bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of chronic venous disease with flavonoids: recommendations for treatment and further studies
Authors: Rabe E , Guex J-J , Morrison N , Ramelet A-A , Schuller-Petrovic S , Scuderi A , Staelens I , Pannier F
Published: April 2013

Objectives:

A variety of studies have suggested that flavonoids are effective for the treatment of CVD. However, many questions remain about their mechanism of action and when, how, and for what signs and symptoms they should be used.

Method:

A panel of experts in CVD met in Budapest, Hungary in December 2011 to discuss the current state of knowledge of CVD and the role of flavonoids in its treatment. The discussion was based on a literature search in the current databases. The goals of this paper are recommendations for further studies on the use of flavonoids in the treatment of CVD.

Results:

There is good evidence to recommend the use of flavonoids in the treatment of CVD. However, because of the poor quality of some older clinical trials, inadequate reporting, and insufficient information, much work is still needed to firmly establish their clinical efficacy and to determine when and how they should be employed. In particular, long-term randomized, placebo-controlled, double-blind studies are needed to establish the efficacy and safety of flavonoids. Additional studies are also needed to establish their mechanism of action, pharmacokinetics, toxicity, and cost-effectiveness.

Conclusions:

Aside from good evidence for the use of flavonoids in CVD further studies are indicated to establish long term treatment in this indication.
Comparison of endovenous laser ablation and high ligation and stripping for varicose vein treatment: a meta-analysis
Authors: Pan Y , Zhao J , Mei J , Shao M , Zhang J
Published: April 2013

Objectives:

To evaluate the efficiency and safety of endovenous laser ablation (EVLA) for primary lower extremity varicosities compared with high ligation and stripping (HLS).

Method:

Prospective non-randomized studies and randomized control trials on comparison of EVLA and HLS in treating varicose vein were included in this study. A meta-analysis on the data of suitable 13 clinical trials was performed using the Mantel–Haenszel method and the risk ratio was calculated. Thirteen studies including a total of 2245 limbs were eligible for inclusion. Among them, 1128 limbs were treated with endovenous laser ablation, whereas 1117 were treated with high ligation and stripping. Primary outcome measures were technical success rates and recurrence rates at different follow-up duration and complication rates.

Results:

No significant difference in initial technical success rates, Procedural failures were more common following EVLA compared with conventional surgery at one- and two-year follow-up. However, the duplex-detected and clinical recurrence rate was similar between conventional surgery and EVLA after one and two years. No statistical significance was found in postoperative phlebitis and bruise in EVLA and HLS (17.9% versus 21.5%). However, fewer complications were observed in EVLA compared with HLS, including bleeding and haematoma (1.28% versus 4.83%), wound infection (0.33% versus 1.91%) and paraesthesia (6.73% versus 11.27%).

Conclusions:

EVLA for varicose veins is safe and effective compared with HLS in a two-year range. More randomized controlled studies follow-up results are needed to clarify longterm recurrence (5 years).
Computational phlebology: reviewing computer models of the venous system
Authors: Zervides C , Giannoukas A D
Published: April 2013

Relatively little attention has been paid to the venous system and valves from a cardiovascular engineering perspective up to now. Given the involvement of venous valve haemodynamics in the development of deep vein thrombosis this is an area that needs more detailed investigation and close collaboration between clinicians and cardiovascular engineers. The purpose of this review article is to provide an indication of the physiological conditions that need to be included in any computational model of the venous system, based on recommendations from clinicians, and to summarize published computational models of the venous system by trying to explore their limitations and application range. A MEDLINE search was carried out on the relevant literature from 1940 until today. Several models have been developed with a specific purpose in mind to coincide with the aim of each individual study. The model complexity and laws used in each model vary significantly. There are more simplistic computational models based on electric circuit analogies, termed as lumped parameter models, which can be used to provide boundary conditions to one-dimensional (1D) and three-dimensional (3D) domain models, followed by 1D continuous models based on analytical equations, which allow the description of pressure wave and can be non-linear in nature. Finally, there are the more advanced 3D models, which are based on the principles of haemodynamics, and consider the compliance of the venous system and the effect that venous valves have on the cardiovascular system. In conclusion, it appears that computer modelling of the venous system can contribute greatly to our understanding of venous physiology and allow us to evaluate the haemodynamic interactions that occur in the venous system under different physiological conditions.
Deep venous thrombosis among disaster shelter inhabitants following the March 2011 earthquake and tsunami in Japan: a descriptive study
Authors: Shibata M , Hanzawa K , Ueda S , Yambe T
Published: April 2013

Objectives

A retrospective analysis of data collected during subject screening following Japan's March 2011 earthquake and tsunami was performed. We aimed to determine the incidence of deep venous thrombosis (DVT) among screened subjects and to identify risk factors associated with the development of DVT as independent variables.

Methods

Calf ultrasonography was undertaken in 269 subjects living in 21 shelters in Miyagi prefecture during the one-month period immediately following the March 2011 disaster. Information regarding the health and risk factors of subjects was collected by questionnaire and assessment of physical signs.

Results

Of the 269 evacuees screened, 65 (24%) met the criteria for calf DVT. We found lower limb trauma, reduced frequency of urination and sleeping in a vehicle to be independent positive predictors of DVT.

