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Sample records for schaffer collateral activation

  1. Reduction of long-term potentiation at Schaffer collateral-CA1 synapses in the rat hippocampus at the acute stage of vestibular compensation

    Science.gov (United States)

    Lee, Gyoung Wan; Kim, Jae Hyo

    2017-01-01

    Vestibular compensation is a recovery process from vestibular symptoms over time after unilateral loss of peripheral vestibular end organs. The aim of the present study was to observe time-dependent changes in long-term potentiation (LTP) at Schaffer collateral-CA1 synapses in the CA1 area of the hippocampus during vestibular compensation. The input-output (I/O) relationships of fEPSP amplitudes and LTP induced by theta burst stimulation to Schaffer's collateral commissural fibers were evaluated from the CA1 area of hippocampal slices at 1 day, 1 week, and 1 month after unilateral labyrinthectomy (UL). The I/O relationships of fEPSPs in the CA1 area was significantly reduced within 1 week post-op and then showed a non-significant reduction at 1 month after UL. Compared with sham-operated animals, there was a significant reduction of LTP induction in the hippocampus at 1 day and 1 week after UL. However, LTP induction levels in the CA1 area of the hippocampus also returned to those of sham-operated animals 1 month following UL. These data suggest that unilateral injury of the peripheral vestibular end organs results in a transient deficit in synaptic plasticity in the CA1 hippocampal area at acute stages of vestibular compensation. PMID:28706456

  2. The temporoammonic input to the hippocampal CA1 region displays distinctly different synaptic plasticity compared to the Schaffer collateral input in vivo: significance for synaptic information processing

    Directory of Open Access Journals (Sweden)

    Ayla eAksoy Aksel

    2013-08-01

    Full Text Available In terms of its sub-regional differentiation, the hippocampal CA1 region receives cortical information directly via the perforant (temporoammonic path (pp-CA1 synapse and indirectly via the tri-synaptic pathway where the last relay station is the Schaffer collateral-CA1 synapse (Sc-CA1 synapse. Research to date on pp-CA1 synapses has been conducted predominantly in vitro and never in awake animals, but these studies hint that information processing at this synapse might be distinct to processing at the Sc-CA1 synapse. Here, we characterized synaptic properties and synaptic plasticity at the pp-CA1 synapse of freely behaving adult rats. We established that field excitatory postsynaptic potentials at the pp-CA1 have longer onset latencies and a shorter time-to-peak compared to the Sc-CA1 synapse. LTP (> 24h was successfully evoked by tetanic afferent stimulation of pp-CA1 synapses. Low frequency stimulation evoked synaptic depression at Sc-CA1 synapses, but did not elicit LTD at pp-CA1 synapses unless the Schaffer collateral afferents to the CA1 region had been severed. Paired-pulse responses also showed significant differences. Our data suggest that synaptic plasticity at the pp-CA1 synapse is distinct from the Sc-CA1 synapse and that this may reflect its specific role in hippocampal information processing.

  3. Potentiation of Schaffer-collateral CA1 synaptic transmission by eEF2K and p38 MAPK mediated mechanisms

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    Weiguang Weng

    2016-10-01

    Full Text Available The elongation factor 2 kinase (eEF2K, likewise known as CaMKIII, has been demonstrated to be involved in antidepressant responses of NMDA receptor antagonists. Even so, it remains open whether direct inhibition of eEF2K without altering up-flow or other signaling pathways affects hippocampal synaptic transmission and neuronal network synchrony. Inhibition of eEF2K by the selective and potent eEF2K inhibitor A-484954 induced a fast pre-synaptically mediated enhancement of synaptic transmission and synchronization of neural network activity. The eEF2K-inhibition mediated potentiation of synaptic transmission of hippocampal CA1 neurons is most notably independent of protein synthesis and does not rely on protein kinase C, protein kinase A or mitogen-activated protein kinase (MAPK /extracellular signal-regulated protein kinase 1/2. Moreover, the strengthening of synaptic transmission in the response to the inhibition of eEF2K was strongly attenuated by the inhibition of p38 MAPK. In addition, we show the involvement of barium-sensitive and more specific the TWIK-related potassium-1 (TREK-1 channels in the eEF2K-inhibition mediated potentiation of synaptic transmission. These findings reveal a novel pathway of eEF2K mediated regulation of hippocampal synaptic transmission. Further research is required to study whether such compounds could be beneficial for the development of mood disorder treatments with a fast-acting antidepressant response.

  4. Temporal expression of extracellular matrix metalloproteinases and tissue plasminogen activator in the development of collateral vessels in the canine model of coronary occlusion.

    Science.gov (United States)

    Tyagi, S C; Kumar, S; Cassatt, S; Parker, J L

    1996-08-01

    Although heart attack is caused by occlusion of a major coronary artery, some patients have occlusion without heart attack because these patients have sufficient collateral circulation to provide an alternate pathway for blood supply to the myocardium at ischemic risk. The growth of new capillary vessels (angiogenesis) and enlargement of preexisting vessels play an important role in the collateral development. We evaluated the hypothesis that extracellular matrix metalloproteinase (MMP) expression is altered in coronary collateral arteries (0.5-1 mm o.d.) isolated from canine hearts 2-4 months after surgical placement of an ameroid occluder around the proximal left circumflex artery (n = 4), during the development of collateral vessels and restructuring new vessels. Histologic studies (hematoxylin and eosin, trichrome, and van Gieson stains) indicated cellular proliferation and increased collagen and elastin content in collateral vessels compared with comparable-sized unoccluded arterial segments of the left anterior descending (LAD) artery. In situ MMP activity of collateral vessels, measured using denatured collagen in the gel matrix, indicated an increase in total MMP activity in the intima of collateral vessels compared with normal LAD vessels. To further identify the type of MMP, tissue homogenates were prepared from collateral and LAD vessels and analyzed by SDS-PAGE zymography. The results suggest induction of gelatinase A and gelatinase B expression in collateral vessels compared with normal LAD tissue, when identical amounts of total protein were loaded onto each lane in the gel. Based on plasminogen-casein zymography, we observed the tissue plasminogen activator level to be increased in collateral vessels. On the basis of immunoblot and mRNA (Northern blot) analyses, we determined that the MMP-1 level was induced in collateral vessels 2 and 4 months after ameroid occlusion. In contrast with MMP-1, the level of TIMP-1 (tissue inhibitor of

  5. Thumb ulnar collateral and radial collateral ligament injuries.

    Science.gov (United States)

    Schroeder, Nicole S; Goldfarb, Charles A

    2015-01-01

    Thumb metacarpophalangeal ulnar and radial collateral ligament injuries occur frequently in the competitive athlete. Collateral ligament integrity is essential to joint stability, pinch strength, and pain-free motion. Acute rupture of the ulnar collateral ligament is due to a sudden radial deviation force on the abducted thumb and is referred to as skier's thumb. An ulnar-directed force causes injury to the radial collateral ligament. The degree of joint instability on clinical examination allows classification of these injuries and guides management. Surgical repair of acute, complete tears results in good outcomes and allows for return to sporting activity. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. A brief etymology of the collateral circulation.

    Science.gov (United States)

    Faber, James E; Chilian, William M; Deindl, Elisabeth; van Royen, Niels; Simons, Michael

    2014-09-01

    It is well known that the protective capacity of the collateral circulation falls short in many individuals with ischemic disease of the heart, brain, and lower extremities. In the past 15 years, opportunities created by molecular and genetic tools, together with disappointing outcomes in many angiogenic trials, have led to a significant increase in the number of studies that focus on: understanding the basic biology of the collateral circulation; identifying the mechanisms that limit the collateral circulation's capacity in many individuals; devising methods to measure collateral extent, which has been found to vary widely among individuals; and developing treatments to increase collateral blood flow in obstructive disease. Unfortunately, accompanying this increase in reports has been a proliferation of vague terms used to describe the disposition and behavior of this unique circulation, as well as the increasing misuse of well-ensconced ones by new (and old) students of collateral circulation. With this in mind, we provide a brief glossary of readily understandable terms to denote the formation, adaptive growth, and maladaptive rarefaction of collateral circulation. We also propose terminology for several newly discovered processes that occur in the collateral circulation. Finally, we include terms used to describe vessels that are sometimes confused with collaterals, as well as terms describing processes active in the general arterial-venous circulation when ischemic conditions engage the collateral circulation. We hope this brief review will help unify the terminology used in collateral research. © 2014 American Heart Association, Inc.

  7. Lateral collateral ligament (image)

    Science.gov (United States)

    The lateral collateral ligament connects the end of the femur (thigh) to the top of the fibula (the thin bone that runs next to the shin bone). The lateral collateral ligament provides stability against varus stress. Varus stress is ...

  8. Pathophysiology of Coronary Collaterals#

    Science.gov (United States)

    Stoller, Michael; Seiler, Christian

    2014-01-01

    While the existence of structural adaptation of coronary anastomoses is undisputed, the potential of coronary collaterals to be capable of functional adaptation has been questioned. For many years, collateral vessels were thought to be rigid tubes allowing only limited blood flow governed by the pressure gradient across them. This concept was consistent with the notion that although collaterals could provide adequate blood flow to maintain resting levels, they would be unable to increase blood flow sufficiently in situations of increased myocardial oxygen demand. However, more recent studies have demonstrated the capability of the collateral circulation to deliver sufficient blood flow even during exertion or pharmacologic stress. Moreover, it has been shown that increases in collateral flow could be attributed directly to collateral vasomotion. This review summarizes the pathophysiology of the coronary collateral circulation, ie the functional adapation of coronary collaterals to acute alterations in the coronary circulation. PMID:23701025

  9. Loan collaterals and collateral substitutes in rural finance: a review ...

    African Journals Online (AJOL)

    The limited availability of conventional collaterals in rural financial markets has led to the acceptance of non-traditional methods of loan security referred to as collateral substitutes. This paper reviews loan collaterals and collateral substitutes in the rural financial markets of developing countries. Keywords:: Collaterals ...

  10. Adequate Access or Equal Treatment: Looking Beyond the IDEA to Section 504 in a Post-"Schaffer" Public School

    Science.gov (United States)

    Walker, Christopher J.

    2006-01-01

    In light of the Supreme Court's decision this Term in "Schaffer v. Weast," this Note analyzes the current state of special education law and argues that parents, attorneys, and advocates should look beyond the Individuals with Disabilities Education Act (IDEA) to Section 504 in the post-"Schaffer" public school. This Note shows…

  11. Alfred Schaffer

    African Journals Online (AJOL)

    Owner

    Zijn op- komst in de voorstad (2000), Dwaalgasten (2002),. Geen hand voor ogen (2004), Schuim (2006) en. Kooi (2008)––word in hierdie keur verteen- woordig, maar streng verteenwoordigend van sy oeuvre is Kom in, dit vries daar buite nie,.

  12. Collateral Intimate Partner Homicide

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    Emily Meyer

    2013-04-01

    Full Text Available Collateral intimate partner homicide (CIPH is an underinvestigated genre of intimate partner violence (IPV where an individual(s connected to the IPV victim is murdered. We conducted a content analysis of a statewide database of CIPH newspaper articles (1990-2007. Out of 111 collateral murder victims, there were 84 IPV female focal victims and 84 male perpetrators. The most frequently reported CIPH decedent was the focal victim’s new partner (30%; 45% of focal victims were themselves killed. News reports framed CIPH as the unexpected result of interpersonal conflict, despite evidence of a systematic pattern of coercion and violence that capitulated in murder.

  13. Selective Modulation of Some Forms of Schaffer Collateral-CA1 Synaptic Plasticity in Mice with a Disruption of the "CPEB-1" Gene

    Science.gov (United States)

    Alarcon, Juan M.; Hodgman, Rebecca; Theis, Martin; Huang, Yi-Shuian; Kandel, Eric R.; Richter, Joel D.

    2004-01-01

    CPEB-1 is a sequence-specific RNA binding protein that stimulates the polyadenylation-induced translation of mRNAs containing the cytoplasmic polyadenylation element (CPE). Although CPEB-1 was identified originally in Xenopus oocytes, it has also been found at postsynaptic sites of hippocampal neurons where, in response to N-methyl-D-aspartate…

  14. Collateralized debt obligations (CDOs

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    Dragosavac Miloš

    2012-01-01

    Full Text Available Collateralized debt obligations (CDOs were issued in 1987 by bankers at Drexel Burnham Lambert Inc. A decade later, CDOs became the leading power on the credit derivative markets, on which the value of derivative assets was derived from the value of other assets. However, unlike options and credit swamps, CDOs are not real, which means that they are constructed, and sometimes even the construction of their construction. CDOs were made to satisfy different types of investors, at one end, there is low-risk with low-income, and at the other, high-risk with high-income. By 2007, following the bubble burst on the US real estate market, losses on the CDO market started to expand. By 2008, the crisis on the CDO market turned into what we call today 'the global financial crisis.' CDOs are 'in the heart' of the crisis, and even wider. Our attempt is to reveal the mechanism of collateralized debt obligations (CDOs and the way in which CDOs expanded the negative effects of the present global financial crisis.

  15. Johanna Schaffer: Ambivalenzen der Sichtbarkeit. Über die visuellen Strukturen der Anerkennung. Bielefeld: transcript Verlag 2008.

    Directory of Open Access Journals (Sweden)

    Tanja Maier

    2010-03-01

    Full Text Available Wie können minorisierte Gruppen sichtbar (gemacht werden, ohne dabei in der Art und Weise ihrer visuellen Darstellung die Minorisierungen zu wiederholen, die sie eigentlich kritisieren wollen? Dies ist die zentrale Frage, die sich durch die vorliegende Arbeit von Johanna Schaffer zieht. Sie bearbeitet den Modus der Sichtbarkeit im Feld der visuellen Kultur unter epistemologischen, politischen und insbesondere ästhetischen Gesichtspunkten. Ihre Einwände gegen naive Vorstellungen, die Sichtbarkeit kausal mit einem Zugewinn an Macht verbinden, entwickelt Schaffer aus einem Zusammenspiel von Bildanalysen mit Theorie- und Begriffsarbeit. Insgesamt ein lesenswertes Buch, das nicht nur theoretisch fundiert ist und interessante Bildlektüren liefert, sondern auch ein (bild-analytisches Instrumentarium an die Hand gibt.How can minority groups be made visible without, however, reproducing the manner in which their minority status is formed, which is what their visual representation, in turn, intends to critique? This is the central question that runs through Johanna Schaffer’s study. She treats modes of visibility in the field of visual culture with respect to epistemology, politics, and especially aesthetics. Schaffer develops objections to naïve conceptions that causally connect visuality with an increase of power by basing her objections on the interplay between image analysis and work with theory and terminology. Overall this is a book worth reading, for it is not only theoretically founded and offers interesting readings of images, but it also equips readers with a set of instruments for (image analysis.

  16. Demonstrating the fibular collateral ligament.

    OpenAIRE

    Pridmore, S A

    1980-01-01

    A posture is described which allows palpation of the fibular collateral ligament of the knee as an isolated structure. Visual identification is also possible. This is of interest to the clinician and student of surface anatomy.

  17. Torn lateral collateral ligament (image)

    Science.gov (United States)

    ... LCL), is an injury to the lateral collateral ligament, a ligament extending from the top-outside surface of the ... the bottom-outside surface of the femur. The ligament prevents the knee joint from side-to-side ( ...

  18. Torn medial collateral ligament (image)

    Science.gov (United States)

    ... MCL), is an injury to the medial collateral ligament. This ligament extends from the upper-inside surface of the ... the bottom-inside surface of the femur. The ligament prevents the knee joint from medial instability, that ...

  19. Dynamics of the Collateral Encyclopedia

    DEFF Research Database (Denmark)

    Thellefsen, Torkild Leo; Sørensen, Bent; Thellefsen, Martin Muderspach

    2015-01-01

    Both Umberto Eco and Charles S. Peirce have been concerned with the notion of background knowledge. Eco refers to background knowledge as the encyclopedia; Peirce’s term of reference is collateral experience. The aim of this article is to investigate the degree to which these two concepts...... are comparable. We focus on one major metaphysical issue, viz. the fact that Eco defines collateral experience, which is the first step in any process of cognition, as private, whereas Peirce, as a realist, would never accept the concept of private thoughts, feelings, etc. We suggest that freeing collateral...... experience from its nominalistic nomenclature makes possible a comparison and synthesis of Eco’s and Peirce’s conceptions when seen from the perspectives of their cognitive type, nuclear type, and molar content....

  20. Sovereign collateral as a Trojan Horse

    DEFF Research Database (Denmark)

    Buschmann, Christian; Schmaltz, Christian

    2017-01-01

    Sovereign bonds are widely used as collateral in banks' funding and trading operations. If a sovereign becomes distressed, the collateral mechanism impairs and banks are suddenly facing significant liquidity calls. Basel III's Liquidity Coverage Ratio (LCR) protects banks against unexpected...

  1. 7 CFR 1779.48 - Collateral.

    Science.gov (United States)

    2010-01-01

    ... (CONTINUED) WATER AND WASTE DISPOSAL PROGRAMS GUARANTEED LOANS § 1779.48 Collateral. (a) Lender responsibility. The lender is responsible for obtaining and maintaining proper and adequate collateral to protect...

  2. 30 CFR 800.21 - Collateral bonds.

    Science.gov (United States)

    2010-07-01

    ... a margin which is the ratio of bond value to market value, as determined by the regulatory authority... value of collateral exceed the market value. (f) Persons with an interest in collateral posted as a bond... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Collateral bonds. 800.21 Section 800.21 Mineral...

  3. Lateral collateral ligament of the elbow joint

    DEFF Research Database (Denmark)

    Olsen, Bo Sanderhoff; Vaesel, M T; Søjbjerg, Jens Ole

    1996-01-01

    The structure and kinematics of the lateral collateral ligament of the elbow joint were investigated in 10 cadaveric specimens. The lateral collateral ligament was observed to be a distinct part of the lateral collateral ligament complex. It contains posterior fibers that pass through the annular...

  4. The dynamics of the coronary collateral circulation.

    Science.gov (United States)

    Zimarino, Marco; D'Andreamatteo, Mariangela; Waksman, Ron; Epstein, Stephen E; De Caterina, Raffaele

    2014-04-01

    Coronary collaterals are present at birth, with wide interindividual variation in their functional capacity. These vessels protect jeopardized myocardium, and the number of collaterals and the extent of their coverage are associated with improved survival in patients with coronary heart disease. The collateral circulation is not a permanent set of structures, but undergoes dynamic changes with important consequences for cardioprotection. If a severe atherosclerotic lesion develops in an artery supplying tissue downstream of a total occlusion through collateral blood flow, pressure gradients across the collateral bed change. The result is that some of the collateral flow previously supplying the perfusion territory of the totally occluded artery is redirected to the perfusion territory of the donor artery, thus producing a 'collateral steal'. The collateral circulation can regress once antegrade flow in the main dependent artery is re-established, as occurs following the recanalization of a chronic total occlusion. The clinical benefits of coronary revascularization must be cautiously weighed against the risk of reducing the protective support derived from coronary collaterals. Consequently, pharmacological, gene-based, and cell-based therapeutic attempts have been made to enhance collateral function. Although such approaches have so far yielded no, or modest, beneficial results, the rapidly accruing data on coronary collateral circulation will hopefully lead to new effective therapeutic strategies.

  5. Coordinated activation of distinct Ca2+ sources and metabotropic glutamate receptors encodes Hebbian synaptic plasticity

    Science.gov (United States)

    Tigaret, Cezar M.; Olivo, Valeria; Sadowski, Josef H.L.P.; Ashby, Michael C.; Mellor, Jack R.

    2016-01-01

    At glutamatergic synapses, induction of associative synaptic plasticity requires time-correlated presynaptic and postsynaptic spikes to activate postsynaptic NMDA receptors (NMDARs). The magnitudes of the ensuing Ca2+ transients within dendritic spines are thought to determine the amplitude and direction of synaptic change. In contrast, we show that at mature hippocampal Schaffer collateral synapses the magnitudes of Ca2+ transients during plasticity induction do not match this rule. Indeed, LTP induced by time-correlated pre- and postsynaptic spikes instead requires the sequential activation of NMDARs followed by voltage-sensitive Ca2+ channels within dendritic spines. Furthermore, LTP requires inhibition of SK channels by mGluR1, which removes a negative feedback loop that constitutively regulates NMDARs. Therefore, rather than being controlled simply by the magnitude of the postsynaptic calcium rise, LTP induction requires the coordinated activation of distinct sources of Ca2+ and mGluR1-dependent facilitation of NMDAR function. PMID:26758963

  6. Seizure-like activity disrupts LTP in vitro.

    Science.gov (United States)

    Moore, S D; Barr, D S; Wilson, W A

    1993-11-26

    Amnesia is one of the most common consequences of seizures. We modelled this phenomenon in the in vitro hippocampal slice preparation by examining effects of seizure-like activity on long-term potentiation (LTP). LTP is an expression of neuronal plasticity which has been correlated with learning. Electrographic seizures (EGSs) were induced in area CA1 by electrical stimulation of CA3. Trains of tetanic stimuli were then immediately delivered to the Schaffer collateral-CA1 pathway in order to induce LTP. The subsequent LTP in these test slices was significantly lower in magnitude compared to LTP in control slices (with no EGSs). LTP could be successfully induced in test slices 1 h after the EGS. EGSs alone produced no long-lasting effect on baseline responses. These results indicate that the hippocampal slice preparation may serve as a model system in which to study the mechanisms by which seizures can disrupt neuronal plasticity.

  7. Asymmetric dimethylarginine and coronary collateral vessel development.

    Science.gov (United States)

    Kocaman, Sinan Altan; Sahinarslan, Asife; Biberoglu, Gursel; Hasanoglu, Alev; Akyel, Ahmet; Timurkaynak, Timur; Cengel, Atiye

    2008-11-01

    Nitric oxide (NO) plays a major role in collateral vessel development. Asymmetric dimethylarginine (ADMA) that is an endogenous inhibitor of NO synthesis may impair the effective coronary collateral vessel development. The aim of this study was to evaluate the relationship between plasma ADMA level and coronary collateral vessel development. The patients with a greater than or equal to 95% obstruction in at least one epicardial coronary artery were included in the study. Degree of coronary collateral development was determined according to Rentrop method. Patients with grade 2-3 collateral development were regarded as good collateral group and formed group I. The patients with grade 0-1 collateral development were regarded as poor collateral group and were included in group II. Group III that had been formed as a control group included the patients with a normal coronary angiogram. We compared the plasma ADMA, symmetric dimethylarginine, L-arginine/ADMA ratio among three groups. Seventy-four patients have been included in the study. Patients with good collateral development had lower plasma ADMA level in comparison with patients with poor collateral development (0.41+/-0.25 micromol/l vs. 0.70+/-0.23 micromol/l, P=0.001) and had similar plasma ADMA levels with the patients who have normal coronary arteries. When we compared L-arginine/ADMA ratio between good and poor collateral groups, we found that the patients with higher L-arginine/ADMA ratio have significantly better collateral development (270.8+/-168.0 vs. 120.9+/-92.1, P<0.001). In the analyses comparing Rentrop score with ADMA level and L-arginine/ADMA ratio, there were significant correlations (r=-0.444, P=0.008 and r=0.553, P=0.001, respectively). In multivariate analysis, ADMA level (odds ratio, 0.009; 95% confidence interval, 0.000-0.466, P=0.020) and L-arginine/ADMA ratio (odds ratio, 1.010; 95% confidence interval, 1.001-1.020, P=0.032) were independent predictors of collateral development. Increased

  8. Multiple coil closure of isolated aortopulmonary collateral

    Directory of Open Access Journals (Sweden)

    Padhi Sumanta

    2010-01-01

    Full Text Available A 7-month-old girl was diagnosed to have large aortopulmonary collateral during evaluation for congestive heart failure. There was no other evidence of cardiopulmonary disease. The collateral was successfully closed with multiple coils delivered sequentially. We describe the issues associated during closure of the aortopulmonary collateral in this case. To the best of our knowledge, this is the first reported case of large aortopulmonary collateral presenting with heart failure in an otherwise structurally normal heart that was closed successfully with multiple coils delivered sequentially.

  9. Mesenteric stenosis, collaterals, and compensatory blood flow

    NARCIS (Netherlands)

    van Petersen, Andre S.; Kolkman, Jeroen J.; Meerwaldt, Robbert; Huisman, Ad B.; van der Palen, Jacobus Adrianus Maria; Zeebregts, Clark J.; Geelkerken, Robert H.

    2014-01-01

    Background The mesenteric circulation has an extensive collateral network. Therefore, stenosis in one or more mesenteric arteries does not necessarily lead to symptoms. The objective of this study was to determine the effect of collateral flow on celiac artery (CA) and superior mesenteric artery

  10. 13 CFR 120.343 - Collateral.

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Collateral. 120.343 Section 120.343 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Special Purpose Loans... letters of credit). Collateral must be located in the United States, its territories or possessions. ...

  11. Mesenteric stenosis, collaterals, and compensatory blood flow

    NARCIS (Netherlands)

    van Petersen, Andre S.; Kolkman, Jeroen J.; Meerwaldt, Robbert; Huisman, Ad B.; van der Palen, Job; Zeebregts, Clark J.; Geelkerken, Robert H.

    Background: The mesenteric circulation has an extensive collateral network. Therefore, stenosis in one or more mesenteric arteries does not necessarily lead to symptoms. The objective of this study was to determine the effect of collateral flow on celiac artery (CA) and superior mesenteric artery

  12. Mapping of contributions from collateral ligaments to overall knee joint constraint: an experimental cadaveric study.

    Science.gov (United States)

    Cyr, Adam J; Shalhoub, Sami S; Fitzwater, Fallon G; Ferris, Lauren A; Maletsky, Lorin P

    2015-06-01

    Understanding the contribution of the soft-tissues to total joint constraint (TJC) is important for predicting joint kinematics, developing surgical procedures, and increasing accuracy of computational models. Previous studies on the collateral ligaments have focused on quantifying strain and tension properties under discrete loads or kinematic paths; however, there has been little work to quantify collateral ligament contribution over a broad range of applied loads and range of motion (ROM) in passive constraint. To accomplish this, passive envelopes were collected from nine cadaveric knees instrumented with implantable pressure transducers (IPT) in the collateral ligaments. The contributions from medial and lateral collateral ligaments (LCL) were quantified by the relative contribution of each structure at various flexion angles (0-120 deg) and compound external loads (±10 N m valgus, ±8 N m external, and ±40 N anterior). Average medial collateral ligament (MCL) contributions were highest under external and valgus torques from 60 deg to 120 deg flexion. The MCL showed significant contributions to TJC under external torques throughout the flexion range. Average LCL contributions were highest from 0 deg to 60 deg flexion under external and varus torques, as well as internal torques from 60 deg to 110 deg flexion. Similarly, these regions were found to have statistically significant LCL contributions. Anterior and posterior loads generally reduced collateral contribution to TJC; however, posterior loads further reduced MCL contribution, while anterior loads further reduced LCL contribution. These results provide insight to the functional role of the collaterals over a broad range of passive constraint. Developing a map of collateral ligament contribution to TJC may be used to identify the effects of injury or surgical intervention on soft-tissue, and how collateral ligament contributions to constraint correlate with activities of daily living.

  13. Understanding Collateral Evolution in Linux Device Drivers

    DEFF Research Database (Denmark)

    Padioleau, Yoann; Lawall, Julia Laetitia; Muller, Gilles

    2006-01-01

    In a modern operating system (OS), device drivers can make up over 70% of the source code. Driver code is also heavily dependent on the rest of the OS, for functions and data structures defined in the kernel and driver support libraries. These properties pose a significant problem for OS evolution......, as any changes in the interfaces exported by the kernel and driver support libraries can trigger a large number of adjustments in dependent drivers. These adjustments, which we refer to as collateral evolutions, may be complex, entailing substantial code reorganizations. As to our knowledge there exist...... no tools to help in this process, collateral evolution is thus time consuming and error prone.In this paper, we present a qualitative and quantitative assessment of collateral evolution in Linux device driver code. We provide a taxonomy of evolutions and collateral evolutions, and use an automated patch...

  14. The collateral circulation of the heart

    Science.gov (United States)

    2013-01-01

    The coronary arteries have been regarded as end arteries for decades. However, there are functionally relevant anastomotic vessels, known as collateral arteries, which interconnect epicardial coronary arteries. These vessels provide an alternative source of blood supply to the myocardium in cases of occlusive coronary artery disease. The relevance of these collateral arteries is a matter of ongoing debate, but increasing evidence indicates a relevant protective role in patients with coronary artery disease. The collateral circulation can be assessed by different methods; the gold standard involves intracoronary pressure measurements. While the first clinical trials to therapeutically induce growth of collateral arteries have been unavailing, recent pilot studies using external counterpulsation or growth factors such as granulocyte colony stimulating factor (G-CSF) have shown promising results. PMID:23735225

  15. How isometric are the medial patellofemoral, superficial medial collateral, and lateral collateral ligaments of the knee?

    Science.gov (United States)

    Victor, Jan; Wong, Pius; Witvrouw, Eric; Sloten, Jos Vander; Bellemans, Johan

    2009-10-01

    Ligament isometry is a cornerstone in the description of normal knee function and thorough knowledge is mandatory for successful repair of torn ligaments. This study was undertaken to validate a novel experimental model for the study of ligament strains and to determine the length changes in the superficial medial collateral, lateral collateral, and medial patellofemoral ligaments. Descriptive laboratory study. Passive motions and loaded squats of 12 cadaveric specimens were performed while controlling ankle load and optically tracking the motion of the bones. Preexperiment and postexperiment computed axial tomography scans allow the transformation of rigid body motion to relative motion of relevant anatomic landmarks on the femur, tibia, and patella. The superficial medial collateral ligament is a near-isometric ligament with a strain of less than 2%. The ligament is a little more slack in midflexion (30 degrees to 50 degrees ) and in deep flexion, but length changes are not significant (P > .05). The lateral collateral ligament behaves near isometric (tension from the collateral ligaments (P superficial medial collateral ligament is a near-isometric ligament with no significant length changes. The medial patellofemoral ligament behaves differently in its cranial and caudal parts. In knees with chronic medial collateral ligament insufficiency, isometric repair of the superficial medial collateral ligament can be attempted. A medial patellofemoral ligament reconstruction with a double fixation on the medial patellar border is supported. The cranial bundle should be tightened at full extension and the caudal bundle at 30 degrees of knee flexion.

  16. The PLAU P141L single nucleotide polymorphism is associated with collateral circulation in patients with coronary artery disease.

    Science.gov (United States)

    Duran, Joan; Sánchez-Olavarría, Pilar; Mola, Marina; Götzens, Víctor; Carballo, Julio; Martín-Pelegrina, Eva; Petit, Màrius; García Del Blanco, Bruno; García-Dorado, David; de Anta, Josep M

    2014-07-01

    Urokinase-type plasminogen activator, which is encoded by the PLAU gene, plays a prominent role during collateral arterial growth. We investigated whether the PLAU P141L (C > T) polymorphism, which causes a mutation in the kringle domain of the protein, is associated with coronary collateral circulation in a cohort of 676 patients with coronary artery disease. The polymorphism was genotyped in blood samples using a TaqMan-based genotyping assay, and collateral circulation was assessed by the Rentrop method. Multivariate logistic regression models adjusted by clinically relevant variables to estimate odds ratios were used to examine associations of PLAU P141L allelic variants and genotypes with collateral circulation. Patients with poor collateral circulation (Rentrop 0-1; n = 547) showed a higher frequency of the TT genotype than those with good collateral circulation (Rentrop 2-3; n = 129; P = .020). The T allele variant was also more common in patients with poor collateral circulation (P = .006). The odds ratio of having poorly developed collaterals in patients bearing the T allele (adjusted for clinically relevant variables) was statistically significant under the dominant model (odds ratio = 1.83 [95% confidence interval, 1.16-2.90]; P = .010) and the additive model (odds ratio = 1.73 [95% confidence interval, 1.14-2.62]; P = .009). An association was found between coronary collateral circulation and the PLAU P141L polymorphism. Patients with the 141L variant are at greater risk of developing poor coronary collateral circulation. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  17. Existence of collateral Equilibrium without survival assumption

    Directory of Open Access Journals (Sweden)

    Jaime Orrillo

    2011-03-01

    Full Text Available This paper shows the existence of a collateral equilibrium without assuming any hypotheses on the strict positivity, be they individual initial endowments, including the ex post initial endowments, or aggregated initial endowments. Because of dropping the strict positivity of social initial endowment we fail to get an equilibrium. Instead, we get a quasi-equilibrium. Then, appealing to the concept of irreducibility (introduced by McKenzie in 1959 which is adapted to the collateral model, we show that the quasi-equilibrium is indeed a legitime equilibrium.

  18. 26 CFR 403.29 - Deposit of collateral.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Deposit of collateral. 403.29 Section 403.29... ADMINISTRATION DISPOSITION OF SEIZED PERSONAL PROPERTY Seizures and Forfeitures § 403.29 Deposit of collateral... principal by the United States, may be pledged and deposited by claimants as collateral security in lieu of...

  19. 27 CFR 24.151 - Deposit of collateral security.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Deposit of collateral... § 24.151 Deposit of collateral security. (a) Bonds or notes of the United States, or other obligations... pledged and deposited as collateral security in lieu of corporate sureties in accordance with the...

  20. 46 CFR 308.509 - Collateral deposit fund.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Collateral deposit fund. 308.509 Section 308.509... Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.509 Collateral deposit fund. (a) Requirements. An assured electing to use a cash collateral deposit fund pursuant to § 308.507 shall comply with...

  1. 27 CFR 72.25 - Deposit of collateral.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Deposit of collateral. 72... Seizures and Forfeitures § 72.25 Deposit of collateral. (a) Bonds or notes of the United States, or other... be pledged and deposited by claimants as collateral security in lieu of corporate sureties in...

  2. Trade credit, collateral liquidation and borrowing constraints

    NARCIS (Netherlands)

    Fabbri, D.; Menichini, A.M.C.

    2009-01-01

    The paper proposes a model of collateralized bank and trade credit. Firms use a two-input technology. Assuming that the supplier is better able to extract value from existing assets and has an information advantage over other creditors, the paper derives a series of predictions. (1) Financially

  3. 28 CFR 104.47 - Collateral sources.

    Science.gov (United States)

    2010-07-01

    ... compensation, including life insurance, pension funds, death benefits programs, and payments by Federal, State... determining the appropriate value of offsets for pension funds, life insurance and similar collateral sources... Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) SEPTEMBER 11TH VICTIM COMPENSATION FUND OF 2001...

  4. Debt capacity of real estate collateral

    NARCIS (Netherlands)

    Giambona, E.; Golec, J.; Schwienbacher, A.

    2014-01-01

    We study whether real estate assets have a greater positive influence on firm leverage than other tangible assets. Using a large sample of COMPUSTAT firms, we find a significant positive relation between tangibility and leverage in general, and the relation is strongest for real estate collateral.

  5. Collateral Learning and Mathematical Education of Teachers

    Science.gov (United States)

    Abramovich, Sergei

    2012-01-01

    This article explores the notion of collateral learning in the context of classic ideas about the summation of powers of the first "n" counting numbers. Proceeding from the well-known legend about young Gauss, this article demonstrates the value of reflection under the guidance of "the more knowledgeable other" as a pedagogical method of making…

  6. 31 CFR 202.6 - Collateral security.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Collateral security. 202.6 Section 202.6 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE... section to the Federal Reserve Bank of the district, as fiscal agent of the United States, and in any...

  7. Kölliker–Fuse neurons send collateral projections to multiple hypoxia-activated and nonactivated structures in rat brainstem and spinal cord.

    Science.gov (United States)

    Song, Gang; Wang, Hui; Xu, Hui; Poon, Chi-Sang

    2012-10-01

    The Kölliker–Fuse nucleus (KFN) in dorsolateral pons has been implicated in many physiological functions via its extensive efferent connections. Here, we combine iontophoretic anterograde tracing with posthypoxia c-Fos immunohistology to map KFN axonal terminations among hypoxia-activated/nonactivated brain stem and spinal structures in rats. Using a set of stringent inclusion/exclusion criteria to align visualized axons across multiple coronal brain sections, we were able to unequivocally trace axonal trajectories over a long rostrocaudal distance perpendicular to the coronal plane. Structures that were both richly innervated by KFN axonal projections and immunopositive to c-Fos included KFN (contralateral side), ventrolateral pontine area, areas ventral to rostral compact/subcompact ambiguus nucleus, caudal (lateral) ambiguus nucleus, nucleus retroambiguus, and commissural–medial subdivisions of solitary tract nucleus. The intertrigeminal nucleus, facial and hypoglossal nuclei, retrotrapezoid nucleus, parafacial region and spinal cord segment 5 were also richly innervated by KFN axonal projections but were only weakly (or not) immunopositive to c-Fos. The most striking finding was that some descending axons from KFN sent out branches to innervate multiple (up to seven) pontomedullary target structures including facial nucleus, trigeminal sensory nucleus, and various parts of ambiguus nucleus and its surrounding areas. The extensive axonal fan-out from single KFN neurons to multiple brainstem and spinal cord structures("one-to-many relationship"’) provides anatomical evidence that KFN may coordinate diverse physiological functions including hypoxic and hypercapnic respiratory responses, respiratory pattern generation and motor output,diving reflex, modulation of upper airways patency,coughing and vomiting abdominal expiratory reflex, as well as cardiovascular regulation and cardiorespiratory coupling.

  8. Collateral effects of antiarrhythmics in pediatric age.

    Science.gov (United States)

    Ali, K M Sulafa

    2008-01-01

    Although there are numerous reports of antiarrhythmic use in children, controlled, comparison trials of antiarrhythmic agents in children are virtually nonexistent and most data are obtained from case series of children treated. Effective and safe pharmacological therapy requires that the physicians attempt to identify a drug with the most appropriate profile to attack the most vulnerable parameter of the mechanisms of the cardiac arrhythmia with the least pro arrhythmic/collateral effects. Digoxin in patients with Wolf-Parkinson -White syndrome, verapamil in infants and intravenous quinidine should be avoided as there is clear evidence that they can cause serious side effects. Collateral effects of other antiarrhythmic drugs are discussed in details in this review. Well-designed, controlled trials are needed to further evaluate the comparative efficacy of antiarrhythmics in children, as well as to evaluate dosing and toxicity in various age groups.

  9. Acquired portosystemic collaterals: anatomy and imaging

    Energy Technology Data Exchange (ETDEWEB)

    Leite, Andrea Farias de Melo; Mota Junior, Americo, E-mail: andreafariasm@gmail.com [Instituto de Medicina Integral Professor Fernando Figueira de Pernambuco (IMIP), Recife, PE (Brazil); Chagas-Neto, Francisco Abaete [Universidade de Fortaleza (UNIFOR), Fortaleza, CE (Brazil); Teixeira, Sara Reis; Elias Junior, Jorge; Muglia, Valdair Francisco [Universidade de Sao Paulo (FMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina

    2016-07-15

    Portosystemic shunts are enlarged vessels that form collateral pathological pathways between the splanchnic circulation and the systemic circulation. Although their causes are multifactorial, portosystemic shunts all have one mechanism in common - increased portal venous pressure, which diverts the blood flow from the gastrointestinal tract to the systemic circulation. Congenital and acquired collateral pathways have both been described in the literature. The aim of this pictorial essay was to discuss the distinct anatomic and imaging features of portosystemic shunts, as well as to provide a robust method of differentiating between acquired portosystemic shunts and similar pathologies, through the use of illustrations and schematic drawings. Imaging of portosystemic shunts provides subclinical markers of increased portal venous pressure. Therefore, radiologists play a crucial role in the identification of portosystemic shunts. Early detection of portosystemic shunts can allow ample time to perform endovascular shunt operations, which can relieve portal hypertension and prevent acute or chronic complications in at-risk patient populations. (author)

  10. Collateral artery pathways of the femoral and popliteal artery.

    Science.gov (United States)

    Kruse, Rombout R; Doomernik, Denise E; Maltha, Kasper V; Kooloos, Jan G M; Kozicz, Tamas L; Reijnen, Michel M P J

    2017-05-01

    The role of collateral artery circulation in the lower limb is under debate but clinically relevant, particularly when using covered stents for occlusive disease. Covered stents seem to outperform nitinol stents in extensive disease, but collaterals could be essential in case of acute thrombosis. In the present study, we describe the collateral pathways of the deep and superficial femoral artery (DFA, SFA) and the popliteal artery (PA), observed in human cadavers. Ten fresh frozen cadaver legs were selected. The SFA and DFA were separately cannulated and injected with a different colored latex mixture simultaneously. After curing of the latex, the circulation was dissected thus visualizing the main arteries and their collateral vessels. The process was photographed and recorded, and collateral pathways were analyzed using a standardized vessel segmentation. The upper leg was divided in three regions, that is, the femoral triangle (F), the adductor canal (H), and the popliteal fossa (P) that, in turn, were split in three segments (1, 2, and 3, from proximal to distal). Overall, 113 collateral vessels were found; 69 originated from the DFA, 34 from the SFA, and 10 from the PA. The majority of collaterals originating from the DFA terminated in the SFA (57%). Fifty-six of 113 collaterals (50%) ended in either the distal adductor channel (H3) or the proximal PA (P1). Another 28 collateral arteries (25%) had their origin in this segment (H3, P1) and mostly connected to the P2 and P3 segments. Forty-three collaterals of the DFA and H3 segment had a direct or indirect connection to below the knee muscles. The majority of collaterals originate from the DFA, and the greater part of all collaterals has a connection with the H3-P1 segment. This observation may have clinical implications in the planning of endovascular procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. The human coronary collateral circulation: development and clinical importance.

    Science.gov (United States)

    Seiler, Christian; Stoller, Michael; Pitt, Bertram; Meier, Pascal

    2013-09-01

    Coronary collaterals are an alternative source of blood supply to myocardium jeopardized by ischaemia. In comparison with other species, the human coronary collateral circulation is very well developed. Among individuals without coronary artery disease (CAD), there are preformed collateral arteries preventing myocardial ischaemia during a brief vascular occlusion in 20-25%. Determinants of such anastomoses are low heart rate and the absence of systemic arterial hypertension. In patients with CAD, collateral arteries preventing myocardial ischaemia during a brief occlusion are present in every third individual. Collateral flow sufficient to prevent myocardial ischaemia during coronary occlusion amounts to one-fifth to one-fourth the normal flow through the open vessel. Myocardial infarct size, the most important prognostic determinant after such an event, is the product of coronary artery occlusion time, area at risk for infarction, and the inverse of collateral supply. Well-developed coronary collateral arteries in patients with CAD mitigate myocardial infarcts and improve survival. Approximately one-fifth of patients with CAD cannot be revascularized by percutaneous coronary intervention or coronary artery bypass grafting. Therapeutic promotion of collateral growth is a valuable treatment strategy in those patients. It should aim at growth of large conductive collateral arteries (arteriogenesis). Potential arteriogenic approaches include the treatment with granulocyte colony-stimulating factor, physical exercise training, and external counterpulsation.

  12. PRINSIP 6C (CHARACTER, CAPACITY, CAPITAL, CONDITION OF ECONOMY, COLLATERAL DAN CONSTRAINT DALAM WIRAUSAHA MAHASISWA

    Directory of Open Access Journals (Sweden)

    Henny Sri Astuty

    2015-04-01

    Full Text Available Abstrak: Prinsip 6C (Character, Capacity, Capital, Condition of Economy, Collateral dan Constraint dalam Wirausaha Mahasiswa. Kegiatan wirausaha yang sekarang banyak dilakukan oleh mahasiswa memiliki sisi positif maupun negatif, dari yang berhasil kuliah dan wirausahanya hingga yang gagal semuanya. Untuk ini diperlukan pemahaman tentang prinsip enam C (character, capacity, capital, condition of economy, collateral and constraint yang akan membantu mahasiswa sebagai bekal dalam melakukan kegiatan usahanya. Banyak faktor yang diperoleh dalam prinsip ini yaitu aspek manajemen, pemasaran, produksi, dan keuangan. Kata Kunci: prinsip 6c, wirausaha, mahasiswa Abstract: 6C Principles (Character, Capacity, Capital, Condition of Economy, Collateral and Constraint in Entrepreneurial Students. Entrepreneurial activity that is widely performed by students has two different stories. Some of them are successful on the other hand, the rest of them are fail. Accordingly, it is required an understanding of the 6C principles of the six C (character, capacity, capital, condition of economy, collateral and constraints which will help the students as a preparation in conducting their business activities. Many factors obtained in this principle namely: management, marketing, production, and financial aspects. Keywords: 6C principles, entrepreneurs, students

  13. Mortgage Finance and Security of Collateral

    DEFF Research Database (Denmark)

    Haldrup, Karin

    2011-01-01

    Developing economies face a gigantic lack of financing for urbanization due to the absence of formal and transparent property markets. The paper discuss the interference between mortgage finance and collateral security by using the Danish mortgage financing model as an example, because of its 200...... years long history, and because the system is recommended as an option in emerging markets and as a possible model for remedying failures in mature housing finance markets. It is suggested that development policies in land administration need to be revised in order to support a widening of credit...

  14. Transvenous closure of large aortopulmonary collateral

    Directory of Open Access Journals (Sweden)

    Parag W Barwad

    2014-01-01

    Full Text Available Aortopulmonary collaterals (APCs are occluded either preoperatively or at the time of cardiac surgery in patients with pulmonary atresia and ventricular septal defect (PAVSD. If left untreated, APCs are an important cause of deterioration in the early postoperative period. We present here an unusual case with a large residual APC causing refractory low-output state in the early postoperative period. Usual arterial approach failed due to extensive angulation with ostial narrowing. The large residual APC was successfully closed with an Amplatzer duct occluder (ADO device delivered through the transvenous route.

  15. The relationship of serum erythropoietin level with coronary collateral grade.

    Science.gov (United States)

    Sahinarslan, Asife; Yalcin, Ridvan; Kocaman, Sinan Altan; Ercin, Ugur; Tanalp, Ali Cevat; Topal, Salih; Bukan, Neslihan; Boyaci, Bulent; Cengel, Atiye

    2011-01-01

    Erythropoietin has been shown to induce neovascularization and protect against ischemic vascular injury. We investigated whether a higher serum erythropoietin (EPO) level is related to better coronary collateral vessel grade. Ninety-nine patients with stable angina pectoris who have at least 1 coronary stenosis of equal to or greater than 70% at coronary angiography were prospectively enrolled. Serum EPO and vascular endothelial growth factor (VEGF) levels were studied. Coronary collateral degree was graded according to the Rentrop method. Patients with grade 2-3 collateral degree were included in the good collateral group and formed Group I. The patients with grade 0-1 collateral degree were included in the poor collateral group and formed Group II. The serum EPO level was significantly higher in the good collateral group (17.3 ± 9.3 mU/mL vs 11.7 ± 5.0 mU/mL; P < 0.001). There was also a positive correlation between serum EPO level and Rentrop score (r = 0.39; P < 0.001). In multivariate analysis, serum EPO level (odds ratio [OR] 1.336; 95% confidence interval [CI], 1.120-1.593; P = 0.001), oxygen saturation (OR 0.638; 95% CI, 0.422-0.963; P = 0.033) and presence of chronic total occlusion (CTO) (OR 26.7; 95% CI, 3.874-184.6; P = 0.001) were independently related to well-developed coronary collaterals. Higher serum EPO level is related to better coronary collateral development. Erythropoietin may have a positive effect on the development of collaterals and may provide a new agent for the treatment strategies to enhance coronary collateral vessel development. Copyright © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  16. Factors affecting agreement between alcohol abusers' and their collaterals' reports.

    Science.gov (United States)

    Sobell, L C; Agrawal, S; Sobell, M B

    1997-07-01

    Because of their low cost and ease of use, collaterals' reports are the most frequent source of independent corroboration with alcohol abusers' self-reports of drinking and related events. Although several reviews have shown that we can have confidence in the accuracy of alcohol abusers' reports of their drinking and in the use of collateral reports as an independent validity criterion, neither data source is error free. This study examined factors that influence the level of agreement between collaterals' and alcohol abusers' reports. Using data from a study of natural recoveries from alcohol-related problems, this study examined how agreement between 120 alcohol abusers' (79.2% male) and their collaterals' reports varied as a function of collateral type and of the collaterals' ratings of their confidence in the accuracy of their reports of the subjects' drinking and related behaviors. Collaterals' awareness of nonalcohol-related levels was also examined. The best agreement occurred for reports from alcohol abusers' spouses who were fairly confident about the information provided. For all variables, some proportion of collaterals respond to demand characteristics of the interview by providing very specific information about subjects' behavior yet admit to being unsure of this information. Collaterals who are fairly sure of the information they provide are the preferred informants to corroborate alcohol abusers' reports of drinking and related behaviors. In some cases the best collaterals are spouses who are fairly sue of the information they reported. It is also recommended that treatment outcome studies should accept reports only from collaterals who are confident about the information they report.

  17. Dopamine D2 Receptors Regulate Collateral Inhibition between Striatal Medium Spiny Neurons

    Science.gov (United States)

    van der Goes, Marie-Sophie; Partridge, John G.; Vicini, Stefano

    2013-01-01

    The principle neurons of the striatum are GABAergic medium spiny neurons (MSNs), whose collateral synapses onto neighboring neurons play critical roles in striatal function. MSNs can be divided by dopamine receptor expression into D1-class and D2-class MSNs, and alterations in D2 MSNs are associated with various pathological states. Despite overwhelming evidence for D2 receptors (D2Rs) in maintaining proper striatal function, it remains unclear how MSN collaterals are specifically altered by D2R activation. Here, we report that chronic D2R stimulation regulates MSN collaterals in vitro by presynaptic and postsynaptic mechanisms. We used corticostriatal cultures from mice in which MSN subtypes were distinguished by fluorophore expression. Quinpirole, an agonist for D2/3 receptors, was used to chronically activate D2Rs. Quinpirole increased the rate and strength of collateral formation onto D2R-containing MSNs as measured by dual whole-cell patch-clamp recordings. Additionally, these neurons were more sensitive to low concentrations of GABA and exhibited an increase in gephyrin puncta density, suggesting increased postsynaptic GABAA receptors. Last, quinpirole treatment increased presynaptic GABA release sites, as shown by increased frequency of sIPSCs and mIPSCs, correlating with increased VGAT (vesicular GABA transporter) puncta. Combined with the observation that there were no detectable differences in sensitivity to specific GABAA receptor modulators, we provide evidence that D2R activation powerfully transforms MSN collaterals via coordinated presynaptic and postsynaptic alterations. As the D2 class of MSNs is highly implicated in Parkinson's disease and other neurological disorders, our findings may contribute to understanding and treating the changes that occur in these pathological states. PMID:23986243

  18. Functional Enabling and Physiotherapeutic Treatment of Sportsmen after Injuring Collateral Ligaments of Knee Joint

    Directory of Open Access Journals (Sweden)

    Vukosav Joksimović

    2007-05-01

    Full Text Available Ligamental compound of knee joint represents in mechanical terms, the most complex joint ligamental concatenation. According to seriousness and occurrence of damage, injuries of collateral ligaments can be divided into three degrees. Aim of paper was monitoring and evaluation of results of physiotherapeutic treatment in sportsmen with collateral ligaments injury (CLs of knee joint. The paper comprises 54 sportsmen over the period of four years aged from 16 to 32. Results of paper: 40% (74% injured collateral ligaments while playing game, during football game and 14 (26% while training, 43 (79,6% had collateral ligament injuries of right leg and 11 (20,4% of left leg. In 20( 37% it was a fi rst (1 st degree injury, in 26(48,1 % - second (2nd degree and in 8 (14% third (3rd degree injury. Treatment was conducted over three phases: fi rst - the phase of immobilization ( 2- 6 weeks with K.T.H. of free extremities. Second - the phase of removing immobilization, cryo T.h in combination with available electro- procedures. Third phase was enabling for high- risk physical activities. Results of paper have been classifi ed into four groups: excellent result was observed in 41 ( 76% sportsmen, good in 6 (11 % and satisfactory in 2( 3,8%. Conclusion: Illustrated results obtained on the basis of functional research and after completed rehabilitation allow us to recommend this rehabilitation program as on of the most effi cient ways in treatment of such serious injuries.

  19. Collateral artery pathways of the femoral and popliteal artery

    NARCIS (Netherlands)

    Kruse, R.R.; Doomernik, D.E.; Maltha, K.V.; Kooloos, J.G.M.; Kozicz, T.; Reijnen, M.

    2017-01-01

    BACKGROUND: The role of collateral artery circulation in the lower limb is under debate but clinically relevant, particularly when using covered stents for occlusive disease. Covered stents seem to outperform nitinol stents in extensive disease, but collaterals could be essential in case of acute

  20. Exercise promotes collateral artery growth mediated by monocytic nitric oxide.

    Science.gov (United States)

    Schirmer, Stephan H; Millenaar, Dominic N; Werner, Christian; Schuh, Lisa; Degen, Achim; Bettink, Stephanie I; Lipp, Peter; van Rooijen, Nico; Meyer, Tim; Böhm, Michael; Laufs, Ulrich

    2015-08-01

    Collateral artery growth (arteriogenesis) is an important adaptive response to hampered arterial perfusion. It is unknown whether preventive physical exercise before limb ischemia can improve arteriogenesis and modulate mononuclear cell function. This study aimed at investigating the effects of endurance exercise before arterial occlusion on MNC function and collateral artery growth. After 3 weeks of voluntary treadmill exercise, ligation of the right femoral artery was performed in mice. Hindlimb perfusion immediately after surgery did not differ from sedentary mice. However, previous exercise improved perfusion restoration ≤7 days after femoral artery ligation, also when exercise was stopped at ligation. This was accompanied by an accumulation of peri-collateral macrophages and increased expression of endothelial nitric oxide synthase and inducible nitric oxide synthase (iNOS) in hindlimb collateral and in MNC of blood and spleen. Systemic monocyte and macrophage depletion by liposomal clodronate but not splenectomy attenuated exercise-induced perfusion restoration, collateral artery growth, peri-collateral macrophage accumulation, and upregulation of iNOS. iNOS-deficient mice did not show exercise-induced perfusion restoration. Transplantation of bone marrow-derived MNC from iNOS-deficient mice into wild-type animals inhibited exercise-induced collateral artery growth. In contrast to sedentary controls, thrice weekly aerobic exercise training for 6 months in humans increased peripheral blood MNC iNOS expression. Circulating mononuclear cell-derived inducible nitric oxide is an important mediator of exercise-induced collateral artery growth. © 2015 American Heart Association, Inc.

  1. 27 CFR 17.104 - Deposit of collateral.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Deposit of collateral. 17... PRODUCTS Bonds and Consents of Sureties § 17.104 Deposit of collateral. Except as otherwise provided by law... guaranteed as to both interest and principal by the United States, may be pledged and deposited by principals...

  2. Collateral Informant Assessment in Alcohol Use Research Involving College Students

    Science.gov (United States)

    Hagman, Brett T.; Cohn, Amy M.; Noel, Nora E.; Clifford, Patrick R.

    2010-01-01

    Objective: This study examined the associations between college students' self-reported alcohol use and corresponding collateral reports and identified factors that influence agreement between both sets of reports. Participants/Methods: Subject-collateral pairs (N = 300) were recruited from undergraduate psychology courses. Results: Data yielded…

  3. Radiologic analysis of the medical collateral ligament rupture

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Chung Che; Lee, Chang Jun; Kim, Kun Sang; Park, Soo Soung [Chung Ang University College of Medicine, Seoul (Korea, Republic of)

    1979-06-15

    The medical collateral ligament rupture is the most common injury involving the knee joint ligaments. The ruptured medical collateral ligaments of 73 cases with clinical and surgical confirmations were radiologically analyzed. The results were obtained as follows: 1. The most risky age for tearing of the medical collateral ligament was third to fifth decades (50 cases of male and 23 of females). 2. The most common cause of the medical collateral ligament rupture was traffic accident (82.2%). 3. The mean distance of medial knee joint space was 7.9 {+-} 2.0 mm on the normal side and 13.7 {+-} 4.2 mm on the affected side. 4. The mean degree of knee joint space was 10.1 {+-} 2.5 on the normal side and 14.7 {+-} 3.8 on the affected side. 5. The fibula was the bone fractured most frequently in association with the medial collateral ligament rupture (30.6%)

  4. Tight coupling of astrocyte energy metabolism to synaptic activity revealed by genetically encoded FRET nanosensors in hippocampal tissue.

    Science.gov (United States)

    Ruminot, Iván; Schmälzle, Jana; Leyton, Belén; Barros, L Felipe; Deitmer, Joachim W

    2017-01-01

    The potassium ion, K+, a neuronal signal that is released during excitatory synaptic activity, produces acute activation of glucose consumption in cultured astrocytes, a phenomenon mediated by the sodium bicarbonate cotransporter NBCe1 ( SLC4A4). We have explored here the relevance of this mechanism in brain tissue by imaging the effect of neuronal activity on pH, glucose, pyruvate and lactate dynamics in hippocampal astrocytes using BCECF and FRET nanosensors. Electrical stimulation of Schaffer collaterals produced fast activation of glucose consumption in astrocytes with a parallel increase in intracellular pyruvate and biphasic changes in lactate . These responses were blocked by TTX and were absent in tissue slices prepared from NBCe1-KO mice. Direct depolarization of astrocytes with elevated extracellular K+ or Ba2+ mimicked the metabolic effects of electrical stimulation. We conclude that the glycolytic pathway of astrocytes in situ is acutely sensitive to neuronal activity, and that extracellular K+ and the NBCe1 cotransporter are involved in metabolic crosstalk between neurons and astrocytes. Glycolytic activation of astrocytes in response to neuronal K+ helps to provide an adequate supply of lactate, a metabolite that is released by astrocytes and which acts as neuronal fuel and an intercellular signal.

  5. The relationship between diastolic pressure and coronary collateral circulation in patients with stable angina pectoris and chronic total occlusion.

    Science.gov (United States)

    Shu, Wang; jing, Jing; Fu, Liu Chang; Min, Jiang Tie; Bo, Yang Xiao; Ying, Zhou; Dai, Chen Yun

    2013-05-01

    The most important biomechanical source of activation of the coronary collateral circulation (CCC) is increased tangential fluid shear stress at the arterial endothelial surface. The coronary circulation is unique in that most coronary blood flow occurs in diastole. Consequently, the diastolic blood pressure (DBP) may influence the tangential fluid shear stress on the arterial endothelial surface in diastole, therebyaffecting development of the CCC. To investigate this, we conducted a study of 222 patients with stable angina pectoris and chronic total occlusion of coronary arteries. All of the patients had no history of coronary artery interventional therapy, coronary artery bypass surgery, cardiomyopathy, or congenital heart disease. The extent of the collateral vasculature of the area perfused by the artery affected by chronic total occlusion was graded as poor or well-developed according to Rentrop's classification. Univariate analysis showed a significant difference between the study subgroup with poorly developed collaterals and that with well-developed collaterals in terms of high diastolic blood pressure (DBP) and mean DBP. Multivariate analysis revealed high DBP as the only independent positive predictor of a well-developed collateral circulation. High DBP is positively related to a well-developed CCC. Differences in development of the CCC may be one of the pathophysiologic mechanisms responsible for the J-curve phenomenon in the relationship between DBP and cardiovascular risk.

  6. Documenting and automating collateral evolutions in Linux device drivers

    DEFF Research Database (Denmark)

    Padioleau, Yoann; Hansen, René Rydhof; Lawall, Julia

    2008-01-01

    The internal libraries of Linux are evolving rapidly, to address new requirements and improve performance. These evolutions, however, entail a massive problem of collateral evolution in Linux device drivers: for every change that affects an API, all dependent drivers must be updated accordingly....... Manually performing such collateral evolutions is time-consuming and unreliable, and has lead to errors when modifications have not been done consistently. In this paper, we present an automatic program transformation tool, Coccinelle, for documenting and automating device driver collateral evolutions...

  7. Synaptic excitation by climbing fibre collaterals in the cerebellar nuclei of juvenile and adult mice.

    Science.gov (United States)

    Najac, Marion; Raman, Indira M

    2017-11-01

    The inferior olive sends instructive motor signals to the cerebellum via the climbing fibre projection, which sends collaterals directly to large premotor neurons of the mouse cerebellar nuclei (CbN cells). Optogenetic activation of inferior olivary axons in vitro evokes EPSCs in CbN cells of several hundred pA to more than 1 nA. The inputs are three-fold larger at younger ages, 12 to 14 days old, than at 2 months old, suggesting a strong functional role for this pathway earlier in development. The EPSCs are multipeaked, owing to burst firing in several olivary afferents that fire asynchronously. The convergence of climbing fibre collaterals onto CbN cells decreases from ∼40 to ∼8, which is consistent with the formation of closed-loop circuits in which each CbN neuron receives input from 4-7 collaterals from inferior olivary neurons as well as from all 30-50 Purkinje cells that are innervated by those olivary neurons. The inferior olive conveys instructive signals to the cerebellum that drive sensorimotor learning. Inferior olivary neurons transmit their signals via climbing fibres, which powerfully excite Purkinje cells, evoking complex spikes and depressing parallel fibre synapses. Additionally, however, these climbing fibres send collaterals to the cerebellar nuclei (CbN). In vivo and in vitro data suggest that climbing fibre collateral excitation is weak in adult mice, raising the question of whether the primary role of this pathway may be developmental. We therefore examined climbing fibre collateral input to large premotor CbN cells over development by virally expressing channelrhodopsin in the inferior olive. In acute cerebellar slices from postnatal day (P)12-14 mice, light-evoked EPSCs were large (> 1 nA at -70 mV). The amplitude of these EPSCs decreased over development, reaching a plateau of ∼350 pA at P20-60. Trains of EPSCs (5 Hz) depressed strongly throughout development, whereas convergence estimates indicated that the total number of

  8. Antiepileptic effects of GABAb receptor activation in area CA3 of rat hippocampus.

    Science.gov (United States)

    Morrisett, R A; Lewis, D V; Swartzwelder, H S; Wilson, W A

    1993-01-15

    The role of GABAb receptor activation in the expression of both interictal and ictal phenomena was investigated in slices of area CA3 of the rat hippocampal formation. Interictal-like bursts occurred following application of high frequency trains to the Schaffer collaterals. When two bursts were triggered using paired stimuli, profound depression of the second burst was seen 150-600 ms following the first burst. GABAb receptor antagonists potently reversed the paired pulse depression of the interictal-like bursts. Reversal of the paired depression was also accomplished by increasing the extracellular concentration of K+ by 2-3 mM. Additional experiments were performed in area CA3 to determine the role of GABAb receptor activation on the expression of ictal phenomena. Electrographic seizures (EGSs) were induced by application of high frequency trains. 2-Hydroxy-saclofen (200 microM) significantly decreased the duration of trains required to elicit EGSs. Taken together, these data suggest that GABAb receptor activation has potent inhibitory effects on both ictal and interictal-like events.

  9. Pricing a Collateralized Derivative Trade with a Funding Value Adjustment

    Directory of Open Access Journals (Sweden)

    Chadd B. Hunzinger

    2015-01-01

    Full Text Available The 2008 credit crisis changed the manner in which derivative trades are conducted. One of these changes is the posting of collateral in a trade to mitigate the counterparty credit risk. Another is the realization that banks are not risk-free and, as a result, cannot borrow at the risk-free rate any longer. The latter led banks to introduced the controversial adjustment to derivative prices, known as a funding value adjustment (FVA, which is interlinked with the posting of collateral. In this paper, we extend the Cox, Ross and Rubinstein (CRR discrete-time model to include collateral and FVA. We prove that this derived model is a discrete analogue of Piterbarg’s partial differential equation (PDE, which describes the price of a collateralized derivative. The fact that the two models coincide is also verified by numerical implementation of the results that we obtain.

  10. Atraumatic medial collateral ligament oedema in medial compartment knee osteoarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Bergin, D.; Keogh, C.; O' Connell, M.; Zoga, A. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland); Rowe, D.; Shah, B. [Boston Univ., MA (United States). Medical Center; Fitzpatrick, P. [Department of Public Health and Epidemiology, University College Dublin (Ireland); Eustace, S. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland); X-Ray Department, Cappagh National Orthopedic Hospital, Dublin (Ireland)

    2002-01-01

    Objective: To describe and determine the prevalence of atraumatic medial collateral oedema identified in patients with medial compartment osteoarthritis. Design and patients: Sixty patients, 30 patients with medial compartment knee osteoarthritis (Kellgren and Lawrence grade 2 to 4) and 30 age-matched patients with atraumatic knee pain without osteoarthritis, referred for MR imaging over a 2 year period were included in the study. In each case, severity of osteoarthritis was recorded on radiographs and correlated with the presence or absence of medial collateral ligament oedema at MR imaging. Results: Medial collateral oedema was identified in 27 of the 30 patients with osteoarthritis, of whom 14 had grade 1 oedema and 13 had grade 2 oedema compared with the presence of medial collateral ligament oedema (grade 1) in only two of the 30 control patients without osteoarthritis (P<<0.0001). Conclusion: Medial collateral oedema is common in patients with osteoarthritis in the absence of trauma. When identified, medial collateral ligament oedema should be considered to be a feature of osteoarthritis and should not be incorrectly attributed to an acute traumatic injury. (orig.)

  11. Management of Medial Collateral Ligament Injury During Primary Total Knee Arthroplasty: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Paul Della Torre, MD

    2014-07-01

    augmentation of an medial collateral ligament injury recognised intraoperatively during total knee arthroplasty. An implant with greater constraint may have reduced longevity in younger, more active patients through aseptic loosening. In elderly or less mobile patients, and in situations where the medial collateral ligament repair is deemed poor quality or incomplete, an implant with greater constraint would seem prudent. In patients where direct repair with or without augmentation was used, a period of 4-6 weeks of unrestricted rehabilitation in a hinged knee brace should be followed.

  12. [Collateral ligament injuries of the metacarpophalangeal joints].

    Science.gov (United States)

    Pillukat, T; Schädel-Höpfner, M; Windolf, J; Prommersberger, K-J

    2012-07-01

    Collateral ligament injuries of the metacarpal joints of the fingers are rare conditions. The injury should be diagnosed by clinical investigation and standard radiographs. Leading symptoms are local tenderness and joint instability. Instability is verified by clinical stress testing of the metacarpophalangeal joint in 90° of flexion. In Grade I injuries stability is preserved due to ligament attenuation or small partial tears. Grade II injuries show laxity with firm endpoint according to incomplete tear. In Grade III injuries instability without endpoint can be found as a result of complete tears. Radiographs may show avulsed bone fragments.In Grade I and II tears or non- displaced avulsion fragments treatment is conservative with buddy taping for 6 weeks. In case of persistent instability or grade III tears suturing or refixation of the ligament are performed. Small avulsion fragments are removed and the ligament is fixed to the bone. Greater avulsion fragments are fixed by suitable small implants. Adequate treatment will lead to reliable good results. Even in chronic tears reconstruction with local material or tendon transplants is usually successful.

  13. Ulnar collateral ligament reconstruction in major league baseball pitchers.

    Science.gov (United States)

    Gibson, Brett W; Webner, David; Huffman, G Russell; Sennett, Brian J

    2007-04-01

    Ulnar collateral ligament reconstruction is commonly performed in major league pitchers, but little is known about pitching performance after a return to major league play. Pitching performance after ulnar collateral ligament reconstruction returns to baseline by the second season after surgery. Cohort study (prognosis); Level of evidence, 2. Data were reviewed for 68 major league pitchers who pitched in at least 1 major league game before undergoing ulnar collateral ligament reconstruction between 1998 and 2003. Mean innings pitched per season, earned run average, and walks and hits per inning pitched were compared for each major league pitcher before and after surgery. All demographic and performance variables were analyzed for an association with ulnar collateral ligament insufficiency and a successful return to major league play. Fifty-six (82%) pitchers returned to major league play at a mean of 18.5 months after surgery with no significant change in mean earned run average or walks and hits per inning pitched. The mean innings pitched per season was not statistically different from controls by the second season after surgery. Starting pitchers demonstrated a higher risk of ulnar collateral ligament injury requiring reconstruction. More experienced pitchers and those with a higher earned run average were less likely to require ulnar collateral ligament reconstruction. No factors predictive of a successful return to play were identified. Most major league pitchers return from ulnar collateral ligament reconstruction by the second season after surgery with no statistical change in mean innings pitched, earned run average, or walks and hits per inning pitched from preinjury levels.

  14. [Restoration of ulnar collateral ligament stability of the metacarpophalangeal joint of the thumb].

    Science.gov (United States)

    Langer, M F; Hermann, K; Oeckenpöhler, S; Wieskötter, B

    2015-10-01

    Restoration of ulnar collateral ligament stability of the metacarpophalangeal (MP) joint of the thumb with elimination of palmar subluxation while retaining mobility for chronic instability without osteoarthritis. Acquired or congenital chronic instability of the MP joint of the thumb with compelling reasons for joint preservation and against arthrodesis, e.g., an arthrodesis or arthritis of adjacent joints. Arthritis of the thumb MP joint. Contractures of the MP joint. Low natural range of motion of the joint (compared to the contralateral hand). Additional palmar instability with significant hyperextensibility. Infections. Lesions to the median and/or ulnar nerve with impaired active mobility. Anatomical reconstruction of the ulnar collateral ligament and the accessory collateral ligament using a tendon graft (palmaris longus tendon). Ulnar approach, transosseous course of the tendon graft and elimination of subluxation. Splint for 5 weeks and hand therapy. Of 12 patients undergoing this type of ligament reconstruction, all achieved good stability and pain-free range of motion, which was 60-95% of the contralateral hand. This surgical procedure has few complications and is considered reliable.

  15. 'Wellbeing': a collateral casualty of modernity?

    Science.gov (United States)

    Carlisle, Sandra; Henderson, Gregor; Hanlon, Phil W

    2009-11-01

    In the now vast empirical and theoretical literature on wellbeing knowledge of the subject is provided mainly by psychology and economics, where understanding of the concept are framed in very different ways. We briefly rehearse these, before turning to some important critical points which can be made about this burgeoning research industry, including the tight connections between the meanings of the concept with the moral value systems of particular 'modern' societies. We then argue that both the 'science' of wellbeing and its critique are, despite their diversity, re-connected by and subsumed within the emerging environmental critique of modern consumer society. This places concerns for individual and social wellbeing within the broader context of global human problems and planetary wellbeing. A growing number of thinkers now suggest that Western society and culture are dominated by materialistic and individualistic values, made manifest at the political and social levels through the unending pursuit of economic growth, and at the individual level by the seemingly endless quest for consumer goods, regardless of global implications such as broader environmental harms. The escalating growth of such values is associated with a growing sense of individual alienation, social fragmentation and civic disengagement and with the decline of more spiritual, moral and ethical aspects of life. Taken together, these multiple discourses suggest that wellbeing can be understood as a collateral casualty of the economic, social and cultural changes associated with late modernity. However, increasing concerns for the environment have the potential to counter some of these trends, and in so doing could also contribute to our wellbeing as individuals and as social beings in a finite world.

  16. Middle cerebral artery stenosis associated with moyamoya pattern collateralization

    Directory of Open Access Journals (Sweden)

    Randall Edgell

    2010-11-01

    Full Text Available Background and Purpose: Moyamoya disease is a well described phenomenon presenting with terminal internal carotid artery occlusion and rete pattern of collateralization around the occlusion. The development of moyamoya-like collaterals secondary to isolated middle cerebral artery stenosis or occlusion and the natural history of this entity in Caucasians have not been well described. Methods: Cerebral angiograms and CT angiograms performed between August 2004 and August of 2006 demonstrating moyamoya collateralization at a single US center were retrospectively reviewed. All cases of middle cerebral artery stenosis associated with a rete pattern of collateralization were included in this series. Demographic, clinical, and angiographic data were obtained. Results: There were 3 cases of middle cerebral artery stenosis associated with a moyamoya pattern of collateralization. The average age of the patients was 36 years old, 2 were male, and all were Caucasian. All patients presented with ischemic symptoms. The average degree of stenosis was 91%. No stenosis was seen in the supraclinoid internal carotid arteries or elsewhere in the intracranial vasculature. Conclusion: We describe a moyamoya-like pattern of anastomosis associated with isolated severe middle cerebral artery stenosis or occlusion in Caucasians.

  17. Collateral vessels in moyamoya disease : comparison of MR and MRA with conventional angiography

    Energy Technology Data Exchange (ETDEWEB)

    Shim, Joo Eun; Yoon, Dae Young; Yi, Jeong Geun; Kim, Ho Chul; Choi, Chul Sun; Bae, Sang Hoon [Hallym University College of Medicine, Choonchun (Korea, Republic of)

    1998-01-01

    To determine the value of magnetic resonance imaging (MR) and magnetic resonance angiography (MRA) in assessing collateral vessels of moyamoya disease. Twenty-four patients with moyamoya disease who underwent MR, 3D TOF MRA, and conventional angiography participated in this study. Two radiologists working independently and with no knowledge of the angiographic findings, interpreted the MR and MRA images. To determine the presence of parenchymal and leptomeningeal collaterals (48 hemispheres) and transdural collaterals (38 hemispheres in 19 patients were depicted by angiography of the external carotid), the findings were compared with those of angiography. Parenchymal, leptomeningeal, and transdural collaterals were depicted by conventional angiography in 34 (71%), 32 (67%), and 11 (29%) hemispheres respectively. The sensitivity and specificity of MR/MRA for collateral vessels were 79.1/88.1 % for parenchymal collaterals, 72.1/88.1 % for leptomeningeal collaterals, and 0.1/18.1 % for transdural collaterals, respectively. Respective sensitivity and specificity of MR/MRA were 88.94/94.1% for leptomeningeal collaterals, and 18.93/55.1 % for transdural collaterals, when the prominent posterior cerebral and external carotid artery were regarded as secondary signs of leptomeningeal and transdural collateral vessels. In moyamoya disease, MR and MRA are useful imaging modalities for the assessment of collateral vessels. The prominent posterior cerebral artery and external carotid artery can be useful secondary signs of leptomeningeal and transdural collateral vessels. (author). 18 refs., 2 figs.

  18. Collateral Development in Thrombosis of the Hepatic Artery After Transplantation.

    Science.gov (United States)

    García Bernardo, C M; Argüelles García, B; Redondo Buil, P; Miyar de León, A; González Dieguez, L; Cadahía Rodrigo, V; González-Pinto Arrillaga, I; Vázquez Velasco, L

    2016-11-01

    The authors sought to identify strictures or hepatic artery obstruction with posterior collateral transformation in our series of liver transplantation, treatment, and evolution. The thrombosis or severe hepatic artery stenosis sometimes presents a compensation mechanism, the collateral transformation of the artery. From April 2002 to December 2011 we collected 18 cases of collateral transformation. We analyzed data regarding the transplantation, diagnosis, treatment, clinical evolution, liver function, and Doppler-ultrasound. The main indication was alcoholic cirrhosis, followed by hepatocellular carcinoma - hepatitis C virus. The mean cold ischemia time was 292.2 minutes mean hot ischemia was 48.8. The anastomosis was performed on the gastroduodenal-splenic patch donor in 14 cases, the celiac trunk in 2 cases, and on grafts to the aorta in another 2. Doppler ultrasound showed 8 cases without complications, 8 with low flows, and 2 cases with alterations of the right hepatic artery. Computed tomographic (CT) angiography was performed in patients with impaired eco-Doppler and found 4 obstructions, 2 cases with kinking, 1 stenosis, and 3 normal cases. Three patients with low flows were re-operated and another re-transplanted. After diagnosis of collateral transformation, all were treated with antiplatelet agents. Two cases of angioplasty were associated. The collaterals were diagnosed 1 month to 44.8 months after transplantation. Five patients died. In the latest data, 10 patients do not have analytical alteration. The Doppler ultrasound shows 7 cases being normal and 6 with flow but low resistances. In our series, all patients with collateral transformation, except one who was transplanted, maintain good liver function with permeable vessels. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Does high-quality auditing decrease the use of collateral? Analysis from the perspective of lenders’ self-protection

    Directory of Open Access Journals (Sweden)

    Yang Yang

    2014-09-01

    Full Text Available We examine the association between audit quality and the use of collateral in a sample of Chinese firms from 2005 to 2011. Using the full sample, we document a negative relationship between audit quality and the use of collateral that is consistent with lenders’ interests. We also show that audit quality and collateral are regarded as alternative means of reducing debt credit risk. Our conclusions are robust after using an auditor-switching test, the Heckman two-stage model and a propensity-score matching model to address endogeneity issues. China’s institutional background is also considered. First, we find that in the group of firms in which large shareholders are able to control borrowers’ activities, the substitution effects between collateral and audit quality are reduced when the degree of separation between large shareholders’ control and ownership is high. Second, these substitution effects are greater when the borrowers’ ultimate controller is a state-owned enterprise (SOE rather than a non-state-owned enterprise (NSOE. Third, the differences in substitution effects between NSOEs and SOEs are smaller in areas with a high market-development index. We conclude that the substitution effects are smaller in high credit risk firms than in low credit risk firms.

  20. Historical Aspects and Relevance of the Human Coronary Collateral Circulation

    Science.gov (United States)

    Seiler, Christian; Meier, Pascal

    2014-01-01

    In 1669, anastomoses between the right and left coronary artery were first documented by Richard Lower of Amsterdam. Using post-mortem imaging, a debate followed on the existence of structural inter-coronary anastomoses, which was not resolved before the first half of the 20ieth century in case of the presence of coronary artery disease (CAD), and not before the early 1960ies in case of the normal human coronary circulation by William Fulton. Functional coronary collateral measurements during coronary interventions were first performed only in the 1970ies, respectively in the early 1980ies. In humans, the existence of functional coronary collaterals in the absence of CAD has not been documented before 2003. Though the coronary collateral circulation has been recognized as an alternative source of blood supply to ischemic myocardium, its prognostic significance for the CAD population as a whole has been controversial until recently. The debate was due to different populations examined (acute versus chronic CAD, varying severity of CAD), to variable definitions of the term “prognosis”, to insufficient statistical power of the investigation with rare occurrence of prognostic endpoints, to short duration of follow-up and to blunt instruments employed for collateral assessment. Individually, it has been acknowledged that a well functioning collateral supply to a myocardial area at risk for necrosis reduces infarct size, preserves ventricular function, prevents ventricular remodelling and aneurysm formation. Collectively, evidence has accumulated only recently that an extensive coronary collateral circulation is a beneficial prognosticator quoad vitam. In a recent meta-analysis on the topic, the risk ratio to die from any cause for high vs low or absent collateralization in patients with subacute myocardial infarction was 0.53 (95% confidence interval 0.15–1.92; p=0.335), and for patients with acute myocardial infarction, it was 0.63 (95% confidence interval 0.29

  1. Leptomeningeal collateral status predicts outcome after middle cerebral artery occlusion

    DEFF Research Database (Denmark)

    Madelung, Christopher Fugl; Ovesen, C; Trampedach, C

    2017-01-01

    reperfusion therapy. MATERIALS AND METHODS: This retrospectively planned analysis was passed on prospectively collected data from 187 consecutive patients with middle cerebral artery occlusion admitted within 4.5 hours to one center and treated with intravenous thrombolysis alone (N = 126), mechanical...... thrombectomy alone (N = 5), or both (N = 56) from May 2009 to April 2014. Non-contrast CT (NCCT) and computed tomography angiography (CTA) were provided on admission and NCCT repeated at 24 hours. Collateral status was assessed based on the initial CTA. Hemorrhagic transformation was evaluated on the 24-hour...... population (P = .001). CONCLUSIONS: Leptomeningeal collateral status predicts functional outcome, mortality, and hemorrhagic transformation following middle cerebral artery occlusion....

