bluuebunny/crossref_metadata_2025 huggingface dataset:
Design of standard operating procedure (SOP) based at ergonomic working attitude through musculoskeletal disorders (Msd’s) complaints
Authors: Susihono Wahyu , Ariesca  , Suryanawati  , Mirajiani  , Gunawan Gugun
Published: October 2018

PT PJC is a company synthetic resin. Synthetic resin is that produced by PT PJC is sold to the market in three types of packing, one of then is the drum packing type that weigh 208 kg. One of the activities that use the manual handling product (manual material handling) is the activity of filling, the drum-packed product will be transfered with drum packaging to the finishing goods area which done by the man force. Manual material handling concept has several advantages, one of which is easy to do by humans. However, manual handling material handling becomes an issue if the material load exceeds the maximum lifting of the worker because of the potential risk of injury to the human body, especially if it is carried out simultaneously for a relatively long period of time. One of the risks of human injury that can be experienced is Musculoskeletal Disorders (MSDs). This research will investigate the musculoskeletal complaints on Filling workers which will form the basic of the ergonomically-based Standard Operating Procedure (SOP) design basic. Data is taken by a Nordic Body Map (NBM) questionnaire. The result shows that most of the dominant body pain felt by the worker as the impact of previous day’s work was the complaints of pain on the left and right wrists, left and right palms, left and right knees, left and right calves, left and right ankles, while the pains felt by the workers after the activity are pain in the back, waist, left and right elbow, left and right thighs, left and right calvs, left and right ankles. The pain work will disappear after the night rest, but there is no guarantee that the worker’s body will be fit in the morning, because of the remnants of body pain that have not been fully fit, thus affecting the readiness of physical conditions at work in the morning. These body pain can be reduced by designing the right standard operating procedure (SOP) based on an ergonomic work attitude. Musculoskeletal pain before the activity were 39.3 ± 10.6 and after activity was 76.5 ± 14.9 or an increase in musculoskeletal pain of 94.66%.
Planning to Increasing Production Flexibility on Highest Unmatching Ratio Products in Automotive Company with DMAIC Approach
Authors: Maulida Hakim Inaki , Wahyuningtyas Rina , Kusuma Narpawandawi
Published: October 2018

This study aims to increasing production flexibility on highest unmatching ratio products in an Indonesia company. This study focuses on the problem of an inability to absorb orders fluctuations by dealer or end customer at one of Indonesia's leading automotive companies. If it is not solved, it will potentially causes cancelation order. Therefore, the necessary improvements in order to increase the production flexibility of the company. Method used in this research is DMAIC (Define, Measure, Analyze, Improve & Control) in way to get the right solution. Improvements will have an impact on opportunity cost and unmatching ratio. In this study, absorption scheme fluctuations order on a weekly basis in the form of WOC (Weekly Order Change) with adding a safety stock of unique part by using Q-model calculations. The results obtained from this study is the profit as the opportunity cost IDR 431,635,851 and unmatching ratio decrease from 4.9% in before condition become 1.2% in after condition.
Knoblauch zur Gesunderhaltung
Authors: Vlachojannis Julia , Chrubasik-Hausmann Sigrun
Published: October 2018

Es gibt viele klinische Studien, deren Daten in zusammenführenden Studien gepoolt wurden. Sie belegen, dass Knoblauch ein natürlicher Blutdruck- und Cholesterinsenker ist. Ein normaler Blutdruck wurde durch Knoblauch nicht beeinflusst. Unklar ist, warum manche Hypertoniker und manche Patienten mit hohen Blutfetten nicht auf Knoblauch ansprechen. Viele Studien weisen auf eine Senkung der kardiovaskulären Risikofaktoren und auf eine Senkung des Risikos für Herz-Kreislauf-Komplikationen (Schlaganfall, Herzinfarkt) hin sowie auf die Reduktion arteriosklerotischer Gefäßveränderungen. Bei Erkältungskrankheiten ist die Wirksamkeit von Knoblauch vielversprechend, bei Krebsleiden, Rheuma, Diabetes und bei der Alzheimer-Demenz dagegen noch nicht endgültig geklärt.

Knoblauch und Zubereitungen daraus können mit unerwünschten Ereignissen (UEs) einhergehen wie Ausdünstung, Sodbrennen, Übelkeit, Erbrechen und Durchfall. Bei der Einnahme geruchloser Knoblauchpräparate sind UEs nicht zu befürchten. Auf Wechselwirkungen von weißem Knoblauch mit Medikamenten muss geachtet werden (wohl kaum bei Einnahme geruchloser Knoblauchpräparate). Vorsichtshalber sollten aber auch die Knoblauchextrakte mit wasserlöslichen Inhaltsstoffen nicht zusammen mit synthetischen Gerinnungshemmern eingenommen bzw. vor Operationen abgesetzt werden. Obwohl Knoblauch in den empfohlenen Dosen nicht toxisch wirkt, sollten Schwangere Knoblauch nur in Maßen zu sich nehmen, bis das komplette Sicherheitsprofil erstellt ist.
Cochlear Implantation for Children and Adults with Severe-to-Profound Hearing Loss
Authors: Warren Sarah , Messersmith Jessica , Entwisle Lavin
Published: October 2018

