bluuebunny/crossref_metadata_2025 huggingface dataset:
A Prospective, Randomized Trial Comparing a Transparent Dressing and a Dry Gauze on the Exit Site of Long Term Central Venous Catheters of Hemodialysis Patients
Authors: Le Corre I. , Delorme M. , Cournoyer S.
Published: March 2018

The objective of this study was to assess the risk of bacteremia, estimate the cost and evaluate the quality of life by using a transparent dressing (TD) versus (vs) a dry gauze (DG) on the exit site of long term central I.V. catheters (LTCC) of hemodialysis patients.

This 6-months preliminary study was conducted on 58 patients (pts) randomized to receive DG replaced 3 times/week (29 pts) or TD replaced every 7 days (29 pts). Data on patients, conditions of the exit site, local infection, bacteremia, quality of life and cost related to each type of dressing were collected.

Two pts in the DG group experienced bacteremia related to their LTCC vs 1 pt in the group TD. A total of 7 (DG) vs 13 (TD) pts experienced skin condition changes at the catheter exit site. Some skin reactions, erythema and pruritus, did occur initially in the group TD and was due in part to insufficient drying time of the skin preparation solution. The estimated individual, weekly costs for using the DG was $7.60 vs $4.72 Canadian dollars for the TD. The SF-36™ scores did not show a significant difference between the 2 groups during the study (3.8 (PCS), 6.4 (MCS) at study end).

Although this study was statistically underpowered, it suggests that the incidence of bacteremia was not increased with the use of a TD. Moreover, the use of a TD allowed fewer dressing changes, lowered total treatment costs, with no observed unfavorable impact on the quality of life and without significant local complications of the exit site. Based on the positive results observed in this pilot study, further study is warranted to examine the cost effectiveness of long-term use of TD dressings on dialysis catheter exit sites.
Evaluating the Impact of an Aggressive Strategy to Create Wrist Arterio-Venous Fistula in Patients on Hemodialysis
Authors: Barama A.A.
Published: March 2018

Objectives

To compare two approaches to hemodialysis arterio-venous fistula (AVF) creation, and to evaluate the benefit of expanding wrist-AVF selection criteria.

Background

The recommendation summarized under the Dialysis Outcome and Quality Initiative (DOQI) suggests the placement of a wrist-AVF as a first choice for patients starting hemodialysis. However, its benign complications contrast with its high early failure rates. In the absence of predictors of a successful access, decision on whether or not to attempt such an access depends on the subjective clinical judgment.

Methods

This is a retrospective study of patients with ESRD disease in Southern Alberta who underwent a vascular access creation during the year 2000. The surgery was performed by 2 surgeons each having his own approach to access selection (approach A and B). Approach A had broader criteria (vessels < 3 mm) for wrist-AVF creation, whereas approach B was more conservative, thus limiting the selection to patients with wrist vessels superior to 3 mm. The type of simultaneous access created in the same limb was dependant of this first choice. A Markov decision tree analysis was used to model yearly transition between patent and failed access. The absence of further possibility of access creation in the same arm was taken as a time horizon. Sensitivity analysis was used to test the effect of maximizing a wrist-AVF on overall arm failure.

Results

In approach A there was 69% of wrist AVF creation as the first type of access compared to 31% in approach B. A two-year wrist-AVF patency was 80% in approach B versus 61% in approach A. The expected mean time to complete limb failure was longer in patients treated with approach A (3.62 versus 3.50 years). Sensitivity analysis showed an ultimate benefit for approach A.

Conclusion

Wrist vessel size less than 3 mm should not be a limiting factor for the creation of a wrist-AVF. Maximizing the creation of such an access, despite increasing the rate of early failure, prolongs the option of hemodialysis access in the same arm.
Creation of Secondary AV Fistulas from Failed Hemodialysis Grafts: The Role of Routine Vein Mapping
Authors: Nguyen V.D. , Treat L. , Griffith C. , Robinson K.
Published: March 2018

Pre-existing forearm grafts lead to dilatation of upper arm veins of the ipsilateral arm that greatly facilitates the creation of secondary arteriovenous fistulas (AVF). In this retrospective review of 18 patients, the routine and periodical revision of failed grafts were discontinued. Vein mapping by physical examination or Duplex studies was performed prior to graft failure and a secondary AVF was created when the graft failed. Using this management strategy, an AVF creation success rate of 95% was achieved despite high incidence of co-morbidity factors within the patient population. This success rate demonstrates the value of vein selection by vascular mapping prior to graft failure and early vascular access planning in the successful creation of secondary AVF.
Serum LDL Levels are a Major Prognostic Factor for Arteriovenous Fistula Thrombosis (AVFT) in Hemodialysis Patients
Authors: Serati A.R. , Roozbeh J. , Sagheb M.M.
Published: March 2018

Introduction

Arteriovenous fistula thrombosis (AVFT) is still a common cause of morbidity in patients undergoing regular hemodialysis (HD). Many factors have been found to induce AVFT. Some of those factors are local and others are systemic ones. In this study, we evaluated some local and systemic factors simultaneously, to predict the most potent risk factor for AVFT in HD patients.

