bluuebunny/crossref_metadata_2025 huggingface dataset:
Decontamination of laundry exposed to Microsporum canis hairs and spores
Authors: Moriello Karen A
Published: May 2015

Objectives

The objective of this study was to determine the efficacy of decontamination of fabric exposed to Microsporum canis hairs and spores by mechanical washing using hot or cold water with or without a sodium hypochlorite additive, and to field test a washing protocol for terry cloth and denim exposed to M canis via direct contact with infected cats.

Methods

Cotton, terry cloth and denim fabric swatches were contaminated with isolated infective spores and hairs and then washed in water at temperatures of 30°C and 60°C, with and without a sodium hypochlorite additive, and with and without mechanical drying. Terry cloth and denim were contaminated by direct contact with infected kittens and washed at 30°C until culture-negative.

Results

All prelaundering samples had >300 colony forming units (cfu)/plate. Experimentally contaminated fabrics were culture-negative, regardless of fabric type, water temperature, the presence or absence of sodium hypochlorite, or tumble drying after one wash. After one wash, 22/34 (65%) of terry cloth towels and 12/20 (60%) denim fabric squares were culture-positive, but the infective load was minimal (1–5 cfu/plate). After two washes in cold water there was no detectable contamination of fabric. The rinse water was not contaminated with spores. The laundry tub was easily decontaminated via mechanical cleaning followed by use of a disinfectant.

Conclusions and relevance

Washable textiles exposed to M canis can be decontaminated via mechanical washes in cold water without the addition of bleach. Two washes are recommended to ensure removal of spores. Laundry can be effectively decontaminated by washing twice in cold water on a long wash cycle (for ⩾14 mins). It is important to ensure maximal agitation (ie, the machine should not be overloaded).
Effects of Interaction Between Dopamine D2 Receptor and Monoamine Oxidase A Genes on Smoking Status in Young Men
Authors: Huang Chih-Ling , Ou Wei-Chih , Chen Pei-Lain , Liu Chen-Nu , Chen Mei-Chih , Lu Chia-Chen , Chen Yi-Chun , Lin Min-Hsuan , Huang Ching-Shan
Published: May 2015

Although the effect of gene–gene interaction on nicotine–dopamine metabolism for smoking behavior has been reported, polymorphisms of dopamine D2 receptor ( DRD2) and monoamine oxidase A ( MAOA) have not been simultaneously examined among smokers. In this study, 481 young Taiwanese men completed a self-report questionnaire on smoking status, and data were obtained on polymorphisms of DRD2 rs1800497, DRD2 rs1079597, MAOA rs309850, and MAOA rs1137070, urinary nicotine, and urinary cotinine. In a comparison of 261 current smokers and 220 never smokers, odds ratios ( ORs) for the development of smoking in all genotypes were not statistically significant. Among smokers with DRD2 rs1079597 GG// MAOA rs309850 3-repeat, the OR of heavier smoking was 2.67 times higher (95% confidence interval [CI]: [1.08, 6.59], p = .031) and the score on the Fagerstrom test for nicotine dependence was higher (4.26 vs. 2.83) than in those with DRD2 rs1079597 AA// MAOA rs309850 3-repeat. Adjusted urinary cotinine concentration was significantly different between those two groups (median value: 95.83 ng/μl vs. 133.24 ng/μl, respectively, p = .045). These findings suggest that the interaction of DRD2 rs1079597 and MAOA rs309850 3-repeat affects smoking intensity in young Taiwanese men.
The occurrence of dystonia in upper-limb multiple sclerosis tremor
Authors: Van der Walt A , Buzzard K , Sung S , Spelman T , Kolbe SC , Marriott M , Butzkueven H , Evans A
Published: May 2015

Background:

The pathophysiology of multiple sclerosis (MS) tremor is uncertain with limited phenotypical studies available.

Objective:

To investigate whether dystonia contributes to MS tremor and its severity.

Methods:

MS patients ( n = 54) with and without disabling uni- or bilateral upper limb tremor were recruited (39 limbs per group). We rated tremor severity, writing and Archimedes spiral drawing; cerebellar dysfunction (SARA score); the Global Dystonia Scale (GDS) for proximal and distal upper limbs, dystonic posturing, mirror movements, geste antagoniste, and writer’s cramp.

Results:

Geste antagoniste, mirror dystonia, and dystonic posturing were more frequent and severe ( p < 0.001) and dystonia scores were correlated with tremor severity in tremor compared to non-tremor patients. A 1-unit increase in distal dystonia predicted a 0.52-Bain unit (95% confidence interval (CI) 0.08–0.97), p = 0.022) increase in tremor severity and a 1-unit (95% CI 0.48–1.6, p = 0.001) increase in drawing scores. A 1-unit increase in proximal dystonia predicted 0.93-Bain unit increase (95% CI 0.45–1.41, p < 0.001) in tremor severity and 1.5-units (95% CI 0.62–2.41, p = 0.002) increase in the drawing score. Cerebellar function in the tremor limb and tremor severity was correlated ( p < 0.001).