Cochlear implants (CIs) have proven to be a useful treatment option for individuals with severe-to-profound hearing loss by providing improved access to one's surrounding auditory environment. CIs differ from traditional acoustic amplification by providing information to the auditory system via electrical stimulation. Both postlingually deafened adults and prelingually deafened children can benefit from a CI; however, outcomes with a CI can vary. Numerous factors can impact performance outcomes with a CI. It is important for the audiologist to understand what factors might play a role and impact performance outcomes with a CI so that they can effectively counsel the recipient and their family, as well as establish appropriate and realistic expectations with a CI. This review article will discuss the CI candidacy process, CI programming and postoperative follow-up care, as well as considerations across the lifespan that may affect performance outcomes with a CI.
First Report of Congenital Short Bowel Syndrome in an Iranian Patient Caused by a Mutation in the CLMP Gene
Authors: Gharesouran Jalal , Esfahani Behnaz , Valilou Saeed , Moradi Mohsen , Mousavi Mir , Rezazadeh Maryam
Published: October 2018

Congenital short bowel syndrome (CSBS) is a rare congenital neonatal disorder. CSBS results from intestinal impairment during embryogenesis. Mutated CXADR-like membrane protein (CLMP) and Filamin A genes are involved in the cause of CSBS. In this study, due to our misdiagnosis, we had to perform whole exome sequencing on the patient, and also we implemented cosegregation analysis on his parents with consanguineous marriage and also parents' mothers. We identified a homozygous loss of function mutation in the CLMP gene in exon 5 (c.664C > T, p.R222X). Also, both parents and grandmothers of the proband were heterozygous for this mutation. Loss of function mutation in CLMP causes CSBS, leading to impaired intestinal development.
Acute Gaucher Disease-Like Condition in an Indian Infant with a Novel Biallelic Mutation in the Prosaposin Gene
Authors: Radha Rama Devi Akella , Kadali Srilatha , Radhika Ananthaneni , Singh Vineeta , Kumar M. , Reddy Gummadi , Naushad Shaik
Published: October 2018

This is the first reported case of prosaposin (PSAP) mutation from India manifesting as an acute neuronal Gaucher disease-like condition. A 2-month-old male baby presented with encephalopathy, resistant tonic–clonic seizures, moderate hepatosplenomegaly, hypotonia, and cherry red spot in the retinae. The child had anemia, thrombocytopenia, elevated chitotriosidase, and normal activity of acid sphingomyelinase and low normal activity of β-glucosidase 1 (β-glucocerebrosidase 1, GBA). The child succumbed in the fourth month of life due to persistent respiratory distress and refractory seizures. The clinical phenotype, cherry red spots, elevated chitotriosidase, and lysosomal assays led to the suspicion of Gaucher disease. Exome sequencing revealed a homozygous stop codon mutation in the PSAP gene (c.G1228T, p.Glu410ter). Prenatal diagnosis in the next pregnancy revealed a carrier fetus, who was unaffected postnatally. The diagnosis of specific activator deficiency such as saposin C and saposin D deficiency (in the current study) should be considered and tested for when Gaucher disease is suspected in an infant with partially deficient or near normal GBA activity.
Two molecular species of phytochrome A with distinct modes of action
Authors: Sineshchekov V.
Published: October 2018

Adaptation of plants to environmental light conditions is achieved via operation of a highly complex photoreceptor apparatus. It includes the phytochrome system comprising phytochromes A and B (phyA and phyB) as the major components. phyA differs from phyB by several properties, including its ability to mediate all three photoresponse modes – the very low and low fluence responses (VLFR and LFR respectively) and the high irradiance responses (HIR), whereas phyB is responsible for LFR. This review discusses the uniqueness of phyA in terms of its structural and functional heterogeneity. The photoreceptor is presented in monocots and dicots by two native molecular species, phyAʹ and phyAʹʹ, differing by spectroscopic, photochemical and phenomenological properties. phyA differentiation into substates includes post-translational phosphorylation of a serine residue(s) at the N-terminal extension of the molecule with phyAʹ being the phosphorylated species and phyAʹʹ, dephosphorylated. They differ also by their mode of action, which depends on the cellular context. The current working hypothesis is that phyAʹ mediates VLFR and phyAʹʹ, HIR and LFR. The content and functional activity of the two pools are regulated by light and by phosphatase/kinase equilibrium and pH in darkness, what contributes to the fine-tuning of the phytochrome system. Detection of the native pools of the cryptogamic plant fern Adiantum capillus-veneris phy1 (phy1ʹ and phy1ʹʹ) similar to those of phyA suggests that the structural and functional heterogeneity of phyA is not a unique phenomenon and may have arisen earlier in the molecular evolution of the phytochrome system than the appearance of the angiosperm phytochromes.
Critical assessment 31: On the modelling of tertiary creep in single-crystal superalloys
Authors: Sulzer Sabin , Reed Roger
Published: October 2018