Patients and methods

One hundred and eighteen patients aged 20–80 yrs with end-stage renal disease (ESRD) were evaluated prospectively for a period of 14 months. First, anticardiolipin antibodies (ACLA), TG, cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) were analyzed by conventional methods. Other basic data were accessed from patients' medical records. All fistulas were evaluated clinically as patent at the start of this study. Patients were followed-up for any evidence of AVFT within 14 months. Finally, all factors (diabetes, hypertension, presence of ACLA, ultrafiltration ≥3 L, age, gender, weight, hypotension during dialysis, fistula site, epoetin alpha usage, TG, HDL, LDL and total cholesterol) were analyzed in a stepwise regression analysis.

Results

Eighteen episodes of AVFT documented with Doppler sonography occurred in 17 patients (15.3%). Regression analysis showed only LDL values were the AVFT predictor in our patients (p=0.002, β-coefficient=0.3). Kaplan-Meier analysis showed a significantly lower AVF patency time in patients with LDL >130 mg/dl than those with LDL <130 mg/dl (log rank=0.0014).

Discussion

LDL value is a major prognostic factor for AVFT in HD patients and lowering it to <130 mg/dl could improve fistula patency.
Venae Comitantes Fistulae: An Option in Patients with Difficult Hemodialysis Access
Authors: Srinivasaiah N. , Yalamuri R.R , Umez-Eronini N.O. , Rix D. , Talbot D.
Published: March 2018

Objectives

To evaluate the outcome of use of venae comitantes vessels in the formation of arterio-venous fistulae as vascular access for hemodialysis, in patients with limited venous anatomy.

Methods

Twenty patients who underwent arterio-venous anastomosis between brachial artery and venae comitantes were identified (2002 – 2005) and the notes reviewed.

Results

There was early failure in two (10%) patients (immediate postoperative period) and a further four (20%) failed late (mean 26 weeks, range 7–60). One patient developed a steal syndrome with radial nerve dysfunction requiring ligation of the fistula. Six (30%) patients utilised their fistulae for dialysis successfully without additional surgery and a further 6(30%) required surgical intervention to exteriorise the fistulae by the use of interposition grafts to allow successful use.

Conclusion

Venae Comitantes arterial fistulae offer an option in patients with limited venous anatomy for standard reconstruction. If access surgery utilizes such veins second stage procedures are often required with overall 70% use.
Stenosis at the area of Transposition – An Under-Recognized Complication of Transposed Brachiobasilic Fistulas
Authors: Beaulieu M.C. , Gabana C. , Rose C. , Macdonald P.S. , Clement J. , Kiaii M.
Published: March 2018

Background

With an increased focus on native AV fistula creation in hemodialysis patients, a transposed brachiobasilic fistula (tBBF) is becoming an increasingly utilized option. This study describes the outcomes of tBBFs in a chronic hemodialysis population. In particular, we focus on the incidence and location of stenosis, and review the impact of angioplasty on these lesions.

Methods

A retrospective cohort study using all patients with a tBBF created between January 2001 and December 2004.

Results

Of the 543 fistulas created during the study period, 93 were tBBFs. The mean age of patients was 65 years, 56% were male and 55% were diabetic. Stenosis occurred in 54% (46/85) of fistulas; the location of stenosis in the majority (74%) was at or near the area of basilic vein transposition and 50% of fistulas with stenosis in this location required three or more angioplasties. Primary (unassisted) patency was 42% at one year in this cohort. Secondary patency was 68% at 1 year and 58% and 53% at 2 and 3 years respectively.

Conclusion

In a cohort of hemodialysis patients who received a tBBF, we describe a reasonable primary and secondary patency rate and a high rate of stenosis at the point of transposition of the basilic vein. Such stenosis usually requires multiple percutaneous or surgical interventions to ensure or reestablish conduit patency. Further study is required regarding the optimal surgical technique, monitoring, and treatment of stenosis of this fistula type including the utility of repeat angioplasty.
Accessory Veins and Radial-Cephalic Arteriovenous Fistula Non-Maturation: A Prospective Analysis Using Contrast-Enhanced Magnetic Resonance Angiography
Authors: Planken R.N. , Duijm L.E. , Kessels A.G. , Leiner T. , Kooman J.P. , Van Der Sande F.M. , Tordoir J.H.M.
Published: March 2018

Purpose

To determine if large caliber accessory veins are associated with radial-cephalic arteriovenous fistula (RC-AVF) non-maturation.

Methods

RC-AVFs were created in 15 consecutive patients (radial artery and cephalic vein diameter >2 mm, in the absence of arterial inflow or venous outflow stenoses or occlusions). Contrast-enhanced magnetic resonance angiography (CE-MRA) was performed preoperatively for the determination of vessel diameters, stenoses and occlusions. The location and caliber of accessory veins was determined. Vascular access (VA) function was monitored and all interventions required to obtain a functioning VA were recorded. Non-maturation was defined as a nonfunctional VA at 2 months after creation. The predictive value of accessory vein caliber for prediction of RC-AVF non-maturation was evaluated using receiver operating characteristic (ROC) analysis.