Conclusions:

Upper limb dystonia is common in MS tremor suggesting that MS tremor pathophysiology involves cerebello-pallido-thalamo-cortical network dysfunction.
Level of education and multiple sclerosis risk after adjustment for known risk factors: The EnvIMS study
Authors: Bjørnevik Kjetil , Riise Trond , Cortese Marianna , Holmøy Trygve , Kampman Margitta T , Magalhaes Sandra , Myhr Kjell-Morten , Wolfson Christina , Pugliatti Maura
Published: May 2015

Background:

Several recent studies have found a higher risk of multiple sclerosis (MS) among people with a low level of education. This has been suggested to reflect an effect of smoking and lower vitamin D status in the social class associated with lower levels of education.

Objective:

The objective of this paper is to investigate the association between level of education and MS risk adjusting for the known risk factors smoking, infectious mononucleosis, indicators of vitamin D levels and body size.

Methods:

Within the case-control study on Environmental Factors In MS (EnvIMS), 953 MS patients and 1717 healthy controls from Norway reported educational level and history of exposure to putative environmental risk factors.

Results:

Higher level of education were associated with decreased MS risk ( p trend = 0.001) with an OR of 0.53 (95% CI 0.41–0.68) when comparing those with the highest and lowest level of education. This association was only moderately reduced after adjusting for known risk factors (OR 0.61, 95% CI 0.44–0.83). The estimates remained similar when cases with disease onset before age 28 were excluded.

Conclusion:

These findings suggest that factors related to lower socioeconomic status other than established risk factors are associated with MS risk.
Cardiopulmonary fitness is related to disease severity in multiple sclerosis
Authors: Heine Martin , Wens Inez , Langeskov-Christensen Martin , Verschuren Olaf , Eijnde Bert O , Kwakkel Gert , Dalgas Ulrik
Published: May 2015

Background:

In persons with MS (pwMS), a lower cardiopulmonary fitness has been associated with a higher risk for secondary disorders, decreased functional capacity, symptom worsening and reduced health-related quality of life.

Objective:

To investigate the association between disease severity and cardiopulmonary fitness.

Methods:

Data from cardiopulmonary exercise tests, previously conducted in three different countries, were pooled. The association between disease severity (Expanded Disability Status Scale (EDSS)) and cardiopulmonary fitness (peak oxygen uptake (VO2peak)) was adjusted for age, sex and the country of origin.

Results:

The combined sample comprised 116 ambulant pwMS having a mean (± SD) EDSS score of 2.7 ± 1.3. There was a significant correlation ( r = -0.418, p < .01) between VO2peak and EDSS. A multiple regression model (R2 = 0.520, p < .01) was constructed to describe VO2peak (mL∙kg−1∙min−1); VO2peak = 36.622 − 5.433 (Sex (1=men)) – 0.124 (Age) − 2.082 (EDSS) + 2.737 (Belgium) + 8.674 (Denmark).

Conclusion:

There was a significant association between disease severity and cardiopulmonary fitness. The close relation between cardiopulmonary fitness and chronic conditions associated with physical inactivity, suggest a progressive increase in risk of secondary health conditions in pwMS
Progressive multiple sclerosis exhibits decreasing glutamate and glutamine over two years
Authors: MacMillan EL , Tam R , Zhao Y , Vavasour IM , Li DKB , Oger J , Freedman MS , Kolind SH , Traboulsee AL
Published: May 2015

Background:

Few biomarkers of progressive multiple sclerosis (MS) are sensitive to change within the two-year time frame of a clinical trial.

Objective:

To identify biomarkers of MS disease progression with magnetic resonance spectroscopy (MRS) in secondary progressive MS (SPMS).

Methods:

Forty-seven SPMS subjects were scanned at baseline and annually for two years. Concentrations of N-acetylaspartate, total creatine, total choline, myo-inositol, glutamate, glutamine, and the sum glutamate+glutamine were measured in a single white matter voxel.

Results:

Glutamate and glutamine were the only metabolites to show an effect with time: with annual declines of (95% confidence interval): glutamate −4.2% (−6.2% to −2.2%, p < 10−4), glutamine −7.3% (−11.8% to −2.9%, p = 0.003), and glutamate+glutamine −5.2% (−7.6% to −2.8%, p < 10−4). Metabolite rates of change were more apparent than changes in clinical scores or brain atrophy measures.

Conclusions:

The high rates of change of both glutamate and glutamine over two years suggest they are promising new biomarkers of MS disease progression.
Peripheral late reactivation of a previously typical monofocal Baló’s concentric sclerosis lesion
Authors: Pique J , Bonneville F , Brassat D , Peaureaux D , Benaiteau M , Dumas H , Fabre N , Clanet M , Biotti D
Published: May 2015

We report a 41-year-old woman with rapidly progressive left hemiparesis, revealing an inflammatory reactivation of a previously known parietal Baló’s concentric sclerosis lesion. The first attack occurred five years before. After a slow recovery following high-dose steroid infusions the patient stabilized. Because of recurrent ataxia and left hemiparesis a new magnetic resonance imaging was performed showing an extension of the initial lesion with a peripheral gadolinium enhancement on T1-weighted images. Such a reactivation pattern of an isolated Baló’s concentric sclerosis lesion, occurring some years later, is described for the first time.
Neuroenhancement through cognitive training and anodal tDCS in multiple sclerosis
Authors: Mattioli Flavia , Bellomi Fabio , Stampatori Chiara , Capra Ruggero , Miniussi Carlo
Published: May 2015

Background:

Cognitive training has been shown to improve cognitive function and quality of life in multiple sclerosis (MS) patients and is correlated with increased activity in the left dorsolateral prefrontal cortex (DLPFC).

