bluuebunny/crossref_metadata_2025 huggingface dataset:
Figure 4 from Engineering Oncogenic Hotspot Mutations on SF3B1 via CRISPR-Directed PRECIS Mutagenesis
Authors: Fernandez Mike M. , Yu Lei , Jia Qiong , Wang Xuesong , Hart Kevyn L. , Jia Zhenyu , Lin Ren-Jang , Wang Lili
Published: September 2024

SF3B1 mutant cells exhibit significant CNV changes that are consistent with primary CLL. CNVs analysis comparing SF3B1 mutant samples vs. isogenic WT based on whole-genome sequencing data for (A) Nalm-6, (B) HG-3, and (C) MEC-1. Significant CNV events are denoted by blue for deletions and red for amplifications. Centromeric region demarcating the p and q chromosomal arms is indicated by a red dotted line. Red arrows indicate CNV events shared with primary patient CLL. D, Violin plot of the number of CNV events found in patients with del(17p) and del(13q) CLL that are either SF3B1 WT or mutant based on CLLmap data (https://cllmap.org/). A Mann–Whitney test was used (***, P ≤ 0.001). CNVs associated with either (E) SF3B1 mutation and del(13p) and (F) SF3B1 mutation and del(17p) co-occurrences. The red arrow indicates chromosomal amplification shared between primary CLL samples and cell lines. A χ2 test was performed with −log10(0.05) as the statistical cutoff. G, Top, Cytogenetic loci on the p and q arm and (bottom) WGS analysis for chromosome 7. Some figures created with BioRender.com.
Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation
Authors: Brown Todd M. , Pack Quinn R. , Aberegg Ellen , Brewer LaPrincess C. , Ford Yvonne R. , Forman Daniel E. , Gathright Emily C. , Khadanga Sherrie , Ozemek Cemal , Thomas Randal J. ,   on behalf of the American Heart Association Exercise, Cardiac Rehabilitation and Secondary Prevention Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Quality of Care and Outcomes Research
Published: September 2024

The science of cardiac rehabilitation and the secondary prevention of cardiovascular disease has progressed substantially since the most recent American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation update on the core components of cardiac rehabilitation and secondary prevention programs was published in 2007. In addition, the advent of new care models, including virtual and remote delivery of cardiac rehabilitation services, has expanded the ways that cardiac rehabilitation programs can reach patients. In this scientific statement, we update the scientific basis of the core components of patient assessment, nutritional counseling, weight management and body composition, cardiovascular disease and risk factor management, psychosocial management, aerobic exercise training, strength training, and physical activity counseling. In addition, in recognition that high-quality cardiac rehabilitation programs regularly monitor their processes and outcomes and engage in an ongoing process of quality improvement, we introduce a new core component of program quality. High-quality program performance will be essential to improve widely documented low enrollment and adherence rates and reduce health disparities in cardiac rehabilitation access.
Clinical and Prognostic Characteristics of Acute BAD–Related Stroke: A Multicenter MRI–Based Prospective Study
Authors: Li Shengde , Wang Lihua , Liu Bin , Zhang Ping , Zhang Jiangtao , Chen Guofang , Yang Qingsong , Bian Hong , Li Xin , Wu Jian , Zhao Fengli , Liu Shifu , Bai Hongying , Zhao Weili , Yue Wei , Feng Kai , Tang Yufeng , Lu Zhengqi , Li Yusheng , Zhang Jingbo , Zhou Lixin , Zhu Yicheng , Ni Jun , Peng Bin ,   on behalf of BAD-Study Investigators
Published: September 2024

BACKGROUND:

Branch atheromatous disease (BAD)–related stroke has emerged as a meaningful subtype of ischemic stroke yet remained understudied. We aimed to investigate the demographic, clinical, therapeutic, and prognostic characteristics of BAD-related stroke.

METHODS:

The BAD-study was a nationwide, multicenter, prospective, observational cohort study in 20 Chinese hospitals from June 2021 to June 2023, enrolling patients aged 18 to 80 years with BAD-related stroke within 72 hours of onset. Eligible single subcortical infarct in the territory of lenticulostriate artery and paramedian pontine artery was included. Clinical, laboratory, and treatment data were collected at baseline. The primary outcome was a proportion of good outcomes (modified Rankin Scale score, 0–2) at 90 days. Main secondary outcomes included early neurological deterioration (END), cerebrovascular event, major bleeding, and excellent outcome (modified Rankin Scale score, 0–1) during 90-day follow-up.

RESULTS:

We finally enrolled 476 patients, with a median age of 60 (interquartile range, 53–68) years, and 70.2% were male. The median National Institutes of Health Stroke Scale score was 3 (interquartile range, 2–6) at enrollment. Involvement of the lenticulostriate artery was more common than the paramedian pontine artery (60.7% versus 39.3%). END occurred in 14.7% of patients, with a median time from onset of 38 (interquartile range, 22–62) hours. The rates of good and excellent outcomes were 86.5% and 72%, respectively. Its 90-day stroke recurrence rate was 1.9%. Acute-phase therapy (from onset to 7 days of enrollment) showed heterogeneity and was not associated with prognosis. Multivariable logistic regression analysis identified the National Institutes of Health Stroke Scale score ≥4 at admission and END as negative predictors and extracranial artery stenosis as a positive predictor of good outcomes. Age ≥60 years, National Institutes of Health Stroke Scale score ≥4 at admission, and END were negative predictors of excellent outcomes.

