bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hybrid Endovascular Surgical Repair in Takayasu's Arteritis: Duplex Ultrasound Follow-up
Authors: Broadbent Karen , Garami Zsolt , Peden Eric K. , Lumsden Alan 
Published: March 2018

Introduction Takayasu's arteritis (TA), a rare condition occurring primarily in young women, is a granulomatous vasculitis usually affecting the aorta and its branches. Our case report describes the duplex ultrasound findings in a 16-year-old Hispanic woman after a hybrid endovascular procedure. Patient Description TA in this patient was diagnosed in 2005 after a pulsatile neck mass developed on the right side of her neck. To date, she has required four vascular interventions in less than 3 years. The first procedure was an aortic root, ascending aorta and aortic arch replacement with Dacron graft replacement of the left common carotid and innominate arteries. She then developed a pseudoaneurysm in the distal left common carotid artery replacement graft, which was excluded with a stent-graft. The third procedure was a balloon angioplasty of an anastomotic stenosis of the aorto-innominate artery graft. This, however, recurred and there was also a small anastomotic pseudoaneurysm at this site. Revascularization was complicated by the fact that the left subclavian artery was occluded, with reversed flow in the left vertebral artery. Consequently, preservation of antegrade flow in the right vertebral artery was a priority. Transposition of the right common carotid artery to the subclavian artery with placement of a balloon expandable stent graft from the aortoinnominate artery graft into the subclavian artery (proximal to the vertebral artery) was performed. Methods All available imaging exams and operative reports were reviewed. Bilateral carotid duplex evaluation in addition to duplex examination of all bypasses and the distal native arteries were performed using high resolution ultrasound equipment and probes of varying frequency. Results Normal caliber wall thickness was identified in bilateral common carotid arteries. No evidence of intimal hyperplasia could be detected in stented areas. All open surgical or endovascular repair sites were well visualized, with the exception of only the proximal most innominate artery bypass graft and the aortic arch. Primarily retrograde left vertebral artery flow feeds the left subclavian artery. There was no evidence of restenosis or pseudoaneurysm formation. Discussion Long-term follow-up of the patient with TA after open surgical or endovascular procedures is extremely important because of the chronic nature of the disease process. Duplex ultrasound is a safe, effective adjunct to the standard radiologic arsenal usually used to follow these high-risk patients.
Unusual Presentation and Identification of a Post-traumatic Arteriovenous Fistula Identified with the Use of Duplex Ultrasonography
Authors: Umphrey Susan , Levesque Sally , Gupta Vishal , Shea Lori D. , Root Drena , Cambria Richard P. , Jaff Michael R. 
Published: March 2018

Case Report A 49-year-old athletic male presented with a 3-year history of unrelenting left lower-extremity edema after a motor vehicle accident. He underwent a venous duplex ultrasound, which revealed distal left superficial femoral and popliteal deep venous thrombosis and multiple venous collaterals with arterial Doppler signals within the thrombus and vein wall at the level of the popliteal fossa. Doppler waveforms were highly suspicious for an arteriovenous fistula (AVF). Direct auscultation of the popliteal fossa revealed a continuous bruit. Magnetic resonance arteriography revealed early venous filling of the left femoral vein with multiple dilated veins in the region of the popliteal artery, consistent with AVF. The patient underwent surgical interruption of the AVF with significant resolution of the lower extremity edema. Conclusion In our experience, unusual Doppler waveform characteristics and multiple collateral vessels should alert the sonographer to the possibility of an AVF. This report exemplifies the role of Doppler ultrasound in the diagnosis of unrelenting and unexplained lower extremity edema.
Safety and feasibility of above cuff vocalisation for ventilator-dependant patients with tracheostomies
Authors: McGrath Brendan A , Wallace Sarah , Wilson Mark , Nicholson Leanne , Felton Tim , Bowyer Christine , Bentley Andrew M 
Published: March 2018

