bluuebunny/crossref_metadata_2025 huggingface dataset:
Neoadjuvant imatinib in patients with locally advanced non metastatic GIST in the prospective BFR14 trial
Authors: Blesius Aurore , Cassier Philippe A , Bertucci François , Fayette Jerome , Ray-Coquard Isabelle , Bui Binh , Adenis Antoine , Rios Maria , Cupissol Didier , Pérol David , Blay Jean-Yves , Le Cesne Axel
Published: February 2011

Background

The role of surgery in the management of patients with advanced gastrointestinal stromal tumors (GIST) in the era of imatinib mesylate (IM) remains debated. We analyzed the outcome of patients with non metastatic locally advanced primary GIST treated with IM within the prospective BFR14 phase III trial.

Methods

The database of the BFR14 trial was searched for patients with no metastasis at time of inclusion. Patients treated for recurrent disease were excluded. Twenty-five of 434 patients met these criteria.

Results

Fifteen of 25 patients (60%) had a partial response to IM. Nine of the 25 patients (36%) underwent surgical resection of their primary tumor after a median of 7.3 months of IM treatment (range 3.4-12.0). Per protocol patients received continuous IM treatment in the post resection period, in an adjuvant setting. With a median follow-up of 53.5 months, there was a significant improvement in progression-free survival (PFS) and overall survival (OS) for patients who underwent surgical resection versus those who did not (median not reached vs 23.6 months, p = 0.0318 for PFS and median not reached vs 42.2 months, p = 0.0217 for OS). In the group of patients who underwent resection followed by IM, the 3-year PFS and OS rates were 67% and 89% respectively

Conclusions

Following neoadjuvant IM for non metastatic locally advanced GIST 9 of 25 patients (36%) were selected for resection of the primary tumor. OS and PFS figures were close to those of localised intermediate or high risk GIST (70% at 5 years) in the subgroup of operated patients, while the outcome of the non-operated subgroup was similar to that of metastatic GIST.
Room temperature spin diffusion in (110) GaAs/AlGaAs quantum wells
Authors: Hu Changcheng , Ye Huiqi , Wang Gang , Tian Haitao , Wang Wenxin , Wang Wenquan , Liu Baoli , Marie Xavier
Published: February 2011

Transient spin grating experiments are used to investigate the electron spin diffusion in intrinsic (110) GaAs/AlGaAs multiple quantum well at room temperature. The measured spin diffusion length of optically excited electrons is about 4 μm at low spin density. Increasing the carrier density yields both a decrease of the spin relaxation time and the spin diffusion coefficient Ds.
Investigation of cracks in GaN films grown by combined hydride and metal organic vapor-phase epitaxial method
Authors: Liu Jianming , Liu Xianlin , Li Chengming , Wei Hongyuan , Guo Yan , Jiao Chunmei , Li Zhiwei , Xu Xiaoqing , Song Huaping , Yang Shaoyan , Zhu Qinsen , Wang Zhanguo , Yang Anli , Yang Tieying , Wang Huanhua
Published: February 2011

Cracks appeared in GaN epitaxial layers which were grown by a novel method combining metal organic vapor-phase epitaxy (MOCVD) and hydride vapor-phase epitaxy (HVPE) in one chamber. The origin of cracks in a 22-μm thick GaN film was fully investigated by high-resolution X-ray diffraction (XRD), micro-Raman spectra, and scanning electron microscopy (SEM). Many cracks under the surface were first observed by SEM after etching for 10 min. By investigating the cross section of the sample with high-resolution micro-Raman spectra, the distribution of the stress along the depth was determined. From the interface of the film/substrate to the top surface of the film, several turnings were found. A large compressive stress existed at the interface. The stress went down as the detecting area was moved up from the interface to the overlayer, and it was maintained at a large value for a long depth area. Then it went down again, and it finally increased near the top surface. The cross-section of the film was observed after cleaving and etching for 2 min. It was found that the crystal quality of the healed part was nearly the same as the uncracked region. This indicated that cracking occurred in the growth, when the tensile stress accumulated and reached the critical value. Moreover, the cracks would heal because of high lateral growth rate.
Long-Term Nucleos(t)ide Analogues Therapy for Adults With Chronic Hepatitis B reduces the Risk of Long-Term Complications: a meta-analysis
Authors: Zhang Qin-Qin , An Xuan , Liu Ying-Hong , Li Shi-Ying , Zhong Qing , Wang Jing , Hu Huai-Dong , Zhang Da-Zhi , Ren Hong , Hu Peng
Published: February 2011

Background

The effect of antiviral therapy in chronic hepatitis B (CHB) on reducing the risk of long-term complications (LTCs) remains unclear so far. To study whether long-term nucleos(t)ide analogues therapy can reduce the risk of long-term complications.

Methods

We searched MEDLINE, EMBASE, OVID, the Cochrane Central Register of Controlled Trials. Relative risks (RRs) of long-term complications with or without treatment were studied. Also subgroup analyses including the status of drug-resistance, HBeAg and pre-existing compensated cirrhosis were done using relative risks of long-term complications either with or without treatment or among nucleos(t)ide analogues treatment groups.

