bluuebunny/crossref_metadata_2025 huggingface dataset:
Tumor Treating Fields (TTFields) Therapy and Lomustine Chemotherapy for the Treatment of Unresectable Progressive Glioblastoma
Authors: Mergen Ertan , Landrock Sonja , Chizzali Barbara
Published: September 2024

Introduction: Tumor Treating Fields (TTFields) therapy used concomitantly with maintenance temozolomide through second progression after radio-chemotherapy is associated with improved survival outcomes compared to adjuvant temozolomide alone in individuals with newly diagnosed glioblastoma (GBM). Lomustine (CCNU) is frequently used as monotherapy or concomitant with other chemotherapy regimens as second-line treatment for recurrent GBM. Case Presentation: We report a 59-year-old female patient diagnosed with MGMT-promoter methylated, isocitrate dehydrogenase-wildtype GBM (World Health Organization Grade 4) who received TTFields therapy concomitant with first- and second-line chemotherapy following partial resection. The patient experienced tumor pseudoprogression/progression after three cycles of maintenance temozolomide/TTFields therapy and again after a further two cycles of procarbazine/CCNU/TTFields therapy, and was then switched to CCNU/TTFields therapy. During 18 months of treatment with concomitant TTFields therapy and CCNU, the patient experienced regression/reduction of both tumor volume and perifocal edema with tolerable hematotoxicity and was able to maintain a high rate of TTFields therapy usage. The patient ultimately died after developing chemotherapy-related acute myeloid leukemia. Conclusion: This patient case is reflective of the EF-14 study outcome using TTFields therapy beyond first progression concomitantly with chemotherapy. The observations from this case suggest that TTFields therapy concomitant with CCNU is a valuable treatment modality in patients with GBM, in this context.
Higher Platelet Count Mostly in the Normal Range Is Associated with the First Episode of Peritonitis Risk in Incident Peritoneal Dialysis Patients
Authors: Yu Jing , Ye Hongjian , Li Yi , Hua Shun , Liu Jiaqi , Li Hongyu , Wang Yating , Mao Haiping
Published: September 2024

Introduction: Platelets play parts in infection and immune processes. However, the association between platelet count and the risk of peritoneal dialysis (PD)-associated peritonitis is unclear. Methods: This was a retrospective, observational, single-center cohort study. A Cox regression analysis was used to evaluate the independent association of platelet count with the occurrence of first PD-associated peritonitis. Models were adjusted for gender, age, body mass index, cardiovascular disease, diabetes mellitus, white blood cell count, neutrophil-lymphocyte ratio, hemoglobin level, albumin level, potassium level, and anti-platelet medication usage. Results: A total of 2,374 patients were enrolled in this study (59% men; mean age 47.40 ± 12.12). The average platelet count was 229.30 ± 82.12 × 109/L. 467 (20%) patients suffered from PD-associated peritonitis at least once. In the multivariable model, the adjusted hazard ratios (HRs) for quartiles 2, 3 and 4 versus quartile 1 were 1.428 (95% CI 1.060–1.924, p = 0.019), 1.663 (95% CI 1.240–2.229, p < 0.001) and 1.843 (95% CI 1.363–2.492, p < 0.001) with baseline data. A nonlinear relationship between platelet count and first PD-associated peritonitis was observed. Further, the association between platelet and first PD-associated peritonitis was significant in the patients with hypokalemia (P for interaction = 0.040). Conclusion: In PD patients, elevated platelet counts were significantly associated with an increased risk of the first onset of PD-associated peritonitis.
Realizing Synthetic Active Inference Agents, Part II: Variational Message Updates
Authors: van de Laar Thijs , Koudahl Magnus , de Vries Bert
Published: September 2024

The free energy principle (FEP) describes (biological) agents as minimizing a variational free energy (FE) with respect to a generative model of their environment. Active inference (AIF) is a corollary of the FEP that describes how agents explore and exploit their environment by minimizing an expected FE objective. In two related papers, we describe a scalable, epistemic approach to synthetic AIF by message passing on free-form Forney-style factor graphs (FFGs). A companion paper (part I of this article; Koudahl et al., 2023) introduces a constrained FFG (CFFG) notation that visually represents (generalized) FE objectives for AIF. This article (part II) derives message-passing algorithms that minimize (generalized) FE objectives on a CFFG by variational calculus. A comparison between simulated Bethe and generalized FE agents illustrates how the message-passing approach to synthetic AIF induces epistemic behavior on a T-maze navigation task. Extension of the T-maze simulation to learning goal statistics and a multiagent bargaining setting illustrate how this approach encourages reuse of nodes and updates in alternative settings. With a full message-passing account of synthetic AIF agents, it becomes possible to derive and reuse message updates across models and move closer to industrial applications of synthetic AIF.
A new nothospecies of Prosthechea (Orchidaceae: Laeliinae) from the Diamantina Plateau, Minas Gerais, Brazil
Authors: VIEIRA TIAGO L. , VIOTTI JULIA , MENEZES EULER L.F.
Published: September 2024

Based on morphological evidence found in some specimens recently collected in the Diamantina Plateau region, Minas Gerais State, Brazil, a new natural hybrid between Prosthechea calamaria and P. faresiana is described and illustrated as P. ×riopretensis. Both putative parental species are known for the region and their flowering period overlaps. The new nothospecies carries most of the morphological features of P. calamaria, such as short plants (≤ 19 cm height) and inflorescences (≤ 7 cm long), and flowers with a small ovate lip (≤ 1 cm long), but the floral color pattern are remarkably like P. faresiana – sepals and petals covered by longitudinal vinaceous stripes. In addition to a digital composite plate of the taxonomic novelty, further images and a distribution map of the new nothospecies and its putative parents are provided, as well as notes on morphology, phenology, and ecology.
Validation of the lectotypification of the name Umbilicaria africana (Umbilicariaceae, lichenized Ascomycota)
Authors: DAVYDOV EVGENY A. , YAKOVCHENKO LIDIA S.
Published: September 2024

