bluuebunny/crossref_metadata_2025 huggingface dataset:
Spiral CT Angiography versus Aortography in the Assessment of Aortoiliac Length in Patients Undergoing Endovascular Abdominal Aortic Aneurysm Repair
Authors: Armon Matthew P. , Whitaker Simon C. , Gregson Roger H.S. , Wenham Peter W. , Hopkinson Brian R.
Published: March 2015

Purpose:

To compare measurements of aortoiliac length obtained with spiral computed tomographic angiography (CTA) and aortography in patients undergoing endovascular aneurysm repair.

Methods:

The distances from the lower-most renal artery to the aortic bifurcation and from the aortic bifurcation to the common iliac artery (CIA) bifurcation were measured using both CTA and aortography in 108 patients with abdominal aortic aneurysms.

Results:

The level of agreement between CTA and aortography was high, with 69% of aortic and 76% of iliac measurements within 1 cm and > 90% within 2 cm of each other. Mean differences were −0.35 ± 1.20 cm and 0.25 ± 1.10 cm, respectively, for aortic and iliac lengths. Aortography overestimated renal artery to aortic bifurcation length in comparison to CTA (p = 0.003), particularly in patients with large aneurysms (> 6.5 cm) and lumen diameters > 4.5 cm (p < 0.0001). Measurements of CIA length were shorter by aortography than CTA (p = 0.02).

Conclusions:

There is a high level of agreement between CTA and aortography in the measurement of aortoiliac length, but aortography overestimates renal artery to aortic bifurcation length in patients with large-diameter aneurysms and wide aneurysm lumens. CTA is sufficiently accurate in the majority of cases to be used as the sole basis for the construction of endovascular grafts.
Femoral Artery Exposure for Endovascular Aneurysm Repair through Oblique Incisions
Authors: Chuter Timothy A.M. , Reilly Linda M. , Stoney Ronald J. , Messina Louis M.
Published: March 2015

Purpose:

To offer an alternative technique for accessing the femoral artery prior to endovascular grafting.

Technique:

An oblique incision is made over the medial half of the inguinal ligament and continues to the femoral sheath, which is opened longitudinally. The distal external iliac artery and proximal common femoral artery are isolated. A tiny stab wound is made distal to the primary wound for femoral artery puncture and catheter access.

Conclusions:

Using an oblique incision at the level of the inguinal ligament optimizes exposure for endograft insertion and may minimize the frequency of serious wound complications.
A Method for Adjusting a Malpositioned Bifurcated Aortic Endograft
Authors: Rückert Ralph I. , Romaniuk Paul , Rogalla Patrik , Umscheid Thomas , Stelter Wolf J. , Müller Joachim M.
Published: March 2015

Purpose:

To report the successful application of a method to adjust a malpositioned bifurcated stent-graft after endovascular aortic aneurysm repair.

Method and Results:

A 62-year-old male patient underwent endovascular repair of a 5.1-cm abdominal aortic aneurysm (AAA) with a Vanguard bifurcated stent-graft. After complete deployment of the stent-graft, the intraoperative completion angiogram disclosed unexpected occlusion of the left renal artery. Intra-aortic adjustment of the bifurcated graft was possible with a crossover guidewire, which was pulled caudally. The method worked perfectly to restore blood flow to the left renal artery. The patient is well 16 months postoperatively without any evidence of endoleak or graft migration; the left renal artery remains open.

Conclusions:

A technique is demonstrated for intra-aortic repositioning of a bifurcated stent-graft to correct insufficient deployment. If required, this technique should be attempted before conversion to an open procedure.
Endovascular Repair of Aortic Aneurysms in the Presence of a Horseshoe Kidney
Authors: Loftus Ian K. , Thompson Matthew M. , Fishwick Guy , Boyle Jonathan R. , Bell Peter R.F.
Published: March 2015

Purpose:

To report two cases of endovascular aortic aneurysm exclusion in patients with a horseshoe kidney.

Methods and Results:

Two male patients, one with a known horseshoe kidney and history of multiple previous laparotomies, presented with abdominal aortic aneurysms of approximately 6-cm diameter. Each was treated with a tapered aortomonoiliac polytetrafluoroethylene graft secured proximally with a Palmaz balloon-expandable stent. The endograft was sutured distally to a Dacron femorofemoral crossover graft. An anomalous renal vessel was sacrificed in one case. The aneurysms were successfully excluded, and the patients recovered without sequelae.

Conclusions:

Endovascular repair should be considered as a treatment option in patients with aortic aneurysm in the presence of a horseshoe kidney, particularly if the renal vasculature can be wholly preserved.
Renal Complications following Endovascular Repair of Abdominal Aortic Aneurysms
Authors: Walker Stuart R. , Yusuf S. Waquar , Wenham Peter W. , Hopkinson Brian R.
Published: March 2015

Purpose:

To investigate the renal complications associated with endovascular repair of abdominal aortic aneurysms (AAAs).

Methods:

Data were prospectively collected on 164 AAA patients (154 males; median age 72 years; interquartile range 51 to 88) undergoing endovascular grafting. Any history of renal failure and diabetes mellitus was recorded. Serum urea and creatinine levels were measured preoperatively and at regular intervals postoperatively. Renal impairment was defined as serum creatinine > 130 μmol/L.