Objective:

This study aims to test whether combining attention training with anodal transcranial direct current stimulation (a-tDCS) over the left DLPFC can improve training efficacy.

Methods:

Twenty patients impaired in attention/speed of information processing were randomly assigned to cognitive training during a-tDCS over the left DLPFC or cognitive training during sham tDCS for 10 daily sessions. Neuropsychological evaluations were conducted at baseline, after treatment and six months later.

Results:

When a-tDCS, rather than sham, was applied during the cognitive training, patients showed a significantly greater improvement in the Symbol Digit Modality Test (SDMT) and Wisconsin Card Sorting Test (WCST) after treatment ( p < 0.05) and in the Paced Auditory Serial Addition Test (PASAT) 2” and WCST six months later ( p < 0.05). They also had significantly shorter time to reach the most difficult exercise level, compared to sham treatment (6.3 vs. 7.4 sessions; p < 0.05).

Conclusions:

These results indicate that a-tDCS on the DLPFC during cognitive training fosters improvements in attention and executive function in MS patients and shortens treatment duration.
The broad autism phenotype predicts relationship outcomes in newly formed college roommates
Authors: Faso Daniel J , Corretti Conrad A , Ackerman Robert A , Sasson Noah J
Published: May 2015

Although previous studies have reported that the broad autism phenotype is associated with reduced relationship quality within established relationships, understanding how this association emerges requires assessment prior to relationship development. In the present longitudinal study, college roommates with minimal familiarity prior to cohabitation (N = 162) completed the broad autism phenotype questionnaire and intermittently reported on their relationship quality and interpersonal behaviors toward their roommate over their first 10 weeks of living together. Actor–Partner Interdependence Models demonstrated that roommates mismatched on aloofness (one high and one low) had lower relationship satisfaction than those matched on it, with the interpersonal behavior of warmth mediating this association. Because relationship satisfaction remained high when both roommates were aloof, satisfaction does not appear predicated upon the presence of aloofness generally but rather reflects a product of dissimilarity in aloof profiles between roommates. In contrast, although participants reported less relationship satisfaction and commitment with roommates higher on pragmatic language abnormalities, mismatches on this broad autism phenotype trait, and on rigid personality, were less consequential. In sum, these findings suggest that complementary profiles of social motivation may facilitate relationship quality during the early course of relationship development.
Self and informant reports of mental health difficulties among adults with autism findings from a long-term follow-up study
Authors: Moss Philippa , Howlin Patricia , Savage Sarah , Bolton Patrick , Rutter Michael
Published: May 2015

Data on psychiatric problems in adults with autism are inconsistent, with estimated rates ranging from around 25% to over 75%. We assessed difficulties related to mental health in 58 adults with autism (10 females, 48 males; mean age 44 years) whom we have followed over four decades. All were of average non-verbal intelligence quotient when diagnosed as children. Overall ratings of mental health problems were based on data from the Family History Schedule (Bolton et al., 1994). Informant reports indicated that many of the cohort (44%) had experienced no mental health problems in adulthood; 28% had experienced mild to moderate difficulties, 23% had severe and 5% very severe problems. Depression was the most commonly reported problem. Among those adults ( n = 22) able to report on their own mental state, again many (45%) reported no mental health problems, although 27% reported very severe mental health problems related to anxiety, depression and/or obsessive–compulsive symptoms. Informant ratings of poor mental health were not associated with gender, severity of autism in childhood, or child or adult intelligence quotient, but there were small correlations with overall social functioning (rho = 0.34) and current autism severity (rho = 0.37). The findings highlight the difficulties of assessing mental health problems in adults with autism and the need for appropriately validated measures.
In pursuit of democratic policing
Authors: Hope Kempe Ronald
Published: May 2015

Police reforms in Kenya took on a new impetus following the unprofessional and unethical behaviour of the police in their response to the violence that followed the country’s presidential elections in December 2007. Against that backdrop there was a clamour for police reforms that pursued democratic policing to re-orient the police force into a national police service that acted professionally, respected human rights and the rule of law, and served in the interest of all Kenyans. This article outlines, describes, and analytically reviews and assesses the outcomes of the police reforms that have been implemented, in that regard, over the past six years in Kenya. It finds some key achievements in police reforms. However, it also finds there is still a far way to go to rid the police of their bad habits. Corruption, brutality, the sometimes senseless and wanton use of firearms, for example, are still rampant and are inconsistent with democratic policing.
The unruly queer figure’s phallic seductions and the re/production of sexual (in)difference
Authors: Hammers Corie
Published: May 2015

This article interrogates a psychoanalytically inflected strain of anti-social queer theory that in privileging refusal and negation, views as paradigmatic of ‘queerness’ the destructive, annihilative aspects in (queer) sex. In this view, sexuality is a product of the unconscious, thus irreducible to gender, such that gender is irrelevant to (and indeed hinders) understandings of desire. Informed by feminism, which views gender as crucial to any theory on sexuality, I expose that which ‘sexual negation’ masks through this very disavowal – that of gender and the body itself. I argue that subtending the figural representation of queer/ness is a deep-seated, albeit disguised, masculinism that, through negation, works to re-centre and re-virilise (gay) men’s sexual economies. I take up Butler’s lesbian phallus to de-idealise and thus challenge this privileging of the penis operating within this strain of queer – as only phallic sexual economies can, it seems, deliver the very annihilation we (all) seek.
Developing relationships between care staff and people with dementia through Music Therapy and Dance Movement Therapy: A preliminary phenomenological study
Authors: Melhuish Ruth , Beuzeboc Catherine , Guzmán Azucena
Published: May 2015

Background

There is an increasing focus on providing effective psychosocial interventions to improve quality of life in dementia care. This study aims to explore the attitudes and perceptions of staff who participated regularly in Music Therapy (MT) and Dance Movement Therapy (DMT) groups for residents with dementia in a nursing home.

