bluuebunny/crossref_metadata_2025 huggingface dataset:
Lesion Pattern in Patients With Erectile Dysfunction of Suspected Arterial Origin
Authors: von Allmen Regula S. , Nguyen Daniel P. , Birkhäuser Frédéric D. , Bednar Rudolf , Kammer Rafael , Do Dai-Do , Diehm Nicolas
Published: December 2015

Purpose: To determine the specific lesion pattern of supplying arteries in patients with cardiovascular risk factors suffering from treatment-refractory erectile dysfunction (ED). Methods: From May 2012 to August 2013, 26 men (median age 55 years) poorly responsive to phosphodiesterase-5 inhibitor therapy were evaluated for a possible vascular cause for their ED. The men were examined with penile duplex sonography and digital subtraction angiography (DSA). Arterial lesions in the common and internal iliac arteries and the internal pudendal arteries considered amenable to endovascular therapy were treated with angioplasty ± stents. Retrospectively, 2 blinded investigators independently evaluated the DSA images and categorized the vascular patterns of the erection-related arteries as normal, macroangiopathy (occlusive lesions of the internal pudendal arteries), or microangiopathy (smaller caliber arteries distal to the internal pudendal circulation with no distal arterial reconstitution). Results: Seventeen macroangiopathic lesions were successfully treated by angioplasty in 11 patients. The treated arterial lesions were mainly located in the internal (n=10) and common iliac arteries (n=2), whereas the internal pudendal artery were involved in 5 cases. Microangiopathic lesions lacking distal reconstitution were present in 7 patients, and the remaining 8 patients had normal vessels supplying the penis. Patients with macroangiopathy undergoing angioplasty had a higher prevalence of peripheral artery disease (63.6% vs 6.7%, p=0.003). Conclusion: In this preliminary series of ED patients with cardiovascular risk factors and pathologic duplex sonographic flow parameters, roughly 40% exhibited arterial lesions amenable to endovascular revascularization. In the patients with macroangiopathy, vessels upstream of the internal pudendal artery were most commonly affected. More studies are warranted to define the role of endovascular procedures in this ED subpopulation.
Thoracic Endovascular Repair of Complicated Penetrating Aortic Ulcer
Authors: Jánosi Rolf Alexander , Gorla Riccardo , Tsagakis Konstantinos , Kahlert Philipp , Horacek Michael , Bruckschen Florian , Dohle Daniel-Sebastian , Jakob Heinz , Schlosser Thomas , Eggebrecht Holger , Bossone Eduardo , Erbel Raimund
Published: December 2015

Purpose: To analyze an 11-year single-center experience of treating complicated penetrating aortic ulcer (PAU) using thoracic endovascular aortic repair (TEVAR). Methods: This study included 63 consecutive patients (mean age 69.1±11.5 years; 40 men) with complicated PAU (42 symptomatic, 22 with rupture) who underwent TEVAR between 2002 and 2013. The PAUs were located in the aortic arch (n=11), the descending thoracic aorta (n=43), and the thoracoabdominal aorta (n=9). Results: TEVAR was performed within 14 days of diagnosis in 33 (52.3%) cases (19 ruptures treated immediately); the other 30 (47.6%) patients had an average interval between diagnosis and intervention of 40±39 days. Technical success was 98.4% (62/63). One patient had a type I endoleak after stent-graft repair of a PAU in the aortic arch without great vessel transposition; another procedure was required for carotid-subclavian bypass and proximal stent-graft extension. No patient experienced spinal cord ischemia after TEVAR. Five (7.9%) patients died in-hospital; 3 had severe cardiac complications, 1 died from complications of aortic rupture, and the other succumbed to septic shock. Mean follow-up was 45.6±47.2 months, during which 12 (19.0%) patients needed a secondary intervention because of late endoleaks (n=4, 6.3%) or new complications due to disease progression. Multivariate analysis indicated that a PAU depth >15 mm was an independent predictor of mortality (hazard ratio 6.92, p=0.03). In the biomarker analysis, symptomatic patients had significantly higher D-dimer and troponin levels compared to asymptomatic patients [559.5±460.7 vs 283.2±85.2 µg/L (p=0.016) and 0.22±0.61 vs 0.02±0.03 ng/mL (p=0.04), respectively]. Conclusion: Patients with PAU suffer from underlying severe atherosclerotic disease and have a significant number of cardiovascular comorbidities that lead to relevant mortality and morbidity after TEVAR. As a PAU diameter >15 mm represented high risk for disease progression, these patients may be candidates for early intervention. D-dimer levels may help identify patients at risk and with progression of PAU.
Paclitaxel-Eluting Balloon vs Standard Angioplasty to Reduce Restenosis in Diabetic Patients With In-Stent Restenosis of the Superficial Femoral and Proximal Popliteal Arteries
Authors: Grotti Simone , Liistro Francesco , Angioli Paolo , Ducci Kenneth , Falsini Giovanni , Porto Italo , Ricci Lucia , Ventoruzzo Giorgio , Turini Filippo , Bellandi Guido , Bolognese Leonardo
Published: December 2015

