bluuebunny/crossref_metadata_2025 huggingface dataset:
Middle School Mathematics Instruction in Instructionally Focused Urban Districts
Authors: Boston Melissa D. , Wilhelm Anne Garrison
Published: March 2015

Direct assessments of instructional practice (e.g., classroom observations) are necessary to identify and eliminate opportunity gaps in students’ learning of mathematics. This study examined 114 middle school mathematics classrooms in four instructionally focused urban districts. Results from the Instructional Quality Assessment identified high percentages of lessons featuring cognitively challenging tasks, but declines in cognitive challenge during implementation and discussions. Overall instructional quality exceeded results from studies with nationally representative samples and paralleled results of studies of instructionally focused urban middle schools. Significant differences existed between districts, favoring the district with veteran teachers, long-term use of Standards-based curricula, and professional development initiatives.
Where Houston Met Hollywood
Authors: Calhoun Claudia
Published: March 2015

In trying to understand why one of the United States’ biggest cities has been overlooked in scholarship, this article argues that the mass media has helped to obscure Houstonians’ own narratives of their city. This article looks closely at the opening of the Shamrock Hotel in Houston in 1949 and the release of the film Giant (1956), which fictionalizes that event. This case study shows how Giant constructed the city as an anti-modern space, overshadowing the discourse proposed by Glenn McCarthy and the Shamrock, which promoted Houston as a modern city. This article also analyzes Houstonians’ responses to Giant: Reviews were largely enthusiastic, but the perspective from Houston also allowed viewers to see some of the film’s weaknesses more clearly.
Mitral valve repair for rheumatic mitral regurgitation: Mid-term results
Authors: Waikittipong Somchai
Published: March 2015

Aim

This retrospective study was undertaken to evaluate the midterm results of mitral valve repair for rheumatic mitral regurgitation, in term of survival rate and late valve failure.

Methods

From January 2003 to January 2014, 97 patients underwent mitral valve repair in our hospital. Age ranged from 8 to 74 years, mean 24 ± 1.4 years; 74 (76%) patients were female. Mean preoperative functional class was 2.47 ± 0.07. Mean preoperative ejection fraction was 59.9% ± 2%. The lesions were pure mitral regurgitation in 79 (81.4%) patients, predominant mitral regurgitation with stenosis in 9 (9.3%), and predominant mitral stenosis with regurgitation in 9 (9.3%). Seventy-one (73%) patients were in normal sinus rhythm.

Results

One patient died in the postoperative period, and 8 were lost during follow-up. Follow-up time ranged from 6 to 137 months, mean 58.8 ± 4.2 months. There were 6 late deaths. Actuarial survival at 5 and 10 years was 95.5% and 89.2%, respectively. Twenty-seven (27.8%) patients had mitral regurgitation during follow-up, and 7 underwent reoperation with no hospital mortality. Freedom from reoperation at 5 and 10 years was 94.5% and 82.7%, respectively. Freedom from reoperation or progression of mitral regurgitation at 5 and 10 years was 70.4% and 61.8%, respectively. Freedom from all late events at 5 and 10 years was 68 % and 56.4%, respectively.

Conclusions

Mitral valve repair for rheumatic mitral regurgitation is associated with a significant rate of valve failure and reoperation. However, it has a satisfactory survival rate and is a good alternative to valve replacement, especially for young patients, to avoid the life-long risks of a prosthetic valve.
Morphological features of retinal development in premature Chinese infants observed by computer-assisted indirect ophthalmoscope imaging
Authors: Chen Feng , Xiang Daoman , Mao Yani , Liu Tian
Published: March 2015

Objective

To investigate retinal maturation in premature infants (gestation age <37 weeks). using computer-assisted indirect ophthalmoscope imaging.

Methods

Premature infants at postmenstrual age 33–46 weeks, who underwent fundus examinations using computer-aided indirect ophthalmoscopy, were stratified into seven postmenstrual-age groups. Images of macular morphology, peripheral retinal vascularization and fundus pigmentation were compared.

Results

The study included 268 infants in the following postmenstrual-age groups: 33–34 weeks ( n = 19), 35–36 weeks ( n = 37), 37–38 weeks ( n = 49), 39–40 weeks ( n = 55), 41–42 weeks ( n = 49), 43–44 weeks ( n = 34), and 45–46 weeks ( n = 25). The macula matured with increasing postmenstrual age. A mature macula was observed in 92% of infants at 45–46 weeks. Complete vascularization was achieved at 41–42 weeks in the nasal retina and at 43–44 weeks in the temporal retina. The number of retinas with normal pigmentation increased with postmenstrual age (rising to 84% of infants at postmenstrual age 45–46 weeks).

Conclusions

Following premature birth, macular morphology, retinal vascularization and retinal pigmentation continue to develop. This study provides reference images of normal retinal development in premature infants.
Infratrochlear neuralgia
Authors: Pareja Juan A , Casanova Ignacio , Arbex Andrea , Cuadrado María L
Published: March 2015

Introduction

The infratrochlear nerve supplies the medial aspect of the upper eyelid, the superolateral aspect of the nose and the lacrimal caruncle. This nerve may contribute to the pain stemming from the trochlea, but infratrochlear neuralgia has not been identified as a specific cause of pain.

Methods

Over a 10-year period we have been recruiting patients with pain in the internal angle of the orbit that did not show features of trochlear pain.

