Introduction Albeit uncommon, hydrothorax is an important complication of peritoneal dialysis (PD). Due to paucity of evidence for optimal treatment, this study aimed to evaluate the effectiveness and safety of computed tomographic (CT) peritoneography and surgical intervention involving video-assisted thoracic surgery (VATS) for hydrothorax in a retrospective cohort of patients who underwent PD in Japan. Methods Of the 982 patients who underwent PD from six centers in Japan between 2007 and 2019, 25 (2.5%) with diagnosed hydrothorax were enrolled in this study. PD withdrawal rates were compared between patients who underwent VATS for diaphragm repair (surgical group) and those who did not (non-surgical group) using the Kaplan-Meier method and log-rank test. Results The surgical and non-surgical groups comprised a total of 11 (44%) and 14 (56%) patients, respectively. Following hydrothorax diagnosis by thoracentesis and detection of penetrated sites on the diaphragm using CT peritoneography, VATS was performed at a median time of 31 days (interquartile range [IQR], 20-96 days). During follow-up (median, 26 months; IQR, 10-51 months), 9 (64.3%) and 2 (18.2%) patients in the non-surgical and surgical groups,
Cardiovascular disease is the most common comorbidity in chronic kidney disease (CKD) patients, affecting both their prognosis and quality of life. Cardiac fibrosis is common in CKD patients with left ventricular diastolic dysfunction, and it is associated with increased risk of heart failure and mortality. Recent evidence suggests that high salt intake activates immune responses associated with local accumulation of sodium. We reported that high salt intake promotes cardiac inflammation in subtotal nephrectomized (Nx) mice. We investigated the effects of administration of MR16-1, a rat anti-mouse monoclonal interleukin (IL)-6 receptor antibody, in Nx mice with salt loading (Nx-salt). Expression of monocyte chemoattractant protein (MCP)-1, tumor necrosis factor (TNF)-a, IL-1b, and IL-6 mRNAs and macrophage infiltration was significantly reduced in the heart of Nx-salt mice treated with MR16-1 (Nx-salt-MR16-1) as compared with Nx-salt mice treated with control rat immunoglobulin G1 (rat IgG1) (Nx-salt-rat IgG1). Correspondingly, cardiac fibrosis was significantly attenuated in Nx-salt-MR16-1 mice compared with Nx-salt-rat IgG1 mice. Furthermore, in the heart of Nx-salt-MR16-1 mice, expression of mRNA for nicotinamide adenine dinucleotide phosphate oxidase-2, an oxidative stress marker, was significantly downregulated compared with Nx-salt-rat IgG1 mice. Increases in cardiac metabolites including histidine and γ-butyrobetaine were also reversed by IL-6 blockade treatment. In conclusion, IL-6 blockade exerts anti-inflammatory, anti-fibrotic, and partial anti-oxidative effects in the heart of Nx-salt mice.
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Objective: Carotid artery stenting (CAS) for common carotid artery stenosis via the transfemoral approach might have a potential risk of iatrogenic distal embolism. In this study, we present a technique of transradial stenting with 6 Fr modified Simmonds guiding sheath for stenosis of the common carotid artery. Case Presentations: A 6 Fr modified Simmonds guiding sheath was introduced via the right radial artery and advanced to the common carotid artery without passing a guidewire or coaxial catheter through the stenotic lesions. Two cases with common carotid artery stenosis were treated successfully with this procedure. Conclusion: Transradial CAS with modified Simmonds guiding sheath provides a safe and durable alternative option for patients with common carotid artery stenosis having vulnerable plaques. Keywords▶ common carotid artery stenosis, carotid artery stenting, transradial approach, modified Simmonds guiding sheath, lesion cross
Objective: To clarify the usefulness and safety of neuroendovascular treatment with a 6 Fr guiding sheath via the right radial artery for anterior circulation lesions.Methods: A total of 20 patients (carotid artery stenting: 11 patients, coil embolization of cerebral aneurysms: nine patients) who underwent neuroendovascular treatment via the right radial artery under general anesthesia, between September 2016 and June 2017, were included in this study. We retrospectively analyzed 1) the pertinent anatomy of the target-side common carotid artery and the aortic arch, 2) devices, 3) method to advance the guiding sheath into the common carotid artery, 4) hemostasis at the puncture site, and 5) outcome (success rate, perioperative complications, and complications at the site of puncture).
Results:In all patients, a 6 Fr guiding sheath could be guided into the common carotid artery, and treatment was accomplished. Furthermore, there was no perioperative or puncture-site complication.
Conclusion:Transradial neuroendovascular treatment is considered as a safe and successful choice for anterior circulation lesions.
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