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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">THE PERIODICITY OF VASCULAR ACCESS THROMBOSIS REVISITED&#58; &#191;TIS THE SEASON</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">CHARLES J&#46; DISKIN M&#46;D&#46;&#44; CLINICAL ASSOCIATE PROFESSOR</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"></span></p><p class="elsevierStylePara">WORD COUNT &#58;452</p><p class="elsevierStylePara">FUNDING&#58; NONE</p><p class="elsevierStylePara">REFERENCES&#58; 2</p><p class="elsevierStylePara">FIGURES&#58; 2 </p><p class="elsevierStylePara">All authors have no conflicts of interest</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CHARLES J&#46; DISKIN M&#46;D&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">HNDT</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"></span><span class="elsevierStyleBold">AUBURN UNIVERSITY BLDG 21</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">121 N&#46; 20<span class="elsevierStyleSup">th</span> STREET</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"></span><span class="elsevierStyleBold">OPELIKA&#44; AL 36801</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Fax 334-742-0242</span></p><p class="elsevierStylePara">HNDT512&#64;bellsouth&#46;net&#46;</p><br></br><p class="elsevierStylePara">I would like to congratulate Dr&#46; Gorriz and his colleagues for their excellent work on the increased incidence of hemodialysis vascular access thrombosis &#40;VAT&#41; during the summer months&#46;<span class="elsevierStyleSup">1</span> Their work adds significant insight to this subject&#46; As Dr&#46; Gorriz noted&#44; we also had been interested in this topic more than a decade ago&#44; yet we found no increased incidence of VAT during the summer months&#46;<span class="elsevierStyleSup"> 2</span> Indeed although we found no significant differences&#44; the numerically highest rates of VAT were during November and December for the years we studied&#44; 1989-1994 &#40;Figure 1&#41;&#46;<span class="elsevierStyleSup">2</span> Using chaos theory&#44; the only periodicity we found was that VAT was more likely &#40;almost invariably&#41; to occur on a day of dialysis&#46; We could not tell whether such a relationship was due to the procedure itself&#44; or more likely to be a reporting phenomenon that existed since most patients did not notice the asymptomatic thrombosis until they appeared for dialysis and found that their access was unable to be cannulated&#46; </p><p class="elsevierStylePara">How should we reconcile the disparity of the findings&#63; I doubt that the differences result from the type of access&#44; since similar to Dr&#46; Gorriz&#44; polyflurotetraethylene grafts were predominant among the 947 VAT in our series also&#46; Neither is a climate difference likely since temperatures differences are not very great between Valencia and Opelika&#46; Opelika actually has the higher average temperatures during the summer months &#40;Figure 2&#41;&#46; Perhaps the difference is&#44; as Dr&#46; Gorriz suggests&#44; related to a local seasonal custom such as less experienced nursing and technical personnel during the summer months in Valencia&#46; Perhaps the experienced surgeons take more vacation during those months&#46; We had no such seasonal variation in personnel in our study&#46; Finally perhaps the problem is statistical&#46; As Dr&#46; Gorriz correctly notes&#44; both of our studies are observational and fraught with problems&#46; Since neither of us actually measured access survival&#44; neither of us can conclude that access survival was either unchanged or shortened during those months&#44; but merely the observed episodes of VAT were either unchanged or higher&#46; Similarly&#44; since the data is censored &#40;that is&#44; not all accesses thrombosed&#41; perhaps we both should have employed logistic analysis with Kaplan Meyer survival curves&#46; Finally&#44; since in all statistical studies we accept some chance &#40;p&#60;0&#46;05 or p &#60;0&#46;01&#41; of accepting a finding as significant when there is no significance&#44; the more times we perform the same study the more likely we are to accept an insignificant finding as significant or a significant finding as not significant&#46; At this point&#44; I would agree with Dr&#46; Gorriz&#44; that nephrologists should be alert that there might be a problem and that a full scale prospective study should be performed to find out if indeed there is a relationship&#46; </p><p class="elsevierStylePara">1&#46; <a href="http&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;entrez&#47;query&#46;fcgi&#63;db&#61;pubmed&#38;cmd&#61;Retrieve&#38;dopt&#61;AbstractPlus&#38;list&#95;uids&#61;17402881&#38;query&#95;hl&#61;1&#38;itool&#61;pubmed&#95;docsum" class="elsevierStyleCrossRefs">Gorriz JL&#44; Manzanera MJ&#44; Perez Hoyos S&#44; Sancho A&#44; Molina P&#44; Avila A&#44; Gavela E&#44; Fernandez Najera JE&#44; Pallardo LM&#46;</a> Seasonal perodicity in vascular access thrombosis for haemodialysis Nefrologia&#46; 2007&#59;27&#40;1&#41;&#58;62-7&#46; Spanish&#46;</p><p class="elsevierStylePara">2&#46; Diskin CJ&#44; Stokes TJ&#44; Panus L&#46; The periodicity of vascular access thrombosis&#46; Nephron&#46; 1996&#59;73&#40;4&#41;&#58;532-5&#46;</p>&#160; "