Purpose: To report the 3-year safety and effectiveness outcomes from the prospective all-comers DEBATE-ISR study ( ClinicalTrials.gov identifier NCT01558531) of symptomatic diabetic patients with femoropopliteal in-stent restenosis (ISR) undergoing treatment with paclitaxel-eluting balloons compared with historical diabetic controls. Methods: From January 2010 to December 2011, 44 consecutive diabetic patients (mean age 74±11 years; 32 men) were treated with drug-eluting balloons (DEBs) and enrolled in the study. The control group comprised 42 consecutive diabetic patients (age 76±7 years; 23 men) treated with conventional balloon angioplasty (BA) from 2008 to 2009. Results: No significant differences in terms of clinical, angiographic, or procedural characteristics were observed between the study groups. Critical limb ischemia was present in the majority of patients. Tosaka class III ISR was observed in more than half of the patients. Mean lesion length was 132±86 and 137±82 mm in the DEB and BA groups, respectively (p=0.7). At 3-year follow-up, the rate of target lesion revascularization (TLR) was 40% in the DEB group vs 43% in the BA group (p=0.8); Kaplan-Meier analysis showed no significant differences in terms of freedom from TLR. The presence of a Tosaka class III occlusion was associated with a worse outcome in both study groups (odds ratio 3.96, 95% confidence interval 1.55 to 10.1, p=0.004). Conclusion: Using DEBs for femoropopliteal ISR yielded similar results to BA in terms of TLR at 3-year follow-up. The treatment of more complex ISR lesions was associated with an increased rate of TLR, irrespective of the technology used.
Treatment Modalities for Small Saphenous Vein Insufficiency
Authors: Boersma Doeke , Kornmann Verena N. N. , van Eekeren Ramon R. J. P. , Tromp Ellen , Ünlü Çagdas , Reijnen Michel M. J. P. , de Vries Jean-Paul P. M.
Published: December 2015

Purpose: To investigate and compare the anatomical success rates and complications of the treatment modalities for small saphenous vein (SSV) incompetence. Methods: A systematic literature search was performed in PubMed, EMBASE, and the Cochrane Library on the following therapies for incompetence of SSVs: surgery, endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS), steam ablation, and mechanochemical endovenous ablation (MOCA). The search found 49 articles (5 randomized controlled trials, 44 cohort studies) reporting on the different treatment modalities: surgery (n=9), EVLA (n=28), RFA (n=9), UGFS (n=6), and MOCA (n=1). A random-effects model was used to estimate the primary outcome of anatomical success, which was defined as closure of the treated vein on follow-up duplex ultrasound imaging. The estimate is reported with the 95% confidence interval (CI). Secondary outcomes were technical success and major complications [paresthesia and deep vein thrombosis (DVT)], given as the weighted means. Results: The pooled anatomical success rate was 58.0% (95% CI 40.9% to 75.0%) for surgery in 798 SSVs, 98.5% (95% CI 97.7% to 99.2%) for EVLA in 2950 SSVs, 97.1% (95% CI 94.3% to 99.9%) for RFA in 386 SSVs, and 63.6% (95% CI 47.1% to 80.1%) for UGFS in 494 SSVs. One study reported results of MOCA, with an anatomical success rate of 94%. Neurologic complications were most frequently reported after surgery (mean 19.6%) and thermal ablation (EVLA: mean 4.8%; RFA: mean 9.7%). Deep venous thrombosis was a rare complication (0% to 1.2%). Conclusion: Endovenous thermal ablation (EVLA/RFA) should be preferred to surgery and foam sclerotherapy in the treatment of SSV incompetence. Although data on nonthermal techniques in SSV are still sparse, the potential benefits, especially the reduced risk of nerve injury, might be of considerable clinical importance.
Type IIIb Endoleak With the Endurant Stent-Graft
Authors: McWilliams Richard G. , Vallabhaneni S. Rao , Naik Jagjeeth , Torella Francesco , Fisher Robert K.
Published: December 2015

Purpose: To report 2 cases of type IIIb endoleak with the Endurant stent-graft and postulate the cause for the events. Case Report: A type IIIb endoleak was diagnosed at open conversion for a ruptured aneurysm 4 years after implantation of an Endurant stent-graft. In the other case, the endoleak was diagnosed at angiography 4 years after the Endurant stent-graft was implanted; the stent-graft was relined. In both cases the fabric hole was in the body of the stent-graft at the level of the top of the contralateral limb. Conclusion: The cause of the type IIIb endoleaks in these cases was fabric erosion likely due to interaction between the bare metal at the top of the contralateral limb and the fabric of the stent-graft body.
Global Experience With the Nellix Endosystem for Ruptured and Symptomatic Abdominal Aortic Aneurysms
Authors: Reijnen Michel M. P. J. , de Bruin Jorg L. , Mathijssen Elke G. E. , Zimmermann Eric , Holden Andrew , Hayes Paul , Krievins Dainis , Böckler Dittmar , de Vries Jean-Paul P. M. , Thompson Matt M.
Published: December 2015