Method

In-depth interviews were conducted with seven members of care home staff. Data were analysed using interpretative phenomenological analysis.

Results

A representation modelling the impact of MT and DMT in a nursing care home. Three main themes were identified. 1) Discovering residents' skills and feelings; 2) Learning from the therapists to change approaches to care practice with subthemes: time, space and pace, choice, following the residents' lead; 3) Connection between staff and residents.

Conclusion

The model indicated that both interventions performed in parallel helped staff to discover residents' skills and feelings. Although it is a small sample size, this study strongly suggests that MT and DMT can have a positive influence in helping care staff to provide a meaningful care environment.
Energy flow models for underwater radiation noise prediction in medium-to-high-frequency ranges
Authors: Kwon Hyun-Wung , Hong Suk-Yoon , Song Jee-Hun
Published: May 2015

Energy flow analysis is studied as a promising tool for the noise and vibration analysis of system structures in medium-to-high-frequency ranges. The energy flow finite element method, combining energy flow analysis with the finite element method, is efficient for the vibration analysis of a built-up structure, and the energy flow boundary element method, combining energy flow analysis with the boundary element method, is useful for predicting the noise level of a vibrating complex structure. In this article, the energy flow finite element/energy flow boundary element method and semi-coupling relationships are used to investigate the vibration and radiation noise of a reinforced cylindrical structure in water. Energy flow finite element method is employed to analyze the vibrational responses of the reinforced cylindrical structure, considering fluid loading effects, and energy flow boundary element method is applied to analyze the underwater radiation noise. Therefore, the energy flow coupling relationship of structure-to-acoustic space is used to link the energy flow finite element/energy flow boundary element methods together. The vibrational energy of the structure is treated as an acoustic intensity boundary condition of energy flow boundary element method to calculate underwater radiation noise. Numerical simulations are presented and the results are compared with experimental measurements for the reinforced cylindrical structure in water.
An analysis of the theory/concept entries in the SAGE Encyclopedia of Action Research: What we can learn about action research in general from the encyclopedia
Authors: Greenwood Davydd J
Published: May 2015

The SAGE Encyclopedia of Action Research consists of 314 entries totaling around 600,000 words by people expert in their topic. What if it was treated as a corpus of data about the current state of action research and related matters? So treated, it can provide a valuable current perspective on what action research is, who uses it for what purpose, and how it is done. A companion paper by Bob Dick reports on what the encyclopedia has to say about current action research methodology. This paper does the same for theories/concepts used in action research. I review and comment on what the encyclopedia says about the broad array of theoretical perspectives and concepts that are often deployed in varying combinations in action research. I emphasize some of the key features of many approaches to action research and make it clear that action researchers borrow eclectically from other fields in orchestrating action research processes.
Theory and method: Why action research does not separate them
Authors: Dick Bob , Greenwood Davydd J
Published: May 2015

This is a combined introduction to two associated papers. Both are occasioned by the publication of the SAGE Encyclopedia of Action Research (Coghlan & Brydon-Miller, 2014), and an invitation from its editors, David Coghlan and Mary Brydon-Miller to use the publication as an opportunity to review the present state of action research. The focus of one of the papers, by Davydd Greenwood (2015, this issue) , is on the theory and concepts of action research. The other paper, by Bob Dick (2015) , addresses how action research is done: that is, its methodology and methods. And therein lies a difficulty. The two papers, and their corresponding dimensions of action research, are necessarily intertwined. The theory and concepts determine the research approach. The approach, in turn, yields the data and the experiences that between them generate or modify the theory and concepts.
Does pulmonary rehabilitation reduce peripheral blood pressure in patients with chronic obstructive pulmonary disease?
Authors: Canavan Jane L , Kaliaraju Djeya , Nolan Claire M , Clark Amy L , Jones Sarah E , Kon Samantha SC , Polkey Michael I , Man William D-C
Published: May 2015

Pulmonary rehabilitation (PR) can improve aerobic exercise capacity, health-related quality of life and dyspnoea in patients with chronic obstructive pulmonary disease (COPD). Recent studies have suggested that exercise training may improve blood pressure and arterial stiffness, albeit in small highly selected cohorts. The aim of the study was to establish whether supervised outpatient or unsupervised home PR can reduce peripheral blood pressure. Resting blood pressure was measured in 418 patients with COPD before and after outpatient PR, supervised by a hospital-based team (HOSP). Seventy-four patients with COPD undergoing an unsupervised home-based programme acted as a comparator group (HOME). Despite significant improvements in mean (95% confidence interval) exercise capacity in the HOSP group (56 (50–60) m, p < 0.001) and HOME group (30 (17–42) m, p < 0.001) systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) did not change in either the HOSP (SBP: p = 0.47; DBP: p = 0.06; MAP: p = 0.38) or HOME group (SBP: p = 0.67; DBP: p = 0.38; MAP: p = 0.76). Planned subgroup analysis of HOSP patients with known hypertension and/or cardiovascular disease showed no impact of PR upon blood pressure. PR is unlikely to reduce blood pressure, and by implication, makes a mechanism of action in which arterial stiffness is reduced, less likely.
Developing the Theater of Leadership
Authors: Tawadros Tammy
Published: May 2015

