Background and aims: Atherosclerotic calcification is a powerful predictor of cardiovascular disease. This study aims to determine whether circulating levels of a local/systemic calcification inhibitor or a marker of bone formation correlate with measures of coronary or extracoronary calcification. Methods and results: Clinical computed tomography (CT) was performed on 64 arterial disease participants undergoing carotid and lower extremity endarterectomy. Coronary artery calcium (CAC) scores and volumes were acquired from the CT scans (n Z 42). CAC scores and volumes were used to derive CAC density scores. Micro-CT was performed on excised carotid (n Z 36) and lower extremity (n Z 31) plaques to quantify the volume and volume fraction of extracoronary calcification. Circulating levels of dephospho-uncarboxylated Matrix Gla Protein (dp-ucMGP), fetuin-A, carboxylated and uncarboxylated osteocalcin (ucOC) were quantified using commercial immunoassays. Carotid participant CAC density scores were moderately negatively correlated with plasma dp-ucMGP (r s Z À0.592, P Z 0.008). A weak negative association was found between CAC scores and %ucOC for all participants (r s Z À0.335, P Z 0.040). Another weak negative correlation was observed between fetuin-A and the volume of calcification within
Background: Arteriovenous fistulae (AVF) have superior clinical outcomes compared to central venous catheters (CVC) among haemodialysis (HD) patients. Yet, there is increasing recognition that health-related quality of life (HRQoL) may be more important to patients than survival and that differences may exist between AVF and CVCs in this regard. This study compared HRQoL between AVF and CVC in an Irish cohort. Methods: We conducted a cross-sectional survey among prevalent haemodialysis patients (n=119) dialysing with either an AVF or CVC at a regional programme. The Short Form 36 (SF-36) and a validated Vascular Access Questionnaire (SF-VAQ) compared QoL between AVF and CVC in domains of physical functioning, social functioning and dialysis complications. Multivariable logistic regression compared differences between groups for outcomes of physical functioning, social functioning and dialysis complications expressed as adjusted odds ratios and 95% CI. Results: Mean age was 66.1 years, 52.1% were using an AVF while 47.9% had a CVC. Patients dialysing with an AVF were more satisfied with their access when asked directly (6.2 vs 5.0, P<0.01). Physical functioning scores for bleeding, swelling and bruising were significantly higher for AVF than CVC (P<0.005 for all). In contrast, patients with CVC reported greater difficulties in bathing and showering than those using an AVF (4.4 vs 2.0, P <0.001) whereas patients with AVF expressed greater concerns with physical appearances. Compared to AVF, CVC users were less likely to report difficulties in physical functioning (OR 0.35, 95% 0.12-0.94), P=0.04) but more likely to report dialysis complications (OR 1.94 (0.69-5.87), P=0.22). Conclusion: Vascular access contributes to HRQoL in haemodialysis. CVCs are associated with fewer difficulties from bleeding and bruising but greater negative impact on social activities including bathing and showering. Overall, patients with a CVC had lower dissatisfaction scores than patients with AVF when all 3 domains were added. Innovation in vascular access design and engineering may confer benefits and improve patient comfort on HD.
Background and Purpose: The purpose of this study is to examine the ability of ex vivo derived Agatston, Volume, and Density-Volume calcium scores or calcium density measurements to differentiate between carotid plaques based on preoperative cerebrovascular symptomatology. Methods: Thirty-eight carotid plaques were acquired from standard endarterectomy. Micro-computed tomography was performed on the ex vivo samples. Image series were downsampled to represent the resolution of clinical multidetector computed tomography. Agatston, Volume, and Density-Volume carotid calcium scores were then calculated using coronary methodologies. The fractions of low- and high-density calcification were also determined. Results: The coronary calcium scores could not differentiate between carotid plaques from asymptomatic versus symptomatic patients. However, plaques from asymptomatic patients contained significantly lower fractions of low-density calcification and higher fractions of high-density calcification. Conclusions: Screening for carotid calcium density in noncontrast computed tomography could reflect plaque stability.
Objective: Pseudomonas aeruginosa is a Gram-negative bacillus that commonly colonises lower limb venous ulcers. Its effects on venous ulcer healing are widely debated. It produces exotoxins and elastase, as well as forming biofilms in hard-to-heal wounds. It is postulated that these virulence factors lead to slower healing times in patients with lower limb venous ulcers colonised with Pseudomonas. This review aimed to summarise the available evidence pertaining to this topic. Method: A systematic review was performed in August 2019, where the Pubmed, Cochrane and Embase databases were searched for relevant literature according to PRISMA guidelines. Retrospective and prospective studies examining the effect of Pseudomonas colonisation on any measure of ulcer healing were included. Results: Some 282 articles were screened, of which seven studies including 491 patients were ultimately included for analysis. Of these, no study demonstrated a significant association between Pseudomonas colonisation and delayed healing of venous ulcers. In five of the seven studies, the effect of Pseudomonas aeruginosa on initial ulcer size at presentation was recorded. Conclusion: All the studies demonstrated an association between ulcer size and the presence of Pseudomonas aeruginosa. While Pseudomonas aeruginosa may colonise larger ulcers or those with a worse prognosis, no evidence was found to support the hypothesis that this colonisation had a negative impact on lower limb venous ulcer healing.
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