bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shoulder Functional Performance Status of National Collegiate Athletic Association Swimmers
Authors: Wymore Lucas , Fronek Jan 
Published: March 2015

Background: Shoulder trouble, described in the literature as “swimmer’s shoulder,” has been associated with competitive swimmers. The Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Score is a validated survey used to define functional and performance measures of the upper extremity in overhead athletes. To date, no study has investigated the baseline functional scores for swimmers actively competing in the sport. Purpose: To establish a baseline score for National Collegiate Athletic Association (NCAA) swimmers actively competing in the sport. Study Design: Cross-sectional study; Level of evidence, 3. Methods: After institutional review board approval, the KJOC Shoulder and Elbow Score was administered to 5 NCAA swim teams (N = 99 participants; 46 men, 53 women). The results on 10 specific individual questions and on the total score were calculated according to the survey’s original description. The mean scores were calculated for all participants. The Mann-Whitney U test was used to determine differences between sexes, years swimming, and self-reported injury status. Results: The mean ± SD baseline KJOC score (out of a possible 100) for all participants was 79.0 ± 18.7; the mean score for men was 81.9 ± 15.6 and for women 76.6 ± 20.8. The score for athletes identifying themselves as injured at baseline was 53.9 ± 18.8, compared with 84.4 ± 13.6 for those not reporting as injured ( P < .001). Athletes competing ≥11 years had a mean score of 72.0 ± 22.1; those competing ≤10 years scored 86.4 ± 11.4 ( P = .007). Conclusion: Baseline scores for swimmers, which were lower than expected, were lower than baseline scores seen in studies of other overhead sports athletes. The data corroborate previous studies identifying swimmers as having a high level of shoulder trouble. Further research is indicated for improving shoulder symptoms and performance in competitive swimmers.
Cognitive Dissonance as an Effect of Indulging on Credit
Authors: Dugar Anurag , Shreshtha Mani , Jain Rishabh 
Published: March 2015

Indians are known to have high regard for savings, thanks to the age-old pro-saving lessons that are part of the Indian DNA. Till recently, this deep-rooted pro-savings attitude made sure that Indian consumers were uncomfortable with the idea of indulging, and indulging on credit has been a taboo. However, changing lifestyles and exposure to the glamour and thrill of spending are unfastening this grip. If numbers of “active card holders” and “usage of credit” are any indicator, than Indians have started accepting credit as a way of life. Most of the research work carried out on the subject is restricted to “usage patterns” in different markets and impact of demographic factors and lifestyle on acceptance and usage of credit cards. This study is aimed at finding insights on whether consumers feel that credit cards encourage them to indulge and post-spending there is a higher level of cognitive dissonance. Data, for this study, have been collected from upper-middle-class urban consumers and analyzed through statistical tools to figure out the answers to these questions. This study can be of immense use for credit card marketers as they can figure out if they have to reduce the cognitive dissonance of the consumers of their credit cards and they will also figure out whether brand positioning based on symbolic benefits would be advantageous or utilitarian value that the brand offers.
Enterprise as a Social System
Authors: Oleksyn Tadeusz 
Published: March 2015

An enterprise in satisfying defined social needs and sustaining its position creates a specific social system and is simultaneously submerged in the broader social system in which it operates. Without both of these systems—the internal and the external ones—it could neither exist nor do anything. It is therefore possible to distinguish out of different notions and models of enterprises the model of enterprises perceived as a social system. This article aims at reflection on this very system and model. It reviews select issues associated with this theme. The purpose is to inspire reflections and to raise questions on the role of enterpsises at an interdisciplinary level.
Transcranial Doppler Monitoring in Angioplasty and Stenting of the Carotid Bifurcation
Authors: Ackerstaff R.G.A. ,   Antonius Carotid Endarterectomy, Angioplasty, and Stenting Study Group
Published: March 2015