N/A
An alternative subgeneric classification of Kalanchoe (Crassulaceae subfam. Cotyledonoideae) globally: a nomenclatural and taxonomic review, with a new status for K. subg. Pubescentes
Authors: SMITH GIDEON F.
Published: September 2024

In the most recently presented global synopsis of Kalanchoe (Crassulaceae subfam. Cotyledonoideae), which was published in 2003 by Bernard Marie Descoings (1931–2018), only two sections, K. sect. Kalanchoe [geographically widespread] and K. sect. Bryophyllum [geographically naturally limited to Madagascar, but with some species and nothospecies naturalised elsewhere], were recognised in the genus. Three years later, Descoings changed his views on the infrageneric classification of Kalanchoe when, in 2006, he published the subgenus name K. subg. Calophygia for a rather disparate group of species from virtually across the entire natural geographical distribution range of the genus. In this regard, Descoings built on and expanded the kalanchooid infrageneric concept that Sijfert Hendrik Koorders (1863–1919) put forward for Kalanchoe almost 90 years earlier. Apart from recognising K. subg. Calophygia in 2006, Descoings additionally upheld the autonymic K. subg. Kalanchoe and K. subg. Bryophyllum, both of which he recognised at the rank of section in 2003. The infrageneric classification of Kalanchoe that recognises primary diversity in the genus at the rank of subgenus, rather than at that of section, is now firmly entrenched. Following on from Descoings recognising three subgenera in 2006, the subgenus classification of Kalanchoe has recently been expanded with the publication of a further four subgenus names, in 2018 (K. subg. Kitchingia), in 2020 (K. subg. Fernandesiae), in 2023 (K. subg. Alatae), and in 2024 (K. subg. Pubescentes). The most up-to-date subgenus classification of Kalanchoe is presented here, with five subgenera recognised. With the exception of the geographically widespread K. subg. Kalanchoe, the four other subgenera are naturally endemic to Madagascar.
A new endophytic species, Diaporthe litseae, from medicinal plants in Guizhou Province, China
Authors: SUN YA-RU , LIU NING-GUO , AL-OTIBI FATIMAH O. , HYDE KEVIN D. , JAYAWARDENA RUVISHIKA S.
Published: September 2024

During our study on microfungi associated with medicinal plants in China, a new endophytic taxon, Diaporthe litseae was isolated from healthy leaves of Litsea kobuskiana collected in Guizhou Province, China. The new species is characterized by its coelomycetous asexual morph, which has dark brown to black, globose conidiomata, cylindrical, aseptate conidiophores, phialidic conidiogenous cells, and fusiform, hyaline, aseptate, guttulate conidia. The phylogenetic analyses of combined ITS, tef1-α, β-tubulin, cal and his3 sequence data indicate D. litseae is phylogenetically distinct from other species. A detailed description and illustration for D. litseae are provided herein.
Hericium yunnanense (Hericiaceae, Russulales), a new edible mushroom from Yunnan, China
Authors: WANG SHUAI , ZHAO LONG , CHEN DECHAO , LUO HONGMEI , TANG SONGMING , LI EXIAN , LI SHUHONG
Published: September 2024

Yunnan Province of China is one of the most abundant wild fungi resources in China. This paper describes a new species of Hericium collected from Mopanshan National Nature Reserve in Yunnan Province, China. The study showed that two specimens of Hericium were different from the known Hericium species in morphology and phylogeny. Hericium yunnanense associated with the host Alnus nepalensis has a coral-like, milky white to yellow and larger basidiomata (180–300 × 110–170 mm), small and amyloid, broadly ellipsoid basidiospores. A description, illustrations, and a phylogenetic analysis are provided to show the placement of the new species.
Allium elifadae (A. sect. Codonoprasum, Amaryllidaceae), a unique new species from Taurus Mountains/Türkiye
Authors: EKER İSMAİL
Published: September 2024

Allium elifadae Eker, a new species in sect. Codonoprasum, is described and illustrated from Adana, Türkiye. It is a quite isolated species, showing some relationships with A. glumaceum Boissier & Haussknecht, from which differs in several morphological features, regarding the bulb tunics, leaves, inflorescence, spathe valves, perigone, stamens and ovary. Its morphology, ecology, distribution, conservation status and taxonomic relationships are examined.
New cavum-bearing Planothidium (Achnanthidiaceae, Bacillariophyceae) species from the Kamchatka Peninsula, Russia
Authors: TSEPLIK NATALIA , MALTSEV YEVHEN , GLUSHCHENKO ANTON , GENKAL SERGEY , MIRONOVA ELINA , KULIKOVSKIY MAXIM
Published: September 2024

Two new species of the genus Planothidium isolated from a river and hot spring in the Kamchatka Peninsula, Russia, are described on the basis of morphological and molecular data. These are P. tyushovii sp. nov. and P. dyakonovii sp. nov. The new species are characterised by the presence of a covered depression in the centre of the rapheless valve (i.e., a cavum). Comparison of the new species with closely related taxa is given and the phylogenetic relationships of the Planothidium frequentissimum species group are discussed.
Moving Beyond “Facts Are Facts”: Managing Emotions and Legitimacy After a Fake News Attack
Authors: Joachim Marie , Castelló Itziar , Parry Glenn
Published: September 2024