Purpose: To assess the feasibility and safety of the endovascular aneurysm sealing (EVAS) technique in the treatment of acute abdominal aortic aneurysm (AAA). Methods: A retrospective, multicenter, observational study was conducted at 8 centers (7 European and 1 in New Zealand) experienced with EVAS in the elective setting. From February 2013 to April 2015, 58 patients (mean age 74±9 years; 46 men) with an acute AAA were treated (28 ruptured and 30 symptomatic). The primary endpoint of the study was 30-day mortality; secondary endpoints included endoleak, reinterventions, and 30-day morbidity. Results: The overall intensive care unit and hospital stays were 2.2±6.6 days and 9.7±11.4 days, respectively. Thirty-day mortality rates were 32% (9/28) for the ruptured group and 7% (2/30) for the symptomatic group, with morbidity rates of 57% and 17%, respectively. Early endoleak was present in only 2 (3%) patients, one in each group; both leaks were type Ia. Reinterventions within 30 days were performed in 8 patients in the ruptured group; in the symptomatic patients, the only perioperative reintervention was embolization a type Ia endoleak. The mean follow-up was 9.3±3.1 months in the ruptured group and 12.4±5.4 months in the symptomatic group. The mean aneurysm diameter at 30-day follow-up was 71.8±16.0 mm compared with 74.7±15.7 mm preoperatively in the ruptured group and 66.1±13.5 mm compared with 65.8±13.0 mm in the symptomatic group. Conclusion: EVAS in the acute setting appears safe and feasible and concordant with the literature for endovascular aneurysm repair. More robust prospective and comparative data are required to establish the position of the technique in the treatment algorithm of acute AAA.
Use of the Off-the-Shelf t-Branch Device to Treat an Acute Type Ia Endoleak in a Symptomatic Juxtarenal Abdominal Aortic Aneurysm
Authors: Khanafer Adib , Khashram Manar , Ruiz Carmen-Maria , Mann Dana , Laing Andrew
Published: December 2015

Purpose: To report the use of the off-the-shelf Zenith t-Branch Thoracoabdominal Endovascular Graft for the treatment of a symptomatic acute type Ia endoleak subsequent to previous infrarenal bifurcated endovascular aneurysm repair. Case Report: A 72-year-old man presented 4 years after implantation of an Anaconda stent-graft with sac expansion and type II endoleak, which was treated over the next 18 months with repeated coil and glue embolization of the leak and sac. Six months after the last attempt, imaging disclosed a new type Ia endoleak. Sac enlargement became symptomatic, and emergent treatment was performed using the off-the-shelf Zenith b-Branch device. The 4 visceral arteries were bridged with Fluency stent-grafts. The Anaconda stent-graft precluded the use of a standard Zenith universal distal body bifurcated device below the t-Branch graft, so a reversed tapered 16×20×82-mm iliac limb was placed to bridge the t-Branch to the larger Anaconda limb; the smaller 12-mm contralateral Anaconda limb was occluded. The procedure was concluded with a femorofemoral bypass. At 10 months after the procedure, the patient is well; the sac diameter has decreased, and there is no endoleak on imaging. Conclusion: The multibranched Zenith t-branch device may be useful in treating proximal endoleaks in bifurcated stent-grafts.
Meta-Analysis of Studies Evaluating the Effect of Cilostazol on Major Outcomes After Carotid Stenting
Authors: Galyfos George , Geropapas Georgios , Sigala Fragiska , Aggeli Konstantina , Sianou Argiri , Filis Konstantinos
Published: December 2015

Purpose: To evaluate the effect of cilostazol on major outcomes after carotid artery stenting (CAS). Methods: A systematic literature review was conducted conforming to established criteria in order to identify articles published prior to May 2015 evaluating major post-CAS outcomes in patients treated with cilostazol vs patients not treated with cilostazol. Major outcomes included in-stent restenosis (ISR) within the observation period, the revascularization rate, major/minor bleeding, and the myocardial infarction/stroke/death rate (MI/stroke/death) at 30 days and within the observation period. Data were pooled for all studies containing adequate data for each outcome investigated; effect estimates are presented as the odds ratios (ORs) and 95 confidence intervals (CI). Results: Overall, 7 studies pertaining to 1297 patients were eligible. Heterogeneity was low among studies so a fixed-effect analysis was conducted. Six studies (n=1233) were compared for the ISR endpoint, showing a significantly lower ISR rate with cilostazol treatment after a mean follow-up of 20 months (OR 0.158, 95% CI 0.072 to 0.349, p<0.001). Five studies (n=649) were compared regarding 30-day MI/stroke/death (OR 0.724, 95% CI 0.293 to 1.789, p=0.484) and 3 studies (n=1076) were analyzed regarding MI/stroke/death within the entire follow-up period (OR 0.768, 95% CI 0.477 to 1.236, p=0.276); no significant difference was found between the groups. Data on bleeding rates and revascularization rates post ISR were inadequate to conduct further analysis. Conclusion: Cilostazol seems to decrease total ISR rates in patients undergoing CAS without affecting MI/stroke/death events, both in the early and late settings.
Postoperative CT Evaluation After EVAR
Authors: Törnqvist Per , Resch Timothy , Gottsäter Anders , Malina Martin , Wasselius Johan
Published: December 2015