Results:

There were no significant differences in pre- and 1-day postoperative serum urea and creatinine levels. Among 15 (9.1%) patients with preoperative renal failure, 7 (47%) died, 4 (27%) in the perioperative period. Of the 149 patients with normal renal function preoperatively, 4 (2.7%) developed renal failure as part of multisystem organ failure. Another 9 (6.2%) developed significant postoperative elevations (> 20%) in their creatinine levels compared to baseline; 4 of these patients died, 2 in the perioperative period. There was no significant difference in the median dose of intravascular contrast used for those patients that did and did not have a deterioration in their renal function (250 mL versus 300 mL).

Conclusions:

In this study, approximately 6% of patients with normal preoperative renal function who undergo endovascular AAA repair develop renal dysfunction. For patients with preoperative renal impairment, the perioperative mortality rate is high, 27%, following endovascular aortic aneurysm repair.
Combined Approach to Stent-Graft Treatment of an Aortic Arch Aneurysm
Authors: Buth Jacob , Penn Olaf , Tielbeek Alexander , Mersman Marijke
Published: March 2015

Purpose:

To report the first use of dual brachiocephalic vessel transposition from the aortic arch prior to endovascular exclusion of an arch aneurysm.

Methods and Results:

Patch graft repair of a saccular aortic arch aneurysm in a 74-year-old woman failed to exclude the lesion, resulting in aneurysm enlargement. Because the patient was debilitated, a combined open and endovascular procedure was performed in which the common carotid and subclavian arteries were transposed prior to successful insertion of a Vanguard aortic stent-graft to exclude the aneurysm. Imaging 1 and 6 months after the combined procedure demonstrated complete thrombosis of the aneurysm.

Conclusions:

Transposition from the aortic arch of one or more brachiocephalic vessels may allow stent-graft exclusion of aortic arch aneurysms. However, the durability of thoracic aortic endografts must be ascertained before the indications for their use are expanded.
Endovascular Treatment of Internal Iliac Artery Aneurysms
Authors: Henry Michel , Amor Max , Henry Isabelle , Tzvetanov Kiril , Buniet Jean-Michel , Amicabile Claude
Published: March 2015

Purpose:

To describe a technique for percutaneous endovascular repair of internal iliac artery aneurysms.

Technique:

In a patient with an isolated internal iliac artery aneurysm and combined tight stenoses at the origins of the external and internal iliac arteries, interventional treatment consisted of coil embolization of the internal iliac artery and branches using the contralateral femoral approach. Balloon dilation of the external iliac stenosis occluded the internal iliac artery, and Palmaz stents were placed in the external iliac stenosis to overcome residual luminal narrowing.

Conclusions:

This one-step percutaneous technique allows total exclusion of the internal iliac artery aneurysm using coil embolization. This treatment may be an alternative to surgery in isolated internal iliac artery aneurysms with small orifices.
The Effect of Nonporous PTFE-Covered Stents on Intimal Hyperplasia following Balloon Arterial Injury in Minipigs
Authors: Yuan John G. , Ohki Takao , Marin Michael L. , Quintos Ricardo T. , Krohn Douglas L. , Beitler Jonathan J. , Veith Frank J.
Published: March 2015

Purpose:

To report an experimental study investigating the ability of nonporous polytetrafluoroethylene (PTFE) covering on a metallic stent to retard the development of neointimal hyperplasia (NIH).

Methods:

Three groups of Hanford miniature swine underwent standardized balloon injury to both external iliac arteries. Group I animals (control) received balloon injuries only. Group II had the site of balloon injury supported by a properly sized, balloon-expandable Palmaz stent placed directly over the injury site. Group III animals received a Palmaz stent covered with PTFE graft. All animals underwent arteriography immediately after intervention and again prior to sacrifice and specimen harvest at 4 weeks. The specimens were examined grossly and histologically at the proximal, middle, and distal segments for NIH development.

Results:

Uncovered stents developed significantly more NIH (p < 0.0001) and greater luminal narrowing (p < 0.001) than the controls. PTFE-covered stents (group III) exhibited less NIH (p < 0.001) and luminal reduction (p < 0.01) than bare stents (group II) at the middle portion of the stent-graft, but the PTFE cover had no effect on NIH and lumen reduction at the proximal or distal ends of the prosthesis.

Conclusions:

PTFE-covered stents retarded NIH at 4 weeks, but only at the midportion of the devices; the covering did not prevent neointimal pannus ingrowth at the proximal and distal ends.
In Vivo Crushing of an Aortic Stent Enables Endovascular Repair of a Large Infrarenal Aortic Pseudoaneurysm
Authors: Dorros Gerald , Jaff Michael R. , Parikh Ashish , Sehgal Rajesh , Thota Venkat , Ramireddy Keshav , Carballo Richard E.
Published: March 2015

Purpose:

To report an unusual approach to endovascular exclusion of a large aortic pseudoaneurysm.

Methods and Results:

A 63-year-old male had an unsuccessful endovascular repair of an aortic anastomotic pseudoaneurysm that left an expanded, uncovered Palmaz stent lying obliquely within the aorta. After nearly 3 years, the pseudoaneurysm enlarged to 7 cm, and the patient became symptomatic. Repair of the pseudoaneurysm was accomplished by crushing the indwelling stent to allow placement of a stent-graft.

