bluuebunny/crossref_metadata_2025 huggingface dataset:
Sartorius Myoplasty in the Treatment of Exposed Arterial Grafts
Authors: Sladen J. G. , Thompson R. P. , Brosseuk D. T. , Kalman P. G. , Petrasek P. F. , Martin R. D.
Published: September 2022

The long-term success of sartorius myoplasty in 14 of 16 patients who presented with an exposed vascular graft in an infected groin is described. The presenting complications were wound dehiscence (ten patients), hemorrhage (two), skin erosion (two), late bilateral fistulas (one) and false aneurysm (one). Ten grafts were prosthetic and six autogenous. Positive cultures were obtained from 15 wounds; four grew Staphylococcus epldermidis, the remainder mixed or Gram-negative bacteria. Each groin was radically debrided, including the surface of the arterial graft, and, if possible, closed immediately with a sartorius myoplasty applied directly to the graft. Twist, fan and loop myoplasties were equally effective. Grossly infected wounds were debrided initially and obviously infected grafts were replaced in situ before myoplasty. Sartorius myoplasty is recommended as an elegant solution for the infected groin in which there is an exposed arterial graft.
Treatment of Congenital Venous Avalvulosis Using a Surgically Created Autogenous Vein Valve
Authors: Karagöz H. Y. , Doǧan N. , Kocailik A. , Süngün M. , Duran E.
Published: September 2022

A patient with venous valve hypoplasia resulting in chronic venous insufficiency is presented and a method of surgical correction by creation of an autogenous femoral vein valve described. A saphenous vein segment was opened posteriorly and inverted cephalad into the common femoral vein to construct a monocuspid vein valve. At 1 month after operation the patient experienced significant symptomatic improvement. The valve was patent and competent when assessed by Doppler venous examination but slight incompetence was shown by Valsalva's manoeuvre. This procedure appears to be a useful technique for the correction of deep vein reflux caused by venous valve aplasia and hypoplasia but requires further short- and long-term investigation.
Neuropathological Features of Profoundly Hypothermic Circulatory Arrest: An Experimental Study in the Pig
Authors: Th. Fessatidis I. , Thomas V. L. , Shore D. F. , Hunt R. H. , Weller R. O.
Published: September 2022

Twenty-four neonatal pigs were exposed to periods of circulatory arrest of between 70 and 120 min under profound hypothermia at 15°C. Brain tissue taken 6h after cardiopulmonary bypass was examined histologically and by electron microscopy for evidence of hypoxic damage. Specimens from control pigs and animals subjected to 70 min arrest showed no morphological changes in the cerebral or cerebellar neurones. The earliest changes were seen after 90-min arrest; these were highly significant after 120 min. The changes involved mainly the Purkinje cells of the cerebellum with vacuolation in the cytoplasm; the inferior half of the cerebellum was particularly affected. The frequency and pattern of selective vulnerability of the cerebellum may be related primarily to the nature of its blood supply.
Risk Factors for Stroke in Patients Undergoing Coronary Artery Bypass Grafting
Authors: Bull D. A. , Neumayer L. A. , Hunter G. C. , Keksz J. , Sethi G. K. , McIntyre K. E. , Bernhard V. M.
Published: September 2022

Stroke is a significant cause of morbidity and mortality following coronary artery bypass grafting (CABG). Over a 30-month period, 245 consecutive patients undergoing elective CABG were prospectively examined to determine which risk factors might predispose to stroke following surgery. The risk factors evaluated included hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, smoking, atrial fibrillation, a history of cerebrovascular accident or transient ischemic attack, carotid artery stenosis > 60% documented by duplex scanning, severe atherosclerosis of the ascending aorta, and the presence of ventricular thrombus. Postoperative stroke occurred in five of the 245 patients (2%), four evident immediately on awakening and one on day 7 after surgery. The probable causes of the immediate strokes were atheroembolism in three patients and severe ipsilateral carotid stenosis in one. Hypertensive hemorrhage was responsible for the one case of delayed stroke. In this study, carotid artery stenosis did not presage stroke following CABG, but ventricular thrombus was highly predictive of stroke after surgery.
Ultrasonic Angioplasty for Ostial Stenosis of the Left Coronary Artery
Authors: Kotsuka Y. , Furuse A. , Matsunaga H. , Chikada M.
Published: September 2022

Coronary artery bypass grafting is the first-choice treatment for lesions of the left main trunk, but this procedure is associated with the problem of long-term graft patency. Some surgeons thus prefer to perform patch angioplasty for such lesions; however, the safety of this operation is not well established. Operative angioplasty using an ultrasonic aspiration system in a patient with ostial stenosis of the left coronary artery was successfully performed. This is the first report of the application of ultrasonic angioplasty to coronary artery disease.
Arterial Reconstruction in Elderly Patients
Authors: Esato K. , Zempo N. , O-Hara M. , Fujioka K. , Kuga T.
Published: September 2022

