bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring hotspots and user information behaviour of WeChat official accounts: An empirical study based on stimulus–response model
Authors: Yang Bo , Huang Jingyun , Cheng Xusen , Du Shuyu
Published: September 2022

The aim of this study was to investigate the hotspots of WeChat official accounts and the impact of their pushes on user information behaviour including reading rate, sharing rate, number of comments or collections and fan growth rate. Using nine official accounts provided by the Sootoo Network, this study collected data on more than 10,000 pushes released from January to December 2017. In this study, a second-order user information behaviour model using the collected data was constructed. Based on empirical research, a prediction model of user information behaviour was built using a backpropagation neural network and random forest algorithm, and two variable sets were used for training. Then, the effect of different prediction models was analysed to determine the main factors affecting user information behaviour. This study addresses gaps in the field of WeChat research, and the results are of great practical significance for the operators of WeChat official accounts: they can help them optimise operation effects and enhance the influence of official accounts.
The multiple-theories problem: The case of spatial industrial clustering
Authors: Marchionni Caterina , Oinas Päivi
Published: September 2022

Multiple theories of the same phenomenon abound in many interdisciplinary research areas, but it is often unclear how the theories relate, and there are no clear guidelines for dealing with this plurality. The history of research on spatial industrial clustering is a case in point. We identify a number of solutions to the problem of multiple theoretical accounts proposed in this literature. We label them definitional, taxonomic, integrative, and multi-perspectival. We then offer the erotetic solution as an indispensable complement to any attempt at resolving the multiple-theories problem. It accounts for theoretical plurality in terms of different explanation-seeking questions different theories aim to address. We analyse three prominent explanations in the recent history of research on spatial industrial clustering and show how the erotetic approach can contribute to foster interdisciplinary dialogue.
The Impact of Marijuana Legalization on Police in Colorado
Authors: Iannacchione Brian , Ward Kyle C.
Published: September 2022

The purpose of this study was to survey a random sample of police departments in Colorado to assess their views on the impact of marijuana legalization in the state. While police perceptions have been used in prior research to assess other topics, very few studies have assessed police perceptions of marijuana legalization. To address this, police officers and sheriff deputies at 64 randomly selected police departments across Colorado were administered surveys that assessed the impact marijuana has had on enforcement and their personal perceptions of marijuana. In addition, qualitative questions were asked to explore these topics in greater detail. The findings of the 131 respondents suggest that most police officers in Colorado are slightly supportive of legalization, but have noted that it has made their job more difficult.
A Systematic Examination of the Influence of Indicators of Mental Illness on Deaths in the Texas Criminal Justice System
Authors: Pollock Wendi , Sibila Deborah , Frantzen Durant , Luo Fei , Carmen Alex del
Published: September 2022

The publicized deaths of individuals such as Sandra Bland raise questions about whether, and how, the American criminal justice system should handle individuals who display symptoms of mental illnesses. The current study seeks to establish whether there is a stage in the criminal justice process at which the presence of an indicator of a mental illness represents a particularly high risk of death in custody. Using multilevel logistic regression and data on 10,667 civilian deaths that occurred in the custody of criminal justice agencies across the state of Texas, from January 1st, 2005, through October 30th, 2020, results suggest that indicators of mental illness represent the highest risk of death when an individual is in the custody of police. At later stages in the criminal justice system process, particularly jail and prison, indicators of a mental illness reduce the chances that someone will die in custody. Policy implications are discussed.
Violent Assault on a Chinese Man: COVID-19 Psychosocial Resource Loss Diminishes Right Wing Authoritarianism Variability in Societal Reactions
Authors: Johnson James , Sattler David , Van Hiel Alain , Dierckx Kim , Luo Shanhong , Vezzali Loris
Published: September 2022

We examined whether prejudice-related personality characteristics (i.e., right wing authoritarianism [RWA]) and COVID-19–driven psychological resource loss might predict perpetrator-directed punitive responding (i.e., support for criminal charges) to a COVID-19–related attack on a Chinese victim by a White male. Across two studies, participants completed an RWA measure and reported the extent they had experienced COVID-19–related psychosocial resource loss. They then read a passage describing the COVID-19–related physical assault. For both studies, at low resource loss levels, low RWA participants reported greater punitive responding toward the perpetrator than high RWA participants. This RWA–punitive responding association was mediated by greater victim-directed suffering sensitivity (i.e., empathy) for Study 1 and greater anti-perpetrator reactions (i.e., hate crime perceptions) for Study 2. The RWA association with the relevant outcome variables (i.e., suffering sensitivity, anti-perpetrator bias, and punitive responding) was eliminated at high psychological resource loss levels. Specifically, low and high RWA participants reported similar reactions. While previous research has demonstrated that high RWA individuals tend to report greater outgroup-directed prejudicial responses due to COVID-19–driven perceptions of threat, our findings demonstrate that the COVID-19 pandemic can also elicit feelings of resource loss that can diminish the egalitarian reactions typically reported by low RWA individuals. In sum, we demonstrate that experiencing difficult life circumstances such as COVID-19 psychosocial resource loss can diminish supportive reactions toward victimized minority group members even among low RWA participants who are typically expected to be more sensitive to the struggles of those who are disadvantaged.
Investigation of microstructure and mechanical properties of Cu-Ni alloy processed by equal channel angular pressing
Authors: Sachin S , Nayaka H Shivananda
Published: September 2022