Purpose: To compare the postoperative computed tomography angiography (CTA) assessment made by vascular surgeons and interventional radiologists after endovascular aneurysm repair (EVAR) at a tertiary vascular clinic to an outside core review facility. Methods: One hundred patients (mean age 78.7 years, range 88–55; 84 men) with consecutive, elective, routine CTA controls after EVAR were retrospectively studied. Consultant vascular surgeons or radiologists had evaluated all original scans and written the original report. All scans were then reevaluated by an independent core clinic. Findings were classified as vascular or extravascular and stratified as clinically significant or clinically nonsignificant by an independent external reviewer. Results: The number of vascular findings detected by the vascular clinic was 72 vs 69 by the core clinic. The vascular clinic reported more clinically significant findings (primarily stent compression or kinks) as well as endoleaks and their origin. The core clinic reported more pseudoaneurysms (24 vs 12). None of the patients with puncture complications needed reintervention. Interrater analysis of all findings between the 2 clinics showed good agreement when comparing endoleaks overall (without subclassification) and moderate agreement when assessing aneurysm growth. The core clinic reported extravascular findings in 58 patients; 37 of these were classified as clinically significant. The vascular clinic reported extravascular findings in 23 patients; 7 of these were clinically significant. The core clinic also reported 2 cases of suspected malignancies, which had not been reported by the vascular clinic. Conclusion: During routine CTA follow-up after EVAR, a significant number of vascular and nonvascular findings are detected. Whereas a highly dedicated vascular clinic identifies most vascular findings regardless of the specialty of the reader, some extravascular findings are missed. However, the frequency of clinically significant findings or findings that might warrant reintervention was low in this study.
Neuromonitoring, Cerebrospinal Fluid Drainage, and Selective Use of Iliofemoral Conduits to Minimize Risk of Spinal Cord Injury During Complex Endovascular Aortic Repair
Authors: Banga Peter V. , Oderich Gustavo S. , Reis de Souza Leonardo , Hofer Jan , Cazares Gonzalez Meaghan L. , Pulido Juan N. , Cha Stephen , Gloviczki Peter
Published: December 2015

Purpose: To review outcomes of continuous motor/somatosensory-evoked potential (MEP/SSEP) monitoring, cerebrospinal fluid drainage, and selective use of iliofemoral conduits in patients undergoing endovascular repair of descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysms (TAAAs). Methods: The clinical data of 49 patients (mean age 75±8 years; 38 men) who underwent endovascular repair of DTA and TAAAs (2011–2014) were reviewed. All patients had cerebrospinal fluid drainage, permissive hypertension (mean arterial pressure ≥80 mm Hg), and MEP/SSEP monitoring. There were 44 (90%) patients with TAAAs and 5 (10%) with DTA. Types I and II TAAAs were repaired in staged procedures. Iliofemoral conduits were used for small iliac arteries and to minimize time of lower extremity ischemia in patients with difficult anatomy. In patients with changes in MEP/SSEPs, a standardized protocol was employed to optimize spinal cord perfusion and restore lower extremity blood flow. Endpoints were mortality, spinal cord injury (SCI), and lower extremity ischemic complications. Results: Sixteen (33%) patients had staged TAAA repair. A total of 163 visceral arteries were targeted by fenestrations and branches (mean 3.7±1.0 vessels/patient). Temporary iliofemoral conduits were used in 16 limbs/14 patients. A stable MEP/SSEP was achieved in all patients. Thirty-one (63%) patients had a ≥75% decrease in MEP/SSEP amplitude in 50 limbs starting on average 75±28 minutes after obtaining vascular access. MEP/SSEP amplitude improved with maneuvers in 12 (39%) patients and returned to baseline with restoration of lower extremity flow in all except 1 patient who developed immediate SCI. Thirty-day mortality was 4%. Three (6%) patients had SCI, 2 permanent and 1 temporary at 14 days. There were no lower extremity ischemic complications. Conclusion: Neuromonitoring predicted immediate SCI and allowed use of a protocol to optimize spinal cord and lower extremity perfusion during complex endovascular aortic repair. Larger clinical experience is needed to evaluate the efficacy of neuromonitoring to prevent SCI.
Two-Dimensional Perfusion Angiography of the Foot
Authors: Murray Timothy , Rodt Thomas , Lee Michael J.
Published: December 2015

Purpose: To report the feasibility, technical considerations, and initial results of 2-dimensional (2D) perfusion angiography of the foot before and after endovascular interventions. Methods: A retrospective single-center study involved 21 patients (mean age 73.4±10.5 years; 14 men) with severe peripheral vascular disease [Fontaine stage III (n=10) or IV (n=14)] who underwent lower limb digital subtraction angiography (DSA) prior to and following endovascular treatment of above- and/or below-knee lesions. A standardized contrast administration protocol (15 mL iodixanol 320 mg I/mL at 3 mL/s via a 5/6-F antegrade sheath) was applied during DSA using a 2D perfusion–enabled image intensifier. Representative hindfoot and forefoot regions of interest were analyzed, and representative numeric density values [time to peak (TTP), peak density value (PDV), and area under the (time-density) curve (AUC)] were calculated using 2D perfusion–enabled angiographic software to assess foot perfusion. Values were compared before and after angioplasty and by level of treatment (above or below knee). The parameters were correlated with disease severity (stenosis vs occlusion) and symptom level (Fontaine stage). Results: A clinically significant improvement (29.4%) in the AUC was noted following angioplasty, reaching statistical significance within the hindfoot (p=0.03). No significant change in TTP or PDV was detected following angioplasty. Foot movement remained problematic when measuring time-density values. No statistical difference in perfusion values was appreciable between above- and below-knee angioplasty. Conclusion: Two-dimensional perfusion angiography of the foot allows quantitative evaluation using various density values with potential benefit for treatment planning and technical outcome analysis. Methodical restrictions currently remain, mainly regarding patient movement.
EndoAnchors to Resolve Persistent Type Ia Endoleak Secondary to Proximal Cuff With Parallel Graft Placement
Authors: Donselaar Esmé J. , van der Vijver-Coppen Rozemarijn J. , van den Ham Leo H. , Lardenoye Jan Willem H. P. , Reijnen Michel M. P. J.
Published: December 2015

