causes significant morbidity & mortality in patients on hemodialysis
⚡️Most AV access associated complications are due to vascular stenosis👇🏽
2/
💥 Role of Stents in Dialysis Vascular Access - Tweetorial
⚡️Indications for Stent Use
⚡️Recent Clinical Trials of Stents in Dialysis Vascular Access
⚡️Complications associated with Stent Use
1/
@ASDINNews
#VascularAccessPearls
causes significant morbidity & mortality in patients on hemodialysis
⚡️Most AV access associated complications are due to vascular stenosis👇🏽
2/
-Scribner’s Shunt in 1960 ➡️
-Brescia-Cimino AVF in 1966 ➡️
-1st Balloon Angioplasty in 1981 ➡️
-1st Bare Metal Stent in 1988 ➡️
-1st Covered Stent in 1996 ➡️
-DCB use in 2012
3/
-Percutaneous Balloon Angioplasty (PTA) remains the 1st line therapy for stenosis but it is NOT very effective
-AVF patency after PTA is only 50% at 6-months & it is worse for AVGs👇🏽
4/
-Hemodynamic stress
-Surgical trauma
-Cannulation needle trauma
-AVG
‼️But balloon angioplasty, the treatment for stenosis, can itself induce NIH & cause restenosis👇🏽
5/
⚡️What are Endovascular Stents?
They are scaffolds that provide mechanical endoluminal support to the vessel wall to maintain patency
6/
-1st generation stents were Bare-Metal Stents made of stainless steel
-Next generation of metal stents were Nitinol Stents made of nickel-titanium alloy
- Covered-Stents (Stent-Grafts) are Nitinol stents covered w/ ePTFE or Dacron
7/
⚡️Covered Stents (Stent-Grafts) theoretically form a barrier, & prevent tissue in-growth through the stent & cause less restenosis👇🏽
8/
⚡️But before we get to the trials, let’s discuss the basic indications for Stent use:
☄️Rupture of the vessel
☄️Recoil (Residual stenosis)
☄️Restenosis
9/
⚡️In most cases, extravasation can be controlled w/ manual compression or balloon tamponade but if bleeding persists then stents can be used to control the bleeding👇🏽
10/
⚡️Recoil is defined as residual stenosis of > 30% following angioplasty & is thought to occur due to elastic recoil of the vessel wall
⚡️Recoil is associated w/ poor AV access survival👇🏽
11/
⚡️AVG patency post-angioplasty is very poor👇🏽
⚡️Most common site for AVG stenosis is at the graft-vein anastomosis, therefore recent clinical trials have tested the Stent-grafts at this site👇🏽
12/
☄️Flair PIVOTAL Trial: Flair SG vs. PTA for AVG
☄️REVISE Trial: Viabahn SG vs PTA for AVG
⚡️Both trials showed better 6-month patency with SG use compared to PTA for graft-vein anastomosis stenosis👇🏽
13/
☄️RESCUE Trial: Fluency SG vs PTA for In-stent restenosis in both AVF & AVG
⚡️RESCUE Trial showed better 6-month patency with SG compared to PTA👇🏽
14/
☄️Recurrent graft-vein anastomosis stenosis in AVG
☄️In-stent restenosis in AVF & AVG👇🏽
16/
17/
☄️Stent Migration
☄️Stent Fracture
☄️Stent Strut Protrusion
☄️Jailing of the veins
☄️Infection
18/
⚡️Stent fracture & protrusion can occur due to repeated cannulation thru the stent👇🏽
⚡️Stent fracture can occur if stent is placed across a joint👇🏽
19/
⚡️Hence, the operator must be very careful during stent deployment in order to avoid this complication👇🏽
20/
⚡️Stent associated AV access infections are more common when the stents are placed in the Pseudo-aneurysms 👇🏽
21/
More from Health
🚨Important changes to lockdown/self-isolation regulations from 5pm
The Health Protection (Coronavirus, Restrictions) (All Tiers and Self-Isolation) (England) (Amendment) Regulations 2021
£800 'house party' FPN & police can now access track & trace data
https://t.co/k9XCpVsXhC
“Large gathering offence”
As trailed by Home Secretary last week there is now a fixed penalty notice of £800 (or £400 if you pay within 14 days) for participating in an gathering of over 15 people in a private residence
Fixed Penalty Notices double for each subsequent “large gathering offence” up to £6,400
Compare:
- Ordinary fixed penalty notice is £200 or £100 if paid in 14 days
- Holding or being involved in the holding of a gathering of over 30 people is £10,000
Second big change:
Since September has been a legal requirement to sell-isolate if you test positive/notified by Track & Trace of exposure to someone else who tested positive
Police can now be given access to NHS Track & Trace data if for the purpose of enforcement/prosecution
This will make it easier for police to enforce people breaking self-isolation rules. Currently there has been practically no enforcement.
Data says only a small proportion of people meant to be self-isolating are fully doing so.