Results

Non-maturation occurred in 10 (67%) out of 15 RC-AVFs. Large caliber accessory veins (n=4), venous stenosis (n=3) or both (n=2) were associated with RC-AVF non-maturation. The presence of large caliber accessory veins was the only significant predictor for RC-AVF non-maturation (p=0.01). Preoperatively detected accessory veins with a diameter >70% of the cephalic vein diameter, had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 80, 100, 100 and 91% for prediction of RC-AVF non-maturation on patient level. Accessory vein ligation and dilatation of venous stenosis resulted in an overall salvage success rate of 89% (8/9).

Conclusion

Large caliber accessory veins are associated with RC-AVF non-maturation. Ligation of large caliber accessory veins is a successful salvage procedure in a substantial group of patients. Furthermore, ligation of these accessory veins during initial RC-AVF creation can potentially reduce non-maturation rates; and therefore, preoperative assessment of accessory veins is recommended.
Using Arteriovenous Fistulae as a Dual Access for Hemodialysis and Total Parenteral Nutrition Administration is Feasible with a Good Outcome: A Case Series
Authors: Tang V.C.Y , Morsy M.A , Chemla E.S.
Published: March 2018

End stage renal failure patients requiring long term total parenteral nutrition (TPN) often have multiple central line placements due to line infection or occlusion. Sometimes this can cause central venous stenosis or even occlusion. We present three cases in this consecutive series, in which we have successfully used arteriovenous fistulae for both hemodialysis and long term TPN administration as an alternative route without any complications. We therefore think that native AVF and grafts can be used as dual access for hemodialysis and TPN administration provided careful case selection, counselling and follow-up.
Measurement of Hemodynamic and Anatomic Parameters in a Swine Arteriovenous Fistula Model
Authors: Krishnamoorthy M. , Roy-Chaudhury P. , Wang Y. , Roy A. Sinha , Zhang J. , Khoury S. , Munda R. , Banerjee R.
Published: March 2018

Purpose

Although arteriovenous fistulae (AVFs) are currently the preferred mode of permanent hemodialysis access they do have significant problems due to initial non-maturation and a later venous stenosis. These problems appear to have been exacerbated following a push to increase AVF prevalence in the US. The reasons for both AVF non-maturation and the later venous stenoses are unclear but are thought to be related to abnormal hemodynamic wall shear stress (WSS) profiles. This technical note aims to describe the successful development of measurement techniques that can be used to establish a complete hemodynamic profile in a pig model with two different configurations of AVF.

Methods and results

The curved and straight AVF configurations were created in an in vivo pig model. Flow and pressure in the AVFs were measured using the perivascular flow probes and Doppler flow wires while the pressure was recorded using a pressure transducer. The anatomical configuration was obtained using two different approaches: a) combination of intravascular ultrasound (IVUS) and angiograms, (b) 64 slice CT angiography. 3D models were reconstructed using image processing and computer modeling techniques. Numerical calculations were then performed by applying the measured flow and pressure data into the configurations to obtain the hemodynamic WSS profiles.

Conclusion

The described methodologies will allow the calculation and optimization of WSS profiles in animal models. This information could then be translated to the clinical setting where it would have a positive impact on improving the early maturation rates of AVFs as well as reducing the late venous stenoses.
Brachial Vein Transposition Arteriovenous Fistula: Is it an Acceptable Option for Chronic Dialysis Vascular Access?
Authors: Torina P.J. , Westheimer E.F. , Schanzer H.R.
Published: March 2018

Purpose

The aim of this study was to evaluate the midterm performance of brachial vein arteriovenous fistulas (AVFs) and to compare this performance with arteriovenous grafts (AVGs) and basilic vein transposition AVFs.

Methods

A retrospective analysis was performed. Between December 2002 and October 2006, 149 AV access procedures consisting of brachial vein transposition AVFs (11 one-stage and 2 two-stage procedures), basilic vein transposition AVFs (n=42), and AVGs (n=94) were performed in 141 patients.

Results

73% of one-stage brachial vein AVF patients experienced at least one complication during follow-up vs. 52% of the basilic vein transposition AVF group and 55% of the AVG group. The primary patency rates at 12 months for one-stage brachial vein AVFs, basilic vein AVFs, and AVGs were 24, 45 and 50%, respectively. The assisted primary patency rates were 45, 74 and 63%, and the secondary patency rates were 45, 74 and 78%, respectively. A significant difference in the overall secondary patency rates between one-stage brachial vein AVF and AVGs (p=0.015) was detected. Significance was approached between one-stage brachial vein AVFs and basilic vein AVFs overall assisted primary patency (p=0.055) and secondary patency (p=0.055) rates.

Conclusion

The brachial vein transposition, when done as a one-stage procedure, is associated with inferior patency rates when compared to the basilic vein transposition AVF and AVG. Therefore, in the setting of inadequate cephalic and basilic vein, a prosthetic graft is superior to a brachial vein transposition. A two-stage procedure, as suggested by others, may improve the results of this technique.
Transposed Brachiobasilic Fistula or PTFE Arm Graft - Alternative or Complementary?
Authors: Milburn J.A. , Lo S.T. , Szucs Z.J. , Humphrey A. , Macaulay E.M.
Published: March 2018

Purpose

Our primary aims were (1) to examine the patency of transposed brachiobasilic (TBB) fistulae compared to arm arteriovenous graft (AVG) without prior transposition, and (2) to examine the patency of AVG with and without prior transposition.

Methods

Single institution; analysis of prospectively collected data between January 2001 and January 2007. Dedicated database and medical records were reviewed and results analyzed with SPSS.