Drawing upon case study research investigating the Irish Health Service Executive’s (HSE) response to a fake news attack on their human papillomavirus (HPV) vaccination campaign, we argue that responses to fake news should be analyzed from a legitimacy perspective. A model for emotional legitimacy management is proposed in which the HSE and a third-party collaborate to (a) connect with the emotional aspects of the issue; (b) leverage emotions to build vicarious legitimacy; (c) transfer the third-party’s legitimacy to the HSE; and (d) emotionally activate the public. This study contributes to fake news and legitimacy management by moving beyond fact-checking and debunking strategies. We suggest a framework centered on legitimacy in which emotions are used to counteract fake news. Finally, we emphasize the importance of third-party vicarious legitimacy building and the transfer of this legitimacy to the organization.
Race and caste in the making of US sociology
Authors: Yengde Suraj Milind
Published: September 2024

In this article, we take a look at the influence of 20th-century provenance of caste as a category of academic importance meriting a debate in American sociology and beyond. Two actors participated in the animating discourse of caste and race in the annals of American sociology. Oliver Cromwell Cox took a class position to define caste, unmaking the hierarchies set in social structures. Instead, he advocated for a racialized system to understand the post-slavery capitalist America. Gerald Berreman represented a different camp that found social hierarchies to be co-determinant of relations and division arranged into a caste society. The debate over caste, nevertheless, admitted to the plausibility of castes contrasted with India’s caste system. However, caste categorization was found to be an appropriate application to the conditions of social inequalities. Gunnar Myrdal and other scholars of repute contributed to the debate. What remained limited in their theoretical contributions to the discussion was an inadequate focus on the lived reality and politics of the caste formulations in the postcolonial, socialist mode of production. A serious examination of untouchability, sub-castes and sub-sub-castes that regulate the kernel of the caste system as well as the racialized castes in India were not studied or referenced in detail. This article adds to that void a theoretical understanding of the discussion on caste, race and colour in sociological and anthropological disciplines.
ALKBH5 Regulates Osteogenic Differentiation via the lncRNA/mRNA Complex
Authors: Song Y. , Gao H. , Pan Y. , Gu Y. , Sun W. , Wang Y. , Liu J.
Published: September 2024

Human adipose-derived stem cells (hASCs) are commonly used in bone tissue regeneration. The N6-methyladenosine (m6A) modification has emerged as a novel regulatory mechanism for gene expression, playing a critical role in osteogenic differentiation of stem cells. However, the precise role and mechanism of alkylation repair homolog 5 (ALKBH5) in hASC osteogenesis remain incompletely elucidated and warrant further investigation. Herein, we employed methylated RNA immunoprecipitation sequencing, RNA sequencing, and weighted gene coexpression network analysis to identify a key long noncoding RNA (lncRNA) in hASCs: lncRNA AK311120. Functional experiments demonstrated that lnc-AK311120 promoted the osteogenic differentiation of hASCs, while a mutation at the m6A central site A of lnc-AK311120 was found to decrease the level of m6A modification. The osteogenic effect of ALKBH5 was confirmed both in vitro and in vivo using a mandibular defect model in nude mice. Subsequent investigations revealed that knockdown of ALKBH5 resulted in a significant increase in the m6A modification level of lnc-AK311120, accompanied by a downregulation in the expression level of lnc-AK311120. Additional rescue experiments demonstrated that overexpression of lnc-AK311120 could restore the phenotype after ALKBH5 knockdown. We observed that AK311120 interacted with the RNA-binding proteins DExH-Box helicase 9 (DHX9) and YTH domain containing 2 (YTHDC2) to form a ternary complex, while mitogen-activated protein kinase kinase 7 (MAP2K7) served as the shared downstream target gene of DHX9 and YTHDC2. Knockdown of AK311120 led to a reduction in the binding affinity between DHX9/YTHDC2 and the target gene MAP2K7. Furthermore, ALKBH5 facilitated the translation of MAP2K7 and activated the downstream JNK signaling pathway through the AK311120–DHX9–YTHDC2 complex, without affecting its messenger RNA level. Collectively, we have investigated the regulatory effect and mechanism of ALKBH5-mediated demethylation of lncRNA in hASC osteogenesis for the first time, offering a promising approach for bone tissue engineering.
Barriers to the treatment of clubfoot in low- and middle-income countries: A guide to improve compliance
Authors: Barik Sitanshu , Kumar Vishal , Raj Vikash , Varshney Saurabh
Published: September 2024

The Ponseti method of clubfoot treatment is ideal for low- and middle-income countries since it is minimally invasive and easily implementable through non-surgeon providers. However, variables related to the socioeconomic status of the community, patient-related factors, treatment provider-related factors, and health system-related factors may influence the outcome of this deformity. These barriers need a two-pronged approach, a top-down (involvement at the policy level) as well as a bottom-up method (involvement at an individual level). Improving the knowledge level of the caregiver as well as the provider and addressing the issues regarding financial constraints will help in eliminating various barriers to the treatment of clubfoot. Furthermore, regular audits help in identifying the efficacy of various solutions employed as well as identifying new barriers to treatment. Integration at the policy level with the involvement of governmental as well as non-governmental organisations helps to remove health system-level bottlenecks.
Unusual renal displacement due to massive splenomegaly: a rare case report and review of literature
Authors: He Zhihua , Liu Wuhao , Xiao Jiafu , Xiao Guancheng
Published: September 2024