Purpose: To describe 2 patients with a distally migrated endograft causing a type Ia endoleak and treatment with a proximal cuff and chimney grafts that required EndoAnchors to finally seal the leak. Case Report: Two men, ages 86 and 72 years, presented with stent-graft migration and type Ia endoleak at 5 and 15 years after endovascular repair, respectively. Both were treated with a proximal cuff in combination with a chimney graft to the left renal artery. In both cases, the type Ia endoleak persisted, likely due to gutter formation. Both patients were treated in the same setting with EndoAnchors that instantly resolved the endoleak. At 1-year follow-up, there was no recurrent endoleak or migration, with patent chimney grafts and renal arteries and stable renal function. Conclusion: EndoAnchors may effectively resolve a persistent type Ia endoleak arising from gutter formation after placement of a proximal cuff and chimney grafts.
Study of thermal properties of jute and hollow conjugated polyester fibre reinforced non-woven composite
Authors: Zakriya G Mohamed , Ramakrishnan G , Palani Rajan T , Abinaya D
Published: December 2015

Sandwich structure of non-woven composite is produced by using a compressive hot pressing method. It is ranging from 2500 grams per square meter (gsm) to 3500 gsm. Composite sample is designed using Box and Behnken model. Considering 50–70% weight of jute fibre content with 30–50% weight of hollow conjugated polyester fibre, ideal thickness of the composites is maintained in the range from 4 to 5 mm. Thermal properties such as thermal conductivity, thermal resistance, thermal transmittance and thermal diffusivity were evaluated by considering three factors: weight of jute (A), weight of hollow conjugated polyester (B) and thickness of the composite (C). The thermal conductivity of the composite material is determined by heat flow meter method ASTM C518. Experiment result will help to make a suitable standardized panel composite for thermal insulation. It requires 3600 gsm 51/49 parts of contribution of jute/hollow conjugated polyester fibre with 5.0 mm thickness and 3200 gsm 76.5/23.5 parts of contribution of jute/hollow conjugated polyester fibre with 4.5 mm thickness of the composites. The composite weight of 3280 gsm shown optimized thermal responses, it was predicted from response surface method graph. Contribution of jute/hollow conjugated polyester fibre of 54/46 parts with 5.0 mm thickness would be considered to make standardized composite panel. Mostly air conditioning process reduces the energy cost spent for the thermal stability in indoor climate of dwellings.
Complex three- dimensional-shaped knitting preforms for composite application
Authors: Hamouda T
Published: December 2015

For decades, street lighting and electric poles are made of metal and it is vulnerable to corrosion due to the harsh weather and chemicals. To overcome such essential problems, galvanized iron is used although it adds more hard work to increase the manufacturing cost. Therefore, fiber reinforced polymer lighting pole is proposed. Fiber reinforced polymer materials possess many advantages such as corrosion resistance, high specific strength and stiffness, etc. Two-dimensional woven fabrics and three-dimensional woven fabrics preforms are used to produce composite structures. However, complex shapes cannot be manufactured as a one piece preform. Woven fabrics, whether two-dimensional or three-dimensional need to be cut into patterns to finally produce the complex shapes. These processes add more cost and time to the final composite products. In this research, innovative technique to produce a three-dimensional complex shape knitted preform using regular flat-knitting machine will be presented. Production of such shaped three-dimensional preform permits the production of one piece-shaped preform without any connection or further sewing processes. Produced knitted preform can be used for various reinforcement applications such as light and communication poles, scaffold façades, traffic sign, oars, and wind mill blades.
Use of Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, and Risk of Dementia in Heart Failure
Authors: Chitnis Abhishek S. , Aparasu Rajender R. , Chen Hua , Kunik Mark E. , Schulz Paul E. , Johnson Michael L.
Published: December 2015

Objective:

To test the effect of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) on reducing the risk of dementia in patients with heart failure (HF).

Methods:

This retrospective, longitudinal study used a cohort of HF patients identified from a local Medicare advantage prescription drug plan. Multivariable time-dependent Cox model and marginal structural model using inverse-probability-oftreatment weighting were used to estimate the risk of developing dementia. Adjusted dementia rate ratios were estimated among current and former ACEI/ARB users, as compared with nonusers.

Results:

Using the time-dependent Cox model, the adjusted dementia rate ratios (95% confidence-interval) among current and former users were 0.90(0.70-1.16) and 0.89 (0.71-1.10), respectively. Use of marginal structural model resulted in similar effect estimates for current and former users as compared with the nonusers.

