BACKGROUND AND OBJECTIVE:Arteriovenous fistula (AVF) is a surgical intervention that establishes an artificial conduit between an artery and a vein, which is essential for hemodialysis treatment. The blood flow sounds has the potential to diagnose AVF stenosis. The research primarily addresses two critical questions: whether there is stenosis within the vascular pathway, and the precise location of the stenosis within the vascular pathway. However, most existing studies focus only on the anastomosis site using single-location acoustic data. This approach fails to fully leverage the acoustic information from other segments of the vascular pathway, limiting the overall diagnostic accuracy. METHODS:Given that stenosis at one site affects acoustic properties elsewhere, we propose a multi-position fusion architecture with position metadata (MPFA). Two fusion strategies are introduced: channel fusion and temporal fusion. In the proposed method, acoustic features extracted from five consecutive locations are fused either across channels or over time dimension. Each location undergoes learnable encoding, which is then integrated into the acoustic features. Following this, a deep feature extractor is used to extract deep feature, which are then fed into a classifier for classification. This architecture is integrated into both the universal model and the individual location-based model to address the two aforementioned questions, respectively. This approach enhances diagnosis through leveraging multi-location information, not model complexity, and can be embedded into other network architectures. RESULTS:Extensive experimental results have demonstrated that multi-location fusion method has significant advantages over single-location. Furthermore, the integration of position metadata serves as a beneficial augmentation, overall improving diagnostic accuracy in the temporal fusion architecture. For the diagnosis of stenosis at the anastomosis site, the accuracy can reach 93.94%. For the antecubital vein segment, the accuracy reach 87.58%. In the universal model, the overall accuracy can reach 79.45%. CONCLUSION:The findings of our experiments demonstrated the effectiveness of a multi-position fusion architecture with position metadata in the AVF stenosis diagnosis. The MPFA does not rely on increasing model parameters and its simplicity and flexibility allow easy integration into other deep learning models. This approach provides researchers with a new perspective for diagnosing AVF stenosis using blood flow sounds.

OBJECTIVE:This study used random forest model to explore the feasibility of radial artery calcification in prediction of coronary artery calcification in hemodialysis patients.MATERIAL AND METHODS:We enrolled hemodialysis patients and performed ultrasound examinations on their radial arteries to evaluate the calcification status using a calcification index. All involved patients received coronary artery computed tomography scans to generate coronary artery calcification scores (CACS). Clinical variables were collected from all patients. We constructed both a random forest model and a logistic regression model to predict CACS. Logistic regression model was used to identify the risk factors of radial artery calcification.RESULTS:One hundred eighteen patients were included in our analysis. In random forest model, the radial artery calcification index, age, serum C-reactive protein, body mass index (BMI), diabetes, and hypertension history were related to CACS based on the average decrease of the Gini coefficient. The random forest model achieved a sensitivity of 76.9%, specificity of 75.0%, and area under receiver operating characteristic of 0.869, while the logistic regression model achieved a sensitivity of 75.2%, specificity of 68.7%, and area under receiver operating characteristic of 0.742 in prediction of CACS. Sex, BMI index, smoking history, hypertension history, diabetes history, and serum total calcium were all the risk factors related to radial artery calcification.CONCLUSIONS:A random forest model based on radial artery calcification could be used to predict CACS in hemodialysis patients, providing a potential method for rapid screening and prediction of coronary artery calcification.

