bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrograde technique for great saphenous vein ablation using the VenaSeal™ closure system – Ideal approach for deep seated or small below the knee refluxing truncal veins
Authors: Chan Sally SJ , Tang Tjun Y , Chong Tze T , Choke Edward C , Tay Hsien T 
Published: May 2019

Objectives The VenaSeal™ closure system (Medtronic, Galway, Ireland) is a novel non-thermal, non-tumescent ablative device that induces endovenous closure by inducing fibrosis of the truncal superficial vein. The conventional IFU antegrade technique is straightforward except when the great saphenous vein is small at the planned access site below the knee, deep, or steeply traverses the fascia making passage of the introducer wire to the groin difficult. We describe our technique for retrograde great saphenous vein puncture, which mitigated these access problems and assessed the effectiveness and outcomes. Methods Fourteen patients (14 legs; 14 great saphenous vein) underwent VenaSeal™ ablation via a retrograde puncture, all for great saphenous vein incompetence; 10/14 (71.4%) had C4–C5 disease. Retrograde puncture introduces the VenaSeal™ catheter in a cranial-caudal manner, with the designated puncture site at the most proximal point of the great saphenous vein reflux. Patients were reviewed at 1 week, 3, 6 and 12-months post-procedure. Post-operative outcomes and complications were recorded, along with patient satisfaction. Results The most common reason for a retrograde puncture approach was the small great saphenous vein calibre below the knee, in 9/14 (64.3%) patients. There was 100% technical success, with no major complications from the procedure; 11/14 (78.6%) patients tolerated the procedure under local anaesthesia without any sedation. There was 100% Duplex-occlusion rate at 1 week, 3, 6 and 12-months post-procedure. Conclusion The retrograde puncture technique for the VenaSeal™ Closure system is safe and effective in ablating the great saphenous vein in patients who are not amendable to the conventional antegrade puncture approach. Patients tolerated this procedure without additional mean operative time and minimal complications. More extensive studies with longer follow-up periods are required to validate the long-term outcomes of this technique.
Quantitative and Qualitative Assessment of Posterolateral Meniscal Anatomy: Defining the Popliteal Hiatus, Popliteomeniscal Fascicles, and the Lateral Meniscotibial Ligament
Authors: Aman Zachary S. , DePhillipo Nicholas N. , Storaci Hunter W. , Moatshe Gilbert , Chahla Jorge , Engebretsen Lars , LaPrade Robert F. 
Published: May 2019

Background: Surgical treatment of lateral meniscal tears can be challenging due to the greater mobility of the lateral meniscus, thin capsule, and management of the popliteal hiatus. There has been a lack of quantitative assessments of the structural attachments to the posterior horn of the lateral meniscus (PHLM) to guide repairs. Purpose: To qualitatively and quantitatively describe the anatomy of the PHLM, popliteomeniscal fascicles, and the posterolateral capsule. Study Design: Descriptive laboratory study. Methods: Fourteen male, nonpaired, fresh-frozen cadaveric knees were used. The attachments of the posterolateral capsule, popliteomeniscal fascicles, and meniscofemoral ligaments to the lateral meniscus and the attachment of the meniscotibial ligament to the tibia were identified. A 3-dimensional coordinate measuring system was used to measure the relationships of these attachments to surgically relevant landmarks and their structural relationship with the lateral meniscus. Results: The posterolateral capsule attachment had a confluent attachment at the superior margin of the PHLM, quantitatively attaching to the proximal 11% of the total height of the PHLM. On average, the length of the posterolateral capsule attachment to the superior surface of the PHLM was 16.7 ± 2.7 mm. The average length of the meniscotibial attachment to the posteroinferior aspect of the meniscus was 12.8 ± 3.9 mm. There was a lack of ligamentous attachments to the lateral meniscus between the lateral aspect of the meniscotibial ligament and the anterior aspect of the anterosuperior popliteomeniscal fascicle, where only popliteomeniscal fascicle and capsular attachments to the posterior meniscus were present. Conclusion: This anatomic study provides quantitative guidelines for the complex attachments to the PHLM. Knowledge of the quantitative descriptions of these attachments may aid in an improved intraoperative diagnosis of PHLM tears that extend to the popliteal hiatus, and further studies related to the surgical repair of the intricate attachments to the PHLM are recommended. Clinical Relevance: The findings of this study provide the anatomic foundation for an improved understanding of the role of the meniscocapsular, meniscotibial, and popliteomeniscal fascicle attachments of the posterolateral meniscus. Understanding the differences between the lengths of the superior and inferior aspects of the popliteal hiatus will help to further refine characterization of tears extending into the popliteal hiatus and to avoid potential overconstraint of the more mobile lateral meniscus during a repair by anatomically reproducing its native structural attachments.
Differential tissue expression of erythroblast macrophage protein in a MRL/lpr mouse model of lupus
Authors: Fan H , Li N , Fan P , Hu X , Liang K , Zhang S , Cheng X , Wu Y 
Published: May 2019

