bluuebunny/crossref_metadata_2025 huggingface dataset:
Data from Engineering Oncogenic Hotspot Mutations on SF3B1 via CRISPR-Directed PRECIS Mutagenesis
Authors: Fernandez Mike M. , Yu Lei , Jia Qiong , Wang Xuesong , Hart Kevyn L. , Jia Zhenyu , Lin Ren-Jang , Wang Lili
Published: September 2024

Abstract
SF3B1 is the most recurrently mutated RNA splicing gene in cancer. However, research of its pathogenic role has been hindered by a lack of disease-relevant cell line models. Here, our study compared four genome engineering platforms to establish SF3B1 mutant cell lines: CRISPR-Cas9 editing, AAV homology-directed repair editing, base editing (ABEmax, ABE8e), and prime editing (PE2, PE3, PE5max). We showed that prime editing via PE5max achieved the most efficient SF3B1 K700E editing across a wide range of cell lines. Our approach was further refined by coupling prime editing with a fluorescent reporter that leverages a SF3B1 mutation-responsive synthetic intron to mark successfully edited cells. By applying this approach, called prime editing coupled intron-assisted selection (PRECIS), we introduced the K700E hotspot mutation into two chronic lymphocytic leukemia cell lines, HG-3 and MEC-1. We demonstrated that our PRECIS-engineered cells faithfully recapitulate known mutant SF3B1 phenotypes, including altered splicing, copy number variations, and cell-growth defect. Moreover, we discovered that the SF3B1 mutation can cause the loss of Y chromosome in chronic lymphocytic leukemia. Our results showcase that PRECIS is an efficient and generalizable method for engineering genetically faithful SF3B1 mutant models. Our approach provides new insights on the role of SF3B1 mutation in cancer and enables the generation of SF3B1 mutant cell lines in relevant cellular context.
Significance:
This study developed an approach that can reliably and efficiently engineer SF3B1 mutation into different cellular contexts, thereby revealing novel roles of SF3B1 mutation in driving aberrant splicing, clonal evolution, and genome instability.
David G. Sherman Lecture: Improving Stroke Diagnosis and Treatment—A Journey Toward the End of Time
Authors: Warach Steven J.
Published: September 2024

In the 2024 David G. Sherman Lecture, Steven J. Warach, illustrating with examples from his research, walks through the history of magnetic resonance imaging in acute stroke from the 1990s and early 2000s with the introduction, validation, and application of diffusion-weighted imaging, penumbral imaging (the diffusion-perfusion mismatch), and other imaging markers of the acute stroke pathology into routine clinical practice and stroke trials. The adaptation of diffusion-weighted imaging for clinical scanners in the acute hospital setting began a revolution in ischemic stroke diagnosis as the presence, location, and size of ischemic lesions could now be visualized at the earliest times after stroke onset when computed tomography and conventional magnetic resonance imaging still appeared normal. In combination with perfusion magnetic resonance imaging, diffusion-weighted imaging made imaging of the ischemic penumbra a practical reality for routine clinical use and feasible for integration as a selection tool into clinical trials. It was apparent from the initial use of diffusion-perfusion imaging in acute stroke that many patients had persistence of penumbra as late as 24 hours after stroke onset although the probability of penumbra decreased over time. The therapeutic time window for ischemic stroke selected by clinical and temporal criteria reflected the decreased proportion of patients with the therapeutic target over time rather than the absence of the penumbral target in all patients at later times. This work provided the empirical and conceptual framework for the shift toward selection and evaluation of patients for acute stroke therapies based on direct observation of the target pathology and away from the exclusive dependence on clinical and temporal surrogates to infer the presence of stroke therapeutic targets, a shift that has expanded the indications for acute reperfusion therapies over the last 10 years.
Serra and Us
Authors: Bois Yve-Alain
Published: September 2024

Yve-Alain Bois discusses and describes the many essays that October editors and contributors have written about Richard Serra, particularly Rosalind Krauss, Benjamin H. D. Buchloh, Yve-Alain himself, Leah Dickerman (most recently), and Hal Foster (most abundantly).

The article begins: “I don't think it is an exaggeration to say that no artist can be more immediately identified with October than Richard Serra, particularly during the journal's first decades. Several of its editors or editors-to-be wrote repeatedly about his work, in the journal and elsewhere, and he himself participated directly in the life of the publication via a lengthy interview, not to mention his unwavering financial support since issue 39 (Winter 1986).

“In 1991, The Destruction of Tilted Arc: Documents appeared in the October book series; edited by Clara Weyergraf-Serra and Martha Buskirk, it offered nearly three hundred pages of documentation concerning the legal battle waged (and lost) by the artist to prevent the destruction by the American government of the site-specific work it had commissioned for Federal Plaza in New York City (installed in 1981, it was dismantled in 1989). Needless to say, the October gang came en bloc to defend the work at the public hearing (the testimonies of Rosalind Krauss, Annette Michelson, Douglas Crimp, Benjamin Buchloh, and regular contributor Abigail Solomon-Godeau figure in the book).

