bluuebunny/crossref_metadata_2025_split huggingface dataset:
Post Catheterization Inferior Epigastric Artery to Common Femoral Vein Fistula: Complimentary Role of Duplex Sonography and Computed Tomographic Angiography
Authors: Riggs Kristin D. , Kindhart Jennifer , Lee Savina , Keefer Mary , Gupta Kamal 
Published: March 2018

Introduction Iatrogenic arteriovenous fistulas (AVF) are usually formed between the common femoral artery (CFA) and the common femoral vein (CFV). Diagnosis is confirmed with duplex sonography (DS). They are usually treated conservatively or with surgery. AVF arising from the inferior epigastric (IEA) branch of the CFA are rare and present unique challenges, as DS usually cannot differentiate AVF origin from CFA or IEA. Case Study A 21-year-old woman presented with mild groin discomfort and bruit after an electrophysiological procedure via the right CFV. DS confirmed an AVF, but computed tomography angiography was performed to assess the origin. A small fistula was seen from the proximal right IEA to CFV. This offered an opportunity to percutaneously close the fistula by coiling the IEA if clinically indicated. However, a repeat DS 6 weeks later demonstrated spontaneous AVF closure. Conclusion DS is usually the only diagnostic study performed for evaluation of AVF. Diagnosis is usually made on the basis of relatively low resistance flow in the CFA, increased pulsatile CFV flow, and high-velocity, disturbed pulsatile flow in the tract. Occasionally, turbulent flow results in soft-tissue vibrations (perivascular speckling) that obscure visualization of AVF tract. Computed tomography angiography defined the exact origin of the fistula from proximal IEA and offers a complimentary role in assessment of AVF and their management.
Timeliness in Notification of Critical Vascular Laboratory Test Results is Part of Quality Assurance
Authors: Satiani Bhagwan , Kiser Dennis 
Published: March 2018

Introduction Regulatory and accrediting bodies, including Intersocietal Commission for the Accreditation of Vascular Laboratories, require a policy for timely notification of caregivers with potentially life-threatening or “critical” findings on vascular laboratory (VL) testing. However, the timeliness of notification with reference to VL tests is often not specified. Objective To audit all “critical” results as defined by our written policy requiring notification within 120 minutes of completion of a test. Methods The VL database, when queried for results between August 1, 2008, and December 31, 2009, showed that “critical” results constituted 6.1% (988/16,168) of all VL tests performed during that period. Reporting time was the time between test completion and contact with an appropriate caregiver. The type of test, indication, in or out-patient status, and after-hour or regular work hours testing was recorded during a separate focused audit. Results A focused audit performed during December 2009 showed 3.49% (31/888) of all tests reported as critical. The majority of critical results were abnormal venous studies (93.5%), performed in inpatients (61%), and during regular working hours (93.5%). The time to notification was a mean of 11.92 minutes (SD 9.51; range, 1–40 minutes). Conclusions Promptness of notification of “critical” VL results to caregivers must be part of an audit quality assurance program. A well-established protocol for communication and documentation of critical results must be instituted in all VLs.
The Findings of a Retrospective Audit of Clinical Indications and Outcomes Related to Renal Artery Duplex Ultrasounds Performed during a 2-Year Period
Authors: Pemble Lucia , Gibbs Harry 
Published: March 2018

Introduction In this retrospective audit of renal artery duplex ultrasounds (RADU), performed on 791 patients during a 2-year period, we analyze the clinical indications for testing, the patient cohort characteristics, and RADU results and outcomes. Results We found RADU to be sensitive and specific for the detection of renal artery stenosis with limitations in some instances attributable to physical interactions between ultrasound and body tissues and the variable presence of accessory renal arteries, even when performed by qualified experienced vascular sonographers. The results show the wide range of clinical indications for the performance of the test and document the multiple co morbidities of the patient population. Results show the majority of renal artery lesions are atherosclerotic in nature and that few patients go on to have renal artery intervention. The interventions do result in improvement of blood pressure but no change in resistive index. Conclusion The future role of RADU will be determined by medical research that provides evidence-based outcomes of the natural history of renal artery stenosis in the context of hypertension, allowing algorithms to be developed that best identify the medical versus interventional therapies for individual patients attempting to optimize renal function and blood pressure control while modifying associated risk factors. This will then allow more selective use of this diagnostic tool to answer more specified clinical questions on a case-by-case basis.
Case Series of Subclavian Artery Aneurysms in the Noninvasive Vascular Laboratory
Authors: Casanegra Ana I. , Whitelaw Susan M. , Greenberg Roy K. , Kashyap Vikram , Gornik Heather L. 
Published: March 2018