Here, the case of a female patient in her late 60s, who presented to hospital for a scheduled health check relating to a history of myelofibrosis for the previous 9 years, is described. She recently experienced weight loss and abdominal distention. Physical examination revealed no abnormality or tenderness. Laboratory examination showed decreased blood cells, platelets and haemoglobin, and normal renal function. Ultrasound and computed tomography scans revealed a massively enlarged spleen and displaced and compressed left kidney with abnormal features, but normal right kidney. The patient declined surgery and her myelofibrosis was treated with ruxolitinib, with a recommendation of annual follow-up observation. Despite many recorded cases of left renal displacement caused by splenomegaly, it is very rare for the left kidney to be pushed across the midline to the right side by an enlarged spleen. This article explores the causes and management of this uncommon condition and provides a review of previous literature reports with the aim of enhancing the understanding of unusual renal displacement due to massive splenomegaly, and its potential treatment options.
Thermodynamic investigation of biomass-steam gasification in converter vaporisation flue for synthesis gas production
Authors: Xiao Mei-mei , Wang Bao , Li Si-jia , Chen Xian-lin , Zhou Jian-an
Published: September 2024

Biomass gasification for hydrogen production is a highly promising technology for energy conversion and utilisation. This paper proposed a novel technology for the injection of biomass and steam into the flue of a converter vaporisation to produce hydrogen-rich syngas. The feasibility of hydrogen generation through gasification between biomass, steam, and carbon dioxide in the high-temperature flue gas was investigated based on the thermodynamic principle of Gibbs free energy minimisation. The influence of gasification parameters on the composition of syngas was also explored. The results indicate that in the gasification process, biomass and steam injected into the converter vaporisation flue can effectively inhibit the generation of by-products such as tar. As the steam volume increases, the volume fraction of hydrogen in the product also increases, while the concentration of carbon monoxide decreases. By adjusting the steam-to-biomass ratio, syngas with a hydrogen content exceeding 20% can be produced. At a reaction temperature of 1200 °C, with a steam addition of 5%, a biomass addition of 8 g/L, and a [Formula: see text] ratio of 3, the gas products are composed of 25% hydrogen and 67% carbon dioxide. The process has the potential to achieve a hydrogen yield of up to 90%, a syngas yield of 94%, and a CO2 conversion rate of 70%. Additionally, the lower heating value of the syngas is measured at 11.24 MJ/Nm3. The research results have confirmed the viability of the new technology, thus establishing a theoretical foundation for the industrial implementation of injecting biomass and steam into the converter vaporisation flue to produce hydrogen-rich syngas.
Enhancing pitch angle control in variable speed doubly fed induction generator based wind energy conversion system using advanced adaptive neuro-fuzzy approach with particle swarm optimization
Authors: Sahoo Satyabrata
Published: September 2024

Pitch angle control is a common method used to smooth out output power fluctuations in the wind turbines. This paper focuses on Particle Swarm Optimization (PSO) based Adaptive Neuro-Fuzzy Inference System (ANFIS) pitch angle control scheme for a variable speed Doubly Fed Induction Generator (DFIG) based wind energy conversion system designed for operation in high wind speed regions. The proposed enhanced adaptive controller comprises both Sugeno type fuzzy inference system (FIS) and neural network architecture. In the Sugeno type FIS, the membership functions are optimized using a revisited PSO method. The primary objective is to control the pitch angle to ensure that generator power and speed operate within desired references, reducing fluctuations and minimizing mechanical blade stress. A MATLAB/SIMULINK model of wind energy conversion system setup is prepared and simulations are conducted using different control methods. The effectiveness of the proposed approach is confirmed based on the simulation results.
Not “Citizens in Waiting”: Student Counter-Narratives of Anti-Equity Campaigns
Authors: Castro Andrene J. , Hewko April , Clay Kevin L. , Siegel-Hawley Genevieve , Bridges Kim
Published: September 2024

Recent efforts prohibiting race-related diversity, equity, and inclusion initiatives have informed localized public pushback narrating anti-equity campaigns. Emerging research and media accounts have largely focused on adults engaged with or against these efforts, with less attention on youth and their perceptions of these campaigns. To center youth voice, we analyzed 224 student newspaper articles published in Carmel, Indiana and Loudoun County, Virginia—two sites replete with localized contestations of equity reform. Using narrative policy analysis and approaches to counter-narratives, findings demonstrate youths’ roles as engaged policy actors as student journalists highlighted forms of political engagement and action in their local contexts. We include recommendations for school leaders and policymakers to promote youth voice and engagement in education governance.
Optimization and characterization of boric acid powder mixed electrical discharge machining of Ti-6Al-4V ELI
Authors: Baroi Binoy Kumar , Kar Siddhartha , Jagadish  , Patowari Promod Kumar
Published: September 2024