Conclusion:

This study found no difference in risk of dementia among the current and former users of ACEI/ARB as compared with the nonusers in an already at-risk HF population.
A Systematic Review of Metacognitive Differences Between Alzheimer’s Disease and Frontotemporal Dementia
Authors: DeLozier Sarah J. , Davalos Deana
Published: December 2015

Clinicians often have difficulty distinguishing between various forms of dementia to achieve a correct diagnosis. Little research has been done to examine whether awareness of one’s cognitive deficits, or metacognitive monitoring, might differ between dementia diagnoses, thereby providing an additional means of differentiating between dementia subtypes. We review articles examining metacognitive comparisons between two of the most common dementia subtypes: Alzheimer’s disease and frontotemporal dementia. Greater monitoring deficits were apparent in frontotemporal dementia than in Alzheimer’s disease, and participants with frontotemporal dementia were less likely to utilize task experience to update and improve the accuracy of subsequent monitoring judgments. Results provide evidence for the utility of metacognitive measures as a means of distinguishing between Alzheimer’s disease and frontotemporal dementia.
Spousal Caregiver Perspectives on a Person-Centered Social Program for Partners With Dementia
Authors: Han Areum , Radel Jeff
Published: December 2015

This qualitative study explored spousal caregiver perspectives on the experience and impact of a person-centered social program for partners with dementia. Interviews with 5 caregivers and the spouses with dementia were conducted 7 to 8 months after the program ended to explore the sustained impact of the program. Interpretative phenomenological analysis was used to support in-depth exploration of interviews. Three themes emerged including benefits of the program for caregivers, initial expectations and later perspectives of caregivers about the program, and conflicting values and perspectives between caregivers and the spouses. These findings suggest participation in a person-centered social program by people with dementia benefits their caregivers, by meeting the caregivers’ desire for their spouses to increase social participation and engagement in meaningful activities. Participation in the program provided a sustained benefit to one couple in particular, by encouraging the caregiver to resume arranging activities the couple once enjoyed but now had difficulty pursuing.
Simple Neuropsychological Tests May Identify Participants in Whom Aspirin Use Is Associated With Lower Dementia Incidence
Authors: Oveisgharan Shahram , Hachinski Vladimir
Published: December 2015

Background:

We hypothesized that neuropsychological tests could help in identifying preclinical stages of vascular cognitive impairment, when aspirin use might be associated with lower dementia incidence.

Methods:

We used data of Canadian Study of Health and Aging (CSHA) which was a longitudinal study of Canadians older than 65 years and was done in 3 waves, 1991 to 1992 (CSHA-1), 1996 to 1997 (CSHA-2), and 2001 to 2002.

Results:

CSHA-1 participants with vascular dementia performed worse in copying pentagons and writing subtests of modified Mini-Mental State Examination test than participants with probable Alzheimer’s disease. Salicylates use was associated with lower incident dementia among normal cognition CSHA-1 participants who had low scores in copying pentagons and writing subtests after controlling for age, sex, education, and vascular risk factors (odds ratio = 0.25, 95% confidence interval: 0.073-0.86, P = .028).

Conclusions:

Two simple neuropsychological tests might help in identifying preclinical stages of vascular cognitive impairment, and salicylates use was associated with lower dementia incidence.
Relation of Poor Memory to Soluble Tumor Necrosis Factor Receptor Type Two (sTNF-RII)
Authors: Lehrer Steven , Rheinstein Peter
Published: December 2015

The association of soluble tumor necrosis factor receptor type two with poor memory in patients with breast cancer and controls found by Patel et al (2015) may confirm the finding of Holmes et al in 2009 that tumor necrosis factor α is linked to cognitive decline.
Sleep in the Acute Phase of Severe Traumatic Brain Injury
Authors: Wiseman-Hakes Catherine , Duclos Catherine , Blais Hélène , Dumont Marie , Bernard Francis , Desautels Alex , Menon David K. , Gilbert Danielle , Carrier Julie , Gosselin Nadia
Published: December 2015

Background and Objectives. The onset of pervasive sleep-wake disturbances associated with traumatic brain injury (TBI) is poorly understood. This study aimed to ( a) determine the feasibility of using polysomnography in patients in the acute, hospitalized stage of severe TBI and ( b) explore sleep quality and sleep architecture during this stage of recovery, compared to patients with other traumatic injuries. Methods. A cross-sectional case-control design was used. We examined the sleep of 7 patients with severe TBI (17-47 years; 20.3 ± 15.0 days postinjury) and 6 patients with orthopedic and/or spinal cord injuries (OSCI; 19-58 years; 16.9 ± 4.9 days postinjury). One night of ambulatory polysomnography was performed at bedside. Results. Compared to OSCI patients, TBI patients showed a significantly longer duration of nocturnal sleep and earlier nighttime sleep onset. Sleep efficiency was low and comparable in both groups. All sleep stages were observed in both groups with normal proportions according to age. Conclusion. Patients in the acute stage of severe TBI exhibit increased sleep duration and earlier sleep onset, suggesting that the injured brain enhances sleep need and/or decreases the ability to maintain wakefulness. As poor sleep efficiency could compromise brain recovery, further studies should investigate whether strategies known to optimize sleep in healthy individuals are efficacious in acute TBI. While there are several inherent challenges, polysomnography is a useful means of examining sleep in the early stage of recovery in patients with severe TBI.
Postural Motor Learning Deficits in People With MS in Spatial but Not Temporal Control of Center of Mass
Authors: Gera Geetanjali , Fling Brett W. , Van Ooteghem Karen , Cameron Michelle , Frank James S. , Horak Fay B.
Published: December 2015

