bluuebunny/crossref_metadata_2025 huggingface dataset:
State Budgetary Delays in an Era of Party Polarization
Authors: Birkhead Nathaniel A.
Published: January 2017

This article examines the relationship between state budgetary delays and party polarization. Although others have evaluated the influence of divided government on a state’s likelihood of passing a budget on time, the influence of party polarization has not been explored. Given the growing rate of party polarization in the American states, it is important to understand the implications that this trend has for the budgetary process. The first analysis in this article predicts if a budgetary delay will occur, and the second evaluates the factors that explain how long the stalemate continues when a delay occurs.
Describing the Status of Programs for the Gifted
Authors: Callahan Carolyn M. , Moon Tonya R. , Oh Sarah
Published: January 2017

Using three leveled surveys of school district personnel (elementary, middle, and high school), we collected data on the current status of practices and procedures in gifted education across the nation. Results from 1,566 respondents in separate school districts to questions relating to administration (staffing), identification of gifted students, curriculum and instruction, program delivery models, financing, program evaluation, teacher qualification requirements, and professional development document a national picture of current practice. In addition, we structured data collection procedures to assess the degree to which the NAGC Pre-K–Grade 12 Gifted Education Programming Standards are used to guide programming. The resulting picture of current practices was often a mirror of practices from 20 or more years ago, suggesting a need for a national dialogue focused on reshaping gifted education for the 21st century.
Teen girls and sexual agency: exploring the intrapersonal and intergroup dimensions of sexting
Authors: García-Gómez Antonio
Published: January 2017

The electronic swapping of sexually provocative images and texts, commonly known as sexting, seems to have become part and parcel of adolescents’ social lives. In spite of both media and policy attention, questions remain about the way(s) young women navigate sexual relationships and construct their gendered identity discursively by endorsing/challenging social and behavioural norms of sexual agency. Guided discussions involving 36 young women were conducted. The main of aim of this study was to gain insight into the characteristics of sexualised adolescent cyberculture by analysing their discourses about sexting, the effects on their lives and its implications. In this article, I argue that the discourse analysis of these young women’s own construction of their sexualised gender identity may throw light on the interrelationships between dominant purportedly sexualised culture and agency.
Childhood Adversity, Religion, and Change in Adult Mental Health
Authors: Jung Jong Hyun
Published: January 2017

Research indicates that childhood adversity is associated with poor mental health in adulthood. The purpose of this study is to examine whether the deleterious long-term effects of childhood adversity on adult mental health are reduced for individuals who are involved in religious practices. Using longitudinal data from a representative sample of American adults ( N = 1,635), I find that religious salience and spirituality buffer the noxious effects of childhood abuse on change in positive affect over time. By contrast, these stress-buffering properties of religion fail to emerge when negative affect serves as the outcome measure. These results underscore the importance of religion as a countervailing mechanism that blunts the negative impact of childhood abuse on adult mental health over time. I discuss the theoretical implications of these findings for views about religion, childhood adversity, and mental health.
Family Predictors of Child Mental Health Conditions
Authors: Nguyen Jenny , Hinojosa Melanie Sberna , Strickhouser Vega Sara , Newman Rameika , Strohacker Emily , Noyongoyo Boniface
Published: January 2017

Research suggests that minority children with one mental health condition are more likely than White children to have a secondary mental health condition. However, there are no current studies that test the interaction between race and family resources to examine this apparent racial difference in mental health conditions in children. Yet research suggests that family resources vary by race/ethnicity. This study examines the interaction between family structure and socioeconomic status by race and ethnicity to understand how it predicts the number of mental health conditions among children. Our findings are consistent with the existing literature that children in resource-poor families (single parent, step-parent families, and lower income families) have higher counts of mental health conditions. Yet we also found that children in resource-rich families (two-parent biological families with higher levels of income) in some cases also had higher counts of mental health conditions and this varied by race/ethnicity.
Spontaneous Extramural Coronary Arteritis in Dogs,
Authors: Hartman Howard A.
Published: January 2017

Control and treated beagle and random-source dog hearts obtained from 119 toxicological experiments were evaluated histologically to study the incidence and characteristics of a microscopic inflammatory lesion specific to the extramural coronary arteries. The lesion occurred in 23% of the experiments. The incidence was 2.3% of the control and treated beagle hearts examined. In the control begales, it was present in 3.1% of males and 1.3% of females and in the treated beagles, in 1.8% males and 2.8% females. It occurred in 4.7% of the random-source animals. While not visible grossly, histologically, the solitary lesions were characterized by adventitial infiltrates of mononuclear cells, occasional areas of necrosis with inflammatory cell infiltrates occurring in the mural and subendothelial regions. The latter resulted in prominent separation of the intima from the media. The lesions occurred in the right and left coronary arteries and in the dorsal, circumflex and ventral descending branches of the left coronary artery. Similar vascular lesions were not found in the intramural coronary vessels or in other organs in the affected animals. Expanded sampling of the extramural coronary arteries revealed an incidence of 5–9%. This lesion of focal extramural coronary arteritis was considered idiopathic, and not a manifestation of recently reported polyarteritis syndromes in dogs.
Acute Alterations of Tissue Ca++ and Lethal Tubular Cell Injury During HgCl2 Nephrotoxicity in the Rat
Authors: Weinberg Joel M. , Johnson Kent J. , de la Iglesia Felix A. , Allen Edward D.
Published: January 2017