  2. 13 CFR 120.1850 - Will the Collateral be held by SBA?

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Will the Collateral be held by SBA... Loan Program) § 120.1850 Will the Collateral be held by SBA? Yes, SBA or its expressly authorized agent will take physical possession of all Collateral. SBA or its expressly authorized agent shall maintain...

  3. Timing-Invariant Imaging of Collateral Vessels in Acute Ischemic Stroke

    NARCIS (Netherlands)

    Smit, E.J.; Vonken, E.J.; Seeters, T. van; Dankbaar, J.W.; Schaaf, I.C. van der; Kappelle, L.J.; Ginneken, B. van; Velthuis, B.K.; Prokop, M.

    2013-01-01

    BACKGROUND AND PURPOSE: Although collateral vessels have been shown to be an important prognostic factor in acute ischemic stroke, patients with lack of collaterals on standard imaging techniques may still have good clinical outcome. We postulate that in these cases collateral vessels are present

  4. 76 FR 33817 - Protection of Cleared Swaps Customer Contracts and Collateral; Conforming Amendments to the...

    Science.gov (United States)

    2011-06-09

    ... another customer by making certain that the value of the cleared swaps collateral that the DCO holds... value of FCM or DCO investments of cleared swaps customer collateral. Section 4d(f) of the CEA permits... Swaps Customer Contracts and Collateral; Conforming Amendments to the Commodity Broker Bankruptcy...

  5. The Collateral Circulation in Moyamoya Disease: A Single-Center Experience in 140 Pediatric Patients.

    Science.gov (United States)

    Zhao, Meng; Zhang, Dong; Wang, Shuo; Zhang, Yan; Deng, Xiaofeng; Zhao, Jizong

    2017-12-01

    The patterns and clinical significance of the presence of collaterals in moyamoya disease has not been elucidated thoroughly. We aimed to summarize the clinical features of collaterals in pediatric moyamoya disease. We reviewed consecutive pediatric patients with moyamoya vasculopathy who were admitted to our hospital from 2009 to 2015. Only pediatric moyamoya patients with digital subtraction angiography examinations were included in this study. We classified spontaneous collaterals into two groups by their origins, the internal carotid artery and vertebral artery (ICA-VA)-originated collaterals and the external carotid artery (ECA)-originated collaterals. A total of 140 pediatric patients with moyamoya disease (mean age, 10.1 ± 3.7 years) were included in this study. We identified collaterals originated from ICA-VA in 122 (87.1%) pediatric patients (222 hemispheres). Patients in the ICA-VA collaterals group had similar Suzuki stages with patients without collaterals originated from ICA-VA (mean, 3.86 vs 3.50; P = 0.157). We identified collaterals originated from ECAs in 70 (50.0%) pediatric patients (106 hemispheres) with moyamoya disease. The infarctions were more common in patients with ECA-originated collaterals than in patients without ECA-originated collaterals (25 versus 12; P = 0.021). Our results demonstrate that collaterals originating from ECAs are associated with advanced Suzuki stages and infarction presentations in children with moyamoya disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Coronary collateral circulation: clinical significance and influence on survival in patients with coronary artery occlusion

    DEFF Research Database (Denmark)

    Hansen, J F

    1989-01-01

    In a consecutive series of 96 patients with coronary artery occlusion, 67 had good and 29 had no or poor collateral circulation. Patients with good collaterals had the severest degree of coronary artery disease. Good collaterals are associated with a higher incidence of angina pectoris and normal...

  7. Expression of Proinflammatory Factors, Proangiogenic Factors and Endostatin in Patients with Heart Failure and Different Grades of Collateral Circulation Development.

    Science.gov (United States)

    Kobusiak-Prokopowicz, Małgorzata; Jołda-Mydłowska, Beata; Grzebieniak, Tomasz; Początek, Karol; Mysiak, Andrzej

    2015-01-01

    The process of collateral vessel maturation is stimulated by numerous factors affecting the endothelium and smooth muscle cells building the vessel wall. Looking for arteriogenesis stimulating factors means looking for a potential innovative heart failure treatment method in the patients unresponsive to traditional therapies. The purpose of this study was to assess the changes in serum concentrations of pro-inflammatory factor IL-6, growth factors FGF (FGFa, FGFb, FGFbH), HGF, VEGF and endostatin in heart failure patients in relation to the coronary collaterals development stage. This study included 22 patients with chronic heart failure NYHA II or III (mean age 62.5 ± 11.6 years) and 8 control patients (mean age 58.4 ± 10.7 years). Coronary angiography was performed and the presence and grade of collateral circulation was assessed by a four-level scale proposed by Rentrop and Cohen. The level of the studied factors was determined in the blood samples collected during the angiographic procedure. The concentration of IL-6 was significantly higher in the heart failure patients than in the control group (p < 0.001) and in NYHA III vs. NYHA II patients (p < 0.02). Patients with heart failure and collaterals grade 1 or 2 exhibited higher serum concentrations of FGFbH (from p < 0.03 to p < 0.01). The serum VEGF level in NYHA III patients was significantly higher than in NYHA II individuals (from p < 0.03 to p < 0.01). Higher levels of IL-6 and FGFbH were observed in patients with heart failure. Collaterals formation seems to be associated with the activation of pro-inflammatory factors, growth factors and endostatin.

  8. 12 CFR 614.4250 - Collateral evaluation standards.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Collateral evaluation standards. 614.4250 Section 614.4250 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM LOAN POLICIES AND... marketing period for the property; (iii) The current market conditions and trends that will affect projected...

  9. Stiffness of the healing medial collateral ligament of the mouse.

    NARCIS (Netherlands)

    Gijssen, Y.; Sierevelt, I.N.; Kooloos, J.G.M.; Blankevoort, L.

    2004-01-01

    The knee joints of mice can serve as a model for studying knee ligament properties. The goal of our study was to measure the structural stiffness of the medial collateral ligament (MCL) of the murine knee. A tensile test was developed for this purpose. First 84 femur-MCL-tibia complexes of

  10. Targeting pathogen metabolism without collateral damage to the host

    NARCIS (Netherlands)

    Haanstra, Jurgen R.; Gerding, Albert; Dolga, Amalia M.; Sorgdrager, Freek J. H.; Buist-Homan, Manon; du Toit, Francois; Faber, Klaas Nico; Holzhuetter, Hermann-Georg; Szoor, Balazs; Matthews, Keith R.; Snoep, Jacky L.; Westerhoff, Hans V.; Bakker, Barbara M.

    2017-01-01

    The development of drugs that can inactivate disease-causing cells (e.g. cancer cells or parasites) without causing collateral damage to healthy or to host cells is complicated by the fact that many proteins are very similar between organisms. Nevertheless, due to subtle, quantitative differences

  11. SPECT bone scintigraphy of medial collateral ligament/meniscus injury

    Energy Technology Data Exchange (ETDEWEB)

    Micallef, L.; Larcos, G. [Westmead Medical Imaging, Westmead, NSW (Australia)

    1998-06-01

    Full text: Acute or chronic knee pain is common amongst athletic persons. MRI is generally regarded as the best test, but is not widely available and may lack specificity in meniscal tears and cruciate injury. Bone scan with SPECT is an appealing alternative since it is relatively cheap and easily obtained. Further, a number of investigators have published data indicating sensitivity and specificity exceeding 85%. The purpose of the study is to determine typical scintigraphic findings in medial collateral ligament or medial meniscus injury. We present a small group of patients with acute knee trauma in whom arthroscopy and/or clinical follow-up indicated medial collateral ligament injury. Bone scans were undertaken after 900-1000 MBq of {sup 99m}Tc-MDP with immediate blood pool, delayed planar images and SPECT acquired on a Picker Prism 2000. SPECT was obtained with high resolution collimators and 20 sec/stop for 180 deg each. SPECT images showed focal radiopharmaceutical accumulation in the medial proximal tibial shaft and medial femoral condyle, corresponding to the superficial layer of the medial collateral ligament (best seen on coronal images). Disruption of the deep layer and/or medial meniscus can be suspected with abnormal uptake in part or all of the meniscus (best seen on transverse images). We conclude that acute/chronic medial collateral ligament injury can be detected on bone scintigraphy with abnormal uptake at the predicted anatomic site of attachment

  12. The epidemiology of medial collateral ligament sprains in young athletes.

    Science.gov (United States)

    Roach, Christopher J; Haley, Chad A; Cameron, Kenneth L; Pallis, Mark; Svoboda, Steven J; Owens, Brett D

    2014-05-01

    A medial collateral ligament (MCL) knee sprain is a prevalent injury in athletic populations that may result in significant time lost to injury. Remarkably little is known of the epidemiology of this injury. To define the incidence of MCL tears and to determine the demographic and athletic risk factors. Descriptive epidemiological study. A longitudinal cohort study was performed to examine the epidemiology of isolated MCL sprains at the United States Military Academy (USMA) between 2005 and 2009. Charts and radiographic studies were reviewed by an independent orthopaedic surgeon to identify all new isolated MCL sprains resulting in time lost to sport and activity that occurred within the study period. Incidence rates (IRs) with 95% confidence intervals (CIs) were calculated per 1000 person-years at risk and by sex, sport, and level of competition. The IR per 1000 athlete-exposures (AEs) was also determined. Incidence rate ratios (IRRs) and respective 95% CIs were calculated between male and female students, intercollegiate and intramural athletes, and male and female intercollegiate athletes involved in selected sports. Chi-square and Poisson regression analyses were used to examine the relationship between the variables of interest and the incidence of MCL sprains, with statistical significance set at P student person-years from 2005 to 2009. This resulted in an IR of approximately 7.3 per 1000 person-years. Of the 128 injuries, 114 were in male athletes (89%) and 14 were in female athletes (11%). Male cadets had a 44% higher IR than did female cadets (7.60 vs 5.36, respectively), although this was not significant (P = .212). Of 5820 at-risk intercollegiate athletes, 59 (53 male, 6 female) sustained an isolated MCL sprain during 528,523 (407,475 male, 121,048 female) AEs for an overall IR of 10.14 per 1000 person-years and 0.11 per 1000 AEs. The IRR of MCL sprains of men compared with women involved in intercollegiate athletics was 2.87 (95% CI, 1.24-8.18) per

  13. Status of systemic to pulmonary arterial collateral flow after the fontan procedure.

    Science.gov (United States)

    Whitehead, Kevin K; Harris, Matthew A; Glatz, Andrew C; Gillespie, Matthew J; DiMaria, Michael V; Harrison, Neil E; Dori, Yoav; Keller, Marc S; Rome, Jonathan J; Fogel, Mark A

    2015-06-15

    The investigators recently validated a method of quantifying systemic-to-pulmonary arterial collateral flow using phase-contrast magnetic resonance imaging velocity mapping. Cross-sectional data suggest decreased collateral flow in patients with total cavopulmonary connections (TCPCs) compared with those with superior cavopulmonary connections (SCPCs). However, no studies have examined serial changes in collateral flow from SCPCs to TCPCs in the same patients. The aim of this study was to examine differences in collateral flow between patients with SCPCs and those with TCPCs. Collateral flow was quantified by 2 independent measures from 250 single-ventricle studies in 219 different patients (115 SCPC and 135 TCPC studies, 31 patients with both) and 18 controls, during routine studies using through-plane phase-contrast magnetic resonance imaging. Collateral flow was indexed to body surface area, aortic flow, and pulmonary venous flow. Regardless of indexing method, SCPC patients had significantly higher collateral flow than TCPC patients (1.64 ± 0.8 vs 1.03 ± 0.8 L/min/m(2), p SCPC and TCPC patients demonstrate substantial collateral flow, with SCPC patients having higher collateral flow than TCPC patients overall. On the basis of the paired subset analysis, collateral flow does not decrease in the short term after TCPC completion and trends toward an increase. In the long term, however, collateral flow decreases over time after TCPC completion. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Determinants of leptomeningeal collateral flow in stroke patients with a middle cerebral artery occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Seeters, Tom van; Velthuis, Birgitta K. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Biessels, Geert Jan; Kappelle, L.J. [University Medical Center Utrecht, Department of Neurology, Brain Center Rudolf Magnus, Utrecht (Netherlands); Graaf, Yolanda van der [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Collaboration: on behalf of the Dutch acute stroke study (DUST) investigators

    2016-10-15

    Poor leptomeningeal collateral flow is related to worse clinical outcome in acute ischemic stroke, but the factors that determine leptomeningeal collateral patency are largely unknown. We explored the determinants of leptomeningeal collateral flow and assessed their effect on the relation between leptomeningeal collateral flow and clinical outcome. We included 484 patients from the Dutch acute stroke study (DUST) with a middle cerebral artery (MCA) occlusion. The determinants of poor leptomeningeal collateral flow (≤50 % collateral filling) were identified with logistic regression. We calculated the relative risk (RR) of poor leptomeningeal collateral flow in relation to poor clinical outcome (90-day modified Rankin Scale 3-6) using Poisson regression and assessed whether the determinants of leptomeningeal collateral flow affected this relation. Leptomeningeal collateral flow was poor in 142 patients (29 %). In multivariable analyses, higher admission glucose level (odds ratio (OR) 1.1 per mmol/L increase (95 % CI 1.0-1.2)), a proximal MCA occlusion (OR 1.9 (95 % CI 1.3-3.0)), and an incomplete posterior circle of Willis (OR 1.7 (95 % CI 1.1-2.6)) were independently related to poor leptomeningeal collateral flow. Poor leptomeningeal collateral flow was related to poor clinical outcome (unadjusted RR 1.7 (95 % CI 1.4-2.0)), and this relation was not affected by the determinants of leptomeningeal collateral flow. Our study shows that admission glucose level, a proximal MCA occlusion, and an incomplete ipsilateral posterior circle of Willis are determinants of leptomeningeal collateral flow that represent a combination of congenital, acquired, and acute factors. After adjustment for these determinants, leptomeningeal collateral flow remains related to clinical outcome. (orig.)

  15. Significance of good collateral compensation in symptomatic intracranial atherosclerosis.

    Science.gov (United States)

    Lau, Alexander Y L; Wong, Edward H C; Wong, Adrian; Mok, Vincent C T; Leung, Thomas W; Wong, Ka-sing Lawrence

    2012-01-01

    Collateral circulation stabilizes cerebral blood flow in patients with acute occlusion, but its prognostic role is less studied in intracranial atherosclerosis and appears different in moderate to severe stenosis. We aimed to study the associations between antegrade flow across stenosis, collateral flow via leptomeningeal anastomosis, and the neurological outcome and recurrence risk in patients with symptomatic intracranial stenosis. We examined a cohort of consecutive patients admitted for stroke or transient ischemic attack (TIA) with symptomatic intracranial stenosis confirmed by digital subtraction angiography in a single-center retrospective study. Angiograms were graded systematically in a blinded fashion for antegrade and collateral flow, using Thrombolysis in Cerebral Infarction (TICI) and American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading, respectively, and integrated to a simple composite circulation score. Demographic and clinical variables, modified Rankin Scale (mRS) scores at 3 months, recurrent stroke or TIA in 12 months were collected. Uni- and multivariate analyses were performed to identify independent predictors of good outcome (mRS 0-2) and recurrence in a logistic regression model. Among 69 patients with pure intracranial atherosclerosis ≥ 50%, compromised antegrade flow (TICI 0-2a) was observed in 26 (36%) patients and was associated with more severe arterial stenosis (mean 86 vs. 74%, p = 0.001). Poor collateral compensation resulting in a poor composite circulation score was observed in 8 (12%) patients. Patients with a good circulation score (n = 61, 88%) had preserved flow, which was associated with more favorable outcome (OR 7.50, 95% CI 1.11-50.7, p = 0.04) and less recurrent TIA or stroke (OR 0.18, 95% CI 0.04-0.96, p = 0.04). Prognosis was not significantly associated with antegrade or collateral grade per se. Good collateral compensations are more important in

  16. Predictors of Collateral Learning Transfer in Continuing Vocational Training

    Directory of Open Access Journals (Sweden)

    Anja-Christina Hinrichs

    2014-08-01

    Full Text Available Against the background of demographic change and skill shortages continuing vocational training is of great significance in Germany. However, the training effectiveness is mostly assessed only at the end of a training program or several months after the training. Since in continuing vocational training the two contexts learning field (training and performance field (work context act simultaneously, the presented study investigated whether there are already situations in the work context which allow the application of newly acquired knowledge in parallel with the training. The main focus lies in the identification of predictors of learning transfer that takes place alongside the training participation and in the investigation of their causal relationships. Using structural equation modelling five latent variables were identified which have a significant effect on learning transfer parallel to the training – the so called collateral learning transfer. These five predictors explain together 62% of the variance of collateral learning transfer (gathered as performance improvement at work.

  17. [MRI of the thumb collateral ligament at the metacarpophalangeal joint: anatomy and injuries].

    Science.gov (United States)

    Ye, Wei; Zhan, Huili; Bai, Rongjie; Qian, Zhanhua; Li, Yaxiong; Wu, Bodong

    2015-05-05

    To explore the anatomy and injuries features of the thumb collateral ligamentat the metacarpophalangeal (MCP) joints. The study was reviewed and approved by an institutional review board of hospital. Clinical imaging data of 7 healthy volunteers who without injuries and 20 patients with thumb collateral ligament injuries were retrospectively analyzed. All subjects underwent magnetic resonance examination, then comparative analysis of the normal anatomy and the thumb collateral ligament injury at MCP joints of MRI features in healthy volunteers and patients with injury. Imaging findings were compared with the surgical results and confirmed by followed up in patients. Seven volunteers without ligament injures showed homogeneous low-signal-intensity on T1-weighted and proton fat saturation sequence (PD-FS) images. The average thickness of the ulnarcollateral ligament is about 2.0 to 2.3 mm, however, the normal radial collateral ligament is thinner, the average thickness is about 1.4-1.5 mm. There were 20 patients with thumb collateral ligament injuresat MCP joints, including 12 cases of ulnar collateral ligament injury and 8 cases of radial collateral ligament injury, which demonstrated poor definition, discontinuity and heterogeneously increased signal intensity in proton fat saturation sequence (PD-FS) of the involved collateral ligament. There was edema in the soft tissues surrounding the injured sites. MRI is an accurate method for evaluation of the anatomy and pathologic conditions of the thumb collateral ligamentsat MCP joints, and it is a useful tool for early diagnosis and treatment of the thumb collateral ligaments injuries.

  18. The relationship between gamma-glutamyltransferase and coronary collateral circulation in patients with chronic total occlusion.

    Science.gov (United States)

    Şahin, Müslüm; Demir, Serdar; Kalkan, Mehmet Emin; Özkan, Birol; Alıcı, Gökhan; Çakalağaoğlu, Kamil Cantürk; Yazıcıoğlu, Mehmet Vefik; Sarıkaya, Sabit; Biteker, Murat; Türkmen, Mehmet Muhsin

    2014-02-01

    The aim of this study was to evaluate the relation between blood gamma-glutamyltransferase (GGT) levels and coronary collateral circulation in patients with chronic total occlusion (CTO). Two hundred twenty-two patients with chronic stable coronary artery disease (CAD) and CTO were included in this cross-sectional, observational study. Coronary collaterals were graded from 0 to 3 according to the Rentrop method. Patients with grade 0-1 collateral development were regarded as poor collateral group (n=66) while patients with grade 2-3 collateral development were regarded as good collateral group (n=156). Statistical analysis was performed using independent samples t, Mann-Whitney U and Chi-square tests, logistic regression and receiver operator curve analysis. The poor coronary collateral group had significantly higher levels of serum GGT compared to the good collateral group (pcirculation (OR-0.946, 95% CI=0.918-0.9719, pcoronary collateral circulation in patients with CTO. GGT may be used to predict the grade of coronary collateral circulation in CTO patients with chronic stable CAD.

  19. Salient features of the coronary collateral circulation and its clinical relevance.

    Science.gov (United States)

    Stoller, Michael; Seiler, Christian

    2015-01-01

    The coronary collateral circulation provides an alternative source of blood supply to myocardium jeopardised by ischaemia. Collaterals enlarge with obstructive coronary artery disease to allow bulk flow, but blood flow deliverable by the native, pre-formed collateral extent can already be sizeable. Genetic determinants contribute significantly to the wide variability observed in both native collateral extent and its capacity to enlarge, and the severity of the coronary stenosis is the most significant environmental determinant for collateral enlargement. The protective effect of a well-developed coronary collateral circulation translates into relevant improvements in all-cause and cardiac mortality in the acute and chronic phases of coronary artery disease, as well as into a reduction of future adverse cardiovascular events.

  20. Morphological study of mechanoreceptors in collateral ligaments of the ankle joint

    OpenAIRE

    Wu, Xiaochuan; Song, Weidong; Zheng, Cuihuan; Zhou, Shixiong; Bai, Shengbin

    2015-01-01

    Background The aim of this study was to analyze the pattern and types of sensory nerve endings in ankle collateral ligaments using histological techniques, in order to observe the morphology and distribution of mechanoreceptors in the collateral ligaments of cadaver ankle joint, and to provide the morphological evidence for the role of the ligament in joint sensory function. Methods Twelve lateral collateral ligaments including anterior talofibular ligament (ATFL; n?=?6), posterior talofibula...

  1. Coronary collateralization shows sex and racial-ethnic differences in obstructive artery disease patients.

    Directory of Open Access Journals (Sweden)

    Zhi Liu

    Full Text Available Coronary collateral circulation protects cardiac tissues from myocardial infarction damage and decreases sudden cardiac death. So far, it is unclear how coronary collateralization varies by race-ethnicity groups and by sex.We assessed 868 patients with obstructive CAD. Patients were assessed for collateral grades based on Rentrop grading system, as well as other covariates. DNA samples were genotyped using the Affymetrix 6.0 genotyping array. To evaluate genetic contributions to collaterals, we performed admixture mapping using logistic regression with estimated local and global ancestry.Overall, 53% of participants had collaterals. We found difference between sex and racial-ethnic groups. Men had higher rates of collaterals than women (P-value = 0.000175. White Hispanics/Latinos showed overall higher rates of collaterals than African Americans and non-Hispanic Whites (59%, 50% and 48%, respectively, P-value = 0.017, and especially higher rates in grade 1 and grade 3 collateralization than the other two populations (P-value = 0.0257. Admixture mapping showed Native American ancestry was associated with the presence of collaterals at a region on chromosome 17 (chr17:35,243,142-41,251,931, β = 0.55, P-value = 0.000127. African ancestry also showed association with collaterals at a different region on chromosome 17 (chr17: 32,266,966-34,463,323, β = 0.38, P-value = 0.00072.In our study, collateralization showed sex and racial-ethnic differences in obstructive CAD patients. We identified two regions on chromosome 17 that were likely to harbor genetic variations that influenced collateralization.

  2. Status of Systemic To Pulmonary Arterial Collateral Flow After the Fontan Procedure

    OpenAIRE

    Whitehead, Kevin K.; Harris, Matthew A.; Glatz, Andrew C.; Gillespie, Matthew J.; DiMaria, Michael V.; Harrison, Neil E.; Dori, Yoav; Keller, Marc S.; Rome, Jonathan J.; Fogel, Mark A.

    2015-01-01

    We recently validated a method of quantifying systemic to pulmonary arterial collateral flow using phase-contrast magnetic resonance imaging velocity mapping (PC-MRI). Cross-sectional data suggest decreased collateral flow in patients with total cavopulmonary connections (TCPC) compared to those with superior cavopulmonary connections (SCPC). However, no studies have examined serial changes in collateral flow from SCPC to TCPC in the same patients. We sought to examine differences in collater...

  3. Associations Between Collateral Status and Thrombus Characteristics and Their Impact in Anterior Circulation Stroke.

    Science.gov (United States)

    Alves, Heitor C; Treurniet, Kilian M; Dutra, Bruna G; Jansen, Ivo G H; Boers, Anna M M; Santos, Emilie M M; Berkhemer, Olvert A; Dippel, Diederik W J; van der Lugt, Aad; van Zwam, Wim H; van Oostenbrugge, Robert J; Lingsma, Hester F; Roos, Yvo B W E M; Yoo, Albert J; Marquering, Henk A; Majoie, Charles B L M

    2018-02-01

    Thrombus characteristics and collateral score are associated with functional outcome in patients with acute ischemic stroke. It has been suggested that they affect each other. The aim of this study is to evaluate the association between clot burden score, thrombus perviousness, and collateral score and to determine whether collateral score influences the association of thrombus characteristics with functional outcome. Patients with baseline thin-slice noncontrast computed tomography and computed tomographic angiography images from the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands) were included (n=195). Collateral score and clot burden scores were determined on baseline computed tomographic angiography. Thrombus attenuation increase was determined by comparing thrombus density on noncontrast computed tomography and computed tomographic angiography using a semiautomated method. The association of collateral score with clot burden score and thrombus attenuation increase was evaluated with linear regression. Mediation and effect modification analyses were used to assess the influence of collateral score on the association of clot burden score and thrombus attenuation increase with functional outcome. A higher clot burden score (B=0.063; 95% confidence interval, 0.008-0.118) and a higher thrombus attenuation increase (B=0.014; 95% confidence interval, 0.003-0.026) were associated with higher collateral score. Collateral score mediated the association of clot burden score with functional outcome. The association between thrombus attenuation increase and functional outcome was modified by the collateral score, and this association was stronger in patients with moderate and good collaterals. Patients with lower thrombus burden and higher thrombus perviousness scores had higher collateral score. The positive effect of thrombus perviousness on clinical outcome was only present in patients with

  4. Detection of human collateral circulation by vasodilation-thallium-201 tomography

    Energy Technology Data Exchange (ETDEWEB)

    Nienaber, C.A.; Salge, D.; Spielmann, R.P.; Montz, R.; Bleifeld, W. (University Hospital Eppendorf, Hamburg (Germany, F.R.))

    1990-04-15

    Coronary arteriolar vasodilation may provoke redistribution of flow to collateral-dependent jeopardized myocardium. To assess the physiologic significance of collaterals, 80 consecutive post-infarction patients (age 58 +/- 8 years) underwent vasodilation-redistribution thallium-201 tomographic imaging after administration of 0.56 mg of intravenous dipyridamole/kg body weight. Circumferential profile analysis of thallium-201 uptake and redistribution in representative left ventricular tomograms provided quantitative assessment of transient and fixed defects and separation between periinfarctional and distant inducible hypoperfusion. Tomographic perfusion data were correlated to wall motion and collateral circulation between distinct anatomic perfusion territories. Patients were grouped according to presence (59%) or absence (41%) of angiographically visible collateral channels to jeopardized myocardium. In the presence of collaterals, distant reversible defects were larger than in absence of collaterals (p less than 0.05); the extent of combined periinfarctional and distant redistribution was also larger in collateralized patients (p less than 0.025), whereas the size of the persistent perfusion defect was similar in both groups. By prospective analysis the tomographic perfusion pattern of combined periinfarctional and distant redistribution revealed a sensitivity of 85% and a specificity of 78% for the detection of significant collateral circulation in this group of patients. Thus, using the exhausted flow reserve as a diagnostic tool, vasodilation-thallium-201 tomography has the potential to identify and quantitate collateralized myocardium in post-infarction patients and may guide diagnostic and therapeutic decision-making.

  5. The fibular collateral ligament of the knee: a detailed review.

    Science.gov (United States)

    Song, Young-Bin; Watanabe, Koichi; Hogan, Elizabeth; D'Antoni, Anthony V; Dilandro, Anthony C; Apaydin, Nihal; Loukas, Marios; Shoja, Mohammadali M; Tubbs, R Shane

    2014-07-01

    The fibular collateral ligament (FCL) is one of the larger ligaments of the knee. The FCL, along with the popliteus tendon, arcuate popliteal ligament, and joint capsule, make up the posterolateral corner of the knee. Recently, there has there been an increased awareness and research on the structures of the posterolateral corner of the knee, particularly the FCL. Studying the detailed structure of the FCL may provide a better understanding that can lead to better diagnosis and treatments following injury. Therefore, this article reviews the FCL, which appears to be the primary restraint to varus rotation but is poorly oriented to resist external rotation of the knee. © 2013 Wiley Periodicals, Inc.

  6. GABAergic activities control spike timing- and frequency-dependent long-term depression at hippocampal excitatory synapses

    Directory of Open Access Journals (Sweden)

    Makoto Nishiyama

    2010-06-01

    Full Text Available GABAergic interneuronal network activities in the hippocampus control a variety of neural functions, including learning and memory, by regulating θ and γ oscillations. How these GABAergic activities at pre- and post-synaptic sites of hippocampal CA1 pyramidal cells differentially contribute to synaptic function and plasticity during their repetitive pre- and post-synaptic spiking at θ and γ oscillations is largely unknown. We show here that activities mediated by postsynaptic GABAARs and presynaptic GABABRs determine, respectively, the spike timing- and frequency-dependence of activity-induced synaptic modifications at Schaffer collateral-CA1 excitatory synapses. We demonstrate that both feedforward and feedback GABAAR-mediated inhibition in the postsynaptic cell controls the spike timing-dependent long-term depression of excitatory inputs (“e-LTD” at the θ frequency. We also show that feedback postsynaptic inhibition specifically causes e-LTD of inputs that induce small postsynaptic currents (<70 pA with LTP timing, thus enforcing the requirement of cooperativity for induction of long-term potentiation at excitatory inputs (“e-LTP”. Furthermore, under spike-timing protocols that induce e-LTP and e-LTD at excitatory synapses, we observed parallel induction of LTP and LTD at inhibitory inputs (“i-LTP” and “i-LTD” to the same postsynaptic cells. Finally, we show that presynaptic GABABR-mediated inhibition plays a major role in the induction of frequency-dependent e-LTD at α and β frequencies. These observations demonstrate the critical influence of GABAergic interneuronal network activities in regulating the spike timing and frequency dependences of long-term synaptic modifications in the hippocampus.

  7. Collateral methotrexate resistance in cisplatin-selected murine leukemia cells

    Directory of Open Access Journals (Sweden)

    Bhushan A.

    1999-01-01

    Full Text Available Resistance to anticancer drugs is a major cause of failure of many therapeutic protocols. A variety of mechanisms have been proposed to explain this phenomenon. The exact mechanism depends upon the drug of interest as well as the tumor type treated. While studying a cell line selected for its resistance to cisplatin we noted that the cells expressed a >25,000-fold collateral resistance to methotrexate. Given the magnitude of this resistance we elected to investigate this intriguing collateral resistance. From a series of investigations we have identified an alteration in a membrane protein of the resistant cell as compared to the sensitive cells that could be the primary mechanism of resistance. Our studies reviewed here indicate decreased tyrosine phosphorylation of a protein (molecular mass = 66 in the resistant cells, which results in little or no transfer of methotrexate from the medium into the cell. Since this is a relatively novel function for tyrosine phosphorylation, this information may provide insight into possible pharmacological approaches to modify therapeutic regimens by analyzing the status of this protein in tumor samples for a better survival of the cancer patients.

  8. Regionally selective alterations in local cerebral glucose utilization evoked by charybdotoxin, a blocker of central voltage-activated K+-channels.

    Science.gov (United States)

    Cochran, S M; Harvey, A L; Pratt, J A

    2001-11-01

    The quantitative [14C]-2-deoxyglucose autoradiographic technique was employed to investigate the effect of charybdotoxin, a blocker of certain voltage-activated K+ channels, on functional activity, as reflected by changes in local rates of cerebral glucose utilization in rat brain. Intracerebroventricular administration of charybdotoxin, at doses below those producing seizure activity, produced a heterogeneous effect on glucose utilization throughout the brain. Out of the 75 brain regions investigated, 24 displayed alterations in glucose utilization. The majority of these changes were observed with the intermediate dose of charybdotoxin administered (12.5 pmol), with the lower (6.25 pmol) and higher (25 pmol) doses of charybdotoxin producing a much more restricted pattern of change in glucose utilization. In brain regions which displayed alterations in glucose at all doses of charybdotoxin administered, no dose dependency in terms of the magnitude of change was observed. The 21 brain regions which displayed altered functional activity after administration of 12.5 pmol charybdotoxin were predominantly limited to the hippocampus, limbic and motor structures. In particular, glucose utilization was altered within three pathways implicated within learning and memory processes, the septohippocampal pathway, Schaffer collaterals within the hippocampus and the Papez circuit. The nigrostriatal pathway also displayed altered local cerebral glucose utilization. These data indicate that charybdotoxin produces alterations in functional activity within selected pathways in the brain. Furthermore the results raise the possibility that manipulation of particular subtypes of Kv1 channels in the hippocampus and related structures may be a means of altering cognitive processes without causing global changes in neural activity throughout the brain.

  9. 13 CFR 123.513 - Does SBA require collateral on its Military Reservist EIDL?

    Science.gov (United States)

    2010-01-01

    ... Military Reservist EIDL? 123.513 Section 123.513 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION DISASTER LOAN PROGRAM Military Reservist Economic Injury Disaster Loans § 123.513 Does SBA require collateral on its Military Reservist EIDL? SBA will not generally require you to pledge collateral to secure...

  10. 7 CFR 1421.106 - Warehouse-stored marketing assistance loan collateral.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Warehouse-stored marketing assistance loan collateral...) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS GRAINS AND... Marketing Assistance Loans § 1421.106 Warehouse-stored marketing assistance loan collateral. (a) A commodity...

  11. Collateralization, Bank Loan Rates and Monitoring : Evidence from a Natural Experiment

    NARCIS (Netherlands)

    Cerqueiro, G.M.; Ongena, S.; Roszbach, K.

    2011-01-01

    Collateral is one of the most important features of a debt contract. A substantial theoretical literature motivates the use of collateral as a means to alleviate ex-ante and ex-post information asymmetries between borrowers and lenders and the incidence of credit rationing. Through its seniority

  12. Validation of ultrasound parameters to assess collateral flow via ophthalmic artery in internal carotid artery occlusion.

    Science.gov (United States)

    Tanaka, Tomotaka; Doijiri, Ryosuke; Saito, Kozue; Kajimoto, Katsufumi; Ihara, Masafumi; Yamagami, Hiroshi; Miyashita, Kotaro; Nagatsuka, Kazuyuki

    2014-01-01

    This study aimed to characterize the flow patterns using ultrasound (US) in the external carotid artery (ECA) in patients with total occlusion of internal carotid artery (ICA) and characterize collateral retrograde flow through the ophthalmic artery (OA, secondary collateral, internalization). This study was performed on 45 patients who were retrospectively selected with total occlusion of the ICA, who underwent digital subtraction angiography (DSA), magnetic resonance angiography (MRA), and US (43 men; mean age 68.1 ± 7.9 years). Collateral retrograde flow and collateral flow through the circle of Willis (primary collateral) were determined by DSA and MRA. We compared several US parameters such as ECA peak systolic velocity, mean velocity, end-diastolic (ED) velocity, pulsatility index (PI), and pulsatility transmission index (PTI). PTI was defined as the ratio of ipsilateral ECA PI to the ipsilateral common carotid artery (CCA). In this patient group, 27 patients showed retrograde flow through OA as assessed by DSA. The presence of primary collateral flow was significantly lower in patients with retrograde flow than without (P ECA ED velocity was significantly higher, and PI and PTI were significantly lower with retrograde flow through OA than without (P ECA because a collateral pathway through OA in cases of ICA occlusion had less primary collateral pathways. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. Selective cyclooxygenase-1 inhibition improves collateral vascular reactivity in biliary cirrhotic rats

    Directory of Open Access Journals (Sweden)

    Ching-Chih Chang

    2013-10-01

    Conclusion: There was no significant hemodynamic change and renal toxicity after acute administration of COX inhibitor in the FBDL-induced cirrhotic rats. Preincubation of selective COX-1, but not COX-2, inhibitor could enhance collateral vascular response to AVP, indicating that COX-1 plays a major role in the collateral vascular reactivity.

  14. Laparoscopic umbilical hernia repair in the presence of extensive paraumbilical collateral veins: A case report

    NARCIS (Netherlands)

    S.S. Lases (Seilenna); H.H. Eker (Hasan); E.G.J.M. Pierik; P.J. Klitsie (Pieter); B. de Goede (Barry); M.P.F.V. Peeters; G. Kazemier (Geert); J.F. Lange (Johan)

    2011-01-01

    textabstractA patient with an umbilical hernia presenting with collateral veins in the abdominal wall and umbilicus is a case that every hernia surgeon has to deal with occasionally. Several underlying diseases have been described to provoke collateral veins in the abdominal wall. However, the

  15. Role of coronary collaterals in off-pump and on-pump coronary bypass surgery

    NARCIS (Netherlands)

    Nathoe, H.M.|info:eu-repo/dai/nl/267961472; Buskens, Erik; Jansen, E.W.L.; Suyker, W.J.L.|info:eu-repo/dai/nl/321847024; Stella, P.R.|info:eu-repo/dai/nl/304814717; Lahpor, J.R.; van Boven, W.J.; van Dijk, D.|info:eu-repo/dai/nl/241616301; Diephuis, J.C.; Borst, C.; Moons, K.G.M.|info:eu-repo/dai/nl/152483519; Grobbee, D.E.|info:eu-repo/dai/nl/071889256; de Jaegere, P.P.T.

    2004-01-01

    BACKGROUND: Collaterals limit infarct size, preserve viability, and reduce mortality in patients with acute myocardial infarction. In patients with stable coronary disease, collaterals are associated with less angina and ischemia during angioplasty and fewer ischemic events during follow-up. The

  16. [Senile dementia: differentiation of syndromes according to meridians based on the theory of "cerebral collaterals injury by toxin"].

    Science.gov (United States)

    Zhou, Li; Zhang, Yun-Ling; Hou, Xiao-Bing; Hu, Hui

    2012-11-01

    The pathogenesis and treatments based on meridian differentiation of senile dementia are discussed through analyses and researches on the theory of "cerebral collaterals injury by toxins" and "collateral diseases". The symptoms of "Cerebral collaterals injury by toxins" are preliminary characterized by toxins and blood stasis occluding brain collaterals. "Cerebral collateral injury by toxins" and "Governor Vessel occlusion by blood stasis" are taken as the major pathogeneses of senile dementia. And the treatment should be focused on clearing the collaterals. Clearance acting as reinforcing as well as to clear and modify the Governor Vessel are taken as crucial sections in the treatment of senile dementia based on meridian differentiation. It is also the application of acupuncture-moxibustion intervention in senile dementia based on the theory of "cerebral collateral injury by toxins", which expands the application of the theory concerning "collateral diseases" in disease prevention and treatment with acupuncture-moxibustion.

  17. Collaterals: an Important Determinant of Prolonged Ischemic Penumbra versus Rapid Cerebral Infarction?

    Directory of Open Access Journals (Sweden)

    Elisabeth Breese Marsh

    2014-10-01

    Full Text Available Intravenous tissue plasminogen activator is the mainstay for the treatment of acute ischemic stroke in patients presenting within 4.5 hours of symptom onset. Studies have demonstrated that treating patients early leads to improved long term outcomes. MR imaging currently allows quantification of the ischemic penumbra in order to better identify individuals most likely to benefit from intervention, irrespective of time last seen normal. Its increasing use in clinical practice has demonstrated individual differences in rate of infarction. One explanation for this variability is a difference in collateral blood flow. We report two cases that highlight the individual variability of infarction rate, and discuss potential underlying mechanisms that may influence treatment decisions and outcomes.

  18. The association of circulating monocyte count with coronary collateral growth in patients with diabetes mellitus.

    Science.gov (United States)

    Kocaman, Sinan Altan; Sahinarslan, Asife; Akyel, Ahmet; Timurkaynak, Timur; Boyaci, Bulent; Cengel, Atiye

    2010-03-01

    The status of inflammation may affect the collateral development in patients with diabetes mellitus (DM). Monocytes were found to have an important role in collateral growth in animal studies. We aimed to investigate the possible association of circulating monocyte count with collateral development in patients with DM and severe coronary artery disease (CAD). We enrolled 134 consecutive patients with DM who had > or =95 stenosis in at least one major coronary artery and investigated the relationship between circulating monocyte count and collateral growth. When we analyzed the coronary angiograms of eligible patients, we found that 64 of them had good collateral growth and 70 had poor collateral growth according to the Cohen-Rentrop method. The monocyte count was significantly different between good and poor collateral growth groups (643 +/- 184 vs. 479 +/- 143 per mm(3), P < 0.001). In the analysis comparing the Rentrop score with the Gensini score and circulating monocyte count, we found significant correlations (r = 0.293, P = 0.001 and r = 0.455, P < 0.001, respectively). The duration of ischemic symptoms tended to be longer in the good collateral group (1.9 +/- 4.1 vs. 0.8 +/- 1.3 years, P = 0.079). The Gensini score was also correlated with the duration of myocardial ischemic symptoms (r = 0.299, P = 0.004). Multivariate analysis revealed an increased monocyte count in the good collateral group [odds ratio (OR), 5.726; 95% confidence interval (CI), 1.817-18.040, P = 0.003, the cut-off value for monocyte was defined as 550 cell/mm(3)]. The increased circulating monocyte count in diabetic patients was evidently related to good coronary collateral growth. This finding may be potentially important in clinical and basic cardiovascular medicine.

  19. [Synopsis about the hypothesis of "information channel" of channel-collateral system].

    Science.gov (United States)

    Chang, Xi-Lang

    2008-10-01

    The author of the present paper founded a theorem about the "incompleteness of single channel structure" (nerve, blood vessel, lymphatic, interspace, aperture, etc.) through quantitative and qualitative analysis about the economic information channel in the human body, which eliminates the probability of single channel structure in the information channel of channel (meridian)-collateral system. After comprehensive analysis on the current researches, the author puts forward a neodoxy, i.e., the body "information channel" structure of the channel-collateral system, mainly follows the distribution regularity of systemic statistics, and is not a single specific entity; various layers of the information channel in the main stems of the channel-collaterals are composed of optimized structure tissues. Hence, the structure of this information channel of channel-collateral system is an overall-optimized, sequential and compatible systemic structure. From this neodoxy, the author brings forward a working principle of channel-collaterals, which is supported theoretically by bio-auxology. The longitudinal distribution of the main stems of meridian-collaterals is considered to result from that in the process of the animal evolution, in the animals moving forward, the microscopic complicated movement of intracorporeal information and energy molecules is related to the forward macroscopic and non-uniform movement of organism in trans-measure. Its impulse and kinetic momentum forms a main vector in the longitudinal direction of the body (the direction of the main stem of channel-collaterals). In order to adapt to and utilize natural regularities, the main stems of the channel-collaterals gradually differentiate and evolve in the living organism, forming a whole system. The "hypothesis of biological origin of channel-collateral system" and "that of information channel of the channel-collaterals in the body" constitute a relatively complete theoretical system framework.

  20. The effect of collateral flow and myocardial viability on the distribution of technetium-99m sestamibi in a closed-chest model of coronary occlusion and reperfusion

    Energy Technology Data Exchange (ETDEWEB)

    Chareonthaitawee, P. [MRC Cyclotron Unit, Hammersmith Hospital, London (United Kingdom); Div. of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN (United States); O' Connor, M.K. [Dept. of Nuclear Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN (United States); Gibbons, R.J.; Christian, T.F. [Div. of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN (United States); Ritman, E.L. [Dept. of Physiology, Mayo Clinic and Mayo Foundation, Rochester, MN (United States)

    2000-05-01

    The objective of this study was to determine the effect of myocardial viability and the degree of collateral blood flow on the uptake and retention of {sup 99m}Tc-sestamibi by examining three animal models of coronary occlusion and reperfusion, each reflecting a different state of viability and collateral blood flow. Three closed-chest animal models were studied: canine (high collateral flow, preserved viability), porcine (low collateral flow, absent viability) and porcine with slowly occlusive coronary stents producing infarction and enhanced collateral blood flow (high collateral flow, absent viability). There were seven dogs, seven pigs and six pigs, respectively, in each animal model. Animals from all three models were subjected to a 40-min total left anterior descending artery (LAD) occlusion followed by 2 h of reperfusion. {sup 99m}Tc-sestamibi and radiolabelled microspheres were injected during LAD occlusion 10 min prior to reperfusion. Animals were sacrificed after 2 h of reperfusion flow. Ex situ heart slice imaging to determine risk area was followed by viability staining to determine infarct size. Slices were subsequently sectioned into equally sized radial segments and placed in a gamma well counter. Risk area as determined by ex situ {sup 99m}Tc-sestamibi imaging was not significantly different by model. Pathological infarct size differed significantly by model [canine = 1%{+-}1% of the left ventricle (LV); porcine = 13%{+-}8% LV; porcine with stent = 14%{+-}7% LV; P=0.002]. Collateral blood flow by microspheres during occlusion tended to differ among models (overall P=0.08), with the canine and porcine with stent models having relatively high flow rates compared with the acute porcine model. {sup 99m}Tc-sestamibi activity correlated with microsphere blood flow in all three models, with r values for individual animals (n=20) ranging from 0.86 to 0.96 (all P<0.0001). There was a significant difference in the regression line intercepts (P<0.0001) and

  1. On Security of Collateral in Danish Mortgage Finance

    DEFF Research Database (Denmark)

    Haldrup, Karin

    2017-01-01

    on the balance principle that assigns risks and responsibility to market players in a self-disciplinary manner and protected the mortgage banks against cash flow mismatches even during deep crisis, as history attests. It is shown how property registers and effective enforcement have created transparent property......Specialized mortgage intermediaries in Denmark have for over two hundred years provided owners and buyers of real property wide access to credit. The present paper sets out to explore the safeguards that nurtured development of a robust, market based financing system and a deep mortgage market....... Observations are made on the nature of collateral performance in respect to property rights, mortgage law and market development in search of general features of required institutional arrangements. The robustness of the Danish mortgage finance system is largely accredited to the securitization model based...

  2. Medial collateral ligament recession for chronic medial knee laxity.

    Science.gov (United States)

    Backes, Jeffrey R; Wiltfong, Roger E; Steensen, Robert N

    2013-06-01

    The medial collateral ligament (MCL) is the primary restraint to valgus stress of the knee. Although the MCL has demonstrated an ability to reliably heal with conservative management, chronic medial instability has been well described following an isolated MCL injury or in combination with an anterior cruciate ligament (ACL) tear. When the MCL heals with persistent medial laxity surgical treatment may be necessary to prevent chronic medial instability and valgus overload of a reconstructed cruciate ligament. We present a simple technique for MCL recession that can be used for isolated MCL laxity as well as in chronic ACL/MCL knee injuries. This technique allows for secure fixation with bone-to-bone healing, avoids donor-site morbidity, maintains relative MCL isometry, and can be performed through a modest incision. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  3. Stress changes of lateral collateral ligament at different

    Directory of Open Access Journals (Sweden)

    ZHONG Yan-lin

    2011-04-01

    Full Text Available 【Abstract】 Objective: To create a 3-dimensional finite element model of knee ligaments and to analyse the stress changes of lateral collateral ligament (LCL with or without displaced movements at different knee flexion conditions. Methods: A four-major-ligament contained knee specimen from an adult died of skull injury was prepared for CT scanning with the detectable ligament insertion footprints, locations and orientations precisely marked in advance. The CT scanning images were converted to a 3-dimensional model of the knee with the 3-dimensional reconstruction technique and transformed into finite element model by the software of ANSYS. The model was validated using experimental and numerical results obtained by other scientists. The natural stress changes of LCL at five different knee flexion angles (0°, 30°, 60°, 90°, 120° and under various motions of anterior-posterior tibial translation, tibial varus rotation and internal-external tibial rotation were measured. Results: The maximum stress reached to 87%-113% versus natural stress in varus motion at early 30° of knee flexions. The stress values were smaller than the peak value of natural stress at 0° (knee full extension when knee bending was over 60° of flexion in anterior-posterior tibial translation and internal-external rotation. Conclusion: LCL is vulnerable to varus motion in almost all knee bending positions and susceptible to anterior- posterior tibial translation or internal-external rotation at early 30° of knee flexions. Key words: Knee joint; Collateral ligaments; Finite element analysis

  4. Surgical treatment of grade Ⅲ collateral ligament injury of knee joint caused by military training

    Directory of Open Access Journals (Sweden)

    Qiang ZHANG

    2011-08-01

    Full Text Available Objective To explore the method and effect of surgical treatment on grade Ⅲ collateral ligament injuries caused by military training.Methods Sixteen cases of grade Ⅲ collateral ligament injuries caused by military training were involved in the present study.Injuries to insertion of collateral ligament was repaired with suture anchor,fresh rupture of medial collateral ligament parenchyma was sutured directly,old rupture of medial collateral ligament parenchyma was repaired by direct suture and strengthening with autologous semitendinosus-gracilis tendon graft,while both fresh and old rupture of lateral collateral ligament parenchyma was reconstructed with autologous semitendinosus-gracilis tendon graft.Knee function was assessed 1 year after operation by Lysholm scores and compared with that before the operation.Results All the 16 patients were followed-up for 12 to 33 months with a mean of 20.5 months.The Lysholm knee scores of 1 year after peration(92.45±4.03 was significantly higher than that before operation(56.45±11.03,P < 0.05.Conclusions For the grade Ⅲ collateral ligament injuries caused by military training,the treatment principle was early diagnosis and early operation,and different surgical methods should be used according to the injury types for the sake of obtaining best therapeutic effects.

  5. Effective collateral circulation may indicate improved perfusion territory restoration after carotid endarterectomy.

    Science.gov (United States)

    Lin, Tianye; Lai, Zhichao; Lv, Yuelei; Qu, Jianxun; Zuo, Zhentao; You, Hui; Wu, Bing; Hou, Bo; Liu, Changwei; Feng, Feng

    2018-02-01

    To investigate the relationship between the level of collateral circulation and perfusion territory normalisation after carotid endarterectomy (CEA). This study enrolled 22 patients with severe carotid stenosis that underwent CEA and 54 volunteers without significant carotid stenosis. All patients were scanned with ASL and t-ASL within 1 month before and 1 week after CEA. Collateral circulation was assessed on preoperative ASL images based on the presence of ATA. The postoperative flow territories were considered as back to normal if they conformed to the perfusion territory map in a healthy population. Neuropsychological tests were performed on patients before and within 7 days after surgery. ATA-based collateral score assessed on preoperative ASL was significantly higher in the flow territory normalisation group (n=11, 50 %) after CEA (P territory normalisation group [>mean differences+2SD among control (MMSE=1.35, MOCA=1.02)]. This study demonstrated that effective collateral flow in carotid stenosis patients was associated with normalisation of t-ASL perfusion territory after CEA. The perfusion territory normalisation group tends to have more cognitive improvement after CEA. • Evaluation of collaterals before CEA is helpful for avoiding ischaemia during clamping. • There was good agreement on ATA-based ASL collateral grading. • Perfusion territories in carotid stenosis patients are altered. • Patients have better collateral circulation with perfusion territory back to normal. • MMSE and MOCA test scores improved more in the territory normalisation group.

  6. Infarct Pattern and Collateral Status in Adult Moyamoya Disease: A Multimodal Magnetic Resonance Imaging Study.

    Science.gov (United States)

    Kim, Dong Yeop; Son, Jeong Pyo; Yeon, Je Young; Kim, Gyeong-Moon; Kim, Jong-Soo; Hong, Seung-Chyul; Bang, Oh Young

    2017-01-01

    Moyamoya disease (MMD) is a unique cerebrovascular disease characterized by the progressive stenosis of large intracranial arteries and a hazy network of basal collaterals, called moyamoya vessels. Although hemodynamic studies have been applied in MMD patients, the mechanisms of stroke in MMD are still unclear. The present study evaluated the infarct pattern and collateral status using multimodal magnetic resonance imaging in MMD patients. Adult MMD patients with acute ischemic stroke were prospectively recruited, and infarct pattern on diffusion-weighted imaging was evaluated. A collateral flow map, derived from magnetic resonance perfusion-weighted imaging data, was generated through automatic postprocessing, and collateral status was assigned into 3 grades. Transcranial Doppler monitoring was performed to detect microembolic signals in selected patients. A total of 67 hemispheres (31 patients with bilateral and 5 patients with unilateral MMD) were analyzed. Most patients (83.7%) showed embolic pattern and rarely deep (9.3%) or hemodynamic infarct pattern (7.0%) on diffusion-weighted imaging. Most cases (86%) showed good collateral status, and few patients with acute infarcts of embolic pattern showed poor collateral status (n=7). One third (31.6%) of patients who underwent transcranial Doppler monitoring showed microembolic signals. In the studied population of adult MMD patients, embolic phenomenon played an important role in ischemic stroke. Therapeutic strategies against thromboembolism, as well as collateral enhancing strategies targeting improvement of hemodynamic status or increased washout of emboli, are warranted. © 2016 American Heart Association, Inc.

  7. The fissure: interlobar collateral ventilation and implications for endoscopic therapy in emphysema.

    Science.gov (United States)

    Koster, Theodoor David; Slebos, Dirk-Jan

    2016-01-01

    In patients with severe emphysema, bronchoscopic lung volume reduction using one-way valves is a promising therapeutic option to improve lung function and quality of life. The goal of this treatment is to achieve a complete lobar atelectasis. In a significant proportion of patients, this atelectasis cannot be achieved due to interlobar collateral ventilation. This collateral ventilation is generated through incomplete lobar fissures. Therefore, only patients with complete fissures and no collateral ventilation can be selected for endobronchial therapy with one-way valves. Incomplete fissures are very common and exhibit a great variation in anatomy. The reported prevalence is 17%-85% for the right major fissure, 19%-74% for the left major fissure, and 20%-90% for the minor fissure. There are several methods of measuring or predicting the presence of collateral ventilation, with computed tomography (CT)-fissure analysis and the Chartis measurement being the most important. CT-fissure analysis is an indirect method to measure the completeness of fissures as a surrogate for collateral ventilation. The Chartis system is an endobronchial method to directly measure the presence of collateral ventilation. Both methods have unique value, and the combination of both can accurately predict the treatment response to the bronchoscopic placement of endobronchial valves. This review provides an in-depth view of lung fissure and collateral ventilation to help understand its importance in selecting the appropriate patients for new emphysema treatments and thus avoid useless treatment in unsuitable patients.

  8. Impact of obstructive sleep apnea in recruitment of coronary collaterality during inaugural acute myocardial infarction.

    Science.gov (United States)

    Ben Ahmed, H; Boussaid, H; Longo, S; Tlili, R; Fazaa, S; Baccar, H; Boujnah, M R

    2015-09-01

    Obstructive sleep apnea (OSA) may lead to myocardial preconditioning by increasing coronary collateral vessel recruitment in patients with acute coronary occlusion. To determine the relationship between the severity of obstructive sleep apnea and coronary collaterality during acute myocardial infarction. This study prospectively included 71 patients with an inaugural myocardial infarction who had undergone a coronary angiography within 24h of onset. All patients underwent an overnight polygraph before discharge and were classified according to the apnea-hypopnea index (AHI). Coronary collaterals were scored by visual analyses and according to the Rentrop grading system. Mean age was 59±11years and 83% of patients were men. All patients had complete or subtotal occlusion of the infarct-related artery. After the sleep study, patients were divided into two groups: 25 were suffering from OSA (AHI>15/h). Patients with OSA showed better collateral vessel development (Rentrop score≥1) compared to non-OSA patients (68 vs. 41%, P=0.032). AHI was significantly higher in patients with developed coronary collaterals (Rentrop≥1) compared to those without collaterality (17.74±13.2 vs. 12.24±10.9, P=0.025). Coronary collateral development may be increased in OSA patients who are presenting with a first myocardial infarction. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  9. A novel method for selectively labelling olivocochlear collaterals in the rat.

    Science.gov (United States)

    Baashar, Ahmaed; Robertson, Donald; Mulders, Wilhelmina H A M

    2015-07-01

    Axons of olivocochlear neurons originate from the brainstem and project to the cochlea. A subpopulation, medial olivocochlear (MOC) neurons, also projects collateral branches to the cochlear nucleus. The precise targets of these collaterals are as yet unknown. Previous methods for labelling these collaterals include firstly, cochlear injections of retrograde tracers, but this is technically demanding and can also label afferent projections or secondly, labelling by injecting tracers into the nuclei of origin of MOC neurons. However, this latter method is non-specific because it also labels non-MOC projections. A technique was used to specifically label MOC collaterals, which involved injections of the tracer biocytin at the floor of the fourth ventricle and fixation 3 hours later. Biocytin injections resulted in labelled neurons in the ventral nucleus of the trapezoid body and rostral periolivary nucleus, confirming MOC axonal labelling. Labelled neurons in dorsal cochlear nucleus indicated labelling of the dorsal acoustic stria and these injections were discarded. After selective MOC labelling, collateral branches were found to innervate granule cell regions, medial edge and core of the ventral cochlear nucleus, as well as the dorsal cochlear nucleus, in agreement with previous data. Therefore we conclude that injections at the floor of the fourth ventricle provide a simple, rapid and specific technique for labelling the majority of MOC axons and their collaterals and this technique may assist in defining the precise neuronal targets of olivocochlear collaterals in cochlear nucleus. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Severe Degeneration of the Medial Collateral Ligament in Hallux Valgus: A Histopathologic Study in 12 Consecutive Patients

    Science.gov (United States)

    Prasitdumrong, Ittipol; Rungprai, Chamnanni; Reeboonlarb, Nitit; Poonpracha, Tara; Phisitkul, Phinit

    2013-01-01

    Objective To determine the degree and location of degenerative changes of the medial collateral ligament of the first metatarsophalangeal joint, using the lateral collateral ligament as a control, in patients undergoing hallux valgus correction. Materials and Methods A strip of medial and lateral collateral ligaments were biopsied from 12 consecutive patients (age 45 ± 4.8 years) with symptomatic hallux valgus. A blinded analysis of histopathology was performed by an experienced pathologist. Results The medial collateral ligament was significantly more degenerated compared to the lateral collateral ligament (x2 = 23.41, DF = 2, p hallux valgus correction. The Authors received no financial support for this study. PMID:24027461

  11. Alternative Evolutionary Paths to Bacterial Antibiotic Resistance Cause Distinct Collateral Effects.

    Science.gov (United States)

    Barbosa, Camilo; Trebosc, Vincent; Kemmer, Christian; Rosenstiel, Philip; Beardmore, Robert; Schulenburg, Hinrich; Jansen, Gunther

    2017-09-01

    When bacteria evolve resistance against a particular antibiotic, they may simultaneously gain increased sensitivity against a second one. Such collateral sensitivity may be exploited to develop novel, sustainable antibiotic treatment strategies aimed at containing the current, dramatic spread of drug resistance. To date, the presence and molecular basis of collateral sensitivity has only been studied in few bacterial species and is unknown for opportunistic human pathogens such as Pseudomonas aeruginosa. In the present study, we assessed patterns of collateral effects by experimentally evolving 160 independent populations of P. aeruginosa to high levels of resistance against eight commonly used antibiotics. The bacteria evolved resistance rapidly and expressed both collateral sensitivity and cross-resistance. The pattern of such collateral effects differed to those previously reported for other bacterial species, suggesting interspecific differences in the underlying evolutionary trade-offs. Intriguingly, we also identified contrasting patterns of collateral sensitivity and cross-resistance among the replicate populations adapted to the same drug. Whole-genome sequencing of 81 independently evolved populations revealed distinct evolutionary paths of resistance to the selective drug, which determined whether bacteria became cross-resistant or collaterally sensitive towards others. Based on genomic and functional genetic analysis, we demonstrate that collateral sensitivity can result from resistance mutations in regulatory genes such as nalC or mexZ, which mediate aminoglycoside sensitivity in β-lactam-adapted populations, or the two-component regulatory system gene pmrB, which enhances penicillin sensitivity in gentamicin-resistant populations. Our findings highlight substantial variation in the evolved collateral effects among replicates, which in turn determine their potential in antibiotic therapy. © The Author 2017. Published by Oxford University Press on

  12. Collateral blood flow in different cerebrovascular hierarchy provides endogenous protection in cerebral ischemia.

    Science.gov (United States)

    Luo, Chuanming; Liang, Fengyin; Ren, Huixia; Yao, Xiaoli; Liu, Qiang; Li, Mingyue; Qin, Dajiang; Yuan, Ti-Fei; Pei, Zhong; Su, Huanxing

    2017-11-01

    Collateral blood flow as vascular adaptions to focal cerebral ischemia is well recognized. However, few studies directly investigate the dynamics of collateral vessel recruitment in vivo and little is known about the effect of collateral blood flow in different cerebrovascular hierarchy on the neuropathology after focal ischemic stroke. Here, we report that collateral blood flow is critically involved in blood vessel compensations following regional ischemia. We occluded a pial arteriole using femtosecond laser ablating under the intact thinned skull and documented the changes of collateral flow around the surface communication network and between the surface communication network and subsurface microcirculation network using in vivo two photon microscopy imaging. Occlusion of the pial arteriole apparently increased the diameter and collateral blood flow of its leptomeningeal anastomoses, which significantly reduced the cortical infarction size. This result suggests that the collateral flow via surface communicating network connected with leptomeningeal anastomoses could greatly impact on the extent of infarction. We then further occluded the target pial arteriole and all of its leptomeningeal anastomoses. Notably, this type of occlusion led to reversals of blood flow in the penetrating arterioles mainly proximal to the occluded pial arteriole in a direction from the subsurface microcirculation network to surface arterioles. Interesting, the cell death in the area of ischemic penumbra was accelerated when we performed occlusion to cease the reversed blood flow in those penetrating arterioles, suggesting that the collateral blood flow from subsurface microcirculation network exerts protective roles in delaying cell death in the ischemic penumbra. In conclusion, we provide the first experimental evidence that collateral blood vessels at different cerebrovascular hierarchy are endogenously compensatory mechanisms in brain ischemia. © 2016 International Society of

  13. Leptomeningeal collateralization in acute ischemic stroke: Impact on prominent cortical veins in susceptibility-weighted imaging

    Energy Technology Data Exchange (ETDEWEB)

    Verma, Rajeev K., E-mail: rajeev.verma@insel.ch [University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern (Switzerland); Hsieh, Kety; Gratz, Pascal P.; Schankath, Adrian C.; Mordasini, Pasquale; Zubler, Christoph; Kellner-Weldon, Frauke [University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern (Switzerland); Jung, Simon [Department of Neurology, Inselspital, University of Bern, Bern (Switzerland); Schroth, Gerhard; Gralla, Jan; El-Koussy, Marwan [University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern (Switzerland)

    2014-08-15

    Background: The extent of hypoperfusion is an important prognostic factor in acute ischemic stroke. Previous studies have postulated that the extent of prominent cortical veins (PCV) on susceptibility-weighted imaging (SWI) reflects the extent of hypoperfusion. Our aim was to investigate, whether there is an association between PCV and the grade of leptomeningeal arterial collateralization in acute ischemic stroke. In addition, we analyzed the correlation between SWI and perfusion-MRI findings. Methods: 33 patients with acute ischemic stroke due to a thromboembolic M1-segment occlusion underwent MRI followed by digital subtraction angiography (DSA) and were subdivided into two groups with very good to good and moderate to no leptomeningeal collaterals according to the DSA. The extent of PCV on SWI, diffusion restriction (DR) on diffusion-weighted imaging (DWI) and prolonged mean transit time (MTT) on perfusion-imaging were graded according to the Alberta Stroke Program Early CT Score (ASPECTS). The National Institutes of Health Stroke Scale (NIHSS) scores at admission and the time between symptom onset and MRI were documented. Results: 20 patients showed very good to good and 13 patients poor to no collateralization. PCV-ASPECTS was significantly higher for cases with good leptomeningeal collaterals versus those with poor leptomeningeal collaterals (mean 4.1 versus 2.69; p = 0.039). MTT-ASPECTS was significantly lower than PCV-ASPECTS in all 33 patients (mean 1.0 versus 3.5; p < 0.00). Conclusions: In our small study the grade of leptomeningeal collateralization correlates with the extent of PCV in SWI in acute ischemic stroke, due to the deoxyhemoglobin to oxyhemoglobin ratio. Consequently, extensive PCV correlate with poor leptomeningeal collateralization while less pronounced PCV correlate with good leptomeningeal collateralization. Further SWI is a very helpful tool in detecting tissue at risk but cannot replace PWI since MTT detects significantly more ill

  14. Recruitable collateral blood flow index predicts coronary instent restenosis after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Thayssen, Per; Lassen, Jens Flensted

    2007-01-01

    AIMS: Collateral flow may influence long-term results after percutaneous coronary intervention (PCI) because of haemodynamic forces compete with the antegrade flow through the dilated lesion. The aim of the study was to assess the influence of recruitable collateral blood flow on restenosis......-derived collateral flow index (CFI) was determined as (P(w)-P(cvp))/(P(a)-P(cvp)), where P(w) represents coronary wedge pressure, P(cvp) central venous pressure, and P(a) mean aortic blood pressure. Both were measured during transient coronary occlusion by a balloon inflation of 30 s. Pre-interventional FFR (0...

  15. PENGEMBANGAN HAK KEKAYAAN INTELEKTUAL SEBAGAI COLLATERAL (AGUNAN UNTUK MENDAPATKAN KREDIT PERBANKAN DI INDONESIA

    Directory of Open Access Journals (Sweden)

    Sri Mulyani

    2012-09-01

    Full Text Available Intellectual Property Rights is granted the exclusive rights to creators, inventors or designers for the creation or invention that has commercial value, either directly or through the automatic registration of the relevant agencies as awards, recognition should be given the protection of the rights of the community development law. Globally, the IPR will be used as collateral to obtain a bank loan internasional. In this law is necessary to realize the concept of legislation in each country who are willing to apply that regulate substance loading, binding, and registration of intellectual property as collateral. Key words: development of intellectual property rights, collateral, bank credit in Indonesia

  16. Injuries to the Collateral Ligaments of the Metacarpophalangeal Joint of the Thumb, Including Simultaneous Combined Thumb Ulnar and Radial Collateral Ligament Injuries, in National Football League Athletes.

    Science.gov (United States)

    Werner, Brian C; Belkin, Nicole S; Kennelly, Steve; Weiss, Leigh; Barnes, Ronnie P; Rodeo, Scott A; Warren, Russell F; Hotchkiss, Robert N

    2017-01-01

    Thumb collateral ligament injuries occur frequently in the National Football League (NFL). In the general population or in recreational athletes, pure metacarpophalangeal (MCP) abduction or adduction mechanisms yield isolated ulnar collateral ligament (UCL) and radial collateral ligament (RCL) tears, respectively, while NFL athletes may sustain combined mechanism injury patterns. To evaluate the incidence of simultaneous combined thumb UCL and RCL tears among all thumb MCP collateral ligament injuries in NFL athletes on a single team. Case series; Level of evidence, 4. A retrospective review of all thumb injuries on a single NFL team from 1991 to 2014 was performed. All players with a thumb MCP collateral ligament injury were included. Collateral ligament injuries were confirmed by review of both physical examination findings and magnetic resonance imaging. Player demographics, surgical details, and return-to-play data were obtained from the team electronic medical record and surgeons' records. A total of 36 thumbs in 32 NFL players were included in the study, yielding an incidence of 1.6 thumb MCP collateral ligament injuries per year on a single NFL team. Of these, 9 thumbs (25%) had a simultaneous combined UCL and RCL tear injury pattern confirmed on both physical examination and MRI. The remaining 27 thumbs (75%) were isolated UCL injuries. All combined UCL/RCL injuries required surgery due to dysfunction from instability; 63.0% of isolated UCL injuries required surgical repair ( P = .032) due to continued pain and dysfunction from instability. Repair, when required, was delayed until the end of the season. All players with combined UCL/RCL injuries and isolated UCL injuries returned to play professional football the following season. Simultaneous combined thumb UCL and RCL tear is a previously undescribed injury pattern that occurred in 25% of thumb MCP collateral ligament injuries on a single NFL team over a 23-year period. All players with combined thumb UCL

  17. Sigma-2 receptor agonists as possible antitumor agents in resistant tumors: hints for collateral sensitivity.

    Science.gov (United States)

    Niso, Mauro; Abate, Carmen; Contino, Marialessandra; Ferorelli, Savina; Azzariti, Amalia; Perrone, Roberto; Colabufo, Nicola Antonio; Berardi, Francesco

    2013-12-01

    With the aim of contributing to the development of novel antitumor agents, high-affinity σ2 receptor agonists were developed, with 6,7-dimethoxy-2-[4-[1-(4-fluorophenyl)-1H-indol-3-yl]butyl]-1,2,3,4-tetrahydroisoquinoline (15) and 9-[4-(6,7-dimethoxy-1,2,3,4-tetrahydroisoquinolin-2-yl)butyl]-9H-carbazole (25) showing exceptional selectivity for the σ2 subtype. Most of the compounds displayed notable antiproliferative activity in human MCF7 breast adenocarcinoma cells, with similar activity in the corresponding doxorubicin-resistant MCF7adr cell line. Surprisingly, a few compounds, including 25, displayed enhanced activity in MCF7adr cells over parent cells, recalling the phenomenon of collateral sensitivity, which is under study for the treatment of drug-resistant tumors. All of the compounds showed interaction with P-glycoprotein (P-gp), and 15 and 25, with the greatest activity, were able to revert P-gp-mediated resistance and reestablish the antitumor effect of doxorubicin in MCF7adr cells. We therefore identified a series of σ2 receptor agonists endowed with intriguing antitumor properties; these compounds deserve further investigation for the development of alternate strategies against multidrug- resistant cancers. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  18. Use of collateral sensitivity networks to design drug cycling protocols that avoid resistance development

    DEFF Research Database (Denmark)

    Imamovic, Lejla; Sommer, Morten

    2013-01-01

    and select against drug resistance development. We identified hundreds of such drug sets and demonstrated that the antibiotics gentamicin and cefuroxime can be deployed cyclically such that the treatment regimen selected against resistance to either drug. We then validated our findings with related bacterial......New drug deployment strategies are imperative to address the problem of drug resistance, which is limiting the management of infectious diseases and cancers. We evolved resistance in Escherichia coli toward 23 drugs used clinically for treating bacterial infections and mapped the resulting...... collateral sensitivity and resistance profiles, revealing a complex collateral sensitivity network. On the basis of these data, we propose a new treatment framework-collateral sensitivity cycling-in which drugs with compatible collateral sensitivity profiles are used sequentially to treat infection...

  19. Cerebral collateral therapeutics in acute ischemic stroke: A randomized preclinical trial of four modulation strategies.

    Science.gov (United States)

    Beretta, Simone; Versace, Alessandro; Carone, Davide; Riva, Matteo; Dell'Era, Valentina; Cuccione, Elisa; Cai, Ruiyao; Monza, Laura; Pirovano, Silvia; Padovano, Giada; Stiro, Fabio; Presotto, Luca; Paternò, Giovanni; Rossi, Emanuela; Giussani, Carlo; Sganzerla, Erik P; Ferrarese, Carlo

    2017-10-01

    Cerebral collaterals are dynamically recruited after arterial occlusion and highly affect tissue outcome in acute ischemic stroke. We investigated the efficacy and safety of four pathophysiologically distinct strategies for acute modulation of collateral flow (collateral therapeutics) in the rat stroke model of transient middle cerebral artery (MCA) occlusion. A composed randomization design was used to assign rats (n = 118) to receive phenylephrine (induced hypertension), polygeline (intravascular volume load), acetazolamide (cerebral arteriolar vasodilation), head down tilt (HDT) 15° (cerebral blood flow diversion), or no treatment, starting 30 min after MCA occlusion. Compared to untreated animals, treatment with collateral therapeutics was associated with lower infarct volumes (62% relative mean difference; 51.57 mm3 absolute mean difference; p therapy.

  20. Aspirin, but not clopidogrel, reduces collateral conductance in a rabbit model of femoral artery occlusion

    NARCIS (Netherlands)

    Hoefer, Imo E.; Grundmann, Sebastian; Schirmer, Stephan; van Royen, Niels; Meder, Benjamin; Bode, Christoph; Piek, Jan J.; Buschmann, Ivo R.

    2005-01-01

    OBJECTIVES The objective of this study was to test the potential of aspirin and clopidogrel to influence collateral artery growth (arteriogenesis). BACKGROUND Aspirin and clopidogrel are antiplatelet agents commonly used in the treatment of ischemic cardiovascular disease. Both inhibit platelet

  1. Kinematics of partial and total ruptures of the medial collateral ligament of the elbow

    DEFF Research Database (Denmark)

    Eygendaal, D; Olsen, Bo Sanderhoff; Jensen, Steen Lund

    2000-01-01

    In this study the kinematics of partial and total ruptures of the medial collateral ligament of the elbow are investigated. After selective transection of the medial collateral ligament of 8 osteoligamentous intact elbow preparations was performed, 3-dimensional measurements of angular displacement...... ligament and was maximum between 70 degrees to 90 degrees of flexion. No radial head movement was seen after partial or total transection of the anterior bundle of the medial collateral ligament was performed. In conclusion, this study indicates that valgus or internal rotatory elbow instability should...... be evaluated at 70 degrees to 90 degrees of flexion. Detection of partial ruptures in the anterior bundle of the medial collateral ligament based on medial joint opening and increased valgus movement is impossible....

  2. Management of Medial Collateral Ligament Injury During Primary Total Knee Arthroplasty: A Systematic Review

    National Research Council Canada - National Science Library

    Della Torre, MD, Paul; Stephens, MD, Andrew; Oh, MD, Horng Lii; Kamra, MD, Akshay; Zicat, MD, Bernard; Walker, MD, Peter

    2014-01-01

    Medial collateral ligament injury during primary total knee arthroplasty is a recognised complication potentially resulting in valgus instability, suboptimal patient outcomes and a higher rate of revision or reoperation...

  3. Contrast-Enhanced Sonography for Diagnosing Collateral Transformation of the Hepatic Artery After Liver Transplantation.

    Science.gov (United States)

    Lyu, Su-Qin; Ren, Jie; Zheng, Rong-Qin; Meng, Xiao-Chun; Huang, Ming-Sheng; Wang, Ping

    2015-09-01

    To determine the contrast-enhanced sonographic features of hepatic artery collateral transformation in patients with hepatic artery complications after liver transplantation. Ninety-nine liver transplant recipients who underwent contrast-enhanced sonography were recruited from April 2004 to May 2014. The reference standards were conventional angiography and computed tomographic angiography. The contrast-enhanced sonographic features of the hepatic artery in patients with and without collateral arteries were retrospectively analyzed. All 15 patients with hepatic artery collateral transformation had hepatic artery thrombosis (10 of 15) or hepatic artery stenosis (5 of 15). The collateral artery detection rate on contrast-enhanced sonography was 100%. The peripheral hepatic artery could not be visualized by contrast-enhanced sonography in most of the patients with hepatic artery collateral transformation (14 of 15). Additionally, many small tortuous collateral arteries in the porta hepatis region were visualized during the arterial and early portal phases, showing reticulated/patchy (15 of 15) and striped (3 of 15) enhancement patterns on contrast-enhanced sonography. Collateral transformation of the hepatic artery in patients with hepatic artery complications after liver transplantation appears to have characteristic features on contrast-enhanced sonography, especially a reticulated or patchy enhancement pattern in the porta hepatis region during the arterial and early portal phases combined with the absence of the peripheral hepatic artery. Contrast-enhanced sonography may be a novel method for diagnosing hepatic artery collateral transformation, which may be a highly specific sign of hepatic artery thrombosis or stenosis. © 2015 by the American Institute of Ultrasound in Medicine.

  4. Does information sharing reduce the role of collateral as a screening device?

    OpenAIRE

    Stacescu, Bogdan; Karapetyan, Artashes

    2014-01-01

    This is the authors’ accepted, refereed and final manuscript to the article. Publisher’s version available at http://dx.doi.org/10.1016/j.jbankfin.2014.02.010 Information sharing and collateral are both devices that help banks reduce the cost of adverse selection. We examine whether they are likely to be used as substitutes (information sharing reduces the need for collateral) or complements. We show that information sharing via a credit bureaus and registers may increase, r...

  5. Isolated lateral collateral ligament complex injury in rock climbing and Brazilian Jiu-jitsu.

    Science.gov (United States)

    Davis, Bryan A; Hiller, Lucas P; Imbesi, Steven G; Chang, Eric Y

    2015-08-01

    We report two occurrences of high-grade tears of the lateral collateral ligament complex (LCLC), consisting of the anterolateral ligament (ALL) and fibular collateral ligament (FCL). One injury occurred in a rock climber and the other in a martial artist. Increasing awareness of isolated injuries of the LCLC will allow for appropriate diagnosis and management. We review and discuss the anatomy of the LCLC, the unique mechanism of isolated injury, as well as physical and imaging examination findings.

  6. Retrospective analysis of intravertebral collateral enhancement in patients with central venous obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Simeone, F.J.; Chang, Connie Y.; Huang, Ambrose J.; Kattapuram, Susan V.; Bredella, Miriam A.; Torriani, Martin [Massachusetts General Hospital and Harvard Medical School, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Bennett, Debbie L. [Saint Louis University School of Medicine, Department of Radiology, Saint Louis, MO (United States)

    2016-02-15

    To compare prevalence and patterns of intravertebral collateral enhancement in patients with and without central venous obstruction (CVO). Chest CTs performed between 1/1/2000 and 12/15/2012 with reports containing terms indicating CVO were identified. All contrast enhanced CTs were examined for the presence of CVO and collateral venous pathways. If intravertebral collateral enhancement was present, the pattern was recorded as nodular, linear, or both. In 209 suspected cases of CVO, 53 (25 %) were confirmed with obstruction and 156 (75 %) were without obstruction. In patients with CVO, 47 % (25/53) demonstrated collateral venous flow through an intravertebral marrow pathway compared to 5 % (8/156) of patients without CVO (P < 0.0001). The most common level of enhancement was the upper thoracic spine, involving only the vertebral body. Nodular, linear, and combined nodular-linear enhancement patterns were seen with similar frequency. Nodular intravertebral collateral enhancement was mistaken for sclerotic metastases in 33 % (3/9) of cases. Intravertebral collateral enhancement was seen in almost half the patients with CVO and when nodular enhancement is present, it is important to differentiate between metastatic lesions and enhancement related to CVO. (orig.)