Modelling of tertiary creep in single-crystal superalloys – operative over the majority of the temperature/stress regime of relevance – is assessed. Traditional, empirical approaches are useful for the prediction of component life; a modern trend is for more physically faithful models which account for microstructure and alloy composition. Calculations are made using different methods, to identify advantages/disadvantages, in an effort to approach best practice. The predictions are tested against experimental data. The creep resistance can be estimated to within approximately one-half of a Larson–Miller parameter, from an input of alloy composition, deformation conditions, and estimates of microstructural parameters, rate laws (and parameters therein), and physical constants. Different merit indices are considered to identify the most appropriate for compositional optimisation.
Short‐term slackline training improves task‐specific but not general balance in female handball players
Authors: Ringhof Steffen , Zeeb Nina , Altmann Stefan , Neumann Rainer , Woll Alexander , Stein Thorsten
Published: October 2018

Slackline training has been shown to improve balance and neuromuscular performance. However, recent studies suggested that balance is task‐specific, implying that transferability of balance skills is limited and might depend on the similarity of the tasks. This study therefore investigated if short‐term slackline training could improve performance in balance tasks that are either more or less similar to the trained slackline task. Furthermore, we assessed potential transfer effects to other neuromuscular performance tests.

25 female handball players (23.7 ± 3.9 years) participated in our study and were matched to either a slackline training (SLT; n = 14) or a control group (CON; n = 11). The intervention comprised 12 sessions with overall 120 minutes of slackline training using single and double slacklines. Slackline standing time and measures of dynamic and static balance were assessed before and after the intervention, as well as power and sprint‐related performance parameters.

Two‐way repeated‐measures ANOVA found a significant group × time interaction for slackline standing time, indicating larger training effects for SLT. For the remaining dynamic and static balance tests, no significant interactions were found. With regard to neuromuscular performance, there was a significant group × time interaction only in change of direction.

In essence, the study showed that slackline training induced task‐specific balance improvements without affecting general balance. This adds further evidence to the task‐specificity principle of balance, although the specificity of the sample as well as the briefness of the intervention should be taken into account when generalizing our findings. Nonetheless, this study contains practical implications for team sports interventions and future balance training studies, highlighting the importance of selecting appropriate balance exercises to yield rapid and the desired training outcomes.
Joint and plantar loading in table tennis topspin forehand with different footwork
Authors: Lam Wing‐Kai , Fan Jia‐Xing , Zheng Yi , Lee Winson Chiu‐Chun
Published: October 2018

Table tennis players often execute one‐step, side‐step or cross‐step to move to an appropriate position for topspin forehand. However, to our knowledge, no studies have investigated the footwork effects on lower‐limb kinetics and kinematics, which are related to playing performance and injury prevention. This study examined the ground reaction forces, joint kinetics and in‐shoe plantar pressure distribution during topspin forehand with three typical footwork patterns. Fifteen male table tennis players performed cross‐court topspin forehands in one‐step, side‐step and cross‐step. Force plate, motion capturing, and instrumented insole systems were used to measure ground reaction force, joint moments and plantar pressure variables. One‐way ANONA with repeated measures was performed to determine any significant differences between footwork. Results indicated that participants exhibited significantly higher ground reaction force loadings, knee flexion angle, knee moment, ankle inversion and moment during side‐step and cross‐step compared with one‐step footwork condition (p < .01). Plantar pressure data indicated that the significantly higher peak pressure were observed in the total foot, toe, 1st, 2nd and 5th metatarsal regions during side‐step and cross‐step (p < .01). Additionally, cross‐step had induced higher peak pressure in medial midfoot and heel regions than one‐step and higher peak pressure in total and 1st metatarsal regions than side‐step (p < .01). These results suggest that foot orthotic designs should consider the stronger emphasis on those high‐pressured areas and that the differential joint and plantar loadings in side‐step and cross‐step may provide useful insights to injury mechanism and training protocol development.
Development and initial validation of the Psychological Characteristics of Developing Excellence Questionnaire version 2 (PCDEQ2)
Authors: Hill Andy , MacNamara Áine , Collins Dave
Published: October 2018

Given sport's ever‐increasing value and competitiveness, the race to identify and develop the next generation of sporting talent has never been more intense. Accordingly, in an effort to increase the effectiveness and efficiency of talent development, and recognising the critical role that psychology plays in these processes, this paper seeks to develop a formative assessment tool that will allow practitioners to measure and monitor the development of the psychological skills, characteristics and behaviours – both adaptive and maladaptive – that underpin effective development. Following a process of item generation and justification, a 135‐item questionnaire was completed by 512 developing male athletes from academy‐based team sports. Exploratory factor analysis was conducted to identify any underpinning latent factor structures, resulting in an 88‐item, 7‐factor solution that accounted for 40% of the explained variance, with an overall reliability of α = 0.879. A subsequent discriminant function analysis was conducted and the questionnaire was able to correctly classify 72.9% of participants based on their responses. Accordingly, the Psychological Characteristics of Developing Excellence Questionnaire version 2 (PCDEQ2) provides talent development environments with a valid and reliable measure form which to base effective psycho‐behavioural interventions, ultimately improving the effectiveness of talent development processes.
Incorporating Sub‐National Brazilian Agricultural Production and Land‐Use into U.S. Biofuel Policy Evaluation
Authors: Carriquiry Miguel , Elobeid Amani , Dumortier Jerome , Goodrich Ryan
Published: October 2018