The relationship between acute alterations of tissue Ca++ and the development of acute renal failure and lethal renal tubular cell injury in the kidney was studied. Nephrotoxicity was induced by HgCl2, and its course was modified by prior saline drinking. Both a semiquantitative scale measuring the extent of lethal tubule cell injury and a computerized assessment of numbers of nuclei in Feulgen stained sections of cortex were used for morphologic analysis. The 2 methods agreed very closely with each other, indicating the utility of an automated computerized approach as a rapid, quantitative adjunct for the assessment of lethal cell injury in the kidney. Increases of blood urea nitrogen during 12-24 hr after HgCl2 were associated with increasing extent of lethal cell injury in both saline and water drinking rats. Striking progressive increases of renal cortical Ca++ developed. In both water and saline drinking rats, the increases in tissue Ca++ were significantly associated with increasing blood urea nitrogen levels and extent of lethal cell injury as determined morphologically. However, similar degrees of increased blood urea nitrogen and extensive lethal cell injury were accompanied by substantially lower tissue Ca++ levels in saline drinking rats than in water drinking rats, indicating an independent effect of saline drinking to ameliorate the increases in tissue Ca++ occurring during lethal cell injury in this model. These data provide further insight into the relationship between structural and functional changes during HgCl2 nephrotoxicity and establish the utility of an automated computerized morphometric method for assessing the extent of lethal cell injury.
Detection and Cellular Localization of Lead by Electron Probe Analysis in the Diagnosis of Suspected Lead Poisoning in Rhesus Monkeys
Authors: Sass Bernard , Banfield William G. , Saffiotti Umberto
Published: January 2017

Lead poisoning of unknown source was diagnosed histologically in 2 rhesus monkeys (Macaca mulatto) by finding acid-fast intranuclear inclusion bodies in the epithelial cells of renal cortical tubules. The presence of lead in the inclusions was determined by scanning electron microscopy/energy dispersive x-ray analysis using sections from paraffin embedded tissues. This observation indicates the usefulness of this technique for the detection and cellular localization of lead in tissues, even from archival material.
Fast foods perception among adolescents by gender and weight status
Authors: Allehdan Sabika S , Tayyem Reema F , Bawadi Hiba A , Al-Awwad Narmeen J , Al-Mannai Mariam , Musaiger Abdulrahman O
Published: January 2017

Background:

Fast food restaurants have become widespread in both developed and developing countries due to nutritional and economic transitions. The frequency of fast food intake is relatively high among adolescents; however, fast food consumption is positively associated with total energy intake and obesity in adolescents.

Objective:

This study aimed to examine the perception of Jordanian adolescents towards fast foods relative to gender and obesity.

Methods:

A cross-sectional survey was conducted on 400 boys and 395 girls, aged 15–18 years. The adolescents completed a validated questionnaire to measure the perception of adolescents towards fast foods during the year 2013–2014. Weight and height were measured. Numbers who were non-overweight, overweight, and obese were calculated for each age and sex using the International Obesity Task Force (IOTF) standard.

Results:

The majority of participants perceived foods which are eaten as sandwiches as fast foods. A significant difference between boy and girl adolescents was reported regarding perception of French fries ( p < 0.012), fried chicken ( p < 0.001), fattayer ( p < 0.001), foul (boiled broad beans) sandwich ( p < 0.001), falafel sandwich ( p < 0.044) and fried eggs sandwich ( p < 0.001) as fast foods. Girls were significantly more enthusiastic than boys to consider cuscusi plate ( p < 0.001), rice dishes ( p < 0.002), Chinese foods ( p < 0.001), Indian foods ( p < 0.010), Mexican foods ( p < 0.011), and Italian foods ( p < 0.004) as non-fast foods. The difference between obese and non-obese regarding the perception of fast foods was only significant among boy participants. Western or non-Arab foods, food prepared fast and eaten fast in self-service outlets, and food rich in calories were significantly perceived as fast food by Jordanian adolescents ( p < 0.05).

Conclusions:

The perception of foods as fast foods or non-fast foods was significantly different between both genders as well as in obese and non-obese male Jordanian adolescents.
Knowledge, attitudes and perception on dietary salt reduction of two communities in Grahamstown, South Africa
Authors: Mushoriwa Fadzai , Townsend Nick , Srinivas Sunitha
Published: January 2017

Introduction:

Dietary salt reduction has been identified as a cost effective way of addressing the global burden of non-communicable diseases (NCDs), particularly cardiovascular diseases. The World Health Organization has recommended three main strategies for achieving population-wide salt reduction in all member states: food reformulation, policies and consumer awareness campaigns. In 2013, the South African Ministry of Health announced the mandatory salt reduction legislation for the food manufacturing sector. These were set to come into effect on 30 June 2016. This decision was influenced by the need to reduce the incidence of NCDs and the fact that processed food is the source of 54% of the salt consumed in the South African diet. However, with discretionary salt also being a significant contributor, there is need for consumer awareness campaigns. The aim of this study was to assess the knowledge, attitudes and practices of guardians and cooks at two non-governmental organisations based in Grahamstown, South Africa, towards dietary salt reduction.