Results

Ninety-one patients underwent 111 procedures (52 TBB: 39 AVG as index); 28 TBB failed with 17 (60%) being replaced with an ipsilateral AVG. TBB compared to AVG (without prior TBB) had significantly (log rank <0.05) better primary, primary assisted and secondary patency. Secondary patency at 2 yrs was 47% to 33%, respectively. Ipsilateral AVG after TBB to primary AVG had superior patency rates (secondary patency at 2 yrs 52 vs. 33%) but did not reach significance (log rank =0.073). Combined secondary patency of TBB and AVG after TBB was 81% at 2 yrs.

Conclusions

The TBB offers an autogenous fistula in the upper arm which has superior patency rates to an arm AVG. Once a TBB has failed an ipsilateral AVG is technically feasible and may offer better patency than a primary AVG.
Predicting Arteriovenous Fistula Maturation with Intraoperative Blood Flow Measurements
Authors: Berman S.S. , Mendoza B. , Westerband A. , Quick R.C.
Published: March 2018

Objective

To establish the criteria for intraoperative blood flow measurements taken at the time of autologous arteriovenous fistula (AVF) construction to predict future access maturation and thereby avoid waiting periods for futile fistulas to declare themselves.

Methods

From April 2006 through to March 2007 consecutive patients undergoing native AVF construction at one institution underwent intraoperative measurements of blood flow using transit-time ultrasound technology. No action was taken based upon the flow measurement at the time of surgery. Patients were followed and data collected comprising demographics and AVF maturation. A fistula was considered mature when it was successfully accessed for hemodialysis (HD) at least three times. Statistical analysis was performed including receiver operating characteristics (ROC), ANOVA, and Chi square using the JMP software package.

Results

During the 12-month period, 70 autologous AVFs were created including 41 antecubital brachiocephalic, 21 radiocephalic, and 8 basilic vein transpositions in 35 females and 33 males with a mean age of 58 ± 1.7 (mean ± SEM). The group included 37 Hispanic, 17 Native American, 10 Caucasian, 3 African American and 1 Asian patient. The etiology of renal failure comprised 53 diabetics, 13 hypertensives, 1 polycystic kidney disease and 1 congenital abnormality. Complete follow-up was available in 69/70 AVFs in 67 patients. Patients were excluded from analysis if they had not yet started dialysis (n=12), stopped or died (n=4) before their fistula was accessed. Patients whose AVFs were patent, but required a secondary procedure to achieve a functional access were considered non-functional. There was a significant difference between the maximal intraoperative flow rates between functional and non-functional AVFs (573.6 ± 103 mL/min vs. 216.8 ± 35.8 mL/min; p<0.05). There was no difference between groups in regard to age, gender, race or etiology of renal failure. ROC analysis suggested a threshold value of 140 mL/min for radiocephalic and 308 mL/min for brachiocephalic AVFs to predict maturation to a functional access.

Conclusion

Intraoperative blood flow measurements obtained at the time of autologous AVF construction can identify fistulas that are unlikely to mature; and therefore, that require immediate revision or abandonment which will ultimately expedite the establishment of a useful access in the HD patient. This is the first study to establish the minimal flow values uniquely needed for both radial artery and brachial artery AVFs to expect primary maturation to a functional access.
Cross-Over Endovascular Retrieval of a Lost Guide Wire from the Subclavian Vein
Authors: Struck M.F. , Kaden I. , Heiser A. , Steen M.
Published: March 2018

Background

The lost guidewire in central venous catheterization is a commonly described complication. The percutaneous endovascular retrieval method is safe and has a very low complication rate.

Objectives

Guidewires extending to the inferior cava vein are usually retrieved via the femoral vein. Under special circumstances, femoral venous access may be impossible and alternative vascular approaches are required.

Case report

We report a case in which we used an alternative vascular approach, from the subclavian site contralateral to the insertion, in a patient with extensive inguinal burn injuries.

Conclusions

Cross-over subclavian retrieval can be an alternative approach for retrieval of a lost guidewire, but it involves an increased risk of puncture-related complications such as pneumothorax.
Exchange over the guidewire from non-tunneled to tunneled hemodialysis catheters can be performed without patency loss
Authors: Park Hoon Suk , Choi Joonsung , Kim Hyung Wook , Baik Jun Hyun , Park Cheol Whee , Kim Young Ok , Yang Chul Woo , Jin Dong Chan
Published: March 2018

Purpose:

The exchange from a non-tunneled hemodialysis catheter to a tunneled one over a guidewire using a previous venotomy has been reported to be safe. However, some concerns that it may increase infection risk prevent its clinical application. This approach seems particularly useful for acute kidney injury patients requiring initial renal replacement therapy, in whom we frequently worry about the choice of non-tunneled versus tunneled catheters.

Materials and methods:

From March 2012 to February 2016, 88 cases to receive the over-the-guidewire exchange method from a non-tunneled to a tunneled catheter and 521 cases to receive de novo tunneled catheter placement from the hemodialysis vascular access cohort were compared retrospectively.