Conclusions

Evacuees had an increased risk of developing DVT, associated with tsunami-related lower limb injury, immobility and dehydration.
Compression and venous ulcers
Authors: Stücker M , Link K , Reich-Schupke S , Altmeyer P , Doerler M
Published: April 2013

Compression therapy is considered to be the most important conservative treatment of venous leg ulcers. Until a few years ago, compression bandages were regarded as first-line therapy of venous leg ulcers. However, to date medical compression stockings are the first choice of treatment. With respect to compression therapy of venous leg ulcers the following statements are widely accepted: (1) Compression improves the healing of ulcers when compared with no compression; (2) Multicomponent compression systems are more effective than single-component compression systems; (3) High compression is more effective than lower compression; (4) Medical compression stockings are more effective than compression with short stretch bandages.

Healed venous leg ulcers show a high relapse rate without ongoing treatment. The use of medical stockings significantly reduces the amount of recurrent ulcers. Furthermore, the relapse rate of venous leg ulcers can be significantly reduced by a combination of compression therapy and surgery of varicose veins compared with compression therapy alone.
Dose-saving isolation procedure in percutaneous ethanol sclerotherapy for venous malformations
Authors: Kishi K , Morita N , Terada T , Sato M
Published: April 2013

Objectives:

To evaluate the feasibility and effectiveness of an isolation technique during ethanol injection sclerotherapy for venous malformations (VMs) in the head and neck region.

Methods:

The subjects were 23 patients with 35 VM lesions in the head and neck, treated between 1999 and 2012. The mean lesion area was 3.75 ± 3.09 cm2 (± standard deviation). We confirmed the contour of the lesions to be treated on a fully filled image on direct injection cisternography, and observed patterns of communicating drainage to systemic veins. The cisterns were evacuated by squeezing and were isolated by manual compression of the communicators. Ethanol (94.5%) with a contrast agent was then injected into both isolable and unisolable lesions, up to a total volume of 1 mL/cm2, avoiding complications. We investigated the relationship between lesion size and injected ethanol dose, and also dose per unit area.

Results:

Both manual evacuation by compression and isolation were performed in 20 (57.1%) isolable lesions, but not in 15 unisolable lesions. The mean injected ethanol dose was 0.65 ± 0.31 mL/cm2 overall, 0.70 ± 0.32 in isolable and 0.59 ± 0.30 in unisolable lesions (NS). However, the injected ethanol dose was significantly lower for lesions sized >6 cm. Complete to near-complete shrinkage was observed in all isolable lesions, and in 60% of unisolable lesions ( P < 0.05). Clinical outcome seemed unrelated to the injected ethanol dose or the dose per unit area. There was one case of recurrence and one complication in the unisolable lesions. No further relapses or complications were observed during the follow-up period of 38.6 ± 12.3 months.

Conclusions:

Clinical outcome was related to the isolability not to the injected dose. The isolation appears useful for improving the safety and effectiveness of ethanol sclerotherapy for VM.
Haemodynamics and catheter-based imaging in the diagnosis of venous disease. An interventional targeted approach
Authors: Rosales A , Sandbæk G
Published: April 2013

The investigation of patients with severe chronic venous insufficiency (CVI, C3–C6) represents a challenge that requires the understanding of venous pathophysiology and a multidisciplinary approach; it should be aimed to assess valve function, evaluate the haemodynamic significance of obstruction and assess the function of the vein-muscle pump. Combining haemodynamic tests and imaging techniques best accomplish the investigation of these three aspects of the pathophysiology in CVI. The information obtained from ambulatory venous pressure and color duplex ultrasound is accurate when assessing reflux in the different segments of the different venous systems. The valve anatomic location and dynamic picture is supplied by descending phlebography. In case of venous obstruction, the haemodynamic tests lack accuracy and sensitivity. Therefore, imaging catheter techniques have to fill-in to depict vein morphology as well as inflow/outflow characteristics. The participation of several specialties in the investigation of these patients widens the treatment possibilities by identifying those who may benefit from advanced surgical and/or endovascular procedures. This interventional-targeted approach should be a centralized function.
Venous malformation and haemangioma: differential diagnosis, diagnosis, natural history and consequences
Authors: Lee B B
Published: April 2013

Venous malformation (VM) is the most common form of congenital vascular malformation (CVM). VM presents at birth as an inborn vascular defect and never disappears/regresses spontaneously through the rest of life; it will continue to grow slowly at a rate that is proportional to the growth rate of the body. Haemangioma is not a vascular malformation but one of the vascular tumours originating from the endothelial cells; it develops after birth mostly in the infantile/neonatal period with a distinctive growth cycle: a proliferation phase of early rapid growth followed by an involutional phase of slow regression. Although the vascular malformation and vascular tumour belong to the ‘vascular anomaly’ together, both conditions are fundamentally different not only in their anatomical, histological and pathophysiological findings but also in their clinical courses. Therefore, an appropriate differential diagnosis of the VM is mandated not only from other kinds of CVMs but also from ‘genuine’ haemangioma. Appropriate diagnosis and assessment of VMs can be made based on clinical presentation and a proper combination of basic non-invasive studies in general but the presence of a mixed lesion involving other types of CVM lesions and the type of VM lesion, extratruncular and truncular, will dictate the need for further work-up with additional non- to less-invasive study or angiography. Otherwise, angiography is usually reserved for therapeutic planning and treatment.
Sapheon: the solution?
Authors: Lawson J , Gauw S , Van Vlijmen C , Pronk P , Gaastra M , Mooij M , Wittens C H A
Published: April 2013