Purpose: To assess the impact of cerebral embolism and hemodynamic changes during the successive stages of carotid angioplasty and stenting (CAS) using transcranial Doppler (TCD) monitoring of the middle cerebral artery (MCA). Methods: In 297 patients (206 men; mean age 69.9±8.0 years), the association of various TCD emboli and velocity variables with procedure-related death and cerebral events (amaurosis fugax, transient ischemic attacks, and stroke) was evaluated. Baseline patient characteristics (age, sex, preoperative cerebral symptoms, and prior carotid endarterectomy) and their associations with procedure-related cerebral events were also assessed. A distinction was made between adverse events that occurred during CAS and those that happened within 7 days. Results: Of the 36 procedure-related retinal and cerebral events, 28 (78%) were encountered intraprocedurally; an additional 6 (2%) events occurred within 7 days after the procedure. Two (0.7%) patients died. At 1 week, the combined minor and major stroke and death rate was 3.7%. Adverse outcome was associated with >4 showers of microemboli at postdilation (odds ratio [OR] 3.2, 95% CI 1.3 to 7.8, p = 0.03), particulate macroemboli (OR 9.1, 95% CI 5.1 to 16.1, p<.001), massive air embolism from ruptured balloons (OR 11.3, 95% CI 7.6 to 16.6, p<0.001), and angioplasty-induced asystole with significant hypotension plus MCA blood flow reduction (OR 3.3, 95% CI 1.4 to 8.3, p = 0.03). Of the patient characteristics, male gender (OR 10.5, 95% CI 1.4 to 75.8, p = 0.02) and preoperative cerebral ischemia (OR 3.3, 95% CI 1.6 to 6.6, p = 0.003) were also related to outcome. Conclusions: In CAS, TCD monitoring provides insight into the pathogenesis of procedure-related cerebral events. Microemboli during poststent dilation, particulate macroembolism, massive air embolism, and angioplasty-induced asystole are associated with adverse outcome, as are male gender and prior cerebral ischemia.
Treatment of Axillosubclavian Vein Thrombosis: A Novel Technique for Rapid Removal of Clot Using Low-Dose Thrombolysis
Authors: Arko Frank R. , Cipriano Paul , Lee Eugene , Filis Konstantinos A. , Zarins Christopher K. , Fogarty Thomas J. 
Published: March 2015

Purpose: To report successful combined percutaneous mechanical thrombectomy and pharmacological lysis for axillosubclavian vein thrombosis, with rapid clot removal at a single setting using low-dose thrombolysis. Case Reports: Two consecutive patients presented with arm swelling; the diagnosis of axillosubclavian vein thrombosis was confirmed with duplex ultrasound. Both patients were treated percutaneously with the Solera mechanical thrombectomy device, after which 5 mg of tissue plasminogen activator were delivered within ∼10 minutes via the Trellis infusion catheter to remove any residual thrombus. Completion venography and serial duplex ultrasound scans in follow-up demonstrated widely patent axillosubclavian veins with no residual thrombus in both cases. Conclusions: Standard treatment of axillosubclavian vein thrombosis may require 12 to 36 hours, with multiple trips to the angiography suite. The novel technique combining mechanical thrombectomy and pharmacological lysis can be performed safely and successfully at a single setting with a small dose of the lytic drug.
Percutaneous Modular Stent-Grafts in the Treatment of Abdominal Aortic Aneurysms
Authors: Lee Do Yun , Kang Sung-Gwon , Choi Donghoon , Lee Gwang Hoon , Maeda Munehiro , Roh Byung Suk , Won Jae Whan , Kim Chang Won , Kim Eun Sang , Song Ho-Young 
Published: March 2015

Purpose: To describe a newly designed bifurcated modular stent-graft and assess the feasibility and safety of its use in the treatment of abdominal aortic aneurysms (AAA). Methods: Thirteen patients (10 men; mean age 61.2±16 years, range 57–78) with AAAs underwent treatment with a bifurcated stent-graft consisting of 4 components: an unsupported bifurcated stent-graft, an inner bare stent, and 2 stent-grafts. The system was placed sequentially through a percutaneously introduced 12-F sheath; the preloaded bifurcated main body of the stent-graft was deployed first, followed by the inner bare stent and individual stent-graft limbs through separate 10-F sheaths. Spiral computed tomography (CT) was performed before treatment and at 1 week, 3 months, and then at 6-month intervals. Results: The stent-grafts were successfully deployed in all patients, although 3 types of procedure-related adverse events occurred: left limb kinking in 1, postimplantation syndrome (fever, leukocytosis, and decreased platelet count) in 5, and a small access site arteriovenous fistula in 1. Postprocedural angiography and 1-week follow-up CT scanning did not identify any endoleaks. At a mean 9.2±4.6-month follow-up, all devices were intact, with complete exclusion of the aneurysms and no endoleaks. Conclusions: This newly designed bifurcated modular stent-graft appears to be effective for percutaneous AAA repair; further investigation is warranted.
Endotension in the Closed Aneurysm Sac during Aortic and Iliac Cross Clamping: Implications of Pressure and Flow Measurements
Authors: Gawenda Michael , Brunkwall Jan 
Published: March 2015

