bluuebunny/crossref_metadata_2025_split huggingface dataset:
The long non-coding RNA NEAT1 contributes to extracellular matrix degradation in degenerative human nucleus pulposus cells
Authors: Ruan Zhi , Ma Hui , Li Jing , Liu Huiyong , Jia Haoruo , Li Feng 
Published: March 2018

Intervertebral disc degeneration is a complex disease involving genetic and environmental factors and multiple cellular processes. The role and expression of the lncRNA NEAT1 were assessed in intervertebral disc degeneration. NEAT1 expression was assessed in degenerative and control nucleus pulposus using RT-PCR. Western blotting and RT-PCR were also used to investigate p53 and p21 levels in nucleus pulposus tissues. NEAT1 function in degenerative nucleus pulposus cells was assessed with gain- and loss-of-function experiments. ERK/MAPK signaling was also examined. NEAT1, p53, and p21 were dramatically upregulated in intervertebral disc degeneration. Furthermore, catabolic MMP13 and ADAMTS5 were dysregulated and collagen II and aggrecan were downregulated after NEAT1 overexpression. This effect was reversed by transfection with si-NEAT1 in degenerative nucleus pulposus cells. In addition, NEAT1 was found to affect the activation of the ERK/MAPK pathway. The NEAT1-induced ECM degradation may involve ERK1/2/MAPK signaling. LncRNA NEAT1 may represent a novel molecular target for intervertebral disc degeneration treatment by preventing nucleus pulposus ECM degradation. Impact statement For the first time, our study demonstrates that lncRNA NEAT1 plays a role in the occurrence and development of IDD by participating in extracellular matrix remodeling. This lncRNA regulates catabolic MMP13 and ADAMTS5 and anabolic collagen II and aggrecan by affecting the ERK/MAPK signaling pathway in degenerative human nucleus pulposus (NP) cells. Our research provides a scientific basis for targeting of NEAT1 for the IDD.
Duplex Evaluation of Trauma from Gunshot Wounds
Authors: Rama Kumara , Greene Kathleen , Heal Theresa , Hennard Lynn 
Published: March 2018

Introduction Diagnosis and repair of arterial injury from penetrating trauma is critical because the lack of intervention can result in limb loss or death. Patients that have conspicuous arterial injuries can be explored and repaired in the operating room with or without preoperative diagnostic imaging. Patients without definite clinical evidence of vascular injury (i.e., hematoma, pulsatile mass, bruit, or pulse deficit) generally undergo angiography because of proximity of injury. Arteriography is an expensive and invasive procedure for patients; it carries some discomfort and has potential complications associated with its use. In our experience, ankle/brachial index (ABI) alone has not been a dependable study to rule out significant arterial injury of extremities. Color flow duplex imaging is a painless procedure, has no risk to the patient, is not as expensive as arteriography and is readily available in most institutions. We present two patients who had normal pulses and ABIs after gunshot wounds to extremities. Both patients had significant arterial injury detected by color flow duplex imaging as the initial diagnostic modality and subsequently proceeded on to arteriography based on the findings of the duplex studies. Conclusions The findings of the duplex imaging were in direct correlation with arteriography. These two cases demonstrate the sensitivity of color flow duplex ultrasonography to detect extremity arterial injuries in a community hospital.
Femoral Artery Pseudoaneurysm Caused by an Osteochondroma of the Femur: A Case Report
Authors: Nelms Courtney , Carter Kathleen , DeMasi Richard , Meier George , Chaler Dulcie , Beedie Felicia , LeSar Chris , Gayle Robert , Parent F. Noel , Marcinczyk Michael 
Published: March 2018