CONCLUSIONS:

With distinct demographic, clinical, and prognostic characteristics, along with a high incidence of END and a low risk of stroke recurrence, BAD-related stroke could be categorized as a separate disease entity. Moreover, its acute-phase treatment strategies were undetermined, awaiting further high-quality studies.
Annotated Checklist of the European Dacnusini and the Dapsilarthra genus group of the Alysiini (Hymenoptera: Braconidae, Alysiinae)
Authors: GODFRAY H. CHARLES J. , ACHTERBERG CORNELIS VAN
Published: September 2024

An annotated checklist of the European Dacnusini (426 species) and the Dapsilarthra genus group of the Alysiini (16 species) (Hymenoptera: Braconidae, Alysiinae) is provided. In addition to a species list with synonymy, further details are given of: (i) intrageneric groupings; (ii) a reference to each species’ treatment in the unindexed and multipart major revisions of Nixon & Griffith as well as the long keys of Tobias; (iii) a hypothesis about host range for the 60% of species which have been reared, and the evidence upon which it is based; (iv) whether a DNA barcode sequence is available (30% of species); (v) for species published after Griffiths’ revision a reference to similar species; (vi) any further relevant notes. One new synonym is established: Chorebus luzulae Griffiths syn. nov. is synonymised with Chorebus aphantus Marshall. Mesocrina Förster is excluded from the Dapsilartha genus group and whether Grandia Goidanich and Lodbrokia Hedqvist are in the Dacnusini is considered uncertain.
Parliamentary Diplomacy as a Key Factor to Conclude the Monitoring Process of the Council of Europe in Andorra and Monaco
Authors: Xuclà Jordi
Published: September 2024

The Principalities of Andorra and Monaco acceded to the Council of Europe with significantly different motivations of origin. The Principality of Andorra managed to approve a constitution and join the Council of Europe in 1994 after a very relevant campaign of parliamentary diplomacy exogenous to the country itself. In the case of the Principality of Monaco, the impetus of Prince Rainier led to the Principality’s entry into the Council of Europe in 2004 but with the obligation to undertake legal and institutional reforms in which parliamentary diplomacy played a central role. In both cases, parliamentary diplomacy served to remove obstacles and facilitated the accomplishment of the requirements that had to be honored to be part of the pan-European international organization. In the case of Andorra with an ex ante monitoring and in the case of Monaco with an ex post monitoring to its entrance to the organisation. This article studies the entrance of Andorra and Monaco to the Council of Europe, the political and parliamentary debates that the access provoked outside and within the respective countries, and how parliamentary diplomacy helped to establish the fulfillment of their obligations with the principles and standards of the International Organization.
Hyperspectral Imaging Database of Human Facial Skin
Authors: Gomes Andreia E. , Nascimento Sérgio M. C. , Linhares João M. M.
Published: September 2024

The perceived color of human skin is the result of the interaction of environmental lighting with the skin. Only by resorting to human skin spectral reflectance, it is possible to obtain physical outcomes of this interaction. The purpose of this work was to provide a cured and validated database of hyperspectral images of human faces, useful for several applications, such as psychophysics-based research, object recognition, and material modeling. The hyperspectral imaging data from 29 human faces with different skin tones and sexes, under constant lighting and controlled movements, were described and characterized. Each hyperspectral image, which comprised spectral reflectance of the whole face from 400 to 720 nm in 10 nm steps at each pixel, was analyzed between and within nine facial positions located at different areas of the face. Simultaneously, spectral measurements at the same nine facial positions using conventional local point and/or contact devices were used to ascertain the data. It was found that the spectral reflectance profile changed between skin tones, subjects, and facial locations. Important local variations of the spectral reflectance profile showed that extra care is needed when considering average values from conventional devices at the same area of measurement.
Enhancing fiber/matrix interface adhesion in polymer composites: Mechanical characterization methods and progress in interface modification
Authors: Goda Ibrahim , Padayodi Essolé , Raoelison Rija Nirina
Published: September 2024

The interface between the fiber and polymer matrix is a crucial region that plays a major role in the mechanical performance of fiber reinforced polymer composites (FRPCs) materials. The properties of this zone are recognized to have a significant influence on the fracture and failure of FRPCs. As a result, strong adhesion at the interface is required for effective stress transfer and load distribution within the composite material. In light of this, the aim of this work is to provide an up-to-date review of test methods for assessing fiber/matrix interface adhesion in FRPCs under static and dynamic loadings, along with advancements in interface modification techniques. At the outset, we give an overview of the different modification treatments used thus far, alongside interface testing methods, in order to optimize fiber/matrix compatibility, improve interfacial bonding and scrutinize their impact on interfacial adhesion properties. Particular attention is then focused on the description of the main mechanical characterization techniques used to assess the fiber/matrix interfacial properties. In the final outlook, we highlight the key findings and discuss potential directions for characterization of the fiber/matrix interface.
Advanced controller design based on interval type-2 fuzzy neural network for elementary super-lift Luo converter
Authors: Gani Ahmet
Published: September 2024