Method:

Data was collected through observation and explorative, voice-recorded semi-structured interviews and transcribed data was analysed using NVivo®.

Results:

At both centres, salt shakers were not placed on the tables during mealtimes. Only 14% the participants perceived their personal salt intake to be a little. No participants were aware of the recommended daily salt intake limit or the relationship between salt and sodium. Only five out of the 19 participants had previously received information on dietary salt reduction from sources such as healthcare professionals and the media.

Conclusion:

The results from the first phase of this study highlighted gaps in the participants’ knowledge, attitudes and practices towards dietary salt reduction. The aim of the second phase of the research is to design and implement a context specific and culturally appropriate educational intervention on dietary salt reduction.
Fluoride concentrations in a range of ready-to-drink beverages consumed in Heilongjiang Province, north-east China
Authors: Liu Ying , Maguire Anne , Tianqui Guan , Yanguo Shi , Zohoori Fatemeh V
Published: January 2017

Consumption of ready-to-drink beverages, as a potential source of fluoride (F), has increased considerably in China over the last decade. To help inform the public and policy makers, this study aimed to measure F concentration of ready-to-drink beverages on sale in Heilongjiang province, north east China. Three batches of 106 drink products manufactured by 26 companies were purchased from the main national supermarkets in Harbin, Heilongjiang province, China. The F concentration of all samples was determined, in triplicate, using a fluoride ion-selective electrode in conjunction with a meter and a direct method of analysis. The products were categorised into 10 groups according to product type. F concentrations of the samples ranged from 0.012–1.625 mg/l with a mean of 0.189 mg/l and a median of 0.076 mg/l. More than half of the products (55%) had an F concentration of ≤0.1 mg/l, while <5% had a F concentration of >0.7 mg/l. The ‘tea with milk’ group contained the highest mean F concentration (1.350 mg/l), whereas the lowest mean F concentration (0.027 mg/l) was found for the ‘fruit juice’ group. For some products, such as tea, fruit juice and carbonated beverages, there were substantial variations in F concentration between batches, manufacturers and production sites. In conclusion, ready-to-drink products (apart from tea), sold in Heilongjiang province, China, when consumed in moderation are unlikely to constitute a substantial risk factor for the development of dental or skeletal fluorosis.
Chinese business information sources
Authors: Ying-Shan Han
Published: January 2017

Han Ying-Shan is the managing director of Han Consultants. He specializes in providing Chinese business and marketing information in English. He has published several English-language directories, and also offers market studies, direct marketing and database services, translation, literature design and printing.
Changes in Metalloproteinase (MMP-1, MMP-2) Expression in the Proximal Region of the Varicose Saphenous Vein Wall in Young Subjects
Authors: Buján J. , Jurado F. , Gimeno M. J. , García-Honduvilla N. , Pascual G. , Jiménez J. , Bellón J. M.
Published: January 2017

Objective:

An evaluation of the proteoglycan perlecan, collagen I and III, and metalloproteinases MMP−1, −2, −3 and −9 was performed to explore the possible relationships between ageing, affected vein region and reactive state of the varicose vein wall.

Methods:

Segments of saphenous vein were obtained from healthy subjects and from those with varicose veins. The vein specimens were subdivided according to subject age (<50/^50) and vein source (distal/proximal).

Results:

The walls of control vein specimens acquired a more collagenous appearance with age. These changes were not accompanied by significant modifications in the immunohistochemical markers used. In specimens from young patients, proximal varicose vein segments showed an increase in MMP-1, MMP-2 and MMP-9 expression. Subjects of more advanced age showed an increase in perlecan expression.

Conclusion:

This increase in MMPs could lead to the acceleration of the final fibrosclerotic process characteristic of the varicose vein wall.
Limited Usefulness of Tests of Coagulation Defects for Predicting Symptomatic Pulmonary Embolism after an Initial Episode of Deep Vein Thrombosis
Authors: Yasuhara H. , Muto T.
Published: January 2017

Objective:

To establish the usefulness of currently available tests of coagulation defects for predicting symptomatic pulmonary embolism (PE) in patients with lower extremity deep vein thrombosis (DVT).

Methods:

Between 1980 and 1996, 294 patients with DVT were followed for a mean period of 7.9 years. The coagulation defects included low activity of antithrom-bin III, protein C, protein S or plasminogen, and positivity for lupus anticoagulant or anticardiolipin antibody. The influences of these coagulation abnorm-alities on PE incidence were analysed, using a Cox regression hazards model.

Results:

Coagulation defects were found to be an important variable predicting PE (risk ratio = 7.272). ‘PE-free survival’ in patients with no coagulation defect was significantly longer than that in patients with one or more of these defects ( p = 0.0001). The sensitivity of coagulation tests for predicting PE was only 47% despite the negative predictive value of 93%.

Conclusions:

Determining these defects has limited usefulness in identifying patients who would be appropriate candidates for intensive anticoagulation therapy.
Oedema in Chronic Venous Insufficiency: Physiopathology and Investigation
Authors: Allegra C. , Carlizza A.
Published: January 2017

Aim:

To review the physiology of the venous system in the leg and the events in the microcirculation of the skin leading to development of the symptoms of chronic venous insufficiency (CVI).

