Isolation and Genetic Characterization of a Novel Adenovirus Associated with Mass Mortality in Great Cormorants (Phalacrocorax carbo)

High mortality in great cormorants (Phalacrocorax carbo) was registered on the Alakol Lake in eastern Kazakhstan in 2021 when about 20% of juveniles died. High-throughput sequencing revealed the presence of a putative novel cormorant adenovirus significantly divergent from known aviadenoviruses. We suggest that this cormorant adenovirus can be considered an emerging threat to the health and conservation of this species.

Dyakonov waves generation at uniaxial chiral-plasma interface

Numerical analysis of Dyakonov waves generation has been carried out at uniaxial chiral-plasma planar interface. The extended electromagnetic wave theory is utilized, and an impedance boundary conditions approach is employed to obtain characteristics equation. Effective mode index and attenuation under the different values of collisional frequency, plasma frequency and chirality in the THz frequency range for three cases for uniaxial chiral media are discussed. These results can be used in the field of photonics and integrated optics to fabricate nanophotonic devices in the THz frequency range.

Prevalence of anxiety, sleep bruxism and temporomandibular disorders during COVID-19 in Qatari children and adolescents: a cross-sectional study

PURPOSE

Understanding the impact of coronavirus disease-2019 (COVID-19) pandemic social restrictions on the lives of children and adolescents is of utmost importance to enable timely diagnosis and treatment. Therefore, the aim of this study was to explore the prevalence of anxiety, sleep bruxism, temporomandibular disorders (TMD) and change in dietary and brushing habits and their association with COVID-19 social restrictions.

METHODS

Parents of fit and healthy Qatari children and adolescents were recruited and interviewed by the research team, whereby validated questioners were used to assess the prevalence of children's/adolescents' anxiety, sleep bruxism and TMD. Furthermore, changes in dietary and brushing habits were also evaluated.

RESULTS

A total of 199 parents of children and adolescents (mean age = 9.3 ± 3.2 years old) were included. Overall anxiety symptoms, sleep bruxism and TMD were evident in 29.6%, 5.7% and 23.1%, respectively. An increased consumption of food, sweets and worsening of brushing habits were evident in 51.8%, 62.8% and 31.2%, respectively.

CONCLUSION

Within the limitations of this study, pandemic-related social restrictions could result in elevated levels of anxiety, specifically, social phobia, amongst children and adolescents, which could inevitably lead to unwanted dental consequences.

Genome sequence of equine influenza virus isolated from horses in southeast Kazakhstan in 2020

An influenza virus strain, A/equine/Almaty/268/2020, was isolated from horses in southeast Kazakhstan in 2020. Here, we present the nearly complete genome sequence of this epidemic strain. This study was aimed at obtaining the complete genome sequence of the isolate.

Evaluation of a novel real-time polymerase chain reaction assay for identifying H3 equine influenza virus in Kazakhstan

Background and Aim

Equine influenza (EI) is a highly contagious disease that causes fever and upper respiratory tract inflammation. It is caused by influenza virus A, belonging to the Orthomyxoviridae family, with subtypes H3N8 and H7N7. This study presents data on the development of a real-time polymerase chain reaction (RT-PCR) assay using TaqMan probes to detect the H3 subtype of EI virus (EIV).

Materials and Methods

The evaluation of the developed RT-PCR assay involved five strains of EIV as positive controls and ten nasopharyngeal swab samples collected from horses. RNA was isolated using the GeneJet Viral DNA and RNA Purification Kit, and primers and probes were designed using the Integrated DNA Technology PrimerQuest Tool. The assay was optimized by investigating the annealing temperature, primer and probes concentrations, sensitivity, and specificity. Sequencing was performed using the Thermo Fisher 3130 Genetic Analyzer, and the evolutionary history was inferred using the Neighbor-Joining method.

Results

The designed primers and probes, targeting the H3 gene, were found to be specific to the EIV. The RT-PCR assay was capable of detecting as low as 50 femtogram (f) or 3 × 103 copies of genomic RNA. No cross-reactions were observed with other respiratory viral and bacterial pathogens, indicating the high specificity of the assay. To evaluate its effectiveness, ten nasopharyngeal swab samples collected from farms in North Kazakhstan regions during disease monitoring were analyzed. The accuracy of the analysis was confirmed by comparing the results with those obtained from a commercial RT-PCR assay for EI identification. The developed RT-PCR assay exhibited high sensitivity and specificity for detecting the EIV.