The Health Protection (Coronavirus, Restrictions) (All Tiers and Self-Isolation) (England) (Amendment) Regulations 2021
£800 'house party' FPN & police can now access track & trace data
https://t.co/k9XCpVsXhC
“Large gathering offence”
As trailed by Home Secretary last week there is now a fixed penalty notice of £800 (or £400 if you pay within 14 days) for participating in an gathering of over 15 people in a private residence
Fixed Penalty Notices double for each subsequent “large gathering offence” up to £6,400
Compare:
- Ordinary fixed penalty notice is £200 or £100 if paid in 14 days
- Holding or being involved in the holding of a gathering of over 30 people is £10,000
Second big change:
Since September has been a legal requirement to sell-isolate if you test positive/notified by Track & Trace of exposure to someone else who tested positive
Police can now be given access to NHS Track & Trace data if for the purpose of enforcement/prosecution
This will make it easier for police to enforce people breaking self-isolation rules. Currently there has been practically no enforcement.
Data says only a small proportion of people meant to be self-isolating are fully doing so.
Very important that obvious failures with Track and Trace and self-isolation (study late last year said 18% of people complying https://t.co/dhJUZ7Pm0l) are not painted as an enforcement issue. Plainly not. Would just pass buck to police who have almost no capacity to enforce https://t.co/Eb4Kl5Ze0E
— Adam Wagner (@AdamWagner1) January 25, 2021
Thread on how atheism leads to mental retardation (backed with medical citations🧵💉)
To start with, atheism is an unnatural self-contradicting doctrine.
Medical terminology proves that human beings are naturally pre-disposed to believe in God. Oxford scientists assert that people are "born believers".
https://t.co/kE0Fi588yn
https://t.co/OqyXcGIMJn
It should be known that atheism could never produce an intelligently-functioning society and neither ever will.
Contrastingly, Islam produced several intellectuals & polymaths, was on the forefront of scientific development, boasting 100% literacy
It is also scientifically proven that atheism led to lesser scientific curiosity and scientific frauds, which is also why atheists incline to pseudo-science.
Whereas, religion in general and Islam in particular boosted education.
https://t.co/19Onc84u3g
Atheists are also likely to affected by pervasive mental and developmental disorders like high-functioning autism.
Cognitive Scientists and renowned Neurologists found that more atheism is leads to greater autism.
https://t.co/zRjEyFoX3P
To start with, atheism is an unnatural self-contradicting doctrine.
Medical terminology proves that human beings are naturally pre-disposed to believe in God. Oxford scientists assert that people are "born believers".
https://t.co/kE0Fi588yn
https://t.co/OqyXcGIMJn
It should be known that atheism could never produce an intelligently-functioning society and neither ever will.
Contrastingly, Islam produced several intellectuals & polymaths, was on the forefront of scientific development, boasting 100% literacy
If the Muslim world had not existed, there literally would be no technology/achievements today.
— Starks\u262a\ufe0f\U0001f1f9\U0001f1e9 (@MegaIntelIect) January 8, 2021
Science only developed because of Islam, Europe should be grateful to Islam for civilizing their barbaric cult.
Source: The Caliph's Splendor, Pg 204-05 https://t.co/HVypO52Tpc pic.twitter.com/00jYSbaDSs
It is also scientifically proven that atheism led to lesser scientific curiosity and scientific frauds, which is also why atheists incline to pseudo-science.
Whereas, religion in general and Islam in particular boosted education.
https://t.co/19Onc84u3g
Atheists are also likely to affected by pervasive mental and developmental disorders like high-functioning autism.
Cognitive Scientists and renowned Neurologists found that more atheism is leads to greater autism.
https://t.co/zRjEyFoX3P
This is the $1mln question still without an answer: why were these workers cleaning bat guano from that abandoned mine?
Surprisingly we simply don't know.
China would have all interest in clarifying that point if for instance they were prospecting or selling guano. It did not.
What we know is that EcoHealth + WIV were sampling bat sites in the vicinity at the exact time of the workers being in that mine.
#DRASTIC wrote about this and about other oddities in the official story:
Maybe it's just one of these coincidences.
Then it gets interesting: about a year after the miners death, Olival & Epstein from EcoHealth Alliance co-authored a paper about the coronavirus risk infection from bat guano collection.
No mention of the
That paper oddly used some old bat samples collected by DARPA in 2006/7 at the famous Thai bat cave.
It never mentioned that the Thai monks have been doing this every Sunday for many many years without infection.
But most interestingly it never mentioned the Mojiang mine accident, even if the perfect timing and recycling of old DARPA bat samples seem to point to a likely knowledge of it.
Anyway, the idea was to ask for more money, as you correctly
Surprisingly we simply don't know.
China would have all interest in clarifying that point if for instance they were prospecting or selling guano. It did not.
The miners were tasked with removing bat feces. AFAIK it hasn't been established why they were doing this. Given that EcoHealth was collecting bat fecal samples in the same province around the same time, is it possible these miners were actually collecting guano for EcoHealth?