Introduction Subclavian artery aneurysm (SAA) is an uncommon entity, and there is little information in the vascular ultrasound literature regarding this disorder. Methods Query of a single-center noninvasive vascular laboratory database for all duplex examinations performed from January 1, 2000, to December 31, 2009 with a diagnosis of SAA. Medical records, archived ultrasound images, and correlative imaging studies were reviewed. Result A total of 12 patients with SAA were identified. Median age 56 years (range, 24–86 years), 58% male. The etiology of SAA was as follows: atherosclerosis (3/12), thoracic outlet syndrome (TOS; 3/12), connective tissue disorder (3/12), trauma (2/12), and vasculitis (1/12). All patients with SAA not caused by TOS had additional peripheral arterial or aortic aneurysm(s) previously or subsequently documented on imaging studies. Ten patients had symptoms at the time of diagnosis, most commonly arm and neck pain, arm claudication, and neurological findings. Aneurysms were equally distributed between right and left sides. The majority of SAA (9/12) were located at the origin or proximal subclavian artery; 3 were dissecting aneurysms. The median aneurysm maximal diameter was 2.35 cm (range, 1.5–6.4 cm), and the median contiguous normal artery diameter was 0.85 cm. Three patients had significant velocity shifts noted within the aneurysm. Vertebral artery flow was abnormal in one-third of SAA (4/12). Marked tortuosity of either internal carotid artery was a common related finding among these patients (6/12). Correlative computed tomography scan was available for 5 patients. A total of 75% of subjects in this series underwent open or endovascular aneurysm repair, whereas the remaining patients were followed with no intervention. Conclusion Duplex ultrasound is a useful tool for diagnosis and characterization of subclavian artery aneurysms. Among patients with SAA who have no evidence of TOS, careful evaluation for co-existent aortic and peripheral aneurysms is critical.
Hold the Stroke Alert! Acute Axillary Artery Embolus Unmasked by Emergency Bedside Ultrasound
Authors: Strony Robert 
Published: March 2018

Objective —To describe a case of axillary artery embolus detected by emergency physician- performed bedside ultrasound. Case Report —A patient presented with a possible stroke but was diagnosed correctly with acute axillary artery embolus. The axillary artery embolus was detected by the emergency physician by the use of bedside ultrasound. Results —An acute axillary artery embolus was detected rapidly by emergency physician-performed bedside ultrasound. This led to rapid definitive vascular surgical care. Conclusion —Rapid bedside emergency ultrasound of the upper extremity arterial system can accurately detect life- and limb-threatening pathology and expedite, as this case demonstrates, definitive limb-saving surgical care.
Use of Duplex Ultrasound for Evaluation of Complex Aortic Arch Vessel Re-routing for Thoracic Endovascular Aneurysm Repair
Authors: Liu Anyi , Wartak Siddharth , Srivastava Sunita , Roselli Eric E. , Whitelaw Susan , Gornik Heather L. 
Published: March 2018