Results

Six eligible studies (3644 patients in all) were included. Data showed the incidence of long-term complications in treatment groups was induced by 74%(RR:0.26, 95% CI: 0.15-0.47) compared with no treatment. Whether drug-resistant happened or not during the long-term therapy, the incidence of long-term complications was still significantly induced respectively by 45%(RR: 0.55,95%CI:0.40-0.76) and 78% (RR:0.22, 95%CI: 0.13-0.36). For both different status of HBeAg and pre-existing compensated cirrhosis, there was significant lower incidence of long-term complications in treatment groups compared with no treatment, too. Moreover, among the NA treatment groups, patients with drug-resistance had 2.64 times (RR:2.64, 95%CI: 1.58-4.41) higher chance of developing to long-term complications, and patients with pre-existing compensated cirrhosis also had 3.07 times (RR:3.07, 95%CI: 1.04-9.11) higher chance of developing to long-term complications.

Conclusions

Long-term nucleos(t)ide analogue therapy for adults with CHB prevents or delays the development of long-term complications including decompensated cirrhosis, CHB-related death or CHB-related HCC in patients with CHB. The patients who need take antiviral drugs should receive the antiviral therapy as soon as possible.
Maternal Ghrelin Deficiency Compromises Reproduction in Female Progeny through Altered Uterine Developmental Programming
Authors: Martin J. Ryan , Lieber Sarah B. , McGrath James , Shanabrough Marya , Horvath Tamas L. , Taylor Hugh S.
Published: February 2011

Ghrelin has a well-known role in the regulation of appetite, satiety, energy metabolism, and reproduction; however ghrelin has not been implicated in reproductive tract development. We examined the effect of ghrelin deficiency on the developmental programming of female fertility. We observed that female wild-type mice born of ghrelin heterozygote dams (i.e. exposed in utero to ghrelin deficiency) had diminished fertility and produced smaller litters. We demonstrate that exposure to in utero ghrelin deficiency led to altered developmental programming of the reproductive tract. The number of ovarian follicles, corpora lutea, and embryos produced were identical in both exposed and unexposed mice. However wild-type embryos transferred to uteri of mice exposed to in utero ghrelin deficiency had a 60% reduction in the rate of embryo implantation compared with those transferred to wild-type unexposed uteri. We identified significant alterations in the uterine expression of four genes critical for implantation and a defect in uterine endometrial proliferation. Taken together, these results demonstrate that the mechanism of subfertility was abnormal endometrial function. In utero exposure to decreased levels of ghrelin led to defects in developmental programming of the uterus and subsequent subfertility in wild-type offspring.
Experimental myocardial infarction triggers canonical Wnt signaling and endothelial-to-mesenchymal transition
Authors: Aisagbonhi Omonigho , Rai Meena , Ryzhov Sergey , Atria Nick , Feoktistov Igor , Hatzopoulos Antonis K.
Published: February 2011

Despite available therapies, myocardial infarction (MI) remains a leading cause of death worldwide. Better understanding of the molecular and cellular mechanisms that regulate cardiac repair should help to improve the clinical outcome of MI patients. Using the reporter mouse line TOPGAL, we show that canonical (β-catenin-dependent) Wnt signaling is induced 4 days after experimental MI in subepicardial endothelial cells and perivascular smooth muscle actin (SMA)-positive (SMA+) cells. At 1 week after ischemic injury, a large number of canonical-Wnt-positive cells accumulated in the infarct area during granulation tissue formation. Coincidently with canonical Wnt activation, endothelial-to-mesenchymal transition (EndMT) was also triggered after MI. Using cell lineage tracing, we show that a significant portion of the canonical-Wnt-marked SMA+ mesenchymal cells is derived from endothelial cells. Canonical Wnt signaling induces mesenchymal characteristics in cultured endothelial cells, suggesting a direct role in EndMT. In conclusion, our study demonstrates that canonical Wnt activation and EndMT are molecular and cellular responses to MI and that canonical Wnt signaling activity is a characteristic property of EndMT-derived mesenchymal cells that take part in cardiac tissue repair after MI. These findings could lead to new strategies to improve the course of cardiac repair by temporal and cell-type-specific manipulation of canonical Wnt signaling.
The role of the N-terminal domain in dimerization and nucleocytoplasmic shuttling of latent STAT3
Authors: Vogt Michael , Domoszlai Tamas , Kleshchanok Dzina , Lehmann Swen , Schmitt Anne , Poli Valeria , Richtering Walter , Müller-Newen Gerhard
Published: February 2011

STAT3 is an important transcription factor involved in immunity and cancer. In response to cytokine stimulation, STAT3 becomes phosphorylated on a single tyrosine residue. Tyrosine-phosphorylated STAT3 accumulates in the nucleus, binds to specific DNA response elements and induces gene expression. Unphosphorylated, latent STAT3 shuttles constitutively between cytoplasm and nucleus. We analysed the importance of previously identified putative nuclear localization sequences (NLS) and nuclear export sequences (NES) for nucleocytoplasmic shuttling of latent STAT3 using STAT3-deficient cells reconstituted with fluorescently labelled STAT3 mutants. Mutation of a putative NLS or NES sequence did not impair nucleocytoplasmic shuttling of latent STAT3. We were also interested in the structural requirements for dimerization of unphosphorylated STAT3 and its relevance for nucleocytoplasmic shuttling. By native gel electrophoresis and dual-focus fluorescence correlation spectroscopy (2f-FCS) we identified the N-terminal domain (amino acids 1–125) to be essential for formation of unphosphorylated STAT3 dimers but not for assembly of tyrosine-phosphorylated STAT3 dimers. In resting cells, the monomeric N-terminal deletion mutant (STAT3-ΔNT) shuttles faster between the cytoplasm and nucleus than the wild-type STAT3, indicating that dimer formation is not required for nucleocytoplasmic shuttling of latent STAT3. STAT3-ΔNT becomes phosphorylated and dimerizes in response to interleukin-6 stimulation but, surprisingly, does not accumulate in the nucleus. These results highlight the importance of the N-terminal domain in the formation of unphosphorylated STAT3 dimers and nuclear accumulation of STAT3 upon phosphorylation.
Kindlin-2 regulates podocyte adhesion and fibronectin matrix deposition through interactions with phosphoinositides and integrins
Authors: Qu Hong , Tu Yizeng , Shi Xiaohua , Larjava Hannu , Saleem Moin A. , Shattil Sanford J. , Fukuda Koichi , Qin Jun , Kretzler Matthias , Wu Chuanyue
Published: February 2011