The Copper-Nickel alloy, C70600, was subjected to severe plastic deformation by the equal channel angular pressing (ECAP) technique. The material was pressed at room temperature along route BC for eight passes. Microstructural analysis and mechanical characterization of the material were done for each of the ECAP pass samples. The initial homogenized material having equiaxial grains of average grain size 75 µm was reduced to 20 µm after eight ECAP passes. Electron backscatter diffraction data presented an increase in low angle grain boundaries with an increase in the number of ECAP passes. Initially, the ultimate tensile strength and the hardness increased by 56% and 94% respectively. After the fifth ECAP pass, a drastic reduction in ultimate tensile strength and ductility was witnessed. Hardness value remained constant after the fifth ECAP pass. Fractography analysis indicate the ductile mode of fracture with reduced dimple size at higher ECAP passes.
Investigation of shear-induced platelet activation in ventricular assist device
Authors: Bounouib Mohamed , Benakrach Hind , Maazouzi Wajih , Taha-Janan Mourad
Published: September 2022

Due to the scarcity of organ donations, ventricular assist devices are the most accessible treatment for patients with advanced heart failure. Since their development, these devices have helped thousands of patients and could have helped even more had it not been for some of the complications they still experience. Among the most common complications are thrombosis and hemolysis. The purpose of this paper is to numerically investigate the effect of the blade angle and the blade count on the hydraulic properties of a newly designed ventricular assist device, as well as the potential for shear-induced platelet activation. The study was conducted on several models with different blade angles and blade counts using a variety of rotational speeds. Analysis of the obtained results showed a significant improvement in the pressure rise and the hydraulic efficiency in models with higher blade angle and lower blade count. In contrast, the other models showed slight improvement or deterioration of the hydraulic performance. In terms of shear-induced platelet activation, although the performance of all models was within an acceptable range, models with a higher blade angle and lower blade count had the lowest average platelet activation state.
Recognition of Masked Faces in the Era of the Pandemic: No Improvement Despite Extensive Natural Exposure
Authors: Freud Erez , Di Giammarino Daniela , Stajduhar Andreja , Rosenbaum R. Shayna , Avidan Galia , Ganel Tzvi
Published: September 2022

Face masks, which became prevalent across the globe during the COVID-19 pandemic, have had a negative impact on face recognition despite the availability of critical information from uncovered face parts, especially the eyes. An outstanding question is whether face-mask effects would be attenuated following extended natural exposure. This question also pertains, more generally, to face-recognition training protocols. We used the Cambridge Face Memory Test in a cross-sectional study ( N = 1,732 adults) at six different time points over a 20-month period, alongside a 12-month longitudinal study ( N = 208). The results of the experiments revealed persistent deficits in recognition of masked faces and no sign of improvement across time points. Additional experiments verified that the amount of individual experience with masked faces was not correlated with the mask effect. These findings provide compelling evidence that the face-processing system does not easily adapt to visual changes in face stimuli, even following prolonged real-life exposure.
Economic, social, and political determinants of environmental sustainability: Panel data evidence from NEXT eleven economies
Authors: Mughal Nafeesa , Wen Jun , Zhang Qianxiao , Pekergin Zehra Betül , Ramos-Meza Carlos Samuel , Pelaez-Diaz Guillermo
Published: September 2022

This paper aims to investigate the impact of social, economic, and political variables on per capita ecological footprint consumption in the NEXT Eleven economies over the period 1984- 2018. The study utilized the dynamic heterogeneous panel estimators of Cross-Sectionally Augmented Auto-regressive Distributive Lag (CS-ARDL) along with the estimator with a multifactor error structure. The study also estimated the cross-Sectionally augmented distributed lag (CS-DL) model while for robustness check the augmented mean group (AMG) and cross-Sectionally augmented error correction method (CS-ECM) is also considered. The study finding maintains that the impact of GDP per capita, multifaceted phenomena of financial development, and military expenditure is positive and significant suggesting that a unit increase in these variables deteriorates the environment in the NEXT Eleven economies. In contrast, higher life expectancy and government stability improve the environment in the long run. The findings of the study suggest that eco-friendly technologies to be used in the production process, as well as projects using outdated technologies, should be discouraged along with the assurance of government stability and reduction of military expenditure in the NEXT Eleven economies.
Long-Term Comparison of Aortic Arch Replacement with or without Elephant Trunk Procedure via Retrograde Cerebral Perfusion for Aortic Arch Dissection
Authors: Kirali Kaan , Ömeroğlu Suat N. , Ardal Hasan , Toker Mehmet E. , Erdoğan Hasan B. , Dağlar Bahadir , Balkanay Mehmet , İpek Gökhan , Işik Ömer , Yakut Cevat
Published: September 2022

Objective

The aim of this study is to investigate the effects of the duration of retrograde cerebral perfusion (RCP) in patients with aortic arch dissection.

