bluuebunny/crossref_metadata_2025 huggingface dataset:
CSR as a Strategic Management Tool
Authors: Agwu Edwin M. , Taylor Agnes R.
Published: May 2014

Corporate social responsibility (CSR) as a concept has been a subject of debate in the management cycle for decades. However, the incorporation of CSR, competitive advantage and strategic management into top management decision making processes, forms a set of new alliances that are beginning to gain attention. This paper examined the strategic alliances of these highly volatile but significantly critical components in order to determine the extent to which these three seemingly incongruous factors can be achieved in reality within a developing country such as Nigeria. Using a comparative case study approach, the activities of two multinationals - Shell Plc and Coca Cola – were examined. The critical success factors were explained based on the strategies adopted in order to determine the impact on the society and whether they were in line with stakeholders' expectations. Findings however indicate that there has been an interplay of high level forces which has resulted in the unsavoury news emanating from the oil producing communities in Nigeria, unfortunately, the activities of Coca cola in both the content and context of their operations have received little or no attention. This paper contributes to the scarce literature of this discourse within the African continent in general and Nigerian state in particular as well as sets a precedent for future research.
Development and Validation of the Method for Value Assessment of SOA-Based IS Projects
Authors: Likhvarev Alexey , Babkin Eduard
Published: May 2014

Responding to the rapidly growing market share for Information Systems (IS) based on Service-Oriented Architecture (SOA), the demand emerges for methods of measuring the value of SOA-based IS projects. The goal of the present research is to adapt available methods of project assessment to this expanding demand. This study describes a new method which takes into consideration a possibility to divide deployment and evolution of SOA-based IS into separate flows, one per service. Like that the process of value assessment could become more precise and exact compared to other known methods which use the single flow for the whole project. In addition the work proposes Real Options for calculating such components of the value as flexibility. The described method is validated using a specific simulation model. Value assessment of a real IS project is performed using the developed method and the simulation model.
Protein Phosphatase 6 Controls BCR-Induced Apoptosis of WEHI-231 Cells by Regulating Ubiquitination of Bcl-xL
Authors: Kajihara Ryutaro , Sakamoto Hitomi , Tanabe Kano , Takemoto Kazuki , Tasaki Masayoshi , Ando Yukio , Inui Seiji
Published: May 2014

Crosslinking BCR in the immature B cell line WEHI-231 causes apoptosis. We found that Bcl-xL was degraded by polyubiquitination upon BCR crosslinking and in this study explored the mechanism that controls the degradation of Bcl-xL. Ser62 of Bcl-xL was phosphorylated by JNK to trigger polyubiquitination, and this was opposed by serine/threonine protein phosphatase 6 (PP6) that physically associated with Bcl-xL. We show BCR crosslinking decreased PP6 activity to allow Ser62 phosphorylation of Bcl-xL. CD40 crosslinking rescues BCR-induced apoptosis, and we found PP6 associated with CD40 and PP6 activation in response to CD40. Our data suggest that PP6 activity is regulated to control apoptosis by modulating Ser62 phosphorylation of Bcl-xL, which results in its polyubiquitination and degradation.
Preemptive Donor Apoptotic Cell Infusions Induce IFN-γ–Producing Myeloid-Derived Suppressor Cells for Cardiac Allograft Protection
Authors: Bryant Jane , Lerret Nadine M. , Wang Jiao-jing , Kang Hee-Kap , Tasch James , Zhang Zheng , Luo Xunrong
Published: May 2014

We have previously shown that preemptive infusion of apoptotic donor splenocytes treated with the chemical cross-linker ethylcarbodiimide (ECDI-SPs) induces long-term allograft survival in full MHC-mismatched models of allogeneic islet and cardiac transplantation. The role of myeloid-derived suppressor cells (MDSCs) in the graft protection provided by ECDI-SPs is unclear. In this study, we demonstrate that infusions of ECDI-SPs increase two populations of CD11b+ cells in the spleen that phenotypically resemble monocytic-like (CD11b+Ly6Chigh) and granulocytic-like (CD11b+Gr1high) MDSCs. Both populations suppress T cell proliferation in vitro and traffic to the cardiac allografts in vivo to mediate their protection via inhibition of local CD8 T cell accumulation and potentially also via induction and homing of regulatory T cells. Importantly, repeated treatments with ECDI-SPs induce the CD11b+Gr1high cells to produce a high level of IFN-γ and to exhibit an enhanced responsiveness to IFN-γ by expressing higher levels of downstream effector molecules ido and nos2. Consequently, neutralization of IFN-γ completely abolishes the suppressive capacity of this population. We conclude that donor ECDI-SPs induce the expansion of two populations of MDSCs important for allograft protection mediated in part by intrinsic IFN-γ–dependent mechanisms. This form of preemptive donor apoptotic cell infusions has significant potential for the therapeutic manipulation of MDSCs for transplant tolerance induction.
CD36-Mediated Hematoma Absorption following Intracerebral Hemorrhage: Negative Regulation by TLR4 Signaling
Authors: Fang Huang , Chen Jing , Lin Sen , Wang PengFei , Wang YanChun , Xiong XiaoYi , Yang QingWu
Published: May 2014

