bluuebunny/crossref_metadata_2025_split huggingface dataset:
TCD Evaluation before and after Stenting in Patients with Severe Primary Carotid Artery Stenosis versus Restenosis
Authors: Telman Gregory , Kouperberg Efim , Sprecher Elliot , Gruberg Luis , Beyar Rafael , Yarnitsky David 
Published: March 2015

Purpose: To evaluate cerebral hemodynamics before and after carotid angioplasty and stenting (CAS) using transcranial Doppler (TCD). Methods: Sixty-eight patients (52 men; mean age 69±9.5 years) with severe carotid stenosis (83.4%±10.2%) were examined by TCD before and 2 months after CAS. Thirty-two (47%) patients had primary carotid stenosis and 36 (53%) had restenosis after carotid endarterectomy (CEA). A broad TCD protocol was employed to estimate cerebral hemodynamics, including assessment of velocities (V) and asymmetry of cerebral blood flow velocity (CBFV) in the middle cerebral artery, (MCA) anterior cerebral artery (ACA), and basilar artery (BA); the pulsatility indexes; and flow acceleration. Results: Ipsilateral MCA mean velocities before stenting were 46.3±12.6 cm/s in the primary stenosis group and 47.1±12.3 cm/s in restenosis group; after stenting, the velocities were 53.8±12.1 and 52.7±9.6 cm/s, respectively (p<0.005 for both groups). MCA asymmetry by Vmean before CAS was higher in the primary stenosis group (27.6%±2.4% versus 19.8%±2.3%, p<0.05). After stenting, this index was significantly lower in both groups: 16.4%±2.4% and 12.3%±2.3%, respectively (p<0.0001 for each group). All other TCD parameters improved significantly in both groups after CAS as well (p<0.05), showing the strong hemodynamic effect of this procedure. Conclusion: CAS effectively improves cerebral hemodynamics in patients with severe primary and restenosis of the internal carotid artery.
Multicenter Safety and Efficacy Analysis of Assisted Closure after Antegrade Arterial Punctures Using the StarClose Device
Authors: Williams Robin Edward Thomas , Angel Claude Y. , Bourkaib Ryad , Brenot Philippe , Commeau Philippe , Fisher Robert Kendall , Jackson Ralph , Kay Caroline Helen , Le Dref Olivier , Riou Jean-Yves , Rose John , MacDonald Sumaira 
Published: March 2015

Purpose: To evaluate the safety and efficacy of the StarClose device for closure of antegrade punctures following infrainguinal endovascular interventions. Methods: A retrospective review was conducted of 221 consecutive patients treated with the StarClose device in a 12-month period at 5 centers (4 French and 1 British). Of these, 107 patients (69 men; median age 75 years, range 44–93) were from the UK cohort (111 closures), and 94 patients (75 men; median age 67 years, range 32–95) were from the French cohort (111 closures). Technical success, complication rates, demographic data, medical history, and procedural details were gathered for all patients. Residual bleeding and the requirement for additional manual compression were recorded when the device failed. Clinical evaluation was performed at discharge; color-coded duplex ultrasonography was done in a subset of French patients. Results: The overall technical success rate was 94.6% (210/222; 95% CI 3.1%–9.2%). The results were similar in the 2 cohorts: 95.5% (106/111; 95% CI 1.9%–10.1%) in the UK and 93.7% (104/111; 95% CI 3.1%–12.4%) in France. The 12 failures (5 UK and 7 France) were due to several mechanisms: device failure (n=5), obesity (n=1), groin scarring (n=2), and unexplained (n=4). In 2 failed cases, open surgical closure of the arteriotomy was performed because pressure hemostasis failed. Two pseudoaneurysms were observed: one after immediate failure was successfully treated by prolonged pressure; the other, after apparent success of the device, required surgical therapy. The incidence of serious vascular complication was 1.8% (4/222; 95% CI 0.7%–4.5%); 2 patients from each cohort. Conclusion: The StarClose device safely and effectively closes antegrade punctures after infrainguinal endovascular intervention, even in patients who would be considered to be at high risk for puncture-site bleeding. However, a randomized trial would be required to support any definitive recommendations.
Targeted Renal Therapy and Contrast-Induced Nephropathy during Endovascular Abdominal Aortic Aneurysm Repair: Results of a Feasibility Pilot Trial
Authors: Allie David E. , Lirtzman Mitchell D. , Wyatt Charles H. , Keller V. Antoine , Mitran Elena V. , Hebert Chris J. , Patlola Raghotham , Veerina Kalyan K. , Walker Craig M. 
Published: March 2015

