bluuebunny/crossref_metadata_2025 huggingface dataset:
Sonographically Guided Therapeutic Injections in the Meniscoid Lesion in Patients With Anteromedial Ankle Impingement Syndrome
Authors: Jose Jean , Mirpuri Tarun , Lesniak Bryson , Kaplan Lee
Published: August 2014

We describe a sonographically guided technique to perform therapeutic injections for anteromedial ankle impingement syndrome. Scans are carried out using a high-frequency small footprint linear array transducer, positioned along the anteromedial aspect of the tibiotalar joint. A 25 gauge needle is advanced under direct sonographic guidance into the “meniscoid lesion” (area of scarring), and a standardized therapeutic mixture is injected extra-articularly. Image-guided injections have a positive influence on clinical decision making by improving patient management, increasing the accuracy of diagnosis, and decreasing patient pain. Sonography allows confirmation of correct injection placement, resulting in increased accuracy and more successful patient outcomes.

Levels of Evidence: Therapeutic, Level V, Expert Opinion
Spinal Manipulative Therapy for Chronic Lower Back Pain in Older Veterans
Authors: Dougherty Paul E. , Karuza Jurgis , Dunn Andrew S. , Savino Dorian , Katz Paul
Published: August 2014

Introduction:

Chronic lower back pain (CLBP) is problematic in older veterans. Spinal manipulative therapy (SMT) is commonly utilized for CLBP in older adults, yet there are few randomized placebo-controlled trials evaluating SMT.

Methods:

The purpose of the study was to compare the effectiveness of SMT to a sham intervention on pain (Visual Analogue Scale, SF-36 pain subscale), disability (Oswestry Disability Index), and physical function (SF-36 subscale, Timed Up and Go) by performing a randomized placebo-controlled trial at 2 Veteran Affairs Clinics.

Results:

Older veterans (≥ 65 years of age) who were naive to chiropractic were recruited. A total of 136 were included in the study with 69 being randomly assigned to SMT and 67 to sham intervention. Patients were treated 2 times per week for 4 weeks assessing outcomes at baseline, 5, and 12 weeks postbaseline. Both groups demonstrated significant decrease in pain and disability at 5 and 12 weeks. At 12 weeks, there was no significant difference in pain and a statistically significant decline in disability scores in the SMT group when compared to the sham intervention group. There were no significant differences in adverse events between the groups.

Conclusions:

The SMT did not result in greater improvement in pain when compared to our sham intervention; however, SMT did demonstrate a slightly greater improvement in disability at 12 weeks. The fact that patients in both groups showed improvements suggests the presence of a nonspecific therapeutic effect.
Characterisation of coelectrodeposited Ni–Al composite coating
Authors: Arghavanian R. , Bostani B. , Parvini-Ahmadi N.
Published: August 2014

Ni–Al composite coating was prepared by coelectrodeposition technique in Watt's bath containing dispersed Al particles to be codeposited. Pure Ni coating was also prepared as a comparison. Morphology and composition studies showed that Al particles were uniformly distributed in the Ni matrix. Microhardness measurements and microstructure studies revealed that the incorporation of Al particles lowers the microhardness of Ni coating due to the high ductility of Al and weak bonds between Al and Ni. The results of potentiodynamic polarisation tests demonstrated that the corrosion resistance of Ni–Al composite coating is lower than that of pure Ni. The microstructure and corrosion path studies revealed that the lower corrosion resistance of Ni–Al composite coating is resulted from weak bonds between Al particles and Ni matrix and formation of active–passive cells on the surface of the coating.
Platelet 12-LOX is essential for FcγRIIa-mediated platelet activation
Authors: Yeung Jennifer , Tourdot Benjamin E. , Fernandez-Perez Pilar , Vesci Joanne , Ren Jin , Smyrniotis Christopher J. , Luci Diane K. , Jadhav Ajit , Simeonov Anton , Maloney David J. , Holman Theodore R. , McKenzie Steven E. , Holinstat Michael
Published: August 2014

Key Points

Platelet 12-LOX modulates FcγRIIa signaling and presents a viable therapeutic target in the prevention of immune-mediated thrombosis. This novel therapeutic approach is supported by pharmacologic inhibition and genetic ablation of 12-LOX in human and mouse platelets.
Gastroenteritis due to typhoidal Salmonella: a decade of observation at an urban and a rural diarrheal disease hospital in Bangladesh
Authors: Das Sumon Kumar , Chisti Mohammod Jobayer , Afrad Mokibul Hassan , Malek Mohammad Abdul , Ahmed Shahnawaz , Ferdous Farzana , Farzana Fahmida Dil , Das Jui , Shahunja KM , Afroze Farzana , Salam Mohammed Abdus , Ahmed Tahmeed , Faruque Abu Syed Golam , Baker Peter John , Al Mamun Abdullah
Published: August 2014

Background

The study aimed to compare the socio-demographic, host and clinical characteristics, seasonality and antimicrobial susceptibility of Typhoidal Salmonella (Salmonella enterica serovar Typhi and Paratyphi) (TS) with diarrhea between urban and rural Bangladesh.

Methods

Relevant information of 77/25,767 (0.30%) and 290/17,622 (1.65%) patients positive with TS (in stool) were extracted from the data archive of Diarrheal Disease Surveillance System of icddr,b (urban Dhaka and rural Matlab Hospitals respectively) during 2000–2012. Comparison group (diarrhea patients negative for TS) was randomly selected from the database (1:3 ratio). Two poisson regression models were investigated for modelling seasonal effects on the number of cases.