The elementary super-lift Luo converter is a third-order DC/DC step-up converter developed using the super-lift method that increases input voltage with low current and voltage ripples and a high voltage gain. On account of the nonlinearity and uncertainty incorporated with voltage, load changes, and switching operation of elementary super-lift Luo (ESLL) converter, it is a challenging task to design an efficient controller. To overcome these problems, this study proposes a new control approach based on interval type-2 fuzzy neural network (IT2FNN) to regulate a DC output current and voltage of ESLL converter. The parameters of IT2FNN were trained offline using a gradient descent algorithm. Mean square error (MSE), one of the most used statistical performance indicators, was used to evaluate the convergence accuracy performance of gradient descent algorithm. The DC output voltage regulation performance of IT2FNN was evaluated via a comparative simulation with interval type-2 fuzzy controller (IT2FC) and proportional + integral (PI) controller in MATLAB/Simulink environment in terms of settling time, average computational time, and recovery time under three different operational conditions: various reference voltages, input voltage, and load. Moreover, the DC output current regulation performance of IT2FNN was evaluated via a comparative simulation with IT2FC and PI controller in MATLAB/Simulink environment in terms of settling time and steady-state error under various reference current changes. The detailed simulation results obtained from comparative simulation validated the effectiveness of IT2FNN.
Mandible-First and Maxilla-First Sequencing in Virtual Surgical Planning for Orthognathic Surgery: Comparison of Planned and Actual Outcomes
Authors: Bozok Ece , Ozel Abdullah , Akkoyun Emine Fulya , Dolanmaz Elvan
Published: September 2024

Background: Recent studies have shown that virtual planning for orthognathic surgery is an accurate and repeatable method. It is also a fact that surgical sequence can affect the results in terms of accuracy. Various studies stated that both approaches offer comparable results when properly planned and implemented; however, further clinical studies are still needed. This study aims to evaluate the effect of virtual surgical planning (VSP) on surgical outcomes and whether it is affected by mandible-first or maxilla-first approaches. Methods: This study analyzed data from 45 patients who underwent orthognathic surgery due to dentofacial deformity. Six of these patients underwent single-jaw orthognathic surgery, and 39 underwent bimaxillary orthognathic surgery (Maxilla-first group: 21, mandible-first group: 18). The displacements of specific landmarks were assessed by comparing preoperative and postoperative conventional computed tomographies with VSP data. Results: This study showed a statistically significant relationship between the measurements made with the 2 methods ( r = .944; P = .0001). The fact that the intra-class correlation coefficient value is statistically significant and relatively high and that most of the differences in the Bland–Altman chart fall between the limits of compliance indicates a correlation between the virtual plan and surgical outcomes. In addition, in vertical measurements, the absolute mean difference of the B point and the Pogonion in the Maxilla-first group were statistically significantly higher than in the Mandible-first group ( P = .038, P = .011). Conclusions: Our findings corroborate the high accuracy of the VSP reported in previous studies and also demonstrate that VSP with both maxilla-first and mandible-first sequencing achieves high accuracy in the sagittal and coronal planes. Although virtual planning significantly influences accurate surgical outcomes, it is not the sole determinant. Factors like condylar positioning and fixation methods can also impact the final results.
Congenital Middle Ear Cholesteatoma: A Report of 3 Cases and a Literature Review
Authors: Xie Li , Zeng Lingling
Published: September 2024

Background: Congenital cholesteatoma is defined as a white mass behind an intact eardrum without a history of otitis media or previous otologic procedures. Congenital cholesteatoma is a relatively rare disease that accounts for about 2% to 5% of all cholesteatomas. However, the actual incidence rate of congenital cholesteatoma may be underestimated. Conductive hearing loss is the most common presenting symptom. The current study aims to describe the clinical characteristics and management of patients with congenital cholesteatoma and promote awareness of the disease in unilateral or asymmetric conductive hearing loss patients. Methods: In this study, we report a case series of 3 patients including 1 child, 1 adolescent, and 1 young adult, managed in our department between June and August 2023, and present a summary of the literature. Results: Congenital cholesteatoma is primarily a pediatric disease, but it has also been reported in adults. Two cases presented with unilateral secretory otitis media, and 1 case presented with asymmetric unilateral conductive hearing loss. Two patients of Potsic stage III congenital middle ear cholesteatomas underwent transcanal endoscopic ear surgery, and 1 patient of Potsic stage IV underwent conventional microscopic approach canal wall-up mastoidectomy combined with endoscopy. Conclusions: In children or young adults with persistent unilateral or asymmetric conductive hearing loss, congenital middle ear cholesteatoma should be considered. Congenital cholesteatoma cannot be ruled out in children with unilateral secretory otitis media.
From Dependent to Self-Directed Learning in Medical Education: Can Online Modular Intervention Facilitate the Transition?
Authors: Murthy Vasantmeghna , Mohanram Arun
Published: September 2024

Background:

Indian medical graduates are expected to be lifelong learners, and medical teachers need to find newer and more engaging ways to help them hone their lifelong learning skills. Online learning can be a stepping stone toward this goal.

Methods:

We conducted a pre-post design interventional study in which 22 phase two MBBS students rated their self-directedness in learning using the Self-Rating Scale of Self-directed Learning (SRSSDL) at two points in time—before and after completing a 10-week online basic psychopharmacology module. Participant feedback was obtained regarding various aspects of the online modular learning experience.