Results

Seven patients (six female, one male; mean age, 46.1 ± 18.9) presented with pain in the territory of the infratrochlear nerve. The pain appeared in the internal angle of the orbit and upper eyelid ( n = 3), the superolateral aspect of the nose ( n = 3), or the lacrimal caruncle ( n = 1). All patients had a paroxysmal pain, with the attacks lasting five to 30 seconds. Pain attacks were mostly spontaneous, but two patients had triggers. Between attacks, all patients had local allodynia. Pain did not increase with vertical eye movements. Six patients were treated with gabapentin with complete response, and one patient experienced long-lasting relief with an anesthetic blockade of the infratrochlear nerve.

Conclusion

Infratrochlear neuralgia should be considered as a possible cause of pain in the internal angle of the orbit.
Gender Biases in (Inter) Action
Authors: Latu Ioana M. , Mast Marianne Schmid , Stewart Tracie L.
Published: March 2015

Although explicit stereotypes of women in the workplace have become increasingly positive, negative stereotypes persist at an implicit level, with women being more likely associated with incompetent—and men with competent—managerial traits. Drawing upon work on self-fulfilling prophecies and interracial interactions, we investigated whether and how implicit and explicit gender stereotypes held by both male interviewers and female applicants predicted women’s interview outcomes. Thirty male interviewers conducted mock job interviews with 30 female applicants. Before the interview, we measured interviewers’ and applicants’ implicit and explicit gender stereotypes. The interviewers’ and applicants’ implicit stereotypes independently predicted external evaluations of the performance of female applicants. Whereas female applicants’ higher implicit stereotypes directly predicted lower performance, male interviewers’ implicit stereotypes indirectly impaired female applicants’ performance through lower evaluations by the interviewer and lower self-evaluations by the applicant. Moreover, having an interviewer who was at the same time high in implicit and low in explicit stereotypes predicted the lowest performance of female applicants. Our findings highlight the importance of taking into account both implicit and explicit gender stereotypes in mixed-gender interactions and point to ways to reduce the negative effects of gender stereotypes in job interviews. Additional online materials for this article are available to PWQ subscribers on PWQ’s website at http://pwq.sagepub.com/supplemental .
Are outsiders equally out everywhere? The economic disadvantage of outsiders in cross-national perspective
Authors: Fervers Lukas , Schwander Hanna
Published: March 2015

Despite intense policy debate over labour market dualization, research on cross-country differences in the ‘outsider penalty’ is still in its infancy. In this article, we assess two explanations for cross-national variation in the disadvantages affecting temporary workers (‘outsiders’), measured by the chances of regular employment and risk of unemployment: their socio-economic composition and the effect of labour market institutions (employment protection regulation and the strength of unions). Our findings suggest that variation in the outsider penalty is not caused by the socio-economic composition of the outsider group, but rather by the institutional setting of a country. Outsiders are more disadvantaged in countries with strong employment protection legislation. In contrast, strong unions do not reinforce but mitigate insider/outsider divides in at least some dimensions, a finding that adds to recent research about unions’ reorientation towards mobilizing outsiders.
Working alliances not loggerheads: understanding and addressing dissonance between families and treating teams in older people’s mental health
Authors: Jones Carolyn , Peisah Carmelle
Published: March 2015

Objectives:

To identify and describe common sources of dissonance which arise for treating teams in older person’s mental health and the strategies for addressing them.

Methods:

A literature review was conducted with the terms: ‘family conflict and treatment team’, ‘family therapy and old age’ and ‘family caregiver’.

Results:

We discuss the importance of an alliance with families regarding older people’s mental health, and the contribution of engagement, attachment and family dynamics to dissonance. We offer strategies to prevent and address dissonance.

Conclusions:

To prevent and manage dissonance, its causes need to be identified and understood. Routinely ‘thinking family’ first, then ‘knowing’ and ‘hearing’ the family are crucial steps to enhancing communication with families.
Effects of emulsion gels containing bioactive compounds on sensorial, technological, and structural properties of frankfurters
Authors: Pintado T , Herrero AM , Ruiz-Capillas C , Triki M , Carmona P , Jiménez-Colmenero F
Published: March 2015

Emulsion gels prepared with olive oil, chia, and cold gelling agents (transglutaminase, alginate, or gelatin) were used as fat replacers in reduced-fat frankfurter formulation. Nutritional advantages, sensory analysis, technological properties, and microbiological populations of frankfurters were evaluated along with their lipid structural characteristics over chilled storage. Frankfurters with emulsion gels showed significant improvements in fat content (lower saturated fatty acid, higher mono- and polyunsaturated fatty acid contents) and had good fat and water-binding properties. The presence of an emulsion gel reduced lightness and redness, but increased yellowness. Textural behavior of samples was significantly affected by the presence of emulsion gels and by storage. Sensory properties were not affected by the incorporation of emulsion gels, and all frankfurters were judged acceptable. Attenuated total reflectance–Fourier transform infrared spectroscopy results showed that samples with emulsion gels involve more lipid–protein interactions. Frankfurters with emulsion gels showed good stability to oxidation during storage and contained lower levels of microorganism than reduced-fat control at 85 days.
Intra- and inter-observer variability in ultrasonographical measurements of the uterus and ovaries in healthy, non-pregnant queens
Authors: Gatel Laure , Gory Guillaume , Chalvet-Monfray Karine , Saunders Jimmy H , Rault Delphine N
Published: March 2015

Objectives

We aimed to (1) evaluate how frequently the uterus and ovaries of healthy, non-pregnant queens are visible; (2) describe their appearance; (3) take their measurements; and (4) determine intra- and inter-observer variabilities in their measurements. We hypothesised that, using a high-frequency linear probe, the uterus and ovaries could be ultrasonographically visualised during any period of the sexual cycle and with any level of operator expertise.