Less invasive endovenous techniques have been shown to be as effective as open surgery in the treatment of varicose veins. Furthermore, they cause less postoperative bruising and pain and enable early return to normal activities and work. Tumescent anaesthesia is safe and obviates complications of general or spinal anaesthesia. Drawbacks are a steep learning curve and painful administration during treatment. Tumescentless techniques like Clarivein™ or VenaSeal™ Sapheon Closure System are recently under investigation. Short-term results of VenaSeal™ are comparable with thermal ablation. The procedure is safe without serious adverse events. Perioperative pain and patient discomfort with this tumescentless approach is minimal but postoperative recovery is temporarily hindered by thrombophlebitis in 14–15 % of patients. One-year results in a small feasibility study has demonstrated durable closure at this endpoint. No longer-term results are available. A randomized control trial between VenaSeal™ and Covidien ClosureFast™ is in a preparatory phase.
Reflux time estimation on air-plethysmography may stratify patients with early superficial venous insufficiency
Authors: Lattimer C R , Kalodiki E , Azzam M , Geroulakos G
Published: April 2013

Objectives

It has been suggested that quantification of haemodynamic parameters of venous disease may complement clinical assessment and may help identify a group of patients with severe venous disease or alternatively patients with early venous disease. However, there has been very little work to prove this hypothesis. The venous filling index (VFI) of air-plethysmography (APG) can quantify severity and treatment effect but has limited discriminatory value. However, the components of the VFI, total venous volume (VV) and time to reach 90% of VV (VFT90), have never been fully studied. The aim was to investigate the contribution of VV and VFT90 to an elevated VFI and determine their relationship to great saphenous vein (GSV) diameter and clinical severity scoring.

Method

Ninety-three consecutive patients/legs (22–78 years) with primary GSV reflux (>0.5 seconds) awaiting endovenous treatment were recruited. CEAP (clinical, aetiological, anatomical and pathological elements) assessments were: 33 (35.5%) C2, 14 (15.0%) C3, 29 (31.2%) C4a, 5 (5.4%) C4b, 7 (7.5%) C5 and 5 (5.4%) C6. The median venous clinical severity score (VCSS) was 6 (2–20) and the averaged GSV diameter at three sites was 7.5 mm (4–12). The VFI, VV and VFT90 were recorded using APG.

Results

There was no correlation between the VV and the VFT90 ( r = −0.103, P = 0.324). The VFI, VV and VFT90 significantly correlated ( P < 0.0005, Spearman) with the GSV diameter: r = 0.623, r = 0.567, r = −0.432, respectively, and the C of CEAP ( P < 0.05): r = 0.4, r = 0.225, r = −0.343, respectively. None of the 25 (26.9%) patients with a VFT90 > 25 seconds were among the 17 (18.3%) patients in categories C4b–6 or with a VCSS > 9 ( P = 0.005, Fisher's exact test, corrected odds ratio: 17.3).

Conclusions

The VFT90 complements the VFI as a marker of severe superficial venous insufficiency. However, in contrast to the VFI, it may have discriminatory value in stratifying patients with early disease into two groups based on the severity of haemodynamic impairment.
New Concept: Different Types of Insufficiency of the Saphenofemoral Junction Identified by Duplex as a Chance for a More Differentiated Therapy of the Great Saphenous Vein
Authors: Stücker M , Moritz R , Altmeyer P , Reich-Schupke S
Published: April 2013

Even though the item ‘saphenofemoral junction’ (SFJ) is anatomically well defined, the incontinence of the SFJ is often incompetently described in clinical practice and studies. Especially with regard to the optimal therapy of the great saphenous vein, it might be of importance to have a more distinct regard to the SFJ as it is known that about 10–30% of the saphenous refluxes have no femoral origin. Considering the terminal and preterminal valve three types of incompetence of the SFJ may be differentiated: Type 1: Incompetent terminal, but competent preterminal valve; Type 2: Competent terminal, but incompetent preterminal valve; Type 3: Incompetent terminal and preterminal valve (complete incompetence). A review on prior studies and reports leads to the assumption that the differentiation of the distinct types of SFJ-incompetence allows a more individual and – perhaps – more effective therapy. Finally, studies are necessary to evaluate the here given new concept.
Re-modelling of venous thrombosis
Authors: Malgor R D , Labropoulos N
Published: April 2013

Venous thromboembolism is one of the most common causes of morbidity and mortality in modern societies. The entirety of events involved in venous thrombus formation and resolution remains to be elucidated. Temporal relation between the initial cellular insult, thrombus formation and resolution is critical for instituting a prompt treatment. This paper analyses the current basic knowledge and the events involved in venous remodelling after an episode of venous thrombosis.
Short-term gain for long-term pain? Which patients should be treated and should we ration?
Authors: Lane T R A , Dharmarajah B , Kelleher D , Franklin I J , Davies A H
Published: April 2013

Objectives:

Treatments of common conditions which do not affect mortality often become sidelined in the drive to improve efficiency and reduce costs. The rationing of patients is a divisive but crucial component to universal health care. How should this be accomplished?