Kindlin-2 is a FERM and PH domain-containing integrin-binding protein that is emerging as an important regulator of integrin activation. How kindlin-2 functions in integrin activation, however, is not known. We report here that kindlin-2 interacts with multiple phosphoinositides, preferentially with phosphatidylinositol 3,4,5-trisphosphate. Although integrin-binding is essential for focal adhesion localization of kindlin-2, phosphoinositide-binding is not required for this process. Using biologically and clinically relevant glomerular podocytes as a model system, we show that integrin activation and dependent processes are tightly regulated by kindlin-2: depletion of kindlin-2 reduced integrin activation, matrix adhesion and fibronectin matrix deposition, whereas overexpression of kindlin-2 promoted these processes. Furthermore, we provide evidence showing that kindlin-2 is involved in phosphoinositide-3-kinase-mediated regulation of podocyte-matrix adhesion and fibronectin matrix deposition. Mechanistically, kindlin-2 promotes integrin activation and integrin-dependent processes through interacting with both integrins and phosphoinositides. TGF-β1, a mediator of progressive glomerular failure, markedly increased the level of kindlin-2 and fibronectin matrix deposition, and the latter process was reversed by depletion of kindlin-2. Our results reveal important functions of kindlin-2 in the regulation of podocyte-matrix adhesion and matrix deposition and shed new light on the mechanism whereby kindlin-2 functions in these processes.
Effect of Ultrasonography in the Assessment of Carotid Artery Stenosis
Authors: Salles-Cunha Sergio X. , Ascher Enrico , Hingorani Anil P. , Markevich Natalia , Schutzer Richard W. , Kallakuri Sreedhar , Yorkovich William , Hou Alexander
Published: February 2011

Although ultrasonography (US) advantageously portrays lumen and wall thickness, velocity criteria have been used primarily to interpret carotid artery stenosis. The relationship of US and velocity measurements was investigated.

Peak-systolic and end-diastolic velocities (PSV, EDV) increase exponentially as the lumen of the internal carotid artery narrows and the percent stenosis (%S) increases. We tested the consistency of the relationship between carotid velocities and US %S in two distinct data sets. One data set was used to obtain regression equations relating velocity parameters and %S based on US. Validation of these equations was conducted using a separate, independent data set. US measurements were classified in 12 %S intervals. PSV, EDV, the ratio of the internal carotid artery to the common carotid artery PSV, and %S were entered consecutively until 10 records for each %S interval were obtained. Regression equations obtained in the first data set were used to predict %S in the second data set. Predicted %S was then compared with actual US %S.

The highest correlation in the first data set ( r = .89) was between %S and the natural logarithm (ln) of PSV. This ln PSV -%S equation was then applied to a second data set of an additional 120 carotid duplex images. In the second data set, actual %S and PSV–predicted %S differed by > 10% in 38 cases (32%). When all velocity-%S regression equations were used for comparison, differences between actual and at least one velocity-predicted %S were > 10% in 19% of the arteries. Conversely, actual %S matched at least one prediction of %S based on velocity data in 81% of the cases.

US %S differed significantly from single velocity-based estimates of %S in at least one-third of the cases. On the other hand, four of five US measurements were confirmed by at least one velocity parameter. Emphasis on US, in addition to velocity data, is recommended for the interpretation of duplex US carotid examinations.
Role of Apoptosis and Proteolysis in the Pathogenesis of Iliac Artery Aneurysms
Authors: Jacob Theresa , Hingorani Anil , Ascher Enrico
Published: February 2011

