The management of dialysis access thrombosis during the COVID-19 pandemic.

BACKGROUND: Maintaining patent access is essential for haemodialysis dependent end stage renal failure patients. The COVID-19 pandemic has significantly affected surgical and interventional radiology services worldwide. We aimed to review the impact COVID-19 has caused to the management of acute dialysis access thrombosis. METHODS: We conducted a single centre retrospective review of outcomes of patients with arteriovenous fistula and arteriovenous graft thrombosis between March and May 2020, which coincided with the first peak of the COVID-19 pandemic in London, and a similar period in the previous year, March-May 2019. Outcomes in both cohorts of patients were compared, including attempts at salvage, salvage success, 1-month patency rates after salvage and subsequent surgery on the same access. We also analysed the use of tunnelled haemodialysis lines (THL), either due to failed salvage attempts or when salvage was not attempted. RESULTS: There was a similar incidence of access thrombosis in both periods (26 cases in 2019, 38 in 2020). There were 601 patients dialysing via an arteriovenous fistula or graft in 2019, and 568 patients in 2020. Access salvage, when attempted, had similar success rates and 1-month patency (salvage success 74% vs 80%, p = 0.39; 1-month patency 55% vs 62%, p = 0.69). The proportion of patients where access salvage was not attempted and a THL inserted was significantly higher in 2020 compared to 2019 (32% vs 4%, p = 0.007). There were more patients who subsequently had surgery to salvage or revise the same access in 2019 compared to 2020 (62% vs 13%, p < 0.001). CONCLUSIONS: During the peak of the COVID-19 pandemic, there were fewer attempts at access salvage. This was a conscious decision due to increased pressure on the healthcare system, access to emergency interventional radiology or operative theatres and the perceived risk/benefit ratio of access salvage. The long-term effects of this change in practice remain unknown.

Adapting a Dialysis Service for Delivery of Percutaneous Arteriovenous Fistulas.

The percutaneous arteriovenous fistula (pAVF) is an exciting and novel addition to the vascular access options available to patients with end-stage kidney disease who require dialysis. Early clinical results have been promising, with high rates of maturation and low rates of reintervention. To successfully adapt an existing hemodialysis service to include the provision of pAVF formation, it is essential to identify and align the interests of key clinical and nonclinical stakeholders. Only through strong collaboration can the service be supported. The authors provide a comprehensive overview of the planning fundamentals required, including the referral pathway, screening and clinical assessment, and practical procedural elements and considerations, as well as follow-up requirements such as cannulation, fistula surveillance, and maintenance. Key staffing requirements are highlighted, including those pertaining to vascular US screening and dialysis nurse training. A broad and structured planning approach ensures that the entire network of key stakeholder interests is included and provides a strong foundation for a compelling business plan to attract the necessary funding and managerial support for the service. The authors present a systematic framework of the essential considerations necessary to facilitate the planning, funding, and ultimately delivery of a successful pAVF service. Online supplemental material is available for this article. ©RSNA, 2022.

Some Distinct Attributes of ZnO Nanorods Arrays: Effects of Varying Hydrothermal Growth Time.

This study investigates the growth time effect on the structural, morphological, optical, and photoelectrochemical characteristics of highly oriented ZnO nanorod arrays (ZNRAs). The nanorod arrays were grown on ITO substrates using the unified sol-gel spin coating and hydrothermal techniques. ZnO nanoparticles (ZNPs) were synthesized using the sol-gel spin coating method. In contrast, the hydrothermal method was used to grow the ZnO nanorods. The hydrothermal growth time investigated was between 4 and 12 h. The synthesized ZNRAs were used as the photoanode electrodes to investigate their photoelectrochemical (PEC) electrode potency. The as-prepared ZNRAs were characterized using various analytical tools to determine their structures, morphologies, optical, and photoelectrochemical traits. EDX spectra showed the presence of uncontaminated ZnO chemical composition, and FTIR spectra displayed the various functional groups in the samples. A rod-shaped ZnO nanocrystallite with mean lengths and diameters of 300-500 nm and 40-90 nm, respectively, is depicted. HRTEM images indicated the nucleation and growth of ZNRAs with a lattice fringe spacing of 0.26 nm and a growth lattice planer orientation of [002]. The optimum ZNRAs (grown at 8 h) as photoelectrode achieved a photoconversion efficiency of 0.46% and photocurrent density of 0.63 mA/cm2, that was 17 times higher than the one shown by ZNPs with Ag/AgCl as the reference electrode. Both values were higher than those reported in the literature, indicating the prospect of these ZNRAs for photoelectrode applications.