Methods

Eight queens were enrolled in the study and the ultrasonographical appearance of their uterus and ovaries assessed with a high-frequency linear probe of 15–19 MHz. The diameter of the uterine horns, body and cervix in transverse and longitudinal sections, and the length of the ovaries were recorded. Three observers of different expertise level participated in the study, and the differences between the separate measurements made per queen were evaluated.

Results

The ovaries and the entire uterus were visualised in every queen. The ovaries were ovoid structures with submillimetric follicles during anoestrus and additional larger follicles depending on the stage of the cycle. An ovarian pattern suggesting cortex and medulla was observed in half the cases. In the uterus, the serosa was a thin hyperechoic outer rim, and layering was observed in half the cases. The cervix was difficult to identify. The intra- and inter-observer variabilities in the uterine horns and the ovaries were minimal (coefficient of variation [CV] 1.4–4.1%) compared with the differences within the queens (CV 10.9–43.4%). The longitudinal and transverse measurements of the horns and the uterine body were the same.

Conclusions and relevance

The ovaries and uterine horns in queens are accessible ultrasonographically at any stage of their cycle, and can be measured with low intra- and inter-observer variabilities.
Intralesional Bleomycin for Warts
Authors: Kruter Laura , Saggar Vishal , Akhavan Alaleh , Patel Parth , Umanoff Nicole , Viola Kate V. , Stebbins William , Smith Elizabeth , Akhavan Arash , Cohen Justine V. , Cohen Steven R.
Published: March 2015

Background:

The treatment of warts is challenging with regards to both tolerability and efficacy.

Objective:

Ascertain the efficacy, tolerability, and patient satisfaction of intralesional bleomycin in the treatment of warts.

Methods:

Retrospective chart review followed by telephone interviews with patients from university-based dermatology referral centers.

Results:

Seventy-four percent (34/46) of patients had complete resolution (CR) of all warts. Of 34 patients who experienced CR, an average of 1.7 treatments were required. Pain experienced during the procedure and recovery, irrespective of outcome, was rated 5.8 out of 10 (range, 1-10; SD, 2.72; SEM, 0.40). Approximately 70% of patients had pain that lasted less than 2 days after treatment. Seventy-eight percent (36/46) of patients in the study were satisfied with treatment and would recommend it to others.

Conclusion:

Patients felt bleomycin to be an effective treatment modality for warts, offering high rates of CR in lesions resistant to more traditional therapies.
Factors associated with general self-efficacy and resilience among youth heads of households in Kenya
Authors: Goodman Michael L , Lloyd Linda E , Selwyn Beatrice J , Morgan Robert O , Mwongera Moses , Gitari Stanley , Keiser Philip H
Published: March 2015

This study assesses resilience and general self-efficacy among Kenyan orphans and vulnerable children ( n = 1060) active in a community-based program combining economic household strengthening with psychosocial support. Quantile regression analyses modeled associations between the 25th, 50th, and 75th percentiles of resilience and general self-efficacy and multiple covariates. Program participation positively predicted increased general self-efficacy at all levels. Program participation predicted increased resilience at the 25th percentile but decreased resilience at the 75th percentile. Other significant predictors included economic, educational, sexual behavior and other demographic factors. This study suggests support for an integrated approach to economic and psychosocial empowerment.
Integration of acupuncture into conventional medicine from health professionals’ perspective: A thematic synthesis of qualitative studies
Authors: García-Escamilla Esther , Rodríguez-Martín Beatriz , Martínez-Vizcaíno Vicente
Published: March 2015

Acupuncture is a prominent Complementary Medicine. Although health professionals’ conceptions of acupuncture may affect its utilisation and integration within conventional medicine, these aspects have not been well studied. The aim of this review was to analyse the integration of acupuncture into conventional medicine from the perspective of health professionals.

We conducted a systematic review and a thematic synthesis of qualitative studies that analysed the integration of acupuncture into conventional medicine grounded in participants’ perspectives. A systematic search was undertaken in PubMed, Web of Science, the Cochrane Library Plus, Scopus and CINAHL.

This review included 18 articles: 6 analysed the viewpoint of physicians, 3 of nurses and 9 comprised different health-related professionals. Most of these studies included healthcare professionals practising acupuncture and took place in sites where the relation between acupuncture and biomedicine is favourable. The most used research techniques were convenience sampling, semi-structured interviews and interpretative approach. The holistic approach of acupuncture and its lack of adverse effects were highlighted by the analysed studies. This led to health professionals encouraging its integration into conventional medicine. The main obstacles perceived for the integration were lack of knowledge and institutional support. In general, acupuncture has been adapted to the biomedical model (often practised in an unsystematic and individual manner), and it is conceived as a supplement of Western medicine.

