bluuebunny/crossref_metadata_2025 huggingface dataset:
Determining the Significance of Reversed Flow in the Internal Carotid Artery
Authors: Green Judi
Published: March 2018

Introduction

—Carotid duplex ultrasound continues to be the most precise and cost-effective noninvasive technique for the assessment of the extracranial arterial system. Two-dimensional imaging, color Doppler, and spectral analysis can be used to quickly assess and support the monitoring of those patients at risk for stroke. Clinically, this effective technique of patient assessment has proven itself in preventative as well as in postevent treatment.

Case Study

—The patient focused in this case study is a 79-year-old man whose diagnosis was bruit. Based on the diagnosis and risk factors, a carotid duplex was performed.

Conclusion

—This report demonstrates the importance of critical thinking during the evaluation of the extracranial vessels. It requires a systematic approach and a thorough knowledge of hemodynamics, anatomic variations, and pathologic disease processes. Color Doppler is a invaluable tool used for accurate and decisive evaluation of abnormal hemodynamics.
Duplex-Guided Diagnosis and Surgical Repair of a Posterior Circumflex Humeral Artery Aneurysm in a Major League Baseball Pitcher
Authors: Kane Katherine Y. , Shutze William P. , Vines Tracie , Pearl Gregory J.
Published: March 2018

Aneurysms involving the third portion of the axillary artery and its branches have been reported in baseball pitchers and in other overhead-throwing athletes. The abnormality can vary from intermittent compression to axillary artery thrombosis and formation of an aneurysm. Patients presenting with symptoms secondary to an axillary artery injury, like upper extremity weakness, require rapid and precise diagnosis. Moreover, accurate identification of the arterial pathology helps guide necessary surgical therapy. Previous reports have made the diagnosis from physical examination, noninvasive studies, and additional, invasive studies, such as arteriography. In this case, a young healthy major league baseball pitcher was referred for hand numbness and a suspected axillary artery aneurysm. We were able to confirm the physical examination abnormalities with arterial duplex only and make an operative plan on the basis of the ultrasound findings.
Is a Constant Doppler Angle of Insonation Worthwhile during Carotid Duplex Ultrasound?
Authors: Asbeutah Akram M. , Asbeutah Abdul Aziz A. , Swamy Nayanatara
Published: March 2018

Background/Aims.

—Velocity ratio is a good indication to determine the degree of vessel stenosis. This study was done to determine the effect of Doppler angle in carotid artery velocity ratio measurements.

Methods.

—Thirty-eight patients who underwent routine carotid duplex ultrasound were asked to participate in this study. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) at distal common carotid artery (CCA) and proximal internal carotid artery (ICA) with constant and different Doppler angles were recorded. The ICA/CCA PSV ratio was calculated.

Results.

—There were 12 female and 26 male patients; their mean age (year, ±SD) was 50.53 ± 16.4 and their mean body mass index (kg/m2, ±SD) was 29.6 ± 9.53. The mean ± SD. ICA PSV, CCA PSV, and the ICA/CCA PSV ratio with a 60° Doppler angle were 80.40 ± 16.6, 87.90 ± 16.96, and 0.93 ± 0.18, respectively. However, the mean ± SD. ICA PSV, CCA PSV, and the ICA/CCA PSV ratio with a 45° Doppler angle were 63.84 ± 16.18, 70.67 ± 16.19, and 0.91 ± 0.17, respectively. Moreover, the ICA60°/CCA45° PSV ratio was 1.17 ± 0.25 and the ICA45°/CCA60° PSV ratio was 0.73 ± 0.16. Paired Student's t-test showed a statistical significance for different Doppler angle of insonation ( p = 0.001) but was not statistically significant when the Doppler angle was constant ( p = 0.389).

Conclusion.

—Constant Doppler angle is preferred during carotid ultrasound for a consistent result.
Impact of a Structured Duplex Ultrasound Hemodialysis Access Surveillance Program on Access Intervention Rates
Authors: Kundu Sanjoy , Modabber Milad , Chiu Brandon , You John M. , Moazzami Mitra , Babcock Rob
Published: March 2018

Purpose

—To assess the impact of a structured duplex ultrasound hemodialysis access surveillance program on the frequency of diagnostic fistulograms and endovascular interventions.

Methods

—A structured ultrasound hemodialysis access surveillance program was implemented at our institution on March 1, 2010. The access ultrasound comprised the measurement of vessel diameter, velocity, and flow in the feeding artery, anastomosis, and at specific points along the outflow vein (2.5, 5.0, 7.5, and 10 cm beyond anastomosis) along with a waveform pattern in the ipsilateral axillary and internal jugular vein. In this retrospective multicenter study, we compared the frequency of diagnostic contrast fistulograms and endovascular interventions (angioplasty) performed from March 2010 to February 2011 (12 months) by using the implemented ultrasound access surveillance program (postsurveillance) to the preceding 12 month period (March 2009 to February 2010) where no ultrasound access surveillance program was used (pre-surveillance).