Promoting hematoma absorption is a novel therapeutic strategy for intracerebral hemorrhage (ICH); however, the mechanism of hematoma absorption is unclear. The present study explored the function and potential mechanism of CD36 in hematoma absorption using in vitro and in vivo ICH models. Hematoma absorption in CD36-deficient ICH patients was examined. Compared with patients with normal CD36 expression, CD36-deficient ICH patients had slower hematoma adsorption and aggravated neurologic deficits. CD36 expression in perihematomal tissues in wild-type mice following ICH was increased, whereas the hematoma absorption in CD36−/− mice was decreased. CD36−/− mice also showed aggravated neurologic deficits and increased TNF-α and IL-1β expression levels. The phagocytic capacity of CD36−/− microglia for RBCs was also decreased. Additionally, the CD36 expression in the perihematoma area after ICH in TLR4−/− and MyD88−/− mice was significantly increased, and hematoma absorption was significantly promoted, which was significantly inhibited by an anti-CD36 Ab. In vitro, TNF-α and IL-1β significantly inhibited the microglia expression of CD36 and reduced the microglia phagocytosis of RBCs. Finally, the TLR4 inhibitor TAK-242 upregulated CD36 expression in microglia, promoted hematoma absorption, increased catalase expression, and decreased the H2O2 content. These results suggested that CD36 mediated hematoma absorption after ICH, and TLR4 signaling inhibited CD36 expression to slow hematoma absorption. TLR4 inhibition could promote hematoma absorption and significantly improve neurologic deficits following ICH.
Caspase-8 Acts as a Molecular Rheostat To Limit RIPK1- and MyD88-Mediated Dendritic Cell Activation
Authors: Cuda Carla M. , Misharin Alexander V. , Gierut Angelica K. , Saber Rana , Haines G. Kenneth , Hutcheson Jack , Hedrick Stephen M. , Mohan Chandra , Budinger G. Scott , Stehlik Christian , Perlman Harris
Published: May 2014

Caspase-8, an executioner enzyme in the death receptor pathway, was shown to initiate apoptosis and suppress necroptosis. In this study, we identify a novel, cell death–independent role for caspase-8 in dendritic cells (DCs): DC-specific expression of caspase-8 prevents the onset of systemic autoimmunity. Failure to express caspase-8 has no effect on the lifespan of DCs but instead leads to an enhanced intrinsic activation and, subsequently, more mature and autoreactive lymphocytes. Uncontrolled TLR activation in a RIPK1-dependent manner is responsible for the enhanced functionality of caspase-8–deficient DCs, because deletion of the TLR-signaling mediator, MyD88, ameliorates systemic autoimmunity induced by caspase-8 deficiency. Taken together, these data demonstrate that caspase-8 functions in a cell type–specific manner and acts uniquely in DCs to maintain tolerance.
Sedimentology and source-rock potential of the lower Kaskapau Formation (cenomanian-lowermost turonian), northwestern Alberta
Authors: Wallace-Dudley K E , Leckie D A
Published: May 2014

The Cenomanian to earliest Turonian Kaskapau Formation in northwestern Alberta and adjacent British Columbia contains three sandstone bodies, the Doe Creek, Pouce Coupe, and Howard Creek members. The three sandbodies are encased in shale. The sedimentary
structures, microfauna, megafauna and trace fossils in the Doe Creek, Pouce Coupe, and Howard Creek members and surrounding Kaskapau shale indicate deposition on a shallow, marine shelf with normal to near normal salinity. The members represent a series of relatively thin, shallow water marine
sandstones, deposited approximately parallel to the shoreline of the correlative Dunvegan Formation during brief episodes of progradation, within an overall transgressive phase represented by the thick shales of the Kaskapau Formation. Each of the sandbodies comprising the Doe Creek, Pouce Coupe,
and Howard Creek members, as well as those sandbodies within the individual members, is bound by unconformities. The lower bounding surface represents rapid deltaic progradation during a drop in relative sea level. The upper bounding surface is a flooding surface, transgressed and abandoned as
relative sea level subsequently rose. Within the Doe Creek Member, the overlapping I, N, and A reservoir sandbodies of the Valhalla Field suggest high-frequency, fluctuating sea levels and an oscillatory shoreline during an overall retrogradational interval. The sea-level changes need not be
eustatic, but may be relative in nature, possibly caused by autocyclic processes such as delta switching.
The shale of the lower to middle Kaskapau Formation (Cenomanian) from the top of the Dunvegan Formation to the base of the Howard Creek Member was deposited in a cool, shallow water, nearshore marine environment between fairweather and storm wave base. Sedimentation was generally slow and
continuous, permitting intense bioturbation and thorough mixing of the sediments, but was periodically interrupted by storms during which numerous thin sandstone lenses were deposited. The overlying Second White Speckled Shale (Turonian) was deposited during the peak of a marine transgression, which
corresponds to a global eustatic sea-level rise. The Second White Speckled Shale contains in excess of 11 per cent dispersed total organic carbon and has very good hydrocarbon generation capacity.
Breast Cancer Knowledge, Beliefs, and Screening Practices among Women Seeking Care at District Hospitals in Dar es Salaam, Tanzania
Authors: Morse Emma Perry , Maegga Bertha , Joseph Gertrud , Miesfeldt Susan
Published: May 2014

Background

Limited disease awareness among women may impact breast cancer stage-at-diagnosis in Tanzania, reducing survival. This study assessed breast cancer knowledge, screening practices, and educational preferences among outpatients at Tanzanian government-supported hospitals.

Methods

A convenience sample of women was surveyed regarding (1) knowledge/beliefs of breast cancer etiology, risk factors, symptoms, treatment, (2) early detection knowledge/practice, and (3) educational preferences.