Results:

The immediate complication, later catheter dysfunction requiring replacement, and infection rates were comparable between the two groups. Newly placed tunneled catheter survival in the over-the-guidewire exchange group was comparable with survival in the de novo tunneled catheter group (p = 0.24). In addition, when we compared the same two methods among only intensive care unit patients; they remained similar (p = 0.19).

Conclusion:

An exchange with the over-the-guidewire method from a non-tunneled to a tunneled catheter was comparable to a de novo catheter placement technique. Therefore, this method should be viewed more favorably and should especially be considered for acute kidney injury patients.
After peritoneal dialysis discontinuation: When will we remove peritoneal dialysis catheter?
Authors: Kasuga Hirotake
Published: March 2018

Most of the peritoneal dialysis patients stop their peritoneal dialysis therapy and transfer to hemodialysis or kidney transplantation. In Japan, most end-stage kidney disease patients select hemodialysis after peritoneal dialysis discontinuation. Peritoneal dialysis catheter will be removed after stopping peritoneal dialysis. If peritoneal dialysis patients suffer from refractory peritonitis or severe tunnel infection, we remove the peritoneal dialysis catheter immediately. However, the causes of peritoneal dialysis discontinuation are ultrafiltration failure or peritoneal membrane dysfunction, and we have to consider the timing of peritoneal dialysis catheter removal. Encapsulating peritoneal sclerosis is the most important adverse event of peritoneal dialysis. And encapsulating peritoneal sclerosis often develops after stopping peritoneal dialysis. Risk factors associated with encapsulating peritoneal sclerosis are high peritoneal equilibration test values, longer peritoneal dialysis period, frequent peritonitis, and so on. There is no evidence to prevent encapsulating peritoneal sclerosis completely. Therefore, we can preserve the peritoneal dialysis catheter and assess the changes of peritoneal function after peritoneal dialysis discontinuation, if patient is suspected to have high risk of encapsulating peritoneal sclerosis.
Central venous catheterization for acute trauma resuscitation: Tip position analysis using routine emergency computed tomography
Authors: Struck Manuel F , Ewens Sebastian , Schummer Wolfram , Busch Thilo , Bernhard Michael , Fakler Johannes K M , Stumpp Patrick , Stehr Sebastian N , Josten Christoph , Wrigge Hermann
Published: March 2018

Purpose:

Central venous catheter insertion for acute trauma resuscitation may be associated with mechanical complications, but studies on the exact central venous catheter tip positions are not available. The goal of the study was to analyze central venous catheter tip positions using routine emergency computed tomography.

Methods:

Consecutive acute multiple trauma patients requiring large-bore thoracocervical central venous catheters in the resuscitation room of a university hospital were enrolled retrospectively from 2010 to 2015. Patients who received a routine emergency chest computed tomography were analyzed regarding central venous catheter tip position. The central venous catheter tip position was defined as correct if the catheter tip was placed less than 1 cm inside the right atrium relative to the cavoatrial junction, and the simultaneous angle of the central venous catheter tip compared with the lateral border of the superior vena cava was below 40°.

Results:

During the 6-year study period, 97 patients were analyzed for the central venous catheter tip position in computed tomography. Malpositions were observed in 29 patients (29.9%). Patients with malpositioned central venous catheters presented with a higher rate of shock (systolic blood pressure <90 mmHg) at admission (58.6% vs 33.8%, p = 0.023) and a higher mean injury severity score (38.5 ± 15.7 vs 31.6 ± 11.8, p = 0.041) compared with patients with correctly positioned central venous catheter tips. Logistic regression revealed injury severity score as a significant predictor for central venous catheter malposition (odds ratio = 1.039, 95% confidence interval = 1.005–1.074, p = 0.024).

Conclusion:

Multiple trauma patients who underwent emergency central venous catheter placement by experienced anesthetists presented with considerable tip malposition in computed tomography, which was significantly associated with a higher injury severity.
Sustainability of a national arts festival
Authors: van Heerden Chris , Saayman Melville
Published: March 2018

With more than 600 annual South African festivals to choose from, the ongoing sustainability of established festivals is uncertain. The rationale of sustainability usually rests on what renewable social, economic and cultural benefits the festival offers the community. However, changing visitor characteristics and economic difficulties putting more strain on the disposable income of households compel organizers and marketers to rethink their strategy in order to ensure the sustainability of festivals. This novel and exploratory study utilized a multistage DEA model to identify the presence of tendencies to overspend and budget mismanagement exhibited by visitors at the Innibos National Arts Festival. By identifying the sources of these inefficiencies, this study was able to formulate a framework that can guide organizers and marketers to develop price discounts or package combos that will ensure greater satisfaction which is a vital contributor to sustainability. The results accentuated the need to tailor these package combos to both male and female attendees, with the emphasis on improving satisfaction by limiting the tendencies to overspend that relate to paying for entrance fees, food and drinks.
Making Skin Visible
Authors: Borgerson Janet L , Schroeder Jonathan E
Published: March 2018