Purpose: To evaluate the feasibility of targeted renal therapy (TRT) to decrease the rate of contrast-induced nephropathy (CIN) during endovascular aortic aneurysm repair (EVAR) in patients at risk for CIN. Methods: A prospective nonrandomized analysis of TRT was performed in 10 high-risk patients (8 men; median age 66.5 years, range 56–80) with pre-existing renal insufficiency. TRT involved high-dose intrarenal artery infusions of fenoldopam (FEN), a short acting selective dopamine-1 agonist and renal arteriolar vasodilator, delivered percutaneously via a left brachial access using the 5-F Benephit PV Infusion System during EVAR. Results: There were no device-related complications. TRT infusion duration ranged from 3.5 to 6.0 hours (median 4.5). Median contrast dosage was 120 mL (range 50–200). At 24 and 72 hours after EVAR, creatinine clearance (CrCl) had improved in 7 (70%) patients, remained unchanged in 2 (20%), and declined >25% in 1 (10%); the latter returned to baseline on day 5. At 30 days, 7 (70%) patients had improved CrCl and 3 (30%) remained unchanged. Conclusion: TRT is feasible during EVAR in high-risk patients. Further investigation is warranted to determine the safety and efficacy of TRT in preserving renal function during EVAR.
Changes in Coronary Flow Reserve following Stent Implantation in the Swine Descending Thoracic Aorta
Authors: Zacharoulis Achilles A. , Arapi Sophia M. , Lazaros George A. , Karavidas Apostolos I. , Zacharoulis Apostolos A. 
Published: March 2015

Purpose: To evaluate coronary flow reserve (CFR) changes following stent implantation in the descending thoracic aorta (DTA) of a porcine model. Methods: Six pigs (3 males; 40 to 44 kg) were anesthetized and kept on mechanical ventilation. A 6-F guiding right Judkins catheter was advanced under fluoroscopy to the right coronary artery, and a pressure wire with a temperature sensor was placed within the vessel lumen at a distance of 4 cm from the ostium. CFR was estimated by the thermodilution method before and after maximal coronary vasodilation with 20 mg of intracoronary papaverine. Aortography was also performed to measure aortic diameter. Subsequently, a self-expanding vascular stent was deployed into the DTA just below the left subclavian artery (LSA), and CFR was measured again. All animals were maintained for 3 weeks; at the end of this period, a further CFR was calculated using the same procedure. Results: The mean aortic diameter below the LSA was 12.15±0.15 mm. Following stent deployment, the mean aortic diameter measured at the stented segment was 12.58±0.11 (p=0.001 versus baseline). The mean CFR value was 4.7062.00 before stent implantation, 2.6860.86 immediately after, and 4.0561.15 at 3 weeks after stenting. Accordingly, CFR values were significantly depressed immediately after stent placement compared with baseline (p=0.027). However, CFR values obtained 3 weeks following stent deployment were similar to the initial values (p=0.59). Conclusion: Stent deployment in the normal swine DTA produces a significant immediate decrease in CFR, which is attenuated 3 weeks later. The clinical impact of CFR changes following DTA endografting remain to be elucidated.
Risk Factors for Developing Postprocedural Microemboli following Carotid Interventions
Authors: Tedesco Maureen M. , Coogan Sheila M. , Dalman Ronald L. , Haukoos Jason S. , Lane Barton , Loh Christopher , Penkar Tejus S. , Lee Jason T. 
Published: March 2015