Results:

The participants’ mean SRSSDL scores before and after the intervention were 231.31 ± 26.64 and 227.31 ± 31.33. The difference is not significant. The students’ scores at both points in time placed them in the “high” range of level of self-directed learning, leaving less realistic scope for a large change in the given time frame. Participant feedback was encouraging, with 19 out of 22 reporting that the overall learning experience was a “positive” one.

Conclusions:

Second-year medical students’ self-reported self-directedness is high. Online modular learning may be a feasible addition to medical education, even though it may not increase self-directedness in the short term. A limited sample size can lead to type 2 errors.
Mechanisms of GTN-induced migraine: Role of NOS isoforms, sGC and peroxynitrite in a migraine relevant mouse model
Authors: Ernstsen Charlotte , Obelitz-Ryom Karina , Kristensen David Møbjerg B. , Olesen Jes , Christensen Sarah Louise , Guo Song
Published: September 2024

Background

Migraine research has highlighted the pivotal role of nitric oxide (NO) in migraine pathophysiology. Nitric oxide donors such as glyceryl trinitrate (GTN) induce migraine attacks in humans, whereas spontaneous migraine attacks can be aborted by inhibiting NO production. The present study aimed to investigate how GTN triggers migraine through its three nitric oxide synthase (NOS) isoforms (neuronal NOS (nNOS), endothelial NOS (eNOS) and inducible NOS (iNOS)) via a suspected feed-forward phenomenon.

Methods

Migraine-relevant hypersensitivity was induced by repeated injection of GTN in an in vivo mouse model. Cutaneous tactile sensitivity was assessed using von Frey filaments. Signaling pathways involved in this model were dissected using non-selective and selective NOS inhibitors, knockout mice lacking eNOS or nNOS and their wild-type control mice. Also, we tested a soluble guanylate cyclase inhibitor and a peroxynitrite decomposition catalyst (Ntotal = 312).

Results

Non-selective NOS inhibition blocked GTN-induced hypersensitivity. This response was partially associated with iNOS, and potentially nNOS and eNOS conjointly. Furthermore, we found that the GTN response was largely dependent on the generation of peroxynitrite and partly soluble guanylate cyclase.

Conclusions

Migraine-relevant hypersensitivity induced by GTN is mediated by a possible feed-forward phenomenon of NO driven mainly by iNOS but with contributions from other isoforms. The involvement of peroxynitrite adds to the notion that oxidative stress reactions are also involved.
Centering the Most Marginalized: Black Women Movement Actors and Misogynoir in the Movement for Black Lives
Authors: Destine Shaneda
Published: September 2024

This research evaluates the extent to which 30 Black women movement actors (e.g., leaders, organizers, and protestors) narrate their intersectional experiences in the Movement for Black Lives (M4BL) in the District of Columbia and Maryland. Specifically, through the narratives and experiences of Black women movement actors (BWMAs) within contemporary social movements, this work uses sociological intersectionality as a theoretical conceptualization and analytical method to link misogynoir to movement literature. Misogynoir was a recurring, embedded concept that had a sustaining effect on movement goals. Also, the amount of time in movement acted as an important identifier of a structural analysis for BWMAs intersectional interpretations. Joya Misra, Celeste Vaughan Curinton, and Venus Mary Green proffer six tenets of sociological analysis that help to illuminate the tools BWMAs use to challenge local organizations to decenter male-centric goals and center women, queer, and differently abled needs for liberation, toward a more comprehensive movement. Implications for future research are discussed.
Exploring advancements and emerging trends in robotic swarm coordination and control of swarm flying robots: A review
Authors: Alqudsi Yunes , Makaraci Murat
Published: September 2024

Swarm Robotics (SR) is an interdisciplinary field that is rapidly advancing to address complex industrial challenges. This paper provides a comprehensive review of recent advancements and emerging trends in SR, with a specific focus on the coordination and control of Swarm Flying Robots (SFRs). The motivation behind this review is to explore scalable and robust solutions for SFRs to enhance their performance and adaptability across various applications. Key objectives include examining the characteristics and essential behaviors of SR, analyzing the challenges and so lutions for implementing SR in Flying Robots (FRs), and highlighting current and future research directions. The review delves into critical areas such as multiple robot path planning, Swarm Intelligence (SI), combinatorial optimization, and formation flying using SFR. Special attention is given to coordination and control techniques, including formation control in GPS-denied environments, to underscore their significance in advancing SR. The paper also addresses ethical, privacy, and security considerations, emphasizing the importance of responsible practices in SR development. Major takeaways from this review include the identification of key technical challenges and potential solutions in SFR, the exploration of SI algorithms, and the future research directions necessary for fully realizing the potential of SR technologies. By offering detailed insights into state-of-the-art research and its industrial implications, this paper serves as a foundational guide for future studies in the dynamic and promising domain of swarm robotics.
Dynamic implementation and verification of the gauge changing function of high-speed variable gauge bogies
Authors: Liu Yumei , Hu Ting , Wang Hongren , Zhuang Jiaojiao , Sheng Jiaxiang
Published: September 2024