‘Working together’ and overcoming the biomedical model are recognised by the participants as key conditions for successful integration of acupuncture.
Radio frequency identification–enabled capabilities in a healthcare context: An exploratory study
Authors: Hornyak Rob , Lewis Mark , Sankaranarayan Balaji
Published: March 2015

Increasingly, the adoption and use of radio frequency identification systems in hospital settings is gaining prominence. However, despite the transformative impact that radio frequency identification has in healthcare settings, few studies have examined how and why this change may occur. The purpose of this study is to systematically understand how radio frequency identification can transform work practices in an operational process that directly impacts cost and operational efficiency and indirectly contributes to impacting patient safety and quality of care. We leverage an interdisciplinary framework to explore the contextual characteristics that shape the assimilation of radio frequency identification in healthcare settings. By linking the use of radio frequency identification with specific contextual dimensions in healthcare settings, we provide a data-driven account of how and why radio frequency identification can be useful in inventory management in this setting. In doing so, we also contribute to recent work by information systems scholars who argue for a reconfiguration of conventional assumptions regarding the role of technology in contemporary organizations.
Reading packages: social semiotics on the shelf
Authors: Wagner Karin
Published: March 2015

Packaging is surrounded by many restrictions and at the same time is the subject of much innovative design solutions. It is an area that offers rich material for studying how signs and codes are transformed and generate new meanings. The purpose of this article is to show how semiosis is enacted in food packaging and to discuss the semiotic resources involved. Three topics are analysed: how greenwashing can be achieved with the help of graphic design, how symbols, icons and barcodes are used for communication and how the closure of beverage packages can convey meaning. The analyses show that making pastiches of or tweaking required information like ingredients lists, recycling symbols and barcodes can add another level of meaning to such information and make them useful for marketing purposes. The article further shows that a material resource like closure is a semiotic resource with as much potential as graphic design.
Managing nonignorable missing data with clustered multinomial responses
Authors: Wang Mu-Cyun , Lin I-Feng
Published: March 2015

Clustered multinomial responses are common in public health studies. In this situation, the baseline logit random effects model is usually suggested as a general modelling approach. When nonignorable missing outcomes exist, naïve methods such as complete case analysis or likelihood methods ignoring missing information may distort the conclusions that are drawn. While methods to deal with binary and ordinal outcomes have been proposed, no easily implementable method is specifically available for missing clustered nominal responses. Joint modelling is usually one of the available choices but has high complexity in terms of likelihood. The numerical integration of both missing data and random effects is challenging. In this study, we have derived a closed form of likelihood. A simplified likelihood is also proposed, which is an extension of a previous study. One advantage is that both methods are easily implemented with commonly used software. We illustrate our proposed methods using the Global Youth Tobacco Survey and compare the results obtained by naïve methods that ignore missing data with the results obtained using the proposed methods. Our approaches restore the parameter estimates and predicted probability of each category to an acceptable extent. Analysis guidelines for the use of our methods are provided.
Retention of College Students and Freshman-Year Music Ensemble Participation
Authors: Crowe Don R.
Published: March 2015

This study investigates the effects of music ensemble participation during the freshman fall semester on the ongoing retention of college students. Retention of college students is a concern across the nation. The research question for the study was, “Is there a correlation between participation in music ensembles during college students' freshman fall semester and the retention of students for the sophomore, junior, senior, and (where applicable) fifth years?” The study compares the retention of students who enrolled in such ensembles at a midwestern university over a 4-year subsequent period with that of students who did not enroll. Data from Fall 2005 through Fall 2011 were collected and examined. Each freshman in each cohort (class) was assigned to one of two groups: those who enrolled in a music ensemble their first semester and those who did not. Enrollment data for each group for the following 4 years were analyzed to determine the incidence of retention for the sophomore, junior, senior, and fifth years (as applicable) for each cohort and for class standing across cohorts. The data show that those who enrolled in music ensembles returned for the subsequent 3 years at a significantly greater rate than those who did not, and that the difference in retention increased in each of these years.
Balloon Dilation and Stenting of Chronic Iliac Vein Obstruction: Technical Aspects and Early Clinical Outcome
Authors: Neglén Peter , Raju Seshadri
Published: March 2015

Purpose:

To describe the technical aspects of percutaneous balloon dilation and stenting for the treatment of venous outflow obstruction in chronic venous insufficiency.

Methods:

Between March 1997 and December 1998, 94 consecutive patients (median age 48 years, range 14 to 80) with suspected iliac vein obstruction in 102 limbs were studied prospectively with the intent to treat any venous occlusion or stenosis verified during femoral vein cannulation. Data from the history, clinical examination, procedure, and follow-up were recorded. Preoperative indicators of obstruction were venographic evidence of occlusion, stenosis, or pelvic collateral vessels; increased arm-foot venous pressure differential; and abnormal hyperemia-induced venous pressure elevation.

Results:

Cannulation and technical success rates were 98% and 97%, respectively, with 118 Wallstents deployed in 77 veins. Primary, assisted primary, and secondary patency rates at 1 year were 82%, 91%, and 92%, respectively. Clinical improvement in pain and swelling was significant.