Purpose: To relate the mean and pulse pressures in the cross-clamped aortic aneurysm sac to the systemic pressures during open repair (OR) of abdominal aortic aneurysm (AAA). To correlate the intrasac pressures to the number of bleeding lumbar arteries (LA) and the flow pattern of the inferior mesenteric artery (IMA). Methods: In a prospective study of 55 patients (45 men; median age 69 years, range 47–84) undergoing open repair, the IMA flow and the mean pressure in the aneurysm sac (ASPmean) were measured before and after aortic and iliac artery cross clamping. The systemic mean pressure (SPmean) was recorded simultaneously. The aneurysm sac (ASPpulse) and systemic pulse pressures (SPpulse) were calculated, as were the mean pressure ratio (ASPmean/SPmean) and the pulse pressure ratio (ASPpulse/SPpulse). Values are given as the median (range). Results: Cross clamping of the proximal aortic neck significantly reduced the mean pressure to 31 mmHg (14–64), with a pressure ratio of 0.39±0.14; the pulse pressure decreased to 0 mmHg (0–13) (p<0.001). Additional cross clamping of the iliac arteries did not alter the pressure levels any further. In the patent IMA (n = 23), an orthograde median flow of 43 mL/min (2–135) was measured; sequential cross clamping of the aorta and iliac arteries reduced the flow to −6 mL/min (–130 to +21) and −3 mL/min (–120 to +22), respectively. There was no correlation between the pressure ratio and IMA patency, its volume flow, or the number of backbleeding lumbar arteries. Conclusions: The aneurysm sac is still pressurized with no pulsatility after cross clamping during open AAA repair. The aneurysm mean and pulse pressures did not correlate to the number of backbleeding lumbar arteries. Finally, the pressure ratios did not correlate to the highly variable IMA flow pattern during aortic cross clamping.
Clinical Experience with the OptiMed Sinus Stent in the Peripheral Arteries
Authors: Henry Michel , Henry Isabelle , Klonaris Christos , Hugel Michele 
Published: March 2015

Purpose: To retrospectively evaluate the performance of a new self-expanding nitinol stent in the treatment of lower limb arterial occlusive lesions. Methods: The Sinus stent is a flexible, laser-cut device with good radiopacity and radial strength, allowing precise placement via a 7-F introducer, even in tortuous arteries. Over a 3.5-year period, 315 patients (254 men; mean age 64.9±10.8 years, range 39–93) had 403 lower limb lesions treated: 172 iliac (132 stenoses, 40 occlusions), 204 femoral (131 stenoses, 73 occlusions), and 27 popliteal (19 stenoses, 8 occlusions). The majority of patients (272, 86%) were in stage IIb of Fontaine's classification, 31 (10%) in stage III, and 12 (4%) in stage IV. Mean lesion lengths were iliac: 51.9±32.1 mm, femoral: 66.3±51.5 mm, and popliteal: 44.3±27.2 mm. Indications for stenting were 222 postdilation residual stenoses, 125 dissections, and 35 restenoses; 21 lesions were directly stented. Results: Immediate technical success was 100%. Clinical success was 98%. The anklebrachial index increased from 0.62±0.12 to 0.91 ±0.14. In 64 lesions, there were 3 early thromboses. Mean follow-up was 16.1 ±9.7 months (range to 40). There were 79 restenotic episodes: 14 iliac, 56 femoral, and 9 popliteal. Primary and secondary patencies for all lesions at 3 years were 72.5%±6.6% and 81.8%±5.9%, respectively. Stenoses demonstrated better patency than occlusions (primary: 78.0%±7.3% versus 60.2%±7.1%, p<0.001; secondary: 86.8%±6.1% versus 71.3%±6.7%, p<0.001). Men had better secondary patency at 3 years (83.7% versus 73.4%, p<0.05). For femoral lesions >8 cm, the results were acceptable for stenoses (66.7% primary and secondary patency at 3 years), but for lengthy occlusions, the restenosis rate was high (50.0% for occlusions versus 25.0% for stenoses, p<0.05). Conclusions: Angioplasty with the Sinus stent seems safe and effective in the treatment of peripheral arterial occlusive diseases, giving excellent results at the iliac and common femoral artery levels. Treatment results are better for stenoses than for occlusions. An occlusion length ≤8 cm seems to be the limit for stenting.
The “Y” Stent: A Technique Using Nitinol Stents to Treat Bifurcations
Authors: Sze Daniel Y. , Razavi Mahmood K. , Mitri Ragheed K. , Regala Alan C. , Dake Michael D. 
Published: March 2015