Conclusions:

Malpositioned stents that are hindering an endoluminal procedure may be crushed against the arterial wall in vivo to facilitate passage of endovascular instruments or devices.
Endovascular Repair of Aortic Aneurysms: Treatment of Complications
Authors: Görich Johannes , Rilinger Norbert , Söldner Joachim , Krämer Stefan , Orend Karl-Heinz , Schütz Ansgar , Sokiranski Roman , Bartel Martin , Sunder-Plassmann Ludger , Scharrer-Pamler Reinhard
Published: March 2015

Purpose:

To evaluate the use of interventional procedures for treating complications following endovascular repair of aortic aneurysms.

Methods:

Fifty-five patients (49 men; mean age 67.5 years) underwent endoluminal stent-graft repair of traumatic (n = 4) or arteriosclerotic (n = 51) aortic aneurysms in the thoracic (n = 3) or infrarenal (n = 52) aorta. Follow-up of therapeutic success included periodic clinical examination, angiography, and spiral computed tomography.

Results:

Discounting the 25 (45%) cases of postimplantation syndrome that did not require treatment, there were 22 complications observed in 20 (36%) patients over a mean 10-month follow-up (range 1 to 27). There were 2 transrenal endograft maldeployments, 1 case of twisted graft limbs, 2 access site problems (1 patient), 12 endoleaks (11 patients), 1 late graft limb thrombosis, 1 symptomatic internal iliac artery occlusion, 2 myocardial infarctions, and 1 transient psychosis. Seven (13%) patients did not undergo specific therapy, while 4 (7%) required operation (2 crossover bypass grafts, 1 suture revision, and 1 graft replacement). Among 9 (16%) patients treated with interventional techniques, 7 underwent percutaneous coil embolization for 8 endoleaks (7 successfully resolved). One late stent-graft disconnection required an additional stent-graft, and 1 of the 2 malpositioned endografts was repositioned. All patients remain alive with no increase in the diameter of the aneurysm in any patient.

Conclusions:

Technical problems resulting from the endovascular repair of aortic aneurysms often respond to interventional treatment.
Ambulatory Endovascular Surgery: Cost Advantage and Factors Influencing its Safe Performance
Authors: Shindelman Larry E. , Ninnul Gowen B. , Curtiss Steven I. , Konigsberg Stephen F.
Published: March 2015

Purpose:

To perform a retrospective analysis of chronic limb ischemia and determine whether endovascular surgery can be performed safely and cost effectively on an ambulatory basis.

Methods:

Among 42 patients undergoing endovascular interventions for lower limb ischemia over a 12-month period ending October 1997, 32 (18 men, mean age 68 years, range 44 to 89) were treated solely by endovascular interventions. These patients were grouped according to time inhospital: 20 (63%) patients had endovascular procedures performed on an ambulatory basis, 7 (22%) were hospitalized for > 24 hours, and 5 (16%) required an overnight stay. The angioplasty procedures, which included placement of 21 stents, were performed in the abdominal aorta (n = 1) and the common iliac (n = 9), external iliac (n = 7), superficial femoral (n = 11), popliteal (n = 5), tibioperoneal (n = 7), and subclavian (n = 1) arteries. Hospital charges were compared for the 3 groups.

Results:

Other than the presence of coronary artery disease, there were no significant differences in demographics or risk factors among the 3 groups. Angioplasty was technically successful in all patients, and there were no procedural complications. Patients with tissue loss required hospitalization more frequently compared to those with claudication. Significantly more patients who were hospitalized had epidural anesthesia as opposed to local when compared to the ambulatory group, 43% versus 5%, respectively (p = 0.04). Excluding professional fees, mean total hospital cost differed significantly between the ambulatory group and the group of patients with a hospital stay > 24 hours ($8227 versus $40,383, respectively; p = 0.03) and between the 2 hospitalized groups ($9476 for overnight stay versus $40,383 for > 24-hour stay, p = 0.03).

Conclusions:

Peripheral endovascular interventions can be performed safely on an ambulatory basis resulting in decreased hospital cost. Patients who receive epidural anesthesia, require concomitant open vascular reconstruction, present with tissue loss, or have unstable medical conditions are more likely to require hospitalization.
Closure of Large Percutaneous Access Sites Using the Prostar XL Percutaneous Vascular Surgery Device
Authors: Haas P. Clay , Krajcer Zvonimir , Diethrich Edward B.
Published: March 2015

Purpose:

To report early experience using a vascular closure device following endovascular aortic aneurysmal repair in which large-bore sheaths are used.

Technique:

A 10F Prostar XL Percutaneous Vascular Surgery device is used to deploy sutures around sheath entry sites up to 16F. At the completion of the procedure, the sutures are tied with a sliding knot to ensure adequate hemostasis.

Conclusions:

Maintaining the minimal invasiveness of the percutaneous approach to aortic endografting reduces patient discomfort and permits earlier ambulation and hospital discharge. Initial success seems to be maintained at 1 month, however, longer follow-up will be required.
Endotension: An Explanation for Continued AAA Growth after Successful Endoluminal Repair
Authors: White Geoffrey H. , May James , Petrasek Paul , Waugh Richard , Stephen Michael , Harris John
Published: March 2015

Purpose:

To present and analyze several cases that illustrate persistent sac pressurization following endovascular abdominal aortic aneurysm (AAA) repair.

Methods and Results:

Four patients with successful endovascular AAA exclusion presented in follow-up with an expanding aneurysm. Two had initial sac diameter decrease, but by 18 and 24 months, respectively, the AAA had enlarged and become pulsatile. There was no endoleak evident, but the proximal attachment stents had migrated distally in both cases. One patient developed endoleak with aneurysm expansion at 6 months; contained rupture occurred at 12 months. The last case had slowly evolving aneurysm expansion over 36 months but no endoleak. All endografts were removed and successfully replaced with conventional grafts. Intrasac thrombus was implicated as the means of pressure transmission that precipitated AAA expansion in these cases.