Background Vascular calcification (VC) has been observed in patients with hemodialysis, whereas few studies have investigated calcification in the upper extremity vasculature. Both ultrasound and X-ray are used to investigate the calcification of arteries in patients. However, there is a lack of data on the consistency between these two methods. The aim of this study was to investigate the occurrence of VC in the radial and ulnar arteries of hemodialysis patients and investigate the detection consistency in VC between ultrasound and X-ray. Methods Ultrasound and X-ray examinations were performed in the radial and ulnar arteries of both the left and right upper extremities of 40 patients on hemodialysis. The calcification status of arteries was evaluated by the calcification index from ultrasound and X-ray respectively. Clinical variables of patients were collected from all the involved patients. Results Of the 40 patients, VC was detected in 31 patients by ultrasound, while X-ray detected VC in 22 patients. Compared to ultrasound assessment, X-ray assessment was 73.21% sensitive but only 66.35% specific with a positive predictive value of 53.95% for detecting calcifications in the radial or ulnar artery. The level of agreement between ultrasound and X-ray results was fair. In addition, our data showed that more ulnar arteries had VCs than the corresponding radial arteries. Conclusion Ultrasound is more sensitive in detecting the presence of calcified atherosclerotic lesions. Ultrasound and X-ray exhibited fair consistency. Ultrasound screening for upper extremity radial and ulnar arteries in hemodialysis patients may deserve attention to explore its clinical significance.

BACKGROUND:Thrombosis is one of the main complications leading to the failure of autologous arteriovenous fistula (AVF) for patients with renal failure. Thrombectomy is one of the major therapies to remove thrombi to salvage the AVF and prolong its patency.MATERIALS AND METHODS:Fifty-six patients with AVF thrombosis at the anastomosis were recruited for this study and underwent thrombectomy procedures. Their clinical variables were collected. The vasculature was accessed at the site of the aneurysmal dilatation. Under ultrasound guidance, a scoop thrombectomy procedure was performed by anterograde and retrograde scooping to remove the thrombus using forceps. Then, a sheath was placed in the direct vertical direction. Angioplasty was performed with a balloon to treat the underlying primary arteriovenous stenosis. Patients were followed up for 12 months after surgery. The procedural success, primary and secondary patency rates, and incidence of procedure-related complications were analyzed.RESULTS:There were 2 minor (3.6%) and no major complications. Clinical success was achieved in 55 of the 56 procedures (98.2%). No symptomatic pulmonary embolism or arterial embolization was noted. The primary patency rates at 3, 6, and 12 months were 92.9, 83.8, and 73.3%%, respectively, according to the Kaplan-Meier survival analysis.CONCLUSION:Scoop thrombectomy is a safe procedure with high technical success and a low complication rate, and it is an effective method for patients to receive hemodialysis immediately.

Abstract Previous studies have shown that tubulointerstitial fibrosis (TIF) and pyroptosis are crucial in high-glucose (HG)-induced renal tubular epithelial cell injury and thus contribute to the development of diabetic nephropathy (DN). Previous reports have shown that Nrf2 plays an important role in the occurrence of anti-inflammatory and anti-fibrotic effects, but it is unclear whether Nrf2 has a common point of action between TIF and pyroptosis. In this study, an immortalized human proximal tubular cell line (human kidney-2 (HK-2) cells) was used in all experiments. The protein levels of Nrf2, Caspase-1, Caspase-1-p10, GSDMD, GSDMD-N, TGF-β1, p-Smad3, α-SMA, and FN were measured using western blotting. The mRNA levels of Nrf2, Caspase-1, GSDMD, α-SMA, and FN were examined using RT-qPCR. Immunofluorescence was performed to detect GSDMD, α-SMA, and Caspase-1 expression. ROS levels in cells and mitochondria were detected using fluorescent probe DCFH-DA staining and Mito Sox Red fluorescent probe staining, respectively. The data showed that in a HG environment, the expression of Caspase-1, Caspase-1-p10, GSDMD, GSDMD-N, α-SMA, and FN increased significantly, which was correlated with the expression of Nrf2. Further study showed that after adding the Nrf2 activator TBHQ and knocking down the Nrf2 gene, ROS increased, and the expression of the above proteins decreased and increased, respectively. In addition, the P38 MAPK or PI3K/AKT signaling pathway may be involved in HG-induced Nrf2 activation. To verify the correlation between Caspase-1 and the TGF-β1/Smad3 signaling pathway, the Caspase-1 inhibitor VX-765 was added to significantly reduce the protein levels of TGF-β1 and p-Smad3. These results indicated that Nrf2 attenuates HG-induced TIF and pyroptosis in HK-2 cells by targeting Caspase-1.