Introduction Temporary tracheostomy is commonly used in patients admitted to intensive care units. Cuffed tubes prevent laryngeal airflow, preventing vocalisation. Sub-glottic suction tubes such as the ‘Blue Line Ultra Suctionaid™’ are used primarily to remove sub-glottic secretions, but retrograde gas flows via the suction port can facilitate above cuff vocalisation. The aims were to assess whether patients could achieve an audible voice using above cuff vocalisation, to demonstrate the safe use of the Blue Line Ultra Suctionaid™ tracheostomy tube for above cuff vocalisation, and to assess potential benefits of above cuff vocalisation for communication, secretion management and swallowing. Methods Our study (Reference 15/NW/0464, IRAS 178997) recruited adult intensive care unit patients who were alert, able to participate in an above cuff vocalisation trial and dependent on an inflated Blue Line Ultra Suctionaid™ cuff for ventilatory support. Consenting participants underwent fibreoptic endoscopic assessment of swallow by experienced Speech & Language Therapy staff with and without above cuff vocalisation. Clinical and fibreoptic endoscopic assessment of swallow, assessment of voice quality, swallowing and secretion management were recorded and scored. Median differences between paired observations and scores were analysed with and without above cuff vocalisation. Adverse events were identified by follow up fibreoptic endoscopic assessment of swallow and patient accounts. Results Ten patients completed the study. Above cuff vocalisation was used for a median of 15 min, during a median of nine episodes, over a median of three days. Above cuff vocalisation resulted in an audible voice in eight of the 10 patients, during 66 out of 91 above cuff vocalisation attempts. There improvements in unstimulated dry cough and swallow frequency and aspiration ratings measured by fibreoptic endoscopic assessment of swallow. No complications were reported or observed in 66 attempts with only one episode terminated prematurely. Conclusions Above cuff vocalisation can achieve effective, safe, well-tolerated vocalisation in ventilator-dependant intensive care unit patients. Above cuff vocalisation has the potential to aid earlier, more effective communication and may improve laryngeal function and rehabilitation.
Fractures at the junction of diaphysis and metaphysis of the proximal phalanges in adults
Authors: Shewring David J. , Trickett Ryan W. , Smith Adam 
Published: March 2018

We describe the treatment of 101 patients with 113 fractures of the proximal phalanx at the junction of the diaphysis with the proximal metaphysis. Fractures were stabilized using a single extra-articular percutaneous Kirschner wire passed lateral to the metacarpal head into the base of the phalanx base and across the fracture to engage the lateral cortex. Patients were treated semi-electively on a day surgery unit. The metacarpophalangeal joint was splinted in flexion with mobilization of the proximal inter-phalangeal joints, until the wire was removed at 24 days and the hand then freely mobilized. The mean total active movement was 230° and no patients experienced problems with significant pain. There were two pin site infections. There were no cases of angular or rotational malunion. These injuries can be successfully and safely treated using this simple technique, negating the need for close monitoring for angular displacement of the fracture, which is frequently seen with non-surgical management. Level of evidence: IV
Rheolytic effects of left main mid-shaft/distal stenting: a computational flow dynamic analysis
Authors: Rigatelli Gianluca , Zuin Marco , Dell’Avvocata Fabio , Nguyen Thach 
Published: March 2018

Background The aim of this study was to evaluate the rheolytic effects of stenting a mid-shaft/distal left main coronary artery (LMCA) lesion with and without ostial coverage. Stenting of the LMCA has emerged as a valid alternative in place of traditional coronary bypass graft surgery. However, in case of mid-shaft/distal lesion, there is no consensus regarding the extension of the strut coverage up to the ostium or to stent only the culprit lesion. Methods We reconstructed a left main-left descending coronary artery (LM-LCA)-left circumflex (LCX) bifurcation after analysing 100 consecutive patients (mean age 71.4 ± 9.3, 49 males) with LM mid-shaft/distal disease. The mean diameter of proximal LM, left anterior descending (LAD) and LCX, evaluated with quantitative coronary angiography (QCA) was 4.62 ± 0.86 mm, 3.31 ± 0.92 mm, and 2.74 ± 0.93 mm, respectively. For the stent simulation, a third-generation, everolimus-eluting stent was virtually reconstructed. Results After virtual stenting, the net area averaged wall shear stress (WSS) of the model and the WSS at the LCA-LCX bifurcation resulted higher when the stent covered the culprit mid-shaft lesion only compared with the extension of the stent covering the ostium (3.68 versus 2.06 Pa, p = 0.01 and 3.97 versus 1.98 Pa, p < 0.001, respectively. Similarly, the static pressure and the Reynolds number were significantly higher after stent implantation covering up the ostium. At the ostium, the flow resulted more laminar when stenting only the mid-shaft lesion than including the ostium. Conclusions Although these findings cannot be translated directly into real practice our brief study suggests that stenting lesion 1:1 or extending the stent to cover the LM ostium impacts differently the rheolytic properties of LMCA bifurcation with potential insights for restenosis or thrombosis.
Numerical methods study of solving transient flow of impeller machinery under mutational working conditions
Authors: Zhang Yu-Liang , Zhu Zu-Chao , Zhou Zhao-Zhong , Sheng Yi-Ni , Zhao Yan-Juan 
Published: March 2018