The variable gauge bogie has become an effective method to resolve the different gauge problems existed in cross-country and inter-regional railroad transportation, for which the variable gauge function implementation and dynamic performance is investigated in high-speed variable gauge train. This study provides comprehensive analysis of the stress state of the vehicle’s key components during gauge changing and the motion characteristics of the unlocking-locking device under high-speed operation conditions. The analysis results prove the mechanical properties of key components meet the requirements of national standards, and the gauge changing action can be completed reliably during the gauge changing process. The phenomenon of slippage and resonance will not occur during normal operation, which can ensure the safe operation of the trains. A simulation model for the dynamics of a high-speed variable gauge train with a gauge width of 1435/1520 mm is established based on SIMPACK, which is used to analyse and verify the operational stability, quality and smoothness of the designed variable gauge train. The results indicate that all dynamic performance indices meet the operational requirements.
Research on random dynamic cylinder deactivation control strategy of engine based on nonlinear model prediction
Authors: Jin Zhaohui , Lu Dayou , You Tian , Su Yan
Published: September 2024

In the process of cycle cylinder deactivation, the different proportion of cylinder deactivation between adjacent working cycles will cause the problem of uneven operation of each cylinder. In this paper, a random dynamic cylinder deactivation (RD-CDA) control method based on nonlinear model prediction is proposed. The RBF neural network model of the RD-CDA system is built. The K-means algorithm is applied to the offline training of the center position c of the hidden layer node. The P-nearest algorithm is used to train the hidden layer node width σ offline. The recursive least squares (RLS) algorithm is applied to train the output layer weight vector w online. The online adaptive change of the model is realized, and the model verification is carried out. Then, the nonlinear model predictive control system structures with the minimum torque fluctuation and brake specific fuel consumption rate (BSFC) are built respectively. Under different working conditions, the average torque fluctuation per cycle is improved by about 9% to 18.75%, and the average BSFC is improved by about 2 % -3.9 %, which verifies the effectiveness of this strategy in reducing the dynamic fluctuation of random dynamic cylinder deactivation torque and improving fuel economy.
Recurrent Varices after Surgery (REVAS), a Consensus Document
Authors: Perrin Michel R. , Guex J. Jerome , Ruckley C. Vaughan , dePalma Ralph G. , Royle John P. , Eklof Bo , Nicolini Philippe , Jantet Georges ,   REVAS group
Published: September 2024

Report of the meeting† held in Paris on 17th & 18th July 1998 with participation oft: Ugo Baccaglini, Italy; Pierre Barthelemy. France; Jean-Claude Couffinhal. France: Denis Creton. France: Simon Darke, United Kingdom; Ralph De Palma, United States of America; Bo Eklof, United States of America; Ermenegildo Enrici, Argentina; Gilbert Franco, France; Jean Pierre Gobin, France; Louis Grondin, Canada; Jean-Jerome Guex. France; Georges Jantet. France; Claude Juhan. France; Jordi Maeso y Lebrun. Spain; Philippe Nicolini. France; Andreas Oesch, Switzerland; Marcelo Paramo-Diaz. Mexico; Michel Perrin. France; Paul Puppinck, France; Eberhard Rabe, Germany: Rene Rettori, France; John Royle, Australia; Vaughan Ruckley, United Kingdom; Michel Schadeck, France; Jean Claude Schovaerdts, Belgium; John Scurr, United Kingdom; Georgio Spreafico, Italy; Jan Struckman, Denmark; Frederic Vin, France

Recurrent varicose veins after surgery (REVAS) are a common, complex and costly problem. The frequency of REVAS is stated to be between 20 and 80% depending on the definition of the condition. A consensus meeting on the topic (Paris 1998, July) decided to adopt a clinical definition: the presence of varicose veins in a lower limb previously operated on for varices. The pathology of recurrent varicose veins has been poorly correlated with clinical examination and operative findings.

Clinical diagnosis remains essential but does not allow a precise assessment of REVAS. Consequently, the use of imaging investigations is essential. Duplex scan is considered as the method of choice. Both clinical diagnosis and imaging investigations allow the development of a classification for every day usage and future studies. This new classification of CEAP needs to be expanded to define the sites, nature and sources of recurrence, the magnitude of the reflux and other (possible) contributory factors. Methods for REVAS treatment include compression, drugs, sclerotherapy and redo surgery. There was no general consensus in favour of sclerotherapy, surgery or both to treat REVAS. Very few data were available to assess the results of treatment. Factors responsible for recurrence and recommendations for primary prevention were debated and are presented in this article.

Guidelines for well-planned prospective studies have been produced.
Delayed Treatment of Isthmic Aortic Rupture
Authors: Pierangeli Angelo , Turinetto Bruno , Galli Roberto , Caldarera Ilaria , Fattori Rossella , Gavelli Giampaolo
Published: September 2024

Traumatic rupture of the thoracic aorta is a life-threatening injury with a high mortality, and is difficult to manage in polytraumatized patients. Between 1980 and 1998. 50 patients were admitted to our Department with acute traumatic aortic rupture (TAR). The site of lesion was usually isthmic (86% of patients). From 1980 to 1992, 21 patients (Group I) underwent emergency surgical repair; from 1992 to January 1998, 29 patients (Group II) underwent intensive medical treatment, except one who was haemodynamically unstable and died 8 h after the trauma from a massive haemothorax before an emergency thoracotomy could be attempted. The aortic rupture was followed up by MRI or CT scan. Twenty-one patients in Group II underwent aortic repair an average of 8.6 months after the injury. In two patients the operation was expedited because of an enlarging aortic aneurysm. In Group I the postoperative mortality was 19%, three patients developed postoperative paraplegia and one acute renal failure. In Group II there were no postoperative deaths and no major complications.
Mesenteric Vascular Disease: A Review of Diagnostic Methods and Therapies
Authors: Geelkerken R. H. , van Bockel J. H.
Published: September 2024

