Technical success was defined as the ability to remove the fat and to palpate the patent vein immediately

under the skin at the end of the operation. Clinical success was defined as the ability to perform at least three consecutive dialysis sessions with two needles. All patients were checked systematically every 6 months by the surgeon.

Results: Technical and clinical success rates were 96% (47 of 49) and 94% (46 of 49), respectively. Mean vein depth decreased from 8 +/- 2 to 3 +/- 1 mm according to duplex ultrasound imaging. The mean vein diameter increased from 6 +/- to 8 +/- 2 mm. In one patient, vein tortuosity that was overlooked required conventional repeat tunneling. One extensive hematoma resulted in loss of the fistula. One patient died before the fistula could be used. Primary patency rates were 71% +/- 7% buy AZD8931 and 63% +/- 8% at 1 and 3 years, respectively, SC79 mw and secondary patency rates were 98% +/- 2% and 88% +/- 7%. Delayed complications were treated by surgery (n = 7) or by endovascular procedures (n = 10).

Conclusion: Lipectomy is a safe, effective, and durable approach to make deep arterialized forearm veins accessible for routine cannulation for hemodialysis in obese patients.

It might even be hypothesized that incident obese dialysis patients will eventually have the highest proportion of radial-cephalic fistulas because they often have distal veins that have been preserved by their fat from previous attempts at cannulation for blood sampling or infusion. (J Vasc Surg 2009;50:369-74.)”
“Ribbon synapses in the retina and inner ear maintain tonic neurotransmitter release at high rates to transduce a broad bandwidth of stimulus intensities. In ribbon synapses, synaptic vesicles can be released by a slow, Sustained mode and by fast, synchronous mechanisms. The high release rates require Structural and functional specializations. The synaptic ribbon is the key structural specialization of ribbon synapses. Synaptic ribbons are large, electron-dense structures that immobilize numerous synaptic vesicles next to presynaptic release sites. A main component of synaptic

ribbons is the protein RIBEYE that has the capability to build the scaffold of the synaptic ribbon via multiple RIBEYE-RIBEYE interactions. A PDK4 modular assembly model of synaptic ribbons has been proposed in which synaptic ribbons are formed from individual RIBEYE subunits. The scaffold of the synaptic ribbon provides a docking site for RIBEYE-associated proteins that Could execute specific synaptic ribbon functions. Multiple functions have been assigned to synaptic ribbons including roles in exocytosis, endocytosis, and synaptic membrane trafficking. Recent studies demonstrated the importance of synaptic ribbons for fast, synchronous release and emphasized the need of a tight and efficient Coupling between presynaptic Ca(2+) signaling and exocytosis.