Conclusions:

Stenting of benign iliac vein obstruction is a safe method with good short-term results. Venous lesions should always be stented; when treating iliocaval junction lesions, stents should be inserted well into the inferior vena cava. Absence of collateral vessels does not exclude the existence of significant obstruction, and their presence may indicate an obstruction not visualized. No gold standard for accurate pre- or intraoperative patient selection is currently available.
Endovascular Treatment of Multiple Visceral Artery Paradoxical Emboli with Mechanical and Pharmacological Thrombolysis
Authors: Sternbergh W. Charles , Ramee Stephen R. , DeVun Daniel A. , Money Samuel R.
Published: March 2015

Purpose:

To report a case of paradoxical emboli to multiple visceral vessels treated with both mechanical (AngioJet device) and pharmacological (urokinase) thrombolysis.

Methods and Results:

A 72-year-old man presented with a 48-hour history of symptomatic right renal ischemia, which was treated with heparinization. Five days later, an abrupt creatinine elevation prompted arteriography, which demonstrated thromboembolism of the superior mesenteric artery (SMA) and both renal arteries. The AngioJet aspiration device was employed to successfully remove the clot from the SMA; urokinase infusion restored flow to the left kidney. At the 16-month follow-up evaluation, the patient was normotensive without medication and had a stable creatinine (1.4 mg/dL).

Conclusions:

Because of its speed and minimal morbidity, the AngioJet device may be an attractive alternative to surgical embolectomy or pharmacological thrombolysis in highly selected cases of acute visceral artery thromboembolism.
Repair of Mycotic Paravisceral Aneurysm with a Fenestrated Stent-Graft
Authors: Kinney Edward V. , Kaebnick Hermann W. , Mitchell Richard A. , Jung Matthew T.
Published: March 2015

Purpose:

To report the successful endovascular repair of a mycotic paravisceral aneurysm using a fenestrated stent-graft.

Methods and Results:

A 55-year-old white female with a history of rheumatoid arthritis presented with an 8-cm paravisceral aneurysm secondary to pneumonia complicated by empyema. Intravascular ultrasound identified a defect in the aortic wall at the level of the celiac axis. Repair was accomplished with a fenestrated stent-graft that excluded the aneurysm and maintained flow to the celiac axis and superior mesenteric artery. Recovery was uneventful and the patient was discharged in 2 days. Six-month follow-up computed tomographic scanning confirmed aneurysm exclusion and flow to the celiac and superior mesenteric arteries. There was no evidence of graft infection. The patient died from a clinically diagnosed myocardial infarction 10 months after the stent-graft repair.

Conclusions:

Fenestrated stent-graft repair may evolve into a useful technique for the treatment of mycotic paravisceral aneurysms.
Midterm Changes in Aortic Aneurysm Morphology after Endovascular Repair
Authors: Resch Timothy , Ivancev Krassi , Brunkwall Jan , Nirhov Nick , Malina Martin , Lindblad Bengt
Published: March 2015

Purpose:

To study midterm changes in aortic aneurysm morphology after endovascular aneurysm repair.

Methods:

Of 94 patients with abdominal aortic aneurysms (AAAs) treated with endografts between November 1993 and August 1998, 84 were available for follow-up. Patients were evaluated preoperatively by spiral computed tomography (CT) and aortography; in follow-up, spiral CT scanning was performed at 1, 3, and 6 months and semiannually thereafter. Measurements of the aneurysm neck diameter, maximum aneurysm diameter, and the distance from the lowermost renal artery to the aortic bifurcation were made preoperatively and in follow-up.

Results:

Mean follow-up was 17.5 ± 1.1 months; 56 (67%) patients were followed for 1 year and 28 (33%) for ≥2 years. There was a median 2-mm increase (interquartile range [IQR] 0 to 3) in neck diameter at 18 months. However, a ≥3-mm increase was seen in 18 (46%) of 39 patients examined at 18 months (median 4 mm, IQR 3 to 4, p = 0.0001). The maximum AAA diameter decreased by 9 mm (IQR 4 to 16, p = 0.0003) at 24 months, but after 18 months, no further interval decrease was seen. Aneurysms with a persistent endoleak showed either increasing or unchanged AAA diameters. There was no change in the renal artery to bifurcation distance.

Conclusions:

The infrarenal aortic neck appears to dilate after AAA endografting, but only in a subset of patients. Shrinkage of aneurysms after successful stent-grafting seems to stop after 18 months, implying that the only indication of late failure in the absence of endoleak might be aneurysm enlargement. Graft-related endoleaks are often associated with an increase in aneurysm diameter.
Percutaneous Treatment of Life-Threatening Congenital Arteriovenous Malformations with the Wallgraft Endoprosthesis
Authors: Haas P. Clay , Angelini Paolo , Leachman D. Richard , Krajcer Zvonimir
Published: March 2015

Purpose:

To report the percutaneous endovascular repair of massive congenital arteriovenous malformations (AVMs) of the right arm complicated by tissue ischemia, severe edema, and life-threatening recurrent hemorrhagic episodes.

Methods and Results:

A 25-year-old man with a 3-year history of symptomatic upper right arm AVMs had been treated unsuccessfully with surgical ligation and coil embolization. The arm had become massively enlarged, disfigured, severely painful, and unusable, with extension of swelling to the upper chest. Under compassionate use as part of an investigational protocol, the AVMs were closed with 6 overlapping Wallgraft endoluminal prostheses deployed in the right brachial, axillary, and subclavian arteries, preserving the vertebral and distal circulations. Unfortunately, the patient suffered numerous pulmonary emboli and died 2 days after the procedure.