The Problem

Recent models of leadership emphasize the importance of adaptive, strategic, and socio-emotional capabilities for success. The development of leadership has transformed from teaching about the concept to an experiential learning of leadership, an approach that focuses on identity and problem solving. Over the past decade, improvisational theater and interactive drama based leadership development has received increasing attention; moreover, many advocate its use as a powerful and innovative experiential learning tool, to foster self-awareness and increase ability to deal with the unexpected and unpredictable. Through simulated, unscripted scenarios with actors, improvisation allows experimentation, discovery, and rehearsal of leadership behavior in a group context. It generates individual, relational learning that is immediate, emergent, and relevant to the emotional and cognitive complexities of real-world leadership. There is a paucity of literature on theater-based leadership. This makes it difficult for HRD professionals to justify giving theater-based leadership development (TBLD) techniques preference over other, less resource-intensive techniques.

The Solution

This article proposes a practical model for the systematic evaluation of TBLD techniques . A pathway mapping approach will be used. The model draws on recent social psychology research on social interaction and identity. Based on this, “micro” analytic techniques of discursive psychology and conversation analysis are proposed to examine patterns of leadership interaction behavior. The findings are to be used as a basis for building a “high fidelity,” evidence-based methodology for role-play and improvisation as development training for leaders. The approach offers a clear framework for HRD professionals. It will be used to analyze and inform the effective use of TBLD. This article is purely theoretical; it does not include empirical research.

The Stakeholders

Many can potentially benefit by using TBLD techniques, including human resource (HR) professionals and HRD practitioners, leadership development specialists and training providers, organization development practitioners, and professional actor trainers.
Local Tumor Control and Normal Tissue Toxicity of Pulsed Low-Dose Rate Radiotherapy for Recurrent Lung Cancer
Authors: Zhang Peng , Wang Bin , Chen Xiaoming , Cvetkovic Dusica , Chen Lili , Lang Jinyi , Ma C.-M.
Published: May 2015

Objectives:

This study investigates (1) local tumor control and (2) normal tissue toxicity of pulsed low-dose rate radiotherapy (PLDR) for recurrent lung cancer.

Methods:

For study 1, nude mice were implanted with A549 tumors and divided into the following 3 groups: (1) control (n = 10), (2) conventional radiotherapy (RT; n = 10), and (3) PLDR (n = 10). Tumor-bearing mice received 2 Gy daily dose for 2 consecutive days. Weekly magnetic resonance imaging was used for tumor growth monitoring. For study 2, 20 mice received 8 Gy total body irradiation either continuously (n = 10) or 40 × 0.2 Gy pulses with 3-minute intervals (n = 10).

Results:

For study 1, both conventional RT and PLDR significantly inhibited the growth of A549 xenografts compared with the control group (>35% difference in the mean tumor volume; P < .05). The PLDR results were slightly better than conventional RT (8% difference in the mean tumor volume; P > .05). For study 2, the average weight was 20.94 ± 1.68 g and 25.69 ± 1.27 g and the survival time was 8 days and 12 days for mice treated with conventional RT and PLDR ( P < .05), respectively.

Conclusion:

This study showed that PLDR could control A549 tumors as effectively as conventional RT, and PLDR induced much less normal tissue toxicity than conventional RT. Thus, PLDR would be a good modality for recurrent lung cancers.

Advances in Knowledge:

This article reports our results of an in vivo animal investigation of PLDR for the treatment of recurrent cancers, which may not be eligible for treatment because of the dose limitations on nearby healthy organs that have been irradiated in previous treatments. This was the first in vivo study to quantify the tumor control and normal tissue toxicities of PLDR using mice with implanted tumors, and our findings provided evidence to support the clinical trials that employ PLDR treatment techniques.
Incidence of delayed angiographic femoral artery complications using the EXOSEAL vascular closure device
Authors: Grandhi Ramesh , Zhang Xiaoran , Panczykowski David , Choi Phillip , Hunnicutt Christopher T , Jadhav Ashutosh P , Ducruet Andrew F , Jovin Tudor , Jankowitz Brian
Published: May 2015

Background and purpose

Femoral artery injuries are known complications of percutaneous vascular closure devices (VCDs). We studied the incidence of delayed femoral artery angiographic irregularities after neurointerventional procedures in which the EXOSEAL extravascular closure device was used for femoral arterial puncture closure.

Methods

Adult patients who underwent femoral arterial puncture closures with an EXOSEAL VCD and had a follow-up femoral artery angiogram from June 2012 through August 2013 were reviewed. A blinded radiologist compared pre-deployment and follow-up femoral arteriograms for the presence of femoral artery stenosis, dissection, pseudoaneurysm, or development of an arteriovenous fistula. Hospital records were reviewed for major or minor complications of the groin site or femoral artery.