Conclusions:

Excluded AAAs can increase in size owing to persistent or recurrent pressurization (endotension) of the sac even when there is no evidence of endoleak. One proposed mechanism is pressure transmission via thrombus that lines the attachment site. Endotension may also represent an indiscernible, very low flow endoleak that allows blood to clot at the source of leakage.
Outpatient Carotid Artery Stenting: A Case Report
Authors: New Gishel , Roubin Gary S. , Iyer Sriram S. , Lawrence Emily J. , Oetgen Matthew , Al-Mubarek Nadim , Moussa Issam , Moses Jeffrey W. , Vitek Jiri J.
Published: March 2015

Purpose:

To report a case of carotid artery stenting for asymptomatic carotid restenosis performed in an outpatient setting.

Methods and Results:

A 68-year-old man with right carotid restenosis after repeat carotid endarterectomy underwent carotid angioplasty and stenting on an ambulatory basis. The procedure to implant a Smart stent required 45 minutes; the femoral access site was closed with a puncture closure device. The patient experienced no sequelae to this procedure and is well 6 months after treatment.

Conclusions:

Outpatient delivery of percutaneous carotid stenting may be feasible in appropriately selected patients.
Endovascular AAA Repair: Prevention of Side Branch Endoleaks with Thrombogenic Sponge
Authors: Walker Stuart R. , Macierewicz Jan , Hopkinson Brian R.
Published: March 2015

Purpose:

To report a technique that might decrease the incidence of lumbar artery endoleaks following endovascular repair (EVR) of abdominal aortic aneurysms (AAAs).

Methods:

Ninety-three patients (86 males, median age 72 years, range 56 to 88) undergoing EVR with the aortomonoiliac technique were entered into a study to detect and then occlude patent side branches before completion of the endografting procedure. Prior to deploying the iliac occluder, an aneurysmogram was performed to detect patent aortic side branches. If these side branches were found, an absorbable gelatin sponge was inserted into the aneurysm sac via the occluder introducer sheath. The patients were followed with contrast-enhanced spiral computed tomography (CT) at 1 week and 3, 6, and 12 months to detect the presence of endoleaks.

Results:

Forty-eight (52%) patients demonstrated patent side branches that were occluded by the insertion of gelatin sponges into the aneurysm sac. The remaining 45 patients without evidence of side branch flow were untreated. Ten (10.7%) patients died in the perioperative period, and 15 (16.1%) primary endoleaks (13 proximal, 2 distal) were detected. This left 68 (73.1%) patients for follow-up, 33 (48.5%) of whom had patent branch vessels treated with the thrombogenic sponge. The median follow-up was 4 months (range 1 to 17), during which time no side branch endoleak was detected on surveillance CT scans in any of the 68 patients, which included all patients treated with the thrombogenic sponge technique and those in whom no patent side branches had been identified.

Conclusions:

We have demonstrated a safe and reliable method of preventing lumbar artery endoleaks following endovascular AAA repair.
Response of Renal and Femoropopliteal Arteries to Palmaz Stent Implantation Assessed with Intravascular Ultrasound
Authors: Leertouwer Trude C. , Gussenhoven Elma J. , van Lankeren Winnifred , van Overhagen Hans
Published: March 2015

Purpose:

To establish the processes responsible for late lumen loss in renal and femoropopliteal Palmaz stents using intravascular ultrasound (IVUS).

Methods:

The first 7 consecutive patients treated with stents for renal (n = 4) and femoropopliteal (n = 3) arterial occlusive disease were studied with IVUS immediately after angiographically successful stent placement (< 10% residual stenosis) and periodically during follow-up. Images of both stent edges and the most stenotic site inside the stent at follow-up were matched to the same cross sections captured immediately after stent placement for quantitative analysis.

Results:

Late lumen loss in renal artery stents at 5 to 34 months was considerably less than in femoropopliteal stents (17% versus 62%, respectively). In the renal location, late lumen loss (3.0 ± 1.3 mm2) was due to neointimal hyperplasia, whereas stent area remained unchanged (3% decrease). Late lumen loss (7.4 ± 8.2 mm2) in femoropopliteal stents was due to neointimal hyperplasia and stent area reduction (26%). Overall, in both types of arteries, neointimal development and stent area reduction were larger at the most stenotic site than at the stent edges.

Conclusions:

These data suggest that there may be differences between renal and femoropopliteal arteries in the extent of hyperplastic response to stents.
Clinical Experience with Superior Vena Caval Greenfield Filters
Authors: Ascher Enrico , Hingorani Anil , Mazzariol Fernanda , Jacob Theresa , Yorkovich William , Gade Prasad
Published: March 2015

Purpose:

To evaluate the results of superior vena caval (SVC) Greenfield filters in patients at risk for pulmonary embolism (PE) secondary to upper extremity deep venous thrombosis (UEDVT).

Methods:

Over a 46-month period, 26 patients (10 men, mean age 67 years, range 25 to 89) with UEDVT in whom anticoagulation was contraindicated (n = 22) or ineffective in preventing recurrent PE or extension of the thrombus (n = 4) were treated with placement of SVC Greenfield filters.