Background: Multiple sclerosis (MS) is associated with balance deficits resulting in falls and impaired mobility. Although rehabilitation has been recommended to address these balance deficits, the extent to which people with MS can learn and retain improvements in postural responses is unknown. Aim: To determine the ability of people with MS to improve postural control with surface perturbation training. Methods: A total of 24 patients with mild MS and 14 age-matched controls underwent postural control training with a set pattern of continuous, forward-backward, sinusoidal, and surface translations provided by a force platform. Postural control was then tested the following day for retention. The primary outcome measures were the relative phase and center-of-mass (CoM) gain between the body CoM and the platform motion. Results: People with MS demonstrated similar improvements in acquiring and retaining changes in the temporal control of the CoM despite significant deficits in postural motor performance at the baseline. Both MS and control groups learned to anticipate the pattern of forward-backward perturbations, so body CoM shifted from a phase-lag (age-matched controls [CS] = −7.1 ± 1.3; MS = −12.9 ± 1.0) toward a phase-lead (CS = −0.7 ± 1.8; MS = −6.1 ± 1.4) relationship with the surface oscillations. However, MS patients were not able to retain the changes in the spatial control of the CoM acquired during training. Conclusions: People with MS have the capacity to improve use of a feed-forward postural strategy with practice and retain the learned behavior for temporal not spatial control of CoM, despite their significant postural response impairments.
Effects of Subdural Monopolar Cortical Stimulation Paired With Rehabilitative Training on Behavioral and Neurophysiological Recovery After Cortical Ischemic Stroke in Adult Squirrel Monkeys
Authors: Plautz Erik J. , Barbay Scott , Frost Shawn B. , Zoubina Elena V. , Stowe Ann M. , Dancause Numa , Eisner-Janowicz Ines , Bury Scott D. , Taylor Michael D. , Nudo Randolph J.
Published: December 2015

Background. Cortical stimulation (CS) combined with rehabilitative training (RT) has proven effective for enhancing poststroke functional recovery in rats, but human clinical trials have had mixed outcomes. Objective. To assess the efficacy of CS/RT versus RT in a nonhuman primate model of cortical ischemic stroke. Methods. Squirrel monkeys learned a pellet retrieval task, then received an infarct to the distal forelimb (DFL) representation of primary motor cortex. A subdural monopolar electrode was implanted over the spared DFL representation in dorsal premotor cortex (PMD). Seven weeks postinfarct, monkeys underwent 4 to 6 weeks of RT (n = 8) or CS/RT (n = 7; 100 Hz, cathodal current) therapy. Behavioral performance was assessed before and after infarct, prior to therapy, and 1 and 12 weeks posttherapy (follow-up). The primary outcome measure was motor performance at 1 week posttherapy. Secondary outcomes included follow-up performance at 12 weeks and treatment-related changes in neurophysiological maps of spared DFL representations. Results. While postinfarct performance deficits were found in all monkeys, both groups demonstrated similar recovery profiles, with no difference in motor recovery between the RT and CS/RT groups. Posttherapy, PMD DFL area was significantly expanded in the RT group but not the CS/RT group. A significant relationship was found between motor recovery and DFL expansion in premotor cortex. Conclusions. Results suggest that the specific parameters utilized here were not optimal for promoting behavioral recovery in nonhuman primates. Though CS/RT has consistently shown efficacy in rat stroke models, the present finding has cautionary implications for translation of CS/RT therapy to clinical populations.
Epidural Cortical Stimulation as Adjunctive Treatment for Nonfluent Aphasia
Authors: Cherney Leora R.
Published: December 2015

Background. There is increasing interest in the application of cortical stimulation (CS) as an adjuvant strategy in aphasia rehabilitation. Epidural CS, although more invasive than other methods, can provide high-frequency ipsilesional stimulation with greater spatial specificity. Objective. We review methods and results of a phase 1 study of epidural CS in combination with rehabilitation therapy in aphasia and provide new objective and self-report data collected between 6 and 21 months after the end of treatment. Methods. Eight stroke survivors with nonfluent aphasia received intensive language therapy, 3 hours a day, for 6 weeks. Four participants also underwent surgical implantation of an epidural stimulation device that was activated only during therapy sessions. Behavioral data were collected before treatment, at the end of treatment, and at 6 and 12 weeks after the end of treatment. Of the 8 participants, 7 also participated in the longer-term follow-up visit. Results. Changes in objective scores from baseline were larger in investigational participants than controls at all assessments, including the longer-term follow-up visit. Satisfaction ratings and ratings of overall improvement by investigational participants and their companions were more varied than those of the controls, but all indicated that they would recommend the investigational treatment to others with aphasia. Conclusions. Improvements were generally maintained for at least 12 weeks posttreatment and possibly as long as 21 months posttreatment. Epidural CS is a potentially safe, feasible adjunctive intervention for persons with chronic nonfluent aphasia that spares the ventral premotor cortex and warrants further investigation.
The Game of Politics
Authors: Kelly Matthew
Published: December 2015

This article examines the game Papers, Please to demonstrate how the aesthetic experience of gameplay resonates with the cultural logic of contemporary globalist paradigms. The author demonstrates how video games make their players undertake a synthesis of work and play via a process of psychological and physical self-modification. This interrelation between work, play, and subjectivity modification within gameplay experiences embodies the same ideological framework that governs many knowledge-based economies which thrive off of user-generated content. In using the work/play/subjectivity connection to locate similarities between video games and the logic of globalist paradigms, the author presents a revised understanding of what constitutes the political dimensions of video games and the experiences they elicit in their players. This article concludes with an analysis of how the mechanics and narrative of Papers, Please embodies the cultural mind-set of work-as-play while simultaneously challenging the discourses often applied to user-focused information technologies.
Innovations in the Indian pharmaceutical industry: The present scenario and an agenda for the future
Authors: Banerjee Kaushik , Thakurta Rahul
Published: December 2015