Methods and Results:

In this article we examine the outcomes of various rationing methods in varicose veins.

Conclusions:

No method is perfect and treatment of symptoms and complications should remain the target for all physicians.
Inflammation in chronic venous ulcers
Authors: Raffetto J D
Published: April 2013

Chronic venous ulcers (CVUs) occur in approximately 1% of the general population. Risk factors for chronic venous disease (CVD) include heredity, age, female sex and obesity. Although not restricted to the elderly, the prevalence of CVD, especially leg ulcers, increases with age.1 CVD has a considerable impact on health-care resources. It has been estimated that venous ulcers cause the loss of approximately two million working days and incur treatment costs of approximately $3 billion per year in the USA.2 Overall, CVD has been estimated to account for 1–3% of the total health-care budgets in countries with developed health-care systems.1 The pathophysiology of dermal abnormalities in CVU is reflective of a complex interplay that involves sustained venous hypertension, inflammation, changes in microcirculation, cytokine and matrix metalloproteinase (MMP) activation, resulting in altered cellular function and delayed wound healing.3,4
The incidence of pulmonary embolism during deep vein thrombosis
Authors: Nielsen J D
Published: April 2013

Among life-threatening cardiovascular diseases, pulmonary embolism (PE) is the third most common after myocardial infarction and stroke. PE is a manifestation of venous thromboembolism (VTE). PE shares risk factors with deep vein thrombosis (DVT) and is regarded as a consequence of DVT rather than a separate clinical entity. Risk factors for VTE include major surgery, major trauma, high age, myocardial infarction, chronic heart failure, prolonged immobility, malignancy, thrombophilia and prior VTE. It is, however, important to recognize that these factors are not equally important and not equally common in patients with PE and DVT, respectively. Compared with DVT, PE is more often associated with major surgery, major trauma, high age, myocardial infarction and chronic heart failure, whereas malignancy and thrombophilia primarily are clinical predictors of DVT. In patients with prior VTE the initial clinical manifestation strongly predicts the manifestation of recurrent episodes, i.e. patients with previous PE are more likely to develop recurrent PE than DVT while patients with DVT predominantly are at risk of recurrent DVT.
Wound care in venous ulcers
Authors: Mosti G
Published: April 2013

Wound dressings: ulcer dressings should create and maintain a moist environment on the ulcer surface. It has been shown that in an ulcer with a hard crust and desiccated bed, the healing process is significantly slowed and sometimes completely blocked so favouring infection, inflammation and pain. In contrast a moist environment promotes autolytic debridement, angiogenesis and the more rapid formation of granulation tissue, favours keratinocytes migration and accelerates healing of wounds. Apart from these common characteristics, wound dressings are completely different in other aspects and must be used according to the ulcer stage. In necrotic ulcers, autolytic debridement by means of hydrogel and hydrocolloids or with enzymatic paste is preferred. In case of largely exuding wounds alginate or hydrofibre are indicated. When bleeding occurs alginate is indicated due to its haemostatic power. Where ulcers are covered by granulation tissue, polyurethane foams are preferred. When infection coexists antiseptics are necessary: dressing containing silver or iodine with large antibacterial spectrum have proved to be very effective. In the epithelization stage polyurethane films or membranes, thin hydrocolloids or collagen based dressings are very useful to favour advancement of the healing wound edge. Despite these considerations, a Cochrane review failed to find advantages for any dressing type compared with low-adherent dressings applied beneath compression. Surgical debridement and grafting of wounds, negative wound pressure treatment: surgical and hydrosurgical debridement are indicated in large, necrotic and infected wounds as these treatments are able to get rid of necrotic, infected tissue very quickly in a single surgical session, thereby significantly accelerating wound bed preparation and healing time. Negative wound pressure treatment creating a negative pressure on ulcer bed is able to favour granulation tissue and shorten healing time. In case of hard-to-heal leg ulcers such as large, deep, infected and long-lasting venous ulcers, sharp debridement and skin grafting may favour and shorten ulcer healing.
Patterns of reflux in the great saphenous vein system
Authors: Chastanet S , Pittaluga P
Published: April 2013

Objective:

To report the patterns of reflux in the great saphenous vein as well as to investigate the correlations between patterns of reflux, the demographics and the clinical findings in the population studied.

Methods:

A total of 1882 limbs were assessed by duplex ultrasound examination in 1449 patients (348 men and 1101 women). Ages ranged from 21 to 94 years (mean 51.8). The presence of symptoms of venous disease (aching, heaviness, night cramps, swelling, itching, burning, tingling and throbbing) and clinical signs were recorded.

Results:

Varicose veins without saphenous reflux occurred at a younger age (43 versus 55.6 years P < 0.05). The presence of incompetence at the saphenofemoral junction occurred in older patients (58.5 versus 54.1 years P < 0.05). Venous reflux to the ankle also occurred in older patients (mean 64.0 years P < 0.05). Saphenous vein reflux without clinical varices was associated with more advanced signs (C4–C6: 20.3% P < 0.05). A younger age was associated with less advanced signs (C0–C2:49.4 versus C4–C6: 60.1 years P < 0.05). Presence of symptoms was associated with advancing patient age (51.1 versus 49.1 years P < 0.05).