Introduction Technological advances have increased availability of endovascular therapies for complex aortic disease. Endovascular repair of thoracic aortic aneurysms (TEVAR) involving the arch and proximal descending thoracic aorta is challenging with respect to the proximal landing zone for fixation of the endograft and prevention of endoleak. In such cases, additional vascular procedures may be necessary for re-routing of arch vessels. Patient Description An 88 year-old man was treated for chronic type B aortic dissection with aneurysm and rapid growth, including involvement of the distal aortic arch (arch 6.5 cm, descending thoracic aorta 6.2 cm). He underwent a left common carotid artery (CCA) to subclavian artery (SCA) bypass followed by a second bypass procedure communicating the right CCA to the left CCA–SCA graft. A thoracic endograft was placed which covered the origin of the left SCA and left CCA with distal fixation just above the celiac artery. Two weeks after the surgery, he developed confusion and a carotid duplex study was conducted using a Philips iU22 with a 9-3 MHz linear transducer. Findings Both synthetic bypass grafts were well visualized and were widely patent with no velocity shifts indicative of stenosis. The right to left graft ran behind the esophagusbefore its anastomosis to the left CCA–SCA graft. A dissection flap and small, partially thrombosed pseudoaneurysm were visualized at the right internal carotid artery (ICA) origin consistent with prior carotid dissection, but there was no evidence of stenosis. A plaque was visualized in the left ICA with a velocity shift noted consistent with moderate stenosis. The vertebral arteries were patent with antegrade flow, although flow in the left vertebral artery had a delayed upstroke, likely reflecting the long re-routing of blood flow. Conclusion Vascular technologists may be called to assist in the care of patients who have undergone re-routing of the aortic arch vessels for TEVAR. The complex anatomy of these cases emphasizes the importance of preparation for the examination, including review of operative reports and communication with referring clinicians.
Metabolic syndrome and the risk of adverse cardiovascular events after an acute coronary syndrome
Authors: Cavallari Ilaria , Cannon Christopher P , Braunwald Eugene , Goodrich Erica L , Im KyungAh , Lukas Mary Ann , O’Donoghue Michelle L 
Published: March 2018

Background The incremental prognostic value of assessing the metabolic syndrome has been disputed. Little is known regarding its prognostic value in patients after an acute coronary syndrome. Design and methods The presence of metabolic syndrome (2005 International Diabetes Federation) was assessed at baseline in SOLID-TIMI 52, a trial of patients within 30 days of acute coronary syndrome (median follow-up 2.5 years). The primary endpoint was major coronary events (coronary heart disease death, myocardial infarction or urgent coronary revascularization). Results At baseline, 61.6% ( n = 7537) of patients met the definition of metabolic syndrome, 34.7% (n = 4247) had diabetes and 29.3% had both ( n = 3584). The presence of metabolic syndrome was associated with increased risk of major coronary events (adjusted hazard ratio (adjHR) 1.29, p < 0.0001) and recurrent myocardial infarction (adjHR 1.30, p < 0.0001). Of the individual components of the definition, only diabetes (adjHR 1.48, p < 0.0001) or impaired fasting glucose (adjHR 1.21, p = 0.002) and hypertension (adjHR 1.46, p < 0.0001) were associated with the risk of major coronary events. In patients without diabetes, metabolic syndrome was numerically but not significantly associated with the risk of major coronary events (adjHR 1.13, p = 0.06). Conversely, diabetes was a strong independent predictor of major coronary events in the absence of metabolic syndrome (adjHR 1.57, p < 0.0001). The presence of both diabetes and metabolic syndrome identified patients at highest risk of adverse outcomes but the incremental value of metabolic syndrome was not significant relative to diabetes alone (adjHR 1.07, p = 0.54). Conclusions After acute coronary syndrome, diabetes is a strong and independent predictor of adverse outcomes. Assessment of the metabolic syndrome provides only marginal incremental value once the presence or absence of diabetes is established.
iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL
Authors: Hallek Michael , Cheson Bruce D. , Catovsky Daniel , Caligaris-Cappio Federico , Dighiero Guillermo , Döhner Hartmut , Hillmen Peter , Keating Michael , Montserrat Emili , Chiorazzi Nicholas , Stilgenbauer Stephan , Rai Kanti R. , Byrd John C. , Eichhorst Barbara , O’Brien Susan , Robak Tadeusz , Seymour John F. , Kipps Thomas J. 
Published: March 2018

Abstract
The previous edition of the consensus guidelines of the International Workshop on Chronic Lymphocytic Leukemia (iwCLL), published in 2008, has found broad acceptance by physicians and investigators caring for patients with CLL. Recent advances including the discovery of the genomic landscape of the disease, the development of genetic tests with prognostic relevance, and the detection of minimal residual disease (MRD), coupled with the increased availability of novel targeted agents with impressive efficacy, prompted an international panel to provide updated evidence- and expert opinion–based recommendations. These recommendations include a revised version of the iwCLL response criteria, an update on the use of MRD status for clinical evaluation, and recommendations regarding the assessment and prophylaxis of viral diseases during management of CLL.
Bis-Indole–Derived NR4A1 Ligands and Metformin Exhibit NR4A1-Dependent Glucose Metabolism and Uptake in C2C12 Cells
Authors: Mohankumar Kumaravel , Lee Jehoon , Wu Chia Shan , Sun Yuxiang , Safe Stephen 
Published: March 2018