The objective of this study was to investigate the role of inflammation, programmed cell death, its molecular modulators, and proteolysis in the pathogenesis of iliac artery aneurysms (IAAs). Nineteen IAA specimens were obtained from patients undergoing elective surgical repair. All were males with ages ranging from 55 to 85 years (mean 73 years). Controls were iliac arteries ( n = 6) retrieved from surgical patients without aneurysmal disease. Standard histochemical techniques were used to assess elastic lamellae fragmentation and inflammatory infiltrate in aneurysmal and normal tissues. Identification of different types of cells in the aneurysm wall and detection of death-promoting molecules, Fas, p53, perforin, apoptosis-mediating bcl-2 family proteins, apoptotic death substrate, and poly(adenosine diphosphate–ribose) polymerase were performed immunohistochemically. Apoptosis was detected by terminal deoxynucleotidyl transferase–mediated digoxigenin–deoxyuridine triphosphate nick end-labeling (TUNEL) assay and caspase activity. Proteolytic activity was determined by 10% gelatin gel zymography. There is a conspicuous disruption and fragmentation of elastic lamellae in IAAs compared with normal arteries. Increased gelatinolytic activity was observed at 92, 72, and 67 kDa in the aneurysmal tissues. There was a significant loss of vascular smooth muscle cells (VSMCs) in the IAA walls compared with normal arteries ( p < .02). Large numbers of inflammatory cells were observed in the IAA specimens ( p = .01). Only aneurysmal arteries showed CD8+ T cells expressing death-promoting molecules. CD3+, CD8+, CD20+, CD30+, and CD68+ immunoreactive cells were significantly more prominent in the aneurysmal tissues than in the control arteries. There was a significant increase in the number of cells undergoing apoptosis in aneurysmal tissue than in the normal vessels ( p < .02), as well as in the expression of bax, p53, CPP-32, and Fas. Apoptotic cells and proapoptotic molecules predominantly localized to the inflammatory infiltrate. VSMC apoptosis was significant in IAAs. The data confirm the architectural disruption of the IAA wall and illustrate an apparent biologic response involving inflammatory infiltrate, apoptosis, and signaling molecules capable of initiating cell death. In addition to compromising the mechanical integrity of the vessel wall, VSMC loss may contribute to imbalance in the protein profile, accelerating extracellular matrix degradation that could favor IAA development.
Distal Peripheral Microembolism
Authors: Chauvapun Joe P. , Dryjski Maciej
Published: February 2011

Distal peripheral microembolism is caused by embolization of atherosclerotic debris into small arteries and arterioles. The recent advances in endovascular technique have been met with a gradual increase in the incidence of iatrogenic atheroembolism. This review seeks to explore the nature of distal peripheral microembolism, pathophysiology, and the management options, with a focus on iatrogenic distal peripheral microembolism.
Arterial Reconstruction after Mangled Extremity: Injury Severity Scoring Systems Are Not Predictive of Limb Salvage
Authors: Elsharawy Mohamed Amin
Published: February 2011

The Vascular Unit at Suez Canal University Hospital in Egypt covers a wide area with high rates of severe injuries. This is a prospective study of mangled extremities to identify risk factors associated with limb loss in these patients.

Between December 2000 and August 2003, a prospective study on all patients with arterial injuries in mangled extremities was undertaken. All patients were scored using the Mangled Extremity Severity Score (MESS) and the Mangled Extremity Severity Index (MESI).

During this period, arterial reconstruction was performed in 62 patients. Primary patency, secondary patency, and limb salvage rates were 81%, 85.5%, and 93.5%, respectively. The only factor affecting limb salvage (statistical trend) was the site of trauma (upper limb 100% vs lower limb 89%; p = .08%). There was no significant effect related to the mechanism of trauma (blunt 90% vs stab 100%; p = .125), MESS (< 7, 100% vs > 7, 91%; p = .22), and MESI (< 20, 100% vs > 20, 90.5%; p = .154).

Upper limb injuries were the least likely to lead to amputation. We recommend that all injuries, whatever their score, should be surgically explored before treatment decisions are made.
Total Laparoscopic Aortofemoral Bypass as a Routine Procedure for the Treatment of Aortoiliac Occlusive Disease
Authors: Lin Judith C. , Kolvenbach Ralf , Schwierz Elisabeth , Wassiljew Sergej
Published: February 2011

The purpose of our study was to evaluate whether total laparoscopic aortofemoral bypass can be performed routinely in patients who require surgical intervention for aortoiliac occlusive disease. In a prospective study, 68 consecutive patients underwent total laparoscopic aortofemoral bypass between 2002 and 2004. Among these patients, there were 50 men and 18 women, with a mean age of 68.4 ± 9 years. The mean operating time was 199 minutes, with a mean aortic cross-clamp time of 85.8 minutes. There were five major complications (7.3%). The mean postoperative hospital stay was 6.3 days. Most of the younger patients could be discharged on the third or fourth postoperative day. Our results show that total laparoscopic aortic surgery can be offered as a routine procedure to the majority of patients with long-segment aortoiliac occlusive disease.
Redefining the Role of Arterial Imaging in the Management of Penetrating Zone 3 Neck Injuries
Authors: Ferguson Eric , Dennis James W. , Vu Jonathan H. , Frykberg Eric R.
Published: February 2011

The purpose of this study was to assess the role of arteriography (AG) in the diagnosis and treatment of vascular trauma in patients with zone 3 penetrating neck injuries. The records of all cases of penetrating neck trauma for the past 14 years at a level 1 trauma center were reviewed retrospectively.

Eight hundred forty-four penetrating neck injuries were documented, of which 72 (8.5%) traversed zone 3 of the neck (gunshot, 35; stab, 32; shotgun, 5). Twenty patients (27%) had hard signs of vascular injury (hemorrhage, expanding hematoma, bruit, thrill, neurologic deficit). Twelve of these (60%) underwent immediate exploration, 1 had no significant injury, and 11 had successful surgical repair or ligation of the vascular injury. AG in the other eight patients with hard signs revealed injuries requiring embolization (three patients), urokinase infusion (one patient), and observation (three patients) and one normal examination.

Fifty-two patients had no hard signs of vascular injury. Twenty-four of these underwent AG, of which 18 were negative. Positive findings included internal carotid artery narrowings (two patients), external compression of the internal carotid artery (one patient), vertebral artery intimal flap (one patient), and nonbleeding injuries to small, noncritical arteries (two patients), none of which required treatment. Twenty-four of the remaining 28 patients were observed clinically, and 4 patients had negative explorations. Nine patients had ultrasonography performed, but these examinations did not yield any useful information.