Purpose: To determine risk factors predictive of microemboli found on diffusion-weighted magnetic resonance imaging (DW-MRI) following carotid angioplasty and stenting (CAS) with distal protection and carotid endarterectomy (CEA). Methods: A retrospective review was conducted of all carotid interventions at a single institution between 2004 and 2006. In that time frame, 64 carotid interventions (34 CAS, 30 CEA) were performed in 63 male patients (mean age 69.5 years, range 52 to 91) with DW-MRI scans available for review. Patient characteristics, including age, gender, smoking history, diabetes mellitus, hypertension, hyperlipidemia, obesity (body mass index >30), coronary artery disease (CAD), chronic obstructive pulmonary disease, peripheral vascular disease, and atrial fibrillation, were documented. For the CAS patients, anatomical and procedural characteristics, including fluoroscopy time, contrast volume, performance of an arch angiogram, and lesion anatomy, were recorded. Bivariate analyses were performed to determine which parameters were associated with the occurrence of acute postprocedural microemboli found on DW-MRI by 2 blinded neuroradiologists. Results: Twenty-four (71%) of the 34 CAS patients and 1 (3%) of the 30 CEA patients demonstrated new cerebral microemboli postoperatively. In the bivariate analyses of all patient, anatomical, and procedural characteristics, only a history of CAD was associated with an increased risk of microemboli; 20 (80%) of the 25 patients who had postprocedure microemboli had CAD compared to 18 (46%) of 39 patients without microemboli (p=0.007). Twenty (53%) of the 38 (59%) patients with CAD developed microemboli compared to 5 (19%) of the 26 patients without CAD (p=0.007). All other patient, procedural, and anatomical characteristics were not found to be independent risk factors predictive of postprocedure microemboli. Conclusion: CAS with distal protection carries a significantly greater risk for developing new microemboli compared to CEA. Of all the risk factors analyzed, only a history of CAD emerged as an independent risk factor for the development of microemboli following carotid intervention. This finding may influence the decision to perform CAS in patients deemed high risk solely due to the presence of CAD.
Increased Anterior Abdominal Aortic Wall Motion: Possible Role in Aneurysm Pathogenesis and Design of Endovascular Devices
Authors: Goergen Craig J. , Johnson Bonnie L. , Greve Joan M. , Taylor Charles A. , Zarins Christopher K. 
Published: March 2015

Purpose: To determine whether variations in aortic wall motion exist in mammalian species other than humans and to consider the potential implications of such variations. Methods: M-mode ultrasound was used to measure abdominal aortic wall motion in 4 animal species [mice (n=10), rats (n=8), rabbits (n=7), and pigs (n=5)], and humans (n=6). Anterior wall displacement, posterior wall displacement, and diastolic diameter were measured. The ratio of displacement to diameter and cyclic strain were calculated. Results: Body mass varied from 24.1±2.4 g (mouse) to 61.8±13.4 kg (human); aortic diameter varied from 0.53±0.07 mm (mouse) to 1.2±1 mm (human). Anterior wall displacement was 2.5 to 4.0 times greater than posterior among the species studied. The ratios of wall displacement to diastolic diameter were similar for the anterior (range 9.40%–11.80%) and posterior (range 2.49%–3.91%) walls among species. The ratio of anterior to posterior displacement (range 2.47–4.03) and aortic wall circumferential cyclic strain (range 12.1%–15.7%) were also similar. An allometric scaling exponent was experimentally derived relating anterior wall (0.377±0.032, R2=0.94) and posterior wall (0.378±0.037, R2=0.93) displacement to body mass. Conclusion: Abdominal aortic wall dynamics are similar in animals and humans regardless of aortic size, with more anterior than posterior wall motion. Wall displacement increases linearly with diameter, but allometrically with body mass. These data suggest increased dynamic strain of the anterior wall. Increased strain, corresponding to increased elastin fatigue, may help explain why human abdominal aortic aneurysms initially develop anteriorly. Aortic wall motion should be considered when developing endovascular devices, since asymmetric motion may affect device migration, fixation, and sealing.
Endovascular Rescue of a Fused Monorail Balloon and Cerebral Protection Device
Authors: Campbell John E. , Bates Mark C. , Elmore Michael 
Published: March 2015

Purpose: To present a case of successful endovascular retrieval of a monorail predilation balloon fused to an embolic protection device (EPD) in the distal internal carotid artery (ICA) of a high-risk symptomatic patient. Case Report: A 60-year-old man with documented systemic atherosclerotic disease had a severe (>70%) restenosis in the left ICA 3 years after endarterectomy. He was scheduled for carotid artery stenting (CAS) with cerebral protection; however, he developed unstable angina and was transferred to our facility, where the admitting team decided that staged CAS followed by coronary bypass grafting would be the best option. During the CAS procedure, a 6-mm AccuNet filter was passed across the lesion via a 6-F carotid sheath and deployed in the distal ICA without incident. However, the 4-×20-mm predilation monorail balloon was then advanced without visualizing the markers, resulting in inadvertent aggressive interaction that trapped the balloon's tip in the filter. Several maneuvers to separate the devices were unsuccessful. Finally, the filter/balloon combination was moved gently retrograde until the balloon was straddling the subtotal ICA lesion. The lesion was dilated to 4 mm with the balloon, and the sheath was gently advanced across the lesion as the balloon was deflated. Angiography excluded interval occlusion of the filter from the embolic debris during the aforementioned aggressive maneuvers and documented antegrade flow. The filter was slowly withdrawn into the 6-F sheath with simultaneous aspiration. A second 6-mm filter was deployed, and the procedure was completed satisfactorily. The patient did well, with no neurological sequelae. Conclusion: EPDs are an essential in carotid artery stenting and, keeping in mind the potential risks associated with their use, will help the operator avoid complications such as this one.
Improving Endograft Stability by Accommodation onto the Aortic Bifurcation
Authors: Perdikides Theodossios P. , Avgerinos Efthimios D. , Lagios Konstantinos , Ziegler Peter , Stelter Wolf 
Published: March 2015