AbstractTreatment of C2C12 muscle cells with metformin or the NR4A1 ligand 1,1-bis(3′-indolyl)-1-(p-hydroxyphenyl)methane (DIM-C-pPhOH) induced NR4A1 and Glut4 messenger RNA and protein expression. Similar results were observed with buttressed (3- or 3,5-substituted) analogs of DIM-C-pPhOH, including 1,1-bis(3′-indolyl)-1-(3-chloro-4-hydroxy-5-methoxyphenyl)methane (DIM-C-pPhOH-3-Cl-5-OCH3), and the buttressed analogs were more potent than DIM-C-pPhOH NR4A1 agonists. Metformin and the bis-indole substituted analogs also induced expression of several glycolytic genes and Rab4, which has previously been linked to enhancing cell membrane accumulation of Glut4 and overall glucose uptake in C2C12 cells, and these responses were also observed after treatment with metformin and the NR4A1 ligands. The role of NR4A1 in mediating the responses induced by the bis-indoles and metformin was determined by knockdown of NR4A1, and this resulted in attenuating the gene and protein expression and enhanced glucose uptake responses induced by these compounds. Our results demonstrate that the bis-indole–derived NR4A1 ligands represent a class of drugs that enhance glucose uptake in C2C12 muscle cells, and we also show that the effects of metformin in this cell line are NR4A1-dependent.
PUF-8 facilitates homologous chromosome pairing by promoting proteasome activity during meiotic entry in C. elegans
Authors: Kumar Ganga Anil , Subramaniam Kuppuswamy 
Published: March 2018

ABSTRACT
Pairing of homologous chromosomes is essential for genetic recombination during gametogenesis. In many organisms, chromosome ends are attached to cytoplasmic dynein, and dynein-driven chromosomal movements facilitate the pairing process. Factors that promote or control the cytoskeletal tethering of chromosomes are largely unknown. Here, we show that the conserved RNA-binding protein PUF-8 facilitates the tethering and pairing processes in the C. elegans germline by promoting proteasome activity. We have isolated a hypomorphic allele of pas-1, which encodes a proteasome core subunit, and find that the homologous chromosomes fail to pair in the puf-8; pas-1 double mutant due to failure of chromosome tethering. Our results reveal that the puf-8; pas-1 meiotic defects are caused by the loss of proteasome activity. The axis component HTP-3 accumulates prematurely in the double mutant, and reduction of its activity partially suppresses some of the puf-8; pas-1 meiotic defects, suggesting that HTP-3 might be an important target of the proteasome in promoting early meiotic events. In summary, our results reveal a role for the proteasome in chromosome tethering and identify PUF-8 as a regulator of proteasome activity during early meiosis.
Matrix elasticity regulates mesenchymal stem cell chemotaxis
Authors: Saxena Neha , Mogha Pankaj , Dash Silalipi , Majumder Abhijit , Jadhav Sameer , Sen Shamik 
Published: March 2018

ABSTRACT
Efficient homing of human mesenchymal stem cells (hMSCs) is likely to be dictated by a combination of physical and chemical factors present in the microenvironment. However, crosstalk between the physical and chemical cues remains incompletely understood. Here, we address this question by probing the efficiency of epidermal growth factor (EGF)-induced hMSC chemotaxis on substrates of varying stiffness (3, 30 and 600 kPa) inside a polydimethylsiloxane (PDMS) microfluidic device. Chemotactic speed was found to be the sum of a stiffness-dependent component and a chemokine concentration-dependent component. While the stiffness-dependent component scaled inversely with stiffness, the chemotactic component was independent of stiffness. Faster chemotaxis on the softest 3 kPa substrates is attributed to a combination of weaker adhesions and higher protrusion rate. While chemotaxis was mildly sensitive to contractility inhibitors, suppression of chemotaxis upon actin depolymerization demonstrates the role of actin-mediated protrusions in driving chemotaxis. In addition to highlighting the collective influence of physical and chemical cues in chemotactic migration, our results suggest that hMSC homing is more efficient on softer substrates.
Prolonged Effects of Elevated 17β-Estradiol on Physical Activity after Orchidectomy
Authors: STOTT NICOLE L. , ABREU MITCHELL R. , CATES BRITTANY E. , DILLARD BRYCE M. , FOSTER BRITTANY R. , HASKETT MYRRHANDE J. , LEE JAMES C. , SIMÕES HELEN G. , SPIVEY THOMAS P. , BOWEN ROBERT S. 
Published: March 2018

ABSTRACT
The biological mechanisms regulating physical activity patterns appear to be linked to the sex hormones. Elucidation of these regulatory mechanisms may enhance individual physical activity patterns producing positive gains in health.