The absence of hard signs reliably excludes surgically significant vascular injuries in penetrating zone 3 neck trauma, suggesting that AG is not necessary. Hard signs in stable patients should mandate AG because these vascular injuries may be amenable to endovascular therapy.
Screening Algorithm for Aortoiliac Occlusive Disease Using Duplex Ultrasonography–Acquired Velocity Spectra from the Distal External Iliac Artery
Authors: Fontcuberta Juan , Flores Angel , Langsfeld Mark , Orgaz Antonio , Cuena Rafael , Criado Enrique , Doblas Manuel
Published: February 2011

Aortoiliac duplex scanning can be difficult to perform owing to the deep location of these vessels. We propose a new method to indirectly screen for aortoiliac disease by performing duplex examination of the distal external iliac artery (DEIA). After performing a preliminary study on 21 patients, the parameters of the Doppler waveform that best distinguish normal from diseased arteries were the presence or absence of reverse flow, peak systolic velocity, and resistance index. These values were used in a derived equation, with the value Y ≥ 0.78 predicting normal proximal inflow. We then studied 118 aortoiliac segments in 81 consecutive patients with arteriography and DEIA duplex ultrasonography. To predict moderate to severe stenosis, duplex ultrasonography had a sensitivity of 95.7%, a specificity of 84.1%, a positive predictive value of 80%, and a negative predictive value of 96.8%. Our formula thus predicted significant disease in 55 of the 118 aortoiliac segments (47%), with these segments needing further arteriographic evaluation. The other 63 limbs can be safely considered as having normal aortoiliac inflow.

Our method accurately screens for aortoiliac disease and is excellent for predicting normal inflow. This information can be used to better plan the intraoperative diagnostic study and intervention.
Surveillance and Conservative Management of a Persistent Sciatic Artery Aneurysm
Authors: Forshaw Matthew J. , Abedin Asad , Wilson Patrick A. , Wilson Yvonne G.
Published: February 2011

A persistent sciatic artery aneurysm is a rare congenital vascular anomaly. Surgical intervention is reserved for symptomatic cases. The authors report the case of a 72-year-old woman who presented with thromboembolic occlusion of an aneurysmal persistent sciatic artery. Although initially symptomatic, she was managed expectantly with the aid of serial duplex sonographic imaging. The persistent sciatic artery subsequently thrombosed as a result of hypotension secondary to a myocardial infarction. No surgical intervention was required. The current literature on this condition is reviewed.
Coiling of the Brachial Artery: An Uncommon Cause of Difficult Thrombectomy
Authors: Ilijevski Nenad S. , Jagodic Sinisa , Sagic Dragan , Radak Djordje
Published: February 2011

Coiling (or looping) of the artery is a rare morphologic entity, most frequently described in the internal carotid artery. In other arteries, coiling is rarely reported because it remains asymptomatic and without clinical relevance unless inadvertently injured, as for diagnostic or monitoring purposes. We present a case of an unusually difficult thrombectomy of the brachial artery after occlusion following withdrawal of the arterial cannula placed for monitoring during cardiac surgery owing to coiling of the distal part of the artery, which produced the “spring-squeeze phenomenon” during balloon catheter thrombectomy.
Infections of the Aorta: Case Report and Review of Treatment
Authors: Lehner Shannon , Wittgen Catherine
Published: February 2011

Radiographic documentation of the rapid development of an aortic infection has not previously been reported. We report the case of a 68-year-old woman who presented with back pain. A computed tomographic(CT) scan documented a nondisplaced L1 compression fracture as well as an atherosclerotic but nonaneurysmal aorta. Two weeks after discharge, she developed left lower lobe pneumonia and was readmitted. A second CT scan was obtained because of continuous complaints of back pain. A contained rupture of the visceral aorta was now clearly visible. Emergent operation successfully repaired her aorta.

The microorganisms responsible for aortic infection have changed since the widespread use of antibiotics. Patterns of aortic involvement have also evolved. The difficulty in making these diagnoses, the role of current antibiotic therapy, and the surgical options for these infections will be discussed.
Adverse Events at the Aneurysmal Neck Identified at Follow-Up after Endovascular Abdominal Aortic Aneursym Repair: How Do They Correlate?
Authors: Leurs Lina J. , Stultiëns Guido , Kievit Jur , Buth Jaap ,   on behalf of the EUROSTAR Collaborators
Published: February 2011

The objective of this study was to assess the prevalence of and the correlation between dilatation of the infrarenal neck and proximal device migration after endovascular abdominal aortic aneurysm repair (EVAR). The analysis made use of the EUROSTAR registry.

Between 1994 and 2004, 4,233 patients with an abdominal aortic aneurysm larger than 4 cm underwent EVAR. Only patients with available follow-up data regarding neck size and device position were included in this assessment. Chi-square and t-tests or Wilcoxon rank sum tests were used for comparison of discrete and continuous variables, respectively. Time-dependent variables were evaluated by log-rank tests. In addition, multivariate analysis was performed to determine anatomic and operative variables with an independent correlation with neck growth and device migration, respectively. In addition, the association with proximal endoleak was assessed.

Neck dilatation and proximal migration were found in 1,342 (32%) and 192 (4.5%) of the 4,233 patients, respectively. One hundred twelve patients (2.5%) had neck dilatation and migration of the proximal device extremity. The correlation between proximal migration and neck dilatation was statistically significant ( p < .0001). Other independent variables for migration were a wider neck and aneurysmal diameter, shorter necks, proximal endoleak, and absence of suprarenal fixation. Neck dilatation was predicted by narrow necks, use of devices with suprarenal fixation, and larger device diameters. Proximal endoleak occurred in 136 (3.2%) patients and was significantly associated with shorter, angulated necks and proximal migration.