Conclusions:

A significant correlation between the extent of great saphenous vein reflux and the patient age and the clinical stage of SVI has been observed in this study. The authors hypothesize that these findings support the concept of early treatment of venous insufficiency before symptomatic and physiological deterioration occurs.
Pros and cons for intravascular ultrasound in stenting
Authors: Clair D
Published: April 2013

Intravascular ultrasound is an invaluable tool, necessary for treating patients with venous occlusive disease. The combination of adequate preoperative imaging using duplex ultrasound and axial imaging with computed tomography and/or magnetic resonance allows preoperative identification of extravascular anatomic issues, which may lead to venous obstructive symptoms. During performance of the venous intervention, reliance upon contrast venography alone will lead to frequently missed intravascular pathology which inevitably will lead to inadequate treatment and higher overall failure rates than necessary.
Microcirculatory changes in venous disease
Authors: Huisman L C , Den Bakker C , Wittens C H A
Published: April 2013

Objective:

The aim of this study was to investigate the feasibility to measure microcirculatory blood flow changes in patients with venous ulcers, by using the laser speckle imaging.

Methods:

Nine patients with a leg ulcer were measured with the laser speckle imager in a sitting position before and after mimicking venous hypertension, with the legs raised, by applying a blood pressure cuff and inflating it to 60 mmHg.

Results:

The results were inconclusive, due to the fact that a lot of practical problems interfered with the measurements, e.g. movement artefacts and inadequate wound visualisation.

Conclusion:

The additional value of laser speckle imaging in daily practice for wound care still remains an important question for further research. A reliable, reproducible microcirculation measurement in venous ulcers might predict venous ulcer healing and recurrence and therefore would be a valuable diagnostic tool in daily practice.
Intralesional copper wire retention and pingyangmycin injection: an effective combinational therapy for complex venous malformation in soft tissue
Authors: Yuan S-M , Hong Z-J , Jiang H-Q , Wang J , Hu X-B
Published: April 2013

Objectives: Complex venous malformations (VMs) may extensively involve the soft tissue. The treatment remains a challenge till now. Here we introduce a combinational therapy of copper wires and pingyangmycin (bleomycin A5, PYM).

Methods: Copper wires were retained in VMs by repeated penetration with a straight needle. Subsequently, PYM solution was injected into the lesion. Eight to 10 days later, copper wires were removed. The dressing was changed every day until the puncture pores healed. Magnetic resonance imaging scanning was performed to observe the change of VMs.

Results: From January 2001 to December 2011,56 patients were treated. During the follow-up period, most of the VMs shrunk obviously. The symptoms were relieved or disappeared. The complications included local pain, temporary paraesthesia and moderate fever, which disappeared quickly after the removal of copper wires.

Conclusions: This combinational therapy is a safe and effective approach for the complex VMs in soft tissue.
Value of magnetic resonance venography and computed tomographic venography in lower extremity chronic venous disease
Authors: Arnoldussen C W K P , De Graaf R , Wittens C H A , De Haan M W
Published: April 2013

For the treatment of chronic venous disease (CVD) of the lower extremity, identification of the underlying venous pathologies is essential. Traditionally, the pathologies to detect with imaging have been centred on insufficiency and reflux of the superficial, perforator and deep veins of the leg. More recently, stenosis and obstruction of the deep veins of the pelvis and abdomen (i.e. inferior vena cava, common and external iliac veins) have been identified as significant underlying pathologies in CVD. Accurate detection of stenotic and/or occlusive venous disease expands the treatment options for patients with CVD. In most cases, imaging of venous disease is performed with duplex ultrasound. In this article we discuss the existing evidence and potential value of computed tomographic venography and magnetic resonance venography to contribute in accurately identifying chronic venous disease, in particular chronic venous obstruction.
Sex steroid hormones are not altered in great saphenous veins after varicose vein treatment in male patients
Authors: Kendler M , Kratzsch J , Wetzig T , Simon J C
Published: April 2013

Objective:

The objective of this study was to assess differences in blood samples (sex steroid hormone levels and blood counts) before and after surgical treatment of incompetent great saphenous veins (GSV) in males.

Methods:

Antecubital vein and GSV blood samples were taken from 11 men with varicose veins and GSV reflux before and after treatment. Six patients were treated with high ligation, stripping and phlebectomy. Five patients were treated with endoluminal radiofrequency ablation and phlebectomy. After a four-year follow-up period (FU) cubital vein and GSV blood samples were taken again.

Results:

In men with varicose veins, significantly higher ( P < 0.05) serum testosterone (median 25.18 nmol/L, range 8.82–225.1) and oestradiol (median 179 pmol/L, range 79–941) levels were found in the saphenous vein samples before and after the FU (testosterone 18.8 nmol/L, range 7.96–83.1, oestradiol 171 pmol/L range 125–304) compared with the cubital vein samples before therapy (testosterone 15.72 nmol/L, range 8.36–23.29; oestradiol 84 pmol/L, range 41–147) and after the FU (testosterone 14.5 nmol/L, range 6.10–22.2, oestradiol 117 pmol/L, range 95–165). After the FU, one patient demonstrated recurrent varicose veins with groin neovascularization. Another presented with axial reflux of the anterior accessory saphenous vein. Further differences in blood counts and serum androstenedione levels between the upper and lower extremities were not detected.