Results:

One SVC filter was misplaced into the innominate vein but left in place; this vein remains patent after 2 months without evidence of filter migration. Follow-up ranged from 10 days to 46 months (mean 7.8 months). Fifteen (58%) patients died inhospital of causes unrelated to the SVC filter or recurrent thromboembolism (mean time to death 36 days). Of the 11 survivors, follow-up ranged from 1 to 38 months (mean 22). Sequential chest roentgenograms in 9 (82%) patients revealed no filter migration or displacement. No evidence of PE was found in any of the survivors over the course of follow-up.

Conclusions:

Insertion of SVC Greenfield filters is a safe and feasible therapy to prevent recurrent thromboembolism in patients with UEDVT who are refractory to or inappropriate for anticoagulation therapy.
Aorto—Left Renal Vein Fistula: Is There a Place for Endovascular Management?
Authors: Sultan Sherif , Madhavan Prakash , Colgan Mary Paula , Hughes Neil , Doyle Meave , Malloy Martin , Moore Dermot , Shanik Gregor
Published: March 2015

Purpose:

To describe the endovascular treatment of an aorto-left renal vein fistula.

Methods and Results:

A 77-year-old man with multiple comorbidities presented with low back pain, hematuria, cyanosis, and a pulsatile abdominal mass. Imaging confirmed a 7-cm abdominal aortic aneurysm with a contained rupture into the left renal vein. Owing to the patient's high surgical risk, a Talent Endoluminal Stent-Graft was implanted to satisfactorily exclude the aneurysm. Hemodynamic stability and normal renal function were restored; however, continued perfusion of the sac prompted an attempt to percutaneously repair the renal vein defect. This effort failed, so open laparotomy was necessary.

Conclusions:

Although total endovascular management was not successful in this case, the initial use of a minimally invasive approach allowed the patient's clinical status to improve and lower the risk of subsequent surgery.
A discourse analysis of hand hygiene policy in NHS Trusts
Authors: Cole Mark
Published: March 2015

Introduction

Healthcare-associated infection is a major patient safety concern. Hand hygiene is widely thought to be the single most important measure to affect reductions but compliance is problematic. Producing policies that clearly outline the responsibilities of staff is seen as a key way to instil accountability and improve performance.

Objectives:

The purpose of this study is to examine the discourse of hand hygiene policies across 359 NHS Trusts in England and consider the implications for practice.

Method:

The data were examined by combining the techniques of corpus linguistics with critical discourse analysis to generate keywords and concordance lines and then to make an interpretation what this may mean for the healthcare worker.

Results:

High frequency words such as ‘must’, ‘should’, ‘will’, ‘responsible’, ‘compliance’ and ‘audit’ suggest a tone that is authoritative and unyielding. This creates a fractured relationship between those who produce policies and the healthcare workers who need to comply with them.

Conclusion:

In their intentions to advance patient care policy, producers take little account of the messy, contextual factors that make the recommendations challenging to implement in daily practice. Firstly, Trusts should consider the use language that acknowledges the dynamic nature of practice and, secondly, cease using audit data as an indicator of performance as the conditions under which information is collected lacks reliability.
Cartilage regeneration for treatment of osteoarthritis: a paradigm for nonsurgical intervention
Authors: Tiku Moti L. , Sabaawy Hatem E.
Published: March 2015

Osteoarthritis (OA) is associated with articular cartilage abnormalities and affects people of older age: preventative or therapeutic treatment measures for OA and related articular cartilage disorders remain challenging. In this perspective review, we have integrated multiple biological, morphological, developmental, stem cell and homeostasis concepts of articular cartilage to develop a paradigm for cartilage regeneration. OA is conceptually defined as an injury of cartilage that initiates chondrocyte activation, expression of proteases and growth factor release from the matrix. This regenerative process results in the local activation of inflammatory response genes in cartilage without migration of inflammatory cells or angiogenesis. The end results are catabolic and anabolic responses, and it is the balance between these two outcomes that controls remodelling of the matrix and regeneration. A tantalizing clinical clue for cartilage regrowth in OA joints has been observed in surgically created joint distraction. We hypothesize that cartilage growth in these distracted joints may have a biological connection with the size of organs and regeneration. Therefore we propose a novel, practical and nonsurgical intervention to validate the role of distraction in cartilage regeneration in OA. The approach permits normal wake-up activity while during sleep; the index knee is subjected to distraction with a pull traction device. Comparison of follow-up magnetic resonance imaging (MRI) at 3 and 6 months of therapy to those taken before therapy will provide much-needed objective evidence for the use of this mode of therapy for OA. We suggest that the paradigm presented here merits investigation for treatment of OA in knee joints.
When ignorance is not bliss – a study of poor awareness of radiation exposure
Authors: Poullis Chris , Mackay Alice , Ahmed Munir
Published: March 2015

Introduction and objective:

Patient safety is at the forefront of quality of care. Radiation exposure secondary to diagnostic imaging is increasing rapidly. Coupled with clinicians’ lack of awareness concerning radiation, doses incurred during these common procedures mean patients are being exposed to substantial cumulative radiation. Recent publications have indicated a significant minority of cancers are secondary to medical ionising radiation. The purpose of this study was to establish physician knowledge of radiation dosages.