Conclusion

The results demonstrate that the developed RT-PCR assay is suitable for diagnosing EI. This simple, highly sensitive, and specific assay for detecting H3 EIV can be a reliable tool for diagnosing and surveilling EI. Implementing this RT-PCR assay in veterinary practice will enhance and expedite the timely response to potential outbreaks of EI, thus positively impacting the overall epizootic well-being of EI in Kazakhstan.

Genetic characterization of a new candidate hemagglutinin subtype of influenza A viruses

AbstractAvian influenza viruses (AIV) have been classified on the basis of 16 subtypes of hemagglutinin (HA) and 9 subtypes of neuraminidase. Here we describe genomic evidence for a new candidate HA subtype, nominally H19, with a large genetic distance to all previously described AIV subtypes, derived from a cloacal swab sample of a Common Pochard (Aythya ferina) in Kazakhstan, in 2008. Avian influenza monitoring in wild birds especially in migratory hotspots such as central Asia is an important approach to gain information about the circulation of known and novel influenza viruses. Genetically, the novel HA coding sequence exhibits only 68.2% nucleotide and 68.5% amino acid identity with its nearest relation in the H9 (N2) subtype. The new HA sequence should be considered in current genomic diagnostic AI assays to facilitate its detection and eventual isolation enabling further study and antigenic classification.

Detection and Phylogenetic Characterization of a Novel Adenovirus Found in Lesser Mouse-Eared Bat (Myotis blythii) in South Kazakhstan

Bats are an important natural reservoir of various pathogenic microorganisms, and regular monitoring is necessary to track the situation of zoonotic infections. When examining samples from bats in South Kazakhstan, nucleotide sequences of putative novel bat adenovirus (AdV) species were found. Estimates of amino acid identities of the hexon protein have shown that potentially novel Bat mastadenovirus BatAdV-KZ01 shared higher similarity with monkey Rhesus adenovirus 59 (74.29%) than with Bat AdVs E and H (74.00%). Phylogenetically, BatAdV-KZ01 formed a separate clade, distant from Bat AdVs and other mammalian AdVs. Since adenoviruses are essential pathogens for many mammals, including humans and bats, this finding is of interest from both scientific and epidemiological points of view.

Genome Sequence of Highly Pathogenic Avian Influenza Virus A/Chicken/North Kazakhstan/184/2020 (H5N8)

The influenza virus strain A/chicken/North Kazakhstan/184/2020 (H5N8) was isolated in North Kazakhstan during a highly pathogenic avian influenza outbreak in 2020. This study aimed to obtain the complete genome sequence of the isolate.

Foresight methodologies to unravel the indirect health economic impact of the COVID-19 pandemic on cancer care and management in Belgium studied in the HELICON project

Background

The COVID-19 pandemic had indirect effects on segments of the population affected with non-COVID-19 diseases e.g. through delayed care and management of cancer patients. Early diagnosis and appropriate treatment are key to improving patient outcomes and reducing societal and health care costs. Tio support policymakers to anticipate these trends a public health foresight study (PHFS) was done.

Methods

The PHFS follows a structured approach provided through a compact guide and is supervised by PHIRI team members. Its evolution is measured through a template gathering data on the study's contextual information, objective, main target groups, conceptual model, indicators, driving forces, time horizon, spatial unit, identifying uncertainties, scenario logics, scenario type, stakeholders, data, tools and instruments, projection methods, communication strategy/products, and the uptake of results and evaluation.

Results

Several foresight elements were identified. Contextual information on the resources and governance structure were elucidated. The objective was made clear by identifying the topic, general issue, and sub-issues of the initial study. A conceptual model was developed to analyse the interaction of the topic with other aspects that could influence it. The main driving forces, which are factors that influence the studied topic, were then determined through the DESTEP method. Stakeholders were identified and classified through the power-interest matrix.

Conclusions

Establishing a foresight study on the indirect impact of the COVID-19 pandemic on the care and management of cancer patients allows exploring potential and unsuspected issues that may affect society, health care systems, and patients. Those groups should not be considered individually but as an ecosystem continuously interacting, where a decision may affect everyone. This type of information may be of high relevance to policy- and decision-makers in their public health interventions.