Conclusion:

The differences between testosterone and oestradiol levels in the leg veins compared with the cubital veins persist after treating men with refluxing saphenous veins. These results suggest that local hormone regulation may be different between leg and arm veins in men with varicose veins.
Venous leg ulcer in the context of chronic venous disease
Authors: Sánchez F S Lozano , Roura J Marinel Io , Carrasco E Carrasco , González-Porras J R , Rodríguez J R Escudero , Nevarez I Sánchez , Sánchez S Díaz ,   Representing The Sociedades Españolas De Angiología Y Cirugía Vascular (Seacv), Capítulo Español De Flebologia, The Médicos De Atención Primaria (Semergen), And Medicina Familiar Y Comunitaria (Semfyc)
Published: April 2013

Objectives

Chronic venous disease (CVD) is a frequent disorder with a high socioeconomic impact. Little is known about the possible differences between healed ulcer (C5 group) and active ulcer (C6 group) in terms of disease severity and quality of life (QoL). Our aim was to determine the possible differences in severity disease and QoL between the C5–C6 and C1 (control) group.

Methods

Data from a national, multicentre, observational and cross-sectional study ( n = 1598) were used to compare three groups of CVD: C1 ( n = 243), C5 ( n = 136) and C6 ( n = 70). CVD severity was assessed with the Venous Clinical Severity Score (VCSS) and QoL with the Short Form 12 Health Survey (SF-12) and Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ-20).

Results

Patients with active ulcers had a higher mean total VCSS than patients with healed ulcers ( P < 0.05). Both SF-12 and CIVIQ-20 QoL questionnaires indicated a poorer QoL in patients with ulcers than in those with C1 ( P < 0.05). Compared with the C5 group, patients with active ulcers (C6) had lower QoL scores, but the differences were not statistically significant.

Conclusions

Patients with venous leg ulcers (C5–C6) are associated with high severity and poor QoL. However, the healing of a leg ulcer did not contribute to improvement of QoL.
Non-ST-elevation myocardial infarction following foam ultrasound-guided sclerotherapy
Authors: Stephens R , Dunn S
Published: April 2013

The objective of the study was to describe a very rare complication of foam ultrasound-guided sclerotherapy (FUGS). An unusual case of persisting chest discomfort following FUGS in a 61-year-old woman led to a diagnosis of non-ST-elevation myocardial infarction. The patient was found to have a patent foramen ovale (PFO). The differential diagnoses of paradoxical embolism, gas embolism or vasospasm are discussed, with reference to relevant literature. A hypothesis of post sclerotherapy release of endothelin-1 (in a patient with a known PFO) leading to sustained coronary artery spasm causing sufficient myocardial damage to be reflected in elevated troponin levels is suggested.

Any episode of chest tightness or pain following FUGS should be considered as possibly cardiac in origin. Sustained symptoms warrant admission to hospital for troponin monitoring and ECG assessment.
Latent life: Concepts and practices of human tissue preservation in the International Biological Program
Authors: Radin Joanna
Published: April 2013

Before the rise of DNA sequence analysis or the controversies over the Human Genome Diversity Project, there was the International Biological Program, which ran from 1964 to 1974. The Human Adaptability arm of the International Biological Program featured a complex encounter between human geneticists and biological anthropologists. These scientists were especially interested in what could be learned from the bodies of people they referred to as both primitive and in danger of going extinct. In this article, I address how new access to technologies of cold storage, which would allow blood to be transported from the field to the lab and be stored for subsequent reanalysis, gave shape to this episode in Cold War human biology and has ramified into our genomic age. This case study highlights the importance of cryopreservation to projects of genetic salvage as well as to the life sciences, more generally. I argue that ‘latency’, a technical term initially used by cryobiologists to describe life in a state of suspended animation, can be extended as a concept for science studies scholars interested in technoscientific efforts to manage the future.
Elbow Arthroscopic Surgery Update for Sports Medicine Conditions
Authors: Byram Ian R. , Kim H. Mike , Levine William N. , Ahmad Christopher S.
Published: April 2013

Elbow arthroscopic surgery can now effectively treat a variety of conditions that affect athletes. Advances in instrumentation, increased surgeon familiarity, and expanded indications have led to significant growth in elbow arthroscopic surgery in the past few decades. While positioning, portal placement, and specific instruments may vary among surgeons, anatomic considerations guide surgical approaches to minimize neurovascular compromise. Arthroscopic procedures vary in difficulty, and surgeons should follow stepwise advancement with experience. Removal of loose bodies, debridement of synovial plicae, and debridement of the extensor carpi radialis brevis for lateral epicondylitis are considered simple procedures for novice elbow arthroscopic surgeons. More advanced procedures include management of osteochondritis dissecans, valgus extension overload in the throwing athlete, and capsular release. With proper technique, a variety of athletic elbow conditions can be treated arthroscopically with predictable results and minimal morbidity.
Ameliorative effect of lycopene against 2,3,7,8-tetrachlorodibenzo-p-dioxin-induced rat liver microsomal toxicity
Authors: Aly Hamdy AA , El-Shitany Nagla A , El-Beshbishy Hesham A , Ashour Osama M
Published: April 2013

