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Surgery improves survival in diabetic patients with heart disease - NephrologyNews.com PDF Print

Among diabetic patients with severe heart disease, coronary artery bypass grafting (CABG) surgery is better than stenting (percutaneous coronary intervention) at improving long-term survival and reducing the risk of adverse complications, according to an article in the April 2015 issue of The Annals of Thoracic Surgery.

“Adults with diabetes are two to four times more likely to have heart disease than non-diabetics, and at least 65% of these patients will die from their heart disease,” said Paul Kurlansky, MD, from Columbia University Medical Center in New York, who led the study. “Diabetic patients who require medical intervention for their heart disease should speak candidly with their physician to determine the best treatment option for them. Our study has shown that this discussion should be informed by the general superiority of bypass surgery over stenting for this population.”

Using a community-based registry, Kurlansky and colleagues examined data on all patients undergoing CABG or PCI for coronary artery disease February 1–July 31, 2004, who also had follow-up data by 2011. Of the 1,082 patients who met the criteria, the researchers were able to compare 240 well-matched patients from each treatment group.


Read also:
Blood pressure-lowering treatment for type 2 diabetes linked to longer survival

Study finds routine imaging screening of diabetic patients for heart disease not effective


“Unlike a lot of other studies that focus on select groups of patients who receive special therapies, our results reflect a ‘real world’ picture of contemporary medical practice and are broadly applicable to the general population of diabetic patients with severe coronary artery disease,” said Kurlansky.

Results showed that mortality was more common in patients who received PCI than those who underwent CABG. Patients in the PCI group also had a higher risk of non-fatal heart attack and need for revascularization. Dr. Kurlansky said that CABG may be more effective in this growing segment of the population because diabetes is a systemic rather than a localized disease. “Since PCI addresses localized lesions, CABG addresses the entire downstream circulation, which tends to be a more complete solution for these patients.”

The study did not examine the long-term risk of stroke among the two patient groups, and the researchers note that this parameter warrants further investigation.

“Each patient is an individual and needs to be carefully evaluated according to his or her specific circumstances and needs,” said Kurlansky. “The most important advice for the diabetic patient is to control modifiable risk factors for heart disease—stop smoking, lower your blood pressure, control your weight, exercise, and monitor your blood sugar levels.”

In an invited commentary in the same issue, Robert F. Tranbaugh, MD, from Mount Sinai Beth Israel in New York, emphasized the importance of the findings noting, “Kurlansky et al are to be commended for their efforts to better define the optimal treatment of diabetic patients with coronary artery disease.”

“It is important for these findings to be incorporated into the management of diabetic patients with multivessel heart disease, starting with an emphasis on the heart team approach,” said. Tranbaugh. “Cardiac surgeons and cardiologists need to work together in the decision making and need to be advocates for our patients, seeking the safest and most durable treatment option.”

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April 2015 Political Preview - The Elsberry Democrat PDF Print

Posted on Thursday, April 2, 2015 at 10:19 am

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Elsberry Special Road District

Larry Wheeler, 57, Elsberry, Equipment Salesman, Mordt Tractor.
Political background: Commissioner ESRD for past two terms (three years) with being president past two years. Committee chairman for Freled of NRA (Eastern Mo. chapter).
Reason for Seeking Election: Oversee the ESRD annual budget, keep accountability of maintenance of right of ways, roads, culverts, bridges and other issues that arise.
Other comments: As board president for the past two years, I’ve overseen each meeting with respect and made sure that all visitors have had an opportunity to express their concerns. This is something that needs to continue. Also ESRD Commissions have done a good job of spending the money wisely. Presently there is approximately 30 miles (CHP, seal, asphalt) of road miles of (CHP, seal, asphalt) roads. Under my rein the board created a five year program to perform maintenance to seal these roads to assure that the investment was protected. This program will be completed within three years. Leaving the board to focus on right of ways’s things that need updates whether it be culvert pipes, clearing of brush and general maintenance issues. The district has also been able to save funds for equipment updates. At present the District owns and maintains two dump trucks, two graders, one backhoe and two pickup trucks. This money has been set aside for any major breakdown or replacement of this equipment or any major road repair whether it is bridge, box culvert repair or replacement.
What would you like to see accomplished if elected? At present there are numerous low weight rated box culverts within the district. At some point these crossings are going to have to be addressed. Also I would like to maintain the relationship that the board has with their constituents. The board strives to relate with all requests as the budget allows. I look forward to working with the staff and board members to obtain all issues that arise.