Method:

A review of current literature in the field of CVI has been conducted, with particular reference to the microcirculation and the means of investigating this.

Synthesis:

Venous valvular incompetence and obstruction in the lower limb causes damage to the microcirculation of the skin. The resulting venous hypertension is resisted by the microcirculation. Cutaneous vasomotion alters, with a prevalence of closing periods of the pre-capillary sphincters, limiting capillary hypertension and resulting in capillary haemoconcentration. This phenomenon promotes drainage of fluids from the interstitial spaces and prevents hypoxic damage to the endothelium. In severe CVI this defence mechanism is overwhelmed, vasomotion declines and arteriolar vasoparalysis occurs. The capillary bed is filled and the intracapillary pressure increases. Reduced microcircula-tory perfusion flow velocity favours capillary plugging by white cells. Leucocyte activation damages the endothelium through the release of proteolytic enzymes, oxygen metabolites and lipid oxidation products. Increased permeability of the endothelium allows passage of fibrinogen and results in a perivascular fibrin cuff. Initially this protects the capillary but later blocks oxygen exchange. These events lead to capillary thrombosis with destruction of capillaries with tissue ischaemia and trophic lesions.

Conclusions:

The result of venous hypertension in the large veins of the lower limb is damage to the microcirculation of the skin. This leads to lipodermato-sclerosis and eventually ulceration in some patients.
Catheter-Directed Thrombolysis for the Treatment of Acute Iliofemoral Deep Venous Thombosis
Authors: Comerota A. J. , Kagan S. A.
Published: January 2017

Objective:

Acute iliofemoral deep venous thrombosis (DVT) is a serious venous thrombotic disorder with potentially morbid post-thrombotic sequelae. The purpose of this report is to present our single-centre evolution of technique and the results of catheter-directed thrombolysis for the treatment of acute iliofemoral DVT, and put it into perspective with current literature.

Patients and methods:

Between May 1988 and April 2000, 54 patients were treated with catheter-directed thrombolysis for occlusive iliofemoral and vena caval thrombosis. Average age was 45 years (range 17-68 years) and the duration of leg symptoms was 5.2 days (range 2-30 days). Routine vena caval filters were not used, although caval filters were inserted in patients with irregular and non-occlusive vena caval thrombus. Initially, urokinase infusion via a right jugular vein and/or contralateral femoral vein approach was used, delivering a 250000-500000 U bolus followed by continuous infusion of 250000-300000 LVh. Catheter delivery has evolved to an ultrasound-guided popliteal or posterior tibial vein puncture and the use of recombinant tissue plasminogen activator at a bolus dose of 4–8 mg followed by 2–4 mg/h. All patients received heparin infusion at 500-1000 U/h.

Results:

Fifty-one of the 54 patients had successful catheter positioning. Forty-five (83%) had a successful outcome. Of those that failed, 2 were treated with a known chronic occlusion and in 2 patients plasminogen deficiency was suspected. Two patients had persistent iliac vein lesions which led to early re-thrombosis. Overall, 14 (26%) were asymptomatic, 28 (52%) demonstrated moderate improvement, 6 (11%) showed mild improvement and 6 (11%) had no clinical improvement. Serious complications occurred in 5 patients (9%). Four (7%) required blood transfusion and 1 (2%) required operative evacuation of an inguinal haematoma with repair of the common femoral vein. Eight patients (15%) developed a puncture site haematoma and 1 patient (2%) had a guidewire perforation of the common femoral vein.

Conclusions:

Catheter-directed thrombolysis is the preferred treatment for symptomatic iliofemoral DVT. Following successful lysis, residual iliac vein lesions should be corrected with balloon angioplasty and stenting if necessary. Considering the current results and those of contemporary series, a successful outcome can be anticipated in 80-85% of patients, with a significant improvement in quality of life when compared with standard anticoagulation.
A Modern Leg Ulcer Service
Authors: Barwell J. R. , Deacon J. , Taylor M. , Wakely C. , Poskitt K. R. , Whyman M. R.
Published: January 2017

Aim:

To define the components and organization of a modern leg ulcer service that is acceptable to patients cost effective and produces high quality outcomes.

Method:

Analysis of data from published literature as well as experience from the organisation of a leg ulcer service in Gloucestershire.

Synthesis:

Assessment of leg ulcers requires the services of a vascular laboratory to assess the venous and arteria systems. Effective systems of compression must be employed. Staff and patients must be educated to understand the principals behind their use. For some patients pinch-grafting may be appropriate. Where arterial disease is present in the lower limb, reconstructive surgery should be used for the lower limb vessels The organisation of such a service must ensure good liaison between General Practitioners, community nurses and hospital specialists. Many patients may be managed in community leg ulcer clinics. In some cases, the advice of specialists such as rheumatologists and dermatologists may be required.

Conclusions:

A national framework for leg ulceir management is needed within which resources are made available in a way that satisfy local needs. Such a framework must be based on management protocols derived from evidence-based practices that have been developed through the experiences of modern leg ulcer services.
Patterns of Incompetence in Patients with Recurrent Varicose Veins: A Duplex Ultrasound Study
Authors: Farrah J. , Shami S. K.
Published: January 2017

Objectives:

To identify the patterns of venous incompetence in patients with recurrent varicose veins using duplex ultrasound scanning.

