bluuebunny/crossref_metadata_2025 huggingface dataset:
Venous Insufficiency Evaluation with Duplex Scanning
Authors: Fowler Brian , Zygmunt Joe , Ramirez Hugo , Kolluri Raghu
Published: March 2018

Venous duplex scanning can be divided into two different subcategories: (1) scanning to diagnose thrombus and (2) scanning to diagnose incompetence. Venous incompetence testing is used to assess the physiology of the superficial and deep venous systems, making it a much more complex and time-consuming test, primarily because sonographers need to take into consideration the great number of anatomical variations of the superficial venous system, venous flow patterns, as well as physiology. To perform these examinations efficiently and to obtain consistent results, it is imperative to standardize protocols and to break down these examinations into manageable components.
Outpatient Surveillance Protocol of Isolated Calf Deep-Vein Thrombosis
Authors: Cox Samantha , Moawad John A. , Marshall Lee A. , Petrinec Drazen , McShannic Joseph , Fink John A.
Published: March 2018

Objectives

This study aims to compare the management of isolated soleal, gastrocnemius, peroneal, and posterior tibial vein thrombosis among outpatients with serial duplex ultrasound (DUS) over 30 days, versus anticoagulation.

Methods

After obtaining IRB approval, a retrospective chart review was conducted from January 2009 to December 2010. A total of 15, 877 lower extremity DUS were performed. Inpatients, trauma patients, and patients with thrombi in or proximal to the popliteal vein were excluded to focus exclusively on an unprovoked outpatient population. Univariate and multivariate analyses were conducted as well as descriptive statistics of the data.

Results

The cohort consists of one hundred sixty-eight (n = 168) outpatients with isolated calf deep vein thrombosis (ICDVT). Thrombus was most frequently identified in the soleal vein (45%) followed by the peroneal (39%), gastrocnemius (29%), and the posterior tibial vein (23%). Following diagnosis of ICDVT, thirty-eight patients (n = 38) received anticoagulation. The remaining cohort (n = 130) underwent surveillance with serial DUS at 3, 10, and 30 days. Eleven percent (11%) propagated to the popliteal vein or proximally during surveillance, versus 8% following anticoagulation. Among those that propagated proximally, 85% propagated within two weeks of initial diagnosis. Proximal propagation ( p = 0.8328), pulmonary embolism ( p = 0.0537), and development of new thrombus in additional calf veins ( p = 0.1471) did not differ among those treated with anticoagulation or serial DUS.

Conclusions

Serial DUS without anticoagulation is safe management of ICDVT in unprovoked ambulatory outpatients.
Surgicel Mimicking Acute Vessel Occlusion after Carotid Endarterectomy: A Case Report
Authors: Morris Rhys , Bosanquet David C. , Mapstone Julia , James Dorrien , Fligelstone Louis
Published: March 2018

Surgicel (oxidized regenerated cellulose; Ethicon, Somerville, NJ) is widely used in surgery to achieve hemostasis but can interfere with postoperative imaging. A patient was noted to have lateralizing neurologic deficits immediately after a carotid endarterectomy, with an internal carotid artery flow void on duplex. However, at return to the operating theater, no flow void was noted after Surgicel was removed. Reapplying Surgicel around the vessel recreated this acoustic shadow, confirming this ultrasonographic finding was simply an artifact. Surgicel is known to trap air within the interstices of the gauze. This phenomenon can obscure vessel flow to mimic an occlusion on duplex imaging.
Comparison of Subjective versus Objective Lower-Extremity Arterial Plethysmographic Waveform Analysis for the Identification of Hemodynamically Significant Inflow Disease
Authors: Scissons Robert P. , Toha Robert , Comerota Anthony
Published: March 2018

Objective

Segmental pressures and subjective air plethysmography waveform (APW) analysis commonly are used in the noninvasive diagnosis of lower-extremity peripheral arterial disease (PAD) and have been used historically to define the extent of PAD. A recent investigation identified objective thigh arterial pulse waveform characteristics for defining hemodynamically significant (>50% diameter) PAD above the level of the common femoral artery (INFLOW). The purpose of this study is to compare subjective and objective APW analysis methodologies for defining INFLOW.

Methods

Patients who underwent segmental APW analysis and arteriography within 30 days of their noninvasive procedure were studied. Objective APW characteristics obtained from the thigh cuff included acceleration time, maximum amplitude, waveform down-slope curvature, relative amplitude reduction, and gain compensation index. Arteriograms were the basis for comparisons of objective APW criteria versus subjective APW pattern recognition interpretations of INFLOW disease.

Results

A total of 107 extremities were analyzed. There were statistically significant differences in sensitivity, specificity, positive predictive and negative predictive values, and accuracy for identifying hemodynamically significant INFLOW disease using objective (85%, 93%, 85%, 93%, 91%) versus subjective (53%, 85%, 62%, 80%, 75%) APW analysis, p = 0.0110.