Results

Among 225 respondents, 98.2% knew of breast cancer; 22.2% knew someone affected by breast cancer. On average, 30% of risk factors and 51% of symptoms were identified. Most accepted one or more breast cancer myths. Among 126 aware of breast self-exam, 40% did not practice it; only 0.9% underwent regular clinical breast examinations despite 68% being aware of the procedure. Among treatments, 87% recognized surgery, 70% radiation, and fewer systemic therapy. Preferred educational sources were group sessions, television/radio, and meetings with breast cancer survivors.

Conclusions

This work reveals incomplete breast cancer awareness among Tanzanian women and promises to inform development of user-focused educational resources.
Design Strategies of Biodegradable Scaffolds for Tissue Regeneration
Authors: Bitar Khalil N. , Zakhem Elie
Published: May 2014

There are numerous available biodegradable materials that can be used as scaffolds in regenerative medicine. Currently, there is a huge emphasis on the designing phase of the scaffolds. Materials can be designed to have different properties in order to match the specific application. Modifying scaffolds enhances their bioactivity and improves the regeneration capacity. Modifications of the scaffolds can be later characterized using several tissue engineering tools. In addition to the material, cell source is an important component of the regeneration process. Modified materials must be able to support survival and growth of different cell types. Together, cells and modified biomaterials contribute to the remodeling of the engineered tissue, which affects its performance. This review focuses on the recent advancements in the designs of the scaffolds including the physical and chemical modifications. The last part of this review also discusses designing processes that involve viability of cells.
Species-Specific Regulation of t-PA and PAI-1 Gene Expression in Human and Rat Astrocytes
Authors: Tjärnlund-Wolf Anna , Hultman Karin , Blomstrand Fredrik , Nilsson Michael , Medcalf Robert L. , Jern Christina
Published: May 2014

In recent years, the role and physiological regulation of the serine protease tissue-type plasminogen activator (t-PA) and its inhibitors, including plasminogen activator inhibitor type-1 (PAI-1), in the brain have received much attention. However, as studies focusing these issues are difficult to perform in humans, a great majority of the studies conducted to date have utilized rodent in vivo and/or in vitro models. In view of the species-specific structural differences present in both the t-PA and the PAI-1 promoters, we have compared the response of these genes in astrocytes of rat and human origin. We reveal marked quantitative and qualitative species-specific differences in gene induction following treatment with various physiological and pathological stimuli. Thus, our findings are of importance for the interpretation of previous and future results related to t-PA and PAI-1 expression.
Bounded Derived Categories of Infinite Quivers: Grothendieck Duality, Reflection Functor
Authors: Asadollahi Javad , Hafezi Rasool , Vahed Razieh
Published: May 2014

We study bounded derived categories of the category of representations of infinite quivers over a ring R. In case R is a commutative noetherian ring with a dualising complex, we investigate an equivalence similar to Grothendieck duality for these categories, while a notion of dualising complex does not apply to them. The quivers we consider are left (resp. right) rooted quivers that are either noetherian or their opposite are noetherian. We also consider reflection functor and generalize a result of Happel to noetherian rings of finite global dimension, instead of fields.
Characterising terrestrial influences on Antarctic air masses using radon-222 measurements at King George Island
Authors: Chambers S. D. , Hong S.-B. , Williams A. G. , Crawford J. , Griffiths A. D. , Park S.-J.
Published: May 2014

Abstract. We report on one year of high precision direct hourly radon observations at King Sejong Station (King George Island) beginning in February 2013. Findings are compared with historic and ongoing radon measurements from other Antarctic sites. Monthly median concentrations reduced from 72 mBq m−3 in late summer to 44 mBq m−3 in late-winter and early-spring. Monthly 10th percentiles, ranging from 29 to 49 mBq m−3, were typical of oceanic baseline values. Diurnal cycles were rarely evident and local influences were minor, consistent with regional radon flux estimates one tenth of the global average for ice-free land. The predominant fetch region for terrestrially influenced air masses was South America (47–53° S), with minor influences also attributed to aged Australian air masses and local sources. Plume dilution factors of 2.8–4.0 were estimated for the most terrestrially influenced (South American) air masses, and a seasonal cycle in terrestrial influence on tropospheric air descending at the pole was identified and characterised.
MATCH–SALSA – Multi-scale Atmospheric Transport and CHemistry model coupled to the SALSA aerosol microphysics model – Part 1: Model description and evaluation
Authors: Andersson C. , Bergström R. , Bennet C. , Robertson L. , Thomas M. , Korhonen H. , Lehtinen K. E. J. , Kokkola H.
Published: May 2014

Abstract. We have implemented the sectional aerosol dynamics model SALSA in the European scale chemistry-transport model MATCH (Multi-scale Atmospheric Transport and Chemistry). The new model is called MATCH–SALSA. It includes aerosol microphysics, with several formulations for nucleation, wet scavenging and condensation. The model reproduces observed higher particle number concentration (PNC) in central Europe and lower concentrations in remote regions. The model PNC size distribution peak occurs at the same or smaller particle size as the observed peak at five measurement sites spread across Europe. Total PNC is underestimated at Northern and Central European sites and accumulation mode PNC is underestimated at all investigated sites. On the other hand the model performs well for particle mass, including secondary inorganic aerosol components. Elemental and organic carbon concentrations are underestimated at many of the sites. Further development is needed, primarily for treatment of secondary organic aerosol, both in terms of biogenic emissions and chemical transformation, and for nitrogen gas-particle partitioning. Updating the biogenic SOA scheme will likely have a large impact on modeled PM2.5 and also affect the model performance for PNC through impacts on nucleation and condensation. An improved nitrogen partitioning model may also improve the description of condensational growth.
A methodological proposal to evaluate a city image through associative maps
Authors:   Departamento de Economía de la Empresa. Universidad Politécnica de Cartagena C/Real, Nº 3, 30201 josean.martinez@upct.es, Martínez Jose A.
Published: May 2014