Purpose: To report the technique for deploying a 3-part endovascular graft onto the native aortic bifurcation for greater stent-graft stability. Technique: The Zenith Composite Endovascular Graft is a 3-part system consisting of a proximal tubular body with an uncovered Gianturco Z stent, a distal bifurcated body, and a contralateral leg. Proximally, 8-mm flexible interstent gaps facilitate precise infrarenal aortic placement, even in angulated necks. Technically, the bifurcated part is deployed first and pulled down to the aortic bifurcation, while the tubular main body and contralateral leg deployment follow. Using this technique to accommodate the graft onto the natural aortic bifurcation, distal stability can be enhanced and graft migration minimized. Conclusion: The Composite configuration can be an alternative to ensure a higher security index in difficult anatomies. It may be beneficial in patients with short (10–15 mm), angulated (>60°), or conical necks and deserves investigation in these patient populations.
Treatment of a Totally Occluded Superior Mesenteric Artery Facilitated by Retrograde Crossing via Collaterals from the Celiac Artery
Authors: Robken Jon , Shammas Nicolas W. 
Published: March 2015

Purpose: To present a new approach route for recanalization of a chronically occluded superior mesenteric artery (SMA). Technique: Percutaneous treatment of an SMA occlusion can be accomplished in some cases via retrograde crossing through collaterals from the celiac artery. From a right common femoral artery (CFA) approach, an 8-F RDC guide catheter is advanced to the origin of the celiac artery via. Using a 5-F angled Glidecath, a long 0.035-inch stiff Glidewire, and a Choice PT wire, the glide catheter is advanced via the celiac artery into the superior pancreaticoduodenal artery. Using the angled Glidewire and the Choice PT wire, the occluded SMA is cannulated in a retrograde fashion. Through an 8-F sheath in the left CFA, an 8-F RDC guide catheter is advanced into the abdominal aorta. A goose neck snare is used to capture the Choice wire, which is withdrawn through the left catheter and sheath. The SMA occlusion is dilated, and the RDC guide is advanced into the SMA origin over the balloon. Another Choice PT wire and a 0.035-inch Wholey High Torque wire are placed in an antegrade fashion through the now open SMA. Angioplasty and stenting are then completed in the SMA over the Wholey wire. Conclusion: Retrograde recanalization of the SMA via celiac collaterals offers a new endovascular approach to treating patients with chronic mesenteric ischemia and a chronically occluded SMA.
Population health in New Zealand 2000–2013: From determinants of health to targets
Authors: Sheridan Nicolette F , Kenealy Timothy W , Schmidt-Busby Jacqueline IG , Rea Harold H 
Published: March 2015

Objective: To determine how ‘population health’ has been understood in practice and policy and has influenced health system restructuring in New Zealand since 2000. Methods: Interviews in 2007–2008 with managers, clinicians, government policy advisors and academics were undertaken to explore the relationships between population health, determinants of health, and health system restructuring. This was augmented by a review of major government health policies from 2009 to 2013 to establish which notions of population health were reflected. Results: Population health shifted from a broad notion of health determinants to focus on a small number of quantifiable health targets driven by financial incentives. Meantime, an emphasis on ‘quality and safety’ impeded population health activities. District Health Board programmes to identify high risk individuals, by disease or hospital service utilisation, diverted attention from broader population health outcomes. District Health Boards were not held accountable for integrating a population health approach in service planning and did not initiate or lead intersectoral work. Community consultation was limited. Primary Health Organisations, although mandated to address population health, typically aligned with the small-business model of general practice making service integration difficult to achieve. In policy, ‘population health’ dropped from favour in the mid-2000s, although many documents, outside the health sector, carried forward these values. Conclusion: A progressively narrower focus on a small number of health targets and on organisational processes undermined earlier policy intentions and health system restructuring that sought to improve broader population health outcomes.
Multidimensional Dyspnea Profile: an instrument for clinical and laboratory research
Authors: Banzett Robert B. , O'Donnell Carl R. , Guilfoyle Tegan E. , Parshall Mark B. , Schwartzstein Richard M. , Meek Paula M. , Gracely Richard H. , Lansing Robert W. 
Published: March 2015