Results

Salmonella Typhi was more frequently isolated in Dhaka than Matlab (57% vs. 5%, p < 0.001); while Salmonella Paratyphi was more frequent in Matlab than Dhaka (96% vs. 43%; p < 0.001). Fever [adj. OR-5.86 (95% CI: 2.16, 15.94)], antimicrobial use at home [5.08 (2.60, 9.90)], and fecal red blood cells [2.53 (1.38, 4.64)] were significantly associated with detection of TS in stool of patient from Dhaka. For Matlab, the correlates were, vomiting [1.88 (1.35, 2.64)], fecal macrophage [1.89 (1.29, 2.74)] in addition to fever and duration of diarrhea and antimicrobial use. At Dhaka, all Salmonella Typhi isolates were susceptible to ceftriaxone; while in Dhaka and Matlab however, for ciprofloxacin it was 45% and 91%, respectively. Susceptibility to chloramphenicol, ampicillin, trimethoprim-sulphamethoxazole and nalidixic acid ranged from 12%-58%. Salmonella Paratyphi were susceptible to ceftriaxone (99%). A significant seasonal trend and year difference (before and after 2007) for Matlab was observed (p < 0.001 for all effects). Dhaka does not show significant year or seasonal effects (p = 0.07 for years and p = 0.81 and p = 0.18 for the cos and sin components, respectively). While not significant, two seasonal peaks were observed in Dhaka (January-February and September-November); while a single peak (August-November) was observed in Matlab.

Conclusions

Proportion of serovar distribution of TS and their clinical characteristics, antimicrobial susceptibility and seasonal pattern were different among diarrhea patients in urban Dhaka and rural Matlab of Bangladesh.
Unipolar resistive switching of ZnO-single-wire memristors
Authors: Huang Yong , Luo Ying , Shen Zihan , Yuan Guoliang , Zeng Haibo
Published: August 2014

Well unipolar resistive switching (RS) behaviors were observed from Ag/ZnO single-microwire/Ag memristors. The reset voltages were larger than the set voltages, and all of them were less than 1 V. The resistance ratios of high-resistance state (HRS) to low-resistance state (LRS) reached 103. The bistable RS behaviors were entirely reversible and steady within 100 cycles. It was found that the dominant conduction mechanisms in LRS and HRS were ohmic behavior and space-charge-limited current (SCLC), respectively.
Medication in nursing homes in Alsace: a preferential list of drugs obtained by consensus
Authors: Hannou Sophia , Rousseau Amélie , Rybarczyk-Vigouret Marie-Christine , Michel Bruno
Published: August 2014

In order to improve patient care, OMEDIT (Observatory of drugs, medical devices and therapeutic innovation) Alsace, conducted a study to develop a Preferential list of Drugs adapted to the Elderly (PDE list) in nursing homes. The study conducted from December 2011 to June 2012 was organized in 4 phases: 1) creation of a preliminary list of drugs from those currently used in nursing homes in Alsace, 2) application of a two-round Delphi process to evaluate the preliminary list involving mobilization of experts from different backgrounds (geriatricians, general practitioners, pharmacists …), 3) identification of molecules considered in literature as potentially inappropriate, 4) generation of a final PDE list, including information concerning proper use of drugs for prescription and administration. 53 experts participated in the study. In the first round, 338 drugs were on the preliminary list, 246 were considered as appropriate by experts and 28 as inappropriate. 64 drugs without consensus were submitted to a second round. 32 of them were considered as inappropriate and 32 others remained on the list with no consensus. These last 32 were evaluated by OMEDIT and 3 were considered as appropriate drugs for the elderly. Totally, 252 drugs constitute the final PDE list from our study. The PDE list constitutes a new guide for optimization of both prescription and administration of drugs in nursing homes and could help reduce misuses and poly-medication, which are constant preoccupations to avoid adverse drug reactions in elderly.

Key points

● The study was carried out with the aim to create a Preferential list of Drugs adapted to the Elderly (PDE list) in nursing homes using a modified Delphi method.

● The PDE list constitutes a new guideline to harmonize practices in nursing homes and to help physicians and nurses to achieve best possible care management.
College Student Personality Traits Related to TOEIC and GEPT
Authors: Lin Chia-Hui
Published: August 2014

Personality had been conceptualized from different theoretical perspectives. Many psychologists had divided language of personality as important and useful for daily interaction. Thus, personality traits seemed to be an important factor in achieving educational goals for students learning foreign languages. TOEIC and GEPT tests measured English proficiency for the international working environment and educational organizations. A number of colleges and universities also employed TOEIC and GEPT tests as tools for student placement, tracking progress, and program evaluation. This study quantitatively examined non-experimental relationships among personality traits, TOEIC, GEPT, foreign language classroom anxiety, classroom structure, and satisfaction. A total of 110 surveys were distributed, and 100 surveys were returned, with a return rate of 91%, with 9% missing data. Results showed that 3 of the 5 examined personality traits were statistically significant. Furthermore, TOEIC and GEPT tests did not influence personality traits, and GEPT participation had more statistical significance than TOEIC participation for student personality traits. The findings did not help statistical differences in foreign language classroom anxiety, and classroom structures for satisfaction and personality traits. The results of this research might influence educational organizations, government, and company decisions and strategies. Future studies should be enlarged to strengthen the generalizability of this research.
Rethinking Assessment of Thai EFL Learners' Speaking Skills
Authors: Sinwongsuwat Kemtong
Published: August 2014