The aim of this research was to introduce a simple, affordable, and easily applicable method to analyze the brand image of a city by using associative maps (Henderson, Iacobucci & Calder, 1998). Through the employment of both statistical and interpretative criteria, a consensus map is created, which reflects the main associations citizens have in their minds when they think about their city. In addition, this study has given clear instructions about how to apply this method, which it is recommendable to be periodically applied, in order to observe the dynamics of brand associations. These brand associations are dependent of the strategic and tactical decisions made by the public government. Finally, the application of this method is illustrated with a real study about the city of Cartagena, using a random sample of 195 participants.
Business identity, image and reputation: The integration of theoretical perspectives for a successful management
Authors:   1 Área de Comercialización e Investigación de Mercados. Universidad de Cantabria. Avda. Los Castros s/n. 39005 Santander (Cantabria). perezran@unican.es, Pérez Andrea , Rodríguez del Bosque Ignacio ,   1 Área de Comercialización e Investigación de Mercados. Universidad de Cantabria. Avda. Los Castros s/n. 39005 Santander (Cantabria). rbosquei@unican.es
Published: May 2014

The corporate marketing perspective is a new paradigm which identifies the management of the business identity, image and reputation as an essential tool for the survival and success of companies. Accordingly, the correct understanding of these three concepts is a basic pre-requisite for the companies interested in managing their businesses in accordance to the latest marketing trends. Nonetheless, the proliferation of diverse approaches to the study of the identity, image and reputation hampers the generation of useful knowledge regarding these issues. In this paper, an integrative perspective is proposed to better understand the concepts and dimensions of the business identity, image and reputation. The theoretical review provided in the paper allows scholars and practitioners to better understand these three faces of the corporate marketing perspective.
Placebo effect associated to artistic products; the case of poetry
Authors:   Departamento de Economía de la Empresa. Universidad Politécnica de Cartagena. C/Real, Nº 3, 30201 josean.martinez@upct.es, Martínez Jose A.
Published: May 2014

This research finds unambiguous evidence about the existence of the placebo effect in the evaluation of an artistic product, such as a poem. After applying different methods and under disparate test situations, results indicate that the name of the author who signs the poem significantly influence the subjective valuation people achieve. Therefore, this study provides an answer to the question: may a literary work be judged in a different manner depending on the person who signs that artistic piece? Results derived from this research clearly show the prevalence of this effect, so that a poem is evaluated more favorably when the reader believes that it has been written by a well-known poet than when the reader thinks the poem is anonymous. Consequently, the brand name influences the product perception. However, the placebo effect decreases when highly experienced people evaluate the product. The implications for the marketing literature and for the editorial industry are finally discussed.
In vitro Study of Hemodynamic Treatment Improvement: Hunterian Ligation of a Fenestrated Basilar Artery Aneurysm after Coiling
Authors: Goubergrits Leonid , Spuler Andreas , Schaller Jens , Wiegmann Nils , Berthe Andre , Hege Hans-Christian , Affeld Klaus , Kertzscher Ulrich
Published: May 2014

Hunterian ligation affecting hemodynamics in vessels was proposed to avoid rebleeding in a case of a fenestrated basilar artery aneurysm after incomplete coil occlusion. We studied the hemodynamics in vitro to predict the hemodynamic changes near the aneurysm remnant caused by Hunterian ligation. A transparent model was fabricated based on three-dimensional rotational angiography imaging. Arteries were segmented and reconstructed. Pulsatile flow in the artery segments near the partially occluded (coiled) aneurysm was investigated by means of particle image velocimetry. The hemodynamic situation was investigated before and after Hunterian ligation of either the left or the right vertebral artery (LVA/RVA). Since post-ligation flow rate in the basilar artery was unknown, reduced and retained flow rates were simulated for both ligation options. Flow in the RVA and in the corresponding fenestra vessel is characterized by a vortex at the vertebrobasilar junction, whereas the LVA exhibits undisturbed laminar flow. Both options (RVA or LVA ligation) cause a significant flow reduction near the aneurysm remnant with a retained flow rate. The impact of RVA ligation is, however, significantly higher. This in vitro case study shows that flow reduction near the aneurysm remnant can be achieved by Hunterian ligation and that this effect depends largely on the selection of the ligated vessel. Thus the ability of the proposed in vitro pipe-line to improve hemodynamic impact of the proposed therapy was successfully proved.
In vitro Study of a Standardized Approach to Aortic Cusp Extension
Authors: Vismara Riccardo , Leopaldi Alberto M. , Romagnoni Claudia , Contino Monica , Mangini Andrea , Stevanella Marco , Fiore Gianfranco B. , Antona Carlo
Published: May 2014

Purpose

Cusp extension technique (CET) is a reparative surgical procedure for restoring aortic valve function by suturing patches to the compromised native leaflets. Its outcomes are strongly dependent on the ability of the surgeon. We proposed and tested a novel approach on an in vitro model, aimed at standardizing and simplifying the surgical procedure.