Human skin, photography, and consumer culture combine to produce striking images designed to promote visions of the good life. Branding and marketing imagery mobilize skin to resonate and communicate with consumers, which influences the meaning-making possibilities of skin more broadly. Representations of skin in consumer culture, including marketing communications, are anything but ‘blank’ backgrounds or ‘neutral’ meaning spaces. We analyse how skin ‘appears’ to work, and how its appearance in consumer culture imagery reveals ideological and pedagogical aspects of skin. Building upon psychodynamic and interdisciplinary understandings of skin, we discuss dimensions of the body that feed marketing communications and branding. We highlight representational fetishization and the epidermal schema as conceptual tools to interrogate the commodification of skin and as constitutive elements in processes of skin commodification. We provide theoretical insights to address the ways in which skin is implicated in new and emerging concerns of digital representational practices.
Effect of earthquake damage on the behaviour of composite steel frames in fire
Authors: Suwondo Riza , Gillie Martin , Cunningham Lee , Bailey Colin
Published: March 2018

Fire loading following earthquake loading is possible in any building in a seismic-prone area. However, most design approaches do not consider fire following earthquake as a specific loading case. Moreover, seismic design philosophies allow a certain degree of damage in structural elements which make structures more vulnerable when subjected to post-earthquake fire. This study uses three-dimensional numerical models to investigate the effect of earthquake damage on the fire resistance of composite steel-frame office buildings. A total of two types of earthquake damage, fire insulation delamination and residual lateral frame deformation, are investigated. It is concluded that earthquake damage can significantly reduce the fire resistance of composite buildings, with delamination of fire protection having the greatest effect. The results of this study can be used by designers to improve the post-earthquake fire resistance of composite buildings.
Unearthing the geotourism experience: Geotourist perspectives at Mount Pinatubo, Philippines
Authors: Aquino Richard S , Schänzel Heike A , Hyde Kenneth F
Published: March 2018

This study aims to explore the geotourism experience by undertaking a qualitative inquiry of the narratives of geotourists to Mount Pinatubo in the Philippines. This study proposes that the geotourism experience is created onsite through the tourists’ visual, performative and social aspects of gazing and produced in the tourists’ minds through their perception, imagination and self-reflection. Semi-structured interviews were carried out with 12 purposefully selected geotourists. Thematic analysis procedures reveal 11 experiential themes that illustrate varying perspectives on the geotourism experience, categorised into three dimensions: ‘natural’, ‘recreational’ and ‘socio-cultural’. The findings indicate that apart from the expected leisure, hedonic and adventurous experiences, deeper outcomes such as a sense of awe, personal reflections and spiritual outcomes are apparent in the geotourism experience, as a result of individuals’ negotiations with Mount Pinatubo’s natural landscape and touristic environment. More meaningful and transformative experiences are also discovered from geotourists’ engagement with the landform’s cultural landscape, particularly from their social interaction with the indigenous people who live at Mount Pinatubo. These outcomes suggest the gaining of a holistic view of the Earth and its inhabitants through geotourism. This article thus provides some understanding of the experiential aspects of geotourism.
Social Effects of Tears and Small Pupils Are Mediated by Felt Sadness: An Evolutionary View
Authors: Küster Dennis
Published: March 2018

Small pupils elicit empathic socioemotional responses comparable to those found for emotional tears. This might be understood in an evolutionary context. Intense emotional tearing increases tear film volume and disturbs tear layer uniformity, resulting in blurry vision. A constriction of the pupils may help to mitigate this handicap, which in turn may have resulted in a perceptual association of both signals. However, direct empirical evidence for a role of pupil size in tearful emotional crying is still lacking. The present study examined socioemotional responses to different pupil sizes, combined with the presence (absence) of digitally added tears superimposed upon expressively neutral faces. Data from 50 subjects showed significant effects of observing digitally added tears in avatars, replicating previous findings for increased perceived sadness elicited by tearful photographs. No significant interactions were found between tears and pupil size. However, small pupils likewise elicited a significantly greater wish to help in observers. Further analysis showed a significant serial mediation of the effects of tears on perceived wish to help via perceived and then felt sadness. For pupil size, only felt sadness emerged as a significant mediator of the wish to help. These findings support the notion that pupil constriction in the context of intense sadness may function to counteract blurry vision. Pupil size, like emotional tears, appears to have acquired value as a social signal in this context.
Informality and Ukrainian higher educational institutions: Happy together?
Authors: Polese Abel , Stepurko Tetiana , Oksamytna Svitlana , Kerikmae Tanel , Chochia Archil , Levenets Olena
Published: March 2018

In post-socialist spaces, informal payments in educational institutions have often been at the centre of anti-corruption campaigns. A direct consequence, so far, has been that reforms in the public sector have largely been based on attempts to eradicate, or at least minimize, the phenomenon of informal payments. Ukraine is no exception. According to several independent surveys, educational institutions are second only to health care providers for the number of informal transactions recorded. While more than two in three of Ukrainians claim to have engaged with informal exchanges in the past 12 months, almost half of them has made an informal payment in an educational institution, be this a university or a school. The goal of this paper is two-fold. First, we explore the nature and relevance of the phenomenon of informal payments in the educational sector. We rely for this on quantitative studies showing how widespread informal payments are. Second, we provide an alternative explanation on informal payments by suggesting that they have an ambiguous function: while often regarded as a legacy of the socialist period, they can also be seen as a way to cope with an ineffective system that is mostly based on informal rules. By doing this we will provide some recommendations on how anti-corruption policies, and in general reforms aimed at decreasing the amount of informal payments in the country, could be improved.
Electoral Competition and Legislator Effectiveness
Authors: Barber Michael , Schmidt Soren
Published: March 2018