This paper reassesses the mainstream tasks used for evaluating Thai ELF learners' speaking skills: face-to-face interview and role-play. Based on final and preliminary findings from small-scale classroom research, it examines the capacity of these two tasks to assess the learners' conversation skills in particular and recommends a task that is more oriented towards features of natural conversation; i.e., non-scripted role-play. It is argued that if implemented with an appropriate rubric, this task should enable us to better assess the students' ability to converse in naturally-occurring communicative situations and with practice make it possible to develop students with better proficiency in English conversation. Some implications are also noted for English conversation teaching stemming from the proposed application of the assessment task in Thai EFL classroom contexts.
Mixed reality temporal bone surgical dissector: Mechanical design
Authors: Hochman Jordan Brent , Sepehri Nariman , Rampersad Vivek , Kraut Jay , Khazraee Milad , Pisa Justyn , Unger Bertram
Published: August 2014

Objective

The Development of a Novel Mixed Reality (MR) Simulation. An evolving training environment emphasizes the importance of simulation. Current haptic temporal bone simulators have difficulty representing realistic contact forces and while 3D printed models convincingly represent vibrational properties of bone, they cannot reproduce soft tissue. This paper introduces a mixed reality model, where the effective elements of both simulations are combined; haptic rendering of soft tissue directly interacts with a printed bone model. This paper addresses one aspect in a series of challenges, specifically the mechanical merger of a haptic device with an otic drill. This further necessitates gravity cancelation of the work assembly gripper mechanism. In this system, the haptic end-effector is replaced by a high-speed drill and the virtual contact forces need to be repositioned to the drill tip from the mid wand. Previous publications detail generation of both the requisite printed and haptic simulations.

Method

Custom software was developed to reposition the haptic interaction point to the drill tip. A custom fitting, to hold the otic drill, was developed and its weight was offset using the haptic device. The robustness of the system to disturbances and its stable performance during drilling were tested. The experiments were performed on a mixed reality model consisting of two drillable rapid-prototyped layers separated by a free-space. Within the free-space, a linear virtual force model is applied to simulate drill contact with soft tissue.

Results

Testing illustrated the effectiveness of gravity cancellation. Additionally, the system exhibited excellent performance given random inputs and during the drill's passage between real and virtual components of the model. No issues with registration at model boundaries were encountered.

Conclusion

These tests provide a proof of concept for the initial stages in the development of a novel mixed-reality temporal bone simulator.
Pathways of care of women in secure hospitals: which women go where and why
Authors: Bartlett Annie , Somers Nadia , Fiander Matthew , Harty Mari Anne
Published: August 2014

Background

Care pathways for women needing expensive, secure hospital care are poorly understood.

Aims

To characterise women in low and medium security hospitals in England and Wales and to compare populations by security and service provider type.

Method

Census data from all specialist commissioning areas. Sociodemographic, clinical, medico-legal, criminological and placement needs data were requested on all women in low and medium secure hospital beds. Parametric tests were used for continuous data and chi-square or Fisher's exact tests for categorical data. Thematic analysis was used for free text data.

Results

The independent sector is the main service provider. A third of all women (n = 1149) were placed outside their home region despite spare local National Health Service (NHS) capacity. The independent sector provides for women with relatively rare disorders, including intellectual disability. The NHS admits most serious offenders. One in 20 are detained because of self-harm alone.

Conclusions

Patient-specific factors (notably the diagnosis of personality disorder) and organisational inadequacy (commissioner and service provider) contribute to placements that compromise rehabilitation. Responses should include local solutions for women whose main risk is self-harm and a national approach to women with highly specialist needs.
BF3·Et2O-catalyzed One-pot Synthesis of N,N′-(2-Alkyl-1,3-diarylprop-1-ene-1,3-diyl)diacetamides through a Tandem Aldol–Double Ritter-type Reaction
Authors: Kasthuri Mahesh , Nakka Srinuvasu , Babu H Sharath , Sudhakar Ch , Venkatanarayana M , Kumar P V Nagendra
Published: August 2014

An atom and step economic synthesis of multifunctional N,N′-(2-alkyl-1,3-diarylprop-1-ene-1,3-diyl)diacetamides employing a novel tandem aldol–double Ritter-type multicomponent one-pot reaction between aromatic aldehydes, enolizable ketones, and a nitrile source in the presence of 20 mol % of BF3·Et2O is described. The reaction boosts operational simplicity, shortens reaction time, and has a simple work-up.
The developing potential of educational projects of school students
Authors: Землянская  , Zemlyanskaya Elena
Published: August 2014

The article reveals the potential of class projects in promoting personal growth of pupils. Techniques for teachers organizing project work for

primary students are discussed; stages of the process are thoroughly described. Methodological recommendations are included.
Basic lines of consumer goods market development at the macro- and meso-levels
Authors: Данилов Андрей , Danilov Andrey , Данилова Вероника , Danilova Veronika , Литвинова Елена , Litvinova Elena
Published: August 2014

