bluuebunny/crossref_metadata_2025 huggingface dataset:
Near-Infrared Spectroscopy during Peripheral Vascular Surgery
Authors: Eiberg J. P. , Schroeder T. V. , Vogt K. C. , Secher N. H.
Published: September 2024

Near-infrared spectroscopy was performed perioperatively on the dorsum of the foot in 14 patients who underwent infrainguinal bypass surgery using a prosthesis or the greater saphenous vein. Dual-wavelength continuous light spectroscopy was used to assess changes in tissue saturation before, during and after the operation. Following the use of peripheral vascular grafts an immediate postoperative increase in tissue saturation of median 28 (range −10 to + 81) arbitrary units was noted ( P < 0.01), Following distal clamping of the common femoral artery, maximal ischaemia corresponding to a median reduction in tissue saturation of 61 (range 6–94) units was reached after 26 (range 8–95) min ( P < 0.01). The maximal tissue saturation following declamping was median 27 (range −16 to +100) units higher than the preoperative level ( P < 0.01) and was reached after median 42 (range 8–125) min, The results indicate that near-infrared spectroscopy is appropriate for perioperative monitoring during vascular grafting.
Corridor Procedure — Surgical Option for Treatment of Chronic Atrial Fibrillation in Patients Undergoing Mitral Valve Replacement
Authors: Velimirovic D. B. , Petrovic P. , Djukic P. , Vranes M. , Pavlovic S. U. , Zivkovic M.
Published: September 2024

The aim of this study was to determine the effectiveness of the ‘corridor’ procedure when added to mitral valve replacement in restoring and maintaining sinus rhythm in patients with chronic atrial fibrillation resulting from rheumatic mitral valve disease. Twenty-two patients with rheumatic mitral valve disease and chronic atrial fibrillation with fast, irregular ventricular response were divided into two groups. In the first group ( n = 12), mitral valve replacement was combined with sinus node-AV node isolation (‘corridor’); in the second, control group ( n = 10), mitral valve replacement was performed through the left atriotomy. The effectiveness of the ‘corridor’ procedure on heart rhythm was analysed by: (i) 24-h Holter monitoring performed before and during 72 h after surgery, at hospital discharge, and 2 months later; and (ii) postoperative electrophysiological studies using temporary epicardial wires on each isolated atrial compartment. Immediately after surgery and in the following 2 months, heart rate variability analysis showed significantly lower hourly ventricular rates and rate variations in the ‘corridor’ group compared with those of the control group ( P < 0.01). A significant difference was also found when comparing postoperative to preoperative findings in the corridor group ( P < 0.05). In the control group, however, no significant differences ( P > 0.05) were found concerning pre- and postoperative ventricular rate variations. At hospital discharge, nine of 12 patients with ‘corridor’ procedure were in sinus rhythm. Control patients remained in atrial fibrillation with irregular ventricular rate. The ‘corridor’ procedure, when added to mitral valve replacement, prolonged surgery, but led to restoration and long-term maintenance of sinus rhythm in 75% of patients with chronic atrial fibrillation and rheumatic mitral valve disease.
Correlating Clinical Indicators of Lower-Limb Ischaemia with Quality of Life
Authors: Chetter I. C. , Dolan P. , Spark J. I. , Scott D. J. A. , Kester R. C.
Published: September 2024

The objectives of the study were to analyse the impact of increasing lower-limb ischaemia upon quality of life and to assess the correlation between clinical indicators of lower-limb ischaemia and such quality. A prospective observational study of a consecutive series of 235 patients (144 men and 91 women; median age 68 (range 41–87) years presenting with varying degrees of lower-limb ischaemia graded according to ISCVS criteria was performed. Data was collected at interview before any intervention. Clinical indicators of lower-limb perfusion included: intermittent claudication and maximum walking distance on standardized treadmill testing; ankle:brachial pressure indices and isotope limb blood flow. Quality of life analysis was performed using the EuroQol (EQ) questionnaire. This is a standardized generic instrument for describing health-related quality of life and consists of a descriptive system of five dimensions, each measured on three levels. Thus, a profile and two single indices of quality of life were derived using different methods. Increasing lower-limb ischaemia results in a statistically significant deterioration in both global quality of life and in all EQ-measured quality of life dimensions ( P < 0.01 Kruskal–Wallis, ANOVA). The correlation between clinical indicators and quality of life is statistically significant but not sufficiently close (correlation coefficients < 0.6) to assume that variations in clinical indicators result in reciprocal variations in quality of life. In conclusion, as might be expected, a significant correlation exists between clinical indicators of lower-limb ischaemia and health-related quality of life. However, the low correlation coefficients emphasize how tenuous the association is. Thus, a significant improvement in the clinical indicators of lower-limb ischaemia cannot be assumed to impart a similar benefit on quality of life. The latter concept must therefore be analysed independently.
Is Mechanical Circulatory Support Helpful before Cardiac Retransplantation?
Authors: Noirhomme P. , d'Udekem Y. , Jacquet L , El Khoury G. , Verhelst R. , Rubay J. , Goenen M. , Dion R.
Published: September 2024