The surgical results of primary peripheral arterial reconstruction for arteriosclerosis obliterans during a 16-year period were examined as a function of age. Data in group 1 were of 121 procedures performed on 95 patients aged ⩾70 years and those in group 2 of 215 procedures performed on 148 patients aged ⩽69 years. There was no significant difference between the operative mortality rate of 4% (four of 95) in group 1 and 3.4% (five of 148) in group 2. The long-term mortality rate was 33% (31 of 95) in group 1. significantly higher ( P<0.05) than 18.9% (28 of 148) in group 2. The most common cause of death in both groups was cardiac failure. Cumulative 5-year survival rates in groups 1 and 2 were 56.3 and 78.3% respectively ( P<0.0001). The cumulative primary 5-year patency rates of suprainguinal bypass grafts in the two groups were 94.2 and 90.4%. respectively, while those of infrainguinal reconstruction were 67.7 and 55.0% respectively. The 5-year cumulative limb salvage rate was 93.1% in group 1 and 92.7% in group 2. None of these differences was significant. The results support an active approach to surgery in elderly patients with peripheral arterial obstruction caused by arteriosclerosis obliterans.
Surgical Management of Renal Artery Aneurysm
Authors: Dzsinich C. , Gloviczki P. , McKusick M. A. , Pairoiero P. C. , Bower T. C. , Hallett J. W. , Cherry K. J.
Published: September 2022

Between 1978 and 1990, 32 patients (15 men and 17 women; mean age 48 (range 15–83) years) underwent 35 operations for renal artery aneurysm (4.2% of 829 renal artery repairs). Eleven patients presented with acute symptoms (nine with hematuria, eight with abdominal pain, two with acute hypertension). Twenty-eight of the 32 patients had chronic hypertension. The diagnosis was confirmed by angiography in all but two. The mean diameter of the renal artery aneurysm was 1.7 (range 0.7–9.0) cm. Seventeen patients had concomitant renal artery stenosis; none of the aneurysms ruptured. Nephrectomy was performed in seven patients and excision of the aneurysm without reconstruction in five. Twenty patients underwent 23 reconstructions using lateral suture (three procedures), vein patch (three), saphenous vein (13), Dacron (three) or composite (vein and hypogastric artery) graft (one). Seven patients underwent ex vivo renal artery repair. There was no perioperative death or secondary nephrectomy. One postoperative graft occlusion was successfully revised. Hypertension improved in 50% of patients. The presence of hypertension, enlargement of a renal artery aneurysm, solitary kidney, bilateral involvement, acute hematuria or potential loss of kidney or renal function may be indications for surgical treatment of an aneurysm > 1.5 cm in diameter. A renal artery aneurysm of any size should be repaired in women who may become pregnant. Where there is branch involvement, ex vivo repair is the procedure of choice for renal salvage.
Outcome following Blunt Vascular Trauma of the Upper Extremity
Authors: Thompson P. N. , Chang B. B. , Shah D. M. , Darling R. C. , Leather R. P.
Published: September 2022

Blunt trauma to the upper extremity may cause extensive vascular damage in addition to severe musculoskeletal injury. Over a 5.5-year period. 17 patients with a total of 23 arterial injuries were treated. Diagnosis was made in 16 patients before surgery by physical and Doppler ultrasonographic examination. Angiography performed in ten patients assessed the extent of injury. Associated orthopedic injuries were present in 11 patients and neurologic injury in 16. At surgery, 21 of 23 arterial repairs required autologous vein. The initial limb salvage rate was 76%. Pour patients underwent above-elbow amputation because of progressive sepsis and myonecrosis. A fifth underwent delayed amputation at 7 months due to loss of limb function. Neurologic impairment was the major long-term morbidity. The data show that outcome following blunt vascular trauma of the upper extremity is governed by the associated injuries.
Iatrogenic Vascular Injury following Arterial Cannulation: The Importance of Early Surgery
Authors: Waller D. A. , Sivananthan U. M. , Diament R. H. , Kester R. C. , Rees M. R.
Published: September 2022

Prospective data were collected over a 7-year period on patients undergoing repair of iatrogenic vascular injury following arterial cannulation. From 9375 procedures (7790 coronary angiograms. 835 coronary angioplasties. 445 other cardiac catheterizations. 155 femoral angiograms. 150 peripheral angioplasties) surgical repair was required in 26 patients. The overall incidence of significant injury was 0.28% and higher in therapeutic than diagnostic procedures. The mode of presentation included: critical limb ischaemia in 18 cases, false aneurysm in three, haematoma in three and claudication in two. The common femoral artery was the most common site of injury. No patient presenting with false aneurysm or haematoma suffered any deleterious sequelae. However, 50% of those presenting with critical ischaemia suffered permanent disability after operation. The median delay to surgery was significantly longer in this group (24 versus 4h; P< 0.001) but there was no difference in age or incidence of underlying peripheral vascular disease. The physical, psychological and litigious sequelae of the complications of iatrogenic vascular injury cannot be overstated. It is strongly advocated that immediate surgical consultation be applied when limb ischaemia is suspected.
Pelvic Necrosis: A Complication of Infected Aortic Graft Excision
Authors: Mohan Das B. , Zama N. , Satlani B. , Vaccaro P. S.
Published: September 2022