Russian economy modernization currently under way requires a systemic, synchronous and balanced approach on both the industry and the territory scale. An efficient regional consumer market modernization is to be conducted in accordance with the strategic framework established for different levels of economy management, and bearing on the systemic and contextual approaches. Applying the above-mentioned criteria, the authors have developed a SWOT-analysis matrix for the consumer goods market in the Moscow region, paying special attention to the regional consumer goods market development mechanisms at macro- and meso-levels. The analysis as carried out by the authors has revealed the key internal- and external-contradiction-related challenges to consumer goods market development. In the article, the authors define the stages of and activities for the structural and functional modernization of the consumer goods market, their interrelation with the strategic policy documents concerning other lines of regional development, as well as the problems solved as a result of their implementation.
Regional brand as a development option for major and minor urban settlements
Authors: Хаванова Наталья , Khavanova Natalya , Шестакова Светлана , Shestakova Svetlana
Published: August 2014

The article is devoted to an analysis of the current state and development prospects of tourism in major and minor urban settlements in the Russian Federation. According to the authors, an effective implementation of events aimed at their image potential promotion encourages the socio-economic development of the areas under consideration. The authors identify the immediate prerequisites for tourism development and provide an analysis of the key factors which constrain the development of domestic and in-bound tourism in Russian cities and towns. In the article, the authors pay special attention to the concerted action of the state, cities/towns, the business sector and society to arrange for the conditions and to design the mechanisms which will ensure the planned development of the tourist industry in Russian cities and towns at an ever increasing pace.
Regional tourism development: Financial aspects (Case study: Yaroslavl Oblast)
Authors: Виноградова Марина , Vinogradova Marina
Published: August 2014

The article focuses on the financial aspect of regional tourism development, with Yaroslavl oblast selected as a case study. In the article, the author proposes a practical approach to the identification of the financial flow influenced and generated by regional tourism development. The author states that the financial flow consists of two components: financial provision/assurance (the funds required for policy measures implementation) and tourist turnover (tourism-generated income, which is tourism contribution to the gross regional product). Financial provision/assurance is regarded as part of the resources provision intended for policy measures, the author demonstrates the possible approaches to its specification and dwells on the approach taken to develop the target project “Tourism development strategies for Yaroslavl oblast: period of implementation – up to 2025”. The author also provides an evaluation of tourist turnover as predicted for Yaroslavl oblast, with due consideration given to the tourism development policy measures implementation in the framework of scenarios proposed. In particular, the author describes different approaches to predicted tourist-arrival volume evaluation, demonstrates calculations of future tourist expenses, and provides a description of two alternatives for tourist turnover calculation. Moreover, the author puts forth a methodology of tourist turnover prediction based on practical calculations and regarded from a strategic perspective. Thus, the author attempts to specify the calculation procedure, which is prerequisite for effective policy decision-making and regional tourism development strategy formulation. The author insists on the urgent nature of the issues raised in the article, especially in the light of the current trends in global tourism development.
The Effect of Temperature on the Tear Behavior of Various Elastomers: Part 2—Application Considerations
Authors: Bafna Sudhir
Published: August 2014

Part 1 (Bafna, S. S., “The Effect of Temperature on the Tear Behavior of Various Elastomers,” J. Test. Eval., Vol. 42, No. 3, 2014, pp. 1–10) of this series discussed the tear behavior per ASTM D624-00 Type B (propagation) and Type C (initiation) for commercial sealing grade butyl, ethylene propylene diamine (EPDM), fluorosilicone (FS), and two fluorocarbon elastomers. Part 2 provides additional insight based on application considerations. The behavior of polychloroprene intended for shock and vibration isolation applications is compared to that of silicone and other elastomers intended for sealing applications (such as O-rings). The trend of tear strength for propagation being higher than or equal to (within measurement error) that for initiation is confirmed. This is shown to be an artifact of the difference in the ASTM D624-00 test specimen geometries. Propagation tear strength/energy values reported in literature are from the “trouser” tear (ASTM D624 Type-T or modification thereof) test, which leads to lower values than Type B. While Type-T is closer in deformation mode to pure tear, Types B and C more closely simulate tear damage in actual hardware. The polychloroprene grade tested is processed using transfer molding and has a much lower viscosity in the uncured state. After cure, its tensile strength is lower than that of all compression molding grades and its tensile elongation is the highest. However, its tear strength is higher than that of the silicone or FS grades tested, consistent with its application requirements. At the higher temperatures, the polychloroprene tear strength is higher than that of all the compression molding grades. A higher level of filler (as manifested by a high specific gravity), along with strain induced crystallization, helps explain this retention of tear properties with temperature. The tear strain at break generally increases with temperature but, if temperature is sufficiently above the glass transition temperature, then the tear strain actually decreases with temperature and thus non-monotonic behavior is observed. The poor tear properties of silicones and FS are confirmed.
Renal Artery Stenting – Developments in Practice
Authors: Schwarzwälder Uwe , Zeller Thomas ,   Department of Angiology, Heart Centre Bad Krozingen,   Department of Angiology, Heart Centre Bad Krozingen, Herz-Zentrum Bad Krozingen Suedring 15, 79189 Bad Krozingen, Germany. E: thomas.zeller@herzzentrum.de
Published: August 2014