The present study documented that migration may be caused by neck dilatation. However, neck dilatation was not significantly promoted by proximal migration. Other factors, such as dimensions of the neck, the device fixation system, and perhaps progressive wall degeneration, are also likely to play a role in the pathogenesis of neck dilatation. To obtain good results from EVAR, accepted criteria of neck dimensions should be adhered to.
Utility of Basilic Vein Transposition for Dialysis Access
Authors: El Sayed Hosam F. , Mendoza Bernardo , Meier George H. , LeSar Christopher J. , DeMasi Richard J. , Glickman Marc H. , Gregory Roger T. , Parent F. Noel , Marcinczyk Michael J. , Gayle Robert G.
Published: February 2011

Autologous arteriovenous access is the key to long-term success with hemodialysis and is strongly supported by the National Kidney Foundation's Dialysis Outcomes Quality Initiative guidelines. Basilic vein transposition (BVT) fulfills the need for a durable conduit with high patency and maturation rates. This retrospective review examines a single group's experience with this procedure.

All patients undergoing BVT for hemodialysis with available follow-up data were reviewed. Telephone interviews were used to supplement clinical data where needed. Functional assisted patency was used as the end point for this procedure, and if the access was never used for dialysis, then the patency was considered zero. Secondary interventions performed while the access remained patent and in use were not considered detrimental to the patency reported.

One hundred seventy BVTs in 162 patients were performed between November 1992 and October 2001. There were 87 women (53.7%) and 112 black patients (69.1%); hypertension was present in 138 patients (85.2%) and diabetes in 89 patients (54.9%). Each year, an increasing incidence of BVT was performed in our dialysis population. The BVT was performed as the first access in that extremity in 73 of the procedures (42.9%). Functional patency (primary assisted) was achieved in 40.0% at 2 years and 15.2% at 5 years. The mean assisted patency was 14.6 months. To maintain BVT patency, 40 percutaneous secondary interventions (69.0%) and 18 surgical revisions (31.0%) occurred in 32 patients (19.0%). Ligation for swelling was necessary in 4 patients (2.5%), and steal syndrome occurred in 3 patients (1.9%).

BVT is a useful autologous procedure for hemodialysis and the preferred access alternative in patients without an adequate cephalic vein. Although patencies remain poor relative to other conventional arterial vascular procedures, BVT is our most durable hemodialysis access procedure and is often the only available autologous conduit for hemodialysis.
Aortoduodenal Fistula after Abdominal Aortic Stent Graft Presenting with Extremity Abscesses
Authors: Lyden Sean P. , Tanquilut Eugene M. , Gavin Timothy J. , Adams Julie E.
Published: February 2011

Aortoenteric fistula (AEF) has been described after endovascular stent graft repair of abdominal aortic aneurysms (EVAR). AEF after EVAR has been associated with aneurysm growth, endoleak, migration, and aortic inflammation. We report a patient with an AEF presenting 2 years after EVAR with two abscesses in the right leg. A computed tomographic scan showed a gas-filled thrombus lining the right limb of his graft. At conversion, no endoleak, device migration, or residual aneurysm sac was found. AEF can occur after endoluminal stent graft (ELG) in the absence of aneurysm growth, endoleak, migration, or inflammation. AEF can cause ELG infection and extremity infection.
Popliteal Traumatic Arteriovenous Fistula
Authors: Ilijevski Nenad S. , Nenezić Dragoslav Đ. , Sagić Dragan , Radak Đorđe
Published: February 2011

Popliteal trauma requires particular attention because blood vessel injuries in that zone might cause serious complications. Popliteal traumatic arteriovenous fistula (AVF) should be considered for serious leg amputation, and long-standing fistulae produce cardiac overload. The diagnosis is usually made after clinical examination, finding palpable thrill and audible bruit over the injury site, and is confirmed after duplex ultrasonography and/or angiography.

We present a case of popliteal traumatic arteriovenous fistula with false aneurysm (pseudoaneurysm) (PSA), in which duplex ultrasonography and angiography findings proved inconsistent with the findings at surgery, thus resulting in an unnecessary extensive dissection of a major artery and vein, whereas the fistula and the PSA were found in minor vessels (genicular artery and vein).
Aorfix Stent Graft for Abdominal Aortic Aneurysms Reduces the Risk of Proximal Type 1 Endoleak in Angulated Necks: Bench-Test Study
Authors: Albertini Jean-Noël , DeMasi Maria-Angela , Macierewicz Jan , El Idrissi Redouane , Hopkinson Brian R. , Clément Claude , Branchereau Alain
Published: February 2011

Neck angulation (NA) is an important risk factor for type 1 proximal endoleaks following stenting of abdominal aortic aneurysms. The Aorfix (Lombard Medical, Oxon, UK) is a new flexible stent graft designed to overcome this issue. The aim of this study was to compare the endoleak flow rate (EFR) in relation to NA between the Aorfix and other manufactured stent grafts.