Purpose
The purpose of this study was to evaluate the prolonged effects of estrogen on wheel running distance, duration, and speed in orchidectomized mice.

Methods
The physical activity patterns of 9-wk-old C57BL/6j male mice (n = 28) were observed. Wheel running distance, duration, and speed were assessed under physiological conditions for 7 d. Next, physical activity patterns were evaluated after bilateral orchidectomy (n = 14) or sham orchidectomy (n = 14) for an additional 7 d. Orchidectomized mice were provided estrogen containing capsules for three additional weeks; control mice were provided estrogen-free capsules. Wheel running distance, duration, and speed were analyzed by three two-way (treatment group–phase of study) analysis of variance tests.

Results
Wheel running speed was unaffected by sex hormone status. Distance (mean ± SD = 6.74 ± 2.13 km at baseline) decreased significantly after orchidectomy (2.27 ± 1.55 km) and remained low after initial estrogen treatment (3.04 ± 1.05 km). Prolonged estrogen exposure sustained a significant elevation of daily distance (4.47 ± 1.87 km). Prolonged estrogen exposure recovered and significantly sustained wheel running duration (baseline, 248 ± 60 min; postorchidectomy, 102 ± 53 min; prolonged exposure, 170 ± 63 min).

Conclusions
Wheel running behavior was reduced significantly after orchidectomy and remained low after initial treatment with estrogens, but recovered to near control levels after 2 wk of exposure to estrogens. The estrogenic mechanism regulating wheel running behavior in male mice appears to induce an extensive but slow acting biological mechanism. Understanding the biological drive behind this mechanism may aid in developing useful therapeutic strategies to combat health issues related to physical inactivity.
Intravenous Iron Does Not Augment the Hemoglobin Mass Response to Simulated Hypoxia
Authors: GARVICAN-LEWIS LAURA A. , VUONG VICTOR L. , GOVUS ANDREW D. , PEELING PETER , JUNG GRACE , NEMETH ELIZABETA , HUGHES DAVID , LOVELL GREG , EICHNER DANIEL , GORE CHRISTOPHER J. 
Published: March 2018

ABSTRACT

Purpose
Iron is integral for erythropoietic adaptation to hypoxia, yet the importance of supplementary iron compared with existing stores is poorly understood. The aim of the present study was to compare the magnitude of the hemoglobin mass (Hbmass) in response to altitude in athletes with intravenous (IV), oral, or placebo iron supplementation.

Methods
Thirty-four, nonanemic, endurance-trained athletes completed 3 wk of simulated altitude (3000 m, 14 h·d−1), receiving two to three bolus iron injections (ferric carboxymaltose), daily oral iron supplementation (ferrous sulfate), or a placebo, commencing 2 wk before and throughout altitude exposure. Hbmass and markers of iron regulation were assessed at baseline (day −14), immediately before (day 0), weekly during (days 8 and 15), and immediately, 1, 3, and 6 wk after (days 22, 28, 42, and 63) the completion of altitude exposure.

Results
Hbmass significantly increased after altitude exposure in athletes with IV (mean % [90% confidence interval (CI)], 3.7% [2.8–4.7]) and oral (3.2% [2.2–4.2]) supplementation and remained elevated at 7 d postaltitude in oral (2.9% [1.5–4.3]) and 21 d after in IV (3.0% [1.5–4.6]) supplementation. Hbmass was not significantly higher than baseline at any time point in placebo.

Conclusions
Iron supplementation appears necessary for optimal erythropoietic adaptation to altitude exposure. IV iron supplementation during 3 wk of simulated live high–train low altitude training offered no additional benefit in terms of the magnitude of the erythropoietic response for nonanemic endurance athletes compared with oral supplementation.