Significant renal artery stenosis (RAS) is a well-accepted cause of arterial hypertension and renal insufficiency. Technical improvements of diagnostic and interventional endovascular tools have led to more widespread use of endoluminal renal artery revascularisation and the extension of the indications for this type of therapy during the past two decades. Since the first renal artery angioplasties were performed by Felix Mahler and Andreas Grüntzig, numerous single-centre studies have reported the beneficial effect of percutaneous transluminal renal angioplasty, and since the early 1990s stenting of RAS caused by either atherosclerosis or fibromuscular dysplasia. However, none of the published or presented randomised controlled trials (RCTs) prove a beneficial outcome of RAS revascularisation compared with medical management. As a result of these negative trials, including the recently published or presented STAR and ASTRAL trials, referrals to endovascular renal artery revascularisation have decreased and, moreover, reimbursement of these procedures has become a matter of debate. This article provides an overview of the state-of-the-art endovascular technique of renal artery stenting and discusses the limitations of the published trials, highlighting the crucial aspect of proper patient selection.
Developments in Endovascular Abdominal Aortic Aneurysm Treatment
Authors: Thompson Matt ,   Professor of Vascular Surgery, St George’s Vascular Institute, 4th Floor, St James Wing, St George’s Hospital, London, SW17 0QT, UK. E: matt.thompson@stgeorges.nhs.uk
Published: August 2014

The endovascular treatment of infra-renal abdominal aortic aneurysm (AAA) has become an established treatment modality over the last 10 years. This technique is now arguably the first-line therapy for the majority of patients. Data to support this position can be derived regarding early mortality rates, cost-effectiveness and reduction of re-intervention rates. Endovascular repair of AAA requires further refinement with regard to enhancing long-term durability through the use of better intra-operative techniques and patient selection. Adoption of 3D computed tomography (CT) imaging and better methods of intra-operative quality control are essential to ensure continuing improvement of technical results. Future developments will see the adoption of endovascular repair for ruptured and supra-renal aneurysms.
Percutaneous Coronary Intervention without On-site Surgical Back-up
Authors: Dehmer Gregory J ,   Professor of Medicine, Texas A&M University College of Medicine, and Director, Cardiology Division, Scott & White Clinic, 2401 South 31st Street, Temple, TX 76508, US. E: gdehmer@swmail.sw.org
Published: August 2014

Although accepted in several countries, in the US the performance of percutaneous coronary intervention (PCI) without on-site surgical back-up remains controversial. The current US guidelines do not endorse elective PCI in facilities without on-site surgical back-up, but acknowledge that primary PCI for ST-segment elevation myocardial infarction (STEMI) is acceptable under carefully regulated and monitored circumstances. In the US, survey data indicate that either primary PCI alone or primary and elective PCI without on-site surgery is currently being performed in all but seven states, and the number of patients treated in this setting is increasing. Several recent reports continue to document the safety of PCI without on-site surgical back-up, but have limitations as these data are from retrospective reviews or prospective registries. Although it appears that primary and elective PCI without on-site surgery is safe, it is not clear that this is the best way to deliver PCI care to the majority of patients.
Iodinated Contrast Media – A Safety Review
Authors: Dusaj Raman , Reiner Jonathan S ,   Fellow, Cardiology,   Professor of Medicine and Director, Cardiac Catheterization Laboratories, Division of Cardiology, George Washington University Medical Center, Washington, DC 20037, US. E: jreiner@mfa.gwu.edu
Published: August 2014

Iodinated contrast media (CM) are administered to millions of patients every year, yet controversy continues to exist regarding the safety of the various agents. Iodinated CM are either ionic or non-ionic, and vary in their osmolality relative to plasma. It is generally accepted that first-generation ionic, high-osmolality CM (HOCM) are less well tolerated than non-ionic, low-osmolar CM (LOCM). However, whether there are differences in safety among the remaining classes or individual CM, particularly with regard to nephrotoxicity and ischaemic complications, remains controversial. Many clinical studies and meta-analyses have compared the safety of the various CM and, depending on the patient population and study design, conflicting results have often been obtained. However, strong trends are emerging to indicate that, with regard to nephrotoxicity and adverse cardiac events, little if any differences exist among the majority of LOCM and between LOCM and the one available iso-osmolar contrast medium (IOCM). Herein we review the data regarding the tolerability, nephrotoxicity and thrombotic risks associated with the use of iodinated CM.
Magnetic Resonance Imaging for the Interventional Cardiologist
Authors: Gilard Martine , Mejri Mourad , Pierre-Yves Pennec , Boschat Jacques ,   Department of Cardiology, La Cavale Blanche Hospital, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex, France. E: martine.gilard@chu-brest.fr,   Department of Cardiology, La Cavale Blanche Hospital, Brest,   Department of Cardiology, La Cavale Blanche Hospital, Brest,   Department of Cardiology, La Cavale Blanche Hospital, Brest
Published: August 2014

Cardiovascular magnetic resonance imaging (MRI) has evolved over the last few years into a valuable tool for the diagnosis and management of cardiovascular diseases. Late gadolinium-enhanced MRI and stress myocardial perfusion MRI have been shown to be useful in detecting infarct tissue and in predicting myocardial viability and patient prognosis. The strengths of MRI lie in its ability to comprehensively image cardiac anatomy, function, perfusion, viability and physiology in ‘one-stop testing’ and to provide high-quality diagnostic information without the need for radiation. This article summarises the current clinical applications of MRI in interventional cardiology.
What Would Be the Ideal Drug-eluting Stent for Managing Patients with Long Lesions?
Authors: Shelton Rhidian J , Blackman Daniel J ,   Yorkshire Heart Centre, Leeds General Infirmary,   Yorkshire Heart Centre, Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK. E: daniel.blackman@leedsth.nhs.uk
Published: August 2014