Results

The EXOSEAL VCD achieved hemostasis, without evidence of a groin hematoma or requiring subsequent prolonged manual compression, in 400 of 441 closures following transfemoral arterial access, representing a device success rate of 90.7%. A total of 98 patients underwent 102 repeat angiograms following closure with the EXOSEAL VCD. The average time to the repeat angiogram was 73.5 days (range 0–488, median 28). Follow-up femoral arteriography demonstrated an irregularity in seven cases, all of which were vessel stenoses of <50%. There were no dissections, pseudoaneurysms, infections, or ischemic events in the study population.

Conclusions

Angiographic irregularities were seen in 6.86% of cases after closure with the EXOSEAL VCD. There were no clinically significant vascular complications. Thus, femoral artery closure with EXOSEAL carries a low risk of clinically significant delayed angiographic findings.
Early middle cerebral artery stenosis following stent-assisted thrombectomy
Authors: Akpınar Süha , Yılmaz Güliz
Published: May 2015

Stent-assisted thrombectomy (SAT) is an extensively used endovascular treatment method for stroke in which the thrombectomy stents come into direct contact with the vascular intimal surface and entrap the thrombus causing the arterial occlusion. Although there are a few studies that demonstrate that the vessel wall changes in the arteries where stroke intervention is performed, we observed progressive stenosis in early follow-up imaging studies in a case. We present a middle cerebral artery (MCA) stroke patient who had four repetitive stent passes during SAT and developed distal MCA stenosis 2 months after SAT at the control magnetic resonance angiography (MRA). Inclusion of early follow-up MRA studies would be helpful in defining the silent vascular changes in patients who have undergone repetitive SAT.
Onyx resorbtion with AVM recanalization after complete AVM obliteration
Authors: Bauer Andrew M , Bain Mark D , Rasmussen Peter A
Published: May 2015

Brain arteriovenous malformations (BAVM) are some of the most complex lesions treated by clinical neuroscientists. The recent publication of the ARUBA trial, showing higher complication rates with treatment compared with the natural history over a short period of follow-up, puts even more pressure on the physician to achieve complete BAVM eradication without complication. These lesions are often treated by multimodality therapy with some combination of endovascular embolization, radiosurgery, and microsurgical resection; however, multimodality therapy involves the additive risk of procedural complication with each procedure. While surgical resection has long been accepted as monotherapy with good cure rates, staged pre-operative endovascular embolization has facilitated microsurgical resection with lower blood loss. Endovascular embolization is more often utilized in conjunction with surgical resection, and often the portions of the AVM and feeders that are completely embolized with Onyx or glue may not be surgically resected since they have been “internally obliterated.” We present a case where the AVM was preoperatively embolized with Onyx and subsequently partially surgically resected. Post-operative angiography showed complete obliteration or “cure” of the AVM with no filling of the nidus or early venous drainage. The patient presented 12 months later with seizures and imaging showed volume loss in the residual Onyx cast and recanalization of the AVM nidus. The patient subsequently underwent repeat resection with complete removal of the residual AVM and Onyx cast. To our knowledge this is the first published report of volume loss within the Onyx cast leading to recanalization of the AVM nidus. This suggests that extreme care should be taken with partial resection of the AVM nidus or with embolization for cure, as late recanalization may occur.
Initial experience with the AXERA 2 Femoral Access System in neurovascular procedures
Authors: Grandhi Ramesh , Zwagerman Nathan T , Zhang Xiaoran , Chen Stephanie H , Jadhav Ashutosh P , Jovin Tudor , Jankowitz Brian T
Published: May 2015

Introduction

Conventional cerebral angiography is a commonly performed procedure in medicine. Vascular closure devices have been developed as alternatives to manual compression at the arteriotomy site and prolonged bed rest. The risks of using these devices include arterial dissection, groin hematoma, and device failure. Herein, we describe our experience with the use of a novel device used for arterial access and closure, the AXERA 2 Access System.

Methods

A total of 13 patients underwent vascular access and closure with the AXERA 2 Access System.

Results

Arterial access using the AXERA 2 Access System was achieved in 11 of 13 patients. Amongst the patients with successful access, one patient experienced a groin hematoma requiring manual compression and two patients suffered occlusions of the common femoral artery due to dissections, with both patients requiring femoral artery thromboendarterectomies.

Conclusions

This small series highlights a heretofore underreported serious complication rate of the AXERA 2 Access System. Additional studies are warranted to provide further insight into risk factors for device failure and complication development.
Update of vertebral cementoplasty in porotic patients
Authors: Guarnieri Gianluigi , Masala Salvatore , Muto Mario
Published: May 2015

Vertebroplasty (VP) is a percutaneous mini-invasive technique developed in the late 1980s as antalgic and stabilizing treatment in patients affected by symptomatic vertebral fracture due to porotic disease, traumatic injury and primary or secondary vertebral spine tumors. The technique consists of a simple metameric injection of an inert cement (poly-methyl-methacrylate, PMMA), through a needle by trans-peduncular, parapeduncular or trans-somatic approach obtaining a vertebral augmentation and stabilization effect associated with pain relief. The technique is simple and fast, and should be performed under fluoroscopy or CT guidance in order to obtain a good result with low complication rate. The aim of this paper is to illustrate the utility of VP, the indications-contraindications criteria, how to technically perform the technique using imaging guidance, and the results and complications of this treatment in patients affected by symptomatic vertebral compression fracture.
Flow diversion in the treatment of carotid injury and carotid-cavernous fistula after transsphenoidal surgery
Authors: Iancu Daniela , Lum Cheemum , Ahmed Muhammad E , Glikstein Rafael , dos Santos Marlise P , Lesiuk Howard , Labib Mohamed , Kassam Amin B
Published: May 2015