Introduction The osteochondroma is the most common benign tumor of bone. Typically asymptomatic bony protuberances are discovered in childhood or adolescence. Although vascular complications are rare, these bony spikes can course along an artery and cause severe arterial complications. Reported here is a case involving the use of color duplex ultrasonography (CDU) to identify a superficial femoral artery (SFA) pseudoaneurysm as a result of an osteochondroma. Case Report A 12-year-old girl had been experiencing left lower extremity pain for approximately 2 months. The pain became progressively severe, and her parents noticed that she was limping. Magnetic resonance imaging (MRI) demonstrated a mass in the left thigh, suggesting the possibility of a femoral aneurysm. A bony spicule was noted on x-ray at the distal femur, projecting posteriorly. Clinical evaluation revealed an impressive pulsatile mass in the left distal medial thigh. The left thigh was noticeably larger than the right with poor pedal pulses compared with the asymptomatic limb. CDU was performed and identified an aneurysm of the SFA at the adductor canal. There was unusual oscillatory flow in the SFA proximal to the aneurysm with monophasic signals distally. The large aneurysm size displaced the normal anatomic course of the SFA and vein. Ankle-brachial indices (ABI) were 0.72 and monophasic in the affected limb and >1.0 and triphasic in the contralateral limb. Angiography confirmed the CDU and MRA findings, demonstrating a large pseudoaneurysm at the adductor canal caused by an osteochondroma of the femur. At time of surgical repair, the bony spicule was noted to have eroded into the femoral artery. Conclusion Vascular complications as a result of an osteochondroma are rare. Rapid diagnosis is necessary to prevent serious arterial compromise in these young patients. CDU can quickly and accurately confirm the presence of a pseudoaneurysm when an osteochondroma is suspected.
Ganglion “A Rare Finding in Popliteal Fossa”
Authors: Deibe Roger , Ganepola Ganepola , Strobeck John 
Published: March 2018

Most medical conditions that occur in the popliteal fossa are symptomatic due to the compact anatomy of the area. Usually common problems behind the knee involve either the soft tissue, and/or vasculature and therefore are limited to several commonly known pathology and sequela. Complications behind the knee are mostly consistent in presentation due to a set of conditions, and are age/gender specific. Ultrasound is a noninvasive (and for the most part) painless and inexpensive exam with a high sensitivity for identifying atypical structures behind the knee. This article draws attention to a rare mass in the popliteal space, which required an alternate approach to a set protocol in order to meet the specific symptoms of the patient. As a result, we were able to identify the vascular effect caused by this mass. In this particular situation, with the aid of another diagnostic modality, proper assessment of the structure was made possible. The findings were consistent with a ganglion, which is a relatively uncommon occurrence behind the knee.
Is Ultrasound Gel a Reservoir for Bacterial Pathogens? Results from a Tertiary Care Vascular Laboratory
Authors: Morrissette Jason R. , Heggerick Paula A. , Perry Ingrid L. , Iafrati Mark , Mackey William C. , Estes James 
Published: March 2018

Purpose We sought to determine whether refilling and heating of ultrasound gel bottles promotes bacterial colonization. Methods The study took place in a busy, university hospital–based vascular laboratory that performs approximately 300 studies per month. Six heated gel bottles, labeled A through F, along with two random bottles, were refilled with ultrasound gel, heated, and cultured weekly for 12-weeks. Control cultures were collected from clean, empty ultrasound gel bottles, a sterile pack of ultrasound gel, and a 5-liter bulk container of ultrasound gel. Of these, approximately 5% were performed on patients with bacterial isolation precautions. Results A total of 104 cultures was collected and analyzed for bacterial growth. Of these, 12 (12%) were positive. Propionibacterium species were present in six isolates (6%), diphtheroids in two isolates (2%), Staphylococcus species (coagulase negative) in one isolate (1%), Staphylococcus aureus in one isolate (1%), Micrococcus species in one isolate (1%), and anaerobic gram-positive cocci in one isolate (1%). All positive cultures were sporadic and did not persist throughout the sampling period. Initial control samples of the new gel bottles, sterile gel, and the 5-liter bulk container were negative for bacterial growth. Conclusions The isolation of pathogenic organisms from ultrasound gel is uncommon, even in a hospital environment favoring colonization of bacterial species. This suggests that ultrasound gel may resist the growth and proliferation of organisms and supports our current practice of heating and refilling bottles for 12-weeks. However, this study did not address the long-term colonization of gel bottles.
Pan-Diastolic Flow Reversal in the Subclavian Artery: An Indicator of Aortic Insufficiency
Authors: Oglesby Beverly , Sorrell Kathryn 
Published: March 2018