Photoconversion efficiency of In2S3/ZnO core-shell heterostructures nanorod arrays deposited via controlled SILAR cycles.

This paper reports the structures, morphologies, optical properties, and photoconversion efficiency (η%) of the In2S3/ZnO core-shell heterostructures nanorod arrays (IZCSHNRAs) produced via the controlled successive ionic layer absorption and reaction (SILAR) cycles. As-produced samples were characterized using XRD, FESEM, TEM, UV-Vis, PL, XPS and FTIR techniques. The proposed IZCSHNRAs revealed nearly double photocurrent density and η% values compared to the pure ZnO nanorod arrays (ZNRAs). In addition, the light absorption, crystallinity and microstructures of the specimens were appreciably improved with the increase of the SILAR cycles. The deposited nanoparticles of In2S3 (ISNPs) on the ZNRAs surface was responsible for the improvement in the heterostructures, light absorption and photogenerated electron-hole pairs separation, thus enhancing the photoconversion performance. It is established that a simple SILAR approach can be very useful to produce good quality IZCSHNRAs-based photoelectrodes required for the future development of high performance photoelectrochemical cells (PECs).

Detection of outliers in high-dimensional data using nu-support vector regression.

Support Vector Regression (SVR) is gaining in popularity in the detection of outliers and classification problems in high-dimensional data (HDD) as this technique does not require the data to be of full rank. In real application, most of the data are of high dimensional. Classification of high-dimensional data is needed in applied sciences, in particular, as it is important to discriminate cancerous cells from non-cancerous cells. It is also imperative that outliers are identified before constructing a model on the relationship between the dependent and independent variables to avoid misleading interpretations about the fitting of a model. The standard SVR and the µ-ε-SVR are able to detect outliers; however, they are computationally expensive. The fixed parameters support vector regression (FP-ε-SVR) was put forward to remedy this issue. However, the FP-ε-SVR using ε-SVR is not very successful in identifying outliers. In this article, we propose an alternative method to detect outliers i.e. by employing nu-SVR. The merit of our proposed method is confirmed by three real examples and the Monte Carlo simulation. The results show that our proposed nu-SVR method is very successful in identifying outliers under a variety of situations, and with less computational running time.

Patient, Caregiver, and Clinician Participation in Prioritization of Research Questions in Pediatric Hospital Medicine.

Importance: The research agenda in pediatric hospital medicine has seldom considered the perspectives of young people, parents and caregivers, and health care professionals. Their perspectives may be useful in identifying questions on topics for research. Objective: To prioritize unanswered research questions in pediatric hospital medicine from the perspectives of young people, parents/caregivers, and health care professionals. Design, Setting, and Participants: Between August 4, 2020, and August 19, 2021, two online surveys and a virtual workshop were conducted, using modified Delphi technique and nominal group technique. Young people, parents/caregivers, and health care professionals with experiences in pediatric hospital medicine in Canada were included. Interventions: The established James Lind Alliance Priority Setting Partnership method was used. In phase 1, a survey collected unanswered questions regarding pediatric hospital medicine via 3 open-ended questions. Survey responses were used to develop summary questions that went through an evidence-checking process. Unanswered questions were brought to a phase 2 interim prioritization survey. The top 10 unanswered research questions in pediatric hospital medicine were established at the final priority setting workshop. Main Outcomes and Measures: Survey responses, top 10 research questions. Results: The phase 1 survey was completed by 188 participants (148 of 167 [89%] females; 17 of 167 [10%] males; mean [SD] age, 39.5 [12.4] years) and generated 495 unanswered research questions and comments, of which 58 were deemed out of scope. The remaining 437 responses were grouped into themes (eg, communication, shared decision-making, health service delivery, and health service management) and then refined to 75 unanswered research questions. Of these 75, only 4 questions had sufficient evidence. To make the number of questions in phase 2 manageable, 21 questions submitted by only 1 respondent were eliminated. Fifty unanswered research questions were included in the phase 2 survey, which was completed by 201 participants (165 of 186 [89%] females; 19 of 186 [10%] males; mean [SD] age, 40.0 [11.0] years). A short list of 16 questions-the top 10 questions from patient partners (youths, parents/caregivers) and clinicians-was presented at the final priority setting workshop and the top 10 questions were prioritized. The top 10 questions focused on the care of special inpatient populations (eg, children with medical complexity), communication, shared decision-making, support strategies in the hospital, mental health supports, shortening length of stay, and supporting Indigenous patients, parents/caregivers, and families. Conclusions and Relevance: This patient-oriented pediatric hospital medicine priority setting partnership identified the most important unanswered research questions focused on the care of children in the hospital. These questions provide a possible roadmap for research on areas deemed important to young people, parents/caregivers, and clinicians.

