bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasmon-Enhanced Photodynamic Therapy for Gastric Cancer by Integrating Targeted Gold Nanorods and Photosensitizer
Authors: Xin Jing , Fu Lei , Wang Sijia , Wang Jing , Zhang Zhenxi , Yao Cuiping
Published: September 2022

Gold nanoparticles are widely used for biomedical purposes because of their unique optical, surface plasmon resonance properties, ease of surface functionalization, and high load capacity. Gold nanorods (AuNR), which are rod-shaped gold nanoparticles, have been used as an effective
photodynamic treatment (PDT) carrier to boost singlet oxygen (SOG) generation through localized surface plasmon resonance (LSPR) effect and then improve PDT efficacy. However, the suitable spatial location should be established to enable photosensitizer to feel the LSPR enhancement. In this
study, we utilized multifunctional PEG chain to adjust efficient distance to induce more photosensitizers to feel the enhanced LSPR effect of AuNR and used a novel gastric tumor angiogenesis marker to prevent the uncontrolled LSPR shift induced by the aggregation of AuNR, and then acquire
plasmon-enhanced PDT. The synthesized nano-system of integrated photosensitizer and targeted AuNR could significantly enhance SOG generation and improve the apoptosis-inducing ability through activation of the mitochondria-mediated apoptotic pathway, and -shorten the induction time for apoptosis,
thus acquire efficient plasmon-enhanced PDT. Comparing to the normal photosensitizer, half of the targeted photosensitizer produce same antitumor effect, which improves maximum tolerable dose. Generally, this novel targeted delivery system is a promising agent of plasmon-enhanced PDT for gastric
cancer.
Intra-Epidural Space Injection of OX26-PEGylated Selenium Nanoparticles Enhances Motor Function and Decrease the Risk of Neural Damage in Animal Model of Subarachnoid Hemorrhage
Authors: Wang Yuli , Zheng Jie , Hu Hongqi , Xing Zhenyi
Published: September 2022

Objective: To evaluate the effectiveness of PEGylated (PEG) OX26 loaded with Selenium (Se) on locomotor activity and brain function and exploring underlying mechanism in animal model of subarachnoid hemorrhage (SAH). Methods: Thoracis spinal cord injury in Wistar rats
was used to induce SAH and intra-epidural injection of OX26-PEG-Se nanoparticles (NPs) was then applied. Locomotor function test was used to evaluate the behavioral outcome in addition, ELISA kit was used to evaluate the serum level of NSE and S100B. Immunofluorescent imaging was used to detect
the expression of eNOS and NT-1. In addition, NeuN staing was used to assess the neural damage. Results: The locomotor function of animals with SAH was significantly increase afgter treating with OX26-PEG-Se NPs. In addition, the expression levels of NSE and S100B were significantly
decrease after treating animals with OX26-PEG-Se NPs in comparison to sham operated animals. We observed that OX26-PEG-Se NPs decrease the neural damage and the level of NT-1, while increase the eNOS in brain. Conclusion: Intra-epidural injection of OX26-PEG-Se NPs improved the locomotor
activity and also inhibit the risk of neural damage through ET-1/eNOS pathway after subarachnoid hemorrhage.
Midlatitude jet position spread linked to atmospheric convective types
Authors: Fuchs David , Sherwood Steven C. , Waugh Darryn , Dixit Vishal , England Matthew H. , Hwong Yi-Ling , Geoffroy Olivier
Published: September 2022

Midlatitude weather is largely governed by bands of strong westerly winds known as the midlatitude jets, but what controls the jet properties, particularly their latitudes, remains poorly understood. Climate models show a spread of about ten degrees in their simulated present-day latitude of the Southern Hemisphere (SH) jet, and a related spread in its predicted poleward shift under global warming. We find that models with more poleward jets simulate more low-level moisture, a warmer upper troposphere, and different precipitation patterns than those with equatorward jets, potentially implicating inter-model differences in moist convection and microphysics. Accordingly, a suite of atmospheric model runs is performed where the deep or shallow convective parametrizations are individually turned off either globally or in specific latitude bands. These experiments suggest that models that produce more shallow convection in the midlatitudes tend to position the jet relatively poleward in SH summer, whereas those which favor deep convection tend to position it equatorward. This accounts for a spread 60% as large as that of AMIP during the Austral summer. Our results suggest that, in the Boreal summer, similar biases appear in the northern hemisphere. The presence of shallow convection in the Northern Hemisphere midlatitudes reduces SH jet shift in a warmer climate in accordance to the correlation between jet positions and shift seen in this season. These results can help explain inter-model differences in the position and shift of the jet, and point to an unexpected role for atmospheric moist convection in the midlatitude circulation.
Integrated soft sensor of COD for WWTP based on ASP model and RBF neural network
Authors: Cong Qiu-mei , Bo Gui-hua , Shi Hui-yuan
Published: September 2022

