A comparison of transposed brachiobasilic fistulae with nontransposed fistulae and grafts in the Fistula First era.

This retrospective study compares outcomes of transposed brachiobasilic fistulae (avf), nontransposed avf, and grafts (avg). There were 161 (21%) transposed avf, 321 (42%) nontransposed avf, and 285 (37%) avg placed and followed over a 3-year period. Of the nontransposed avf, 203 (63%) were forearm radiocephalic avf and 118 (37%) were upper arm brachiocephalic avf. Grafts were able to be used in shorter time than avf and had a lower primary failure rate. However, avg had a significantly higher infection rate (0.23/patient/year vs. 0.07/patient/year) and required more procedures over the life of the access than avf (2.90/patient/year vs. 0.51/patient/year). Despite a higher primary failure rate, avf had better overall patency. Among nontransposed avf, brachiocephalic avf had significantly better primary patency than radiocephalic avf (p < 0.0001). Transposed avf had better cumulative patency than either nontransposed avf or grafts (p < 0.0001). Cumulative patency was best for transposed avf, intermediate for brachiocephalic avf, and worst with radiocephalic avf and avg. There was no difference in cumulative patency between radiocephalic avf and grafts (p = 0.5601). This analysis supports the current recommendation to prefer transposed avf over avg. In addition, the data suggest that both nontransposed brachiocephalic avf and transposed brachiobasilic avf outcomes may be superior to radiocephalic fistulae.

Domestication of the donkey: timing, processes, and indicators.

Domestication of the donkey from the African wild ass transformed ancient transport systems in Africa and Asia and the organization of early cities and pastoral societies. Genetic research suggests an African origin for the donkey, but pinpointing the timing and location of domestication has been challenging because donkeys are uncommon in the archaeological record and markers for early phases of animal domestication are hard to determine. We present previously undescribed evidence for the earliest transport use of the donkey and new paleopathological indicators for early phases of donkey domestication. Findings are based on skeletal data from 10 approximately 5,000-year-old ass skeletons recently discovered entombed in an early pharaonic mortuary complex at Abydos, Middle Egypt, and a concurrent study of 53 modern donkey and African wild ass skeletons. Morphometric studies showed that Abydos metacarpals were similar in overall proportions to those of wild ass, but individual measurements varied. Midshaft breadths resembled wild ass, but midshaft depths and distal breadths were intermediate between wild ass and domestic donkey. Despite this, all of the Abydos skeletons exhibited a range of osteopathologies consistent with load carrying. Morphological similarities to wild ass show that, despite their use as beasts of burden, donkeys were still undergoing considerable phenotypic change during the early Dynastic period in Egypt. This pattern is consistent with recent studies of other domestic animals that suggest that the process of domestication is slower and less linear than previously thought.

The diagnostic effect of various needle tip positions in selective lumbar nerve blocks: an analysis of 1202 injections.

STUDY DESIGN: Retrospective chart review. OBJECTIVE: To determine the effect of various needle tip positions on immediate postinjection pain in selective lumbar nerve blocks. SUMMARY OF BACKGROUND DATA: To our knowledge, no large study has examined the effect of various needle tip positions within or adjacent to the intervertebral foramen on immediate pain outcome. METHODS: A total of 1774 cases of intervertebral lumbar nerve blocks performed by our radiology staff between April 7, 1997 and May 31, 2002, were reviewed. Of the 1774 cases, 1202 met the study criteria (i.e., a single-level injection in an adult). The position of the needle tip and degree of immediate postinjection pain relief were examined. RESULTS: The blocks resulted in an average pain reduction of 4.14 U, as graded on a 0-10 ordinate scale (95% confidence interval 3.98-4.30). The degree of pain reduction was not associated with the needle tip position. CONCLUSIONS: Our results suggest that precise needle tip position within or adjacent to the intervertebral foramen made no difference on immediate pain reduction. These findings allow the practitioner more freedom in performing an injection. This study does not evaluate the long-term effects of various needle tip positions in selective lumbar nerve blocks.