Conclusions

Objective APW analysis of thigh level waveform characteristics may improve the identification of INFLOW disease in patients undergoing physiologic testing for lower extremity PAD.
Waveform Recognition in Code Stroke Transcranial Doppler Studies
Authors: Alexander Thomas H. , Plotkin George M.
Published: March 2018

The Code Stroke designation was implemented in the 1990's to insert time urgency in treating stroke patients with intravenous or intra-arterial tissue plasminogen activator (t-PA). This drug can fragment the intracranial arterial thrombus before the advent of permanent brain damage (3 hours after symptom onset) in roughly 20% of Code Stroke patients. Fragmentation and resolution of intra-arterial thrombus is a dynamic process. Transcranial Doppler (TCD) is uniquely positioned to monitor these changes as they occur. Five unique TCD waveforms have been isolated that commonly occur during and after a stroke. A registered vascular sonographer should be able to rapidly obtain and recognize these waveforms.
A Case Study of Duplicated Inferior Vena Cava: An Incidental Finding in an Abdominal Vascular Evaluation
Authors: Mofazzali Azin , Bean Barton A.
Published: March 2018

Often during routine studies, vascular technologists are confronted with unusual findings. This case presentation describes finding a duplicated inferior vena cava (IVC) in a 43-year-old man with fatigue, dizziness, and a physical finding of dilated iliac veins. When insonating the mid aorta in transverse view, we noted that the aorta had what appeared to be two IVCs (one IVC on each side of the aorta). As a result of the finding, further assessment took place. The proximal IVC was visualized with color Doppler in longitudinal view and noted to be anterior to the aorta. Further evaluation took place and a second vein appearing to be a duplicated IVC was discovered posterior to the aorta. Duplicated IVC is a rare congenital anomaly that results from persistence of right and left supracardinal veins in embryo. Duplicated IVC needs to be recognized in association with vena cava filter placement and renal anomalies.
Traumatic Vertebral Artery Arteriovenous Fistula
Authors: Kidd Jenifer
Published: March 2018

Arteriovenous formation in the neck is commonly a result of trauma to the craniocervical region or from a medical intervention such as jugular venous catheterization. We report a case of a left vertebrojugular arteriovenous fistula formation caused by a traumatic blow to the neck that was diagnosed with color duplex ultrasound and subsequently treated with endovascular intervention achieving a good clinical outcome.
Early-Life Markers of Atherosclerosis Using Aortic and Carotid Intima-Media Thickness: An Assessment of Methods to Account for Child Size
Authors: McCloskey Kate , Vuillermin Peter , Carlin John B. , Skilton Michael R. , Raitakari Olli , Jachno Kim , Cheung Michael , Burgner David P. , Ponsonby Anne-Louise
Published: March 2018

Background

Distinguishing pathological from physiological relationships between vessel size and aortic intima-media thickness (aIMT) is an important challenge, especially in growing children. We examined the relationship between childhood vessel diameter and aIMT and assessed common analytic approaches used to address this relationship.

Methods

We analyzed aIMT in two population-derived cohorts; 6-week-old infants and 19-year-olds. We simulated datasets in which we assumed a simple physiological relationship between vessel diameter and aIMT, and then superimposed possible pathological effects on aIMT; (a) intrauterine growth retardation, (b) macrosomia and (c) both intrauterine growth retardation and macrosomia. Using simulated datasets and cohorts, we evaluated analytic strategies including those in which the relationship between vessel diameter and aIMT was (a) ignored, (b) adjusted for by dividing aIMT by weight, or (c) adjusted for using varying regression techniques.

Results

aIMT was found to increase in proportion to vessel diameter in both cohorts (138 μm/mm at 6 weeks and 52 μm/mm at 19 years of age). Simply dividing aIMT by weight produced negative associations with weight across all datasets. By contrast, adjusting for vessel diameter as a covariate enabled accurate distinction of the direction of the association between aIMT and weight in all simulated datasets. These results were replicated in the cohort studies for both aIMT and carotid intima-media thickness.

Conclusion

There is a physiological relationship between vessel diameter and aIMT. Simply dividing aIMT by weight may lead to incorrect assumptions regarding the relationship between weight and aIMT. However, the physiological relationship is appropriately estimated by including vessel diameter as a covariate in regression.
Anterior Tibial Artery Pseudoaneurysm: A Case Report and Literature Review
Authors: Charles-Harris Håkan
Published: March 2018

Background

Anterior tibial artery pseudoaneurysm is a very uncommon complication after orthopedic surgery and trauma. A combined treatment modality using thrombin injection, coil embolization, and surgical approach is described and currently being evaluated compared with other treatment modalities.

Patient Description

This study reports the case of a 33-year-old man who presented in the office with a pulsatile mass just below the right knee. The patient with a history of trauma to his right leg during a motor vehicle accident underwent open reduction internal fixation of a proximal tibia-fibula fracture. Eight weeks later the patient had a pulsatile mass in the surgical area. A venous Doppler ultrasound was initially performed in the emergency room which revealed an incidental finding of a 5.60 cm × 3.54 cm pseudoaneurysm.

Methods

As modalities of treatment the patient had coil embolization as well as two separate sessions of thrombin injection with poor response. Finally, he underwent repair of the right anterior tibial artery pseudoaneurysm with a vein patch, which was successful. This case highlights different modalities that have been used to treat anterior tibial artery pseudoaneurysms.