Methods

Between 1993 and December 2000, 56 patients were operated on for aortic arch dissection. Elephant trunk procedure was performed in 28 patients (Group A) and semiarcus replacement in 28 patients (Group B). Type I dissection ( P=0.003), chronic ethiology ( P=0.006), medial degeneration ( P<0.001), and preoperative hemodynamic instability ( P=0.004) were observed significantly more in Group A. In both groups RCP was used for cerebral protection.

Results

Hospital mortality was higher in Group A than Group B (32.1% versus 7.1%; P=0.015). Late mortality was observed only in Group A (10.5%; P=0.049). Actuarial survival was 55.1±11.55% in Group A and 91.67±5.64% in Group B at 5 yr ( P=0.0113). while cumulative survival for all patients was 78.38±5.77% at 5 yr. RCP time was longer in Group A (62.7±16.8 versus 34.2±19.5 min; P<0.001). Forward stepwise logistic regression analysis showed that chronic obstructive pulmonary disease ( P=0.014) and renal insufficiency ( P=0.004) were significantly predictors for hospital mortality, whereas elephant trunk ( P=0.052) and RCP (>60 min) ( P=0.175) did not increase early mortality. Only hemodynamic instability was significantly ( P=0.006) predictors for late mortality.

Conclusions

Preoperative severity of dissection, hemodynamic instability or organ dysfunctions impair early or late outcome. Elephant trunk technique with increased RCP time do not increase early or late mortality. To shorten RCP time (<60–65 min) can improve surgical results.
Assessment of Left Mammary Artery Grafts (LIMA) to Left Anterior Descending Artery (LAD) after Off-Pump Coronary Artery Bypass Grafting by Color Doppler
Authors: Driever R. , Fuchs S. , Schmitz E. , Vetter H. O.
Published: September 2022

Background:

Off-pump coronary artery bypass grafting (OPCAB) on a beating heart with a LIMA graft to the LAD is established for patients with one vessel disease. The aim of the study was to assess the LIMA patency noninvasive by transcutaneous duplex ultrasound.

Methods:

25 patients (16 male, 9 female, mean age 58±13 yr) with LIMA grafts to LAD by OPCAB procedures were studied 7–20 days after surgery. Doppler velocity parameters were measured by use of a 7 MHz transducer placed in left intercostal space. The conventional coronary angiographies performed showed the LIMA graft patent.

Results:

In all cases a typical biphasic pattern of blood flow was recorded with forward flow in both systole and diastole respectively. Under basal conditions the mean peak velocities in systole were 0.36 m/s and the mean peak velocities in diastole were 0.27 m/s with a mean systolic/diastolic ratio of 1.33.

Conclusion:

Transcutaneous Doppler ultrasound is useful in the detection of the LIMA graft flow. This non-invasive technique may find applications for routine postoperative follow-up of patients with LIMA grafts.
False Aneurysm of the Peroneal Artery: An Unusual Complication of Femoro-Peroneal Bypass Grafting
Authors: Parry D. J. , Kessel D. , Scott D. J. A.
Published: September 2022

Non-traumatic false aneurysm formation involving the native crural vessels is rare. We present the case of a false aneurysm of the native peroneal artery, which complicated femoro-peroneal bypass grafting. It seemed most likely to be of an infective aetiology, arising as a consequence of contiguous methicillin resistant Staphylococcus aureus wound infection. This was previously unreported in the literature. Successful management was achieved by primary suture, local wound debridement, excision of the distal graft and replacement with an interposition vein graft through uninfected tissue planes.
Extrahepatic Portal Vein Aneurysm: A Case Report and Review of the Literature
Authors: Lau H. , Chew D. K. , Belkin M.
Published: September 2022

Portal vein aneurysm is a rare clinical entity with only 42 published cases in the English literature. We present a 30-yr old woman who was incidentally diagnosed with an extrahepatic portal vein aneurysm during the investigation for dyspepsia. Expectant management with regular follow-up and surveillance imaging was adopted. This pathology is increasingly encountered with the frequent use of radiological imaging modalities in the work-up of abdominal disorders. Etiology, clinical significance and management strategies for extrahepatic portal vein aneurysms are discussed.
Organized Thrombus in the Ascending Aorta Originating from the Ostium of the Right Coronary Artery
Authors: Shahin G. M. M. , Bosker H. A. , Knaepen P. J. , Morshuis W. J. , Undeboom J. E.
Published: September 2022

This case report describes the rare finding of a pedunculate thrombus in the ascending aorta originating from the ostium of the right coronary artery (RCA) detected after an inferior wall myocardial infarction in a young female. The thrombus was removed surgically during an emergency cardiopulmonary bypass procedure
Primary Closure of Median Sternotomy: Techniques and Principles
Authors: Losanoff Julian E. , Jones James W. , Richman Bruce W.
Published: September 2022

Understanding the biomechanics of midline sternotomy repair is important to successful surgical outcome. High-risk patients, particularly those with immunosuppression, diabetes, and osteoporosis, should be identified. Details of technique should be monitored, and closure should incorporate lateral support of the sternum in patients at risk. Sternal dehiscence can occur under physiologic loads. Closure techniques and materials should insure stable repair, with avoidance of material migration through the bone.
Hemorrhage Related Reexploration following Open Heart Surgery: The Impact of Pre-Operative and Post-Operative Coagulation Testing
Authors: Hall Timothy S. , Sines Jean C. , Spotnitz Alan J.
Published: September 2022

Purpose:

Our objective was to determine the association of pre-operative and post-operative coagulation testing abnormalities with the cause of post-operative bleeding requiring re-exploration following cardiac surgery.