We estimate emissions from indirect land‐use change associated with U.S. corn ethanol production by using the updated Center for Agricultural and Rural Development/Food and Agricultural Policy Research Institute global agricultural outlook model, which incorporates sub‐national land‐use modeling in Brazil and endogenous crop yield‐price relationships. Emissions estimates range between 9.7–23.9 g CO2 per mega Joule (MJ−1), which is consistent with other estimates. We compare the results of the current model to the 2008 model version. Using the data from the 2016 model in the 2008 model results in emissions that range from 23.2–32.2 g CO2 MJ−1. The addition of detailed modelling in Brazil, for example, double‐cropping, reduced estimates considerably and highlights the importance of continuous improvements in global agricultural models.
The National Household Food Acquisition and Purchase Survey: Innovations and Research Insights
Authors: Page Elina T , Larimore Elizabeth , Kirlin John A , Denbaly Mark
Published: October 2018

Evidence‐based policies that effectively address adverse public health trends, including the increasing burden of diet‐related disease and food insecurity, require quality and comprehensive data. For food and nutrition policy, that means data on household and individual food choices and the many factors influencing food demand, including income, food assistance program participation, food security status, and the local food environment. To meet this data need, the USDA sponsored the National Household Food Acquisition and Purchase Survey (FoodAPS), an innovative survey that collected nationally‐representative data on household food purchases and acquisitions, including from low‐income households and households participating in the Supplemental Nutrition Assistance Program (SNAP). To further enable and enrich analysis, the household survey data were linked to SNAP administrative records, USDA nutrient data, and geographic information related to the local food environment. This article provides a thorough overview of FoodAPS, including the rationale for the survey, recent research findings and insights on American diet quality, food assistance programs, and food environment, as well as the challenges encountered from developing, collecting, and processing the data.
Exaggerated Functional Impairment due to Malingered Neurocognitive Dysfunction Following Mild Traumatic Brain Injury
Authors: Elias David A , MacLaren Vance V , Brien Erin K , Metcalfe Arron W S
Published: October 2018

Objective

Functional impairment associated with Neurocognitive Disorder is often claimed in medico-legal settings after mild Traumatic Brain Injury (mTBI). This case–control study examined self-reported functional impairment and the plausibility of chronic disability claims following uncomplicated mTBI.

Method

Independent Medical Evaluations included a battery of performance and symptom validity tests, along with self-reports of physical or emotional complaints and functional impairment. Slick and colleagues’ (Slick, D. J., Sherman, E. M., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13, 545–561.) criteria ruled out probable malingering in 21 mTBI cases without psychiatric comorbidity and their self-reports were compared to those of seven non-malingering cases with a psychiatric comorbidity, 17 who were probable malingerers, and 31 orthopedic pain sufferers. Coherence Analysis of medical documentation corroborated assignment of mTBI cases to non-malingering versus probable malingering groups.

Results

Probable malingerers reported more postconcussion symptoms than non-malingerers (d = 0.79) but they did not differ significantly on tests of neurocognitive performance. Probable malingerers and orthopedic pain patients gave significantly higher ratings of functional impairment (d = 1.28 and 1.26) than non-malingerers. Orthopedic pain patients reported more disability due to pain than non-malingerers (d = 1.03), but pain catastrophizing was rated more highly by the probable malingerers (d = 1.21) as well as by the orthopedic pain patients (d = 0.98). The non-malingerers reported lower emotional distress than the other three groups, but only the probable malingerers reported elevated depression symptoms compared to the non-malingerers (d = 1.01).

Conclusions

The combined evaluation of performance validity, function, and coherence analysis would appear to enhance the difficult clinical evaluation of postconcussion symptoms in the medical-legal setting.
A curious case of entropic decay: Persistent complexity in textual cultural heritage
Authors: Nielbo Kristoffer L , Baunvig Katrine F , Liu Bin , Gao Jianbo
Published: October 2018

To understand an author’s developmental trajectory, the static traits and properties of author reconstruction and profiling are not sufficient. Instead, it is necessary to focus on high-level indicators of the complex set of variables that underlie the author’s transient mental states during his or her creative production. We propose a method that combines information theory with random fractal theory to study the mental dynamics of an author as indicated by text complexity. To illustrate its application, we analyze the developmental trajectory of the culturally influential and ‘graphomanic’ 19th-century Danish pastor N. F. S. Grundtvig. This approach can detect an age-related trend (entropic decay), a significant Kehre (turning point), and multiple event-related change points in his production. We argue that the approach is applicable beyond the specific case and can be extended to comparative analysis within and between authors, and, finally, to dynamic analysis of cultural information systems.
Consultation
Authors: Vatakencherry Geogy , Bhatt Alok , Baadh Amanjit S.
Published: October 2018