Expression and roles of GRAS gene family in plant growth, signal transduction, biotic and abiotic stress resistance and symbiosis formation-a review

The GRAS (derived from GAI, RGA and SCR) gene family consists of plant-specific genes, works as a transcriptional regulator and plays a key part in the regulation of plant growth and development. The past decade has witnessed significant progress in understanding and advances on GRAS transcription factors in various plants. A notable concern is to what extent the mechanisms found in plants, particularly crops, are shared by other species, and what other characteristics are dependent on GRAS transcription factor (TFS)-mediated gene expression. GRAS are involved in many processes that are intimately linked to plant growth regulation. However, GRAS also perform additional roles against environmental stresses, allowing plants to function more efficiently. GRAS increase plant growth and development by improving several physiological processes, such as phytohormone, biosynthetic and signalling pathways. Furthermore, the GRAS gene family plays an important role in response to abiotic stresses, e.g. photooxidative stress. Moreover, evidence shows the involvement of GRAS in arbuscule development during plant-mycorrhiza associations. In this review, the diverse roles of GRAS in plant systems are highlighted that could be useful in enhancing crop productivity through genetic modification, especially of crops. This is the first review to report the role and function of the GRAS gene family in plant systems. Furthermore, a large number of studies are reviewed, and several limitations and research gaps identified that must be addressed in future studies.

Reflectance and transmittance of terahertz waves from graphene embedded into metamaterial structures

In this work, the theoretical study of the interaction of terahertz (THz) waves with graphene embedded into two different semi-infinite metamaterials was carried out. To model the graphene, the effective surface conductivity approach based on the Kubo formalism was used. In addition, two types of metamaterials, i.e., double-positive (DPS) and double-negative (DNG), were studied in the THz regime. The numerical modeling of metamaterials was performed in the framework of causality-principle-based Kramers-Kronig relations. The reflectance and transmittance from the graphene-embedded metamaterial structures are studied for the following four different configurations: DPS-Graphene-DPS, DPS-Graphene-DNG, DNG-Graphene-DPS, and DNG-Graphene-DNG. The influence of the chemical potential and scattering rate on the reflectance and transmittance for each configuration is analyzed. It is concluded that the DPS-Graphene-DPS and DNG-Graphene-DNG configurations behave as anti-reflectors for the THz waves, while the DPS-Graphene-DNG and DNG-Graphene-DPS configurations are suitable for THz reflector applications. Moreover, a parametric study revealed that the relative permittivity of the partnering metamaterial can be used as an additional degree of freedom to control the reflectance and transmittance of THz waves. In conclusion, the transmissive and reflective characteristics of THz waves can be controlled effectively with the appropriate choice of graphene parameters, as well as the configuration of metamaterial structures. The convergence of the analytical and numerical results is found with the published results under special conditions. The present work may have potential applications in the design of THz wave controllers, reflectors, absorbers, and anti-reflectors.

Optical characterization of non-thermal plasma jet energy carriers for effective catalytic processing of industrial wastewaters

An argon plasma jet was sustained in open air and characterized for its chemical composition. The optically characterized plasma jet was used to treat industrial wastewater containing mixed textile dyes and heavy metals. Since plasma jet produces UV-radiations, the photocatalytic TiO₂ was used to enhance plasma treatment efficiency especially for degradation of dyes. Mixed anatase and rutile phases of TiO₂ (5.2-8.5 nm) were produced through surfactant assisted sol-gel approach. The emission spectrum confirmed the presence of excited argon, OH, excited nitrogen, excited oxygen, ozone and nitric oxide in the plasma jet. The spectral lines of excited Ar, NO, O₃, OH^-, N₂, [Formula: see text], O, [Formula: see text] and O⁺ species were observed at wavelength of 695-740 nm, 254.3 nm, 307.9 nm, 302-310 nm, 330-380 nm, 390-415 nm, 715.6 nm, 500-600 nm and 400-500 nm. These reactive species decompose the organic pollutants and separate the heavy metals from the water samples. The conductivity of plasma exposed water samples increased while pH and hardness decreased. The atomic absorption spectrophotometry analysis confirmed the presence of heavy metals in the samples, which were effectively removed through plasma treatment. Finally, the effect of plasma treatment on Staphylococcus aureus strains was more pronounced than Escherichia coli strains.