Randy Bluhm

Randy Bluhm

Randy Bluhm, 52, Foley, Sheet metal mechanic.
Political background: Two terms Foley alderman, mid 1990’s, 18 years volunteer fire fighter WFFPD.
Reason for  seeking election: I enjoy serving the public and believe I have skills that can be used to better the E.S.R.D.
Other comments: Accountability is my greatest concern for the E.S.R.D. from the laborers all the way through to president of the board.
What would you like to see accomplished if elected? My understanding is that the roads are to be maintained at their present condition, i.e. gravel stays gravel. I want to change that policy so that roads are improved as funds allow. This may be drainage concerns, bridge repair or widening.
At this time, I see growth from new subdivisions we need to improve the roads to keep up with that growth.

Ambulance District Candidates

Jamie Keim-Thurman

Jamie Keim-Thurman

Jamie Keim-Thurman, 26, Troy, Managing Partner of Kemper-Millard-Keim Family Funeral Chapels.
Reason for Seeking Election: As a 4th generations of Lincoln County I know how important it is to have strong ambulance district readily available for the citizens of our county and for many generations to come. I find it very beneficial to help seek ways to help educate the community of what the local ambulance district has to offer. While raising a family, being a business partner and a citizen of the county.  I can insure you that I will do what is in the best interest for the families in this community.
Other comments: With family as top priority, my husband and I find it very important to be involved within our community. As our actions today will help prepare the future for our two year old daughter, Lucy. With the experience of serving on various boards and a current member of several organizations. I know how vital it is to have everyone working together and doing the little things that can make a big difference within our county.

Diane Mueller, 48, Silex, Veterinary assistant.
Political background: Served on LCAD board and currently serving as board member.
Reason for Seeking Election: To have LCAD provide quality service, to have the district expand to serve this growing community, keep life saving equipment available to residents.
Other comments: I will work hard to ensure Lincoln County ambulance bases are adequately staffed and to reduce response time and to eliminate unnecessary cost.
What would you like to see accomplished if elected? To improve Lincoln County Ambulance District’s staffing level and update all life saving equipment in a fiscally responsible manner.

Mike Pirtle, 33, Troy, Law enforcement supervisor.
Political background: First time seeking political office. Conservative views.
Reason for Seeking Election: Like many of my fellow citizens, I have grown disappointed with some of the fiscally irresponsible decisions made by the current ambulance board and the unnecessary risk to public safety caused by the rotating base closures, for no other reason than political grandstanding. It has become obvious the current board will not listen to the voters at the polls and the only way to effect change is from within.
Other comments: I welcome any public comment or concern, and will be more than happy to discuss such on an individual basis. I can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
What would you like to see accomplished if elected? If elected I hope to put an immediate end to the base closures without creating a significant fiscal burden to the citizens of Lincoln County. I also hope to make it easier for the general public to access the information from the board minutes and know exactly what their elected officials are doing.

Foley Mayor

William (Matt) Dodson

William (Matt) Dodson

William (Matt) Dodson, 47, Foley, Disabled.
Political background: Foley alderman Ward 1, 06-08 chairman of board.
Reason for  seeking election: Having lived in Foley for 20 years I would like a chance to work for the people to make a family oriented community.
Other comments: Having served in Foley, I am familiar with how things work and will do my best for the voters. This isn’t about me, this is about Foley.
What would you like to see accomplished if elected? Fix streets, clean out storm drains.

Kathleen Schimpf, 68, Foley, Retired.
Political background: Former Alderperson Ward 1, former president of the board of alderpersons, currently Mayor of Foley since September 2014.
Reason for  seeking election: To continue working with the board of alderpersons to create policies and procedures that will prevent the return of corruption that has plagued Foley for too many years. To continue ensuring that the city budget is balanced and wasteful spending is not allowed.
Other comments: I had the honor of working with a dedicated and determined board of alderpersons last year to rid the city of Foley of corrupt officials. It was a tough battle but their courage and ethics got the job done.
What would you like to see accomplished if elected? I would like to see Foley become a more “family friendly” town by making sure that illegal drugs are kept out of our town. I would also like to see more concentrated efforts to focus on activities and events for our residents, especially the children.

Keith Vertrees, 52, Foley, Security officer for St. Charles Security.
Political background: I am currently in touch with the other mayors in Lincoln County concerning Senate Bill 5 dealing with the Mack Creek Law that will affect the town of Foley’s revenue and the safety of all Foley residents. Senate Bill 5 could have a major impact on Foley’s financial future. Foley is currently being audited, and when the report is made available to me I will update all the citizens of Foley on their findings. I have participated in mayors’ meetings in other local towns and have also participated in meetings with Corp of Engineers and Lincoln County.
Reason for  seeking election: To ensure the future of Foley and to achieve high standards and consistency.
Other comments: I will conduct myself as a city official in the best possible manor for the citizens of Foley.
What would you like to see accomplished if elected? I would like to bring back small town values and a sense of pride in the community. I will maintain high standards of safety and health and welfare of the residents of Foley.