Ventricular assist devices are widely used as a bridge for cardiac transplantation patients. The purpose of the present study was to evaluate retrospectively, whether the use of ventricular assist devices could increase survival after early or late retransplantation. Over the past 10 years, 219 patients were transplanted in the authors' centre. Eight of 11 retransplanted patients required preoperative insertion of a ventricular assist device. Five assist systems were implanted in the early period after transplantation (< 30 days) and three later after transplantation (> 30 days). After early retransplantation, two patients survived and three died. All three late retransplantations were successful and all patients are still alive with a mean (s.d.) follow-up of 25(22) months. Ventricular assist devices are helpful for late retransplantation but do not improve poor survival after early retransplantation. Such devices should not be set up for early retransplantation.
The Hand Arm Vibration Syndrome: A Review
Authors: Chetter I. C. , Kent P. J. , Kester R. C.
Published: September 2024

Since its first description over eight decades ago, the hand arm vibration syndrome — vibration white finger as it was previously known — has become one of the most common prescribed diseases in the industrialized world. This article is intended to provide a broad review of existing evidence and knowledge regarding a disease which, for medicolegal reasons, demands attention from all medical personnel. Detailed discussion is presented regarding: the multifactorial aetiology of the syndrome; suggestions for clinical assessment, laboratory investigations and classification of disease severity: and strategies for the prevention and treatment of the syndrome.
Predicting Outcome after Myocardial Revascularization in Patients with Left Ventricular Dysfunction
Authors: De Carlo M. , Milano A. , Borzoni G. , Pratali S. , Barzaghi C. , Tartarini G. , Mariani M. , Bortolotti U.
Published: September 2024

In order to identify the risk factors which could predict outcome after coronary artery bypass grafting in patients with left ventricular dysfunction, 80 consecutive patients with an ejection fraction ≤ 30%, who underwent isolated coronary artery bypass grafting at the authors' centre between January 1994 and May 1996 were evaluated. Preoperatively, mean(s.d.) ejection fraction was 27.1(3.8)%, 56 patients (70%) had angina, and 56 (70%) were in New York Heart Association (NYHA) functional class III or IV. There were five operative deaths, with a hospital mortality rate of 6.3%. Significant risk factors for hospital death were NYHA class IV, preoperative ventricular arrhythmias and left ventricular end-diastolic volume index > 110 ml/m2. At mean follow-up of 15(7) (range 6–30) months, there were six late deaths, five of which were from cardiac causes. Actuarial survival rate at 2 years was 82(5)% and freedom from cardiac death 84(5)%. Risk factors for overall mortality from cardiac causes were preoperative grade 2 mitral regurgitation, associated with left ventricular dilatation, and renal dysfunction (creatininaemia ≥ 180 μmol/l). At follow-up, mean ejection fraction was 37.5(8.4)%, and the overall functional status had improved: 12 patients (18%) had angina and eight (12%) were in NYHA class III and IV. Myocardial revascularization in patients with left ventricular dysfunction can be performed with acceptably low operative risk, good survival rate at 2 years, and functional status improvement. Patients with extensive ventricular dilatation, associated with significant mitral regurgitation, have a lower life expectancy and less functional benefits from coronary artery bypass grafting. These patients are better treated by cardiac transplantation.
Na+ /H+ Exchange Inhibition Improves Post-Transplant Myocardial Compliance in 4-Hour Stored Donor Hearts
Authors: Kim Y. I. , Herijgers P. , Lommel A. Van , Verbeken E. , Flameng W.
Published: September 2024

Na+/H+ exchange inhibitors have cardioprotective properties. The effects of the new Na+/H+ exchange inhibitor, HOE642 on myocardial function were assessed after transplantation of canine brain-dead and non-brain-dead donor hearts preserved for 4 h. Four groups were studied: brain-dead donors; non-brain-dead donors; brain-dead donors and recipients treated with HOE642 (2 mg/kg): and treated non brain-dead donors and recipients. Donor hearts were stored in NIH2. At the end of 60 min reperfusion after transplantation, pressure–volume curves were constructed. Biopsies were analysed histologically and ultrastructurally. Afterwards, weaning from cardiopulmonary bypass was accomplished. H0E642 improved compliance in hearts from both brain-dead and non-brain-dead donors. No differences in myocardial water content nor in myocardial performance were detected. No irreversible damage was seen ultrastructurally. It is concluded that myocardial compliance after transplantation was improved by administration of HOE642. The use of this inhibitor might improve the current myocardial preservation technique for transplantation.
Predictors of Hospital Mortality in Type A Aortic Dissections: A Retrospective Analysis of 148 Consecutive Surgical Patients
Authors: Goossens D. , Schepens M. , Hamerlijnck R. , Hartman M. , Suttorp M. J. , Koomen E. , Vermeulen F.
Published: September 2024