Conclusion

Based on previous reported cases and our own case, we concluded that surgical approach is the most successful modality of treatment for proximal anterior tibial artery pseudoaneurysms.
Transcranial Doppler: Uses in Stroke Prevention
Authors: Spence J. David
Published: March 2018

Transcranial Doppler (TCD) is useful in stroke prevention for at least three purposes: diagnosis of intracranial stenosis, detection of right-to-left shunt in patients with suspected paradoxical embolism, and detection of microemboli in patients with carotid stenosis. Other uses may include assessment of cerebral blood flow, which is not discussed in this review. TCD saline studies are more sensitive than transesophageal echocardiography, and more strongly predictive of risk of recurrent events. TCD embolus detection is the best-validated method for identifying among patients with asymptomatic carotid stenosis the few who could benefit from carotid endarterectomy or stenting.
Waveform Recognition in Code Stroke Transcranial Doppler Studies
Authors: Alexander Thomas H. , Plotkin George M.
Published: March 2018

Evaluating the intracranial arteries emergently as a stroke is in progress uniquely positions the transcranial Doppler (TCD) as a tool to not only help diagnose the cause of the stroke but to serially monitor the cerebral arteries before, during, and after emergent pharmaceutical and/or endovascular interventions. Five Doppler waveforms are presented each representing a potential hemodynamic cause of the patient's symptoms. These waveforms can be easily obtained in the CODE STROKE room by a Registered Vascular Technologist without interfering with the emergent nursing protocols.
Plaque Echolucency May Play a Critical Role in Predicting Cerebral Embolization in Patients Undergoing Carotid Angioplasty and Stenting
Authors: Chung Christine , Han Daniel , Gustavson Susan M. , Marin Michael L. , Faries Peter L.
Published: March 2018

Introduction

Despite ongoing studies, the relationship of plaque echomorphology with increased risk of stroke in patients undergoing carotid angioplasty and stenting (CAS) remains elusive. The aim of this study is to examine whether carotid plaque echolucency is associated with greater plaque instability as determined by the quantification of captured embolic debris in CAS patients.

Methods

A total of 41 consecutive CAS patients with high-grade carotid stenosis were prospectively evaluated. B-mode images for 21 patients were available for analysis. Plaque echolucency was determined by grayscale median (GSM), a computer-assisted measure of echogenicity. Images were standardized with a GSM value of 0–5 for the vessel lumen and 185–195 for the adventitia. Echolucent (EL) plaques were defined by GSM < 25, and echogenic (EG) plaques were defined by GSM ≥ 25. Protective filters were visualized by stereomicroscopy along three perpendicular axes and quantified through video imaging software. Because of heterogeneity in particle shape, individual particle sizes were determined by greatest length.

Results

Mean GSM was 45.5, and 10% plaques were echolucent. Particulate debris was detected in all filters. Plaques with lower GSM were associated with a greater number of particles (EL: 33.5 ± 10.6 particles, EG: 14.0 ± 10.3 particles; p = 0.02). Echolucent plaques also demonstrated particles of greater size: maximum size (EL: 3490 ± 1954 μm, EG: 1026 ± 1186 μm; p = 0.015) and number of particles >1000 μm (EL: 3.5 ± 2.1 particles, EG: 0.7 ± 1.4 particles; p = 0.019).

Conclusions

Echolucent carotid plaques, as determined by GSM, may cause increased embolization of greater-sized embolic debris during CAS. Our study confirms previous findings that suggest that a GSM cut-off point of 25 may be linked with the release of more embolic debris. Therefore, increased plaque echolucency may place patients at greater risk for perioperative embolic events, making patients with such lesion characteristics more likely to experience postprocedural neurologic complications.
Combination of Duplex Ultrasound Data Improves Positive Predictive Value for Carotid Stenoses Greater than 70 Percent
Authors: French-Sherry Eileen , Burns K.
Published: March 2018

A routine laboratory accuracy study for identifying an internal carotid artery (ICA) diameter stenosis of 70% using an ICA/CCA ratio of 4.0 revealed an overall accuracy of 85% but the positive predictive value (PPV) was noted to be only 56%. A subsequent Receiver Operating Characteristics (ROC) curve analysis compared carotid duplex measurements to arteriography in 239 carotid arteries. The analysis yielded new thresholds for single velocity and B-mode image measurements as follows: peak systolic velocity (PSV) 267 cm/sec, end diastolic velocity (edv) 99 cm/ sec, ICA/CCA ratio 4.2, and an image diameter measurement of 78%. The overall accuracy for each parameter was 91, 83, 90, and 89% respectively with PPV's of 65, 66, 66, and 74% each. Further analysis combining these best thresholds in all possible combinations revealed overall accuracies that ranged between 85–94%. The three best combinations with the highest overall accuracies were a) image diameter measurement >78% with ICA/CCA ratio >4.2 (94%), b) ratio >4.2 with PSV >267 cm/ sec (91%) and c) image diameter >78% with PSV >267 cm/sec (91%). The PPV's for these combinations were 86%, 80%, and 70% respectively.
A Study Comparing the Results of Duplex Ultrasound and Magnetic Resonance Venography to Diagnose Pelvic Vein Congestion in Conjunction with a Compression Syndrome
Authors: Kelly Donna M. , Sanford Deborah , Stoughton Julianne
Published: March 2018

Purpose

To compare the imaging modalities of duplex ultrasound (DU) and magnetic resonance venography (MRV) in determining the presence of the anatomy associated with compression syndromes as well as the presence of pelvic varices in patients with suspected pelvic vein congestion syndrome (PCS).

Methods

A prospective study of 29 patients (27 females and 2 males) with signs and symptoms of PCS as well as MTS. Each patient underwent a DU and an MRV, for the purpose of diagnosing the presence of nutcracker anatomy (NA) and May–Thurner anatomy (MTA). The images were graded in an effort to determine if either DU or MRV was a better workup modality for the diagnosis of PCS and the compression syndromes that can be associated with it. A blinded independent reviewer did the grading.