Infection is a devastating complication of synthetic aortic graft surgery. Patients with significant occlusive atherosclerosis of the internal iliac arteries undergoing aortic graft removal for graft infection may be at risk of pelvic and midbody necrosis. An unusual and fatal complication of this nature associated with the management of synthetic aortic graft infection has been encountered in two patients treated by extra-anatomic revascularization and staged removal of the infected aortic prosthesis. The hallmark of their presentation was pelvic and midbody necrosis in the presence of excellent distal perfusion with palpable pulses. Marginal pelvic circulation was therefore compromised further by graft removal and absence of retrograde pelvic perfusion. The finding of focal ischemic changes in the pelvic area of a patient with increasing serum creatinine phosphokinase activity, leukocytosis, myoglobinuria and paraplegia following infected aortic graft removal signals a grave and fatal prognosis.
Arterial Thrombosis: A Rare Complication of the Nephrotic Syndrome
Authors: Farkas J.-C. , Tabet G. , Marzelle J. , Cormier F. , Laurian C. , Cormier J.-M.
Published: September 2022

Arterial thrombosis is a rare complication of the nephrotic syndrome, occurring mainly in men. Two cases of arterial thrombosis are described, the first affecting a 54-year-old man in whom aortic thrombosis initiated the nephrotic syndrome and who relapsed 1 year later resulting in graft thrombosis, the second affecting a 15-year-old male patient with extensive popliteal and distal arterial thrombosis, followed by recurrent venous bypass thrombosis. A review of the literature shows that arterial thrombosis occurs primarily in the femoropopliteal, renal and coronary arteries. The genesis of arterial thrombosis in patients with nephrotic syndrome involves increased blood viscosity, platelet adhesion and aggregation, high levels of fibrinogen, low levels of serum antithrombin III, diuretic agents and steroid therapy. For high-risk patients with low levels of plasma albumin or those receiving steroids, anticoagulation therapy should be introduced to prevent thrombosis. Urine protein should be evaluated in patients with arterial thrombosis of unknown origin.
Thromboangiitis Obliterans Associated with Coeliac Disease
Authors: Durand J. M. , Lefevre P. , Kaplanski G. , Quiles N. , Branchereau A. , Soubeyrand J.
Published: September 2022

A case of thromboangiitis obliterans associated with coeliac disease is presented. The relationship between the two diseases remains unknown, although an immunological connection is suspected.
Descending Thoracic Aortomyoplasty: Effect of Chronically Conditioned Muscle on Heart Failure
Authors: Constance C. G. , Sabini G. , Turi G. K. , Hines G. L.
Published: September 2022

The effect of descending thoracic aortomyoplasty using conditioned latissimus dorsi muscle on cardiac output in five mongrel dogs with pharmacologically induced congestive heart failure was evaluated. A neurovascular left latissimus dorsi flap was lifted and through a left thoracotomy placed around the proximal descending thoracic aorta. The flap was conditioned for 4–6 weeks with a neurostlmulator using the following parameters: amplitude 0.5 V. pulse width 210 μs and frequency 2 Hz. The neurostlmulator was then removed and a cardiomyostlmulator inserted and programmed to burst-stimulate the muscle during diastole. Baseline measurements of central venous pressure, heart rate, mean arterial blood pressure, pulmonary capillary wedge pressure, and cardiac output were obtained with the cardiomyostlmulator off and on (study 1). Heart failure was induced with a combination of propranolol and verapamil, and measurements again taken with the stimulator off and on. The neurostimulator was reimplanted to continue stimulation of the latissimus dorsi muscle, and another set of measurements taken at 6 weeks with the cardiomyostlmulator off and on (study 2). Counterpulsation in control conditions (before cardiac failure) in both studies demonstrated no significant increase in cardiac output. However, mean(s.d.) cardiac output was significantly (P < 0.1) increased by muscle stimulation in dogs with heart failure (study 1: from 2.39(1.10) to 3.14(1.41)l/min; study 2: from 1.89(0.64) to 2.38(0.57) l/min). There was no significant difference in the increase in cardiac output associated with muscle stimulation between studies 1 and 2. The results indicate that the model can increase cardiac output in heart failure and that this improvement is constant over a 4–6-week period, suggesting that muscle fatigue may not occur.
Heterogeneous Metabolic Changes in the Calf Muscle of the Rat during Ischaemia-reperfusion: in Vivo Analysis by 31P Nuclear Magnetic Resonance Chemical Shift Imaging and 1H Magnetic Resonance Imaging
Authors: Morikawa S. , Inubushi T. , Kito K.
Published: September 2022

Non-localized and localized 31P nuclear magnetic resonance (NMR) spectra of rat calf muscle during arterial occlusion and after reperfusion were concurrently observed using chemical shift imaging and ‘H magnetic resonance imaging (MRI). During ischaemia. the levels of high-energy phosphates (phosphocreatine and adenosine 5′-triphosphate) were depleted and that of inorganic phosphate was increased. In addition, the signal intensity on 1H MRI was increased. These changes were observed to be relatively homogeneous throughout the calf. In contrast, the changes during reperfusion were heterogeneous. In the central part of the calf, inorganic phosphate disappeared, phosphocreatine was restored immediately on reperfusion and the ‘H signal was decreased. However, in the regions of the tibialis anterior muscle and the superficial part of the gastrocnemius muscle, inorganic phosphate persisted for several hours, phosphocreatine was not restored and the signal intensity on T2-weighted 1H MRI was increased further. The heterogeneous changes detected by 31P NMR spectroscopy and 1H MRI showed close agreement. The susceptibility of different calf muscles to ischaemia and reperfusion seems to depend on their predominant muscle fibre type (i.e. fast-twitch or slow-twitch fibres). Reversible and irreversible ischaemic changes could be non-invasively distinguished by in vivo31P NMR spectroscopy and 1H MRI.
Effect of Right Atrial Appendicectomy on the Release of Atrial Natriuretic Peptide in Humans
Authors: Kalaycioǧlu S. , Soncul H. , Halit V. , Gökgöz L. , Akçora N. , Hayran M. , Yener A. , Ersöz A.
Published: September 2022