Temporal-spatial variation, source forensics of PAHs and their derivatives in sediment from Songhua River, Northeastern China.

The distribution patterns and health risk assessment of nitrated polycyclic aromatic hydrocarbons (NPAHs), hydroxy polycyclic aromatic hydrocarbons (OH-PAHs), and regular 16 priority polycyclic aromatic hydrocarbons (PAHs) in sediment from the Songhua River in northeastern China were investigated in this research. During dry seasons, concentrations of 16 USEPA priority PAHs, OH-PAHs, and NPAHs were extremely high, with average values of 1220 ± 288, 317 ± 641, 2.54 ± 3.98, and 12.2 ± 22.1 ng/g (dry weight, dw). The dry period level was confirmed to be 4 times greater than the wet period concentration. Modeling with positive matrix factorization (PMF) and estimation of diagnostic isomeric ratios were applied for identifying sources, according to the positive matrix factorization model: vehicle emissions (38.1%), biomass burning (25%), petroleum source (23.4%), and diesel engines source (13.5%) in wet season as well as wood combustion (44.1%), vehicle source (40.2%), coke oven (10.8%), and biomass burning (4.9%) in the dry season. The greatest seasonal variability was attributed to high molecular weight compounds (HMW PAHs). BaP was confirmed to be 81% carcinogenic in this study, which offers convincing proof of the escalating health issues.

Determination of Polycyclic Aromatic Hydrocarbons and Their Methylated Derivatives in Sewage Sludge from Northeastern China: Occurrence, Profiles and Toxicity Evaluation.

This paper assesses the occurrence, distribution, source, and toxicity of polycyclic aromatic hydrocarbons (PAHs), and their methylated form (Me-PAHs) in sewage sludge from 10 WWTPs in Northeastern China was noted. The concentrations of ∑PAHs, ∑Me-PAHs ranged from 567 to 5040 and 48.1 to 479 ng.g-1dw, which is greater than the safety limit for sludge in agriculture in China. High and low molecular weight 4 and 2-ring PAHs and Me-PAHs in sludge were prevalent. The flux of sludge PAHs and Me-PAHs released from ten WWTPs, in Heilongjiang province, was calculated to be over 100 kg/year. Principal component analysis (PCA), diagnostic ratios and positive matrix factorization (PMF) determined a similar mixed pyrogenic and petrogenic source of sewage sludge. The average values of Benzo[a]pyrene was below the safe value of 600 ng.g-1 dependent on an incremental lifetime cancer risk ILCR of 10-6. Sludge is an important source for the transfer of pollutants into the environment, such as PAHs and Me-PAHs. Consequently, greater consideration should be given to its widespread occurrence.

Occurrence, Removal, and Mass Balance of Polycyclic Aromatic Hydrocarbons and Their Derivatives in Wastewater Treatment Plants in Northeast China.

Polycyclic aromatic hydrocarbons (PAHs), 33 methylated PAHs (Me-PAHs), and 14 nitrated PAHs (NPAHs) were measured in wastewater treatment plants (WWTPs) to study the removal efficiency of these compounds through the WWTPs, as well as their source appointment and potential risk in the effluent. The concentrations of ∑PAHs, ∑Me-PAHs, and ∑NPAHs were 2.01-8.91, 23.0-102, and 6.21-171 µg/L in the influent, and 0.17-1.37, 0.06-0.41 and 0.01-2.41 µg/L in the effluent, respectively. Simple Treat 4.0 and meta-regression methods were applied to calculate the removal efficiencies (REs) for the 63 PAHs and their derivatives in 10 WWTPs and the results were compared with the monitoring data. Overall, the ranges of REs were 55.3-95.4% predicated by the Simple Treat and 47.5-97.7% by the meta-regression. The results by diagnostic ratios and principal component analysis PCA showed that "mixed source" biomass, coal composition, and petroleum could be recognized to either petrogenic or pyrogenic sources. The risk assessment of the effluent was also evaluated, indicating that seven carcinogenic PAHs, Benzo[a]pyrene, Dibenz[a,h]anthracene, and Benzo(a)anthracene were major contributors to the toxics equivalency concentrations (TEQs) in the effluent of WWTPs, to which attention should be paid.