In the 1960s, Dr. Charles Dotter created the field of vascular and interventional radiology. Despite tremendous opposition from competing providers, he forged ahead, bringing percutaneous vascular intervention to the mainstream of modern medicine. Since Dotter, vascular and interventional radiology has undergone a dramatic transformation marked by repeated innovation. In September 2012, the American Board of Medical Specialties recognized interventional radiology as the 37th primary specialty in medicine, acknowledging the unique nature of this specialty, in that it combines clinical, imaging, and technical skill sets. As the field evolves from one focused on techniques and procedures to involving disease specialists with the inclusion of consultative services, it is imperative that the interventionalist becomes better integrated in patient management through more effective consultations. This chapter provides a framework for providing effective consultations to patients and families, referring providers, and colleagues.
Wound Care
Authors: Ramjit Amit , Shebrain Saad
Published: October 2018

The skin and subcutaneous tissues protect the body from the external environment. Invasive procedures compromise the skin, necessitating these structures to heal which restores their protective function. Skin undergoes a systematic physiologic and predictable repair process. However, pathological conditions such as infection result in abnormal wound healing, which requires the healthcare provider to monitor the wound-healing process closely. Failure in wound healing can place the patient at risk for deeper infection, life-threatening complications such as necrotizing fasciitis (NF), and cosmetically unacceptable wounds. Abnormal healing outcomes, such as a history of keloid or hypertrophic scarring from previous trauma or invasive procedures, give the clinician clues to managing additional procedures properly. Knowledge of wound care techniques such as dressings allows the clinician to manage wounds properly during the repair process.
Principles of Sedation and Analgesia
Authors: Kotin Alan , Mascarenhas Jennifer , Fischer Mary
Published: October 2018

The interventional radiology (IR) suite has created an increasing demand for anesthesia services. Also, technological advancements and a movement toward minimally invasive surgery have moved procedures once performed in the operating room (OR) to IR suites, often in remote locations. Historically, patient sedation in the IR suite has been administered under the supervision of the interventional radiologist, utilizing conscious sedation. The updated Joint Commission regulations have fostered a closer relationship between anesthesia services and IR programs. Despite the apparent simplicity of this relationship, providing anesthesia services in remote locations can be challenging. This relationship requires that the specialties become familiar with each other. The increased need for anesthesia has also created a demand for expertise in non-OR anesthesia (NORA). This chapter discusses the principles of sedation and analgesia, as well as the role and challenges that the anesthesia team faces while providing service in the IR suite.
Cardiopulmonary Emergencies
Authors: Torres Lisa K. , Horowitz James , Rajwani Kapil , Berlin David A.
Published: October 2018

Emergencies of the cardiovascular and respiratory systems are common causes of death and disability. Virtually all illnesses can culminate in disorders of these two systems. This chapter will review some of the most common causes of cardiovascular and respiratory failure that occur in hospitalized patients. It will review the systematic primary and secondary survey approach to rapidly identify life-threatening organ failure and provide a framework for initial resuscitation.
Upper-Extremity Arteries
Authors: Zybulewski Adam , Livshitz Ilya , Patel Bhumika , Fischman Aaron
Published: October 2018

This chapter evaluates the spectrum of pathologic diseases that affect the upper-extremity arteries, their clinical manifestations, imaging characteristics, and treatment options. We review the role of surgical and endovascular intervention for the treatment of acute upper limb ischemia (AULI) and chronic upper limb ischemia (CULI), the clinical and imaging findings associated with Raynaud’s phenomenon, hypothenar hammer syndrome, distal hypoperfusion ischemic syndrome (DHIS), thromboangittis obliterans (TOA), thoracic outlet syndrome (TOS), giant cell arteritis, Bechet’s disease, radiation arteritis, and traumatic arterial injury, including compartment syndrome and pseudoanuerysm formation. Finally, the evolution of upper-extremity arterial access and use of transradial access (TRA), including benefits and risks, technique, and complications, are discussed.
Lower-Extremity Arteries
Authors: Patel Parag J. , Rigas Diamanto “Amanda”
Published: October 2018

Peripheral arterial disease (PAD) is a common manifestation of atherosclerotic disease affecting circulation in the extremities, which carries significant morbidity and mortality. High morbidity and mortality rates and subsequent healthcare costs are associated with PAD. More than 200 million people worldwide are estimated to suffer from PAD, and an estimated 8.5 million Americans above the age of 40 are affected by it. This chapter on lower-extremity PAD explores the incidence, risk factors, and patient presentation of the disease. It reviews diagnostic studies, including the ankle-brachial index (ABI), toe-brachial index, and pulse volume recordings (PVRs), as well as imaging studies. The spectrum of patient presentations is discussed, including the Rutherford and Fontaine classification schemes. Treatment options, including medical and endovascular and surgical revascularization, are reviewed as well.
Deep Venous System
Authors: Ramaswamy Raja S. , Vedantham Suresh
Published: October 2018

The lower-extremity venous system includes the superficial, deep, and perforating veins. Veins are composed of intimal, medial, and adventitial layers. The intimal layer rests on the basement membrane and produces many thrombogenic substances, including tissue plasminogen activator (tPA). The medial layer consists of three smooth muscle layers interspersed with collagen and elastin. The adventitia is the outermost and thickest layer, containing proportionately more collagen. In this chapter, the discussion focuses on the deep venous system, which provides the main drainage of the lower extremity. Knowledge of the anatomy, physiology, natural history, clinical evaluation, treatment approach, and outcomes is essential to providing patients with the most appropriate care for deep venous disorders.
Peripheral Malformations
Authors: Jacobs David T. , Moe David C. , Burrows Patricia E.
Published: October 2018