Introduction For many labs, Doppler evaluation of the subclavian artery (SCA) is routinely included in the carotid protocol. At our center, we have noted that many patients have a unique SCA waveform present bilaterally, characterized by flow reversal throughout the entire diastolic interval. The purpose of this study was to define the cause and significance of these atypical SCA waveforms. Methods During a 6-month period, 21 patients with normal bilateral SCA waveforms, who also had Doppler echocardiography (DEC), were evaluated for the presence of aortic insufficiency (AI). Similarly, 25 patients who had pan-diastolic flow reversal (PDFR) in their SCAs bilaterally were also evaluated for the presence of AI on DEC. Patients with upper extremity deep vein thrombosis (DVT), bypass grafts, compartment syndrome, or dialysis access were excluded from this investigation. Results Of the 25 patients with bilateral SCA PDFR, 20 patients had aortic regurgitation present on DEC. Normal triphasic waveforms were present bilaterally in 21 patients. Of these, 20 patients had no evidence of AI by DEC. Statistical analysis resulted in a sensitivity of 80%, specificity of 95%, positive predictive value of 95%, and an overall accuracy of 87% for the detection of AI by SCA Doppler evaluation. Conclusion PDFR in the SCA bilaterally is a waveform associated with AI. Although DEC is the preferred technique for the evaluation of suspected aortic valve dysfunction, many patients with this condition have no detectable murmur or other indication of this condition. Consequently, the identification of this unique waveform in both SCAs during carotid duplex may provide useful clinical information and lead to additional cardiac workup.
Role of Intraoperative Completion Duplex Scan for Diagnosis of Iatrogenic Injuries of the Common Femoral Artery (CFA) and External Iliac Artery (EIA) during Endograft Placement
Authors: Marks Natalie A. , Ascher Enrico , Hingorani Anil , Schutzer Richard 
Published: March 2018

Objective To assess whether the femoral artery entry site could cause early endograft limb occlusion complication, we prospectively evaluated the ipsilateral common femoral artery (CFA) with intraoperative duplex scans (IDS). Methods Forty-seven patients underwent 41 abdominal aortic and 8 common iliac artery (CIA) aneurysms repair with endografts. All procedures were performed via open exposure of the CFA. All patients underwent IDS of the CFA and distal external iliac artery after repair of the arteriotomies. Results Overall, there were 91 arteries assessed with IDS. Overall incidence of significant lesions requiring repair was 11 of 91 (12%). In 10 arteries (11%) we documented intimal flaps causing severe (>80%) stenoses that required repair. One more patient (1%) had no defects at the repair site, but low CFA peak systolic velocity with ratio 2:1 as compared with the contralateral CFA. Intraoperative abdominal duplex scan revealed a severe stenosis in the ipsilateral CIA that was not observed on the completion arteriogram. In addition, 13 (14%) nonsignificant flaps were visualized. No limb thromboses were noted in this group of patients on follow-up examinations. Conclusions IDS is helpful in detecting clinically unsuspected technical defects of the CFA. Timely diagnosis and repair of these defects may improve early patency of endograft limbs.
Traumatic Intracranial Arteriovenous Malformation
Authors: Kala Rajinder S. , Lively Stephen A. , McDevitt Daniel T. , Levy Alan M. , Mackay Bruce C. , Elder Terri A. , Marin Ma Lalane A. , Quinteros Diana E. 
Published: March 2018

Introduction This report is the first of a traumatic intracranial arteriovenous malformation (AVM) identified with the use of ultrasound imaging. This case study involves a 49-year-old man with a traumatic intracranial arteriovenous malformation that was identified using transcranial imaging and spectral analysis studies. Methods Transcranial ultrasonic imaging with spectral analysis was performed, using a 2.5MHz hand-held probe identified the traumatic AVM. Correlated follow-up testing was conducted using magnetic resonance angiography and computed tomography scan. Results were correlated with ultrasound findings. Results Bilateral middle cerebral and anterior cerebral arteries were identified revealing normal waveforms and velocities. Left posterior cerebral artery could not be insonated or visualized whereas the right posterior cerebral artery revealed normal waveforms and velocities. A single area of “jet” flow was in the distal internal carotid artery (in the area of carotid cavernous sinus). A peak systolic velocity of 318 cm/sec and an end diastolic velocity of 152 cm/sec were identified in the “jet,” which is consistent with the clinical suspicion of an AVM. The magnetic resonance angiography demonstrated normal right internal carotid, middle cerebral, and anterior cerebral arteries. On the left, there was diffusion of signal in the region of the cavernous sinus. This flow signal extended anteriorly and laterally into the region of the lateral orbit. Also, a second channel of flow appeared extending up into the middle cerebral artery territory, suggesting some retrograde venous flow. Findings reported were consistent with AVM of the carotid artery at the cavernous sinus. Conclusion This report represents with the first reported incidence of diagnosis of traumatic AVM of intracranial vessels. Duplex scanning should be considered if concern exists for such an entity as it appears capable of actually identifying this pathology.
Percutaneous Ultrasound-Guided Thrombin Injection for Coagulation of a Post-Traumatic Superficial Temporal Artery Pseudoaneurysm
Authors: Blasingame Nancy , Lewinstein Charles , Winter Jeffrey , Whitney Brooks A. , Zarge Joseph I. , Doubler Peter H. , Villemure Patrice 
Published: March 2018