Methods:

Clinician knowledge of radiation doses was determined by a questionnaire distributed to 40 doctors across all specialties in a District General Hospital in England. Clinicians were asked to estimate the radiation dose incurred during common diagnostic investigations, environmental exposure and the relation to increased cancer risk. The results were correlated against seniority and previous formal education on ionising radiation.

Results:

Clinician knowledge of radiation doses was poor with a mean score of 17% (range 0–44%). There was, on average, more than a 12-fold underestimation of radiation exposure levels across all grades and specialties of doctors. Those with previous formal education outperformed those without, but not significantly ( p > 0.05).

Conclusions:

Clinician awareness surrounding radiation doses of common diagnostic modalities is poor, grossly underestimating the true values. Increasing seniority or prior formal radiology training did not significantly alter the outcome. There is a need to educate clinicians, raise radiation dose awareness and avoid the financial, medico-legal and health delivery implications of unnecessary patient exposure to radiation.
The Experiences of South-Western Taiwanese Male Adolescents Controlling Their Smoking After Exposure to an Education Program
Authors: Hong Rei-Mei , Chen Mei-Yen , Guo Su-Er , Hee Lisa
Published: March 2015

Tobacco use is the most preventable cause of chronic diseases and cancers worldwide. In south-western Taiwan, tobacco use has become one of the top risk behaviors. Smoking in young people has been associated with alcohol addiction and drug abuse in later life; and most smokers start young. Initiation of cigarette smoking at an early age leads to more life-years of tobacco use, makes quitting harder, and increases the risk for serious health consequences. How adolescent boys effectively control their tobacco use is still uncertain. The article explores on the experience of 12 adolescent boys in south-western Taiwan controlling tobacco use as a result of participating in a smoking prevention education program. In addition to the use of interviews and focus groups as the traditional method of data gathering, the lead author also included the use of participants’ paintings as representations of the participants’ lived experience of the phenomenon. The findings of the study suggest that adolescent boys with smoking experience in Taiwan had the desire to control their smoking behavior after obtaining information through a local education program. In addition, they chose suitable methods for controlling their smoking based on the information that had been provided.
The Gender of Managers and Sickness Absence
Authors: Melsom Anne May
Published: March 2015

This study analyses the association between the gender of managers and sickness absence in workplaces. It uses Norwegian administrative register data which are broadly representative of the private workforce. Previous research argues that the gender of managers affects a range of outcomes related to performance and productivity, but sickness absence has received limited attention. The analyses indicate a positive relationship between female managers and sickness absence rates. The results are in line with theories of a more lenient absence culture at workplaces managed by women.
Small Island Visitor Attractions
Authors: Allahar Haven
Published: March 2015

This article proposes a process framework for developing and managing visitor attractions (VA) in small island developing states with Trinidad and Tobago, a two-island state in the Caribbean, as the case study. An extensive literature review was conducted, supported by field observations, individual depth interviews, and small and large focus group meetings. The process framework identified four sets of processes: national policy formulation and legislation; inventory, classification, evaluation, and ranking of VA; general operations management involving project management activities; and site specific activities of development, operations, and maintenance. The value of the framework lies in the fact that no similar framework applicable to small islands was covered in the literature and validation was obtained from a panel of experts and a cross section of tourism stakeholders in Tobago.
The Scholarship of Teaching and Learning
Authors: McBride Leslie Gail , Kanekar Amar Shireesh
Published: March 2015

The scholarship of teaching and learning (SoTL) has a fascinating history, has played a significant role in higher education for the past 25 years, and has a specific meaning that has developed over time and with much debate. It has been part of national and international conversations that have questioned the role of scholarship and whether its increasingly restrictive standards have limited higher education’s ability to respond adequately to today’s academic and social mandates. This essay introduces Pedagogy in Health Promotion readers to SoTL’s origin as one of four scholarly functions proposed in Ernest Boyer’s highly influential book Scholarship Reconsidered: Priorities of the Professoriate. It summarizes these functions, describes SoTL’s subsequent development, and then applies all four functions to health education and health promotion discussing their relevance to the field. Finally, this essay raises questions regarding the current alignment of scholarship with professional roles and responsibilities and inquires whether a more authentic alignment might be achieved.
Talking About Race
Authors: Robillard Alyssa G. , Annang Lucy , Buchanan Kyrel L.
Published: March 2015

This article is a reflection of the individual and collective experiences of university professors of color whose work addresses African American health disparities. As instructors with the responsibility of introducing undergraduate students to the concept of health disparities, we believe it is beneficial for students to examine health disparities within the historical context of race. From our collective experiences, we offer selected resources to help students (1) understand race as a social construct and (2) understand that health disparities are not a consequence of inherent race-based biological differences. This is paramount to initiating a discussion of African American health disparities. Furthermore, this challenges students to think critically about social determinants of health and the broader ecological factors associated with health disparities. In preparing future professionals in health promotion, this results in more well-rounded practitioners who are better able to engage with more diverse communities.
Development of an Online Course in Public Health for Undergraduates
Authors: Mincey Krista D.
Published: March 2015

Online courses offer students’ flexibility and universities more opportunities to expand their student enrollment. With the increase in online degrees to accommodate nontraditional students and working professionals, online courses serve as an avenue to reach more people and increase the dwindling public health workforce. With the start of accreditation of undergraduate baccalaureate programs in public health, the need for work on public health course development at the undergraduate level is needed. This article outlines how an online undergraduate introduction to public health course was developed. All elements of the course are discussed from course structure, design, and assignments. In addition, evaluations of the course from the instructor and the students are discussed along with lessons learned.
Friction stir welding of dissimilar aluminium–magnesium joints: sheet mutual position effects
Authors: Buffa G. , Baffari D. , Di Caro A. , Fratini L.
Published: March 2015

