ObjectiveAutogenous arteriovenous fistula (AVF) is recommended as the first choice for hemodialysis vascular access. A small-caliber vein is one of the independent risk factors for AVF maturation and patency. However, the specific threshold is still unclear, making it difficult to accurately determine whether these vessels are suitable for AVF creation.DesignThis is a single-center retrospective study.MethodPatients who underwent AVF creation in our medical center between January 2020 and September 2022 and satisfied the eligibility criteria were included in this retrospective study. Logistic regression analysis was performed to identify risk factors for functional maturation and additional intervention. The optimal cutoff value was determined based on the receiver operating curve (ROC) and the Youden index. Kaplan–Meier analysis was utilized in further patency rate comparisons.ResultA total of 125 forearm AVFs were created in 121 patients with end-stage renal disease (ESRD). The mean age was 53.88 ± 15.10  years. Preoperative vascular Doppler ultrasound (DUS) was conducted and recorded in 106 cases (84.80%). The mean targeted artery and vein diameters were 2.17 ± 0.54 and 1.71 ± 0.75  mm, respectively. Small-caliber vein is the risk factor for functional maturation failure (OR = 0.256, 95%CI [0.06–0.75], p = 0.033) and additional intervention (OR = 0.306, 95% CI [0.09–0.78], p = 0.031). The optimal cutoff value is 1.35  mm (augmented) when specificity and sensitivity reach 80 and 63.7%, respectively. The AVFs with a vein diameter of more than 1.35 mm (augmented) showed higher patency rates (p < 0.01).ConclusionAfter comprehensive DUS evaluation, intraoperative hydrodilation, postoperative active exercise and intensive DUS detection, and application of balloon-assisted maturation, if necessary, using a vein more than 1.35 mm (augmented), could achieve satisfactory functional maturation and postoperative patency in AVF formation.

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Background Efforts to delineate factors linked with rural to urban transition, paralleling the staggering rise in CD incidence, have been hampered by the universal modernization in the west. China is ongoing transition from a predominantly traditional rural to an urban and industrialized society. We aimed to study the effect of changes and their relationship to CD. Methods SOURCE characterized environmental exposures, diet, and microbiome in rural and urban genetically similar Chinese controls and newly diagnosed CD in Guangdong province, and in Israeli CD and controls Results 380 subjects (median age 34years, 51% males); 40 CD and 162 rural controls and 121 urban controls from China, and 25 CD and 32 controls from Israel. Significant factors affecting the gut microbial composition were identified using PERMANOVA including the amount of time spent in urban area, dietary consumption of fat, fruits, iron, and added sugar, and exposures to farm animals. As the amount of time spent in urban area was linked with microbial composition, we stratified subjects living in rural area to those spending<50% of their time in the last year in urban areas ('rural', n=88) and those living in rural area but spending³50% of their time in urban environment ('rural-urban’, n=74) and compared then to the city-dwellers ('urban', n=121). Environmental exposures differed (Fig. 1) whereby flush toilet availability was reported in 5% rural, 35% rural-urban, and 61% urban, and 100% of Israelis. Having farm animals was noted in 60% rural, 24% rural-urban, and 3% of urban. Dietary habits also differed substantially; drinking at least weekly soft drink was reported in 5% rural and 27% of urban Chinese subjects, and 60% of the Israeli controls, while coffee was reported in 1% of rural, 15% of rural-urban, 32% urban, and 77% of Israelis. UniFrac-based PCoA indicated separation between rural and rural-urban control samples, with differences in β diversity (Fig. 2). Additionally, a-diversity was lower in rural-urban vs. rural controls, and in CD vs. urban cases. Composing a rural index based on an independent cohort (PMID:28915922) also indicated reduced rural index in rural-urban vs. rural controls, and in CD vs. urban cases. Using another independent health microbial index (PMID:35197084) also indicated reduced health index in rural-urban vs. rural controls, and in CD vs. urban cases (Fig. 2). Conclusion Trajectory of rural-urban transition is continuous and not dichotomous, whereby time spent in urban area associates with diet, exposures, and gut microbial composition. Living in rural area but spending ³50% of daily-life in urban environment (rural-urban) is linked with reduction in a-diversity, reduced rural index, and reduced microbial health index mirroring CD profile.

Objective Post-thrombotic syndrome (PTS), an important complication of deep venous thrombosis (DVT), adversely affects patients’ quality of life. Endovascular intervention in PTS can relieve symptoms rapidly with high therapeutic value. This study mainly focuses on how to improve postoperative stent patency rates and aims to find prognostic factors impacting patency. Methods According to the specific inclusion and exclusion criteria, PTS patients who underwent endovascular intervention at the First Affiliated Hospital of Sun Yat-sen University from December 1, 2014, to December 31, 2019, were included in this single-center prospective study. Follow-up data were collected and analyzed regularly over 2 years. Results Overall, 31 PTS patients were enrolled in the study. The mean age of these patients was 55.39 ± 11.81, including 19 male patients. Stent implantation was successful in 22 PTS patients, with a technical success rate of 70.97%. The average Villalta scores of the stent-implanted group and the non-stent-implanted group were 5.95 ± 2.57 and 5.78 ± 2.95, respectively, with no significant difference observed. In the stent-implanted group, the perioperative patency rate was 81.81% (18/22), and the follow-up patency rates were 68.18% (15/22) within 3 months, 59.09% (13/22) within 6 months, 45.45% (10/22) within 1 year, and 36.36% (8/22) within 2 years. Based on the stent placement segments, the 22 PTS patients were divided into two subgroups: the iliofemoral vein balloon dilation + iliofemoral vein stent implantation (FV-S) subgroup and the iliofemoral vein balloon dilation + iliac vein stent implantation (FV-B) subgroup. In the FV-S subgroup, the perioperative patency rate was 100.00% (14/14), and the follow-up patency rates were 85.71% (12/14), 71.43% (10/14), 57.14% (8/14) and 50.00% (7/14), which were higher than those for overall stent patency of all patients. The postoperative patency rates in the FV-B subgroup were 50.00% (4/8), 37.50% (3/8), 37.50% (3/8), 25.00% (2/8), and 12.50% (1/8). The secondary postoperative patency rates in the FV-B subgroup were 100.00% (8/8), 87.50% (7/8), 75.00% (6/8), 62.50% (5/8) and 50.00% (4/8). Conclusions For PTS patients with iliofemoral vein occlusion but patent inflow, iliofemoral vein stent implantation is a more efficient therapeutic option than iliofemoral vein balloon dilation with iliac vein stent implantation for PTS patients.