The present study evaluated the effect of right atrial appendicectomy on the release of atrial natriuretic peptide (ANP) and subsequent changes in postoperative haemodynamics in 20 men undergoing coronary artery bypass graft surgery. The right atrial appendix was removed in ten patients and saved in ten. Serum ANP, sodium levels and urinary sodium excretion were measured before and on days 1, 7 and 30 after surgery. Haemodynamic parameters were monitored before surgery and on day 30. Serum ANP levels fell significantly in patients undergoing appendicectomy ( P < 0.05); haemodynamic parameters were unchanged. Hence, appendicectomy reduced serum ANP levels in the short term, though these tended to rise again with time; cardiac function was not affected by lowered levels of serum ANP. Consequently, saving the appendix in right atrial apendicectomy improves natriuresis and may decrease diuretic requirement.
Surgical Management of the Scimitar Syndrome: An Age-Dependent Spectrum
Authors: Torres A. R. , Dietl C. A.
Published: September 2022

Fourteen patients with scimitar syndrome, aged from 4 days to 20 years, underwent surgical treatment between September 1980 and August 1988. Patients were separated into two groups. Group A comprised four neonates with heart failure and severe pulmonary hypertension; part of the right lung was supplied by large aberrant systemic subphrenic arteries (ASSAs) in each. Group B included ten patients (nine children and one adult) with mild to moderate symptoms, normal pulmonary artery pressures; only two had ASSAs. In group A, one neonate with multiple ventricular septal defects underwent pulmonary artery banding but later required a lobectomy because of a lung abscess. The other three neonates underwent ligation of ASSAs; two improved rapidly, and one died of sepsis. In group B, all patients survived intracardiac repair and remain asymptomatic during a follow-up of 24 to 108 (mean 54.9) months. In summary, prognosis after intracardiac repair is excellent in patients without pulmonary hypertension. Neonates with heart failure usually improve after ligation of ASSAs, and pulmonary resection is only indicated in patients with intractable pulmonary sequestrations.
Vascular Graft Infections: A Personal Experience
Authors: Bunt T. J.
Published: September 2022

Fifty-five vascular graft infections were personally managed by the author over an 8-year period. For 22 patients with aortic graft infection, Staphylococcus epidermidis was the most common pathogen (18 of 22 patients), presenting as limb thrombosis in nine and pseudoaneurysm in five. All patients underwent staged extra-anatomic reconstruction and graft resection 4–5 days later. For 33 patients with peripheral infection, S. aureus was the most common pathogen (29 of 33 patients), presenting as clinical graft sepsis usually within months of initial operation. Local therapy was successful in seven of nine patients, whereas graft resection with autologous reconstruction achieved limb salvage in all 11 patients involved. Overall, the mortality rate was 9.1% for 22 aortic and zero for 33 peripheral infections; amputation rates were 14 and 12%, respectively.
Pathogenesis of Lipodermatosclerosis of Venous Disease: The Lesson Learned from Eosinophilic Fasciitis
Authors: Naschitz J. E. , Yeshurun D. , Schwartz H. , Croitoru S. , Shajrawi I. , Misselevich I. , Boss J. H.
Published: September 2022

The histological features of lipodermatosclerosis and eosinophilic fasciitis and its variants were compared in a prospective study of outpatients attending the vascular clinic and inpatients in the Department of Medicine of a regional university hospital. Main outcome measures examined were swelling and induration of the subcutaneous layers with a stocking distribution in the calves. The inflammatory and fibrosing alterations involving the panniculus adiposus, superficial fascia and perimysium were essentially indistinguishable histologically in patients with lipodermatosclerosis or eosinophilic fasciitis and its variants. The intensity of the subcutaneous induration was related to the underlying nosological entity and the duration of the process. Infectious cellulitis was found to aggravate the clinical symptoms of lipodermatosclerosis. Since the stereotypical inflammatory and fibrosing processes in lipodermatosclerosis and eosinophilic fasciitis and its variants are similar irrespective of the initiating factors, it is suggested that there is a common final pathway in the pathogenesis of both disorders.
Aneurysm of the Right Gastroepiploic Artery: A Case Report of Laparoscopic Resection
Authors: Uchikoshi F. , Sakamoto T. , Imabunn S. , Lee S. , Taniguchi E. , Kai Y. , Miyata M.
Published: September 2022