Friction stir welding (FSW) is a solid state welding process used to weld difficult to be welded or unweldable materials as aluminium alloys. In the last years, other materials have been successfully tested as magnesium, titanium and nickel based alloys. Dissimilar joints can be obtained by FSW, but issues arise concerning the correct choice of the process parameters. In the paper, the results of an experimental and numerical campaign aimed to produce dissimilar AZ31-AA6016-T6 butt joints are presented. The effect of sheet mutual position and main process parameters was investigated. It was found that intermetallics are the main cause of the poor quality of the joints. Sound joints can be produced only if the magnesium alloy is in the advancing side.
Solidification behaviour of a high chromium nickel base alloy weld deposited metal
Authors: Di X. J. , Chen B.
Published: March 2015

The solidification behaviour including microsegregation and secondary phase formation of a high chromium nickel base alloy weld deposited metal was examined with optical microscopy, scanning electron microscopy and transmission electron microscopy. Microsegregation potential of major alloying elements in the weld deposited metal was investigated. The microconstituents formed during solidification were identified to be TiC and γ/Laves eutectic constituent. Most γ/Laves eutectic constituents were located at the dendrite interstices due to the microsegregation of Nb, Mo and Si. The volume percent of γ/Laves constituent was predicted by using Scheil equation, and there was a reasonable agreement between the predicted and measured value. Last, two possible solidification paths added to the γ-Nb-C pseudoternary solidification diagram were proposed to analyse the solidification sequence of the new high chromium nickel base alloy.
Autophagy is required for stem cell mobilization by G-CSF
Authors: Leveque-El Mouttie Lucie , Vu Therese , Lineburg Katie E. , Kuns Rachel D. , Bagger Frederik O. , Teal Bianca E. , Lor Mary , Boyle Glen M. , Bruedigam Claudia , Mintern Justine D. , Hill Geoffrey R. , MacDonald Kelli P. A. , Lane Steven W.
Published: March 2015

Key Points

G-CSF activates autophagy in HSCs and neutrophils. The response and survival of HSCs mobilized by G-CSF in vivo require autophagy.
N-Acetyl-Cysteine, a Drug that Enhances the Endogenous Activation of Group-II Metabotropic Glutamate Receptors, Inhibits Nociceptive Transmission in Humans
Authors: Truini Andrea , Piroso Serena , Pasquale Erica , Notartomaso Serena , Stefano Giulia Di , Lattanzi Roberta , Battaglia Giuseppe , Nicoletti Ferdinando , Cruccu Giorgio
Published: March 2015

Background

Emerging research seeking novel analgesic drugs focuses on agents targeting group-II metabotropic glutamate receptors (mGlu2 and mGlu3 receptors). N-Acetylcysteine (NAC) enhances the endogenous activation of mGlu2/3 receptors by activating the glial glutamate:cystine membrane exchanger. Here, we examined whether NAC inhibits nociceptive responses in humans and animals. We tested the effect of oral NAC (1.2 g) on thermal-pain thresholds and laser-evoked potentials in 10 healthy volunteers, according to a crossover, double-blind, placebo-controlled design, and the effect of NAC (100 mg/kg, i.p.) on the tail-flick response evoked by radiant heat stimulation in mice.

Results

In healthy subjects, NAC treatment left thermal-pain thresholds unchanged, but significantly reduced pain ratings to laser stimuli and amplitudes of laser-evoked potentials. NAC induced significantly greater changes in these measures than placebo. In the tail-flick test, NAC strongly reduced the nocifensive reflex response to radiant heat. The action of NAC was abolished by the preferential mGlu2/3 receptor antagonist, LY341495 (1 mg/kg, i.p.).

Conclusions

Our findings show for the first time that NAC inhibits nociceptive transmission in humans, and does the same in mice by activating mGlu2/3 receptors. These data lay the groundwork for investigating the therapeutic potential of NAC in patients with chronic pain.
Critical care capacity in Canada: results of a national cross-sectional study
Authors: Fowler Robert A , Abdelmalik Philip , Wood Gordon , Foster Denise , Gibney Noel , Bandrauk Natalie , Turgeon Alexis F , Lamontagne François , Kumar Anand , Zarychanski Ryan , Green Rob , Bagshaw Sean M , Stelfox Henry T , Foster Ryan , Dodek Peter , Shaw Susan , Granton John , Lawless Bernard , Hill Andrea , Rose Louise , Adhikari Neill K , Scales Damon C , Cook Deborah J , Marshall John C , Martin Claudio , Jouvet Philippe ,   on behalf of the Canadian Critical Care Trials Group and The Canadian ICU Capacity Group
Published: March 2015

Introduction

Intensive Care Units (ICUs) provide life-supporting treatment; however, resources are limited, so demand may exceed supply in the event of pandemics, environmental disasters, or in the context of an aging population. We hypothesized that comprehensive national data on ICU resources would permit a better understanding of regional differences in system capacity.

Methods

After the 2009–2010 Influenza A (H1N1) pandemic, the Canadian Critical Care Trials Group surveyed all acute care hospitals in Canada to assess ICU capacity. Using a structured survey tool administered to physicians, respiratory therapists and nurses, we determined the number of ICU beds, ventilators, and the ability to provide specialized support for respiratory failure.