Objective The objective of this study was to observe the expression features of erythroblast macrophage protein (EMP) between the tissues of MRL/lpr mice, a mouse model of systemic lupus erythematosus (SLE), and control mice. Methods We examined the serum ANA in both mice groups through indirect immunofluorescence (IIF). Expression features of EMP in bone marrow, liver, renal, spleen, brain, and lung tissues of the MRL/lpr mice and control mice groups were followed using quantitative real-time polymerase chain reaction (Q-PCR). Meanwhile, the expression of EMP was located through immunohistochemical (IHC) studies and the expressive cell identified through double immunofluorescent labeling. Results IIF showed that lupus mice have strong positive fluorescence, but no significant fluorescence was observed in control mice. Q-PCR detection revealed that EMP was expressed in the marrow, liver, renal, spleen, lung, and brain tissues of lupus mice. The highest levels were observed in the bone marrow, but there was no statistical difference between these tissues. EMP mRNA expression in the liver ( t = 2.747, p = 0.01) and bone marrow ( t = 3.853, p = 0.008) of lupus mice was significantly higher than in the control mice. However, no differences in EMP mRNA expression were observed in the renal, spleen, lung, and brain tissues between the lupus and control mice ( p > 0.05). In addition, the IHC results showed that EMP protein is ubiquitously expressed in all of the tissues of the lupus and control mice. The positive expression rate in the bone marrow and liver tissues of the lupus mice was higher than in the control mice, but without an obvious difference in the other tissues. The double IF staining method shows that EMP protein was expressed in macrophages in the tissues of the lupus mice and the control mice. Conclusions Our data showed that EMP is ubiquitously expressed in macrophages at all of the tissues of the lupus and control mice. However, the expression of EMP in bone marrow and liver tissues of lupus mice was higher than in the control mice, which indicates that EMP may be important in the development of SLE.
Radiographic Assessment of Foot Alignment in Juvenile Hallux Valgus and Its Relationship to Flatfoot
Authors: Kim Hyun Woo , Park Kun Bo , Kwak Yoon Hae , Jin Seokhwan , Park Hoon 
Published: May 2019

Background: The relationship between juvenile hallux valgus (JHV) and flatfoot has not been clearly established. The aim of this study was to assess radiographic measurements in feet with JHV compared with matched controls and to investigate whether the foot alignment of JHV is related to flatfoot. Methods: We retrospectively reviewed 163 patients with JHV as defined as hallux valgus angle greater than 20 degrees and intermetatarsal greater than angle than 10 degrees. Patients with open physes of the feet and who had weight-bearing radiographs of the feet were included. Another 55 normal participants served as controls. Patients with JHV were divided into 2 subgroups: Group 1 included patients with asymptomatic JHV and group 2 consisted of those treated with correctional surgery for painful JHV. Twelve radiographic indices were analyzed, including calcaneal pitch angle, tibiocalcaneal angle, talocalcaneal angle, naviculocuboid overlap, talonavicular coverage angle, lateral talo–first metatarsal angle, anteroposterior talo–first metatarsal angle, metatarsus adductus angle, hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and first metatarsal cuneiform angle. The groups were compared by age, gender, and the above radiographic parameters. Results: There was no significant difference in hindfoot alignment of patients with JHV and controls. Naviculocuboid overlap ( P <.001), lateral talo–first metatarsal angle ( P = .002), and metatarsus adductus angle ( P = .004) were significantly greater in patients with JHV than in controls, whereas the anteroposterior talo–first metatarsal angle ( P = .026) was significantly less. Symptomatic and asymptomatic JHV patient subsets showed no significant radiologic differences. Conclusion: Radiographic profiles in patients with JHV were inconsistent with regard to features of flatfoot, and foot alignment was unrelated to the presence of symptoms or degree of deformity in JHV. Level of Evidence: Level III, retrospective comparative series.
Women who contributed to past research in multiple sclerosis
Authors: McCombe Pamela A 
Published: May 2019

Background: The history of multiple sclerosis (MS) is dominated by the discoveries of famous men. However, women would like to feel part of the story and to know that women have contributed to MS research. Objective: To identify women who contributed to the history of discovery in MS. Method: This was a personal survey from my knowledge of previous work. Results: There were no women participants in the early stages of MS research. However, since 1950 there are many women who have contributed to MS research. In the 20th century, there were famous women who contributed to the scientific fields that form the basis of MS research. In the 21st century, more women participate in MS research but studies suggest that they are under-represented in positions of prominence. Conclusion: Women have been part of the effort to understand MS, but are not well recognized.
Integrated telerehabilitation approach in multiple sclerosis: A systematic review and meta-analysis
Authors: Di Tella Sonia , Pagliari Chiara , Blasi Valeria , Mendozzi Laura , Rovaris Marco , Baglio Francesca 
Published: May 2019