Reports in the literature frequently concern miscellaneous types of dissections. This makes correct interpretation of data difficult. In order to assess the determinants of hospital mortality, the results of 148 consecutive patients over a 23-year period, all operated on for a type A dissection, were reviewed. Mean(s.d.) age was 56(13.1) years, 64% were male. An acute dissection (surgery within 14 days after onset of symptoms) was performed in 139 patients. Stigmata of the Marfan syndrome were present in 6.1% ( n = 9). Peripheral vascular ischaemic complications were observed in 27.7%. Nowadays, diagnosis is primarily confirmed using transoesophageal echocardiography (75 correct diagnoses among 76 performed). Operation consisted of repair or replacement of the ascending aorta. Resuspension of the aortic valve was performed in 74 patients, and arch replacement in 25. In 74 patients, distal repair was done under deep hypothermic circulatory arrest. Hospital mortality rate was 23.6% (35 patients), though mortality rate calculated over the period 1990–1993 was 17.4% (P= n.s.). Univariate analysis revealed the following variables to be statistically significant predictors of hospital mortality ( P < 0.05): preoperative ischaemic complications, preoperative resuscitation, haemopericardium, postoperative neurological complications, rethoracotomy, renal insufficiency and intestinal ischaemia. Multivariate stepwise logistic regression indicated preoperative resuscitation, postoperative haemodialysis and postoperative neurological complications as the only independent predictors of hospital death. Dissections arising from a primary intimal tear in the descending aorta had a more favourable outcome ( P = 0.06, odds ratio 0.1). Although hospital mortality has declined over the past few years, no decline was seen in operative mortality since gelatine-resourcine-formol (GRF) glue is used as a routine. Transoesophageal echocardiography is the first choice in confirming diagnosis. Early operation is advocated, with careful haemostasis, before the development of cardiac tamponade or end-organ ischaemia, as the cornerstone of a successful treatment of a type A dissection. Reduction of neurological complications will further improve the results.
Coronary Artery Bypass Grafting in a Patient with Type II Heparin Associated Thrombopenia
Authors: Christiansen S. , Geiger A. , Splittgerber F. H. , Reidemeister J. Chr.
Published: September 2024

Two types of heparin-associated thrombopenia can be distinguished. Patients with the type II condition present a particularly difficult management problem when they require full anticoagulation. There is no consensus about the proper anticoagulation management for type II patients who have to undergo cardiopulmonary bypass. The case is reported of a type II heparin-associated thrombopenia patient who underwent successful aortocoronary saphenous vein grafting. Sodium-danaparoid was used for anticoagulation. The anti-factor Xa level was kept below the value reported in the literature for patients undergoing cardiopulmonary bypass. No fibrin formation was observed during the time of cardiopulmonary bypass, nor was any severe postoperative haemorrhage seen, as is frequently described in the literature.
Endovascular Repair of Abdominal Aortic Aneurysm: Getting Out of Trouble
Authors: Chuter T. A. M. , Reilly L. M. , Kerlan R. K. , Sawhney R. , Canto C. J. , Ring E. J. , Messina L. M.
Published: September 2024

The standard techniques of endovascular aneurysm repair sometimes fail to produce atraumatic stent-graft delivery of hemostatic implantation, and additional maneuvers are required to avoid conversion to open repair. Between June 1996 and May 1997 elective endovascular aneurysm repair was performed in 33 high risk patients, using a Z-stent-based prosthesis. Challenging anatomic features included: short neck (< 15 mm) in four cases, angulated neck (> 60°) in seven, iliac aneurysm in six, and iliac tortuosity (> 80°) in 24. There were no deaths, no renal failure, no pulmonary failure, no graft thrombosis, no migration, and no conversions to open surgery. Deviations from standard technique were required to treat iliac artery dissection, iliac artery stenosis, and leaks resulting from proximal stent malalignment, proximal stent malposition, and distal stent malposition. The necessary adjunctive maneuvers included: additional stent placement, additional stent-graft placement, and balloon dilatation. Mean operating time was 191 ± 72 min, mean contrast volume was 148 ± 76 ml, and mean blood loss was 314 ± 427 ml. Mean time from operation to discharge from the hospital was 3.5 ± 1.67 days. These short-term results demonstrate that endovascular aneurysm repair is safe and effective in high risk patients, only if adjunctive maneuvers are available to supplement standard technique.
Aortic Reconstructive Surgery for Limb Ischaemia: Immediate and Long-Term Follow-Up to Provide a Standard for Endovascular Procedures
Authors: Harris R.A. , Hardman D.T.A. , Fisher C. , Lane R. , Appleberg M.
Published: September 2024

Purpose:

Aortobifemoral and aortobiliac bypass has been a preferred treatment of severe aortoiliac occlusive disease. Recently, endovascular procedures and unilateral bypass grafting have been introduced. We report the results of aortic reconstructive surgery over a 19-year period (1975–1994).

Methods:

A total of 285 patients underwent surgery. Follow-up data from clinical notes, general practitioner questionnaire or phone interview was available in 93.3% (266/285).