Winfield School Board

Jennifer Bryan

Jennifer Bryan

Jennifer Bryan, 40, Winfield, Vice President.
Political background: None.
Reason for  seeking election: I am a life long resident of Winfield, Mo. and attended the district from Kindergarten through 12th grade. As a concerned parent with two children attending the district, I am determined to do my part to ensure the best public education possible for the students of Winfield R-IV.
Other comments: I am vice president of a company with over 20 years of business management experience. In my current position, I oversee all the company financials,  business management and human resources. I bring to the table expertise in budgeting, negotiating bids and contracts and team building skills. Quite often you will find me volunteering at our school for PTO programs, sports programs and our Teacher Assistance Programs. This puts me in a unique position to see first hand the day-to-day operations and needs of the school, teachers and students.
What would you like to see accomplished if elected? One of my goals is to find ways to free up revenue within our current expenditures and to seek alternate means of funding.
I would like to emphasize board member and parent unity. I am committed to making sure parents, teachers and all administration are informed and have an open avenue to voice their opinions and concerns.
I would like to explore new methods to increase teacher retention.

Melanie Jordan, 42, Winfield, Childcare director.
Reason for  seeking election: To improve district with children’s best interest in mind. Improve communication between school administration and parents.

What would you like to see accomplished if elected? To improve the public opinion of school district and its goal with the children’s best interest in mind.

Winfield Ward II Alderman

Debra (Debbie) Rubottom, 60, Winfield, Retired part-time cashier.
Political background: None.
Reason for  seeking election: Wanting to give a new perspective to our town. I have seen a change in the way the town is being lead by the last few officials and wanting a true balance for the town of Winfield.
Other comments:  Have been a resident for almost 40 years now, and have always been active in our local elections. I have felt disappointed in the way our leadership have taken our town. We are a small town that needs to grow but keep a balance of it. You can’t grow and maintain a town if there is not a balance.
What would you like to see accomplished if elected? See more business come to Winfield and to get Winfield Police back into Winfield Schools. And to get a true budget for the town the equals the town’s income.

Winfield Mayor

Ryan Ruckel

Ryan Ruckel

Larry Cudney, 70, Winfield, Retired – Part-time driver for OATS.
Political background: Ex-alderman and acting mayor.
Reason for  seeking election: I feel that the current administration has gotten out of hand with the wages being paid to some and also equipment purchases. This is a town of 1,400 and we have a small tax base.
Other comments: I spent three years in the Army attaining the rank of Sgt. E5. I’m a life member of VFW post 5517, a 19 year member of O’Fallon American Legion Post 0388 and also a life member of the NRA. I also had some college.
What would you like to see accomplished if elected? I want to get city hall back to resident friendly, a board of aldermen working together for the good of the city, an audit of city hall and also work on infrastructure. I also want to get the DARE program back next year.

Ryan Ruckel, 36, Winfield, Environmental Safety Manager.
Political background: Winfield Planning and Zoning Committee, Eagles Bluff Estates Trustee.
Reason for  seeking election: As mayor, I look forward to shifting the conversation from “what was done” to “where we are going.” The next two years are going to prove especially challenging for small cities, including our own. A declining economy has caused tax revenues to decline, the cost of providing emergency services is increasing, and Missouri SB-5 may slash our city’s budget even further. I provide our residents and businesses with a choice in leadership that can create a plan to meet these issues head-on, not just a plan for the next board meeting.
Other comments: The growth and maturity of a community is not always about becoming a big city. It’s about us leaving our children with a city that is thriving and relevant; with the infrastructure and land for them to build their homes, businesses and families upon. We cannot merely enjoy the “today” of Winfield without leaving the next generation with a Winfield prepared for “tomorrow.”
What would you like to see accomplished if elected? Winfield has empty commercial property and almost no residential property. We need an economic development plan that addresses both issues, short and long term. The Mayor should be leaning on the city’s Planning and Zoning Committee to explore all options and make recommendations. The members of this committee prioritize the interests of the city and represent the voice of our community.

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Survey finds pregnancy for women on dialysis is becoming more common - NephrologyNews.com PDF Print

With the rise in chronic kidney disease in the United States, pregnancy in women with kidney failure is becoming more common, according to new findings presented at the National Kidney Foundation's 2015 Spring Clinical Meetings.

Severe kidney disease can make it hard to become pregnant, but among 75 U.S.-based nephrologists surveyed, 43% reported having cared for pregnant women on dialysis, Drs. Mala Sachdeva, Jyotsana Thakkar, and Ilene Miller of the Hofstra North Shore - LIJ School of Medicine found.