For wastewater treatment process (WWTP), mechanism model for activated sludge process (ASP) is unsuitable for estimating the effluent COD (Chemical Oxygen Demand) as the parameters of ASM (Activated Sludge Model) series models are varying with operating conditions. This paper presents an integrated model to predict the effluent COD. The model consists of two sub-models which are simplified mechanism model of ASP and RBFNN (RBF Neural Network) with variable structure (VSRBFNN). ASP model can express the dynamic biochemical reactions occurred in WWTP, and VSRBFNN is used to reduce the prediction error of the ASP model as an error compensation model. To reduce the complexity of the mechanism model of ASP, the parameters of mechanism model are fixed. The layout and the parameters of VSRBFNN can be adjusted according to the training data, and the stable learning algorithm can restrict the modeling error of VSRBFNN within a bounded domain. The output value of the integrated model is weighted sum of those of two sub-models, where the weights denote the contributions of the two “sub-models” to the prediction error of integrated model and are rectified according to the relative prediction error online. The structure of the integrated soft sensor is concise and real-time capability is improved. Simulations show that the presented soft sensor has satisfactory prediction accuracy under various operating characteristics.
Disturbance observer-based control with adaptive neural network for unknown nonlinear system
Authors: Hu Jing , Zheng Meirong
Published: September 2022

This paper presents an adaptive neural network controller based on a disturbance observer to compensate the disturbance caused by neural network approximation for a class of unknown nonlinear systems. The proposed adaptive neural network control with an updated parameters mechanism is not subject to the restriction of compact set assumption for satisfying the universal approximation property. The neural network approximation error can be compensated online through the proposed disturbance observer. The proposed method eliminates the need to obtain an exact system model before applying the ideal controller. The effectiveness of the proposed method is validated by numerical simulations.
Motivational factors among social work undergraduates in online education during the post-COVID-19 era
Authors: Azhar Athirah
Published: September 2022

This essay summarises social work students’ experiences with online learning during a pandemic and investigates motivational factors post-pandemic. Post-COVID, 56 percent prefer hybrid learning. Students reported that they were the primary source of motivation for online classes, followed by course instructors and the environment.
Strategic processes to further the professional status of social work in Nigeria
Authors: Gray Mel , Amadasun Solomon
Published: September 2022

This article examines pivotal issues relating to social workers’ search for professional recognition in Nigeria. It begins with a historical discussion of social work’s universal quest to establish a distinct professional identity. Thereafter, it examines Nigerian social work’s path to professionalisation before introducing an analytical framework through recourse to an R-lexicon to highlight the interrelated processes by which professions establish their credentials and attain legitimation. These are registration and regulation, relevance, recognition, representation, relational connection, rights and research. This R-lexicon highlights key strategic areas Nigerian social workers might address to advance their quest for professional status.
Paediatric paranasal sinus fibrous dysplasia
Authors: Adeyemo AA , Ogunkeyede SA , Daniel A , Lasisi AO
Published: September 2022

Fibrous dysplasia in the bony walls of a paranasal sinus is a developmental tumour that is associated with a marked facial deformity. Delay in hospital presentation contributes to the destructive resection techniques employed and the management outcome. Our study looks at the factors for delay in hospital presentation and the management outcome by a retrospective review between January 1997 and December 2018. Of 43 children (M: F 1:1.2) with a mean age of 12 ± 1.75 years, the maxillary bones were mostly affected. All underwent surgical resection with good management outcomes except for maxillectomy. Tumour recurrence was noted in five and there was no mitotic cell at histology. The clinical symptoms of fibrous dysplasia vary in severity and age of onset, often with late hospital presentation already with complications. Health education is needed to reverse this trend.
Information behaviour in high risk decision making: Study of international postgraduates
Authors: McNicholas Carolyn , Marcella Rita
Published: September 2022

This article explores the role of information in high risk consumer decision making. Forty-two qualitative interviews were undertaken with international non-EU postgraduates when making the high risk decision to study in a UK Business School. Prospective international postgraduates moved iteratively through the stages in Kuhlthau’s Information Search Process model and learnt from the search process they had undertaken in a continuous cyclical manner. Word-of-mouth recommendations were the most influential sources of information gathered, and online sources were perceived to be credible regardless of their origins. The perception of risk impacted the rigour of the information search process. An iterative decision making cycle model is proposed with Kuhlthau’s model and word of mouth information at its core, which reflects the connectedness of individuals in this digital era. This study provides new insights by combining both marketing and LIS models and extends Kuhlthau’s research into a new context.
Cell-based serum anticholinergic activity assay and working memory in cognitively healthy older adults before and after scopolamine: An exploratory study
Authors: Chandramouleeshwaran Susmita , Ghazala Zaid , Nobrega José N , Raymond Roger , Gambino Sara , Pollock Bruce G. , Rajji Tarek K
Published: September 2022

Background:

A new cell-based serum anticholinergic activity (cSAA) assay that measures anticholinergic activity specifically at muscarinic M1 receptors and eliminates many of the drawbacks of the existing assay was developed by our team.

Aims:

We aimed to study the relationship between changes in working memory and executive function with changes in cSAA using the new assay in cognitively healthy older adults.

Methods:

Cognitively healthy participants aged 50 years and above, received a single dose of 0.4 mg of intravenous scopolamine. Cognition and cSAA levels were measured before and 30 min after receiving scopolamine. Cognition was measured using the Cambridge Neuropsychological Test Automated Battery.

Results:

Ten participants were recruited, and nine (mean age = 69.8, SD = 9.5, range 59–86 years) completed the study. Following scopolamine, participants experienced an increase in cSAA (cSAA pre = 0.90 ± 0.97 vs cSAA post = 12.0 ± 3.70 pmol/L; t-test ( df = (8) = −9.5, p < 0.001). In addition, there was an association between change in cSAA and changes in working memory (Spearman’s ρ = 0.68, p = 0.042) and executive function (Spearman’s ρ = 0.72, p = 0.027).