Results

—Within our hemodialysis program, there was an average of 119 active fistulae during the presurveillance period versus 141 in the postsurveillance period. There were no significant demographic differences in our study populations across the two time frames ( p > 0.05). In the presurveillance period, 59 diagnostic contrast fistulograms were performed, whereas 47 diagnostic contrast fistulograms were performed during the post surveillance period. Using a two-sample test for equality of proportions, we found there was a significant decrease in the proportion of diagnostic contrast fistulograms after implementation of an access ultrasound surveillance program ( p = 0.0114). Similarly, 81 endovascular interventions were performed during the presurveillance period, whereas a significantly decreased number of endovascular interventions (n = 50) were performed postsurveillance ( p < 0.0001).

Conclusions

—There was a significant decrease in the number of invasive diagnostic contrast fistulograms and endovascular interventions upon implementation of an ultrasound access surveillance program. Such a structured surveillance program has the potential to provide significant reduction in patient discomfort and to minimize unnecessary invasive endovascular procedures.
Freehand 3D Ultrasound to Measure Thrombus Volume in Patients with Acute Deep-Vein Thrombosis
Authors: Zhao Limin , Kampmann Meghan , Prior Steven J. , Sorkin Michael J. , Braganza Melita , McEvoy Sue , Lal Brajesh K.
Published: March 2018

Objective

—Current imaging techniques are limited in their ability to quantify thrombus burden, progression, or resolution in patients with acute deep-vein thrombosis (DVT). These assessments are critical measures of therapeutic success when thrombolytic or thrombectomy treatment protocols are used for DVT. We have developed a novel freehand three-dimensional (3D) ultrasound method to measure thrombus volume. In this study, we evaluated the reliability of this new technology.

Methods

—We studied consecutive hospital inpatients with a first episode of acute DVT. Treatment decisions were not influenced by the study protocol. A combination of routine imaging in grayscale, color-flow, and power-Doppler modes along-with freehand 3D volumetric imaging with a linear transducer attached to an external tracking sensor was performed using a personal computer–based ultrasound scanner. Image-processing software loaded on the personal computer was used to process and reconstruct the serial cross-sectional images of the affected veins and outlined thrombus into a composite 3D image. Imaging and processing was performed twice by one sonographer, and repeated once by another sonographer.

Results

—The mean age of patients was 56.7 ± 15 years; 40% were women. A total of 70% of DVTs were in the lower extremity and 60% received anticoagulation. Thrombus volume was reliably determined by our protocol. The mean inter- and intraobserver differences in measurements were −0.09 ± 0.59 cm3 and 0.23 ± 0.43 cm3 (mean ± SD), which were well within 2 SD (Bland Altman statistics) of the mean volumes. Measurements of the second sonographer correlated well with those of the first (regression slope = 0.95 ± 0.07, p = 0.001) and those of the first observation correlated with the second observation performed by the same sonographer (regression slope = 0.91 ± 0.03, p = 0.001). Interrater agreement was good between the two sonographers (kappa = 0.71) and between two measurements by the same sonographer (kappa = 0.82).

Conclusions

—We have developed a novel freehand 3D-ultrasound imaging technique and protocol that reliably measures venous thrombus volume. There is good agreement in measurements between two observers and repeated measurements by one observer. The technique can be readily adapted for routine clinical practice. This protocol will be of increasing value as the appreciation for the deleterious effects of residual thrombus after DVT increases; and the use of aggressive thrombus removal treatments for acute DVT increases.
Duplex Ultrasound Diagnosis of Traumatic Popliteal Pseudoaneurysm with Associated Arteriovenous Fistula after Total Knee Replacement
Authors: Ierardi Ralph P. , Mitchell Cynthia L. , Chory Fiona M.
Published: March 2018

A traumatic injury to the popliteal vasculature after orthopedic procedures is a known but uncommon entity in the vascular community and is estimated to occur from 0.08 to 0.5% in the literature comprising primarily case series and reports. Prompt recognition and appropriate management strategies are critical to an ultimate favorable outcome, preventing limb dysfunction and potentially limb loss. We describe the case of an elderly patient who developed calf swelling in the early postoperative period after total knee replacement, and the patient was found to have evidence of a popliteal arteriovenous disruption on duplex ultrasound. The use of ultrasound was paramount to the early diagnosis in this particular case.
Comparison of in Vivo Arteriovenous Fistula Volume Flow Measurements Using a Transonic Transit-Time Ultrasound Flow Device and Doppler Ultrasound
Authors: Schroedter William B. , Burke Steven K. , Blair Andrew , Mendenhall Vince
Published: March 2018

Introduction

Doppler ultrasound (US) is extensively validated for classification of vascular disease based on velocity calculations. Although widely used to evaluate dialysis access arteriovenous fistulas (AVF), accurate volume flow measurements have proved more elusive, with significant variability resulting in large thresholds for differentiation of normally functioning from failing fistulae. We sought to compare in vivo measurements of AVF blood flow volume measured by the Transonic transit-time ultrasound flow device with those of Doppler US.

Methods

Bilateral femoral AVFs (n = 6) were created in swine (n = 3). Comparative volume flow measurements were made at baseline, 15, 30, 60, and 120 minutes after the creation of AVFs with the Transonic device and with Doppler US using an estimated time averaged velocity and the diameter of the vessel to calculate volume flow using the formula: Q = v A = v (π r2), where Q = volume flow, v = time and spatial averaged mean velocity, A = cross-sectional area, and r = radius of the vessel. Repeat measurements (minimum 3) were performed at each time point. Linear and multiple linear regression analyses were performed.