A traumatic pseudoaneurysm of the right gastroepiploic artery in a 55-year-old woman was resected using laparoscopy. The durations of anaesthesia and operation were 260 and 220 min respectively. Blood loss was minimal. The perioperative period was uneventful; the patient needed no analgesic treatment and ate her first meal on the morning of the day after surgery. She was discharged 5 days later and has progressed well for 5 months since surgery without any abnormal findings.
A New Technique of Tricuspid Valve Replacement for Ebstein's Anomaly
Authors: Yamazaki K. , Hoshino S. , Tagusari O. , Fujino S. , Takemura T. , Koyanagi H.
Published: September 2022

For surgical management of Ebstein's anomaly, a new technique of tricuspid valve replacement on the true annulus, avoiding injury to the conduction system, has been developed. At operation, the valve fixation sutures are placed around the true annulus except for a part of Koch's triangle. A 3times3cm xenograft patch is sutured to cover the atrioventricular node and bundle of His. The remainder of the valve fixation sutures in Koch's triangle are placed only on the patch to prevent conduction injury, and the valve fixation annulus is completed. This new technique has been applied to three patients and has preserved atrioventricular conductivity well in all cases. It is concluded that this procedure of tricuspid replacement on the true annulus can be safely applied and is remarkably effective in preventing atrioventricular conduction disturbance.
Cardiac Angiosarcoma — a Diagnostic Dilemma
Authors: Klima U. , Wimmer-Greinecker G. , Harringer W. , Mair R. , Groß Ch. , Brücke P.
Published: September 2022

A 25-year-old man suffering from sudden onset of haemoptysis after 1 week of orthopnoea, fatigue and general weakness was admitted to a cardiology department in Vienna. No diagnosis was made. Four weeks later cardiopulmonary resuscitation and pericardiocentesis were necessary because of cardiac tamponade. Although all modern imaging procedures were performed, a diagnosis of rapidly progressive primary cardiac angiosarcoma could not be established. Definitive diagnosis was established only after exploratory median sternotomy. The patient exhibited no response to chemotherapy. He died 5 days after surgery as a result of respiratory failure.
Sequential Internal Mammary Artery Grafts: Clinical and Angiographic Assessment
Authors: Tashiro T. , Todo K. , Haruta Y. , Yasunaga H. , Tachikawa Y.
Published: September 2022

Between January 1988 and August 1992, the internal mammary artery was used as a sequential graft to the left anterior descending artery and/or diagonal branch in 34 patients. One patient died in hospital. After surgery all survivors were free from angina for a follow-up of up to 4 years. Recatheterization was performed in 33 patients within 1 year of surgery. Postoperative angiography showed that 65 anastomoses (98%) were patent, but three patent grafts (5%) between the proximal and distal sequential anastomoses showed ‘string sign’. It is important to prevent ‘string sign’ in sequential grafting. It is considered that sequential internal mammary artery grafting should be limited to coronary arteries with severe stenosis that divides anastomosed coronary arteries into two.
Role of Angiographic Catheters in Surgery of Popliteal Arteriovenous Fistulas
Authors: Joseph S. , Unni N. Madhavan , Neelakandhan K. S. , Ravimandalam K.
Published: September 2022

A 50-year-old woman with a chronic, traumatic popliteal arteriovenous fistula was treated surgically by closure of the fistula. Placement of an angiographic catheter across the fistula into the venous sac immediately before surgery helped to locate the fistula accurately and quickly at operation. This simple manoeuvre will facilitate surgical treatment, particularly in cases of long-standing, chronic arteriovenous fistulas.
Considering patient narrative-based and medico-scientific epistemologies in framing psychiatric care
Authors: Looi Jeffrey CL , Bastiampillai Tarun , Allison Stephen , Maguire Paul A
Published: September 2022

Objective

Personal narratives of lived experience with psychiatric illness and distress remain central in the epistemology of mental illness. We provide a commentary on this potential bridging of patient narrative-based epistemology, and medico-scientific epistemology used by psychiatrists used for diagnosis, formulation, prognosis and treatment.

Conclusion

Discussion and planning of psychiatric care can be framed by understanding the narrative-based epistemology of a patient’s illness as highlighted by five key questions to explore the patient’s illness explanatory models. We propose five key questions for the psychiatrist’s complementary consideration of medico-scientific epistemology that frame conceptual models of aetiology, pathophysiology, diagnosis, formulation, prognosis and treatment, which are embedded in the predominant socio-cultural environment. These questions assist in bridging patient narrative and medico-scientific explanatory models to facilitate more effective collaborative care planning.
Self-sensing of pulsed laser ablation in carbon nanofiber-based smart composites
Authors: Jain Rajan , Kedir Nesredin , Hassan Hashim , Chen Weinong W , Tallman Tyler N
Published: September 2022