The transient performances of impeller machinery under typical mutational working conditions play an important role in the area of engineering and have attracted extensive attention. In order to fully understand transient behaviors of impeller machinery under mutational working conditions, it is very necessary to confirm an efficient and reliable solving method. In this paper, the dynamic mesh method and the sliding mesh method are respectively used to be solved the inner transient flow of a 2D centrifugal pump model during abrupt start-up period. The Renormalization-group (RNG) k– ε turbulence model in eddy viscosity models is chosen to close the Reynolds-average equation and to complete the turbulence calculation. Moreover, the SIMPLE algorithm is also adapted to accomplish the coupling calculation between velocity and pressure. The study shows that in theory, the most appropriate method to solve transient flow is the dynamic mesh method, but it has the shortage of low mesh quality during mesh reconstruction. The sliding mesh method with high mesh quality is an ideal solving method under mutational working conditions. In general, both of the methods would reflect the basic characteristics of inner flow, while the sliding mesh method has higher solution precision.
Risk Factors for Postoperative Coronal Balance in Adult Spinal Deformity Surgery
Authors: Lewis Stephen J. , Keshen Sam G. , Kato So , Dear Taylor E. , Gazendam Aaron M. 
Published: March 2018

Study Design: A retrospective case-control study. Objectives: To determine factors influencing the ability to achieve coronal balance following spinal deformity surgery. Methods: Following institutional ethics approval, the radiographs of 47 patients treated for spinal deformity surgery with long fusions to the pelvis, were retrospectively reviewed. The postoperative measurements included coronal balance, L4 tilt, and L5 tilt, levels fused, apical vertebral translation and maximum Cobb angle. L4 and L5 tilt angles were measured between the superior endplate and the horizontal. Sagittal parameters including thoracic kyphosis, lumbar lordosis, pelvic incidence, and sagittal vertical axis were recorded. Coronal balance was defined as the distance between the central sacral line and the mid body of C7 being ≤40 mm. Surgical factors, including levels fused, use of iliac fixation with and without connectors, use of S2A1 screws, interbody devices, and osteotomies. Statistical tests were performed to determine factors that contribute to postoperative coronal imbalance. Results: Of the 47 patients reviewed, 32 were balanced after surgery and 14 were imbalanced. Coronal balance was 1.30 cm from center in the balanced group compared to 4.83 cm in the imbalanced group ( P < .01). Both L4 and L5 tilt were statistically different between the groups. Gender and the use of transverse connectors differed between the groups but not statistically. Conclusions: In adult spinal deformity patients undergoing primary fusions to the pelvis, the ability to level the coronal tilt of L4 and L5 had the greatest impact on the ability to achieve coronal balance in this small series. A larger prospective series can help validate this important finding.
Does Obesity Explain the Effect of the Metabolic Syndrome on Complications Following Elective Lumbar Fusion? A Propensity Score Matched Analysis
Authors: Lovecchio Francis , Fu Michael C. , Iyer Sravisht , Steinhaus Michael , Albert Todd 
Published: March 2018