Conclusions:

In our sample of cognitively healthy older adults, the new cSAA assay was able to quantify the scopolamine induced increase in anticholinergic load which correlated significantly with the observed decline in working memory and executive function.
Nonlocal dual-phase-lag thermoviscoelastic response of a polymer microbeam incorporating modified couple stress and fractional viscoelastic theories
Authors: Peng Wei , Qi Zezhang , He Tianhu
Published: September 2022

Ultra-slow relaxation process of polymers has the memory-dependent feature, integer-order thermoviscoelastic models may fail to describe the dynamic behaviors of viscoelastic structures accurately. Additionally, it is noticed that the small-scale effect of elastic deformation and heat conduction in a non-isothermal temperature environment is becoming significant due to the development of micro-devices. To better capture the memory-dependent effect and the small-scale effect of viscoelastic micro-structures in heat transfer environment, as a first attempt, present work focuses on developing a refined fractional Kelvin-Voigt thermoviscoelastic model by incorporating the nonlocal dual-phase-lag (NDPL) heat conduction model and the modified coupled stress theory (MCST). Then, the model is applied to investigating the transient response of a polymer microbeam subjected to a harmonic thermal loading. The governing equations involving the modified parameters are formulated and then solved by Laplace transform method. Some parametric results are demonstrated to display the impacts of the nonlocal thermal parameter, the material length-scale parameter and the fractional-order parameter on the considered physical quantities. The results show that the small-scale effect and the memory-dependent effects strongly depend on the polymer micro-structure characteristics in thermal environment.
Who am I as a Sexual Being? The Role of Sexual Self-Concept Between Dispositional Mindfulness and Sexual Satisfaction among Child Sexual Abuse Survivors
Authors: Guyon Roxanne , Fernet Mylène , Girard Marianne , Cousineau Marie-Marthe , Tardif Monique , Godbout Natacha
Published: September 2022

Childhood sexual abuse (CSA) is associated with long-lasting and pervasive impacts on survivors’ sexual health, particularly on their sexual satisfaction. Dispositional mindfulness has been found to be associated with greater sexual satisfaction among adult CSA survivors. However, the mechanisms involved in this association remain understudied. The present study examined the role of sexual self-concept (i.e., sexual esteem, sexual preoccupation, and sexual depression) in the relationship between dispositional mindfulness and sexual satisfaction among CSA survivors. A total of 176 adult CSA survivors (60.6% women, 39.4% men) completed an online survey assessing dispositional mindfulness, sexual self-concept, and sexual satisfaction. Path analyses revealed that dispositional mindfulness was positively related to sexual satisfaction through a significant indirect effect of higher sexual esteem and lower sexual depression. The integrative model explained 66.5% of the variance in sexual satisfaction. These findings highlight the key roles that dispositional mindfulness and sexual self-concept play in CSA survivors’ sexual satisfaction. Implications for interventions based on trauma-sensitive mindfulness targeting the sexual self-concept are discussed, as they may promote sexual satisfaction in adult CSA survivors.
Generational and Social Forces in the Life Events and Experiences of Lesbian and Gay Midlife and Older Adults Across the Iridescent Life Course
Authors: Fredriksen-Goldsen Karen , Hoy-Ellis Charles , Kim Hyun-Jun , Jung Hailey H. , Emlet Charles A. , Johnson Ian , Goldsen Jayn
Published: September 2022

Objectives

Utilizing Iridescent Life Course, we examine life events among three generations of lesbian and gay adults: Invisible (born 1920–1934), Silenced (born 1935–1949), and Pride (born 1950–1964) Generations. Methods: We utilized a subsample ( n = 2079) from the 2014 wave of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS). Demographic characteristics, life events, and gender and generational interactions were compared. Results: Compared to other generations, the Invisible Generation disclosed their identity at older ages, were more likely to be retired, served in the military, and survived a partner’s death. Compared to the other generations, the Pride Generation was more likely to have disclosed their identities earlier and experienced higher levels of victimization/discrimination. Discussion: This paper is the first to examine the lived experiences of the oldest lesbians and gay men and compare them to other generations. The findings illustrate the heteronormative nature of most life course research.
Did 9/11 Affect Donations to Islamic Charities in the United States?
Authors: Wasif Rafeel
Published: September 2022

This article studies the impact of exogenous shocks on nonprofit operations by assessing the effect of 9/11 on donations to Muslim American nonprofits. The first narrative promoted by civil rights groups and some Islamic charities argues that donations to Islamic charities have declined. Individuals are afraid of getting indicted by law enforcement agencies for advertently or inadvertently funding an organization that supports terrorism. The second narrative is that donations to Islamic charities have increased post-9/11 as donors push back against Islamophobia by supporting Muslim nonprofits. I systematically assess these narratives using difference-in-difference (DiD) methodology and find that 9/11 had no significant impact on overall contributions to Islamic charities. Although donations to internationally focused Islamic charities declined in the year following 9/11, when compared with domestic-focused Islamic charities, they also recovered shortly after that. Moreover, they did not reduce significantly when compared with non-Islamic internationally focused organizations.
Admissible edge-dependent finite-time ℋ∞ filtering for discrete-time switched systems with average dwell time
Authors: Tong Yanhui , Zhao Xudong , Zhai Mingyuan , Wang Hailong , Li Xiaohang
Published: September 2022