Methods:

Retrospective chart review of post-operative bleeding and the incidence of re-exploration for hemorrhage in 2263 adult patients undergoing elective and emergency open heart surgery which included coronary artery bypass, valvular, and combined valve coronary procedures.

Results:

Eighty-two patients (3.6%) required re-exploration. Sixty-six percent had surgical bleeding; the remaining 34% were coagulopathic (no surgical site found). The pre-operative PT and ACT were significantly elevated in coagulopathic patients ( P<0.005). Post-operative ACT, PT, and APTT were increased and fibrinogen levels were decreased in coagulopathic patients ( P<0.05).

Conclusions:

Pre-operative testing (ACT, PT) weakly correlated with post-operative coagulopathy. Post-operative coagulation abnormalities were identified with high risk ratios and good diagnostic accuracy when using testing cut-off values to assist in surgical decision making.
Acute Abdominal Aortic Thrombosis following the Hiemlich Maneuver
Authors: Ayerdi Juan , Gupta Sushil K. , Sampson Lawrence N. , Deshmukh Narayan
Published: September 2022

Complications from the Heimlich maneuver are relatively infrequent. Two fatal cases of abdominal aortic thrombosis have been reported following this technique. We report on the first patient that suffered an acute thrombosis of the abdominal aorta and survived. Prompt recognition of this complication provides the only hope of survival from this rare and catastrophic complication.
Successful Surgical Treatment of a Patient with Multiple Visceral Artery Aneurysms Due to Fibromuscular Dysplasia
Authors: Kojima Atsuo , Shindo Shunya , Kubota Kenji , Iyori Keiji , Ishimoto Tadao , Kobayashi Masahiro , Tada Yusuke
Published: September 2022

Multiple visceral artery aneurysms due to fibromuscular dysplasia are rare. A 43-yr-old man with a pulsatile abdominal mass detected by ultrasonography had multiple visceral artery aneurysms diagnosed by angiography. This included a huge superior mesenteric artery aneurysm. Aneurysm resection and arterial reconstruction was performed successfully. Pathologic examination revealed fibromuscular dysplasia of the medial fibroplasia type.
Management of Infected Femoral Closure Devices
Authors: Geary Kevin , Landers Jeffrey T. , Fiore William , Riggs Patrick
Published: September 2022

An increase in infectious complications has been noted with the introduction of percutaneous femoral artery closure devices. We report five cases of infected groins and/or femoral arteries following angiographic procedures that were completed using the Perclose Suture Mediated Closure Device (Perclose). Each patient required drainage of the abscess and removal of the Perclose suture. Most patients required more extensive vascular reconstructive procedures. When these complications arise, we recommend expeditious drainage of the abscess, removal of the suture, and adequate exposure of the femoral artery to facilitate repair of the vessel.
Inflammatory Components in Endarterectomy Lesions: An Immunohistological Study
Authors: Zembala M. , Wojnicz R. , Ryfiński B. , Piegza J. , Kaperczak J. , Przybylski R. , Gąsior M. , Zembala M. , Kaczmarski J.
Published: September 2022

The aim of this study was to characterize the immunohistological components of chronic inflammation in endarterectomy lesions. Therefore, in 24 patients endarterectomy specimens were obtained from coronary arteries during CABG surgery (16 from RCA and 8 from LCA) and immunohistologically analyzed using avidin-biotin method (LSAB®/AP) with monoclonal antibodies. Macrophages and CD3 lymphocytes were counted under 200x magnification but MHC class II and ICAM-1 adhesion molecules were analyzed semi-quantitatively (scale from 0 to 3+). The mean macrophages density was 47.8±9.8 cells per mm2 and mean CD3 lymphocyte density was 1.3±0.6 cells per mm2. Lack or weak expression of HLA-DR (0–1+) on macrophages was found in 17 of 24 cases (70.8%). In the remaining seven cases (29.2%) there was a moderate and strong expression (2+ and 3+) of HLA-DR antigens. Similarly, no or weak ICAM-1 expression on macrophages was detected in 19 cases (79.2%). These cells were positively stained for ICAM-1 in only five cases (20.8%). Our data suggest that in advanced primary atherosclerotic lesions chronic inflammation is still present. On the other hand, the small number of activated inflammatory cells and the absence of positively stained endothelium suggests that inflammatory process tends to be burnt-out.
Transposed Saphenous Vein Arteriovenous Fistula Revisited: New Technology for an Old Idea
Authors: Illig Karl A. , Orloff Mark , Lyden Sean P. , Green Richard M.
Published: September 2022

Patients without renal function are living longer than in the past, and the provision of dialysis access is a growing problem. The distal end of the greater saphenous vein can be anastomosed to the femoral artery, creating a transposed saphenous vein thigh arteriovenous fistula, which offers the theoretical advantages of autologous conduit and a native venous ‘anastomosis.’ This is a rarely performed procedure, however, in part because of the morbidity of vein harvest and the risk of groin infection. We have been favorably impressed by the reduction in morbidity and wound infection following endoscopic vein harvest for lower extremity bypass, and believe that the success of this technique merits a reevaluation of this procedure.
Predictors of Nephrological Morbidity after Coronary Artery Bypass Surgery
Authors: Janssen Douglas P. B. , Noyez Luc , van Druten Johannes A. M. , Skotnicki Stefan H. , Lacquet Leon K.
Published: September 2022

Aim:

The aim of this study was to analyse the nephrological morbidity after myocardial revascularization.