Purpose: To investigate a new method of stent deployment using commercially available self-expanding stents to treat bifurcation lesions, providing complete lesion coverage without obstructing branches. Methods: After preliminary in vitro and clinical testing with biliary obstructions, 11 vascular obstructive lesions in 10 patients (7 men; mean age 63 years, range 32–81) were treated by percutaneous Y-shaped stenting. Five patients had iliac arterial stenoses involving the iliac bifurcation; the other 5 patients had 6 central venous obstructions involving branch points. Bifurcated stents were constructed in situ by deploying a nitinol stent extending into one branch and selective balloon fracturing of struts to create a fenestration. A second stent was deployed through the hole, followed by symmetrical fracturing of struts in the second stent to form a Y-shaped configuration. Results: All deployments were technically successful and resulted in complete coverage of the bifurcation lesions. Protrusion of fractured stent material into flow lumens was minor as determined by angiography, intravascular ultrasound, and passage of balloons, but it required the stents to be oversized. The lengths and luminal diameters were tailored for each arm of the Y-shaped stents. Conclusions: In situ creation of a Y-shaped stent using 2 self-expanding nitinol stents is a feasible option with potential advantages in the treatment of obstructive lesions involving a bifurcation.
Transient Ischemic Attack Due to Early Carotid Stent Thrombosis: Successful Rescue with Rheolytic Thrombectomy and Systemic Abciximab
Authors: Bush Ruth L. , Bhama Jay K. , Lin Peter H. , Lumsden Alan B. 
Published: March 2015

Purpose: To describe a successful neurorescue technique in a patient with generalized seizures followed by hemiparesis immediately after carotid artery stenting (CAS) for a postsurgical restenosis. Case Report: A 65-year-old man with a symptomatic recurrent high-grade carotid stenosis after carotid endarterectomy was treated with CAS. The procedure was complicated by sudden transient ischemic attack caused by acute carotid stent thrombosis with clot propagation into the cerebral circulation. Percutaneous mechanical thrombectomy was performed with adjunctive infusion of intravenous abciximab, resulting in complete thrombus dissolution and resolution of neurological symptoms. Conclusions: Access to a mechanical thrombectomy device was essential for rapid thrombus extraction, and adjunctive abciximab aided in residual clot dissolution. As a result of this combined method of clot removal, a disastrous outcome was averted.
Frequency, Predictive Factors, and Consequences of Stent-Graft Kink following Endovascular AAA Repair
Authors: Fransen Gerdine A.J. , Desgranges Pascal , Laheij Robert J.F. , Harris Peter L. , Becquemin Jean-Pierre 
Published: March 2015