Drug-eluting stents (DES) substantially reduce the risk of restenosis, particularly in complex coronary disease. Their use is now standard in demanding anatomy, including in long lesions, which represent an increasing proportion of percutaneous coronary intervention (PCI) cases. However, long lesions pose a number of procedural and clinical challenges for DES, specifically stent deliverability, stent overlap and an increased risk of restenosis, peri-procedural myocardial infarction, geographical miss and stent thrombosis. The ideal DES for long lesions would incorporate a number of specific design characteristics to meet these challenges, including low late loss to minimise restenosis risk, thin struts to enhance deliverability and minimise risk of peri-procedural infarction and the availability of long lengths to minimise overlap and avoid geographical miss. It is clear from a knowledge of their properties, and from available data on DES performance in long lesions, that some currently available DES have superior design characteristics and clinical outcomes in the setting of diffuse disease. An awareness of these issues is essential for the practising interventional cardiologist in treating long lesions in routine clinical practice.
Clinical Implications of the SYNTAX Study
Authors: Serruys Patrick , Garg Scot ,   Erasmus MC, Thoraxcentre, Kamer Ba583, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. E: p.w.j.c.serruys@erasmusmc.nl,   Thoraxcenter, Erasmus MC, Rotterdam
Published: August 2014

Recent years have seen an ongoing debate as to whether coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) is the most appropriate revascularisation strategy for patients with coronary heart disease (CAD). The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) study was conducted with the intention of defining the specific roles of each therapy in the management of de novo three-vessel disease or left main CAD. Interim results after 12 months show that PCI leads to significantly higher rates of major adverse cardiac or cerebrovascular events compared with CABG (17.8 versus 12.4; p=0.002), largely owing to increased rates of repeat revascularisation. However, CABG was much more likely to lead to stroke. Interestingly, categorisation of patients by severity of CAD complexity according to the SYNTAX score has shown that there are certain patients in whom PCI can yield results that are comparable to, if not better than, those achieved with CABG. Careful clinical evaluation and comprehensive assessment of CAD severity, alongside application of the SYNTAX score, can aid practitioners in selecting the most suitable therapy for each individual CAD patient.
HORIZONS and Drug-eluting Stent Usage in Acute Myocardial Infarction
Authors: Nakazawa Gaku , Nakano Masataka , Vorpahl Marc , Kolodgie Frank , Virmani Renu ,   CVPath Institute Inc., Gaithersburg,   CVPath Institute Inc., Gaithersburg,   CVPath Institute Inc., Gaithersburg,   CVPath Institute Inc., Gaithersburg,   CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, US. E: rvirmani@cvpath.org
Published: August 2014

Myocardial infarction (MI) is one of the few clinical presentations whereby percutaneous coronary intervention reduces the risk of death compared with medical therapy alone. However, treatment with drug-eluting stents (DES) – so-called ‘off-label’ use for patients with ST-segment-elevation MI (STEMI) – raises safety concerns with respect to the morbidity and mortality attributed to late stent thrombosis (LST). Pathology data clearly indicate delayed healing as the primary substrate in all cases of DES-related LST, where differences in lesion morphology invariably show a greater prevalence of uncovered struts, accumulated fibrin and inflammation in ruptures relative to stable plaques. The prolonged risk of LST appears to persist up to at least four years after DES implantation. Results from the recently published Harmonising Outcomes with Revascularisation and Stents – Acute Myocardial Infarction (HORIZONS-AMI) trial of 3,006 prospective patients presenting with STEMI, randomised to paclitaxel-eluting (PES) or identical bare-metal stents (BMS), show similar 12-month death and stent thrombosis rates. Despite a significant reduction in ischaemia-driven target lesion revascularisation, a sub-study analysis showed a greater incidence of malapposition in patients receiving PES. Along these same lines, other registry studies point towards inconsistencies in advocating the use of DES for AMI. Considering that arterial healing in response to DES is delayed for periods longer than one year, long-term follow-up beyond this point is required to confirm the results of the HORIZONS trial. However, despite the final outcome, the results may remain disputable since the trial may not have been sufficiently powered to address the relative risks of LST or mortality. Clearly, there remains a need for larger randomised controlled studies before the broader use of this technology in AMI patients is settled.
Stent Passivation with Silicon Carbide as a Possible Alternative to Drug-eluting Stents – A Comprehensive Review of Pre-clinical and Clinical Results
Authors: Hehrlein Christoph ,   Department of Cardiology, University of Heidelberg, Bergheimerstr. 58, 69115 Heidelberg, Germany. E: christoph.hehrlein@uniklinik-Frelburg.de
Published: August 2014