“In 2000, the first volume of the October Files appeared; edited by Hal Foster, it took Serra as its subject. Memorial tributes are an awkward genre in that they are almost inevitably nostalgic and take a narcissistic turn (“me and the great man”). But what if one were simply to commemorate the prolonged interaction of the journal's editors with Serra's work by chronologically recapitulating the various instances of their engagement? This will be done with pride, for sure, but also as a duty to forestall amnesia.”
Ring Composition and the Skepticism of the De Republica
Authors: Keoseyan Benjamin
Published: September 2024

The fragmentary state of Cicero’s De Republica makes it difficult to see how it is a unified work. In this article, I argue that Cicero uses ring composition to unify the dialogue as a polemic against the Epicurean prohibition on political involvement. Cicero is following Plato in his use of ring composition, and just as Plato uses ring composition in the Republic to express his views about philosophical method, so does Cicero. Ring composition turns out to be central to a plausible skeptical reading of the De Republica, in which Cicero both tries to induce suspension of belief in the Epicurean prohibition on political involvement, as well as prevent the reader from unreflectively adopting his own provisionally held views, both consistent with his commitment to the pedagogical aims of Academic skeptical philosophy.
Bias, Knowledge, Skepticism, and Disagreement: Précis of Part iii of Bias: A Philosophical Study
Authors: Kelly Thomas
Published: September 2024

The third and final part of Bias: A Philosophical Study explores the connections between bias and some of the central topics of epistemology, including knowledge, skepticism, and disagreement. It defends the possibility of biased knowing: biased believers can sometimes know, even when they believe in accordance with their biases, and even if those biases guarantee that they would believe as they do even if the truth were otherwise. It argues that the possibility of biased knowing has significant implications for both philosophical methodology and traditional forms of skepticism. Extended consideration is given to the question of whether those of us who robustly favor our ordinary commonsense views over the possibilities that the skeptic calls to our attention are biased against skepticism in any objectionable sense. Finally, it critically examines our tendency to attribute bias to others in response to interpersonal disagreement and the epistemological significance of “the bias blind spot.”
Memories of al-Shāfiʿī’s Inquisition
Authors: Saba Elias G.
Published: September 2024

This paper studies an account of the “inquisition” (miḥna) of Muḥammad b. Idrīs al-Shāfiʿī (d. 204/820) by the caliph Hārūn al-Rashīd (r. 170–193/786–809). In this account, al-Shāfiʿī is twice brought to the court of the caliph in chains but he is able to win the caliph’s favor through his rhetorical eloquence. The account is compared to that of the inquisition of Aḥmad b. Ḥanbal (d. 241/855) during the reign of the caliph al-Muʿtaṣim (r. 218–227/833–42). The paper shows the resonances between the two accounts, especially the heroic resistance to the caliphal questioning and the steadfast adherence to each jurist’s theological beliefs. The story of al-Shāfiʿī’s miḥna is structured so as to create a story for him that is reminiscent of the story of Aḥmad b. Ḥanbal.
ʿAlī Jumʿa as Editor: Reviving the Ḥāshiya in Late-Twentieth-Century Egypt
Authors: Elston Mary
Published: September 2024

The article analyzes a 2002 edition of Tuḥfat al-murīd ʿalā Jawharat al-tawḥīd, a supercommentary written by Ibrāhīm al-Bājūrī (d. 1860) on Ibrāhīm al-Laqānī’s (d. 1632) base text in Ashʿarī theology. The edition was edited by the Muslim religious scholar and former grand mufti of Egypt, ʿAlī Jumʿa (b. 1952). The article shows that in Jumʿa’s edition taḥqīq is a practice of selecting a text that has been widely available, reframing its importance in the introduction and footnotes, and making the text understandable to contemporary readers. In his selection and framing of the text, Jumʿa situates al-Bājūrī’s ḥāshiya against Salafī opponents, while his explicit audience for the edition consists of Muslim students. The article argues that Jumʿa’s taḥqīq, which is both ideologically and pedagogically oriented, reflects his larger religiopolitical project of bolstering the authority and intellectual legacy of al-Azhar in the context of inter-Sunni rivalry in the late twentieth century.
Nature without Suffering: Herbivorisation of Predator Species for the Compassionate Stewardship of Earth’s Ecosystems
Authors: Bruers Stijn , Davis Adam James , Hojjat Sara , Koskensilta Aatu , Lepeltier Thomas , Pearce David
Published: September 2024

Predation causes suffering and the premature deaths of prey animals. With innovative technologies on the horizon, humanity could phase it out. We argue that herbivorisation, i.e., turning carnivorous species into herbivorous ones with biotechnologies, is better than other strategies for ending predation, because it is the one most likely to preserve environmental values such as biodiversity and receive democratic support. Pressure on vegetation in herbivorised ecosystems would increase, but fertility control could relieve this pressure. We respond to other objections and conclude that the process should be considered as a future megaproject to reduce naturogenic harms.
Using ROC Analysis to Refine Cut Scores Following a Standard Setting Process
Authors: Wang Dongwei , Keller Lisa A.
Published: September 2024