Purpose: To determine from the EUROSTAR registry the incidence of stent-graft kink, predictive factors for kinking, and the consequences of this complication on graft patency and aneurysm exclusion. Methods: From January 1994 to June 2002, 4613 patients who underwent endovascular aneurysm repair were registered in the EUROSTAR registry. Presence of kink was determined according to the information available on the follow-up Case Record Form. The population was divided into those with and without stent-graft kink. Patient characteristics, morphological aneurysm features, team experience, type of device, period of implantation, and outcome were compared between the groups by univariate analysis. Significant factors were subsequently submitted to a multivariate Cox proportional hazard analysis. Results: One hundred seventy (3.7%) patients were reported as having a kink of the stent-graft during a mean follow-up of 21 months (range 1–72). Gender, neck angulation, team experience, period of implantation, ASA classification, and device type were independent predictors of kink. The presence of a kink was significantly associated with type I endoleaks (proximal and distal), type III endoleaks (midgraft), graft stenosis, graft limb thrombosis, graft migration, and conversion to open repair. No relationship was found between a decrease in the aneurysm diameter and the occurrence of stent-graft kink. Conclusions: Kinks of stent-grafts were infrequent events in the intermediate term. Patients most at risk were women with angulated aortic necks treated by a minimally experienced team. Kinks are potentially damaging events because they may lead to delayed device-related endoleaks, graft stenosis, thrombosis, and conversion to open repair. They appear more closely associated to graft migration than to aneurysm diameter reduction.
Endovascular Stent-Graft Repair of a Complicated Penetrating Ulcer of the Descending Thoracic Aorta: A Word of Caution
Authors: D'Ancona Giuseppe , Bauset Richard , Normand Jean-Pierre , Turcotte Roc , Dagenais François 
Published: March 2015

Purpose: To report a pitfall encountered during stenting of a complicated penetrating ulcer of the descending thoracic aorta. Case Report: A 65-year-old man was diagnosed with a complicated penetrating ulcer of the thoracic aorta. A 38-mm Talent endograft was implanted. On balloon dilation of the distal end of the endoprosthesis, the terminal bare stent became distorted and penetrated the aortic wall. A 42-mm endoprosthesis was immediately placed to exclude the aortic perforation. Control aortography demonstrated exclusion of the original proximal aortic ulcer and the distal iatrogenic aortic tear. Conclusions: Endoprostheses may present some drawbacks in terms of elasticity and adaptability to tortuous and angulated diseased aortas. Caution is advised in the treatment of penetrating aortic ulcers where the aortic wall is diffusely friable. In this condition, balloon dilation should be limited to the covered portion of the stent-graft to prevent stent distortion and erosion through the aortic wall.
Endoluminal Repair of a Thoracic Arch Aneurysm Using a Scallop-Edged Stent-Graft
Authors: Kruger Allan J. , Holden Andrew H. , Hill Andrew A. 
Published: March 2015

Purpose: To report a new technique of endoluminal thoracic aortic arch aneurysm repair using a scalloped stent-graft. Case Report: A 79-year-old man presented with a 7.5-cm thoracic aneurysm involving the inner curve of the aortic arch. Endoluminal repair was performed with a scalloped stent-graft that allowed perfusion of the brachiocephalic (innominate) artery. Preliminary extra-anatomical left common carotid and subclavian artery bypass grafting had been performed to allow coverage of the origins of these vessels. Conclusions: The use of fenestrated endoluminal grafts in the aortic arch can be achieved safely and may increase the treatment options for the high-risk patient.
Development of a Branched Stent-Graft for Endovascular Repair of Aortic Arch Aneurysms
Authors: Chuter Timothy A.M. , Buck David G. , Schneider Darren B. , Reilly Linda M. , Messina Louis M. 
Published: March 2015

Purpose: To develop a branched stent-graft for endovascular repair of aortic arch aneurysm. Methods: Four different prototypes of a branched aortic stent-graft were inserted into a rubber model of the human aortic arch under fluoroscopic guidance. Each prototype was tested, modified, and tested again through a series of 4 iterations. The first 3 prototypes had multiple short side branches, as docking sites for extensions into the branches of the aortic arch. The last iteration had only 1 short branch for an extension into the distal aorta and 1 long branch for direct perfusion of the innominate artery. Results: With every re-design, the prototype aortic stent-graft became shorter, and its insertion site moved to a more proximally located arch artery. Stent-graft insertion, orientation, and extension also became quicker and easier with each change in device design. However, the only system to perform reliably was the last, which was subsequently used to treat a large, symptomatic pseudoaneurysm of the aortic arch in a high-risk patient. Conclusions: None of our multibranched systems was simple, safe, or durable enough for insertion into the aortic arch; only an iteration that had a short branch for an extension into the distal aorta and a long branch for direct perfusion of the innominate artery could be deployed without difficulty or delay.