How do legislators respond to electoral competition? We consider this question by looking at the relationship between legislative productivity and the competitiveness of legislators’ primary and general elections. Building on Volden and Wiseman’s preliminary investigation of the electoral connection to legislative productivity, we introduce to that analysis the critical and often-overlooked distinction between primary and general election competitiveness. Employing panel data of U.S. House members spanning three decades (1979-2009), we find significant evidence of a positive relationship between primary vote share and legislative effectiveness, much of which is explained by having primary opposition at all. These results have substantial implications for our understanding of both the electoral connection and legislative behavior.
DNA Chips: The Future of Biomarkers
Authors: de Benedetti V.M.G. , Biglia N. , Sismondi P. , de Bortoli M.
Published: March 2018

DNA chips are small, solid supports such as microscope slides onto which thousands of cDNAs or oligonucleotides are arrayed, representing known genes or simply EST clones, or covering the entire sequence of a gene with all its possible mutations. Fluorescently labeled DNA or RNA extracted from tissues is hybridized to the array. Laser scanning of the chip permits quantitative evaluation of each individual complementary sequence present in the sample.

DNA chip technology is currently being proposed for qualitative and quantitative applications, firstly for the detection of point mutations, small deletions and insertions in genes involved in human diseases or affected during cancer progression; secondly, to determine on a genome-wide basis the pattern of gene expression in tumors, as well as in a number of experimental situations.

The extraordinary power of DNA chips will have a strong impact on medicine in the near future, both in the molecular characterization of tumors and genetic diseases and in drug discovery and evaluation. Quantitative applications will soon spread through all fields of biology.
Significance of Soluble Endothelial Molecule E-Selectin in Patients with Breast Cancer
Authors: Hebbar M. , Peyrat J.-P.
Published: March 2018

Increasing evidence suggests that endothelial cells are involved in tumor growth and metastasis. E-selectin, an adhesion molecule specifically expressed or secreted by activated endothelial cells, may enhance tumor angiogenesis and the adhesion of tumor cells to endothelial cells at distant sites. The aim of this study was to assess the relationship between concentrations of circulating soluble E-selectin and clinical, pathological and biological features in patients with breast cancer (BC). sE-selectin concentrations were analyzed by an ELISA method in sera from 113 patients with metastatic BC, 30 patients with primary inflammatory BC, 105 patients with primary non-inflammatory BC, 456 patients with node-negative BC, and 42 healthy controls. sE-selectin in the metastatic BC group was significantly higher than in the healthy control group. In metastatic BC, sE-selectin was significantly higher in patients with liver metastases than in patients without liver metastases. In patients with primary non-inflammatory BC, a negative correlation was found between sE-selectin concentrations and tumoral microvessel count. In overall and disease-free survival studies performed in the node-negative population (median follow-up duration 7.5 years), multivariate analyses demonstrated a prognostic value of sE-selectin and tumor size. This study suggests that endothelial activation might play a role in the development of BC. This role seems not to be related to angiogenesis.
Illegitimate Villin Transcripts in Normal Bone Marrow Precludes Detection of Colon Cancer Micrometastases
Authors: Salbe C. , de Cremoux P. , Bonneton C. , Manet S. , Almeida A. , Magdelénat H. , Bourstyn E. , Robine S.
Published: March 2018

Villin is a specific marker for normal and tumoral colon tissue. We have developed a highly sensitive assay using reverse transcription (RT) and real-time PCR to detect villin transcripts. The sensitivity of detection is one colon cancer cell. However, high levels of illegitimate villin transcripts were observed in normal bone marrow, precluding the use of villin RT-PCR for routine detection of colon cancer cells in bone marrow of patients with colon cancer.
Prognostic Significance of CEA and CA 19–9 inc Colorectal Cancer in Kuwait
Authors: Behbehani A.I. , Al-Sayer H. , Farghaly M. , Kanawati N. , Mathew A. , Al-Bader A. , Van Dalen A.
Published: March 2018

Preoperative CEA and CA 19–9 levels have been used in the past as prognostic indicators in colorectal cancer, but Dukes’ stage is still considered to be the most important prognostic factor. Recent survival estimates may have been influenced by the fact that in the last decade adjuvant chemotherapy and postoperative irradiation have been included in the routine management of advanced-stage disease. In a heterogeneous Kuwaiti population higher reference levels (95th percentile) of CEA and CA 19–9 have been found than those usually employed. In the present study 62 patients with Dukes’ stage B + C could be analyzed for two-year disease-free survival (DFS). Relapse was observed in 19 patients, 28 patients were disease free and 15 patients with censored observations were included. No significant difference in DFS was observed in Dukes’ B (69%) versus Dukes’ C (48%) patients (p=0.09). On the other hand, Dukes’ stage B+C patients with elevated preoperative levels of CEA or CA 19–9 had a significantly poorer DFS than patients with normal levels. For CEA levels below or above the cutoff the DFS was 74% versus 23% (p=0.003); for CA 19–9 levels below or above the cutoff the DFS was 71% versus 33% (p=0.004). In 54 patients with Dukes’ stage B+C for whom preoperative levels of both CEA and CA 19–9 were available multivariate analysis revealed a decreasing risk of relapse in the following order: CEA and/or CA 19–9 elevated (chi-square 7.09; p=0.008), CA 19–9 elevated (chi-square 6.27; p=0.01), CEA elevated (chi-square 5.47; p=0.02), and Dukes’ C (chi-square 2.08; p=0.15 n.s.). Hence, novel treatment protocols may have improved the disease-free survival, but the use of adjuvant chemotherapy and/or radiotherapy is of questionable benefit in patients who have elevated levels of CEA and/or CA 19–9 prior to treatment.
Is Adjuvant Tamoxifen Recommended in Post-Menopausal Node-Negative Breast Cancer Patients with High Estrogen Receptor Values?
Authors: Floiras J.-L. , Hacene K. , Turpin F. , Spyratos F.
Published: March 2018