The powder mixed electrical discharge machining (PMEDM) process is used for enhancing machining efficiency and improving the surface characteristics of the workpiece compared to normal EDM. The present study evaluates the effect of boric acid powder mixed in deionized water in PMEDM of Ti-6Al-4V ELI (extra low interstitial). The PMEDM process is assessed by evaluating material removal rate (MRR) and surface roughness (SR) at varying powder concentration (PC), current and pulse duration ( Ton). Boric acid PMEDM exhibits advantageous for both MRR and SR, where MRR increases and SR decreases with an increase in PC. To simultaneously achieve higher MRR and lower SR, the grey-fuzzy logic method is employed. Initially, the raw input data is normalized into grey numbers and a single index is obtained through grey relational analysis. Subsequently, triangular membership functions are assigned to the inputs and output. Fuzzy logic rules are then formulated, and grey fuzzy relational grade (GFRG) is calculated for each condition. The optimum condition (GFRG = 0.787) is attained at 15 g/l PC, 9 A current and 106 µs Ton, resulting in a 63% improvement compared to the initial condition. At the optimum condition, MRR increased by 145% and SR decreased by 29% compared to the initial condition. The effect of boric acid in PMEDM can be visualized through the formation of smooth surfaces, exhibiting reduced SR, smaller and shallower craters, and fewer debris and globules. Additionally, the boric acid PMEDM experiments resulted in the formation of a hard TiB phase on Ti-6Al-4V, thus improving its wear resistance.
ANN modeling and optimization of friction stir welding performance for AA6061 and AA5083 alloy joints
Authors: Sivasundar Vijayakumar , Kakkassery Joseph J. , Jaganathan Maniraj , Satheesh Kumar Patchaiappan Sivasamy , Vignesh Margabandu , Anbuchezhiyan Gnanasambandam
Published: September 2024

This research focused on the characteristics of the AA6061/AA5083 alloy joints which are fabricated by the friction stir welding (FSW) technique. The impact of FSW parameters such as tool tilt angle, pin depth, and tool geometry on the mechanical properties and fractographic characteristics were studied. Ultimate tensile strength (UTS), hardness (HBN), and specific wear rate (SWR) were examined for characterization while fractography analyses were done using scanning electron microscopy. Taguchi-Grey relational analysis (GRA) was employed to execute multicriteria optimization and recognize the best grouping of parameters. The optimized values attained from this analysis were 259.2 MPa for UTS, 94.9 HV for HBN, and 0.0819 m³/Nm for SWR. The analysis of variance (ANOVA) results derived from the GRA revealed that tool geometry exerted the most significant influence (39.79%) on output factors, followed by pin depth (24.90%) and tilt angle (24.26%). To enhance the predictive accuracy of the output responses, an artificial neural network (ANN) model was developed utilizing the Levenberg-Marquardt (LM) algorithm. The optimized ANN architecture, configured as (3–10–3), exhibited robust regression analysis outcomes, showcasing correlation coefficients ( R) of 0.99999, 0.99967, and 0.99994 for the training, validation, and test datasets. The overall R-value, computed at 0.99958, affirmed high conformity between experimental and predicted values.
Patient Selection for Endovascular Repair of Aortoiliac Aneurysms
Authors: Yano Osvaldo J. , Marin Michael , Hollier Larry
Published: September 2024

Purpose:

This study was conducted to establish criteria to aid in the selection of patients for endovascular repair of aorto-iliac aneurysms.

Methods:

Characterization of pertinent factors used to determine whether a patient is eligible to undergo stent-graft repair of an aorto-iliac aneurysm.

Principal findings and conclusions:

The determinant factor that dictates whether or not one is eligible to undergo endovascular repair of aorto-iliac aneurysm is the arterial anatomy of the affected area and its surrounding vessels. Some of the initial limitations imposed in this technology have changed such as an acceptance of much shorter neck than initially conceptualized, by the use of supra-renal stent deployment. However, unsolved issues remain regarding the differentiation of thrombus and atherosclerotic plaque in the infra-renal aortic region, iliac artery disease, and the need to have an enhanced flexibility of the delivery system for proper deployment in tortuous aortic necks. The question of long-term device durability remains the most important issue that has to be taken into consideration before one chooses minimally invasive endovascular approaches.
Impact of Sequential Grafting of the Internal Thoracic or Right Gastroepiploic Arteries on Multiple Coronary Revascularization
Authors: Ochi M. , Yamada K. , Ishii Y. , Ogasawara H. , Fujii M. , Yajima T. , Kanno S. , Tanaka S.
Published: September 2024

Objective.

The aim of the study is to clarify the efficacy of the sequential anastomotic technique of the arterial conduits for multiple coronary revascularization.

Background.

The internal thoracic artery (ITA) is now widely accepted as a durable conduit for myocardial revascularization. The right gastroepiploic artery (GEA) has been developed as a third in situ arterial graft with an outcome similar to that of the ITA.

Material and method.

One hundred and forty five consecutive patients (116 male, 29 female, mean age 60.4 yr) who received sequential grafting of either the ITA or GEA or both were retrospectively analysed.

Results.

Sequential anastomoses were performed in 121 in situ left ITAs. 36 in situ GEAs and 12 composite right ITAs. No in situ right ITA was anastomosed sequentially. Two to six vessels (mean 3.8) were revascularized for each patient. Of the total 543 bypassed vessels, 432 (79.6%) were reconstructed with the arterial grafts. In 85 patients with quadruple bypass or more, the arterial grafts were able to reconstruct 266 out of 360 (74.0%) target vessels. Seventy one patients (49.0%) were revascularized without venous grafts. The arterial grafts could revascularize 293 out of 310 vessels (94.5%) in the LAD ∼ Diagonal region, 83 out of 113 (73.4%) in the distal RCA or Cx region. There were no cardiac events responsible for the arterial grafts in the follow up period.

Conclusion.

In light of our experience, multiple revascularization with in situ arterial sequential grafts is feasible. Aggressive application of this technique provides patients requiring multiple coronary revascularization with favorable long-term results.
Calcification and Degeneration Characteristics of the Biocor No-React Bovine Internal Mammary Artery (BIMA) — in Vivo Evaluation in a Sheep Model
Authors: Jashari Ramadan , Herijgers Paul , Verbeken Eric , Van Lommel Alfons , Nishimura Yosuke , Ràcz Rozalia , Flameng Willem
Published: September 2024

Objective:

The No-React process for biomaterials was suggested to prevent calcification and degeneration. We examined in vivo in a chronic sheep model the performance of a Biocor bovine internal mammary artery (BIMA) graft after No-React processing.