Results:

Of the total 68% were male (180/226) and the median age was 63 years (range 22–85 years). Indications for surgery were tissue loss/gangrene ( n = 32), rest pain ( n = 84), severe claudication ( n = 40), moderate claudication ( n = 110). Total of 177 bifurcated grafts, 51 iliofemoral, eight left/right aortofemoral, and 30 other procedures were performed. The median duration of follow-up was 49.8 months. Cumulative secondary graft patency for 2, 5 and 10 years was 97.7%, 95.9%, and 94.4%. The amputation rate was 4.5% (12/266). Early mortality occurred in eight of 266 patients (3%) and late mortality in 60 patients. The most common cause of late death was ischaemic heart disease (24/60 followed by cancer (14/60). Data was further analysed by type of graft, risk factors, complications and previous and subsequent surgery. In our experience, aortic reconstructive surgery is a successful option for the management of severe aortoiliac occlusive disease. The outcome of other methods of maintaining arterial patency should be measured against this standard.
Increasing the Colloid Osmotic Pressure of Cardiopulmonary Bypass Prime and Normothermic Blood Cardioplegia Minimizes Myocardial Oedema and Prevents Cardiac Dysfunction
Authors: Mehlhorn U. , Allen S. J. , Davis K. L. , Geissler H. J. , Waiters R. D. , de Vivie E. Rainer
Published: September 2024

Our recent work demonstrated that normothermic continuous antegrade blood cardioplegia results in cardiac dysfunction related to myocardial oedema. This oedema was partially due to increased myocardial microvascular fluid filtration induced by crystalloid hemodilution. We hypothesized that increasing the colloid osmotic pressure of blood cardioplegia would stop fluid filtration into the cardiac interstitium, thus preventing myocardial oedema and cardiac dysfunction.

Methods:

We determined myocardial water content in six dogs by microgravimetry and myocardial lymph flow from the major prenodal cardiac lymphatic. Preload recruitable stroke work was derived from sonomicrometry and micromanometry. The dogs were subjected to normothermic cardiopulmonary bypass primed with 6% hetastarch and 1 h of normothermic continuous antegrade blood cardioplegia (4:1 blood:6% hetastarch colloid osmotic pressure 21 ± 2 mmHg) delivered at 50 mmHg perfusion pressure.

Results:

We found that despite increased colloid osmotic pressure, a small but significant increase in myocardial water content still occurred during blood cardioplegia. As myocardial Jymph flow virtually ceased during cardioplegia, myocardial microvascular filtration must have been present. However, increased myocardial lymph flow following cardioplegia resulted in complete oedema resolution associated with normal left ventricular performance post-cardiopulmonary bypass.

Conclusions:

Our data show that the plegic myocardium is prone to oedema formation because of both relatively enhanced fluid filtration and lymph flow cessation. We conclude that increasing the colloid osmotic pressure of normothermic blood cardioplegia minimizes myocardial oedema, thus preventing post-cardiopulmonary bypass cardiac dysfunction.
Options in the Surgical Management of Aorto-Iliac Occlusive Disease: A Changing Perspective
Authors: Rutherford R. B.
Published: September 2024

The numerous options available for the treatment of aortoiliac occlusive disease have led to controversy over which is best. Not only are the technical aspects of direct aortoiliac reconstruction debated but the role of lower risk but less durable options such as extraanatomic bypass and balloon angioplasty and/or stenting is still unsettled. Rather than yield to the tendency to apply one method preferentially over the others, it is important to realize that each approach has a selective role to play in the overall management of aortoiliac occlusive disease, if applied in appropriate settings. In discussing these applications, the history of these controversies, and the pros and cons of each competitive approach are reviewed, along with the results of experiences with them by the author and others. While it is apparent that outcome data, stratified for location, and degree and extent of the occlusive disease being treated, are still needed for proper comparisons of some competitive techniques, especially balloon angioplasty and stenting, there is sufficient evidence to make certain general recommendations: endarterectomy should be limited to younger patients with soft atheromatous disease of the lower aorta and proximal iliac arteries; a femoral distal anastamosis is preferable to one at the iliac bifurcation; choice of proximal anastamosis should be based on the distribution of aortoiliac occlusive disease; concomitant profundaplasty is effective only if significant profunda narrowing is present (and not simply superficial femoral artery occlusion); the need for concomitant distal bypass can and should be predicted; axillobifemoral bypass should be limited to patients with ‘prohibitive’ risk or ‘hostile’ abdominal pathology; and, in view of the low risk and good long term patency of unilateral iliac bypasses, iliac PTA and stenting should not be extended to category III and IV lesions without demonstrating superior long term results for such lesions.
The Use of Low-Dose Heparin is Safe in Carotid Endarterectomy and Avoids the Use of Protamine Sulfate
Authors: Paty P. S. K. , Darling R. Clement , Kreienberg P. B. , Chang B. B. , Groudine S. B. , Sakawi Y. , Worth G. , Lloyd W. E. , Rockmore J. , Shah D. M.
Published: September 2024

Controversy exists concerning the appropriate dose of heparin needed during carotid endarterectomy. Use of high-dose heparin (100 U/kg) during carotid endarterectomy may require the use of protamine to minimize perioperative bleeding complications. At the authors' institution the use of 30 U/kg heparin for arterial reconstruction has obviated the need for protamine. A retrospective study of carotid endarterectomies performed was undertaken. Patients undergoing combined procedures with carotid endarterectomy were excluded. A total of 420 carotid endarterectomies were performed in 330 patients. All received 3000 U of heparin or less during carotid endarterectomy. Non-fatal stroke and transient neurological deficits occurred in 0.48% and 1.9%. respectively. Mortality was 0.9%. Wounds were dry in 97%, swollen in 2.5% and bloody in 0.5%. No patient received protamine. Two patients were returned to the operating room for re-exploration because of hematoma. In conclusion, the use of protamine may be safely avoided with 30 U/kg heparin, and give acceptable stroke- and minimal complication rates.
Asymptomatic Carotid Artery Stenosis Associated with Peripheral Vascular Disease: A Prospective Study
Authors: House A. K. , Bell R. , House J. , Mastaglia F. , Kumar A. , D'Antuono M.
Published: September 2024