Results

Linear regression analyses showed a weak correlation (R2 = 0.103, p = 0.002) between Transonic and Doppler volume flow measurements. Doppler consistently showed greater volume flow over all time points than Transonic data. Average Transonic values had less variability over time (R2 = 0.9505) compared with average Doppler measurements (R2 = 0.7601). Average flow increased over time, regardless of the flow measurement device, consistent with reported clinical observation of AVF maturation process. Multiple linear regression analysis demonstrated correlation between Doppler and Transonic data (R2 = 0.197, p = 0.013), and provided a formula to estimate Transonic flow measurement from the Doppler data. [Transonic = 113.742 + (0.334 * Doppler)].

Conclusions

Transonic data demonstrated a stronger relationship between volume flow and time than Doppler data, suggesting transit time ultrasound volume flow measurements may be more accurate. Doppler data tended to overestimate volume flow measurements; however, it may be feasible to use a correction factor for Doppler data that predicts Transonic results.
Longitudinal Changes in Size and Composition of Carotid Artery Plaques Using Ultrasound: Adaptation and Validation of Methods (Inter- and Intraobserver Variability)
Authors: Bjornsdottir Gudlaug , Sigurdsson Sigurdur , Sturlaugsdottir Ran , Gudmundsdottir Agnes , Eiriksdottir Gudny , Thorsson Bolli , Aspelund Thor , Gustavsson Tomas , Launer Lenore J. , Harris Tamara B. , Gudnason Vilmundur
Published: March 2018

Introduction

B-mode ultrasonography of the carotid arteries enables quantitative measurements of atherosclerotic plaque area and composition assessed as grayscale median (GSM). The purpose of this study was to set up a standardized ultrasound protocol to measure longitudinal changes in plaque area and composition and to determine the intra- and interobserver variability of the measurements in a longitudinal population based study, the Age Gene/Environment Susceptibility Reykjavik study.

Method

A total of 219 participants from the Age Gene/Environment Susceptibility Reykjavik study (76 ± 6 years old, 36% males) underwent 2-dimensional, B-mode ultrasound examination of the carotid arteries approximately 5 years apart for a longitudinal assessment of plaque area and composition. Standardized protocol was used to acquire comparable images from both visits. Ultrasound was performed bilaterally on the common carotid artery, internal carotid artery, and bifurcation. An image analysis program was modified and adapted for a longitudinal assessment of plaque area and plaque composition by GSM. Twenty-five subjects were selected from the group of 219 for intra- and interobserver variability assessment.

Results

Intraobserver variability for plaque area ranged from 12.10 to 18.63% and 0.89 to 0.96 for coefficient of variation and correlation (r), respectively, for plaque GSM ranged from 7.77 to 8.04% and 0.86 to 0.90. Interobserver variability for plaque area was 23.29% and 0.81 and 8.55% and 0.87 for plaque GSM.

Conclusion

The results from this study show that ultrasound can be used consistently for assessment of changes in plaque area and GSM over time. This can be achieved by proper training of ultrasound sonographers and by applying and following strict image acquisition and image analysis protocols.
Vascular Laboratory Technology that Was Current in the 1970s
Authors: Needham Ann , Needham Terry
Published: March 2018

Plethysmography and continuous-wave Doppler were the noninvasive testing modalities that predominated in the 1970s diagnostic vascular laboratory. Grayscale ultrasound imaging (with a mechanically guided, pulsed-wave [PW] Doppler) was in its infancy, although PW Doppler-derived mapping had been described in 1971. Pulsed-wave Doppler spectral analysis of the intracranial circulation (transcranial Doppler) was not introduced into the United States until the early 1980s. This article describes the application of directional continuous-wave and PW Doppler, plethysmography (air, strain gauge, and photo) and spectrum analyzers to the diagnosis of peripheral vascular disease in the 1970s decade.
May-Thurner Syndrome
Authors: Cardinale Maria , Montgomery Russell S. , Rossi Christian
Published: March 2018

May-Thurner syndrome, iliac vein compression syndrome, or iliocaval compression syndrome is caused by the compression of the left common iliac vein by the right common iliac artery. We report a case of MTS and the subsequent course of the findings and clinical outcome.
Clinical and Ultrasound Sequelae of Nonvisualized Calf Veins on Duplex Ultrasound for Suspected Deep Vein Thrombosis
Authors: Henry Jon C. , Strosberg David , Warhadpande Shantanu , Satiani Bhagwan , Go Michael R.
Published: March 2018

Objectives

Calf veins are not visualized in up to 40% of lower extremity venous duplex ultrasounds (DUS). Little is known about the clinical implications of nonvisualized calf veins. We sought to investigate the incidence of nonvisualized calf veins, rate of subsequent venous thromboembolism (VTE), and factors influencing successful visualization on subsequent DUS.

Methods

We reviewed all patients who had DUS in 2012 at our institution who had nonvisualized calf veins, no deep vein thrombosis (DVT), and available follow-up. Demographics, Well's score, body mass index (BMI), indication for DUS, activity level, reason for nonvisualization, initial and subsequent DUS results, and subsequent occurrence of VTE were collected.