Study Design: Propensity score matched retrospective cohort study. Objectives: Obesity is a major confounder in determining the independent effect of metabolic syndrome (MetS) on complications after spinal surgery. The purpose of this study is to differentiate MetS from obesity as an independent influence on perioperative outcomes after elective lumbar spine fusion. Methods: One- to 3-level posterior spinal fusion cases were identified from the 2011-2014 American College of Surgeons’ National Surgical Quality Improvement Program. To determine the effects of MetS outside of obesity itself, patients with MetS were first compared to a no-MetS cohort and then to an obese-only no-MetS cohort. Two propensity score matches based on demographics, comorbidities, surgical complexity, and diagnosis were used to match patients in 1:1 ratios and compare outcomes. Logistic regression with propensity score adjustment was further utilized as a secondary method of reducing selection bias. Results: Out of 18 605 patients that met criteria for inclusion, 1903 (10.2%) met our definition of MetS. Patients with MetS had a higher rate of wound complications (3.8% vs 2.7% obese no MetS, P = .045; vs 2.6% no MetS, P = .035), readmissions (7.4% vs 2.2% obese no MetS, P < .001; vs 4.6% no MetS, P < .001), and extended length of stay (29.1% vs 23.9% obese no MetS, P < .001; vs 23.5% no MetS, P < .001). Patients with MetS were more likely to experience a wound complication (odds ratio = 1.47, 95% confidence interval = 1.02-2.12) or readmission (odds ratio = 1.48, 95% confidence interval = 1.22-1.80). Conclusions: Even after controlling for obesity, MetS is an independent risk factor for adverse short-term outcomes. These findings have various implications for preoperative risk stratification and reduction strategies.
Warfarin alters vitamin K metabolism: a surprising mechanism of VKORC1 uncoupling necessitates an additional reductase
Authors: Rishavy Mark A. , Hallgren Kevin W. , Wilson Lee , Singh Savita , Runge Kurt W. , Berkner Kathleen L. 
Published: March 2018

Key PointsAnalysis of full VKORC1 reduction of vitamin K epoxide vs the individual reactions shows that warfarin uncouples the 2 reactions. A mutant becomes more active than wild-type VKORC1 only in the presence of warfarin, revealing a novel mechanism for warfarin resistance.
Selectins and chemokines use shared and distinct signals to activate β2 integrins in neutrophils
Authors: Yago Tadayuki , Zhang Nan , Zhao Liang , Abrams Charles S. , McEver Rodger P. 
Published: March 2018

Key Points
Selectin and chemokine signals use both Rap1a and PIP5Kγ90 to activate β2 integrins in neutrophils. Suboptimal chemokine signals synergize with selectin signals to activate β2 integrins in neutrophils.
Estimates of Cancer Incidence in Ethiopia in 2015 Using Population-Based Registry Data
Authors: Memirie Solomon Tessema , Habtemariam Mahlet Kifle , Asefa Mathewos , Deressa Biniyam Tefera , Abayneh Getamesay , Tsegaye Biniam , Abraha Mihiret Woldetinsae , Ababi Girma , Jemal Ahmedin , Rebbeck Timothy R. , Verguet Stéphane 
Published: March 2018

Purpose Noncommunicable diseases, prominently cancer, have become the second leading cause of death in the adult population of Ethiopia. A population-based cancer registry has been used in Addis Ababa (the capital city) since 2011. Availability of up-to-date estimates on cancer incidence is important in guiding the national cancer control program in Ethiopia. Methods We obtained primary data on 8,539 patients from the Addis Ababa population-based cancer registry and supplemented by data on 1,648 cancer cases collected from six Ethiopian regions. We estimated the number of the commonest forms of cancer diagnosed among males and females in Ethiopia and computed crude and age-standardized incidence rates. Results For 2015 in Ethiopia, we estimated that 21,563 (95% CI, 17,416 to 25,660) and 42,722 (95% CI, 37,412 to 48,040) incident cancer cases were diagnosed in males and females, respectively. The most common adult cancers were: cancers of the breast and cervix, colorectal cancer, non-Hodgkin lymphoma, leukemia, and cancers of the prostate, thyroid, lung, stomach, and liver. Leukemia was the leading cancer diagnosis in the pediatric age group (age 0 to 14 years). Breast cancer was by far the commonest cancer, constituting 33% of the cancers in women and 23% of all cancers identified from the Addis Ababa cancer registry. It was also the commonest cancer in four of the six Ethiopian regions included in the analysis. Colorectal cancer and non-Hodgkin lymphoma were the commonest malignancies in men. Conclusion Cancer, and more prominently breast cancer, poses a substantial public health threat in Ethiopia. The fight against cancer calls for expansion of population-based registry sites to improve quantifying the cancer burden in Ethiopia and requires both increased investment and application of existing cancer control knowledge across all segments of the Ethiopian population.
“Everything Is Alive”: Moving and Reading in Excess of American Freedom
Authors: Curseen Allison S. 
Published: March 2018