The role of tacit knowledge in communication and decision-making during emerging public health incidents

Strong communication systems for knowledge exchange are required to prevent, respond to and mitigate the effects of emerging public health incidents (EPHIs). The objective of this paper is to examine how "tacit knowledge" - implicit knowledge used to guide everyday practice - is employed in professional relationships and communication processes between public health and acute care settings. A qualitative study design was used to explore the experiences of key informants from public health and acute care settings in Ontario, Canada, to examine how specific dimensions of tacit knowledge are employed in communications about EPHIs. Twenty-six in-depth interviews were conducted from 2014 to 2015. The results describe the way in which participants employ discretion and knowledge of local context, and rely on relationships built on trust and credibility, to facilitate decision-making and communication during EPHIs. Given the uncertainty characterizing most EPHIs, communicators rely a great deal on their informal knowledge and networks which allow them to remain flexible and respond quickly to changing situations. The results reveal that communication about public health guidance during emergencies is a complex and active process that draws from past experiences of the individuals involved, and is shaped by the requirements of local circumstances. The broader implications of these findings for building resilient and responsive health systems are considered. In particular, for rethinking the authority of standardized forms of evidence in public health decision-making, and the importance of knowledge which is grounded in the uniqueness of specific local contexts.

Electromagnetic surface waves supported by a resistive metasurface-covered metamaterial structure

This study examines the analytical and numerical solution of electromagnetic surface waves supported by a resistive metasurface-covered grounded metamaterial structure. To simulate the metamaterial, the Kramers-Kronig relation based on the causality principle is used, while the modeling of the resistive metasurface has been done by implementing the impedance boundary conditions. The analytical expressions for the field phasors of surface waves are developed for the transverse magnetic (TM) polarized mode and transverse electric (TE) polarized mode. The characteristic equations are computed for both modes, and the unknown propagation constant is evaluated numerically in the kernel. After computation, the dispersion curves, electric field profiles, effective mode index ([Formula: see text]), and phase speeds ([Formula: see text]) are presented for both the TM and TE polarized modes. To study the tunability of surface waves, the influence of the thickness of the metamaterial slab ([Formula: see text]), effective permittivity of the metamaterial ([Formula: see text]), thickness of the resistive metasurface ([Formula: see text]), and effective permittivity of the metasurface ([Formula: see text]) on all the numerical results has been studied. However, the geometrical parameters are found to be more sensitive to the effective mode index ([Formula: see text]) and phase speed ([Formula: see text]) of the surface waves. The results are consistent with the published results, which reflects the accuracy of the work. It is concluded that the appropriate choice of parameters can be used to achieve surface waves with the desired characteristics in the GHz range. The present work may have potential applications in surface waveguide design, surface wave speed controllers, surface communication devices, and light trapping configurations.

The cost of adverse events from knee surgery in the United Kingdom: an in-depth review of the National Health Service Litigation Authority database

BACKGROUND

There has been a significant rise in the number and value of claims against the National Health Service (NHS), with limited studies on litigation in orthopaedic surgery and none in knee surgery alone. We aimed to examine claims against the NHS involving all aspects of knee surgery with respect to costs and trends.

CLINICAL RELEVANCE

To raise awareness of the reasons for litigation in knee surgery, thus potentially improve patient care and reduce future claims.

METHODS

We analysed the NHS litigation authority (NHSLA) database for all orthopaedic surgery claims reported to the NHSLA between 2005 and 2010, with calculation of litigation success rates and odds ratios for those relating to knee surgery.

RESULTS

There were 515 cases identified from the 4609 orthopaedic cases in the NHSLA database (11.2%): 298 (58%) involving total knee replacements (TKRs), 11 (2%) involving unicondylar knee replacements, and 90 cases (30%) remaining open. The total pay out for closed cases was £10.45 million and amputation following TKR resulted in the highest single pay out. Litigation success rates for claimants were highest for retained drains (100%), incorrect prosthesis/prosthesis size (78%), renal failure (75%), poor outcome requiring further surgery (74%) and malalignment (71%). There were also 60 cases of delayed diagnosis which resulted in pay outs totalling £2.90 million. Based on these data, projected future pay out costs for the open TKR cases were estimated to be £2.71 million.

CONCLUSION

Litigation success rates for TKR were highest following technical errors such as malalignment compared to events less under the surgeon's control, such as infection. The number of claims involving incorrect prosthesis/size continues to be of concern. Despite the increased availability of imaging modalities, missed diagnosis also resulted in substantial pay outs.