In educational assessment, cut scores are often defined through standard setting by a group of subject matter experts. This study aims to investigate the impact of several factors on classification accuracy using the receiver operating characteristic (ROC) analysis to provide statistical and theoretical evidence when the cut score needs to be refined. Factors examined in the study include the sample distribution relative to the cut score, prevalence of the positive event, and cost ratio. Forty item responses were simulated for examinees of four sample distributions. In addition, the prevalence and cost ratio between false negatives and false positives were manipulated to examine their impacts on classification accuracy. The optimal cut score is identified using the Youden Index J. The results showed that the optimal cut score identified by the evaluation criterion tended to pull the cut score closer to the mode of the proficiency distribution. In addition, depending on the prevalence of the positive event and cost ratio, the optimal cut score shifts accordingly. With the item parameters used to simulate the data and the simulated sample distributions, it was found that when passing the exam is a low-prevalence event in the population, increasing the cut score operationally improves the classification; when passing the exam is a high-prevalence event, then cut score should be reduced to achieve optimality. As the cost ratio increases, the optimal cut score suggested by the evaluation criterion decreases. In three out of the four sample distributions examined in this study, increasing the cut score enhanced the classification, irrespective of the cost ratio when the prevalence in the population is 50%. This study provides statistical evidence when the cut score needs to be refined for policy reasons.
Responsive Constitutionalism in Australia
Authors: Dixon Rosalind
Published: September 2024

Responsive constitutionalism is a theory of constitutionalism that starts from the idea that democracy involves two overlapping commitments — to a relatively thin ‘minimum core’ set of norms and institutions and thicker, more contestable set of rights and deliberative commitments. It then proceeds to affirm a commitment both to legal and political constitutionalism. This article explores the relevance of this theory for Australian constitutionalism and suggests that it in fact has strong resonance with the Australian constitutional tradition. First, the capital ‘C’ Constitution gives strong legal protection to the ‘minimum core’ of democracy in ss 7, 24 and the High Court’s decisions on the implied freedom of political communication and access to the franchise. Second, the small ‘c’ constitution adopts norms that help protect the democratic minimum core and advance a responsive approach to thicker democratic commitments to rights. Third, there are important connections between the idea of responsive constitutionalism and limits on the scope legal constitutionalism and judicial review in Australia. Yet, there are also ways in which a responsive approach points to potential reforms of the Australian constitutional model — to include more robust rights-based constitutional protections, albeit in ways that are premised on a notion of shared legal and political authority and enforcement, and therefore involve a ‘weak-form’ national rights charter or extended principle of legality.
Reduced pineal gland volume in patients with obsessive-compulsive disorder
Authors: Atmaca Murad , Yildiz Sevler , Tabara Muhammed Fatih , Gurok Mehmet Gurkan , Yildirim Mustafa , Yildirim Hanefi
Published: September 2024

Objective

Patients with obsessive-compulsive disorder (OCD) can have hyperactivity of the hypothalamic-pituitary-adrenal axis and may have increased secretion of adrenocorticotropic hormone and cortisol and reduced secretion of melatonin. Examination of pineal gland volumes in patients with OCD compared to healthy controls, thus, is an important consideration and the focus of this study.

Methods

A total of 20 patients with OCD and 20 healthy controls were enrolled. Demographic and clinical characteristics of participants were assessed, and structural magnetic resonance imaging was performed.

Results

Patients with OCD had a statistically significant smaller pineal gland volumes compared to healthy controls.

Conclusion

In this initial small study, patients with OCD exhibited smaller pineal gland volumes compared to healthy control subjects. While this finding suggests a potential link between the pineal gland and OCD pathophysiology, further research with larger sample sizes and measurement of hormonal changes are necessary.
The Impact of Preoperative Flexible Fiberoptic Laryngoscopy on Anesthesia’s Intubation Plans
Authors: Gibson Anna Celeste , Farsi Soroush , Davis Kyle , King Deanne , Moreno Mauricio , Sunde Jumin , Vural Emre A.
Published: September 2024

Purpose: To assess the value of conducting a preairway management review of flexible fiberoptic laryngoscopy examinations (FFL) by the anesthesia team for patients with head and neck cancer and to examine its impact on intubation strategies and overall patient safety. Methods: Prospective study at a single tertiary referral center including patients with stage T2 and greater cancers of the oropharynx, hypopharynx, or larynx who underwent intubation by the anesthesia team between May 2022 and April 2023. Pre- and postoperative surveys gathered data on the intubation plan, including details such as method, sedation, patient respiration, laryngoscope, tube size, and use of paralysis. Postoperative surveys gauged the FFL’s subjective utility and documented intubation details and complications. Results: Thirty-four patients (49-87 years of age) were included in the study. Eleven intubation plans were changed after reviewing the FFL, while 23 were not. Although this was a pilot study, there was no significant correlation between location of the tumor and change in intubation plan. Of the 34 intubations, 9 were executed based on the plan after reviewing FFL. The majority of the attending anesthesiologists agreed or strongly agreed that seeing the FFL was more helpful than reading the findings in clinic notes and that reviewing the FFL was helpful in creating the intubation plan, 77% and 88%, respectively. Conclusion: Reviewing the FFL led to changes in the anesthesia team’s intubation plan in 32% of the cases in our pilot study. While these findings are promising, they highlight the need for further research with larger sample sizes and across multiple centers to validate the impact of FFL on intubation strategies for patients with stage T2 and greater cancers of the oropharynx, hypopharynx, or larynx.
Greater social network complexity mitigates pandemic-related negativity
Authors: Haque Eisha , Harp Nicholas R. , Neta Maital
Published: September 2024