Considering that the property of finite-time convergence is of great significance for practical filters, this article is focused on the finite-time ℋ∞ filtering for discrete-time switched systems with average dwell time. Different from the case of the general mode-dependent switching, the information of the admissible switching edge is fully exploited to derive more preferable filtering scheme. In order to further reduce the design conservatism, the multiple discontinuous Lyapunov function approach, which incorporates the concept of admissible edge-dependent average dwell time, is used to analyze the finite-time stability and ℋ∞ performance of the filtering error system. This approach assigns each subsystem of the error system with a discontinuous function rather than a continuous one, so it is less conservative compared to the conventional multiple Lyapunov function approach. First, the finite-time boundedness and ℋ∞ performance is analyzed for general switched nonlinear systems with admissible edge-dependent average dwell time. Then, a sufficient condition of the finite-time boundedness and ℋ∞ performance is derived for the filtering error system based on the obtained criterion. Subsequently, an admissible edge-dependent finite-time filtering scheme is proposed for the underlying system in terms of linear matrix inequalities. Finally, the proposed filter design scheme is applied to a DC–DC power converter circuit, and its effectiveness and superiority are verified by the simulation results.
Does Conservative Surgical Approach Improve Early and Late Outcome in Patients with Acute Type A Aortic Dissection?
Authors: Kirali Kaan , Mansuroğlu Denyan , Rabuş Murat B. , Erentuğ Vedat , Tuncer Altug , Akinci Esat , İpek Gökhan , Işik Ömer , Yakut Cevat
Published: September 2022

Objective:

Acute type A aortic dissection (AAAD) represents an emergency in cardiac surgery that requires immediate treatment to prevent death due to its fatal complications. The surgical approach is dependent on the involvement of AAAD.

Methods:

Sixty-one patients were operated for AAAD at our clinic. 48 (78.7%) were male and 13 (21.3%) were female with a mean age of 51±12.3 yr (range, 21–80 yr). Only the ascending aorta was replaced in 33 (54.1%) patients (Group I) and aortic arch replacement was included in 28 (45.9%) patients (Group II). The aortic valve was preserved in 43 (70.5%) patients (Group A) and replaced in 18 (29.5%) patients (Group B).

Results:

Early mortality rate was 23% (14/61). Multivariate analysis revealed that previous cardiac operations ( P=0.048), renal complications ( P=0.024), pump time ( P=0.024), and cardiac complications ( P=0.017) were significantly factors increasing early mortality. Late mortality rate was 8.5% (4/47) and multivariate analysis revealed that pulmonary complication ( P=0.015) was the only statistically significant independent risk factor. Arch replacement or aortic valve replacement was not a predictor for early or late mortality. Cumulative survival was 73.8±5.63% at 1 yr and 68.3±6.46% at 7.5 yr. Cumulative survival was not different between groups (P>0.05).

Conclusions:

Both radical and conservative surgical approaches in AAAD do not differ in mean of early or late results. Surgery before development of hemodynamic instability and prevention of other system complications improves the outcome of surgical treatment in AAAD.
Splanchnic Oxygenation in Patients Undergoing Abdominal Aortic Aneurysm Repair and Volume Expansion with eloHAES
Authors: Rittoo D. , Gosling P. , Bonnici C. , Burnley S. , Millns P. , Simms M. H. , Smith S. R. G. , Vohra R. K.
Published: September 2022

Background:

Gastric intramucosal pH (pHi), a surrogate marker of splanchnic oxygenation, falls following abdominal aortic aneurysm surgery. Aim: To investigate the effects of volume expansion with hydroxyethyl starch (eloHAES) on splanchnic perfusion compared to another colloid such as gelofusine. Patients and methods: Twenty-two consecutive patients undergoing AAA repair were randomised to receive either eloHAES or gelofusine as plasma expanders. Tissue oxygenation was monitored (10 gelofusine and 12 eloHAES) indirectly by measuring pHi using a nasogastric tonometer.

Results:

Compared to the eloHAES group, the fall in pHi was significantly greater in the gelofusine group at clamp release (7.29 vs 7.33, P = 0.003) and at 4 h following clamp release (7.29 vs 7.33, P= 0.03). There was a good inverse correlation between the lowest pHi and the peak serum interleukin-6 ( rs= −0.47, P= 0.03). By multivariate analysis, the only factor that influenced the pHi was the type of colloid used ( F= 5.54. P= 0.005). The eloHAES treated patients required significantly less colloid on the first postoperative day (3175±175 vs 4065±269 ml, P=0.01).

Conclusion:

In patients undergoing abdominal aortic aneurysm repair, plasma expansion with eloHAES improves microvascular perfusion and splanchnic oxygenation.
Stentless Aortic Valve Replacement in Elderly Patients
Authors: Gelsomino S. , Da Col P. , Morocutti G. , Frassani R. , Porreca L. , Minen G. , Livi U.
Published: September 2022

Objective.

Seven-year clinical and hemodynamic results of the Cryolife O'Brien (CLOB) stentless bioprosthesis in elderly patients are reported.

Methods.

From 1993 to 2000, 36 patients aged >75 years had a CLOB implanted in the aortic position. Eighteen (50%) were male. All patients were monitored with serial echocardiograms performed preoperatively, at discharge, six months, one year and yearly thereafter.

