Association between brachial artery peak systolic velocity and ipsilateral radio-cephalic arteriovenous fistula maturation.

OBJECTIVE: To evaluate the association between brachial artery blood velocity by color Doppler flow imaging (CDFI) and primary maturation of radio-cephalic autologous arteriovenous fistula (RC-AVF). METHODS: Clinical data from patients who underwent end-to-side cephalic-radial anastomosis were collected from December 2015 to December 2020. The anastomosis diameter (mm), blood velocity (cm/s), and brachial artery diameters (mm) 7 cm proximal to the elbow pre- and postoperation were measured by GE LOGIC-E9 ultrasound. The AVF was mature if it could be cannulated successfully and the blood flow was >200 ml/min during dialysis. RESULTS: A total of 197 patients were included in our statistical analysis. A total of 163 patients had mature AVFs, and 34 patients had poor maturity (assisted and failed maturation). There were no significant differences in the clinical characteristics, peak systolic velocity (PSV) of the brachial artery, diameter of the radial artery or cephalic vein measured by CDFI preoperatively. The diameter of the brachial artery (5.41 ± 0.77 vs 4.89 ± 0.90, p = 0.00) and the fistula anastomosis (2.79 ± 0.78 vs 2.45 ± 0.85, p = 0.02) and PSV of the brachial artery (123.58 ± 37.11 vs 89.63 ± 28.31, p = 0.00) in the mature group were higher than those in the immature group. CONCLUSION: Brachial artery PSV and increased brachial artery PSV could be used to detect RC-AVF maturation in the early stage.

Clinical analysis of suspected acute aortic dissection with ST-segment elevation detected by inferior leads / 中华急诊医学杂志

Objective To analyze the clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads in order to avoid the misdiagnosis of acute aortic dissection facilitating an appropriate treatment strategy carried out in time.Methods A total of 14 patients with suspected acute aortic dissection with ST-segment elevation detected by inferior leads were enrolled.Their clinical presentation,ECG features,imaging findings,laboratory testing,coronary angiography results, treatment and outcome were retrospectively analyzed.Results Clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads suggested that hypertension as a single risk factor accounted for 79%.The patients with normal blood pressure or high blood pressure in emergency visits accounted for 86%.The amplitude of ST elevation in lead Ⅲ was greater than that in lead Ⅱ,and lead Ⅲ accompanied with ST elevation in lead V1 or V4R accounted for 86%.Significantly elevated D-dimer >2 000 ng/mL was found in those patients.Coronary angiography showed that the opening of coronary artery not seen,normal coronary arteries or a simple right coronary artery proximal lesion.Transesophageal echocardiography and computed tomography angiography were used to identify the diagnosis with 100%accuracy.The mortality rate of this group was 50%.Conclusions Patients with acute aortic dissection evidenced by ST-segment elevation detected by inferior leads are in critical setting of high mortality. Emergency surgical treatment can significantly improve the survival rate of patients.

Application of clinical pathway in teaching of kidney disease / 中华医学教育探索杂志

Objective To evaluate the effects of applying clinical pathway in clinic teaching of kidney diseases. Methods Data of average in-hospital days,costs,percentage of antibiotic drugs, improvement rate and satisfaction of patients who received the clinic pathway in nephrology depart-ment from January 2010 to December 2012 were used to evaluate the quality of clinical pathway and were compared with those of patients not received clinic pathway in 2009. Teaching effects of eight-year clinic medical students whose scores were provided by internal medical teaching section were al-so analyzed. Questionnaire of hospital quality was adopted to assess satisfaction of patients,nurses and doctors and the results were compared with those of 2009 students. All data were analyzed by SPSS 13.0 software. Chi-square test was used for enumeration data and results were expressed as percentage while t test was used for measurement data and results were expressed as (x±s),with P<0.05 stand-ing for statistically significant differences. Results After applying clinical pathway,average in-hos-pital days were reduced from 10.7 d in 2009 to 8.7 d in 2012,percentage of medical drugs were de-creased from 86.6% in 2009 to 33.4% in 2012 and percentage of antibiotic drug were reduced from 79.1%to 23.0%. Average in-hospital days and costs of IgA nephropathy and lupus nephritis were de-creased. Satisfaction of patients was increased from 94.1% to 99.0% and scores of students were in-creased from (81.0 ±2.5)points to (89.5 ±2.8)points. Conclusions Application of clinical path-way in clinic medical teaching should be encouraged. It can enhance the teaching quality and is help-ful for culturing inno-vative clinic thinking of medical students and cultivate practical medical talents.