Five to eight years follow-up for trapeziectomy and Weilby ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis

Trapeziectomy and Weilby ligament reconstruction is a recognized treatment for osteoarthritis of the trapeziometacarpal joint. Studies published using this procedure have limited follow-up post-surgery. In this series of 24 cases assessed objectively and 36 subjectively with a minimum follow-up of five years, patients continue to have pain relief and function comparable to the opposite non-operated hand. Patient satisfaction is high at 92% and the rate of complications is low. Despite these encouraging results the need for interposition arthroplasty and/or ligament reconstruction in addition to trapeziectomy alone is discussed.

Nitric oxide metabolites in sera of patients across the spectrum of leprosy

Leprosy, a chronic infectious disease, caused by Mycobacterium leprae infection, manifests itself as a clinical spectrum depending on the patients' immunological response, finally leading to peripheral nerve damage and deformities in the patients. Nitric oxide (NO) which is known to contribute to pathogenesis of several neurological diseases has been detected in tissues and urine of leprosy patients. This is the first study assessing NO as its stable end products, nitrites and nitrates, in sera of patients across the spectrum of the disease as a possible parameter of prognostic value. Comparison of NO metabolites showed a significant increase in multibacillary patients and patients with type I reactions as compared to healthy control individuals. These levels reduced significantly after treatment. This study has further borne out the utility and reliability of the cadmium-reduction method of estimation of NO metabolites--a relatively inexpensive procedure that lends itself to large-scale screening and follow-up of patients.

Developmental outcome of very preterm babies using an assessment tool deliverable by health visitors

AIM

To assess the developmental outcome of very preterm infants using a developmental screening tool deliverable by health visitors.

METHODS

The study cohort consisted of preterm infants born at <32 weeks gestation or <1500g. Infants were assessed at 12 and 24 months corrected age using the Schedule of Growing Skills developmental screening test. Scores for skill areas were converted to developmental levels in months and graded as normal or mild, moderate or severe delay.

RESULTS

Of 101 infants assessed at 12 months, 12 (12%) had severe developmental delay (developmental level <6months) in one or more skill areas. At 24 months, severe developmental delay (developmental level <12 months) was found in 8 (9.1%) infants. Only 3 infants had severe global delay. However, approximately a third of infants showed mild or moderate delay in hearing and language, social or cognitive skill areas by 24 months.

CONCLUSION

Developmental assessment undertaken by health visitors may be used to measure outcome in preterm infants. Severe developmental delay was at a level consistent with other follow-up studies of very preterm infants. Severe delay was identified by the 12-month check and was mainly in areas of motor function and language. High levels of mild to moderate developmental delay were identified at the 24-month assessment.

Smokeless tobacco use in Pakistan and its association with oropharyngeal cancer

Smokeless tobacco (ST), widely used in Pakistan, poses a high risk for oral cancer. Our hospital-based data illustrate that oropharyngeal cancer (9.9%) is the second leading malignancy after breast cancer (16.1%), and is significantly higher than in other Member States of the World Health Organization's Eastern Mediterranean Region. Urdu-speaking communities had a proportionately higher rate of oropharyngeal cancer (20.4%), followed by Balochis (19.9%), Sindhis (16.8%), Punjabis (11.7%) and Pashtuns (9.6%). Association of oropharyngeal cancer with ST use was four times higher relative to no history of tobacco use after adjustingfor age, ethnicity and gender. Our findings also show a predominance of this cancer among males relative to females and one-third of the reported cases occurred among individuals under 40 years. These findings have significant social impact, indicating the need for urgent intervention against the use of ST.

Early prediction of neurological outcome by term neurological examination and cranial ultrasound in very preterm infants

AIM

To assess the value of term neurological examination and cranial ultrasound in the early prediction of neurological outcome at 12 months corrected age in a cohort of very preterm infants.

METHODS

A cohort of 102 preterm infants born at <32 weeks gestation or with a birth weight of <1500 g were assessed using the Hammersmith Term Neurological Examination. They underwent cranial ultrasound examinations according to local guidelines. The Hammersmith Infant Neurological Examination was performed at 12 months corrected age. Scores for the term examinations were compared with scores derived from healthy infants born at term and with scores from low-risk preterm infants at term equivalent age. Term neurological scores and cranial ultrasound findings were compared in the prediction of 12-month neurological outcome.