  7. Acute development of collateral circulation and therapeutic prospects in ischemic stroke

    Directory of Open Access Journals (Sweden)

    Eri Iwasawa

    2016-01-01

    Full Text Available In acute ischemic stroke, collateral circulation plays an important role in maintaining blood flow to the tissue that is at risk of progressing into ischemia, and in increasing the successful recanalization rate without hemorrhagic transformation. We have reported that well-developed collateral circulation is associated with smaller infarct volume and better long-term neurological outcome, and it disappears promptly once the effective recanalization is achieved. Contrary to the belief that collateral vessels develop over time in chronic stenotic condition, there exists a phenomenon that collateral circulation develops immediately in acute stenosis or occlusion of the arteries and it seems to be triggered by fluid shear stress, which occurs between the territories of stenotic/occluded arteries and those fed by surrounding intact arteries. We believe that this acute development of collateral circulation is a target of novel therapeutics in ischemic stroke and refer our recent attempt in enhancing collateral circulation by modulating sphingosine-1-phosphate receptor 1, which is a known shear-stress mechanosensing protein.

  8. Differential impact of diabetes mellitus type II and arterial hypertension on collateral artery growth and concomitant macrophage accumulation.

    Science.gov (United States)

    Ito, Wulf D; Lund, Natalie; Sager, Hendrik; Becker, Wiebke; Wenzel, Ulrich

    2015-01-01

    Diabetes mellitus type II and arterial hypertension are major risk factors for peripheral arterial disease and have been considered to reduce collateral growth (arteriogenesis). Collateral growth proceeds through different stages. Vascular proliferation and macrophage accumulation are hallmarks of early collateral growth. We here compare the impact of arterial hypertension and diabetes mellitus type II on collateral proliferation (Brdu incorporation) and macrophage accumulation (ED 2 staining) as well as collateral vessel function (collateral conductance) in a rat model of peripheral vascular disease (femoral artery occlusion), diabetes mellitus type II (Zucker fatty diabetic rats and Zucker lean rat controls) and arterial hypertension (induced via clip placement around the right renal arteriy). We furthermore tested the impact of monocyte chemoattractant protein-1 (MCP‑1) on collateral proliferation and macrophage accumulation in these models Diabetic animals showed reduced vascular proliferation and macrophage accumulation, which however did not translate into a change of collateral conductance. Hypertensive animals on the contrary had reduced collateral conductances without altered macrophage accumulation and only a marginal reduction in collateral proliferation. Infusion of MCP‑1 only enhanced vascular proliferation in diabetic animals. These findings illustrate that impaired monocyte/macrophage recruitment is responsible for reduced collateral growth under diabetic conditions but not in arterial hypertension suggesting that diabetes mellitus in particular affects early stages of collateral growth whereas hypertension has its impact on later remodeling stages. Successful pro-arteriogenic treatment strategies in a patient population that presents with diabetes mellitus and arterial hypertension need to address different stages of collateral growth and thus different molecular and cellular targets simultaneously.

  9. Outcomes of Medial Collateral Ligament Injuries during Total Knee Arthroplasty.

    Science.gov (United States)

    Siqueira, Marcelo B P; Haller, Kathryn; Mulder, Andrew; Goldblum, Andrew S; Klika, Alison K; Barsoum, Wael K

    2016-01-01

    Intraoperative medial collateral ligament (MCL) disruption during total knee arthroplasty (TKA) is often managed with either primary repair or use of a constrained implant. A total of 23 patients with an MCL injury during TKA between 2003 and 2009 were compared with 92 matched controls. Of the 23 patients, 10 were treated with an unconstrained implant and primary MCL repair, 8 with constrained implants, 3 with constrained implants and MCL repair, and 2 with unconstrained implants and no MCL repair. After an average 5-year follow-up, patients had lower Knee Society Scores (KSS), 79 versus 87 (p = 0.03), but similar Knee Function Scores (KFS), 68 versus 72 (p = 0.35). The improvement between preoperative and postoperative KSS and KFS did not vary among the two groups (p = 0.88 and p = 0.77, respectively). Postoperative scores did not vary significantly among the four treatment modalities. Conservative treatment can provide satisfactory outcomes and avoid potential complications of increased constraint. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  10. COLLATERAL'S IMPORTANCE IN SMES FINANCING: WHAT IS THE BANKS RESPONSE? SOME EVIDENCE FOR ROMANIA

    Directory of Open Access Journals (Sweden)

    Petria Nicolae

    2011-07-01

    Full Text Available Searching for funding, SMEs managers face various obstacles arising from information asymmetry, lack of experience, severe market conditions, and insufficient or unsatisfactory collaterals for banks (OECD 2006; Badulescu and Badulescu 2010; OECD 2000 and 2004; Lin and Sun 2006; Toivanen and Cresy, 2000. The collateral issue is extensively discussed in literature preventing moral hazard, the alignment the interests (Stiglitz and Weiss 1981:393-410; Chan and Thakor 1987:345-363; Jimenez and Saurina 2004, a means to discipline the borrowers behaviour (ex post given the existence of a credible threat (Aghion and Bolton 1992:473-494, or even banking behaviour on the market (Manove et al. 2001:726-744, Argentiero 2009. In the same time we find that the perception of firms, revealed by National Bank of Romania (NBR 2010 survey data, show that banks still use the collateral as a measure of pressure, in special in crisis times. For an important part of managers, the bank increased the level of required collateral for existing, renewing or new credits, asking for new covenants, revealing a paradox of crisis time: while the bank loans remained the favourite method of external financing needs of business, the banks often reduce their availability. Although the bank loan remains the favorite mean to support the growth ambitions, the higher level of collateral or lending costs are seen as principal obstacles by the majority of manager in EU. According to NBR survey, the influence of risk factors related to collateral had a climax at the end of 2008 and 2009, when the banks have tightened the requirement for loan guarantee. Using National Bank of Romania (NBR 2010 survey data, we show that the banks still use the collateral as a measure of pressure, in special in crisis times. For an important part of managers, the bank increased the level of required collateral for existing, renewing or new credits, asking for new covenants, revealing a paradox of crisis time

  11. Cognitive assessment of older adults in general practice: the collateral history.

    Science.gov (United States)

    Dyer, Adam H; Foley, Tony; O'Shea, Brendan; Kennelly, Sean P

    2017-12-02

    The collateral (or informant) history is a key component in the assessment of older adults presenting with a memory problem or concern over cognition. Despite this, it rarely features in medical literature and academic curricula. Its role in general practice has never been assessed. The aim of this study is to assess the role of the collateral history in the investigation of cognitive impairment in general practice. An online survey distributed to three nationally representative cohorts of GPs in Ireland (n = 692). Ninety-five (14%; 52.2% male) responded. Nearly all (87%; 83/95) indicate that it is most often a family member who brings possible cognitive impairment to the attention of their GP. The vast majority obtain a collateral history in > 90% of cases (72.6%; 69/95) and rate it very useful in their clinical assessment of cognition. GPs report the collateral history as readily available and rarely refused, with the general practice environment well-suited to obtaining collateral histories. A small minority routinely use the GPCOG informant section (3.2%; 3/95). Nearly all (92.6%; 88/95) report having received no training in obtaining collateral histories with most (79%; 75/95) welcoming of further training in this area. Despite recognition of the utility and importance of the collateral history, the vast majority of GPs report having never received training in obtaining one and do not use structured tools to guide their interview. Further emphasis on the informant history as a distinct clinical entity on medical curricula and increasing emphasis on the availability of structured informant tools are warranted.

  12. Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kariya, Shuji, E-mail: kariyas@hirakata.kmu.ac.jp; Nakatani, Miyuki, E-mail: nakatanm@hirakata.kmu.ac.jp; Yoshida, Rie, E-mail: yagir@hirakata.kmu.ac.jp; Ueno, Yutaka, E-mail: uenoyut@hirakata.kmu.ac.jp; Komemushi, Atsushi, E-mail: komemush@takii.kmu.ac.jp; Tanigawa, Noboru, E-mail: tanigano@hirakata.kmu.ac.jp [Kansai Medical University, Department of Radiology (Japan)

    2017-01-15

    PurposeThis study was designed to investigate thoracic duct collateral leakage and the supply route of lymphatic fluid by lymphangiography and transcatheter thoracic ductography and to evaluate the results of embolization for thoracic duct collateral leakage performed to cut off this supply route.MethodsData were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery. Extravasation of lipiodol at the ruptured thoracic duct collaterals was confirmed in all patients on lymphangiography. Transcatheter thoracic ductography was used to identify extravasation of iodinated contrast agent and to identify communication between the thoracic duct and leakage site. Thoracic duct embolization (TDE) was performed using the percutaneous transabdominal approach to cut off the supply route using N-butyl cyanoacrylate (NBCA) mixed with lipiodol (1:5–1:20).ResultsClinical success (drainage volume ≤10 mL/kg/day within 7 days after TDE) was achieved in all patients. The collateral routes developed as consequence of surgical thoracic duct ligation. In three patients, NBCA-Lipiodol reached the leakage site through direct communication between the thoracic duct and the ruptured lymphatic duct. In the other two patients, direct communication and extravasation was not detected on thoracic ductography, and NBCA-Lipiodol did not reach the leakage site. However, NBCA-Lipiodol did reach the cisterna chyli, lumbar trunks, and some collateral routes via the cisterna chyli or lumbar lymphatics. As a result, leakage was stopped.ConclusionsTDE was effective for the management of leakage of the collaterals in high-output chylothorax after thoracic surgery.

  13. Do Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Represent Good Collaterals before Reperfusion Therapy?

    Science.gov (United States)

    Mahdjoub, E; Turc, G; Legrand, L; Benzakoun, J; Edjlali, M; Seners, P; Charron, S; Hassen, W Ben; Naggara, O; Meder, J-F; Mas, J-L; Baron, J-C; Oppenheim, C

    2017-10-26

    In acute ischemic stroke, whether FLAIR vascular hyperintensities represent good or poor collaterals remains controversial. We hypothesized that extensive FLAIR vascular hyperintensities correspond to good collaterals, as indirectly assessed by the hypoperfusion intensity ratio. We included 244 consecutive patients eligible for reperfusion therapy with MCA stroke and pretreatment MR imaging with both FLAIR and PWI. The FLAIR vascular hyperintensity score was based on ASPECTS, ranging from 0 (no FLAIR vascular hyperintensity) to 7 (FLAIR vascular hyperintensities abutting all ASPECTS cortical areas). The hypoperfusion intensity ratio was defined as the ratio of the time-to-maximum >10-second over time-to-maximum >6-second lesion volumes. The median hypoperfusion intensity ratio was used to dichotomize good (low hypoperfusion intensity ratio) versus poor (high hypoperfusion intensity ratio) collaterals. We then studied the association between FLAIR vascular hyperintensity extent and hypoperfusion intensity ratio. Hypoperfusion was present in all patients, with a median hypoperfusion intensity ratio of 0.35 (interquartile range, 0.19-0.48). The median FLAIR vascular hyperintensity score was 4 (interquartile range, 3-5). The FLAIR vascular hyperintensities were more extensive in patients with good collaterals (hypoperfusion intensity ratio ≤0.35) than with poor collaterals (hypoperfusion intensity ratio >0.35; P for Trend = .016). The FLAIR vascular hyperintensity score was independently associated with good collaterals (P for Trend = .002). In patients eligible for reperfusion therapy, FLAIR vascular hyperintensity extent was associated with good collaterals, as assessed by the pretreatment hypoperfusion intensity ratio. The ASPECTS assessment of FLAIR vascular hyperintensities could be used to rapidly identify patients more likely to benefit from reperfusion therapy. © 2018 by American Journal of Neuroradiology.

  14. Morphology of the medial collateral ligament of the knee

    Directory of Open Access Journals (Sweden)

    Gill Thomas J

    2010-09-01

    Full Text Available Abstract Background Quantitative knowledge on the anatomy of the medial collateral ligament (MCL is important for treatment of MCL injury and for MCL release during total knee arthroplasty (TKA. The objective of this study was to quantitatively determine the morphology of the MCL of human knees. Methods 10 cadaveric human knees were dissected to investigate the MCL anatomy. The specimens were fixed in full extension and this position was maintained during the dissection and morphometric measurements. The outlines of the insertion sites of the superficial MCL (sMCL and deep MCL (dMCL were digitized using a 3D digitizing system. Results The insertion areas of the superficial MCL (sMCL were 348.6 ± 42.8 mm2 and 79.7 ± 17.6 mm2 on the tibia and femur, respectively. The insertion areas of the deep MCL (dMCL were 63.6 ± 13.4 mm2 and 71.9 ± 14.8 mm2 on the tibia and femur, respectively. The distances from the centroids of the tibial and femoral insertions of the sMCL to the tibial and femoral joint line were 62.4 ± 5.5 mm and 31.1 ± 4.6 mm, respectively. The distances from the centroids of dMCL in the tibial insertion and the femoral insertion to the tibial and femoral joint line were 6.5 ± 1.3 mm and 20.5 ± 4.2 mm, respectively. The distal portion of the dMCL (meniscotibial ligament - MTL was approximately 1.7 times wider than the proximal portion of the dMCL (meniscofemoral ligament - MFL, whereas the MFL was approximately 3 times longer than the MTL. Conclusions The morphologic data on the MCL may provide useful information for improving treatments of MCL-related pathology and performing MCL release during TKA.

  15. Prevalence of Ulnar Collateral Ligament Surgery in Professional Baseball Players.

    Science.gov (United States)

    Conte, Stan A; Fleisig, Glenn S; Dines, Joshua S; Wilk, Kevin E; Aune, Kyle T; Patterson-Flynn, Nancy; ElAttrache, Neal

    2015-07-01

    While the high rate of ulnar collateral ligament (UCL) injuries in professional baseball is widely discussed in the media and medical literature, the actual prevalence of UCL reconstruction has not been documented. The prevalence of UCL reconstruction will be higher among pitchers than nonpitchers, and Major League Baseball (MLB) pitchers will have a higher prevalence than will minor league pitchers. Descriptive epidemiology study. An online questionnaire was distributed to all 30 MLB organizations. Certified athletic trainers from each team administered the questionnaire to all players in the organization, including major league players and 6 levels of minor league players. Demographic data were compared between major and minor league players. Continuous variables (age, years of professional baseball, country of origin, etc) were compared with Student t tests (P baseball players (722 major league and 4366 minor league) participated in the survey. Pitchers represented 53% of all players, and 497 players reported at least 1 UCL reconstruction, demonstrating a prevalence rate of 10% (497 of 5088). Pitchers reported a significantly higher prevalence of UCL reconstruction (16%; 437 of 2706) than nonpitchers (3%; 60 of 2382; P major league pitchers, 25% (96 of 382) had a history of UCL reconstruction, while minor league pitchers showed a 15% (341 of 2324) prevalence (P Major league pitchers were also significantly older (28.8 ± 3.9 years) than minor league pitchers (22.8 ± 3.0; P majority of major leaguers (86%) had their UCL reconstruction as professional pitchers, whereas the majority of minor league pitchers (61%) underwent their UCL reconstruction during high school and college (P major league and minor league pitchers. No difference in prevalence was shown between pitchers born in the United States versus Latin American countries. Pitchers have a high prevalence of UCL reconstruction in professional baseball, with 25% of major league pitchers and 15% of minor

  16. Biologic Augmentation of the Ulnar Collateral Ligament in the Elbow of a Professional Baseball Pitcher

    Directory of Open Access Journals (Sweden)

    James K. Hoffman

    2015-01-01

    Full Text Available Tears of the ulnar collateral ligament (UCL of the elbow are common injuries in overhead athletes. Although surgical reconstruction of the UCL has improved outcomes, not all athletes return to their previous level of competition and when this goal is achieved, the time required averages one to two years. Therefore, additional techniques are needed to further improve return to play and the rate of return to play in overhead athletes. A construct comprising a dermal allograft, platelet rich plasma (PRP, and mesenchymal stem cells (MSCs has been shown to successfully improve healing in the rotator cuff. Given the promising provisional findings, we postulated that this construct could also improve healing if applied to the UCL. Therefore, the purpose of the present report was to examine the feasibility of utilizing a dermal allograft, PRP, and MSC construct to augment UCL reconstruction in a professional baseball pitcher. No complications were encountered. Although limited to minimal follow-up, the patient has demonstrated excellent progress and has returned to activity.

  17. Semitendinosus and gracilis transfer for treatment of medial collateral ligament injury of total knee arthroplasty.

    Science.gov (United States)

    Cao, J-G; Wang, L; Zhao, H-W; Liu, J

    2016-09-01

    The objective of the study is to evaluate the clinic effectiveness of semitendinosus and gracilis transfer for the treatment of medial collateral ligament (MCL) injury of total knee arthroplasty (TKA). From March 2009 to May 2014, a series of 11 patients with MCL injuries of primary TKA were treated by semitendinosus and gracilis transfer. Another 18 patients (21 knees) were recruited as control group. The two groups of patients were comparable for gender, age, body mass index, varus knee deformity, KSS score, joint activity degree and type of prosthesis comparison without significant difference (p > 0.05). All the patients were regularly followed-up using the American Knee Society Scoring System (KSS). No patient of either group reported impaired wound healing, joint instability, pain, prosthesis loosening and other complications. At the final follow-up, the mean knee objective score and the functional score of the injury group include (89.82 ± 3.76) points and (89.54 ± 3.50) points, respectively. The control group includes (90.19 ± 3.39) and (90 ± 3.53) points. They were significantly higher than the preoperative conditions. The difference was not statistically significant. The difference of KSS score was not statistically significant (t = 0.158, p = 0.877; t = 0.820, p = 0.432). The semitendinosus and gracilis transfer are reliable for the treatment of MCL injury of TKA. The semitendinosus and gracilis are close to the knee MCL, which can effectively improve knee function.

  18. The therapeutic effect of collateral meridian therapy is comparable to acupoint pressure therapy in treating myofascial pain syndrome.

    Science.gov (United States)

    Lee, Si-Huei; Lu, Wan-An; Lee, Chang-Shun; Wang, Jia-Chi; Lin, Tsung-Ching; Yang, Jen-Lin; Chan, Rai-Chi; Ko, Shan-Chi; Kuo, Cheng-Deng

    2014-11-01

    This study compared the therapeutic effects of collateral meridian therapy (CMT) with traditional acupoint pressure therapy (APT) in patients with unilateral upper back pain. Forty-nine patients with active myofascial trigger points in upper trapezius muscle were randomly allocated to the control (CTL), APT, or CMT group. Each subject in the CMT and APT groups received 2 sessions of treatment per week over 1 month. Patients in the APT and CMT groups showed significant improvements 1 month after treatment in visual analogue scale, range of motion, pain pressure threshold, regional superficial blood flow, and physical health, as compared to the CTL group. No significant differences in outcome measures were found between APT and CMT groups 1 month after treatment. Both APT and CMT have comparable therapeutic efficacy in the treatment of unilateral upper back pain with active myofascial trigger points in the upper trapezius muscle. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Increased circulating monocyte count is related to good collateral development in coronary artery disease.

    Science.gov (United States)

    Kocaman, Sinan Altan; Arslan, Uğur; Tavil, Yusuf; Okuyan, Hizir; Abaci, Adnan; Cengel, Atiye

    2008-04-01

    Monocytes have been shown to take an important role in collateral growth in animal studies. The aim of the study was to investigate the relation of circulating monocyte count with collateral development in patients with severely stenotic CAD. Patients who had > or =95% stenosis in at least one major coronary artery were included in the study. Coronary angiograms of 210 eligible patients from our database were analyzed again and 103 of them had good and 107 had poor collateral development according to Cohen-Rentrop method. Only the monocyte count was found to be significantly different between two groups (671+/-218 mm(-3) versus 522+/-195 mm(-3), p<0.001) when multivariate analysis was performed and an increased monocyte count was observed in the good collateral group (Odds ration [OR], 2.918; 95% confidence interval [CI], 1.281-6.648, p=0.011). This study in which the relationship between monocyte count in blood and collateral development was disclosed has a potential importance in clinical and basic cardiovascular medicine.

  20. [Repair of collateral ligament rupture in the interphalangeal joint using superficial flexor tendon of finger].

    Science.gov (United States)

    Ka, S; Guan, Z M; Liu, C

    2000-01-01

    To introduce the surgical procedure and clinical result of microsurgical repair on collateral ligament rupture in the interphalangeal joint using superficial flexor tendon of finger. From 1987, 23 cases with collateral ligament rupture in the interphalangeal joint were repaired by part of superficial flexor tendon of finger. The initial point of collateral ligament was drilled two holes, 2 to 3 mm in distance, and crossed by steel wire. Then the superficial flexor tendon of finger was crossed under the steel wire and sutured to the terminal point of superficial flexor tendon of finger by 5/0 to 7/0 nontraumatic suture thread to maintain suitable tension, and sutured to collateral ligament by 8/0 nontraumatic suture thread. Extension splint fixation was performed 4 to 6 weeks postoperatively. Followed up 3 to 6 months, 15 cases were excellent, 6 cases were better, 2 cases were moderate, and the excellent rate was 91.34% according to Saetta standard. Microsurgical repair on collateral ligament rupture in the interphalangeal joint using superficial flexor tendon of finger is a convenient and effective surgical method.

  1. The role of VEGF and KDR polymorphisms in moyamoya disease and collateral revascularization.

    Directory of Open Access Journals (Sweden)

    Young Seok Park

    Full Text Available We conducted a case-control study to investigate whether vascular endothelial growth factor (VEGF -2578, -1154, -634, and 936 and kinase insert domain containing receptor (KDR -604, 1192, and 1719 polymorphisms are associated with moyamoya disease. Korean patients with moyamoya disease (n = 107, mean age, 20.9±15.9 years; 66.4% female and 243 healthy control subjects (mean age, 23.0±16.1 years; 56.8% female were included. The subjects were divided into pediatric and adult groups. Among the 64 surgical patients, we evaluated collateral vessel formation after 2 years and divided patients into good (collateral grade A or poor (collateral grade B and C groups. The frequencies and distributions of four VEGF (-2578, -1154, -634, and 936 and KDR (-604, 1192, and 1719 polymorphisms were assessed from patients with moyamoya disease and compared to the control group. No differences were observed in VEGF -2578, -1154, -634, and 936 or KDR -604, 1192, and 1719 polymorphisms between the control group and moyamoya disease group. However, we found the -634CC genotype occurred less frequently in the pediatric moyamoya group (p = 0.040 whereas the KDR -604C/1192A/1719T haplotype increased the risk of pediatric moyamoya (p = 0.024. Patients with the CC genotype of VEGF -634 had better collateral vessel formation after surgery. Our results suggest that the VEGF -634G allele is associated with pediatric moyamoya disease and poor collateral vessel formation.

  2. The Effect of Placing Flow-Diverting Stents in Intracranial Collateral Arteries of Miniature Pig.

    Science.gov (United States)

    Wang, Jiwei; Ding, Yanan; Wang, Qiuxia; Wang, Yanan; Mu, Shiqing; Bi, Lixin; Li, Youxiang

    2017-03-23

    BACKGROUND Flow-diverting stent (FDS) has been suggested as an effective intracranial aneurysm treatment. However, the effects of FDS on collateral branches of an aneurysm parent artery still remain unknown. Thus, the present study aimed to comprehensively evaluate the effects of placing a FDS in the intracranial collateral artery, using a miniature pig animal model. MATERIAL AND METHODS Ten healthy miniature pigs were included in the study: one pig was reserved as a control and the remaining nine pigs were placed in three experimental groups: FDS (i.e., Pipeline), LVIS, and Solitaier-AB stent groups. Pigs in the experimental groups were examined by cerebral angiography immediately after stent placement, followed by hemodynamic analyses. In addition, magnetic resonance imaging (MRI) of the brain of pigs in the experimental groups was performed to inspect the brain for obstruction and blood flow. Stents were examined for the growth of neointimas. RESULTS The results showed that neointimas, consisting of smooth muscle cells, collagenous fibers, and macrophages, were 0.67 mm thick on average and partially covered the stent wires. The thickness of neointimas in the FDS group was significantly higher than in the two conventional intracranial stent groups. There was no obvious obstruction identified in collateral arteries where the FDS was placed. CONCLUSIONS These results indicated that neointimas in collateral arteries of a miniature pig would be slightly thickened after one month of FDS placement; and FDS was shown to be safe for collateral arteries.

  3. Injuries to the medial collateral ligament and associated medial structures of the knee.

    Science.gov (United States)

    Wijdicks, Coen A; Griffith, Chad J; Johansen, Steinar; Engebretsen, Lars; LaPrade, Robert F

    2010-05-01

    *The superficial medial collateral ligament and other medial knee stabilizers-i.e., the deep medial collateral ligament and the posterior oblique ligament-are the most commonly injured ligamentous structures of the knee. *The main structures of the medial aspect of the knee are the proximal and distal divisions of the superficial medial collateral ligament, the meniscofemoral and meniscotibial divisions of the deep medial collateral ligament, and the posterior oblique ligament. *Physical examination is the initial method of choice for the diagnosis of medial knee injuries through the application of a valgus load both at full knee extension and between 20 degrees and 30 degrees of knee flexion. *Because nonoperative treatment has a favorable outcome, there is a consensus that it should be the first step in the management of acute isolated grade-III injuries of the medial collateral ligament or such injuries combined with an anterior cruciate ligament tear. *If operative treatment is required, an anatomic repair or reconstruction is recommended.

  4. Effect of dehydration on the development of collaterals in acute middle cerebral artery occlusion.

    Science.gov (United States)

    Chang, S-W; Huang, Y-C; Lin, L-C; Yang, J-T; Weng, H-H; Tsai, Y-H; Lee, T-H

    2016-03-01

    Recent large series studies have demonstrated that dehydration is common amongst stroke subjects and is associated with poor outcome. However, the effects of hydration status on the development of collaterals have never been discussed. In this study, the hypothesis that hydration status is an important factor for developing collaterals after acute middle cerebral artery (MCA) infarction was tested. Eighty-seven patients with acute infarction due to occlusion of the MCA were enrolled. Two collateral markers, posterior cerebral artery (PCA) laterality and fluid-attenuated inversion recovery hyperintense vessels (HVs) were assessed from magnetic resonance imaging. Dehydration status was defined by a nitrogen to creatinine ratio ≧ of 15. The associations between dehydration status and the development of collaterals were estimated. Sixty-one of 87 patients (70.1%) were identified as dehydrated. The development of PCA laterality and HVs shows a significant difference between dehydrated and euhydrated patients. A serum nitrogen to creatinine ratio Dehydration remained an independent negative predictor for the development of PCA laterality and HVs in the multivariate analysis. Hydration status is associated with the development of collateral flow after acute MCA occlusion. This preliminary study provides an imaging clue that hydration status and early hydration therapy could be important for acute stroke management. © 2016 EAN.

  5. [EFFICACY COMPARISON BETWEEN DEEP MEDIAL COLLATERAL LIGAMENT REPAIR AND CONSERVATIVE TREATMENT FOR COMPLETE MEDIAL COLLATERAL LIGAMENT RUPTURE].

    Science.gov (United States)

    Zhang, Hangzhou; Bai, Xizhuang; Liang, Qingwei; Wang, Yanfeng; Liu, Xiangnan; You, Fuli

    2016-03-01

    To compare the clinical efficacy between deep medial collateral ligament (dMCL) repair and conservative treatment for complete MCL rupture. Between August 2009 and December 2013, 36 patients with grade 3 MCL rupture underwent superior MCL (sMCL) reconstruction with tibial Inlay technique. Of 36 cases, 19 received dMCL repair (repair group), and 17 received conservative treatment (conservation group) after sMCL reconstruction. There was no significant difference in gender, age, knee sides, type of injury, disease duration and preoperative medial joint opening, knee Lysholm scores, and International Knee Documentation Committee (IKDC) score between 2 groups (P > 0.05). The Lysholm and IKDC scores, medial joint opening, range of motion (ROM), visual analogue scale (VAS) scores, and complications were used to assess the knee joint function. All patients achieved primary incision healing without acute postoperative complications of incision infection and deep vein thrombosis in the lower limb. The patients were followed up 28-65 months (mean, 46.3 months) in the repair group, and 26-69 months (mean, 45.9 months) in the conservation group. No knee stiffness, vascular or nerve injury, and knee joint infection occurred in 2 groups. All the patients recovered medial stability at 2 years postoperatively. At 2 years after operation, no significant difference was shown in knee ROM between 2 groups (t = 0.26, P = 0.80); the VAS score of the repair group was significantly lower than that of the conservation group (t = 5.22, P = 0.00); medial joint opening, IKDC score, and Lysholm score were significantly improved when compared with preoperative ones in 2 groups (P 0.05). Whether or not additional dMCL repair is performed can recover medial stability after sMCL reconstruction. However, the additional dMCL repair is better in relieving medial knee pain than the conservative treatment.

  6. Surgical technique: medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury.

    Science.gov (United States)

    Marx, Robert G; Hetsroni, Iftach

    2012-03-01

    Previous approaches for medial collateral ligament (MCL) reconstruction have been associated with extensive exposure, risk of donor site morbidity with autografts, loss of motion, nonanatomic graft placement, and technical complexity with double-bundle constructs. Therefore, we implemented a technique that uses Achilles allograft, small incisions, and anatomic insertions to reconstruct the MCL. The MCL femoral insertion was identified, and a socket reamed over a guide pin. The Achilles bone plug was fixed in the socket and the tendon passed distally under the skin and fixed on the tibia, creating isometric reconstruction. We evaluated 14 patients who had this MCL reconstruction. We determined range of knee motion, knee ligament laxity, functional outcome scores (International Knee Documentation Committee [IKDC]-subjective, Lysholm, Knee injury and Osteoarthritis Outcome Score [KOOS]), and activity level scores (Tegner, Marx). Followup range was 24 to 61 months. Knee motion was maintained in 12 cases. Grade 0-1 + valgus stability was obtained in all 14 cases. In cases of MCL with primary ACL reconstruction, IKDC-subjective, Lysholm, and KOOS-sports scores were 91 ± 6, 92 ± 6, and 93 ± 12, respectively, and return to preinjury activity levels was achieved. In cases of MCL with revision ACL reconstruction, function was inferior, and patients did not return to their preinjury activity levels. This technique uses allograft that provides bone-to-bone healing on the femur, requires small incisions, and creates isometric reconstruction. When performed with a cruciate reconstruction, knee stability can be restored at 2 to 5 years followup. In patients with MCL with primary ACL reconstruction, return to preinjury activity level in recreational athletes can be achieved.

  7. Pulmonary fissure integrity and collateral ventilation in COPD patients.

    Directory of Open Access Journals (Sweden)

    Jiantao Pu

    Full Text Available To investigate whether the integrity (completeness of pulmonary fissures affects pulmonary function in patients with chronic obstructive pulmonary disease (COPD.A dataset consisting of 573 CT exams acquired on different subjects was collected from a COPD study. According to the global initiative for chronic obstructive lung disease (GOLD criteria, these subjects (examinations were classified into five different subgroups, namely non-COPD (222 subjects, GOLD-I (83 subjects, GOLD-II (141 subjects, GOLD-III (63 subjects, and GOLD-IV (64 subjects, in terms of disease severity. An available computer tool was used to aid in an objective and efficient quantification of fissure integrity. The correlations between fissure integrity, and pulmonary functions (e.g., FEV1, and FEV1/FVC and COPD severity were assessed using Pearson and Spearman's correlation coefficients, respectively.For the five sub-groups ranging from non-COPD to GOLD-IV, the average integrities of the right oblique fissure (ROF were 81.8%, 82.4%, 81.8%, 82.8%, and 80.2%, respectively; the average integrities of the right horizontal fissure (RHF were 62.6%, 61.8%, 62.1%, 62.2%, and 62.3%, respectively; the average integrities of the left oblique fissure (LOF were 82.0%, 83.2%, 81.7%, 82.0%, and 78.4%, respectively; and the average integrities of all fissures in the entire lung were 78.0%, 78.6%, 78.1%, 78.5%, and 76.4%, respectively. Their Pearson correlation coefficients with FEV1 and FE1/FVC range from 0.027 to 0.248 with p values larger than 0.05. Their Spearman correlation coefficients with COPD severity except GOLD-IV range from -0.013 to -0.073 with p values larger than 0.08.There is no significant difference in fissure integrity for patients with different levels of disease severity, suggesting that the development of COPD does not change the completeness of pulmonary fissures and incomplete fissures alone may not contribute to the collateral ventilation.

  8. [Dendritic cells and coronary collateral circulation in coronary heart disease].

    Science.gov (United States)

    Li, Chuanchang; Liu, Wei; Yi, Jun; Li, Zhenyu; Pu, Xiaoqun; Yang, Tianlun; Xie, Qiying; Mo, Long; Chen, Xiaobin

    2010-05-01

    To determine the relationship between the number,phenotype and functional status of dendritic cells (DCs) and coronary collateral circulation (CCC) in coronary heart disease (CHD). Forty patients with severe coronary stenosis were recruited and divided into a CCC formation group (Group A, n=22) and a non-CCC formation group (Group B, n=18). Density gradient centrifugation was applied to separate the mononuclear cells (MNCs) from coronary artery blood samples, and MNCs were cultured and proliferated in vitro. The morphology of DCs was observed under converted microscope. The number of harvested cells and DCs was counted by hematocytometer. Flow cytometry was applied to investigate the phenotype and the mean fluorescence intensity (MFI). Mixed lymphocyte reaction was used to test the function of DCs to stimulate the proliferation of T lymphocytes. Stimulation index (SI) was calculated and compared. (1) After in vitro proliferation, DCs were cultured successfully from the mononuclear cells from coronary artery blood samples and the morphology of DCs was not different in the 2 groups. (2) The number of mononuclear cells (MNC no) was (3.95+/-1.41)*10(6), in the CCC group and (2.76+/-0.92)*10(6) in the non-CCC group. The MNC number was significantly increased in the CCC group (P=0.003). (3) The number of DCs was (1.54+/-0.96)*10(6) in the CCC group, and (0.99+/-0.46)*10(6) in the non-CCC group (P=0.033). (4)There was no statistical significance in the percent of CD1a+, CD1a+CD80+, CD1a+CD83+, CD1a+CD86+ cells, and MFI in the 2 groups (P>0.05). (5) SI was 4.96+/-2.30 in the CCC group, whereas 2.66+/-1.04 in the non-CCC group. The SI in the CCC group increased significantly(P=0.0003). In CHD patients with severe coronary stenosis, patients with CCC formation have higher number of DCs and stronger potential of T lymphocyte stimulation.

  9. ISOLATED MAJOR AORTOPULMONARY COLLATERAL ARTERY CAUSING CCF IN A NEWBORN: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Mohammed Ashfaque Tinmaswala, Pallavi P Saple, Arpita Gupta, Prachi N, Nitinkumar A, Kaba Amin

    2015-04-01

    Full Text Available ABSTRACT Major Aortopulmonary collateral artery (MAPCA is an anamolous vascular connection in between aorta or one of its main branches and pulmonary artery. It is single or multiple in which case it’s called multiple anamolousaortopulmonary collaterals (MAPCAs. These are usually seen in association with congenital heart diseases with decreased pulmonary blood flow but rarely may it be present as an isolated anamoly without evidence of any structural heart disease. The infant may present with pulmonary hypertension, bronchopulmonary dysplasia, recurrent lower respiratory tract infections or Congestive cardiac failure (CCF. We describe here a case of isolated Aortopulmonary collateral artery causing congestive cardiac failure in a late preterm baby. The congestive cardiac failure in this infant was successfully managed by obliteration of MAPCA by a single coil.

  10. Penetrating neck injury: Collaterals for another life after ligation of common carotid artery and subclavian artery

    Directory of Open Access Journals (Sweden)

    Annu Babu

    2017-02-01

    Full Text Available Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially life-threatening hemorrhage but also need profound surgical expertise in management. Development of collateral circulation in neck is well known; however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of penetrating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient presented with no neurological or motor deficits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery.

  11. Early mobilization of rabbit medial collateral ligament repairs: biomechanic and histologic study.

    Science.gov (United States)

    Goldstein, W M; Barmada, R

    1984-05-01

    The postoperative management of repaired medial collateral ligaments is controversial. There are proponents for either early mobilization or immobilization. To contribute to an understanding of the issues, 24 adult Dutch rabbits were divided into four groups and a comparative study was made of their incised medial collateral ligaments, contrasting early immobilization with mobilization at three and six weeks. The ligaments were studied histologically and biomechanically. At three weeks, the immobilized ligaments were twice as strong as mobilized ligaments. Histologically, the immobilized ligaments demonstrated more fibroblastic reaction while the mobilized ligaments showed more mature tissue development at the repair site. There were no statistically significant differences between knees mobilized for six weeks and knees immobilized for three weeks and then subsequently mobilized for three weeks. In view of these results, the authors conclude that the deleterious effects of immobilization should be considered when planning postoperative or postinjury treatment of torn medial collateral ligaments.

  12. SmPL: A Domain-Specific Language for Specifying Collateral Evolutions in Linux Device Drivers

    DEFF Research Database (Denmark)

    Padioleau, Yoann; Lawall, Julia Laetitia; Muller, Gilles

    2007-01-01

    identifying the affected files and modifying all of the code fragments in these files that in some way depend on the changed interface. We have studied the collateral evolution problem in the context of Linux device drivers. Currently, collateral evolutions in Linux are mostly done manually using a text...... editor, possibly with the help of tools such as grep. The large number of Linux drivers, however, implies that this approach is time-consuming and unreliable, leading to subtle errors when modifications are not done consistently. In this paper, we propose a transformation language, SmPL, to specify...... collateral evolutions. Because Linux programmers are accustomed to exchanging, reading, and manipulating program modifications in terms of patches, we build our language around the idea and syntax of a patch, extending patches to semantic patches. Udgivelsesdato: January 3...

  13. Hemodynamic contribution of transdural collateral flow in adult patients with moyamoya disease.

    Science.gov (United States)

    Hong, Ji Man; Hong, Yoon Hee; Lee, Seong-Joon; Lee, Sung Eun; Lee, Jin Soo; Shin, Dong Hoon

    2016-12-01

    To evaluate the hemodynamic contributions of collateral flow in adult patients with moyamoya disease, neurological deterioration or fluctuation during admission, Suzuki grade, various collateral routes, lesion volume, cerebral blood flow (CBF), and their associations were analyzed. Thirty patients (60 cerebral hemispheres, mean age 45 ± 25 years, and 73.3 % female) who were diagnosed with moyamoya disease or syndrome were enrolled over 3 years. Moyamoya stages from each hemisphere were stratified according to the Suzuki's criteria through six-vessel angiography into internal carotid arteries (ICAs), external carotid arteries (ECAs), and vertebral arteries (VAs). Collateral routes were categorized into the circle of Willis, leptomeningeal, and transdural. The volume of ipsilateral infarction was analyzed by magnetic resonance imaging. CBF volume was measured using color-coded duplex sonography. Suzuki's grade was inversely correlated with flow volume of the ICAs (p moyamoya disease, suggesting a protector against an impending ischemic attack.

  14. Relationship between haemodynamic impairment and collateral blood flow in carotid artery disease

    DEFF Research Database (Denmark)

    Hartkamp, Nolan S; Petersen, Esben T; Chappell, Michael A

    2018-01-01

    Collateral blood flow plays a pivotal role in steno-occlusive internal carotid artery (ICA) disease to prevent irreversible ischaemic damage. Our aim was to investigate the effect of carotid artery disease upon cerebral perfusion and cerebrovascular reactivity and whether haemodynamic impairment...... is influenced at brain tissue level by the existence of primary and/or secondary collateral. Eighty-eight patients with steno-occlusive ICA disease and 29 healthy controls underwent MR examination. The presence of collaterals was determined with time-of-flight, two-dimensional phase contrast MRA and territorial...... arterial spin labeling (ASL) imaging. Cerebral blood flow and cerebrovascular reactivity were assessed with ASL before and after acetazolamide. Cerebral haemodynamics were normal in asymptomatic ICA stenosis patients, as opposed to patients with ICA occlusion, in whom the haemodynamics in both hemispheres...

  15. Dynamic Magnetic Resonance Angiography Provides Collateral Circulation and Hemodynamic Information in Acute Ischemic Stroke.

    Science.gov (United States)

    Hernández-Pérez, María; Puig, Josep; Blasco, Gerard; Pérez de la Ossa, Natalia; Dorado, Laura; Dávalos, Antoni; Munuera, Josep

    2016-02-01

    Contrary to usual static vascular imaging techniques, contrast-enhanced dynamic magnetic resonance angiography (dMRA) enables dynamic study of cerebral vessels. We evaluated dMRA ability to assess arterial occlusion, cerebral hemodynamics, and collateral circulation in acute ischemic stroke. Twenty-five acute ischemic stroke patients with proximal anterior circulation occlusion underwent dMRA on a 3T scanner within 12 hours of symptoms onset. Diffusion weighted imaging, Tmax6 s lesion volumes and hypoperfusion intensity ratio as volume of Tmax>6 s/volume of Tmax>10 s were measured. Site and grade of occlusion (Thrombolysis in Myocardial Infarction criteria) were evaluated on time-of-flight MRA and dMRA. Leptomeningeal collaterality (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology [ASITN/SIR] Scale) and asymmetries in venous clearance were assessed exclusively on dMRA. Collateral filling was dichotomized into incomplete (ASITN/SIR 0-2) or complete (ASITN/SIR 3-4). On dMRA, site of occlusion was M1 in 21 patients, tandem internal carotid artery/M1 in 2 and tandem internal carotid artery/terminal internal carotid artery in 2 patients. Three tandem occlusions were not detected on time-of-flight-MRA. All patients had Thrombolysis in Myocardial Infarction 0 to 1 on time-of-flight-MRA, but three of them had Thrombolysis in Myocardial Infarction 2 on dMRA. Complete collateral filling (n=12, 48%) was associated with smaller diffusion weighted imaging lesion volume (P=0.039), smaller hypoperfused volume (P=0.018), and lower hypoperfusion intensity ratio (P=0.006). Patients with symmetrical clearance of transverse sinuses (52%) were more likely to have complete collateral filling (P=0.015). As a fast, direct, feasible, noninvasive, and reliable method to assess site of occlusion, collateral circulation and hemodynamic alterations, dMRA provides profound insights in acute stroke. © 2015 American Heart Association, Inc.

  16. Morphological study of mechanoreceptors in collateral ligaments of the ankle joint.

    Science.gov (United States)

    Wu, Xiaochuan; Song, Weidong; Zheng, Cuihuan; Zhou, Shixiong; Bai, Shengbin

    2015-06-12

    The aim of this study was to analyze the pattern and types of sensory nerve endings in ankle collateral ligaments using histological techniques, in order to observe the morphology and distribution of mechanoreceptors in the collateral ligaments of cadaver ankle joint, and to provide the morphological evidence for the role of the ligament in joint sensory function. Twelve lateral collateral ligaments including anterior talofibular ligament (ATFL; n = 6), posterior talofibular ligament (PTFL; n = 6), and calcaneofibular ligament (CFL; n = 6) were harvested from six fresh frozen cadavers. The ligaments were embedded in paraffin, sectioned at 4 μm, and then stained using a modified gold-chloride staining methods. The collateral ligament was divided into three segments: proximal, middle, and distal segments. Fifty-four ATFL slides, 90 PTFL slides, and 108 CFL slides were analyzed. Mechanoreceptors were classified based on Freemen and Wyke's classification. Mechanoreceptor distribution was analyzed statistically. One-way ANOVA (postHoc LSD) was used for statistical analysis. All the four typical types of nerve endings (the Ruffini corpuscles, Pacinian corpuscles, Golgi tendon organs, and free nerve endings) were identified in these ligaments. Pacinian corpuscles were the predominant in all four complexes. More mechanoreceptors were found in synovial membrane near both ends of the ligaments attached to the bone. No statistical differences were found in the amount of mechanoreceptors among distal, middle, and proximal parts of the ligaments. The four typical types of mechanoreceptors were all identified in the collateral ligaments of the human ankle. Pacinian corpuscles were the predominant in all four complexes. This indicates that the main function of ankle collateral ligaments is to sense joint speeds in motions.

  17. Cerebrovascular Collaterals Correlate with Disease Severity in Adult North American Patients with Moyamoya Disease

    Science.gov (United States)

    Strother, M.K.; Anderson, M.D.; Singer, R.J.; Du, L.; Moore, R.D.; Shyr, Y.; Ladner, T.R.; Arteaga, D.; Day, M.A.; Clemmons, P.F.; Donahue, M.J.

    2015-01-01

    BACKGROUND AND PURPOSE Cerebrovascular collaterals have been increasingly recognized as predictive of clinical outcomes in Moyamoya disease in Asia. The aim of this study was to characterize collaterals in North American adult patients with Moyamoya disease and to assess whether similar correlations are valid. MATERIALS AND METHODS Patients with Moyamoya disease (n = 39; mean age, 43.5±10.6 years) and age- and sex-matched control subjects (n = 33; mean age, 44.3±12.0 years) were graded via angiography. Clinical symptoms of stroke or hemorrhage were graded separately by imaging. Correlations between collateralization and disease severity, measured by the modified Suzuki score, were evaluated in patients with Moyamoya disease by fitting a regression model with clustered ordinal multinomial responses. RESULTS The presence of leptomeningeal collaterals (P = .008), dilation of the anterior choroidal artery (P = .01), and the posterior communicating artery/ICA ratio (P = .004) all correlated significantly with disease severity. The presence of infarct or hemorrhage and posterior steno-occlusive disease did not correlate significantly with the modified Suzuki score (P=.1). Anterior choroidal artery changes were not specific for hemorrhage. Patients with Moyamoya disease were statistically more likely than controls to have higher posterior communicating artery/ICA ratios and a greater incidence of leptomeningeal collaterals. CONCLUSIONS As with Moyamoya disease in Asian patients, the presence of cerebrovascular collaterals correlated with the modified Suzuki score for disease severity in North American patients with Moyamoya disease. However, anterior choroidal artery changes, which correlated with increased rates of hemorrhage in Asian studies, were not specific to hemorrhage in North Americans. PMID:24651814

  18. Evaluation and treatment of medial collateral ligament and medial-sided injuries of the knee.

    Science.gov (United States)

    Jacobson, Kurt E; Chi, Frederic S

    2006-06-01

    Injuries to the medial side of the knee are not always isolated injuries of the superficial medial collateral ligament. Medial-sided injuries can also involve the deep medial collateral ligament, the posteromedial corner, or the medial meniscus. Magnetic resonance imaging is a useful adjunct to the physical examination; however, the extent of medial-sided injuries is frequently underappreciated on these images. An understanding of the anatomy and biomechanics of the medial side of the knee and a thorough physical examination aids the physician in determining the full extent of injury and helping the physician to treat each unique injury pattern.

  19. Aberrant Ovarian Collateral Originating from External Iliac Artery During Uterine Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Joon Ho; Kim, Man Deuk, E-mail: mdkim@yuhs.ac; Lee, Kwang-hun; Lee, Myungsu; Lee, Mu Sook; Won, Jong Yun; Park, Sung Il; Lee, Do Yun [Yonsei University College of Medicine, Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Korea, Republic of)

    2013-02-15

    We report a case of a 35-year-old woman who underwent uterine artery embolization (UAE) for symptomatic multiple uterine fibroids with collateral aberrant right ovarian artery that originated from the right external iliac artery. We believe that this is the first reported case in the literature of this collateral uterine flow by the right ovarian artery originated from the right external iliac artery. We briefly present the details of the case and review the literature on variations of ovarian artery origin that might be encountered during UAE.

  20. Incidence and angiographic predictors of collateral function in patients with stable coronary artery disease scheduled for percutaneous coronary intervention

    NARCIS (Netherlands)

    de Vries, Jessica; Anthonio, Rutger L.; van den Heuvel, Ad F. M.; Tan, Eng-Shiong; Jessurun, Gillian A.; de Smet, Bart J. G. L.; DeJongste, Mike J. L.; Zijlstra, Felix

    2007-01-01

    Objectives: To investigate the incidence and angiographic predictors of functional collateral perfusion in patients with stable coronary artery disease, scheduled for elective PCI. Background: Functional collateral perfusion is defined as a Pw/Pa ratio >= 0.24. Since this can only be measured

  1. Impact of Collateral Status Evaluated by Dynamic Computed Tomographic Angiography on Clinical Outcome in Patients With Ischemic Stroke

    NARCIS (Netherlands)

    van den Wijngaard, Ido R.; Boiten, Jelis; Holswilder, Ghislaine; Algra, Ale|info:eu-repo/dai/nl/07483472X; Dippel, Diederik W J; Velthuis, Birgitta K.|info:eu-repo/dai/nl/176956301; Wermer, Marieke J H; van Walderveen, Marianne A A

    2015-01-01

    BACKGROUND AND PURPOSE—: Status of collateral circulation is a strong predictor of outcome after acute ischemic stroke. Our aim was to compare the predictive value of strategies for collateral blood flow assessment with dynamic computed tomographic angiography (CTA) and conventional single-phase CT

  2. Coronary Collateral Growth Induced by Physical Exercise: Results of the Impact of Intensive Exercise Training on Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease (EXCITE) Trial.

    Science.gov (United States)

    Möbius-Winkler, Sven; Uhlemann, Madlen; Adams, Volker; Sandri, Marcus; Erbs, Sandra; Lenk, Karsten; Mangner, Norman; Mueller, Ulrike; Adam, Jennifer; Grunze, Martin; Brunner, Susanne; Hilberg, Thomas; Mende, Meinhard; Linke, Axel P; Schuler, Gerhard

    2016-04-12

    A well-developed coronary collateral circulation provides a potential source of blood supply in coronary artery disease. However, the prognostic importance and functional relevance of coronary collaterals is controversial with the association between exercise training and collateral growth still unclear. This prospective, open-label study randomly assigned 60 patients with significant coronary artery disease (fractional flow reserve ≤0.75) to high-intensity exercise (group A, 20 patients) or moderate-intensity exercise (group B, 20 patients) for 4 weeks or to a control group (group C, 20 patients). The primary end point was the change of the coronary collateral flow index (CFI) after 4 weeks. Analysis was based on the intention to treat. After 4 weeks, baseline CFI increased significantly by 39.4% in group A (from 0.142±0.07 at beginning to 0.198±0.09 at 4 weeks) in comparison with 41.3% in group B (from 0.143±0.06 to 0.202±0.09), whereas CFI in the control group remained unchanged (0.7%, from 0.149±0.09 to 0.150±0.08). High-intensity exercise did not lead to a greater CFI than moderate-intensity training. After 4 weeks, exercise capacity, Vo2 peak and ischemic threshold increased significantly in group A and group B in comparison with group C with no difference between group A and group B. A significant improvement in CFI was demonstrated in response to moderate- and high-intensity exercise performed for 10 hours per week. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01209637. © 2016 American Heart Association, Inc.

  3. Biomechanical performance of baseball pitchers with a history of ulnar collateral ligament reconstruction.

    Science.gov (United States)

    Fleisig, Glenn S; Leddon, Charles E; Laughlin, Walter A; Ciccotti, Michael G; Mandelbaum, Bert R; Aune, Kyle T; Escamilla, Rafael F; MacLeod, Toran D; Andrews, James R

    2015-05-01

    A relatively high number of active professional baseball pitchers have a history of ulnar collateral ligament reconstruction (UCLr) on their throwing elbow. Controversy exists in the literature about whether professional baseball pitchers regain optimal performance after return from UCLr. It has been suggested that pitchers may have different biomechanics after UCLr, but this has not been previously tested. It was hypothesized that, compared with a control group without a history of UCLr, professional pitchers with a history of UCLr would have (1) significantly different throwing elbow and shoulder biomechanics; (2) a shortened stride, insufficient trunk forward tilt, and excessive shoulder horizontal adduction, characteristics associated with "holding back" or being tentative; (3) late shoulder rotation; and (4) improper shoulder abduction and trunk lateral tilt. Controlled laboratory study. A total of 80 active minor league baseball pitchers (and their 8 Major League Baseball organizations) agreed to participate in this study. Participants included 40 pitchers with a history of UCLr and a matched control group of 40 pitchers with no history of elbow or shoulder surgery. Passive ranges of motion were measured for each pitcher's elbows and shoulders, and then 23 reflective markers were attached to his body. The pitcher took as many warm-up pitches as desired and then threw 10 full-effort fastballs for data collection. Ball speed was recorded with a radar gun. The reflective markers were tracked with a 10-camera, 240-Hz automated motion analysis system. Eleven biomechanical parameters were computed for each pitch and then averaged for each participant. Demographic, range of motion, and biomechanical parameters were compared between the UCLr group and the control group by use of Student t tests (significance set at Pbaseball after UCLr pitch with biomechanics similar to that of noninjured professionals. © 2015 The Author(s).

  4. Plasma chemokine levels are associated with the presence and extent of angiographic coronary collaterals in chronic ischemic heart disease.

    Directory of Open Access Journals (Sweden)

    Ellen C Keeley

    Full Text Available In patients with chronic ischemic heart disease (IHD, the presence and extent of spontaneously visible coronary collaterals are powerful determinants of clinical outcome. There is marked heterogeneity in the recruitment of coronary collaterals amongst patients with similar degrees of coronary artery stenoses, but the biological basis of this heterogeneity is not known. Chemokines are potent mediators of vascular remodeling in diverse biological settings. Their role in coronary collateralization has not been investigated. We sought to determine whether plasma levels of angiogenic and angiostatic chemokines are associated with of the presence and extent of coronary collaterals in patients with chronic IHD.We measured plasma concentrations of angiogenic and angiostatic chemokine ligands in 156 consecutive subjects undergoing coronary angiography with at least one ≥90% coronary stenosis and determined the presence and extent of spontaneously visible coronary collaterals using the Rentrop scoring system. Eighty-eight subjects (56% had evidence of coronary collaterals. In a multivariable regression model, the concentration of the angiogenic ligands CXCL5, CXCL8 and CXCL12, hyperlipidemia, and an occluded artery were associated with the presence of collaterals; conversely, the concentration of the angiostatic ligand CXCL11, interferon-γ, hypertension and diabetes were associated with the absence of collaterals (ROC area 0.91. When analyzed according to extent of collateralization, higher Rentrop scores were significantly associated with increased concentration of the angiogenic ligand CXCL1 (p<0.0001, and decreased concentrations of angiostatic ligands CXCL9 (p<0.0001, CXCL10 (p = 0.002, and CXCL11 (p = 0.0002, and interferon-γ (p = 0.0004.Plasma chemokine concentrations are associated with the presence and extent of spontaneously visible coronary artery collaterals and may be mechanistically involved in their recruitment.

  5. CUDA-based acceleration of collateral filtering in brain MR images

    Science.gov (United States)

    Li, Cheng-Yuan; Chang, Herng-Hua

    2017-02-01

    Image denoising is one of the fundamental and essential tasks within image processing. In medical imaging, finding an effective algorithm that can remove random noise in MR images is important. This paper proposes an effective noise reduction method for brain magnetic resonance (MR) images. Our approach is based on the collateral filter which is a more powerful method than the bilateral filter in many cases. However, the computation of the collateral filter algorithm is quite time-consuming. To solve this problem, we improved the collateral filter algorithm with parallel computing using GPU. We adopted CUDA, an application programming interface for GPU by NVIDIA, to accelerate the computation. Our experimental evaluation on an Intel Xeon CPU E5-2620 v3 2.40GHz with a NVIDIA Tesla K40c GPU indicated that the proposed implementation runs dramatically faster than the traditional collateral filter. We believe that the proposed framework has established a general blueprint for achieving fast and robust filtering in a wide variety of medical image denoising applications.

  6. Collateral damage: Spread of repeat-induced point mutation from a ...

    Indian Academy of Sciences (India)

    Unknown

    of the erg-3 gene, present in single copy, to the spread of RIP from duplications of adjoining sequences. Ge- nomic segments ... [Vyas M and Kasbekar D P 2005 Collateral damage: Spread of repeat-induced point mutation from a duplicated DNA sequence into an ad- .... was essentially as described by Davis and De Serres.

  7. Collateral Damage Related to Rape and Interpersonal Violence in Higher Education

    Science.gov (United States)

    Jones, Dan L.

    2014-01-01

    Collegiate communities are often faced with difficult situations from sexual assault, rape, and other forms of interpersonal violence. These events are not only tragic or traumatic for the individuals involved but also have ripple effects and create collateral damage within the campus community. Many universities are instituting bystander training…

  8. [Surgical treatment of ulnar collateral ligament injuries of the thumb metacarpophalangeal joint].

    Science.gov (United States)

    Ziegler, C; Neshkova, I; Schmidt, K; Meffert, R; Jakubietz, M; Jakubietz, R

    2016-04-01

    Reconstruction of the ruptured ulnar collateral ligament of the metacarpophalangeal (MP) joint of the thumb. Ruptured ulnar collateral ligament of the thumb MP joint with instability: joint opening of more than 30° in flexion and more than 20° in extension, Stener lesion, displaced avulsion fractures. Abrasions, wound-healing disturbance, skin disease, osteoarthritis. Curved skin incision dorsoulnar above the thumb MP joint. Protection of the branches of the superficial radial nerve. Incision of the adductor aponeurosis. Exposing the ulnar collateral ligament; opening and examination of the joint. Depending on the injury, primary suture repair, transosseous suture, repair with a bone anchor, osteosynthesis with K-wires or small screws in avulsion fracture, ligament reconstruction in chronic instability or older injury. Cast splint of the MP joint until swelling subsides; cast immobilization for 6 weeks; range-of-motion exercises, avoiding forced radial deviation of the MP joint for 3 months. Complete joint stability 3 months postoperatively in all 34 patients with rupture of the ulnar collateral ligament.

  9. Light scattering changes follow evoked potentials from hippocampal Schaeffer collateral stimulation

    DEFF Research Database (Denmark)

    Rector, D M; Poe, G R; Kristensen, Morten Pilgaard

    1997-01-01

    We assessed relationships of evoked electrical and light scattering changes from cat dorsal hippocampus following Schaeffer collateral stimulation. Under anesthesia, eight stimulating electrodes were placed in the left hippocampal CA field and an optic probe, coupled to a photodiode or a charge-c...

  10. Clinical study of the hypothesis of “endogenous collateral wind” on ...

    African Journals Online (AJOL)

    Background: Acute Coronary Syndrome (ACS), is a serious threat to people's health, and life, and in recent years, the incidence has increased yearly. This study was to propose the hypothesis of “endogenous collateral wind” based on the patho-mechanism of thrombogenesis complicated by ruptured plaque on ACS, and ...

  11. Natural killer cells and CD4+ T-cells modulate collateral artery development

    NARCIS (Netherlands)

    Weel, V. van; Toes, R.E.M.; Seghers, L.; Deckers, M.M.L.; Vries, M.R. de; Eilers, P.H.; Sipkens, J.; Schepers, A.; Eefting, D.; Hinsbergh, V.W.M. van; Bockel, J.H. van; Quax, P.H.A.

    2007-01-01

    OBJECTIVE - The immune system is thought to play a crucial role in regulating collateral circulation (arteriogenesis), a vital compensatory mechanism in patients with arterial obstructive disease. Here, we studied the role of lymphocytes in a murine model of hindlimb ischemia. METHODS AND RESULTS -

  12. Collateral sensitivity to cisplatin in KB-8-5-11 drug-resistant cancer cells.

    LENUS (Irish Health Repository)

    Doherty, Ben

    2014-01-01

    KB-8-5-11 cells are a drug-resistant cervical cell model that overexpresses ABCB1 (P-glycoprotein). KB-8-5-11 has become sensitive to non-ABCB1 substrate cisplatin. Understanding the mechanism of collateral sensitivity to cisplatin may lead to biomarker discovery for platinum sensitivity in patients with cancer.

  13. 12 CFR 221.7 - Supplement: Maximum loan value of margin stock and other collateral.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Supplement: Maximum loan value of margin stock... FOR THE PURPOSE OF PURCHASING OR CARRYING MARGIN STOCK (REGULATION U) § 221.7 Supplement: Maximum loan value of margin stock and other collateral. (a) Maximum loan value of margin stock. The maximum loan...

  14. Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome.

    NARCIS (Netherlands)

    van Petersen, Andre S.; Kolkman, Jeroen; Gerrits, Dick G; van der Palen, Job; Zeebregts, Clark J.; Geelkerken, Robert H

    OBJECTIVE: Although extensive collateral arterial circulation will prevent ischemia in most patients with stenosis of a single mesenteric artery, mesenteric ischemia may occur in these patients, for example, in patients with celiac artery compression syndrome (CACS). Variation in the extent of

  15. Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome

    NARCIS (Netherlands)

    van Petersen, Andre S.; Kolkman, Jeroen J.; Gerrits, Dick G.; van der Palen, Job; Zeebregts, Clark J.; Geelkerken, Robert H.

    Objective: Although extensive collateral arterial circulation will prevent ischemia in most patients with stenosis of a single mesenteric artery, mesenteric ischemia may occur in these patients, for example, in patients with celiac artery compression syndrome (CACS). Variation in the extent of

  16. Dynamic knee alignment and collateral knee laxity and its variations in normal humans

    Directory of Open Access Journals (Sweden)

    Kamal eDeep

    2015-11-01

    Full Text Available Alignment of normal, arthritic and replaced human knees is a much debated subject as is the collateral ligamentous laxity. Traditional quantitative values have been challenged. Methods used to measure these are also not without flaws. Authors review the recent literature and a novel method of measurement of these values has been included. This method includes use of computer navigation technique in clinic setting for assessment of the normal or affected knee before the surgery. Computer navigation has been known for achievement of alignment accuracy during knee surgery. Now its use in clinic setting has added to the inventory of measurement methods. Authors dispel the common myth of straight mechanical axis in normal knees and also look at quantification of amount of collateral knee laxity. Based on the scientific studies it has been shown that the mean alignment is in varus in normal knees. It changes from lying non weight bearing position to standing weight bearing position in both coronal and the sagittal planes. It also varies with gender and race. The collateral laxity is also different for males and females. Further studies are needed to define the ideal alignment and collateral laxity which the surgeon should aim for individual knees.

  17. Assessment of collateral artery function and growth in a pig model of stepwise coronary occlusion

    NARCIS (Netherlands)

    de Groot, Daphne; Grundmann, Sebastian; Timmers, Leo; Pasterkamp, Gerard; Hoefer, Imo E.

    de Groot D, Grundmann S, Timmers L, Pasterkamp G, Hoefer IE. Assessment of collateral artery function and growth in a pig model of stepwise coronary occlusion. Am J Physiol Heart Circ Physiol 300: H408-H414, 2011. First published October 15, 2010; doi: 10.1152/ajpheart.00070.2010.-Therapeutic

  18. Functional outcomes following revision ulnar collateral ligament reconstruction in Major League Baseball pitchers.

    Science.gov (United States)

    Jones, Kristofer J; Conte, Stan; Patterson, Nancy; ElAttrache, Neal S; Dines, Joshua S

    2013-05-01

    There is a paucity of data regarding outcomes following revision ulnar collateral ligament (UCL) reconstruction in Major League Baseball (MLB) pitchers. A single case series comprised of 4 MLB pitchers has reviewed outcomes in this cohort and reported a 75% rate of return to pitching. We hypothesize that MLB pitchers demonstrate a low rate of return to their pre-injury pitch workload following revision surgery. Clinical outcomes were reviewed with an emphasis on return to pre-injury pitch workload. Utilizing MLB player performance statistics, the postoperative pitch workload (appearances for relief pitchers and games started/innings pitched for starting pitchers) was calculated to determine if players were able to resume pre-injury throwing activity. Position-specific analyses for pitchers (starter vs relief) were also performed utilizing objective pitching statistics. Overall, 78% (14/18) of pitchers were able to return to MLB play within 2 full seasons. Relief pitchers were able to resume 50% of their pre-injury pitch workload, while starting pitchers only reached 35% of their prior workload (P = .52). Relievers demonstrated better pitching statistics (ERA [earned run average], K/9 [strikeouts per 9 innings], and BB/9 [walks per 9 innings]) when compared to starters. Two starting pitchers were reassigned to relief roles by their teams, resulting in improvement in their postoperative pitch workload (mean 94%). The overall rate of return to pre-injury pitch workload following revision UCL reconstruction is low among professional pitchers. Starting pitchers may be at higher risk for treatment failure in the revision setting, given the increased demands of the position, and may benefit from reassignment to a relief role. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  19. Evaluation of portosystemic collaterals by MDCT-MPR imaging for management of hemorrhagic esophageal varices

    Energy Technology Data Exchange (ETDEWEB)

    Kodama, Hideaki [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Aikata, Hiroshi, E-mail: aikata@hiroshima-u.ac.jp [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Takaki, Shintaro; Azakami, Takahiro; Katamura, Yoshio; Kawaoka, Tomokazu; Hiramatsu, Akira; Waki, Koji; Imamura, Michio; Kawakami, Yoshiiku; Takahashi, Shoichi [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Toyota, Naoyuki; Ito, Katsuhide [Department of Radiology, Division of Medical Intelligence and Informatics, Programs for Applied Biomedicine, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Chayama, Kazuaki [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan)

    2010-11-15

    Objective: To study the correlation between changes in portosystemic collaterals, evaluated by multidetector-row computed tomography imaging using multiplanar reconstruction (MDCT-MPR), and prognosis in patients with hemorrhagic esophageal varices (EV) after endoscopic treatment. Methods: Forty-nine patients with primary hemostasis for variceal bleeding received radical endoscopic treatment: endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL). Patients were classified according to the rate of reduction in feeding vessel diameter on MDCT-MPR images, into the narrowing (n = 24) and no-change (n = 25) groups. We evaluated changes in portosystemic collaterals by MDCT-MPR before and after treatment, and determined rebleeding and survival rates. Results: The left gastric and paraesophageal (PEV) veins were recognized as portosystemic collaterals in 100 and 80%, respectively, of patients with EV on MDCT-MPR images. The rebleeding rates at 1, 2, 3, and 5 years after endoscopic treatment were 10, 15, 23, and 23%, respectively, for the narrowing group, and 17, 24, 35, and 67%, respectively, for the no-change group (P = 0.068). Among no-change group, the rebleeding rate in patients with large PEV was significantly lower than that with small PEV (P = 0.027). The rebleeding rate in patients with small PEV of the no-change group was significantly higher than that in the narrowing group (P = 0.018). There was no significant difference in rebleeding rates between the no-change group with a large PEV and narrowing group (P = 0.435). Conclusion: Changes in portosystemic collaterals evaluated by MDCT-MPR imaging correlate with rebleeding rate. Evaluation of portosystemic collaterals in this manner would provide useful information for the management of hemorrhagic EV.

  20. The Role of VEGF and KDR Polymorphisms in Moyamoya Disease and Collateral Revascularization

    Science.gov (United States)

    Park, Young Seok; Jeon, Young Joo; Kim, Hyun Seok; Chae, Kyu Young; Oh, Seung-Hun; Han, In Bo; Kim, Hyun Sook; Kim, Won-Chan; Kim, Ok-Joon; Kim, Tae Gon; Choi, Joong-Uhn; Kim, Dong-Seok; Kim, Nam Keun

    2012-01-01

    We conducted a case-control study to investigate whether vascular endothelial growth factor (VEGF −2578, −1154, −634, and 936) and kinase insert domain containing receptor (KDR −604, 1192, and 1719) polymorphisms are associated with moyamoya disease. Korean patients with moyamoya disease (n = 107, mean age, 20.9±15.9 years; 66.4% female) and 243 healthy control subjects (mean age, 23.0±16.1 years; 56.8% female) were included. The subjects were divided into pediatric and adult groups. Among the 64 surgical patients, we evaluated collateral vessel formation after 2 years and divided patients into good (collateral grade A) or poor (collateral grade B and C) groups. The frequencies and distributions of four VEGF (−2578, −1154, −634, and 936) and KDR (−604, 1192, and 1719) polymorphisms were assessed from patients with moyamoya disease and compared to the control group. No differences were observed in VEGF −2578, −1154, −634, and 936 or KDR −604, 1192, and 1719 polymorphisms between the control group and moyamoya disease group. However, we found the −634CC genotype occurred less frequently in the pediatric moyamoya group (p = 0.040) whereas the KDR −604C/1192A/1719T haplotype increased the risk of pediatric moyamoya (p = 0.024). Patients with the CC genotype of VEGF −634 had better collateral vessel formation after surgery. Our results suggest that the VEGF −634G allele is associated with pediatric moyamoya disease and poor collateral vessel formation. PMID:23077562

  1. Rapid Liver Hypertrophy After Portal Vein Occlusion Correlates with the Degree of Collateralization Between Lobes-a Study in Pigs.

    Science.gov (United States)

    Deal, Rebecca; Frederiks, Charles; Williams, Lauren; Olthof, Pim B; Dirscherl, Konstantin; Keutgen, Xavier; Chan, Edie; Deziel, Daniel; Hertl, Martin; Schadde, Erik

    2017-08-01

    Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) induces more rapid liver growth than portal vein ligation (PVL). Transection of parenchyma in ALPPS may prevent the formation of collaterals between lobes. The aim of this study was to determine if abrogating the formation of collaterals through parenchymal transection impacted growth rate. Twelve Yorkshire Landrace pigs were randomized to undergo ALPPS, PVL, or "partial ALPPS" by varying degrees of parenchymal transection. Hepatic volume was measured after 7 days. Portal blood flow and pressure were measured. Portal vein collaterals were examined from epoxy casts. PVL, ALPPS, and partial ALPPS led to volume increases of the RLL by 15.5% (range 3-22), 64% (range 45-76), and 32% (range 18-77), respectively, with significant differences between PVL and ALPPS/partial ALPPS (p portal vein collaterals were found. The number of collaterals correlated inversely with the growth rate (p = 0.039). Portal vein pressure was elevated in all models after ligation suggesting hyperflow to the portal vein-supplied lobe (p < 0.05). These data suggest that liver hypertrophy following PVL is inversely proportional to the development of collaterals. Hypertrophy after ALPPS is likely more rapid due to reduction of collaterals through transection.

  2. [Observation and analysis on the meridian-collateral running track-related anatomical structure in the human body].

    Science.gov (United States)

    Xie, Hao-ran; Li, Fang-chun; Zhang, Wei-bo

    2009-06-01

    In the present paper the authors analyze the anatomical structure of the meridian running track by using the dialectical thought and comprehensive analysis of the integrated Chinese and western medicine. It has been observed that the "Qi-passages" of the 14 meridians of Chinese medicine are located in the connective tissue among the interspace of the muscles, etc. distributing longitudinally. The "Qi-passages" of the 15 Luomai (collaterals of the meridians) are located in the connective tissue among the interspace of the muscles, etc. distributing transversally, while those of the small branches of the meridian collaterals are located in the interspace mesenchyme of the muscle bundles distributing in the whole body. The "Qi-passages" of the tiny branches of the meridian collaterals are located in the mesenchyme of the intracellular space, such as the muscle fibers in the whole body. The authors hold that the so-called "Mai Qi" of the meridian-collaterals is the liquid-Qi flowing in the vertical and horizontal tissue interspaces. The "Qi-passage" of the meridian-collaterals of Chinese medicine is the pathway of the liquid-Qi of the tissue interspaces. The structure of the meridian-collaterals is the tissue interspace. The meridian-collateral system is a regulation-control system in the human body where the Qi-passages communicate with each other, and is, in fact, the protoplasm, the liquid-Qi circulating in the tissue interspaces.

  3. Admission hyperglycemia causes infarct volume expansion in patients with ICA or MCA occlusion: association of collateral grade on conventional angiography.

    Science.gov (United States)

    Shimoyama, T; Shibazaki, K; Kimura, K; Uemura, J; Shiromoto, T; Watanabe, M; Inoue, T; Iguchi, Y; Mochio, S

    2013-01-01

    Hyperglycemia (HG) is associated with infarct volume expansion in acute ischaemic stroke patients. However, collateral circulation can sustain the ischaemic penumbra and limit the growth of infarct volume. The aim of this study was to determine whether the association between HG and infarct volume expansion is dependent on collateral circulation. We performed a retrospective analysis of 93 acute ischaemic stroke patients with internal carotid artery or middle cerebral artery occlusion within 24 h of onset were retrospectively studied. HG was diagnosed in patients with an admitting blood glucose value ≥140 mg/dl. Angiographic collateral grade 0-1 was designated as poor collateral circulation and grade 2-4 as good collateral circulation. Infarct volume was measured at admission and at again within 7 days using diffusion-weighted magnetic resonance images. Among 34 patients with poor collateral grade, the change in infarct volume was significantly greater in the HG group than in the non-HG group (106.0 ml vs. 22.7 ml, P = 0.002). Among the 59 patients with good collateral circulation, the change in infarct volume was greater in the HG group than in the non-HG group (53.3 ml vs. 10.9 ml, P = 0.047). Multiple regression analysis indicated that admission HG (P = 0.004), baseline National Institutes of Health Stroke Scale score (P = 0.018), and poor collateral circulation (P = 0.040) were independently associated with infarct volume expansion. Infarct volume expansion was greater in individuals with HG on admission regardless of collateral circulation status. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

  4. Subcellular structural plasticity caused by the absence of the fast Ca2+ buffer calbindin D-28k in recurrent collaterals of cerebellar Purkinje neurons

    Directory of Open Access Journals (Sweden)

    David eOrduz

    2014-11-01

    Full Text Available Purkinje cells (PC control spike timing of neighboring PC by their recurrent axon collaterals. These synapses underlie fast cerebellar oscillations and are characterized by a strong facilitation within a time window of <20 ms during paired-pulse protocols. PC express high levels of the fast Ca2+ buffer protein calbindin D-28k (CB. As expected from the absence of a fast Ca2+ buffer, presynaptic action potential-evoked [Ca2+]i transients were previously shown to be bigger in PC boutons of young (second postnatal week CB-/- mice, yet IPSC mean amplitudes remained unaltered in connected CB-/- PC. Since PC spine morphology is altered in adult CB-/- mice (longer necks, larger spine head volume, we summoned that morphological compensation/adaptation mechanisms might also be induced in CB-/- PC axon collaterals including boutons. In these mice, biocytin-filled PC reconstructions revealed that the number of axonal varicosities per PC axon collateral was augmented, mostly confined to the granule cell layer. Additionally, the volume of individual boutons was increased, evidenced from z-stacks of confocal images. EM analysis of PC-PC synapses revealed an enhancement in active zone (AZ length by approximately 23%, paralleled by a higher number of docked vesicles per AZ in CB-/- boutons. Moreover, synaptic cleft width was larger in CB-/- (23.8 ± 0.43 nm compared to wild type (21.17 ± 0.39 nm synapses. We propose that the morphological changes, i.e. the larger bouton volume, the enhanced AZ length and the higher number of docked vesicles, in combination with the increase in synaptic cleft width likely modifies the GABA release properties at this synapse in CB-/- mice. We view these changes as adaptation/homeostatic mechanisms to likely maintain (preserve characteristics of synaptic transmission in the absence of the fast Ca2+ buffer CB. Our study provides further evidence on the functioning of the Ca2+ homeostasome.

  5. Anterior Rectal Resection in a Patient with Aortoiliac Occlusive Disease and Coexisting Collateral Pathways: Management and Pitfalls

    Directory of Open Access Journals (Sweden)

    Floryn Cherbanyk

    2016-01-01

    Full Text Available Chronic aortoiliac occlusive disease most often affects the common iliac arteries and distal aorta but can progress all the way to the renal arteries, occluding the inferior mesenteric artery. A compensatory collateral network typically develops to preserve lower body perfusion. Inadvertent compression or ligation of such collaterals during surgery can have catastrophic consequences. In this article, we present the case of a 63-year-old patient with aortoiliac occlusive disease, requiring surgery for an adenocarcinoma of the rectosigmoid junction. A CT angiography was performed in order to map out the collateral pathways that had developed and Doppler ultrasound was used to mark their positions. The surgical procedure was adapted to his specific anatomy. A successful anterior resection was performed, and the patient made an uneventful recovery. In cases of aortoiliac obliteration, the existence of collaterals must be kept in mind and investigated with a multidisciplinary approach before any surgery is considered.

  6. Collateral management a jeho zachycení a podpora v informačních systémech peněžního ústavu

    OpenAIRE

    Dudek, Tomáš

    2011-01-01

    The main objective of this thesis is to capture and support for Collateral Management in the environment of financial institution. The thesis deals with general and practical description Collateral Management, realizaction collateral management, trouble banking institucion implemented through the parent banking institution, and aplicaton design Collateral Management. The main benefits of this thesis I find the introduction of Collateral Management and submitting information on IT application ...

  7. Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy.

    Science.gov (United States)

    Bandali, Murad Feroz; Mirakhur, Anirudh; Lee, Edward Wolfgang; Ferris, Mollie Clarke; Sadler, David James; Gray, Robin Ritchie; Wong, Jason Kam

    2017-03-14

    Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.

  8. Posttraumatic incarceration of medial collateral ligament into knee joint with anterior cruciate ligament injury.

    Science.gov (United States)

    Kini, Sunil-Gurpur; du Pre, Karel; Bruce, Warwick

    2015-01-01

    Medial collateral ligament of the knee is an important coronal stabiliser and often injured in isolation or as combination of injuries. The article reports a case of incarcerated medial collateral ligament (MCL) injury in combination with anterior cruciate ligament (ACL) injury in 20 year old male who presented to us 4 weeks after injury. Clinical examination and MRI was correlated to complete ACL tear with torn distal MCL and incarceration into the joint. Patient was taken up for ACL hamstring graft reconstruction with mini-arthrotomy and repair of the torn MCL. Patient was followed up with dedicated rehabilitation protocol with good functional results. At one year follow-up, patient exhibited full range of motion with negative Lachman, Pivot shift and valgus stress tests. This article highlights the rare pattern of MCL tear and also reviews the literature on this pattern of injury.

  9. The association of plasma miR-155 and VCAM-1 levels with coronary collateral circulation.

    Science.gov (United States)

    Wang, Junnan; Yan, Youyou; Song, Dandan; Liu, Lulu; Liu, Bin

    2017-02-01

    Inflammation plays an important role in development of coronary collateral circulation (CCC). The aim of this study is to determine whether the inflammation-related miRNA miR-155 and the inflammation marker VCAM-1 could be a biomarker for CCC. We measured levels of plasma VCAM-1 and miR-155 in patients with CCC according to Rentrop grade by ELISA or real-time polymerase chain reaction, respectively (n = 112). Plasma miR-155 was negatively correlated with VCAM-1 in the poor CCC group and with Rentrop grade in all patients with CCC. In addition, plasma VCAM-1 was significantly decreased in CAD patients with CCC. Plasma miR-155 might be a potent independent predictor of collateral formation.

  10. Sphingosine-1-Phosphate Receptor-1 Selective Agonist Enhances Collateral Growth and Protects against Subsequent Stroke.