Abstract
Focusing on the minor details of suffering cats, I read The Adventures of Tom Sawyer as an exemplary illustration of the way in which American novels of individual development destabilize around the movement of minor bodies and minor characters. This destabilization allows not only an interrogation of the limits of US citizenship but also an exploration of how narratives may register something in excess of the citizen and the subject. Distinguishing between the antebellum (boy) characters’ violent play with cats and the postbellum narrator’s ludic play as cat, I argue that cats emerge in Tom Sawyer as captive bodies (among many hard-to-see captives). In the constrained but spectacular movements of these captive bodies, the novel troubles the particularly American freedom actualized in Tom’s play and gestures to a fugitive or feral movement that, though necessary to Tom’s development, always leaps beyond and in the way of efforts to produce a free, individual subject.
Whole-transcriptome splicing profiling of E7.5 mouse primary germ layers reveals frequent alternative promoter usage during mouse early embryogenesis
Authors: Lu Xukun , Zhao Zhen-Ao , Wang Xiaoqing , Zhang Xiaoxin , Zhai Yanhua , Deng Wenbo , Yi Zhaohong , Li Lei 
Published: March 2018

ABSTRACTAlternative splicing (AS) and alternative promoter (AP) usage expand the repertories of mammalian transcriptome profiles and thus diversify gene functions. However, our knowledge about the extent and functions of AS and AP usage in mouse early embryogenesis remains elusive. Here, by performing whole-transcriptome splicing profiling with high-throughput next generation sequencing, we report that AS extensively occurs in embryonic day (E) 7.5 mouse primary germ layers, and may be involved in multiple developmental processes. In addition, numerous RNA splicing factors are differentially expressed and alternatively spliced across the three germ layers, implying the potential importance of AS machinery in shaping early embryogenesis. Notably, AP usage is remarkably frequent at this stage, accounting for more than one quarter (430/1,648) of the total significantly different AS events. Genes generating the 430 AP events participate in numerous biological processes, and include important regulators essential for mouse early embryogenesis, suggesting that AP usage is widely used and might be relevant to mouse germ layer specification. Our data underline the potential significance of AP usage in mouse gastrulation, providing a rich data source and opening another dimension for understanding the regulatory mechanisms of mammalian early development.
Evaluation of controlled type II diabetics ascending and descending a ramp surface at an imposed speed: A case-control study
Authors: Rosario Martin G. , Orozco Elizabeth , Babilonia Nairoby , Tellez Greisy , Mojica Francheska , Gonzalez-Sola Maryvi , Bayron Flavia 
Published: March 2018

Background: Patients with diabetes have been shown to suffer from increased fall risk. Research shows that this risk is higher on irregular surfaces. Existing studies evaluate gait on irregular surfaces, such as stairs, asphalt, grass and stones. This study evaluates gait parameters in individuals with diabetes mellitus type II (DMII) with no history of peripheral neuropathy, while ascending and descending a ramp at an imposed speed, and compares them with healthy controls. Methods: Fifteen healthy volunteer participants and fifteen participants with DMII and no peripheral neuropathy (females and males) between the ages of 40-65 were recruited for this study. Participants walked three times at 100 bpm while ascending and descending a wooden ramp. Temporospatial and kinematic parameters were analyzed. Results: We observed minimal changes in temporospatial and kinetic parameters in people with controlled DMII with no evidence of peripheral neuropathy. Conclusion: Focusing on individuals with controlled DMII allowed us to determine if only the diagnosis of diabetes without peripheral neuropathy influenced gait parameters. Clinicians and researchers should focus their assessments on neuromuscular activation during this stage of the condition, thus preventing complications, such as abnormal gait, that increases the risk for falls.