Mesenteric vascular disease is a relatively rare disease; however the morbidity and mortality are significant. Improved diagnosis and treatment of mesenteric obstructive arterial disease and its complications have occurred. Biplanar angiography of the mesenteric arteries remains the best method of diagnosing mesenteric vascular diseases, though duplex sonography of the mesenteric arteries appears to be a valuable screening tool. Magnetic resonance angiography has the potential to improve on the diagnostic accuracy. Mesenteric artery reconstructive surgery remains the treatment of choice. Newer surveillance techniques such as tonometry may enhance perioperative monitoring and consequently improve the results of mesenteric artery reconstructive surgery. Aggressive support medical therapy plays a significant role in the treatment and reduces patient morbidity and mortality in carefully selected cases. There remains a dearth of prospective controlled trials in patients with this condition.
Surgical Management of Concurrent, Coeliac and Bilateral Iliac Artery Aneurysms
Authors: Rodrigus I. E. , Berry M. C. J. , Gdeedo A. , Van Schil P. E. , Vanmaele R. G.
Published: September 2024

A 76-year-old man was admitted with bilateral common iliac artery aneurysms found incidentally on computed tomography. Transfemoral digital subtraction arteriography demonstrated atherosclerotic plaques in the aorta with bilateral common iliac artery aneurysms and a coeliac axis aneurysm. The coeliac artery aneurysm was resected and an aortobifemoral bypass performed with reimplantation of the inferior mesenteric artery into the prosthesis. The patient was well when discharged 2 weeks after operation. The incidence, natural history and management of coeliac axis and iliac artery aneurysms are reviewed.
Combined Congenital Pericardial and Diaphragmatic Defects: A Case Report
Authors: Tosson R. , Korbmacher B. , Schulte H. D.
Published: September 2024

This report describes the case of a 62-year-old woman who had a preoperative diagnosis of mitral valve insufficiency. At operation her heart was covered by fat which was identified as omental tissue. The pathogenesis, clinical presentation and management of this disorder are presented.
Management of Arterial Occlusive Disease following Radiation Therapy
Authors: Andros G. , Schneider P. A. , Harris R. W. , Dulawa L. B. , Oblath R. W. , Salles-Cunha S. X.
Published: September 2024

Clinically significant arterial occlusive disease developed in 26 patients at between 5 months and 44 years (mean(s.d.) 10.7(12.0) years) following radiation therapy. Therapeutic radiation was associated with lesions of the carotid artery (nine patients), subclavian-axillary arteries (seven) and the abdominal aorta and its branches (10). Clinical presentations included transient ischemic attack, stroke, vertebrobasilar insufficiency, carotid bruit, upper- or lower-extremity ischemia and renovascular hypertension. Surgery for cerebrovascular insufficiency included carotid endarterectomy with vein patch, interposition grafting or subclavian-to-carotid bypass. Carotid or subclavian-to-axillary bypass was performed for upper-extremity ischemia. A combination of endarterectomy and Dacron or saphenous vein grafts was used for infrarenal reconstruction. Tunnels were placed orthotopically. Musculocutaneous flaps assisted in healing selected wounds. Ureteral catheters were useful adjuncts in abdominal vascular reconstructions. There were no operative deaths, strokes or amputations. One patient had recurrent transient ischemic attacks following subclavian-to-carotid bypass. The mean(s.d.) postoperative follow-up was 48.1(39.6) months. Patients presenting with end-organ ischemia following radiation therapy can be managed successfully with aggressive surgical revascularization using a broad spectrum of reconstructive techniques.
Surgical Treatment of Brucella Endocarditis
Authors: Quiroga J. , Miralles A. , Farinola T. , Obi C. , Granados J. , Fontanillas C. , Saura E. , Benito M. , Calbet J. M. , Castells E.
Published: September 2024

Between April 1987 and October 1992, six cases of Brucella endocarditis were operated on in the authors' hospital for valve replacement. They were five men and one woman with a mean(s.d.) age of 52(15) years (range 30–71 years). Three patients were in New York Heart Association (NYHA) class III and three in class IV. Two patients had previous history of rheumatic fever, one was a drug abuser, two had peripheral embolism and one constrictive pericarditis. Most were living in rural areas. Echocardiographic diagnoses were: severe aortic regurgitation in two patients, mixed disease in two and double valve involvement in two. Valve vegetations were demonstrated in two patients, valve calcification in two and annulus abscess in two others. Serological tests were positive in all patients. All patients had valve replacements and three were operated on as emergencies. Surgical findings were: valve vegetations in two patients, cusp perforation in two, annulus abscess in two and prosthetic leak in two. Mean(s.d.) cardiopulmonary bypass time was 123(77) min with a mean ischaemic time of 79(43) min. All patients were given specific antibiotic treatment after surgery. There was no intraoperative mortality and the 5-year survival rate was 100%. Early reoperations were needed in three patients, two because of prosthetic leakage causing severe regurgitation and one for tamponade. The results suggests that Brucella endocarditis is rare, but still occurs in Mediterranean areas. Surgical replacement is needed in spite of antibiotic treatment and recurrences with prosthetic leaks are usual.
Use of Temporary Atrial Pacing in Management of Patients after Cardiac Surgery
Authors: Takeda M. , Furuse A. , Kotsuka Y.
Published: September 2024