This chapter, on peripheral malformations, provides an overview of vascular anomalies encountered in the practice of interventional radiology (IR), with a brief discussion of vascular tumors followed by vascular malformations. These include low-flow lesions, lymphatic malformations (LMs) and venous malformations (VMs); high-flow lesions, arteriovenous malformations (AVMs) and arteriovenous fistula (AVF); and Klippel-Trenaunay syndrome (KTS), the combined vascular lesion syndrome of the lower extremity. The natural history, signs and symptoms, clinical appearance, imaging appearance, and treatment of these lesions will be discussed, and illustrative photographs and radiologic studies of typical cases are provided. In recent years, much has been learned about the genetic basis of vascular malformations, which are caused by somatic mutations in a number of angiogenic proteins. Pharmacological treatment, based on these molecular findings, is available for some lesions. Extensive discussion on the biological basis for vascular anomalies is beyond the scope of this chapter.
Pulmonary Arteriovenous Malformations
Authors: Pollak Jeffrey S.
Published: October 2018

Pulmonary arteriovenous malformations (PAVMs) are dilated directly, connecting pulmonary arteries and veins with no capillary bed. They are generally congenital and frequently occur in patients with autosomal-dominant hereditary hemorrhagic telangiectasia (HHT), so they should be screened for PAVM. HHT causes variable-sized arteriovenous malformations (AVMs) from telangiectases to larger connections and affects mucocutaneous surfaces. Epistaxis is the most common symptom, and these vascular lesions can occur in other organs, including the lungs, central nervous system, liver, and gastrointestinal (GI) tract. PAVMs can result in hypoxemia with dyspnea, paradoxical embolization with ischemic stroke and abscess formation, and hemorrhage. Treatment consists of embolization of sufficiently sized lesions; antibiotic prophylaxis before procedures prone to produce bacteremia, such as dental processes that can cause abscesses; and avoidance of air or clots in intravenous (IV) lines. Lifelong follow-up is essential to assess for adequacy of embolization and enlargement of PAVMs that are too small to embolize.
Cardiopulmonary System: The Basics
Authors: Warren Andrew L. , Sridhar Sreevathsan , Bhalla Sanjeev
Published: October 2018

This chapter provides a basic introduction to the anatomy of the chest as it pertains to the general practice of interventional radiology (IR). The focus is on pertinent imaging anatomy relevant to commonly performed interventional procedures, with specific references to anatomical structures that are often targeted by interventional radiologists, frequently used landmarks, and anatomic relationships that may present pitfalls for creating complications. Arterial and venous anatomy is described in detail, along with the pertinent musculoskeletal, lung, pleural, and nervous anatomy. A brief discussion of the relevant cardiac structures, as well as both common variant anatomy and normal anatomy, is included.
Arteriography and Endovascular Intervention in the Lungs
Authors: Zuckerman Darryl , Marks Christina
Published: October 2018

Massive hemoptysis, which can be caused by a variety of chronic pulmonary diseases, is well-suited to treatment by arterial-directed transcatheter-based therapies. Results after bronchial artery embolization are excellent. Knowledge of the arterial anatomy and pathophysiology is critical to clinical success. Pulmonary embolism is a common entity responsible for over 100,000 deaths in the U.S alone. Understanding cardiopulmonary hemodynamics is helpful in deciding which patients will benefit most from interventional techniques such as catheter-directed thrombolysis and thrombectomy. The role of selective catheterization of pulmonary arteries for therapeutic purposes in the setting of PE continues to evolve. This chapter describes the fundamental clinical and anatomic issues when confronting patients with acute pulmonary vascular disease.
Cardiopulmonary Diseases: Nonvascular Diseases
Authors: Smirniotopoulos John , Browne William F. , Charalel Resmi A.
Published: October 2018

Pleural effusions are frequently encountered in the clinical setting, affect thousands of patients annually, and have numerous etiologies. The interventional radiologist has an important set of tools available for the treatment of pleural effusions, ranging from image-guided chest tube placement to thoracic duct (TD) embolization. Knowledge of these nonvascular percutaneous interventions is an essential part of the basic and advanced toolset for every practicing interventional radiologist. An understanding of the pathophysiology of various pleural pathologies, the appropriate indications for small-caliber tube thoracostomy placement, and the management of chest tubes in the periprocedural setting is vital for appropriate patient care. In this chapter, the etiologies, management protocols, and techniques for treatment of several types of pleural effusions are reviewed, with a special look at the lymphatic system.
Cardiopulmonary System: Oncologic
Authors: Lee Kyungmouk Steve , Pua Bradley B.
Published: October 2018

Lung cancer is the leading cause of cancer death in both men and women in the United States, with more than 160,000 Americans dying each year, and 1.6 million die of the disease worldwide. Interventional radiology (IR) involvement in the treatment of oncologic processes in the pulmonary system lags that of other organ systems, such as the hepatobiliary and renal systems. Nonetheless, more and more data is being accrued to support the utilization of minimally invasive techniques to treat both primary and secondary lung cancers. This chapter reviews the manifestation of lung cancer, as well as treatment options for oncologic diseases of the lung.
Hepatopancreaticobiliary: The Basics
Authors: Covey Anne M. , Brody Lynn A.
Published: October 2018