A flow model with silicone proximal and distal necks was used. EFRs corresponding to 10 neck angles between 0 and 70° were measured. Eight stent grafts were tested: Aorfix, Ancure (Guidant, Indianapolis, IN), Powerlink (Endologix, Irvine, CA), AneuRx (Medtronic, Sunnyvale, CA), Excluder (W.L. Gore & Associates, Flagstaff, AZ), Zenith and Zenith-Flex (Cook Inc., Bloomington, IN), and Lifepath (Edwards Lifesciences, Irvine, CA).

For all stent grafts except the Aorfix, the EFR was greater than at baseline for NA ≥ 30° ( p < .01). The EFR at NA ≥ 30° was lower with the Aorfix compared with the other stent grafts ( p < .01).

NA had no influence on the EFR with the Aorfix. The Aorfix may decrease the incidence of proximal type 1 endoleak in patients with a severely angulated aortic neck.
Stent Grafts for Thoracic Aortic Pathology: Single-Center Experience in Western Australia
Authors: Velu Ramesh B. , Halak Moshe , Muhlmann Mark , Baker Steve
Published: February 2011

The purpose of this article is to report a single-center experience in treating thoracic aortic pathology with stent grafts. This is a retrospective review of cases done within a period of 30 months.

Between January 2002 and May 2004, 12 patients were treated in our institution with thoracic stent grafts ( n = 12) for various clinical conditions. There were seven men and five women. Three patients required emergency treatment ( n = 3), two for aortic transection and one for iatrogenic injury during lung biopsy. Others were treated electively ( n = 9).

All patients were high risk for open surgery. There was one perioperative death, with a patient with multiple trauma succumbing to head injury 4 weeks after stent graft insertion. There was no incidence of paraplegia. Three patients underwent bypass surgery in the neck to achieve an adequate proximal seal zone prior to stent grafting. One patient with an aneurysm of the descending thoracic aorta required an extension limb below the original graft for an increase in sac size, possibly owing to endotension. Renal failure occurred in one patient and resolved without dialysis. One patient died 18 months after her procedure, possibly owing to aneurysm expansion.

Stent grafts are a viable alternative to open surgery for thoracic aortic pathology in high-risk individuals. Visceral and spinal cord ischemia is less prevalent with stent grafts compared with open surgery. The short-term results are promising. Long-term follow-up is awaited. Stent grafts might have greater impact in the thoracic aorta than the abdominal aorta for which they were initially developed.
Femoral Artery to Prosthetic Graft Anastomotic Dehiscence Owing to Infection: Successful Treatment with Arterial Reconstruction and Limb Salvage
Authors: Goldstein Kenneth A. , Veith Frank J. , Ohki Takao , Gargiulo Nicholas J. , Lipsitz Evan C.
Published: February 2011

A 66-year-old man had foot gangrene and a fixed contracture of the knee following two failed femoropopliteal bypasses, one with vein and one with polytetrafluoroethylene (PTFE). An external iliac to anterior tibial artery bypass and skeletal traction via the os calcis resulted in limb salvage and successful normal ambulation. After 3 months, he ruptured the infected femoral anastomosis of the failed PTFE femoropopliteal bypass with external bleeding. The use of arteriography and a balloon catheter to obtain proximal control allowed arterial repair, removal of the graft, and preservation of flow within a patent common and deep femoral artery. This flow preservation maintained the viability and function of the limb when the anterior tibial bypass closed 4 years later, and the limb continues to be fully functional 3 years later. Aggressive secondary attempts at limb salvage are worthwhile even in unfavorable circumstances.
Minimally Invasive Surgical Solution in the Treatment of an Unusual Distal Type I Endoleak after Endovascular Abdominal Aortic Aneurysm Repair
Authors: Pereira Adamastor Humberto , Machado da Costa Luiz Francisco , Gonçalves de Souza Gilberto , Araujo Pereira Alexandre
Published: February 2011

Most distal type I endoleaks can be treated by endovascular techniques such as coil embolization of the hypogastric artery and additional stent or extension stent grafts. We report a case of a difficult type I endoleak located in the distal end of a monoiliac conical stent graft used to treat an abdominal aortic aneurysm extensively involving both common iliac arteries. Cranial migration of the endograft and incarceration in the contralateral iliac aneurysm were observed on the computed tomographic scan. The patient was submitted to a procedure that involves endovascular and limited open surgery techniques. A 26 mm balloon catheter was used to secure the proximal implantation site, and through a Gibson incision, the iliac arteries were controlled. An interpositional 8 mm regular Dacron graft was then sutured end to end between the endograft and the external iliac artery.
Achieving change in practice by using unembalmed cadavers to teach ultrasound-guided regional anaesthesia
Authors: Hocking Graham , McIntyre Owen
Published: February 2011

We are at risk of teaching our trainees to be ‘image-seekers’. Sonoanatomy is easily demonstrated but teaching the practical skills of ultrasound-guided nerve block constitutes a greater challenge. Participants may return to their institutions after attending educational courses as proficient ‘image-seekers’, yet still unsure about performing nerve blocks. Safe ultrasound-guided regional anaesthesia (USGRA) requires integration of several skills. These are correct image acquisition, accurate needle guidance and appropriate spread of local anaesthesia. Most educational courses cannot combine all these skills. We describe realtime nerve blocks on cadavers to teach USGRA. Unembalmed cadavers offer more realistic imaging and tactile needle feedback than other models. We evaluated participants' perceptions of cadavers for training, their impact on confidence and whether subsequent change in practice occurred. Fifty participants completed pre- and post-training questionnaires and were followed up at three months. Confidence was scored on a five-point scale. Complete data-sets were received from 42 participants (84%). Most (98%) found the cadavers to be of educational benefit and 86% found the imaging and tissue properties comparable to clinical practice. Mean (±SD) confidence score increased from 1.7 (±0.92) precourse to 4.3 (±0.65) postcourse ( P < 0.0001). At three-month follow-up, 84% considered they had received sufficient training to introduce ultrasound into their clinical practice and 87% (27% precourse) now used ultrasound routinely. Only four participants had not made a change to their practice.
The use of SonoVue for HyCoSy: UK experience to date
Authors: Killick Stephen R , Allison Gillian , Parker Pamela
Published: February 2011