Methods

A set of standard pre-cut bovine pericardium patches, available in different sizes, was developed. The surgeon can choose the leaflet-specific patches to be implanted according to the patient anatomy, using a geometrical model of the aortic valve whose inputs are the measured intercommissural distances. The hemodynamic performance of this approach was evaluated on porcine aortic roots in a pulsatile mock loop. Hydrodynamic and kinematic evaluation of the samples was provided.

Results

After CET, mean and maximum pressure drops were 3.1 ± 1.3 mmHg and 25.4 ± 5.0 mmHg respectively, and EOA was 3.8 ± 0.8 cm2. Static regurgitant fraction and closing volumes were 6.9 ± 2.7% and 7.0 ± 1.5 mL, respectively. All the hemodynamics changes induced by the surgery were statistically significant yet clinically irrelevant as compared to baseline. The treatment also induced a statistically significant alteration in the closing time of the valve.

Conclusions

Our approach to cusp extension proved to be reliable and effective in restoring valve functioning, without significantly altering the physiological kinematics. The use of pre-cut patches considerably simplified the surgery, increasing standardization and repeatability.
Pyoderma Gangrenosum: An Exceptional Complication of Venous access Device
Authors: La Marca Sophie , Toussoun Gilles , Quoc Christophe Ho , Sebban Henry , Delay Emmanuel
Published: May 2014

Introduction

Pyoderma gangrenosum (PG) is a rare disease whose precise etiology remains unknown. It causes rapidly developing skin necrosis and can occur after surgery, or after a nonspecific external stimulus. This condition is difficult to diagnose because it often mimics a fulminant infection.

Clinical case

We present a case of very significant local presentation of PG after placement of a venous access device. Fifteen days after placement, the patient developed extensive cutaneous ulcers and necrosis in the subclavicular area, which led to the misdiagnosis of infection. The device was removed and the patient was given antibiotics. Because there was no improvement following antibiotic treatment, combined with the worrying and extensive appearance of the skin and extremely intense pain, the diagnosis of PG was made. The patient was immediately treated with high-dose corticosteroids, resulting in rapid improvement of the lesions and relief of pain.

Conclusion

PG should be considered in cases of extensive, antibiotic-resistant ulceration and treatment with corticosteroids should be initiated. Clinical improvement is usually dramatic, with almost immediate suppression of the pain and arrest of the lesion's progression. Early treatment is the best guarantee for an effective recovery.
Very High-dose Cholecalciferol and Arteriovenous Fistula Maturation in ESRD: A Randomized, Double-blind, Placebo-Controlled Pilot Study
Authors: Wasse Haimanot , Huang Rong , Long Qi , Zhao Yize , Singapuri Salman , McKinnon William , Skardasis George , Tangpricha Vin
Published: May 2014

Purpose

While vitamin D is critical for optimal skeletal health, it also appears to play a significant role in vascular homeostasis. This pilot study compared arteriovenous (AV) access outcomes following cholecalciferol supplementation compared to placebo in end-stage renal disease patients preparing to undergo AV access creation.

Methods

A total of 52 adult hemodialysis patients preparing for arteriovenous fistula (AVF) creation were randomized to receive perioperative high-dose cholecalciferol versus placebo in this double-blind, randomized, placebo-controlled pilot study. The primary outcome was mean response to high-dose oral cholecalciferol versus placebo, and secondary outcome AV access maturation at 6 months. Logistic regression was used to assess the association between AV access maturation and baseline, posttreatment and overall change in vitamin D concentration.

Results

A total of 45% of cholecalciferol-treated and 54% of placebo-treated patients were successfully using their AVF or arteriovenous graft (AVG) at 6 months (p=0.8). Baseline serum concentrations of 25(OH)D and 1,25(OH)2D did not differ between those who experienced AVF or AVG maturation and those who did not (p=0.22 and 0.59, respectively). Similarly, there was no relationship between AVF or AVG maturation and posttreatment serum 25(OH)D and 1,25(OH)2D concentration (p=0.24 and 0.51, respectively).

Conclusions

Perioperative high-dose vitamin D3 therapy does correct 25(OH)D level but does not appear to have an association with AV access maturation rates. Future research may include extended preoperative vitamin D3 therapy in a larger population or in certain subpopulations at high risk for AVF failure.
Systemic Effects of a High-Flow Arteriovenous Fistula for Hemodialysis
Authors: Vaes Roel H. , Tordoir Jan H. , Scheltinga Marc R.
Published: May 2014

Purpose

Absolute treatment criteria for reducing the access volume of a high-flow access (HFA, access flow >2 L/min) are absent. Previous studies suggested that a HFA may influence the systemic circulation including blood pressure (BP) and heart rate (HR). The aim of this study was to determine these parameters after access clamping in hemodialysis patients undergoing flow-reducing access surgery.

Methods

Systolic BP (SBP), diastolic BP (DBP) and HR in HFA patients undergoing flow-reducing surgery were measured intraoperatively before and after access clamping. Data were compared to values obtained in patients receiving surgery for severe hand ischemia due to an access (HAIDI, hemodialysis access-induced distal ischemia).