Introduction Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system and a major cause of disability in young adults. Recently, there has been a growing interest in the development of innovative ways to deliver rehabilitation care outside of a hospital setting. The aim was to conduct a systematic review and a meta-analysis of the efficacy of an integrated telerehabilitation approach (ITA) on motor, cognitive and participation outcomes delivered to people with MS (pwMS). Methods We systematically searched for original manuscripts regarding ITA in pwMS. Efficacy on motor, cognitive and participation outcomes was measured as the standardized mean difference (Hedges' g) of pre and post training. Results Nine studies encompassing 716 pwMS diagnosis were included. The overall effect of ITA was: large for motor outcomes (g = 1.05; p = 0.013); small for cognitive performance outcomes (g = 0.16; p = 0.237); and small for participation outcomes (g = 0.15; p = 0.259). Domain-specific results showed that the effect on motor disability was large ( g = 1.18), while on gait and balance was medium ( g = 0.32 and g = 0.48, respectively). Moreover, all effects on single cognitive domains were small. Finally, among the single participation outcomes considered (depression, fatigue, daily functioning, quality of life and self-efficacy) only depression showed a nearly medium effect (g = 0.30). Conclusions PwMS can benefit from ITA in the treatment of motor symptoms according to the current model of continuity of care. However, the low efficacy of ITA on cognition and participation domains suggests the necessity to develop intervention models that include a broader spectrum of needs and objectives.
Effects of ATP administration on isolated swine hearts: Implications for ex vivo perfusion and cardiac transplantation
Authors: Seewald Maria S , Gaasedelen Erik N , Iles Tinen L , Mattison Lars M , Mattson Alexander R , Schmidt Megan M , Braun-Dullaeus Ruediger C , Iaizzo Paul A 
Published: May 2019

Cardiac transplant outcomes can be compromised by the effects of global ischemia and associated reperfusion injury. In attempts to alleviate these phenomena, various pharmaceutical agents can be administered. Previous reports have shown that adenosine triphosphate (ATP) may act as either a postconditioning (PoC) or supplementary (Sup) therapy with cardiosupportive benefits. To further evaluate ATP’s relative effectiveness, we used an isolated swine heart four-chamber working model to monitor both hemodynamic and metabolic responses. We employed two strategies of ATP administration: (1) a postconditional (PoC) bolus just prior to reanimation, and (2) regular dosing throughout the assessment period (Sup). Ex vivo swine hearts in the Sup group elicited significantly higher left ventricular function during the 2 h monitoring period than controls. In contrast, PoC administration appeared to induce depressed cardiac function. The effects of ATP on cardiac function can have varied effects, dependent on when it is administered. Impact statement We employed an isolated swine heart four-chamber working model to investigate two potential strategies for adenosine triphosphate (ATP) administration as an ex vivo therapy: (1) application of a single bolus dose during reperfusion (postconditioning or PoC), and (2) repeated bolus dosing throughout the experiment (supplementary or Sup). Ex vivo swine hearts in the Sup group elicited significantly higher left ventricular function during the 2 h experimental monitoring period. In contrast, ATP administration in the PoC group appeared to induce a degree of depressed hemodynamic function. These data suggest varied functional roles of ATP administration relative to their use in ex vivo perfusion strategies. We consider that both treatment strategies, if appropriately administered and with further investigation of dosing paradigms, may eventually elicit value in various clinical scenarios, including heart transplantation and ex vivo heart perfusion to assess potential organs for transplantation and potentially increase the pool of viable donor hearts.
Stenting of symptomatic lateral sinus thrombosis refractory to mechanical thrombectomy
Authors: Lu Guangdong , Shin Jae Ho , Song Yunsun , Lee Deok Hee 
Published: May 2019