This study aimed to determine the prevalence of symptomless internal carotid artery stenosis in consecutive patients presenting with peripheral vascular disease. Duplex ultrasound screening of the carotid arteries was used to determine the degree of stenosis. Co-morbidities were recorded together with age, sex and tobacco use. Internal carotid artery stenosis of > 50% was found in 35% of patients. Among these there was ≥ 70% stenosis in 18% of patients and of this group 5% had an occluded carotid vessel at first presentation. Males presented with peripheral vascular disease and associated carotid stenoses at a younger age than females. Male smokers had a higher prevalence of stenosis ( P = 0.036) but all smokers had developed stenoses 3–5 years before non-smokers. Females with abdominal aortic aneurysms had a greater prevalence of carotid stenosis ( P = 0.037), and male aneurysmal disease diminished stenosis prevalence ( P = 0.023). Men with an elevated serum creatinine were more likely to have a stenosis ( P = 0.019), but not women. The other co-morbidities were not specifically associated with carotid artery stenosis.
Septic Endarteritis and Fatal Iliac Wall Rupture after Endovascular Stenting of the Common Iliac Artery
Authors: Schachtrupp A. , Chalabi K. , Fischer U. , Herse B.
Published: September 2024

A 52-year-old female with arterial occlusive disease underwent an uneventful percutaneous transluminal angioplasty and placement of a vascular metallic stent in the left common iliac artery. Ten days later she presented with clinical symptoms of septic endarteritis. Shortly after re-admittance, an emergency laparotomy had to be performed because of an acute retroperitoneal bleeding. Rupture of the common iliac artery directly overlaying the penetrating stent was found but control of haemorrhage was of no avail. In this report of a case, septic endarteritis following placement of a vascular metallic stent preceded fatal rupture of the common iliac artery. This up to now unknown constellation requires surgical intervention without undue delay.
Antifibrinolytic Therapy with Tranexamic Acid in Cardiac Operations
Authors: Matsuzaki K. , Matsui K. , Tanoue Y. , Nagano I. , Haraguchi N. , Tatewaki H.
Published: September 2024

To demonstrate its antifibrinolytic effects and establish an effective regimen of tranexamic acid for hemostasis, the authors measured α2-plasmin inhibitor—plasmin complexes, thrombin—antithrombin III complexes and postoperative blood loss in three groups undergoing different regimens during cardiac operations. Forty-six patients undergoing coronary artery bypass grafting or valve replacement were enrolled in this study. They were divided into three groups of drug administration. A bolus infusion of 50 mg/kg tranexamic acid was given to 17 patients at the end of cardiopulmonary bypass (control group) and to 14 patients at the beginning of cardiopulmonary bypass (group A). In addition to the same bolus infusion at the beginning of cardiopulmonary bypass as group A, a continuous infusion of 10 mg/kg per h, starting at the time of skin incision and maintained for 6 h after cardiopulmonary bypass was given to 15 patients (group B). The marked increase in α2-plasmin inhibitor—plasmin complexes at the end of cardiopulmonary bypass in the control group was significantly reduced in group A ( P < 0.01) and a further reduction was observed in group B ( P < 0.001). The difference in postoperative blood loss only reached significant levels between the control group and group B ( P < 0.05). Although a significant increase in thrombin—antithrombin III complexes during cardiopulmonary bypass was similarly observed in all groups, no thromboembolic events occurred in any group, nor was any difference seen in graft patency. From the tranexamic acid therapy regimens tested in this study, a continuous infusion of 10 mg/kg per h starting at the time of skin incision to 6 h after cardiopulmonary bypass, with a bolus infusion of 50 mg/kg at the beginning of cardiopulmonary bypass, proved to be the most effective.
Is Transcranial Doppler Useful in the Detection of Internal Carotid Artery Cross-Clamp Intolerance?
Authors: Lacroix H. , Beyens G. , Van Hemelrijck J. , Nevelsteen A. , Verhaeghe R. , Suy R.
Published: September 2024

The aim of this study was to test the hypothesis that a drop in the systolic blood flow velocity in the middle cerebral artery of 70% or more, measured by transcranial Doppler, is a better criteria in the detection of cross-clamp intolerance than electroencephalogram (EEG) and somatosensory evoked potential (SSEP) monitoring. After exclusion of patients with a recent stroke, urgent procedures and combined procedures, a transcranial Doppler with compression test was scheduled in 85 patients. In 13 patients the drop was 70% or more and in these patients a transcranial Doppler was also performed during the reconstruction of the internal carotid artery (the study group) under general anaesthesia. A shunt was used because of EEG and SSEP abnormality in one patient. No changes were observed in the remaining patients and no intraoperative strokes were seen. The transcranial Doppler monitoring was unreliable in three patients. During cross-clamp, the systolic blood flow velocity in the middle cerebral artery dropped less than 70% in four and 70% or more in six patients. It is concluded that using a drop of 70% or more of the systolic blood flow velocity in the middle cerebral artery during internal carotid artery cross-clamp, as an indicator of cross-clamp intolerance, will lead to unnecessary shunting.
Extraperitoneal Laparoscopic Aortic Control with Endovascular Visualization of a Stent-Graft Combination
Authors: Andrews S. M. , Freestone T. , Pate P. , Greenhalgh R. M. , Nott D. M.
Published: September 2024

Objectives:

To demonstrate the feasibility of minimally invasive approaches to the aorta using retroperitoneal laparoscopy and to clamp the aorta to give views for perfemoral aortic angioscopy.