RESULTS

Seventy-eight (76.5%) preterm infants had suboptimal total neurological scores at term when compared to healthy infants born at term. However, most went on to have optimal neurological scores at 12 months corrected age. When our cohort was compared with low-risk preterm infants at term equivalent age only 14 (13.7%) scored outside the normal range. Neither system of scoring predicted neurological outcome at 12 months corrected age as reliably as cranial ultrasound (sensitivity 0.83, specificity 0.87).

CONCLUSION

Neurological examination of preterm babies at term may be unreliable in the prediction of neurological outcome at 12 months corrected age. For early prediction of neurological outcome cranial ultrasound examination was found to be more reliable.

Pharmacodynamic-guided, modified continuous reassessment method (mCRM)-based, dose finding study of rapamycin in adult patients with solid tumors

3020

Background: Pharmacodynamic (PD) studies, using either surrogate or tumor tissues, are frequently incorporated in Phase I trials. However, it has been less common to base dose selection, the primary endpoint in Phase I trials, in PD effects. We conducted a PD-based dose selection study with rapamycin (Rap). Methods: We used the modified continuous reassessment method (mCRM), a computer-based dose escalation algorithm, and adapted the logit function from its classic toxicity-based input data to a PD-based input. We coupled this design to a Phase I trial of Rap with 2 parts: a dose estimation phase where PD endpoints are measured in normal tissues and a confirmation phase where tumor tissue is assessed. Patients (pts) had solid tumors refractory to standard therapy. Rap was given starting at 2 mg/day continuously in 3-pt cohorts. The PD endpoint was pP70S6K in skin and tumor. Biopsies were done on days 0 and 28 of cycle 1, and a PD effect was defined as ≥ 80% inhibition from baseline. The first 2 dose levels (2 and 3 mgs) were evaluated before implementing the mCRM. The data was then fed to the computer that based on the PD effect calculated the next dose level. The mCRM was set so escalation continued until a dose level elicited a PD effect and the mCRM assigned the same dose to 8 consecutive pts, at which point the effect of that dose will be confirmed in tumor biopsies. Other correlates were PET-CT and pharmacokinetics. Results: Ten pts were enrolled at doses of 2 mg (n = 4), 3 mg (n = 3) and 6 mg (n = 3). Toxicity was anemia (4 G1, 1 G2), leucopenia (1 G1, 2 G2), low ANC (2 G2), hyperglycemia (2 G1, 1 G2), hyperlipidemia (4 G1), and mucositis (1 G1, 1 G2). PD responses were seen in 2 and 1 pt at 2 and 3 mg dose levels. Input of data to the mCRM selected a dose of 6 mg for the third cohort, where PD effect was seen in 1 pt, and thus a fourth dose around 9 mg will be tested. No responses by RECIST occurred, but 2 pts had a response by PET. The PK was consistent with prior data (t1/2 24.6 ± 10.2 h, CL 31.4 ± 12.0 L/h, vol of distribution 235 ± 65 L), and exposure increased with dose. Steady-state concentration were in the 5–20 nM range. Conclusions: mCRM-based dose escalation based on real-time PD assessment is feasible and permits the exploitation of PD effects for dose selection in a rational manner.

No significant financial relationships to disclose.

The Brachial Artery-basilic Vein Arterio-venous Fistula in Vascular Access for Haemodialysis—A Review Paper

AIMS

To review the available literature regarding patency rates and complications of the brachial-basilic arterio-venous fistula (BBAVF) and to discuss this with relation to the current dialysis outcomes quality initiative guidelines.

METHODS

An internet based literature search was performed using Pubmed, Medline and Medscape databases to identify all published reports of the BBAVF in the English language from which the full articles were retrieved and cross-referenced.

RESULTS

Of 136 papers identified, 28 were directly relevant to this review including four prospective studies (one randomised trial, three non-randomised trials) and 24 retrospective studies. First described by Dagher in 1976, the BBAVF has since been modified to a two-stage procedure with initial fistula formation followed by superficialisation of the basilic vein 6 weeks later. It can be formed successfully in 95% of cases. Mean 1-year primary and secondary patency rates were 72 and 74.6%, respectively. Complications included haematoma (3.8%), stenosis (2.3%), thrombosis (9.7%), transient arm oedema (3.7%), steal syndrome (2.9%) and aneurysm/pseudoaneurysm formation (1.9%). The BBAVF had a lower rate of infection than prosthetic fistulas (3.6 vs. 16%).

CONCLUSIONS

The BBAVF has good primary and secondary patency rates with lower rates of infection than prosthetic fistulas making it a preferred secondary access procedure.