Introduction Pseudoaneurysm of the superficial temporal artery (STA) is rare and most commonly caused by blunt trauma. The STA is the most frequent site of traumatic aneurysm in the face because of its anatomic location. The diagnosis is easily confirmed by color duplex ultrasound. The usual treatment is surgical ligation and resection. This type of pseudoaneurysm can be successfully treated by ultrasound-guided injection of thrombin, which is easy, quick, and cost-effective. Case report A 71-year old man on Coumadin therapy fell out of bed and lacerated his right forehead. A pulsatile mass under the laceration was imaged with color duplex ultrasound, which demonstrated a 1.5- x 1.0-cm pseudoaneurysm off a branch of the STA, 6 mm below the skin line. Under ultrasound guidance, a 21-gauge needle was introduced into the pseudoaneurysm and 300 units of thrombin was injected into the sac with complete thrombosis of the pseudoaneurysm cavity. The STA remained patent after the procedure, and the pseudoaneurysm remained thrombosed after the procedure. Conclusions Post-traumatic STA pseudoaneurysm can be safely and successfully treated with ultrasound-guided injection of thrombin. Percutaneous ultrasound-guided injection of thrombin for repair of post-traumatic STA pseudoaneurysm is a fast, safe, and effective alternative to surgical repair resulting in rapid thrombosis of the pseudoaneurysm.
Superficial Venous Thrombosis Embolizes to Cause Pulmonary Embolus
Authors: Prem Jeffrey , Beck Chris , Lancaster Mark , Miller Jeffrey , Troyer Randy , Williams Rebecca 
Published: March 2018

Introduction Superficial venous thrombosis (SVT) has not received as much attention in research and publications as that of deep venous thrombosis. This case demonstrates the importance of identifying the characteristics of an SVT before releasing the patient and stating the patient was positive for SVT. Case Study A 56-year-old man presented to our emergency department complaining of left lower-extremity pain for 2 weeks. The patient described the location of the pain as an area below his left knee. The area was erythematous, cord-like, and the patient denied any history of trauma. A venous duplex was performed on the left lower extremity. Upon examination of the greater saphenous vein (GSV), a free floating SVT was noted. The thrombus moved with patient respirations and was described as a loosely attached, acute SVT. Conclusion Research has provided clinicians the percentages of SVT that cause a pulmonary embolism. However, the question is raised: do the superficial venous thromboses that cause a pulmonary embolism become dangerous because they propagate into the deep system or can the SVT itself embolize from the superficial system and travel through the deep system and into the lungs? This case study revealed a loosely attached free-floating SVT within the GSV in the distal thigh. This SVT moved proximally and joined the otherwise-unaffected deep system and moved out of range of ultrasound and embolized to the pulmonary arteries. The patient complained of chest pain and shortness of breath within 2 min. The patient was treated with systemic thrombolytics and anticoagulation and had a favorable outcome.
The Incidence of Popliteal Artery Aneurysms in Patients with Abdominal Aortic Aneurysms
Authors: Grimm Jodi J. , Wise Matthew M. , Meissner Mark H. , Nicholls Stephen C. 
Published: March 2018