Results.

The 30-day mortality was 2.4% (1/36). Actuarial survival at one, five and seven years were 96.7±1.5. 94.8±2.0 and 94.8±2.0%, respectively. Peak and mean gradients (PG and MG) reduced and effective orifice area index (EOAI) increased over time ( P<0.001). Left ventricular mass index (LVMI) reduced by 32 g/m2 at discharge ( P<0.001) and by 33 g/m2 at six months ( P<0.001) without further significant changes.

Conclusions.

In our series CLOB xenograft resulted to be a satisfactory valve substitute in elderly patients.
The Effect of Age on Serum Creatinine Levels in an Aging Population: Relevance to Vascular Surgery
Authors: Tiao Jim Yu-Hsiang , Semmens James B. , Masarei John R. L , Lawrence-Brown Michael M. D
Published: September 2022

Background and Aim.

Serum creatinine is commonly used to assess and monitor renal function in the management of abdominal aortic aneurysm with endoluminal grafting, and for intervention of renal artery occlusive disease. The majority of patients selected for these procedures are elderly and serum creatinine is used post-operatively to monitor renal function. There is a need to adjust the serum creatinine concentration for age to determine the changes that might be due to the procedure: especially with endoluminal grafting using transrenal manipulation and fixation, and procedures involving interventions directly on the renal arteries. A single reference interval for serum creatinine is usually given for each sex but does not take into account variation due to age. The objective of this study was to establish age related reference intervals for serum creatinine, especially for those over 60 years of age to assist in the clinical interpretation of creatinine levels in the years following endoluminal grafting for aneurysms of the abdominal aorta.

Methods.

A pathology services database was established for serum creatinine measurements from 98,688 patients (44,784 males and 53,904 females). Data was stratified into five year age groups and reference intervals assigned for each age group after a reference population was determined. The heterogeneous population was refined firstly by removing patients with extreme (≥200 μmol/1) concentrations of serum creatinine, outliers and repeated values. Secondly, a putative “healthy” population was determined by removing values outside three standard deviations of the mean. Two statistical methods, the Bhattacharya and Hoffmann methods, were then applied to obtain a putative reference population. Serum creatinine data was obtained from the Busselton Population Research Foundation for comparison.

Findings.

Serum creatinine concentration increased steadily with age; in females from the age of 40 years and 60 years for males. Reference intervals for males and females aged from 20 to 94 years were established. Advancing age affects serum creatinine levels, especially in the “vascular” age group of 60 to 80 years. The changes in serum creatinine concentration that occur with age is relevant in interpretation of the results of renal monitoring after intervention.
Initial in Vivo Results of the New Medtronic Advantage™ Bileaflet Valve in Aortic Position and Comparison to the SJM
Authors: Kleine Peter , Klesius Armin A. , Scherer Mirella , Abdel-Rahman Ulf , Moritz Anton
Published: September 2022

The present study investigated the Medtronic Advantage (MA) bileaflet valve in an animal model and compared the results to the St. Jude Medical (SJM) valve. Systolic performance and coronary artery flow in different orientations were studied.

A rotation device holding either a MA or SJM aortic valve size 23 mm was implanted into eight pigs. Transvalvular pressure gradients and ventricular dimensions were investigated with the valves in different orientations. Coronary artery flow was measured at normal and high cardiac output.

Orientation significantly influenced the hemodynamic performance of both valves. The best results for both valves were obtained with one orifice proximal to the right cusp. Pressure gradients and ventricular dimensions of the MA corresponded to the SJM. Coronary artery flow was higher for the MA.

The systolic performance of the new MA bileaflet valve was similar to the SJM. During diastole, the MA showed significantly higher LAD coronary flow.
Collateral Growth: Cells Arrive at the Construction Site
Authors: Heilmann Claudia , Beyersdorf Friedhelm , Lutter Georg
Published: September 2022

Coronary artery disease (CAD) and peripheral artery occlusion disease are the most common diseases in the Western world which are treated by pharmacological and surgical therapies. However, patients in the endstage of the disease are not suitable candidates for bypass surgery. Alternative therapies that boost the endogenous collateralization are required. Two mechanisms are naturally activated after onset of ischemia: 1. Angiogenesis, sprouting of capillaries, and 2. arteriogenesis, enlargement of small preexisting arterioles. In the first part of this review, we describe the sequence of events during the development of collateral vessels. The second part focuses on two types of cells which are crucial for the development of collateral circulation, and which migrate to the site of vessel growth via peripheral blood: monocytes/macrophages and endothelial progenitor cells. The role of these cells and the implications for their use in treating ischemic diseases of cardiac and sceletal muscle are discussed.
Primary Forearm Arteriovenous Fistula for Hemodialysis Access — An Integrated Approach to Improve Outcomes
Authors: Shemesh D. , Zigelman C. , Olsha O. , Alberton J. , Shapira J. , Abramowitz H.
Published: September 2022

Purpose

Maximizing the ratio of primary arteriovenous fistula (PAVF) over bridge graft fistula (BGF) for hemodialysis access is a primary recommendation of the National Kidney Foundation published as Dialysis Outcomes Quality Initiative (DOQI). Imaging, anesthetic and surgical techniques were taken into account to achieve this and other goals, including extensive use of forearm vessels to lower immediate and early failure rates and prolong the useful life of PAVFs.