Results

The left renal vein was well visualized to evaluate for the presence or absence of NA 89% of the time with DU and 81% of the time with MRV. The left common iliac vein was well visualized for the presence or absence of MTA 93% of the time with DU and 76% of the time with MRV. Pelvic varices were well visualized in 100% of the time for both DU and MRV. With an experienced technologist performing the DU, our study has demonstrated that DU can consistently provide the needed imaging in a noninvasive and less-expensive manner while continuing to allow the clinician and patient to make a well-informed decision about their diagnosis and treatment.
Quantification of Soft Tissue Loss among Patients with Peripheral Arterial Disease
Authors: Ali Abbas S. , Baig Taha , Sadique Muhammad , Ali Mohammed , Qamar Asad U.
Published: March 2018

Objective

Tissue atrophy is known to occur amongst patients with peripheral arterial disease (PAD). We report quantification and assessment of severity of calf tissue atrophy amongst patients with PAD.

Patient types

Calf atrophy amongst patients who presented for peripheral transluminal angioplasty (PTA) at the Institute for Cardiovascular excellence (ICE) in 2012 was assessed using X-ray methods (n = 48). This cohort has the most severe PAD. Patients suspected of having PAD were assessed using lower extremity arterial ultrasound (LAU) and had their calves measured with a tape. This group had patients with (n = 355) and without (n = 245) PAD. Not all of those with PAD needed angiography and PTA thus these represent patients with moderate to severe PAD. The third cohort included patients from National Health and Nutritional Examination survey (NHANES) and included normal patients without PAD (n = 6391), those with abnormal ankle brachial index (ABI) (n = 422). These represent those with mild to moderate PAD. Amongst NHANES patients, those who either had no ABI or un-interpretable ABI were excluded from analysis (n = 2332).

Calf Measurement

Tape measurement of calf circumference followed the method adopted in NHANES and identified the widest portion of the calf with the patient in the seated position. Calf circumference from X-ray involved visualization of both edges of soft tissue at calf level. A visible catheter of known size in the same run was used for calibration. Using measured soft tissue diameter from X-ray calf circumference was calculated.

Data Analysis

Data analysis included descriptive statistics and generalized linear modeling after data cleaning and transformation.

Results

After adjusting for all other factors, the odds of having PAD per centimeter increase in calf circumference are 0.88. Compared with smokers, nonsmokers' odds of PAD are 0.42. Odds of PAD among nonhypertensives are 0.58 in comparison to the hypertensives.

Implications of our findings

Among patients who present to the doctors' office for routine assessment, if calf circumference width were to be measured as a part of physical examination using 36.5 cm as a cutoff to help identify PAD patients. These patients could then undergo a more careful assessment for PAD.
Intraoperative Ultrasound for Correction of Type III Endoleak may be Superior to Angiography
Authors: Mukherjee Dipankar , Joseph Allen , Siegel Jack , Ochoa Nelson
Published: March 2018

Endovascular aneurysm repair (EVAR) has become the primary form of treatment for infrarenal abdominal aortic aneurysm (AAA). Although this modality has demonstrated superior results in terms of mortality and morbidity over the short term when compared with open surgical treatment, there continues to be problems related to long-term durability. The repair needs ongoing monitoring, and endoleaks can lead to failure of the treatment at any time in the course of follow-up. Most vascular surgeons prefer ultrasound as a means of surveillance to computed tomography angiogram (CTA). When an endoleak is seen especially when associated with sac expansion, diligent investigation of the source of the endoleak and correction of the same is warranted. Precise identification of the endoleak can be challenging despite the use of all available modalities. We present a case where real-time ultrasound examination on the operating table clearly identified the source of the endoleak when angiography failed to do so.
A Rare Case of a Spontaneous Brachial Artery Aneurysm
Authors: Pazienza Kathy
Published: March 2018

Brachial artery aneurysms and pseudoaneurysms are rare. What follows is a case of a pseudoaneurysm found in the right brachial artery in the mid upper arm. The patient denied trauma and there had not been any needle injections previously. The initial diagnosis was either a pseudoaneurysm or a saccular aneurysm. Surgical exploration suggested a spontaneous pseudoaneurysm.
Leg Venous Ulcer Size Inversely Related to Number of Notable Perforating Veins: A Word of Caution
Authors: de Carvalho Abreu Jesus Antonio , Salles-Cunha Sergio Xavier
Published: March 2018

Background

Perforating vein ligation has been proposed for the treatment of chronic venous ulcers in the leg. Pubmed.org , however, showed a lack of increase in subfascial endoscopic perforator surgery (SEPS) publications, even before the popularization of perforating vein thermal or chemical ablation procedures. We renewed an investigation on perforating vein ligation surgery as part of venous ulcer treatment. The basic question was if ulcer size and number of notable perforating veins were related.

Methods

Leg perforating veins were detected by ultrasonography (US) and by clinical palpation in 118 legs of 104 subjects, mostly women (79, 76%). This group represented a sample of a mostly rural Brazilian population. Inclusion criterion was any “request for venous US at any stage of ulcer treatment.” Ulcer size in centimeters squared and number of detected perforating veins (NP) were compared using Pearson correlation coefficient p available with Excel.

Results

Average ulcer size was 13 ± 17 cm2 (1–100) for NP = 0–7, resulting in p = −0.18 for the 118 pairs of data. Subgroup averages were 16, 16, 11, 8, and 8 cm2 for NP = 0, 1, 2, 3, and ≥4 perforating veins detected (n = 32, 30, 29, 16, and 11, respectively), resulting in p = −0.94 for such averages and NP.