The authors' clinical experience with temporary atrial pacing to evaluate its use in the management of patients after cardiac surgery was reviewed. A total of 339 patients undergoing cardiac surgery were studied with regard to postoperative pacing therapy. Postoperative pacing was performed in 186 of 339 patients to treat supraventricular bradycardia or tachyarrhythmias. Rapid atrial pacing was performed to interrupt re-entrant supraventricular tachyarrhythmias. In bradycardic patients, haemodynamics could be improved as the result of significant increase of blood pressure and oxygen saturation in the pulmonary artery (Svo2) caused by atrial pacing. Premature beats could be suppressed in 63% and supraventricular tachyarrhythmias could be interrupted in 66% of the patients only by atrial pacing. Temporary atrial pacing is safe, rapid and effective as the treatment of choice; it is believed that the technique should be applied in preference to pharmacological treatment in the management of patients after cardiac surgery.
Results of 1000 Consecutive Elective Abdominal Aortic Aneurysm Repairs
Authors: Lloyd W. E. , Paty R S. K. , Darling R. C. , Chang B. B. , Fitzgerald K. M. , Leather R. P. , Shah D. M.
Published: September 2024

In order to identify major risks for death and complications from elective repair of abdominal aortic aneurysm, the authors analyzed their experience with the last 1000 such repairs over a 15-year period. Of the patients, 772 were men and 228 were women; average age was 70 (range 37–92) years. Some 20% of the patients had severe chronic obstructive pulmonary disease and 33% had baseline creatinine level >115μmol/l. Fifteen patients were dialysis-dependent and 24% (242/1000) had significant cardiac disease. Operation used a retroperitoneal approach in 834 patients and a transperitoneal approach in 166. The perioperative mortality rate was 2.4%, but this did not change either chronologically or with technique: some 50% of the deaths were due to cardiac causes. Renal and pulmonary impairment did not affect mortality or complication; 64% of non-fatal complications were distributed in the renal (17%), pulmonary (19%) and cardiac groups (28%). The authors' experience showed that patients with cardiac disease remain at significant risk for post-abdominal aortic aneurysm repair complications in spite of selective preoperative cardiac evaluation. Renal and pulmonary risk factors did not cause additional mortality or morbidity. They suggest that elective abdominal aortic aneurysm repair can be performed with low mortality and morbidity, even in increasing numbers of high-risk patients.
Internal Mammary Artery Graft Function is Not Affected in Hypertensive Patients on Therapy
Authors: Deja M. A. , Golba K. S. , Wos S. , Mrozek R. , Bachowski R. , Biernat J.
Published: September 2024

Results are presented which assess the reactivity of isolated human internal mammary artery fragments from non-hypertensive and treated hypertensive patients In vitro. Material from three patient groups was examined: group I, no hypertension; group II, arterial hypertension treated with ACE inhibitors; and group III, arterial hypertension treated with nifedipine. Responses to KCl, norepinephrine and acetylcholine, as well as the influence of NG-monomethyl-L-arginine (L-NMMA) on the effects of norepinephrine were tested. Response to KCl was highest in group II, while the contractile reactivity to norepinephrine was depressed in group II. Relaxation after acetylcholine was enhanced in groups II and III. Incubation of vessel fragments with L-NMMA sensitized the tissue to norepinephrine in the order of potency group II>group III>group I. internal mammary artery function as the graft, and particularly in terms of endothelial function, is not adversely affected in arterial hypertension, although proper antihypertensive treatment may be essential.
Prediction of Requirement for, and Outcome of, Prolonged Mechanical Ventilation following Cardiac Surgery
Authors: Thompson M. J. , Elton R. A. , Mankad P. A. , Campanella C. , Walker W. S. , Sang C. T. M. , Cameron E. W. J.
Published: September 2024

The prediction of requirement for, and short- and long-term outcome of, prolonged mechanical ventilation after cardiac surgery is ill-defined. The aims of this study were to isolate any predictive indices which might identify those groups of patients who may require prolonged ventilation postoperatively and to determine which factors significantly affect outcome in the prolonged-ventilation group. Following case note review of 139 consecutive cardiac surgical patients ventilated for ≥ 7 days following surgery, 43 factors were recorded on each patient, including smoking, pulmonary function, chest infection, and chronic obstructive airways disease. Of 139 patients. 89 were discharged from hospital (64% survival); of these, 52 were alive at long-term follow-up (58% long-term survival). Statistical analysis identified urban residence, chronic obstructive airways disease, prolonged operation, and bypass time as significant predictors of requirement for prolonged ventilation postoperatively. On multivariate analysis five factors were predictive of increased intensive care mortality, including urban residence, inotrope days, sepsis, perioperative cerebrovascular accident and coagulopathy requiring fresh frozen plasma transfusion postoperatively. Following discharge from hospital, four factors were found to be significant predictors of increased mortality: these are impaired preoperative ejection fraction, increasing age, impaired preoperative pulmonary function, and abscence of preoperative aspirin medication. These factors should be considered in intensive care planning, long-term follow-up and importantly on clinical decision making in the individual patient.
Homocysteinemia as a Risk Factor for Atherosclerosis: A Review
Authors: Nehler M. R. , Taylor L. M. , Porter J. M.
Published: September 2024

In industrialized nations, the leading cause of death and disability is atherosclerosis. Despite a widespread research effort spanning decades, there remains no clearly defined cause or cure for this disease that directly or indirectly affects the lives of almost all individuals in the western world. Autopsy findings show atherosclerosis to some degree in nearly all aged people, suggesting it should be regarded as a normal aging process as well as a disease.

