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A review of technical steps in the performance of arteriovenous fistula creation
Get PDFAlthough it is accepted that a functional arteriovenous fistula (AVF) is the optimal vascular access for dialysis, achieving function is difficult as the outcomes of AVF creation are sub-optimal. Many technical steps have been proposed to improve outcomes, but the strength of evidence to support these is unclear. Thus, a systematic review of all randomised controlled trials (RCT) of operative strategies to optimise AVF outcomes was performed to summarise the evidence, review the overall level of standardisation in RCT and thus determine if there was an objective basis for the technical steps in AVF creation. A systematic review of all RCT was performed and studies categorised by intervention type. The rationale for each intervention, outcomes and limitations were described. Most importantly, the completeness of reporting procedural steps was compared for all RCT and the therapeutic impact considered by AVF site. Of 6741 records meeting the search criteria, 31 RCT were included. Most RCT did not control for all technical aspects or fully detail the operative methods, with a mean of 4 technical steps not reported for which other RCT have been performed. Of studies involving a surgical intervention in RCF, 10/13 reported a significant benefit compared to only 5/15 studies in BCF or larger vessels. Overall, the adequacy of reporting the technical details in all RCT of technical steps in AVF creation was poor. Despite this, there was a consistent patency benefit found in RCT performed in smaller vessels although the extent of interaction between these is uncertain. There remain gaps in the literature in defining the optimal steps in fistula creation that, if confirmed, could significantly improve AVF outcomes. This makes it essential that future studies of novel techniques, such as percutaneous AVF creation, incorporate a standardised operating procedure of optimal current practice of surgically created AVF as a meaningful comparator
Global Entrepreneurship Monitor 2024/2025 Global Report: Entrepreneurship Reality Check
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The Golden Thread: Embedding Case Analysis and Consultancy Methods for External Collaboration in MBA Programmes
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Long-term effects of SARS-CoV-2 infection on blood vessels and blood pressure - LOCHINVAR
Get PDFObjective:
The COVID-19 pandemic has been linked to endothelial dysfunction and renin–angiotensin–aldosterone system (RAAS) dysregulation, potentially worsening hypertension. Longitudinal studies are needed to establish COVID-19's lasting effects on blood pressure (BP) and endothelial function. Our objective was to determine whether COVID-19 increases future hypertension risk by comparing BP and endothelial function in nonhypertensive COVID-19 survivors with nonhypertensive controls.
Methods:
This single-centre prospective longitudinal study included participants without hypertension history, with cases being hospital-admitted COVID-19 survivors and controls having negative SARS-CoV-2 antibody tests. Ambulatory blood pressure monitoring, flow-mediated dilatation (FMD), 6-min walk test (6MWT), and quality of life (QoL) assessments were conducted at baseline and 12 months. RAAS phenotyping was performed at baseline. Data analysis used paired t-tests and multivariable regression on full and per-protocol datasets.
Results:
The full (n = 97) and per-protocol (n = 66) datasets included 37 and 15 cases respectively. Median ages (IQR: interquartile range) were 49.0 (43.0–53.5) and 50.0 (42–54.0) years. Baseline RAAS parameters were similar. Multivariable adjusted analyses in the per-protocol group showed SARS-CoV-2 positive participants had a 12-month increase in mean systolic BP (4.57 mmHg, [95% CI –0.04 to 9.18], P = 0.052), diastolic BP (4.46 mmHg [1.01 to 7.90], P = 0.012), decrease in FMD (–3.15% [–6.33 to 0.04], P = 0.053) and improvement in 6MWT (145.6 m [49.1 to 242.1], P = 0.004) compared to controls. QoL assessments indicated continued challenges for recovered COVID-19 individuals at 12 months.
Conclusions:
Persistent vascular dysfunction and BP increase post-COVID-19 underscore the need for further studies on the long-term risk of hypertension and cardiovascular disease.