    Directory of Open Access Journals (Sweden)

    Masahiko Ichijo

    Full Text Available Collateral growth after acute occlusion of an intracranial artery is triggered by increasing shear stress in preexisting collateral pathways. Recently, sphingosine-1-phosphate receptor-1 (S1PR1 on endothelial cells was reported to be essential in sensing fluid shear stress. Here, we evaluated the expression of S1PR1 in the hypoperfused mouse brain and investigated the effect of a selective S1PR1 agonist on leptomeningeal collateral growth and subsequent ischemic damage after focal ischemia.In C57Bl/6 mice (n = 133 subjected to unilateral common carotid occlusion (CCAO and sham surgery. The first series examined the time course of collateral growth, cell proliferation, and S1PR1 expression in the leptomeningeal arteries after CCAO. The second series examined the relationship between pharmacological regulation of S1PR1 and collateral growth of leptomeningeal anastomoses. Animals were randomly assigned to one of the following groups: LtCCAO and daily intraperitoneal (i.p. injection for 7 days of an S1PR1 selective agonist (SEW2871, 5 mg/kg/day; sham surgery and daily i.p. injection for 7 days of SEW2871 after surgery; LtCCAO and daily i.p. injection for 7 days of SEW2871 and an S1PR1 inverse agonist (VPC23019, 0.5 mg/kg; LtCCAO and daily i.p. injection of DMSO for 7 days after surgery; and sham surgery and daily i.p. injection of DMSO for 7 days. Leptomeningeal anastomoses were visualized 14 days after LtCCAO by latex perfusion method, and a set of animals underwent subsequent permanent middle cerebral artery occlusion (pMCAO 7 days after the treatment termination. Neurological functions 1 hour, 1, 4, and 7 days and infarction volume 7 days after pMCAO were evaluated.In parallel with the increase in S1PR1 mRNA levels, S1PR1 expression colocalized with endothelial cell markers in the leptomeningeal arteries, increased markedly on the side of the CCAO, and peaked 7 days after CCAO. Mitotic cell numbers in the leptomeningeal arteries increased after

  11. IMATERALISASI JAMINAN BENDA DALAM BENTUK CASH COLLATERAL SEBAGAI JAMINAN PROYEK INFRA STRUKTUR MELALUI MEKANISME SWIFT

    Directory of Open Access Journals (Sweden)

    Tarsisius Murwaji

    2013-10-01

    Full Text Available The construction of infrastructure projects require large expenses. The cost for the project loan is usually derived from international banks. Legal issues, among others: we do not guarantee the legal system conducive to use in large financing; corporate body and banking institutions we considered to be of international standard, and our le-gal system is regarded as the country risk. The other hand many people of Indonesia who have collateral material, usually pure gold (precious metals that have been diimaterialization and included in the accounts of foreign banks. Such guarantees may be used as the basis of the issuance of bank guarantees and through the mechanism of Society Worldwide Interbank Financial Telecommunications (SWIFT can be used as loan collateral banks in Indonesia. Key words: bank guaranty, SWIFT, security law, international banking system

  12. Endovascular therapy of ruptured distal anterior choroidal artery aneurysm associated with moyamoya pattern collateralization secondary to middle cerebral artery occlusion

    Directory of Open Access Journals (Sweden)

    Hidenori Oishi

    2013-01-01

    Full Text Available We report a case of a ruptured distal anterior choroidal artery (AChoA aneurysm associated with moyamoya pattern collateralization secondary to the middle cerebral artery occlusion. Patient was successfully treated with the coil embolization of the distal AChoA. This case supports the feasibility and efficacy of the endovascular therapy for the distal AChoA aneurysms in patients with MCA occlusion with moyamoya pattern collateralization.

  13. Impact on left ventricular function of the exercise response of coronary collateral flow in coronary heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Tweddel, A.C.; Martin, W.; McGhie, I.; Hutton, I.

    1985-05-01

    This study was designed to determine the effect of physiological stress on regional myocardial flow, and the effect of collateral circulation on left ventricular function. Myocardial flow was measured by the Xenon clearance technique in 25 patients with stable angina, studied at routine coronary angiography, with normal distribution of flow obtained from 10 patients. Regional wall motion was quantified from the contrast ventriculogram by percentage shortening of radial chords. Twenty collateral distributions were identified angiographically and a further 14 with intracoronary Xenon. Scans were performed at rest and immediately post maximal supine exercise. Collateral flows in response to dynamic exercise were differentiated as follows: in 8 regions identified arteriographically, mean flow fell from 46.3 +- 5.1 to 40 +- 5.1 ml/100g/min (p<0.02) and from 28.9 +- 3.6 to 21.1 +- 1.4 ml/100g/min (p<0.05) in regions of collateral flow seen with Xenon. In these regions, mean left ventricular percentage shortening was 22 +- 6.0% and 35.5 +- 5.0% respectively. In contrast, in 12 regions demonstrated angiographically, collateral flow increased 41.2 +- 4.6 to 63.4 +- 5.8 ml/100g/min (p<0.005), and 6 Xenon collateral distributions where flow increased post exercise from 19.5 +- 7.8 to 37.8 +- 5.1 ml/100g/min (p<0.05). The mean left ventricular percentage shortening was 43.2 +- 7.3% (p<0.02) in these collateral distributions identified arteriographically and 44 +- 4.5% (p<0.05) with Xenon. The authors conclude that collateral flow, which increased in response to stress, appears to be beneficial in the preservation of regional left ventricular function.

  14. FLAIR vascular hyperintensities and dynamic 4D angiograms for the estimation of collateral blood flow in posterior circulation occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Foerster, Alex; Wenz, Holger; Kerl, Hans Ulrich; Al-Zghloul, Mansour; Habich, Sonia; Groden, Christoph [University of Heidelberg, Department of Neuroradiology, Universitaetsmedizin Mannheim, Mannheim (Germany)

    2014-09-15

    The objectives of this paper are to assess collateral blood flow in posterior circulation occlusion by MRI-based approaches (fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs), collateralization on dynamic 4D angiograms) and investigate its relation to ischemic lesion size and growth. In 28 patients with posterior cerebral artery (PCA) and 10 patients with basilar artery (BA) occlusion, MRI findings were analyzed, with emphasis on distal FVH and collateralization on dynamic 4D angiograms. In PCA occlusion, distal FVH was observed in 18/29 (62.1 %), in BA occlusion, in 8/10 (80 %) cases. Collateralization on dynamic 4D angiograms was graded 1 in 8 (27.6 %) patients, 2 in 1 (3.4 %) patient, 3 in 12 (41.4 %) patients, and 4 in 8 (27.6 %) patients with PCA occlusion and 0 in 1 (10 %) patient, 2 in 3 (30 %) patients, 3 in 1 (10 %) patient, and 4 in 5 (50 %) patients with BA occlusion. FVH grade showed neither correlation with initial or follow-up diffusion-weighted image (DWI) lesion size nor DWI-perfusion-weighted imaging (PWI) mismatch ratio. Collateralization on dynamic 4D angiograms correlated inversely with initial DWI lesion size and moderately with the DWI-(PWI) mismatch ratio. The combination of distal FVH and collateralization grade on dynamic 4D angiograms correlated inversely with initial as well as follow-up DWI lesion size and highly with the DWI-PWI mismatch ratio. In posterior circulation occlusion, FVH is a frequent finding, but its prognostic value is limited. Dynamic 4D angiograms are advantageous to examine and graduate collateral blood flow. The combination of both parameters results in an improved characterization of collateral blood flow and might have prognostic relevance. (orig.)

  15. The Effect of Ulnar Collateral Ligament Reconstruction on Pitch Velocity in Major League Baseball Pitchers

    OpenAIRE

    Lansdown, Drew A.; Feeley, Brian T.

    2014-01-01

    Background: The medial ulnar collateral ligament (UCL) is the primary restraint to valgus load, and injury is commonly encountered as a result of overuse in throwing athletes. Reconstruction of this ligament has allowed for a high rate of return to sport for elite pitchers. Public perception of this procedure has resulted in a commonly held belief of increased throwing velocity following UCL reconstruction. Hypothesis: Fastball velocity for Major League Baseball (MLB) pitchers is significantl...

  16. Circle of Willis Collateral During Temporary Internal Carotid Artery Occlusion II: Observations From Computed Tomography Angiography.

    Science.gov (United States)

    Wang, Bill Hao; Leung, Andrew; Lownie, Stephen P

    2016-07-01

    The Circle of Willis (CoW) is the most effective collateral circulation to the brain during internal carotid artery (ICA) occlusion. Carotid stump pressure (CSP) is an established surrogate measure of the cerebral collateral circulation. This study aims to use hemodynamic and computed tomography angiography measurements to determine the strongest influences upon the dependent variable, CSP. These findings could help clinicians noninvasively assess the adequacy of the collateral circulation and facilitate surgical risk assessment in an outpatient setting. CSP and mean arterial pressure were measured during carotid endarterectomy or during carotid balloon test occlusion in 92 patients. Intracranial arterial diameters were measured on computed tomography angiography at 16 different locations. Univariate and multivariate analyses were used to determine the key factors associated with CSP. In a subgroup of individuals (n=27) with severe (>70% North American Symptomatic Carotid Endarterectomy Trial) contralateral stenosis or occlusion, the same analysis was performed. The contralateral anterior cerebral artery proximal to anterior communicating artery (A1) of the CoW had the strongest influence upon CSP, followed by the mean arterial pressure, the contralateral ICA diameter, and the anterior communicating artery diameter (R 2=0.364). In the subgroup with high-grade contralateral ICA stenosis, the ipsilateral posterior communicating artery exerted the strongest influence (R 2=0.620). During ICA occlusion, the anterior CoW dominates in preserving collateral flow, especially the contralateral A1 segment. In individuals with high-grade contralateral carotid stenosis, the posterior communicating artery calibre becomes a dominant influence. The most favourable anatomy consists of large contralateral A1 and anterior communicating arteries, and no contralateral carotid stenosis.

  17. Return to Play after Nonsurgical Treatment of Elbow Ulnar Collateral Ligament Injuries in Professional Baseball Players

    OpenAIRE

    Ford, Gregory M.; Genuario, James; Noonan, Thomas J.; Kinkartz, Jason D.; Githens, Thomas; Murayama, Scott

    2014-01-01

    Objectives: Injury to the elbow ulnar collateral ligament (UCL) is relatively common in pitchers. In the 70's reconstructive surgery was developed as a viable option to a potentially career ending injury. Multiple studies have demonstrated return to play (RTP) rates of 74-83% after reconstruction. Studies of RTP after nonoperative treatment in throwing athletes are limited, reporting 42%. There are no studies reporting RTP rates with nonoperative treatment of professional baseball players. Th...

  18. Blood ammonia levels in liver cirrhosis: a clue for the presence of portosystemic collateral veins

    Directory of Open Access Journals (Sweden)

    Tripodi Francesca

    2009-03-01

    Full Text Available Abstract Background Portal hypertension leads to the formation of portosystemic collateral veins in liver cirrhosis. The resulting shunting is responsible for the development of portosystemic encephalopathy. Although ammonia plays a certain role in determining portosystemic encephalopathy, the venous ammonia level has not been found to correlate with the presence or severity of this entity. So, it has become partially obsolete. Realizing the need for non-invasive markers mirroring the presence of esophageal varices in order to reduce the number of endoscopy screening, we came back to determine whether there was a correlation between blood ammonia concentrations and the detection of portosystemic collateral veins, also evaluating splenomegaly, hypersplenism (thrombocytopenia and the severity of liver cirrhosis. Methods One hundred and fifty three consecutive patients with hepatic cirrhosis of various etiologies were recruited to participate in endoscopic and ultrasonography screening for the presence of portosystemic collaterals mostly esophageal varices, but also portal hypertensive gastropathy and large spontaneous shunts. Results Based on Child-Pugh classification, the median level of blood ammonia was 45 mcM/L in 64 patients belonging to class A, 66 mcM/L in 66 patients of class B and 108 mcM/L in 23 patients of class C respectively (p The grade of esophageal varices was concordant with venous ammonia levels (rho 0.43, p Conclusion Identifying cirrhotic patients with high blood ammonia concentrations could be clinically useful, as high levels would lead to suspicion of being in presence of collaterals, in clinical practice of esophageal varices, and pinpoint those patients requiring closer follow-up and endoscopic screening.

  19. Repo collateral fire sales: the effects of exemption from automatic stay

    OpenAIRE

    Sebastian Infante

    2013-01-01

    What are the consequences of a potential fire sale stemming from the exemption of repurchase agreements (repos) from automatic stay? This paper shows that repo's exemption from stay alters firms' financing and investment decisions ex ante. Specifically, a stay exemption changes firms' investment opportunity set, enabling them to purchase assets of defaulted firms at fire sale prices. Fire sales arise endogenously because of limited capital available to purchase collateral posted by insolvent ...

  20. Intra-articular entrapment of the medial collateral ligament: radiographic and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Patel, J.J. [Dept. of Radiology, Baystate Medical Center, Springfield, MA (United States)

    1999-11-01

    Displacement of the medial collateral ligament (MCL) into the medial knee joint is an extremely rare finding associated with MCL tears, and is easily diagnosed on magnetic resonance imaging. A case of intra-articular interposition of the MCL during a severe knee injury is presented. A radiolucent ''fat stripe'' sign and adjacent skin dimpling on radiographs may be relatively specific indicators of this injury. (orig.)

  1. Relation between prognosis and collateral circulation or recanalization in occlusive cerebral vascular diseases

    Energy Technology Data Exchange (ETDEWEB)

    Saito, Yuko (Tokyo Women' s Medical Coll. (Japan))

    1982-09-01

    CT images and angiograms were compared, in occlusive cerebral vascular diseases with complete stroke in the region of internal carotid artery, and following subjects were discussed. 1) Relation between size of final low density area on CT and prognosis. 2) Effectiveness of collateral circulation and recanalization to the low density area on CT in the territory of occluded artery. For the subject 1,100 cases of infarction of the region of middle cerebral artery were chosen at random, and the prognosis was compared with the size of low density area on CT. For the subject 2,186 cases of infarction in the region on internal carotid artery were selected, and CT images and angiograms were compared, considering the duration between stroke and angiography. With these studies, following conclusions were obtained. There is tendency that cases with the smaller low density areas on CT have the better prognosis. The low density on CT appears inside of the territory of the occluded artery. When there is neither collateral circulation nor recanalization, appearance of the low density on CT is not avoided. Collateral circulation or recanalization is able to rescue the affected area from appearance of low density on CT, even if it is formed later than 6 hours after ictus. The critical period when collateral circulation or recanalization effects on the involved area is variable depending on each cases, but it is suspected to be 24 or 72 hours after onset. Blood supply which begins later than 73 hours after occlusion of artery does not effect on the involved area.

  2. Endocan: a novel biomarker associated with well-developed coronary collateral circulation in patients with stable angina and chronic total occlusion.

    Science.gov (United States)

    Emet, Samim; Elitok, Ali; Onur, Imran; Kocaaga, Mehmet; Bilge, Ahmet Kaya; Oflaz, Huseyin; Umman, Berrin; Oncul, Aytac; Bugra, Zehra; Adalet, Kamil; Mercanoglu, Fehmi

    2017-01-01

    Angiogenesis and arteriogenesis have a crucial role in the formation of coronary collateral vessels. It has been shown that endocan and vascular cell adhesion molecule-1 (VCAM-1) are potential angiogenetic factors. We investigated the relationship between serum endocan levels and grade of coronary collaterals, and also the correlation of endocan levels with serum VCAM-1 levels. Patients with stable angina and at least one total coronary occlusion at invasive coronary angiography were included in our study. Collateral degree was graded according to Rentrop and Cohen's classification. Patients who had grade 0 or 1 collateral vessels were included in the poorly-developed collateral group, and those with grade 2 or 3 coronary collateral vessels were included in the well-developed collateral group. Serum endocan and VCAM-1 levels were significantly higher in the well-developed collateral group (436.6 ± 213.3 ng/mL vs. 216.1 ± 78.5 ng/mL, p coronary collateral development. In the event that these results are confirmed in further studies, endocan may be considered as an anti-ischemic treatment strategy in order to improve collateral development.

  3. The sword of Damocles: an illustrative example of the life-saving effect of the collateral circulation.

    Science.gov (United States)

    Meier, Pascal

    2011-03-01

    There is an ongoing debate on the effective importance of the collateral network, especially in the current era, where most patients with significant coronary artery disease are revascularized, be it percutaneously or surgically; thus, people may question a significant benefit of the coronary collateral circulation. However, the presented 61-year-old male patient demonstrates an unambiguous situation of a life-saving effect of the collateral circulation. The patient presented without any angina symptoms and with only mild shortness of breath on moderate to severe exertion. A subsequent angiography revealed a complete chronic occlusion of the main coronary artery. The entire left coronary system was provided by well-developed right to left collaterals. Additionally, the patient had an 80-90% stenosis of his mid-right coronary artery (RCA). The entire blood supply to the heart had to pass this lesion to provide the RCA area and also the left anterior descending and left circumflex areas via collaterals. This extreme example illustrates the potentially lifesaving effect of the coronary collateral circulation. Obviously, the entire myocardium can in some cases be perfused entirely via one critically stenosed vessel.

  4. Evaluation of the thickness of the medial ulnar collateral ligament in junior high and high school baseball players.

    Science.gov (United States)

    Nagamoto, Hideaki; Yamamoto, Nobuyuki; Kurokawa, Daisuke; Takahashi, Hiroyuki; Muraki, Takayuki; Tanaka, Minoru; Koike, Yoichi; Sano, Hirotaka; Itoi, Eiji

    2015-07-01

    Thickening of the medial ulnar collateral ligament in the throwing arm of adult baseball players is a well-known phenomenon. However, onset of the thickening is unclear among young baseball players. The purpose of this study was to evaluate the thickness of the medial ulnar collateral ligament in junior high and high school baseball players. Seventy-one uninjured and asymptomatic junior high and high school baseball players were included in the study. Participants underwent physical examination after completing a questionnaire, followed by ultrasonographic evaluation. The thickness of the medial ulnar collateral ligament was measured bilaterally. The thickness of the throwing and non-throwing sides in high school and junior high school baseball players, and within each group, was compared and statistically analyzed. The medial ulnar collateral ligament in the throwing arm of high school baseball players was thicker than that in the non-throwing arm (5.5 vs. 4.4 mm), although no significant difference was seen in junior high school baseball players. High school baseball players showed a significantly thicker medial ulnar collateral ligament in the throwing arm than junior high school baseball players. Thickening of the medial ulnar collateral ligament in the throwing arm of asymptomatic and uninjured baseball players may begin by the time the players reach high school.

  5. The association between prolongation in QRS duration and presence of coronary collateral circulation in patients with acute myocardial infarction.

    Science.gov (United States)

    Karahan, Zülküf; Altıntaş, Bernas; Uğurlu, Murat; Kaya, İlyas; Uçaman, Berzal; Uluğ, Ali Veysel; Altındağ, Rojhat; Altaş, Yakup; Adıyaman, Mehmet Şahin; Öztürk, Önder

    2016-01-01

    It is known that QRS duration is related to prognosis in acute myocardial infarction. The relation between QRS duration and coronary collateral circulation is uncertain. In the present study, we aimed to determine the relation between QRS duration and coronary collateral circulation in patients admitted with acute myocardial infarction. The present study was composed of 109 consecutive patients with acute myocardial infarction. All patients had total occlusion in the left anterior descending coronary artery. Electrocardiographic recordings on admission were obtained for the assessment of QRS duration. The Rentrop classification was used to define coronary collateral circulation on coronary angiography. Patients were divided into two groups as follows: Group 1 with poor coronary collateral circulation (Rentrop 0-1) and Group 2 with good coronary collateral circulation (Rentrop 2-3). Of all patients, 62 patients were included in group 1 and 47 patients in group 2, respectively. In the present study, patients in the group 1 had longer QRS duration than patients in the group 2 (p coronary collateral circulation in patients with acute myocardial infarction.

  6. Impact of Collateral Status Evaluated by Dynamic Computed Tomographic Angiography on Clinical Outcome in Patients With Ischemic Stroke.

    Science.gov (United States)

    van den Wijngaard, Ido R; Boiten, Jelis; Holswilder, Ghislaine; Algra, Ale; Dippel, Diederik W J; Velthuis, Birgitta K; Wermer, Marieke J H; van Walderveen, Marianne A A

    2015-12-01

    Status of collateral circulation is a strong predictor of outcome after acute ischemic stroke. Our aim was to compare the predictive value of strategies for collateral blood flow assessment with dynamic computed tomographic angiography (CTA) and conventional single-phase CT angiography. Patients with a proximal middle cerebral artery occlusion underwent noncontrast CT, single-phase CTA and whole brain CT perfusion/dynamic CTA within 9 hours after stroke onset. We defined poor outcome as a score on the modified Rankin Scale score of ≥3. The association between collateral score and clinical outcome at 3 months was analyzed with Poisson regression. The prognostic value of collateral scoring with dynamic CTA and single-phase CTA in addition to age, stroke severity, and noncontrast CT was assessed with logistic regression and summarized with the area under the curve. Seventy patients were included, with a mean age of 68 years. We observed an increased risk of poor outcome in patients with poor collaterals on single-phase CTA (risk ratio, 1.8; 95% confidence interval, 1.0-3.1) and on dynamic CTA (risk ratio, 2.0; 95% confidence interval, 1.5-2.7). The prediction of poor clinical outcome by means of collateral adjustment was better with dynamic CTA (area under the curve, 0.84; likelihood ratio test PURL: http://www.trialregister.nl/trialreg. Unique identifier: NTR1804. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00880113. © 2015 American Heart Association, Inc.

  7. Novel Suture Anchor Technique with Continuous Locking Stitch for Collateral Ligament Repair.

    Science.gov (United States)

    Tokunaga, Susumu; Abe, Yoshihiro

    2016-06-01

    Collateral ligaments are difficult to repair due to large amount of fraying in detached ligaments and attenuated stumps that may not provide enough strength after the repair. Although strong locking sutures are used to repair the ligament with proper tension, these damages can cause pull-out failure or relaxation of the repaired ligaments even from undersized load that may extend postoperative splinting or casting time. Furthermore, current suture techniques can repair varus or valgus instability of the elbow and radial or ulnar instability of the fingers, but these techniques do not offer rotatory stability of these areas. We have developed a novel suture anchor technique that has overcome this problem of current suture techniques, and this can be used to correct rotatory instability in the elbow and fingers. We used this procedure in seven cases with injury of collateral ligament in the elbow and eight cases with detached collateral ligaments of finger joint. No patient experienced rerupture or any kind of residual instability. We believe that the proposed method can produce much stronger repair and may shorten the postoperative immobilization period.

  8. The relationship between ischemia modified albumin and good coronary collateral circulation.

    Science.gov (United States)

    Gök, Murat; Kundi, Harun; Kızıltunç, Emrullah; Topcuoglu, Canan; Örnek, Ender

    2017-11-13

    It is important to determine the grade of the coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD). In this study, we aimed to investigate the relationship between the ischemia modified albumin (IMA) level and good CCC. A total of 95 patients with coronary angiography and at least one epicardial coronary artery obstruction were included in the study. The Rentrop classification was used with CCC grading, where 0 and 1 were defined as poor collateral, and 2 and 3 were defined as good collateral. The IMA level of the patients was measured using an enzyme-linked immunosorbent assay (ELISA). The receiver-operating characteristic curve was used to show the sensitivity and specificity of IMA levels and the optimal cut-off value for predicting good CCC. The multiple logistic regression analysis revealed that the IMA level in the good CCC group was higher (p good CCC group (p good CCC level, and this shows good CCC with 70.2% sensitivity and 60.3% specificity. The IMA level could serve as a simple and useful predictor of well-developed CCC.

  9. Mechanistic, technical, and clinical perspectives in therapeutic stimulation of coronary collateral development by angiogenic growth factors.

    Science.gov (United States)

    Rubanyi, Gabor M

    2013-04-01

    Stimulation of collateral vessel development in the heart by angiogenic growth factor therapy has been tested in animals and humans for almost two decades. Discordance between the outcome of preclinical studies and clinical trials pointed to the difficulties of translation from animal models to patients. Lessons learned in this process identified specific mechanistic, technical, and clinical hurdles, which need to be overcome. This review summarizes current understanding of the mechanisms leading to the establishment of a functional coronary collateral network and the biological processes growth factor therapies should stimulate even under conditions of impaired natural adaptive vascular response. Vector delivery methods are recommended to maximize angiogenic gene therapy efficiency and reduce side effects. Optimization of clinical trial design should include the choice of clinical end points which provide mechanistic proof-of-concept and also reflect clinical benefits (e.g., surrogates to assess increased collateral flow reserve, such as myocardial perfusion imaging). Guidelines are proposed to select patients who may respond to the therapy with high(er) probability. Both short and longer term strategies are outlined which may help to make therapeutic angiogenesis (TA) work in the future.

  10. The relationship between mean platelet volume and coronary collateral vessels in patients with acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Gaurav Singhal

    2016-01-01

    Full Text Available Background: Elevated mean platelet volume (MPV has been proposed as a risk factor for coronary artery disease (CAD and is associated with poor clinical outcome in acute coronary syndrome (ACS. However, some studies have contradictory findings. Hence, we aimed to evaluate the association of MPV with the presence of coronary collateral vessel (CCV in patients with ACS. Objective: To find MPV value in ACS patients and to find the predictive value of MPV in the spectrum of CAD and to examine whether levels of MPV predict the presence of CCVs. Methods: A total of 180 patients with first ACS were included in the study. MPV was measured. All patients underwent coronary angiography to know disease severity and CCVs. The CCVs are graded according to the Rentrop scoring system and according to coronary angiography results; patients were divided into two groups as Group 1 (poor CCV and Group 2 (good CCV. Results: The MPV was 10.74 ± 2 fl in poor collateral group patients and 11.01 ± 1.7 fl in good collateral group (P = 0.421. The presence of CCV was not significantly associated with high levels of MPV. MPV value did not show any prediction of the spectrum of CAD. Conclusion: MPV on admission was not associated with the development of CCV positively in patients with ACS. Furthermore, it is not associated with a number of vessel involvements.

  11. Biomechanical model of knee collateral ligament injury with six degrees of freedom.

    Science.gov (United States)

    Ozada, Neriman

    2016-05-01

    Knee ligament injuries cannot be fully described using simplified joint models or by experimentation alone. The study objective was to model the contributions of the collateral ligaments over six degrees of freedom (DOF) of knee joint articulation to aid the diagnosis of knee ligament injuries. A kinematic model of the knee joint with six DOF was developed using the Musculoskeletal Joint Modeller software, and the effects of medial collateral ligament (MCL) and lateral collateral ligament (LCL) rupture were evaluated. The centres of mass of the tibia and femur were determined from their surface geometry, and the displacement of the moving tibia was determined by measuring the displacements of the attached ligaments with respect to its centre of mass. Compared to an intact knee, a tibia without the LCL had higher medial translation and lower valgus rotation, while a tibia without the MCL had higher lateral translation and higher valgus rotation. At 0°, 30° and 60° of flexion, the tibia without the LCL had more internal rotation than an intact knee. Understanding the complete kinematics of knee joints may improve the diagnosis of ligament injuries and guide tissue replacement surgery. Predicting joint behaviour in the clinic after treatment might benefit from a combined modelling approach that includes both clinicians and basic researchers.

  12. Preliminary (Collateral Question in the International Private Law: Concept and Legal Nature

    Directory of Open Access Journals (Sweden)

    Victoria A. Kosovskaya

    2016-03-01

    Full Text Available One of the most difficult problems of application of conflict-of-laws rules in the international private law is the problem of statement and permission of a preliminary (collateral question. This results from the fact that in the scientific doctrine there was no uniform understanding of the legal nature and ways of permission of a preliminary question, and lack of his fixing at the legislative level. In article the concept of a preliminary (collateral question as legal treatment of the actual circumstances accompanying consideration of the main legal relationship reveals and also examples of those actions which need to be executed before definition of applicable law to the main legal relationship or in the course of its application are given. Permission of a preliminary question is necessary for the correct and complete idea of all actual facts of the case arising by consideration of the civil dispute complicated by a foreign element. The author reveals possible solutions of various options of a preliminary (collateral question, in particular, by means of use of the right of the country of court (lex fori, the right of the country with which legal relationship in general (lex causae, and also the legal procedure of the national right is connected.

  13. Studies on intracranial collateral circulation with multi-slice CT angiography in patients with symptomatic cerebral artery stenosis

    Directory of Open Access Journals (Sweden)

    Shu-qing ZHOU

    2011-06-01

    Full Text Available Objective To explore the features of intracranial collateral circulation in patients with symptomatic cerebral artery stenosis.Method Ninety-four patients with ischemic cerebrovascular disease admitted from Apr.2004 to Jun.2009 were involved in present study.All the patients were examined with cerebral multi-slice CT angiography,and the features of cerebral artery stenosis and intracranial collateral circulation were evaluated using maximum intensity projection(MIP and volume rendering(VR images of CT angiography.Result Of the 94 patients involved,48 were diagnosed as cerebral artery stenosis,including 29 cases of cerebral infarction,18 of transient ischemic attack(TIA and 1 of moyamoya disease(MMD.Among the 14 cases of severe cerebral artery stenosis or occlusion,cerebral infarction was found in 6 cases with lesser intracranial collateral vessels(including massive cerebral infarction in 4 cases and watershed infarction in 2 cases,and focal infarction of central semi-ovale in 1 case and TIA in 7 cases were found with abundant intracranial collateral vessels.Multiple lacunar infarction was found in 22 cases of mild or moderate cerebral artery stenosis,but there was no significant correlation between the stenosed arteries and infarction sites.Abundant intracranial collateral vessels were found in one patient with Moyamoya disease but no infarction was observed.Conclusions Intracranial collateral circulation plays an important role of compensation in patients with severe cerebral artery stenosis or occlusion.Cerebral angiography with multi-slice CT is of great significance in evaluation of cerebral artery stenosis and intracranial collateral circulation.

  14. Clinical features and injury patterns of medial collateral ligament tibial side avulsions: "wave sign" on magnetic resonance imaging is essential for diagnosis.

    Science.gov (United States)

    Taketomi, Shuji; Uchiyama, Eiji; Nakagawa, Takumi; Takeda, Hideki; Nakayama, Shuichi; Fukai, Atsushi; Sanada, Takaki; Iwaso, Hiroshi

    2014-12-01

    Medial collateral ligament tibial avulsion is rare. Consequently, diagnostic criteria and a treatment regimen for medial collateral ligament tibial side avulsions remain to be established. The purpose of this study is to clarify the clinical features of medial collateral ligament tibial side avulsions. We performed a retrospective clinical and magnetic resonance imaging review of a consecutive series of 12 medial collateral ligament tibial side avulsions. All patients were treated operatively and the final diagnosis was made based on the intraoperative findings. Post-injury magnetic resonance imaging studies were reviewed to assess injury patterns with respect to the intraoperative findings. Eleven of 12 cases (92%) had grade III valgus laxity (unstable to valgus stress at both 0° and 30° of flexion) on an examination under anesthesia. Concomitant anterior cruciate ligament tear was noticed in all cases. Intraoperative findings were classified into 3 types depending on the location of the ruptured end of the superficial medial collateral ligament with respect to the pes anserinus tendons. Magnetic resonance imaging depicted characteristic waving ("wave sign") of the superficial layer of medial collateral ligament in all cases. "Wave sign" of the superficial layer of medial collateral ligament on magnetic resonance imaging is essential for diagnosing medial collateral ligament tibial side avulsions. Based on the clinical features and injury patterns, operative treatment is primarily recommended for medial collateral ligament tibial side avulsions. Case series, Level IV. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. Barbara Paul, Johanna Schaffer: Mehr(wert queer – Queer Added (Value. Visuelle Kultur, Kunst und Gender-Politiken – Visual Culture, Art, and Gender Politics. Bielefeld: transcript Verlag 2009.

    Directory of Open Access Journals (Sweden)

    Julia Jäckel

    2010-03-01

    Full Text Available ‚Mehr Queer‘ lautet die Programmatik der Autor/-innen des Sammelbandes, die sich in ihren Beiträgen mit ästhetischen und politischen Praxen auseinandersetzen, welche die Ordnungsparameter der Binarität und Heterosexualität verunsichern. Der Titel Mehr(wert queer schließt dabei an ökonomische Semantiken an, um die Verwobenheit von symbolischer Kunst und ökonomischen Realitäten in den Blick zu bekommen, aber auch um aktiv an Umdeutungen mitzuwirken. Im Mittelpunkt stehen visuelle Kunst- und Bilderpolitiken, die Normalitätsdiskurse um Sexualität, Geschlecht und Begehren hinterfragen. Die Autor/-innen kommen aus den Kunst- und Kulturwissenschaften, den Medienwissenschaften, der Philosophie, aber auch aus der künstlerischen sowie der kunst- und kulturpolitischen Praxis.“More queer”: this is the program of the authors of this collected volume, who in their essays confront this program with aesthetic and political practice that disrupts the organizational frameworks provided by binary thinking and heterosexuality. The title Mehr(wert queer [Added (value queer] thus picks up on economic semantics in order to bring into focus the entanglement of symbolic art with economic realities, but also to contribute actively to reinterpretation. Central to the study is visual art and image politics, which question normative discourse surrounding sexuality, gender, and desire. The authors come from Art History and Cultural Studies, Media Studies, and Philosophy, but also artistic as well as art and culture political practice.

  16. Biomechanical study using fuzzy systems to quantify collagen fiber recruitment and predict creep of the rabbit medial collateral ligament.

    Science.gov (United States)

    Ali, A F; Taha, M M Reda; Thornton, G M; Shrive, N G; Frank, C B

    2005-06-01

    In normal daily activities, ligaments are subjected to repeated loads, and respond to this environment with creep and fatigue. While progressive recruitment of the collagen fibers is responsible for the toe region of the ligament stress-strain curve, recruitment also represents an elegant feature to help ligaments resist creep. The use of artificial intelligence techniques in computational modeling allows a large number of parameters and their interactions to be incorporated beyond the capacity of classical mathematical models. The objective of the work described here is to demonstrate a tool for modeling creep of the rabbit medial collateral ligament that can incorporate the different parameters while quantifying the effect of collagen fiber recruitment during creep. An intelligent algorithm was developed to predict ligament creep. The modeling is performed in two steps: first, the ill-defined fiber recruitment is quantified using the fuzzy logic. Second, this fiber recruitment is incorporated along with creep stress and creep time to model creep using an adaptive neurofuzzy inference system. The model was trained and tested using an experimental database including creep tests and crimp image analysis. The model confirms that quantification of fiber recruitment is important for accurate prediction of ligament creep behavior at physiological loads.

  17. Pathogenesis of Portal Cavernoma Cholangiopathy: Is it Compression by Collaterals or Ischemic Injury to Bile Ducts During Portal Vein Thrombosis?

    Science.gov (United States)

    Puri, Pankaj

    2014-01-01

    The pathogenesis of portal cavernoma cholangiopathy (PCC) is important as it can impact the choice of treatment modalities. PCC consists of a reversible component, which resolves by decompression of collaterals as well as a fixed component, which persists despite the decompression of collaterals. The reversible component is due to compression by large collaterals located adjacent to the bile duct as well as possibly intracholedochal varices. The fixed component is likely to be due to ischemia at the time of portal vein thrombosis, local ischemia by compression as well as encasement by a solid tumor-like cavernoma comprising of fibrous hilar mass containing multiple tiny collateral veins rather than markedly enlarged portal collaterals. Although cholangiographic abnormalities in portal hypertension are common, the prevalence of symptomatic PCC is low. This is likely to be related to the cause of portal hypertension, the duration of portal hypertension and possibly the pattern of occlusion of the splenoportal axis. There may possibly be higher prevalence of symptomatic PCC in extension of the thrombosis to the splenomesentric veins. PMID:25755592

  18. Noninvasive evaluation of collateral blood flow through circle of Willis in cervical carotid stenosis using selective magnetic resonance angiography.

    Science.gov (United States)

    Ito, Kenji; Sasaki, Makoto; Kobayashi, Masakazu; Ogasawara, Kuniaki; Nishihara, Takashi; Takahashi, Tetsuhiko; Natori, Tatsunori; Uwano, Ikuko; Yamashita, Fumio; Kudo, Kohsuke

    2014-01-01

    Preoperative assessment of intracranial collateral circulation is helpful in predicting cerebral ischemia during surgical procedures for cervical internal carotid artery (ICA) stenosis. However, magnetic resonance angiography (MRA) and other less-invasive techniques cannot evaluate collateral blood flow because these techniques are nonselective. Hence, by using a newly developed selective MRA technique, we attempted to visualize collaterals via the circle of Willis in patients with ICA stenosis. Twelve patients who underwent carotid endarterectomy were prospectively examined with a 1.5-T MR scanner. Both selective and nonselective MRA were obtained using a 3-dimensional time-of-flight technique, with or without a cylindrical saturation pulse that suppresses the flow signal from the region of the target ICA. Maximum intensity projection MRA images were generated and compared with digital subtraction angiography (DSA) images. In all patients, the distal flow signal of the ipsilateral ICA was completely suppressed on selective MRA compared with nonselective MRA. In addition, collateral blood flow through the anterior and posterior communicating arteries was visualized in 5 and 2 patients, respectively. These findings corresponded well with the DSA imaging. Selective MRA techniques can readily suppress signals from the distal blood flow of the target artery and visualize the presence of collateral flows through the circle of Willis in patients with cervical ICA stenosis. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. A novel method to assess pial collateralization from stroke perfusion MRI: subdividing T{sub max} into anatomical compartments

    Energy Technology Data Exchange (ETDEWEB)

    Potreck, Arne; Seker, Fatih; Hoffmann, Angelika; Pfaff, Johannes; Bendszus, Martin; Heiland, Sabine; Pham, Mirko [Heidelberg University Hospital, Department of Neuroradiology, Heidelberg (Germany); Nagel, Simon [Heidelberg University Hospital, Department of Neurology, Heidelberg (Germany)

    2017-02-15

    To develop and validate a quantitative and observer-independent method to evaluate pial collateral circulation by DSC-perfusion MRI and test whether this novel method delivers diagnostic information which is redundant to or independent from conventional penumbra imaging by the mismatch approach. We retrospectively identified 47 patients with M1 occlusion who underwent MR diffusion/perfusion imaging and mechanical thrombectomy at our facility. By automated registration and segmentation, T{sub max} delays were attributed specifically to the pial, cortical and parenchymal compartments. The resulting pial volumes at delay were defined as the pial T{sub max} map-assessed collateral score (TMACS) and correlated with gold standard digital subtraction angiography (DSA). Mismatch ratio was assessed by conventional penumbra defining MRI criteria. Strong correlation was found between TMACS and angiographically assessed collateral score (Pearson ρ = -0.74, p < 0.001). In multiple logistic regression, both good collaterals according to TMACS [OR 4.3 (1.1-19, p = 0.04)] and mismatch ratio ≥ 3.5 [OR 12.3 (1.88-249, p = 0.03)] were independent predictors of favourable clinical outcome. Perfusion delay in the pial compartment, as evaluated by TMACS, closely reflects the extent of pial collaterals in gold-standard DSA. TMACS and mismatch ratio were found to be complementary predictors of a favourable clinical outcome, each adding independent predictive information. (orig.)

  20. Sonography of injury of the ulnar collateral ligament of the elbow - initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Theodore T. [Department of Radiology, North Shore University Hospital, 825 Northern Boulevard, 11021, Great Neck, NY (United States); Adler, Ronald S. [Department of Imaging and Nuclear Medicine, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY (United States); Friedman, Lawrence [Department of Radiology, Hamilton Health Sciences - Henderson Division, 711 Concession Street, L8V 1C3, Hamilton, Ontario (Canada)

    2004-07-01

    The purpose of this study is to describe the sonographic appearance of injuries of the ulnar collateral ligament (UCL) of the elbow. Eight non-professional male baseball pitchers, ages 13-35 years, with medial elbow pain and clinical suspicion of ulnar collateral ligament injury, were referred for imaging. All eight underwent sonography of the affected and contralateral asymptomatic elbow, and six also underwent MR imaging. Neither valgus stress nor power Doppler was used during the sonographic examinations. Time from onset of symptoms to imaging was 1.5 weeks to 6 months. Three patients had surgical confirmation of their injuries, with time from imaging to surgery of 2 days to 9 months. In four patients, the UCL was ruptured, manifest sonographically in three cases as discontinuity of the normally hyperechoic ligament with anechoic fluid in the gap and in one case as non-visualization of the ligament with heterogeneous echogenicity in the expected location of the ligament. Two adolescent patients had avulsions of the UCL from the medial epicondyle, with sonographic demonstration of the avulsed echogenic bony fragment in both cases. One patient had a mild sprain, manifest as mild thickening and decreased echogenicity of the ligament sonographically compared with the contralateral normal elbow, with mild surrounding hypoechoic edema. The eighth patient had a small partial tear of the deep surface of the distal aspect of the ligament, visualized as a hypoechoic focus between the deep surface of the ligament and its ulnar attachment. Tears of the ulnar collateral ligament are manifested sonographically as non-visualization of the ligament or alteration of the normal morphology. (orig.)

  1. High-resolution MRI of the ulnar and radial collateral ligaments of the wrist.

    Science.gov (United States)

    Nozaki, Taiki; Wu, Wei Der; Kaneko, Yasuhito; Rafijah, Gregory; Yang, Lily; Hitt, Dave; Yoshioka, Hiroshi

    2017-12-01

    Background Accurate diagnosis of injuries to the collateral ligaments of the wrist is technically challenging on MRI. Purpose To investigate usefulness of high-resolution two-dimensional (2D) and isotropic three-dimensional (3D) magnetic resonance imaging (MRI) for identifying and classifying the morphology of the ulnar and radial collateral ligaments (UCL and RCL) of the wrist. Material and Methods Thirty-seven participants were evaluated using 3T coronal 2D and isotropic 3D images by two radiologists independently. The UCL was classified into four types: 1a, narrow attachment to the tip of the ulnar styloid (Tip); 1b, broad attachment to the Tip; 2a, narrow attachment to the medial base of the ulnar styloid (Base); and 2b, broad attachment to the Base. The RCL was also classified into four types: 1a, separate radioscaphoid and scaphotrapezial ligaments (RS + ST) with narrow scaphoid attachment; 1b, RS + ST with broad scaphoid attachment; 2a, continuous radio-scapho-trapezial ligaments (RST) with narrow scaphoid attachment; and 2b, RST with broad scaphoid attachment. The inter-observer reliability of these classifications was calculated. Results Type 1a was the most common of both collateral ligaments. Of UCL classifications, 31.4% were revised after additional review of multiplanar reconstruction (MPR) images from isotropic data. The inter-observer reliability of UCL classification was substantial (k = 0.62) without MPR, and almost perfect (k = 0.84) with MPR. The inter-observer reliability of RCL classification was almost perfect (k = 0.89). Anatomic delineation between the two sequences was not statistically different. Conclusion The UCL and RCL were each identified on high-resolution 2D and isotropic 3D MRI equally well. MPR allows accurate identification of the UCL attachment to the ulnar styloid.

  2. Radial collateral ligament injury of the little finger proximal interphalangeal joint in young pianists.

    Science.gov (United States)

    Gong, Hyun Sik; Cho, Hoyune Esther; Rhee, Seung Hwan; Kim, Jihyeong; Lee, Young Ho; Baek, Goo Hyun

    2014-08-01

    To report the features of radial collateral ligament injury of the little finger proximal interphalangeal joint in young piano players. Between 2005 and 2012, we treated 6 cases of radial collateral ligament injury of the little finger proximal interphalangeal joint in young piano players at a single referral center. We conducted a retrospective review of charts and radiographs and telephone-interviewed all patients at a mean follow-up of 33 months (range, 12-66 mo) to evaluate features of this injury. All patients were girls with a mean age of 10 years (range, 8-12 y), and all had injuries in their right hands. Patients had been playing piano for a mean 3.8 years (range, 3-5 y) and practicing for a mean 1.8 hours per day (range, 1-3 h). Pain was commonly aggravated when they played octaves or advanced pieces requiring extensive finger movements. All patients were playing on standard-size piano keyboards and had generalized hypermobility with a mean Beighton and Horan score of 6.3 (range, 5-9). Two patients had an ulnar deviation deformity of 10° and 15° each at the proximal interphalangeal joint whereas the others had no fixed joint deformity. Five patients showed improvement with conservative treatment, but 1 patient underwent surgery. In our practice, all piano-related radial collateral ligament injuries were in female preadolescents with evidence of generalized hypermobility; patients had been playing piano extensively, suggesting that the injury could have resulted from stress on the joint during piano playing. Future studies should further evaluate the efficacy of modifying keyboard size, techniques, and repertoires for piano lessons and of patient education for this type of injury. Therapeutic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Infrared Thermal Imaging in Patients with Medial Collateral Ligament Injury of the Knee - A Retrospective Study

    Directory of Open Access Journals (Sweden)

    HyunJung Yang

    2014-12-01

    Full Text Available Objectives: Digital infrared thermographic imaging (DITI has been used widely for various inflammatory diseases, circulatory diseases, skin diseases, musculoskeletal diseases and cancers. In cases of ligament injury, obviously the temperature of the damaged area increases due to local inflammation; however, whether the temperature also increases due to DITI has not been determined. The purpose of the present study was to identify whether or not the changes of temperature in patient’s with medial collateral ligament injury were really due to infrared thermography and to determine the applicability of DITI for assessing ligament injuries. Methods: Twenty patient’s who underwent DITI for a medial collateral ligament injury from September 2012 to June 2014 were included in the current study. The thermographic images from the patient’s knees were divided to cover seven sub-areas: the middle of the patella, and the inferomedial, the inferolateral, the superomedial, the superolateral, the medial, and the lateral regions of patella. The temperatures of the seven regions were measured, and the temperature differences between affected and unaffected regions were analyzed by using the Wilcoxon signed rank test. Results: The 20 patient’s were composed of 14 women (70% and 6 men (30%, with a mean age of 62.15 ± 15.71 (mean ± standard deviation (SD years. The temperature of the affected side, which included the middle of the patella, and the inferomedial, the superomedial, the superolateral, and the medial regions, showed a significant increase compared to that of the unaffected side (P < 0.05. The inferolateral and the lateral regions showed no significant changes. Conclusion: Our study results suggest that DITI can show temperature changes if a patient has a ligament injury and that it can be applied in the evaluation of a medial collateral ligament injury.

  4. The association of plasma vitamin A and E levels with coronary collateral circulation.

    Science.gov (United States)

    Söğüt, Erkan; Kadı, Hasan; Karayakalı, Metin; Mertoğlu, Cuma

    2015-04-01

    To investigate if plasma levels of vitamin A and E have an association with coronary collateral development. A total of 189 patients who underwent coronary angiography and had total occlusion in at least one major epicardial coronary artery were enrolled in the study. To classify coronary collateral circulation (CCC), the Rentrop scoring system was used. Patients were classified as having poor CCC (Rentrop grades 0-1) or good CCC (Rentrop grades 2-3), and all patients were also screened for hypertension, hypercholesterolemia, diabetes, and smoking history. There were no differences in plasma vitamin A and E levels between the two groups (vitamin A: 2.37 ± 0.65 vs. 2.35 ± 0.78, p = 0.253; vitamin E: 47.1 ± 12.8 vs. 44.6 ± 15.1, p = 0.082), and plasma vitamin A and E levels were not associated with CCC. Serum high-sensitivity C-reactive protein (hs-CRP) levels were significantly higher in patients with poor CCC (4.68 ± 2.52 vs. 3.89 ± 1.78, p = 0.001). The higher frequency of diabetes and higher serum hs-CRP levels were found to be an independent predictor for poor CCC (odds ratio = 2.44, p = 0.006; odds ratio = 1.24, p = 0.007, respectively). And a higher frequency of total occluded RCA was found to be a positive predictor for good CCC (odds ratio = 2.36, p = 0.06) in a multivariate logistic regression analysis. We found that serum hs-CRP levels, presence of diabetes, and total occlusion of RCA have an effect on coronary collateral development. We found no correlation between plasma vitamin A and E levels and CCC. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. A Technique of Superficial Medial Collateral Ligament Reconstruction Using an Adjustable-Loop Suspensory Fixation Device.

    Science.gov (United States)

    Deo, Shaneel; Getgood, Alan

    2015-06-01

    This report describes superficial medial collateral ligament reconstruction of the knee using a novel method of graft fixation with the ACL Tightrope RT (Arthrex, Naples, FL). After tibial fixation with either a standard interference screw or staple, femoral fixation of the semitendinosus tendon is performed with the adjustable-loop suspensory fixation device, which allows for both initial graft tensioning and re-tensioning after cyclical knee range of motion. This provides the ability for the graft to accommodate for resultant soft-tissue creep and stress relaxation, thereby allowing for optimal soft-tissue tension and reduction in laxity at the end of the procedure.

  6. Prediction of resistance development against drug combinations by collateral responses to component drugs

    DEFF Research Database (Denmark)

    Munck, Christian; Gumpert, Heidi; Nilsson Wallin, Annika

    2014-01-01

    to do so. Thus, predictive models are needed to rationally design resistance-limiting therapeutic regimens. Using adaptive evolution, we studied the resistance response of the common pathogen Escherichia coli to 5 different single antibiotics and all 10 different antibiotic drug pairs. By analyzing...... adaptation to the component drugs. Then, using engineered E. coli strains, we confirmed that drug resistance mutations that imposed collateral sensitivity were suppressed in a drug pair growth environment. These results provide a framework for rationally selecting drug combinations that limit resistance...

  7. Surgical Management and Treatment of the Anterior Cruciate Ligament/Medial Collateral Ligament Injured Knee.

    Science.gov (United States)

    Dale, Kevin M; Bailey, James R; Moorman, Claude T

    2017-01-01

    The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. The anterior cruciate ligament (ACL) is the most commonly injured ligament in conjunction with the MCL. Most MCL injuries can be treated nonoperatively, whereas the ACL often requires reconstruction. A good physical examination is essential for diagnosis, whereas radiographs and MRI of the knee confirm diagnosis and help guide treatment planning. Preoperative physical therapy should be completed before surgical management to allow for return of knee range of motion and an attempt at MCL healing. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Collateral ligament reconstruction of the chronic thumb injury with bio-tenodesis screw fixation

    DEFF Research Database (Denmark)

    Gvozdenovic, Robert; Boeckstyns, Michel

    2014-01-01

    We describe a new technique for the reconstruction of chronic lesions of the collateral ligaments of the metacarpophalangeal ligaments of the thumb, using a Bio-Tenodesis screw for the fixation of a tendon graft in a triangular manner with proximal apex and allowing early mobilization, starting 2...... weeks after operation. Short-term results after 12 to 43 months (mean, 26 mo), showed no significant differences in grip and pinch strength compared with the opposite thumb and restricted loss of motion in the metacarpophalangeal joints (10%) and the interphalangeal joints (4%). We conclude...

  9. Wikileaks: costruire la trasparenza - Analisi del video “Collateral Murder”

    Directory of Open Access Journals (Sweden)

    Isabella Pezzini

    2014-12-01

    Full Text Available L’articolo esamina la strategia comunicativa adottata da Wikileaks in occasione della diffusione del video “Collateral murder” (3 aprile 2010, in cui denunciava il comportamento dell’aviazione americana nella guerra in Iraq e si proponeva come un nuovo soggetto della controcomunicazione globale. Analizzando i modi in cui il video fu costruito a partire dalle registrazioni delle azioni militari sottratte agli stessi USA, emerge il rovesciamento narrativo che Wikileaks riuscì a ottenere, presentando la propria struttura come il vero Destinante custode dei valori condivisi dall’opinione pubblica mondiale, smascherando viceversa gli USA come Antidestinante.

  10. [Diagnosis of medial collateral ligament injury by stress X-ray and MRI of knee joint].

    Science.gov (United States)

    Zhang, Long-Jun; Chen, Jian-Liang; Xu, Yong; Zhu, Shao-Bing

    2012-11-01

    To study the application of stress X-ray of knee joint for the diagnosis ot medial collateral ligament injury. From January 2008 to June 2011, 46 patients with medial collateral ligament injury were reviewed. Among the patients, 32 patients were male and 14 patients were female, ranging in age from 28 to 72 years, with an average of (49.46 +/- 22.54) years. Left knee joint injuries occurred in 22 patients, and 24 patients had injuries in right knee joint. Thirty-one patients were treated with surgical method, and 15 patients were treated with conservative method including 1 patient finally received operation after 3 months treatment with conservative method without effect. The injury side and normal side were observed by X-ray under stress and non-stress, as well as MRI. Operation was used to treat patients with medial gap markedly widen and the deep layer of medial collateral ligament injury in MRI. A line (line A) was drawn from medial condyle to lateral condyle of tibia platform. The line A was translated to the inner margin of condylus medialis femoris, which was line B. The perpendicular distance was measured, which was line C. The ration of space difference (R) was calculated by (space at stress force of injured side-space at non-stress force of injured side)/(space at stress force of normal side-space at non-stress force of normal side). The relationship between R and ligament injury type were investigated. There were 17 patients with injuries of superficial lamella, 21 patients with injuries of deep lamella. Eight patients had associated injuries of articular capsule and posterior cruciate ligament. When R value was between 1.51 to 5.24, the injury of superficial ligament was found in 15 patients, actual injuries were found in 17 patients. When R value between 5.28 and 13.85, the injuries of bathypelagic ligament were found in 19 patients, actual injuries were found in 21 patients. When R value was between 15.61 and 26.25, the associated injuries of

  11. Repair of collateral ligament ruptures in the metacarpophalangeal joints of the long fingers.

    Science.gov (United States)

    Vigasio, Adolfo; Marcoccio, Ignazio

    2012-03-01

    Isolated collateral ligament ruptures in the metacarpophalangeal joints of the fingers seem to be more frequent than described. For ligament repair, dorsal access is generally described, but the proper method by which to proceed inside the joint is unclear and left to the surgeon's discretion and experience. With the technique we propose, it is possible to explore the interior of the joint from the top, allowing an easy and complete examination of the entire length of the ligament. This proposed method allows for a better identification of the lesion and the area of ligament reinsertion, facilitating technical decision-making, and reducing the operating time.

  12. Biliary collateral veins and associated biliary abnormalities of portal hypertensive biliopathy in patients with cavernous transformation of portal vein.

    Science.gov (United States)

    Liu, Yubao; Hou, Baohua; Chen, Ren; Jin, Haosheng; Zhong, Xiaomei; Ye, Weitao; Liang, Changhong

    2015-01-01

    The purpose was to investigate magnetic resonance imaging (MRI) features of biliary collateral veins and associated biliary abnormalities of portal hypertensive biliopathy (PHB). Thirty-six patients including 18 patients with abnormal biliary changes and 18 patients as control group were involved in this study. MRI features of biliary collateral veins were analyzed. Stenosis with dilated proximal bile ducts occurred in 33.3% of patients, 27.8% of patients had irregular ductal walls, 22.2% of patients had thickened ductal walls, 16.7% of patients had angulated ductal walls, and 44.4% of patients had thickened gallbladder walls. Biliary collateral veins and associated biliary abnormalities of PHB can be detected by MRI. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Distribution of collateral fibers in the monkey cervical spinal cord detected with diffusion-weighted magnetic resonance imaging

    DEFF Research Database (Denmark)

    Lundell, Henrik; Nielsen, Jens Bo; Ptito, Maurice

    2011-01-01

    techniques. We calculate the diffusion tensor and the persistent angular structure (PAS), a multi-fiber reconstruction technique, from high quality post mortem data of a perfusion-fixed vervet monkey cervical spinal cord sample and simulated crossing fiber data. Our results show that (i) cylindrical geometry......Diffusion anisotropy monitored with diffusion-weighted magnetic resonance imaging (DWMRI) is a sensitive marker to monitor developmental or pathological microstructural changes in spinal cord. The white matter is often treated as a unidirectional axonal bundle but collateral fibers branching off...... in the white matter of the spinal cord is an invalid assumption due to collateral fibers. We also demonstrate that (ii) collateral fibers can be resolved as distinct peaks in the water diffusion propagator in white matter using multi-fiber models. Finally, we show that (iii) crossing fibers are mainly located...

  14. Visualization of Periventricular Collaterals in Moyamoya Disease with Flow-sensitive Black-blood Magnetic Resonance Angiography: Preliminary Experience

    Science.gov (United States)

    FUNAKI, Takeshi; FUSHIMI, Yasutaka; TAKAHASHI, Jun C.; TAKAGI, Yasushi; ARAKI, Yoshio; YOSHIDA, Kazumichi; KIKUCHI, Takayuki; MIYAMOTO, Susumu

    2015-01-01

    Fragile abnormal collaterals in moyamoya disease, known as “moyamoya vessels,” have rarely been defined. While flow-sensitive black-blood magnetic resonance angiography (FSBB-MRA) is a promising technique for visualizing perforating arteries, as of this writing no other reports exist regarding its application to moyamoya disease. Six adults with moyamoya disease underwent FSBB-MRA. It depicted abnormal collaterals as extended lenticulostriate, thalamic perforating, or choroidal arteries, which were all connected to the medullary or insular artery in the periventricular area and supplied the cortex. This preliminary case series illustrates the potential for FSBB-MRA to reveal abnormal moyamoya vessels, which could be reasonably defined as periventricular collaterals. PMID:25739429

  15. A new risk scoring model for prediction of poor coronary collateral circulation in acute non-ST-elevation myocardial infarction.

    Science.gov (United States)

    İleri, Mehmet; Güray, Ümit; Yetkin, Ertan; Gürsoy, Havva Tuğba; Bayır, Pınar Türker; Şahin, Deniz; Elalmış, Özgül Uçar; Büyükaşık, Yahya

    2016-01-01

    We aimed to investigate the clinical features associated with development of coronary collateral circulation (CCC) in patients with acute non-ST-elevation myocardial infarction (NSTEMI) and to develop a scoring model for predicting poor collateralization at hospital admission. The study enrolled 224 consecutive patients with NSTEMI admitted to our coronary care unit. Patients were divided into poor (grade 0 and 1) and good (grade 2 and 3) CCC groups. In logistic regression analysis, presence of diabetes mellitus, total white blood cell (WBC) and neutrophil counts and neutrophil to lymphocyte ratio (NLR) were found as independent positive predictors of poor CCC, whereas older age (≥ 70 years) emerged as a negative indicator. The final scoring model was based on 5 variables which were significant at p coronary collateralization in patients with acute NSTEMI.

  16. Collateral Damage

    Science.gov (United States)

    1978-10-01

    Revised, October 1971. 3.13 Cockayne , Z.E., and E.V. Lofgren, "Tactical Implictions of Air B6a=1 ,ariations from Nuclear Weapon Tests," SAIReport SAI...radiation lethality is characterized by three syndromes depending upon dose (Ref. 5.34): * Hematopoietic syndrome - whole-body doses of less than 500 rads...Gastrointestinal syndrome - whole-body doses between about 500 and 2000 rads 5-16 ,ew.tologic oep.$$ion 14:5 Ot~er/ .BD so(%.CRP) Tissue Kermin (free

  17. Coronary collaterals

    NARCIS (Netherlands)

    Koerselman, Jeroen

    2004-01-01

    Cardiovascular diseases, in particular coronary artery disease, are the leading cause of death and disease in industrialized countries. Atherosclerotic changes of the arterial vessel wall constitute one of the major causes for the occurrence of cardiovascular disease. Important risk factors for

  18. Magnetic resonance imaging guided treatment of equine distal interphalangeal joint collateral ligaments: 2009-2014

    Directory of Open Access Journals (Sweden)

    Nathaniel A. White

    2016-09-01

    Full Text Available Objectives: To determine the success of treating distal interphalangeal joint collateral ligament (DIJCL desmopathy using magnetic resonance imaging (MRI guided ligament injection. Methods: Medical records of 13 adult horses diagnosed with DIJCL desmopathy using low field MRI and treated by MRI guided ligament injection of mesenchymal stem cells and/or platelet rich plasma were reviewed. Information collected included signalment, MRI diagnosis, treatment type, time to resolution of lameness and level of exercise after treatment. Results: Collateral ligament inflammation was diagnosed as a cause of lameness in 13 horses. MRI was used to guide the injection of the injured DIJCL. All lameness attributed to DIJCL desmopathy resolved with the resulting level of performance at expected (10 or less than expected (3. Conclusions and Clinical Relevance: Injection of the DIJCL can be completed in horses standing in a low field magnet guided by MRI as previously demonstrated in cadaver specimens. Administration of stem cells or PRP appears useful as a treatment for DIJCL desmopathy.

  19. Homeless Shelters' Policies on Sex Offenders: Is This Another Collateral Consequence?

    Science.gov (United States)

    Rolfe, Shawn M; Tewksbury, Richard; Schroeder, Ryan D

    2017-12-01

    The primary focus of sex offender research has been on the efficacy and collateral consequences of sex offender registration and notification (SORN) and residence restrictions. Past scholarship has found these laws to cause numerous re-entry barriers for sex offenders. Such barriers have affected sex offenders' ability to find and maintain housing, employment, and social support. Moreover, registered sex offenders (RSOs) have become homeless due to such laws. Although previous scholarship has highlighted the collateral consequences of SORN, there is a lack of scholarship addressing homeless sex offenders. Specifically, the current study assesses policies regarding RSO access to homeless shelters in a four-state region, focusing on the effect of structural, procedural, and geographic factors, as well as a shelter's proximity to children. Drawing on the loose coupling organizational framework, the findings suggest that a small maximum occupancy, unwritten policies for RSOs, being in Kentucky or Tennessee, being located near a school, and being near a higher proportion of homes with children all decrease the odds that a homeless shelter allows RSOs. Furthermore, although unwilling to make exceptions to the policies regarding RSOs, shelters were generally willing to make exceptions to other policies governing shelter accessibility.

  20. Trans-collateral angioplasty in vascular access intervention therapy for subacute occluded vessel.

    Science.gov (United States)

    Higuchi, Yusuke; Nomura, Tetsuya; Ikeda, Kisho; Kubota, Hiroshi; Miyawaki, Daisuke; Urata, Ryota; Sugimoto, Takeshi; Kato, Taku; Keira, Natsuya; Tatsumi, Tetsuya

    2016-05-07

    We describe the first reported case of successful trans-collateral angioplasty (TCA) in vascular access intervention therapy (VAIVT) for a subacute occluded lesion in the vascular access route. TCA is a technique which has been developed in the field of endovascular therapy for peripheral arterial disease and is usually applied for a long chronic total occluded lesion with no available distal puncture site. Because such lesion characteristics suitable for being applied with TCA are not usually seen in the patients who receive VAIVT, there is little opportunity when TCA is performed in VAIVT. The present patient showed subacute occlusion in the vascular access route with well-developed collateral blood vessels. Because antegrade wiring resulted in subintimal tracking, we failed to antegradely introduce the guidewire to the vascular true lumen. Moreover, no puncture site in the venous side was anatomically available. Therefore, we adopted the strategy of TCA and successfully completed the procedure. Although we rarely encounter the situation in which TCA is necessary for VAIVT, the strategy of TCA is a promising procedure if the condition permits.

  1. Comparative analysis of the structural properties of the collateral ligaments of the human knee.

    Science.gov (United States)

    Wilson, William T; Deakin, Angela H; Payne, Anthony P; Picard, Frederic; Wearing, Scott C

    2012-04-01

    Controlled laboratory study. Varus knee instability arising from lateral collateral ligament (LCL) injury increases stress on cruciate ligament grafts, potentially leading to failure of reconstructed ligaments. In contrast to the medial collateral ligament (MCL), little is known about the structural properties of the LCL. To compare the tensile properties of the LCL and MCL complex of the human knee joint. Ten fresh-frozen cadaveric knees (mean ± SD age, 81 ± 11 years), free of gross musculoskeletal pathology, were obtained. Following dissection, the length, width, and thickness of the ligaments were measured using calipers, and bone-ligament-bone preparations were mounted in a uniaxial load frame. After preconditioning, specimens were extended to failure at a rate of 500 mm/min (approximately 20%/s). Force and crosshead displacement were used to calculate structural properties, including stiffness, yield strength, ultimate tensile strength, and failure energy. The fan-shaped MCL was significantly longer (60%; Pligaments (MCL, 63 ± 14 N/mm; LCL, 59 ± 12 N/mm). Despite differences in geometry and strength, there was no significant difference in stiffness of the MCL and LCL when tested in vitro.

  2. [Resveratrol improves coronary collateral circulation in pigs with experimental acute coronary occlusion].

    Science.gov (United States)

    Wang, Zhi-rong; Xu, Wu; Zhang, Chao-qun; Xie, Wei; Zhou, Zhao-feng; Zhou, Xiao-feng; Zhang, Zhuo-qi

    2011-10-01

    To evaluate the impact of resveratrol on coronary collateral circulation in pigs suffered from experimental acute coronary occlusion. Eighteen healthy pigs were randomly divided into 3 groups: resveratrol group, nitroglycerin group and control group. Animal model of acute coronary occlusion was established through PTCA method, and the blood flow spectrum in the left circumflex artery (LCX) was detected using intracoronary Doppler ultrasound. The average peak velocity (APV) in infarction correlation artery (IRA) was significantly decreased immediately after coronary occlusion [(0.85 ± 0.25) cm/s vs. (24.83 ± 3.43) cm/s, P coronary injection of resveratrol (2 mg) or nitroglycerin (0.3 mg). There was no significant difference in peak APV between the resveratrol and nitroglycerin groups. The duration of increased APV was significantly longer in resveratrol group than that in nitroglycerin group [(58.83 ± 6.15) min vs. (21.80 ± 5.79) min, P circulation after acute coronary occlusion was obviously insufficient in pigs. Resveratrol could significantly improve the blood flow in coronary collateral circulation after acute occlusion in this model.

  3. CFD simulation of blood flow inside the corkscrew collaterals of the Buerger's disease.

    Science.gov (United States)

    Sharifi, Alireza; Charjouei Moghadam, Mohammad

    2016-01-01

    Buerger's disease is an occlusive arterial disease that occurs mainly in medium and small vessels. This disease is associated with Tobacco usage. The existence of corkscrew collateral is one of the established characteristics of the Buerger's disease. In this study, the computational fluid dynamics (CFD) simulation of blood flow within the corkscrew artery of the Buerger's disease is conducted. The geometry of the artery is constructed based on the actual corkscrew artery of a patient diagnosed with the Buerger's disease. The blood properties are the same as the actual blood properties of the patient. The blood flow rate is taken from the available experimental data in the literature. The local velocity patterns, pressure and kinematic viscosity distributions in different segments of the corkscrew collateral artery was demonstrated and discussed for the first time for this kind of artery. The effects of non-Newtonian consideration for the blood viscosity behavior were investigated in different segments of the artery. Moreover, the variations of the blood flow patterns along the artery were investigated in details for each segment. It was found that the flow patterns were affected by the complex geometry of this artery in such a way that it could lead to the presence of sites that were prone to the accumulation of the flowing particles in blood like nicotine. Furthermore, due to the existence of many successive bends in this artery, the variations of kinematic viscosity along this artery were significant, therefore the non-Newtonian behavior of the blood viscosity must be considered.

  4. Does rich coronary collateral circulation distal to chronically occluded left anterior descending artery compete with graft flow?

    Science.gov (United States)

    Kaku, Daisuke; Nakahira, Atsushi; Hirai, Hidekazu; Sasaki, Yasuyuki; Hosono, Mitsuharu; Bito, Yasuyuki; Suehiro, Yasuo; Suehiro, Shigefumi

    2013-12-01

    In coronary artery bypass grafting (CABG), graft flow distal to a mild stenosis can compete with relatively preserved native flow through the stenosis and the competition can result in graft stenosis. In chronic total occlusion (CTO), coronary collateral circulation, which is essential to maintain myocardial viability distal to CTO, varies in extent among patients and the extent can be scored by Rentrop grade in coronary angiography. We investigated whether rich collateral circulation distal to CTO competes with distally anastomosed graft flow in association with Rentrop grade. Of 666 patients who underwent CABG from January 2001 to December 2012, 70 patients whose left internal thoracic artery (ITA) was grafted distal to CTO in the left anterior descending artery (LAD) were divided into three groups: Poor collaterals (Rentrop grades 0 and 1, Group P, n = 22), Moderate collaterals (grade 2, Group M, n = 23) and Rich collaterals (grade 3, Group R, n = 25). The intraoperative measurements of mean graft flow (MGF) and pulsatility index (PI) of left ITA grafts, early graft patency and long-term clinical outcomes were compared. The MGF and PI of left ITA grafts differed significantly among the three groups (P = 0.025 and P = 0.046, respectively). Lower Rentrop grade was associated with preferable results of higher MGF and lower PI. The graft flow pattern in Group P showed a significantly higher MGF (P = 0.020) and lower PI (P = 0.041) than those in Group R. All early postoperative coronary angiograms showed patent left ITA grafts. Serial echocardiographic evaluations, survival rates and cardiac event-free rates were comparable with the follow-up of 5.00 ± 3.11 years. Rich collateral circulation distal to CTO in LADs can potentially compete with graft flow, although the competition seems not to affect clinical outcomes probably due to the regression of collaterals surmounted by the graft flow. Rentrop grade is shown to certainly reflect the degree of collateral

  5. Association of Collateral Blood Vessels Detected by Arterial Spin Labeling Magnetic Resonance Imaging With Neurological Outcome After Ischemic Stroke.

    Science.gov (United States)

    de Havenon, Adam; Haynor, David R; Tirschwell, David L; Majersik, Jennifer J; Smith, Gordon; Cohen, Wendy; Andre, Jalal B

    2017-04-01

    Robust collateral blood vessels have been associated with better neurologic outcome following acute ischemic stroke (AIS). The most commonly used methods for identifying collaterals are contrast-based angiographic imaging techniques, which are not possible in all patients after AIS. To assess the association between the presence of collateral vessels identified using arterial spin labeling (ASL) magnetic resonance imaging, a technique that does not require exogenous administration of contrast, and neurologic outcome in patients after AIS. This retrospective cohort study examined 38 patients after AIS admitted to a tertiary academic medical center between 2012 and 2014 who underwent MRI with ASL. According to a prespecified hypothesis, ASL images were graded for the presence of collaterals by 2 neuroradiologists. Modified Rankin Scale (mRS) scores at discharge and other composite data were abstracted from the medical record by a neurologist blinded to radiologic data. Of the 38 patients, 19 (50.0%) were male, and the mean (SD) age was 61 (20) years. In 25 of 38 patients (65.8%), collaterals were detected using ASL, which were significantly associated with both a good outcome (mRS score of 0-2 at discharge; P = .02) and a 1-point decrease in mRS score at discharge (odds ratio, 6.4; 95% CI, 1.7-23.4; P = .005). In a multivariable ordinal logistic regression model, controlling for admission National Institutes of Health Stroke Scale score, history of atrial fibrillation, premorbid mRS score, and stroke parent artery status, there was a strong association between the presence of ASL collaterals and a 1-point decrease in the mRS score at discharge (odds ratio, 5.1; 95% CI, 1.2-22.1; P = .03). Following AIS, the presence of ASL collaterals is strongly associated with better neurological outcome at hospital discharge. This novel association between ASL collaterals and improved neurologic outcome may help guide prognosis and management, particularly in patients

  6. Repair of the Thumb Ulnar Collateral Ligament With Suture Tape Augmentation.

    Science.gov (United States)

    De Giacomo, Anthony F; Shin, Steven S

    2017-09-08

    One of the most commonly injured structures of the thumb metacarpophalangeal (MCP) joint is the ulnar collateral ligament (UCL). An acute injury of this ligament is often amenable to primary repair. Despite the favorable outcomes of primary repair, the thumb is often restricted during initial healing of the ligament with immobilization and delayed rehabilitation. We present a novel technique to augment the repair of the UCL with suture tape to provide immediate biomechanical support and strength during the critical time of ligament healing. We describe the surgical technique of suture tape augmentation for thumb UCL repair. At the ulnar aspect of the thumb MCP joint, a longitudinal midaxial incision is made. Subsequently, the adductor pollicis aponeurosis and extensor mechanism are identified, incised, and retracted. The UCL is exposed and usually torn off the volar-ulnar base of the proximal phalanx. A 2.5-mm PushLock anchor loaded with 1.3-mm SutureTape and 3-0 FiberWire suture, is placed into a hole at the volar-ulnar base of the proximal phalanx after preparation with a 1.8-mm drill bit. The 3-0 FiberWire is used for direct repair of the ligament. Both tails of the 1.3-mm SutureTape is then brought proximally over the ligament and loaded into a 3.5-mm SwiveLock anchor. A 3.2-mm drill bit is then used to make a hole at the ulnar aspect of the metacarpal head, just proximal to the attachment of the proximal UCL. With the thumb MCP joint held in at least 30 degrees of flexion, the tape-loaded 3.5-mm SwiveLock anchor is inserted into metacarpal head. Reinforcement of the repair is then carried out with fine absorbable suture to surrounding capsular tissue. We present a representative case of a professional basketball player treated with this novel procedure. After the surgical repair, the patient was placed in a plaster splint for 3 days to immobilize the thumb and wrist. At 3 days postsurgery, the splint was removed and therapy initiated. Practice drills were

  7. [Value of evaluating the coronary collateral circulation by transluminal attenuation gradient in patients with chronic total occlusion and related influencing factors].

    Science.gov (United States)

    Chen, Y L; Wang, R; He, Y; Li, J N; Yuan, F; Tian, R; Ge, C J; Zhou, Y; Huang, R C; Cui, S; Song, X T

    2017-10-24

    Objective: To observe the value of evaluating the coronary collateral circulation of chronic total occlusion (CTO) by transluminal attenuation gradient (TAG) and Rentrop grading, and analyze the influencing factors for coronary collateral circulation. Methods: A total of 179 CTO patients admitted to Beijing Anzhen hospital during June 2013 to August 2016 were included in this study.All patients received coronary computed tomographic angiography (CCTA) examination before coronary angiography.Finally, 75 patients (79 vessels) were enrolled.Patients were divided into two groups on the basis of Rentrop classification.The Rentrop 3 was defined as a well-developed coronary collateral circulation group, including 50 CTO vessels, Rentrop 2 or below was defined as poorly-developed collateral circulation group, including 29 vessels.TAG values in patients with various Rentrop grades were analyzed.Univariate and multivariate analysis were used to determine the predictors of collateral circulation. Results: TAG increased consistently in proportion to the angiographic extent of collateral flow (TAG was (-33.6±24.4), (-16.5±15.7) and (-12.8±15.8) HU/10 mm in patients with Rentrop grade 0 or 1, 2 and 3, respectively, P=0.007). Number of good collateral circulation vessels predicted by TAG≥15.6 HU/10 mm was 45(57.0%, 45/79), and 50 (63.3%, 50/79) by Rentrop grade (P=0.383). Prevalence of diabetes was significantly lower (20.8%(10/48) vs. 48.1%(13/27), P=0.01), while history of previous myocardial infarction (MI) was significantly higher (35.4%(17/48) vs. 11.1%(3/27), P=0.02) in patients with good collateral circulation than in patients with poor collateral circulation.The TAG of the good collateral circulation group was significantly higher than in poorly collateral circulation group ((-12.8±15.8) HU/10 mm vs. (-21.2±19.6) HU/10mm, P=0.041). Multiple logistic regression analysis revealed that history of MI (OR=0.196, 95%CI 0.041-0.936, P=0.041) and diabetes(OR=6.604, 95%CI 1

  8. The influence of genotype on vascular endothelial growth factor and regulation of myocardial collateral blood flow in patients with acute and chronic coronary heart disease

    DEFF Research Database (Denmark)

    Ripa, R.S.; Jorgensen, E.; Baldazzi, F.

    2009-01-01

    OBJECTIVE: To test the hypothesis that mutations in the vascular endothelial growth factor (VEGF) gene are associated with plasma concentration of VEGF and subsequently the ability to influence coronary collateral arteries in patients with coronary heart disease (CHD). METHODS: Blood samples from...... patients with chronic ischemic heart disease (n=53) and acute coronary syndrome (n=61) were analysed. Coronary collaterals were scored from diagnostic biplane coronary angiograms. RESULTS: The plasma concentration of VEGF was increased in patients with acute compared to chronic CHD (p=0.01). The genotype......-1154 and coronary collateral size (p=0.03) and a significant association between the VEGF plasma concentration and the collateral size (p=0.03). CONCLUSION: VEGF plasma concentration seems related to coronary collateral function in patients with CHD. The results did not support the hypothesis...

  9. [Coronary collateral circulation in infarction-related artery in patients with acute myocardial infarction with rise and without rise of ST segment].

    Science.gov (United States)

    Iaitskiĭ, N A; Zverev, O G; Volkov, A B; Voĭnov, A V; Abdulragimov, R I

    2014-01-01

    The authors analyzed a condition of coronary collateral circulation in infarction-related artery in patients with acute myocardial infarction with rise and without rise of ST segment. The assessment of collateral circulation was made by coronary angiography using Rentop scale. Results of the research showed, that collateral circulation wasn't visualized by angiography in the first hours after acute myocardial infarction with the rise of ST segment. Apparently, this circulation didn't significantly assisted in maintenance of vital capacity of the myocardium in the pool of infarction-related occlusive coronary artery. Visualization of collateral circulation was noted in majority of patients with acute myocardial infarction without the rise of ST segment. Collateral flow was an important alternative source of blood supply of the heart in patients without rise of ST segment in the period of critical reduction of the antegrade blood flow.

  10. Surgical strategy to minimize ischemia during trapping/resection of giant extracranial carotid artery aneurysm stratified by collateral evaluation.

    Science.gov (United States)

    Hongo, Hiroki; Inoue, Tomohiro; Tamura, Akira; Saito, Isamu

    2017-01-01

    Extracranial carotid artery aneurysm (ECAA) is a rare clinical entity, and no standard treatment strategy has been established for this condition. Data from three patients who underwent surgical treatment of enlarging giant ECAAs were retrospectively reviewed. Based on the collateral status, as evaluated by preoperative digital subtraction angiography (DSA), surgical strategy was stratified into (1) high flow bypass followed by cervical ICA (internal carotid artery) ligation, when the collateral status was judged as poor/fair or (2) direct cervical repair with patch application after aneurysmal wall resection when the collateral status was judged as robust. Postoperative results were evaluated by magnetic resonance imaging (MRI). Postoperative follow-up (day 0 to 1, as well as midterm at approximately 6 months) confirmed completely trapped aneurysm with successful robust bypass and robust anterograde flow of the reconstructed cervical carotid artery on magnetic resonance angiography with no additional ischemic lesions on diffusion weighted imaging and T2-weighted imaging when compared with preoperative imaging in all three patients. Postoperatively, there was no stroke event during the midterm follow-up at 6 months. Clinical results of ECAAs treated by a surgical strategy stratified based on collateral status, as evaluated by preoperative DSA, were favorable, without postoperative ischemic event, and with satisfactory mid-term MRI results.