Laser-to-composite interactions are becoming increasingly common in diverse applications such as diagnostics, fabrication and machining, and directed energy weapon systems. These interactions can induce seemingly imperceptible damage to the material. It is therefore desirable to have a means of sensing laser exposure. Smart or self-sensing materials may be a powerful method of addressing this need. Herein, we present a study on the potential of using changes in the electrical properties of carbon nanofiber (CNF)-modified composites as a way of detecting laser exposure and degradation. To test laser sensing capabilities, CNF composite specimens were exposed to an infra-red laser operating at 1064 nm, 35 kHz, and pulse duration of 8 ns for a total of 20 s. The resistances of the specimens were then measured post-ablation, and it was found that for 1.0 wt.% CNFs, the average resistance increased by approximately 18% thereby demonstrating laser sensing capabilities. In order to expand on this result, electrical impedance tomography (EIT) was employed for spatial localization of laser exposures of 1, 3, 5, 10, and 20 s on a larger, plate-like specimens. EIT was not only successful in detecting and localizing exposures, but it could also find laser damages that were virtually imperceptible to the naked eye. Based on these results, this research could lead to the development of novel carbon-based smart material systems for real-time detection and tracking of laser exposure in the measurement, fabrication, and defense industries.
Analysis of Bicarbonate-Based Purge Solution in Patients With Cardiogenic Shock Supported Via Impella Ventricular Assist Device
Authors: Bergen Kyle , Sridhara Shashank , Cavarocchi Nicholas , Silvestry Scott , Ventura Davide
Published: September 2022

Background:

The Impella device is a continuous axial flow pump which provides hemodynamic support by expelling blood into the aorta. The manufacturer recommends using dextrose-based heparin containing solutions as the default purge. As an alternative to anticoagulant solutions, a bicarbonate-based purge solution has been proposed with limited data substantiating adequate protection and durability.

Objective:

To assess the impact of a bicarbonate-based purge solution on Impella pump thrombosis and bleeding outcomes.

Methods:

Single-center, retrospective study of cardiogenic shock patients who received an Impella between December 2020 through September 2021. Patients were evaluated based on whether they received bicarbonate-based purge solutions or remained on heparin-based purge solutions. The primary outcome was the rate of Impella pump thrombosis, defined as multiple purge pressures greater than 800 mm Hg. Secondary outcomes included incidence of bleeding defined as a drop in Hgb of at least 2 g/dL along with use of blood products and supratherapeutic anticoagulation defined as an aPTT of greater than 70 seconds.

Results:

Forty-three patients received bicarbonate-based purge solutions and 49 controls received heparin. The incidence of purge thrombosis by purge pressure threshold was similar between the two groups (16.3% vs 12.2%, P = 0.58). The rate of bleeding was lower with bicarbonate-based purge (27.9% vs 65.3%, P < 0.05) driven by a drop in Hgb of more than 2 g/dL. The rate of supratherapeutic anticoagulation was higher in the heparin arm (65.3% vs 27.9%, P < 0.05)

Conclusion and Relevance:

Nonanticoagulant purge alternatives offer the potential to reduce bleeding complications and laboratory monitoring burden while maintaining durability.
Regression of bilateral orbital inflammation with anti-CD20 in a patient with relapsing granulomatosis with polyangiitis: A case report
Authors: Castellino Niccolò , Scuto Salvatore , Zanoli Luca , Toro Mario Damiano , Avitabile Teresio , Castellino Pietro , Russo Andrea
Published: September 2022

Purpose

To describe a case of bilateral orbital inflammation in a patient with relapsing granulomatosis with polyangiitis as only sign of disease recurrency treated with anti-CD20 antibodies.

Methods

A 62-year-old Caucasian man affected by Granulomatosis with polyangiitis (GPA) was admitted to our hospital showing bilateral orbital inflammation as the only signs of disease recurrency. In addition, eye visit detected severe visual loss in the left eye (light perception). Guidelines to manage severe orbital involvement in patients with GPA are lacking. The patient was treated with intravenous rituximab and glucocorticoids.

Results

Complete regression of inflammatory signs by imaging were observed at three-year of follow-up after the treatment with anti-CD20. However, ocular multimodal imaging showed severe optic nerve damages in the left eye with irreversible visual loss.

Conclusion

Patients affected by GPA with inflammatory orbital involvement may benefit from anti-CD20 antibodies.
Complex norm localization: from price competitiveness to local production in East African Community pharmaceutical policy
Authors: Murray-Evans Peg , O’Reilly Peter
Published: September 2022

This article offers a critical contribution to debates around access to medicines and the global politics of pharmaceutical production in Africa. Specifically, we seek to account for a normative shift within these debates whereby the promotion of local pharmaceutical production in Africa has once again come to be viewed as a central modality for achieving access to health across the continent. While the onset of this normative shift has been highlighted by the global Covid-19 pandemic, in this article we argue that its antecedents can be traced to a more incremental process of global and regional normative change that has been in motion since the late 1990s. To illustrate this, we narrow our empirical focus onto the East African Community (EAC) and the regional initiatives its members have pursued to promote local pharmaceutical production capacities since 2012. We draw and build upon the literature on norm localization to emphasize how the emergence and distinctiveness of this policy reflected the complex way in which policy actors within the EAC sought to localize and combine separate (and somewhat competing) changing global norms around access to health and industrial policy. The article also points to the tensions and unintended consequences which emerged from this complex process of norm localization and the challenges of implementing this strategy within the institutional landscape of the EAC.
An easy-to-implement self-healing smart design for increasing impact strength and crashworthiness resistance of honeycomb sandwich structures
Authors: Güçlü Harun , Osmanoğlu Serhat , Hayırkuş Aslıhan , Taş Oğuzhan , Yazıcı Murat
Published: September 2022