“Before this survey, it had been more than 15 years since data had been collected on pregnancy outcomes for women on hemodialysis in the United States,” said Sachdeva. “We wanted to provide an update by evaluating the current U.S. experience including overall practice patterns and certain maternal and fetal outcomes that have occurred with this specific patient population.”


Related:

Study finds intensive dialysis in pregnant women with kidney failure benefits mother and baby

Chronic kidney disease may increase certain risks during pregnancy


According to this national survey, pregnant women receiving hemodialysis treatment ranged from those who initiated dialysis during the pregnancy (32%), those who became pregnant during the first five years of treatment (58%) and those who became pregnant after being on dialysis for 5+ years (10%).

Most nephrologists prescribed dialysis 4-4.5 hours a day for six days per week. The survey revealed no maternal deaths, but 23% of pregnancies did not result in live births and 50% were complicated by preeclampsia, a condition marked by high blood pressure that may lead to poorer maternal and fetal outcomes. 

“With the increasing prevalence of kidney disease, there are now more women of child-bearing age living with kidney failure,” said Dr. Kerry Willis, Chief Scientific Officer at the National Kidney Foundation. “This survey highlights that the impact of dialysis practice on maternal and fetal outcomes requires further study. This topic was considered in the latest update of the NKF-KDOQI Clinical Practice Guideline for Hemodialysis Adequacy, to be published later this year.”

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Angiotensin Inhibitors May Improve Survival in Sunitinib-Treated Renal Cell ... - Cancer Therapy Advisor PDF Print
April 02, 2015 Concomitant use of angiotensin system inhibitors may improve survival in mRCC with sunitinib.
Concomitant use of angiotensin system inhibitors may improve survival in mRCC with sunitinib.

Concomitant use of angiotensin system inhibitors may significantly improve overall survival and progression-free survival in patients with metastatic renal cell carcinoma (mRCC) receiving sunitinib, a study published in the journal Annals of Oncology has shown.

For the study, researchers retrospectively analyzed data from all patients with mRCC who received sunitinib as first-line treatment at a single cancer institute in France between 2004 and 2013.

Researchers identified 213 patients with a median follow-up of 3.6 years. Of those, 134 were hypertensive and 105 used angiotension system inhibitors.

Results showed that hypertensive patients had a longer median overall survival (41.6 vs 16.4 months; P < 0.0001) and a longer median progression-free survival (12.9 vs 5.6 months; < 0.0001) compared with non-hypertensive patients.

RELATED: Adding More Dietary Lycopene May Help Protect Against Kidney Cancer

In addition, multivariate analysis showed that those who took angiotensin system inhibitors had significantly better overall survival (HR = 0.40; 95% CI: 0.24-0.66; P < 0.001) and progression-free survival (HR = 0.55; 95% CI: 0.35-0.86;P = 0.009) compared with non-users.

Researchers found no difference on outcome between patients who started taking angiotensin system inhibitors before initiating sunitinib and those started during sunitinib treatment.

Reference

  1. Izzedine H, Derosa L, Le Teuff G, et al. Hypertension and angiotensin system inhibitors: impact on outcome in sunitinib treated patients for metastatic renal cell carcinoma. Ann Oncol. 2015. [Epub ahead of print]. doi: 10.1093/annonc/mdv147.

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Partial Nephrectomy Does Not Eliminate CKD Risk - Renal and Urology News PDF Print
April 02, 2015 Partial Nephrectomy Does Not Eliminate CKD Risk - Renal and Urology News
The risk is particularly elevated for patients who have CKD risk factors, such as hypertension, diabetes, and older age.

Patients who have medical risk factors for chronic kidney disease (CKD) are at increased risk of progressive renal impairment despite the use of partial nephrectomy (PN), according to new study findings published online in BJU International.

The study, by Prassannah Satasivam, MD, of Monash Health in Melbourne, and colleagues, included 488 patients undergoing surgery for renal cell carcinoma (RCC). Of these, 156 underwent PN and 332 underwent radical nephrectomy (RN). RN was associated with a 2.7 times increased risk of a new-onset CKD (estimated glomerular filtration rate [eGFR] below 60 mL/min/1.73 m2) compared with PN. Patients undergoing PN, however, were still at risk of new-onset CKD. 

The proportion of PN patients who experienced new-onset CKD more than 6 months after surgery was 7% for those without CKD risk factors, including hypertension, diabetes mellitus, cardiovascular disease, obesity, high cholesterol, family history of CKD, and age, the researchers reported. This proportion rose to 24%, 30%, and 42% for patients older than 60 years and those with hypertension or diabetes mellitus, respectively.

“We contend that, where appropriate, PN should be considered in those patients with normal preoperative renal function and who possess risk factors for future impairment,” the authors concluded.

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