Methods and results:

We analysed the pre- per and postoperative data of 3815 patients who underwent a primary isolated coronary bypass grafting between January 1987 and December 1995. Nephrological complications were divided into renal dysfunction and requiring dialysis. The increase in nephrological complications (1.2–4%) is the result of an increase of patients with renal dysfunction. Unifactorial risk analysis identified age, diabetes, hypertension, nephrological pathology, perfusion time, aortic cross-clamp time, emergency operation and perioperative myocardial infarction as risk factors. Multifactorial risk analysis identified age, diabetes, hypertension, nephrological pathology, perfusion time, perioperative myocardial infarction and the cohorts operated upon in 1990–92, 1993–95 as independent risk factors for renal dysfunction, and age, nephrological pathology and perioperative myocardial infarction for those needing dialysis.

Conclusion:

Several variables have been identified as risk factors for nephrological complications; especially important are pre-existing nephrological pathology and perioperative myocardial infarction.
Carney's Syndrome: Complex Myxomas. Report of Four Cases and Review of the Literature
Authors: Edwards A. , Bermudez C. , Piwonka G. , Berr M. L. , Zamorano J. , Larrain E. , Franck R. , Gonzalez M. , Alvarez E. , Maiers E.
Published: September 2022

Cardiac myxomas are rare tumors. They usually appear as a sporadic isolated condition in the left atrium of middle-aged women with no other coincidental pathology. Carney and others have described in young people a special complex group of cardiac myxomas associated to a distinctive complex pathology, giving identity to the “Syndrome Myxoma” or “Carney's Syndrome”. Four additional cases of this syndrome, treated from 1977 to 1999 at the Hospital Clínico de la Universidad de Chile are presented here with a comprehensive review of the literature, accumulating 100 cases. The main features of our cases include the presence of malignant non cardiac tumors, a familial trend, follow-up of 23 years and an iterative recurrence in the elder case. To date all patients are tumor free. Reviewing the literature, patients with Carney's Syndrome were younger, with a mean age of 26 years and female predominance (62%). Cardiac myxomas affected the four chambers of the heart: 64% the left atrium; 44% the right atrium; 14% the left ventricle and 12% the right ventricle. They were multiple tumors in 41% and involved more than one chamber in 31%, being synchronous or metachronous. There was a marked familial trend (52%), a high incidence of recurrence (20%), with more than one occurring in half the cases. Extra-cardiac involvement consisted of: 68% pigmented skin lesions, 40% cutaneous myxomas, 37% adrenal cortical disease, 27% myxoid mammary fibroadenoma and 34% male patients with testes tumors. A low percentage had pituitary adenoma, melanotic schwannomas and thyroid disease. The diagnosis is made when two or more of these criteria are present. In agreement with these findings the four chambers of the heart should be examined at surgery for atypical myxoma locations, right atriotomy and combined superior-transseptal approach improve exposure of the cavities, careful screening of the first degree family members should be conducted, and closed short and long term follow up controls are important. Complex myxoma appears as a multi-systemic disorder, occasionally having an ominous prognosis and malignant potentiality, and is still undergoing investigation for better understanding and identification.
Repair of an Anomalous Left Coronary Artery
Authors: Kaza A. K. , Tribble C. G. , Crosby I. K.
Published: September 2022

We describe a patient with an anomalous single coronary artery who presented with a syndrome of atypical chest pain. Coronary angiography revealed a single right coronary ostium, with a narrowed left coronary artery originating at the right coronary ostium. The proximal portion of the left coronary artery that was narrowed was noted to run in the aortic wall. We describe the operative management of this patient using ostial remodeling.
Triple Valve Replacement in a Patient with Severe Carcinoid Heart Disease
Authors: Wilhelmi M. , Fritz M. K. H. , Fischer S. , Haverich A. , Harringer W.
Published: September 2022

We report on the case of a 34-year-old male patient suffering from end-stage carcinoid heart disease with severe tricuspid, pulmonary and mitral valve regurgitation. In addition, a persisting foramen ovale was present. The primary carcinoid tumor was never discovered. However, urine 5-hydroxy-indole-acetic-acid (5-HIAA) were consistently elevated after the first diagnosis of carcinoid disease and after eight years of medication with Octreotide and Interferon α -2b our patient developed significant cardiac insufficiency mainly due to severe valvular dysfunction. Ultimately, mechanical tricuspid, mitral and pulmonary valve replacement was performed. Twelve hours following the operation the patient had to be returned to the operating room for persisting intrathoracic hemorrhage. He recovered uneventfully and was discharged from hospital on day 37. Twelve months following triple valve replacement the cardiac status recovered from preoperative NYHA-IV to NYHA-I.
Arterial Compression of the Right Common Iliac Vein; an Unusual Anatomical Variant
Authors: Molloy S. , Jacob S. , Buckenham T. , Khaw K.-T. , Taylor R. S.
Published: September 2022