In this paper, the dynamic compression impact response of an aluminum honeycomb core filled with open-cell foams impregnated with self-healing liquid agents was investigated experimentally. Samples were subjected to a variety of impacts in order to determine healing time and self-healing performance. Three different sandwich specimens were developed to evaluate the effectiveness of self-healing. The sandwich specimens are designated as B (empty honeycomb core cells), S (only open-cell soft polyurethane foam-filled honeycomb core cells), and self-healing agent (SHA) (open-cell soft polyurethane foams impregnated with liquid self-healing agents). The test results were presented by considering the crashworthiness and healing efficiency criteria, and the impact characteristics of the samples were compared related to these criteria. After testing, the results demonstrated that the self-healing agent specimens had much fewer buckling deformation and displacement than their counterparts. Significant improvements were achieved in healing efficiencies and crashworthiness evaluation criteria. The peak load and the energy needed to attain peak load are considered healing efficiency criteria. Self-healing agent specimens reached 29.7% and 12.9% more peak loads, and in the energy absorbed up to peak loads 140% and 34.9% higher values than the B and S sandwiches. In the same samples, crushing strain features were acquired as 50% versus 66%, indicating less displacement in self-healing agent specimens than counterparts. The results indicated that an aluminum honeycomb sandwich structure that can heal itself after damage and recover impact characteristics remarkably could be produced practically.
Assessing national action through emergency paid leave to mitigate the impact of COVID-19-related school closures on working families in 182 countries
Authors: Raub Amy , Heymann Jody
Published: September 2022

In April 2020, nearly 1.6 billion learners were out of school. While a growing body of literature has documented the detrimental impact of these closures on children, less attention has been devoted to the steps countries took to mitigate the impact of these closures on working families. Paid leave is recognized as an important policy tool to enable working parents the time they need to respond to family needs without risking job or income loss. This article uses a novel data set to assess whether countries had policies in place prior to the pandemic to respond to increased care needs and the extent to which policies were introduced or expanded during the pandemic to fill the gap. Only 48 countries had policies in place prior to the pandemic that could be used to respond to the care needs created by school and childcare center closures. In the vast majority of these countries, the duration of leave in these policies was too short to meet the care needs of the pandemic or relied on parents reserving extended parental leave options. Only 36 countries passed new legislation during the pandemic, but the majority of those that did covered the full duration of closures. As countries continue to face COVID-19 and consider how to better prepare for the next pandemic, emergency childcare paid leave policies should be part of pandemic preparedness frameworks to prevent further exacerbating inequalities. The policies introduced during the pandemic offer a wide range of approaches for countries to identify feasible solutions.
The strategy–identity nexus: The relevance of their temporal interplay to climate change
Authors: Schultz Majken
Published: September 2022

Grand Challenges have stimulated a search for new solutions at the interplay between fields and disciplines which previously have been separated. In this essay, I argue that a further development of temporal interplay between strategy and organizational identity may enrich studies of Grand Challenges, exemplified by how actors respond to climate change. This interplay is motivated by recent elaborations of the differences in temporality between strategy and organizational identity from a distinction between a dominant focus on the future (strategy) or the past (organizational identity) to a conceptualization of the differences in temporal structures between them. Using management research to contribute to the fight against climate change, sustained temporal interplay between strategy and organizational identity can advance our understanding of how organizations may act now for future climate goals. I suggest questions for future research focused on making an impact.
Considering the cost of cyber warfare: advancing cyber warfare analytics to better assess tradeoffs in system destruction warfare
Authors: Swallow Robert Chandler
Published: September 2022

The Chinese People’s Liberation Army (PLA) intends to wage systems confrontation and system destruction warfare. “System-of-systems thinking drives how the PLA understands and seeks to win modern warfare … and to achieve integrated joint operations and ‘win informationized local wars’.”1 This paper seeks to raise the odds that the PLA overspends in their pursuit and fails to achieve their objectives by increasing the focus on the role cyber analytics plays in winning system-of-systems warfare, what former Deputy Secretary of Defense Robert Work described as algorithmic warfare.2
Collections With Connections: A Case Study About Collections at Micro Museums in Central Mediterranean Islands
Authors: Vella John
Published: September 2022

The study introduces twelve Mediterranean insular grassroots micromuseums and their collections. Curators were asked a set of questions concerning their collections, thus, the message intended, the method applied, and sources of information used to interpret the collection. They were also asked about the involvement of others and negotiation in interpretation, presentation, and decision-making concerning selection and display of objects. Based on replies, the study showed that while the collections displayed promote a theme, they primarily intend to build connections and bring together communities, whether by place, shared interest, practice, or past experiences such as history or specific events in history. Besides the intended connections, collections displayed at grassroots micromuseums could raise further and deeper connections with different communities and visitors. Also, depending on the curators’ choices, collections displaying different identities at such museums could create more personal connections than impersonal collections aimed to promote a homogenous identity.
Age-specific trends in intravenous thrombolysis and mechanical thrombectomy utilization in acute ischemic stroke in children under age 18
Authors: Kaur Navreet , Patel Smit , Ayanbadejo Michael Omoniyi , Hoffman Haydn , Akano Emmanuel , Anikpezie Nnabuchi , Aneni Ehimen , Lamikanra Oluwatomi , Wee Claribel , Albright Karen , Khandelwal Priyank , Latorre Julius Gene , Chaturvedi Seemant , Otite Fadar Oliver
Published: September 2022

Objectives:

To evaluate current trends in the utilization of intravenous thrombolysis (IV-tPA) and mechanical thrombectomy (MT) in acute ischemic stroke (AIS) in various age groups of children in the United States.