Having strong, diverse social relationships is tightly linked to myriad physical and mental health benefits by mitigating the negative impacts of adverse events. The COVID-19 pandemic brought increased uncertainty and changes to our social lives that reduced the spread of COVID-19 (e.g., social distancing), but also likely impacted emotional well-being. We investigated how one of these changes – changing social networks – relates to emotional bias (a proxy for well-being), specifically one’s tendency to interpret ambiguous stimuli as positive or negative (i.e., valence bias). Participants ( N = 614) categorized the valence of clearly (e.g., angry and happy expressions) and ambiguously valenced stimuli (e.g., surprised expressions), and were asked about their social network before and during the pandemic. Compared to before the pandemic, participants reported a decrease in overall network size ( p < .001) and number of embedded networks (i.e., a measure of network complexity represented by number of areas of social activity; p < .001). In a model with all three social network dimensions (size, complexity, diversity), network complexity uniquely predicted valence bias ( p = .02). Specifically, participants with greater social network complexity during the pandemic showed a more positive bias. Further, participants that did not experience a pandemic-related reduction in network complexity were protected from pandemic-related increases in negativity ( p < .001). In other words, having a more complex social network could act as a protective factor against adverse outcomes in times of uncertainty.
Investigation on electrochemical corrosion behavior of Cu-14Fe -(0, 0.05)Ce alloys
Authors: Hu Qiang , Wu Xinlin , Wang Qiang
Published: September 2024

This work thoroughly investigated the electrochemical corrosion behaviors of Cu-14Fe-(0, 0.05) Ce alloys. Experimental findings revealed that the addition of Ce did not change the phase constituent, but refined α-Fe phase particle from 0.30 ± 0.04 to 0.22 ± 0.03 μm and increased its content from 1.24% to 2.17%. With the increase of corrosion time, adding Ce could increase the linear polarization resistance by up to 3 times, and correspondingly the corrosion rate was reduced to half. Moreover, Ce addition contributed to the densification of corrosion products. The α-Fe phase preferentially underwent anodic dissolution reaction, generating corrosion product Fe2O3. The increase of soaking time resulted in the occurrence of anodic dissolution of Cu-matrix phase, along with the formation of Cu2O and Cu2Cl(OH)3.
Ethical design through grounding and evaluation: The EDGE method for designing information systems for social impact
Authors: Young Amber G , Shuva Syed , Roth Tamara , Zhu Yaping , Hevner Alan R
Published: September 2024

The development of effective socio-technical information systems requires designers to balance ethical goals with functional capabilities and business objectives. To address this challenge, we propose EDGE, a novel ethical design method that focuses on two key activities in the systems development process—ethical grounding and evaluation of ethical impacts. We provide an empirical example of the EDGE method by applying it to the redesign of a sustainable application in the energy industry. This empirical example reveals the need for ethical clarity to ground and evaluate the app to achieve improved ethical performance and social impacts. We conclude with the implications of the new ethical design method and future research directions for its application and enhancement.
Experimental and numerical investigation of the modal parameters for thin laminated composite plates
Authors: Borgaonkar Avinash V , Potdar Shital B , Mulay Amrut S
Published: September 2024

In the present work, glass fiber-reinforced (GFR) composite specimens were fabricated using the vacuum-bag molding process. The properties related to the vibrational response of the fabricated composite plates, such as natural frequency, modal density, and damping loss factor (DLF), were investigated through both experimental and numerical approaches. The effects of different parameters, including boundary conditions (BCs), fiber orientations, laminate layer numbers, and aspect ratios, were comprehensively studied. It was found that the experimental and numerical results were in close agreement. For each case, finite element analysis was performed to determine the natural frequencies and mode shapes. Regarding the various BCs, the DLF was observed to be highest (0.47) for fully clamped BC and lowest (0.12) for free-free BC, whereas the modal density was highest (0.068) for cantilever BC and lowest (0.037) for fully clamped BC. In terms of different lamination schemes, the DLF was highest (0.42) for a plate with quasi-isotropic fibers and lowest (0.25) for a plate with unidirectional fibers, while the modal density was highest (0.068) for quasi-isotropic fibers and lowest (0.047) for unidirectional fibers. Regarding the plates with different laminate layers, the highest DLF (0.47) was observed for a plate with 16 layers, while the lowest DLF (0.33) was found in a plate with 8 layers. Conversely, the highest modal density (0.067) was observed for a plate with 8 layers, and the lowest (0.057) was noted for a plate with 16 layers. Lastly, considering aspect ratios, the highest DLF (0.48) was observed for an aspect ratio of 0.5, and the lowest (0.26) for an aspect ratio of 1.5. The highest modal density (0.09) was also observed for an aspect ratio of 0.5, while the lowest modal density (0.045) was for an aspect ratio of 1.5.
Nonlinear anti-vibration compliant mechanism with inertia amplification
Authors: Feng Xiao , An Ertai , Feng Jian , Qi Long
Published: September 2024

This paper presents a novel nonlinear anti-vibration compliant mechanism with a coupled inertia amplification (NAVCM-IA) for low frequency vibration isolation. This compliant mechanism consists of three-dimensional helical rods with stiffness nonlinearities, and an attached horizontally-installed inertia disc which performs as an inertia amplification. With this unique design, beneficial nonlinear stiffness can be achieved, which reduce the dynamic stiffness at equilibrium position and improve the vibration isolation performance at low frequency range. Moreover, the inertia amplification driven by the compliant mechanism achieves an apparent high dynamic mass and, accordingly, a low resonance frequency. The nonlinear compliant mechanism with a coupled inertia amplification is validated by experimental prototypes for their special nonlinear features. The proposed NAVCM-IA is a unique passive and adjustable low frequency anti-vibration solution in extensive engineering applications.
Chronic Disseminated Intravascular Coagulopathy Cured by Abdominal Aortic Aneurysm Repair
Authors: Rowlands Timothy E. , Norfolk Derek , Homer-Vanniasinkam Shervanthi
Published: September 2024

Disseminated intravascular coagulopathy (DIC) may rarely be caused by a previously asymptomatic abdominal aortic aneurysm (AAA). The authors describe a recent case where repair of the AAA provided a complete cure for the patient's bleeding tendency.