Conclusions:

Percutaneous treatment of massive AVMs appears feasible with the Wallgraft endoprosthesis, but optimal postprocedural management of such large anomalies should include immediate venous filter placement and aggressive anticoagulation therapy with intravenous heparin.
Endovascular AAA Repair Attenuates the Inflammatory and Renal Responses Associated with Conventional Surgery
Authors: Boyle Jonathan R. , Goodall Stephen , Thompson Jonathan P. , Bell Peter R.F. , Thompson Matthew M.
Published: March 2015

Purpose:

To quantify the inflammatory and renal parameters in comparative cohorts of patients undergoing surgical or endovascular repair of abdominal aortic aneurysms (AAAs).

Methods:

Forty-three patients (41 men; ages 58–81 years) underwent endovascular or conventional aneurysm surgery according to aortic morphology. All patients received a standard general anesthetic and had 12 serial blood and urine samples collected during the perioperative period. Samples underwent analysis for the cytokines interleukin (IL) 1β, tumor necrosis factor-alpha (TNF-α), and IL-6. White cell and platelet activation were estimated indirectly by measuring sL-selectin and 11-dehydrothromboxane B2, respectively. The urinary albumin: creatinine ratio (ACR) and N-acetyl-β-d-glucosaminidase (NAG) activity were estimated to assess renal injury. Fibrinogen and fibrinogen degradation products were calculated to assess activation of the clotting cascade.

Results:

Twenty-three patients underwent endovascular AAA repair and 20 had conventional surgery. Concentrations of IL-6 (p < 0.002) and TNF-α (p < 0.0004) were significantly higher in the conventional group. The ACR (p < 0.002) and urinary NAGs (p < 0.0009) were also significantly higher in this group, suggesting greater renal injury. Platelet activity was significantly greater in the endovascular group (p < 0.01), perhaps indicating thrombus organization within the aneurysm sac.

Conclusions:

These data suggest that the inflammatory response associated with conventional aneurysm repair is largely obviated by endovascular techniques. This may potentially translate to a lower incidence of multiple organ failure after endovascular surgery.
Acute Renal Failure after Redo Thoracoabdominal Aortic Aneurysm Repair in a Patient with a Solitary Kidney: Successful Percutaneous Treatment
Authors: Yue Robin L. , Collins Tyrone J. , Sternbergh W. Charles , Ramee Stephen R. , White Christopher J.
Published: March 2015

Purpose:

To report the successful percutaneous treatment of renal artery stenosis that precipitated renal failure following surgical repair of a thoracoabdominal aortic aneurysm (TAAA).

Methods and Results:

A 70-year-old woman with a solitary kidney became anuric 2 hours after urgent repair of a symptomatic true aneurysm of the Carrel patch from an 8-year-old TAAA repair. After medical treatment failed, aortography was performed, identifying complete occlusion of the solitary renal artery. Balloon dilation and implantation of a Palmaz stent restored renal perfusion and improved function. At 6-month follow-up, she was normotensive and her creatinine within normal limits.

Conclusions:

Renal artery stenosis or occlusion is a treatable cause of acute renal failure after TAAA repair. Percutaneous treatment options are likely to be better tolerated than surgical revascularization in this patient population.
Percutaneous Profundaplasty in the Treatment of Lower Extremity Ischemia: Results of Long-term Surveillance
Authors: Silva Jose A. , White Christopher J. , Ramee Stephen R. , Collins Tyrone J. , Jenkins J. Stephen , Sabet Sameh , Shamaileh Qasem , Vivekananthan Krishnamoorthy
Published: March 2015

Purpose:

To assess the procedural and long-term clinical outcomes of balloon angioplasty of the profunda femoris artery in patients with severe limb ischemia.

Methods:

Thirty-one consecutive patients were evaluated for severe ischemia in 32 limbs: 13 (41%) were categorized Fontaine class 2B, and 19 (59%) were class 3 or 4. The superficial femoral artery was occluded in 20 (62%) limbs; an additional vessel was treated in 22 (69%) limbs.

Results:

Procedural success was achieved in 91% (31/32) of limbs. The ankle-brachial index increased from 0.5 ± 0.2 at baseline to 0.7 ± 0.2 after intervention (p < 0.01). In-hospital limb salvage was 94% (30/32), and in-hospital event-free survival was 90% (28/31). At a mean follow-up of 34 ± 20 months, no additional amputations were necessary; 3 patients required repeat revascularization, and 5 patients died. Freedom from revascularization was 88% in the 25 survivors. At follow-up, 88% of the patients had Fontaine class 1 or 2A symptoms, and only 12% had Fontaine class 2B or higher (p < 0.001 compared with baseline).

Conclusions:

These data suggest that percutaneous profundaplasty is safe, effective, and may be considered as an alternative to surgical therapy in patients with anatomically suitable lesions.
Seat Belt Aorta: Endovascular Management with a Stent-Graft
Authors: Fontaine Arthur B. , Nicholls Steven C. , Borsa John J. , Hoffer Eric , Bloch Robert D. , Kohler Ted
Published: March 2015

Purpose:

To report the endovascular treatment of a relatively uncommon type of deceleration injury to the abdominal aorta.

Case Report:

A 21-year-old backseat passenger was wearing a single lap belt without shoulder harness when the car was involved in a collision. He sustained a transverse (Chance) fracture of the third lumbar vertebra and a circumferential dissection of the infrarenal abdominal aorta with pseudoaneurysm. As an interim measure while a stent-graft was obtained, a Wallstent was deployed to tack down the dissection and prevent distal embolization. Thirty-six hours later, an AneuRx endograft was successfully implanted inside the Wallstent to seal the pseudoaneurysm. The patient's recovery was uneventful, and the endograft remains secure and the pseudoaneurysm excluded at 10 months after the accident.