Setting:

Oldchurch District General Hospital, Southeast England.

Patients and methods:

836 patients (581 women, median age 51 years (range 22–86 years) and 255 men, median age 53 years (range 23–28 years) referred to the vascular laboratory for the assessment of recurrent varicose veins. Duplex ultrasonography was undertaken by an experienced operator to evaluate the venous system in the lower limbs. A total of 1254 limbs with recurrent varicose veins were studied.

Results:

Recurrent reflux was found at the sapheno-femoral (SFJ) or saphenopopliteal junction (SPJ) in 43% of cases. The source of recurrent varices was an unoperated SFJ or SPJ in 386 (31%) limbs. Thigh perforators accounted for varices in 16% of limbs.

Conclusion:

Nearly half of recurrences were attributable to inadequate surgical treatment at the initial operation or possible angiogenesis. Nearly a third of recurrences originated at previously unoperated sites, confirming a need for objective venous assessment before recurrent varicose vein surgery.
Surgical Treatment of Iliofemoral Venous Thrombosis
Authors: Eklöf Bo , Einarsson Eibert , Endrys Jiri , Plate Gunnar , Néglen Peter
Published: January 2017

The objectives of treatment in iliofemoral venous thrombosis are to prevent fatal pulmonary embolism, further swelling of the leg with development of phlegmasia caerulea dolens and the severe post-thrombotic syndrome, by preservation of venous patency and normal valves. The experience of thrombectomy and temporary AVF are presented in 155 patients where technical details of management are emphasized. A new technique with percutaneous closure of the AVF after six weeks is described. No patient died due to fatal pulmonary embolism during or immediately after surgery. In a randomized study comparing surgery with conventional anticoagulant treatment follow-up venography of the iliofemoral segment demonstrated excellent results in 76% of the operated group and 36% in the conservatively treated group, while venography of the femoropopliteal segment revealed an occlusion in about one-third of the patients in both groups. Of the patients who had an open femoropopliteal segment it was noted that 52% in the surgical group and 26% in the conservative group had preserved valves with no reflux.
A Reassessment of the Role of Perforating Veins in Chronic Venous Insufficiency
Authors: McMullin G.M. , Scott H.J. , Smith P.D. Coleridge , Scurr J.H.
Published: January 2017

Ambulatory venous hypertension is closely associated with the signs and symptoms of venous disease. It has been shown that reverse flow of blood in the superficial and deep veins is responsible. The pressure derangement caused by incompetence of perforating veins has not been established. The present study documents the pressure disturbances caused by incompetence in each of the three compartments of the venous system, the deep, the superficial and the perforating veins. In total 90 limbs of 49 patients with chronic venous insufficiency were examined and classified by duplex scanning and ascending venography. Ambulatory venous pressure measurements were performed on all 90 limbs and a venous sufficiency index (VSI) for each limb calculated from the percentage drop in pressure and refilling time. VSI was lowest in the group with deep vein incompetence (median 0.9, range 0–36.9), intermediate in the groups with superficial vein incompetence (median 7.6, range 0.4–59) and with incompetent perforating veins (median 14.6, range 0.4–35.7) and highest in the group with normal veins (median 41.7, range 3.5–87.5). The association of symptoms and VSI was also examined. The lower the VSI the more severe were the clinical symptoms and all ulcerated limbs had a VSI < 20. However a number of clinically normal limbs were also found to have low values of VSI.
Which Vein Stripper, Metal or Plastic Disposable?
Authors: Corbett C.R.R. , Harries W.J.
Published: January 2017

When stripping the long saphenous vein it is recommended that the stripper be passed from the groin downwards. If the stripper is passed from below the knee upwards, there is a possibility of it entering the deep veins. Cases are recorded of the consequent, inadvertent, stripping of the deep veins. Plastic ‘single use’ disposable strippers may be easier to handle than metal strippers and perhaps easier to pass against the valves.

A prospective randomized trial was carried out in 80 limbs to compare the performance of plastic and metal strippers. In 37 of 40 limbs the metal stripper could be passed from the groin to below the knee and in 36 of 40 limbs the plastic stripper could also be passed in this way. Hence a stripper could be passed downwards in 73 of 80 (91%) limbs. However, the plastic strippers passed more quickly to below the knee, in a mean time of 24 s compared with 36 s for the metal strippers (Wilcoxon's test, P = 0.03). Against this is the cost of £8.00 for a pair of plastic disposable strippers.
Plication of the Sapheno–Femoral Junction: Effects on Incompetence after Two Years
Authors: Belcaro Giovanni V.
Published: January 2017

Plication of the long saphenous vein at the sapheno–femoral junction (SFJ) is an alternative to flush ligation and stripping. This technique abolishes reflux at the SFJ without altering the vein; this may then be used for arterial surgery or coronary artery grafting. Candidates for plication were selected on the basis of ambulatory venous pressure measurements and duplex scanning. These tests indicate and quantify the degree of superficial venous incompetence. Plication of the SFJ reduces the calibre of the vein to 60–70% for a length of 1.5 cm, allowing the value cusps to close when flow in the femoral vein is reversed. In this study 20 limbs were evaluated (in 20 patients) 6, 12 and 24 months after plication. Venous reflux was significantly reduced and there was an improvement in signs and symptoms.