Metallic stenting has significantly improved short-term procedural outcomes and substantially reduced the rate of restenosis in patients undergoing percutaneous coronary interventions (PCI). Drug-eluting stents (DES) are often used in PCI procedures as they have been associated with a significant reduction in the rate of restenosis compared with PCI alone or PCI with bare-metal stents (BMS). However, there have been reports of stent thrombosis (ST) with DES, especially in patients at high risk of death, thrombosis or restenosis. Surface passivation of stents by amorphous silicon carbide (aSiC:H) coating has been shown in pre-clinical studies to reduce the thrombogenecity and possibly improve the biocompatibility of the stent surfaces. Clinical trials have generally shown low rates of ST, major adverse cardiac events (MACE) and target lesion revascularisation (TLR) in patients with stenotic lesions, with these rates also being low in high-risk patients. Based on indirect comparisons of aSiC:H-coated stents with DES, the former may be alternatives to DES, especially in high-risk patients.
Bifurcation Stenting – Have We Made Progress in the Last 10 Years?
Authors: Wykrzykowska Joanna , van der Giessen Willem J ,   Interventional Cardiology, Thoraxcentre, Erasmus Medical Centre,   Interventional Cardiology, Thoraxcentre Erasmus MC, ‘s-Gravendijkwal 230, 3015CE Rotterdam, The Netherlands. E: w.j.vandergiessen@erasmusmc.nl
Published: August 2014

Bifurcation stenting is one of the unsolved challenges for interventional cardiologists. Patients with bifurcation lesions tend to have more advanced disease and multiple co-morbidities. Over the last 10 years we have come to understand the importance and made progress in bifurcation imaging for planning the procedure and for assessment of procedural success, from 3D angiography and multislice computed tomography (MSCT) to fractional flow reserve (FFR) and optical coherence tomography (OCT). Recent clinical trials have shown improved results with selective use of a two-stent strategy and drug-eluting stents. Rates of major adverse cardiac events (MACE) and peri-procedural myocardial infarction (MI) for bifurcation lesions still remain high. Many challenges such as side-branch access, wire-trapping, incomplete side-branch coverage and restenosis still remain. No single dedicated bifurcation stent design thus far has been able to solve them all. More long-term, prospective, efficacious studies of these novel stent designs with concomitant imaging are needed for the field to progress.
Dedicated Bifurcation Stents Strategy
Authors: Shao-Liang Chen , Sheiban Imad ,   Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China. E: chmengx@126.com,   Interventional Cardiology, Division of Cardiology, University of Turin
Published: August 2014

Coronary bifurcation lesions represent an area of ongoing challenges in interventional cardiology, mainly due to the higher rate of residual stenosis and restenosis at the side branch ostium. Multiple two-stent bifurcation strategies, including T-stenting, V-stenting, simultaneuos kissing stenting, culotte stenting and classic crush techniques, have no advantages over one-stent techniques. This led to provisional stenting being considered as a mainstream approach, based on the results of numerous randomised trials. Dedicated bifurcation stents have been designed specifically to treat coronary bifurcations with the aim of addressing some of the shortcomings of the conventional percutaneous approach and facilitating the provisional approach. The development of more drug-eluting platforms and larger studies with control groups demonstrating their clinical applicability, efficacy and safety are required before these stents are widely incorporated into daily practice.
An Update on Patent Foramen Ovale Closure
Authors: Franke Jennifer , Wunderlich Nina , Sievert Horst ,   CardioVascular Center Frankfurt, Seckbacher Landstr. 65, 60389 Frankfurt, Germany. E: j.franke@cvcfrankfurt.de,   Cardiovascular Center Frankfurt,   Cardiovascular Center Frankfurt
Published: August 2014

The patent foramen ovale is an intra-cardiac right-to-left shunt that is thought to have an important role in a number of disease processes, including stroke, peripheral embolism, systemic oxygen desaturation (i.e. hypoxaemia) and migraine. A wide variety of percutaneous devices to close congenital heart defects are currently commercially available or in clinical trials. The trend in percutaneous closure of patent foramen ovales is shifting towards defect-tailored devices and new strategies that minimise the amount of foreign material left in the atria. This article focuses on the latest technologies available for closure of patent foramen ovales and on experimental devices currently under investigation.
An Update on Carotid Stent Trials and Perspectives
Authors: Bertog Stefan , Hornung Marius , Franke Jennifer , Wunderlich Nina , Sievert Horst ,   Cardiovascular Center Frankfurt,   Cardiovascular Center Frankfurt,   Cardiovascular Center Frankfurt,   Cardiovascular Center Frankfurt,   Cardiovascular Center Frankfurt, Seckbacher Landstrasse 65, 60389 Frankfurt, Germany. E: horstsievertmd@aol.com
Published: August 2014

The presence of carotid artery stenosis is associated with an increased risk of stroke. Carotid endartectomy (CEA) has been demonstrated to reduce the stroke risk in standard-risk patients with symptomatic carotid stenosis as well as in asymptomatic patients, provided that the operative risk is low. The role of percutaneous carotid intervention is less clear. There are no trials that compare percutaneous carotid intervention with medical management. Although trial results comparing CEA with carotid artery stenting (CAS) are variable and/or controversial, some trials have demonstrated promising results and have fostered enthusiasm for the performance of ongoing trials comparing CAS with CEA. This article focuses on the results of completed trials and outlines ongoing and planned trials that aim to clarify the role of CAS in patients with carotid stenosis. In addition, potential unresolved problems associated with CAS, such as CAS in the elderly, in-stent restenosis and distal embolisation, are discussed.
Effects of Seedling Emergence Timing on the Population Dynamics of Horseweed (Conyza canadensisvar.canadensis)
Authors: Tozzi E. , Van Acker R. C.
Published: August 2014