Conclusion

Ulcer size failed to correlate with number of detected perforating veins based on raw data but correlated inversely to such number if subgroup averages were compared. Average ulcer size was larger for subgroups of legs with lesser number of perforating veins. Arbitrary ligation of detectable perforating veins may result in ulcer size augmentation. Detailed research must continue to find criteria to indicate (a) ligation or (b) preservation of specific perforating veins either (a) detrimental or (b) contributory to venous ulcer healing.
Prevalence of Bilateral Greater Saphenous Vein Insufficiency
Authors: Altawan Anita , Bazzi Mazen , Iljas John , Patel Bipinchandra
Published: March 2018

In venous insufficiency states, venous blood escapes from its normal antegrade path of flow and refluxes back down the veins into an already congested leg. Venous insufficiency symptoms are most commonly caused by valvular incompetence in the low-pressure superficial venous system. Patients with venous insufficiency may have signs and symptoms of fatigue, heaviness, aching, cramping, throbbing, itching, lower extremity discoloration, and ulcer. Varicose veins are a sign of underlying venous insufficiency and affect 20–30% of adults. Duplex of the lower extremity venous system to rule out venous insufficiency was performed to determine the prevalence of bilateral great saphenous vein insufficiency in men and women. Great saphenous vein insufficiency is the most common form of venous insufficiency in patients presenting with signs and symptoms.
NonInvasive Vascular Testing for Diagnosis and Management of Hypothenar Hammer Syndrome
Authors: Lin Sophia , Cardullo Paul A. , Patterson Robert B.
Published: March 2018

Hypothenar hammer syndrome (HHS) is a rare condition that may present as a palmar mass due to an aneurysm, or more frequently as digit ischemia due to thromboembolic or occlusive disease of the distal ulnar artery. Often, patients presenting with HHS are young male smokers with an occupational history of repetitive trauma because of working with machinery or engaging in sports where there is regular impact against the palm. Conditions that may present with similar complaints are vasospastic conditions and inflammatory processes. Noninvasive vascular laboratory studies can be used prior to direct arteriogram to help establish the diagnosis of HHS and guide the therapeutic options for treatment.
Carotid Artery Aneurysm
Authors: Jackson Adam E.
Published: March 2018

The role of ultrasound in today's world has become a standardized routine practice, but has had a drastic impact on the landscape of vascular medicine. The advent of this technology plays a major role in helping to identify several types of disease and lesions throughout the vasculature of the body, especially in the use of ultrasound in relation to the carotid arteries. This noninvasive examination can detect and determine the type of atherosclerotic lesions in vessels and identify a hemodynamically significant stenosis that could potentially cause a stroke. If a high-grade lesion is detected, surgery may be required in the form of a carotid artery endarterectomy or carotid stenting to reduce the risk of stroke. These are the most common reasons for a carotid ultrasound, but in rare cases other disease processes can also be found, such as aneurysms. These aneurysms can occur for various reasons with one being due to previous surgical interventions. Identifying a carotid aneurysm with ultrasound is a rare occurrence that often leads to surgical intervention for the patient.
Digital Traumatic Fistula and Arteriovenous Malformation in a Patient with Ulnar Nerve Compression Syndrome
Authors: Varjão de Oliveira Humberto , Salles-Cunha Sergio X.
Published: March 2018

Objective

—Ulnar nerve compression, the Guyon's canal syndrome, is more unusual than carpal tunnel disorders. An exceptional case of a patient with vascular and neurogenic signs and symptoms is described.

Patient Presentation

—A 26-year-old female physiotherapist presented with neurogenic and arteriovenous signs and symptoms involving the right hand. The patient described fourth finger and wrist pain with flexion, and pain and itching extending to arm and forearm. Sensations worsened when exposed to air conditioning. Enlarged vessels were noted in the medial aspect of the fourth digit; trauma occurred 8 years earlier during attempts to open a nail polish container.

Methods

—Color flow, duplex-Doppler ultrasonography (US) of the subclavian to digital vessels was performed using 3- to 13-MHz transducers. Interpretation focused on flow waveforms obtained with the hand open and closed, having the left extremity as reference. Thermography was performed with camera Flir 15, room temperature at 21°C (70°F) and relative humidity at 48%.

Results

—Right subclavian to digital arteries had high diastolic flow with opened hand. Hand closure interrupted diastolic flow except in the ulnar circulation to the fourth digit. Common digital arteries feeding digits 3–4 and 4–5 had significantly more diastolic flow than the artery feeding digits 2–3. Diastolic flow through a dilated ulnar artery despite hand closure was associated to a millimetric arteriovenous fistula in the fourth finger. Hyperthermia saturating at 35°C (95°F) showed channel-like images over the ulnar nerve and artery and fourth digit, compared with 20°C (68°F) for digit 2.

Conclusions

—US and thermography demonstrated high flow and hyperthermia associated with a fourth digit fistula and abnormal vessels, and ulnar artery dilatation likely associated with ulnar nerve injury. A coadjuvant diagnosis of Guyon's canal syndrome at the wrist was raised.
Patterns of Venous Reflux in 1,027 Lower Limbs with Primary Varicose Veins
Authors: Carrison Victoria , Tompkins Brooke , Fronek Lisa , Loerzel Nicole , Bunke Nisha
Published: March 2018

Objective

The purpose of this study was to investigate the anatomical patterns of superficial venous reflux in patients presenting with primary varicose veins.