  11. The Dual Role of Cerebral Autoregulation and Collateral Flow in the Circle of Willis After Major Vessel Occlusion.

    Science.gov (United States)

    Kennedy McConnell, Flora; Payne, Stephen

    2017-08-01

    Ischaemic stroke is a leading cause of death and disability. Autoregulation and collateral blood flow through the circle of Willis both play a role in preventing tissue infarction. To investigate the interaction of these mechanisms a one-dimensional steady-state model of the cerebral arterial network was created. Structural variants of the circle of Willis that present particular risk of stroke were recreated by using a network model coupled with: 1) a steady-state physiological model of cerebral autoregulation; and 2) one wherein the cerebral vascular bed was modeled as a passive resistance. Simulations were performed in various conditions of internal carotid and vertebral artery occlusion. Collateral flow alone is unable to ensure adequate blood flow ([Formula: see text] normal flow) to the cerebral arteries in several common variants during internal carotid artery occlusion. However, compared to a passive model, cerebral autoregulation is better able to exploit available collateral flow and maintain flows within [Formula: see text] of baseline. This is true for nearly all configurations. Hence, autoregulation is a crucial facilitator of collateral flow through the circle of Willis. Impairment of this response during ischemia will severely impact cerebral blood flows and tissue survival, and hence, autoregulation should be monitored in this situation.

  12. The Effects of a Peer-Yoked Contingency on Observational Learning and the Collateral Emergence of Naming

    Science.gov (United States)

    Rothstein, Mindy Bunya; Gautreaux, Grant Gerard

    2007-01-01

    We tested the effects of a Peer-Yoked Contingency on students' acquisition of observational learning repertoires and collateral effects on naming. Three male middle school participants, diagnosed with emotional and behavioral disabilities, were selected for this study. The three participants did not have naming repertoires, and two of the three…

  13. Blood flow and vascular reactivity in collaterally perfused brain tissue. Evidence of an ischemic penumbra in patients with acute stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Larsen, B; Herning, M

    1983-01-01

    In a group of 48 patients with completed stroke, 8 patients had viable collaterally perfused brain tissue which was accessible for rCBF recordings with a two dimensional technique. All 8 had deep subcortical infarcts on CT-scan, and angiographic occlusion of the arteries normally supplying...

  14. 12 CFR 221.120 - Allocation of stock collateral to purpose and nonpurpose credits to same customer.

    Science.gov (United States)

    2010-01-01

    ... nonpurpose credits to same customer. 221.120 Section 221.120 Banks and Banking FEDERAL RESERVE SYSTEM... § 221.120 Allocation of stock collateral to purpose and nonpurpose credits to same customer. (a) A bank... be extended at the same time, each would be evidenced by a separate agreement. Credit A would be...

  15. Female CFOs and loan contracting: Financial conservatism or gender discrimination? – An empirical test based on collateral clauses

    Directory of Open Access Journals (Sweden)

    Xixiong Xu

    2016-06-01

    Full Text Available Based on signaling and gender discrimination theory, we examine whether chief financial officer (CFO gender matters to bank–firm relationships and the designing of collateral clauses in bank loan contracting, and explore the potential path of influence. Data taken from Chinese listed companies between 2009 and 2012 indicate that (1 female-CFO-led firms are less likely to obtain credit loans than male-CFO-led firms; (2 female-CFO-led borrowers are more likely to be required to provide collateral for loans than male-CFO-led borrowers; and (3 banks are more inclined to claim mortgaging collateral when lending to female-CFO-led firms and prefer to guarantee collateral when lending to male-CFO-led firms. Female-CFO-led borrowers seem to be granted more unfavorable loan terms than male-CFO-led borrowers, supporting the hypothesis that female CFOs experience credit discrimination. Further analysis reveals that regional financial development helps to alleviate lending discrimination against female CFOs. Furthermore, female CFOs in SOEs are less likely than their non-SOE counterparts to experience gender discrimination in the credit market.

  16. The relationship of plasma decoy receptor 3 and coronary collateral circulation in patients with coronary artery disease.

    Science.gov (United States)

    Yan, Youyou; Song, Dandan; Liu, Lulu; Meng, Xiuping; Qi, Chao; Wang, Junnan

    2017-11-15

    Previously, decoy receptor 3 (DcR3) was found to be a potential angiogenetic factor, while the relationship of DcR3 with coronary collateral circulation formation has not been investigated. In this study, we aimed to investigate whether plasma decoy receptor 3 levels was associated with CCC formation and evaluate its predictive power for CCC status in patients with coronary artery disease. Among patients who underwent coronary angiography with coronary artery disease and had a stenosis of ≥90% were included in our study. Collateral degree was graded according to Rentrope Cohen classification. Patients with grade 2 or 3 collateral degree were enrolled in good CCC group and patients with grade 0 or 1 collateral degree were enrolled in poor CCC group. Plasma DcR3 level was significantly higher in good CCC group (328.00±230.82 vs 194.84±130.63ng/l, p<0.01) and positively correlated with Rentrope grade (p<0.01). In addition, plasma DcR3 was also positively correlated with VEGF-A. Both ROC (receiver operating characteristic curve) and multinomial logistical regression analysis showed that plasma DcR3 displayed potent predictive power for CCC status. Higher plasma DcR3 level was related to better CCC formation and displayed potent predictive power for CCC status. Copyright © 2017. Published by Elsevier Inc.

  17. Rapid response for invasive waterweeds at the arctic invasion front: Assessment of collateral impacts from herbicide treatments

    Science.gov (United States)

    Sethi, Suresh; Carey, Michael P.; Morton, John M.; Guerron-Orejuela, Edgar; Decino, Robert; Willette, Mark; Boersma, James; Jablonski, Jillian; Anderson, Cheryl

    2017-01-01

    The remoteness of subarctic and arctic ecosystems no longer protects against invasive species introductions. Rather, the mix of urban hubs surrounded by undeveloped expanses creates a ratchet process whereby anthropogenic activity is sufficient to introduce and spread invaders, but for which the costs of monitoring and managing remote ecosystems is prohibitive. Elodea spp. is the first aquatic invasive plant to become established in Alaska and has potential for widespread deleterious ecological and economic impacts. A rapid eradication response with herbicides has been identified as a priority invasion control strategy. We conducted a multi-lake monitoring effort to assess collateral impacts from herbicide treatment for Elodea in high latitude systems. Variability in data was driven by seasonal dynamics and natural lake-to-lake differences typical of high latitude waterbodies, indicating lack of evidence for systematic impacts to water quality or plankton communities associated with herbicide treatment of Elodea. Impacts on native macrophytes were benign with the exception of some evidence for earlier onset of leaf senescence for lily pads(Nuphar spp.) in treated lakes. We observed a substantial increase in detected native flora richness after Elodea was eradicated from the most heavily infested lake, indicating potential for retention of native macrophyte communities if infestations are addressed quickly. While avoiding introductions through prevention may be the most desirable outcome, these applications indicated low risks of non-target impacts associated with herbicide treatment as a rapid response option for Elodea in high latitude systems.

  18. Lipopolysaccharide loss produces partial colistin dependence and collateral sensitivity to azithromycin, rifampicin and vancomycin in Acinetobacter baumannii.

    Science.gov (United States)

    García-Quintanilla, Meritxell; Carretero-Ledesma, Marta; Moreno-Martínez, Patricia; Martín-Peña, Reyes; Pachón, Jerónimo; McConnell, Michael J

    2015-12-01

    Treatment options for multidrug-resistant (MDR) strains of Acinetobacter baumannii that acquire resistance to colistin are limited. Acinetobacter baumannii can become highly resistant to colistin through complete loss of lipopolysaccharide (LPS) owing to mutations in the genes encoding the first three enzymes involved in lipid A biosynthesis (lpxA, lpxC and lpxD). The objective of this study was to characterise the susceptibility to 15 clinically relevant antibiotics and 6 antimicrobial peptides (AMPs) of MDR A. baumannii clinical isolates that acquired colistin resistance due to mutations in lpxA, lpxC and lpxD as well as their colistin-susceptible counterparts. A dramatic increase in antibiotic susceptibility (≥16-fold increase) was observed upon LPS loss for azithromycin, rifampicin and vancomycin, whereas a moderate increase in susceptibility was seen for amikacin, ceftazidime, imipenem, cefepime and meropenem. Importantly, concentrations ranging from 8 mg/L to 32 mg/L of the six AMPs were able to reduce bacterial viability by ≥3 log10 in growth curve assays. We also demonstrate that colistin resistance results in partial colistin dependence for growth in LPS-deficient strains containing mutations in lpxA, lpxC and lpxD, but not when colistin resistance occurs via LPS modification due to mutations in the PmrA/B two-component system. The results of this study indicate that loss of LPS expression results in collateral sensitivity to azithromycin, rifampicin and vancomycin, and that the six AMPs tested retain activity against LPS-deficient strains, indicating that these antibiotics may be viable treatment options for infections caused by these strains. Copyright © 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  19. A new site for venous access: superficial veins of portal collateral circulation.

    Science.gov (United States)

    Turc, Jean; Gergelé, Laurent; Attof, Rachid; Mottard, Nicolas; Bérend, Michel; David, Jean-Stéphane

    2012-01-01

    In case of failure of peripheral vascular access, classical alternatives are central venous or intraosseous access. We report a new site of vascular access necessitating no specific material. A 53-year-old patient with cirrhosis-induced coagulopathy, portal hypertension, and collateral abdominal portosystemic circulation required parenteral antibiotherapy. After failure of peripheral vein catheterization, he was addressed to our resuscitation room for central venous access. To avoid the risks associated with this invasive procedure, we chose an alternative approach. After skin preparation, a 20-gauge peripheral venous catheter was inserted in a dilated subcutaneous vein of abdominal wall. To our knowledge, it is the first human report of insertion of a catheter in a superficial vein of abdominal wall. It could be an alternative approach for vascular access after failure of peripheral venipuncture in patients with portal hypertension.

  20. An Unusual Knee Trauma: Combined Rupture of Medial Collateral Ligament and Patellar Tendon

    Directory of Open Access Journals (Sweden)

    T. De Baere

    2014-01-01

    Full Text Available We present the case of a combined lesion of the medial collateral ligament (MCL and patellar tendon of the knee in a 45-year-old man, after a fall while skiing. Although there are numerous publications concerning associated tears of MCL and other knee ligaments, a combination of MCL tear with a rupture of the patellar tendon is very rare. After a review of the literature and treatment guidelines about these lesions, the clinical case is described and discussed. This knee trauma was treated with a transosseous reinsertion of the patellar tendon, which was reinforced by an allograft of fascia lata, followed by a direct suture of the MCL, which was reinforced with the lateral semitendinosus tendon.

  1. Effects of collateral peer supportive behaviors within the classwide peer tutoring program.

    Science.gov (United States)

    Kohler, F W; Greenwood, C R

    1990-01-01

    A classwide peer tutoring procedure was implemented in an urban elementary school classroom to improve students' spelling performance. Three students combined untrained or collateral tutoring behaviors with the core behaviors initially taught. To explore the function of these natural and spontaneous behaviors, a multielement single-subject experiment with replications was conducted. Results indicated that the additional tutoring behaviors increased (a) the academic response frequencies of 3 tutees and (b) the weekly spelling achievement of 1 target tutee. The remaining class members were successfully taught and continued to use these behaviors over the final 3 weeks of the school year. These findings are discussed with regard to academic instruction, natural communities of peer reinforcement, and the social validation of intervention procedures.

  2. Arthroscopic trans-portal deep medial collateral ligament pie-crusting release.

    Science.gov (United States)

    Atoun, Ehud; Debbi, Ronen; Lubovsky, Omri; Weiler, Andreas; Debbi, Eytan; Rath, Ehud

    2013-02-01

    Arthroscopic treatments of meniscal injuries of the knee are among the most common orthopaedic procedures performed. Adequate visualization of the posterior horn of the medial meniscus might be challenging, especially in patients with tight medial compartments. In these cases instrument manipulation in an attempt to reach the posterior horn of the meniscus can cause an iatrogenic chondral injury because of the narrow medial joint space. A transcutaneous medial collateral ligament (MCL) pie-crusting release facilitates expansion of the medial joint space in a case of a tight medial compartment. Nevertheless, it might cause injury to the superficial MCL, infection, and pain and injury to the saphenous nerve because of multiple needle punctures of the skin. We describe an inside-out, arthroscopic deep MCL pie-crusting release, which allows access to the medial meniscus through the anterior approach to provide good visualization of the footprint and sufficient working space.

  3. Primary Repair of Iatrogenic Medial Collateral Ligament Injury During TKA: A Modified Technique.

    Science.gov (United States)

    Shahi, Alisina; Tan, Timothy L; Tarabichi, Samih; Maher, Ahmed; Della Valle, Craig; Saleh, Usama Hassan

    2015-05-01

    Intraoperative injury to the medial collateral ligament (MCL) is a rare but important complication of total knee arthroplasty (TKA). While described treatment methods are mainly primary repair and revision with a more constrained implant, a few studies have investigated the outcomes of primary repair without constrained implants. A retrospective study was performed to evaluate the prevalence of iatrogenic injury to the MCL during primary TKA and determine the clinical outcomes of MCL repair augmented with synthetic material without the use of a constrained device. The incidence of intraoperative tear of the MCL was 0.43% (15/3432). No patient demonstrated instability during the follow-up period. Primary repair of iatrogenic MCL injury without the use of constrained implants appears to be a potential alternative that warrants further investigation. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Association between uric acid and coronary collateral circulation in patients with stable coronary artery disease.

    Science.gov (United States)

    Uysal, Onur Kadir; Sahin, Durmus Yildiray; Duran, Mustafa; Turkoglu, Caner; Yildirim, Arafat; Elbasan, Zafer; Ozkan, Bugra; Tekin, Kamuran; Kunak, Aysegul Ulgen; Yilmaz, Yucel; Kaya, Mehmet Gungor; Gur, Mustafa; Cayli, Murat

    2014-03-01

    Serum uric acid (SUA) levels have been proposed as a biomarker of coronary artery disease (CAD) and coronary collateral circulation (CCC). We investigated the association between SUA levels and development of CCC in patients with stable CAD. Consecutive patients (n = 480) with stable CAD who underwent coronary angiography and documented total occlusion in 1 of the major coronary arteries were included in this study. Levels of fasting blood glucose, white blood cell (WBC), creatinine, platelet count, and SUA were significantly higher in patients with poor CCC than in those with good CCC. After multivariate analysis, high levels of SUA were an independent predictor of CCC together with levels of fasting blood glucose and WBC. The receiver-operating characteristic analysis provided a cutoff value of 5.65 mg/dL for SUA to predict poor CCC with 60% sensitivity and 66% specificity. High levels of SUA may be associated with poor CCC in patients with stable CAD.

  5. [Exploration and practice on teaching Meridian, collateral and acupoints to international students in China].

    Science.gov (United States)

    Li, Mingyue; Xu, Yilan; Guo, Yi; Xu, Li

    2015-11-01

    Meridian, collateral and acupoints is the basic course of acupuncture and moxibustion and even is the core for training excellent acupuncture physician. Associated with the characters of international students, the writers had the preliminary exploration and practice on teaching this course. For the acupoint names, the international codes of acupoints and Chinese pinyin were applied in combination and the meanings of acupoint were explained to deepen the understanding of acupoints. For acupoint location, the international standards and classical medical works were combined and the experiences in acupoint location were introduced additionally to open the approach to acupoint location. For acupoint effect, the major functions and ancient medical cases were combined to improve the learning interests. For acupoint location practice, the demonstration by teachers was combined with practice and drawing of acupoints and meridians was supplemented to consolidate the foundational knowledge.

  6. Functional Significance of Angiographic Collaterals in Patients with Totally Occluded Right Coronary Artery: Intracoronary Thallium-201 Scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Do Yun; Lee, Jong Doo; Cho, Seung Yun; Shim, Won Heum; Ha, Jong Won; Kim, Han Soo; Kwon, Hyuk Moon; Jang, Yang Soo; Chung, Nam Sik; Kim, Sung Soon [Yonsei University College of Medicine, Seoul (Korea, Republic of); Park, Chang Yun; Kim, Young Soo [Inje University College of Medicine, Seoul (Korea, Republic of)

    1993-07-15

    To compare the myocardial viability in patients suffering from total occlusion of the right coronary artery (RCA) with the angiographic collaterals, intracoronary injection of Thallium-201 (T1-201) was done to 14 coronary artery disease (CAD) patients (pts) with total occlusion of RCA and into four normal subjects for control. All 14 CAD pts had Grade 2 or 3 collateral circulations. There were 14 male and 4 females, and their ages ranged from 31 to 70 years. In nine pts, T1-201 was injected into left main coronary artery (LCA) (300 approx 350 mu Ci) to evaluate the myocardial viability of RCA territory through collateral circulations. The remaining five pts received T1-201 into RCA (200-250 mu Ci) because two had intraarterial bridging collaterals and three had previous successful PTCA. Planar and SPECT myocardial perfusion images were obtained 30 minutes, and four to five hours after T1-201 reinjection. Intravenous T1-201 reinjection (six pts) or {sup 99m}Tc-MIBI (two pts) were also performed in eight CAD pts. Intracoronary myocardial perfusion images were compared with intravenous T1-201(IV T1-201) images, EGG, and ventriculography. Intracoronary TI-201 images proved to be superior to that of IV T1-201 due to better myocardial to background uptake ratio and more effective in the detection of viable tissue. We also found that perfusion defects were smaller on intracoronary T1-201 images than those on the IV T1-201. All of the 14 CAD pts had either mostly viable myocardium (seven pts) or large area of T1-201 perfusion (seven pts) in RCA territory, however ventriculographic wall motion and ECG did not correlate well with intracoronary myocardial perfusion images. In conclusion, total RCA occlusion patients with well developed collateral circulation had large area of viable myocardial in the corresponding territory.

  7. Early CT perfusion mismatch in acute stroke is not time-dependent but relies on collateralization grade

    Energy Technology Data Exchange (ETDEWEB)

    Baumgarten, Louisa von; Straube, Andreas [University of Munich Hospitals, Department of Neurology, Munich (Germany); Thierfelder, Kolja M.; Beyer, Sebastian E.; Baumann, Alena B.; Bollwein, Christine; Reiser, Maximilian F.; Sommer, Wieland H. [Ludwig-Maximilians-University Hospital Munich, Institute for Clinical Radiology, Munich (Germany); Janssen, Hendrik [Ludwig-Maximilians-University Hospital Munich, Department of Neuroradiology, Munich (Germany)

    2016-04-15

    Factors that determine the extent of the penumbra in the initial diagnostic workup using whole brain CT Perfusion (WB-CTP) remain unclear. The purpose of the current study was to determine a possible dependency of the initial mismatch size between cerebral blood flow (CBF) and cerebral blood volume (CBV) from time after symptom onset, leptomeningeal collateralization, and occlusion localization in acute middle cerebral artery (MCA) infarctions. Out of an existing cohort of 992 consecutive patients receiving multiparametric CT scans including WB-CTP due to suspected stroke, we included patients who had (1) a witnessed time of symptom onset, (2) an infarction of the MCA territory as documented by follow-up imaging, and (3) an initial CBF volume of >10 ml. CBF and CBV lesion sizes, collateralization grade, and the site of occlusion were determined. We included 103 patients. Univariate analysis showed that time from symptom onset (168 +/- 91.2 min) did not correlate with relative or absolute mismatch volumes (p = 0.458 and p = 0.921). Higher collateralization gradings were associated with small absolute mismatch volumes (p = 0.004 and p < 0.001). Internal carotid artery (ICA) occlusions were associated with large absolute mismatch volumes (p = 0.004). Multivariate analysis confirmed that ICA occlusion was associated with large absolute mismatch volumes (p = 0.005), and high collateral grade was associated with small absolute mismatch volumes (p = 0.017). There is no significant correlation between initial CTP mismatch and time after symptom onset. Predictors of mismatch size include the extent of the collaterals and a proximal location of the occlusion. (orig.)

  8. Quantitative analysis of axon collaterals of single pyramidal cells of the anterior piriform cortex of the guinea pig.

    Science.gov (United States)

    Yang, Junli; Litscher, Gerhard; Sun, Zhongren; Tang, Qiang; Kishi, Kiyoshi; Oda, Satoko; Takayanagi, Masaaki; Sheng, Zemin; Liu, Yang; Guo, Wenhai; Zhang, Ting; Wang, Lu; Gaischek, Ingrid; Litscher, Daniela; Lippe, Irmgard Th; Kuroda, Masaru

    2017-02-08

    The role of the piriform cortex (PC) in olfactory information processing remains largely unknown. The anterior part of the piriform cortex (APC) has been the focus of cortical-level studies of olfactory coding, and associative processes have attracted considerable attention as an important part in odor discrimination and olfactory information processing. Associational connections of pyramidal cells in the guinea pig APC were studied by direct visualization of axons stained and quantitatively analyzed by intracellular biocytin injection in vivo. The observations illustrated that axon collaterals of the individual cells were widely and spatially distributed within the PC, and sometimes also showed a long associational projection to the olfactory bulb (OB). The data showed that long associational axons were both rostrally and caudally directed throughout the PC, and the intrinsic associational fibers of pyramidal cells in the APC are omnidirectional connections in the PC. Within the PC, associational axons typically followed rather linear trajectories and irregular bouton distributions. Quantitative data of the axon collaterals of two pyramidal cells in the APC showed that the average length of axonal collaterals was 101 mm, out of which 79 mm (78% of total length) were distributed in the PC. The average number of boutons was 8926 and 7101, respectively, with 79% of the total number of boutons being distributed in the PC. The percentage of the total area of the APC and the posterior piriform cortex occupied by the average distribution region of the axon collaterals of two superficial pyramidal (SP) cells was about 18 and 5%, respectively. Our results demonstrate that omnidirectional connection of pyramidal cells in the APC provides a substrate for recurrent processes. These findings indicate that the axon collaterals of SP cells in the PC could make synaptic contacts with all granule cells in the OB. This study provides the morphological evidence for understanding

  9. Injuries of the lateral collateral ligaments of the ankle: assessment with MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kreitner, K.F.; Ferber, A.; Grebe, P.; Thelen, M. [Department of Radiology, Johannes Gutenberg University Mainz (Germany); Runkel, M. [Department of Traumatologic and Reconstructive Surgery, Johannes Gutenberg University Mainz (Germany); Berger, S. [Department of Pediatric Surgery, Johannes Gutenberg University Mainz (Germany)

    1999-04-01

    The aim of this study was to evaluate the ability of MRI to display injuries of the lateral collateral ligamentous complex in patients with an acute ankle distorsion trauma. The MR examinations of 36 patients with ankle pain after ankle distorsion were evaluated retrospectively without knowledge of clinical history, outcome and/or operative findings. The examinations were performed on a 1.5-T whole-body imager using a flexible surface coil. The signs for ligamentous abnormality were as follows: complete or partial discontinuity, increased signal within, and irregularity and waviness of the ligament. The results were compared with operative findings in 18 patients with subsequent surgical repair. Eighteen patients with conservative therapy had a follow-up MR examination after 3 months. There was 1 sprain, 3 partial and 32 complete tears of the anterior talofibular ligament, and 5 sprains, 5 partial, and 7 complete tears of the calcaneofibular ligament. There were no lesions of the posterior talofibular ligament. Compared with surgery, MRI demonstrated in 18 of 18 cases the exact extent of anterior talofibular ligament injuries and underestimated the extent in 2 of 8 cases of calcaneofibular ligament injury. In patients with follow-up MRI after conservative therapy, a thickened band-like structure was found along the course of the injured ligament in 17 of 18 cases. The absence of ligament repair after conservative treatment was confirmed during operative revision in one case. The MRI technique allows for grading of the extent of injury of the lateral collateral ligamentous complex after acute ankle strain. It seems to be suitable for monitoring the healing process after conservative-functional treatment of ligament tears. (orig.) With 5 figs., 2 tabs., 26 refs.

  10. Ethical responsibilities toward indirect and collateral participants in pragmatic clinical trials.

    Science.gov (United States)

    Smalley, Jaye Bea; Merritt, Maria W; Al-Khatib, Sana M; McCall, Debbe; Staman, Karen L; Stepnowsky, Carl

    2015-10-01

    Pragmatic clinical trials are designed to inform decision makers about the benefits, burdens, and risks of health interventions in real-world settings. Pragmatic clinical trials often use for research purposes data collected in the course of clinical practice. The distinctive features of pragmatic clinical trials demand fresh thinking about what is required to act properly toward people affected by their conduct, in ways that go beyond ensuring the protection of rights and welfare for "human research subjects" under conventional research ethics regulations. To stimulate such work, we propose to distinguish among categories of research participants in pragmatic clinical trials as follows: Direct participants: (1) individuals being directly intervened upon and/or (2) individuals from whom personal identifiable data are being collected for the purposes of the pragmatic clinical trial. Indirect participants: individuals who are (1) not identified as direct participants and (2) whose rights and welfare may be affected by the intervention through their routine exposure to the environment in which the intervention is being deployed. Collateral participants: patient groups and other stakeholder communities who may be otherwise affected by the occurrence and findings of the pragmatic clinical trial. We illustrate these distinctions with case examples and discuss the distinctive responsibilities of researchers and pragmatic clinical trial leadership toward each type of participant. We suggest that pragmatic clinical trial investigators, institutional review boards, health systems leaders, and others engaged in the research enterprise work together to identify these participants. For indirect participants, risks and benefits to which they are exposed should be weighed to ensure that their rights and welfare are protected accordingly, and communication strategies should be considered to help them make well-informed decisions. Collateral participants could provide input on the

  11. MR imaging of medial collateral ligament injury and associated internal knee joint injury

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Chae Ha; Lee, Sun Kyoung; Lim, Dong Hun; Kim, Young Sook; Byun, Ju Nam; Kim, Young Chul; Oh, Jae Hee [Chosun Univ. College of Medicine, GwangJu (Korea, Republic of)

    1996-11-01

    To assess the value of MR imaging in the diagnosis of medial collateral ligament injury of the knee, we used MR imaging to evaluate the characteristic findings in MCL tears and the frequency of associated knee joint injury. We retrospectively reviewed 26 patients within four weeks of MCL injury, analysed MR findings and correlated them with surgical findings. We evaluated discontinuity, heterogeneous signal intensity of MCL, thin band- like low signal intensity at MCL, facial edema, loss of clear demarcation of adjacent fat also combined bone injury, meniscus injury and other ligament injury. Complete MCL tears were present in 14 patients and partial tears in 12. Complete tears showed discontinuity of MCL, fascial edema and loss of clear demarcation from adjacent fat in 11 patients(79%);proximal MCL tears are more common than distal tears. Partial tears showed thin band-like low signal intensity within MCL, fascial edema and loss of clear demarcation from adjacent fat in seven patients (58%);all patient s with MCL injury showed fascial edema;in 12 patients there was loss of clear demarcation from adjacent fat. We could not, however, distinguish between complete tears and partial tears when MCL showed heterogeneous high signal intensity. Combined bone injury in MCL tears was found in eight patients(62%);the most common sites of this were the lateral femoral condyle and lateral tibial plateau. There was associated injury involving other ligaments(ACL:50%;PCL:27%). Combined meniscus injury in MCL tears was present in 17 patients and the most common meniscus site(50%) is the posterior horn of the medial meniscus. Complete MCL tears showed discontinuity of MCL and partial tears showed a thin band-like low signal intensity within MCL. All patients with MCL injury showed fascial edema, and loss of clear demarcation from adjacent fat. Various other injuries combine with MCL tears. MR imaging is therefore useful in the evaluation of medial collateral ligament injury and

  12. Effect of a collateral ligament sparing surgical approach on mechanical properties of equine proximal interphalangeal joint arthrodesis constructs.

    Science.gov (United States)

    Bras, Jose J; Lillich, James D; Beard, Warren L; Anderson, David E; Armbrust, Laura J; Frink, Elizabeth; Lease, Kevin

    2011-01-01

    To (1) compare the effect of a collateral ligament sparing surgical approach with an open surgical approach on mechanical properties of proximal interphalangeal joint (PIPJ) arthrodesis, and (2) to determine the percentage of articular cartilage surface removed by transarticular (TA) drilling with different diameter drill bits. Randomized paired limb design. Cadaveric equine limbs (n=76). Cadaveric PIPJ were drilled using a 3.5, 4.5, or 5.5 mm drill bit at 80-84° to the dorsal plane to remove articular cartilage and subchondral bone from the distal articular surface of the proximal phalanx (P1) and the proximal articular surface of the middle phalanx (P2). Bone ends were photographed and the percentage of the projected surface area that was denuded of cartilage was measured. PIPJ arthrodesis constructs (3-hole dynamic compression plate [DCP], two 5.5 mm TA screws inserted in lag fashion, medial and lateral to the DCP; DCP-TA) were created using 2 surgical approaches in paired limbs. A conventional open approach was used in 1 limb and a collateral ligament sparing approach used in the other limb. Constructs were tested to failure in single-cycle 3-point dorsopalmar/plantar or lateromedial bending. Maximum load, yield load, and composite stiffness were compared between techniques. The 3.5, 4.5, and 5.5 mm drill bits removed 24±4%, 35±5%, and 45±7% of total PIPJ articular cartilage surface, respectively. Constructs with the collateral ligament sparing approach had significantly greater mean yield load (11.3±2.8 versus 7.68±1.1 kN, P=.008) and mean maximum load (13.5±3.1 versus 10.1±1.94 kN, P=.02) under lateromedial bending. Under dorsopalmar/plantar bending there was no significant difference between surgical approaches. The collateral ligament sparing arthrodesis technique had a shorter surgical time (19±3 minutes) compared with the open technique (31±3 minutes). A collateral ligament sparing surgical approach to the PIPJ with removal of articular

  13. Cadaveric Evaluation of Dorsal Intermetatarsal Approach for Plantar Plate and Lateral Collateral Ligament Repair of the Lesser Metatarsophalangeal Joints.

    Science.gov (United States)

    Phisitkul, Phinit; Hosuru Siddappa, Vinay; Sittapairoj, Tinnart; Goetz, Jessica E; Den Hartog, Bryan D; Femino, John E

    2017-07-01

    Access to the plantar plate has been described using either a plantar approach or an extensive dorsal approach that required complete joint destabilization and often a metatarsal osteotomy. Clinical scenarios related to plantar plate tear vary and the pathologies in early stages are frequently limited to unilateral soft tissue structures; a less invasive operative approach may be possible. A novel approach requiring a release of only the lateral collateral ligament and the lateral half of the plantar plate is presented in this cadaver model; the extent of joint exposure possible is described. The ability to place a secure suture through the lateral collateral ligament and the plantar plate was analyzed. Nine fresh-frozen cadaveric specimens were dissected in a randomized fashion across the second to fourth metatarsophalangeal joints through the intermetatarsal space dorsally. Under distraction, soft tissue was sequentially released, including dorsal capsule, lateral collateral ligament, and the lateral half of the plantar plate. Integrity of the extensor tendons, deep transverse intermetatarsal ligament, proximal attachment of the plantar plate, and osseous structures was carefully preserved. The joint exposure was quantified after each step with sizing rods. Using a suture passer, 2-0 nonabsorbable braided sutures were passed into the lateral collateral ligament and the plantar plate, and the construct strength was measured using a tensiometer. Progressive increase in mean joint exposure was noted after each step of soft tissue release with the final exposure of 6 mm after release of the lateral half of the plantar plate. Joint exposures after a capsulotomy and a lateral collateral release were 3 mm and 4 mm, respectively. Under distraction, the unilateral release of soft tissue created a lateral opening of the joint while the proximal phalangeal base adducted and medially deviated. Successful suture passage was noted in all specimens that could sustain a minimum

  14. CT angiography collateral scoring: Correlation with DWI infarct size in proximal middle cerebral artery occlusion stroke within 12 h onset

    Directory of Open Access Journals (Sweden)

    Mahmoud M. Higazi

    2016-09-01

    Conclusions: In patients with major acute MCA occlusion strokes, CTA collateral grading is significantly correlated with admission DWI size. This finding may be relevant for clinical practice and helpful for guiding treatment decision and predicting clinical outcome.

  15. Fastball Pitch Velocity Helps Predict Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers.

    Science.gov (United States)

    Chalmers, Peter N; Erickson, Brandon J; Ball, Brian; Romeo, Anthony A; Verma, Nikhil N

    2016-08-01

    Ulnar collateral ligament injury and its subsequent surgical reconstruction are some of the most common issues among Major League Baseball (MLB) players. The purpose of this study was to determine factors predictive of ulnar collateral ligament reconstruction (UCLR) among MLB pitchers. The hypothesis was that pitchers who underwent UCLR would have higher preinjury peak fastball pitch velocity. Case-control study; Level of evidence, 3. Data on pitch velocity, number, and type (fastball, curveball, etc) for every pitcher and game within MLB from April 2, 2007 to April 14, 2015 were gathered from the publically available PitchFx database. Pitcher demographic information was also recorded. Data from after 2012 were excluded to avoid lead-time bias. Using publically available information, the names and approximate dates of surgery for every MLB pitcher who ever underwent UCLR, including those before 2007 and after 2012, were collected. Each pitcher-game was then classified as "control," "preinjury," or "postoperative." Control and preinjury pitchers were then compared to determine risk factors for UCLR. Overall, 1327 pitchers were included, of whom 309 (26.8%) had undergone UCLR. Of these, 145 had preinjury velocity data. Peak pitch velocity was significantly higher among preinjury pitchers than control pitchers (mean [95% CI], 93.3 mph [92.8-93.8] vs 92.1 mph [91.9-92.3]; P < .001), as was mean pitch velocity (87.8 mph [87.3-88.3] vs 86.9 mph [86.7-87.1]; P = .001). Both demonstrated a dose-response relationship. Although height did not differ (P = .934), weight was significantly higher for preinjury pitchers than controls (P = .005). Pitch counts per year were significantly lower for preinjury pitchers compared with control pitchers, although preinjury pitchers threw more breaking pitches (P = .003). On multivariate regression, peak pitch velocity was the primary independent predictor of whether a pitcher underwent UCLR (P < .001), with mean velocity (P = .013), body

  16. Heterotrophic denitrification vs. autotrophic anammox – quantifying collateral effects on the oceanic carbon cycle

    Directory of Open Access Journals (Sweden)

    W. Koeve

    2010-08-01

    Full Text Available The conversion of fixed nitrogen to N2 in suboxic waters is estimated to contribute roughly a third to total oceanic losses of fixed nitrogen and is hence understood to be of major importance to global oceanic production and, therefore, to the role of the ocean as a sink of atmospheric CO2. At present heterotrophic denitrification and autotrophic anammox are considered the dominant sinks of fixed nitrogen. Recently, it has been suggested that the trophic nature of pelagic N2-production may have additional, "collateral" effects on the carbon cycle, where heterotrophic denitrification provides a shallow source of CO2 and autotrophic anammox a shallow sink. Here, we analyse the stoichiometries of nitrogen and associated carbon conversions in marine oxygen minimum zones (OMZ focusing on heterotrophic denitrification, autotrophic anammox, and dissimilatory nitrate reduction to nitrite and ammonium in order to test this hypothesis quantitatively. For open ocean OMZs the combined effects of these processes turn out to be clearly heterotrophic, even with high shares of the autotrophic anammox reaction in total N2-production and including various combinations of dissimilatory processes which provide the substrates to anammox. In such systems, the degree of heterotrophy (ΔCO2:ΔN2, varying between 1.7 and 6.5, is a function of the efficiency of nitrogen conversion. On the contrary, in systems like the Black Sea, where suboxic N-conversions are supported by diffusive fluxes of NH4+ originating from neighbouring waters with sulphate reduction, much lower values of ΔCO2:ΔN2 can be found. However, accounting for concomitant diffusive fluxes of CO2, the ratio approaches higher values similar to those computed for open ocean OMZs. Based on this analysis, we question the significance of collateral effects concerning the trophic

  17. Incidental right Bochdalek hernia with interruption of the inferior vena cava and hepatic venous collateral continuation: A case report

    Directory of Open Access Journals (Sweden)

    Farzanah I. Ismail

    2014-04-01

    Full Text Available A 36-year-old asymptomatic female had a routine chest radiograph to exclude pulmonary tuberculosis, as part of an employee wellness programme. There was opacification of the right lower thorax. Computed tomography and venography demonstrated an incidental right Bochdalek hernia with interruption of the inferior vena cava (IVC and hepatic venous collateral continuation. The association of a Bochdalek hernia with an anomaly of the IVC is rare, with only one case described in the literature.

  18. Myocardial extracellular volume fraction measurement in chronic total coronary occlusion: Association with myocardial injury, angiographic collateral flow, and functional recovery.

    Science.gov (United States)

    Chen, Yin-Yin; Ren, Dao-Yuan; Zeng, Meng-Su; Yang, Shan; Yun, Hong; Fu, Cai-Xia; Ge, Jun-Bo; Jin, Hang; Qian, Ju-Ying; Zhang, Wei-Guo

    2016-10-01

    To investigate whether myocardial extracellular volume fraction (ECV) measurement by cardiac MR is indicative of myocardial injury, angiographic collateral flow, and functional recovery in patients with chronic total coronary occlusion (CTO). A total of 50 CTO patients undergoing 1.5 Tesla MR were prospectively enrolled, and 28 underwent a second MR 6 months after revascularization. T1-mapping based indices, including pre- and postcontrast T1 values and ECV, were obtained from infarcted and non-infarcted myocardium, myocardial segments, and coronary territory. The severity of myocardial injury was rated by transmurality extent of infarction (TEI) and regional wall motion abnormalities (RWMA) score. Angiographic collateral flow was evaluated using Rentrop classification. Improvement in segmental wall motion at 6 months was also assessed. ECV and postcontrast T1 value significantly outperformed precontrast T1 value for identifying myocardial infarction (area under the receiver operating characteristic curve [AUC]: 0.998 and 0.953 versus 0.824, all P < 0.02). Myocardial ECV was strongly correlated with TEI (P = 0.000), RWMA score (P = 0.000), and collateral classification (P = 0.007 for left anterior descending artery [LAD] territory, P = 0.001 for non-LAD territory). Furthermore, the likelihood of functional recovery was better predicted by ECV than by late gadolinium enhancement (LGE) (AUC: 0.76 versus 0.68, P < 0.02). Myocardial ECV may be a useful surrogate to assess myocardial injury and angiographic collateral flow in CTO, and ECV provides incremental value to LGE in assessing functional recovery after revascularization. J. MAGN. RESON. IMAGING 2016;44:972-982. © 2016 International Society for Magnetic Resonance in Medicine.

  19. Case report - calcification of the medial collateral ligament of the knee with simultaneous calcifying tendinitis of the rotator cuff

    OpenAIRE

    Kamawal, Yama; Steinert, Andre F; Boris M. Holzapfel; Rudert, Maximilian; Barthel, Thomas

    2016-01-01

    Background Calcification of the medial collateral ligament (MCL) of the knee is a very rare disease. We report on a case of a patient with a calcifying lesion within the MCL and simultaneous calcifying tendinitis of the rotator cuff in both shoulders. Case presentation Calcification of the MCL was diagnosed both via x-ray and magnetic resonance imaging (MRI) and was successfully treated surgically. Calcifying tendinitis of the rotator cuff was successfully treated applying conservative method...

  20. Cutaneous collateral axonal sprouting re-innervates the skin component and restores sensation of denervated Swine osteomyocutaneous alloflaps.

    Directory of Open Access Journals (Sweden)

    Zuhaib Ibrahim

    Full Text Available Reconstructive transplantation such as extremity and face transplantation is a viable treatment option for select patients with devastating tissue loss. Sensorimotor recovery is a critical determinant of overall success of such transplants. Although motor function recovery has been extensively studied, mechanisms of sensory re-innervation are not well established. Recent clinical reports of face transplants confirm progressive sensory improvement even in cases where optimal repair of sensory nerves was not achieved. Two forms of sensory nerve regeneration are known. In regenerative sprouting, axonal outgrowth occurs from the transected nerve stump while in collateral sprouting, reinnervation of denervated tissue occurs through growth of uninjured axons into the denervated tissue. The latter mechanism may be more important in settings where transected sensory nerves cannot be re-apposed. In this study, denervated osteomyocutaneous alloflaps (hind- limb transplants from Major Histocompatibility Complex (MHC-defined MGH miniature swine were performed to specifically evaluate collateral axonal sprouting for cutaneous sensory re-innervation. The skin component of the flap was externalized and serial skin sections extending from native skin to the grafted flap were biopsied. In order to visualize regenerating axonal structures in the dermis and epidermis, 50 um frozen sections were immunostained against axonal and Schwann cell markers. In all alloflaps, collateral axonal sprouts from adjacent recipient skin extended into the denervated skin component along the dermal-epidermal junction from the periphery towards the center. On day 100 post-transplant, regenerating sprouts reached 0.5 cm into the flap centripetally. Eight months following transplant, epidermal fibers were visualized 1.5 cm from the margin (rate of regeneration 0.06 mm per day. All animals had pinprick sensation in the periphery of the transplanted skin within 3 months post

  1. An examination of the collateral psychological and political damage of drone warfare in the FATA region of Pakistan

    OpenAIRE

    Dengler, Judson J.

    2013-01-01

    CHDS State/Local This research will examine the collateral psychological and political damage of the United States drone warfare program on Pakistani society in the Federally Administered Tribal Areas (FATA), to determine if this is an effective, proactive homeland defense tactic. The use of drone aircraft by the United States government has increased worldwide since this evolving technology was first utilized in 2001. Each drone strike impacts militants, noncombatants, and ordinary civili...

  2. Angiotensin-converting enzyme DD polymorphism is associated with poor coronary collateral circulation in patients with coronary artery disease.

    Science.gov (United States)

    Ceyhan, Koksal; Kadi, Hasan; Celik, Atac; Burucu, Turgay; Koc, Fatih; Sogut, Erkan; Sahin, Semsettin; Onalan, Orhan

    2012-01-01

    Although association between angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and cardiovascular diseases was reported by many studies, the relation between ACE I/D polymorphism and coronary collateral circulation (CCC) has not been studied yet. The aim of the present study was to investigate a possible relationship between ACE I/D polymorphism and CCC. Patients who were subjected to coronary angiography in the 2006 to 2009 period and had at least a completely occluded major artery were included in this study. To classify collateral circulation, we used the Rentrop classification. Patients were classified as having poor CCC (Rentrop grades 0 to 1) or good CCC (Rentrop grades 2 to 3). Gene polymorphism was detected through the detailed melting curve analysis of polymerase chain reaction products after amplification using real-time polymerase chain reaction method and LightCycler 1.5 apparatus. We prospectively studied 113 patients who had at least 1 totally occluded major epicardial coronary artery. Forty-seven patients had poor CCC and 67 patients had good CCC. There were no differences among groups in age, sex, risk factors, lipid profile, uses of cardiovascular drugs, and number of diseased vessels. Plasma ACE levels were significantly higher in poor CCC group (P DD polymorphism was higher in the poor CCC group (P DD genotype (95% CI, 2.55-12.79; P = 0.001), presence of diabetes (95% CI, 1.03-3.16; P = 0.005), and pulse pressure (95% CI, 1.04-1.56; P = 0.045) were independent determinants of poor coronary collateral development. This study showed that ACE DD polymorphism is associated with poor CCC. Poor collateral circulation in patients carrying the D allele may be associated with endothelial dysfunction and elevated blood ACE levels in these patients.

  3. The evaluation of the role of medial collateral ligament maintaining knee stability by a finite element analysis.

    Science.gov (United States)

    Ren, Dong; Liu, Yueju; Zhang, Xianchao; Song, Zhaohui; Lu, Jian; Wang, Pengcheng

    2017-04-21

    A three-dimensional finite element model (FEM) of the knee joint was established to analyze the biomechanical functions of the superficial and deep medial collateral ligaments (MCLs) of knee joints and to investigate the treatment of the knee medial collateral ligament injury. The right knee joint of a healthy male volunteer was subjected to CT and MRI scans in the extended position. The scanned data were imported into MIMICS, Geomagic, and ANSYS software to establish a three-dimensional FEM of the human knee joint. The anterior-posterior translation, valgus-varus rotation, and internal-external rotation of knee joints were simulated to observe tibial displacement or valgus angle. In addition, the magnitude and distribution of valgus stress in the superficial and deep layers of the intact MCL as well as the superficial, deep, and overall deficiencies of the MCL were investigated. In the extended position, the superficial medial collateral ligament (SMCL) would withstand maximum stresses of 48.63, 16.08, 17.23, and 16.08 MPa in resisting the valgus of knee joints, tibial forward displacement, internal rotation, and external rotation, respectively. Meanwhile, the maximum stress tolerated by the SMCL in various ranges of motion mainly focused on the femoral end point, which was located at the anterior and posterior parts of the femur in resisting valgus motion and external rotation, respectively. However, the deep medial collateral ligament could tolerate only minimum stress, which was mainly focused at the femoral start and end points. This model can effectively analyze the biomechanical functions of the superficial and deep layers of the MCLs of knee joints. The results show that the knee MCL II° injury is the indication of surgical repair.

  4. Prevention of the Rerupture of Collateral Artery Aneurysms on the Ventricular Wall by Early Surgical Revascularization in Moyamoya Disease: Report of Two Cases and Review of the Literature.

    Science.gov (United States)

    Kanamori, Fumiaki; Takasu, Syuntaro; Ota, Shinji; Seki, Yukio

    2018-01-01

    Collateral artery aneurysms are a source of intracranial hemorrhage in moyamoya disease. Several reports have shown that surgical revascularization leads to the obliteration of collateral artery aneurysms. However, its effect on the prevention of rebleeding has not been established, and the optimal timing of the operation remains unclear. The purpose of the present study is to evaluate the effects of surgical revascularization and to investigate the optimal operation timing in patients with moyamoya disease who have ruptured collateral artery aneurysms on the ventricular wall. Two patients with moyamoya disease who presented with intraventricular hemorrhage caused by rupture of collateral artery aneurysms on the wall of the lateral ventricle are presented here. In both cases, the aneurysms reruptured approximately 1 month after the initial hemorrhage. Both patients successfully underwent superficial temporal artery-middle cerebral artery anastomosis combined with indirect bypass in the subacute stage. The aneurysms decreased with the development of collateral circulation through the direct bypasses, and rebleeding did not occur after the surgery. Because ruptured collateral artery aneurysms on the wall of the lateral ventricle in moyamoya disease are prone to rerupture within 1 month, surgical revascularization may be recommended as soon as the patients are stable and able to withstand the operation. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Angiopoietin-2 impairs collateral artery growth associated with the suppression of the infiltration of macrophages in mouse hindlimb ischaemia

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    Xiaoyong Tan

    2016-10-01

    Full Text Available Abstract Background Angiopoietin-2 (Ang-2, a ligand of the Tie-2 receptor, plays an important role in maintaining endothelial cells and in destabilizing blood vessels. Collateral artery growth (arteriogenesis is a key adaptive response to arterial occlusion. It is unknown whether the destabilization of blood vessels by Ang-2 can affect arteriogenesis and modulate mononuclear cell function. This study aimed to investigate the effects of Ang-2 on collateral artery growth. Methods Hindlimb ischaemia model was produced in C57BL/6 mice by femoral artery ligation. Blood flow perfusion was measured using a laser Doppler perfusion imager quantitative RT-PCR analysis was applied to identify the level of angiogenic factors. Results After the induction of hindlimb ischaemia, blood flow recovery was impaired in mice treated with recombinant Ang-2 protein; this was accompanied by a reduction of peri-collateral macrophage infiltration. In addition, quantitative RT-PCR analysis revealed that Ang-2 treatment decreased monocyte chemotactic protein-1 (MCP-1, platelet-derived growth factor-BB (PDGF-BB mRNA levels in ischaemic adductor muscles. Ang-2 can lead to macrophage M1/M2 polarization shift inhibition in the ischaemic muscles. Furthermore, Ang-2 reduced the in vitro inflammatory response in macrophages and vascular cells involved in arteriogenesis. Conclusions Our results demonstrate that Ang-2 is essential for efficient arteriogenesis, which controls macrophage infiltration.

  6. Arthroscopic Reinsertion of Lateral Collateral Ligament, Anterior Capsular Plication, and Coronoid Tunneling Technique for Chronic Elbow Posterolateral Rotatory Instability.

    Science.gov (United States)

    Arrigoni, Paolo; D'Ambrosi, Riccardo; Nicoletti, Simone; Randelli, Pietro

    2016-06-01

    Posterolateral rotatory instability (PLRI) of the elbow is a chronic condition that results from lateral collateral ligament complex injury and presents with pain, clicking, and subluxation within the flexion and extension arcs of elbow motion. The primary cause involves a lesion of the lateral collateral ligament complex and its avulsion from the lateral epicondyle. In most cases, it is the result of trauma such as a fall on an outstretched hand or any other mechanism that imparts axial compression, valgus force, and supination. Several surgical techniques have been described for the treatment of PLRI, but there is no consensus regarding the ideal surgical treatment. The advantages of an arthroscopic approach for the treatment of PLRI are first diagnostic. Arthroscopy allows for visualization and diagnosis of every compartment of the elbow. The main steps of the surgical procedure consist of reinsertion of the lateral collateral ligament, anterior capsular plication, and coronoid tunneling. By use of this technique, it is possible to perform an anatomic repair and provide stability of the elbow.

  7. Formation of Collateral Veins in a Graft Pancreas After a Simultaneous Pancreas and Kidney Transplantation: A Case Report.

    Science.gov (United States)

    Choi, B H; Lee, H Y; Park, Y M; Yang, K H; Ryu, J H; Chu, C W

    2015-09-01

    A graft vein thrombosis is the main cause of early graft failure after pancreas transplantation. We report a case of formation of collateral veins in a graft pancreas after transplant. A 30-year-old woman underwent simultaneous pancreas and kidney transplantation. She was discharged 16 days after the operation with good pancreas and kidney function. A total occlusion of the portal vein was discovered on computed tomography (CT) performed at an outpatient clinic. She had no symptoms or signs of hyperglycemia. Venography was attempted for vein thrombectomy but failed. After 2 weeks of heparinization therapy, the edema disappeared and perfusion of the graft pancreas improved. However, the thrombotic occlusion was not resolved on CT. Arteriography of the Y-graft revealed collateral veins. She was discharged with warfarin. She is currently doing well without any symptoms or signs. This is the first reported case of collateral vein formation in a grafted pancreas after pancreas transplantation. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Biomechanical study of the effect of platelet rich plasma on the treatment of medial collateral ligament lesion in rabbits.

    Science.gov (United States)

    Costa, Eduardo Louzada da; Teixeira, Luiz Eduardo Moreira; Pádua, Bruno Jannotti; Araújo, Ivana Duval de; Vasconcellos, Leonardo de Souza; Dias, Luide Scalioni Borges

    2017-10-01

    To evaluate the use of platelet-rich plasma in the early stages of healing of traumatic injury of the medial collateral ligament in the knee of rabbits. Thirty rabbits were subjected to surgical lesion of the medial collateral ligament. Of these, 16 were treated with platelet-rich plasma and 14 with saline (control). After 3 and 6 weeks of treatment, 50% of the animals from each group were sacrificed, and biomechanical tests were performed on the injured ligament to compare the tensile strength between the two groups. Platelet-rich plasma significantly increased the tensile strength of the ligament in the groups treated after3 and 6 weeks. In the group treated with platelet-rich plasma vs. saline, the tensile strength values were 3192.5 ± 189.7 g/f vs. 2851.1 ± 193.1 g/f at3 weeks (p = 0.005) and 5915.6 ± 832.0 g/f vs. 4187.6 ± 512.9 g/f at 6 weeks (p = 0.0001). The use of platelet-rich plasma at the injury site accelerated ligament healing in an animal model, demonstrated by an increase in the tensile strength of the medial collateral ligament.

  9. Firm age, collateral value, and access to debt financing in an emerging economy: evidence from South Africa

    Directory of Open Access Journals (Sweden)

    Abel Ezeoha

    2012-03-01

    Full Text Available This paper applies the Blundell and Bond system generalised method of moments (GMM two-step estimator to examine the impact of age and collateral value on debt financing, using a panel of 177 non-financial companies listed on the Johannesburg Stock Exchange over the period 1999 to 2009. The results show that South African firms have target leverage ratios and adjust their capital structures from time to time to achieve their respective targets, that the relationship between firm age and debt financing is non-monotonic, and that firms with higher collateral value are likely to face fewer constraints on borrowing and therefore have greater access to medium-term and long-term debts. Robustness tests also reveal that during start-up and maturity stages, a firm’s access to debt markets is significantly influenced by investments in assets that are acceptable to external creditors as collateral. These findings suggest that debt financing policies could be more critical for firms in the start-up and maturity stages.

  10. Incarceration of the medial collateral ligament in the intercondylar notch following proximal avulsion

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    Walton, Edward [Fiona Stanley Hospital, Department of Radiology, Perth, Western Australia (Australia); Williams, Martin [North Bristol NHS Trust, Department of Radiology, Bristol (United Kingdom); Robinson, James R. [Bristol Knee Group, Avon Orthopaedic Centre, Bristol (United Kingdom)

    2017-11-15

    Intra-articular entrapment of the medial collateral ligament (MCL) is a rare but recognised complication of traumatic injury to the posteromedial corner (PMC) of the knee. Considering the MCL is the most commonly injured ligament of the knee this complication is extremely rare with only a handful of cases describing MCL entrapment following distal avulsion of the MCL. We present the first known case of MCL entrapment following proximal avulsion of the MCL and posterior oblique ligament (POL) with the mid-substance of the MCL becoming entrapped in the joint, lying on the superior surface of the medial meniscus and extending up into the intercondylar notch. In addition, the medial patellar retinaculum was also entrapped in the medial aspect of the medial patellofemoral joint. MCL entrapment is best treated with expeditious surgical intervention and it is therefore crucial that the MRI findings are not overlooked. Details of the clinical assessment, MRI and operative findings are presented with a literature review of MCL entrapment. (orig.)

  11. Collateral ventilation of obstructed lung during high-frequency oscillation in dogs and pigs.

    Science.gov (United States)

    Takeda, J; Mackenzie, C F; Watson, R; Roberts, H G; Moorman, R; Hoff, B H; Wilson, D; Johnston, G S; Hill, J L

    1987-09-01

    To determine if collateral ventilation (CV) occurs in pigs and dogs during intermittent positive-pressure ventilation (IPPV) and high-frequency oscillation (HFO), seven pigs and seven dogs were studied by measuring Xenon 133 washout (XeW) from an occluded subsegmental bronchus. The rate constant/min (K) for Xe blood uptake (KXeb) was derived, and when subtracted from K for XeW (KXeW) gave K for removal of Xe by CV (KXecv). Pig XeW were single exponentials with mean KXew = 0.25/min during IPPV and 0.12/min with HFO. In pigs, mean K of XeW was no different from KXeb so that all XeW occurred by blood uptake and none by CV. XeW in dogs had two exponentials. Dogs had over 11 times greater mean KXeW than pigs during IPPV and over 24 times greater during HFO. In dogs, on average, 79% (IPPV) and 87% (HFO) of XeW occurred by CV. CV is a means of gas exchange during HFO and IPPV in dogs but not in pigs.

  12. Physical examination and imaging of medial collateral ligament and posteromedial corner of the knee.

    Science.gov (United States)

    Craft, Jason A; Kurzweil, Peter R

    2015-06-01

    The medial collateral ligament (MCL) is the most commonly injured knee ligament. Most will heal well with nonoperative treatment. However, not all medial knee injuries are the same. A detailed physical examination can help determine the severity of the medial-sided injury. When combined with advanced imaging, the examination will delineate damage to associated medial knee structures, including the location of MCL damage, posteromedial capsule injuries, and combined cruciate injuries. Failure to recognize MCL injuries that may be prone to chronic laxity can lead to significant disability, joint damage, and failure of concomitant cruciate ligament reconstructions. Magnetic resonance imaging is the mainstay of diagnostic imaging, with coronal sequences allowing full assessment of the MCL complex. Tangential views aid in the diagnosis of concomitant injuries. Stress radiography can play a role in evaluating MCL healing and subtle chronic laxity. Ultrasonography is also gaining acceptance as a means to assess MCL injuries. Use of a detailed examination and advanced imaging will allow optimal treatment of medial knee injuries and improve clinical outcomes.

  13. Changes in pitching mechanics after ulnar collateral ligament reconstruction in major league baseball pitchers.

    Science.gov (United States)

    Portney, Daniel A; Lazaroff, Jake M; Buchler, Lucas T; Gryzlo, Stephen M; Saltzman, Matthew D

    2017-08-01

    Medial ulnar collateral ligament (UCL) reconstruction is a common procedure performed on Major League Baseball pitchers. Variations in pitching mechanics before and after UCL reconstructive surgery are not well understood. Publicly available pitch tracking data (PITCHf/x) were compared for all Major League Baseball pitchers who underwent UCL reconstruction between 2008 and 2013. Specific parameters analyzed were fastball percentage, release location, velocity, and movement of each pitch type. These data were compared before and after UCL reconstructive surgery and compared with a randomly selected control cohort. There were no statistically significant changes in pitch selection or pitch accuracy after UCL reconstruction, nor was there a decrease in pitch velocity. The average pitch release location for 4-seam and 2-seam fastballs, curveballs, and changeups is more medial after UCL reconstruction (P < .01). Four-seam fastballs and sliders showed decreased horizontal breaking movement after surgery (P < .05), whereas curveballs showed increased downward breaking movement after surgery (P < .05). Pitch selection, pitch velocity, and pitch accuracy do not significantly change after UCL reconstruction, nor do players who require UCL reconstruction have significantly different pitch selection, velocity, or accuracy than a randomly selected control cohort. Pitch release location is more medial after UCL reconstruction for all pitch types except sliders. Breaking movement of fastballs, sliders, and curveballs changes after UCL reconstruction. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. The effects of medial ulnar collateral ligament reconstruction on Major League pitching performance.

    Science.gov (United States)

    Keller, Robert A; Steffes, Matthew J; Zhuo, David; Bey, Michael J; Moutzouros, Vasilios

    2014-11-01

    Medial ulnar collateral ligament (MUCL) reconstruction is commonly performed on Major League Baseball (MLB) pitchers. Previous studies have reported that most pitchers return to presurgical statistical performance levels after MUCL reconstruction. Pitching performance data--specifically, earned run average (ERA), walks and hits per inning pitched (WHIP), winning percentage, and innings pitched--were acquired for 168 MLB pitchers who had undergone MUCL reconstruction. These data were averaged over the 3 years before surgery and the 3 years after surgery and also acquired from 178 age-matched, uninjured MLB pitchers. Of the pitchers who had MUCL reconstruction surgery, 87% returned to MLB pitching. However, compared with presurgical data, pitching performance declined in terms of ERA (P = .001), WHIP (P = .011), and innings pitched (P = .026). Pitching performance also declined in the season before the surgery compared with previous years (ERA, P = .014; WHIP, P = .036; innings pitched, P major league experience at the same age (P major league level. However, after MUCL reconstruction, there is a statistically significant decline in pitching performance. There appears to be a statistically significant decline in pitching performance the year before reconstructive surgery, and this decline is also a risk factor for requiring surgery. In addition, there is an increased risk of MUCL reconstruction for pitchers who enter the major leagues at a younger age. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  15. Periventricular anastomosis in moyamoya disease: detecting fragile collateral vessels with MR angiography.

    Science.gov (United States)

    Funaki, Takeshi; Takahashi, Jun C; Yoshida, Kazumichi; Takagi, Yasushi; Fushimi, Yasutaka; Kikuchi, Takayuki; Mineharu, Yohei; Okada, Tomohisa; Morimoto, Takaaki; Miyamoto, Susumu

    2016-06-01

    OBJECT The authors' aim in this paper was to determine whether periventricular anastomosis, a novel term for the abnormal collateral vessels typical of moyamoya disease, is reliably measured with MR angiography and is associated with intracranial hemorrhage. METHODS This cross-sectional study sampled consecutive patients with moyamoya disease or moyamoya syndrome at a single institution. Periventricular anastomoses were detected using MR angiography images reformatted as sliding-thin-slab maximum-intensity-projection coronal images and were scored according to 3 subtypes: lenticulostriate, thalamic, and choroidal types. The association between periventricular anastomosis and hemorrhagic presentation at onset was evaluated using multivariate analyses. RESULTS Of 136 eligible patients, 122 were analyzed. Eighteen (14.8%) patients presented with intracranial hemorrhage with neurological symptoms at onset. Intra- and interrater agreement for rating of the periventricular anastomosis score was good (κw = 0.65 and 0.70, respectively). The prevalence of hemorrhagic presentation increased with the periventricular anastomosis score: 2.8% for Score 0, 8.8% for Score 1, 18.9% for Score 2, and 46.7% for Score 3 (p moyamoya disease. The clinical utility of periventricular anastomosis as a predictor for hemorrhage should be validated in further prospective studies.

  16. Organization and collateralization of a subendocardial plexus in end-stage human heart failure.

    Science.gov (United States)

    van den Wijngaard, Jeroen P H M; van Horssen, Pepijn; ter Wee, Rene; Coronel, Ruben; de Bakker, Jacques Mt; de Jonge, Nicolaas; Siebes, Maria; Spaan, Jos A E

    2010-01-01

    In the failing myocardium a subendocardial plexus can develop. Detection of the presence or function, however, of such a plexus does not form part of the present diagnostic spectrum for heart failure. This may now change as new methods for high-resolution imaging of myocardial perfusion distribution are being developed. A severely hypertrophic heart was harvested during transplantation and analyzed for morphology of the intramural coronary arterial vasculature. The heart only had one coronary ostium, and the main branches of the coronary artery were cannulated. A fluorescent casting material was infused that was allowed to harden under physiological pressure. The entire heart was frozen and placed in a novel imaging cryomicrotome and sequentially cut in 25-microm slices. High-resolution images of each cutting plane were acquired, allowing a detailed three-dimensional reconstruction of the arterial vasculature. The epicardial layer of the free wall demonstrated a normal vasculature with penetrating branching arteries. The endocardial layer and the septum revealed a highly interconnected vascular plexus with large vessels oriented parallel to the apicobasal axis. An extensive endocardial network with collaterals was detected, forming connections between the main epicardial branches. We conclude that an outward remodeling of transmural vessels did not prevent the generation and growth of subendocardial conduit arteries. The orientation and vascular volume in the plexus provides an opportunity for detection by novel techniques of MRI contrast imaging currently developed. Knowledge of the effect on perfusion studies is required to prevent a misinterpretation of subendocardial perfusion images in heart failure.

  17. Mexico’s northern border conflict: collateral damage to health and human rights of vulnerable groups

    Science.gov (United States)

    Beletsky, Leo; Martinez, Gustavo; Gaines, Tommi; Nguyen, Lucie; Lozada, Remedios; Rangel, Gudelia; Vera, Alicia; McCauley, Heather L.; Sorensen, Andrea; Strathdee, Steffanie A.

    2013-01-01

    Objective To compare distributions of human rights violations and disease risk; to juxtapose these patterns against demographic and structural environmental variables, and to formulate implications for structural interventions. Methods Female sex workers who inject drugs were surveyed in Tijuana and Ciudad Juarez, Mexico. Structured interviews and testing for sexually transmitted infections (STIs) were conducted (October 2008 to October 2009). Frequencies of individual and environmental factors, including police abuse, risk of HIV infection, and protective behaviors, were compared between sites using univariate logistic regression. Results Of 624 women, almost half reported police syringe confiscation despite syringes being legal; 55.6% reported extortion (past 6 months), with significantly higher proportions in Ciudad Juarez (P Ciudad Juarez, P = 0.04) and sexual abuse (15.7% in Tijuana, 18.3% in Ciudad Juarez) by police were commonplace. Prevalence of STIs was significantly lower in Tijuana than in Ciudad Juarez (64.2% and 83.4%, P Ciudad Juarez respondents reported significantly higher median number of monthly clients (6.8 versus 1.5, P Ciudad Juarez in the past year (72.1% versus 59.2%, P = 0.001). Conclusions Collateral damage from police practices in the context of Mexico’s drug conflict may affect public health in the Northern Border Region. Itinerant officers may facilitate disease spread beyond the region. The urgency for mounting structural interventions is discussed. PMID:22767041

  18. [SEMITENDINOUS AND GRACILIS TRANSFER FOR TREATMENT OF MEDIAL COLLATERAL LIGAMENT INJURY CAUSED BY TOTAL KNEE ARTHROPLASTY].

    Science.gov (United States)

    Cao Jiangang; Wang, Lei; Zhao, Huiwen; Liu, Jun

    2016-02-01

    To evaluate the effectiveness of semitendinous and gracilis transfer for the treatment of medial collateral ligament (MCL) injury caused by total knee arthroplasty (TKA). Between March 2009 and May 2014, 11 patients (11 knees) with MCL injuries caused by primary TKA were treated by semitendinous and gracilis transfer in primary TKA (injury group). Another 18 patients (21 knees) without MCL injury were included as the control group. There was no significant difference in gender, age, injury sides, disease duration, body mass index, knee varus deformity, and preoperative Knee Society Score (KSS) between 2 groups (P>0.05), with comparability. KSS score was used to evaluate the function after operation. Primary healing of incision was obtained in all patients, and no complications of joint instability and pain occurred. The follow-up time was-6-29 months in injury group and was 7-34 months in control group. At last follow-up, the KSS clinical score and ftinctional score were significantly increased to 89.82 +/- 3.76 and 89.54 +/- 3.50 in the injury group (Pinjury caused by TKA. The insertions of semitendinous tendon and gracilis are close to that of the knee MCL, which can effectively improve knee function.

  19. MR imaging of tibial collateral ligament injury: comparison with clinical examination

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    Yao, L. [Dept. of Radiological Sciences, UCLA Center for the Health Sciences, Los Angeles, CA (United States); Dungan, D. [Dept. of Radiological Sciences, UCLA Center for the Health Sciences, Los Angeles, CA (United States); Seeger, L.L. [Dept. of Radiological Sciences, UCLA Center for the Health Sciences, Los Angeles, CA (United States)

    1994-10-01

    We sought to clarify the capability of routine magnetic resonance (MR) imaging of the knee to detect and grade tibial collateral ligament (TCL) injury. We also wanted to define the exact MR findings that were the most important for diagnosis. Sixty-three patients were clinically evaluated for TCL injury prior to MR imaging of the knee on a 1.5-tesla system. MR studies were scored with respect to multiple direct and indirect findings. By discriminant analysis, the overall accuracy of classification (into clinical grades 1, 2, 3 and normal) on the basis of MR was 65%. Accuracy for detection of abnormal TCLs was 87%. The most useful MR findings for detection and grading of TCL injury were direct signs: subcutaneous edema over the TCL, focal disruption of the TCL, increased signal in the TCL on T2-weighted images, and longitudinal striations within the TCL. Indirect signs such as trabecular trauma were less useful for TCL evaluation. The presence of a tear of the anterior cruciate ligament, however, correlated with TCL injury of a higher grade. T2-weighted coronal images, by better depicting intraligamentous edema and fiber disruption, improved the MR assessment of the TCL. (orig.)

  20. Distribution of Force in the Medial Collateral Ligament Complex During Simulated Clinical Tests of Knee Stability.

    Science.gov (United States)

    Schafer, Kevin A; Tucker, Scott; Griffith, Timothy; Sheikh, Saad; Wickiewicz, Thomas L; Nawabi, Danyal H; Imhauser, Carl W; Pearle, Andrew D

    2016-05-01

    Pivot-shift injury commonly results in combined anterior cruciate ligament (ACL)/medial collateral ligament (MCL) injury, yet the contribution of the components of the MCL complex to restraining multiplanar rotatory loads forming critical subcomponents of the pivot shift is not well understood. To quantify the role of the MCL complex in restraining multiplanar rotatory loads. Controlled laboratory study. A robotic manipulator was used to apply combined valgus and internal rotation torques in a simplified model of the pivot-shift examination in 12 cadaveric knees (49 ± 11 years). Tibiofemoral kinematics were recorded with the ACL intact. Loads borne by the superficial MCL (sMCL), posterior oblique ligament (POL), deep MCL (dMCL), and ACL were determined via the principle of superposition. The POL bore about 50% of the load carried by the ACL in response to the combined torques at 5° and 15° of flexion. The POL bore load during the internal rotation component of the combined torques, while the sMCL carried load during the valgus and internal rotation phases of the simulated pivot. Load in the dMCL was always knee stability in the ACL-competent knee. Both the sMCL and POL work together with the ACL to resist combined moments, which form key components of the pivot-shift examination. © 2016 The Author(s).

  1. [Control observation between mild moxibustion and TDP for obsolete collateral ligament injury of interphalangeal joints].

    Science.gov (United States)

    Liang, Yulei; Li, Weihua; Xu, Xiaokang; Ding, Chenguang; Tian, Ling; Duan, Jiaqiang; Zhang, Zhifang; Sun, Lihong

    2016-01-01

    To compare the effects between mild moxibustion and specific electromagnetic spectrum therapy apparatus (TDP) for obsolete collateral ligament injury of interphalangeal joints. Sixty patients were randomly divided into a mild moxibustion group and a TDP group, 30 cases in each one. In the mild moxibustion group, pure moxa sticks were used at the affected digital joints locally for 20-30 min a time. In the TDP group, TDP was applied at the affected digital joints locally for 20-30 min a time. The treatment was given once a day for two courses, and 10-day treatment was made into a course. Visual analogue scale (VAS) for pain, swelling degree of the affected digital joints before and after treatment were observed and the clinical efficacy and safety were evaluated in the two groups. The excellent rate was 56.7% (17/30) and the excellent and, good rate was 83.4% (25/30) in the mild moxibustion group,which were better than 36.7% (11/30) and 76.7% (23/30) in the TDP group respectively (both P ligament injury of interphalangeal joints, which is superior to TDP.

  2. Development of Tissue-Engineered Ligaments: Elastin Promotes Regeneration of the Rabbit Medial Collateral Ligament.

    Science.gov (United States)

    Hirukawa, Masaki; Katayama, Shingo; Sato, Tatsuya; Yamada, Masayoshi; Kageyama, Satoshi; Unno, Hironori; Suzuki, Yoshiaki; Miura, Yoshihiro; Shiratsuchi, Eri; Hasegawa, Masahiro; Miyamoto, Keiichi; Horiuchi, Takashi

    2017-12-21

    When ligaments are injured, reconstructive surgery is sometimes required to restore function. Methods of reconstructive surgery include transplantation of an artificial ligament and autotransplantation of a tendon. However, these methods have limitations related to the strength of the bone-ligament insertion and biocompatibility of the transplanted tissue after surgery. Therefore, it is necessary to develop new reconstruction methods and pursue the development of artificial ligaments. Elastin is a major component of elastic fibers and ligaments. However, the role of elastin in ligament regeneration has not been described. Here, we developed a rabbit model of a medial collateral ligament (MCL) rupture and treated animal knees with exogenous elastin [100 µg/(0.5 mL·week)] for 6 or 12 weeks. Elastin treatment increased gene expression and protein content of collagen and elastin (gene expression, 6-fold and 42-fold, respectively; protein content, 1.6-fold and 1.9-fold, respectively), and also increased the elastic modulus of MCL increased with elastin treatment (2-fold) compared with the controls. Our data suggest that elastin is involved in the regeneration of damaged ligaments. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  3. Relationship of coronary collateral circulation with eosinophils in patients with unstable angina pectoris.

    Science.gov (United States)

    Wang, Jun; Li, Qun; Li, Shi-jing; Wang, De-zhao; Chen, Bu-xing

    2016-01-01

    Eosinophils (EOS) have been associated with prognosis of patients with coronary artery disease, and those who showed plenitudinous coronary collateral circulation (CCC) often have good clinical consequences. However, the relationship between EOS and CCC was seldom reported. To investigate the relationship between EOS and CCC development in patients with unstable angina pectoris (UAP). The study population consisted of 502 consecutive patients with UAP who underwent coronary angiography and coronary stenosis ≥80%. CCC was graded according to the Rentrop grading system of 0-3. Rentrop grades of 0 and 1 indicated low-grade CCC group, whereas grades 2 and 3 indicated high-grade CCC group. The EOS was significantly higher in the high-grade CCC group compared with the low-grade CCC group. In multiple logistic regression analysis, EOS (odds ratio: 1.969; 95% confidence interval [CI]: 1.210-3.3205; P=0.006) and neutrophil count (odds ratio: 0.757; 95% CI: 0.584-0.981; P=0.035) were predictors of high-grade CCC development. EOS of >0.12×10(9)/L could independently predict high-grade CCC with 72.5% sensitivity and 58.4% specificity (area under the curve: 0.681; 95% CI: 0.632-0.729). EOS were associated with high-grade CCC in patients with UAP with coronary stenosis ≥80%. Increased EOS count may play an important role in the development of CCC in patients with UAP.

  4. Isometric Tunnel Placement in Ulnar Collateral Ligament Reconstruction with Single CT Scan

    Directory of Open Access Journals (Sweden)

    Erica Kholinne

    2017-01-01

    Full Text Available Background. Isometric tunnel placement for anterior bundle of the medial collateral ligament (MCL reconstruction is mandatory for successful surgery. Purpose. This study aimed to demonstrate a useful method for identifying isometric tunnel placement using a single computed tomography (CT scan. Study Design. Descriptive Laboratory Study. Methods. Five normal elbows were scanned at 4 different flexion angles at 45° increment. Three-dimensional models were analyzed using 2 different approaches: single and multiple CT scans methods. Ligament footprints in the humerus and the ulna were registered. Ligament length and isometric points were defined. The locations of the isometric points were imported into both methods to be compared. Results. There was no significant difference between 2 methods in calculating the length in every zone. There was also no significant difference in determining isometric ligament’s origin point, which is located approximately 18.2±4.0 mm and 18.4±2.9 mm for single and multiple CT, respectively, measured inferolaterally from medial epicondyle. Conclusions. A solid preoperative plan is critical when predicting tunnel locations due to the difficulty in finding isometric points and the individuality of optimal bone tunnel locations. Using single CT scan, optimal locations can be predicted with the same accuracy as a multiple CT scans with less radiation exposure.

  5. Variations of the origin of collateral branches emerging from the posterior aspect of the brachial plexus

    Directory of Open Access Journals (Sweden)

    Ramirez Luis

    2007-06-01

    Full Text Available Abstract Background The frequency of variation found in the arrangement and distribution of the branches in the brachial plexus, make this anatomical region extremely complicated. The medical concerns involved with these variations include anesthetic blocks, surgical approaches, interpreting tumor or traumatic nervous compressions having unexplained clinical symptoms (sensory loss, pain, wakefulness and paresis, and the possibility of these structures becoming compromised. The clinical importance of these variations is discussed in the light of their differential origins. Methods The anatomy of brachial plexus structures from 46 male and 11 female cadaverous specimens were studied. The 40–80 year-old specimens were obtained from the Universidad Industrial de Santander's Medical Faculty's Anatomy Department (dissection laboratory. Parametric measures were used for calculating results. Results Almost half (47.1% of the evaluated plexuses had collateral variations. Subscapular nerves were the most varied structure, including the presence of a novel accessory nerve. Long thoracic nerve variations were present, as were the absence of C5 or C7 involvement, and late C7 union with C5–C6. Conclusion Further studies are needed to confirm the existence of these variations in a larger sample of cadaver specimens.

  6. Return to football and long-term clinical outcomes after thumb ulnar collateral ligament suture anchor repair in collegiate athletes.

    Science.gov (United States)

    Werner, Brian C; Hadeed, Michael M; Lyons, Matthew L; Gluck, Joshua S; Diduch, David R; Chhabra, A Bobby

    2014-10-01

    To evaluate return to play after complete thumb ulnar collateral ligament (UCL) injury treated with suture anchor repair for both skill position and non-skill position collegiate football athletes and report minimum 2-year clinical outcomes in this population. For this retrospective study, inclusion criteria were complete rupture of the thumb UCL and suture anchor repair in a collegiate football athlete performed by a single surgeon who used an identical technique for all patients. Data collection included chart review, determination of return to play, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) outcomes. A total of 18 collegiate football athletes were identified, all of whom were evaluated for follow-up by telephone, e-mail, or regular mail at an average 6-year follow-up. Nine were skill position players; the remaining 9 played in nonskill positions. All players returned to at least the same level of play. The average QuickDASH score for the entire cohort was 1 out of 100; QuickDASH work score, 0 out of 100; and sport score, 1 out of 100. Average time to surgery for skill position players was 12 days compared with 43 for non-skill position players. Average return to play for skill position players was 7 weeks postoperatively compared with 4 weeks for non-skill position players. There was no difference in average QuickDASH overall scores or subgroup scores between cohorts. Collegiate football athletes treated for thumb UCL injuries with suture anchor repair had quick return to play, reliable return to the same level of activity, and excellent long-term clinical outcomes. Skill position players had surgery sooner after injury and returned to play later than non-skill position players, with no differences in final level of play or clinical outcomes. Management of thumb UCL injuries in collegiate football athletes can be safely and effectively tailored according to the demands of the player's football position. Therapeutic IV. Copyright © 2014

  7. Long-term Outcomes After Ulnar Collateral Ligament Reconstruction in Competitive Baseball Players: Minimum 10-Year Follow-up.

    Science.gov (United States)

    Osbahr, Daryl C; Cain, E Lyle; Raines, B Todd; Fortenbaugh, Dave; Dugas, Jeffrey R; Andrews, James R

    2014-06-01

    Ulnar collateral ligament reconstruction (UCLR) has afforded baseball players with excellent results; however, previous studies have described only short-term outcomes. To evaluate long-term outcomes after UCLR in baseball players. Case series; Level of evidence, 4. All UCLRs performed on competitive baseball players with a minimum 10-year follow-up were identified. Surgical data were collected prospectively and patients were surveyed by telephone follow-up, during which scoring systems were used to assess baseball career and post-baseball career outcomes. Of 313 patients, 256 (82%) were contacted at an average of 12.6 years; 83% of these baseball players (90% pitchers) were able to return to the same or higher level of competition in less than 1 year, but results varied according to preoperative level of play. Baseball career longevity was 3.6 years in general and 2.9 years at the same or higher level of play, but major and minor league players returned for longer than did collegiate and high school players after surgery (P Baseball retirement typically occurred for reasons other than elbow problems (86%). Many players had shoulder problems (34%) or surgery (25%) during their baseball career, and these occurrences most often resulted in retirement attributable to shoulder problems (P baseball career outcomes, 92% of patients were able to throw without pain, and 98% were still able to participate in throwing at least on a recreational level. The 10-year minimum follow-up scores (mean ± standard deviation) for the Disabilities of the Arm, Shoulder and Hand (DASH), DASH work module, and DASH sports module were 0.80 ± 4.43, 1.10 ± 6.90, and 2.88 ± 11.91, respectively. Overall, 93% of patients were satisfied, with few reports of persistent elbow pain (3%) or limitation of function (5%). Long-term follow-up of UCLRs in baseball players indicates that most patients were satisfied, with few reports of persistent elbow pain or limitation of function. During their

  8. Collateral Channel Size and Tortuosity Predict Retrograde Percutaneous Coronary Intervention Success for Chronic Total Occlusion.