The Indian industry has grown manifold since independence and today is ranked among the major global players. This has been a result of several factors which together have provided the right environment for India’s growth. However, given the fast pace of change, appropriate course corrections and suitable policy interventions are necessary for sustenance of future growth. In this paper, the authors present an argument rooted on innovativeness of Indian pharmaceutical industry to demonstrate how future growth possibilities can be created and sustained. Some of the challenges besieging the process have been identified as lack of skilled manpower, inadequate finances, low technological base and limited access to new technologies. The final results provide foundations of a business model having the potential of nurturing an innovative ecosystem in India in order to transform India into a producer of innovative pharmaceutical products.
Is there leadership in a fluid world? Exploring the ongoing production of direction in organizing
Authors: Crevani Lucia
Published: December 2015

Although the idea of leadership being a process is clearly stated in leadership definitions, most researchers focus on individuals rather than observing and studying processes. This contradiction has been highlighted by a number of scholars turning to leadership processes and practices, thereby drawing attention to the interactional and social aspects of the phenomenon. Such contributions mostly take process perspectives in which entities still play an important role. In this article, I therefore aim at contributing to leadership studies based on a process ontology by exploring one central aspect of leadership work, the production of direction, processually. I do so by building on geographer Massey’s conception of space, thus adding a spatial dimension that enables me to conceptualize direction as the development of an evolving relational configuration. In order to empirically explore such a conceptualization, two constructs are proposed: the construction of positions and the construction of issues. The reading of leadership work thus produced leads me to suggest ‘clearing for action’ as a means of conveying the spatio-temporal and constructive (reality constructing) character of leadership work.
Experiences of using Bestic, an eating aid for people with intellectual disabilities
Authors: Dag Munir , Svanelöv Eric , Gustafsson Christine
Published: December 2015

This article reports on the results of a pilot study exploring whether and how the meal situations of persons with intellectual disabilities (PWIDs) in need of help and support during meal situations were affected by an eating aid. This article also analyzes how PWIDs and their assistants perceived their experiences of using an eating aid during meal situations. Data for the study were collected in interviews with PWIDs and their assistants. The results are presented in five themes: independence in the meal situation, motivation to use the eating aid, functions of the eating aid, social aspects of using the eating aid, and design corresponding to intellectual disability. The eating aid’s function, user-friendliness, and the assistants’ attitudes appear to be crucial for using the eating aid. Another important aspect is the introductory and training phase, which must be fundamentally adapted to suit the PWIDs ability to learn and understand. When these aspects are controlled, the eating aid can be a tool for increased independence during meal situations for PWIDs who are unable to move their arms or hands.
Adults’ earliest memories of songs and melodies based on a large stratified sample
Authors: Krøjgaard Peter , Kingo Osman S , Berntsen Dorthe
Published: December 2015

Most parents sing to their children. Yet, little is known regarding how early musical experiences are retained later in life. This study is a first attempt to fill this gap in the literature. Based on the stratified sample, we asked 973 adults about their first memories of a song or melody. The results revealed that adults’ earliest memories of a song or melody generally were predated by memories for other events; thus, the music memories were not the very earliest memories. The earliest memories for musical experiences were rated as typical, fragmented, and positive. Women reported earlier music memories than men. Current age had no impact on the age of the earliest music memories, but older respondents rated their memories as more vivid. The reported parental communication quality during childhood was reliably related to the age and characteristics of the earliest music memories.
Life-threatening ketoacidosis in a pregnant woman with psychotic disorder
Authors: Frise Charlotte , Attwood Ben , Watkinson Peter , Mackillop Lucy
Published: December 2015

Pregnancy is an insulin resistant state. Hyperglycaemia and gestational diabetes mellitus are well-recognised complications even in women without existing metabolic syndrome or obesity. Pregnant women also appear to be more vulnerable to ketoacidosis, particularly after short periods of reduced oral intake in the third trimester, and may present with very severe starvation ketoacidosis, prompting emergent delivery. We present a case of a woman with a background of depression and psychotic episodes. Olanzapine had been commenced after a psychotic episode at 20 weeks’ gestation. Gestational diabetes mellitus was diagnosed at 28 weeks, and she was then admitted at 31 weeks with severe euglycaemic ketoacidosis following a short period of vomiting. She underwent caesarean section when the metabolic disturbances did not resolve with medical treatment. We believe atypical antipsychotic therapy contributed to the profound insulin resistance seen here, and that obstetricians, physicians and psychiatrists must be aware of the risks conferred by these agents in pregnancy.
Unplanned pregnancy on a direct oral anticoagulant (Rivaroxaban): A warning
Authors: Myers B , Neal R , Myers O , Ruparelia M
Published: December 2015

Direct oral anticoagulants (DOACs or NOACs -non-vitamin K oral anticoagulants), as the name suggests, are oral anticoagulants with a direct inhibitory action either against factor X or factor II (thrombin). Pregnant women were excluded from participating in all the large trials of the DOACs and they are considered contra-indicated in pregnancy and breast feeding. We present a case of inadvertent exposure to rivaroxaban in a woman who presented at 25 weeks' gestation. The management of her pregnancy and delivery is described, and the previous published case reports are reviewed with a discussion about the use of DOACs in woman of childbearing age.