Methods

Ultrasound scans, detailed vein maps, and histories of patients presenting to a single vein center were retrospectively reviewed. Patients included in the study were those presenting with primary varicose veins and classified as clinical, etiologic, anatomic, and pathophysiologic classes 2 through 4. Patients with histories of venous intervention, malformations, active ulcerations, or deep system abnormalities were excluded from this study.

Results

Overall, 1,027 limbs of 617 patients met the inclusion criterion. The male to female ratio was 1:6.0. Varicose veins were attributed to reflux in the great saphenous vein (GSV) 66% (n = 679) of the time. When GSV reflux was present, the saphenofemoral junction was incompetent 83% of the time. Six percent of varicose veins were attributed to the anterior accessory saphenous vein. Small saphenous vein (SSV) reflux was demonstrated in 34.8% (n = 357). The thigh extension of the SSV and vein of Giacomini demonstrated reflux in 7% (n = 69) and 1% (n = 15) of limbs, respectively. Reflux of nonsaphenous origin was present in 19% (n = 198) of limbs (isolated tributary reflux).

Conclusion

The variations of superficial venous reflux in patients presenting with primary varicose veins are diverse and complex. Therefore, thorough duplex ultrasound is necessary in all patients with primary varicose veins to evaluate the precise source of reflux to determine therapeutic options.
In tragoedia risus: Analysis of dark humour in post-terrorist attack discourse
Authors: Dynel Marta , Poppi Fabio IM
Published: March 2018

In this article, we examine dark humour in Internet posts commenting on an online Italian newspaper report published by Il Fatto Quotidiano and devoted to the 2016 terrorist attack in Nice. The analysis focuses on the linguistic forms and socio-pragmatic functions of this dark humour in the wake of the tragedy. We argue that the creative humorous posts are meant to communicate Internet users’ ideologies conceptualised as their true beliefs about the sociopolitical situation and that they are oriented primarily towards criticising terrorism-related themes, notably: inept security enforcement, radical Islam, political and public reactions and integration policies. The humour in the Italian posts is used as a means of displaying Internet users’ wit and attracting other users’ attention.
Parkinson’s disease in adults
Authors: Forster Danielle A
Published: March 2018

Parkinson’s disease (PD) is a common neurodegenerative condition that is characterised by progressive motor dysfunction and associated non-motor features. Affecting up to 160 people in 100 000 in the UK, PD has a profound impact on a patient’s quality of life and that of their carers. With the number of affected patients predicted to rise by 28% by 2020, it is important for GPs to recognise the features of PD and have some understanding of both pharmacological treatment and non-pharmacological management. Increased recognition can achieve timely specialist referral and early initiation of treatment, and may help reduce symptoms, improve the patient’s quality of life and reduce healthcare costs. This article aims to raise awareness of the features of PD and provide a summary of management strategies currently recommended by the National Institute for Health and Care Excellence.
Custom 3D-Printed Total Talar Prostheses Restore Normal Joint Anatomy Throughout the Hindfoot
Authors: Tracey Joseph , Arora Danny , Gross Christopher E. , Parekh Selene G.
Published: March 2018

Background:

Third generation total talar prostheses (TTPs) are viable options for talar avascular necrosis (AVN) in the absence of neighboring joint pathology. The use of modern three-dimensional (3D) printing allows the production of custom implants that exactly mimic the patient’s anatomy. The aim of this study is to determine the accuracy of 3D printing in reproducing a synthetic talus and, in doing so, restoring more normal anatomical relationships. We hypothesize that this mode of replication will restore and maintain normal radiographic alignment of the ankle, subtalar, and forefoot joints in the setting of talar AVN.

Methods:

A retrospective analysis was performed on all patients undergoing TTP implantation for the treatment of talar AVN between 2016 and 2017. Radiographic measurements were taken preoperatively and postoperatively to determine native talar dimensions, TTP implant dimensions, and the corresponding radiographic alignment about the forefoot, hindfoot, and ankle.

Results:

A total of 14 patients were identified in our cohort. Talar arc length and width were not found to be significantly changed; however, talar height was significantly increased with use of TTP. Five alignment dimensions were measured, of which, only talar tilt angle was significantly changed. Instances of Meary’s angle correction were observed in cavus and planus foot deformity.

Conclusion:

As a proof of concept, 3D-printed TTP was successful in restoring talar height and talar tilt in the setting of AVN. Additionally, the procedure maintained normal alignment in nonpathological joints. TTPs, based on our cohort, are a viable option to restore more normal anatomical alignment.

Levels of Evidence:

Level IV: Case series
The effect of mechanical aspiration of the vertebral body on pulmonary arterial pressure before cement injection in the vertebroplasty procedure
Authors: Kochai Alauddin , Enercan Meric , Kahraman Sinan , Ozturk Cagatay , Hamzaoglu Azmi
Published: March 2018

Purpose:

The aim of this study is to compare the efficacy of the mechanical aspiration technique just prior to cement application in the standard vertebroplasty (VP).

Methods:

Forty patients were included in the study. In group A, mechanical aspiration of the cavity was done just before the cement injection and in group B aspiration of vertebral body did not perform, VP was done with the same size cannula, same injection force, same injection speed and same cement viscosity. Pulmonary arterial pressures (PAPs) and blood d-dimer values were recorded preoperatively, 24 h and 3 days after the procedure. The PAP and d-dimer data were statistically compared with Student’s t-test.