Results

In 8 years, 34 patients underwent surgery for HFA (n=23) or HAIDI (n=11). Preoperative access flows in HFA were larger compared to HAIDI (3,026±147 vs 1,078±139 mL/min, respectively, p<0.001). Temporary clamping (15 sec) caused a 12±2 mm Hg increase in SBP (111±6 to 123±6 mm Hg, p<0.05) and a 6±1 mm Hg rise in DBP (57±4 to 63±5 mm Hg, p<0.05) in HFA patients. In contrast, SBP and DBP increases were not significant in HAIDI patients (+6±3 and +2±2 mm Hg, respectively, p=0.37). HR was modestly reduced in both groups following access clamping (–3±1 beats/min). The relationship between access flow volume and alterations in SBP best fitted a quadratic regression model, suggesting cardiovascular exhaustion with progressively higher access flows > 2-2.5 L/min.

Conclusions

HFA may influence systemic hemodynamics in some hemodialysis patients. The findings of this study may contribute to a tailored management of a high-flow fistula in this population.
Verification of Intravenous Catheter Placement by Auscultation – a Simple, Noninvasive Technique
Authors: Lehavi Amit , Rudich Utay , Schechtman Moshe , Katz Yeshayahu (Shai)
Published: May 2014

Background

Verification of proper placement of an intravenous catheter may not always be simple. We evaluated the auscultation technique for this purpose.

Methods

Twenty healthy volunteers were randomized for 18G catheter inserted intravenously either in the right (12) or left arm (8), and subcutaneously in the opposite arm. A standard stethoscope was placed over an area approximately 3 cm proximal to the tip of the catheter in the presumed direction of the vein to grade on a 0-6 scale the murmur heard by rapidly injecting 2 mL of NaCl 0.9% solution. The auscultation was evaluated by a blinded staff anesthesiologist.

Results

All 20 intravenous injection were evaluated as flow murmurs, and were graded an average 5.65 (±0.98), whereas all 20 subcutaneous injections were evaluated as either crackles or no sound, and were graded an average 2.00 (±1.38), without negative results. Sensitivity was calculated as 95%. Specificity and Kappa could not be calculated due to an empty false-positive group.

Conclusions

Being simple, handy and noninvasive, we recommend to use the auscultation technique for verification of the proper placement of an intravenous catheter when uncertain of its position. Data obtained in our limited sample of healthy subjects need to be confirmed in the clinical setting.
Intravascular Ultrasound-Guided Angioplasty of Hemodialysis Loop Graft in a Patient with Contrast Allergy
Authors: Casey Patrick E. , Miranda Charles J. , Al-Khaffaf Haytham , Woodhead Peter M.
Published: May 2014

Purpose

A surveillance duplex scan detected a stenosis within a left groin hemodialysis loop graft in a 57-year-old woman who was allergic to both iohexol and gadolinium contrast agents. This precluded the use of standard angioplasty treatment techniques. Intravascular ultrasound (IVUS) uses a catheter mounted with a miniaturized ultrasound probe to produce detailed cross-sectional vessel images. Clinically, it has been used in the assessment of coronary artery disease but has also supplemented standard angiography techniques in the assessment of peripheral vascular and hemodialysis access lesions.

Methods

IVUS was utilized as the solitary imaging modality to identify the graft stenosis and guide the placement of a 6 mm diameter angioplasty balloon. Two areas of stenosis were successfully dilated and subsequent IVUS re-examination showed abolition of the stenosis.

Results

Twelve-month follow-up surveillance scan showed that the graft remained functional with good flow rates.

Conclusions

In the setting of contrast allergy, IVUS may provide a valid and safe tool in the localization and treatment of peripheral vessel stenosis, including arteriovenous fistula angioplasty. To our knowledge this is the first reported use of IVUS for hemodialysis graft salvage adopting a completely ‘contrast-free’ technique. More studies are required to establish the true role of IVUS in the management of hemodialysis access angioplasty, but this successful case contributes valuable information to the literature on its clinical application.
Inflow Stenosis as a Contributing Factor in the Etiology of AV Access-induced Ischemic Steal
Authors: Kokkosis Angela A. , Abramowitz Steven D. , Schwitzer Jonathan , Nowakowski Scott , Teodorescu Victoria J. , Schanzer Harry
Published: May 2014

Objective

To determine how frequent inflow stenosis is a contributing factor in the etiology of arteriovenous access-induced steal (AVAIS).

Methods

A retrospective review of hemodialysis patients who underwent interventions from October 1998 to December 2011 for AVAIS was conducted at Mount Sinai Hospital. Patients with grade 3 AVAIS and complete arch and upper extremity vascular imaging were included. Demographics, access history, time to AVAIS, pre-operative angiographic imaging and interventions performed were analyzed.

Results

A total of 52 patients were diagnosed with grade 3 (severe) AVAIS requiring intervention over the study period. Forty-seven percent of the patients were male, average age was 62 years, 47% were of African American race and 88% were diabetic. Seventeen consecutive patients, with imaging, were included in this study. The average time to presentation of steal symptoms was 147±228 days. All of the accesses were proximal, and 65.7% were autogenous. Imaging studies consisted of angiography ( 14 ) and computed tomography angiography ( 3 ). Five patients had imaging evidence of >50% luminal inflow stenosis (29.4%). The location of stenosis was the subclavian (3 cases) and brachial (2 cases) arteries. Patients underwent distal revascularization and interval ligation ( 3 ), ligation ( 1 ) and angioplasty/stenting ( 1 ).