Results

A total of 8,237 DUS were performed in 2012. Of these, 891 (10.8%) DUS in 717 patients had at least one nonvisualized calf vein. Seven hundred twenty-eight limbs (484 patients) had no DVT and had available follow-up and comprised the study population. The most common reasons for nonvisualization were edema (35.5%) and body habitus (31.8%). Twenty-two (4.5%) patients were subsequently identified to have VTE; 9 limbs had only pulmonary emboli, 12 had only DVT, and 1 had both. Only length of stay in the hospital correlated with the development of VTE. One hundred forty-eight of the 484 patients had subsequent DUS at a median of 2.43 months; 45.3% of subsequent DUS successfully imaged the previously nonvisualized veins. Whole lower extremity swelling, single vein nonvisualization, and single limb nonvisualization at initial DUS were associated with successful visualization on subsequent DUS. Thirteen (8.8%) new DVT were seen on subsequent DUS, six were seen in calf veins that previously were not visualized, and seven were seen in either femoropopliteal veins or calf veins that previously were visualized and did not have thrombus.

Conclusions

Non-visualized calf veins are common in DUS. Almost half of patients with nonvisualized veins on initial DUS had successful visualization on subsequent DUS. Whole lower extremity swelling, single vein nonvisualization, and single limb nonvisualization at initial DUS were associated with successful visualization on subsequent DUS. In all, 4.1% of patients with nonvisualized veins on initial DUS go on to develop VTE and 8.8% of patients who have subsequent DUS are found to have DVT. When initial DUS is unable to visualize calf veins, selective repeat DUS may be useful to identify either new or initially unseen DVT.
Ultrasound-Guided Percutaneous Thrombin Injection of Common Carotid Pseudoaneurysm following Carotid Endarterectomy is Possible
Authors: Randazzo Michael A. , Onye Azuka C. , Khariton Konstantin , Singh Kuldeep
Published: March 2018

Pseudoaneurysm (PSA) of the carotid artery is a rare complication of carotid endarterectomy (CEA) with an incidence of less than 1%. PSAs of other named arteries are commonly treated with ultrasound-guided thrombin injection; however, there are few accounts in the literature discussing the use of this technique for the treatment of carotid PSA, specifically, and none for carotid PSA after CEA. We present the case of an 86-year-old woman with a left common carotid artery PSA, which was noted after left CEA. As emergent treatment, ultrasound-guided direct percutaneous thrombin injection was used without embolic protection. This produced immediate thrombosis of the PSA, without complication. Arterial duplex at long-term follow-up demonstrated sustained PSA closure and patency of the carotid artery system. We report our case and review of the very limited available literature on this procedure.
Utilization of Intravascular Ultrasound for the Evaluation and Management of Lower Extremity Malperfusion in a Type B Aortic Dissection
Authors: Dudhani Rahul , Oluwafisayo Adekoya , Amankwah Kwame S.
Published: March 2018

Aortic dissection (AD) is a pathologic entity initiated from a tear in the intimal layer that allows blood flow between the intima and media, resulting in a separation of these layers into a true and false lumen. Subsequently, this flow within the false lumen encroaches on the true lumen flow and may cause malperfusion to vital organs or aortic rupture. On the basis of the anatomical location of the intimal tear, clinical presentation management may differ significantly. AD is classified as Stanford Type A or B based on the location of the intimal injury. In Stanford Type A, the site of injury is at the aortic root, which requires urgent surgical therapy. Type B are dissections that occur at or just distal to the takeoff of the left subclavian artery and in many situations can be managed medically by reduction in blood pressure. 1 , 2 In type B dissections that fail medical management or develop malperfusion, endovascular treatment has been used and described. 3 It provides a minimal invasive method; however, there are cases that may require open or a hybrid approach. 3 , 4
Congenital Brachial Arteriovenous Fistula
Authors: White Dalila , Badgett Mark , Petty John K. , Garg Nitin
Published: March 2018

Despite complex embryologic development, congenital large- and medium-sized arteriovenous (AV) communications are rare. The prevalence of congenital large- and medium-sized AV malformations (AVMs) has been estimated to be 0.08–1%. Malformations do not always result in arterial venous communications though, and could potentially involve single type of vessel (artery or vein or lymphatic). Nontraumatic congenital AV communication in medium/large vessel has been previously reported in a single case report only. In our certified vascular laboratory at a large academic medical center (>1,000 studies per month), there have been no prior cases of medium to large vessel congenital AV communication. Although the etiology is unknown, this maldevelopment results in pathologic connections between arteries and veins upstream of the capillary bed. The most common site of AVMs are the head and neck (>50%), followed by the extremities, then the pelvis and visceral organs. Depending on the size, location, extent, and severity of the AVM, its clinical presentation can be highly variable, ranging from asymptomatic or anemia (usually with visceral AVMs and occult bleeding) to pain, edema, audible bruits, or neurosensory deficits and tissue loss in more severe cases. We present a case of brachial artery to brachial vein communication in a child. This would be the first reported case of this abnormality in a child. The importance of duplex ultrasound in diagnosis and management is discussed.
Posterior Tibial Artery Pseudoaneurysm with Arteriovenous Fistula: Impact of Duplex Ultrasound on Diagnosis and Treatment
Authors: Himes Keith , Bornais Amanda , Bittenbinder Emelia , Cook Judith
Published: March 2018