Methods:

Using retroperitoneal laparoscopy facilitated by balloon dissection the authors developed a new approach to the infrarenal abdominal aorta, in six pigs, to allow control of aortic blood flow. Aortic stent-grafts were then deployed via femoral arteriotomy, and after flushing the blood from the aorta, the stent-grafts were visualized by angioscopy.

Results:

Accurate positioning and patency of the stent-grafts was ascertained by direct vision angioscopy in all cases.

Conclusions:

This series shows that extraperitoneal laparoscopic aortic dissection is feasible and direct endovascular visualization of the aortic lumen can be performed. This may find a role as an adjunct to endovascular techniques such as endovascular stent-graft placement, by aortic angioscopy following minimally-invasive aortic clamping.
How We do it
Authors: Acher C. W. , Wynn Martha M.
Published: September 2024

A systematic approach to paraplegia risk in the surgical treatment of thoracoabdominal aortic aneurysms based on effective strategies identified from the experimental literature is discussed. With this approach, collateral blood flow, rather than direct intercostal reimplantation, moderate hypothermia and endorphin receptor, is emphasized blockade. The result has been a 10-fold reduction in paraplegia risk in elective patients and a 5-fold reduction in acute patients. This reduction in paralysis risk has resulted in improved short- and long-term survival.
Regulations of Immune Response by Astragalus  in Animal Asthma Models: A Meta-analysis
Authors: Wang Song , Chen Xinhua , Shi Zuoqiao , Shen Qianqian , Li Jing , Hua Wang , Shujing Wang , Wu Wanjing , Xi Qing , Li Guowen
Published: September 2024

Background

Asthma is a chronic respiratory condition by airway inflammation. Traditional Chinese medicine, is commonly used to treat it. Astragalus is known for its immunoregulation, anti-inflammatory, and antioxidant effects.

Purpose

To systematically evaluate the efficacy of Astragalus in asthma animal models using meta-analysis methods.

Methodology

A systematic search was performed in various databases, such as China National Knowledge Infrastructure (CNKI), WanFang Data, PubMed, Web of Science, and Cochrane Library databases for animal studies on Astragalus intervention in asthma models, with the search period extending up to September 2023. Two researchers performed independent literature screening and data extraction. The quality of the included studies was assessed by the Systematic Review Center for Laboratory Animal Experimentation (SYRCLE) animal experiment bias risk assessment tool. Meta-analysis was performed with RevMan (version 3.6.1).

Results

A total of 25 experiments were included. Meta-analysis indicated that Astragalus can significantly reduce total leukocytes, neutrophils, lymphocytes, and eosinophils in animal models of asthma. It also downregulated the expression levels of interleukin-4 and interleukin-5, while upregulation of interferon-γ and interleukin-10 expression was observed; however, the impact on macrophages was found to be not statistically significant ( p > 0.05).

Conclusion

Our systemic review suggested the potential efficiency of Astragalus in asthma treatment in China, although its mechanism is still unclear. The functions of Astragalus may be associated with attenuating airway inflammation through the regulation of immune response.
Goal Setting Instruction for Middle School Students Who Receive Services for Emotional and Behavioral Disorders
Authors: Ma Jia , Smith Stephen W. , Barber Brian R.
Published: September 2024

Early adolescents entering middle school are at a pivotal developmental phase as they become less dependent on parents/guardians and seek greater autonomy while encountering a complexity of social demands requiring them to regulate their emotions, thoughts, and behaviors to achieve academic and social success. Yet, students who receive services for emotional and behavioral disorders often struggle with their emotions and externalizing behavior, contributing to a lack of motivation to attain their goals. Fortunately, researchers have found goal setting plays an important role in improving students’ self-regulation skills. As such, we describe explicit instructional techniques that align with a phased goal setting process to bolster students’ intrinsic motivation and self-regulation. First, we underscore the significance of goal setting to amplify students’ motivation and fostering self-regulation that, consequently, can create positive changes in their behavior. We provide a step-by-step guide for educators to assist students in committing to and achieving their goals.
Research Trends in Presurgical Infant Orthopaedic Treatment in Patients with Cleft Lip and Palate: A Bibliometric Analysis of 100 Most-Cited Articles
Authors: Sennimalai Karthik , Selvaraj Madhanraj , Sameemullah Kathijathul Hidhaya , Gothankar Greeshma Shantharam , Siddiqui Hamza Parvez , Arora Garima , Mohaideen Kaja
Published: September 2024

Objective

To assess research trends and publication patterns of literature related to presurgical infant orthopaedics (PSIO) through a bibliometric analysis of the top 100 most-cited articles.