There is growing awareness that dyspnoea, like pain, is a multidimensional experience, but measurement instruments have not kept pace. The Multidimensional Dyspnea Profile (MDP) assesses overall breathing discomfort, sensory qualities, and emotional responses in laboratory and clinical settings. Here we provide the MDP, review published evidence regarding its measurement properties and discuss its use and interpretation. The MDP assesses dyspnoea during a specific time or a particular activity (focus period) and is designed to examine individual items that are theoretically aligned with separate mechanisms. In contrast, other multidimensional dyspnoea scales assess recalled recent dyspnoea over a period of days using aggregate scores.Previous psychophysical and psychometric studies using the MDP show that: 1) subjects exposed to different laboratory stimuli could discriminate between air hunger and work/effort sensation, and found air hunger more unpleasant; 2) the MDP immediate unpleasantness scale (A1) was convergent with common dyspnoea scales; 3) in emergency department patients, two domains were distinguished (immediate perception, emotional response); 4) test–retest reliability over hours was high; 5) the instrument responded to opioid treatment of experimental dyspnoea and to clinical improvement; 6) convergent validity with common instruments was good; and 7) items responded differently from one another as predicted for multiple dimensions.
Erlotinib and bevacizumabversuscisplatin, gemcitabine and bevacizumab in unselected nonsquamous nonsmall cell lung cancer
Authors: Thomas Michael , Fischer Jürgen , Andreas Stefan , Kortsik Cornelius , Grah Christian , Serke Monika , von Eiff Michael , Witt Christian , Kollmeier Jens , Müller Ernst , Schenk Michael , Schröder Michael , Villalobos Matthias , Reinmuth Niels , Penzel Roland , Schnabel Philipp , Acker Thomas , Reuss Alexander , Wolf Martin 
Published: March 2015

Erlotinib with bevacizumab showed promising activity in recurrent nonsquamous (NS) nonsmall cell lung cancer (NSCLC). The INNOVATIONS study was designed to assess in first-line treatment of unselected cisplatin-eligible patients this combination compared to cisplatin, gemcitabine and bevacizumab.Stage IIIB/IV patients with NS-NSCLC were randomised on erlotinib (150 mg daily) and bevacizumab (15 mg·kg−1on day 1, every 3 weeks) (EB) until progression, or cisplatin (80 mg·m−2on day 1, every 3 weeks) and gemcitabine (1250 mg·m−2on days 1 and 8, every 3 weeks) up to six cycles and bevacizumab (15 mg·kg−1on day 1, every 3 weeks) (PGB) until progression.224 patients were randomised (EB n=111, PGB n=113). The response rate (12%versus36%; p<0.0001), progression-free survival (median 3.5versus6.9 months; hazard ratio (HR) 1.85, 95% CI 1.39–2.45; p<0.0001) and overall survival (median 12.6versus17.8 months; HR 1.41, 95% CI 1.01–1.97; p=0.04) clearly favoured PGB. In patients with epidermal growth factor receptor mutations (n=32), response rate, progression-free survival and overall survival were not superior with EB.Platinum-based combination chemotherapy remains the standard of care in first-line treatment of unselected NS-NSCLC. Molecular targeted approaches strongly mandate appropriate testing and patient selection.
Quantum dot-sensitized solar cells having 3D-TiO2 flower-like structures on the surface of titania nanorods with CuS counter electrode
Authors: Buatong Nattha , Tang I-Ming , Pon-On Weeraphat 
Published: March 2015

Abstract
The photovoltaic performance of a quantum dot (QD)-sensitized solar cell consisting of CdS/CdSe/ZnS QDs loaded onto the surface of the three-dimensional (3D) flower-like TiO2 structure grown on an array (1D) of TiO2 nanorods (FTiR) is studied. The flower-like structure on the rod-shaped titania was synthesized using a double-step hydrothermal process. The FTiR array exhibited a 3D/1D composite structure with a specific surface area of 81.87 m2/g. Using CuS as the counter electrode instead of Pt offers the best performance and leads to an increase in the conversion efficiency (η). The efficiency of the CdS/CdSe/ZnS QD-loaded FTiR assembling CuS counter electrode cell improved from η = 2.715% (Voc = 0.692 V, Jsc = 5.896 mA/cm2, FF = 0.665) to η = 0.703% (Voc = 0.665 V, Jsc = 2.108 mA/cm2, FF = 0.501) for the QD-loaded FTiR assembling Pt counter electrode cell. These studies reveal a synergistically beneficial effect on the solar-to-current conversion of these QD-sensitized solar cells when a CuS counter electrode is used instead of the usual Pt counter electrode.