Methods:

We conducted a serial cross-sectional study using primary AIS admissions in children ⩽ 17 years (weighted n = 2807) contained in the 2009–2019 KIDS Inpatient Database. Age-specific utilization frequency of IV-tPA and MT were calculated. Multivariable-adjusted models were used to evaluate demographic predictors of treatment.

Results:

From 2009 to 2019, there were 2807 AIS admissions in children in the KID of which 55.9% were in boys and 29.9% were 15–17 years old.128 (4.6%) received IV-tPA. IV-tPA utilization differed by age (5–9 years: 3.1%, 15–17 years 8.1% p value < 0.001). Overall MT usage was 2.3% and this also varied by age (1–4 years: 0.9% and 15–17years 4.0%, p value = 0.006). IV-tPA utilization almost tripled across the study period (2.5% 2009 to 6.5% in 2019, p value =  0.001) while MT use more than doubled over time (1.2% in 2009 and 3.0% in 2019, p value = 0.048). Increased IV-tPA utilization was seen primarily in children 10–14 years (0.8% in 2009 to 7.2% 2019, p value = 0.005) and 15–17 years (5.4% in 2009 to 10.4% in 2019, p value = 0.045). Utilization in younger age groups remained unchanged over time. MT usage was very variable across various age groups over time. IV-tPA and MT utilization increased over time in nonchildren’s hospitals (both p values < 0.05) but usage in designated children’s hospitals did not change significantly over time. In multivariable models, there was no significant difference in odds of IV-tPA and MT use by sex, race or insurance status.

Conclusion:

IV-tPA and MT utilization in pediatric AIS increased in the United States over the past decade mainly in older children 10–17 years. Utilization increased mainly in patients hospitalized in nonchildren’s hospitals. Usage in children’s hospitals did not change significantly over time.
The influence of exercise therapy dosing on pain and functional outcomes in patients with subacromial pain syndrome: A systematic review
Authors: McConnell Ryan , Klopper Mareli , Rhon Daniel I. , Young Jodi L.
Published: September 2022

Background

The objective was to identify exercise therapy dosing parameters for subacromial pain syndrome (SAPS) associated with improved pain and function outcomes (via effect sizes) and determine the extent of exercise intervention reproducibility.

Methods

An electronic search of PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Cochrane Database of Systematic Reviews, and SportDiscus identified studies that used exercise therapy exclusively to treat SAPS. Exercise therapy dosing parameters were extracted and within-group effect sizes were calculated for all pain and functional outcomes. Template for Intervention Description and Replication and Consensus on Exercise Reporting were used to record intervention reporting. The risk of bias and Grading of Recommendations, Assessment, Development, and Evaluation were assessed by two reviewers.

Results

Twenty-one trials with 674 subjects were included. Effect sizes for pain and function were large in 18 studies, medium in six studies, and small or no effect in four studies, despite the type of supervision. With moderate certainty, effect sizes of pain and function were not influenced by exercise therapy dosing parameters. Intervention reporting was generally poor.

Discussion

Exercise therapy for SAPS was associated with large effect sizes for improvement in pain and function but optimal exercise therapy dosing parameters could not be identified. Strong recommendations conditionally suggest treating SAPS with a variety of exercise therapy dosing parameters.
Recurrence of the frozen shoulder after hydrodilatation, what is the true incidence?
Authors: Flintoft-Burt Matthew , Stanier Paul , Planner Andy , Thahal Hyeladzira , Woods David
Published: September 2022

Purpose of the study

To assess the outcome and recurrence rates of frozen shoulder treated by hydrodilatation in an independent hospital setting.

Method

Patients presenting to a shoulder clinic from August 2019 to July 2021 with a diagnosis of frozen shoulder were offered hydrodilatation. Data included primary or secondary frozen shoulder, length of symptoms, and diabetic status. An Oxford Shoulder Score was completed prior to hydrodilatation. Using ultrasound guidance, 40 mg Triamcinolone and local anaesthetic (10–25 mL depending on patient tolerance) were injected into the rotator interval. At a mean of 9 months, patients recorded their tolerance of the procedure, subsequent progress, the need for further treatment, and their current Oxford Shoulder Score.

Results

From 55 shoulders, six patients had a failure to improve and 10 patients had a transient improvement followed by recurrence (29%). 2/21 (9.5%) patients had 25 mL injected compared to 14/34 (41%) who had < = 20 mL ( p = 0.012). 14/43 (33%) of primary frozen shoulder patients had a recurrence, compared with 2/12 (16%) secondary frozen shoulder patients, p = 0.019.

Conclusion

Further treatment was indicated in 14/34 (41%) of patients who underwent hydrodilatation in the frozen stage of frozen shoulder and could not tolerate more than 20 mL of injection, and was more commonly required in primary (33%) versus secondary (16%) frozen shoulder.