Conclusions:

Endovascular repair of “seat belt aorta” is a minimally invasive, straightforward method of management for this type of aortic injury. The potential for infection in a contaminated peritoneal cavity and the long-term outcome of this treatment have not been determined.
Early Clinical Experience with Color Three-Dimensional Intravascular Ultrasound in Peripheral Interventions
Authors: Irshad Khalid , Reid Donald B. , Miller Peter H. , Velu Raj , Kopchok George E. , White Rodney A.
Published: March 2015

Purpose:

To report early clinical experiences with color 3-dimensional intravascular ultrasound (3-D IVUS) in assisting peripheral interventions.

Technique:

A 3.5-F, 20-MHz IVUS catheter that utilizes ChromaFlo computer software to demonstrate blood flow in color was evaluated in over 100 peripheral interventions. ChromaFlo captures up to 30 conventional IVUS frames every second and generates “realtime” imaging. The software compares sequential axial IVUS images and interprets any differences in the position of echogenic blood particles, which are displayed as colorized flow in axial or 3-D renderings.

Conclusions:

ChromaFlo-enhanced IVUS demonstrates colorized blood flow inside the vessel lumen, which is helpful in distinguishing echolucent disease from luminal blood flow and can also be used to perform peripheral interventions in patients with renal failure or allergy, avoiding the use of contrast media.
Embolization via Collateral Circulation during Carotid Stenting with the Distal Balloon Protection System
Authors: Al-Mubarak Nadim , Vitek Jiri J. , Iyer Sriram , New Gishel , Leon Martin B. , Roubin Gary S.
Published: March 2015

Purpose:

To describe a potential route for embolization to the middle cerebral artery (MCA) during carotid stenting with the distal balloon protection system.

Case Report:

An 82-year-old man with symptomatic severe carotid artery stenosis underwent elective carotid stenting with distal-balloon protection. Despite complete occlusion of the distal internal carotid artery, frequent emboli were detected in the ipsilateral MCA by transcranial Doppler (TCD) during the procedure. Intracranial angiography, performed during the distal-balloon protection, revealed filling of the MCA through collaterals from the ipsilateral external carotid artery. The procedure was successfully completed without complications. The patient remains asymptomatic at 6 months.

Conclusions:

During carotid stenting with distal-balloon protection, asymptomatic embolization into the ipsilateral MCA may occur through collateral circulation. The clinical significance of these emboli is uncertain.
Macroporous Polyester—Covered Stent in an Experimental Abdominal Aortic Aneurysm Model
Authors: Soula Philippe , d'Othée Bertrand Janne , Otal Philippe , Amin Chauki , El Khoury Joe , Delisle Marie-Bernadette , Cérène Alain , Joffre Francis , Rousseau Hervé
Published: March 2015

Purpose:

To validate a recently described animal model of abdominal aortic aneurysm (AAA) and to assess a new macroporous polyester—covered stent for endovascular AAA exclusion.

Methods:

Twenty adult sheep had AAAs surgically created by replacing a segment of the infrarenal aorta with an autologous jugular venous graft. Three months later, surviving animals underwent percutaneous implantation of macroporous polyester—covered nitinol stents; 3 animals with untreated AAAs served as controls. Follow-up surveillance included spiral computed tomography at 1 month and digital subtraction angiography at 3 and 6 months. Endografted animals were sacrificed at 1, 3, and 6 months after implantation; specimens from all animals were examined grossly and microscopically.

Results:

Seven (35%) animals died within 24 hours of causes related to the technique; 1 animal developed paraplegia and was sacrificed on day 1. Three (25%) animals died of spontaneous aneurysm rupture at <10 days, and 6 received the stent-graft at 3 months. The macroporous cover did not prevent continued perfusion of the sac early after stent-graft deployment, but all aneurysms were excluded on the 1-month CT.

Conclusions:

Spontaneous AAA rupture occurred earlier and was not as frequent as previously described for this model. Implantation of the covered stent was feasible, but aneurysm exclusion was not immediate.
Evaluation of Endovascular Techniques for Creating a Porcine Femoral Artery Occlusion Model
Authors: Nikol Sigrid , Armeanu Sorin , Engelmann Markus G. , Pelisek Jaroslav , Fuchs Alexandra , Zähringer Christian , Bartoli Jean-Michel , Mesana Thierry , Rolland Pierre H.
Published: March 2015

Purpose:

To determine the optimal endovascular approach to achieve long-term occlusion of large arteries, while preserving the integrity of periarterial tissue, in an animal model of ischemia.

Methods:

Femoral artery occlusions were created in 16 pigs using detachable balloons, coils, or blinded stent-grafts. Feasibility, safety, primary and long-term success, and the degree of neovascularization were determined over a 6-month period by serial angiography and histological analyses. Four animals served as untreated controls.

Results:

Overall primary success for all occlusion devices was 100%. The 6-month occlusion rate using detachable balloons or coils was 33% and 0%, respectively; however, all arteries occluded with blinded stent-grafts remained obstructed to the end of the study. There was no significant difference in capillary densities and collateralization of periarterial areas when occluded arteries were compared with nonoccluded controls in the same animal. No increase in collateralization was observed following endovascular arterial occlusion.