Post traumatic peripheral vascular injuries resulting in pseudoaneurysm (PSA) or arterial venous fistula (AVF) are rarely reported and may occur independently, or less commonly, concomitantly, following lower extremity fractures, penetrating or blunt trauma, and sports-related or orthopedic injuries. 1 Concomitant traumatic PSA and AVF requires accurate imaging and evaluation of hemodynamics for accurate diagnosis and treatment. Modalities for PSA repair include ultrasound-guided occlusion (thrombin injection), endovascular repair (coils, stents), and open surgical procedures (repair, ligation). A coexisting AVF can potentially impact the efficacy and safety of these options. This case demonstrates the important role of duplex ultrasound in the diagnosis and treatment algorithm of traumatic PSA.
Upper Extremity Arterial Testing: The Diagnostic Criteria for the Physiologic Examination
Authors: Altawan Anita , Golchian David , Iljas John , Patel Bipinchandra , Bazzi Mazen
Published: March 2018

Upper extremity arterial disease is relatively uncommon compared with lower extremity disease, but presents a unique diagnostic challenge for physicians and technologists. It affects approximately 5–10% of the population. The most common causes of upper extremity arterial disease are atherosclerosis and embolic disease. Some common symptoms of upper arterial disease include dysesthesia, paresthesia, pallor, cold intolerance, ulceration, pain, or weakness in one or both extremities. The vascular system plays a vital role in the delivering of nutrients and clearing metabolic waste products from the peripheral tissues and also helps maintain an individual's systemic core temperature. In a majority of patients, the deep and superficial palmar arches provide the dominant blood supply to the hand. The arches are a continuation of the radial and ulnar arteries. These arches are typically connected in approximately 80% of patients. In order to accurately diagnose upper extremity arterial disease, a noninvasive upper extremity physiologic examination is of importance to determine treatment options for patients. The physiologic examination includes upper extremity segmental pressures known as wrist-brachial index, Doppler waveforms; digital evaluations include photoplethysmography and pressures of the digits known as the digital-brachial index. Physiologic tests are indirect examinations. The upper extremity arterial physiologic examination is always completed bilaterally in order to determine if the disease is present in one or both extremities and also assists in the diagnosis of disease severity. The vascular physiologic examination should focus on the symptoms presented by the patient during the history. However, a complete vascular examination is appropriate given the diffuse nature of the atherosclerotic disease process.
Internal Jugular Microembolic Signal Detection in a Patient with Cerebral Sinus Thrombosis Complicated by Pulmonary Embolism
Authors: Sekhar Laligam , Becker Kyra , Moore Anne , Tran Vanessa
Published: March 2018

A 40-year-old woman with prior history of headaches, left-sided weakness, and diplopia was diagnosed with right sigmoid and transverse sinus thrombosis; increased intracranial pressure and associated cerebral venous infarction that underwent 12 months anticoagulation and then stopped. She has been off anticoagulation for about a year then started not “feeling right,” and was diagnosed with pneumonia and pulmonary embolism. During her course of hospitalization, she presented with progressive headache, possible left-sided weakness, associated blurry vision, nausea, and vomiting. Magnetic resonance venogram (MRV) shows lack of flow-related signals within the left half of the distal superior sagittal sinus, left transverse sinus, and nonocclusive thrombus in the left sigmoid sinus. Mechanical sinus thrombectomy attempted without significant difference in clot burden. A transcranial Doppler (TCD) emboli monitoring exam was ordered and was performed on the bilateral internal jugular for 15 min each. Microembolic signals detected: 52 emboli per hour right internal jugular vein (IJV), and 32 emboli per hour left IJV. She was discharged on methazolamide, furosemide, topiramate, and lifelong warfarin. No major events have been reported since discharge from 2008 to 2016.
Technology Dependence of Intima-Media Thickness Ultrasonographic Measurements
Authors: Braga Filipe Amorim , Salles-Cunha Sergio Xavier , de Barros Svetlana Maria Wanderlei , Pitta Guilherme Benjamim Brandão
Published: March 2018

Introduction

Ultrasonographic (US) measurements of intima-media thickness (IMT), particularly of the carotid arteries, have been used as a cardiovascular risk assessment tool. Variations in manual and semiautomatic measurements were investigated in an animal model—the aorta of 10 rabbits with dyslipedemia.

Methods

IMT was measured in B-mode images with 256 shades of gray using a 10 MHz probe by two independent investigators: (a) three same-place manual measurements were averaged in five distinct locations of the aorta of each rabbit for a total of 50 measurements per investigator (subgroups M1 and M2); (b) experimental software allowed for alterations in blood-intima and media-adventitia brightness line definition for IMT detection; observer 1 used brightness 50–200, adaptable to all images (SA1); observer 2 started with 10–60—the usual for human carotid measurements in this package—and increased values until IMT lines were visually acceptable; IMT was measured at optimized values for each image (SA2). Mean values were compared by using the paired t-test available in Excel.

Results

SA1 measurements, 0.379 ± 0.112 (SD) mm, were significantly smaller than SA2, 0.403 ± 0.122 mm, M1, 0.404 ± 0.149 mm, and M2, 0.405 ± 0.140 mm (<0.001 for all three SA1 versus SA2, M1 and M2 comparisons).