Objective Endovascular mechanical thrombectomy for the treatment of cerebral venous sinus thrombosis is not always successful. We present our experience of using self-expanding stents to facilitate effective recanalization of persistent lateral sinus thrombosis refractory to endovascular mechanical thrombectomy. Methods Data from patients who underwent endovascular mechanical thrombectomy for the treatment of acute symptomatic cerebral venous sinus thrombosis between August 2015 and July 2018 were evaluated. Patient demographics, procedural techniques, devices used and follow-up outcomes were assessed. Results A total of 14 patients underwent endovascular mechanical thrombectomy during the study period. Of these, stenting of the occluded sinus was performed in five patients with extensive sinus thrombosis after conventional endovascular mechanical thrombectomy. Three of the five patients had a variable degree of venous infarction and/or hemorrhage before treatment. The target lesion was located in the right lateral sinus in all five patients. Due to the length of the involved sinus, two stents were required in one patient and three stents in two patients. The only procedure-related complication was an asymptomatic tearing of the sinus wall in one patient. Stent patency could not be maintained in two patients due to stent buckling within the jugular foramen segment and an inability to maintain antiplatelet medication. Modified Rankin Scale scores at 2–16 months were zero in two patients, one in two patients, and five in one patient. Conclusions Stenting for the thrombotic occlusion of the lateral sinus is a feasible rescue method to overcome unsuccessful endovascular mechanical thrombectomy. However, currently available stenting systems may be unsuitable for use in the intracranial dural sinus system.
A preoperative predictive model for prolonged post-anaesthesia care unit stay after outpatient surgeries
Authors: Elsharydah Ahmad , Walters Daren R , Somasundaram Alwin , Bryson Trenton D , Minhajuddin Abu , Gabriel Rodney A , Grewal Gaganpreet K 
Published: May 2019

Study objective To create a preoperative predictive model for prolonged post-anaesthesia care unit (PACU) stay for outpatient surgery and compare with an existing (University of California-San Diego, UCSD) model. Design Retrospective observational study. Setting Post-anaesthesia care unit. Patients: Outpatient surgical patients discharged on the same day in a large academic institution. Preoperative data were collected. The study period was three months in 2016. Measurements: Prolonged PACU stay defined as a length of stay longer than the third quartile. We utilized multivariate regression analyses and bootstrapping statistical techniques to create a predictive model for prolonged PACU stay. Main results: Four strong predictors for prolonged PACU stay: general anaesthesia, obstructive sleep apnoea, surgical specialty and scheduled case duration. Our model had an excellent discrimination performance and a good calibration. Conclusion We developed a predictive model for prolonged PACU stay in our institution. This model is different from the UCSD model probably secondary to local and regional differences in outpatient surgery practice. Therefore, individual practice study outcomes may not apply to other practices without careful consideration of these differences.
Postoperative Lyme Arthritis in the Orthopaedic Patient
Authors: Hess Matthew C. , Devilbiss Zachary , Ho Garry Wai Keung , Thal Raymond 
Published: May 2019

Context: Lyme disease is the most common tick-borne illness in North America and Europe, and Lyme arthritis is a frequent late-stage manifestation in the United States. However, Lyme arthritis has rarely been reported as a postoperative complication. Evidence Acquisition: The PubMed database was queried through June 2018, and restricted to the English language, in search of relevant articles. Study Design: Clinical review. Level of Evidence: Level 3. Results: A total of 5 cases of Lyme arthritis as a postoperative complication have been reported in the literature. Conclusion: These cases highlight the importance for providers practicing in Lyme-endemic regions to keep such an infection in mind when evaluating postoperative joint pain and swelling. We propose herein an algorithm for the workup of potential postoperative Lyme arthritis. Strength of Recommendation Taxonomy (SORT): C
Colonic malignant peripheral nerve sheath tumour in a cat
Authors: Boland Lara , Setyo Laura , Sangster Cheryl , Brunel Laurencie , Foo Timothy , Bennett Peter 
Published: May 2019

Case summary A 14-year-old male neutered domestic mediumhair cat presented with a 4 month history of inappetence and weight loss. Pertinent abnormalities on haematology and biochemistry included a mild microcytic regenerative anaemia (packed cell volume [PCV] 24% [reference interval (RI) 30–45%], mean cell volume 30.8 fl [RI 40–45 fl], absolute reticulocyte count 326.8 × 1012) and increased alkaline phosphatase activity (76 IU/l; RI <50 IU/l). Abdominal ultrasound and CT scan revealed masses in the transverse colon (2.0 cm × 1.2 cm) and right medial liver lobe (5.0 cm diameter). Thoracic radiographs were unremarkable. Right medial liver lobe resection and colectomy were performed. Immunohistochemistry was positive for S-100 protein, vimentin and glial fibrillary acidic protein, very weakly positive for c-kit and negative for muscle-specific actin and CD18, consistent with a colonic malignant peripheral nerve sheath tumour (MPNST) with a hepatic metastasis. Postoperative treatment with metronomic cyclophosphamide was well tolerated. Eighteen months postoperatively the cat re-presented after 3 days of progressive lethargy and inappetence. Haematology revealed a marked non- or pre-regenerative anaemia (PCV 10%). Coagulation times were prolonged (prothrombin time 39 s [RI 15–22 s] and activated partial thromboplastin time >300 s [RI 65–119 s]). Abdominal ultrasound identified multiple renal and hepatic nodules. Euthanasia was performed and post-mortem examination confirmed metastasis of the MPNST. Relevance and novel information This report describes the treatment of a metastatic colonic peripheral nerve sheath tumour in a cat. Feline visceral MPNSTs are rare and little is known about prognosis or optimal treatment.