Clinical trial registration:
https://clinicaltrials.gov/study/NCT0508729
Generative AI capabilities for green supply chain management improvement: extended dynamic capabilities view
No full textThis study aims to develop and evaluate generative artificial intelligence (AI) capabilities to enhance green supply chain management (GSCM) in the automotive industry, Indonesia. Prior studies have concentrated on constructing generative AI metrics; however, there is a lack of emphasis on developing the capabilities to address dynamic environmental challenges in GSCM. This study integrates dynamic capabilities view with organisational learning theory and employs the integrated fuzzy Delphi method and fuzzy synthetic evaluation-decision-making trial and evaluation laboratory approach to ascertain the valid attributes to facilitate GSCM improvement. The findings indicate that dynamic knowledge and innovative learning capabilities and reflexive control and measurement capabilities from the perspective of sensing capabilities, as well as co-evolution capabilities from the perspective of seising capabilities, are key capabilities that need to be prioritised to enhance GSCM. In practices, data gathering and analysis for predictive maintenance, and sales and operations strategy identification must be prioritised
Assessing the left ventricular pump function using an immersed boundary method combined with finite element
Get PDFIn this study, we describe a model of the human left ventricle (LV) that uses a hybrid immersed boundary–finite element method. The LV model is derived from clinical cardiac magnetic resonance images and completed with the inflow and outflow tracts. The model simulates LV dynamics with fully coupled fluid–structure interaction. Model parameters are estimated by matching the model’s predictions to the measured volume and strains of the LV at end-diastole and end-systole. The detailed LV dynamics predicted by the model are in good agreement with in vivo measurements. We further assess the effects of diastolic aortic pressure and intracellular Ca2+ transients on LV pump function. Our results show that an increase in diastolic aortic pressure reduces LV pump function, while intracellular Ca2+ transients play an essential role in regulating LV pump function: higher levels of the Ca2+ transients or longer decay times can lead to a larger stroke volume. We conclude that this imaged-based modeling approach has the potential to advance personalized medicine
Impact of commercial gut health interventions on caecal metagenomic and broiler performance
Get PDFBackground:
Maintaining gut health is a persistent and unresolved challenge in the poultry industry. Given the critical role of gut health in chicken performance and welfare, there is a pressing need to identify effective gut health intervention (GHI) strategies to ensure optimal outcomes in poultry farming. In this study, across three broiler production cycles, we compared the metagenomes and performance of broilers provided with ionophores (as the control group) against birds subjected to five different GHI combinations involving vaccination, probiotics, prebiotics, essential oils, and reduction of ionophore use.
Results:
Using a binning strategy, 84 (≥ 75% completeness, ≤ 5% contamination) metagenome-assembled genomes (MAGs) from 118 caecal samples were recovered and annotated for their metabolic potential. The majority of these (n = 52, 61%) had a differential response across all cohorts and are associated with the performance parameter — European poultry efficiency factor (EPEF). The control group exhibited the highest EPEF, followed closely by the cohort where probiotics are used in conjunction with vaccination. The use of probiotics B, a commercial Bacillus strain-based formulation, was determined to contribute to the superior performance of birds. GHI supplementation generally affected the abundance of microbial enzymes relating to carbohydrate and protein digestion and metabolic pathways relating to energy, nucleotide synthesis, short-chain fatty acid synthesis, and drug-transport systems. These shifts are hypothesised to differentiate performance among groups and cycles, highlighting the beneficial role of several bacteria, including Rikenella microfusus and UBA7160 species.
Conclusions:
All GHIs are shown to be effective methods for gut microbial modulation, with varying influences on MAG diversity, composition, and microbial functions. These metagenomic insights greatly enhance our understanding of microbiota-related metabolic pathways, enabling us to devise strategies against enteric pathogens related to poultry products and presenting new opportunities to improve overall poultry performance and health
Takotsubo is an acute myocardial ischaemic syndrome
Get PDFTakotsubo is an acute ischaemic syndrome: a case illustration. A 68-year-old woman with a history of treated hypertension and dyslipidaemia experienced acute chest pain while attending a funeral. Following the involvement of the emergency services, an initial 12-lead electrocardiogram revealed ST-segment elevation in the precordial leads (V2–V6) and T-wave inversion (upper row, right). The peak high-sensitivity troponin T concentration was 692 ng/L. Echocardiography revealed left ventricular systolic dysfunction (ejection fraction 46%) due to anterolateral hypokinesis coupled with hyperdynamic contractility in the basal and inferolateral regions. Urgent, invasive coronary angiography revealed smooth, patent coronary arteries (middle row). Adjunctive coronary function tests (upper row, right) involving bolus saline thermodilution (Coroventis, Uppsala, Sweden) in the left anterior descending coronary artery disclosed a reduced coronary flow reserve (2.0, abnormal ≤ 2.5), an increased index of microvascular resistance (29 mmHg.s, abnormal ≥ 25 mmHg.s), and an increase in myocardial resistance reserve (3.5, abnormal > 3.0). Left ventriculography revealed typical, apical ballooning (middle row, right). Cardiovascular magnetic resonance imaging (MRI) at 1.5 T (Avanto-fit, Siemens Healthcare), performed 13 days from the index presentation, revealed improved left ventricular systolic function (ejection fraction 64%), hyperintense myocardial oedema with an apical distribution [left ventricular four-chamber view, native transverse relaxation time (T2) 65 ms (apex), 44 ms remote zone, basal; reference range 42–52 ms; bottom row, left], and no evidence of scar tissue or fibrosis (four-chamber view, no myocardial late gadolinium enhancement; bottom row, middle). At clinical follow-up 6 months later, the patient had persisting anginal symptoms on exertion, consistent with Canadian Cardiovascular Society angina class 2 and New York Heart Association functional class II. Intravenous adenosine (140 μg/kg/min) stress perfusion cardiovascular MRI revealed a reduction in subendocardial myocardial blood flow during hyperaemia (1.88 mL/min/g; normal > 1.96 mL/min/g) and epicardial hyperaemia, consistent with persistent subendocardial coronary microvascular dysfunction. Left ventricular systolic function and myocardial oedema imaging had normalized
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