Thus, SFJ plication seems to be an effective physiological alternative to flush ligation in some subjects. However, long-term results (> 5 years) must be still evaluated.
The Efficacy of Fibrinolytic Enhancement with Stanozolol in the Treatment of Venous Insufficiency
Authors: McMullin G.M. , Watkin G.T. , Smith P.D. Coleridge , Scurr J.H.
Published: January 2017

Pericapillary fibrin cuffs have been demonstrated in patients with chronic venous insufficiency. It has been suggested that this fibrin deposition is responsible for an oxygen diffusion block, leading to local hypoxia and resulting in ulceration. Fibrinolysis is depressed in patients with venous insufficiency and therefore pharmacological enhancement of this factor might be expected to produce clinical improvement. A total of 60 patients with lipodermatosclerosis were entered into a prospective, double-blind, placebo-controlled, randomized trial. Stanozolol 5 mg or a placebo tablet was given twice daily for a period of 6 months. All patients were supplied with below knee German/Swiss specification class 2 compression stockings. The area of lipodermatosclerosis was measured at monthly intervals and transcutaneous oxygen tension within the liposclerotic area was measured at 3-monthly intervals. The control group showed a mean reduction in area of lipodermatosclerosis of 14% (95% confidence interval −2.6%−31%) compared with a 28% reduction in area in the active treatment group (95% confidence interval 5.3%–46%; P < 0.007). Transcutaneous oxygen measurements showed no change in either group. Side-effects were significantly more common in the active treatment group ( P < 0.002 χ2). Though fibrinolytic enhancement caused a reduction in the area of lipodermatosclerosis, no evidence of any effect on a possible oxygen diffusion block was demonstrated.
Late Results after Thrombectomy for Ilio-Femoral Venous Thrombosis
Authors: Törngren Staffan , Bremme Katarina , Hjertberg Ragnhild , Swedenborg Jesper
Published: January 2017

Sixty-three of 68 patients who underwent thrombectomy with a temporary arteriovenous fistula for ilio-femoral venous thrombosis were followed-up after a mean time of 66 months (range 15–130). Fifty-four were women with a mean age of 29 years (range 13–66). A primary successful operation was performed in 54 patients (86%); at 16 months 34 (54%) were judged to have a patent ilac vein. At long-term follow-up 23 patients had no symptoms, 17 had leg swelling, venous claudication and/or present or previous ulcer while 23 had leg swelling only. Fourteen (22%) had noticed a decreased capacity to perform their job and 21 (33%) had to compensate daily for the discomfort of the diseased leg. Recurrent thrombotic disease occurred in eight patients and did not seem to be associated with symptoms at follow-up. The results of the operated patients seem to be favourable compared to other reports of conservative treatment, especially for fertile women and with a reduced risk of future venous insufficiency. In young patients with a long life expectancy this is particularly important.
Non-Invasive Measurement of Venous Muscle Pump Function in the Supine Position
Authors: van Gerwen H. J. L. , Brakkee A. J. M. , Kuiper J. P.
Published: January 2017

Objective:

A new non-invasive procedure for testing venous muscle pump function in the horizontal position is presented.

Design:

The test is based on an indirect method we use for measuring ambulatory venous pressure by means of strain-gauge plethysmography.

Setting:

University Hospital Nijmegen, The Netherlands.

Patients:

The results of 28 limbs of 20 patients with deep venous insufficiency are compared with 32 limbs of 16 healthy volunteers.

Interventions:

The same test is performed in all patients and volunteers: in the supine position a raised venous pressure in the limb is induced by venous congestion. The reduction in venous volume after standardized leg movements is measured by strain-gauge plethysmography and, with an additionally obtained pressure-volume relation, this volume reduction is converted into a pressure reduction.

Main outcome measure:

The reduction by standardized leg movements of an increased venous pressure is a measure for calf muscle pump function.

Results:

The mean pressure reduction in the patient group was 47% (standard deviation (SD) = 8%), in the healthy group 77% (SD = 6%).

Conclusions:

The new ‘supine venous pump function test’ is a promising method for measuring the function of the deep veins. Since the whole procedure is performed in the horizontal positon, the method offers several important advantages.
Gravitational Reflux Does Not Correlate with Clinical Status of Venous Stasis
Authors: Moulton S. , Bergan J. J. , Beeman S. , Poppiti R.
Published: January 2017

Objective:

To quantify venous reflux by a standard duplex ultrasound technique and correlate the data obtained with clinical grades of severity of venous disease.

Design:

A prospective study in a single group of patients with venous insufficiency.

Setting:

Private practice in secondary and tertiary care.

Patients:

133 inpatients undergoing investigation for venous disease. Patients with known venous obstruction, arterio-venous malformations or lymphoedema were excluded from the study.

Main outcome measures:

Duplex ultrasound scanning was performed to measure the cross-sectional area, severity and duration of venous reflux following calf compression using a standardized technique.