Conclusion

In our population, nearly one-third of the patients with severe AVAIS had a significant subclavian or brachial artery stenosis. The implications of this finding suggest the importance of complete pre-operative imaging. The treatment of the inflow stenosis by itself may not be curative, but the correction may serve as an adjunct and contribute to the success of other therapeutic procedures.
Drug-Eluting Balloon for the Treatment of Failing Hemodialytic Radiocephalic Arteriovenous Fistulas: Our Experience in the Treatment of Juxta-Anastomotic Stenoses
Authors: Patanè Domenico , Giuffrida Stefania , Morale Walter , L'Anfusa Giuseppe , Puliatti Daniela , Bisceglie Paola , Seminara Giuseppe , Calcara Giacomo , Di Landro Domenico , Malfa Pierantonio
Published: May 2014

Purpose

The purpose of this article is to report our experience with drug-eluting balloons for the treatment of juxta-anastomotic stenoses of failing radiocephalic hemodialytic arteriovenous shunt and to evaluate the primary and secondary patency (PP and SP).

Methods

After approval by the local hospital's Ethical and Scientific Review Board, 26 consecutive patients with juxta-anastomotic stenosis of radiocephalic hemodialytic shunt were treated with angioplasty with drug-eluting balloon. The main objective was to evaluate PP defined, in accordance with the Kidney Disease Outcomes Quality Initiative recommendation, as the absence of dysfunction of the vascular access, patent lesion or residual stenosis <30% and no need for further reintervention of the target lesion (TL). PP and SP at 6, 12 and 24 months were evaluated, with echo color doppler and phlebography, for both arteriovenous fistulae, defined as absolute, and TL.

Results

Immediate postprocedural technical and clinical success was 100% for all the patients; we had only one technical failure in repeated treatments. At 6 months the absolute and TL PP was 96.1%; at 12 months the absolute PP was 81.8%, TL PP 90.9%, absolute SP 95.4%, TL SP 100%; at 24 months the absolute and TL PP was 57.8%; absolute and TL SP 94.7%; only one arteriovenous fistula was lost during the period.

Conclusions

The use of drug-eluting balloons, after standard angioplasty, improves primary patency and decreases reinterventions of TL in juxta-anastomotic stenoses of failing native dialytic arteriovenous shunts.
Comparison of Flixene™ and Standard PTFE Arteriovenous Graft for Early Haemodialysis
Authors: Chiang Nathaniel , Hulme Katherine Ria , Haggart Paul Charles , Vasudevan Thodur
Published: May 2014

Purpose

The purpose is to compare the outcomes of FLIXENE™ arteriovenous graft (AVG) to standard polytetrafluoroethylene (PTFE) AVG for early haemodialysis.

Methods

This is a prospective observational study of all AVGs placed over a 40-month period between 2008 and 2011 at our vascular unit. Primary outcome was to examine early cannulation rates for FLIXENE™. Secondary outcomes included patency rates, usability of grafts, complications in particular infections, interventions and death in comparison to standard PTFE grafts.

Results

Forty-five FLIXENE™ and 19 standard PTFE AVGs were placed in the study period; 89% of FLIXENE™ grafts were used for dialysis, with 78% cannulated within 3 days. At 18 months, primary patency (FLIXENE™ 34% vs standard PTFE 24%), primary assisted patency (35% vs 36%) and secondary patency rate (51% vs 48%) were not statistically different; 20.2% of FLIXENE™ grafts were infected at 18 months requiring explantation compared with 40.3% of standard PTFE grafts (p=0.14).

Conclusions

FLIXENE™ can be cannulated for dialysis within 3 days. It has similar patency and complication rates as other prosthetic grafts in the market. In patients who have no access and require urgent dialysis, FLIXENE™ is a viable option.
Patterns of Blood Flow as a Predictor of Maturation of Arteriovenous Fistula for Haemodialysis
Authors: Marie Yazin , Guy Alison , Tullett Karen , Krishnan Hari , Jones Robert G. , Inston Nicholas G.
Published: May 2014

Purpose

A palpable “thrill” is traditionally associated with success following arteriovenous fistula (AVF) surgery. A thrill typically characterizes turbulent flow and this is a paradox as turbulence is a driver of neointimal hyperplasia. Spiral laminar flow (SLF) has been described as normal and protective pattern of flow in native arteries and is associated with superior patency in bypass grafts that generate it. The aim of this study was to define the pattern of flow within AVFs immediately post-operatively and at follow-up to assess maturation.

Methods

Doppler ultrasound was used immediately post-operatively and at follow-up (6 weeks). Blood flow was assessed as SLF or non-SLF. Two blinded qualified observers analysed the images. Patients were followed up for 6 months. Maturation was statistically analysed against the type of flow.

Results

Sequential patients having AVF surgery (n=56) were assessed: 46 (82%) patients had a thrill, 3 patients had no flow and 7 patients had pulsatile flow without a palpable thrill. SLF was present in 80% of those with a thrill but not in any without a thrill (p<0.0001). At follow-up (n=51) 41, patients had a matured AVF (80%), of which 76% had SLF immediately post-operatively. Only one patient with SLF failed to mature. In the non-SLF group 5 of the 15 AVFs failed to mature (66%; p<0.005).