We describe a case of iatrogenic carotid injury with secondary carotid-cavernous fistula (CCF) treated with a silk flow diverter stent placed within the injured internal carotid artery and coils placed within the cavernous sinus. Flow diverters may offer a simple and potentially safe vessel-sparing option in this rare complication of transsphenoidal surgery. The management options are discussed and the relevant literature is reviewed.
Direct percutaneous transorbital puncture under fluoroscopic guidance with a 3D skull reconstruction overlay for embolisation of intraorbital and cavernous sinus dural arteriovenous fistulas
Authors: Lv Ming , Jiang Chuhan , Liu Dong , Ning Zhiguang , Yang Jun , Wu Zhongxue
Published: May 2015

Objective

To describe the direct percutaneous transorbital puncture technique for embolisation of the selected intraorbital and cavernous sinus dural arteriovenous fistula, which failed to be treated by conventional endovascular techniques.

Methods

One case of intraorbital and five cases of cavernous sinus dural arteriovenous fistula were embolised through direct percutaneous transorbital puncture in 2012, and the clinical data were reviewed. Under fluoroscopic guidance with a three-dimensional (3D) skull reconstruction overlay, the cavernous sinus or ophthalmic vein was punctured via the superior orbital fissure. Then a microcatheter was inserted via the needle, and Onyx was injected to embolise the fistula with or without a combination of coils.

Results

Complete obliteration of the fistula was achieved in all six patients. After operation all the patients experienced transient swelling of the punctured orbit persisting for three to five days. No other complications occurred. Follow-up of six patients at three to six months showed resolution of their initial neuro-ophthalmological symptoms in five and left visual loss in one did not recover. Six months follow-up angiogram showed no recurrence of these fistulas.

Conclusion

Direct percutaneous transorbital puncture provides an option for the intraorbital and cavernous sinus dural arteriovenous fistulas, particularly when the conventional transvenous routes are inaccessible. Overlay of the 3D skull reconstruction can facilitate the precise puncture of the superior orbital fissure.
Detection of acute femoral artery ischemia during neuroembolization by somatosensory and motor evoked potential monitoring
Authors: Purger David , Feroze Abdullah H , Choudhri Omar , Lee Leslie , Lopez Jaime , Dodd Robert L
Published: May 2015

Neuromonitoring can be used to map out particular neuroanatomical tracts, define physiologic deficits secondary to specific pathology or intervention, or predict postoperative outcome and proves essential in the detection of central and peripheral ischemic events during neurosurgical intervention. Herein, we describe an instance of elective balloon-assisted coiling of a recurrent basilar tip aneurysm in a 61-year-old woman, where intraoperative somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (TcMEPs) were lost in the right lower extremity intraoperatively. We aim to highlight that targeted use of monitoring proves advantageous in both the open surgical and endovascular setting, even in the avoidance of potential iatrogenic peripheral nerve damage and limb ischemia as documented herein. Consideration of the increased risk for peripheral ischemia in the neurointerventional setting is especially imperative in particular populations where blood vessels might be of diminished size, such as in infants, young children, and severely deconditioned adults.
Open direct carotid artery access for coiling of an intracranial aneurysm under conscious sedation
Authors: Ramaswamy Raghu , Villwock Mark R , Shaw Palma M , Swarnkar Amar , Deshaies Eric M , Padalino David J
Published: May 2015

We describe the case of a 61-year-old patient with significant medical co-morbidities and tortuous vascular anatomy presenting with a large middle cerebral artery aneurysm. To avoid the risks of general anesthesia and circumvent a majority of the tortuous vessels, the aneurysm was accessed by direct open exposure of the common carotid artery under conscious sedation and local anesthesia. We were able to achieve complete endovascular occlusion of the aneurysm and the patient tolerated the procedure well with no intra- or post-operative complications. Use of conscious sedation is possible and safe for direct open common carotid artery access in patients with significant vascular tortuosity that makes the standard trans-femoral approach difficult or impossible.
Endovascular repair of posterior communicating artery aneurysms, associated with oculomotor nerve palsy: A review of nerve recovery
Authors: Sheehan Mark John , Dunne Ruth , Thornton John , Brennan Paul , Looby Seamus , O’Hare Alan
Published: May 2015

Purpose

Oculomotor nerve palsy (ONP) is often the presenting symptom in patients with posterior communicating artery (PCOMM) aneurysms with variable recovery of oculomotor nerve function following treatment. In this study we report the ophthalmologic outcome of 20 patients treated by endovascular coiling for PCOMM aneurysm-induced ONP.

Methods

We performed 230 PCOMM aneurysm endovascular coilings between the years 2006 and 2011, of which 20 cases presented with ONP. We recorded the degree of nerve recovery – complete, partial or none – while also documenting other predictive factors, such as degree of pre-intervention nerve deficit, presence of subarachnoid haemorrhage (SAH), size and location of the PCOMM aneurysm and length of follow-up.