The objective of the current study was to investigate the potential oxidative damage of 2,3,7,8-tetrachlorodibenzo- p-dioxin (TCDD) in hepatic microsomal fractions in vitro and to further elucidate the potential modulatory effect of lycopene. Rat liver microsomes were divided into four groups. Group I served as a control and is incubated with vehicle (toluene). Groups II and IV were incubated with 20 µM lycopene for 1 h before further incubating; groups III and IV with 15 nM of TCDD for further 1 h. Hydrogen peroxide (H2O2) production, lipid peroxidation (LPO), protein carbonyl content and activities of uridine 5′-diphospho-glucuronyltransferase (UDPGT) and P450 were significantly increased. Moreover, the activity of antioxidant enzymes superoxide dismutase, glutathione peroxidase, catalse, glutathione- S-transferase and glutathione reductase as well as the microsomal thiol content were significantly decreased. Incubation with lycopene (group IV) maintained near normal activities of the enzymes, normalized thiol and carbonyl content and significantly reduced LPO and H2O2 production. In conclusion, the findings of the study indicate that TCDD induces a significant oxidative stress in liver microsomes as manifested by increased LPO, H2O2 production, protein carbonyl content and activities of UDPGT and P450 and decreased antioxidant enzymes activities and thiol content. By the reversal of biochemical and oxidative markers toward normalcy, the protective role of lycopene is illuminated in rat liver microsomal toxicity.
Ultrasonic synthesis, characterization of β-aminoketones by bismuth(III) triflate and determination of antigenotoxic properties
Authors: Ozturkcan S Arda , Turhan Kadir , Turgut Zuhal , Karadayi Mehmet , Gulluce Medine
Published: April 2013

Direct-type catalytic Mannich reaction for the synthesis of β-aminoketones from cyclohexanone, substituted aromatic amines and aromatic or hetero-aromatic aldehydes has been applied in water with bismuth triflate under ultrasound. Good yields of the expected β-aminoketones were obtained from available substrates, at room temperature in 1–2 hours. This study was designed to evaluate the mutagenic and antimutagenic potential of synthesized β-aminoketones compounds using Ames/ Salmonella and Escherichia coli WP2 bacterial reverse mutation assay systems.
Feeling Grateful
Authors: Hart Judith D.
Published: April 2013

The author in this article reports a Parse research method study on the universal experience of feeling grateful with 10 participants living in community. The central finding of this study is the structure: The living experience of feeling grateful is potent elation amid tribulation arises with the assuredness-unassuredness of benevolent alliances. The findings are discussed in relation to the humanbecoming school of thought and related literature. New knowledge generated from this study: (a) explicates unique ways of becoming related to feeling grateful, (b) enhances understanding of ways of connecting with persons in practice, and (c) reveals phenomena for further research.
Hearing the Voice of Nurses in Caring Theory-Based Practice
Authors: Dyess Susan MacLeod , Boykin Anne , Bulfin Mary Jo
Published: April 2013

The authors in this paper describe the process and findings of a participatory action research project between a college of nursing and a for-profit acute healthcare organization as practice environment transformation occurred, grounded in caring theory. The participatory action research process and findings emphasize the importance of the intention to know what matters and the required time, courage, and commitment necessary to actualize practice environments that support nursing. Implications show efforts to develop and sustain theory-based practice environments that enable the full expression of nursing and a way of being that honors and celebrates the uniqueness of nurses.
Composite or Confusion
Authors: Baumann Steven L.
Published: April 2013

The importance and challenges of the teaching of nursing theory in Uganda are discussed in this introduction to the column that follows it. Two assumptions are questioned, the first is that it is easier to teach nursing students in places like Uganda concrete theories rather than abstract ones, and the other is that a composite of theoretical perspectives in nursing is more practical than a unified theoretical framework for nurses and advanced practice nurses.
Living Quality
Authors: Parse Rosemarie Rizzo
Published: April 2013

The purpose of this article is to set forth the humanbecoming paradigm and the phenomenon living quality, which better expresses the notion of quality of life from this paradigmatic perspective. The three inherent core knowings of living quality are described and explained in light of the community change concepts. Living quality with sciencing and living the art of humanbecoming are also discussed.
The Humanbecoming Connection
Authors: De Natale Mary Lou , Klevay Anne M.
Published: April 2013

Students are building a foundation to help them move fluidly and naturally while making human to human connections. Parse’s theory of humanbecoming and the associated teaching-learning processes were used as underpinnings to guide students as they come to know more about themselves and others. The teaching-learning processes help nursing students understand that being present and bearing witness are an important part of honoring quality of life and respecting value choices. The purpose of this column is to highlight the humanbecoming teaching-learning processes as students explore their experiences of learning to be with others in true presence.
The Ethics of Defining Quality of Life
Authors: Milton Constance L.
Published: April 2013