Material and methods

The top 100 most-cited articles were identified in the Web of Science (WoS) database using search terms related to PSIO on April 23, 2024, without any restrictions to study design, publication date and language. Standard information about each study was extracted. Citations from WoS, Scopus and PubMed databases were compared. The level of evidence for each article included was assessed. Association between different variables was calculated using Spearman's correlation coefficient with statistical significance set at p < 0.05. Visual analysis of the author's keyword co-occurrence, co-authorship analysis of authors, and citation analysis of journals and authors were performed using VOSviewer.

Results

Top cited articles were published from 1994 to 2020, with total individual database citations being WoS (n = 5378), Scopus (n = 6184) and PubMed (n =  10 450). Eleven articles were considered classic articles. Cleft Palate and Craniofacial Journal (Impact Factor = 1.1) had a maximum number of articles and citations. Two hundred eighty-five individuals contributed to top-cited articles, with 62 corresponding authors from 19 countries. A maximum number of authors were affiliated with universities in the United States. The most common keyword used was “nasoalveolar molding (n = 24)”, “cleft palate (n = 16)”, and “infant orthopedics (n = 16)”. The study design of the majority of articles was retrospective and follow-up studies (level 3; n = 53). A weak negative correlation was observed between citation metrics and both the publication year ( P < 0.01) and the level of evidence ( P < 0.01).

Conclusion

This analysis recognises the contributions of experts and offers valuable insights into trends that have shaped the development and evidence related to PSIO research. Future research should focus on integrating advanced technologies, conducting longitudinal studies, fostering collaboration, and emphasizing patient-centred outcomes.
The Corporate Office as a WorkPlace: A Pandemic-Spanning Exploration of Organizational Place in Context
Authors: Purvanova Radostina K. , Mitchell Alanah
Published: September 2024

Past studies of the impact of the physical work environment on workers have generated mixed results in the organizational space literature. We apply an alternative perspective on how the workspace influences grounded in theorizing on place rather than space. Focusing on the corporate office, we explore the notion that organizations are best positioned to influence employees when they transform their work spaces into work places. Through a qualitative case study, we first uncover a time-spanning placemaking strategy that designers (i.e., organizational leaders) and users (i.e., employees) execute together to infuse place into organizational space. We also uncover place meanings that emerge in the corporate office, and describe outcomes of placemaking. Next, focusing on the longitudinal nature of our exploration which spanned both sides of the COVID-19 pandemic (pre-pandemic; lockdown; hybrid work), we reveal how place evolves with changing work contexts. Thus, our theoretical contribution is twofold: exploring place (including placemaking, place meanings, and place effects) in an under-explored work environment—the corporate office, and showcasing place as a dynamic phenomenon that responds to contextual forces. Practically, our findings illustrate the role place plays in the modern, virtual and physical, workplace. Potential challenges are discussed.
“Virtual Mothering”: A Study of Mothering Practices of Trinidad and Tobago Mothers Stranded Abroad After COVID-19 Border Closures
Authors: Boodram Cheryl-Ann Sarita
Published: September 2024

The COVID-19 pandemic presented threats to the welfare of children and families due to spatial distancing measures, disruption of employment, virtual learning, changes in caregiving, and social isolation. Many studies highlighted the impact of the pandemic on the caregiving practices of mothers. However, little is known about the experiences of mothers who were separated from their children because of COVID-19 border closures. This study used a qualitative methodology to explore the lived experiences of five Trinidad and Tobago mothers stranded abroad and shows the ways in which the COVID-19 border closures altered their caregiving practices with children left behind. Findings show that mothers stranded abroad encountered several challenges in negotiating the physical distance away from their children and the ways that stranded mothers developed digital transnational mothering practices to alleviate the tensions of spatial separation from their children. Although borders have since re-opened, this article argues that the impact of separation between mothers and their children may have lasting effects. The study provides family support professionals and policymakers with an understanding of the experiences of mothers abroad and the need to lend specialized support to this vulnerable group.
Neuronal oscillations in cognition: Down syndrome as a model of mouse to human translation
Authors: Chang Pishan , Pérez-González Marta , Constable Jessica , Bush Daniel , Cleverley Karen , Tybulewicz Victor L. J. , Fisher Elizabeth M. C. , Walker Matthew C.
Published: September 2024

Down syndrome (DS), a prevalent cognitive disorder resulting from trisomy of human chromosome 21 (Hsa21), poses a significant global health concern. Affecting approximately 1 in 800 live births worldwide, DS is the leading genetic cause of intellectual disability and a major predisposing factor for early-onset Alzheimer’s dementia. The estimated global population of individuals with DS is 6 million, with increasing prevalence due to advances in DS health care. Global efforts are dedicated to unraveling the mechanisms behind the varied clinical outcomes in DS. Recent studies on DS mouse models reveal disrupted neuronal circuits, providing insights into DS pathologies. Yet, translating these findings to humans faces challenges due to limited systematic electrophysiological analyses directly comparing human and mouse. Additionally, disparities in experimental procedures between the two species pose hurdles to successful translation. This review provides a concise overview of neuronal oscillations in human and rodent cognition. Focusing on recent DS mouse model studies, we highlight disruptions in associated brain function. We discuss various electrophysiological paradigms and suggest avenues for exploring molecular dysfunctions contributing to DS-related cognitive impairments. Deciphering neuronal oscillation intricacies holds promise for targeted therapies to alleviate cognitive disabilities in DS individuals.
The effect of traumatic brain injury on learning and memory: A synaptic focus
Authors: Eyolfson Eric , Suesser Kirsten R. B. , Henry Holly , Bonilla-Del Río Itziar , Grandes Pedro , Mychasiuk Richelle , Christie Brian R.
Published: September 2024