Assessment of eating habits and lifestyle during the coronavirus 2019 pandemic in the Middle East and North Africa region: a cross-sectional study.

Coronavirus disease 2019 (COVID-19) has rapidly spread globally, forcing countries to apply lockdowns and strict social distancing measures. The aim of this study was to assess eating habits and lifestyle behaviours among residents of the Middle East and North Africa (MENA) region during the lockdown. A cross-sectional study among adult residents of the MENA region was conducted using an online questionnaire designed on Google Forms during April 2020. A total of 2970 participants from eighteen countries participated in the present study. During the pandemic, over 30 % reported weight gain, 6·2 % consumed five or more meals per d compared with 2·2 % before the pandemic (P < 0·001) and 48·8 % did not consume fruits on a daily basis. Moreover, 39·1 % did not engage in physical activity, and over 35 % spent more than 5 h/d on screens. A significant association between the frequency of training during the pandemic and the reported change in weight was found (P < 0·001). A significantly higher percentage of participants reported physical and emotional exhaustion, irritability and tension either all the time or a large part of the time during the pandemic (P < 0·001). Although a high percentage of participants reported sleeping more hours per night during the pandemic, 63 % had sleep disturbances. The study highlights that the lockdown due to the COVID-19 pandemic caused a variety of lifestyle changes, physical inactivity and psychological problems among adults in the MENA region.

Improving the practice of inferior vena cava filter retrieval: a quality improvement intervention and audit outcomes.

OBJECTIVE: To review inferior vena cava (IVC) filter retrieval practice at our institution, the Royal London Hospital, and measure changes following a quality improvement intervention. IVC filters are a preventive treatment for pulmonary embolism when anticoagulation is ineffective/contraindicated. Unless permanent filtration is required, all filters should undergo attempted retrieval within manufacturer's recommendations with a success rate of ≥80 %. METHODS: Retrospective audit of filters inserted between 2011 and 2014, followed by a quality improvement intervention and a second audit between 2015 and 2017. Clinical-radiological data were analysed using the Picture Archiving and Communication System and electronic patient records. RESULTS: During the first audit, filter retrieval was attempted in 92% of cases, of which 82% underwent the procedure within manufacturer's recommendations and 86% were successful. During the second audit, an improvement across indicators was seen. Retrieval increased by 3% and was attempted in 95% of cases (92% of which were within manufacturer's guidelines). Rate of retrievals within manufacturer's guidelines increased by 10%. Filter retrieval success rate increased by 11% - to 97%. CONCLUSIONS: IVC filter retrieval practice at a single institution can be improved by implementing a simple audit intervention. ADVANCES IN KNOWLEDGE: Filter retrieval practice has clinical and medicolegal implications. A simple quality intervention can substantially improve overall practice.

Peripheral artery disease risk factors in Jeddah, Saudi Arabia: a retrospective study.

BACKGROUND: Peripheral artery disease (PAD) is a major health problem in Saudi Arabia with considerable implications for morbidity and mortality. Many risk factors have been established for developing PAD, but the prevalence of these risk factors is variable from one country to another. AIM: To identify the risk factors for PAD and study their prevalence in Jeddah, Saudi Arabia. METHODS: A retrospective chart review study was conducted in a tertiary center in Jeddah from July 2012 to September 2015. All patients with PAD were recruited into this study, and their data were analyzed using IBM SPSS. Correlation between PAD and various risk factors was studied using Spearman's coefficient. RESULTS: A total of 261 patients were recruited, of which 55% were males. Hypertension, diabetes type 2, and obesity were found among 34.2%, 33.3%, and 29.2% of the patients, respectively. About 45% had a history of previous vascular surgery, and amputation was performed in 6.9% particularly in legs. Hypertension and metabolic syndrome were the only risk factors that showed a significant correlation with PAD (P=0.039 and 0.040, respectively). CONCLUSION: The most prevalent risk factors for PAD in Jeddah were hypertension, diabetes, obesity, and smoking. Hypertension and metabolic syndrome were the only risk factors significantly associated with PAD. Males were often more affected by PAD than females. The most commonly affected site was the lower limbs.

Broken Wings: First Reported Cases of Fractured Angel® Catheters, a Temporary Combined Femoral Venous Catheter and Retrievable IVC Filter Device.