Results:

The mean age was 71 (62–87) in A and 70 (64–88) in B. The augmented level was 6.7 in A and 6.9 in B. Cement leakage was present in four in A and six in B. Acute hypotension was observed immediately after cement injection in one patient in A and four patients in B. The preoperative mean PAP in A was 35mm/Hg and elevated to 48 mm/Hg on the first postoperative day and decreased to 42 mm/Hg on the third postoperative day. The mean PAP in B was 36 mm/Hg preoperatively, 71 mm/Hg on the first day, and 58 mm/Hg on the third day ( p < 0.05). The d-dimer values revealed a difference between groups, the PAP values significantly changed between before and after the operation in both groups ( p < 0.005).

Conclusion:

Aspiration of the vertebral body can easily be used to decrease the risk of cement leakage and the migration of fatty particles into the pulmonary circulation.
Race, Space, and Surveillance: Understanding the Relationship between Criminal Justice Contact and Institutional Involvement
Authors: Remster Brianna , Kramer Rory
Published: March 2018

Ethnographies of young men of color offer competing theories regarding how individuals react to criminal justice contact. System avoidance theory suggests that black and Latino men in segregated neighborhoods avoid formal institutions because of fear of surveillance, while Rios contends that they frame their criminal justice contact as a racial injustice and become activists. Using data from the National Longitudinal Survey of Adolescent to Adult Health, this study tests these hypotheses. Findings indicate that system avoidance is not specific to men of color, as the original theory posits; criminal justice contact is associated with avoidance for all men in the sample. In contrast, active engagement is partially racialized; men of color with criminal justice contact are more likely to volunteer than white men, but low-level contact is associated with activism for all men. Furthermore, there is little evidence that reactions to criminal justice contact vary by place.
Characterization of halloysite (North East Rif, Morocco): evaluation of its suitability for the ceramics industry
Authors: El Haddar Abdelilah , Gharibi Elkhadir , Azdimousa Ali , Fagel Nathalie , El Amrani El Hassani Iz-Eddine , El Ouahabi Meriam
Published: March 2018

A halloysite clay from Nador (NE Morocco) was studied to evaluate its suitability in the ceramics industry. A cross-section involving all the Messinian facies was performed in the Melilla Neogene basin, at the foot of the Gourougou volcano, to establish the origin of the halloysite and estimate its reserves. White layers of halloysite and red clays rich in smectite occurring in contact with basal-reef limestone were characterized by mineralogical (XRD, IR), textural (SEM) and physico-chemical analyses (grain-size, Atterberg limits, DTA/TG, XRF and specific surface area). Ceramic properties were evaluated for halloysite fired from 500 to 1100°C to evaluate technical processing for ceramic production.

The halloysite clay consists of fine particles with a high plasticity and a large specific surface area. The XRD investigation revealed the presence of 7 Å non-hydrated halloysite along with gibbsite, alunite, K-feldspar and traces of smectite and illite.

The presence of halloysite was confirmed from the characteristic IR bands at 3695 and 3618 cm−1and the predominance of tubular crystals observed in the SEM. The chemical analysis revealed high contents linked to the presence of Al-rich phases (gibbsite and alunite). DTA/TG and XRD results of fired clay samples proved the dehydroxylation of halloysite and a rearrangement of metakaolinite to form mullite and spinel at 975°C.

The Moroccan halloysite might be suitable for refractory ceramic applications. However, addition of quartz sand might be necessary to avoid crack development during firing and to reduce the plasticity of raw halloysite and minimize shrinkage during sintering.
Ventilator flow data predict bronchopulmonary dysplasia in extremely premature neonates
Authors: Bentsen Mariann H. , Markestad Trond , Halvorsen Thomas
Published: March 2018

Early prediction of bronchopulmonary dysplasia (BPD) may facilitate tailored management for neonates at risk. We investigated whether easily accessible flow data from a mechanical ventilator can predict BPD in neonates born extremely premature (EP).

In a prospective population-based study of EP-born neonates, flow data were obtained from the ventilator during the first 48 h of life. Data were logged for >10 min and then converted to flow–volume loops using custom-made software. Tidal breathing parameters were calculated and averaged from ≥200 breath cycles, and data were compared between those who later developed moderate/severe and no/mild BPD.

Of 33 neonates, 18 developed moderate/severe and 15 no/mild BPD. The groups did not differ in gestational age, surfactant treatment or ventilator settings. The infants who developed moderate/severe BPD had evidence of less airflow obstruction, significantly so for tidal expiratory flow at 50% of tidal expiratory volume (TEF50) expressed as a ratio of peak tidal expiratory flow (PTEF) (p=0.007). A compound model estimated by multiple logistic regression incorporating TEF50/PTEF, birthweight z-score and sex predicted moderate/severe BPD with good accuracy (area under the curve 0.893, 95% CI 0.735–0.973).