Deficits in learning and memory are some of the most commonly reported symptoms following a traumatic brain injury (TBI). We will examine whether the neural basis of these deficits stems from alterations to bidirectional synaptic plasticity within the hippocampus. Although the CA1 subregion of the hippocampus has been a focus of TBI research, the dentate gyrus should also be given attention as it exhibits a unique ability for adult neurogenesis, a process highly susceptible to TBI-induced damage. This review examines our current understanding of how TBI results in deficits in synaptic plasticity, as well as how TBI-induced changes in endocannabinoid (eCB) systems may drive these changes. Through the synthesis and amalgamation of existing data, we propose a possible mechanism for eCB-mediated recovery in synaptic plasticity deficits. This hypothesis is based on the plausible roles of CB1 receptors in regulating inhibitory tone, influencing astrocytes and microglia, and modulating glutamate release. Dysregulation of the eCBs may be responsible for deficits in synaptic plasticity and learning following TBI. Taken together, the existing evidence indicates eCBs may contribute to TBI manifestation, pathogenesis, and recovery, but it also suggests there may be a therapeutic role for the eCB system in TBI.
A Qualitative Analysis of Coping Strategies Among People Assigned Female Birth Who Have Experienced Gynecological Violence in Chile
Authors: Cárdenas-Castro Manuel , Salinero-Rates Stella , Silva-Segovia Jimena
Published: September 2024

Gynecological violence, a form of gender-based violence encountered by women, remains a significant but overlooked issue. It occurs within healthcare settings in the context of gynecological care, and despite its prevalence, there's a dearth of research exploring strategies to combat it. This qualitative study aimed to investigate the coping mechanisms adopted by women and individuals assigned female at birth (cisgender, gender nonconforming, and transgender) following experiences of violence in Chile. We conducted semi-structured interviews to explore their coping strategies. The transcriptions were analyzed employing thematic analysis, which revealed that individuals primarily coped with gynecological violence by seeking interpersonal interactions that provided emotional and instrumental support. Additionally, we identified novel coping mechanisms such as self-protecting behaviors and self-affirming behaviors.
Factors That Impact Effective Public Health Communication With Michigan’s Latinx Population in the Context of COVID-19
Authors: Cross Fernanda L. , Hunt Rebecca , Buyuktur Ayse G. , Woolford Susan J. , Reyes Angela , Ledón Charo , Israel Barbara , Marsh Erica E. , Platt Jodyn
Published: September 2024

The far-reaching impact of the COVID-19 pandemic on Latinx communities is well-documented. This population has higher rates of COVID-19 infection and death compared with non-Latinx White Americans mainly due to long-standing problems related to Social Determinants of Health. Communication about issues such as health threats and safety measures are a vital part of public health, and need to be appropriate to the population of focus. To understand the effectiveness of public health communication to Latinx communities in Michigan during the COVID-19 pandemic, semi-structured interviews ( n = 16) and three focus groups ( n = 24 participants) were conducted virtually in 2021 across counties in Michigan deeply impacted by COVID-19: Washtenaw, Kent, Genesee, and Wayne. Participants shared some facilitating factors that supported effective health communication during the pandemic for their communities. For instance, in their experiences, religious and community leaders were especially effective in communicating information about the pandemic. They also expressed issues with English often being the only language of official communication; the need for bilingual options; and, the need for multiple channels of communication to reach as many people as possible. Participants also highlighted their concerns about inconsistent government communication and politicizing messages as a hindering factor that impacted effective health communication within their communities. Lessons from successes and failures experienced during the COVID-19 pandemic are vital to improving health outcomes for marginalized communities during public health crises. Future responses must ensure that public health communication is appropriate and effective for Latinx communities to better protect them.
Optimizing control variable selection with algorithms: Parsimony and precision in regression analysis
Authors: Campayo-Sanchez Fernando , Nicolau Juan Luis
Published: September 2024

This research note explores the pivotal role of control variables in any tourism and hospitality research that utilizes regression models in statistical analyses. While theory-driven independent variables offer insight into expected effects, the inclusion of control variables is crucial for mitigating potential confounding factors. In an attempt to strike a balance between model complexity and parsimony, researchers face the challenge of selecting the optimal control variables. To address this issue, the study tests three alternative methods: genetic algorithms, lasso models, and the branch and bound algorithm. Despite their underutilization in tourism research, these methods offer efficient means of selecting control variables, enhancing model precision and interpretation without unnecessarily convoluting the model with irrelevant factors.