The multidisciplinary management of this patient is presented, and the evidence for the rare causal role of AAA in DIC is discussed. Coagulation disorders in aneurysm patients are probably under-reported, and warrant careful perioperative assessment.
Coronary Artery Bypass Grafting in Octogenarians
Authors: Sakamoto S. , Matsubara J. , Matsubara T. , Nagayoshi Y. , Nishizawa H. , Shouno S. , Kouno M. , Takeuchi K. , Nonaka T.
Published: September 2024

Preoperative profiles, postoperative complications, and the early and late results in 32 patients 80 yrs of age and older (elderly group) who underwent coronary artery bypass grafting were compared with those in patients under 80 yrs of age (control group). In the elderly group, the prevalence of patients with preoperative creatinine clearance (Ccr.) <50 1/day (34.4%), unstable angina pectoris (78.1%) and left main trunk disease (40.1%) was significantly higher than those in the control group. The incidences of arrhythmia and intensive care unit(ICU) syndrome were also significantly higher in the elderly group than in the control group, however, there was no death due to these complications. In the elderly group, one patient (3.1%) died in the hospital due to low cardiac output syndrome (LOS), while three patients (2.4%) of the control group died in the hospital. As for the long-term results, the 5-yr survival rates for the elderly group and the control group were 82.6% and 85.2%, respectively, and the effectiveness of surgery was remarkable, with improved postoperative activity in 96.9% of the elderly group. These findings indicate that although the elderly patients have higher risks by undergoing surgery and have a disadvantage in the rate of postoperative complications, the postoperative improvement in activity and survival rate can be similar to those in the younger patients.
Emergency Coronary Artery Bypass Grafting: Does Excessive Preoperative Anticoagulation Increase Bleeding Complications and Transfusion Requirements?
Authors: Grubitzsch Herko , Wollert Hans-Georg , Eckel Lothar
Published: September 2024

Patients requiring urgent surgical revascularization due to unstable coronary artery disease are usually pretreated with multiple antithrombotic drugs. The perioperative risks of this type of treatment were investigated in 123 patients who underwent emergency coronary artery bypass grafting (CABG) at our institution.

Eighty-two patients (group A) received heparin and acetylsalicylic acid solely and 41 patients (group B) received additionally ADP-receptor antagonists (82.9%), glycoprotein IIb/IIIa inhibitors (12.2%) or thrombolysis (14.6%) preoperatively. Both groups were similar regarding demographic data and overall clinical status. Preoperative coagulation parameters and intraoperative characteristics were comparable. Blood loss via chest tubes was not significantly different between groups. Transfusion of red blood cells and fresh frozen plasma were slightly, but not significantly increased in group B. Transfusion of pooled platelets was low in general and similar in both groups. Re-exploration rate, medium intensive care unit and hospital stay as well as perioperative mortality were comparable.

Excessive antithrombotic pretreatment seems to bear no additional risk in emergency CABG and may be beneficial in this setting.
Clinical Application of Endovascular Grafts in Aortoiliac Occlusive Disease and Vascular Trauma
Authors: Marin M. L. , Veith F. J.
Published: September 2024

Intravascular stents and stented grafts are becoming important tools for the management of a variety of vascular lesions. This review addresses the technical feasibility and early results of aortoiliac endovascular reconstructions for limb salvage as well as the placement of stented grafts for the treatment of traumatic arterial lesions. Eighteen patients with limb-threatening ischemia secondary to aortoiliac and femoropopliteal occlusive disease who were poor candidates for standard arterial bypass operations and eight patients with traumatic arterial lesions (two arteriovenous fistulas; six pseudoaneurysms) were treated with endovascular stented grafts. These were constructed of 6-mm tubular polytetrafluoroethylene (GORE-TEX) and balloon-expandable stents (Palmaz). Technical success was achieved in 95% of grafts placed to treat long segment occlusive disease of the iliofemoral arteries and in 100% of grafts placed to treat traumatic arterial injuries. There were no deaths and only minor complications in both groups. Although the early results with these grafts are encouraging, long-term follow-up is needed before such devices can be recommended for widespread use.
Sequential Internal Mammary Artery Grafting: A Viable Alternative in Myocardial Revascularization
Authors: Bessone L. N. , Pupello D. F. , Hiro S. P. , Lopez-Cuenca E. , Glatterer M. S. , Angell W.W. , Ebra G.
Published: September 2024