Results

We identified 286 hospitals with 3170 ICU beds and 4982 mechanical ventilators for critically ill patients. Twenty-two hospitals had an ICU that routinely cared for children; 15 had dedicated pediatric ICUs. Per 100,000 population, there was substantial variability in provincial capacity, with a mean of 0.9 hospitals with ICUs (provincial range 0.4-2.8), 10 ICU beds capable of providing mechanical ventilation (provincial range 6–19), and 15 invasive mechanical ventilators (provincial range 10–24). There was only moderate correlation between ventilation capacity and population size (coefficient of determination (R2) = 0.771).

Conclusion

ICU resources vary widely across Canadian provinces, and during times of increased demand, may result in geographic differences in the ability to care for critically ill patients. These results highlight the need to evolve inter-jurisdictional resource sharing during periods of substantial increase in demand, and provide background data for the development of appropriate critical care capacity benchmarks.
Resting energy expenditure and substrate oxidation rates correlate to temperature and outcome after cardiac arrest - a prospective observational cohort study
Authors: Holzinger Ulrike , Brunner Richard , Losert Heidrun , Fuhrmann Valentin , Herkner Harald , Madl Christian , Sterz Fritz , Schneeweiß Bruno
Published: March 2015

Introduction

Targeted temperature management improves outcome after cardiopulmonary resuscitation. Reduction of resting energy expenditure might be one mode of action. The aim of this study was to correlate resting energy expenditure and substrate oxidation rates with targeted temperature management at 33°C and outcome in patients after cardiac arrest.

Methods

This prospective, observational cohort study was performed at the department of emergency medicine and a medical intensive care unit of a university hospital. Patients after successful cardiopulmonary resuscitation undergoing targeted temperature management at 33°C for 24 hours with subsequent rewarming to 36°C and standardized sedation, analgesic and paralytic medication were included. Indirect calorimetry was performed five times within 48 h after cardiac arrest. Measurements were correlated to outcome with repeated measures ANOVA, linear and logistic regression analysis.

Results

In 25 patients resting energy expenditure decreased 20 (18 to 27) % at 33°C compared to 36°C without differences between outcome groups (favourable vs. unfavourable: 25 (21 to 26) vs. 21 (16 to 26); P = 0.5). In contrast to protein oxidation rate (favourable vs. unfavourable: 35 (11 to 68) g/day vs. 39 (7 to 75) g/day, P = 0.8) patients with favourable outcome had a significantly higher fat oxidation rate (139 (104 to 171) g/day vs. 117 (70 to 139) g/day, P <0.05) and a significantly lower glucose oxidation rate (30 (−34 to 88) g/day vs. 77 (19 to 138) g/day; P < 0.05) as compared to patients with unfavourable neurological outcome.

Conclusions

Targeted temperature management at 33°C after cardiac arrest reduces resting energy expenditure by 20% compared to 36°C. Glucose and fat oxidation rates differ significantly between patients with favourable and unfavourable neurological outcome.

Trial registration

Clinicaltrials.gov NCT00500825. Registered 11 July 2007.
Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference is associated with lactate evolution in the hemodynamic resuscitation process in early septic shock
Authors: Mesquida Jaume , Saludes Paula , Gruartmoner Guillem , Espinal Cristina , Torrents Eva , Baigorri Francisco , Artigas Antonio
Published: March 2015

Introduction

Since normal or high central venous oxygen saturation (ScvO2) values cannot discriminate if tissue perfusion is adequate, integrating other markers of tissue hypoxia, such as central venous-to-arterial carbon dioxide difference (PcvaCO2 gap) has been proposed. In the present study, we aimed to evaluate the ability of the PcvaCO2 gap and the PcvaCO2/arterial-venous oxygen content difference ratio (PcvaCO2/CavO2) to predict lactate evolution in septic shock.

Methods

Observational study. Septic shock patients within the first 24 hours of ICU admission. After restoration of mean arterial pressure, and central venous oxygen saturation, the PcvaCO2 gap and the PcvaCO2/CavO2 ratio were calculated. Consecutive arterial and central venous blood samples were obtained for each patient within 24 hours. Lactate improvement was defined as the decrease ≥ 10% of the previous lactate value.

Results

Thirty-five septic shock patients were studied. At inclusion, the PcvaCO2 gap was 5.6 ± 2.1 mmHg, and the PcvaCO2/CavO2 ratio was 1.6 ± 0.7 mmHg · dL/mL O2. Those patients whose lactate values did not decrease had higher PcvaCO2/CavO2 ratio values at inclusion (1.8 ± 0.8vs. 1.4 ± 0.5, p 0.02). During the follow-up, 97 paired blood samples were obtained. No-improvement in lactate values was associated to higher PcvaCO2/CavO2 ratio values in the previous control. The ROC analysis showed an AUC 0.82 (p < 0.001), and a PcvaCO2/CavO2 ratio cut-off value of 1.4 mmHg · dL/mL O2 showed sensitivity 0.80 and specificity 0.75 for lactate improvement prediction. The odds ratio of an adequate lactate clearance was 0.10 (p < 0.001) in those patients with an elevated PcvaCO2/CavO2 ratio (≥1.4).

Conclusion

In a population of septic shock patients with normalized MAP and ScvO2, the presence of elevated PcvaCO2/CavO2 ratio significantly reduced the odds of adequate lactate clearance during the following hours.