Hysterosalpingo-contrast-sonography (HyCoSy) is recommended by the National Institute for Health and Clinical Excellence (NICE) as the investigation of choice for otherwise asymptomatic women who need fallopian tube patency assessment as part of their investigation for subfertility. The technique requires the instillation of a positive contrast agent through the cervix, but after the commercial withdrawal of Echovist the only remaining agent, until very recently, was SonoVue, which is not licensed for intrafallopian use. A questionnaire was distributed to 16 units in the UK who were thought to perform HyCoSy in order to collate experience and opinion with this new contrast agent. Eight units replied to say that they had used SonoVue, giving a collective experience of 449 procedures. The opinion would seem to be that results are good and side-effects are rare, making the case to encourage a product licence application. Nevertheless, careful ongoing audit of results is essential and long-term endometrial effects need to be excluded.
Role of the advanced practitioner: performing image-guided chest and ascitic drainages
Authors: Hampshaw Ann
Published: February 2011

This article recounts the development and implementation of an Advanced Practitioner Interventional Service, performing ultrasound-guided drainage procedures, in one National Health Service Hospital in the UK. The article details and explains the rationale behind implementation of the service, describes the training and supervision required to safely institute the service and documents the problems and limitations encountered during implementation of the service. The service is seen to be a natural progression for the advanced practitioner in ultrasound but with the proviso that there must be a robust support mechanism at all times.
How does ultrasound work?
Authors: Venables Heather
Published: February 2011

Ultrasound image acquisition and interpretation are highly reliant on a reasonable depth of understanding of ‘how ultrasound works’. Where this is lacking, there is considerable scope for confusion. In a point-of-care setting, where novice practitioners may have limited direct supervision, this may lead to significant errors in diagnosis and subsequent patient management. This paper provides a brief introduction to the underlying physical principles of ultrasound and discussion of how these principles can be used to explain typical image appearances.
Predicting Hub-Height Wind Speed for Small Wind Turbine Performance Evaluation Using Tower-Mounted Cup Anemometers
Authors: Ziter Brett , Lubitz William David
Published: February 2011

Industry standards for small wind turbine (SWT) performance evaluation require estimating hub-height wind speed using either a spatially offset meteorological mast or a cup anemometer extending from a lower elevation on the turbine tower. This paper investigates the use of vertical extrapolation to reduce the uncertainty associated with tower-mounted anemometer wind speed measurements. An experimental study has been performed involving a Bergey XL.1 SWT collocated with a meteorological mast. Results indicate that power law extrapolation can significantly reduce the uncertainty of hub-height wind speed predictions, especially if concurrent wind speed measurements are available at multiple elevations. Best practice methods have been provided. To identify the upper limit of anemometer placement, a porous disk wind tunnel test has been performed and compared with three-dimensional wind speed measurements obtained experimentally. To remain outside the rotor's region of influence, it is recommended that the topmost anemometer is positioned one rotor diameter below hub-height.
Health Checks through Landmark Bridges to Sky-High Structures
Authors: Ni Y. Q. , Wong K. Y. , Xia Y.
Published: February 2011

Massive infrastructure projects developed in Hong Kong make for big challenges and unique opportunities for engineers and researchers. The construction of the cables-stayed Stonecutters Bridge sets up a new landmark in the bridge engineering community, with its main span exceeding 1,000 m as well as its sophisticated instrumentation system comprising more than 1,500 sensors. The development of structural health monitoring (SHM) technology has evolved for over 10 years in Hong Kong since the implementation of the so-called “Wind And Structural Health Monitoring System (WASHMS)” on the suspension Tsing Ma Bridge in 1997. The successful engineering paradigms of implementing and operating SHM systems for five cable-supported bridges and experiences gained by practice and research in the past decade have promoted the applications of this technology beyond Hong Kong and extending from long-span bridges to high-rise structures. In this paper, the evolution in the design methodology for SHM systems, the advancement in several aspects of SHM technology, and a performance comparison between the early implemented and lately developed SHM systems for large-scale bridges are first outlined. Subsequently, the concept of the so-called “life-cycle structural health monitoring (LSHM)” is addressed by exploring the integration of in-construction monitoring and in-service monitoring and by realizing such an integrated system to a super-tall tower structure. The issue on how an SHM system benefits structural vibration control is also discussed.
Erratum: Modeling Critical Ground-Motion Sequences for Inelastic Structures (Vol. 13, 665–679, 2010)
Authors: Moustafa Abbas , Takewaki Izuru
Published: February 2011

In Equations (5), (6), (7) and (9–11), the term wijt + (i – 1) T should be replaced with wij{t – (i – 1) T} and the term t + (i – 1) T with t – (i – 1)T.

The envelope function shown in Figure 3 should be replaced with Figure 1 below for the two time periods 0 ⩽ t ⩽ T and T ⩽ t ⩽ 2T.

[Figure: see text]