The internal mammary artery has become the conduit of choice in myocardial revascularization. The expanded use of this ideal conduit for sequential grafting has enhanced its application. Between March 1985 and June 1993, 245 consecutive patients underwent revascularization of the myocardium with internal mammary artery bypass grafts with at least one sequential anastomosis. There were 186 men and 59 women, with a mean age of 65.1 (range 40–82) years. Unstable angina was present in 141 patients (57.6%) and 36 patients (14.7%) had left main coronary artery stenosis (> 50%). Before surgery, five patients (2.0%) were in New York Heart Association (NYHA) class II, 113 (46.1%) in class III, and 127 (51.8%) in class IV. There were a total of 1041 coronary artery grafts, mean 4.2 (range 2–7) grafts per patient and 528 sequential left internal mammary artery anastomoses, mean 2.2 per patient. Hospital mortality rate was 2.4% (six patients). Almost two-thirds of the patients experienced no hospital complications. The most frequent complication included arrhythmia in 36 patients (14.7%), respiratory insufficiency in 15 (6.1)% and temporary left phrenic nerve palsy in ten (4.1%). Mean follow-up was 37.0 (range 1–94.2) months. The mean(s.e.m.) actuarial survival rate for patients discharged from hospital was 94.8(1.6)% at 36 months and 82.4(5.0)% at 72 months. At follow-up of 222 patients, 185 (83.3%) were symptom-free in NYHA class I and 27(12.2%) were in class II. Though technically demanding, multiple sequential internal mammary artery grafting is feasible and can be accomplished with low hospital mortality and morbidity. The added complexity, length of procedure and potential for inadequate volume flow through the application of sequential grafting did not adversely affect the clinical outcome in the series.
Successful Surgical Treatment of Aortocaval Fistula Using Cardiopulmonary Bypass
Authors: Yamashita C. , Kozawa S. , Kujime K. , Okada M.
Published: September 2024

Aortocaval fistula caused by rupture of an abdominal aneurysm was diagnosed before surgery and treated successfully using cardiopulmonary bypass, which effectively controlled the massive bleeding. Rupture of the false lumen of a dissecting aneurysm limited to the abdominal aorta was responsible for the aortocaval fistula. The defect of the inferior vena cava was closed with a running suture and the aneurysm replaced with a collagen-coated Y graft.
Colour Duplex in Assessing the Infrainguinal Arteries in Patients with Claudication
Authors: Davies A. H. , Willcox J. H. , Magee T. R. , Currie I. , Cole S. E. A. , Murphy P. , Lamont P. M. , Baird R. N.
Published: September 2024

Non-invasive assessment of the lower-limb vasculature may avoid unnecessary arteriography. Colour duplex scanning of the femoral and popliteal arteries was performed in claudicants who were potential candidates for endoluminal therapy. This was compared with the findings of biplanar conventional arteriography and intra-arterial digital subtraction angiography. In 112 lower limbs duplex gave the following results compared with angiography: the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for occlusions ( n = 48), stenoses ( n = 31), atheromatous vessel ( n = 21) and disease-free ( n = 12) were all greater or equal to 94%. The lengths of the occlusions were accurately identified by duplex. Clinical examination and spectral analysis at the common femoral artery failed to identify two patients who had an iliac lesion. Colour duplex examination is the investigation of choice in assessing the major infrainguinal arteries in patients with claudication.
Pericardial Mesothelioma Presenting as Left Atrial Thrombus in a Patient with Mitral Stenosis
Authors: Miyamoto Y. , Nakano S. , Shimazaki Y. , Matsuda H. , Fukuda H.
Published: September 2024

Primary pericardial mesothelioma is rare and remains a diagnostic and therapeutic challenge. Pericardial mesothelioma usually occurs independently of intracardiac lesions and infiltrates adjacent tissues superficially. An extremely rare case of malignant pericardial mesothelioma complicated by prior mitral valve surgery is reported. The tumour invaded the left atrium and mimicked a thrombus.
Upper Extremity Thromboembolism after Axillary-axillary Bypass Grafting
Authors: McLafferty R. B. , Taylor L. M. , Moneta G. L. , Yeager R. A. , Edwards J. M. , Porter J. M.
Published: September 2024

Two patients experienced upper extremity thromboembolism after axillary-axillary bypass grafting (AxAG) for symptomatic subclavian artery stenosis. The first patient, a 67-year-old male, presented with left upper extremity thromboembolism 3 years after AxAG with 8 mm externally support PTFE. An arteriogram revealed a patent AxAG, thrombus in the proximal left subclavian arterial stump just distal to its occlusion, and multiple digital artery emboli. The patient was treated with warfarin for 8 months, with resolution of symptoms. The second patient, a 57-year-old male, occluded his AxAG (8 mm knitted Dacron) with minimal return of symptoms. Non-operative treatment was elected and 4 years later the patient presented with right upper extremity (donor side) thromboembolism. Arteriography revealed occlusion of the AxAG, radial artery, and digital arteries of the index, long and ring fingers. Thrombolytic therapy of the right arm was undertaken with minimal improvement. Subsequent detachment of the AxAG and placement of an interposition reversed saphenous vein graft was performed. Both patients continue to be asymptomatic during follow-up of 4.7 and 2.0 years, respectively.
Effects of Pulsatile Perfusion on Human Saphenous Vein Vasoreactivity: A Preliminary Report
Authors: Schwartz L. B. , Purut C. M. , Massey M. F. , Pence J. C. , Smith P. K. , McCann R. L.
Published: September 2024