Conclusions:

Percutaneous insertion of blinded stent-grafts easily, safely, and reliably creates long-term arterial occlusion in pigs, which may make this a more appropriate model for studying the effects of angiogenic factors in vivo.
Endovascular Repair of an Innominate Artery True Aneurysm
Authors: Puech-Leão Pedro , Orra Hussein Amim
Published: March 2015

Purpose:

To describe endovascular repair of a large aneurysm of the innominate artery in a patient with episodes of transient cerebral ischemia.

Case Report:

A 44-year-old man with a history of transient hemiparesis and aphasia demonstrated a large mass in the upper right hemithorax on chest radiography. Systolic brachial pressure in the right arm was 100 mm Hg versus 130 mm Hg in the left. Imaging disclosed a large 12-mm-diameter aneurysm involving the brachiocephalic trunk 1 cm above its origin and the first portion of the right subclavian artery, which was occluded after the dilated segment. The aneurysm was treated with a tapered endograft made from polyester graft attached to a Palmaz stent inserted via a carotid artery arteriotomy. The distal end of the graft was anastomosed to the common carotid artery. Completion angiography showed exclusion of the aneurysm, which has been confirmed by imaging at 21 months. After 2 years, the patient is free from neurological symptoms and has a strong carotid pulse; no arm claudication developed.

Conclusions:

Endovascular correction of innominate artery aneurysms is feasible whenever there is an adequate proximal neck for attachment. In these cases, thoracotomy may be avoided.
Intentional Left Subclavian Artery Occlusion by Thoracic Aortic Stent-Grafts without Surgical Transposition
Authors: Hausegger Klaus A. , Oberwalder Peter , Tiesenhausen Kurt , Tauss Josef , Stanger Olaf , Schedlbauer Peter , Deutschmann Hannes , Rigler Bruno
Published: March 2015

Purpose:

To report the consequences of endoluminal deployment of stent-grafts in the thoracic aorta with intentional occlusion of the left subclavian artery.

Case Reports:

Three patients with an aortic type-B dissection and 1 with a thoracic aneurysm were treated endoluminally with Talent stent-grafts implanted over the ostium of the left subclavian artery without prior surgical subclavian-carotid transposition. The primary intimal tears were sealed and the degenerative aneurysm excluded; blood pressure in the left arm was significantly diminished immediately after the stent-graft was released, but adequate collateral retrograde perfusion via the left vertebral artery was apparent in all patients. No neurological deficit and no symptoms of left arm ischemia were observed in a follow-up that ranged from 14 to 20 months.

Conclusions:

Our limited experience shows that occlusion of the left subclavian artery with a stent-graft is well tolerated. If ischemic symptoms occur, a transposition procedure can be performed on an elective basis.
Micromovements at the Aortic Aneurysm Neck Measured during Open Surgery with Close-Range Photogrammetry: Implications for Aortic Endografts
Authors: Flora Harpaul S. , Woodhouse Neil , Robson Stuart , Adiseshiah Mohan
Published: March 2015

Purpose:

To describe the motion of abdominal aortic aneurysm (AAA) as a first step toward determining if stent-graft migration may be due to propulsive movements at the neck.

Method:

In an initial laboratory validation test, a silicone AAA model was imaged with a stereo-pair configuration of calibrated digital cameras using retro-reflective and ink dot surface targets. This technique was then applied to 4 aneurysm necks imaged at open surgery. In each case the paired images were measured and analyzed to produce sequences of accurate three-dimensional (3-D) surface models of the anterior aspect of the aortic neck. Engineering techniques were used to visualize and identify differences between the generated surfaces, allowing changes in shape of the aortic wall to be determined.

Results:

The correlation between stereoscopic digital imaging with electronic caliper measurements of linear dimensions was accurate, irrespective of the type of surface targets used ( r2 = 0.98). The AAA neck demonstrated complex 3-D movements that ranged from 1.0 to 1.5 mm in the radial direction to 0.6 to 1.0 mm along the longitudinal axis, with a 0.44 to 0.59-mm rotational component (p < 0.05).

Conclusions:

This pilot study raises questions about the validity of accepted models of arterial wall movements and compliance in which rotation has not been described. The technique used to measure dynamic neck morphology appears promising as a means to further define the mechanical parameters of the human aorta, which may assist in designing stent-grafts.
Penetrating Atherosclerotic Ulcer of the Aorta
Authors: Samal Aditya K. , White Christopher J. , Kot James B.
Published: March 2015

Purpose:

To describe a case of penetrating atherosclerotic ulcer of the aorta with a review of its natural history, diagnosis and management.

Case Report:

An elderly patient with a history of hypertension presented to the emergency room with the sudden onset of severe chest pain radiating to the back. The electrocardiogram showed left ventricular hypertrophy; the chest radiograph revealed mediastinal widening. Computed tomography was suspicious for a mediastinal hematoma without aortic dissection. Transesophageal echocardiography was also negative for dissection. An aortogram revealed a penetrating atherosclerotic ulcer of the descending thoracic aorta. The patient underwent successful resection and repair of the lesion.

Conclusions:

Penetrating atherosclerotic ulcer of the aorta is a potentially lethal lesion that must be promptly diagnosed and treated.