This study suggests that flow data obtained from ventilators during the first hours of life may predict later BPD in premature neonates. Future and larger studies are needed to validate these findings and to determine their clinical usefulness.
Analyses of repeated failures in cancer therapy for solid tumors: poor tumor‐selective drug delivery, low therapeutic efficacy and unsustainable costs
Authors: Maeda Hiroshi , Khatami Mahin
Published: March 2018

For over six decades reductionist approaches to cancer chemotherapies including recent immunotherapy for solid tumors produced outcome failure‐rates of 90% (±5) according to governmental agencies and industry. Despite tremendous public and private funding and initial enthusiasm about missile‐therapy for site‐specific cancers, molecular targeting drugs for specific enzymes such as kinases or inhibitors of growth factor receptors, the outcomes are very bleak and disappointing. Major scientific reasons for repeated failures of such therapeutic approaches are attributed to reductionist approaches to research and infinite numbers of genetic mutations in chaotic molecular environment of solid tumors that are bases of drug development. Safety and efficacy of candidate drugs tested in test tubes or experimental tumor models of rats or mice are usually evaluated and approved by FDA. Cost‐benefit ratios of such ‘targeted’ therapies are also far from ideal as compared with antibiotics half a century ago. Such alarming records of failure of clinical outcomes, the increased publicity for specific vaccines (e.g., HPV or flu) targeting young and old populations, along with increasing rise of cancer incidence and death created huge and unsustainable cost to the public around the globe. This article discusses a closer scientific assessment of current cancer therapeutics and vaccines. We also present future logical approaches to cancer research and therapy and vaccines.
Deep Learning–Based Survival Analysis Identified Associations Between Molecular Subtype and Optimal Adjuvant Treatment of Patients With Gastric Cancer
Authors: Lee Jeeyun , An Ji Yeong , Choi Min Gew , Park Se Hoon , Kim Seung Tae , Lee Jun Ho , Sohn Tae Sung , Bae Jae Moon , Kim Sung , Lee Hyuk , Min Byung-Hoon , Kim Jae J. , Jeong Woo Kyoung , Choi Dong-Il , Kim Kyoung-Mee , Kang Won Ki , Kim Mijung , Seo Sung Wook
Published: March 2018

Purpose

Gastric cancer (GC) is the third-leading cause of cancer-related deaths. Several pivotal clinical trials of adjuvant treatments were performed during the previous decade; however, the optimal regimen for adjuvant treatment of GC remains controversial.

Patients and Methods

We developed a novel deep learning–based survival model (survival recurrent network [SRN]) in patients with GC by including all available clinical and pathologic data and treatment regimens. This model uses time-sequential data only in the training step, and upon being trained, it receives the initial data from the first visit and then sequentially predicts the outcome at each time point until it reaches 5 years. In total, 1,190 patients from three cohorts (the Asian Cancer Research Group cohort, n = 300; the fluorouracil, leucovorin, and radiotherapy cohort, n = 432; and the Adjuvant Chemoradiation Therapy in Stomach Cancer cohort, n = 458) were included in the analysis. In addition, we added Asian Cancer Research Group molecular classifications into the prediction model. SRN simulated the sequential learning process of clinicians in the outpatient clinic using a recurrent neural network and time-sequential outcome data.

Results

The mean area under the receiver operating characteristics curve was 0.92 ± 0.049 at the fifth year. The SRN demonstrated that GC with a mesenchymal subtype should elicit a more risk-adapted postoperative treatment strategy as a result of its high recurrence rate. In addition, the SRN found that GCs with microsatellite instability and GCs of the papillary type exhibited significantly more favorable survival outcomes after capecitabine plus cisplatin chemotherapy alone.

Conclusion

Our SRN predicted survival at a high rate, reaching 92% at postoperative year 5. Our findings suggest that SRN-based clinical trials or risk-adapted adjuvant trials could be considered for patients with GC to investigate more individualized adjuvant treatments after curative gastrectomy.
A quantitative method for staging mouse embryos based on limb morphometry
Authors: Musy Marco , Flaherty Kevin , Raspopovic Jelena , Robert-Moreno Alexandre , Richtsmeier Joan T. , Sharpe James
Published: March 2018

To determine the developmental stage of embryonic mice, we apply a geometric morphometric approach to the changing shape of the mouse limb bud as it grows from embryonic day 10 to embryonic day 15 post-conception. As the ontogenetic sequence results in the de novo emergence of shape features not present in the early stages, we have created a standard ontogenetic trajectory for limb bud development – a quantitative characterization of shape change during limb morphogenesis. This trajectory of form as a function of time also gives us the reverse function: the ability to infer developmental stage from form, with a typical uncertainty of 2 h. We introduce eMOSS (embryonic mouse ontogenetic staging system) as a fast, reliable, convenient and freely available online tool for staging embryos from two-dimensional images of their limb buds, and illustrate its use in phenotyping early limb abnormalities.
Xenopus ADAM19 regulates Wnt signaling and neural crest specification by stabilizing ADAM13
Authors: Li Jiejing , Perfetto Mark , Neuner Russell , Bahudhanapati Harinath , Christian Laura , Mathavan Ketan , Bridges Lance C. , Alfandari Dominique , Wei Shuo
Published: March 2018

During vertebrate gastrulation, canonical Wnt signaling induces the formation of neural plate border (NPB). Wnt is also thought to be required for the subsequent specification of neural crest (NC) lineage at the NPB, but the direct evidence is lacking. We found previously that the disintegrin metalloproteinase ADAM13 is required for Wnt activation and NC induction in Xenopus. Here, we report that knockdown of ADAM13 or its close paralog ADAM19 severely downregulates Wnt activity at the NPB, inhibiting NC specification without affecting earlier NPB formation. Surprisingly, ADAM19 functions nonproteolytically in NC specification by interacting with ADAM13 and inhibiting its proteasomal degradation. Ectopic expression of stabilized ADAM13 mutants that function independently of ADAM19 can induce the NC marker/specifier snail2 in the future epidermis via Wnt signaling. These results unveil the essential roles of a novel protease-protease interaction in regulating a distinct wave of Wnt signaling, which directly specifies the NC lineage.