Design

Prospective non-randomized study.

Methods

High-resolution duplex ultrasonography (DUS) was added to careful clinical assessment in planning and follow-up of the dialysis access. Brachial plexus block, which allowed the use of an arterial tourniquet and gave a postoperative sympathectomy type effect, was used for anesthesia, and together with meticulous surgical technique, prevented spasm. Access puncture, post-operative follow-up and surgical revisions were planned in close cooperation with the nephrology team.

Findings

Ninety (57.3%) of the 157 fistulas constructed for new hemodialysis access between August 1998 and March 2000 were PAVFs. Seventy-three (81.1%) of these were confined to the forearm and comprise the study population, with a mean follow-up of 8.4±4.4 months. There were no immediate failures in the study group. The early failure rate (1 month) was 6.8% and revisions based on DUS were easily accomplished in all cases. The one year assisted primary patency rate was 81.8% and the secondary patency rate at 18 months was 98.6%.

Conclusions

DUS for planning and follow-up of PAVF along with careful surgical technique under a brachial plexus blockade can achieve a PAVF/BGF ratio well above 50% with a low early failure rate and a high secondary patency rate. Algorithms are presented to achieve these goals.
Ten Year Experience with Aspire (Tissuemed) Porcine Bioprosthesis: Single Centre Experience
Authors: Kumar P. , Athanasiou T. , Mussa S. , Wood A. J.
Published: September 2022

Background:

Aspire (Tissuemed) bioprosthesis is a third generation porcine bioprosthesis. 10-year outcome of this bioprosthesis is unknown.

Methods:

We report our experience of 139 consecutive prosthesis implanted between 1990–1998. The clinical outcome was reviewed retrospectively.

Results:

126 patients (67 males and 59 females), mean age 68.4 ± 8.4 years underwent 139 valve replacements. Sites of valve implantation included the aortic in 77 patients (61%); mitral in 35 patients (27%); aortic + mitral in 13 patients (10%) and tricuspid in 1 patient (0.8%). 32/126 patients (25%) also underwent concomitant coronary artery bypass grafting (CABG). 30-day mortality for the whole group was 8.7% (11/126) with no valve related deaths. Follow up was 98.4% complete with a mean follow up of 6.1 ± 3.3 years (766 patient-years, range 0–10.2 years). Overall 10-year actuarial survival was 41 ± 7% (AVR 49 ± 10%, MVR 29 ± 11%) and this was influenced by pre-operative poor left ventricular function (EF < 30%) ( p = 0.007) and pre-operative NYHA class III/IV ( p = 0.001). Overall estimated 10-year actuarial freedom from valve related events (Kaplan—Meier) and valve related events expressed as linearised rates (%/patient—year) were: freedom from structural valve failure 97 ± 2% (0.26%/patient—year); non-structural dysfunction 98 ± 1% (0.13%/patient-year); freedom from prosthetic valve endocarditis 94±3% (0.39%/patient—year); freedom from significant haemorrhagic event 82 ± 6% (1.33%/patient—year); freedom from thrombo-embolism 90 ± 3% (0.91 %/patient—year) and freedom from re-operation was 93 ± 3% (0.52%/patient—year).

Conclusion:

In our experience Aspire (Tissuemed) porcine bioprosthesis functions satisfactorily at 10-years with low valve related complications. Further follow-up will determine its long-term durability.
Pre-Operative Balloon Counterpulsation and off-pump Coronary Surgery for High-Risk Patients
Authors: Babatasi G. , Massetti M. , Bruno P. G. , Hamon M. , Le Page O. , Moreilo R. , Khayat A.
Published: September 2022

Coronary artery bypass surgery (CABG) can be performed less invasively without cardiopulmonary bypass (CPB). Multivessel off-pump CABG (OPCAB) is challenging in patients with critical left main stenosis (> 70%) and/or severe ventricular dysfunction (ejection fraction < 0.35) Our objective was the evaluation of efficiency of intra aortic balloon pump (IABP) preoperatively in this high-risk group in order to perform OPCABG safely.

Material and method:

In a consecutive 10-month period (out of 88 OPCABG patients) 23 high-risk patients were treated and were compared with 15 on-pump patients (out of 69) with the same criteria.

Results:

Preoperative implantation of IABP was significantly higher in the OPCABG group (70% vs 46%, p < 0.05). No conversion to CPB was required in the OPCABG group. Postoperative angiography was systematically performed and demonstrated 97.5% patency of anastomosis. No device-related complications occured. No difference was found concerning age, risk factors, emergency surgery, ejection fraction, mean number of grafts per patient (2.64 versus 2.75) and average operating time. In contrast, OPCABG demonstrated a trend toward reduced morbidity in terms of atrial fibrillation, reexploration for bleeding and prolonged ventilator requirement > 12 h. Mortality was less in the OPCABG group ( p < 0.05).