Hepatobiliary pathology presents many opportunities for interventional radiologists to provide patient care. Nearly all tools and techniques employed by the active interventional radiologist, from ablation to venous stenting, can be applied to the liver and bile ducts. These procedures can broadly be divided into vascular procedures, biliary interventions, and procedures focused on the parenchyma. A detailed understanding of the normal physiology and anatomy of this complex organ is a prerequisite for providing optimal care. This chapter reviews hepatobiliary physiology and anatomy and includes the imaging modalities that are used to guide percutaneous hepatic intervention. It also considers the anatomy and physiology of the pancreas, given its association with the liver by ductal anatomy.
Vascular Diseases of the Hepaticopancreaticobiliary System
Authors: Cooper Kyle J. , Smolinski-Zhao Sara E. , Saad Wael E.
Published: October 2018

The liver, pancreas, and biliary tree exist within a complex, interconnected relationship among each other and the enteric tract. They play vital roles in endocrine physiology, metabolism, and immunity. These anatomically complex organs can be affected by a variety of vascular conditions, ranging from acute and self-limited to chronic and life-threatening. The clinical workup and management of these conditions are as important to the interventional radiologist as the procedures that they are asked to perform to treat them. Knowledge of the diseases themselves, their natural course, and medical management can help to familiarize proceduralists with the reasons for referral and the complications and comorbidities that one can expect when treating these patients. In this chapter, we present a clinical overview of vascular diseases affecting the hepaticopancreaticobiliary systems.
Liver Transplant
Authors: Scheller Stephen V. , Agarwal David M.
Published: October 2018

While there have been many advances in surgical technique and post-operative care of patients undergoing liver transplant since the first performed in 1963, procedural complexity still require a long recovery. To compound this, relative shortage of donor organs require extreme care in pre-operative selection and post-operative management. While current knowledge and team based care has limited complications, they remain not infrequent. Many of these expected problems are managed in consultation with an interventional radiologist and this chapter summarizes the most common encountered problems.
Malignant Biliary Obstruction
Authors: Wadhwa Vibhor , Liddell Robert , Hong Kelvin
Published: October 2018

Malignant causes of biliary obstruction are often difficult to treat, as these cancers frequently present at late stages. Fortunately, there are now many diagnostic and therapeutic interventional and endoscopic techniques used to facilitate accurate diagnosis and treatment. Diagnostic strategies range from non-invasive imaging to endoscopic fluoroscopy and ultrasound to facilitate biopsy, as well as direct visualization through cholangioscopy. Therapeutic options include biliary stricture dilation, stenting, and drainage both for symptomatic/palliative management and to optimize patients for further medical and surgical management. Management of these patients are best served by a multidisciplinary approach. This chapter will review the currently available techniques for diagnosing and treating malignant biliary obstruction as well as the issues related to clinical management of these complicated patients.
Primary Liver Tumors
Authors: Rice Samuel L. , Solomon Stephen B. , Madoff David C.
Published: October 2018

Primary liver tumors result in substantial morbidity and mortality. Unfortunately, the majority of these tumors are discovered when the disease has progressed beyond the possibility of a curative surgical intervention. Over the past few decades, minimally invasive transcatheter and percutaneous techniques have been developed that offer patients with primary liver tumors extended survival, improved quality of life, and even potentially curative treatment. These therapies comprise procedures that embolize and locally deliver chemotherapy or radioactivity to these tumors or apply thermal or nonthermal ablative techniques that can be performed via a percutaneous approach utilizing computed tomography (CT), ultrasound, or magnetic resonance imaging (MRI) to kill tumor cells directly, with achievement of an appropriative therapeutic margin. This chapter focuses on the workup and clinical management of patients with primary liver cancer; hepatocellular carcinoma (HCC), and cholangiocarcinoma, as well as the role that these aforementioned interventional oncologic techniques have in treating these neoplasms.
Secondary Liver Tumors
Authors: Rice Samuel L. , Madoff David C. , Solomon Stephen B.
Published: October 2018

Metastatic spread of primary neoplasms to the liver is a poor prognostic factor in oncology. It is associated with a diminished overall survival (OS) rate, with most patients living only 1–2 years after tumors are identified. Systemic chemotherapy is the mainstay of treatment for patients with secondary tumors to the liver. An urgent need exists for the development and utilization of novel therapies to improve survival in these patients. Minimally invasive therapies exist that target hepatic tumors and can work synergistically with the systemic treatments currently available to prolong survival. Interventional radiologists have developed and utilized various liver-directed therapies, including embolization and ablation, to improve patient survival. Given the data that is available, these treatments are underutilized by clinicians due to a lack of knowledge about the potential advantages. This chapter discusses the factors related to treating secondary neoplasms in the liver and reviews the evidence supporting these therapies.
Gastrointestinal Tract: The Basics
Authors: Brejt Sidney Z. , Chheang Sophie
Published: October 2018