There has been increasing use of a novel combined femoral venous sheath, catheter and retrievable self-expanding and collapsible diamond-shaped IVC filter (Angel® Catheter, BiO2 Medical), in severely injured patients who cannot receive anticoagulation. As the filter is not detached from the catheter/sheath, it should be easily retrieved. Outcomes included in large registries demonstrate a high safety profile and a 100% retrieval rate. However, at our institution-a Level 1 major UK trauma centre with 4 years of substantial experience in using this device-we've encountered three cases of device fracture and subsequent complicated retrieval dating from Dec 2016 to March 2017. To the best of the authors' knowledge, we describe the first documented case series of fractured Angel® Catheters and their retrieval.

Quality of sleep and risk for obstructive sleep apnoea in ambulant individuals with type 2 diabetes mellitus at a tertiary referral hospital in Kenya: a cross-sectional, comparative study.

BACKGROUND: Sleep disorders are common and associated with multiple metabolic and psychological derangements. Obstructive sleep apnoea (OSA) is among the most common sleep disorders and an inter-relationship between OSA, insulin resistance, obesity, type 2 diabetes (T2DM) and cardiovascular diseases has been established. Prevalence of sleep disorders in Kenyans, particularly in individuals with T2DM is unknown. We thus aimed to determine prevalence of poor quality of sleep (QOS) and high risk for OSA, among persons with T2DM and determine their associations with socio-demographic and anthropometric variables. METHODS: Utilising a Cross- Sectional Descriptive design, QOS and risk for OSA were determined in a randomly selected sample of patients with T2DM (cases) and an age and sex matched comparison group. The validated Pittsburgh Sleep Quality Index (PSQI) and Berlin Questionnaire (BQ) were used to measure QOS and risk for OSA respectively. Associations between poor QOS, high risk for OSA, and socio-demographic and anthropometric variables in cases were evaluated. RESULTS: From 245 randomly selected persons with T2DM attending outpatient clinics, aged over 18 years, 22 were excluded due to ineligibility thus 223 were included in the analysis; 53.8% were females, mean age was 56.8 (SD 12.2) years and mean BMI was 28.8 kg/m2 (SD 4.4). Among them, 119 (53%, CI 95% 46.5-60.2) had poor QOS and 99 (44% CI 95% 37.8-50.9) were at high risk for OSA. Among 112 individuals in comparison group, 33 (29.5%, CI 95% 20.9-38.3) had poor QOS and 9 (8%, CI 95% 3.3-13.4) had high risk for OSA. Cases had a significantly higher probability for poor QOS [OR 2.76 (95% CI 1.7-4.4))] and high risk for OSA [OR 9.1 (95% CI 4.4-19.0)]. Higher waist circumference was independently associated with a high risk for OSA in cases. CONCLUSIONS: We demonstrate a high burden of sleep disturbances in patients with T2DM. Our findings may have implications for clinicians to screen for sleep disorders when assessing patients with T2DM and warranting further attention by practitioners and researches in this field.

Musculoskeletal complications of haematological disease.

Rheumatological manifestations complicate many benign and malignant blood disorders. Significant advances in haematology, with improved diagnostic techniques and newer musculoskeletal imaging, have occurred in the past two decades. This review focuses on the interrelationship between the major haematological diseases (haemochromatosis, haemophilia, sickle cell disease, thalassaemia, leukaemia, lymphoma, myelodysplastic syndromes, multiple myeloma and cryoglobulinaemia) and rheumatic manifestations.

Novel pseudo-wavelet function for MMG signal extraction during dynamic fatiguing contractions.

The purpose of this study was to develop an algorithm to classify muscle fatigue content in sports related scenarios. Mechanomyography (MMG) signals of the biceps muscle were recorded from thirteen subjects performing dynamic contractions until fatigue. For training and testing purposes, the signals were labeled in two classes (Non-Fatigue and Fatigue). A genetic algorithm was used to evolve a pseudo-wavelet function for optimizing the detection of muscle fatigue. Tuning of the generalized evolved pseudo-wavelet function was based on the decomposition of 70% of the conducted MMG trials. After completing 25 independent pseudo-wavelet evolution runs, the best run was selected and then tested on the remaining 30% of the data to measure the classification performance. Results show that the evolved pseudo-wavelet improved the classification rate of muscle fatigue by 4.70 percentage points to 16.61 percentage points when compared to other standard wavelet functions, giving an average correct classification of 80.63%, with statistical significance (p < 0.05).