Conclusion:

More randomized controlled trials are needed to evaluate the true efficacy of elective IABP in OPCABG high-risk patients. Until such studies are evaluated, and therefore because older and sicker patients now constitute a greater percentage of candidates for OPCABG, the timing of application of the IABP is warranted. These results may further justify preoperative use of the IABP in a large proportion of this group of patients.
Circumferential Dissection with Intimal Intussusception: An Unusual Case of Acute Aortic Type A Dissection
Authors: Orrit J. , Kalangos A. , Trindade P. T. , Christenson J. T.
Published: September 2022

An unusual case of a type-A aortic dissection with complete circumferential dissection just above the aortic valve with intimointimal intussuseption just distal to the left subclavian artery partially obstructing the descending aorta is described. CT-scan and transesophageal echocardiography together with clinical suspicion led to the correct diagnosis.

Intimointimal intussusception is an unusual type of aortic dissection in which a proximal circumferential tear causes dissection with intussusception of the torn intima downstream, which could cause confusion about the appropriate diagnosis [1]. It is a very infrequent complication of aortic dissection with only a few cases reported in the literature [2–6]. CT scan and transesophageal echocardiography are the most accurate diagnostic tools [7–9]. We describe a patient with intimointimal intussusception, diagnosed by CT scan and transesophageal echocardiography.
Aorto-Enteric Fistula is a Serious Complication to Aortic Surgery. Modern Trends in Diagnosis and Therapy
Authors: Sierra J. , Kalangos A. , Faidutti B. , Christenson J. T.
Published: September 2022

Secondary aorto-enteric fistula (AEF) is a serious, but rare, complication following surgery of the abdominal aorta. AEF occurs in 0.3–2%, but is associated with a hospital mortality between 25–90%. It is also associated with an important morbidity with a lower limb amputation rate of 9%, and a 15% risk for renewed graft infection.

Nine secondary AEF were surgically treated. The hospital mortality was high, 44% (4/9). Recurrent AEF was observed in 1 patient 2 years after the first operation. During follow-up 2 patients had mild infections which were resolved by antibiotic treatment.

Diagnostic modalities, and recent advancements in surgical treatment as well as preventive measures are discussed.
A Short-Term Experience with the Tirone David I Valve Sparing Operation for the Treatment of Aneurysms of the Ascending Aorta and Aortic Root
Authors: Gelsomino Sandro , Frassani Romeo , Morocutti Giorgio , Masullo Gianluca , Da Col Paolo , Spedicato Leonardo , Porreca Lorenzo , Livi Ugolino
Published: September 2022

Aim

The aim of this report is to summarize our experience with the Tirone David I technique over a 4-year period.

Methods

Since 1997 15 patients were operated on using this surgical procedure. Of the patients, nine were male (60%) and six (40%) female. Ages ranged from 23 to 75 years (mean 62.1 ± 17.2 years). The underlying disease was chronic aneurysm of the ascending aorta or root in 13 (86.6%) and chronic dissection in two (13.4%). Four patients (26.6%) had skeletal manifestations of Marfan's syndrome. Additional cardiac procedures were performed in two patients (13.4%). Mean follow-up time was 26.6 ± 11.2 months (range 7–50 months).

Results

There were no early deaths. Postoperative non-fatal complications occurred in two (13.3%) patients. There was no valve-related late death occurring 6 months after operation. Actuarial survival was 0.94 ± 0.07 at 4 years; 4-year freedom from reoperation was 0.91 ± 0.07. The probability of needing reoperation was 8 ± 0.9%. There were no instances of infective endocarditis or thromboembolic complications. At the end of the follow-up period, trivial or no aortic regurgitation was demonstrated in 57.1%, mild in 42.9% and no patient had an insufficiency graded ≥moderate. Echocardiography showed early postoperative reduction in left ventricular end-systolic and end-diastolic dimensions, which was maintained at follow-up controls.

Conclusions

The Tirone David I procedure showed good early results, which encourage further use of this type of repair. However, further larger studies and long-term results are necessary for a definite judgment on this operative method.
Multidisciplinary Intervention for Control of Diabetes in Patients Undergoing Coronary Artery Bypass Graft (CABG)
Authors: Cohen Ohad , Dankner Rachel , Chetrit Angela , Luxenburg Osnat , Langenauer Claude , Shinfeld Amihay , Smolinsky Aram K.
Published: September 2022

In Israel, as elsewhere, diabetes mellitus is highly prevalent among patients undergoing coronary artery bypass graft (CABG). The bulk of evidence, derived retrospectively, suggests that poor control of diabetes predisposes to complications of CABG and increases mortality; but the findings in a number of studies fail to support that impression.

Anticipating a prospective investigation designed to resolve this issue, we have carried out a preliminary study of 147 consecutive patients with diabetes who were hospitalized for elective CABG during 1998. Our objective was to determine how well and how often diabetes could be controlled in accordance with selected metabolic goals in the brief interval between hospital admission and surgery and during the operation itself and in the postoperative period. The task was undertaken by a multidisciplinary team, in cooperation with the Department of Cardiac Surgery. The metabolic goals were: fasting blood glucose consistently between 65–140 mg/dl before and after surgery and 120–180 mg/dl at the time of surgery; and postprandial blood glucose consistently < 180 mg/dl. These goals were achieved in 18.1% of fasting blood glucose measurements before and after surgery, 22.1% of preprandial and 14.6% of postprandial blood glucose levels consistently < 180 mg/dl. There were no clinical episodes of hypoglycemia.