    Science.gov (United States)

    Huang, Ching-Chang; Lee, Chih-Kuo; Meng, Shih-Wei; Hung, Chi-Sheng; Chen, Ying-Hsien; Lin, Mao-Shin; Yeh, Chih-Fan; Kao, Hsien-Li

    2018-01-01

    There is little evidence on how to select an interventional collateral channel (CC) in retrograde chronic total occlusion (CTO) percutaneous coronary intervention. We aimed to identify independent angiographic predictors of CC tracking and technical success in retrograde CTO percutaneous coronary intervention. From January 2012 to December 2015, a total of 216 consecutive retrograde CTO percutaneous coronary intervention attempts by a high-volume operator in a tertiary university-affiliated hospital were enrolled. The clinical, angiographic, and procedural details were collected. The characteristics analyzed included channel type, size, tortuosity, angle of attack, length to emerging point, and the Multicenter CTO Registry of Japan score. The Multicenter CTO Registry of Japan score was 4.2±0.8. A total of 242 CCs were attempted for intervention. CC tracking success rate was 83.5%, and the technical success rate (per CC) was 81.4%. The per-patient technical success rate was 91.2%, and the major procedural complication rate was 4.6%. The atrioventricular groove, epicardial, and septal CCs were used in 36 (14.9%), 84 (34.7%), and 122 (50.4%) tracking attempts, respectively. In multivariable analysis, only large channel size and lack of tortuosity were significant independent predictors of CC tracking and technical success. A new scoring system was developed, while large size was given 1 point and lack of tortuosity was given 2 points. The receiver-operating characteristic area by the new model to predict CC tracking and technical success were 0.800 and 0.752, respectively. In retrograde CTO percutaneous coronary intervention, only size and tortuosity of a CC are independent angiographic predictors of CC tracking and technical success. © 2018 American Heart Association, Inc.

  9. The Effect of Ulnar Collateral Ligament Reconstruction on Pitch Velocity in Major League Baseball Pitchers.

    Science.gov (United States)

    Lansdown, Drew A; Feeley, Brian T

    2014-02-01

    The medial ulnar collateral ligament (UCL) is the primary restraint to valgus load, and injury is commonly encountered as a result of overuse in throwing athletes. Reconstruction of this ligament has allowed for a high rate of return to sport for elite pitchers. Public perception of this procedure has resulted in a commonly held belief of increased throwing velocity following UCL reconstruction. Fastball velocity for Major League Baseball (MLB) pitchers is significantly decreased following UCL reconstruction. Case series; Level of evidence, 4. A total of 129 pitchers were identified as undergoing UCL reconstruction from publicly available reports, and a final group of 80 MLB pitchers were included for analysis. Statistics were collected, including pitch velocity, pitch selection, and performance outcomes. Pre- and postoperative statistics were compared using paired t tests to allow for evaluation of each pitcher relative to his baseline velocity and performance. Mean fastball velocity was significantly decreased following UCL reconstruction, with a presurgical mean velocity of 91.3 mph and postoperative velocity of 90.6 mph (P = .003). The greatest observed difference was in pitchers older than 35 years, with fastball velocity decreasing from 91.7 to 88.8 mph (P = .0048). Pitchers threw fewer fastballs after reconstruction. Pitch velocity for curveballs, changeups, and sliders did not change significantly after UCL reconstruction. Additionally, pitchers threw fewer innings and pitches following reconstruction and produced fewer wins above replacement relative to their preinjury state. Contrary to popular opinion, fastball velocity for MLB pitchers is significantly decreased following UCL reconstruction, which should reinforce the importance of preventing overuse injuries.

  10. Collateral damage to the ureter and Nitinol stone baskets during thulium fiber laser lithotripsy.

    Science.gov (United States)

    Wilson, Christopher R; Hardy, Luke A; Irby, Pierce B; Fried, Nathaniel M

    2015-07-01

    The experimental Thulium fiber laser (TFL) is currently being studied as a potential alternative lithotripter to the clinical gold standard Holmium:YAG laser. Safety studies characterizing undesirable Holmium:YAG laser-induced damage to ureter tissue and stone baskets have been previously reported. Similarly, this study characterizes TFL induced ureter and stone basket damage. A TFL beam with energy of 35 mJ per pulse, pulse duration of 500 µs, and variable pulse rates of 50-500 Hz, was delivered through 100-µm-core optical fibers, to either porcine ureter wall, in vitro, or a standard 1.9-Fr Nitinol stone basket wire. Ureter perforation times were measured and gross, histological, and optical coherence tomography images of the ablation area were acquired. Stone basket damage was graded as a function of pulse rate, number of pulses, and working distance. TFL operation at 150, 300, and 500 Hz produced mean ureter perforation times of 7.9, 3.8, and 1.8 seconds, respectively. Collateral damage widths averaged 510, 370, and 310 µm. Nitinol wire damage decreased with working distance and was non-existent at distances greater than 1.0 mm. In contact mode, 500 pulses delivered at pulse rates ≥300 Hz (≤1.5 seconds) were sufficient to cut Nitinol wires. The TFL, operated in low pulse energy and high pulse rate mode, may provide a greater safety margin than the standard Holmium:YAG laser for lithotripsy, as evidenced by longer TFL ureter perforation times and shorter non-contact working distances for stone basket damage than previously reported with Holmium:YAG laser. © 2015 Wiley Periodicals, Inc.

  11. Should We Limit Innings Pitched After Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers?

    Science.gov (United States)

    Erickson, Brandon J; Cvetanovich, Gregory L; Bach, Bernard R; Bush-Joseph, Charles A; Verma, Nikhil N; Romeo, Anthony A

    2016-09-01

    Ulnar collateral ligament reconstruction (UCLR) has become a common procedure among Major League Baseball (MLB) pitchers. It is unclear if a limit on innings pitched after UCLR should be instituted to prevent revision UCLR. Number of innings pitched and number of pitches thrown after UCLR will not affect whether a pitcher requires a revision UCLR. Descriptive laboratory study. All MLB pitchers between 1974 and 2015 who pitched at least 1 full season after UCLR were included in this study. Pitch counts and innings pitched for the first full season after UCLR as well as total pitch count and total innings pitched were recorded. Pitch counts and innings pitched were compared among players who required revision UCLR and those who did not. Overall, 154 pitchers were included. Of these, 135 pitchers did not require revision UCLR while 19 underwent revision UCLR. No significant difference existed between pitchers who underwent revision UCLR and those who did not when comparing number of innings pitched in the season after UCLR (79.4 ± 46.7 vs 90.1 ± 58.6; P = .9016), number of pitches thrown in the season after UCLR (1233.2 ± 710.4 vs 1449.2 ± 904.1; P = .7337), number of innings pitched in the pitcher's career after UCLR (357.4 ± 312.0 vs 399.3 ± 446.4; P = .6945), and number of pitches thrown in the pitcher's career after UCLR (5632.7 ± 4583.9 vs 5674.7 ± 5755.4; P = .4789), respectively. Furthermore, no difference existed in revision rate between pitchers who pitched more or less than 180 innings in the first full season after UCLR (P = .6678). The number of innings pitched and number of pitches thrown in the first full season as well as over a player's career after UCLR are not associated with an increased risk of a pitcher requiring revision UCLR. © 2016 The Author(s).

  12. Major League Baseball pitch velocity and pitch type associated with risk of ulnar collateral ligament injury.

    Science.gov (United States)

    Keller, Robert A; Marshall, Nathan E; Guest, John-Michael; Okoroha, Kelechi R; Jung, Edward K; Moutzouros, Vasilios

    2016-04-01

    The number of Major League Baseball (MLB) pitchers requiring ulnar collateral ligament (UCL) reconstructions is increasing. Recent literature has attempted to correlate specific stresses placed on the throwing arm to risk for UCL injury, with limited results. Eighty-three MLB pitchers who underwent primary UCL reconstruction were evaluated. Pitching velocity and percent of pitch type thrown (fastball, curve ball, slider, and change-up) were evaluated 2 years before and after surgery. Data were compared with control pitchers matched for age, position, size, innings pitched, and experience. The evaluation of pitch velocity compared with matched controls found no differences in pre-UCL reconstruction pitch velocities for fastballs (91.5 vs. 91.2 miles per hour [mph], P = .69), curveballs (78.2 vs. 77.9 mph, P = .92), sliders (83.3 vs. 83.5 mph, P = .88), or change-ups (83.9 vs. 83.8 mph, P = .96). When the percentage of pitches thrown was evaluated, UCL reconstructed pitchers pitch significantly more fastballs than controls (46.7% vs. 39.4%, P = .035). This correlated to a 2% increase in risk for UCL injury for every 1% increase in fastballs thrown. Pitching more than 48% fastballs was a significant predictor of UCL injury, because pitchers over this threshold required reconstruction (P = .006). MLB pitchers requiring UCL reconstruction do not pitch at higher velocities than matched controls, and pitch velocity does not appear to be a risk factor for UCL reconstruction. However, MLB pitchers who pitch a high percentage of fastballs may be at increased risk for UCL injury because pitching a higher percent of fastballs appears to be a risk factor for UCL reconstruction. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  13. Major League pitching workload after primary ulnar collateral ligament reconstruction and risk for revision surgery.

    Science.gov (United States)

    Keller, Robert A; Mehran, Nima; Marshall, Nathan E; Okoroha, Kelechi R; Khalil, Lafi; Tibone, James E; Moutzouros, Vasilios

    2017-02-01

    Literature has attempted to correlate pitching workload with risk of ulnar collateral ligament (UCL) injury; however, limited data are available in evaluating workload and its relationship with the need for revision reconstruction in Major League Baseball (MLB) pitchers. We identified 29 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction and compared them with 121 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared for the seasons after returning from primary reconstruction and for the last season pitched before undergoing revision surgery. The difference in workload between pitchers who did and did not require revision reconstruction was not statistically significant in games pitched, innings pitched, and MLB-only pitch counts. The one significant difference in workload was in total pitch counts (combined MLB and minor league), with the pitchers who required revision surgery pitching less than those who did not (primary: 1413.6 pitches vs. revision: 959.0 pitches, P = .04). In addition, pitchers who required revision surgery underwent primary reconstruction at an early age (22.9 years vs. 27.3 years, P < .001) and had less MLB experience (1.5 years vs. 5.0 years, P < .001). There is no specific number of pitches, innings, or games that place a pitcher at an increase risk for injury after primary UCL reconstruction. However, correlations of risk may be younger age and less MLB experience at the time of the primary reconstruction. Copyright © 2017. Published by Elsevier Inc.

  14. Analysis of pitching velocity in major league baseball players before and after ulnar collateral ligament reconstruction.

    Science.gov (United States)

    Jiang, Jimmy J; Leland, J Martin

    2014-04-01

    Ulnar collateral ligament (UCL) reconstructions are relatively common among professional pitchers in Major League Baseball (MLB). To the authors' knowledge, there has not been a study specifically analyzing pitching velocity after UCL surgery. These measurements were examined in a cohort of MLB pitchers before and after UCL reconstruction. There is no significant loss in pitch velocity after UCL reconstruction in MLB pitchers. Cohort study; Level of evidence, 3. Between the years 2008 to 2010, a total of 41 MLB pitchers were identified as players who underwent UCL reconstruction. Inclusion criteria for this study consisted of a minimum of 1 year of preinjury and 2 years of postinjury pitch velocity data. After implementing exclusion criteria, performance data were analyzed from 28 of the 41 pitchers over a minimum of 4 MLB seasons for each player. A pair-matched control group of pitchers who did not have a known UCL injury were analyzed for comparison. Of the initial 41 players, 3 were excluded for revision UCL reconstruction. Eight of the 38 players who underwent primary UCL reconstruction did not return to pitching at the major league level, and 2 players who met the exclusion criteria were omitted, leaving data on 28 players available for final velocity analysis. The mean percentage change in the velocity of pitches thrown by players who underwent UCL reconstruction was not significantly different compared with that of players in the control group. The mean innings pitched was statistically different only for the year of injury and the first postinjury year. There were also no statistically significant differences between the 2 groups with regard to commonly used statistical performance measurements, including earned run average, batting average against, walks per 9 innings, strikeouts per 9 innings, and walks plus hits per inning pitched. There were no significant differences in pitch velocity and common performance measurements between players who returned to

  15. Medial collateral ligament lengthening by standardized pie-crusting technique: A cadaver study.

    Science.gov (United States)

    Dubois de Mont-Marin, G; Babusiaux, D; Brilhault, J

    2016-06-01

    Pie-crusting (PC) is a tissue expansion technique using multiple perforation to lengthen the medial collateral ligament (MCL), but has still to be codified. Standardized MCL PC allows measured opening of the medial femorotibial (MFT) joint line, without risk of MCL tear. Thirty-one knees were dissected, with medial parapatellar arthrotomy and resection of the cruciate ligaments and menisci. The deep MCL bundle was sectioned, and the thick anterior bundle (AB) of the MCL was observed in each knee. Knees were randomly allocated between AB sparing (AB+; n=15) or sectioning (AB-; n=16). A graduated dynometric tensor applied constant 80N distraction on the MFT joint line. MCL PC used a 19-G needle at the joint line, with a horizontal series of perforations every 2mm over the width of the MCL. MFT compartment opening was measured after each PC series. Mean MFT space after sectioning the cruciate ligaments was 5.52±0.37mm, increasing by 1.64±1.28mm with AB sectioning. Twenty-five perforations were made in the AB+ and 16 in the AB- group. Final mean joint-line increase was 0.18±0.18mm in AB+ and 3.16±2.70mm in AB-. There were no MCL tears. MCL pie-crusting was reliable and reproducible, achieving progressive MFT joint-line lengthening to a mean 8.71±2.62mm when associated to sectioning of the cruciate ligaments and MCL AB. Cadaver. IV. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  16. Simulation of aortopulmonary collateral flow in Fontan patients for use in prediction of interventional outcomes.

    Science.gov (United States)

    Frieberg, Petter; Sjöberg, Pia; Revstedt, Johan; Heiberg, Einar; Liuba, Petru; Carlsson, Marcus

    2017-08-07

    Patients with complex congenital heart disease may need to be converted to a Fontan circulation with systemic venous return surgically connected to the pulmonary circulation. These patients frequently form aortopulmonary collaterals (APC), that is arterial inflows to the pulmonary artery vascular tree. The aim of this study was to develop a method to calculate the effect of APC on the pulmonary flow distribution based on magnetic resonance imaging (MRI) measurements and computational fluid dynamics simulations in order to enable prediction of interventional outcomes in Fontan patients. Patient-specific models of 11 patients were constructed in a 3D-design software based on MRI segmentations. APC flow was quantified as the difference between pulmonary venous flow and pulmonary artery flow, measured by MRI. A method was developed to include the modulating effect of the APC flow by calculating the patient-specific relative pulmonary vascular resistance. Simulations, including interventions with a Y-graft replacement and a stent dilatation, were validated against MRI results. The bias between simulated and MRI-measured fraction of blood to the left lung was 2·9 ± 5·3%. Including the effects of the APC flow in the simulation (n = 6) reduced simulation error from 9·8 ± 7·0% to 5·2 ± 6·3%. Preliminary findings in two patients show that the effect of surgical and catheter interventions could be predicted using the demonstrated methods. The work demonstrates a novel method to include APC flow in predictive simulations of Fontan hemodynamics. APC flow was found to have a significant contribution to the pulmonary flow distribution in Fontan patients. © 2017 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.

  17. Effects of tibial plateau angle and spacer thickness applied during in vitro canine total knee replacement on three-dimensional kinematics and collateral ligament strain.

    Science.gov (United States)

    Baker, Katherine M; Foutz, Timothy L; Johnsen, Kyle J; Budsberg, Steven C

    2014-09-01

    To quantify the 3-D kinematics and collateral ligament strain of stifle joints in cadaveric canine limbs before and after cranial cruciate ligament transection followed by total knee replacement (TKR) involving various tibial plateau angles and spacer thicknesses. 6 hemi-pelvises collected from clinically normal nonchondrodystrophic dogs (weight range, 25 to 35 kg). Hemi-pelvises were mounted on a modified Oxford knee rig that allowed 6 degrees of freedom of the stifle joint but prevented mechanical movement of the hip and tarsal joints. Kinematics and collateral ligament strain were measured continuously while stifle joints were flexed. Data were again collected after cranial cruciate ligament transection and TKR with combinations of 3 plateau angles (0°, 4°, and 8°) and spacer thicknesses (5, 7, and 9 mm). Presurgical (ie, normal) stifle joint rotations were comparable to those previously documented for live dogs. After TKR, kinematics recorded for the 8°, 5-mm implant most closely resembled those of unaltered stifle joints. Decreasing the plateau angle and increasing spacer thickness altered stifle joint adduction, internal rotation, and medial translation. Medial collateral ligament strain was minimal in unaltered stifle joints and was unaffected by TKR. Lateral collateral ligament strain decreased with steeper plateau angles but returned to a presurgical level at the flattest plateau angle. Among the constructs tested, greatest normalization of canine stifle joint kinematics in vitro was achieved with the steepest plateau angle paired with the thinnest spacer. Furthermore, results indicated that strain to the collateral ligaments was not negatively affected by TKR.

  18. A 3D numerical study of the collateral capacity of the Circle of Willis with anatomical variation in the posterior circulation.

    Science.gov (United States)

    Ren, Yuan; Chen, Qiang; Li, Zhi-Yong

    2015-01-01

    The Circle of Willis (CoW) is the most important collateral pathway of the cerebral artery. The present study aims to investigate the collateral capacity of CoW with anatomical variation when unilateral internalcarotid artery (ICA) is occluded. Basing on MRI data, we have reconstructed eight 3D models with variations in the posterior circulation of the CoW and set four different degrees of stenosis in the right ICA, namely 24%, 43%, 64% and 79%, respectively. Finally, a total of 40 models are performed with computational fluid dynamics simulations. All of the simulations share the same boundary condition with static pressure and the volume flow rate (VFR) are obtained to evaluate their collateral capacity. As for the middle cerebral artery (MCA) and the anterior cerebral artery (ACA), the transitional-type model possesses the best collateral capacity. But for the posterior cerebral artery (PCA), unilateral stenosis of ICA has the weakest influence on the unilateral posterior communicating artery (PCoA) absent model. We also find that the full fetal-type posterior circle of Willis is an utmost dangerous variation which must be paid more attention. The results demonstrate that different models have different collateral capacities in coping stenosis of unilateral ICA and these differences can be reflected by different outlets. The study could be used as a reference for neurosurgeon in choosing the best treatment strategy.

  19. Differentiation of chronic total occlusion and subtotal occlusion of the femoropopliteal artery-role of retrograde flow sign and collateral circulation on CT angiography images.

    Science.gov (United States)

    Zhang, Shujun; Su, Yanfei; Chen, Haisong

    2017-08-01

    To study the value of a retrograde flow sign and the collateral circulation on CT angiography (CTA) for the differential diagnosis of chronic total occlusion from subtotal occlusion of the femoropopliteal artery (FPA). 50 patients with obstruction of the FPA underwent CTA and digital subtraction angiography examinations of the lower limbs. The frequency of a retrograde flow sign and collateral circulation on CTA in chronic total and subtotal occlusion was noted and analyzed, with the results of digital subtraction angiography as a standard to judge total or subtotal occlusion. The decreasing CT value from the distal to proximal direction on CTA suggests the existence of retrograde flow. There were significant differences in the occurrence rates of a retrograde flow sign on CTA in the chronic total and subtotal obstruction groups (X2 = 13.1, p sign (X2 = 13.5, p sign and the collateral circulation sign to diagnose chronic total obstruction of the FPA had a sensitivity of 92.3% and specificity of 89.8%. The retrograde flow sign combined with a collateral circulation sign is of great clinical value for differentiation of chronic total stenosis from severe stenosis (subtotal occlusion) of the FPA. Advances in knowledge: A retrograde flow sign combined with a collateral circulation sign is of great clinical value to differentiate between chronic total stenosis and severe stenosis (subtotal occlusion) of the FPA.

  20. Vascular endothelial growth factor and hypoxia-inducible factor-1α gene polymorphisms and coronary collateral formation in patients with coronary chronic total occlusions

    Directory of Open Access Journals (Sweden)

    Vincent Amoah

    2016-06-01

    Full Text Available Introduction: We evaluated the association between two single nucleotide polymorphisms of the vascular endothelial growth factor gene and one of the hypoxia-inducible factor-1α gene and the degree of coronary collateral formation in patients with a coronary chronic total occlusion. Methods: Totally, 98 patients with symptomatic coronary artery disease and a chronic total occlusion observed during coronary angiography were recruited. Genotyping of two vascular endothelial growth factor promoter single nucleotide polymorphisms (−152G>A and −165C>T and the C1772T single nucleotide polymorphism of hypoxia-inducible factor-1α were performed using polymerase chain reaction and restriction fragment length polymorphism analysis. The presence and extent of collateral vessel filling was scored by blinded observers using the Rentrop grade. Results: We found no association between the vascular endothelial growth factor −152G>A, −165C>T and hypoxia-inducible factor-1α −1772C>T with the presence and filling of coronary collateral vessels. A history of percutaneous coronary intervention and transient ischaemic attack/cerebrovascular accident were associated with the presence of enhanced collateral vessel formation following binary logistic regression analysis. Conclusion: The study findings suggest that coronary collateral formation is not associated with the tested polymorphic variants of vascular endothelial growth factor and hypoxia-inducible factor-1α in patients with symptomatic coronary artery disease and the presence of a chronic total occlusion.

  1. Portosystemic pressure reduction achieved with TIPPS and impact of portosystemic collaterals for the prediction of the portosystemic-pressure gradient in cirrhotic patients

    Energy Technology Data Exchange (ETDEWEB)

    Grözinger, Gerd, E-mail: gerd.groezinger@med.uni-tuebingen.de [Department of Diagnostic Radiology, Department of Radiology, University of Tübingen (Germany); Wiesinger, Benjamin; Schmehl, Jörg; Kramer, Ulrich [Department of Diagnostic Radiology, Department of Radiology, University of Tübingen (Germany); Mehra, Tarun [Department of Dermatology, University of Tübingen (Germany); Grosse, Ulrich; König, Claudius [Department of Diagnostic Radiology, Department of Radiology, University of Tübingen (Germany)

    2013-12-01

    Purpose: The portosystemic pressure gradient is an important factor defining prognosis in hepatic disease. However, noninvasive prediction of the gradient and the possible reduction by establishment of a TIPSS is challenging. A cohort of patients receiving TIPSS was evaluated with regard to imaging features of collaterals in cross-sectional imaging and the achievable reduction of the pressure gradient by establishment of a TIPSS. Methods: In this study 70 consecutive patients with cirrhotic liver disease were retrospectively evaluated. Patients received either CT or MR imaging before invasive pressure measurement during TIPSS procedure. Images were evaluated with regard to esophageal and fundus varices, splenorenal collaterals, short gastric vein and paraumbilical vein. Results were correlated with Child stage, portosystemic pressure gradient and post-TIPSS reduction of the pressure gradient. Results: In 55 of the 70 patients TIPSS reduced the pressure gradient to less than 12 mmHg. The pre-interventional pressure and the pressure reduction were not significantly different between Child stages. Imaging features of varices and portosystemic collaterals did not show significant differences. The only parameter with a significant predictive value for the reduction of the pressure gradient was the pre-TIPSS pressure gradient (r = 0.8, p < 0.001). Conclusions: TIPSS allows a reliable reduction of the pressure gradient even at high pre-interventional pressure levels and a high collateral presence. In patients receiving TIPSS the presence and the characteristics of the collateral vessels seem to be too variable to draw reliable conclusions concerning the portosystemic pressure gradient.

  2. Collateral circulation formation determines the characteristic profiles of contrast-enhanced MRI in the infarcted myocardium of pigs

    Science.gov (United States)

    Wang, Jian; Xiang, Bo; Lin, Hung-yu; Liu, Hong-yu; Freed, Darren; Arora, Rakesh C; Tian, Gang-hong

    2015-01-01

    Aim: To investigate the relationship between the collateral circulation and contrast-enhanced MR signal change for myocardial infarction (MI) in pigs. Methods: Pigs underwent permanent ligation of two diagonal branches of the left anterior descending artery. First-pass perfusion (FPP) MRI (for detecting myocardial perfusion abnormalities) and delayed enhancement (DE) MRI (for estimating myocardial infarction) using Gd-DTPA were performed at 2 h, 7 d and 4 weeks after the coronary occlusion. Myocardial blood flow (MBF) was evaluated using nonradioactive red-colored microspheres. Histological examination was performed to characterize the infarcts. Results: Acute MI performed at 2 h afterwards was characterized by hypoenhancement in both FPP- and DE-MRI, with small and almost unchanged FPP-signal intensity (SI) and DE-SI due to negligible MBF. Subacute MI detected 7 d afterwards showed small but significantly increaseing FPP-SI, and was visible as a sluggish hyperenhancement in DE-MRI with considerably higher DE-SI compared to the normal myocardium; the MBF approached the half-normal value. Chronic MI detected at 4 weeks afterwards showed increasing FPP-SI comparable to the normal myocardium, and a rapid hyperenhancement in DE-MRI with even higher DE-SI; the MBF was close to the normal value. The MBF was correlated with FPP-SI (r=+0.94, P<0.01) and with the peak DE-SI (r=+0.92, P<0.01) at the three MI stages. Remodeled vessels were observed at intra-infarction and peri-infarction zones during the subacute and chronic periods. Conclusion: Progressive collateral recovery determines the characteristic profiles of contrast-enhanced MRI in acute, subacute and chronic myocardial infarction in pigs. The FPP- and DE-MRI signal profiles not only depend on the loss of tissue viability and enlarged interstitial space, but also on establishing a collateral circulation. PMID:25832427

  3. Posterior circulation CT angiography collaterals predict outcome of endovascular acute ischemic stroke therapy for basilar artery occlusion.

    Science.gov (United States)

    Goyal, Nitin; Tsivgoulis, Georgios; Nickele, Chris; Doss, Vinodh T; Hoit, Dan; Alexandrov, Andrei V; Arthur, Adam; Elijovich, Lucas

    2016-08-01

    The natural history of acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) is poor. Endovascular reperfusion therapy (EVT) improves recanalization rates in patients with emergent large vessel intracranial occlusion. To examine the hypothesis that good collateral patterns identified by pretreatment CT angiography (CTA) might be associated with favorable outcomes after EVT. We conducted a retrospective chart review of patients presenting with AIS due to BAO in a tertiary care stroke center during a 4-year period. BAO was diagnosed by CTA in all cases. Admission stroke severity was documented using the National Institute of Health Stroke Scale (NIHSS) score. Pretreatment collateral score for posterior circulation was defined as follows: 0, no posterior communicating artery (PCOM); 1, unilateral PCOM; 2, bilateral PCOM. Favorable outcome was defined as modified Rankin Scale score of 0-2 at 3 months. A total of 21 patients with AIS due to BAO (age range 31-84 years, median admission NIHSS score: 18 points, range 2-38) underwent EVT. Eleven of 21 patients (52.4%) had bilateral PCOMs, while unilateral PCOM was seen in 3 patients (14.3%). Patients with bilateral PCOMs tended (p=0.261) to have less severe stroke at admission than those with absent/unilateral PCOM (median NIHSS score 18 vs 27 points). Neurological improvement during hospitalization (quantified by the median decrease in NIHSS score) and the rate of 3-month functional independence were greater in patients with good collaterals (16 vs 0 points (p=0.016) and 72.7% vs 0% (p=0.001)). The presence of bilateral PCOMs on pretreatment CTA appears to be associated with more favorable outcomes in BAO treated with EVT. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. Multidetector CT and MRI of ostial atresia of the coronary sinus, associated collateral venous pathways and cardiac anomalies.

    Science.gov (United States)

    Shum, J S F; Kim, S M; Choe, Y H

    2012-12-01

    To analyse the multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) findings in patients with atresia of the coronary sinus orifice (CSA). MDCT findings of 15 consecutive adult patients with CSAs were retrospectively analysed. The patients underwent contrast-enhanced electrocardiography-gated MDCT (n = 13) or both CT and MRI (n = 2). The mean size of the coronary sinus (CS) was 14.2 mm (range 5.5-24 mm) and 11 patients (73.3%) showed CS dilatation (diameter ≥12 mm). The mean length of the atretic CS segment was 2.9 mm (range 0-8 mm). Different forms of venous collateral pathways were observed in the CSA patients. Nine (60%) of the 15 CSA patients had communication between the right atrium (RA; n = 6) or LA (n = 5) and CS via intraseptal veins; six patients (40%) had persistent left superior caval veins; communications were also observed between the CS and RA (n = 4) or LA (n = 4); two patients had collateral venous pathways between dilated cardiac veins with RA; two patients had unroofing of the CS as outlet channels. Nine patients (60%) had cardiac anomalies: coronary artery fistula to the pulmonary artery (n = 6) or left ventricular base and CS (n = 1), atrial septal defects (n = 2), and a ventricular septal defect (n = 1). CSA patients have venous collateral pathways and a high incidence of associated cardiovascular anomalies such as coronary artery fistulae and atrial septal defects. Copyright © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  5. Incidentally diagnosed Takayasu arteritis on thyroid ultrasonography showing prominent collateral vessels of thyroidal arteries and common carotid artery occlusion

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    Nam, Se Jin; Kim, Eun Kyung [Dept. of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-10-15

    We report a case of middle-aged woman incidentally diagnosed with Takayasu arteritis during the ultrasonography of a thyroid gland nodule. Prominent collaterals of the thyroidal arteries and a thin common carotid artery with mural thickening and deficient intraluminal flow signals were initially depicted on the ultrasonography with color Doppler. Subsequent magnetic resonance angiography and computed tomography aortography confirmed the diagnosis with the imaging features of a bilateral long segment common carotid artery occlusion and segmental stenosis of the left subclavian artery in addition to the suggestive physical findings.

  6. [Repair of old injury of knee medial collateral ligament by a combination of dynamic and static stability].

    Science.gov (United States)

    Liu, Cheng'en; Li, Renhe; Liu, Yanfen; Li, Yuchun

    2011-01-01

    To observe the effectiveness of the combination of dynamic and static stability in the treatment of old knee medial collateral ligament injury. Between March 2004 and June 2008, 26 cases of old knee medial collateral ligament injury were treated, including 19 males and 7 females with a mean age of 38 years (range, 21-48 years). Injury was caused by traffic accident in 6 cases, by sprains in 12 cases, by falling from height in 8 cases. The location was left knee in 15 cases and right knee in 11 cases. Of them, 24 patients showed the positive result of knee valgus test, 2 cases showed slightly relaxed knee tendon. The knee X-ray films of valgus stress position showed that the medial joint space differences between both knees were 3-5 mm in 2 cases and 5-12 mm in 24 cases. The injuries included avulsion of the medial femoral condyle starting point in 19 cases, central laceration in 6 cases, and tibial point laceration concomitant meniscus injury in 1 case. The time from injury to hospitalization was 3-14 months (mean, 6.4 months). Gracilis muscle was used to repair knee medial collateral ligament and the sartorius muscle transfer to reconstruct the medial rotation of knee stability function. All incisions healed by first intention. No joint infection, deep vein thrombosis, or other postoperative complications occurred. Twenty-six cases were followed up 12-58 months with an average of 30 months. The results of knee valgus stress test were negative with no joint tenderness. At 3 months after operation, the knee X-ray films of valgus stress position showed the medial joint space differences between both knees were less than 1 mm. According to the modified Lysholm-Scale score, the results were excellent in 18 cases, good in 7 cases, and fair in 1 case with an excellent and good rate of 96% at last follow-up. A combination of dynamic and static stability in repairing old knee medial collateral ligament injury is easy-to-operate and has the advantages to perform the

  7. Thinned chimeric radial collateral artery perforator flap in complex distal thumb reconstruction.

    Science.gov (United States)

    Song, Dajiang; Deng, Xiangwu; Chen, Yanmin; Xie, Songlin; Zhou, Xiao

    2015-11-01

    Tissue loss accompanied by bone defects in the thumb is a challenging reconstruction problem. Traditional repair methods are unsatisfactory. Microsurgical thumb reconstruction was performed using 13 thinned chimeric radial collateral artery (RCA) perforator flaps. The flap was created with a thinned skin paddle and humeral bone segments using independent perforators. Primary defatting was completed when the thickness of the perforator entry was approximately similar to that in the periphery. The posterior cutaneous nerve of the arm was carried to make a sensory flap. Defects were 8.5 × 4.5 cm(2) on average (ranging in size from 4.5 × 1.5 to 15.0 × 6.0 cm(2)), and flap size was 9.0 × 5.5 cm(2) on average (ranging in size from 5.0 × 2.0 to 16.0 × 7.0 cm(2)), whereas the humeral fragments were 2.0 × 1.0 cm(2) on average (ranging in size from 1.5 × 0.5 to 4.0 × 1.5 cm(2)). All data were expressed as mean ± SD. The cosmetic appearance of the donor and recipient sites, Kapandji opposition score and static two-point discrimination of the operated thumb were evaluated during a follow-up visit. Follow-up time was 16.6 months (ranging from 14 to 28 months). Flap thickness before defatting, measured immediately after flap elevation was 14.5 mm (ranging from 10.0 to 25.0 mm). Average flap thickness after defatting was 3.5 mm (ranging from 3.0 to 6.0 mm). Venous congestion occurred in two cases. Successful microsurgical revision was achieved in both cases. All flaps survived. Bone components achieved union in all cases at an average period of 4.8 months (ranging from 3 to 6 months). Based on Kapandji opposition score, the mean thumb opposition score was 6. The mean sensation of flap was 7.5 mm (ranging from 6 to 11 mm). No further flap revision or defatting procedures were required in all cases. Cosmetically acceptable results were achieved for all patients. Findings proved that thinned chimeric RCA perforator flap is a beneficial microsurgical alternative for

  8. Impact of Coronary Collaterals on Long-term Prognosis in Patients Treated With Primary Angioplasty.

    Science.gov (United States)

    Hernández-Pérez, Francisco José; Goirigolzarri-Artaza, Josebe; Restrepo-Córdoba, María Alejandra; García-Touchard, Arturo; Oteo-Domínguez, Juan Francisco; Silva-Melchor, Lorenzo; Fernández-Díaz, José Antonio; Domínguez-Puente, José Ramón; Alonso-Pulpón, Luis; Goicolea-Ruigómez, Javier

    2017-03-01

    The beneficial effect of coronary collateral circulation (CC) in patients with ST-segment elevation myocardial infarction is controversial. The aim of this study was to evaluate the impact of CC before reperfusion with primary angioplasty (PA) on the long-term prognosis of these patients. Retrospective observational study of a cohort of 947 patients treated with PA and TIMI grade ≤ 1 flow in a single center from 2005 to 2013. Propensity score matching was used to create 2 groups of 175 patients each, matched by the degree of CC (Rentrop 0-1 vs Rentrop 2-3). In the matched cohort, we determined the impact of CC on total mortality, cardiovascular mortality, and a combined adverse cardiovascular event endpoint for a median follow-up of 864 (interquartile range, 396-1271) days. Of a total of 947 patients included, 735 (78%) had Rentrop 0 to 1 and 212 (22%) had Rentrop 2 to 3. During follow-up, 105 patients died, 71 from cardiovascular causes. In the matched cohort, the total mortality rate was similar between the 2 groups (Rentrop 0-1 [8.8%] vs Rentrop 2-3 [6.3%]; HR = 1.22; 95%CI, 0.50-2.94; P = .654). There were no differences in cardiovascular mortality (Rentrop 0-1 [4.6%] vs Rentrop 2-3 [2.3%]; sHR = 0.49; 95%CI, 0.14-1.62; P = .244) or the composite endpoint including cardiovascular death, reinfarction, target vessel revascularization, and coronary artery bypass surgery (Rentrop 0-1 [18.8%] vs Rentrop 2-3 [13.1%]; sHR = 0.68; 95%CI, 0.40-1.15; P = .157). In this contemporary series, the presence of good CC before PA was not associated with better long-term clinical outcomes. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  9. Treatment of Ulnar Collateral Ligament Injuries and Superior Labral Tears by Major League Baseball Team Physicians.

    Science.gov (United States)

    Erickson, Brandon J; Harris, Joshua D; Fillingham, Yale A; Cvetanovich, Gregory L; Bush-Joseph, Charles A; Bach, Bernard R; Romeo, Anthony A; Verma, Nikhil N

    2016-07-01

    To determine practice patterns of Major League Baseball (MLB) team orthopaedic surgeons in addressing the controversial topics of ulnar collateral ligament (UCL) tears, type II SLAP tears, and partial-thickness rotator cuff tear. Seventy-four MLB team orthopaedic surgeons were surveyed via an online survey system. A 14-question survey was used to assess surgeon experience, technique, and graft choice for UCL reconstruction (UCLR), treatment of type II SLAP tears, and other common pathologic conditions. Thirty team orthopaedic surgeons (41%) responded (mean experience as team physicians: 9.37 ± 6.33 years). Seventeen (56.7%) surgeons use the docking technique for UCLR whereas 20% use the modified Jobe technique. Nineteen (63.3%) use palmaris longus autograft in UCLR. Overall, 28 (93.3%) do not routinely perform elbow arthroscopy or perform an obligatory transposition of the ulnar nerve in patients without preoperative ulnar nerve symptoms. Twenty-eight (93.3%) would repair a type II SLAP tear, whereas only 1 (3.3%) would debride the tear. No surgeon would perform a concomitant biceps tenodesis, either open or arthroscopic. Most MLB team orthopaedic surgeons perform a UCLR using the docking technique with a palmaris longus autograft without concomitant elbow arthroscopy or obligatory transposition of the ulnar nerve. The overwhelming majority of these surgeons would also treat an operative type II SLAP tear with a SLAP repair. The number of UCLRs and SLAP repairs performed on MLB pitchers has significantly increased over the past 10 years. To properly treat these conditions in elite, college, and recreational athletes, it is important to understand how the surgeons who take care of the most elite-level athletes treat them, and how they are able to reproducibly attain excellent outcomes. This study shows how these common shoulder and elbow injuries are treated by those surgeons who care for the most elite overhead-throwing athletes in the world. Copyright © 2016

  10. Risk Stratification for Ulnar Collateral Ligament Injury in Major League Baseball Players

    Science.gov (United States)

    DeFroda, Steven F.; Kriz, Peter K.; Hall, Amber M.; Zurakowski, David; Fadale, Paul D.

    2016-01-01

    Background: Ulnar collateral ligament (UCL) injury has become increasingly common in Major League Baseball (MLB) players in recent years. Hypothesis: There is a significant difference in preinjury fastball velocity between MLB pitchers with tears and matched controls without UCL injury. Pitchers with injuries are throwing harder and getting injured earlier in their MLB careers. Study Design: Cohort study; Level of evidence, 3. Methods: From 2007 to 2014, a total of 170 documented UCL injuries (156 pitchers, 14 position players) occurred in MLB. Inclusion criteria for this study consisted of any player who tore his UCL in MLB during this time frame. There were 130 regular-season tears (April-September). From this group, 118 players who pitched more than 100 innings prior to tear were matched to subjects with no tear and were compared using a logistic regression analysis. A subgroup of “early tear” players who threw less than 100 career innings (n = 37) was also identified and compared with the larger tear group using a logistic regression analysis. Results: Of the 130 tears that occurred during the regular season, a significantly larger number (62%) occurred in the first 3 months (P = .011). The rate of UCL tears per MLB player (P = .001) was statistically significant. In the group of 118 matched tears, the mean fastball velocity was greater in the tear group (91.7 mph) compared with the control group (91.0 mph; P = .014). Furthermore, relief pitchers made up a greater percentage of the early tear group (<100 innings) compared with the later tear group (P = .011). Sixteen of the 170 UCL tears (9.4%) were recurrent tears, with 5 of 16 experiencing both tear and retear within the past 4 years. Conclusion: There is a statistically significant difference in the mean fastball velocity of pitchers who injure their UCL. Small increases in pitcher fastball velocity are a main contribution to the increased rate of tear in MLB. In addition, there has been an increased

  11. Pitching performance and longevity after revision ulnar collateral ligament reconstruction in Major League Baseball pitchers.

    Science.gov (United States)

    Marshall, Nathan E; Keller, Robert A; Lynch, Jonathan R; Bey, Michael J; Moutzouros, Vasilios

    2015-05-01

    Medial ulnar collateral ligament (UCL) reconstruction is a common procedure performed on professional pitchers in Major League Baseball (MLB). Although a great deal is known about primary reconstruction, much less is known about revision reconstruction. The purpose of this study was to evaluate statistical performance, return to play, and career longevity in MLB pitchers after revision UCL surgery, with the hypothesis that pitching performance and career longevity will decline after revision surgery. Cohort study; Level of evidence, 3. A total of 33 MLB pitchers who underwent revision UCL reconstruction surgery (UCL-R group) were identified and compared with 33 age- and position-matched controls (CTL group). Return to play, total years played, and statistical performance were evaluated and compared with controls. After revision surgery, 65.5% of UCL-R pitchers returned to the MLB level. On average, the UCL-R pitchers played 0.8 years less in the majors (P<.01) than did the control pitchers. The UCL-R pitchers who returned to the MLB level had a similar earned run average (UCL-R: 4.88, CTL: 4.76, P=.82) and walks/hits per innings pitched (UCL-R: 1.58, CTL: 1.44, P=.22) compared with the control pitchers. There were significant declines, however, in terms of innings pitched (UCL-R: 36.95, CTL: 75.00, P<.01), walks per 9 innings (UCL-R: 4.75, CTL: 3.49, P<.01), and wins (UCL-R: 1.88, CTL: 4.10, P<.01) as well as nonsignificant declines in wins above replacement (UCL-R: 0.25, CTL: 0.62, P=.06) and runs above replacement (UCL-R: 3.26, CTL: 6.91, P=.07). MLB pitchers who undergo UCL-R have a low rate of return to MLB play and have shortened careers after return. Pitchers who returned to the MLB level maintained performance in several statistics such as earned run average and walks/hits per innings pitched; however, pitchers returned with a significantly decreased workload. © 2015 The Author(s).

  12. Predictors of Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers.

    Science.gov (United States)

    Whiteside, David; Martini, Douglas N; Lepley, Adam S; Zernicke, Ronald F; Goulet, Grant C

    2016-09-01

    Ulnar collateral ligament (UCL) reconstruction surgeries in Major League Baseball (MLB) have increased significantly in recent decades. Although several risk factors have been proposed, a scientific consensus is yet to be reached, providing challenges to those tasked with preventing UCL injuries. To identify significant predictors of UCL reconstruction in MLB pitchers. Case control study; Level of evidence, 3. Demographic and pitching performance data were sourced from public databases for 104 MLB pitchers who underwent UCL reconstruction surgery and 104 age- and position-matched controls. These variables were compared between groups and inserted into a binary logistic regression to identify significant predictors of UCL reconstruction. Two machine learning models (naïve Bayes and support vector machine) were also employed to predict UCL reconstruction in this cohort. The binary linear regression model was statistically significant (χ(2)(12) = 33.592; P = .001), explained 19.9% of the variance in UCL reconstruction surgery, and correctly classified 66.8% of cases. According to this model, (1) fewer days between consecutive games, (2) a smaller repertoire of pitches, (3) a less pronounced horizontal release location, (4) a smaller stature, (5) greater mean pitch speed, and (6) greater mean pitch counts per game were all significant predictors of UCL reconstruction. More specifically, an increase in mean days between consecutive games (odds ratio [OR], 0.685; 95% CI, 0.542-0.865) or number of unique pitch types thrown (OR, 0.672; 95% CI, 0.492-0.917) was associated with a significantly smaller likelihood of UCL reconstruction. In contrast, an increase in mean pitch speed (OR, 1.381; 95% CI, 1.103-1.729) or mean pitches per game (OR, 1.020; 95% CI, 1.007-1.033) was associated with significantly higher odds of UCL reconstruction surgery. The naïve Bayes classifier predicted UCL reconstruction with an accuracy of 72% and the support vector machine classifier with an

  13. Repair of Intraoperative Injury to the Medial Collateral Ligament During Primary Total Knee Arthroplasty.

    Science.gov (United States)

    Bohl, Daniel D; Wetters, Nathan G; Del Gaizo, Daniel J; Jacobs, Joshua J; Rosenberg, Aaron G; Della Valle, Craig J

    2016-01-06

    Optimal treatment for intraoperative injury to the medial collateral ligament (MCL) during primary total knee arthroplasty remains controversial. While some advocate primary ligament repair and a period of bracing, others suggest conversion to a knee prosthesis with increased intrinsic constraint. The purpose of this study was to characterize the outcomes of primary repair followed by bracing. We performed a retrospective review of consecutive primary total knee arthroplasties to identify patients with intraoperative MCL laceration or avulsion treated with primary repair. Midsubstance lacerations were treated with end-to-end suture repair, whereas a screw-and-washer construct, suture, and/or suture anchors were used for reattachment of avulsions. All patients were instructed to wear an unlocked hinged knee brace for six weeks postoperatively. Patients were evaluated at a minimum of two years postoperatively for evidence of instability or other modes of failure and complications. An intraoperative MCL injury occurred during forty-eight (1.2%) of the 3922 total knee arthroplasties that had been performed. One patient died less than two years postoperatively, one was lost to follow-up, and one underwent an intraoperative conversion to a constrained total knee arthroplasty, leaving forty-five total knee arthroplasties available for study. There were twenty-four midsubstance lacerations and twenty-one avulsions; thirty-five of these injuries occurred during a cruciate-retaining total knee arthroplasty and ten, during a posterior-stabilized total knee arthroplasty. At a mean of ninety-nine months (range, twenty-four to 214 months), there were no symptoms or physical examination findings of instability. The mean Hospital for Special Surgery knee score increased from 47 preoperatively to 85 at the time of follow-up (p knees required intervention for stiffness (four manipulations and one revision), and two required revision for aseptic loosening. Our results suggest that

  14. [Internal fixation with one-hole microplate for the treatment of collateral ligament injuries of the metacarpophalangeal joint of the thumb combined with fracture].

    Science.gov (United States)

    Wang, Xi-Xun; Sun, De-Tao; Chen, Xu-Hui; Li, Jun; Cui, Yan; Hu, Ji-Chao; Shu, Zheng-Hua; He, Jian; Ding, Chao-Qi; Chen, Bo

    2015-03-01

    To study clinical effects of one-hole microplate internal fixation for the treatment of collateral ligament injuries of the metacarpophalangeal joint of the thumb combined with fracture. Twenty-two patients (16 males, 6 females) with collateral ligament injuries of the metacarpophalangeal joint of the thumb combined fracture were treated with one-hole microplate internal fixation. The age of the patients ranged from 18 to 53 years old with a mean age of 28.5 years old. The duration from injury to surgery ranged from 2 hours to 2 months, and the mean time was 6 days. All the patients had collateral ligament injuries combined with fracture of the metacarpophalangeal joint of the thumb. Thirteen patients had injuries in the right hand and 9 patients had injuries in the left hand. There were 18 cases of closed wound and 4 cases of open wound. Eighteen patients had fresh injuries ( 2 weeks). Sixteen patients had injuries in the ulnar collateral ligament of the thumb combined with fracture, 6 patients had radial collateral ligament injuries of the thumb combined with fracture, 4 cases of which were complicated with injuries of abductor pollicis brevis and the end of the flexor pollicis brevis tender. The size of the avulsed fragment was about 3.0 mm x 4.0 mm to 6.0 mm x 7.0 mm. The incisions of 22 patients healed by first intention. The follow-up periods ranged from 6 months to 5 years old,with an average of 2.5 years old. The thumb function was evaluated by Saetta and other evaluation criteria, and 20 patients got an excellent result and 2 good. The application of one-hole microplate internal fixation in treating collateral ligament injuries with fracture of the metacarpophalangeal joint of the thumb is an effective method.

  15. Reconstruction of chronic thumb metacarpophalangeal joint radial collateral ligament injuries with a half-slip of the abductor pollicis brevis tendon.

    Science.gov (United States)

    Iba, Kousuke; Wada, Takuro; Hiraiwa, Tetsuro; Kanaya, Kohei; Oki, Gosuke; Yamashita, Toshihiko

    2013-10-01

    To evaluate a reconstructive method for chronic radial collateral ligament (RCL) injuries of the thumb metacarpophalangeal (MCP) joint using a combination of RCL advancement and the transfer of a half-slip of the abductor pollicis brevis tendon. Eight patients (4 male and 4 female; mean age, 25 y) with chronic RCL injury of the thumb MCP joint were enrolled. All patients were referred to our institution because of continuing pain and instability on the radial side of the MCP joint when grasping or pinching objects. The mechanism of the injury was adduction stress to the thumb during sporting activities in 5 patients, a heavy object falling on the thumb in 1, and a fall in 2. The mean duration from RCL injury to surgery was 20 weeks. The average postoperative follow-up was 51 months. We evaluated postoperative outcomes including pain, range of motion of the thumb MCP joint, grip strength, key pinch strength, Disabilities of the Arm, Shoulder, and Hand score, and ability to return to preinjury work or sporting activities. No patients demonstrated continuing symptoms, and the MCP joint was stable after surgery. Postoperative grip and pinch strength (37 and 6.3 kg, respectively) were increased compared with preoperative values (34 and 3.9 kg, respectively). All patients returned fully to their preinjury work or sporting activities within 6 months after surgery. Although postoperative flexion was decreased by an average of 6°, no patients noted functional deficiency. We recommend the reconstructive method of RCL advancement and transfer of a half-slip of the abductor pollicis brevis tendon to alleviate pain and improve grip and pinch strength in chronic RCL injuries of the thumb MCP joint. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  16. It takes a village to raise a branch: Cellular mechanisms of the initiation of axon collateral branches.

    Science.gov (United States)

    Armijo-Weingart, Lorena; Gallo, Gianluca

    2017-10-01

    The formation of axon collateral branches from the pre-existing shafts of axons is an important aspect of neurodevelopment and the response of the nervous system to injury. This article provides an overview of the role of the cytoskeleton and signaling mechanisms in the formation of axon collateral branches. Both the actin filament and microtubule components of the cytoskeleton are required for the formation of axon branches. Recent work has begun to shed light on how these two elements of the cytoskeleton are integrated by proteins that functionally or physically link the cytoskeleton. While a number of signaling pathways have been determined as having a role in the formation of axon branches, the complexity of the downstream mechanisms and links to specific signaling pathways remain to be fully determined. The regulation of intra-axonal protein synthesis and organelle function are also emerging as components of signal-induced axon branching. Although much has been learned in the last couple of decades about the mechanistic basis of axon branching we can look forward to continue elucidating this complex biological phenomenon with the aim of understanding how multiple signaling pathways, cytoskeletal regulators and organelles are coordinated locally along the axon to give rise to a branch. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Case report - calcification of the medial collateral ligament of the knee with simultaneous calcifying tendinitis of the rotator cuff.

    Science.gov (United States)

    Kamawal, Yama; Steinert, Andre F; Holzapfel, Boris M; Rudert, Maximilian; Barthel, Thomas

    2016-07-13

    Calcification of the medial collateral ligament (MCL) of the knee is a very rare disease. We report on a case of a patient with a calcifying lesion within the MCL and simultaneous calcifying tendinitis of the rotator cuff in both shoulders. Calcification of the MCL was diagnosed both via x-ray and magnetic resonance imaging (MRI) and was successfully treated surgically. Calcifying tendinitis of the rotator cuff was successfully treated applying conservative methods. This is the first case report of a patient suffering from both a calcifying lesion within the medial collateral ligament and calcifying tendinitis of the rotator cuff in both shoulders. Clinical symptoms, radio-morphological characteristics and macroscopic features were very similar and therefore it can be postulated that the underlying pathophysiology is the same in both diseases. Our experience suggests that magnetic resonance imaging and x-ray are invaluable tools for the diagnosis of this inflammatory calcifying disease of the ligament, and that surgical repair provides a good outcome if conservative treatment fails. It seems that calcification of the MCL is more likely to require surgery than calcifying tendinitis of the rotator cuff. However, the exact reason for this remains unclear to date.

  18. Coronary collateral circulation in patients with chronic coronary total occlusion; its relationship with cardiac risk markers and SYNTAX score.

    Science.gov (United States)

    Börekçi, A; Gür, M; Şeker, T; Baykan, A O; Özaltun, B; Karakoyun, S; Karakurt, A; Türkoğlu, C; Makça, I; Çaylı, M

    2015-09-01

    Compared to patients without a collateral supply, long-term cardiac mortality is reduced in patients with well-developed coronary collateral circulation (CCC). Cardiovascular risk markers, such as N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive C-reactive protein (hs-CRP) and high-sensitive cardiac troponin T (hs-cTnT) are independent predictors for cardiovascular mortality. The main goal of this study was to examine the relationship between CCC and cardiovascular risk markers. We prospectively enrolled 427 stable coronary artery disease patients with chronic total occlusion (mean age: 57.5±11.1 years). The patients were divided into two groups, according to their Rentrop scores: (a) poorly developed CCC group (Rentrop 0 and 1) and (b) well-developed CCC group (Rentrop 2 and 3). NT-proBNP, hs-CRP, hs-cTnT, uric acid and other biochemical markers were also measured. The SYNTAX score was calculated for all patients. The patients in the poorly developed CCC group had higher frequencies of diabetes and hypertension (pcoronary artery disease with chronic total occlusion. © The Author(s) 2014.

  19. C-reactive protein as a predictor for poor collateral circulation in patients with chronic stable coronary heart disease.

    Science.gov (United States)

    Fan, Ying; Li, Sha; Li, Xiao-Lin; Zhu, Cheng-Gang; Guo, Yuan-Lin; Wu, Na-Qiong; Qing, Ping; Gao, Ying; Dong, Qian; Liu, Geng; Li, Jian-Jun

    2016-01-01

    To investigate the association between serum C-reactive protein (CRP) levels and coronary collateral circulation (CCC) in Chinese patients with angiography-proven ≥95% coronary stenosis. In this study, 1158 patients with angiography-proven ≥95% occlusion in ≥1 major epicardial coronary artery were enrolled, and then classified into two groups: poor CCC (Rentrop grades 0-1) and good CCC (Rentrop grades 2-3). CRP levels were grouped using the following two models: Model 1 discretized CRP group with 33.33% and 66.66% as the critical values and Model 2 with 1.0 and 3.0 mg/L as the cut off values. There were significant differences in serum CRP levels between the two groups (5.76 ± 3.45 vs. 3.49 ± 2.44 mg/L, respectively; p coronary artery disease (CAD) and cardiovascular disorders. In a Chinese cohort of patients with coronary artery occlusion or stenosis of ≥95% TIMI grade 1 anterograde-flow, the relationship between CRP concentrations and angiographically visible coronary collateral (CC) was assessed. Our data indicated that elevated CRP associated with a significant impairment in CC development, and might supply a useful biomarker in clinical applications.

  20. MR angiography of collateral arteries in a hind limb ischemia model: comparison between blood pool agent Gadomer and small contrast agent Gd-DTPA.

    Directory of Open Access Journals (Sweden)

    Karolien Jaspers

    Full Text Available The objective of this study was to compare the blood pool agent Gadomer with a small contrast agent for the visualization of ultra-small, collateral arteries (diameter0.10. Inter-observer variation was 24% and 18% for Gadomer and Gd-DTPA, respectively. In conclusion, blood pool agent Gadomer improved vessel conspicuity compared to Gd-DTPA. Steady-state MRA can be considered as an excellent non-invasive alternative to intra-arterial XRA for the visualization of ultra-small collateral arteries.

  1. Selective Embolization of Systemic Collaterals for the Treatment of Recurrent Hemoptysis Secondary to the Unilateral Absence of a Pulmonary Artery in a Child

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Yin, E-mail: zhouyin502@163.com [West China Hospital, Sichuan University, Department of Pediatric Surgery (China); Tsauo, Jiaywei, E-mail: 80732059@qq.com [West China Hospital, Sichuan University, Institute of Interventional Radiology (China); Li, Yuan, E-mail: liyuanletters@163.com [West China Hospital, Sichuan University, Department of Pediatric Surgery (China); Li, Xiao, E-mail: simonlixiao@gmail.com [West China Hospital, Sichuan University, Institute of Interventional Radiology (China)

    2015-10-15

    The unilateral absence of the pulmonary artery (UAPA) is a rare anomaly. Hemoptysis due to systemic collaterals is one of the most common complications of UAPA. To the best of the authors’ knowledge, the utility of selective embolization for the treatment of this condition in children has not been reported previously. This report describes a 6-year-old girl with isolated UAPA (IUAPA) admitted for a 10-month history of recurrent hemoptysis that had worsened during the previous 2 months. Selective embolization of the bronchial systemic collaterals was performed. The patient remained asymptomatic with no recurrence of hemoptysis 8 months after the procedure.

  2. Allicin attenuates tunicamycin-induced cognitive deficits in rats via its synaptic plasticity regulatory activity

    Directory of Open Access Journals (Sweden)

    Qiong Xiang

    2017-06-01

    Full Text Available Objective(s: To illuminate the functional effects of allicin on rats with cognitive deficits induced by tunicamycin (TM and the molecular mechanism of this process. Materials and Methods: 200–250 g male SD rats were divided into three groups at random: control group (n=12, TM group (5 μl, 50 μM, i.c.v, n=12, and allicin treatment group (180 mg/kg/d with chow diet, n=12. After 16 weeks of allicin treatment, the learning ability and memory were tested using novel object recognition (NOR testing on rats with 72 hr TM treatment (5 μl, 50 μM, i.c.v; meanwhile, the variation of field excitatory postsynaptic potential (fEPSP in the Schaffer Collateral (SC-CA1 synapse was detected by extracellular electrophysiological recordings and the morphology of dendritic spine was observed by Golgi staining as well as detecting several synaptic plasticity-related proteins by Western blot. Results: The density of dendritic spine was increased significantly in allicin-treated groups and the correspondence slope of fEPSP in TM-induced cognitive deficits group was enhanced and expression of synaptophysin and glutamate receptor-1(GluR1 in hippocampal neurons was up-regulated. Conclusion: The results indicate that allicin plays an important role in synaptic plasticity regulation. These finding showed that allicin could be used as a pharmacologic treatment in TM-induced cognitive deficits.

  3. Allicin attenuates tunicamycin-induced cognitive deficits in rats via its synaptic plasticity regulatory activity.

    Science.gov (United States)

    Xiang, Qiong; Li, Xian-Hui; Yang, Bo; Fang, Xin-Xing; Jia, Jing; Ren, Jie; Dong, Yu-Chun; Ou-Yang, Cheng; Wang, Guang-Cheng

    2017-06-01

    To illuminate the functional effects of allicin on rats with cognitive deficits induced by tunicamycin (TM) and the molecular mechanism of this process. 200-250 g male SD rats were divided into three groups at random: control group (n=12), TM group (5 μl, 50 μM, ICV, n=12), and allicin treatment group (180 mg/kg/d with chow diet, n=12). After 16 weeks of allicin treatment, the learning ability and memory were tested using novel object recognition (NOR) testing on rats with 72 hr TM treatment (5 μl, 50 μM, ICV); meanwhile, the variation of field excitatory postsynaptic potential (fEPSP) in the Schaffer Collateral (SC)-CA1 synapse was detected by extracellular electrophysiological recordings and the morphology of dendritic spine was observed by Golgi staining as well as detecting several synaptic plasticity-related proteins by Western blot. The density of dendritic spine was increased significantly in allicin-treated groups and the correspondence slope of fEPSP in TM-induced cognitive deficits group was enhanced and expression of synaptophysin and glutamate receptor-1(GluR1) in hippocampal neurons was up-regulated. The results indicate that allicin plays an important role in synaptic plasticity regulation. These finding showed that allicin could be used as a pharmacologic treatment in TM-induced cognitive deficits.

  4. Return to Play after Nonsurgical Treatment of Elbow Ulnar Collateral Ligament Injuries in Professional Baseball Players

    Science.gov (United States)

    Ford, Gregory M.; Genuario, James; Noonan, Thomas J.; Kinkartz, Jason D.; Githens, Thomas; Murayama, Scott

    2014-01-01

    Objectives: Injury to the elbow ulnar collateral ligament (UCL) is relatively common in pitchers. In the 70's reconstructive surgery was developed as a viable option to a potentially career ending injury. Multiple studies have demonstrated return to play (RTP) rates of 74-83% after reconstruction. Studies of RTP after nonoperative treatment in throwing athletes are limited, reporting 42%. There are no studies reporting RTP rates with nonoperative treatment of professional baseball players. The purpose of this study was to identify professional baseball players' ability to return to play after UCL injuries based on nonoperative vs. operative treatment, MRI grade, and player position. Methods: A retrospective review of a single professional baseball organization (6 minor league teams and 1 Major league team) between 2006 & 2011 revealed 72 medial elbow injuries. MRI was performed on all players. UCL injuries were diagnosed in 45 players by physical exam & MRI. Players were treated with rehabilitation, surgery or both. Success was RTP for >1 season. Rates of RTP and return to the same level of play or higher (RTSP) were calculated and correlated with MRI grade, location, and player position. MRI grading used was: 1 intact ligament +/- edema, 2 partial tearing, 3 complete tear, and 4 chronic healed injury. Results: Overall 91% of 45 players had RTP, and 87% had RTSP. Fifteen were treated surgically and 30 nonoperatively with rehab. Of players treated surgically, 73% had RTSP, whereas 93% of nonoperatively treated players had RTSP (p-value 0.07). All players with grade III tears had surgery. Of surgically treated players, none had grade I injuries, 13% had grade II injuries, 53% had grade III injuries, and 33% had grade IV injuries. Of nonoperatively treated players, 13% had grade I injuries, 23% had grade II injuries, none had grade III injuries, and 60% had grade IV injuries. Of all grade II and grade IV injuries, 78% were treated nonoperatively and all but 1 player

  5. Direct and Collateral Effects of Peer Tutoring on Social and Behavioral Outcomes: A Meta-Analysis of Single-Case Research

    Science.gov (United States)

    Bowman-Perrott, Lisa; Burke, Mack D.; Zhang, Nan; Zaini, Samar

    2014-01-01

    This meta-analysis examined the direct (primary) and collateral (secondary) effects of peer tutoring on social and behavioral outcomes for 128 participants in prekindergarten through grade 12 across 20 studies using SCR designs. The overall TauU weighted effect size across studies was 0.62 (95% CI [0.58, 0.66]), indicating that a small to moderate…

  6. Grading medial collateral ligament injury: comparison of MR imaging and instrumented valgus-varus laxity test-device. A prospective double-blind patient study

    NARCIS (Netherlands)

    Rasenberg, E. I.; Lemmens, J. A.; van Kampen, A.; Schoots, F.; Bloo, H. J.; Wagemakers, H. P.; Blankevoort, L.

    1995-01-01

    PURPOSE: The role of MR imaging in grading medial collateral ligament (MCL) injury of the knee in comparison to other grading methods (clinical findings and instrumental measurement) is hardly documented in the literature. The purpose of this study is to compare the results of MR imaging in grading

  7. The Role of Vitamin D Deficiency and Vitamin D Receptor Genotypes on the Degree of Collateralization in Patients with Suspected Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Arash Hossein-Nezhad

    2014-01-01

    Full Text Available We determined the association of vitamin D deficiency and the FokI polymorphism of the vitamin D receptor (VDR gene in 760 patients who underwent angiography due to suspected coronary artery disease (CAD. Angiography and the Rentrop scoring system were used to classify the severity of CAD in each patient and to grade the extent of collateral development, respectively. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP was used to determine the FokI VDR gene polymorphism. The prevalence of severe vitamin D deficiency (serum 25(OHD < 10 ng/mL was significantly higher in patients with at least one stenotic coronary artery compared to those without any stenotic coronary arteries. Severe vitamin D deficiency was not independently associated with collateralization, but it was significantly associated with the VDR genotypes. In turn, VDR genotype was independently associated with the degree of collateralization; the Rentrop scores were the highest in FF, intermediate in Ff, and the lowest in the ff genotype. The results show that FokI polymorphism is independently associated with collateralization. Additionally, vitamin D deficiency is more prevalent in patients with CAD that may result from FokI polymorphism. Therefore, maintaining a normal vitamin D status should be a high priority for patients with CAD.

  8. 31 CFR 380.4 - What collateral may I pledge instead of a surety bond under 31 CFR part 225, and what value will...

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false What collateral may I pledge instead of a surety bond under 31 CFR part 225, and what value will you assign to it? 380.4 Section 380.4 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE...

  9. The influence of water/air cooling on collateral tissue damage using a diode laser with an innovative pulse design (micropulsed mode)-an in vitro study.

    Science.gov (United States)

    Beer, F; Körpert, W; Buchmair, A G; Passow, H; Meinl, A; Heimel, P; Moritz, A

    2013-05-01

    Since the diode laser is a good compromise for the daily use in dental offices, finding usage in numerous dental indications (e.g., surgery, periodontics, and endodontics), the minimization of the collateral damage in laser surgery is important to improve the therapeutical outcome. The aim of this study was to investigate the effect of water/air cooling on the collateral thermal soft tissue damage of 980-nm diode laser incisions. A total of 36 mechanically executed laser cuts in pork liver were made with a 980-nm diode laser in micropulsed mode with three different settings of water/air cooling and examined by histological assessment to determine the area and size of carbonization, necrosis, and reversible tissue damage as well as incision depth and width. In our study, clearly the incision depth increased significantly under water/air cooling (270.9 versus 502.3 μm-test group 3) without significant changes of incision width. In test group 2, the total area of damage was significantly smaller than in the control group (in this group, the incision depth increases by 65 %). In test group 3, the total area of damage was significantly higher (incision depth increased by 85 %), but the bigger part of it represented a reversible tissue alteration leaving the amount of irreversible damage almost the same as in the control group. This first pilot study clearly shows that water/air cooling in vitro has an effect on collateral tissue damage. Further studies will have to verify, if the reduced collateral damage we have proved in this study can lead to accelerated wound healing. Reduction of collateral thermal damage after diode laser incisions is clinically relevant for promoted wound healing.

  10. Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint: a retrospective comparison of pull-out sutures and bone anchor techniques.

    Science.gov (United States)

    Katolik, Leonid I; Friedrich, Jeffrey; Trumble, Thomas E

    2008-11-01

    The use of intraosseous suture anchors in the treatment of ruptures of the ulnar collateral ligament of the thumb metacarpophalangeal joint has previously been described. However, no direct comparisons exist of ulnar collateral ligament repair with bone anchor versus repair with a pull-out button and immobilization. Two cohorts of patients with complete rupture of the ulnar collateral ligament of the thumb metacarpophalangeal joint were compared. Thirty patients in each cohort underwent repair of the ulnar collateral ligament with either an intraosseous suture anchor followed by early mobilization or a pull-out suture tied over a button with cast immobilization. Average follow-up was 29 months. At follow-up, range of motion at the metacarpophalangeal and interphalangeal joints for the anchor group averaged 97 percent of that of the contralateral side compared with 86 percent and 87 percent, respectively, for the button group. For the anchor group, pinch strength averaged 101 percent that of the contralateral side compared with 95 percent for the button group. No significant difference was noted between the groups for grip strength. Average tourniquet time for the anchor group was 28 minutes compared with 43 minutes for the button group. Soft-tissue complications were present in 27 percent of patients (eight of 30) in the pull-out button group compared with 7 percent (two of 30) in the anchor group. Cost analysis demonstrates an approximately $140-per-patient savings when using the suture anchor. Both repair methods are safe and effective for treating thumb ulnar collateral ligament injuries. Suture anchors allow for an accelerated rehabilitation protocol, which may account for the improved range of motion and pinch strength at follow-up.

  11. Hook Plate Versus Suture Anchor Fixation for Thumb Ulnar Collateral Ligament Fracture-Avulsions: A Cadaver Study.

    Science.gov (United States)

    Shin, Emily H; Drake, Matthew L; Parks, Brent G; Means, Kenneth R

    2016-02-01

    To compare the biomechanical properties of hook plate fixation and suture anchor fixation for collateral ligament fracture-avulsions of the thumb metacarpophalangeal ulnar collateral ligament (UCL). A thumb UCL fracture-avulsion model was created in 7 matched pairs of cadaver hands. An osteotomy was made parallel to the shaft of the proximal phalanx along the entire insertion of the UCL. The simulated fracture was secured using either a suture anchor tied over bone tunnels in the avulsion fragment or with a hook plate. Specimens were mounted on a servohydraulic load frame and loaded to failure. Motion perpendicular to the osteotomy was measured using an implanted 3-mm differential variable reluctance transducer device. Differences in load to failure and construct stiffness were compared and analyzed using a t test. The hook plate construct failed at significantly higher loads than suture fixation. Mean load to failure in the hook plate construct was 58 N (± 20 N) compared with 27 N (± 19 N) in the suture anchor construct. The difference in construct stiffness was 49 N/mm (± 17 N/mm) for the plate compared with 7 N/mm (± 13 N/mm) for the suture anchor. The main mechanism of failure for the hook plate construct was screw pullout or screw bending. The usual mechanism of failure for the suture anchor construct was anchor pullout. The hook plate construct was biomechanically superior to the suture anchor construct for fixation of thumb metacarpophalangeal joint UCL fracture-avulsions with regard to load to failure. The hook plate construct provides stronger fixation than a suture anchor for thumb UCL fracture-avulsions. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. Interaction between axons and specific populations of surrounding cells is indispensable for collateral formation in the mammillary system.

    Directory of Open Access Journals (Sweden)

    Nora-Emöke Szabó

    Full Text Available An essential phenomenon during brain development is the extension of long collateral branches by axons. How the local cellular environment contributes to the initial sprouting of these branches in specific points of an axonal shaft remains unclear.The principal mammillary tract (pm is a landmark axonal bundle connecting ventral diencephalon to brainstem (through the mammillotegmental tract, mtg. Late in development, the axons of the principal mammillary tract sprout collateral branches at a very specific point forming a large bundle whose target is the thalamus. Inspection of this model showed a number of distinct, identified cell populations originated in the dorsal and the ventral diencephalon and migrating during development to arrange themselves into several discrete groups around the branching point. Further analysis of this system in several mouse lines carrying mutant alleles of genes expressed in defined subpopulations (including Pax6, Foxb1, Lrp6 and Gbx2 together with the use of an unambiguous genetic marker of mammillary axons revealed: 1 a specific group of Pax6-expressing cells in close apposition with the prospective branching point is indispensable to elicit axonal branching in this system; and 2 cooperation of transcription factors Foxb1 and Pax6 to differentially regulate navigation and fasciculation of distinct branches of the principal mammillary tract.Our results define for the first time a model system where interaction of the axonal shaft with a specific group of surrounding cells is essential to promote branching. Additionally, we provide insight on the cooperative transcriptional regulation necessary to promote and organize an intricate axonal tree.

  13. Noninvasive quantification of systemic-to-pulmonary collateral flow: a major source of inefficiency in patients with superior cavopulmonary connections.

    Science.gov (United States)

    Whitehead, Kevin K; Gillespie, Matthew J; Harris, Matthew A; Fogel, Mark A; Rome, Jonathan J

    2009-09-01

    Systemic-to-pulmonary collateral flow (SPCF) is common in single-ventricle patients with superior cavopulmonary connections (SCPC). Because no validated method to quantify that SPCF exists, neither its hemodynamic burden nor its clinical impact can be systematically evaluated. We hypothesize that (1) the difference in total ascending aortic (Ao) and caval flow (superior vena cava [SVC]+inferior vena cava [IVC]) and (2) the difference between pulmonary vein and pulmonary artery flow (PV-PA) provide 2 independent estimators of SPCF. We measured Ao, SVC, IVC, right (RPA) and left (LPA) PA, and left (LPV) and right (RPV) PV flows in 17 patients with SCPC during routine cardiac MRI studies using through-plane phase-contrast velocity mapping. Two independent measures of SPCF were obtained: model 1, Ao-(SVC+IVC); and model 2, (LPV-LPA)+(RPV-RPA). Values were normalized to body surface area, Ao, and PV, and comparisons were made using linear regression and Bland-Altman analysis. SPCF ranged from 0.2 to 1.4 L/min for model 1 and 0.2 to 1.6 L/min for model 2, for an average indexed SPCF of 0.5 to 2.8 L/min/m(2): 11% to 53% (mean, 37%) of Ao and 19% to 77% (mean, 54%) of PV. The mean difference between model 1 and model 2 was 0.01 L/min (P=0.40; 2-SD range, -0.45 to 0.47 L/min). We present a noninvasive method for SPCF quantification in patients with SCPC. It should provide an important clinical tool in treating these patients. Furthermore, we show that SPCF is a significant hemodynamic burden in many patients with bidirectional Glenn shunt physiology. Future investigations will allow objective study of the impact of collateral flow on outcome.

  14. Influence of a mono-centric knee brace on the tension of the collateral ligaments in knee joints after sectioning of the anterior cruciate ligament--an in vitro study.

    Science.gov (United States)

    Hinterwimmer, S; Graichen, H; Baumgart, R; Plitz, W

    2004-08-01

    To analyze the influence of knee bracing on the tension of the medial and lateral collateral ligaments in anterior cruciate ligament deficiency. The tension of the collateral ligaments in anterior cruciate ligament deficient knees was measured with and without knee bracing using an in vitro model. Anterior cruciate ligament deficiency increases the tension in both collateral ligaments at the knee joint. Therefore knee braces should reduce that tension increase. However, that effect has never been proven quantitatively. After anterior cruciate ligament-transection, the forces of the medial (anterior/posterior part) and lateral collateral ligament were measured in ten fresh human cadaver knees at 0 degrees, 20 degrees, 40 degrees, 60 degrees, 80 degrees and 100 degrees of flexion, with and without application of a mono-centric knee brace. To quantify the ligament forces, strain gauges were fixed at the bony origins of the ligaments. Bracing led to a significant decrease of ligament forces (20-100 degrees: P anterior part of the medial collateral ligament in all joint positions. In the posterior aspect, this effect was observed only at 40 degrees (P ligament, bracing caused a strain reduction from 60 degrees to 100 degrees of flexion (P knee bracing on the strain was seen in the posterior aspect of the medial and in the lateral collateral ligament in anterior cruciate ligament deficient knee joints. Application of a mono-centric knee brace leads to a significant position dependent reduction of collateral ligament tension after anterior cruciate ligament-rupture.

  15. Endothelial progenitor cells (CD34+KDR+) and monocytes may provide the development of good coronary collaterals despite the vascular risk factors and extensive atherosclerosis.

    Science.gov (United States)

    Kocaman, Sinan Altan; Yalçın, Mehmet Rıdvan; Yağcı, Münci; Sahinarslan, Asife; Türkoğlu, Sedat; Arslan, Uğur; Kurşunluoğlu, Nevruz; Ozdemir, Murat; Timurkaynak, Timur; Cemri, Mustafa; Abacı, Adnan; Boyacı, Bülent; Cengel, Atiye

    2011-06-01

    Endothelial progenitor cells (EPC) have a regenerative role in the vascular system. In this study, we aimed to evaluate simultaneously the effects of EPC and inflammatory cells on the presence and the extent of coronary artery disease (CAD) and the grade of coronary collateral growth in patients with clinical suspicion of CAD. This study has a cross-sectional and observational design. We enrolled 112 eligible patients who underwent coronary angiography consecutively (mean age: 59±9 years). The association of circulating inflammatory cells and EPC (defined by CD34+KDR+ in the lymphocyte and monocyte gate) with the presence, severity and extent of CAD and the degree of collateral growth were investigated. Logistic regression analysis was used to define the predictors of collateral flow. Of 112 patients 30 had normal coronary arteries (NCA, 27%, 55±9 years) and 82 had CAD (73%, 61±8 years). Among the patients with CAD, the percent degree of luminal stenosis was <50% in 12 patients; 50-90% in 35 patients; and ≥90% in the other 35 patients. Circulating inflammatory cells were higher (leukocytes, 7150±1599 vs 8163±1588 mm(-3), p=0.001; neutrophils, 4239±1280 vs 4827±1273 mm(-3), p=0.021; monocytes, 512±111 vs 636±192 mm(-3), p=0.001) and EPCs were lower (0.27±0.15% vs 0.17±0.14%, p<0.001; 21±15 vs 13±12 mm(-3), p=0.004) in CAD group than NCA group. When we investigated the collateral growth in patients having ≥90% stenosis in at least one major coronary artery, we found that the patients with good collateral growth had significantly higher EPC (0.22±0.17% vs 0.10±0.05%, p=0.009; 18±15 vs 7±3 mm(-3), p=0.003) in comparison to patients with poor collateral growth. Presence of EPC was associated with reduced risk for coronary artery disease (OR: 0.934, 95%CI: 0.883-0.998, p=0.018) and was an independent predictor for good collateral growth (OR: 1.295, 95%CI: 1.039-1.615, p=0.022). A sum of CD34+KDR-, CD34+KDR+ and CD34-KDR+ cells (192±98 mm(-3)), and a

  16. The Role of the Peripheral Passive Rotation Stabilizers of the Knee With Intact Collateral and Cruciate Ligaments: A Biomechanical Study

    Science.gov (United States)

    Vap, Alexander R.; Schon, Jason M.; Moatshe, Gilbert; Cruz, Raphael S.; Brady, Alex W.; Dornan, Grant J.; Turnbull, Travis Lee; LaPrade, Robert F.