Compression of the left common iliac vein by the right common iliac artery has been well described (Cockett's syndrome). The authors describe a case report of compression of the right common iliac vein by the right internal iliac artery. The patient presented with ipsilateral lower limb oedema. Venography showed smooth extrinsic compression of the right common iliac vein. The CT scan was initially interpreted as showing no extrinsic mass or obvious compressing lesion and lymphography was normal. It was the duplex scan which showed the bifurcation of the right common iliac artery crossing the right common iliac vein and causing significant extrinsic compression.
Computed Tomography-Detected Abnormalities following Conventional AAA Repair
Authors: Libertiny G. , Gibson M. , Torrie E. P. H. , Magee T. R. , Galland R. B.
Published: September 2022

Purpose:

To determine how time since the operation influences vascular abnormalities following conventional infrarenal abdominal aortic aneurysm (AAA) repair.

Methods:

In 47 patients computed tomography was performed 1 to 12 years following the aneurysm repair. Aortic diameters at different levels were measured and other abnormalities recorded.

Results:

Significant correlation was found between time since operation and diameter of the suprarenal aorta ( R= 0.51. P<0.001) but not with aortic neck diameter ( R=–0.10, P= 0.48) or diameter of the prosthetic graft ( R= 0.07, P= 0.66). However, measured diameters of graft and aortic neck showed a significant positive correlation ( R= 0.40. P= 0.005).

Conclusions:

Dilatation of the suprarenal aorta has a different pattern from aortic neck dilatation. The latter showed correlation with the diameter of the prosthetic graft. This may be of interest for future design of endovascular stent-grafts.
Intraoperative Transesophageal Echo-Doppler Evaluation of Stentless Aortic Xenografts. Incidence and Significance of Moderate Gradients
Authors: Morocutti G. , Gelsomino S. , Spedicato L. , Frassani R. , Bernardi G. , Da Col P. , Paparella G. , Fioretti P. , Livi U.
Published: September 2022

Background:

The aim of this study was to assess the utility of intraoperative transesophageal echocardiography (TEE) in the evaluation of patients undergoing aortic valve replacement with the CryoLife-O'Brien® (CLOB) Stentless Porcine Aortic Bioprosthesis.

Methods:

Between May 1994 and March 1995, 26 patients (15 men, mean age 68.4±10.78 years) had a CLOB valve in the aortic position. Transprosthetic gradients and valve regurgitation were detected by intraoperative TEE. Prosthetic regurgitation and transvalvular gradients were evaluated at six-month intervals using transthoracic echo-Doppler (TTE).

Results:

The majority of implants resulted in low gradients (83.7%), with only four patients exhibiting a moderate gradient (15.3%). Color flow Doppler imaging showed central aortic regurgitation in only four of 25 patients (trivial, n = 4; mild, n = 1). There was one paravalvular leak (trivial. n= 1). At follow-up examination (mean 37±12 months), 24 of 25 patients exhibited low mean gradients (7.25±2.81 mmHg). At follow-up one patient who had low velocities in the LVOT at perioperative evaluation exibited a moderate gradient (45 mmHg) with an effective orifice area of 0.8–0.9 cm2.

Conclusions:

Intraoperative TEE was effective in assessing prosthetic stentless valve function.
Surgical Results of Aortic Valve Replacement via Partial Upper Sternotomy: Comparison with Median Sternotomy
Authors: Masiello Paolo , Coscioni Enrico , Panza Antonio , Triumbari Franco , Preziosi Giuseppe , Di Benedetto Giuseppe
Published: September 2022

Background:

the theoretical advantages of mini-invasive cardiac surgery are shorter hospitalisation, better surgical results and costs reduction. In November 1997 we started a non-coronary mini-invasive surgery program using a partial upper median sternotomy. This study has been conceived to retrospectively compare two groups of patients who underwent isolate aortic valve replacement using the conventional and the mini-invasive technique.

Material and methods:

in Group A 100 patients (mean age 62±12 years; 58 male) underwent isolated aortic valve replacement through a partial upper median sternotomy. Group B was composed by the last 100 patients (mean age 63±8 years; 56 male) who underwent the same operation through a conventional median sternotomy. For both groups we recorded the ECC and ischaemic times, postoperative intubation time, total postoperative bleeding, intensive care unit length of stay and total hospitalisation time. Major and minor complications were reported.

Results:

operating times, were significantly longer in Group A (p<0.001). Mechanical ventilation time, 1CU and total hospital stay, and total postoperative bleeding showed no significant difference. Adjunctive statistical evidenced the absence of learning curve. Mortality and other complications failed to reveal any significant difference between the two groups.

Conclusions:

in our experience, partial upper median sternotomy does not increase surgical risks but failed to demonstrate clear advantages. Apart for an increase in operating times, the surgical results are similar to those of a conventional median sternotomy with only improvement in the aesthetical aspect. In our opinion, this supports the conviction that this approach can be proposed to selected patients, to obtain a better cosmethical result for the same given risk.
The Impact of the Duration of Mechanical Ventilation on the Respiratory Outcome in Smokers Undergoing Cardiac Surgery
Authors: Ngaage D. L. , Martins E. , Orkell E. , Griffin S. , Cale A. R. J. , Cowen M. E. , Guvendik L.
Published: September 2022

Study objective.