Results:

Clinical classification assigned to each limb correlated with the presence of venous reflux, but not the quantity, velocity or duration of reflux in the veins studied. Presence of reflux and diameter of the vein studied correlated ( p<0.001) in all the veins except the popliteal vein ( p > 0.03).

Conclusion:

Quantification of venous reflux obtained by cuff deflation does not correlate with clinical severity of venous stasis, but does detect reflux accurately. This allowed greater saphenous sparing in nine limbs in 41 patients but proved the need for saphenous removal in seven limbs not previously suspected clinically of requiring this procedure.
Surgical Options in Post-Thrombotic Syndrome
Authors: Cheatle T. R. , Perrin M.
Published: January 2017

Objective:

To review the outcome of surgical restoration of deep vein competence in 53 patients with post-thrombotic syndrome.

Design:

Single patient group.

Setting:

Unite de Pathologie Vasculaire Jean Kunlin, Clinique du Grand-Large, av. Leon-Blum, Decines Charpieu, France.

Patients:

Fifty-three patients with clinical and radiological evidence of post-thrombotic syndrome uncontrolled by conventional conservative treatment.

Interventions:

Surgical restoration of deep vein competence by one of four methods: valvuloplasty, vein transplantation, vein transposition, or Psathakis' sling procedure.

Main outcome measures:

Sustained ulcer healing, photoplethysmography (PPG) refilling times, abolition of venous reflux on duplex scanning, symptomatic improvement.

Results:

All four techniques led to sustained ulcer healing in approximately two-thirds of patients. There was a poor correlation between maintenance of ulcer healing and improvement in PPG refilling times or abolition of reflux on duplex ultrasound.
Maternal and Fetal Haemodynamics during Late Pregnancy: Effect of Compression Hosiery Treatment
Authors: Austrell C. , Nilsson L. , Norgren L.
Published: January 2017

Objective:

To study the effect of graduated compression on maternal and fetal haemodynamics.

Design:

Measurement of maternal and fetal heart rate and uterine artery flow velocity ( Vmax) in supine and standing positions with and without graduated compression hosiery (25 mmHg at the ankle).

Setting:

Department of Surgery, Lund University, S-22185 Lund, Sweden.

Patients:

Eighteen women in gestational week 32–38.

Results:

An increase in heart rate on standing was recorded for both mother and fetus. Graduated compression stockings decreased these changes. Cyclic heart rate changes were not frequent. Uterine artery flow velocity did not change during change of posture or after compression.

Conclusion:

The utero-vascular syndrome was not common in the patients studied. Graduated compression reduced the vascular response to standing, measured as an increase of heart frequency at standing.
Failure of Angioscopically Guided Sclerotherapy to Permanently Obliterate Greater Saphenous Varicosity
Authors: Biegeleisen K. , Nielsen R. D.
Published: January 2017

Objective:

To assess the long-term outcome of sclerotherapy.

Design:

Single group study of patients with incompetence of the long saphenous vein.

Setting:

All treatments were performed in a private office setting.

Patients:

Sixteen patients with untreated varicosities limited to the greater saphenous vein, which was 10 mm in diameter at the saphenofemoral junction in all cases.

Interventions:

Angioscopically guided sclerosis of the long saphenous vein.

Main outcome measures:

Colour-flow ultrasound was used to establish the presence of residual reflux after angioscopic treatment.

Results:

Total obliteration of saphenofemoral reflux was obtained in 12 veins with angioscopic sclerotherapy. All veins on which follow-up was available (nine veins in seven patients) had undergone substantial recanalization by 12 months after treatment.

Conclusion:

Angioscopically controlled sclerotherapy effectively obliterates the saphenophemoral junction. Recanalization of the sclerosed segment of vein occurs invariably within 12 months of treatment.
Relationship between Venous and Arterial Haemodynamics during Postural Changes in Venous Insufficiency
Authors: Duprez D. , De Buyzere M. , Randon C. , Dad M. , Clement D. L.
Published: January 2017

Objective:

To study the changes in central haemodynamics and the relationship between arterial blood pressure and the venous dynamics of the lower limbs in patients with venous insufficiency.

Design:

Prospective haemodynamic study during postural changes in 14 patients with venous insufficiency with no other concomitant cardiovascular disease or disturbances in autonomic nervous system.

Setting:

Department of Cardiology and Angiology, University Hospital, Gent, Belgium.

Patients:

Fourteen patients with venous valve insufficiency in the lower limbs.

Interventions:

Measurements of arterial blood pressure, heart rate, stroke volume and cardiac output were performed in the supine position after 30 min rest and 5, 15 and 30 min after standing and during the recovery. Venous pressure at the ankle and calf circumference were also measured.

Main outcome measures:

Changes in cardiac output and total peripheral vascular resistance in order to maintain blood pressure during postural changes.

Results:

Arterial blood pressure was maintained constant owing to an increase in total peripheral vascular resistance despite a decrease in cardiac output. Venous pressure is also related to arterial blood pressure.