    2017-01-01

    Background: A subset of patients have clinical internal and/or external knee rotational instability despite no apparent injury to the cruciate or collateral ligaments. Purpose/Hypothesis: The purpose of this study was to assess the effect of sequentially cutting the posterolateral, anterolateral, posteromedial, and anteromedial structures of the knee on rotational stability in the setting of intact cruciate and collateral ligaments. It was hypothesized that cutting of the iliotibial band (ITB), anterolateral ligament and lateral capsule (ALL/LC), posterior oblique ligament (POL), and posteromedial capsule (PMC) would significantly increase internal rotation, while sectioning of the anteromedial capsule (AMC) and the popliteus tendon and popliteofibular ligament (PLT/PFL) would lead to a significant increase in external knee rotation. Study Design: Controlled laboratory study. Methods: Ten pairs (N = 20) of cadaveric knees were assigned to 2 sequential cutting groups (group 1: posterolateral-to-posteromedial [PL → PM] and group 2: posteromedial-to-posterolateral [PM → PL]). Specimens were subjected to applied 5-N·m internal and external rotation torques at knee flexion angles of 0°, 30°, 60°, and 90° while intact and after each cut state. Rotational changes were measured and compared with the intact and previous cut states. Results: Sectioning of the ITB significantly increased internal rotation at 60° and 90° by 5.4° and 6.2° in group 1 (PL → PM) and 3.5° and 3.8° in group 2 (PM → PL). PLT/PFL complex sectioning significantly increased external rotation at 60° and 90° by 2.7° and 2.9° in group 1 (PL → PM). At 60° and 90° in group 2 (PM → PL), ALL/LC sectioning produced significant increases in internal rotation of 3.1° and 3.5°, respectively. In group 2 (PM → PL), POL sectioning produced a significant increase in internal rotation of 2.0° at 0°. AMC sectioning significantly increased external rotation at 30° to 90° of flexion

  17. Hepatocellular carcinoma with extensive hepatic artery injury: transcatheter arterial chemoembolization through collaterals after coil embolizatoin of gastric arteries

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Gab Choul; Yoon, Hyun Ki; Hwang, Jae Cheol; Lee, Duck Hee; Song, Ho Young; Suh, Dong Jin; Lee, Yung Sang; Chung, Young Hwa; Sung, Gyu Bo [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of); Ko, Ki Young [Catholic Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-09-01

    To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE) after coil embolization of the gastroduodenal artery in hepatocellular carcinoma cases with multiple collateral arteries caused by proper hepatic artery injury. Between March 1997 and November 1998, a prospective trial of transcatheter arterial chemoembolization (TACE) was performed through collaterals from the gastroduodenal artery of 31 hepatocellular carcinoma patients with extensive proper hepatic artery injury due to repeated TACE. Among this number, 16 (group A) underwent TACE after coil embolization of the right gastric and gastroduodenal artery. The other 15 patients (group B) underwent TACE without coil embolization. The two groups had the same TNM stage and Clild-Pugh status. During the follow-up period, group A underwent additional TACE 3.3 times, and group B 2.8 times. The therapeutic effect of TACE was evaluated with computed tomography and by measuring alpha-fetoprotein levels. Complications were evaluated by means of gastrofibroscopy, laboratory data, and evaluation of the patients' clinical symptoms. The results obtained after six months and one year were compared within and between each group. At six months follow-up, CT findings had improved or were unchanged in 11 patients(69 %) in group A, and four patients(27 %) in group B(p = 0.032). In ten patients in each group, the level of alpha-fetoprotein was above 200 ng/ml. Its level was decreased in five patients(50 %) and three patients(30 %), respectively. The six-month survival rate was 81 % (13/16) in group A and 67% (10/15) in group B (p 0.43), while the one-year survival figures for these two groups were 50 % (8/16) and 20 % (3/15), respectively(p = 0.135). In group A, the CT findings were steady in five out of eight patients(63 %), while in groupB, CT findings showed that tumors with increased alpha-fetoprotein levels had increased in size and/or number. In group A, it was found that in two (33 %) of six

  18. A novel medial collateral ligament reconstruction procedure using semitendinosus tendon autograft in patients with multiligamentous knee injuries: clinical outcomes.

    Science.gov (United States)

    Kitamura, Nobuto; Ogawa, Munehiro; Kondo, Eiji; Kitayama, Soichiro; Tohyama, Harukazu; Yasuda, Kazunori

    2013-06-01

    Several new procedures for medial collateral ligament (MCL) reconstruction using a hamstring tendon graft have been reported in the 2000s. However, the midterm and long-term clinical outcomes of these procedures have not been reported. Postoperative medial stability of the knee that underwent our MCL reconstruction may not be significantly different from that of the noninjured knee. Case series; Level of evidence, 4. A total of 37 patients who sustained multiligamentous knee injuries underwent combined MCL and cruciate ligament reconstruction at our institution between 1994 and 2007. Thirty of the 37 patients were clinically evaluated at least 2 years after surgery. Sixteen had combined MCL and anterior cruciate ligament (ACL) reconstruction, 5 had combined MCL and posterior cruciate ligament (PCL) reconstruction, and 9 had combined MCL, ACL, and PCL reconstruction. The International Knee Documentation Committee (IKDC) evaluation form and Lysholm score were used to evaluate postoperative knee function. Anteroposterior knee laxity was examined with a KT-2000 arthrometer. To assess objective medial instability, we performed a stress radiograph examination under valgus stress with the knee at 20° of flexion. At the final follow-up, 1 patient showed a loss of knee extension of more than 3°. Five patients revealed a loss of knee flexion of 6° to 15° and 2 patients of 16° to 25°. Lysholm scores averaged 94.8 points. In the IKDC evaluation, 9 patients were graded as A, 17 were graded as B, 3 were graded as C, and 1 was graded as D. In the stress radiograph examination, the mean medial joint opening was 8.5 ± 1.6 mm in the reconstructed knee and 8.0 ± 1.2 mm in the healthy opposite knee. There was no significant difference in the medial joint opening between reconstructed and intact knees. Medial collateral ligament reconstruction for chronic combined knee instabilities can be safely performed using hamstring tendon autografts, and the clinical outcome with a

  19. Simultaneous Reconstruction of the Medial and Lateral Collateral Ligaments for Chronic Combined Ligament Injuries of the Ankle.

    Science.gov (United States)

    Yasuda, Toshito; Shima, Hiroaki; Mori, Katsunori; Tsujinaka, Seiya; Neo, Masashi

    2017-07-01

    Objective data on chronic injuries of the medial collateral ligament (MCL) of the ankle are scarce. Chronic MCL injuries are frequently associated with lateral collateral ligament (LCL) injuries. For patients with chronic combined MCL and LCL injuries, the authors have performed simultaneous surgery of the 2 ligaments. Simultaneous surgery of the 2 ligaments may be effectively used to treat chronic combined MCL and LCL injuries. Case series; Level of evidence, 4. Surgical outcomes were evaluated in 29 consecutive patients presenting with chronic MCL and LCL injuries (30 ankles; 15 men and 14 women; mean age, 31 years; 13 competitive and 10 recreational athletes). Preoperative and postoperative clinical outcomes were measured with the Karlsson score and the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale score. The patients underwent preoperative and postoperative functional measurements and a radiological examination. In addition, preoperative magnetic resonance imaging (MRI) results, arthroscopic findings, and histology of the MCL were evaluated. Preoperatively, the deep fibers of the MCL did not appear striated in 29 ankles, and high-intensity signal changes were observed in 23 ankles on T2-weighted or gradient echo MRI. MCL ruptures were confirmed with arthroscopic surgery. Medial impingement lesions and focal chondral lesions were confirmed in 10 and 21 ankles, respectively. Histology of the reconstructed MCL showed dense collagen fibers with vessels. The mean postoperative follow-up period was 30 months (range, 24-52 months). There was a significant change between preoperative and postoperative Karlsson scores (69.0 vs 96.1 points, respectively; P < .0001) and JSSF scores (69.8 vs 94.5 points, respectively; P < .0001). On varus and valgus stress radiography, the postoperative talar tilt angle was significantly lower than the preoperative angle. Postoperative anterior displacement on stress radiography was significantly lower than

  20. [My humble opinion on teaching of acupoints: discussion on The Channels, Collaterals and Acupoints Science, a national plan teaching material of "the tenth five-year plan"].

    Science.gov (United States)

    Hou, Shu-Wei

    2008-10-01

    Analyze and probe a part of contents in The Channels, Collaterals and Acupoints Science, a national plan teaching material of "the tenth five-year plan", and put forward own opinion on compilation of the teaching materials. Various concepts of acupoints should strive to be strict and terse; location of acupoints should be accurate and conform to clinical practice and reduce errors; the new edition The Channels, Collaterals and Acupoints Science should reasonably select and supplement for extra-ordinary points; increase explanation of the point name, function of acupoints, and association of acupoints; enrich the contents of acupuncture manipulation; reasonably increase and reduce extracts of ancient and modern reports to conform to development of the new age.

  1. Comparative analysis of the development of collateral vessels in macular edema due to branch retinal vein occlusion following grid laser or ranibizumab treatment

    Directory of Open Access Journals (Sweden)

    Kokolaki AE

    2015-09-01

    Full Text Available Afroditi Eleni Kokolaki, Ilias Georgalas, Chryssanthi Koutsandrea, Athanasios Kotsolis, Maria Niskopoulou, Ioannis LadasDepartment of Ophthalmology, University of Athens, Athens, Greece Purpose: To evaluate the differences in the development of collateral vessels in patients with macular edema due to branch retinal vein occlusion (BRVO after treatment with either grid laser or ranibizumab (RNB.Methods: Comparative study including patients with macular edema due to acute BRVO and best-corrected visual acuity (BCVA between 20/40 and 20/200. The sample was divided into two groups according to the treatment applied: laser group, including eyes treated with Argon laser when retinal hemorrhages were sufficiently absorbed to perform the treatment, and RNB group,  including patients treated initially with one monthly intravitreal injection for a period of 3 months of RNB and more injections according to need thereafter.. Before treatment patients in both groups, received a complete ophthalmic examination, including BCVA, fundus examination, optical coherence tomography, fundus color photography, and fundus fluorescein angiography (FA. This same protocol of examination was repeated in every visit after treatment, except FA that was only repeated every 3 months. The detection of the collateral vessels was done by two experienced examiners based on the analysis of the early phase of the FA. If there was a discrepancy in their judgment, the criterion of a third examiner evaluating the FA was considered.Results: Mean baseline BCVA was 0.86±0.26 and 0.82±0.25 (logMAR [logarithm of the minimum angle of resolution] in the RNB and laser groups, respectively (P=0.83. At the end of the follow-up, mean BCVA was 0.38±0.18 and 0.64±0.33 (logMAR in the RNB and laser groups, respectively. The difference in the final BCVA between both groups was statistically significant (P=0.002. Collaterals developed in both groups; 66.67% of patients (14 out of 21

  2. Long-term fluoxetine treatment induces input-specific LTP and LTD impairment and structural plasticity in the CA1 hippocampal subfield.

    Directory of Open Access Journals (Sweden)

    Francisco J Rubio

    2013-05-01

    Full Text Available Antidepressant drugs are usually administered for long time for the treatment of major depressive disorder. However, they are also prescribed in several additional psychiatric conditions as well as during long term maintenance treatments. Antidepressants induce adaptive changes in several forebrain structures which include modifications at glutamatergic synapses. We recently found that repetitive administration of the selective serotonin reuptake inhibitor fluoxetine to naϊve adult male rats induced an increase of mature, mushroom-type dendritic spines in several forebrain regions. This was associated with an increase of GluA2-containing α-amino-3-hydroxy-5-methylisoxazole-4-propionate receptors (AMPA-Rs in telencephalic postsynaptic densities. To unravel the functional significance of such a synaptic re-arrangement, we focused on glutamate neurotransmission in the hippocampus. We evaluated the effect of four weeks of treatment with 0.7 mg/kg of fluoxetine on long-term potentiation (LTP and long-term depression (LTD in the Schaffer collateral-CA1 synapses and the perforant path-CA1 synapses. Recordings in hippocampal slices revealed profound deficits in LTP and LTD at Schaffer collateral-CA1 synapses associated to increased spine density and enhanced presence of mushroom-type spines, as revealed by Golgi staining. However, the same treatment had neither an effect on spine morphology, nor on LTP and LTD at perforant path-CA1 synapses. Cobalt staining experiments revealed decreased AMPA-R Ca2+ permeability in the stratum radiatum together with increased GluA2-containing, Ca2+-impermeable AMPA-Rs. Therefore, 4 weeks of fluoxetine treatment promoted structural and functional adaptations in CA1 neurons in a pathway-specific manner that were selectively associated with impairment of activity-dependent plasticity at Schaffer collateral-CA1 synapses.

  3. Rapid plasticity at inhibitory and excitatory synapses in the hippocampus induced by ictal epileptiform discharges.

    Science.gov (United States)

    Lopantsev, Valeri; Both, Martin; Draguhn, Andreas

    2009-03-01

    Epileptic seizures can induce pathological processes of plasticity in the brain that tend to promote the generation of further seizures. However, the immediate impact of epileptic seizures on cellular excitability remains poorly understood. In order to unravel such early mechanisms of epilepsy-induced plasticity, we studied synaptic transmission before and shortly after three ictal discharges induced by transient elevation of extracellular K(+) in mouse hippocampal slices. Discharges were initiated in the CA3 region and propagated via the Schaffer collaterals into CA1 where they were associated with sustained membrane depolarization and bursts of action potentials in CA1 pyramidal cells. Subsequently, discharges were followed by long-term potentiation (LTP) of Schaffer collateral-evoked field excitatory post-synaptic potentials (EPSPs) in the CA1. The ability to generate epileptiform activity in response to repetitive stimulation was enhanced during LTP. Changes in both inhibitory and excitatory synaptic transmission contributed to LTP in CA1 pyramidal cells. Discharges reduced gamma-aminobutyric acid-A receptor-mediated hyperpolarizing inhibitory post-synaptic potentials by shifting their reversal potentials in a positive direction. At the same time, the amplitudes of Schaffer collateral-evoked RS-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor-mediated EPSPs and action potential-independent miniature EPSPs were enhanced. However, N-methyl-d-aspartate receptor-mediated EPSPs remained unchanged. Paired-pulse stimulation revealed a reduced probability of glutamate release. Together, these changes in synaptic transmission produce a sustained increase in hippocampal excitability. We conclude that a few seizure-like ictal episodes are sufficient to cause fast and lasting changes in the excitation/inhibition balance in hippocampal networks, and therefore may contribute to early phases of progressive epileptogenesis.

  4. Use of Platelet Rich Plasma in an Isolated Complete Medial Collateral Ligament Lesion in a Professional Football (Soccer) Player: A Case Report

    OpenAIRE

    Eirale, Cristiano; Mauri, Eduardo; Hamilton, Bruce

    2012-01-01

    Purpose Platelet-rich plasma (PRP) is derived from centrifuging whole blood to obtain a high platelet concentration containing numerous growth factors. Despite its widespread use, there is still a lack of high-level evidence regarding randomized clinical trials assessing the efficacy of PRP in treating ligament injuries. Although there is research showing an improvement in the early stages of healing in the animal model of acute medial collateral ligament (MCL) injury of the knee, there is no...

  5. Pulmonary atresia and ventricular septal defect with collaterals to right lung associated with anomalous left pulmonary artery from the ascending aorta

    Energy Technology Data Exchange (ETDEWEB)

    Khositseth, Anant [Mahidol University, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok (Thailand); Siripornpitak, Suvipaporn; Pornkul, Ratanaporn [Mahidol University, Department of Radiology, Ramathibodi Hospital, Bangkok (Thailand)

    2010-12-15

    We present a 10-month-old boy with cyanosis. This is a rare case of pulmonary atresia, ventricular septal defect (VSD), major aorto-pulmonary collateral arteries (MAPCAs) to the right lung with absent native right pulmonary artery (RPA) in association with anomalous left pulmonary artery (LPA) from the ascending aorta (AAo). Echocardiography was unable to identify all of the cardiovascular abnormalities. Multidetector CT demonstrated all of these abnormalities and is the investigation of choice instead of cardiac catheterization. (orig.)

  6. Subtracted dynamic MR perfusion source images (sMRP-SI) provide collateral blood flow assessment in MCA occlusions and predict tissue fate

    Energy Technology Data Exchange (ETDEWEB)

    Villringer, Kersten; Serrano-Sandoval, Rafael; Galinovic, Ivana; Ostwaldt, Ann-Christin; Brunecker, Peter; Fiebach, Jochen B. [Charite-Universitaetsmedizin, Academic Neuroradiology, Center for Stroke Research (CSB), Berlin (Germany); Grittner, Ulrike [Charite, Universitaetsmedizin Berlin, Center for Stroke Research, Berlin (Germany); Charite, Department for Biostatistics and Clinical Epidemiology, Berlin (Germany); Schneider, Alice [Charite, Universitaetsmedizin Berlin, Center for Stroke Research, Berlin (Germany); Rocco, Andrea [Charite, Department of Neurology and Center for Stroke Research, Berlin (Germany)

    2016-05-15

    Collateral blood flow is accepted as a predictive factor of tissue fate in ischemic stroke. Thus, we aimed to evaluate a new method derived from MR perfusion source images to assess collateral flow in patients with ICA/MCA occlusions. A total of 132 patients of the prospective 1000+ study were examined. MR perfusion source images were assessed according to Δimg{sub n} = img{sub n} + 1 - img{sub n} - 1 using the five-grade Higashida collateral flow rating system. Higashida scores were correlated to mismatch (MM) volume, mismatch ratio, day 6 FLAIR lesion volumes and day 90 mRS. Patients with Higashida scores 3 and 4 had significantly lower admission NIHSS, smaller FLAIR day 6 lesion volumes (p < 0.001) and higher rates of better long-term outcome (mRS 0-2, p = 0.002). There was a linear trend for the association of Higashida grade 1 (p = 0.002) and 2 (p = 0.001) with unfavourable outcome (day 90 mRS 3-6), but no significant association was found for MM volume, MM ratio and day 90 mRS. Inter-rater agreement was 0.58 (95 % CI 0.43-0.73) on day 1, 0.70 (95 % CI 0.58-0.81) on day 2. sMRP-SI Higashida score offers a non-invasive collateral vessel and tissue perfusion assessment of ischemic tissue. The predictive value of Higashida rating proved superior to MM with regard to day 90 mRS. (orig.)

  7. Collateral Expression of Proangiogenic and Tumorigenic Properties in Intestinal Epithelial Cell Variants Selected for Resistance to Anoikis

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    Janusz Rak

    1999-04-01

    Full Text Available Although in vitro anchorage-independent growth is widely used as a marker of cell transformation, the biological implications of this trait are poorly understood. We previously demonstrated that enforced anchorage-independent growth of a nontumorigenic, immortalized epithelial cell line (IEC-18 in multicellular spheroid culture results in massive apoptotic cell death. This death process, termed anoikis, is prevented by expression of transforming oncogenes, which also confer tumorigenic competence. This study examines whether acquisition of an anoikis-resistant phenotype is causally related to the tumorigenic capacity of transformed epithelial cells. Parental IEC-18 cells were subjected to 10 cycles of selection for survival in speroid culture. Unlike parental cells, the resulting anoikis-resistant variants (AR1.10 and AR2.10 formed relatively large tumors in nude mice. Both anoikis-resistant sublines displayed upregulated expression of vascular endothelial growth factor (VEGF, a potent angiogenesis stimulator. VEGF121 overexpression alone did not induce tumorigenic conversion of parental IEC-18 cells, which remained highly susceptible to anoikis. We postulate that both anoikis-resistance and angiogenic-competence contribute to tumor formation. Development of anoikis-resistance can be then viewed as a precondition for expression of the tumorigenic phenotype. Our results suggest that even when angiogenesis is not a rate limiting factor (e.g. in vitro the selective pressures of solid tumor-like, 3—dimensional growth conditions favoring anoikis resistance result in collateral induction of a proangiogenic phenotype.

  8. Shoulder tip pain after laparoscopic surgery analgesia by collateral meridian acupressure (shiatsu) therapy: a report of 2 cases.

    Science.gov (United States)

    Yeh, Chun-Chang; Ko, Shan-Chi; Huh, Billy K; Kuo, Chang-Po; Wu, Ching-Tang; Cherng, Chen-Hwan; Wong, Chih-Shung

    2008-01-01

    This article describes 2 cases of collateral meridian acupressure (shiatsu) therapy (CMAT) for treatment of shoulder tip pain after laparoscopic cholecystectomy (LC). Both cases showed marked pain relief with reduction of skin temperature (1 degrees C) of the affected shoulder after CMAT. A 32- and a 53-year-old female presented with right shoulder tip pain after LC surgery. The repeated dose of intravenous ketorolac 30 mg and meperidine 50 mg did not improve the pain. Because of persistent pain and episodes of nausea and vomiting after intravenous nonsteroidal anti-inflammatory drugs and opioid medications, patients refused to take more analgesics, and we were consulted for pain management. After informed written consent obtained, CMAT was performed using acupoints located on the contralateral (left) kidney meridian to treat affected (right) shoulder pain. Postoperatively, patients' pain intensity was measured using a numeric pain scale. The infrared thermography of shoulder tip was obtained before and after the CMAT. Both patients reported immediate pain relief after the CMAT, with pain scores decreased from 5 to 1 of 10 and 5 to 0 of 10, respectively. Moreover, the local skin temperature of affected shoulders were significantly decreased in both patients after the CMAT. Similarly, the temperature difference between patients' affected and nonpainful shoulders were also significant after the CMAT. The results of these 2 cases suggest that the CMAT may be effective in reducing patients' post-LC shoulder tip pain without medication. An associated reduction of skin temperature of the painful shoulder with CMAT warrants further investigation.

  9. The Collateral Damage of Mass Incarceration: Risk of Psychiatric Morbidity Among Nonincarcerated Residents of High-Incarceration Neighborhoods.

    Science.gov (United States)

    Hatzenbuehler, Mark L; Keyes, Katherine; Hamilton, Ava; Uddin, Monica; Galea, Sandro

    2015-01-01

    Objectives. We examined whether residence in neighborhoods with high levels of incarceration is associated with psychiatric morbidity among nonincarcerated community members. Methods. We linked zip code-linked information on neighborhood prison admissions rates to individual-level data on mental health from the Detroit Neighborhood Health Study (2008-2012), a prospective probability sample of predominantly Black individuals. Results. Controlling for individual- and neighborhood-level risk factors, individuals living in neighborhoods with high prison admission rates were more likely to meet criteria for a current (odds ratio [OR] = 2.9; 95% confidence interval [CI] = 1.7, 5.5) and lifetime (OR = 2.5; 95% CI = 1.4, 4.6) major depressive disorder across the 3 waves of follow-up as well as current (OR = 2.1; 95% CI = 1.0, 4.2) and lifetime (OR = 2.3; 95% CI = 1.2, 4.5) generalized anxiety disorder than were individuals living in neighborhoods with low prison admission rates. These relationships between neighborhood-level incarceration and mental health were comparable for individuals with and without a personal history of incarceration. Conclusions. Incarceration may exert collateral damage on the mental health of individuals living in high-incarceration neighborhoods, suggesting that the public mental health impact of mass incarceration extends beyond those who are incarcerated.

  10. Medial ulnar collateral ligament reconstruction of the elbow in major league baseball players: Where do we stand?

    Science.gov (United States)

    Erickson, Brandon J; Bach, Bernard R; Bush-Joseph, Charles A; Verma, Nikhil N; Romeo, Anthony A

    2016-06-18

    The ulnar collateral ligament (UCL) is a vital structure to the overhead athlete, especially the baseball pitcher. For reasons not completely understood, UCL injuries have become increasingly more common in major league baseball (MLB) pitchers over the past 10 years. UCL reconstruction (UCLR) is the current gold standard of treatment for these injuries in MLB pitchers who wish to return to sport (RTS) at a high level and who have failed a course of non-operative treatment. Results following UCLR in MLB pitchers have been encouraging, with multiple RTS rates now cited at greater than 80%. Unfortunately, with the rising number of UCLR, there has also been a spike in the number of revision UCLR in MLB pitchers. Similar to primary UCLR, the etiology of the increase in revision UCLR, aside from an increase in the number of pitchers who have undergone a primary UCLR, remains elusive. The current literature has attempted to address several questions including those surrounding surgical technique (method of exposure, graft choice, management of the ulnar nerve, concomitant elbow arthroscopy, etc.), post-operative rehabilitation strategies, and timing of RTS following UCLR. While some questions have been answered, many remain unknown. The literature surrounding UCLR in MLB pitchers will be reviewed, and future directions regarding this injury in these high level athletes will be discussed.

  11. Reconstruction of medial collateral ligament defects with a flexor-pronator fascia patch in complete open release of stiff elbows.

    Science.gov (United States)

    Chen, Shuai; Yan, Hede; Wang, Wei; Zhang, Mei; Hildebrand, Kevin A; Fan, Cun-Yi

    2017-01-01

    Because medial elbow stability is essential for stiff elbow release, surgical techniques have been reported for reconstructing medial elbow stability. However, medial collateral ligament (MCL) defects, caused by inevitable detachment and resection performed for complete release, make the reconstruction more challenging. To our knowledge, no study has evaluated the outcomes after using a flexor-pronator fascia patch in medial elbow reconstruction for open release of stiff elbows. We hypothesized that this technique is effective for repairing MCL defects. We retrospectively reviewed the records of 10 patients. The MCL defects were all reconstructed with a flexor-pronator fascia patch. An external fixator was used in all patients. One patient could not be contacted and was thus excluded from the study. Outcome measures included stability, range of motion, Mayo Elbow Performance Score, ulnar nerve symptoms, power grip, and radiographic findings. The mean follow-up period was 19.6 months; all elbows were stable by the last follow-up. One patient presented with moderate elbow instability and then regained stability 3 months after the external fixator was removed. The Mayo Elbow Performance Score improved from 58 points to 94 points, and the mean flexion arc improved from 40° to 133°. No radiographic manifestations of elbow dislocation or suture anchor looseness were observed. A flexor-pronator fascia patch provides sufficient stability for repairing MCL defects without restricting the range of motion gained during arthrolysis. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

  12. Bilateral Superior Cerebellar Artery Embolic Occlusion with a Fetal-Type Posterior Cerebral Artery Providing Collateral Circulation

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    Taylor J. Bergman

    2016-12-01

    Full Text Available Bilateral infarction of the superior cerebellar arteries with sparing of the rest of the posterior circulation, particularly the posterior cerebral arteries, is an uncommon finding in neurological practice. Most commonly, the deficits of the superior cerebellar arteries and posterior cerebral arteries occur together due to the close proximity of their origins at the top of the basilar artery. A patient was transferred to the neurological intensive care unit with a history of recent-onset falls from standing, profound hypertension, dizziness, and headaches. The neurological exam revealed cerebellar signs, including dysmetria of the right upper extremity and a decreased level of consciousness. Computed tomography of the head and neck revealed decreased attenuation throughout most of the cerebellar hemispheres suggestive of ischemic injury with sparing of the rest of the brain. Further investigation with a computed tomography angiogram revealed a fetal-type posterior cerebral artery on the right side that was providing collateral circulation to the posterior brain. Due to this embryological anomaly, the patient was spared significant morbidity and mortality that would have likely occurred had the circulation been more typical of an adult male.

  13. Histological and ultrastructural evaluation of the early healing of the lateral collateral ligament epiligament tissue in a rat knee model

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    Kinov Plamen S

    2010-06-01

    Full Text Available Abstract Background In this study, we evaluated the changes which occurred in the epiligament, an enveloping tissue of the ligament, during the ligament healing. We assessed the association of epiligament elements that could be involved in ligament healing. Methods Thirty-two 8-month old male Wistar rats were used in this study. In twenty-four of them the lateral collateral ligament of the knee joint was surgically transected and was allowed to heal spontaneously. The evaluation of the epiligament healing included light microscopy and transmission electron microscopy. Results At the eight, sixteenth and thirtieth day after injury, the animals were sacrificed and the ligaments were examined. Our results revealed that on the eight and sixteenth day post-injury the epiligament tissue is not completely regenerated. Till the thirtieth day after injury the epiligament is similar to normal, but not fully restored. Conclusion Our study offered a more complete description of the epiligament healing process and defined its important role in ligament healing. Thus, we provided a base for new strategies in ligament treatment.

  14. Histological and ultrastructural evaluation of the early healing of the lateral collateral ligament epiligament tissue in a rat knee model.

    Science.gov (United States)

    Georgiev, Georgi P; Vidinov, Nikolai K; Kinov, Plamen S

    2010-06-13

    In this study, we evaluated the changes which occurred in the epiligament, an enveloping tissue of the ligament, during the ligament healing. We assessed the association of epiligament elements that could be involved in ligament healing. Thirty-two 8-month old male Wistar rats were used in this study. In twenty-four of them the lateral collateral ligament of the knee joint was surgically transected and was allowed to heal spontaneously. The evaluation of the epiligament healing included light microscopy and transmission electron microscopy. At the eight, sixteenth and thirtieth day after injury, the animals were sacrificed and the ligaments were examined. Our results revealed that on the eight and sixteenth day post-injury the epiligament tissue is not completely regenerated. Till the thirtieth day after injury the epiligament is similar to normal, but not fully restored. Our study offered a more complete description of the epiligament healing process and defined its important role in ligament healing. Thus, we provided a base for new strategies in ligament treatment.

  15. Impact of Coronary Collateral Circulation on In-Hospital Death in Patients with Inferior ST Elevation Myocardial Infarction

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    Baris Yaylak

    2015-01-01

    Full Text Available Objectives. Coronary collateral circulation (CCC may limit the size of right ventricular (RV infarcts but does not fully explain the relationship between CCC and clinical adverse events in patients with inferior STEMI. In this study, it was aimed to assess the relationship between preintervention angiographic evidence of CCC and clinical outcomes in patients with inferior STEMI who have undergone percutaneous coronary intervention. Methods. A total of 235 inferior STEMI patients who presented within the first 12 hours from the symptom onset were included. CCC to the right coronary artery (RCA before angioplasty were angiographically assessed, establishing two groups: 147 (63% patients without CCC and 88 (37% with CCC according to presence of CCC. Results. RV infarction, complete atrioventricular block, VT/VF, cardiogenic shock, and in-hospital death were noted less frequently in patients with CCC than in those without CCC. Absence of CCC to RCA was found to be the independent predictor for in-hospital death among them (odds ratio 4.0, 95% CI 1.8–12.6; p=0.03. Conclusion. Presence of angiographically detectable CCC was associated with better in-hospital outcomes including RV infarction, complete AV block, cardiogenic shock, and VT/VF in patients with inferior STEMI.

  16. Lipoprotein(a as a predictor of poor collateral circulation in patients with chronic stable coronary heart disease

    Directory of Open Access Journals (Sweden)

    Y. Fan

    Full Text Available As a mechanism compensating for obstructive coronary artery disease, coronary collateral circulation (CCC has attracted cardiologists for a long time to explore its potential impact. In the present study, Chinese patients suffering from ≥95% coronary stenosis, as diagnosed by angiography, have been investigated for the correlation between CCC and lipoprotein(a [Lp(a] levels. A cohort of 654 patients was divided into four categories according to Rentrop grades 0, 1, 2, and 3. Lp(a levels were divided into model 1, discretized with critical values of 33 and 66%, and model 2, discretized with a cutoff value of 30.0 mg/dL. Furthermore, we evaluated the correlation between CCC and serum Lp(a levels. The four groups had significantly different Lp(a levels (25.80±24.72, 18.99±17.83, 15.39±15.80, and 8.40±7.75 mg/dL; P30.0 group (OR=6.77, 95%CI=4.44-10.4 was greater than that of Lp(a <30.0 mg/dL. The worst condition of CCC can be predicted independently by Lp(a levels. In addition to clinical usage, Lp(a levels can also be utilized as biological markers.

  17. Lipoprotein(a) as a predictor of poor collateral circulation in patients with chronic stable coronary heart disease.

    Science.gov (United States)

    Fan, Y; Hu, J-S; Guo, F; Lu, Z-B; Xia, H

    2017-07-10

    As a mechanism compensating for obstructive coronary artery disease, coronary collateral circulation (CCC) has attracted cardiologists for a long time to explore its potential impact. In the present study, Chinese patients suffering from ≥95% coronary stenosis, as diagnosed by angiography, have been investigated for the correlation between CCC and lipoprotein(a) [Lp(a)] levels. A cohort of 654 patients was divided into four categories according to Rentrop grades 0, 1, 2, and 3. Lp(a) levels were divided into model 1, discretized with critical values of 33 and 66%, and model 2, discretized with a cutoff value of 30.0 mg/dL. Furthermore, we evaluated the correlation between CCC and serum Lp(a) levels. The four groups had significantly different Lp(a) levels (25.80±24.72, 18.99±17.83, 15.39±15.80, and 8.40±7.75 mg/dL; P30.0 group (OR=6.77, 95%CI=4.44-10.4) was greater than that of Lp(a) <30.0 mg/dL. The worst condition of CCC can be predicted independently by Lp(a) levels. In addition to clinical usage, Lp(a) levels can also be utilized as biological markers.

  18. Do Major League Baseball Team Physicians Harvest the Semitendinosus From the Drive Leg or Landing Leg When Performing Ulnar Collateral Ligament Reconstruction on Elite Baseball Pitchers?

    Science.gov (United States)

    Erickson, Brandon J; Chalmers, Peter N; Dugas, Jeffrey R; Bach, Bernard R; Nicholson, Gregory P; Verma, Nikhil N; Ahmad, Christopher S; Romeo, Anthony A

    2017-07-01

    Hamstring autograft is a common graft choice when performing ulnar collateral ligament reconstruction (UCLR). The purpose of this study was to survey Major League Baseball (MLB) team physicians and determine whether these physicians harvest the hamstring (semitendinosus or gracilis) from the drive leg (ipsilateral to surgical site) or landing leg (contralateral to surgical site) when performing UCLR on elite-level pitchers. The hypothesis was that the majority of surgeons harvest the hamstring from the drive leg when performing a UCLR. Descriptive epidemiology study. Overall, 52 MLB team orthopaedic surgeons were sent the 5-question online survey. The survey assessed surgeon UCLR volume, surgical technique, which leg the hamstring graft was harvested from, the reasoning for choosing that particular leg, and whether the surgeon would change their practice if evidence showed the hamstring from one of the legs was more important than the other. The survey was sent out 5 separate times to maximize the response rate. Forty (77%) MLB team physicians completed the survey. The largest number of surgeons (n = 16; 40%) performed between 5 and 14 UCLRs annually, while 6 (15%) performed more than 50 UCLRs annually. Most surgeons (n = 23; 57.5%) used the docking technique. Significantly more surgeons harvested the hamstring from the landing leg (n = 29; 72.5%) compared with the drive leg (n = 11; 27.5%) (P = .007). More surgeons cited the reason for their choice of leg as a belief that the hamstring they harvested plays less of a role in the ability of a pitcher to generate a forceful pitch (n = 25; 62.5%) than for logistical reasons in the operating room (n = 15; 37.5%); this difference was not statistically significant. Significantly more surgeons would change their practice (n = 35; 87.5%) if evidence showed the hamstrings from a specific (drive or landing) leg to be more active in the throwing motion compared with those who would not (P majority of MLB team physicians

  19. Substance use in individuals with mild to borderline intellectual disability: A comparison between self-report, collateral-report and biomarker analysis.

    Science.gov (United States)

    VanDerNagel, Joanneke E L; Kiewik, Marion; van Dijk, Marike; Didden, Robert; Korzilius, Hubert P L M; van der Palen, Job; Buitelaar, Jan K; Uges, Donald R A; Koster, Remco A; de Jong, Cor A J

    2017-04-01

    Individuals with mild or borderline intellectual disability (MBID) are at risk of substance use (SU). At present, it is unclear which strategy is the best for assessing SU in individuals with MBID. This study compares three strategies, namely self-report, collateral-report, and biomarker analysis. In a sample of 112 participants with MBID from six Dutch facilities providing care to individuals with intellectual disabilities, willingness to participate, SU rates, and agreement between the three strategies were explored. The Substance use and misuse in Intellectual Disability - Questionnaire (SumID-Q; self-report) assesses lifetime use, use in the previous month, and recent use of tobacco, alcohol, cannabis, and stimulants. The Substance use and misuse in Intellectual Disability - Collateral-report questionnaire (SumID-CR; collateral-report) assesses staff members' report of participants' SU over the same reference periods as the SumID-Q. Biomarkers for SU, such as cotinine (metabolite of nicotine), ethanol, tetrahydrocannabinol (THC), and its metabolite THCCOOH, benzoylecgonine (metabolite of cocaine), and amphetamines were assessed in urine, hair, and sweat patches. Willingness to provide biomarker samples was significantly lower compared to willingness to complete the SumID-Q (p<0.001). Most participants reported smoking, drinking alcohol, and using cannabis at least once in their lives, and about a fifth had ever used stimulants. Collateralreported lifetime use was significantly lower. However, self-reported past month and recent SU rates did not differ significantly from the rates from collateral-reports or biomarkers, with the exception of lower alcohol use rates found in biomarker analysis. The agreement between self-report and biomarker analysis was substantial (kappas 0.60-0.89), except for alcohol use (kappa 0.06). Disagreement between SumID-Q and biomarkers concerned mainly over-reporting of the SumID-Q. The agreement between SumID-CR and biomarker

  20. Intensity-based 3D/2D registration for percutaneous intervention of major aorto-pulmonary collateral arteries

    Science.gov (United States)

    Couet, Julien; Rivest-Henault, David; Miro, Joaquim; Lapierre, Chantal; Duong, Luc; Cheriet, Mohamed

    2012-02-01

    Percutaneous cardiac interventions rely mainly on the experience of the cardiologist to safely navigate inside soft tissues vessels under X-ray angiography guidance. Additional navigation guidance tool might contribute to improve reliability and safety of percutaneous procedures. This study focus on major aorta-pulmonary collateral arteries (MAPCAs) which are pediatric structures. We present a fully automatic intensity-based 3D/2D registration method that accurately maps pre-operatively acquired 3D tomographic vascular data of a newborn patient over intra-operatively acquired angiograms. The tomographic dataset 3D pose is evaluated by comparing the angiograms with simulated X-ray projections, computed from the pre-operative dataset with a proposed splatting-based projection technique. The rigid 3D pose is updated via a transformation matrix usually defined in respect of the C-Arm acquisition system reference frame, but it can also be defined in respect of the projection plane local reference frame. The optimization of the transformation is driven by two algorithms. First the hill climbing local search and secondly a proposed variant, the dense hill climbing. The latter makes the search space denser by considering the combinations of the registration parameters instead of neighboring solutions only. Although this study focused on the registration of pediatric structures, the same procedure could be applied for any cardiovascular structures involving CT-scan and X-ray angiography. Our preliminary results are promising that an accurate (3D TRE 0.265 +/- 0.647mm) and robust (99% success rate) bi-planes registration of the aorta and MAPCAs from a initial displacement up to 20mm and 20° can be obtained within a reasonable amount of time (13.7 seconds).

  1. Aortopulmonary collateral flow is related to pulmonary artery size and affects ventricular dimensions in patients after the fontan procedure.

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    Heiner Latus

    Full Text Available BACKGROUND: Aortopulmonary collaterals (APCs are frequently found in patients with a single-ventricle (SV circulation. However, knowledge about the clinical significance of the systemic-to-pulmonary shunt flow in patients after the modified Fontan procedure and its potential causes is limited. Accordingly, the aim of our study was to detect and quantify APC flow using cardiovascular magnetic resonance (CMR and assess its impact on SV volume and function as well as to evaluate the role of the size of the pulmonary arteries in regard to the development of APCs. METHODS: 60 patients (mean age 13.3 ± 6.8 years after the Fontan procedure without patent tunnel fenestration underwent CMR as part of their routine clinical assessment that included ventricular functional analysis and flow measurements in the inferior vena cava (IVC, superior vena cava (SVC and ascending aorta (Ao. APC flow was quantified using the systemic flow estimator: (Ao - (IVC + SVC. Pulmonary artery index (Nakata index was calculated as RPA + LPA area/body surface area using contrast enhanced MR angiography. The patient cohort was divided into two groups according to the median APC flow: group 1 0.495 l/min/m(2. RESULTS: Group 1 patients had significant smaller SV enddiastolic (71 ± 16 vs 87 ± 25 ml/m(2; p=0.004 and endsystolic volumes (29 ± 11 vs 40 ± 21 ml/m(2; p=0.02 whereas ejection fraction (59 ± 9 vs 56 ± 13%; p=0.38 differed not significantly. Interestingly, pulmonary artery size showed a significant inverse correlation with APC flow (r=-0.50, p=0.002. CONCLUSIONS: Volume load due to APC flow in Fontan patients affected SV dimensions, but did not result in an impairment of SV function. APC flow was related to small pulmonary artery size, suggesting that small pulmonary arteries represent a potential stimulus for the development of APCs.

  2. Validation of a Mathematical Model of Bidirectional Glenn Circulation With Aortopulmonary Collaterals and the Implications for QP/QS Calculation.

    Science.gov (United States)

    Fang, Zhe A; Ghelani, Sunil J; Koutsogiannaki, Sophia; DiNardo, James A; Yuki, Koichi

    2017-10-09

    A mathematical model of the oxygen delivery kinetics of the bidirectional Glenn (BDG) shunt circulation incorporating aortopulmonary collateral (APC) flow was created. The model was used to characterize oxygen delivery and compare modeled data to actual patient data obtained using cardiac magnetic resonance imaging (MRI) and catheterization. In addition, cardiac MRI and catheterization assessment of pulmonary blood flow in the presence of APC flow were compared. Mathematical model and retrospective data analysis of patients who underwent cardiac MRI and catheterization. The mathematical model is based on the concept that APC flow to the lungs is recirculated pulmonary venous blood flow, which does not contribute to systemic oxygen delivery. Single-center, university teaching hospital. The study included 98 patients with BDG shunt undergoing cardiac MRI and cardiac catheterization. In the absence of APC flow, the pulmonary blood flow to systemic blood flow ratio (Qp/Qs) calculated using cardiac catheterization data closely matched that obtained with cardiac MRI. In the presence of APC flow, Qp/Qs calculated using cardiac catheterization data systematically underestimated values obtained with cardiac MRI. A mathematical model of BDG shunt oxygen delivery incorporating variable APC flow was created. The model provided reasonable prediction of actual patient data for arterial blood oxygen, superior vena cava oxygen saturation, and oxygen delivery obtained at the time of cardiac catheterization in patients. The oxygen delivery kinetics of a BDG shunt incorporating variable APC flow can be modeled mathematically. Model output can be used to predict blood oxygen saturation after coil embolization of APC flow in the cardiac catheterization laboratory. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Markov Networks of Collateral Resistance: National Antimicrobial Resistance Monitoring System Surveillance Results from Escherichia coli Isolates, 2004-2012.

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    William J Love

    2016-11-01

    Full Text Available Surveillance of antimicrobial resistance (AMR is an important component of public health. Antimicrobial drug use generates selective pressure that may lead to resistance against to the administered drug, and may also select for collateral resistances to other drugs. Analysis of AMR surveillance data has focused on resistance to individual drugs but joint distributions of resistance in bacterial populations are infrequently analyzed and reported. New methods are needed to characterize and communicate joint resistance distributions. Markov networks are a class of graphical models that define connections, or edges, between pairs of variables with non-zero partial correlations and are used here to describe AMR resistance relationships. The graphical least absolute shrinkage and selection operator is used to estimate sparse Markov networks from AMR surveillance data. The method is demonstrated using a subset of Escherichia coli isolates collected by the National Antimicrobial Resistance Monitoring System between 2004 and 2012 which included AMR results for 16 drugs from 14418 isolates. Of the 119 possible unique edges, 33 unique edges were identified at least once during the study period and graphical density ranged from 16.2% to 24.8%. Two frequent dense subgraphs were noted, one containing the five β-lactam drugs and the other containing both sulfonamides, three aminoglycosides, and tetracycline. Density did not appear to change over time (p = 0.71. Unweighted modularity did not appear to change over time (p = 0.18, but a significant decreasing trend was noted in the modularity of the weighted networks (p < 0.005 indicating relationships between drugs of different classes tended to increase in strength and frequency over time compared to relationships between drugs of the same class. The current method provides a novel method to study the joint resistance distribution, but additional work is required to unite the underlying biological and genetic

  4. TNF-α induced down-regulation of lysyl oxidase family in anterior cruciate ligament and medial collateral ligament fibroblasts.

    Science.gov (United States)

    Xie, Jing; Jiang, Jiahuan; Huang, Wei; Zhang, Yanjun; Xu, Chunming; Wang, Chunli; Yin, Lin; Chen, Peter C Y; Sung, K L Paul

    2014-01-01

    The lysyl oxidase (LOX) family has the capacity to catalyze the cross-linking of collagen and elastin, implicating its important fundamental role in injury healing. Tumor necrosis factor alpha (TNF-α) is considered to be an important chemical mediator in the acute inflammatory phase of the ligament injury. The role of the lysyl oxidase family induced by TNF-α in the knee ligaments' wound healing process is poorly understood. Our purpose was to determine the different expressions of the LOXs in poorly self-healing anterior cruciate ligament (ACL) and well functionally self-healing medial collateral ligament (MCL) induced by TNF-α. Semi-quantitative PCR, quantitative real-time PCR and western blot were performed for original research. The results showed that all LOX family members were expressed at higher levels in MCL than those in ACL fibroblasts; the significant differences existed in the down-regulations of the LOXs induced by TNF-α; and the TNF-α-mediated down-regulations of the LOXs were more prominent in ACL than those in MCL fibroblasts. 1-20 ng/ml TNF-α down-regulated mRNA levels in ACL and MCL fibroblasts by up to 76% and 58% in LOX; 90% and 45% in LOXL-1; 97.5% and 90% in LOXL-2; 89% and 68% in LOXL-3; 52% and 25% in LOXL-4, respectively. Protein assay also showed LOXs had lower expressions in ACL than those in MCL. Based on these results, the differential expressions of the LOXs might help to explain the intrinsic differences between the poorly self-healing ACL and well functionally self-healing MCL. Copyright © 2013 Elsevier B.V. All rights reserved.

  5. Surgical Techniques for the Reconstruction of Medial Collateral Ligament and Posteromedial Corner Injuries of the Knee: A Systematic Review.

    Science.gov (United States)

    DeLong, Jeffrey M; Waterman, Brian R

    2015-11-01

    To systematically review reconstruction techniques of the medial collateral ligament (MCL) and associated medial structures of the knee (e.g., posterior oblique ligament). A systematic review of Medline/PubMed Database (1966 to November 2013), reference list scanning and citation searches of included articles, and manual searches of high-impact journals (2000 to July 2013) and conference proceedings (2009 to July 2013) were performed to identify publications describing MCL reconstruction techniques of the knee. Exclusion criteria included (1) MCL primary repair techniques or advancement procedures, (2) lack of clear description of MCL reconstruction technique, (3) animal models, (4) nonrelevant study design, (5) and foreign language articles without available translation. After review of 4,600 references, 25 publications with 359 of 388 patients (92.5%) were isolated for analysis, including 18 single-bundle MCL and 10 double-bundle reconstruction techniques. Only 2 techniques were classified as anatomic reconstructions, and clinical and objective outcomes (n = 28; 100% techniques (n = 114; 52.6% techniques have been used in the treatment of isolated and combined medial knee injuries in the existent literature. Many variations exist among reconstruction techniques and may differ by graft choices, method of fixation, number of bundles, tensioning protocol, and degree of anatomic restoration of medial and posteromedial corner knee restraints. Further studies are required to better ascertain the comparative clinical outcomes with anatomic, non-anatomic, and tendon transfer techniques for medial knee reconstruction. Level IV, systematic review of level IV studies and surgical techniques. Published by Elsevier Inc.

  6. A Biomechanical Evaluation of a 2-Suture Anchor Repair Technique for Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injuries.

    Science.gov (United States)

    Gil, Joseph A; Chambers, Alison; Shah, Kalpit N; Crisco, Joseph J; Got, Christopher; Akelman, Edward

    2017-08-01

    A complete thumb ulnar collateral ligament (UCL) repaired with 1-suture anchor has been demonstrated to be significantly weaker compared with the intact UCL. The objective of this study is to test the biomechanical strength of a 2-anchor thumb UCL repair. Nine paired fresh-frozen hands were used for this biomechanical analysis. One thumb from each pair was randomized to the control group and one to the repair group. In the control group, the UCL was loaded to failure in tension. In the repair group, the UCL was dissected off of the proximal phalanx, subsequently repaired with a 2-anchor technique, and then tested to failure. The mean yield load was 342 N (95% confidence interval [CI], 215-470 N) in the control group and 68 N (95% CI, 45-91 N) in the repair group. The mean maximum load at failure was 379 N (95% CI, 246-513 N) in the control group and 84 N (95% CI, 62-105 N) in the repair group. The mean stiffness was 72 N/m (95% CI, 48-96 N/m) in the control group and 17 N/m (95% CI, 13-21 N) in the repair group. The mean displacement at failure was 7.8 mm (95% CI, 7-9 mm) in the control group and 7.8 mm (95% CI, 7-9 mm) in the repair group. The 2-anchor repair technique we tested does not acutely reestablish the strength of the insertion of the native insertion of the UCL with this technique.

  7. Surgical Repair of Medial Collateral Ligament and Posteromedial Corner Injuries of the Knee: A Systematic Review.

    Science.gov (United States)

    DeLong, Jeffrey M; Waterman, Brian R

    2015-11-01

    To systematically evaluate surgical techniques and objective clinical outcomes of primary repair of the medial collateral ligament (MCL) and posteromedial corner of the knee. A systematic review of the PubMed/Medline Database (1966 to August 2014) was performed to identify all clinical studies describing MCL and other medial-based repairs of the knee. Exclusion criteria were applied to reconstruction techniques, animal models, and non-English publications. Descriptive analysis identified surgical technique, International Knee Documentation Committee (IKDC) objective form valgus stability subscore, functional outcome measures, and laxity on valgus stress. After exclusion of 165 references, 16 publications with 355 knees were included in the final analysis. Fixation construct included suture-only repair (49.5%), staples (12.1%), suture anchors (11.2%), and mixed or unknown fixation (27.0%). When isolating knees with available relative valgus stress opening (n = 223), 75.8% had side-to-side difference of knees (90.0%; 6 studies; range, 60% to 100%). Of 93 knees with quantified values, the mean side-to-side difference in medial joint space opening was 1.25 mm (SD ± 0.85) after primary repair. Thirteen of 212 knees (6.1%) met the criteria for failure, and the average Lysholm score was 91.6 (n = 210; range, 85.5 to 98.5). This systematic review demonstrated that repair of the MCL and posteromedial corner of the knee may be an effective and reliable treatment for medial-sided knee injuries, resulting in improved valgus stability and patient-reported functional scores with low rates of secondary failure. However, repair techniques may vary significantly depending on the chronicity and extent of medial ligamentous knee injuries, and appropriate patient selection is critical in determining ultimate clinical outcomes. IV. Published by Elsevier Inc.

  8. The effect of healing in the medial collateral ligament of human knee joint: A three-dimensional finite element analysis.

    Science.gov (United States)

    Wan, Chao; Hao, Zhixiu; Wen, Shizhu

    2016-06-30

    The medial collateral ligament (MCL) is one of the main ligaments that provide knee joint with major restraints against valgus, internal, and external torque loads. The MCL injury most frequently occurs near its femoral attachment but can be healed spontaneously. Hence, the usual clinical treatment for MCL injury is conservative therapy with early controlled rehabilitation motion. However, the effect of the variations in the healing conditions of the MCL portion (i.e. near the femoral insertion) is still unclear. In this study, finite element tibiofemoral joint models with three different MCL healing conditions were analyzed under six kinds of joint loads, such as 10 and 20 N·m valgus tibial torques, 5 and 10 N·m internal tibial torques, and 5 and 10 N·m external tibial torques. The three healing conditions corresponded to the early, medium, and final (i.e. healthy) stages of the healing period, respectively. It was found that different MCL healing conditions greatly affected the main joint kinematics under valgus tibial torques, but neither the reaction force nor stress results of the MCL. The peak strain values in the MCL healing portion changed greatly under all the six loads. Moreover, all the joint kinematics, strain results, and reaction force of the MCL at the medium stage were similar to those in the healthy joint, that is, at the final healing stage. These imply that the partially healed MCL might be enough for providing the restraints for knee joints and would not lead to some high strains occurring in the MCL. © IMechE 2016.

  9. [One-stage repair and reconstruction of knee anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament].

    Science.gov (United States)

    Chen, Pingquan; Zhu, Zhenkang; Wang, Sheng

    2012-06-01

    To investigate the effectiveness of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction combined with limited open repair of medial collateral ligament (MCL) in recovering the stability and the function of the knee. Between April 2003 and October 2010, 14 patients (14 knees) with multiple injuries of ACL, PCL, and MCL were treated. There were 10 males and 4 females with an average age of 41 years (range, 21-71 years). Injury was caused by traffic accident in 11 cases and falling in 3 cases. The average time from injury to admission was 2 days (range, 1-4 days). Lysholm score was 17.00 +/- 8.29, and the International Knee Documentation Committee (IKDC) score was 20.93 +/- 8.28. The complicated injuries included dislocation of the knee joint in 9 cases and meniscus injury in 5 cases. Allogeneic tendons (2 cases) and autologous harmstring tendon (12 cases) were used to reconstruct ACL and PCL under arthroscopy, and all cases underwent limited open repair of MCL. All incisions healed by first intention. Numbness of the lower limb occurred in 3 cases and alleviated spontaneously. All patients were followed up 14 months on average (range, 12-18 months). The knee flexion was 120 degrees and extension was 0 degrees at 3 months of follow-up. After 1 year of follow-up, IKDC score and Lysholm score were 89.93 +/- 6.26 and 88.93 +/- 4.82, respectively, showing significant differences when compared with preoperative scores (P injuries of the knee ligaments, an arthroscope with limited open repair and reconstruction of the knee ligament can avoid open joint chamber, reduce postoperative articular adhesion, and encourage the joint function recovery.

  10. The relationship between serum thyroid hormone levels, subclinical hypothyroidism, and coronary collateral circulation in patients with stable coronary artery disease.

    Science.gov (United States)

    Ballı, Mehmet; Çetin, Mustafa; Taşolar, Hakan; Uysal, Onur Kadir; Yılmaz, Mahmut; Durukan, Mine; Elbasan, Zafer; Çaylı, Murat

    2016-03-01

    Thyroid disease is a common endocrine disease with important effects on the cardiovascular system. As an adaptive response to myocardial ischemia, coronary collateral circulation (CCC) plays an important role in obstructive coronary artery disease (CAD). The association between serum thyroid hormone levels and development of CCC was investigated in the present study. In total, 430 consecutive patients who underwent coronary angiography procedure and had documented total occlusion in at least 1 major coronary artery were investigated retrospectively. Degree of CCC was classified according to Cohen-Rentrop method. Serum free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were assessed by the chemiluminescence immunoassay technique. In spite of diabetes mellitus (p=0.019), smoking (p<0.001), and TSH (p<0.001), FT3 (p<0.001), FT4 (p=0.015), and subclinical hypothyroidism (SCH) (p<0.001) ratios were significantly different between groups. In regression analysis, SCH (p=0.024), DM (p=0.021), smoking (p<0.001), and heart failure (p=0.029) were independent predictors of poor CCC development in multivariate model 1. When regression analyses were performed based on multivariate model 2, TSH (p<0.001), FT3 (p<0.001), heart failure (p=0.022), smoking (p<0.001), and hyperlipidemia (HPL) (p=0.046) were independent predictors of poor CCC development. In addition to traditional risk factors, SCH, higher serum TSH, and lower FT3 levels were associated with development of poor CCC in patients with obstructive CA.

  11. Halo effect for bariatric surgery: collateral weight loss in patients' family members.

    Science.gov (United States)

    Woodard, Gavitt A; Encarnacion, Betsy; Peraza, Joe; Hernandez-Boussard, Tina; Morton, John

    2011-10-01

    Bariatric surgery is an effective treatment for morbid obesity, which is increasingly recognized as a familial disease. Healthy behavior transmission may be enhanced by family relationships. To determine changes in weight and healthy behavior in patients who underwent Roux-en-Y gastric bypass surgery and their family members. Prospective, longitudinal, and multidimensional health assessment before and 1 year after index Roux-en-Y gastric bypass surgery. An academic bariatric center of excellence, from January 1, 2007, through December 31, 2009. Eighty-five participants (35 patients, 35 adult family members, and 15 children old). Roux-en-Y gastric bypass surgery and associated dietary and lifestyle counseling. Weight and expected body mass index (calculated as weight in kilograms divided by height in meters squared). Secondary outcomes were waist circumference, quality of life (36-Item Short Form or Pediatric Quality of Life Inventory), healthy behaviors, eating behaviors, and activity levels. Participants were grouped by relationship to patient for analysis with paired 2-sample t tests. Before the operation, 60% of adult family members and 73% of children of patients undergoing Roux-en-Y gastric bypass surgery were obese. At 12 months after the operation, significant weight loss was observed in obese adult family members (from 234 to 226 lb; P = .01). There was a trend for obese children to have a lower body mass index than expected for their growth curve (31.2 expected vs 29.6 observed; P = .07). Family members increased their daily activity levels (adults, from 8 to 17 metabolic equivalent task-hours, P = .005; and children, from 13 to 22, P = .04). Adult family members also had improved eating habits with less uncontrollable eating (from 35 to 28; P = .01), emotional eating (from 36 to 28; P = .04), and alcohol consumption (from 11 drinks per month to 1 drink per month; P = .009). Gastric bypass surgery may render an additional benefit of weight loss and

  12. Achievements and Limitations of a Strategy of Rehabilitation of Native Pulmonary Vessels in Pulmonary Atresia, Ventricular Septal Defect, and Major Aortopulmonary Collateral Arteries.

    Science.gov (United States)

    Soquet, Jerome; Liava'a, Matthew; Eastaugh, Lucas; Konstantinov, Igor E; Brink, Johann; Brizard, Christian P; d'Udekem, Yves

    2017-05-01

    A strategy of rehabilitation for pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries (PA/VSD/MAPCAs) comprises repetitive shunting and patching procedures of the central pulmonary arteries. We wanted to determine the feasibility and limitations of a strategy of rehabilitation. The outcomes of 37 consecutive patients operated from June 2003 to December 2014 for PA/VSD/MAPCAs were reviewed. The patients were directed to a rehabilitation strategy, except when they presented in heart failure with very large collaterals. Four patients with very large MAPCAs underwent a one-stage repair with unifocalization of collateral vessels at a median age of 8.6 months. There was no mortality in this group after a median follow-up of 4.6 years. Following a strategy of staged rehabilitation, 33 patients had 2.01 ± 0.9 procedures before repair. Median age at primary shunting was 3.3 weeks (0.4 to 31.9 weeks). Repair rate was 73% (22 patients), at a median age of 1.7 years. Three patients (10%) were left palliated and 3 patients (10%) died. Median follow-up in this group was 4.5 years. Complementary procedures to the rehabilitation strategy consisted in pulmonary artery reconstruction in 25 patients (76%) and MAPCAs ligation in 7 patients (21%). Pulmonary balloon angioplasty was required in 12 patients (36%) and MAPCAs coil occlusion in 8 patients (24%). A strategy of rehabilitation can be implemented in almost 90% of the cases, with a low mortality rate. Following this strategy, 73% of the patients can be successfully repaired. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  13. 4-D MRI flow analysis in the course of interrupted aortic arch reveals complex morphology and quantifies amount of collateral blood flow

    Energy Technology Data Exchange (ETDEWEB)

    Hirtler, Daniel [University Hospital Freiburg, Department of Pediatric Cardiology and Congenital Heart Disease, Freiburg (Germany); Geiger, Julia; Jung, Bernd [University Hospital Freiburg, Department of Radiology, Medical Physics, Freiburg (Germany); Markl, Michael [Northwestern University, Departments of Radiology and Biomedical Engineering, Chicago, IL (United States); Arnold, Raoul [University Hospital Heidelberg, Department of Pediatric Cardiology and Congenital Heart Disease, Heidelberg (Germany)

    2013-08-15

    We present findings in a 17-year-old with interrupted aortic arch, in whom standard imaging techniques missed functional and morphological problems. Flow-sensitive four-dimensional magnetic resonance (4-D MR) enabled assessment of the complex anatomy and blood-flow characteristics in the entire aorta and direct quantification of blood flow in collateral vessels. Our findings highlight the entire morphological and functional problem of interrupted aortic arch and illustrate the potential of flow-sensitive 4-D MR for surgical planning in congenital heart disease. (orig.)

  14. Laxity of the elbow after experimental excision of the radial head and division of the medial collateral ligament. Efficacy of ligament repair and radial head prosthetic replacement

    DEFF Research Database (Denmark)

    Jensen, Steen Lund; Deutch, Søren R; Olsen, Bo Sanderhoff

    2003-01-01

    We studied the stabilising effect of prosthetic replacement of the radial head and repair of the medial collateral ligament (MCL) after excision of the radial head and section of the MCL in five cadaver elbows. Division of the MCL increased valgus angulation (mean 3.9 +/- 1.5 degrees) and internal...... that the radial head is a constraint secondary to the MCL for both valgus displacement and internal rotation. Isolated repair of the ligament is superior to isolated prosthetic replacement and may be sufficient to restore valgus and internal rotatory stability after excision of the radial head in MCL...

  15. Correlation of angina pectoris and perfusion decrease by collateral circulation in single-vessel coronary chronic total occlusion using myocardial perfusion single-photon emssion computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Sang Geon; Park, Ki Seong; Kang, Sae Ryung [Chonnam National University Hospital, Gwangju (Korea, Republic of); and others

    2016-03-15

    To evaluate the perfusion decrease in donor myocardium by collateral circulation and its correlation with angina pectoris in patients with chronic total occlusion (CTO) using myocardial perfusion single-photon emission computed tomography (MPS). Thirty-six patients with single-vessel CTO without any other stenosis were included. All patients underwent MPS and coronary angiography (CAG) within 2 months. Total 72 donor arteries were evaluated for the grades of collaterals to the CTO artery using the Rentrop grading system on CAG. Perfusion defects and perfusion scores in donor and CTO territories were analyzed on MPS. Myocardial perfusion of donor and CTO territories were evaluated according to the presence of angina pectoris and the grades of collateral circulation. When the CTO territory was ischemic, symptomatic patients showed higher summed difference scores in the CTO territory compared to asymptomatic patients (3.5 ± 2.4 vs. 1.5 ± 0.8 for symptomatic and asymptomatic groups respectively; p = 0.034). However, when the CTO territory was nonischemic, symptomatic patients showed higher summed stress scores (SSS, 4.3 ± 2.9 vs. 1.6 ± 1.2; p = 0.032) and summed rest scores (SRS, 4.2 ± 2.5 vs. 1.5 ± 1.1; p = 0.003) in the donor territories. On the per-vessel analysis, perfusion defects in donor territories were more frequent (0 % vs. 53 % vs. 86 % for Rentrop 0, Rentrop 1–2 and Rentrop 3, respectively; p < 0.001) and showed higher SSS (0.0 ± 0.0, 1.3 ± 1.6 and 2.1 ± 1.1 for Rentrop 0, Rentrop 1–2 and Rentrop 3, respectively; p = 0.001) and SRS (0.0 ± 0.0, 1.0 ± 1.4 and 1.7 ± 1.2; p = 0.003) at higher Rentrop grades, but their patterns were variable. Angina pectoris was related to either ischemia of the myocardium beyond CTO or a perfusion decrease in the donor myocardium. The perfusion decrease in donor myocardium positively correlated with the collateral grades.

  16. Deletion of presynaptic adenosine A1 receptors impairs the recovery of synaptic transmission after hypoxia.

    Science.gov (United States)

    Arrigoni, E; Crocker, A J; Saper, C B; Greene, R W; Scammell, T E

    2005-01-01

    Adenosine protects neurons during hypoxia by inhibiting excitatory synaptic transmission and preventing NMDA receptor activation. Using an adeno-associated viral (AAV) vector containing Cre recombinase, we have focally deleted adenosine A(1) receptors in specific hippocampal regions of adult mice. Recently, we found that deletion of A(1) receptors in the CA1 area blocks the postsynaptic responses to adenosine in CA1 pyramidal neurons, and deletion of A(1) receptors in CA3 neurons abolishes the presynaptic effects of adenosine on the Schaffer collateral input [J Neurosci 23 (2003) 5762]. In the current study, we used this technique to delete A(1) receptors focally from CA3 neurons to investigate whether presynaptic A(1) receptors protect synaptic transmission from hypoxia. We studied the effects of prolonged (1 h) hypoxia on the evoked field excitatory postsynaptic potentials (fEPSPs) in the CA1 region using in vitro slices. Focal deletion of the presynaptic A(1) receptors on the Schaffer collateral input slowed the depression of the fEPSPs in response to hypoxia and impaired the recovery of the fEPSPs after hypoxia. Delayed responses to hypoxia linearly correlated with impaired recovery. These findings provide direct evidence that the neuroprotective role of adenosine during hypoxia depends on the rapid inhibition of synaptic transmission by the activation of presynaptic A(1) receptors.

  17. Factors associated with systemic to pulmonary arterial collateral flow in single ventricle patients with superior cavopulmonary connections.

    Science.gov (United States)

    Glatz, Andrew C; Harrison, Neil; Small, Adam J; Dori, Yoav; Gillespie, Matthew J; Harris, Matthew A; Fogel, Mark A; Rome, Jonathan J; Whitehead, Kevin K

    2015-11-01

    Systemic to pulmonary arterial collateral flow (CollF) is common in single ventricle patients with superior cavopulmonary connections (SCPC), although associations with CollF are not well understood. We previously described a method to quantify CollF by cardiac MRI (CMR). We sought to identify factors associated with CollF in a large cross section of patients with SCPC. A retrospective observational cohort study of events from birth to study CMR was performed for all patients with SCPC who had CollF quantified by CMR. CollF was quantified in 96 patients at a median age of 2.6 (IQR 1.9-3.1) years and 2.1 (1.4-2.7) years after SCPC and measured 1.6±0.7 L/min/m(2) (33±11% of aortic flow and 48±16% of pulmonary venous flow). Significantly higher amounts of indices of CollF were associated with: duration of chest tubes (p≤0.05 for all), intensive care unit and hospital length of stay (p≤0.04 for all), higher O2 saturation at Stage 2 discharge (p=0.04 for CollF/aortic), female sex (p≤0.007 for CollF/aortic and CollF/pulmonary venous), and history of a Blalock-Taussig shunt (p<0.04 for CollF and CollF/aortic). Multivariable models were constructed to identify factors independently associated with CollF measures and included: female sex (p≤0.006 for all), O2 saturation at Stage 2 discharge (p=0.013 for CollF/aortic) and total chest tube days (p=0.001 for all). These models explained 20-22% of the variance in the outcomes. These data support hypotheses that perioperative morbidity and pleural inflammation play a role in CollF development and that CollF affects pulmonary blood flow. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. Risk Stratification for Ulnar Collateral Ligament Injury in Major League Baseball Players: A Retrospective Study From 2007 to 2014.

    Science.gov (United States)

    DeFroda, Steven F; Kriz, Peter K; Hall, Amber M; Zurakowski, David; Fadale, Paul D

    2016-02-01

    Ulnar collateral ligament (UCL) injury has become increasingly common in Major League Baseball (MLB) players in recent years. There is a significant difference in preinjury fastball velocity between MLB pitchers with tears and matched controls without UCL injury. Pitchers with injuries are throwing harder and getting injured earlier in their MLB careers. Cohort study; Level of evidence, 3. From 2007 to 2014, a total of 170 documented UCL injuries (156 pitchers, 14 position players) occurred in MLB. Inclusion criteria for this study consisted of any player who tore his UCL in MLB during this time frame. There were 130 regular-season tears (April-September). From this group, 118 players who pitched more than 100 innings prior to tear were matched to subjects with no tear and were compared using a logistic regression analysis. A subgroup of "early tear" players who threw less than 100 career innings (n = 37) was also identified and compared with the larger tear group using a logistic regression analysis. Of the 130 tears that occurred during the regular season, a significantly larger number (62%) occurred in the first 3 months (P = .011). The rate of UCL tears per MLB player (P = .001) was statistically significant. In the group of 118 matched tears, the mean fastball velocity was greater in the tear group (91.7 mph) compared with the control group (91.0 mph; P = .014). Furthermore, relief pitchers made up a greater percentage of the early tear group (<100 innings) compared with the later tear group (P = .011). Sixteen of the 170 UCL tears (9.4%) were recurrent tears, with 5 of 16 experiencing both tear and retear within the past 4 years. There is a statistically significant difference in the mean fastball velocity of pitchers who injure their UCL. Small increases in pitcher fastball velocity are a main contribution to the increased rate of tear in MLB. In addition, there has been an increased incidence of injury in the first 3 months of the season. Finally, early

  19. Performance and Injury Characteristics of Pitchers Entering the Major League Baseball Draft After Ulnar Collateral Ligament Reconstruction.

    Science.gov (United States)

    Wymore, Lucas; Chin, Paul; Geary, Christopher; Carolan, Gregory; Keefe, Daniel; Hoenecke, Heinz; Fronek, Jan

    2016-12-01

    Ulnar collateral ligament (UCL) reconstruction (UCLR) has been studied and shown to be a successful procedure for returning overhead athletes to sport. Many studies of Major League Baseball (MLB) players have shown high levels of return to play with successful statistical performance. No study has followed professional advancement of drafted pitchers who underwent UCLR as amateurs when compared with drafted pitchers who did not undergo the procedure before selection in the MLB draft. There would be no difference in professional advancement, statistical performance, or injury rate between the UCLR and control groups. Cohort study; Level of evidence, 3. Thirty-eight pitchers with a UCLR as an amateur and 114 controls were identified in the MLB draft between 2006 and 2010. Highest level of professional baseball achieved was collected from all players, as well as statistical performance metrics including velocity, wins, earned run average (ERA), and walks and hits per inning pitched (WHIP). Additional data on future injuries were analyzed for days on the disabled list (DL), risk of being placed on the DL, and DL assignment for elbow injury. Thirteen of 38 UCLR pitchers reached the major league level (34.2%) compared with 29 of 114 (25.4%) control pitchers, which was not statically significant (P = .295). The UCLR and control groups were similar for average velocity, peak velocity, innings pitched, games, games started, innings per game, ERA, WHIP, wins, losses, saves, batters faced, and innings pitched per year, as well as hits, runs, home runs allowed, strikeouts, batters walked, and batters struck per inning. The UCLR group had a significantly increased rate of DL assignment when compared with controls (86.8% vs 64.0%; P = .008); however, days on DL (152.8 vs 135.6; P = .723) and DL assignment for elbow injury (45.5% vs 43.8%; P = .877) were similar. There was no difference in the rate of professional advancement among pitchers drafted by the MLB who had undergone

  20. Evaluation of the Morphology and Function of Medial Collateral Ligament afterTotal Knee Arthroplasty with High-frequency Ultrasound.

    Science.gov (United States)

    Jiang, Ling; Liu, Yan-Qing; Cui, Li-Gang; Meng, Ying; Tian, Hua; Zhang, Ke; Wang, Jin-Rui

    2016-10-10

    Objective To explore the feasibility and clinical value of ultrasonography in evaluating the morphology and function of medial collateral ligaments (MCL) after total knee arthroplasty (TKA). Methods Totally 38 patients undergoing routine KTA (group A) and 22 patients undergoing constrained condylar knee arthroplasty KTA with MCL injury (group B) were included. Long axis views of MCL were taken and the MCL thickness was measured on femur side and tibial side 1 cm away from the joint line, respectively. The thicknesses were compared between the two groups. Subsequently, the gap between the metal part of the femoral prosthesis and the spacer after dynamic valgus stress was measured. The distribution and composition of the gap between the two groups were compared. Results High-frequency ultrasound clearly showed the prosthesis and MCL after TKA. MCL fiber structures of both groups were intact. The MCL thickness on the tibial side in group B was (0.25±0.06)cm, which was significantly thinner than group A [(0.32±0.14)cm] (t=2.12, P=0.040).For the femur side, there was no significant difference (t=1.65, P=0.110) between these two groups [(0.37±0.09) cm in group B versus (0.42±0.12)cm in group A]. Under the condition of valgus stress, the gaps between the metal part of the femoral prosthesis and the spacer could be found in 11 cases in group B but only in 1 case in group A. The proportion of gaps in group B was significantly higher than that in group A (Fisher's exact test, P=0.000). Conclusions High-frequency ultrasound can clearly show the prosthesis and MCL after TKA. The injured MCL can be well joined but the thickness is thinner. Under the condition of valgus stress of the knee, the stability of the TKA can be evaluated according to the gap between the prosthesis and the spacer.

  1. Collateral Ventilation Quantification Using Xenon-Enhanced Dynamic Dual-Energy CT: Differences between Canine and Swine Models of Bronchial Occlusion.

    Science.gov (United States)

    Park, Eun-Ah; Goo, Jin Mo; Park, Sang Joon; Lee, Chang Hyun; Park, Chang Min

    2015-01-01

    The aim of this study was to evaluate whether the difference in the degree of collateral ventilation between canine and swine models of bronchial obstruction could be detected by using xenon-enhanced dynamic dual-energy CT. Eight mongrel dogs and six pigs underwent dynamic dual-energy scanning of 64-slice dual-source CT at 12-second interval for 2-minute wash-in period (60% xenon) and at 24-second interval for 3-minute wash-out period with segmental bronchus occluded. Ventilation parameters of magnitude (A value), maximal slope, velocity (K value), and time-to-peak (TTP) enhancement were calculated from dynamic xenon maps using exponential function of Kety model. A larger difference in A value between parenchyma was observed in pigs than in dogs (absolute difference, -33.0 ± 5.0 Hounsfield units [HU] vs. -2.8 ± 7.1 HU, p = 0.001; normalized percentage difference, -79.8 ± 1.8% vs. -5.4 ± 16.4%, p = 0.0007). Mean maximal slopes in both periods in the occluded parenchyma only decreased in pigs (all p Xenon-ventilation CT allows the quantification of collateral ventilation and detection of differences between canine and swine models of bronchial obstruction.

  2. Medial collateral ligament reconstruction using bone-patellar tendon-bone allograft for chronic medial knee instability combined with multi-ligament injuries: a new technique.

    Science.gov (United States)

    Zheng, Xiaozuo; Li, Tong; Wang, Juan; Dong, Jiangtao; Gao, Shijun

    2016-07-22

    The medial collateral ligament (MCL) is the main static stabilizer of the medial knee. The surgical treatment was recommended in cases with serious medial collateral ligament insufficiency combined with multi-ligament injuries and chronic symptomatic medial instability. Several surgical techniques have been described for the MCL reconstruction, while potential problems including donor site morbidity, complicated procedure, and high risk of femoral tunnel collision were reported. In order to minimize such potential limitations, we describe a new medial reconstruction technique for MCL injury using bone-patellar tendon-bone (BPTB) allograft. A longitudinal incision at the medial knee was made. The centers of femoral and tibial attachments were gained through repeated isometricity test. Then, the bone grooves were made around the femoral and tibial centers. The appropriate BPTB allograft was selected, and both ends were trimmed. The prepared bone blocks were embedded into the grooves and fixed with cancellous screws. The programmed rehabilitation exercises were performed after the operation. A strong graft and bone-to-bone healing on both femoral and tibial attachment sites were obtained, and femoral tunnel collision during multi-ligament reconstruction was avoided. Satisfactory valgus and rotatory stability were gained. This novel MCL reconstruction technique using BPTB allograft can be safely performed, and the clinical outcome was favorable with satisfactory valgus and rotatory stability. More cases and additional follow-up results are needed to verify the overall effect of this technique.

  3. Reduced Plasma miR-146a Is a Predictor of Poor Coronary Collateral Circulation in Patients with Coronary Artery Disease.

    Science.gov (United States)

    Wang, Junnan; Yan, Youyou; Song, Dandan; Liu, Bin

    2016-01-01

    Coronary collateral circulation (CCC), an alternative blood supply for ischemic myocardium, improves survival rates among patients with coronary artery disease (CAD). However, there remains a lack of biomarkers to discriminate between patients with poor or good CCC. In this study, we aimed to observe the relationship between plasma microRNA-146a (miR-146a) levels and the coronary collateral circulation (CCC). Additionally, we aimed to explore whether the plasma miR-146a level could serve as a blood-based biomarker for CCC in patients with CAD. We measured the plasma levels of vascular endothelial growth factor A (VEGF-A) and miR-146a in patients with CCC by ELISA and real-time PCR, respectively, according to the Rentrop grades. The results showed that the plasma miR-146a level is significantly increased in CAD patients with good CCC and significantly decreased in those with poor CCC. In contrast, although VEGFA expression in patients followed a similar trend as the CCC, the differences between the groups were not statistically significant. There was a positive correlation between plasma miR-146a levels and the Rentrop grading. In addition, receiver operator characteristic analysis showed that miR-146a could be a potent biomarker for identifying patients with poor CCC.

  4. Reduced Plasma miR-146a Is a Predictor of Poor Coronary Collateral Circulation in Patients with Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Junnan Wang

    2016-01-01

    Full Text Available Coronary collateral circulation (CCC, an alternative blood supply for ischemic myocardium, improves survival rates among patients with coronary artery disease (CAD. However, there remains a lack of biomarkers to discriminate between patients with poor or good CCC. In this study, we aimed to observe the relationship between plasma microRNA-146a (miR-146a levels and the coronary collateral circulation (CCC. Additionally, we aimed to explore whether the plasma miR-146a level could serve as a blood-based biomarker for CCC in patients with CAD. We measured the plasma levels of vascular endothelial growth factor A (VEGF-A and miR-146a in patients with CCC by ELISA and real-time PCR, respectively, according to the Rentrop grades. The results showed that the plasma miR-146a level is significantly increased in CAD patients with good CCC and significantly decreased in those with poor CCC. In contrast, although VEGFA expression in patients followed a similar trend as the CCC, the differences between the groups were not statistically significant. There was a positive correlation between plasma miR-146a levels and the Rentrop grading. In addition, receiver operator characteristic analysis showed that miR-146a could be a potent biomarker for identifying patients with poor CCC.

  5. Vasopressin inhibits LTP in the CA2 mouse hippocampal area.

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    Magda Chafai

    Full Text Available Growing evidence points to vasopressin (AVP as a social behavior regulator modulating various memory processes and involved in pathologies such as mood disorders, anxiety and depression. Accordingly, AVP antagonists are actually envisaged as putative treatments. However, the underlying mechanisms are poorly characterized, in particular the influence of AVP on cellular or synaptic activities in limbic brain areas involved in social behavior. In the present study, we investigated AVP action on the synapse between the entorhinal cortex and CA2 hippocampal pyramidal neurons, by using both field potential and whole-cell recordings in mice brain acute slices. Short application (1 min of AVP transiently reduced the synaptic response, only following induction of long-term potentiation (LTP by high frequency stimulation (HFS of afferent fibers. The basal synaptic response, measured in the absence of HFS, was not affected. The Schaffer collateral-CA1 synapse was not affected by AVP, even after LTP, while the Schaffer collateral-CA2 synapse was inhibited. Although investigated only recently, this CA2 hippocampal area appears to have a distinctive circuitry and a peculiar role in controlling episodic memory. Accordingly, AVP action on LTP-increased synaptic responses in this limbic structure may contribute to the role of this neuropeptide in controlling memory and social behavior.

  6. Arthroscopic pullout repair of posterior root tear of the medial meniscus: the anterior approach using medial collateral ligament pie-crusting release.

    Science.gov (United States)

    Park, Young-Sik; Moon, Hong-Kyo; Koh, Yong-Gon; Kim, Yong-Chan; Sim, Dong-Sik; Jo, Seung-Bae; Kwon, Se-Kwang

    2011-08-01

    Posterior root tears of the medial meniscus are frequently encountered and should be repaired if possible to prevent osteoarthritis of the medial compartment. Various surgical techniques have been proposed to repair posterior root tears. The anterior arthroscopic approach can cause an iatrogenic chondral injury due to the narrow medial joint space. The posterior approaches might be technically unfamiliar to many surgeons because they require the establishment of a posteromedial or trans-septal portal. This paper describes the medial collateral ligament pie-crusting release technique for arthroscopic double transosseous pullout repair of posterior root tears of the medial meniscus through the anterior approach to provide the good visualization of the footprint and sufficient working space.