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    "titulo" => "La periodicidad de la trombosis vascular del acceso revisit&#243;&#58; TIS LA estaci&#243;n"
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">THE PERIODICITY OF VASCULAR ACCESS THROMBOSIS REVISITED&#58; &#191;TIS THE SEASON</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">CHARLES J&#46; DISKIN M&#46;D&#46;&#44; CLINICAL ASSOCIATE PROFESSOR</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"></span></p><p class="elsevierStylePara">WORD COUNT &#58;452</p><p class="elsevierStylePara">FUNDING&#58; NONE</p><p class="elsevierStylePara">REFERENCES&#58; 2</p><p class="elsevierStylePara">FIGURES&#58; 2 </p><p class="elsevierStylePara">All authors have no conflicts of interest</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CHARLES J&#46; DISKIN M&#46;D&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">HNDT</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"></span><span class="elsevierStyleBold">AUBURN UNIVERSITY BLDG 21</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">121 N&#46; 20<span class="elsevierStyleSup">th</span> STREET</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"></span><span class="elsevierStyleBold">OPELIKA&#44; AL 36801</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Fax 334-742-0242</span></p><p class="elsevierStylePara">HNDT512&#64;bellsouth&#46;net&#46;</p><br></br><p class="elsevierStylePara">I would like to congratulate Dr&#46; Gorriz and his colleagues for their excellent work on the increased incidence of hemodialysis vascular access thrombosis &#40;VAT&#41; during the summer months&#46;<span class="elsevierStyleSup">1</span> Their work adds significant insight to this subject&#46; As Dr&#46; Gorriz noted&#44; we also had been interested in this topic more than a decade ago&#44; yet we found no increased incidence of VAT during the summer months&#46;<span class="elsevierStyleSup"> 2</span> Indeed although we found no significant differences&#44; the numerically highest rates of VAT were during November and December for the years we studied&#44; 1989-1994 &#40;Figure 1&#41;&#46;<span class="elsevierStyleSup">2</span> Using chaos theory&#44; the only periodicity we found was that VAT was more likely &#40;almost invariably&#41; to occur on a day of dialysis&#46; We could not tell whether such a relationship was due to the procedure itself&#44; or more likely to be a reporting phenomenon that existed since most patients did not notice the asymptomatic thrombosis until they appeared for dialysis and found that their access was unable to be cannulated&#46; </p><p class="elsevierStylePara">How should we reconcile the disparity of the findings&#63; I doubt that the differences result from the type of access&#44; since similar to Dr&#46; Gorriz&#44; polyflurotetraethylene grafts were predominant among the 947 VAT in our series also&#46; Neither is a climate difference likely since temperatures differences are not very great between Valencia and Opelika&#46; Opelika actually has the higher average temperatures during the summer months &#40;Figure 2&#41;&#46; Perhaps the difference is&#44; as Dr&#46; Gorriz suggests&#44; related to a local seasonal custom such as less experienced nursing and technical personnel during the summer months in Valencia&#46; Perhaps the experienced surgeons take more vacation during those months&#46; We had no such seasonal variation in personnel in our study&#46; Finally perhaps the problem is statistical&#46; As Dr&#46; Gorriz correctly notes&#44; both of our studies are observational and fraught with problems&#46; Since neither of us actually measured access survival&#44; neither of us can conclude that access survival was either unchanged or shortened during those months&#44; but merely the observed episodes of VAT were either unchanged or higher&#46; Similarly&#44; since the data is censored &#40;that is&#44; not all accesses thrombosed&#41; perhaps we both should have employed logistic analysis with Kaplan Meyer survival curves&#46; Finally&#44; since in all statistical studies we accept some chance &#40;p&#60;0&#46;05 or p &#60;0&#46;01&#41; of accepting a finding as significant when there is no significance&#44; the more times we perform the same study the more likely we are to accept an insignificant finding as significant or a significant finding as not significant&#46; At this point&#44; I would agree with Dr&#46; Gorriz&#44; that nephrologists should be alert that there might be a problem and that a full scale prospective study should be performed to find out if indeed there is a relationship&#46; </p><p class="elsevierStylePara">1&#46; <a href="http&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;entrez&#47;query&#46;fcgi&#63;db&#61;pubmed&#38;cmd&#61;Retrieve&#38;dopt&#61;AbstractPlus&#38;list&#95;uids&#61;17402881&#38;query&#95;hl&#61;1&#38;itool&#61;pubmed&#95;docsum" class="elsevierStyleCrossRefs">Gorriz JL&#44; Manzanera MJ&#44; Perez Hoyos S&#44; Sancho A&#44; Molina P&#44; Avila A&#44; Gavela E&#44; Fernandez Najera JE&#44; Pallardo LM&#46;</a> Seasonal perodicity in vascular access thrombosis for haemodialysis Nefrologia&#46; 2007&#59;27&#40;1&#41;&#58;62-7&#46; Spanish&#46;</p><p class="elsevierStylePara">2&#46; Diskin CJ&#44; Stokes TJ&#44; Panus L&#46; The periodicity of vascular access thrombosis&#46; Nephron&#46; 1996&#59;73&#40;4&#41;&#58;532-5&#46;</p>&#160; "
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