To determine the impact of the duration of mechanical ventilation on the rate of pulmonary complications in smokers undergoing cardiac surgery.

Methods:

Retrospective analysis of 2163 patients who underwent elective cardiac surgery between September 1993 and August 1999. Based on a 3-month preoperative smoking cessation, patients were classified as smokers, ex-smokers and non-smokers. Their postoperative pulmonary complications were compared and related to the duration of mechanical ventilation.

Results:

Postoperative pulmonary complications were twice as common in smokers (29.5%) as non-smokers (13.6%) and ex-smokers (14.7%). Although smokers required a longer duration of mechanical ventilation, this was not statistically significant. Smokers had a higher rate of increase in postoperative pulmonary complications beyond 6 h of mechanical ventilation (P<0.002).

Conclusion:

Prolonged mechanical ventilation in active smokers undergoing cardiac surgery is associated with a significant increase in the respiratory morbidity. Surgical strategies that allow early extubation may improve the respiratory outcome in smokers.
Endarterectomy VS Stent Angioplasty: What is the Optimal Treatment of Carotid Stenosis?
Authors: Kilaru Sashi , Lee Thomas Y. , Bush Harry L. , Kent K. Craig
Published: September 2022

Very few operations have been subject to more scientific scrutiny than carotid endarterectomy (CEA). Since its introduction in the 1950s, CEAs have been performed in great numbers with the goal of preventing ischemic stroke. In the mid 1980s concern about over utilization of CEA and reports of excessive perioperative stroke morbidity and mortality prompted the initiation of several multicenter, randomized trials designed to evaluate the efficacy of CEA. As the results of these trials became available, the number and frequency of CEA in the United States increased significantly. However, now a new wave of uncertainty has arisen related to the availability of an alternative to CEA, carotid angioplasty and stent (CAS). Now, more than ever, there is uncertainty as to the proper management of carotid artery stenosis. In this review we summarize the existing data regarding the efficacy of CEA and compare these data to a critical analysis of the recent results of CAS.
Evolution of the Management of Mesenteric Occlusive Disease
Authors: Sarkar Rajabrata
Published: September 2022

Current approaches to the diagnosis and management of occlusive disease of the mesenteric arteries have developed over a relatively short period. Five decades ago chronic mesenteric ischemia was almost exclusively a post-mortem diagnosis with the causative link between proximal occlusive lesions of the mesenteric arteries and bowel infarction still in dispute. Successful management of mesenteric occlusive disease has evolved to overcome numerous associated complicating factors, including the relatively inaccessible anatomic location, the cardiovascular co-morbidity present in these patients, the extensive associated atherosclerotic lesions of the paravisceral aorta and the catastrophic consequences of failed revascularization. Although a wide range of surgical strategies are currently used to treat these lesions, many of the most widely used and most successful approaches were developed at the University of California at San Francisco (UCSF). This review will cover the history of treatment of mesenteric occlusive disease, significant contributions made by vascular surgeons at UCSF, and our current approach to this challenging clinical problem.
Preoperative Cardiac Risk Management
Authors: Krupski William C , Nehler Mark R , Whitehill Thomas A
Published: September 2022

Numerous strategies exist for preoperative cardiac testing before patients undergo vascular operations. Potential adverse effects of evaluation and cardiac intervention should be considered before undertaking screening studies. We recently analyzed the adverse outcomes of preoperative cardiac evaluation and intervention before vascular operations in patients treated at the Denver Department of Veterans Affairs Medical Center. During the 12 month study period, 161 patients were scheduled to undergo major vascular operations; 153 patients came to operation. The decision to pursue a cardiac evaluation was made without a defined protocol. Forty two men. aged 68±9 years underwent comprehensive preoperative cardiac evaluations Sixteen (38%) patients had untoward events related to cardiac evaluation, Including eight patients (19%) who refused vascular surgery after cardiac screening and/or intervention. Other complications included prosthetic graft infection, pseudoaneurysms (2), sternal wound infections (2) amputations (2), renal failure and brain anoxia. Extensive cardiac evaluation prior to vascular operations can result in morbidity, delays, and refusal to undergo vascular surgery. The underlying indication for vascular operations and the local iatrogenic cardiac complication rates must be considered before ordering special studies.
Surgical Treatment of Abdominal Aortic Aneurysms Associated with Aortic Valve Incompetence: Strategies and Outcomes
Authors: Neri E , Toscano T. , Massetti M. , Frati G. , Buklas D. , Tucci E. , Capannini G. , Mondillo S. , Picchi A. , Guerrini F. , Sassi C.
Published: September 2022

Background:

The exact incidence of associated aortic valve incompetence (AVI) and abdominal aortic aneurysm (AAA) in the general population is not known. In recent years, we have observed this association with increasing frequency. This observation is probably due to the extensive preoperative screening of the cardiac and vascular status of patients who are candidates for surgical procedures. The choice of the optimal surgical strategy is needed to achieve low operative morbidity and mortality. The present study reviews our experience with a subset of patients suffering the association of AVI and large AAA. Surgical strategy, clinical management and outcome are presented.