  7. Collateral ventilation quantification using xenon-enhanced dynamic dual-energy CT: Differences between canine and swine models of bronchial occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eun Ah; Goo, Jin Mo; Park, Sang Joon; Lee, Chang Hyun; Park, Chng Min [Dept. of Radiology, Seoul National University College of Medicine and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul (Korea, Republic of)

    2015-06-15

    The aim of this study was to evaluate whether the difference in the degree of collateral ventilation between canine and swine models of bronchial obstruction could be detected by using xenon-enhanced dynamic dual-energy CT. Eight mongrel dogs and six pigs underwent dynamic dual-energy scanning of 64-slice dual-source CT at 12-second interval for 2-minute wash-in period (60% xenon) and at 24-second interval for 3-minute wash-out period with segmental bronchus occluded. Ventilation parameters of magnitude (A value), maximal slope, velocity (K value), and time-to-peak (TTP) enhancement were calculated from dynamic xenon maps using exponential function of Kety model. A larger difference in A value between parenchyma was observed in pigs than in dogs (absolute difference, -33.0 +/- 5.0 Hounsfield units [HU] vs. -2.8 +/- 7.1 HU, p = 0.001; normalized percentage difference, -79.8 +/- 1.8% vs. -5.4 +/- 16.4%, p = 0.0007). Mean maximal slopes in both periods in the occluded parenchyma only decreased in pigs (all p < 0.05). K values of both periods were not different (p = 0.892) in dogs. However, a significant (p = 0.027) difference was found in pigs in the wash-in period. TTP was delayed in the occluded parenchyma in pigs (p = 0.013) but not in dogs (p = 0.892). Xenon-ventilation CT allows the quantification of collateral ventilation and detection of differences between canine and swine models of bronchial obstruction.

  8. Optimized evaluation of a pulsed 2.09 microns holmium:YAG laser impact on the rat brain and 3 D-histomorphometry of the collateral damage.

    Science.gov (United States)

    Ludwig, H C; Bauer, C; Fuhrberg, P; Teichmann, H H; Birbilis, T; Markakis, E

    1998-12-01

    Since more than 20 years CO2 and Nd:YAG lasers are established in the microsurgery of the nervous system. CO2 lasers can be used handheld, but may be focused on the target area by mirror optics and sideports of the operating microscope's micromanipulator. Nd:YAG lasers have the disadvantage of deep penetration into the brain and provocation of a large collateral damage. The need is for a fibre conducted solid system for surgery in delicate areas as for brain stem surgery. Fibre conduction of near infrared lasers allows better exposure of the target area compared to hollow wave guides or mirror equipment. Fibres can be tapered and modified according to the purpose. The holmium:YAG (Ho:YAG) laser has acquired interest by introducing the system into microsurgery of parenchymal tissue. They have not been proven yet sufficiently for neurosurgical tasks. The effort to minimalize the collateral tissue damage has to be maximalized in the surgery of nervous tissue and functional low redundant brain stem or spinal cord tissue. Volumetric data may be more precise in comparison to depth and width data of the laser lesion even when the different levels of the tissue interaction have to be analyzed for estimation of the real side effects in nervous tissue. We have used 50-800 ml delivered Ho:YAG single pulses in cortical areas of Sprague-Dawley rats and investigated the different lesion zones by volumetric data. The functional lesion zone was detected and measured by immunohistological staining of the heat shock protein HSP 72. For further reduction of the focus area, we have used tapered 400 to 200 microns fibres.

  9. Nociceptive afferents to the premotor neurons that send axons simultaneously to the facial and hypoglossal motoneurons by means of axon collaterals.

    Directory of Open Access Journals (Sweden)

    Yulin Dong

    Full Text Available It is well known that the brainstem premotor neurons of the facial nucleus and hypoglossal nucleus coordinate orofacial nociceptive reflex (ONR responses. However, whether the brainstem PNs receive the nociceptive projection directly from the caudal spinal trigeminal nucleus is still kept unclear. Our present study focuses on the distribution of premotor neurons in the ONR pathways of rats and the collateral projection of the premotor neurons which are involved in the brainstem local pathways of the orofacial nociceptive reflexes of rat. Retrograde tracer Fluoro-gold (FG or FG/tetramethylrhodamine-dextran amine (TMR-DA were injected into the VII or/and XII, and anterograde tracer biotinylated dextran amine (BDA was injected into the caudal spinal trigeminal nucleus (Vc. The tracing studies indicated that FG-labeled neurons receiving BDA-labeled fibers from the Vc were mainly distributed bilaterally in the parvicellular reticular formation (PCRt, dorsal and ventral medullary reticular formation (MdD, MdV, supratrigeminal nucleus (Vsup and parabrachial nucleus (PBN with an ipsilateral dominance. Some FG/TMR-DA double-labeled premotor neurons, which were observed bilaterally in the PCRt, MdD, dorsal part of the MdV, peri-motor nucleus regions, contacted with BDA-labeled axonal terminals and expressed c-fos protein-like immunoreactivity which induced by subcutaneous injection of formalin into the lip. After retrograde tracer wheat germ agglutinated horseradish peroxidase (WGA-HRP was injected into VII or XII and BDA into Vc, electron microscopic study revealed that some BDA-labeled axonal terminals made mainly asymmetric synapses on the dendritic and somatic profiles of WGA-HRP-labeled premotor neurons. These data indicate that some premotor neurons could integrate the orofacial nociceptive input from the Vc and transfer these signals simultaneously to different brainstem motonuclei by axonal collaterals.

  10. [Application of pie-crusting the medial collateral ligament release in arthroscopic surgery for posterior horn of 
medial meniscus in knee joint].

    Science.gov (United States)

    Zhu, Weihong; Tang, Qi; Liao, Lele; Li, Ding; Yang, Yang; Chen, You

    2017-09-28

    To explore the effectiveness and safety of pie-crusting the medial collateral ligament release (MCL) in treating posterior horn of medial meniscus (PHMM) tear in tight medial tibiofemoral compartment of knee joint.
 Methods: Thirty-two consecutive patients with PHMM tear in tight medial tibiofemoral compartment of knee joint were admitted to our department from January, 2013 to December, 2014. All patients were performed pie-crusting the MCL release at its tibial insertion with 18-gauge intravenous needle. All patients were evaluated by valgus stress test and bilateral valgus stress radiograph at postoperative 1st day, 4th week and 12th week. Visual Analogue Scales (VAS), Lysholm scores, Tegner scores and International Knee Documentation Committee (IKDC) scores were recorded at the 1st, 3th, 6th month follow-up, then follow-up every 6 months.
 Results: The mean follow-up was 28 (24-36) months. All cases were negative in valgus stress test. MCL rupture, femoral fracture, articular cartilage lesion and neurovascular injury were not found at the last follow-up. The median medial joint space width of affected side and unaffected side for valgus stress radiographs were 6.8 mm and 4.3 mm (P0.05) at the 12th week, respectively. VAS scores was changed from 4.5±1.5 preoperatively to 1.7±1.0 at the final follow-up (t=16.561, PPie-crusting the medial collateral ligament release is a safe, minimal invasive and effective surgical option for posterior horn of medial meniscus tear in tight medial tibiofemoral compartment of knee joint.

  11. Estudo anatômico e funcional do complexo ligamentar colateral medial do cotovelo Anatomical and functional study of the medial collateral ligament complex of the elbow

    Directory of Open Access Journals (Sweden)

    Marcelo Fernandes Tribst

    2012-12-01

    Full Text Available OBJETIVO: Realizar um estudo anatômico do ligamento colateral medial, um importante estabilizador do cotovelo, em diferentes graus de flexo-extensão do cotovelo. MÉTODOS: Foram dissecados 40 cotovelos para analisar o comportamento funcional das bandas anterior, posterior e transversa do ligamento nas manobras de estresse em valgo do cotovelo durante seu movimento de flexão e extensão em diferentes graus. Determinou-se dois grupos: no GPA foi seccionado, a banda posterior do ligamento, depois a cápsula articular e, por fim, a banda anterior; no GAP, a ordem de dissecação foi inversa. RESULTADOS: No GPA observou-se instabilidade somente na terceira etapa e a média de abertura foi maior entre 50&º e 70&º de flexão de cotovelo; no GAP, a instabilidade apareceu desde a primeira etapa e os graus de flexão com maior instabilidade foram nos mesmos do grupo A. CONCLUSÃO: A banda anterior do ligamento colateral medial do cotovelo é o mais importante estabilizador na instabilidade em valgo do cotovelo e sua atuação principal acontece entre 50º e 70º de flexão do cotovelo. Nível de evidência III, Estudo Diagnóstico - Investigação de um exame para diagnóstico.OBJECTIVE: To carry out an anatomical study of the medial collateral ligament, an important elbow stabilizer in different degrees of elbow flexion-extension. METHODS: Forty elbows were dissected in order to analyze the functional behavior of the anterior, posterior and transverse ligament bands during valgus stress maneuvers of the elbow in different degrees of flexion and extension. Two groups were determined; in the group GPA the posterior band of the ligament was sectioned initially, then the articular capsule and finally the anterior band; in group GAP this order was reversed. RESULTS: Instability was observed in GPA only in the third stage, when there was a greater mean elbow's opening during the flexion (between 50º and 70º; in GAP, the instability was present since the

  12. Evaluation of knee-joint cartilage and menisci ten years after isolated and combined ruptures of the medial collateral ligament. Investigation by weight-bearing radiography, MR imaging and analysis of proteoglycan fragments in the joint fluid

    Energy Technology Data Exchange (ETDEWEB)

    Lundberg, M. [Univ. Hospital, Linkoeping (Sweden). Dept. of Orthopaedics and Sports Medicine (Sweden); Thuomas, K.Aa. [Univ. Hospital, Linkoeping (Sweden). Dept. of Diagnostic Radiology; Messner, K. [Univ. Hospital, Linkoeping (Sweden). Dept. of Orthopaedics and Sports Medicine (Sweden)

    1997-01-01

    Purpose: To compare radiography, MR imaging, and chemical analysis in posttraumatic knees. Material and Methods: Ten matched pairs with either isolated partial rupture of the medial collateral ligament or combined medial collateral ligament/anterior cruciate ligament rupture were compared with matched controls 10 years after trauma. Weight-bearing radiographys and MR examinations were compared with proteoglycan fragment concentrations in the joint fluid. Results: The chemical analyses were similar in both trauma groups. The radiographs showed mild signs of arthrosis in half the patients with combined injury. MR images showed almost all injuried knees to have degenerative changes of various degrees in the cartilage and menisci. More frequent and more advanced changes were found after combined injury than after isolated injury (p<0.01). There were no changes in the controls. Conclusion: MR imaging is the best method for detecting and differentiating early posttraumatic knee arthrosis. (orig.).

  13. Sensitivity and specificity of vertically oriented lateral collateral ligament as an indirect sign of anterior cruciate ligament tear on magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Palle, Lalitha; Reddy, Balaji; Reddy, Jagannath [Focus Diagnostics, Sai Baba Temple Lane, Dwarakapuri Colony, Hyderabad, Andhra Pradesh (India)

    2010-11-15

    To evaluate the correlation between anterior cruciate ligament (ACL) tear and straightened, vertically oriented lateral collateral ligament (LCL). This study included 556 patients who underwent MRI of the knee and were divided into three subsets based on ACL morphology. Subset 1 included patients with unequivocal normal ACL. Subset 2 included patients with unequivocal ACL tears. Subset 3 included patients with doubtful ACL who underwent arthroscopy. MR images were reviewed and sensitivity and specificity of vertically oriented LCL as an indirect sign of ACL tear were calculated. The MRI results were as follows: subset 1, out of 282 patients, 270 had oblique LCL and 12 demonstrated vertical LCL; subset 2, out of 212 patients, 189 demonstrated vertical LCL and 23 revealed oblique LCL; subset 3, out of 62 patients, 28 patients with vertical orientation of LCL had a possible ACL tear. Patients with oblique LCL orientation (34) were reported as probably having normal ACL. On comparison with arthroscopy, in 28 patients who we reported as having possible ACL tears, there were 17 patients with torn ACL. The rest of the 11 patients revealed no ACL tears. In the group of 34 patients in whom we reported possible normal, arthroscopy-confirmed tear in 5 patients. Sensitivity and specificity of vertical LCL as an indirect sign of ACL tear was found to be 88% and the specificity 92.85%. Vertically oriented LCL is a useful indirect MRI sign of ACL tear and aids in making a diagnosis, when ACL appearance is equivocal. (orig.)

  14. Interactive 3D Analysis of Blood Vessel Trees and Collateral Vessel Volumes in Magnetic Resonance Angiograms in the Mouse Ischemic Hindlimb Model.

    Science.gov (United States)

    Marks, Peter C; Preda, Marilena; Henderson, Terry; Liaw, Lucy; Lindner, Volkhard; Friesel, Robert E; Pinz, Ilka M

    2013-10-31

    The quantitative analysis of blood vessel volumes from magnetic resonance angiograms (MRA) or μCT images is difficult and time-consuming. This fact, when combined with a study that involves multiple scans of multiple subjects, can represent a significant portion of research time. In order to enhance analysis options and to provide an automated and fast analysis method, we developed a software plugin for the ImageJ and Fiji image processing frameworks that enables the quick and reproducible volume quantification of blood vessel segments. The novel plugin named Volume Calculator (VolCal), accepts any binary (thresholded) image and produces a three-dimensional schematic representation of the vasculature that can be directly manipulated by the investigator. Using MRAs of the mouse hindlimb ischemia model, we demonstrate quick and reproducible blood vessel volume calculations with 95 - 98% accuracy. In clinical settings this software may enhance image interpretation and the speed of data analysis and thus enhance intervention decisions for example in peripheral vascular disease or aneurysms. In summary, we provide a novel, fast and interactive quantification of blood vessel volumes for single blood vessels or sets of vessel segments with particular focus on collateral formation after an ischemic insult.

  15. Improved visualization of collateral ligaments of the ankle: multiplanar reconstructions based on standard 2D turbo spin-echo MR images

    Energy Technology Data Exchange (ETDEWEB)

    Duc, Sylvain R.; Mengiardi, Bernard; Pfirrmann, Christian W.A.; Hodler, Juerg; Zanetti, Marco [University Hospital, Balgrist, From the Departments of Radiology, Zurich (Switzerland)

    2007-05-15

    The purpose of the study was to evaluate the visualization of the collateral ankle ligaments on multiplanar reconstructions (MPR) based on standard 2D turbo spin-echo images. Coronal and axial T2-weighted turbo spin-echo and MPR angled parallel to the course of the ligaments of 15 asymptomatic and 15 symptomatic ankles were separately analyzed by two musculoskeletal radiologists. Image quality was assessed in the asymptomatic ankles qualitatively. In the symptomatic ankles interobserver agreement and reader confidence was determined for each ligament. On MPR the tibionavicular and calcaneofibular ligaments were more commonly demonstrated on a single image than on standard MR images (reader 1: 13 versus 0, P=0.002; reader 2: 14 versus 1, P=0.001 and reader 1: 13 versus 2, P=0.001; reader 2: 14 versus 0, P<0.001). The tibionavicular ligament was considered to be better delineated on MPR by reader 1 (12 versus 3, P=0.031). In the symptomatic ankles, reader confidence was greater with MPR for all ligaments except for the tibiocalcanear ligament (both readers) and the anterior and posterior talofibular ligaments (for reader 2). Interobserver agreement was increased with MPR for the tibionavicular ligament. Multiplanar reconstructions of 2D turbo spin-echo images improve the visualization of the tibionavicular and calcaneofibular ligaments and strengthen diagnostic confidence for these ligaments. (orig.)

  16. A modified Larson’s method of posterolateral corner reconstruction of the knee reproducing the physiological tensioning pattern of the lateral collateral and popliteofibular ligaments

    Directory of Open Access Journals (Sweden)

    Niki Yasuo

    2012-06-01

    Full Text Available Abstract Background Consensus has been lacking as to how to reconstruct the posterolateral corner (PLC of the knee in patients with posterolateral instability. We describe a new reconstructive technique for PLC based on Larson's method, which reflects the physiological load-sharing pattern of the lateral collateral ligament (LCL and popliteofibular ligament (PFL. Findings Semitendinosus graft is harvested, and one limb of the graft comprises PFL and the other comprises LCL. Femoral bone tunnels for the LCL and popliteus tendon are made at their anatomical insertions. Fibular bone tunnel is prepared from the anatomical insertion of the LCL to the proximal posteromedial portion of the fibular head, which corresponds to the insertion of the PFL. The graft end for popliteus tendon is delivered into the femoral bone tunnel and secured on the medial femoral condyle. The other end for LCL is passed through the fibular tunnel from posterior to anterior. While the knee is held in 90 of flexion, the graft is secured in the fibular tunnel using a 5 mm interference screw. Then, the LCL end is passed into the femoral bone tunnel and secured at the knee in extension. Conclusions Differential tension patterns between LCL and PFL is critical when securing these graft limbs. Intrafibular fixation of the graft using a small interference screw allows us to secure these two graft limbs independently with intended tension at the intended flexion angle of the knee.

  17. Is it safe to reconstruct the knee Anterolateral Ligament with a femoral tunnel? Frequency of Lateral Collateral Ligament and Popliteus Tendon injury.

    Science.gov (United States)

    Helito, Camilo Partezani; Bonadio, Marcelo Batista; Gobbi, Riccardo Gomes; da Mota E Albuquerque, Roberto Freire; Pécora, José Ricardo; Camanho, Gilberto Luis; Demange, Marco Kawamura

    2016-04-01

    This study sought to determine the safety limits for performing a femoral bone tunnel to reconstruct the knee anterolateral ligament (ALL) by establishing its distance from the lateral collateral ligament (LCL) and the popliteus muscle tendon (PT) on the lateral femoral condyle. Anatomic study on 48 knee cadaveric specimens. The femoral attachments of the studied structures were isolated, and the distance between them was measured. For each cadaver, the percentage of cases in which at least 50 % of the LCL and PT would be injured when using 4- to 12-mm-diameter drills in an ALL reconstruction procedure was evaluated. The LCL and PT were 3.8 mm and 10.2 mm distant from the ALL, respectively. A 4-mm tunnel would cause LCL injury in 8.3 % of cases, with increasing incidence of injury up to 87.5 % with a 12-mm drill. Injury to the PT would start with the 10-mm drill, causing injury in 2.0 % of cases. Performing a tunnel in the center of the ALL may cause an iatrogenic injury to the LCL origin. No cases of PT injury are expected to occur with drills smaller than 10 mm.

  18. Biomechanical and histologic evaluation of tissue engineered ligaments using chitosan and hyaluronan hybrid polymer fibers: a rabbit medial collateral ligament reconstruction model.

    Science.gov (United States)

    Irie, Toru; Majima, Tokifumi; Sawaguchi, Naohiro; Funakoshi, Tadanao; Nishimura, Shin-Ichiro; Minami, Akio

    2011-05-01

    In this study, we used a rabbit medial collateral ligament reconstruction model to evaluate a novel chitosan-based hyaluronan hybrid polymer fiber scaffold for ligament tissue engineering and to examine whether mechanical forces exerted in an in vivo model increased extracellular matrix production by seeded fibroblasts. Scaffolds were used 2 weeks after incubation with fibroblasts obtained from the same rabbit in a cell-seeded scaffold (CSS) group and without cells in a noncell-seeded scaffold (NCSS) group. At 3, 6, and 12 weeks after surgery, the failure loads of the engineered ligaments in the CSS groups were significantly greater than those in the NCSS groups. At 6 weeks after surgery, the reconstructed tissue of the CSS group was positive for type I collagen, whereas that in the NCSS group was negative for type I collagen. At 12 weeks after surgery, the reconstructed tissue stained positive for type I collagen in the CSS group, but negative in the NCSS group. Our results indicate that the scaffold material enhanced the production of type I collagen and led to improved mechanical strength in the engineered ligament in vivo. Copyright © 2011 Wiley Periodicals, Inc.

  19. Systemic-to-pulmonary collateral flow in patients with palliated univentricular heart physiology: measurement using cardiovascular magnetic resonance 4D velocity acquisition

    Directory of Open Access Journals (Sweden)

    Valverde Israel

    2012-04-01

    Full Text Available Abstract Background Systemic-to-pulmonary collateral flow (SPCF may constitute a risk factor for increased morbidity and mortality in patients with single-ventricle physiology (SV. However, clinical research is limited by the complexity of multi-vessel two-dimensional (2D cardiovascular magnetic resonance (CMR flow measurements. We sought to validate four-dimensional (4D velocity acquisition sequence for concise quantification of SPCF and flow distribution in patients with SV. Methods 29 patients with SV physiology prospectively underwent CMR (1.5 T (n = 14 bidirectional cavopulmonary connection [BCPC], age 2.9 ± 1.3 years; and n = 15 Fontan, 14.4 ± 5.9 years and 20 healthy volunteers (age, 28.7 ± 13.1 years served as controls. A single whole-heart 4D velocity acquisition and five 2D flow acquisitions were performed in the aorta, superior/inferior caval veins, right/left pulmonary arteries to serve as gold-standard. The five 2D velocity acquisition measurements were compared with 4D velocity acquisition for validation of individual vessel flow quantification and time efficiency. The SPCF was calculated by evaluating the disparity between systemic (aortic minus caval vein flows and pulmonary flows (arterial and venour return. The pulmonary right to left and the systemic lower to upper body flow distribution were also calculated. Results The comparison between 4D velocity and 2D flow acquisitions showed good Bland-Altman agreement for all individual vessels (mean bias, 0.05±0.24 l/min/m2, calculated SPCF (−0.02±0.18 l/min/m2 and significantly shorter 4D velocity acquisition-time (12:34 min/17:28 min,p 2; Fontan 0.62±0.82 l/min/m2 and not in controls (0.01 + 0.16 l/min/m2, (3 inverse relation of right/left pulmonary artery perfusion and right/left SPCF (Pearson = −0.47,p = 0.01 and (4 upper to lower body flow distribution trend related to the weight (r = 0.742, p  Conclusions 4D

  20. Increased lubricin/proteoglycan 4 gene expression and decreased modulus in medial collateral ligaments following ovariohysterectomy in the adult rabbit: Evidence consistent with aging.

    Science.gov (United States)

    Lemmex, Devin B; Ono, Yohei; Reno, Carol R; Hart, David A; Lo, Ian K Y; Thornton, Gail M

    2016-02-08

    This study investigated whether ovariohysterectomy (OVH) surgery to induce menopause resulted in changes to modulus, failure strain and lubricin/proteoglycan 4 (PRG4) gene expression in rabbit medial collateral ligaments (MCLs), similar to aging (Thornton et al., 2015a). The MCLs from adult rabbits that underwent OVH surgery as adolescents (15-week-old) and adults (1-year-old) were compared by evaluating mechanical behaviour (adolescent OVH, n=8; adult OVH, n=7; normal, n=7), gene expression (adolescent OVH, n=9; adult OVH, n=8; normal, n=8), and collagen and glycosaminoglycan (adolescent OVH, n=9; adult OVH, n=8; normal, n=8) and water (adolescent OVH, n=9; adult OVH, n=8; normal, n=8) content. Mechanical behaviour evaluated cyclic, static and total creep strain, and ultimate tensile strength, modulus and failure strain. The RT-qPCR assessed mRNA levels for matrix regulatory genes. Adult OVH MCLs exhibited increased cyclic creep and failure strain, and decreased modulus with increased mRNA levels for lubricin/PRG4 and collagen I compared with normal MCLs. Adolescent OVH MCLs exhibited increased cyclic, static and total creep strain with decreased mRNA levels for the progesterone receptor. Lubricin/PRG4 plays a role in the lubrication of collagen fascicles which is likely related to the decreased modulus and increased failure strain observed in ligaments from adult OVH rabbits. Progesterone and its receptor are thought to play a role in the stretching of ligaments in pelvic organ prolapse and pregnancy which is likely related to the increase in creep strain observed in ligaments from adolescent OVH rabbits. Ovariohysterectomy in adult rabbits resulted in changes that were consistent with the aging MCL. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. A quantitative study of the relationship between the distribution of different types of collagen and the mechanical behavior of rabbit medial collateral ligaments.

    Science.gov (United States)

    Wan, Chao; Hao, Zhixiu; Wen, Shizhu; Leng, Huijie

    2014-01-01

    The mechanical properties of ligaments are key contributors to the stability and function of musculoskeletal joints. Ligaments are generally composed of ground substance, collagen (mainly type I and III collagen), and minimal elastin fibers. However, no consensus has been reached about whether the distribution of different types of collagen correlates with the mechanical behaviors of ligaments. The main objective of this study was to determine whether the collagen type distribution is correlated with the mechanical properties of ligaments. Using axial tensile tests and picrosirius red staining-polarization observations, the mechanical behaviors and the ratios of the various types of collagen were investigated for twenty-four rabbit medial collateral ligaments from twenty-four rabbits of different ages, respectively. One-way analysis of variance was used in the comparison of the Young's modulus in the linear region of the stress-strain curves and the ratios of type I and III collagen for the specimens (the mid-substance specimens of the ligaments) with different ages. A multiple linear regression was performed using the collagen contents (the ratios of type I and III collagen) and the Young's modulus of the specimens. During the maturation of the ligaments, the type I collagen content increased, and the type III collagen content decreased. A significant and strong correlation (R2 = 0.839, P ligaments might provide a new perspective for evaluating the linear modulus of global stress-strain curves for ligaments and open a new door for studying the mechanical behaviors and functions of connective tissues.

  2. Length of time between surgery and return to sport after ulnar collateral ligament reconstruction in Major League Baseball pitchers does not predict need for revision surgery.

    Science.gov (United States)

    Erickson, Brandon J; Chalmers, Peter N; Bach, Bernard R; Dines, Joshua S; Verma, Nikhil N; Bush-Joseph, Charles A; Cohen, Steven B; Romeo, Anthony A

    2017-04-01

    Pitchers who return to sport (RTS) sooner will have a higher risk of revision ulnar collateral ligament reconstruction (UCLR) than those who return later. All professional (major and minor league) baseball pitchers who underwent UCLR between 1974 and 2016 were identified. Date of the index UCLR was recorded. The date of the first game back at any professional level after surgery and the date the pitcher returned to the same level of play (if applicable) were recorded. Length of time between these dates was compared for pitchers who required a revision UCLR and those who did not. Overall, 569 pitchers (average age, 24.8 ± 4.1 years) underwent UCLR and had reliable game logs after surgery. No statistically significant difference existed in the length of time to RTS at any professional level or at the same professional level between those pitchers who did not require a revision UCLR and those who did (P = .442, P = .238). Pitchers who required revision UCLR returned to any level of play almost 2 months earlier (14.7 vs. 16.5 months) and returned to the same level of play >2 months earlier (15.2 vs. 17.7 months) than matched controls who did not require revision UCLR, although this was not statistically significant (P = .179, P = .204). No statistically significant difference existed in the length of time to RTS after UCLR in professional baseball players who required a revision UCLR and those who did not. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  3. Algorithmic pie-crusting of the medial collateral ligament guided by sensing technology affects the use of constrained inserts during total knee arthroplasty.

    Science.gov (United States)

    Amundsen, Spencer; Lee, Yuo-Yu; González Della Valle, Alejandro

    2017-06-01

    Intra-operative sensing technology is an alternative to standard techniques in total knee arthroplasty (TKA) for determining balance by providing quantitative analysis of loads and point of contact throughout a range of motion. We used intra-operative sensing (VERASENSE-OrthoSensor, Inc.) to examine pie-crusting release of the medial collateral ligament in knees with varus deformity (study group) in comparison to a control group where balance was obtained using a classic release technique and assessed using laminar spreaders, spacer blocks, manual stress, and a ruler. The surgery was performed by a single surgeon utilizing measured resection and posterior-stabilized, cemented implants. Seventy-five study TKAs were matched 1:3 with 225 control TKAs. Outcome variables included the use of a constrained insert, functional- and knee-specific Knee Society score (KSS) at six weeks, four months, and one year post-operatively. Outcomes were analyzed in a multivariate model controlling for age, sex, BMI, and severity of deformity. The use of a constrained insert was significantly lower in the study group (5.3 vs. 13.8%; p = 0.049). The use of increased constraint was not significant between groups with increasing deformity. There was no difference in functional KSS and knee-specific KSS between groups at any follow-up interval. An algorithmic pie-crusting technique guided by intra-operative sensing is associated with decreased use of constrained inserts in TKA patients with a pre-operative varus deformity. This may cause a positive shift in value and cost savings.

  4. The pie-crusting technique using a blade knife for medial collateral ligament release is unreliable in varus total knee arthroplasty.

    Science.gov (United States)

    Kwak, Dai-Soon; In, Yong; Kim, Tae Kyun; Cho, Han Suk; Koh, In Jun

    2016-01-01

    Despite the documented clinical efficacy of the pie-crusting technique for medial collateral ligament (MCL) release in varus total knee arthroplasty, its quantitative effects on medial gaps and safety remain unclear. This study was undertaken to determine the efficacy (quantitative effect and consistency of the number of punctures) and the safety (frequency of early over-release) of the pie-crusting technique for MCL release. From ten pairs of cadaveric knees, one knee from each pair was randomly assigned to undergo pie crusting in extension (group E) or in flexion (group F). Pie crusting was performed in the superficial MCL using a blade until over-release occurred. After every puncture, the incremental medial gap increase was recorded, and the number of punctures required for 2- or 4-mm gap increases was assessed. In group E, the extension gap increased from 0.8 to 5.0 mm and the flexion gap increased from 0.8 to 3.0 mm. In group F, the extension gap increased from 1.0 to 3.0 mm and the flexion gap increased from 2.6 to 6.0 mm. However, the gap increments were inconsistent with those that followed the preceding blade punctures, and the number of punctures required to increase the gaps by 2 or 4 mm was variable. The number of punctures leading to over-release in group E and group F was 6 ± 1 and 3 ± 1 punctures, respectively. Overall, 70% of over-release occurred earlier than the average number of punctures leading to over-release. Pie crusting led to unpredictable gap increments and to frequent early over-release. Surgeons should decide carefully before using the pie-crusting technique for MCL release and should be cautious of performing throughout the procedure, especially when performing in a flexed knee. Therapeutic study, Level I.

  5. Prodrug enzymes and their applications in image-guided therapy of cancer: tracking prodrug enzymes to minimize collateral damage.

    Science.gov (United States)

    Penet, Marie-France; Chen, Zhihang; Li, Cong; Winnard, Paul T; Bhujwalla, Zaver M

    2012-02-01

    Many cytotoxic therapies are available to kill cancer cells. Unfortunately, these also inflict significant damage on normal cells. Identifying highly effective cancer treatments that have minimal or no side effects continues to be a major challenge. One of the strategies to minimize damage to normal tissue is to deliver an activating enzyme that localizes only in the tumor and converts a nontoxic prodrug to a cytotoxic agent locally in the tumor. Such strategies have been previously tested but with limited success due in large part to the uncertainty in the delivery and distribution of the enzyme. Imaging the delivery of the enzyme to optimize timing of the prodrug administration to achieve image-guided prodrug therapy would be of immense benefit for this strategy. Here, we have reviewed advances in the incorporation of image guidance in the applications of prodrug enzymes in cancer treatment. These advances demonstrate the feasibility of using clinically translatable imaging in these prodrug enzyme strategies.

  6. Effect of Shunting of Collateral Flow into the Venous System on Arteriogenesis and Angiogenesis in Rabbit Hind Limb

    Science.gov (United States)

    Yang, Bao-lin; Wu, Song; Wu, Xiaoqiong; Li, Ming Bo; Zhu, Wu; Guan, Yinglu; Liu, Li-Hua; Luo, Ming-ying; Cai, Wei-Jun; Schaper, Jutta; Schaper, Wolfgang

    2013-01-01

    The aim of this study was to characterize the vascular remodeling in the external iliac artery (EIA) and the lower leg muscles in a rabbit shunt model created between the distal stump of the occluded femoral artery and the accompanying vein. Histology and immunoconfocal microscopy were used in this study. We found that: 1) both endothelial nitric oxide synthase (eNOS) and phosphorylated eNOS (P-eNOS) proteins were significantly increased in the shunt-side EIA; 2) matrix metalloproteinase-2 (MMP-2) expression was 5.5 times in shunt side EIA over that in normal EIA; 3) intercellular adhension molecule-1 (ICAM-1) expression was strongly induced in endothelial cells (EC) and vascular adhension molecule-1 (VCAM-1) expression was significantly increased in both EC and the adventitia of the shunt-side EIA; 4) augmentation of cell proliferation and extracellular proteolysis by macrophage infiltration was observed in shunt-side EIA; 5) cell proliferation was active in shunt side EIA, but quiet in shunt side lower leg’s arterial vessels; 6) capillary density in shunt side lower leg muscles was 2 times over that in normal side. In conclusion, our data demonstrate the paradigm that the power of shear stress takes the reins in arteriogenesis, whereas ischemia in angiogenesis, but not in arteriogenesis. PMID:23554534

  7. Tyrosine phosphatase STEP is a tonic brake on induction of long-term potentiation.

    Science.gov (United States)

    Pelkey, Kenneth A; Askalan, Rand; Paul, Surojit; Kalia, Lorraine V; Nguyen, Tri Hung; Pitcher, Graham M; Salter, Michael W; Lombroso, Paul J

    2002-03-28

    The functional roles of protein tyrosine phosphatases (PTPs) in the developed CNS have been enigmatic. Here we show that striatal enriched tyrosine phosphatase (STEP) is a component of the N-methyl-D-aspartate receptor (NMDAR) complex. Functionally, exogenous STEP depressed NMDAR single-channel activity in excised membrane patches. STEP also depressed NMDAR-mediated synaptic currents whereas inhibiting endogenous STEP enhanced these currents. In hippocampal slices, administering STEP into CA1 neurons did not affect basal glutamatergic transmission evoked by Schaffer collateral stimulation but prevented tetanus-induced long-term potentiation (LTP). Conversely, inhibiting STEP in CA1 neurons enhanced transmission and occluded LTP induction through an NMDAR-, Src-, and Ca(2+)-dependent mechanism. Thus, STEP acts as a tonic brake on synaptic transmission by opposing Src-dependent upregulation of NMDARs.

  8. Impact of different exercise training modalities on the coronary collateral circulation and plaque composition in patients with significant coronary artery disease (EXCITE trial: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Uhlemann Madlen

    2012-09-01

    Full Text Available Abstract Background Exercise training (ET in addition to optimal medical therapy (OMT in patients with stable coronary artery disease (CAD has been demonstrated to be superior to percutaneous coronary interventions (PCI with respect to the composite endpoint of death, myocardial infarction, stroke, revascularization and hospitalization due to worsening of angina. One mechanism leading to this superiority discussed in the literature is the increase in coronary collateral blood flow due to ET. Until now, data demonstrating the positive effect of ET on the collateral blood flow and the functional capacity of the coronary collateral circulation are still lacking. Methods/design The EXCITE trial is a three-armed randomized, prospective, single-center, open-label, controlled study enrolling 60 patients with stable CAD and at least one significant coronary stenosis (fractional flow reserve ≤0.75. The study is designed to compare the influence and efficacy of two different 4-week ET programs [high-intensity interval trainings (IT versus moderate-intensity exercise training (MT in addition to OMT] versus OMT only on collateral blood flow (CBF. The primary efficacy endpoint is the change of the CBF of the target vessel after 4 weeks as assessed by coronary catheterization with a pressure wire during interruption of the antegrade flow of the target vessel by balloon occlusion. Secondary endpoints include the change in plaque composition as assessed by intravascular ultrasound (IVUS after 4 weeks, myocardial perfusion as analyzed in MRI after 4 weeks and 12 months, peak oxygen uptake (V02 peak, change in endothelial function and biomarkers after 4 weeks, 3, 6 and 12 months. The safety endpoint addresses major adverse cardiovascular events (death from cardiovascular cause, myocardial infarction, stroke, TIA, target vessel revascularization or hospitalization after 12 months. Discussion The trial investigates whether ET for 4 weeks increases the CBF in

  9. Impact of different exercise training modalities on the coronary collateral circulation and plaque composition in patients with significant coronary artery disease (EXCITE trial): study protocol for a randomized controlled trial

    Science.gov (United States)

    2012-01-01

    Background Exercise training (ET) in addition to optimal medical therapy (OMT) in patients with stable coronary artery disease (CAD) has been demonstrated to be superior to percutaneous coronary interventions (PCI) with respect to the composite endpoint of death, myocardial infarction, stroke, revascularization and hospitalization due to worsening of angina. One mechanism leading to this superiority discussed in the literature is the increase in coronary collateral blood flow due to ET. Until now, data demonstrating the positive effect of ET on the collateral blood flow and the functional capacity of the coronary collateral circulation are still lacking. Methods/design The EXCITE trial is a three-armed randomized, prospective, single-center, open-label, controlled study enrolling 60 patients with stable CAD and at least one significant coronary stenosis (fractional flow reserve ≤0.75). The study is designed to compare the influence and efficacy of two different 4-week ET programs [high-intensity interval trainings (IT) versus moderate-intensity exercise training (MT) in addition to OMT] versus OMT only on collateral blood flow (CBF). The primary efficacy endpoint is the change of the CBF of the target vessel after 4 weeks as assessed by coronary catheterization with a pressure wire during interruption of the antegrade flow of the target vessel by balloon occlusion. Secondary endpoints include the change in plaque composition as assessed by intravascular ultrasound (IVUS) after 4 weeks, myocardial perfusion as analyzed in MRI after 4 weeks and 12 months, peak oxygen uptake (V02 peak), change in endothelial function and biomarkers after 4 weeks, 3, 6 and 12 months. The safety endpoint addresses major adverse cardiovascular events (death from cardiovascular cause, myocardial infarction, stroke, TIA, target vessel revascularization or hospitalization) after 12 months. Discussion The trial investigates whether ET for 4 weeks increases the CBF in patients with

  10. Rosiglitazone Suppresses In Vitro Seizures in Hippocampal Slice by Inhibiting Presynaptic Glutamate Release in a Model of Temporal Lobe Epilepsy.

    Directory of Open Access Journals (Sweden)

    Shi-Bing Wong

    Full Text Available Peroxisomal proliferator-activated receptor gamma (PPARγ is a nuclear hormone receptor whose agonist, rosiglitazone has a neuroprotective effect to hippocampal neurons in pilocarpine-induced seizures. Hippocampal slice preparations treated in Mg2+ free medium can induce ictal and interictal-like epileptiform discharges, which is regarded as an in vitro model of N-methyl-D-aspartate (NMDA receptor-mediated temporal lobe epilepsy (TLE. We applied rosiglitazone in hippocampal slices treated in Mg2+ free medium. The effects of rosiglitazone on hippocampal CA1-Schaffer collateral synaptic transmission were tested. We also examined the neuroprotective effect of rosiglitazone toward NMDA excitotoxicity on cultured hippocampal slices. Application of 10 μM rosiglitazone significantly suppressed amplitude and frequency of epileptiform discharges in CA1 neurons. Pretreatment with the PPARγ antagonist GW9662 did not block the effect of rosiglitazone on suppressing discharge frequency, but reverse the effect on suppressing discharge amplitude. Application of rosiglitazone suppressed synaptic transmission in the CA1-Schaffer collateral pathway. By miniature excitatory-potential synaptic current (mEPSC analysis, rosiglitazone significantly suppressed presynaptic neurotransmitter release. This phenomenon can be reversed by pretreating PPARγ antagonist GW9662. Also, rosiglitazone protected cultured hippocampal slices from NMDA-induced excitotoxicity. The protective effect of 10 μM rosiglitazone was partially antagonized by concomitant high dose GW9662 treatment, indicating that this effect is partially mediated by PPARγ receptors. In conclusion, rosiglitazone suppressed NMDA receptor-mediated epileptiform discharges by inhibition of presynaptic neurotransmitter release. Rosiglitazone protected hippocampal slice from NMDA excitotoxicity partially by PPARγ activation. We suggest that rosiglitazone could be a potential agent to treat patients with TLE.

  11. Relative strain in the anterior cruciate ligament and medial collateral ligament during simulated jump landing and sidestep cutting tasks: implications for injury risk.

    Science.gov (United States)

    Bates, Nathaniel A; Nesbitt, Rebecca J; Shearn, Jason T; Myer, Gregory D; Hewett, Timothy E

    2015-09-01

    The medial collateral (MCL) and anterior cruciate ligaments (ACL) are, respectively, the primary and secondary ligamentous restraints against knee abduction, which is a component of the valgus collapse often associated with ACL rupture during athletic tasks. Despite this correlation in function, MCL ruptures occur concomitantly in only 20% to 40% of ACL injuries. The purpose of this investigation was to determine how athletic tasks load the knee joint in a manner that could lead to ACL failure without concomitant MCL failure. It was hypothesized that (1) the ACL would provide greater overall contribution to intact knee forces than the MCL during simulated motion tasks and (2) the ACL would show greater relative peak strain compared with the MCL during simulated motion tasks. Controlled laboratory study. A 6-degrees-of-freedom robotic manipulator articulated 18 cadaveric knees through simulations of kinematics recorded from in vivo drop vertical jump and sidestep cutting tasks. Specimens were articulated in the intact-knee and isolated-ligament conditions. After simulation, each ACL and MCL was failed in uniaxial tension along its fiber orientations. During a drop vertical jump simulation, the ACL experienced greater peak strain than the MCL (6.1% vs 0.4%; P anterior force (4.8% vs 0.3% body weight; P < .01), medial force (1.6% vs 0.4% body weight; P < .01), flexion torque (8.4 vs 0.4 N·m; P < .01), abduction torque (2.6 vs 0.3 N·m; P < .01), and adduction torque (0.5 vs 0.0 N·m; P = .03) than the isolated MCL. During failure testing, ACL specimens preferentially loaded in the anteromedial bundle failed at 637 N, while MCL failure occurred at 776 N. During controlled physiologic athletic tasks, the ACL provides greater contributions to knee restraint than the MCL, which is generally unstrained and minimally loaded. Current findings support that multiplanar loading during athletic tasks preferentially loads the ACL over the MCL, leaving the ACL more susceptible to

  12. Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction.

    Science.gov (United States)

    Dong, Jiangtao; Wang, Xiao Feng; Men, Xiaoqian; Zhu, Junjun; Walker, Garth N; Zheng, Xiao Zuo; Gao, Jin Bao; Chen, Baicheng; Wang, Fei; Zhang, Yingze; Gao, Shi Jun

    2015-06-01

    The purpose of this study was to evaluate the clinical results of medial collateral ligament (MCL) anatomic ligament repair (ALR) and triangular ligament reconstruction (TLR) in treating acute grade III MCL injury with respect to imaging and functional results. Between January 2009 and October 2011, a total of 69 patients with an acute grade III MCL tear combined with an anterior cruciate ligament tear were divided into 2 groups: those who underwent ALR and those who underwent TLR. Single-bundle anterior cruciate ligament reconstruction was also performed in all patients. A radiographic stress-position imaging test was performed to evaluate excessive medial opening of the knee. In addition, the Slocum test was carried out to assess anteromedial rotatory instability before surgery and at follow-up. The subjective symptoms and functional outcomes were evaluated preoperatively and postoperatively with International Knee Documentation Committee (IKDC) assessment. Sixty-four patients with a mean follow-up period of 34 months were included in the final analysis. The measurement results for medial opening at the last follow-up appointment decreased significantly from the pretreatment measurements and fell within the normal range, without a statistically significant difference between the 2 groups (P > .05). The overall incidence of anteromedial rotatory instability was reduced to 21.9% compared with 62.5% preoperatively. However, the incidence of anteromedial rotatory instability in the TLR group (9.4%) decreased significantly compared with that in the ALR group (34.4%) (P .05). The comparison of IKDC extension and flexion deficit scores between the 2 groups showed no significant differences. Eleven patients in the ALR group and 4 in the TLR group complained of medial knee pain. The comparison between the 2 groups showed no significant difference (P > .05). The clinical outcomes of this study showed that no major difference existed in the ALR and TLR groups based on IKDC

  13. Opening the medial tibiofemoral compartment by pie-crusting the superficial medial collateral ligament at its tibial insertion: a cadaver study.

    Science.gov (United States)

    Roussignol, X; Gauthe, R; Rahali, S; Mandereau, C; Courage, O; Duparc, F

    2015-09-01

    Arthroscopic treatment of tears in the middle and posterior parts of the medial meniscus can be difficult when the medial tibiofemoral compartment is tight. Passage of the instruments may damage the cartilage. The primary objective of this cadaver study was to perform an arthroscopic evaluation of medial tibiofemoral compartment opening after pie-crusting release (PCR) of the superficial medial collateral ligament (sMCL) at its distal insertion on the tibia. The secondary objective was to describe the anatomic relationships at the site of PCR (saphenous nerve, medial saphenous vein). We studied 10 cadaver knees with no history of invasive procedures. The femur was held in a vise with the knee flexed at 45°, and the medial aspect of the knee was dissected. PCR of the sMCL was performed under arthroscopic vision, in the anteroposterior direction, at the distal tibial insertion of the sMCL, along the lower edge of the tibial insertion of the semi-tendinosus tendon. Continuous 300-N valgus stress was applied to the ankle. Opening of the medial tibiofemoral compartment was measured arthroscopically using graduated palpation hooks after sequential PCR of the sMCL. The compartment opened by 1mm after release of the anterior third, 2.3mm after release of the anterior two-thirds, and 3.9mm after subtotal release. A femoral fracture occurred in 1 case, after completion of all measurements. Both the saphenous nerve and the medial saphenous vein were located at a distance from the PCR site in all 10 knees. PCR of the sMCL is chiefly described as a ligament-balancing method during total knee arthroplasty. This procedure is usually performed at the joint line, where it opens the compartment by 4-6mm at the most, with some degree of unpredictability. PCR of the sMCL at its distal tibial insertion provides gradual opening of the compartment, to a maximum value similar to that obtained with PCR at the joint space. The lower edge of the semi-tendinosus tendon is a valuable landmark

  14. 77 FR 60114 - Agency Information Collection Activities Under OMB Review

    Science.gov (United States)

    2012-10-02

    ... Disclosure and Retention of Certain Information Related to Cleared Swaps, Customer Collateral. DATES... Retention of Certain Information Related to Cleared Swaps, Customer Collateral (OMB Control No. 3038-0091.... Disclosure and Retention of Certain Information Related to Cleared Swaps, Customer Collateral. OMB Control No...

  15. AND COLLATERAL SPOUSE-REP

    African Journals Online (AJOL)

    Corresponding author: Henrik Natvig, Department of Psychology, University of Oslo, PO Box 1094 Blindern, N-0317, Oslo,. Norway. ... influence behaviors. The theory divides social norms into injunctive and descrip- tive norms. Injunctive norms are how we believe those close to us want us to behave in a given situation.

  16. Collateral challenge and enforcement notices

    OpenAIRE

    Hough, Barry

    1997-01-01

    Notorious were the fruitless labours of the poet Samuel Taylor Coleridge in steadfastly advocating a distinction between fancy and the imagination - an endeavour in semantics which was always unconvincing Echoes of this kind of sophistry resonate in the very recent decision of the Court of Appeal (Criminal Division) in R v. Wicks which seeks to resurrect, a supposed dichotomy between the nullity and invalidity of an enforcement notice. Unlike Coleridge's metaphysics, such esoteric and outmode...

  17. Medial Collateral Ligament (MCL) Injuries

    Science.gov (United States)

    ... torn MCL tend to play contact sports, like football and soccer. More severe injuries happen when the outside of the knee is ... the things you love — like running or playing football, field hockey, or ... recovering from an MCL injury, especially a severe one, you might feel angry, ...

  18. Deepening Contractions and Collateral Constraints

    DEFF Research Database (Denmark)

    Jensen, Henrik; Ravn, Søren Hove; Santoro, Emiliano

    and occasionally non-binding credit constraints. Easier credit access increases the likelihood that constraints become slack in the face of expansionary shocks, while contractionary shocks are further amplified due to tighter constraints. As a result, busts gradually become deeper than booms. Based...... on the differential impact that occasionally non-binding constraints exert on the shape of expansions and contractions, we are also able to reconcile a more negatively skewed business cycle with a moderation in its volatility. Finally, our model can account for an intrinsic feature of economic downturns preceded...

  19. Evader Interdiction and Collateral Damage

    Energy Technology Data Exchange (ETDEWEB)

    Gutfraind, Alexander [Los Alamos National Laboratory

    2011-01-01

    In network interdiction problems, evaders (hostile agents or data packets) are moving through a network towards their targets and we wish to choose sensor placement locations in order to intercept them before they reach their destinations. Sensor locations should be chosen economically, balancing security gains with cost, including the inconvenience sensors inflict upon innocent travelers. We give optimal sensor allocation algorithms for several classes of special graphs and hardness and optimal approximation results for general graphs, including for deterministic or Markov chain-based and oblivious or reactive evaders. In a similar-sounding but much different problem setting posed by [10] where the innocent travelers can also be reactive, we again give optimal algorithms for special cases and hardness and (essentially) optimal approximation results on general graphs.

  20. Further Evaluations of Collateral Damage

    Science.gov (United States)

    1978-09-29

    a friendly city and that enemy assault units have occupied a section of the city. The likelihood that military operations in built up areas ( MOBA ...maintained. Although the Soviets would prefer to avoid MOBA , they recognize that such engagements could occur and have given consideration to how they...liming cases include: a lower bound in which the population of the city has fled before the MOBA or similar actions have started, and an upper bound

  1. Collateral ligament (CL) injury - aftercare

    Science.gov (United States)

    ... twisting injury. Skiers and people who play basketball, football, or soccer are more likely to have this ... PT will teach you exercises to strengthen the muscles, ligaments, and tendons around your knee. As your ...

  2. Fratura de fíbula e lesões de ligamento colateral e menisco lateral em muar: relato de caso Fibula fracture and injuries to the collateral ligament and lateral meniscus in mules: case report

    Directory of Open Access Journals (Sweden)

    C.O. Silveira

    2013-02-01

    Full Text Available Relata-se a ocorrência de fratura de fíbula e lesões de ligamento colateral e menisco lateral em um muar, fêmea, de dois anos de idade, provavelmente produzida por um coice na região da articulação femorotibiopatelar do membro pélvico esquerdo. O animal apresentava claudicação de grau 5 desse membro e obteve melhora após bloqueio dos nervos fibular, tibial e safena e da articulação afetada. O exame radiográfico da região acometida revelou fratura do terço proximal da fíbula e, ao exame ultrassonográfico, observaram-se pontos anecoicos no ligamento colateral lateral e menisco.This is a report of the occurrence of fibula fracture and injuries of the collateral ligament and lateral meniscus in a two year old mule, probably due to a kick in the joint area of the femurtibiopatellar left pelvic limb. The animal presented degree 5 lameness which improved after a nerve block of the affected joint. Radiographic examination of the affected area revealed a fracture on the proximal third of the fibula, and the ultrasound examination showed anechoic points observed in the lateral collateral ligament and meniscus.

  3. LOCAL SITE CONDITIONS INFLUENCING EARTHQUAKE INTENSITIES AND SECONDARY COLLATERAL IMPACTS IN THE SEA OF MARMARA REGION - Application of Standardized Remote Sensing and GIS-Methods in Detecting Potentially Vulnerable Areas to Earthquakes, Tsunamis and Other Hazards.

    Directory of Open Access Journals (Sweden)

    George Pararas-Carayannis

    2011-01-01

    Full Text Available The destructive earthquake that struck near the Gulf of Izmit along the North Anatolian fault in Northwest Turkey on August 17, 1999, not only generated a local tsunami that was destructive at Golcuk and other coastal cities in the eastern portion of the enclosed Sea of Marmara, but was also responsible for extensive damage from collateral hazards such as subsidence, landslides, ground liquefaction, soil amplifications, compaction and underwater slumping of unconsolidated sediments. This disaster brought attention in the need to identify in this highly populated region, local conditions that enhance earthquake intensities, tsunami run-up and other collateral disaster impacts. The focus of the present study is to illustrate briefly how standardized remote sensing techniques and GIS-methods can help detect areas that are potentially vulnerable, so that disaster mitigation strategies can be implemented more effectively. Apparently, local site conditions exacerbate earthquake intensities and collateral disaster destruction in the Marmara Sea region. However, using remote sensing data, the causal factors can be determined systematically. With proper evaluation of satellite imageries and digital topographic data, specific geomorphologic/topographic settings that enhance disaster impacts can be identified. With a systematic GIS approach - based on Digital Elevation Model (DEM data - geomorphometric parameters that influence the local site conditions can be determined. Digital elevation data, such as SRTM (Shuttle Radar Topography Mission, with 90m spatial resolution and ASTER-data with 30m resolution, interpolated up to 15 m is readily available. Areas with the steepest slopes can be identified from slope gradient maps. Areas with highest curvatures susceptible to landslides can be identified from curvature maps. Coastal areas below the 10 m elevation susceptible to tsunami inundation can be clearly delineated. Height level maps can also help locate

  4. Estudo anatômico da veia braquial comum como via de drenagem colateral do membro superior Anatomic study of the common brachial vein as a collateral drainage channel of the upper limb

    Directory of Open Access Journals (Sweden)

    Carlos Adriano Silva dos Santos

    2011-03-01

    Full Text Available CONTEXTO: Traumatismos ou tromboses que possam evoluir com alterações da drenagem venosa do membro superior, dependendo do território interrompido, podem ter como mecanismo compensatório uma via colateral de drenagem sem que haja prejuízo para o retorno venoso desse membro. A veia braquial comum apresenta-se como uma alternativa plausível e pouco conhecida. OBJETIVO: Descrever a anatomia da veia braquial comum como via de drenagem colateral no membro superior. MÉTODOS: Utilizamos 30 cadáveres do sexo masculino, cujos membros superiores estavam articulados ao tronco, não importando a raça, formolizados e mantidos em conservação com solução de formol a 10%. Utilizamos como critérios de exclusão cadáveres com um dos membros desarticulado ou alterações deformantes em topografia das estruturas estudadas. RESULTADOS: A veia braquial comum esteve presente em 73% (22/30 dos cadáveres estudados, sendo que em 18% (04/22 dos casos drenou para a veia basílica no seguimento proximal do braço e em 82% (18/22, para a veia axilar. CONCLUSÃO: A veia braquial comum está frequentemente presente e, na maior parte das vezes, desemboca na veia axilar.BACKGROUND: Trauma and thrombosis that can result in changes in the venous drainage of the upper limb, depending on the vascular territory interrupted, may have as a compensatory mechanism a collateral drainage channel that prevents damage to the venous return of that limb. The common brachial vein is a plausible and little known collateral channel for this purpose. OBJECTIVE: To describe the anatomy of the common brachial vein as a collateral drainage channel of the upper limb. METHODS: We have dissected 30 cadavers of people of different races, whose upper limbs were articulated to the trunk and preserved in a 10% formaldehyde solution. The exclusion criteria were disarticulated limbs or deformities in the topography of the studied structures. RESULTS: The common brachial vein was present in 73

  5. Influence of pre-infarction angina, collateral flow, and pre-procedural TIMI flow on myocardial salvage index by cardiac magnetic resonance in patients with ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Kelbæk, Henning; Vejlstrup, Niels

    2012-01-01

    BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) pre-infarction angina, pre-procedural TIMI flow and collateral flow to the myocardium supplied by the infarct related artery are suggested to be cardioprotective. We evaluated the effect of these factors on myocardial...... against the area-at-risk there was a strong trend that the line for the pre-infarction angina group was below the one for the non-angina group (P = 0.05). Patients with pre-procedural TIMI flow 0/1, 2 and 3 had a median MSI of (0.69 (IQR 0.59 to 0.76), 0.78 (0.68 to 0.86) and 0.85 (0.77 to 0...

  6. The differential induction of collateral resistance to 62. 5 MeV (p[yields]Be[sup +]) neutrons and 4 MeV photons by exposure to CIS-platinum

    Energy Technology Data Exchange (ETDEWEB)

    Britten, R.A.; Warenius, H.M. (Univ. of Liverpool (United Kingdom)); Masters, J.R.W. (St. Paul' s Hospital, London (United Kingdom)); Peacock, J.H. (Institute of Cancer Research, Sutton (United Kingdom))

    1993-08-01

    The purpose of this study was to determine the relative sensitivity to cis-platinum, 4 MeV photons and 62.5 MeV (p[yields]Be[sup +]) neutrons in five human tumor cell lines, and their cis-platinum resistant variants. The degree of cross-resistance of five human in-vitro cell lines to photons or fast neutrons was analyzed for both cisplatinum-sensitive and resistant variants. The development of acquired cis-platinum resistance conferred collateral resistance to 62.5 MeV (p-Be[sup +]) neutrons in all five cell lines, but did not consistently decrease the photon sensitivity of these same cells. The reduction in photon and neutron sensitivity following the development of acquired cis-platinum resistance may possibly be regulated by different mechanisms. The reduction in neutron sensitivity was primarily due to a 1.3-1.7 fold reduction in the magnitude of the initial slope ([alpha]), which was independent of the degree of platinum resistance induced, suggesting a non-stochiometric relationship between the mechanisms responsible for acquired cis-platinum, and 62.5 MeV (p[yields]Be[sup +]) neutron resistance. 18 refs., 5 figs., 3 tabs.

  7. Significant survival advantage of high pulmonary vein index and the presence of native pulmonary artery in pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries: results from preoperative computed tomography angiography.

    Science.gov (United States)

    Jia, Qianjun; Cen, Jianzheng; Zhuang, Jian; Zhong, Xiaomei; Liu, Xiaoqing; Li, Jiahua; Liang, Changhong; Huang, Meiping

    2017-08-01

    The prognosis of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA-VSD-MAPCAs) after surgery shows substantial clinical heterogeneity and predictors for outcomes are lacking. This study aimed to assess the predictive value of preoperative cardiac computed tomography angiography (CTA) for survival in patients with PA-VSD-MAPCAs. We retrospectively analysed PA-VSD-MAPCA patients with preoperative CTA who underwent both right ventricular outflow tract reconstruction and MAPCA unifocalization ( n  = 24) or pulmonary artery rehabilitation ( n  = 28). The end-point was overall survival. Prognostic values of CTA were assessed using Cox univariate and multivariate analyses. The significant threshold of independent parameters was calculated using receiver-operating characteristic (ROC) curves. During a median follow-up of 1145 days, a total of 13 deaths were observed. Multivariate analysis identified a high pulmonary vein index (PVI) [hazard ratio (HR) = 0.03; 95% confidence interval (CI): 0.03, 0.28; P  advantage in PA-VSD-MAPCA patients. A PVI ≥438 mm 2 /m 2 may be a reliable positive prognosticator that could improve the decision-making strategy for PA-VSD-MAPCA patients.

  8. International Symposium on Neurotoxins in Neurobiology (4th) Held in Bath, United Kingdom on 19th-23rd September 1993. Speakers’ Abstracts 1-25

    Science.gov (United States)

    1993-01-01

    Barrantes, Bahia Blanca Stable heterologous expression of nicotinic acetylcholine receptor in clonal cell lines: 03bungarotoxin binding and channel...induced by DTx microinfused into the CA1 area. A monolateral surgical lesion to the Schaffer collaterals, through which the CA1 pyramids receive excitatory...J. Barrantes. Instituto de Investigaciones Bioqulmicas de Bahia Blanca , 8000 Bahia Blanca , Argentina. 0 In order to further our studies on modulation

  9. Effects of Regulatory BC1 RNA Deletion on Synaptic Plasticity, Learning, and Memory

    Science.gov (United States)

    Chung, Ain; Dahan, Nessy; Alarcon, Juan Marcos; Fenton, André A.

    2017-01-01

    Nonprotein coding dendritic BC1 RNA regulates translation of mRNAs in neurons. We examined two lines of BC1 knockout mice and report that loss of BC1 RNA exaggerates group I mGluR-stimulated LTD of the Schaffer collateral synapse, with one of the lines showing a much more enhanced DHPG-induced LTD than the other. When the animals were given the…

  10. Spatial modules of coherent activity in pathway-specific LFPs in the hippocampus reflect topology and different modes of presynaptic synchronization.

    Science.gov (United States)

    Benito, N; Fernández-Ruiz, A; Makarov, V A; Makarova, J; Korovaichuk, A; Herreras, O

    2014-07-01

    Ongoing network activity often manifests as irregular fluctuations in local field potentials (LFPs), a complex mixture of multicellular synaptic currents of varying locations and extensions. Among other conditions, for synchronously firing presynaptic units to generate sizable postsynaptic LFPs, their axonal territories should overlap. We have taken advantage of anatomical regularity of the rat hippocampus and combined multiple linear recordings and spatial discrimination techniques to separate pathway-specific LFPs with enough spatial resolution to discriminate postsynaptic regions of varying activation, and to investigate their presynaptic origin, chemical nature, and spatial extension. We identified 6 main excitatory and inhibitory LFP generators with different synaptic territories in principal cells and hippocampal subfields matching anatomical pathways. Some recognized pathways did not contribute notably to LFPs. Each showed different septo-temporal spatial modules over which the field potential fluctuations were synchronous. These modules were explained by either the strong overlap of synaptic territories of coactivated afferent neurons (e.g., CA3 clusters for CA1 Schaffer LFPs), or widespread coalescence of postsynaptic territories (granule cell somatic inhibition). We also show evidence that distinct modes of afferent synchronization generate stereotyped spatial patterns of synchronous LFPs in one pathway. Thus, studying spatial coherence of pathway-specific LFPs provides remote access to the dynamics of afferent populations. © The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  11. [Effect of Chinese herbs for stasis removing and collaterals dredging upon angiotensin-converting enzyme 2-angiotensin-(1-7)-mas axis in the renal cortex of diabetic nephropathy rats].

    Science.gov (United States)

    Xu, Jing; Ma, Er-wei; Bai, Lu; Ma, Yun; Guo, Qian; Jia, Rui; Zhang, Jiang-hua; Chen, Zhi-qiang

    2014-06-01

    To observe the effect of Chinese herbs for stasis removing and collaterals dredging (CHSRCD) upon angiotensin-converting enzyme 2-angiotensin-(1-7)-Mas axis in the renal cortex of diabetic nephropathy rats. Totally 89 male Sprague-Dawley rats were randomly divided into the blank control group (C group, n=22), the high-glucose high-fat control group (H group, n=10), and the streptozotocin (STZ)-injecting group (n=57). The diabetes rat model (n=50) was induced by feeding high-glucose high-fat diet in combination with intraperitoneal injection of STZ, which were further divided into the model group (M group, n=24), the irbesartan group (I group, n=13), and the CHSRCD (Z group, n=13). Rats in I and Z groups were intragastrically fed with suspension of irbesartan and CHSRCD, once daily for 16 weeks. Equal volume of drinking water was administrated to rats in the rest groups. Blood glucose and 24 h urine protein quantitation were tested at four time points. And the mRNA expression of ACE2 and Mas at various time points was detected by Real-time PCR, immunohistochemical assay, and Western blot. Quantitative analyses of ACE2 and Mas protein expression were performed at the end of week 16. Compared with the C group, blood glucose increased in the H and M groups (P Mas mRNA at the end of week 16 between the C group and the M group (P > 0.05). It was lower in the M group than in the H group (P Mas protein in the M group decreased as time went by. The expression quantitation of ACE2 and Mas protein at the end of week 16 was lower in the M group than in the C group (P Mas of the I and Z groups increased more significantly (P Mas, promoting the ACE2-Ang-(1-7)-Mas axis, and lowering urinary protein.

  12. Role of the oblique ligament in the integrity of the medial collateral ligament of the canine elbow joint Papel do ligamento oblíquo na integridade do ligamento colateral medial da articulação do cotovelo de cães

    Directory of Open Access Journals (Sweden)

    D. Oliveira

    2007-02-01

    Full Text Available It was studied the arrangement of the collagen fibrils of the medial collateral ligament of the canine elbow joint and evaluated its diameter, when it was isolated or associated to the oblique ligament and loaded in tension until failure. Eighteen joints were divided in three groups. The first group had the medial collateral ligament collected and not loaded, the second group had the medial collateral ligament tested separately and the third group had both ligaments associately tested. Medial collateral ligament not submitted to strain presented a wavy and reticular pattern of the collagen fibers, which was not totally destroyed when it was loaded associated to the oblique ligament, and totally loses the reticular pattern when stretched separately. When the medial collateral ligament was loaded in tension separately, the mean collagen fibrils diameter increased in relation to the group not submitted to the tensile strain. Associated to the oblique ligament, the mean collagen fibrils diameter was the largest in the insertion area and the smallest in the mid-substance, in relation to the other groups. It was concluded that the oblique ligament could favor the integrity of the medial collateral ligament insertion area, facilitating its reconstruction after lesion with larger efficiency.Foram estudados o arranjo e o diâmetro médio das fibrilas colágenas do ligamento colateral medial da articulação do cotovelo do cão, isolado ou associado ao ligamento oblíquo e tracionado até a ruptura. Dezoito articulações foram divididas em três grupos. O primeiro grupo teve o ligamento colateral medial coletado, mas não tracionado; o segundo grupo teve o ligamento colateral medial tracionado isoladamente; o terceiro grupo teve os ligamentos colateral medial e oblíquo tracionados associadamente. O ligamento colateral medial não submetido ao ensaio de tração apresentou um padrão ondulado das fibras colágenas, o qual não foi totalmente destru

  13. 78 FR 2661 - Agency Information Collection Activities Under OMB Review

    Science.gov (United States)

    2013-01-14

    ...-0091. SUPPLEMENTARY INFORMATION: Title: Disclosure and Retention of Certain Information Related to Cleared Swaps Customer Collateral (OMB Control No. 3038-0091). This is a request for extension of a... Commodity Exchange Act (Act) establish rules for the protection of customer collateral held by futures...

  14. Furosemide depresses the presynaptic fiber volley and modifies frequency-dependent axonal excitability in rat hippocampus.

    Science.gov (United States)

    Andreasen, Mogens; Nedergaard, Steen

    2017-04-01

    The loop diuretic furosemide is known to have anticonvulsant effects, believed to be exerted through blockade of glial Na + -K + -2Cl - cotransport causing altered volume regulation in brain tissue. The possibility that direct effects of furosemide on neuronal properties could also be involved is supported by previous observations, but such effects have not been thoroughly investigated. In the present study we show that furosemide has two opposing effects on stimulus-induced postsynaptic excitation in the nonepileptic rat hippocampal slice: 1 ) an enhancement of e-s coupling, which depended on intact GABA A transmission and was partially mimicked by selective blockade of K + -2Cl - cotransport, and 2 ) a decrement of field excitatory postsynaptic potentials. The balance between these effects varied, depending on the amount of synaptic drive. In addition, the compound action potential (fiber volley) recorded from the stimulated Schaffer collateral axons in stratum radiatum showed a progressive decrease during perfusion of furosemide. This effect was activity-independent, was mimicked by the stilbene derivative DIDS, and could be reproduced on fiber volleys in the alveus. Furosemide also reduced the initial enhancement of the fiber volley observed during trains of high-frequency stimulation (HFS). Results of hyperosmotic expansion of the extracellular volume, with 30 mM sucrose, indicated that both the induction and antagonism of the HFS-induced enhancement were independent of signaling via the extracellular space. Furosemide caused an increased decay of paired-pulse-induced supranormal axonal excitability, which was antagonized by ZD7288. We conclude that furosemide decreases axonal excitability and prevents HFS-induced hyperexcitability via mechanisms downstream of blockage of anion transport, which could include hyperpolarization of axonal membranes. NEW & NOTEWORTHY This study shows that the anion transporter antagonists furosemide and DIDS cause a marked

  15. Topological organization of CA3-to-CA1 excitation.

    Science.gov (United States)

    Hongo, Yoshie; Ogawa, Koichi; Takahara, Yuji; Takasu, Keiko; Royer, Sebastien; Hasegawa, Minoru; Sakaguchi, Gaku; Ikegaya, Yuji

    2015-09-01

    The CA1-projecting axons of CA3 pyramidal cells, called Schaffer collaterals, constitute one of the major information flow routes in the hippocampal formation. Recent anatomical studies have revealed the non-random structural connectivity between CA3 and CA1, but little is known regarding the functional connectivity (i.e. how CA3 network activity is functionally transmitted downstream to the CA1 network). Using functional multi-neuron calcium imaging of rat hippocampal slices, we monitored the spatiotemporal patterns of spontaneous CA3 and CA1 burst activity under pharmacological GABAergic blockade. We found that spatially clustered CA3 activity patterns were transformed into layered CA1 activity sequences. Specifically, synchronized bursts initiated from multiple hot spots in CA3 ensembles, and CA1 neurons located deeper in the pyramidal cell layer were recruited during earlier phases of the burst events. The order of these sequential activations was maintained across the bursts, but the sequence velocity varied depending on the inter-burst intervals. Thus, CA3 axons innervate CA1 neurons in a highly topographical fashion. © 2015 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

  16. Active Disturbance Rejection Approach for Robust Fault-Tolerant Control via Observer Assisted Sliding Mode Control

    Directory of Open Access Journals (Sweden)

    John Cortés-Romero

    2013-01-01

    Full Text Available This work proposes an active disturbance rejection approach for the establishment of a sliding mode control strategy in fault-tolerant operations. The core of the proposed active disturbance rejection assistance is a Generalized Proportional Integral (GPI observer which is in charge of the active estimation of lumped nonlinear endogenous and exogenous disturbance inputs related to the creation of local sliding regimes with limited control authority. Possibilities are explored for the GPI observer assisted sliding mode control in fault-tolerant schemes. Convincing improvements are presented with respect to classical sliding mode control strategies. As a collateral advantage, the observer-based control architecture offers the possibility of chattering reduction given that a significant part of the control signal is of the continuous type. The case study considers a classical DC motor control affected by actuator faults, parametric failures, and perturbations. Experimental results and comparisons with other established sliding mode controller design methodologies, which validate the proposed approach, are provided.

  17. 12 CFR 614.4240 - Collateral definitions.

    Science.gov (United States)

    2010-01-01

    ....4240 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM LOAN POLICIES AND OPERATIONS... an adequately described property as of a specific date(s), supported by the presentation and analysis... individuals engaged in farming enterprises). (f) Cost approach means the process by which an evaluator...

  18. Trade credit, collateral liquidation, and borrowing constraints

    NARCIS (Netherlands)

    Fabbri, D.; Menichini, A.M.C.

    2010-01-01

    Assuming that firms’ suppliers are better able to extract value from the liquidation of assets in default and have an information advantage over other creditors, the paper derives six predictions on the use of trade credit. (1) Financially unconstrained firms (with unused bank credit lines) take

  19. Collateral Damage: Interlibrary Loan Lending Denials

    Science.gov (United States)

    Leykam, Andrew

    2009-01-01

    The intent of this paper is to explore the potential of utilizing interlibrary loan (ILL) data relating to lending denials to improve ILL services while highlighting institutional policies that have a negative impact on lending fulfillment rates. Reasons for denial as well as the types of requests being denied are reviewed. In addition, the author…

  20. Guarding against Collateral Damage during Chromatin Transactions

    DEFF Research Database (Denmark)

    Altmeyer, Matthias; Lukas, Jiri

    2013-01-01

    Signal amplifications are vital for chromatin function, yet they also bear the risk of transforming into unrestrained, self-escalating, and potentially harmful responses. Examples of inbuilt limitations are emerging, revealing how chromatin transactions are confined within physiological boundaries....

  1. Estimating Cargo Airdrop Collateral Damage Risk

    Science.gov (United States)

    2011-03-01

    group mean ( Levene 1960). 33  Bartlett’s test compares the weighted arithmetic average of the sample variances to the weighted geometric...by the p-values for the O’Brien, Brown-Forsythe, Levene and Bartlett tests there appears to be a definite difference among chute categories... Test Results 47 As noted by the p-values for the O’Brien, Brown-Forsythe, Levene and Bartlett tests there appears to be a definite

  2. Knock-in mouse model of alternating hemiplegia of childhood: behavioral and electrophysiologic characterization.

    Science.gov (United States)

    Hunanyan, Arsen S; Fainberg, Nina A; Linabarger, Molly; Arehart, Eric; Leonard, A Soren; Adil, Syed M; Helseth, Ashley R; Swearingen, Amanda K; Forbes, Stacy L; Rodriguiz, Ramona M; Rhodes, Theodore; Yao, Xiaodi; Kibbi, Nadine; Hochman, Daryl W; Wetsel, William C; Hochgeschwender, Ute; Mikati, Mohamad A

    2015-01-01

    Mutations in the ATP1α3 subunit of the neuronal Na+/K+-ATPase are thought to be responsible for seizures, hemiplegias, and other symptoms of alternating hemiplegia of childhood (AHC). However, the mechanisms through which ATP1A3 mutations mediate their pathophysiologic consequences are not yet understood. The following hypotheses were investigated: (1) Our novel knock-in mouse carrying the most common heterozygous mutation causing AHC (D801N) will exhibit the manifestations of the human condition and display predisposition to seizures; and (2) the underlying pathophysiology in this mouse model involves increased excitability in response to electrical stimulation of Schaffer collaterals and abnormal predisposition to spreading depression (SD). We generated the D801N mutant mouse (Mashlool, Mashl+/-) and compared mutant and wild-type (WT) littermates. Behavioral tests, amygdala kindling, flurothyl-induced seizure threshold, spontaneous recurrent seizures (SRS), and other paroxysmal activities were compared between groups. In vitro electrophysiologic slice experiments on hippocampus were performed to assess predisposition to hyperexcitability and SD. Mutant mice manifested a distinctive phenotype similar to that of humans with AHC. They had abnormal impulsivity, memory, gait, motor coordination, tremor, motor control, endogenous nociceptive response, paroxysmal hemiplegias, diplegias, dystonias, and SRS, as well as predisposition to kindling, to flurothyl-induced seizures, and to sudden unexpected death. Hippocampal slices of mutants, in contrast to WT animals, showed hyperexcitable responses to 1 Hz pulse-trains of electrical stimuli delivered to the Schaffer collaterals and had significantly longer duration of K+-induced SD responses. Our model reproduces the major characteristics of human AHC, and indicates that ATP1α3 dysfunction results in abnormal short-term plasticity with increased excitability (potential mechanism for seizures) and a predisposition to more

  3. GABAB receptor-mediated feed-forward circuit dysfunction in the mouse model of fragile X syndrome.

    Science.gov (United States)

    Wahlstrom-Helgren, Sarah; Klyachko, Vitaly A

    2015-11-15

    -type (WT) mice were eliminated by a GABAB R antagonist. Inhibition of GABAB Rs or selective activation of presynaptic GABAB Rs also abolished the differences in the TA feed-forward circuit properties between Fmr1 KO and WT mice. These GABAB R-mediated defects were circuit-specific and were not observed in the Schaffer collateral pathway-associated inhibitory synapses. Our results suggest that the inhibitory synapse dysfunction in the cortico-hippocampal pathway of Fmr1 KO mice causes hyperexcitability and feed-forward circuit defects, which are mediated in part by a presynaptic GABAB R-dependent reduction in GABA release. © 2015 The Authors. The Journal of Physiology © 2015 The Physiological Society.

  4. Alterations of functional properties of hippocampal networks following repetitive closed-head injury.

    Science.gov (United States)

    Logue, Omar C; Cramer, Nathan P; Xu, Xiufen; Perl, Daniel P; Galdzicki, Zygmunt

    2016-03-01

    Traumatic brain injury (TBI) is the leading cause of death for persons under the age of 45. Military service members who have served on multiple combat deployments and contact-sport athletes are at particular risk of sustaining repetitive TBI (rTBI). Cognitive and behavioral deficits resulting from rTBI are well documented. Optimal associative LTP, occurring in the CA1 hippocampal Schaffer collateral pathway, is required for both memory formation and retrieval. Surprisingly, ipsilateral Schaffer collateral CA1 LTP evoked by 100 Hz tetanus was enhanced in mice from the 3× closed head injury (3× CHI) treatment group in comparison to LTP in contralateral or 3× Sham CA1 area, and in spite of reduced freezing during contextual fear conditioning at one week following 3× CHI. Electrophysiological activity of CA1 neurons was evaluated with whole-cell patch-clamp recordings. 3× CHI ipsilateral CA1 neurons exhibited significant increases in action potential amplitude and maximum rise and decay slope while the action potential duration was decreased. Recordings of CA1 neuron postsynaptic currents were conducted to detect spontaneous excitatory and inhibitory postsynaptic currents (sEPSCs/sIPSCs) and respective miniature currents (mEPSCs and mIPSCs). In the 3× CHI mice, sEPSCs and sIPSCs in ipsilateral CA1 neurons had an increased frequency of events but decreased amplitudes. In addition, 3× CHI altered the action potential-independent miniature postsynaptic currents. The mEPSCs of ipsilateral CA1 neurons exhibited both an increased frequency of events and larger amplitudes. Moreover, the effect of 3× CHI on mIPSCs was opposite to that of the sIPSCs. Specifically, the frequency of the mIPSCs was decreased while the amplitudes were increased. These results are consistent with a mechanism in which repetitive closed-head injury affects CA1 hippocampal function by promoting a remodeling of excitatory and inhibitory synaptic inputs leading to impairment in hippocampal

  5. Integrative spike dynamics of rat CA1 neurons: a multineuronal imaging study.

    Science.gov (United States)

    Sasaki, Takuya; Kimura, Rie; Tsukamoto, Masako; Matsuki, Norio; Ikegaya, Yuji

    2006-07-01

    The brain operates through a coordinated interplay of numerous neurons, yet little is known about the collective behaviour of individual neurons embedded in a huge network. We used large-scale optical recordings to address synaptic integration in hundreds of neurons. In hippocampal slice cultures bolus-loaded with Ca2+ fluorophores, we stimulated the Schaffer collaterals and monitored the aggregate presynaptic activity from the stratum radiatum and individual postsynaptic spikes from the CA1 stratum pyramidale. Single neurons responded to varying synaptic inputs with unreliable spikes, but at the population level, the networks stably output a linear sum of synaptic inputs. Nonetheless, the network activity, even though given constant stimuli, varied from trial to trial. This variation emerged through time-varying recruitment of different neuron subsets, which were shaped by correlated background noise. We also mapped the input-frequency preference in spiking activity and found that the majority of CA1 neurons fired in response to a limited range of presynaptic firing rates (20-40 Hz), acting like a band-pass filter, although a few neurons had high pass-like or low pass-like characteristics. This frequency selectivity depended on phasic inhibitory transmission. Thus, our imaging approach enables the linking of single-cell behaviours to their communal dynamics, and we discovered that, even in a relatively simple CA1 circuit, neurons could be engaged in concordant information processing.

  6. Morphoanatomic characterization of the stem and the leaf of Tabernaemontana catharinensis A.DC (Apocynaceae and antimutagenic activity of its leaves

    Directory of Open Access Journals (Sweden)

    D.G.G. GUIDOTI

    2015-01-01

    Full Text Available ABSTRACT Tabernaemontana catharinensis A. DC (Apocynaceae is used as a