Horseweed is a surface-germinating ruderal facultative winter annual. The ruderal nature is a key adaptive characteristic that implicates emergence timing as an important recruitment factor. Experiments were established at three sites in southern Ontario, Canada, from 2009 to 2012 to determine the possible effect of emergence timing of horseweed on plant number, fecundity, and flowering timing. Emerged seedlings were tagged in 0.25-m2plots in five 2-wk cohorts in the fall and spring of each experimental season. Each plot was followed though until the plants contained within each plot completed their life cycle. Generally, spring-emerging plants were found to flower earlier than fall-emerging plants, but with fall emergence there were higher plant densities in August each season compared with spring emergence. Overall, there was no difference in fecundity between spring- or fall-emerging cohorts, but when cohorts were parsed beyond just spring or fall emergence, we found that plants emerging in early fall and early spring were more fecund and flowered earlier than plants emerging in late fall and late spring. Disturbance (tilled versus not-tilled) significantly affected emergence levels but not emergence timing. The differences in performance among emergence cohorts are likely due to spatial or temporal density-dependent growth advantages. These results show that spring-emerging cohorts of horseweed, especially early spring–emerging cohorts, should not be discounted when considering the weediness of this species, and this may hold true for other facultative winter annual weeds as well.
Alleles Contributing to ACCase-Resistance in an Italian Ryegrass (Lolium perennessp.multiflorum) Population from Oregon
Authors: Martins Bianca A. B. , Sánchez-Olguín Elena , Perez-Jones Alejandro , Hulting Andrew G. , Mallory-Smith Carol
Published: August 2014

Acetyl-coenzyme A carboxylase (ACCase)–resistant Italian ryegrass is one of the most difficult-to-control weeds in United States wheat-production systems. Seed was collected from a suspected ACCase-resistant Italian ryegrass population in a winter wheat field with a history of ACCase-inhibitor herbicide use. This study investigated cross-resistance patterns in this Italian ryegrass population. Resistance was identified to the commercial dose of the ACCase herbicides pinoxaden, clethodim, sethoxydim, and clodinafop. Partial chloroplastic ACCase sequences revealed aspartate-to-glycine or isoleucine-to-asparagine substitutions at positions 2078 or 2041 in individuals of the resistant population. This is the first report, to our knowledge, of Asp-2078-Gly and Ile-2041-Asn substitutions in ACCase-resistant Italian ryegrass in the United States. Associating the occurrence of resistance alleles with resistance to specific active ingredients provides a better understanding of ACCase cross-resistance in Italian ryegrass and possibly options for its control.
Hexazinone Resistance in Red Sorrel (Rumex acetosella)
Authors: Li Zhenyi , Boyd Nathan , McLean Nancy , Rutherford Katherine
Published: August 2014

Biannual applications of hexazinone have been applied in many lowbush blueberry fields in Nova Scotia for more than 30 years. Persistent reliance on a single herbicide chemistry may have selected for hexazinone-resistant red sorrel. The recommended rate of hexazinone (1.92 kg ai ha−1) no longer controls red sorrel in many growing regions. Six levels of hexazinone (0, 0.48, 0.96, 1.92, 3.84, and 7.68 kg ai ha−1) were applied to red sorrel plants grown in a greenhouse from seeds collected from three commercial fields and a no blueberry area to determine if they were hexazinone resistant. Red sorrel from two sites where hexazinone had not been applied regularly died at the 0.96 kg ai ha−1rate of hexazinone whereas red sorrel from two commercial fields survived at 7.68 kg ai ha−1. It is concluded that red sorrel is hexazinone-resistant in some wild blueberry fields. A portion of thepsbA gene was sequenced and it was determined that resistant plants had a Phe to Val substitution at position 255 in the D1 protein. This is the first recorded instance of hexazinone resistance in a perennial broadleaf weed in blueberry fields.
Characterization of Glyphosate-Resistant Tropical Sprangletop (Leptochloa virgata) and Its Alternative Chemical Control in Persian Lime Orchards in Mexico
Authors: Pérez-López Macrina , González-Torralva Fidel , Cruz-Hipólito Hugo , Santos Francisco , Domínguez-Valenzuela José A. , De Prado Rafael
Published: August 2014

Field, greenhouse, and laboratory experiments were conducted to investigate resistance to glyphosate in tropical sprangletop biotypes (Lv8 and Lv9) collected in Persian lime from Veracruz, Mexico. Assays to determine the dose required to reduce seedling fresh weight by 50% indicated a resistance factor (RF) of 4.9 and 3.2 for biotypes Lv8 and Lv9, respectively; whereas the LD50showed a RF of 4.4 and 3.3 for biotypes Lv8 and Lv9, respectively. On the other hand, the RFs using whole plant dose–response assays were lower (RF of 3 for Lv8 and 2.3 for Lv9). The susceptible biotype (LvS) accumulated 5.5 and 11.8 times more shikimate than biotypes Lv8 and Lv9, respectively, at 96 h after treatment (HAT). In field experiments, alternatives to glyphosate-resistant tropical sprangletop management were identified. Indaziflam + glufosinate and paraquat + diuron provided over 80% control of in-field populations of tropical sprangletop at 60 d after treatment (DAT). These results confirmed the first reported case of glyphosate-resistant tropical sprangletop.