Conclusion/Discussion

Distinct automatic technologies, including (a) selection of blood-intima and media-adventitia brightness interfaces and (b) signal processing to “improve” line images, may alter IMT measurements significantly. Assumed population variations may be affected by technology used. IMT gender and age tables may be applicable only if the same measurement technology was used consistently.
Resolution of Acute Arterial Occlusion and Residual Stenosis in a Newborn
Authors: Valle William Del , Delegro Frank , Sales Clifford M.
Published: March 2018

Duplex ultrasound examination of the neonatal circulation is challenging to those who do it infrequently. Trepidation regarding pathology and concern for vessel size and interpretation present challenges for the typical Noninvasive Vascular Laboratory tasked with caring for the adult population. We present, herein, a challenging case of an acute iliac arterial occlusion in an 18-hr-old female and discuss the findings and technical perspective of the examination and its interpretation.
On the mechanics of composite structure and electromagnetics of microstrip antenna
Authors: Hung CC , Yang SM , Tsai SE
Published: March 2018

Composite structures with desire mechanical properties can be tailored to embed microstrip antenna in aerospace systems for reducing aerodynamic disturbance. The performance of a rectangular microstrip antenna in composite structures is analyzed in spectral domain in this work. Analysis shows that the electromagnetics of antenna in spectral domain is similar to the mechanics of composite structure in space domain. The electrical field, the immittance (impedance or admittance), and the current density are equivalent to the stress, strain, and stiffness in mechanics of composite structures. The governing equations, though may be of different dimensions, are also similar. It shall be expected that the performance of a microstrip antenna on composite structures is different from that on isotropic structures; just as the mechanics of the former is so different from that of the latter. Analysis confirms that antenna performance depends on the structure’s electromagnetic properties; similar to the mechanics of composite structures depends on the laminate layers’ ply angle and stacking sequence.
Evaluating the effects of a physical activity on agitation and wandering (PAAW) experienced by individuals living with a dementia in care homes
Authors: Traynor Victoria , Veerhuis Nadine , Johnson Keryn , Hazelton Jessica , Gopalan Shiva
Published: March 2018

Aim and Methods

The aim was to evaluate the implementation of a structured physical activity (PA) programme for individuals living with a dementia in care homes. More specifically, the study aimed to test the effects on the behavioural and psychological symptoms of dementia (BPSD) using the Cohen-Mansfield Agitation Inventory and Algase Wandering Scale. The study was undertaken over 16 weeks using a quasi-experimental design. Registered nurses, physiotherapists, assistants in nursing and physiotherapy aids from one aged care organisation in NSW, Australia, undertook the study with academics.

Results

A total of 72 individuals living with a dementia from four care homes participated. Implementation of the structured PA programme generated statistically significant findings with reductions in agitation ( p < 0.001) and eloping ( p = 0.001) achieved for individuals living with a dementia in care homes.

Conclusions

Physiotherapists and exercise physiologists can complement nursing-focused care teams and contribute to a holistic model of care for individuals living with dementia in care homes. The study demonstrated how a structured PA programme positively affected the levels of agitation and wandering experienced by individuals living with a dementia. Individuals living with a dementia in care homes who participated in a structured PA experienced positive outcomes from the programme. The findings demonstrated that they benefited from the programme and PA should be promoted for this group just as it is for other population groups, including general populations of older people.
Subtherapeutic concentrations of infliximab and adalimumab are associated with increased disease activity in Crohn’s disease
Authors: Carlsen Arne , Omdal Roald , Leitao Kristian Øgreid , Isaksen Kjetil , Hetta Anne Kristine , Karlsen Lars Normann , Aabakken Lars , Bolstad Nils , Warren David , Lundin Knut E.A. , Grimstad Tore
Published: March 2018

Background:

Low anti-tumor necrosis factor α (TNFα) serum concentrations may result in lack of treatment response in patients with inflammatory bowel disease. We determined the anti-TNFα drug concentrations in patients with inflammatory bowel disease and investigated whether or not subtherapeutic drug concentrations were associated with increased levels of disease activity.

Methods:

In a single-center cross-sectional study, we included patients with ulcerative colitis or Crohn’s disease who were receiving infliximab or adalimumab maintenance therapy. Demographic data, disease activity symptom scores (Partial Mayo Score, Harvey Bradshaw Index), inflammatory markers [C-reactive protein (CRP), fecal calprotectin], antidrug antibodies and serum drug concentrations were recorded. Therapeutic drug concentrations were defined as 3–8 mg/liter for infliximab and 5–12 mg/liter for adalimumab.

Results:

Of 210 patients included, 137 (65.2%) had Crohn’s disease. In the adalimumab group, subtherapeutic drug concentrations were measured in 16.7% of patients with ulcerative colitis and in 27.7% of patients with Crohn’s disease. In the infliximab group, subtherapeutic drug concentrations were found in 23% (ulcerative colitis) and 30.3% (Crohn’s disease) of patients. In Crohn’s disease, subtherapeutic adalimumab concentrations were associated with higher fecal calprotectin and CRP concentrations compared with therapeutic concentrations. Subtherapeutic infliximab concentrations in patients with Crohn’s disease were also associated with higher CRP concentrations compared with therapeutic concentrations.