The primary goal of this chapter is to provide an overview of the anatomy and physiology of the gastrointestinal (GI) tract, which will form the basis for the upcoming chapters on both vascular and nonvascular interventions. Normal, variant, and postsurgical findings will be discussed, and when pertinent, unique disease states as well. In addition, secretory enzymes and hormones will be discussed and their mechanism of action elucidated. The GI tract is responsible for the ingestion, digestion, and absorption of nutrients. Cumulatively, it receives the largest intra-abdominal blood supply. Understanding the anatomy, physiology, histology, and pathology of the GI tract is vital to the interventional radiologist in order to provide optimal patient treatment while avoiding complications.
Vascular Diseases of the Gastrointestinal System
Authors: Darcy Michael
Published: October 2018

The vessels supplying the gastrointestinal (GI) tract can be involved in almost any kind of pathology. This chapter on vascular diseases of the GI tract examines the presentation, pathology, diagnosis, and management of vascular disease processes in both the upper and lower GI tracts. Given the huge variety of conditions that can affect the GI vessels, this discussion will focus on the entities most commonly encountered in clinical practice, including occlusive mesenteric ischemia, nonocclusive mesenteric ischemia, GI bleeding, visceral aneurysms, and vascular trauma. The specific characteristics of each condition, examination tools such as ultrasound and computed tomography (CT), and possible treatments such as surgery and endovascular therapies are considered.
Nonvascular Interventions: The Gastrointestinal System
Authors: Ward Thomas J. , Mobley David G. , Weintraub Joshua
Published: October 2018

The interventional radiologist has a diverse and expanding role to play in the management and treatment of patients with disorders of the gastrointestinal (GI) system. These patients generally fall into one of two broad categories. The first category includes patients who are unable to tolerate or achieve adequate nutrition by mouth. In these patients, the interventional radiologist may be consulted to obtain percutaneous enteral access so that nutrition or hydration may be administered. The second category includes patients with benign or malignant strictures or obstruction of a hollow viscus, be it the esophagus, stomach, or small or large bowel. In these patients, the goal is to treat the obstruction when possible, or else decompress proximal to the obstruction for palliation of symptoms.
Percutaneous Interventions for Benign Disorders of the Kidney and Adrenal Gland
Authors: Angle John F.
Published: October 2018

Many disorders of the kidney and adrenal gland are amenable to minimally invasive procedures. Although the range of procedures is large, there are several key procedures (such as percutaneous nephrostomy for nephrolithiasis or tumor, renal artery embolization for trauma or vascular masses, adrenal venous sampling for hyperaldosteronism, and renal angioplasty in the setting of fibromuscular dysplasia) that are commonly performed and should be familiar to every interventional radiologist. The goal of this chapter is to review the pathology of the kidney and adrenal gland, list the indications and contraindications for these standard procedures, and highlight the fundamental techniques for performing them.
Male Genitourinary Interventions
Authors: Chen Ronnie C. , Quirk Matthew , McWilliams Justin P.
Published: October 2018

Disorders of the male genitourinary system are commonly encountered and affect men of all ages. The interventional radiologist’s role in the management of these disorders is expanding, particularly given the recent enthusiasm for prostatic artery embolization for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). This chapter describes a selection of male genitourinary interventions, including varicocele embolization, prostate artery embolization for the treatment of BPH, and arterial embolization for high-flow priapism. There is a brief discussion on interventions for vasculogenic erectile dysfunction (ED). Clinical considerations for these disease processes are reviewed as well, with a focus on the pertinent information necessary for patient selection and treatment. In addition, procedural techniques are reviewed, followed by a discussion regarding potential complications as well as patient follow up and outcomes.
Adrenal and Renal-Oncologic Interventions
Authors: Flynn Melissa , Kwok Nathan , Arellano Ronald S.
Published: October 2018

Oncologic processes commonly involve the kidneys and adrenal glands. Renal cell carcinoma is the primary malignancy that affects the kidney, though other primary and metastatic tumors can also involve the kidneys. In contrast, the adrenal is a site frequently affected by metastatic tumors; indeed, primary adrenal cell carcinomas are extremely rare. A variety of oncologic interventions aim to either diagnose or treat renal and adrenal tumors. This chapter will discuss the role interventional oncology as it pertains to tumors of the kidneys and adrenal glands.
Clinical Considerations in Hemodialysis Access Intervention
Authors: Hoffer Eric K.
Published: October 2018

Interventional radiologists developed and refined the endovascular approaches to maintenance of the permanent arteriovenous vascular accesses that are integral to the provision of hemodialysis for patients with end stage renal disease. As methods of percutaneous arteriovenous fistula creation expand the scope of IR, this chapter reviews the clinical indications and preferences pertinent to dialysis access creation with respect to National Kidney Foundation Recommendations. Accesses remain imperfect, plagued by the development of flow-limiting intimal hyperplastic stenoses, and require monitoring and maintenance to minimize complications, morbidity and mortality. The measures of dialysis access function used in the surveillance of vascular accesses that indicate potential stenosis, and the utility of pre-occlusion recanalization of these stenoses are discussed. Complications specific to dialysis access interventions are also addressed.