— The Great Gumbino (@gumby4christ) February 15, 2021
What we know is that EcoHealth + WIV were sampling bat sites in the vicinity at the exact time of the workers being in that mine.
#DRASTIC wrote about this and about other oddities in the official story:
Maybe it's just one of these coincidences.
Then it gets interesting: about a year after the miners death, Olival & Epstein from EcoHealth Alliance co-authored a paper about the coronavirus risk infection from bat guano collection.
No mention of the
That paper oddly used some old bat samples collected by DARPA in 2006/7 at the famous Thai bat cave.
It never mentioned that the Thai monks have been doing this every Sunday for many many years without infection.
But most interestingly it never mentioned the Mojiang mine accident, even if the perfect timing and recycling of old DARPA bat samples seem to point to a likely knowledge of it.
Anyway, the idea was to ask for more money, as you correctly
You May Also Like
#sculpture #story -
Chandesha-Anugraha Murti - One of the Sculpture in Brihadeshwara Temple at Gangaikonda Cholapuram - built by Raja Rajendra Chola I
This Sculpture depicts Bhagwan Shiva along with Devi Paravathi blessing Chandeshwara - one of the 63 Nayanmars.
#Thread
Chandeshwara/Chandikeshwara is regarded as custodian of Shiva Temple's wealth&most of Shiva temples in South India has separate sannathi for him.
His bhakti for Bhagwan Shiva elevated him as one of foremost among Nayanmars.
He gave importance to Shiva Pooja&protection of cows.
There are series of paintings, illustrating the #story of Chandikeshwar in the premises of
Sri Sathiyagireeswarar #Temple at Seinganur,near Kumbakonam,TN
Chandikeshwara's birth name
is Vichara sarman.He was born in the village of Senganur on the banks of River Manni.
His Parent names were Yajnathatan and Pavithrai.
Vichara Sarman was a gifted child and he learnt Vedas and Agamas at a very young age.
He was very devout and would always think about Bhagwan Shiva.
One day he saw a cowherd man brutally assaulting a cow,Vichara Sarman could not tolerate this. He spoke to cowherd: ‘Do you not know that the cow is worshipful & divine? All gods & Devas reside in https://t.co/ElLcI5ppsK it is our duty to protect cows &we should not to harm them.
Chandesha-Anugraha Murti - One of the Sculpture in Brihadeshwara Temple at Gangaikonda Cholapuram - built by Raja Rajendra Chola I
This Sculpture depicts Bhagwan Shiva along with Devi Paravathi blessing Chandeshwara - one of the 63 Nayanmars.
#Thread
Chandeshwara/Chandikeshwara is regarded as custodian of Shiva Temple's wealth&most of Shiva temples in South India has separate sannathi for him.
His bhakti for Bhagwan Shiva elevated him as one of foremost among Nayanmars.
He gave importance to Shiva Pooja&protection of cows.
There are series of paintings, illustrating the #story of Chandikeshwar in the premises of
Sri Sathiyagireeswarar #Temple at Seinganur,near Kumbakonam,TN
Chandikeshwara's birth name
is Vichara sarman.He was born in the village of Senganur on the banks of River Manni.
His Parent names were Yajnathatan and Pavithrai.
Vichara Sarman was a gifted child and he learnt Vedas and Agamas at a very young age.
He was very devout and would always think about Bhagwan Shiva.
One day he saw a cowherd man brutally assaulting a cow,Vichara Sarman could not tolerate this. He spoke to cowherd: ‘Do you not know that the cow is worshipful & divine? All gods & Devas reside in https://t.co/ElLcI5ppsK it is our duty to protect cows &we should not to harm them.
The YouTube algorithm that I helped build in 2011 still recommends the flat earth theory by the *hundreds of millions*. This investigation by @RawStory shows some of the real-life consequences of this badly designed AI.
This spring at SxSW, @SusanWojcicki promised "Wikipedia snippets" on debated videos. But they didn't put them on flat earth videos, and instead @YouTube is promoting merchandising such as "NASA lies - Never Trust a Snake". 2/
A few example of flat earth videos that were promoted by YouTube #today:
https://t.co/TumQiX2tlj 3/
https://t.co/uAORIJ5BYX 4/
https://t.co/yOGZ0pLfHG 5/
Flat Earth conference attendees explain how they have been brainwashed by YouTube and Infowarshttps://t.co/gqZwGXPOoc
— Raw Story (@RawStory) November 18, 2018
This spring at SxSW, @SusanWojcicki promised "Wikipedia snippets" on debated videos. But they didn't put them on flat earth videos, and instead @YouTube is promoting merchandising such as "NASA lies - Never Trust a Snake". 2/
A few example of flat earth videos that were promoted by YouTube #today:
https://t.co/TumQiX2tlj 3/
https://t.co/uAORIJ5BYX 4/
https://t.co/yOGZ0pLfHG 5/