Conclusions:

The prevalence of subtherapeutic drug levels ranged from 17% to 30%. In patients with Crohn’s disease, subtherapeutic serum drug concentrations were associated with significantly higher disease activity with both anti-TNFα agents. These findings were not observed in patients with ulcerative colitis. Clinicaltrials.gov identifier [NCT02134054]
Numerical predictions of the behaviour of plain concrete targets subjected to impact
Authors: Abdel-Kader Mohamed
Published: March 2018

One widely used model implemented in the hydrocode ANSYS Autodyn is the Riedel–Hiermaier–Thoma material model, which is used for the prediction of concrete behaviour under severe loading, such as blast and impact. In the Riedel–Hiermaier–Thoma model, parameters are adjusted to be a function of the compressive strength of specific concrete. This advantage enables occasional users (and those who cannot conduct experiments to determine all the required concrete parameters) to input only this parameter, while the rest is automatically calculated by default settings. This study is an attempt to calibrate (not modify) this model, with the least number of possible changes, to better predict the performance of concrete targets, particularly spalling and scabbing phenomena, impacted by hard projectiles. It is shown that the present calibration of the Riedel–Hiermaier–Thoma material model performed well when compared to the default settings currently available in the model.
The relationship of depressive symptoms and functional and structural markers of subclinical atherosclerosis: A systematic review and meta-analysis
Authors: Wu Yupeng , Sun Dandan , Wang Bin , Li Yanfeng , Ma Yi
Published: March 2018

Objectives

The relationship of depressive symptoms and subclinical atherosclerosis remains controversial. We performed a systematic review and meta-analysis to evaluate the effect of depressive symptoms on the functional and structural markers of subclinical atherosclerosis as measured by carotid intima-media thickness (IMT), pulse wave velocity (PWV) and flow-mediated vasodilation (FMD).

Methods

A systematic literature search was performed electronically. Studies relating IMT, PWV or FMD to depressive symptoms were included. Standard/weighted mean differences (SMD/WMD) and corresponding 95% confidence intervals (95% CIs) were pooled in overall and subgroup analyses (age, sex, depression diagnosis, region, study design, site measured and sample size). Sensitivity analysis and publication bias were also conducted.

Results

Thirty-eight articles involving 5947 patients with depressive symptoms and 34,423 controls without depressive symptoms were included. Compared with controls without depressive symptoms, patients with depressive symptoms showed a significantly thicker IMT (SMD (95% CI) = 0.137 (0.047–0.227), p = 0.003), a higher PWV (SMD (95% CI) = 0.216 (0.139–0.293), p < 0.001) and a lower FMD (WMD (95% CI) = –2.554 (–3.709 to –1.399), p < 0.001). When analyzing subgroups with age and female ratio, all results were still significant ( p < 0.05) except IMT and FMD in age < 50 years subgroups ( p > 0.05). There was no statistical significance in sensitivity analysis and publication bias ( p > 0.05).

Conclusions

Depressive symptoms contributed toward subclinical atherosclerosis, and resulted in impaired functional and structural markers of subclinical atherosclerosis, which holds great promise in early prevention of cardiovascular disease.
Factors Associated with Outcomes of Pre-ART HIV Care
Authors: Stafford Kristen A. , Nganga Lucy W. , Tulli Tuhuma , Foreit Karen G. Fleischman
Published: March 2018

The World Health Organization recommended removing all CD4 requirements for initiation of antiretroviral therapy (ART) in resource-limited settings. We examined the pre-ART period to identify and assess factors associated with outcomes of pre-ART care. Four modes of transition out of pre-ART care were considered. Beta estimates from the competing risks Cox models were used to investigate whether the effects of covariates differed by mode of transition. Median CD4 counts at entry showed no meaningful change over time. Advanced disease progression and presence of opportunistic infections were significant predictors of pre-ART mortality. Men were more likely to die before initiating ART, transfer to another facility, or be lost to follow-up than were women. Removing CD4 thresholds is not likely to substantially reduce program mortality prior to ART initiation unless and until patients enroll earlier in disease progression. Care programs should focus on diagnosis and treatment of opportunistic infections to reduce pre-ART mortality.
A multi-level modeling approach to understanding residential segregation in the United States
Authors: Arcaya Mariana C , Schwartz Gabriel , Subramanian SV
Published: March 2018

A well-known limitation of commonly used segregation measures is their inability to describe patterns at multiple scales. Multi-level modeling approaches can describe how different levels of geography contribute to segregation, but may be difficult to interpret for non-technical audiences and have rarely been applied in the US context. This paper provides a readily interpretable description of multi-scale Black–non-Black segregation in the United States using a multi-level modeling approach and the most recent Census data available. We fit a three-level random intercept multi-level logistic regression model predicting the proportion of the population that is Black (Hispanic and non-Hispanic) at the block group level, with block groups nested in tracts and tracts nested in Metropolitan Statistical Areas (MSAs). For the 102 largest MSAs in the United States, we then estimated the extent to which micro- versus meso-level variability drives overall racial residential patterning within the MSA. Finally, we created a typology of racial residential patterning within MSAs based on the total proportion of the MSA population that is Black and the relative contribution of block groups (micro) versus tracts (meso) in driving variation. We find that nearly 80% of the national variation in the geographic concentration of Black residents is driven by within-MSA, tract-level processes. However, the relative contribution of small versus larger scales to within-MSA segregation varies substantially across metropolitan areas. We detect five meaningfully different types of metropolitan segregation across the largest MSAs. Multi-level descriptions of segregation may help planners and policymakers understand how and why segregated residential patterns are evolving in different places and could provide important insights into interventions that could improve integration at multiple scales.
Sonography of Zenker Diverticulum
Authors: Matuzak Amber R.
Published: March 2018