Methods:

‘No-React’ processing consists of aldehyde cross-linkage following a detoxification process with multiple physical variables and incubation with surfactant. Biocor BIMA No-React treated grafts have been interposed in the carotid artery in seven sheep with a Dacron graft as control. Grafts were explanted after 3 or 6 months and were grossly examined, by X-ray, histology, transmission and scanning electron microscopy, and atomic absorption spectrophotometry.

Results:

In the BIMA, good healing was found with a smooth intimal surface, minimal inflammatory reaction, and a well preserved ultrastructure. Calcification increased progressively. In the Dacron grafts, a fibrous covering the inner surface and infiltration with fibroblasts, histiocytes and macrophages was noted. Calcium content was stable.

Conclusion:

Calcification increased progressively in Biocor BIMA No-React grafts. Minimal inflammatory changes, a smooth inner surface and well preserved ultrastructure were noted.
Combined Carotid Endarterectomy and Coronary Bypass: A Decade Experience at UCLA
Authors: Farooq Michael M. , Reil Todd D. , Gelabert Hugh A. , Ahn Samuel S. , Baker J. Dennis , Moore Wesley S. , Quiñones-Baldrich William J. , Freischlag Julie A.
Published: September 2024

Purpose:

The purpose of this review was to determine outcomes for combined carotid endarterectomy (CEA) and coronary revascularization (CABG) in patients with asymptomatic carotid stenosis.

Methods:

We reviewed the medical records of consecutive combined procedures (CEA and CABG), performed at UCLA Medical Center from October, 1989 to January, 1999.

Findings:

There were 43 patients, 27 men and 16 women, with a mean age of 71 yr (range 51–87). Thirty-four patients 79% (34/43) had asymptomatic carotid stenosis. Stroke occurred in three patients (3/43 = 6.9%). Stroke ipsilateral to the CEA occurred in two patients: one asymptomatic (1/34 = 2.9%) and one symptomatic (1/9 = 11.1%).

Conclusions:

The majority of patients undergoing combined CEA/CABG have asymptomatic carotid stenosis identified in preparation for elective CABG. The asymptomatic carotid subset stroke rate of 2.9% resulting from a combined CEA/CABG is higher than our reported rate for CEA performed alone. In patients with asymptomatic carotid stenosis, the combined procedure should be selectively performed.
Reconstructive Surgery for Carotid Artery Occlusive Disease in the Elderly — a High Risk Operation?
Authors: Ommer A. , Pillny M. , Grabitz K. , Sandmann W.
Published: September 2024

Patients over 80 yr of age may require carotid surgery for symptomatic or critical asymptomatic carotid artery occlusive disease.

A total of 2262 operations were performed between 1990 and 1999; 76 (3.4%) were carotid reconstructions in 70 patients over 80 yr of age. Twenty patients (26%) presented with asymptomatic critical stenosis. Transient ischemic symptoms were the reason for presentation in 35 patients (46%). Progressive stroke was documented in two patients (3%) and a stroke with persisting neurological deficit was demonstrated in 19 cases (25%).

Coronary artery disease was present in 47 patients (38%) and arterial hypertension in 55 (72%). Fifty-nine patients (84%) were classified as ASA group 3. Seventy-one thromboendarterectomies of the carotid bifurcation with vein-patch closure were performed. Five patients had other types of reconstruction.

Simultaneous operations (aorto-coronary vein-bypass, aortic interposition graft etc.) were performed in nine patients. Postoperative complications occurred in three patients. One had a transient neurological deficit and another a lethal stroke; the third patient died from myocardial infarction.

The in-hospital mortality was 2.9%, which was not significantly higher than the results of the other 2186 reconstructions (1.5%).

Surgery for carotid artery occlusive disease can be safely performed in selected patients of more than 80 yr of age.
Comparison of Three Methods for Measuring Cigarette Smoking in Patients with Vascular Disease
Authors: Galvin K. T. , Kerin M. J. , Williams G. , Gorst K. L. , Morgan R. H. , Kester R. C.
Published: September 2024

Although smoking has been identified as an independent risk factor in peripheral vascular disease, smokers do not accurately report their habit. Therefore, a cheap, non-invasive, objective method of measuring smoking behaviour in vascular surgical units is desirable. The value of end-expiratory carbon monoxide monitoring, which is both simple and inexpensive, was compared with two well-established, validated techniques (serum thiocyanate and blood carboxyhaemoglobin levels). Some 33 surgical patients with peripheral vascular disease provided samples of expired air for measurement of carbon monoxide and blood for carboxyhaemoglobin and thiocyanate levels. Carboxyhaemoglobin was the most sensitive test (90%) and had a high specificity (100%). Expired carbon monoxide was the least sensitive (60%) but had a high specificity (100%). The carbon monoxide and carboxyhaemoglobin levels correlated significantly ( r = 0.829; P = 0.0001). Serum thiocyanate was relatively sensitive (80%) but had a lower specificity (70%). Conventional methods for assessing smoking behaviour have not gained widespread use because they are time-consuming, relatively invasive and require technical support. Non-invasive measurement of carbon monoxide gives immediate accurate results and is a useful inexpensive method for measuring cigarette smoking in patients attending a follow-up vascular unit.
Extensive Use of Arterial Grafts for Coronary Artery Bypass Grafting in Japanese Patients
Authors: Nishida H. , Hirota J. , Yamaki F. , Takazawa A. , Koyanagi T. , Endo M. , Koyanagi H.
Published: September 2024