This study examined the effects of exposure to arterial blood pressure and flow on human saphenous vein catecholamine sensitivity. Unused portions of saphenous vein from eight patients undergoing peripheral bypass procedures were mounted parallel in a specially designed organ culture apparatus and perfused with tissue culture medium with 95% CO2 at 37°C. One segment was fixed between two cannulas while the medium was gently agitated (control) and the other was actively perfused via a pulsatile pump system at a rate of 60 beats/min, peak pressure of 100 mmHg and peak flow of 200 ml/min (pulsed; mean pressure 60 mmHg; mean flow 115 ml/min). After 48 h, vein segments were removed and tested for in vitro isometric contraction in response to KCI, norepinephrine and histamine, and relaxation in response to acetylcholine, calcium ionophore A23187, and sodium nitroprusside. There were no differences in mean(s.e.m.) maximal contraction in response to KCl (control 0.61 (0.16) g versus pulsed 0.72(0.27) g; P= n.s.), norepinephrine (control 1.00(0.56) g versus pulsed 1.51 (0.54) g; P=n.s.). or histamine (control 1.47(0.85) g versus pulsed 1.95(0.64) g; P= n.s.). However, pulsed veins exhibited increased sensitivity to both norepinephrine (control -logED506.20(0.23) versus pulsed mean(s.e.m.) 6.60(0.17); P<0.05) and histamine (control -logED505.60(0.27) versus pulsed 6.24(0.20); P= 0.05). Pulsed veins exhibited slightly less acetylcholine-induced relaxation although the difference did not reach statistical significance (control mean(s.e.m.) relaxation at 1 times 10−6M 9.2(14.0)% versus pulsed −13.3(6.4)%; P= n.s.). There were no differences in relaxation in response to either A23187 (control 1 times 10−4M 178(19)% versus pulsed 191(68)% or sodium nitroprusside (control 225(15)% versus pulsed 254(17)%; P= n.s.). The data presented herein indicate that exposure of human saphenous vein to the hemodynamics of the arterial environment for 48 h results in catecholamine supersensitivity while contractile and relaxant function are not affected.
Eversion Endarterectomy in Surgery of the Internal Carotid Artery
Authors: Entz L. , Járányi Zs. , Nemes A.
Published: September 2024

A total of 361 eversion endarterectomies of the internal carotid artery have been carried out on 348 patients between January 1991 and December 1992. Of these patients, 126 were women and 222 were men; average age was 62.9 (range 42–84) years. Some 239 patients had hemispheric symptoms; 37 symptomless patients had a carotid endarterectomy before major vascular reconstruction, and 21 had the operation combined with heart surgery (19 aortocoronary bypasses, two valve replacements). In nine cases (2.5%) a 6-mm interposition graft was used because of unsuccessful eversion endarterectomy. Postoperative bleeding occurred in six patients (1.7%) and postoperative stroke in seven (1.9%); of these patients, four died and two still have mild neurological symptoms. Four reocclusions occurred during the first 6 months that the new method was used. Eversion endarterectomy of the internal carotid artery is a safe and useful technique and is comparable with standard endarterectomies. This technique may reduce the risk of restenosis.
Role of Right Gastroepiploic Artery in Myocardial Revascularization with Arterial Grafts
Authors: Antona C. , Zanobini M. , Pompilio G. , Lotto A. A. , Rona P. , Cavoretto D. , Alamanni F. , Sala A. , Biglioli P.
Published: September 2024

Between July 1990 and December 1992, 112 patients underwent myocardial revascularization with arterial grafts in the Department of Cardiac Surgery, University of Milan. Monovascular patients were excluded from the study. The right gastroepiploic artery was used in 44 patients (39 3%)- mean age was 54.3 years and reoperation rate 18.2%. Of the 44 patients, previous myocardial infarction had occurred in 25 (57%). Emergency operation was performed in one case (2%). Mean left ventricular shortening fraction was 36% and mean ejection fraction 58 6% Coronary artery disease was bivascular in 10 patients (23%) and trivascular in 34 (77%). The arterial revascularization in patients with gastroepiploic artery was performed using a left internal thoracic artery graft in all 44 patients; the right internal thoracic artery was used in 18 (41%) and the inferior epigastric artery in two (4%). The sites of gastroepiploic artery grafting were 55% posterior descending, 16% right coronary artery, 11% posterolateral branch, 14% circumflex and in 4% posterior descending and posterolateral as sequential graft. No patient died; postoperative myocardial infarction rate was 4%. No complications related to gastroepiploic artery utilization were noted. Forty-three (98%) of the gastroepiploic artery group underwent graft reinvestigation: the arteries were correctly visualized in 41 patients (95%) and were patent in 39 cases and stenotic in two. A mid-term postoperative stress test (mean 17.4 months) was performed in 91% of patients. Normal limits were found in 37 patients (92.5%) and an abnormal stress test result in three (7.5%). The contemporary follow-up showed no deaths or myocardial infarctions. Three patients (7%) had recurrent angina. The role of gastroepiploic artery in arterial revascularization has become fundamental, especially, it is believed, for the posterior or posterolateral left ventricular wall. The present data show the patients to be clinically and functionally well 1 year after operation.
Revascularization of the Ischaemic Hand Using in Situ Veins
Authors: Ristow A. v. , Cury J. M. , Costa E. L. F. , Gardeazábal G. , Sampaio M. M. , Peixoto C. C. S.
Published: September 2024