Any investigation of atherosclerosis etiology therefore requires a distinction between atherosclerosis normally observed with aging, and pathologic atherosclerosis causing disease and/or death. Atherosclerosis is most appropriately regarded as a disease when associated with both rapid progression and clinical symptoms. Widely accepted risk factors for atherosclerotic disease include advanced age, diabetes, tobacco use, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, decreased high-density lipoprotein, some hypercoaguable states, sedentary life-style, and elevated plasma homocysteine. The study of lipid metabolism has dominated research into atherosclerosis etiology for decades, although now it is widely recognized that a large number of people with symptomatic atherosclerotic disease have no detectable evidence of abnormal lipid metabolism [1, 2].

Elevation in plasma homocysteine has also been widely studied as an independent risk factor for atherosclerosis. A description of the metabolism of homocysteine, its relationship to vascular disease, evidence supporting its role as an independent risk factor for atherosclerotic vascular disease, and the potential role of treatment will form the basis for this review.
Limitations of Intra-Arterial Thrombolysis
Authors: Rickard M. J. F. X. , Fisher C. M. , Soong C. V. , Hardman D. T. A. , Lane R. J. , Appleberg M.
Published: September 2024

The purpose of this study was to assess the efficacy, costs and complications of acutely ischaemic limbs initially treated with urokinase-induced thrombolysis, and to compare the subsequent patencies of occluded native arteries, vein grafts and prosthetic grafts. Data from 45 consecutive episodes of thrombolysis in 37 patients (37 limbs) were reviewed retrospectively. An initial bolus dose of urokinase was used in all limbs, with pulse-spray in nine 30 limbs received additional infusions of urokinase including six who received initial treatment with pulse-spray. Percutaneous transluminal angioplasty or surgical intervention was undertaken at any stage when considered appropriate. There were 14 occluded native arteries (31%), 12 vein grafts (27%), 16 prosthetic polytetrafluoroethylene grafts (35%), and three composite grafts (7%). Thrombolysis was initially successful in 33 episodes (73%). Of these, no additional procedure was required in three, percutaneous transluminal angioplasty in 23, other surgery in 11 and bypass surgery in seven with more than one additional procedure being undertaken in 10. Of the 12 episodes with initial failure, major surgery was performed in eight and no procedure in four. Lysis-related complications occurred in 19 treatment episodes (42%) with major bleeding in seven (16%), minor bleeding in 10 (22%), distal embolization in 11 (24%) and arterial dissection in two (4%). One amputation (2%) and one death (2%), both directly attributable to thrombolysis, occurred within 1 month of treatment. Complications occurred in 10 of 19 (53%) prosthetic or composite grafts, five of 12 (42%) vein grafts, and four of 14 (29%) native artery occlusions ( P = 0.38). The median follow-up of patients remaining alive was 24 months. The overall mean (s.e.m.)patency rate at 6 months of lysed vessels or replacement bypass grafts was 44% (8%). Presentation with a native artery and or graft occlusion was associated with superior long-term patency (any subsequent conduit) compared with presentation with an occluded prosthetic graft (log rank χ21 = 7.00, P = 0.008) and reflects the inferior run-off of the latter patients. The average cost of thrombolysis in radiological procedures and disposables alone excluding intensive care and complications was AUD$2440.
An Increased Concentration of Rifampicin Bonded to Gelatin-Sealed Dacron Reduces the Incidence of Subsequent Graft Infections following a Staphylococcal Challenge
Authors: Vicaretti M. , Hawthorne W. J. , Ao P. Y. , Fletcher J. P.
Published: September 2024

The purpose of this study was to determine if 10 mg/ml rifampicin bonded to gelatin-sealed Dacron (Gelsoft) reduced staphylococcal infection. Grafts soaked in rifampicin were interposed in the left carotid artery of 20 merino sheep and then inoculated with 108 colony-forming units of MRSA (10 sheep) or a slime producing Staphylococcus epidermidis (10 sheep). Grafts were harvested at 3 weeks, and perigraft abscess, anastomotic disruption and graft occlusion recorded. Swabs were taken to assess bacterial growth of the perigraft tissues, and external and internal graft surface. Grafts segments were incubated in broth medium. Results were compared with previously published results that used graft that were not soaked in rifampicin (control) and grafts soaked in 1.2 mg/ml rifampicin. A total of 4/50 cultures were positive and significantly reduced for S. epidermidis compared with the control group of 30/50 ( P < 0.05) and the 1.2 mg/ml group of 13/45 ( P < 0.05). For the methicillin resistant staphylococcus aureus (MRSA) group, 6/40 cultures were positive, which was significantly reduced compared with the control group (38/40, P < 0.05) and the 1.2-mg/ml group (19/32, P < 0.05). In conclusion an increased concentration of rifampicin significantly reduced the incidence of prosthetic vascular graft infection following a challenge of MRSA or S. epidermidis.