Between August 1985 and December 1992. 298 patients underwent coronary artery bypass grafting with two or more distal anastomoses using arterial grafts. There were 279 males and 19 females, with an average age of 58.4 years. Thirty-one patients underwent sequential bypass with the left internal mammary artery. The remaining 267 patients received two or more arterial grafts. The three major combinations were the left and right internal mammary arteries (120 cases), the left internal mammary and right gastroepiploic arteries (100 cases) and the left and right Internal mammary and right gastroepiploic arterial (43 cases). An additional saphenous vein bypass was contracted in 113 patients, and the average number of distal anastomoses was 2.70 per patient. The operative mortality rate was 1.0% (three patients), and hospital mortality rate 0.7% (two patients). Angiographic patency rate was 97.9% In arterial grafts and 94.3% in venous grafts. There were seven late deaths (three due to cardiac causes), and the 7-year actuarial survival and event-free rates were 92.8% and 86.6%, respectively. In conclusion, the extensive usage of arterial grafts in Japanese patients was accompanied by excellent long-term results without increased operative mortality and morbidity.
Right-Sided Aortic Arch: Surgical Treatment of An Aneurysm Arising from a Kommerell's Diverticulum and Extending to the Descending Thoracic Aorta with an Aberrant Left Subclavian Artery
Authors: Caus T. , Gaubert J.Y. , Monties J.R. , Moulin G. , Mouly A. , Cornen A. , Mesana T.
Published: September 2024

The case of a 44-year-old black man who presented with severe dysphagia, cough and chest pain caused by a 12-cm aneurysm developing from a Kommerell's diverticulum at the origin of an aberrant retro-oesophageal left subclavian artery is reported. The aortic arch and descending thoracic aorta were right sided. Diagnosis was established before operation by computed tomography, magnetic resonance imaging and arteriography. The aneurysm extended a considerable distance down the descending aorta and therefore the risk of postoperative paraplegia was considered to be high. Accordingly selective arteriography was performed to locate the Adamkievicz's artery which arose only 2 cm below the end of the aneurysm. Resection grafting of the aneurysm including the upper third of the descending aorta via right thoracotomy was performed. The patient made an uneventful recovery and was discharged 20 days later. This case appears to be the first successful operation for this pathology.
Aortic Arch Aneurysm in Behçet's Disease: An Unusual Association
Authors: Napoleone C. Pace , Bartolomeo R. Di , Pierangeli G. , Pierangeli A.
Published: September 2024

Vascular complications of Behçet's disease particularly affect the venous system. Arterial lesions include thrombosis and aneurysms. There are few reports of aortic involvement, usually of the abdominal aorta. Aortic arch involvement has not been reported previously. A patient with Behçet's disease who developed an aortic aneurysm involving the ascending aorta to the hiatus with massive incompetence of the aortic valve is described.
Idiopathic True Aneurysm of the Popliteal Artery in Childhood
Authors: Hurley P. R. , Giddings A. E. B.
Published: September 2024

Non-traumatic arterial aneurysms in childhood are very uncommon and are usually associated with inflammatory or degenerative conditions. A case of idiopathic true aneurysm occurring in one popliteal artery of a 14-year-old girl is described. Geniculate artery branches arose from the sac and histological examination confirmed that it was a true aneurysm. Successful treatment by the insertion of a reversed vein graft was confirmed by follow-up years after the operation.
Short-Term Outcome of a New Modification of the Bentall Operation: Carrel Patch and Inclusion Technique
Authors: Kito H. , Eishi K. , Kito Y. , Kawazoe K. , Kawashima Y.
Published: September 2024

Leakage around the coronary ostia continues to be the major complication of composite graft replacement of the ascending aorta and aortic valve. To reinforce coronary anastomosis and reduce the operating time, a new modification of the Bentall operation was developed. This procedure involves dissecting full-thickness coronary buttons while leaving the epicardium on the aortic wall and complete wrap of the composite graft by the tailored aortic wall (Carrel patch and inclusion technique). Since March 1983, this approach has been performed in 12 patients (group A) and other Bentall-type operations in 22 (group B). Time affected by haemostasis was 28min less in group A than in B (P = 0.23). Blood loss and blood transfusion during surgery and hospitalization were significantly lower in group A than B. Significantly less leakage occurred in group A than in B. On the basis of these short-term results, the Carrel patch and inclusion technique is considered to be an accurate time- and blood-saving procedure.
Tricuspid Valve Myxoma in a Child with Coronary Artery Occlusion and Aneurysms
Authors: Togo T. , Hata M. , Sai S. , Ito T. , Sato N. , Haneda K. , Mohri H.
Published: September 2024

The case of a 13-year-old boy with a tricuspid valve myxoma and coronary artery occlusion and aneurysms suspected to be caused by Kawasaki's disease is presented. Simultaneous extirpation of the myxoma and coronary artery bypass grafting to the left anterior descending artery using the left internal mammary artery was performed. His postoperative course was satisfactory. Coronary artery bypass grafting in a child is also discussed.
Cardiac Sarcoidosis: A New Approach to Treatment
Authors: Harris L. M. , Guarino R.
Published: September 2024

Cardiac sarcoid is a disease of young adults. Arrhythmias or sudden death may be the first manifestation of cardiac sarcoidosis. Consideration for cardiac sarcoid should be given to all young patients with arrhythmias, heart failure, or episodes of sudden death. Surgical intervention may be warranted in patients with symptomatic cardiac sarcoid because of poor response to current medical therapy.
Evolution of Carotid Restenosis After Endarterectomy
Authors: Kieny R. , Seiller C. , Petit H.
Published: September 2024