Chronic severe ischaemia of the upper limb is rare, due to the low incidence of arterial disease and to the presence of an adequate pre-existent collateral network. However, sometimes it occasionally occurs, dictating the need for revascularization. Since 1990, the authors have revascularized five upper extremities with severe ischaemic changes, employing the cephalic and/or basilic veins, used in situ. The aetiology of the arterial disease was autoimmune in one case and late sequelae of trauma in the others. Of the in situ venous bypasses performed, three were brachial-radial, and two sequential grafts (one axillary-radial-ulnar and one axillary-brachial-radial-ulnar). One concomitant sympathectomy was performed. All patients had excellent early and late results which leads the authors to recommend such revascularization of the forearm and hand, especially in the presence of severe ischaemia.
Recurrent Femoral Anastomotic False Aneurysms: Is Long Term Repair Possible?
Authors: Melliere D. , Becquemin J. P. , Cervantes-Monteil F. , Chevillier B. Le , Berrahal D.
Published: September 2024

This study was undertaken to evaluate the operative problems and the fate of patients operated on for recurrent femoral anastomotic false aneurysms, following aortofemoral bypass. It was found that 58 of 66 anastomotic false aneurysms which developed after aortoiliac or aortofemoral reconstruction were located at the femoral level, six at the anastomosis of the graft to the aorta and two at the iliac artery anastomosis. Six recurrences developed after surgical repair of femoral anastomotic false aneurysms but there were none after repair of aortic or iliac anastomotic false aneurysms. Of the six recurrences one patient was treated by direct repair and the remaining five by interposition of a prosthetic graft. There were no ischaemic complications or recurrences in a mean of three years. Elective, repeated repair is therefore a successful method of treating anastomotic false aneurysms. Deep sutures should be inserted into the arterial wall, tension should be avoided by placing an interposition graft when necessary, using a careful aseptic technique. Patients should be told to avoid extreme extension and rapid flexion-extension of the hip joint for the rest of their life.
A Prospective Study Comparing Duplex Scan and Venography for Diagnosis of Lower-extremity Deep Vein Thrombosis
Authors: Miller N. , Satin R. , Tousignant L. , Sheiner N. M.
Published: September 2024

This study was designed to compare duplex scanning with contrast venography for the diagnosis of acute deep vein thrombosis of the lower extremity, both at the femoropopliteal (above-knee) and tibioperoneal (below-knee) levels. A total of 216 patients with 220 limbs suspected of acute deep vein thrombosis underwent duplex scanning followed within 24 h by ascending venography. The two studies were interpreted independently by two physicians who were blinded to the results of the corresponding alternative study. Venography was positive for deep vein thrombosis in 44.5% of cases (98/220). Duplex scanning was inadequate at the above-knee level in two cases (0.9%) and at the below-knee level in 17 cases (7.7%). Sensitivity and specificity of duplex scanning at above-knee level were 98.7% and 100% respectively while corresponding values were 85.2% and 99.2% at below-knee level. By excluding technically inadequate duplex studies, the sensitivity at below-knee level was clearly improved (93.8%). It is concluded that with meticulous technique, duplex scanning is highly accurate in diagnosing acute deep vein thrombosis of symptomatic lower extremities, avoiding contrast venography in over 90% of the cases, even at the tibioperoneal level.
A Technique for the Creation of Long Autogenous Tissue Arterial Patches
Authors: Solis M. M. , Cobb M. A. , Johnsont D. D. , Barnest R. W. , Eidt J. F.
Published: September 2024

An endarterectomized segment of an occluded artery (e.g. superficial femoral artery), is an alternative autogenous material for patch angioplasty which preserves the continuity of the saphenous vein. A technique of incising endarterectomized segments of superficial femoral artery in a spiraled manner is presented which allows for the creation of long autogenous tissue patches. A spiral is drawn on the exterior of a harvested arterial segment which is either 1 cm. 7 mm or S mm in width. When incised along the spiral, the length of the resulting elliptical patch will be two. three, or four times, respectively, the length of the original artery segment. The authors have used the technique to close extended profundoplasty in three patients and for construction of a patched distal anastomosis in two patients undergoing prosthetic femoro-popliteal bypass grafting. There have been no early complications.
What are the Limits for the Ross Operation?
Authors: Melo J. Q. , Abecasis M. , Neves J. P. , Canada M. , Ribeiras R. , Parreira L. , Andrade N. , Calquinha J. , Ferreira J. M. , Rebocho M. J. , Seabra-Gomes R.
Published: September 2024

The Ross operation is physiologically the best approach for aortic valve replacement. At the Hospital de Santa Cruz 22 consecutive pulmonary autograft operations have been performed in patients with a mean age of 49 (range 17-65) years. Six patients had mitral valve disease, two had aortic aneurysms and one had a ventricular septal defect. Subcoronary implantation of the autograft was performed in 20 patients. A partial inclusion aortic root replacement technique was used in one and the aortic root was replaced in another. There were no hospital or late deaths. Two patients required autograft replacement at 3 and 9 months postoperatively because of regurgitation. One of these cases was caused by an abnormality of the pulmonary valve and since then echocardiographic assessments of this valve have been performed routinely and have detected significant pulmonary incompetence in four patients who otherwise would have been operated on using the Ross procedure.