LUS and BIS before and after HD-session fully coincided in 33 of 87 MHD patients, partially coincided in 20 patients before and in 25 patients after HD-session. LUS and BIS didn’t coincide completely in only 9 patients. Statistically significant correlation was revealed between BLS and OH before (Rs=0.336; p<0.01), and after (Rs=0,317, p<0,01) HD session. A positive correlation between BLS and OH data was revealed in 53 patients, whose results were almost identical before (Rs=0,488, p<0.01), and in 58 patients after (Rs=0,658, p<0.01) HD session. Conclusion BIS remains the gold standard for the assessment of over-, normo- and dehydration in MHD patients. LUS is a simple and adequate technique for assessing the hydration status in MHD patients, and it is comparable to BIS in assessing over-, as well as normohydration. However, the LUS doesn’t allow diagnosing the body dehydration.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.