Zenker diverticulum, also known as a pharyngeal pouch, is the most common type of esophageal diverticulum. While sonography is not the imaging modality of choice for diagnosis of a suspected diverticulum, it is not uncommon to detect during a sonographic examination. Typically, a Zenker diverticulum is located in close proximity to the left thyroid gland.
RETRACTED ARTICLE: Linc00210 drives Wnt/β-catenin signaling activation and liver tumor progression through CTNNBIP1-dependent manner
Authors: Fu Xiaomin , Zhu Xiaoyan , Qin Fujun , Zhang Yong , Lin Jizhen , Ding Yuechao , Yang Zihe , Shang Yiman , Wang Li , Zhang Qinxian , Gao Quanli
Published: March 2018

Background

Liver tumor initiating cells (TICs) have self-renewal and differentiation properties, accounting for tumor initiation, metastasis and drug resistance. Long noncoding RNAs are involved in many physiological and pathological processes, including tumorigenesis. DNA copy number alterations (CNA) participate in tumor formation and progression, while the CNA of lncRNAs and their roles are largely unknown.

Methods

LncRNA CNA was determined by microarray analyses, realtime PCR and DNA FISH. Liver TICs were enriched by surface marker CD133 and oncosphere formation. TIC self-renewal was analyzed by oncosphere formation, tumor initiation and propagation. CRISPRi and ASO were used for lncRNA loss of function. RNA pulldown, western blot and double FISH were used to identify the interaction between lncRNA and CTNNBIP1.

Results

Using transcriptome microarray analysis, we identified a frequently amplified long noncoding RNA in liver cancer termed linc00210, which was highly expressed in liver cancer and liver TICs. Linc00210 copy number gain is associated with its high expression in liver cancer and liver TICs. Linc00210 promoted self-renewal and tumor initiating capacity of liver TICs through Wnt/β-catenin signaling. Linc00210 interacted with CTNNBIP1 and blocked its inhibitory role in Wnt/β-catenin activation. Linc00210 silencing cells showed enhanced interaction of β-catenin and CTNNBIP1, and impaired interaction of β-catenin and TCF/LEF components. We also confirmed linc00210 copy number gain using primary hepatocellular carcinoma (HCC) samples, and found the correlation between linc00210 CNA and Wnt/β-catenin activation. Of interest, linc00210, CTNNBIP1 and Wnt/β-catenin signaling targeting can efficiently inhibit tumor growth and progression, and liver TIC propagation.

Conclusion

With copy-number gain in liver TICs, linc00210 is highly expressed along with liver tumorigenesis. Linc00210 drives the self-renewal and propagation of liver TICs through activating Wnt/β-catenin signaling. Linc00210 interacts with CTNNBIP1 and blocks the combination between CTNNBIP1 and β-catenin, driving the activation of Wnt/β-catenin signaling. Linc00210-CTNNBIP1-Wnt/β-catenin axis can be targeted for liver TIC elimination.
Whole-Genome and Whole-Exome Sequencing in Pediatric Oncology: An Assessment of Parent and Young Adult Patient Knowledge, Attitudes, and Expectations
Authors: Oberg Jennifer A. , Ruiz Jenny , Ali-Shaw Trisha , Schlechtweg Kathryn A. , Ricci Angela , Kung Andrew L. , Chung Wendy K. , Appelbaum Paul S. , Glade Bender Julia L. , Levine Jennifer M.
Published: March 2018

Purpose

The complexity of results generated from whole-genome sequencing (WGS) and whole-exome sequencing (WES) adds challenges to obtaining informed consent in pediatric oncology. Little is known about knowledge of WGS and WES in this population, and no validated tools exist in pediatric oncology.

Methods

We developed and psychometrically evaluated a novel WGS and WES knowledge questionnaire, the Precision in Pediatric Sequencing Knowledge Questionnaire (PIPseqKQ), to identify levels of understanding among parents and young adult cancer survivors (≥ 18 years old), off therapy for at least 1 year from a single-institution pediatric oncology outpatient clinic. Participants also completed health literacy and numeracy questionnaires. All participants provided written informed consent.

Results

One hundred eleven participants were enrolled: 76 were parents, and 35 were young adults. Of the total cohort, 77 (69%) were female, 63 (57%) self-identified as white, and 74 (67%) self-identified as non-Hispanic. Sixty-six (59%) had less than a college degree. Adequate health literacy (n = 87; 80%) and numeracy (n = 89; 80%) were demonstrated. Internal consistency was high (Cronbach’s α = .88), and test-retest reliability was greater than the 0.7 minimum requirement. Scores were highest for genetic concepts related to health and cancer and lowest for WGS and WES concepts. Health literacy and educational attainment were significantly associated with PIPseqKQ scores. Overall, participants felt the benefits of WGS and WES outweighed the potential risks.

Conclusion

Parents and young adult cancer survivors have some genetics knowledge, but they lack knowledge about WGS and WES. The PIPseqKQ is a reliable tool that can identify deficits in knowledge, identify perceptions of risks and benefits of WGS and WES, and help clinicians tailor their consent discussions to best fit families. The PIPseqKQ also may inform the development of educational tools to better facilitate the informed consent process in pediatric oncology.