The concept of quality of life is a popular, confusing taxonomy of definitions that lacks consensus for practice applications in healthcare disciplines. Usage of the term is infused with diverse and inconsistent meanings in contemporary healthcare literature. This article begins a discussion regarding the ethical implications for current usage of the concept in professional healthcare literature. Potential opportunities-limitations in professional nurse practice are discussed. The theoretical lens of the humanbecoming ethical tenets shall undergird the exploration and articulation of potential meanings of the concept.
Optimal statistical tolerance allocation for reciprocal exponential cost–tolerance function
Authors: Cheng Kuo-Ming , Tsai Jhy-Cherng
Published: April 2013

Statistical tolerancing has been widely employed in industry as it is more practical compared with the worst-case tolerancing in achieving lower manufacturing cost while satisfying design specification. As reciprocal exponential function is one of the commonly employed cost–tolerance models in practice and current approach is difficult to allocate statistical tolerances for such a function, this article investigates a method for optimal statistical tolerance allocation with such a cost–tolerance function. The method is to minimize manufacturing cost subject to constraints on tolerance target and machining capabilities. The optimization problem is solved by applying the algorithmic approach. Particularly, a closed-form expression of the tolerance optimization problem is further derived based on the Lagrange multiplier method with integrating the Lambert W function, a multivalue complex function. In addition, for constrained minimization problems with only equality constraints, the optimal tolerance allocation can be obtained by solving simultaneous equations without the time-consuming computing on differentiating while keeping the solution accurate. An example is illustrated to demonstrate the application of this approach. Through comparisons with the regular Lagrange multiplier method applied to reciprocal exponential cost–tolerance type, the result reveals that tolerances can be allocated much faster using this proposed method.
Manufacture of microporous ceramic layer by suspension–sedimentation for filtration applications
Authors: Laoui Tahar , Patel Faheemuddin , Saheb Nouari , Al-Aqeeli Nasser
Published: April 2013

Microporous layers of 0.3 µm α-alumina powder were deposited on the surface of porous zirconia substrates (average pore size of about 1 µm) using suspension–sedimentation method. The characteristics of the deposited alumina microporous layer was evaluated using different types of dispersants, namely, citric acid, sodium dodecyl sulfate and Triton X-100. The effect of these dispersants on the stability and settling characteristics of alumina suspension was evaluated by sedimentation tests. Scanning electron microscopy analysis of the microporous layers (prior to sintering) revealed that sodium dodecyl sulfate dispersant produced uniform layers with least agglomeration of alumina particles, whereas citric acid showed more agglomeration of alumina particles and the use of Triton X-100 developed holes on the surface of alumina layer. The layers deposited using sodium dodecyl sulfate dispersant were then sintered at 1400 °C in air. Scanning electron microscopy observations revealed that a uniform porous alumina layer with average pore size in the range of 0.5–1.0 µm was produced with this method. The results of sedimentation tests indicated that alumina powder suspension prepared with sodium dodecyl sulfate dispersant yielded very good stability with lowest particle settling rate, whereas citric acid exhibited the highest particle settling rate.
Analysis of magnetic field distribution in a cylindrical-type magnetron sputtering system
Authors: Bae Kang-Yul , Yang Young-Soo , Choi Bum-Ho
Published: April 2013

The magnetic field distribution in magnetron sputtering processes has been verified to influence the collision of positive ions on the target, as well as the efficiency of the deposition onto the substrate. However, locally concentrated collision due to the distribution has also been known to lead to nonuniform erosion on the target, which deteriorates the efficiency of sputtering. In this study, a cylindrical magnetron sputtering system with a rotary-type target is proposed to improve the expected lifetime of the target by reducing the local erosion of target in the magnetron sputtering process. For the sputtering system, the magnetic field distribution over the target was analyzed with finite element method. Based on the analysis, the effect of the configuration of permanent magnets on the magnetic field distribution was investigated. The result of the analysis could be used to predict the region where concentration of positive ions occurs and thus to estimate the pattern of how the erosion on the target surface would occur for the proposed system. The results also reveal that the magnetic field distribution related to the erosion pattern could be controlled with the configuration of the permanent magnets.
Influence of clearance parameters on the rotor dynamic character of hydraulic turbine shaft system
Authors: Gong Ru-Zhi , Wang Hong-Jie , Zhao Jun-Long , Li De-You , Wei Xian-Zhu
Published: April 2013

The study of rotor dynamic stability of hydraulic turbine system has become extremely important because of the increasing capacity, size, and inertia of large turbines. Crown clearance and band clearance in hydraulic turbines will influence the rotor dynamic characters of turbine shaft system. In this article, the character of the turbine shaft system under different clearance parameters is studied in order to observe how the clearance parameters influence the stability of hydraulic turbine. The relationship between the hydraulic turbine stability system and the turbine clearance structure is also analyzed. In this study, the force on the turbine rotor induced by fluid flow in clearances is described with the analytical solution of Reynolds equation obtained in the article, in which the fluid flow is considered to be incompressible and isothermal. And, the rotor dynamic character of the turbine system is calculated by NewMark direct integral method and non-linear forces obtained from Reynolds equation are implemented. Finally, principles related to the clearance parameters influencing the rotor dynamic character of turbine system are summarized.