Purpose We sought to evaluate the incidence of popliteal artery aneurysms (PAAs) in patients who have a diagnosis of abdominal aortic aneurysm (AAA). Methods It has been previously documented that patients with AAA have a greater incidence of PAA. During the past 11 years, 163 patients presented to the Vascular Laboratory at Harborview Medical Center with an AAA. Seventy-one (44%) of these patients had popliteal arteries evaluated using duplex ultrasound (Advanced Technology Laboratory 3000, 5000, 9000). The popliteal artery was measured in the anteroposterior and transverse diameters. A PAA was defined as an artery larger than 1.5 cm and/or an ectatic artery with thrombus present. Results Fourteen patients had a PAA; six patients (43%) had PAA bilaterally, for a total of 20 aneurysms. Nineteen (95%) aneurysms had thrombus present. Various interventional treatments were used: five limbs (25%) received an arterial bypass graft, two (10%) underwent amputation, and two (10%) received thrombolytic therapy Conclusions There is a high incidence of PAA in patients with AAA (19.7% in this series). Patients with a diagnosis of AAA should be screened for PAA and considered for elective repair to prevent the high rate of complications associated with these lesions.
Prevalence of Carotid Siphon Stenosis in Patients Referred for Cerebrovascular Evaluation
Authors: Hughes Joseph P. , Bowman Gary R. , Dubin Rick , Cochran Terence A. , Porreca Francis J. , Kalisz Denise , Rush Michael P. 
Published: March 2018

Introduction The carotid siphon is second only to the carotid bifurcation in the prevalence of hemodynamically significant atherosclerotic plaque formation, yet few noninvasive vascular laboratories report interrogation of this region during routine noninvasive vascular evaluations. The purpose of this investigation was to determine the prevalence of carotid siphon stenosis in patients referred for noninvasive cerebrovascular evaluation. Materials and Methods During a 2-month period, 178 patients (94 male, 84 female, mean age, 71.8 years) were referred to the vascular laboratory for cerebrovascular evaluation, which included interrogation of the extracranial carotid, vertebral, and subclavian arteries as well as the intracranial ophthalmic artery and carotid siphon. All intracranial examinations were performed using a phased array imaging transducer (2–4 MHz). Results Ten patients (6%, 10/178) were found to have hemodynamically significant carotid siphon stenosis. There was a statistically significant association between the presence of carotid siphon stenosis and cervical bruit ( p ≤ 0.05), follow-up of known extracranial carotid artery atherosclerosis ( p ≤ 0.001), and a combination of hypertension, hyperlipidemia, and coronary artery disease ( p ≤ 0.01). Conclusion Investigation of the carotid siphon is worthwhile when performed in conjunction with extracranial carotid duplex examinations. Siphon lesions detected during the cerebrovascular examination, especially in those with cervical bruits, known extracranial atherosclerotic disease, and combinations of risk factors, may affect medical or interventional therapy and can lead to a reduction in neurovascular events.
Duplex Evaluation of a Carotid Artery Aneurysm
Authors: Ripoll Juan C. , Oglesby Beverly , Sorrell Kathryn , Harris Shelley 
Published: March 2018

Introduction A carotid artery aneurysm is a rare yet significant finding. The purpose of this report is to describe the clinical presentation and sonographic findings of a post-endarterectomy aneurysm. Case Report A 65-year-old woman presented to our laboratory with an enlarging mass on the left side of her neck. Her medical history was significant for a left carotid endarterectomy approximately 1o years earlier. Methods A standard carotid Duplex evaluation was performed. Gray scale imaging on the left side of the neck revealed multiple irregular dilatations along the distal common carotid (CCA) and internal carotid arteries (ICA). Results The maximum diameter of the distal CCA measured 2.3cm compared with 0.8cm proximally. Areas of mixed echogenicity suggesting thrombus formation were observed in the CCA where the diameter of the artery was at its greatest. Color and spectral Doppler demonstrated highly turbulent flow in the aneurysmal area, along with an unremarkable velocity profile proximal and distal to this segment. The unusual irregularity of these dilatations along with no obvious neck characteristic of a pseudoaneurysm made it difficult to distinguish whether this lesion represented a false or true aneurysm. A computed tomography angiogram (CTA) demonstrated aneurysmal dilatation of the carotid artery with possible pseudoaneurysm formation at the level of the bifurcation. Angiography and subsequent surgical exploration revealed that the lesion was a true aneurysm. Repair was accomplished by insertion of a 6mm polytetrafluoroethylene interposition graft. Conclusion Color Duplex ultrasound was an accurate technique for identification of an uncommon carotid artery aneurysm.