Some 176 consecutive carotid endarterectomies performed during 1987 were assessed after 11.5 and 44 months. There were four perioperative deaths. At mean follow-up of 32.5 months the 50% restenosis rate progressed from 9.7% to 11.9%. Of the 168 carotid arteries with a normal patency at discharge, 36 showed progression of stenoses as Judged by duplex scanning during the observation period of 44 months. Twenty-nine stenoses were present within 1 year and seven developed between 12 and 44 months. Successive assessments revealed marked differences in the evolution of restenoses which usually depended on the degree of severity reached at the end of the first year: 44% progressed, 28% regressed and only 28% remained stable. The risk of late occlusion in vessels with a < 50% restenosis at 1 year was below 1 % and the risk of progressing to a stenosis > 50% was 3.3%. Assessment at 56 months was limited to patients who had a restenotic lesion during the first 44 months, it confirmed that the disease was still unstable with progression in 7% of cases and regression in 10%. This study did not demonstrate any significant restenosis after 20 endarterectomies using the eversion technique compared with an incidence of 13.4% after 156 standard endarterectomies.
Addisonian Crisis following Pericardiectomy
Authors: Shah S. , Shah A. , Bhatia E. , Ganjoo A. K.
Published: September 2024

In developing countries tuberculosis is a common cause of constrictive pericarditis and its Involvement of other organs may sometimes complicate the surgical management of such patients. A case is reported of constrictive pericarditis in which the patient developed protracted hypotension which was unresponsive to inotropic therapy, following pericardiectomy. On investigation the cause of hypotension was diagnosed as acute adrenocortical insufficiency, secondary to adrenal tuberculosis. The patient was successfully treated with corticosteroids. Low cardiac output after pericardiectomy, which is not uncommon, should not necessarily be attributed to a ‘myocardial factor’. Patients with tuberculous pericarditis may have co-existent Addison's disease.
Factors Influencing Coronary Artery Bypass Graft Patency
Authors: Metcalfe M. J. , Lip G. Y. H. , Dargie H. J.
Published: September 2024

Coronary artery bypass surgery is one of the most frequently performed and successful operations in improving quality of life for patients with intractible angina. Unfortunately, there is accumulating evidence that angina will eventually return and consequently an increasing amount of repeat surgery is being undertaken. Subsequent operations have a reduced chance of benefit and many patients are only in early middle age at the time of initial surgery. It is obviously of paramount importance, therefore, to try and maintain graft patency for as long as possible. Various factors such as avoidance of certain surgical techniques, use of the internal mammary artery whenever possible, continued use of aspirin and attention to major risk factors are known to significantly influence graft patency. This review examines these factors in detail and provides practical advice on how to optimize long-term patency.
Pericarditis: A Persisting Surgical Problem
Authors: Anyanwu C. H. , Umeh B. U. O.
Published: September 2024

A study of pericarditis treated surgically over a period of 14.5 years was conducted to evaluate the current pattern and management of this disease in a tropical environment. The series comprised 86 patients (58 males and 28 females) aged from 5 months to 60 years (mean 21.1 years). Pericarditis was effusive in 41 patients, calcific in 33 and fibrous in 12. Aetlological or associated factors were non-specific, pyogenic infection, rheumatic heart disease, endomyocardial fibrosis, tuberculosis and amoebiasis in 36, 21, eight, eight, six and four patients, respectively. All the patients were in New York Heart Association (NYHA) functional class III or IV. Operative treatment involved pericardiotomy with tube drainage in 32 patients, pericardiectomy in 49, and pericardiotomy with subsequent pericardiectomy in five. The total hospital mortality rate was 8.0%, and was largely a result of severe pre-operative cardiac decompensation and multiple organ failure. Of the 79 early survivors, 91% reverted to NYHA functional class I or II. Surgical treatment remains the most effective management of chronic pericarditis which still constitutes a major clinical problem in some countries.
Role of Neutrophil Depletion and Elastase Inhibition in Modifying Skeletal Muscle Reperfusion Injury
Authors: Crinnion J. N. , Homer-Vanniasinkam S. , Hatton R. , Parkin S. M. , Gough M. J.
Published: September 2024

This study investigated the effect of neutrophil depletion and neutrophil elastase inhibition on the severity of skeletal muscle reperfusion injury. In a rodent model, indices (experimental/ normal limb) of gastrocnemius muscle viability (hlstochemical staining), oedema (wet:dry weight ratio) and myeloperoxidase content (neutrophil recruitment) were assessed in normal (no ischaemia), ischaemic (6-h unilateral hindlimb ischaemia), control (6-h ischaemia and 4-h reperfusion), neutrophil-depleted rats (given antineutrophil serum) and rats receiving the neutrophil elastase inhibitor Elafln. Neutrophil recruitment muscle infarction and oedema did not occur in normal limbs, or in those subjected to ischaemia without reperfusion. In contrast increased muscle myeloperoxidase levels ( P< 0.001), muscle infarction ( P< 0.01) and oedema ( P< 0.001) all occurred in the reperfused limbs of control animals compared with those of normal and ischaemic rats. Antineutrophil serum and Elafln both reduced neutrophil recruitment during reperfusion ( P< 0.001 and P< 0.01 respectively) and muscle viability was preserved. Reperfusion oedema still occurred however, suggesting that altered endothelial permeability is mediated by factors other than neutrophils.