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Outcomes of Routine Coronary Angiography in Asymptomatic Patients With End-Stage Renal Disease Prior to Kidney Transplantation.

肾移植前无症状终末期肾病患者常规冠状动脉造影的结果。

  • 影响因子:1.62
  • DOI:10.1177/0003319720927239
  • 作者列表:"Mohamed TI","Baqal OJ","Binzaid AA","Belhaj K","Ahmad JTH","AlHennawi HT","Ishkare MH","Alashqar M","Alruwaili N","Al-Sergani H","Dahdouh Z
  • 发表时间:2020-09-01
Abstract

:We report the prevalence of coronary artery disease (CAD) in asymptomatic patients with end-stage kidney disease (ESKD) on hemodialysis and explore the best revascularization strategies prior to kidney transplantation. This is a retrospective single-center study, which included all patients who were candidates for kidney transplantation and underwent coronary angiography between 2003 and 2018. All included patients underwent coronary angiography without noninvasive testing and were asymptomatic cardiac-wise. Out of the 368 patients with ESRD, 45% had coronary vessel disease, 17% had 3-vessel disease, 11% had 2-vessel disease, 5.2% had significant left main artery narrowing, and 17% had single-vessel disease. Patients with 3-vessel disease had the worst survival rate at 5 and 10 years. The patients with significant 3-vessel disease or left main artery involvement underwent revascularization; 19% underwent coronary artery bypass grafting, 5% had stenting of the coronary arteries, and 4.7% were on maximal medical therapy. The patients who underwent stenting had a better survival than those on medical therapy, but the difference was not significant (P = .445). Our findings reflect a high prevalence of CAD in patients with ESKD. There is a need for further studies to evaluate benefits of cardiovascular screening in this patient population.

摘要

: 我们报告了无症状终末期肾病 (ESKD) 血液透析患者冠状动脉疾病 (CAD) 的患病率,并探讨了肾移植前的最佳血运重建策略。这是一项回顾性单中心研究,纳入了2003年至2018年间所有肾移植候选者和接受冠状动脉造影的患者。所有纳入的患者都在没有无创检查的情况下接受了冠状动脉造影术,并且是无症状的心脏方面的。在368例ESRD患者中,45% 例有冠心病,17% 例有3支血管病变,11% 例有2支血管病变,5.2% 例有明显的左主干狭窄,17% 例有单支血管病变。3血管疾病患者在5年和10年的生存率最差。有显著3支血管病变或左主干受累的患者接受了血运重建; 19% 接受了冠状动脉旁路移植术,5% 接受了冠状动脉支架术,4.7% 接受了最大程度的药物治疗.接受支架置入术的患者比接受药物治疗的患者有更好的生存,但差异无显著性 (P = .445)。我们的研究结果反映了ESKD患者中CAD的高患病率。需要进一步的研究来评估心血管筛查在该患者群体中的益处。

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影响因子:0.73
发表时间:2020-02-01
DOI:10.3138/jvme.1117-158r1
作者列表:["Hunt JA","Heydenburg M","Kelly CK","Anderson SL","Dascanio JJ"]

METHODS::Veterinary educators use models to allow repetitive practice of surgical skills leading to clinical competence. Canine castration is a commonly performed procedure that is considered a Day One competency for a veterinarian. In this study, we sought to create and evaluate a canine pre-scrotal closed castration model and grading rubric using a validation framework of content evidence, internal structure evidence, and relationship with other variables. Veterinarians (n = 8) and students (n = 32) were recorded while they performed a castration on the model and provided survey feedback. A subset of the students (n = 7) then performed a live canine castration, and their scores were compared with their model scores. One hundred percent of the veterinarians and 91% of the students reported that the model was helpful in training for canine castration. They highlighted several areas for continued improvement. Veterinarians' model performance scores were significantly higher than students', indicating that the model had adequate features to differentiate expert from novice performance. Students' performance on the model strongly correlated with their performance of live castration (r = .82). Surgical time was also strongly correlated (r = .70). The internal consistency of model and live rubric scores were good at .85 and .94, respectively. The framework supported validation of the model and rubric. The canine castration model facilitated cost-efficient practice in a safe environment in which students received instructor feedback and learned through experience without the risk of negatively affecting a patient's well-being. The strong correlation between model and live animal performance scores suggests that the model could be useful for mastery learning.

影响因子:2.56
发表时间:2020-02-01
DOI:10.1007/s00345-019-02780-0
作者列表:["Renninger M","Fahmy O","Schubert T","Schmid MA","Hassan F","Stenzl A","Gakis G"]

METHODS:PURPOSE:To investigate whether hexaminolevulinate-based (HAL) bladder tumor resection (TURBT) impacts on outcomes of patients with primary non-muscle-invasive bladder cancer (NMIBC) who were eventually treated with radical cystectomy (RC). METHODS:A total of 131 consecutive patients exhibiting NMIBC at primary diagnosis were retrospectively investigated whether they had undergone any HAL-guided TURBT prior to RC. Uni- and multivariable analyses were used to evaluate the impact of HAL-TURBT on cancer-specific (CSS) and overall survival (OS). The median follow-up was 38 months (IQR 13-56). RESULTS:Of the 131 patients, 69 (52.7%) were managed with HAL- and 62 (47.3%) with white light (WL)-TURBT only prior to RC. HAL-TURBT was associated with a higher number of TURBTs prior to RC (p = 0.002) and administration of intravesical chemotherapy (p = 0.043). A trend towards a higher rate of tumor-associated immune cell infiltrates in RC specimens (p = 0.07) and a lower utilization rate of post-operative systemic chemotherapy (p = 0.10) was noted for patients who were treated with HAL-TURBT. The 5-year CSS/OS was 90.9%/74.5% for the HAL-group and 73.8%/55.8% for the WL-group (p = 0.042/0.038). In multivariable analysis, lymph node tumor involvement (p = 0.007), positive surgical margins (p = 0.001) and performance of WL-TURBT only (p = 0.040) were independent predictors for cancer-specific death. CONCLUSIONS:The present data suggest that the resection of NMIBC under HAL exerts a beneficial impact on outcomes of patients who will need to undergo RC during their course of disease. This finding may be due to improved risk stratification as the resection under HAL may allow more patients to be treated timely and adequately.

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影响因子:1.46
发表时间:2020-02-01
来源期刊:The Journal of urology
DOI:10.1097/JU.0000000000000313
作者列表:["Alder R","Zetner D","Rosenberg J"]

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泌尿系统出现一些病变,需要通过手术来治疗,这些手术就称为泌尿外科手术。

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