Conclusions:

The arterial and venous systems, even in venous insufficiency, are integrated to maintain blood pressure constant during postural changes.
Air Plethysmography in the Detection of Suspected Acute Deep Vein Thrombosis
Authors: Labropoulos N. , Volteas N. , Leon M. , Volteas S. K. , Nicolaides A. N.
Published: January 2017

Aim:

To test the value of outflow fraction using air plethysmography (APG) in the detection of suspected acute deep vein thrombosis (DVT) extending proximal to the calf.

Design:

Prospective study in patients and normal volunteers.

Setting:

Academic Surgical Unit and Vascular Unit, St Mary's Hospital Medical School, London, UK.

Material and methods:

We prospectively examined 152 lower extremities of 150 patients with clinical suspicion of DVT. Patients were examined by APG (outflow fraction) and either ascending venography or colour flow duplex imaging (CFDI) as gold standards to establish the diagnosis. The reproducibility of outflow fraction was tested in two normal volunteers and was shown to have coefficients of variation of 6.1% and 8.2%, respectively.

Results:

On venography or CFDI, DVT was detected in 96 limbs. Proximal DVT was seen in 74; it was confined to the calf in 22. APG was 95% sensitive, 95% specific and 95% accurate in detecting proximal DVT whereas it was 45% sensitive, 95% specific and 81% accurate for calf DVT.

Conclusions:

Using air plethysmography, the outflow fraction is a highly reproducible and accurate measurement in detecting DVT proximal to the calf. The high positive predictive value means that if the test is positive, treatment can start immediately; if it is negative, duplex scanning is necessary to exclude proximal partially occluded thrombi or calf DVT.
Pharmacology of Oedema Protective Drugs
Authors: Markwardt F.
Published: January 2017

Objective:

To review the drugs used in the treatment of chronic venous diseases of the lower limb.

Data sources:

Published papers referring to the pharmacology of drugs used in the management of chronic venous insufficiency and varicose veins of the lower limb.

Study selection:

Sixty-four papers referring to the use of horse chestnut extract (aescin), flavonoids, tribnoside and calcium dobesilate have been included.

Data extraction:

Papers were examined to establish the mechanism of action of ‘oedema protective’ drugs.

Data synthesis:

Oedema protective drugs modify the permeability of the microcirculatory endothelium in animal models of oedema and probably in patients with venous disease to reduce transcapillary loss of fluid into the tissues. The exact mechanisms of action remain unclear.

Conclusion:

Animal and clinical studies demonstrate that drugs of the four types included in this review moderate the development of tissue oedema.
Edinburgh Vein Study: Methods and Response in a Survey of Venous Disease in the General Population
Authors: Evans C J. , Fowkes F. G. R. , Ruckley C. V. , Allan P. L. , Carson M. N. , Kerracher E. M. G. , Lee A. J.
Published: January 2017

Objective:

To describe the methods required to conduct a large epidemiological study of venous disease in the general population, and the resulting response.

Design:

Cross-sectional study.

Setting:

University of Edinburgh.

Participants:

Men and women aged 18–64 years, randomly selected from general practice registers.

Methods:

Subjects were invited for the following procedures: questionnaire, height and weight measurement, classification of varices and chronic venous insufficiency, duplex measurement of duration of venous reflux and venous blood sampling. A questionnaire survey of non-responders was carried out.

Results of response:

A total of 1566 subjects attended, a final response rate of 53.8%. The response rate increased with age. The distribution of ethnic origin and social class of attenders was similar to that of the general Edinburgh population. Study participants were generally older, from more affluent areas and more often female than non-responders ( p ≤ 0.001).

Conclusions:

Large epidemiological studies of venous disease in the community are feasible but the level of response illustrates the importance of obtaining information on the disease status of non-responders.
Expression and Distribution of Laminin, Fibronectin and Tenascin is Stage Dependently Modulated in the Skin of Chronic Venous Insufficiency
Authors: Peschen M. , Schild A. , Brand-Saberi B. , Rogers A. A. , Augustin M. , Schöpf E. , Vanscheidt W.
Published: January 2017

Objective:

The regulation of tissue remodelling is a function of extracellular matrix (ECM) deposition. Our aim was to determine the expression and distribution pattern of the ECM proteins laminin, fibronectin and tenascin in all stages of chronic venous insufficiency (CVI) from telangiectases to ulceration.

Methods:

In punch biopsies of 25 patients with various stages of CVI and five healthy volunteers, ECM proteins were stained using indirect immunofluroescence. The staining pattern in the affected skin was evaluated by two independent, double-blinded investigators by microscopic examination.

Results:

In specimens of healthy skin or skin with telangiectases or pigmentation, a faint and partly inhomogeneous ECM staining pattern was detected in the upper dermis. In venous eczema, lipodermatosclerosis and venous leg ulcers, an increased expression and a wide-meshed distribution pattern throughout the dermis was observed for laminin, fibronectin and tenascin. Fragmentation of ECM components was first observed in venous eczema, persisting in the more severe stages of CVI. Laminin staining revealed unusual streak-like distributions in the papillary dermis, pronounced in Pigmentation and lipodermatosclerosis and diminished in leg ulcers.

Conclusions:

Our results indicate an important role of laminin, fibronectin and tenascin, and in particular of their proteolytic fragments, in the early phases of CVI, such as venous eczema, by creating permissive environments for cell migration and differentiation, essential for wound healing.