The impact of ER levels on the response to tamoxifen was evaluated in 1,623 postmenopausal primary breast cancer patients treated at our center (median follow-up 8.2 years). In patients receiving adjuvant tamoxifen a significantly longer disease-free survival (DFS) was observed when ER levels were elevated (p<0.00001). Very high ER (>424 fmol/mg protein) appeared to be detrimental in node-negative patients not treated with tamoxifen.
Pepsinogen C Expression in Tumors of Extragastric Origin
Authors: Merino A.M. , Vázquez J. , Rodríguez J.C. , Fernández R. , Quintela I. , González L.O. , Sánchez L.M. , Vizoso F.
Published: March 2018

We have examined by immunohistochemistry the ability of human carcinomas of various origin to produce pepsinogen C, an aspartyl proteinase mainly involved in the digestion of proteins in the stomach and recently found to be associated with breast carcinomas. Of the 268 tumors analyzed 80 (29.8%) showed positive staining for pepsinogen C. These positive tumors included 12 gastric (38.7% of the 31 examined cases), nine pancreatic (42.8%), two renal (20%), 12 prostatic (40%), three bladder (27.3%), 14 endometrial (29.7%) and 18 ovarian (40%) carcinomas. We also detected 10 melanomas (50%) that were positive for pepsinogen C. By contrast, immunohistochemical staining for the proteinase was not detected in colorectal, cervical, lung and basal cell skin carcinomas. These results demonstrate that pepsinogen C, a proteolytic enzyme of highly restricted expression in human tissues, can also be expressed by a wide variety of human carcinomas. In addition, and similar to pepsinogen C expression in breast carcinomas, the production of this enzyme by different human tumors might be related to putative hormonal alterations associated with the development and progression of these tumors.
Use of Tumor Markers in the Management of Head and Neck Cancer
Authors: Rosati G. , Riccardi F. , Tucci A.
Published: March 2018

Serologic tumor markers have been evaluated in the diagnosis, management and follow-up of patients with head and neck cancer. However, to the authors’ knowledge no tumor marker has yet been shown to be useful for monitoring the response to chemotherapy in this type of disease, in particular for undifferentiated tumors. The pretreatment levels of CEA, TPA, SCC and ferritin were evaluated in 98 patients with advanced head and neck cancer. Of this group 64 patients were studied sequentially every month during planned chemotherapy and three weeks after treatment using standard commercial kits. The results showed the following sensitivity values: TPA 50%, CEA 36%, SCC 34% and ferritin 19%. The incidence and magnitude of the marker elevations were correlated with the extent of disease. In patients with squamous cell cancer SCC and CEA were elevated (by 68% and 54%, respectively) in tumors with good differentiation (G1), but only by 13% (both markers) in tumors classified as poorly differentiated (G3). CEA, SCC and ferritin serum levels were not correlated with response to chemotherapy, while TPA values correlated with the clinical response to treatment in 100% of patients with undifferentiated cancer and in 75% of those with squamous cell cancer. Our data indicate that in patients with head and neck cancer TPA appears to be a sensitive marker, followed in decreasing order of sensitivity by CEA, SCC and ferritin. However, SCC and CEA seem to be the most suitable markers for squamous cell cancer and in particular for more differentiated tumors (G1). Finally, TPA has proved to be a useful marker for monitoring the response to chemotherapy in patients with head and neck cancer, in particular for undifferentiated tumors.
Relationship of Tumoral Hyaluronic Acid and Cathepsin D Contents with Histological Type of Gastric Carcinoma
Authors: García I. , Vizoso F. , Suárez C. , Sanz L. , Rodríguez J.C. , Roiz C. , García-Muñiz J.L.
Published: March 2018

The aim of this work was to evaluate the cytosolic contents of hyaluronic acid (HA) and cathepsin D (CatD) in gastric carcinomas and their possible relationships with the clinicopathological parameters of the tumors. Our study demonstrated a wide variability in the cytosolic levels of HA (mean ± SEM: 3748 ± 411 ng/mg protein) and cathepsin D (52 ± 4 pmol/mg protein) in the tumors of 78 gastric cancer patients. In addition, the tumoral contents of HA and CatD were significantly higher (p<0.005) in diffuse type (HA: 6027 ± 1099 ng/mg protein; CatD: 75 ± 13 pmol/mg protein) than in intestinal type (HA: 2735 ± 242 ng/mg protein; CatD: 42±3 pmol/mg protein) carcinomas. These data suggest that both markers may contribute to the biological characterization of gastric carcinomas.