Due to the low incidence of major infection related complications (deep sternal wound infection in only 3 patients (2.0%)) no significant statistical conclusions on the relations between glucose control and these complications could be drawn. The means of all values of FBG and of hemoglobin A1c were significantly higher among patients with complications ( n=49) than in those without ( P=0.01).
CABG 15-Years after Left Pneumonectomy: Feasibility of Off-Pump Approach
Authors: Kumar Pankaj , Swift Simon J. P. , Athanasiou Thanos , Nelson John S. , Glenville B.
Published: September 2022

We report the case of a 70-year-old man who underwent off-pump coronary artery bypass grafting 15-years after left pneumonectomy. He had significant two-vessel coronary artery disease. Comorbidities included poor ventricular function and impaired respiratory function. Operative risks in this clinical setting is increased. Our patient underwent off-pump CABG × 2. Thoracic epidural analgesia was also used to facilitate post-operative recovery. The patient was extubated an hour after the end of the procedure. The role of off-pump surgery in this high-risk population and the use of stabilizing devices in these extreme anatomical situations is discussed.
Stripping Operation with Preservation of the Calf Saphenous Veins for Primary Varicose Veins: Hemodynamic Evaluation
Authors: Nishibe Toshiya , Nishibe Masayasu , Kudo Fabio , Flores Jorge , Miyazaki Keiko , Yasuda Keishu
Published: September 2022

Purpose.

To study early changes in venous hemodynamics in stripping operation with preservation of the calf saphenous veins.

Patients and methods.

From October 1999 to December 2000, 110 extremities of 73 patients were treated for primary varicose veins. Based on preoperative ascending venography, 40 extremities underwent the groin-to-knee stripping of the GSV, 20 underwent the proximal division of the LSV, and 50 received combinations of both surgeries. To evaluate venous hemodynamic changes, air plethysmography was performed before operation and 7–14 days after operation.

Results.

The venous volume, venous filling index and residual volume fraction were improved after surgery, but the ejection fraction did not change. The overall incidence of nerve injury was 4.5% (five limbs).

Conclusions.

In stripping operations, the preservation of the calf saphenous veins, which is shown to be advantageous in reducing saphenous or sural nerve injuries, does not adversely affect early venous hemodynamic improvement.
Military Vascular Injuries in Croatia
Authors: Luetić V. , Šoša T. , Tonković I. , Petrunić M. , Ćohadžić E. , Lončarić L. , Romić B.
Published: September 2022

A single-centre experience of military vascular injuries in the recent conflict in Yugoslavia is reviewed. From 1 April to 13 December 1991, 1020 casualties were admitted to the Surgical Clinic at the Teaching Faculty of the University in Zagreb, Croatia. A total of 120 injured blood vessels in 76 patients were treated in the department of vascular surgery. Casualties were transported to the hospital after treatment by forward surgical facilities. The transportation time ranged from 3 to 18 (mean 7) h. The most common injuries were to the popliteal artery (12.5%) and brachial veins (10.0%). After segmental resection, arterial and venous revascularization with saphenous vein graft interposition was the preferred option. Twenty-six fasciotomies were performed because of compartment syndrome. Indications for six amputations included sepsis, deep vein thrombosis and extensive myonecrosis. Concomitant bone fractures were stabilized by an external fixator in 90.4% of cases. Vascular injuries were repaired before orthopaedic stabilization. Completion arteriography was used to delineate concomitant distal lesions.
Combined Carotid Endarterectomy and Coronary Artery Bypass in a Community Hospital
Authors: Fillinger M. F. , Rosenberg J. M. , Semel L. , Levy I. E. , Byrne J. , Marvasti M. A. , Zaman S. N.
Published: September 2022

A study examining combined carotid endarterectomy and coronary artery bypass (CAB) outside the metropolitan or university hospital setting was performed. Over a 5-year period, 52 patients underwent carotid endarterectomy and CAB under a single anesthetic. Twenty-two patients (42%) had unstable angina and 23 (44%) had previous neurologic symptoms. There were two postoperative strokes (4%). one ipsilateral and one contralateral to the endarterectomy site. No ipsilateral neurologic events occurred after discharge (mean follow-up 25 months). There were four deaths (8%), all of which were cardiac related. Three of the four deaths were in patients with a recent history of congestive heart failure, a subgroup with a high mortality rate (three of seven; 43%). Over the same period, 2421 patients underwent CAB alone with stroke and mortality rates of 1.4 and 2.0% respectively, while 344 patients had carotid endarterectomy alone with stroke and mortality rates of 0.6 and 0.6% respectively. It is concluded that the combined procedure can be performed in a community setting with morbidity and mortality rates similar to those for major centers. Although stroke and mortality rates for the combined procedure were higher than those for the isolated operations, this group has a high incidence of cardiac symptoms, including unstable angina and congestive heart failure. Patients with recent congestive heart failure had the highest mortality rate of any subgroup and these patients should be carefully examined with regard to selection for the combined procedure.
Aortic Valve Replacement within a Composite Graft
Authors: Koshal A. , Masters R. G. , Gill I. S. , Keon W. J.
Published: September 2022

Failure of a bioprosthetic valve within a composite graft presents a challenging surgical problem. A solution to this, as described here, involves leaving a remnant of the failed valve intact within the graft. This forms the annulus to which the new valve is sewn, thus simplifying the operation.
The European Heritage
Authors: Thevenet A.
Published: September 2022

The text of the presidential address given to the 41st International Congress of the European Chapter of The International Society for Cardiovascular Surgery in Montpellier, France. September 1992.