Methods:

Between January 1982 and May 2000, 76 patients with the association of AAA and AVI have been evaluated in our institution. Forty-four patients have been treated for both AAA and aortic valve (AV) regurgitation. These patients have been divided into three groups on the basis of the surgical strategy adopted. Group 1: combined procedure (16 patients); group 2: AAA repair prior to AV surgery (nine patients); group 3: AV surgery prior to aneurysm repair (19 patients).

Results:

Hospital mortality was 4.5% (two patients); overall mortality was 6.8% (three patients).

Conclusions:

In patients with AAA and AVI. an accurate and complete preoperative evaluation is essential. Surgical strategy should be individualized on the basis of the cardiac preoperative status.
Radial Artery Grafts: Surgical Anatomy and Harvesting Techniques
Authors: Galajda Z. , Jagamos E. , Maros T. , Péterffy Á.
Published: September 2022

At present more and more surgeons are using the radial artery as a graft for coronary bypass. The statistics until now show that the patency of radial grafts exceeds that of the venous grafts used up to the present.

In our department we used radial artery for coronary bypass in 515 patients between January1990 and December 2000. The radial artery harvesting with minimally invasive technique developed by us was applied in 50 of these patients while the rest were performed with the traditional method. No ischemic complications occurred in forearm or hand following either of the methods.

One year after the operation we carried out control examinations on 197 consecutive patients. Our surveys showed that following the traditional technique of radial artery harvesting neurological complications (temporary dysaesthesia) occurred in 16.5% of the patients. After the minimally Invasive procedure, temporary dysaesthesia occurred in one case (2%). These complaints ceased within 1–12 months (an average of 3.8 months). Definitive neurological complications did not occur in any of the patients.

In summation, we experienced that both operating techniques can be safely applied. The proportion of temporary neurological complications is higher following the traditional procedure, therefore, further development and application of the minimally invasive procedure should be considered.
Full Sternotomy with Minimal Skin Incision for Congenital Heart Surgery
Authors: Jun Tae-Gook , Park Pyo Won , Lee Young Tak , Park Kay-Hyun , Sung Kiick , Kang I. Seok , Lee Heung Jae
Published: September 2022

Purpose:

The purpose of this paper is to analyze the feasibility of the full sternotomy with minimal skin incision and its related complications and risks.

Methods:

A total of 405 patients with simple congenital heart disease underwent open heart surgery exclusively under full sternotomy with minimal skin incision. We reviewed the available medical records of the patients retrospectively. Bypass time, aorta cross clamp time, and period of hospital stay were compared with the control group (223 patients with standard long skin incision).

Results:

Full sternotomy with minimal skin incision provided adequate surgical views and successful repair was done in all patients. There was no mortality. One patient had chylopericardium after the operation and another patient had a postoperative bleeding at the sternum. Minimal skin incision took the similar aorta cross-clamp time and total cardiopulmonary bypass time compared with full skin incision in atrial septal defect patients. Among the ventricular septal defect patients, minimal skin incision took a little longer aorta cross-clamp time (10%). but similar total cardiopulmonary bypass time compared with full skin incision.

Conclusion:

Minimal skin incision with full sternotomy provides improved cosmetic results. There was no increased mortality and morbidity using minimal access. It can be applied to more complex congenital heart disease contrast to other minimal invasive techniques for atrial septal defect.
Endovascular Abdominal Aortic Aneurysm Repair outside a Tertiary Referral Centre: Feasibility and Impact upon Workload
Authors: Karkos Christos D. , Vimalachandran Dale , Lavelle Janet M. , Wilson Paul , Abraham John S.
Published: September 2022

In the UK, the majority of endovascular abdominal aortic aneurysm repairs (EVAR) are carried out in tertiary referral centres. We studied the feasibility and impact upon workload of an endovascular programme introduced into a district general hospital. Data was collected prospectively on ail patients considered for EVAR since the inception of the programme in April 1999. Evaluation was by contrast enhanced CT scan followed by angiography if potentially suitable for EVAR. We recorded eligibility for EVAR. reasons for exclusion and the outcome of all patients irrespective of the mode of repair. Ninety patients were assessed over a 26-month period, nine of which did not complete the evaluation process. Sixty patients had one or more morphological features that precluded EVAR. Twenty-one patients were eligible for EVAR (26%). of which eighteen proceeded to EVAR. one awaits EVAR and two were below the treatment threshold (< 5.5 cm). Seventeen had successful aneurysm exclusion and one required immediate conversion. One patient died within 30 days from gastrointestinal haemorrhage. There was one type-II endoleak at 1 month and to date we have encountered no ruptures or aneurysm-related deaths. Of the remaining 60 patients. 29 have proceeded to elective and 8 to urgent open repair with 2 deaths within 30 days in each group. EVAR is feasible outside tertiary referral centres and satisfactory early results can be achieved. An endovascular programme has important implications upon radiological and surgical workload. The operative mortality of patients undergoing open aortic repair remains acceptable following the introduction of an endovascular service into a district general hospital.