Conclusions

SLF was strongly supportive of successful fistula maturation. A “thrill” was characteristic of spiral rather than turbulence. The mechanism of this apparent beneficial effect of this pattern of flow requires further investigation.
Variability in Anesthetic Considerations for Arteriovenous Fistula Creation
Authors: Siracuse Jeffrey J. , Gill Heather L. , Parrack Inkyong , Huang Zhen S. , Schneider Darren B. , Connolly Peter H. , Meltzer Andrew J.
Published: May 2014

Introduction

Anesthetic options for arteriovenous fistula (AVF) creation include regional anesthesia (RA), general anesthesia (GA) and local anesthetic for select cases. In addition to the benefits of avoiding GA in high-risk patients, recent studies suggest that RA may increase perioperative venous dilation and improve maturation. Our objective was to assess perioperative outcomes of AVF creation with respect to anesthetic modality and identify patient-level factors associated with variation in contemporary anesthetic selection

Methods

National Surgical Quality Improvement Project (NSQIP) data (2007-2010) were accessed to identify patients undergoing AVF creation. Univariate analysis and multivariate logistic regression were performed to assess the relationships among patient characteristics, anesthesia modality and outcome.

Results

Of 1,540 patients undergoing new upper extremity AVF creation, 52% were male and 81% were younger than 75 years. Anesthesia distribution was GA in 85.2%, local/monitored anesthetic care (MAC) in 2.9% and RA in 11.9% of cases. By multivariate analysis, independent predictors of RA were dyspnea at rest (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.1-4.9), age >75 (HR 1.6, 95% CI 1.1-2.3) and teaching hospital status as indicated by housestaff involvement (HR 3.7, 95% CI 2.5-5.5). RA was associated with higher total operative time, duration of anesthesia, length of time in operating room and duration of anesthesia start until surgery start (p<0.01). There were no differences between perioperative complications or mortality among anesthetic modalities, although all deaths occurred in the GA group.

Discussions

Despite recent reports highlighting potential benefits of RA for AVF creation, GA was surprisingly used in the vast majority of cases in the United States. The only comorbidities associated with preferential RA use were advanced age and dyspnea at rest. Practice environment may influence anesthetic selection for these cases, as a nonteaching environment was associated with GA use. The trend seen here toward higher mortality in GA and the potential perioperative benefits of RA for the access should encourage more widespread use of RA in practice for this high-risk patient population.
Liposuction for Superficialization of Deep Veins after Creation of Arteriovenous Fistulas
Authors: Ladenheim Eric D. , Krauthammer Juergen P. , Burnett John , Dunaway Theresa , Parvez Sanah
Published: May 2014

Purpose

Many individuals with end-stage renal disease (ESRD) have adequate arteries and veins for construction of an arteriovenous fistula (AVF) but the fistula may be too deep to cannulate because of overlying adipose tissue. This study evaluated the safety and efficacy of liposuction to superficialize deep AVFs.

Methods

Between September 2009 and January 2011, 13 patients participated in the study. Mean body mass index (BMI) was 39.1 kg/m2. The study was limited to brachiocephalic and radiocephalic fistulas. Mean fistula depth was 8.1 mm. The primary endpoint was the date of the first successful cannulation with two 17-gauge needles. Patients were followed for 12 mo.

Results

Eleven subjects (85%) underwent successful two-needle cannulation a mean of 33.7 days after the procedure. One patient died of endocarditis and one developed a hematoma and wound necrosis that required surgical elevation to enable cannulation. Projection and palpability of the fistulas tended to increase over time. Mean tissue removed was 243 mL and correlated positively with the number of days to cannulation (r=0.74, p=0.01). Greater BMI correlated positively with more surgical site complications and delays in cannulation. At 12 mo, primary patency after liposuction was 50% and secondary patency was 83%.

Conclusions

Most subjects had prompt, uncomplicated cannulation but a few had wound necrosis, large hematomas and prolonged time until cannulation. Liposuction is effective in enabling cannulation of deep vein fistulas but because of the substantial risk of serious surgical site complications, it may not be the ideal method.
Thromboaspiration of Arteriovenous Hemodialysis Graft Thrombosis using Desilets-Hoffman Sheath: Single-Center Experience
Authors: Goo Dong Erk , Kim Yong Jae , Park Sung Tae , Yang Seung Boo , Yoon Sang Chul , Song Dan
Published: May 2014

Purpose

The purpose of this study was to evaluate the feasibility, efficacy and safety of percutaneous thromboaspiration with a 7F Desilets-Hoffman sheath compared with previously established percutaneous mechanical thrombectomy techniques in occluded hemodialysis grafts.

Materials and Methods

One thousand three hundred five patients (767 women, 538 men; mean age, 61.04±13.09 years; mean graft age, 36.64±30.80 mo) with 2,531 episodes of hemodialysis graft thrombosis underwent percutaneous thromboaspiration with a 7F Desilets-Hoffman sheath using criss-cross or apex puncture technique. Technical success rate, procedure time, complications and patency rates were analyzed.

Results

Technical success was achieved in 2,426 of 2,531 procedures (95.9%). Average procedure time of the intervention was 42.87±22.77 minutes. Primary patency rate was 61.9% at 3 mo, 41.2% at 6 mo and 19.6% at 1 year. Major complications occurred in 4.1% of cases (23 graft outflow rupture; 68 arterial emboli; 1 arterial dissection; 3 symptomatic pulmonary embolism; 1 stent migration) and minor complications occurred in 7.7% of cases (196 cases). These results were comparable to previously reported mechanical thrombectomy techniques in occluded hemodialysis grafts.

Conclusions

Percutaneous thromboaspiration of occluded hemodialysis grafts with a Desilets-Hoffman Sheath is an effective and safe method.