Results

Of the 20 patients, 9 (45%) presented with complete ONP and 11 (55%) with partial ONP. After an average follow-up period of 16 months, all patients achieved oculomotor nerve recovery; 9 (45%) patients had complete recovery and 11 (55%) patients had partial recovery. Of the 9 patients who presented with complete ONP, 5 (56%) patients made a complete recovery and 4 (44%) made a partial recovery. Of the 11 patients who initially presented with partial ONP, 4 (36%) made a complete recovery and 7 (64%) made a partial recovery. 7 (35%) patients also had a SAH, of whom 3 (43%) made a complete recovery with 4 (57%) making a partial recovery.

Conclusions

ONP can occur with PCOMM aneurysm with or without SAH. Endovascular coiling is an effective treatment for ONP due to PCOMM aneurysms.
Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: Five cases and a review of the literature
Authors: Tempaku Akira , Yamauchi Shigeru , Ikeda Hidetoshi , Tsubota Nobuyuki , Furukawa Hironori , Maeda Daisuke , Kondo Kimito , Nishio Akimasa
Published: May 2015

Purpose

Although several strategies against recurrent chronic subdural hematoma (CSDH) have been proposed, no consensus has been established. Recently, middle meningeal artery (MMA) embolization has been proposed as radical treatment for recurrent CSDH. We wanted to estimate the usefulness of MMA embolization for recurrent CSDH.

Methods

From February 2012 to June 2013, 110 patients with CSDH underwent single burr-hole surgery with irrigation and drainage. Among these patients, 13 showed recurrent hematoma formation and were retreated surgically. Furthermore, repeated recurrence of CSDH was observed in six patients. Five of these six patients underwent middle meningeal artery (MMA) embolization with polyvinyl alcohol particles. All five patients with interventional treatment were observed for four to 60 weeks.

Results

No more recurrence of CSDH was observed in any of the patients. During the follow-up period, no patients suffered from any side effects or complications from the interventional treatment.

Conclusion

MMA embolization with careful attention paid to the procedure might be a treatment of choice for recurrent CSDH.
The role of the NLRP3 inflammasome in pulmonary diseases
Authors: Hosseinian Nima , Cho Young , Lockey Richard F. , Kolliputi Narasaiah
Published: May 2015

Respiratory diseases and lung injuries are one of the leading causes of death in the world. One critical component of these diseases is exaggerated inflammatory response. The recently discovered inflammasome is believed to play a key role in inflammation. The inflammasome is an oligomer of intracellular proteins that, once activated by an insult or damage signal, produces mature cytokines from the interleukin-1 family that mediate an inflammatory response. Previous research has provided evidence that suggests the role of the inflammasome in the pathogenesis of many chronic respiratory diseases and acute lung injuries, such as transfusion-related acute lung injury, ventilator-induced lung injury, asthma, chronic obstructive pulmonary disease and pulmonary fibrosis. This article summarizes recent research on the inflammasome and reviews proposed molecular models of the role of the inflammasome in several prominent lung diseases and injuries.
Association between social capital and health in women of reproductive age: a population-based study
Authors: Baheiraei Azam , Bakouei Fatemeh , Mohammadi Eesa , Majdzadeh Reza , Hosseni Mostafa
Published: May 2015

Women’s health is a public health priority. The origins of health inequalities are very complex. The present study was conducted to determine the association between social capital and health status in reproductive-age women in Tehran, Iran. In this population-based, cross-sectional study, the Social Capital Integrated Questionnaire, the SF-36 and socio-demographic questionnaires were used. Analysis of data by one-way ANOVA test and stepwise multiple linear regression showed that the manifestation dimensions of social capital (groups and networks, trust and solidarity, collective action and cooperation) can potentially lead to the outcome dimensions of social capital (social cohesion and inclusion, and empowerment and political action), which in turn affect health inequities after controlling for socio-demographic differences.
Risk of intracranial hypertension with intrauterine levonorgestrel
Authors: Etminan Mahyar , Luo Hao , Gustafson Paul
Published: May 2015

Objectives:

The objective of this study was to quantify the risk of intracranial hypertension (ICH) with the intrauterine levonorgestrel (IUL) device Mirena®.

Methods:

We used the United States Food and Drug Administration’s Adverse Events Reporting System (FAERS) database to quantify a reporting odds ratio (ROR) for ICH and Mirena®. We also conducted a retrospective cohort study using the IMS LifeLink® database, comparing the risk of two oral contraceptives ethinyl estradiol (EE) with Mirena®. A Bayesian sensitivity analysis was performed to account for the effect of body mass index (BMI).

Results:

The reported odds ratios (ORs) for ICH and papilledema with Mirena® were 1.78 (95% confidence interval [CI] 1.41–2.25) and 1.50 (95% CI 1.10–2.05), respectively. In the cohort study, the OR for ICH and EE-norgestimate and EE-norethindrone compared with Mirena® were 1.29 (95% CI 0.83–2.00) and 0.31 (95% CI 0.04–2.29), respectively. The presence of a strong confounder BMI did not affect the estimated OR (OR = 1.31, 95% CI 0.73–2.41 for EE-norgestimate; OR = 0.18, 95% CI 0.01–1.27 for EE-norethindrone).

Conclusion:

We found a higher than expected number of reports of ICH with Mirena® in the FAERS database. We also found a similar risk of ICH with Mirena® compared with the oral contraceptive EE-norgestimate. The higher risk of ICH with EE-norethindrone, another oral contraceptive should be further investigated.