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Sample records for target vessel revascularization

  1. Triple-Vessel Percutaneous Coronary Revascularization In Situs Inversus Dextrocardia

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    Nikolaos Kakouros

    2010-01-01

    Full Text Available Dextrocardia with situs inversus occurs in approximately one in 10,000 individuals of whom 20% have primary ciliary dyskinesia inherited as an autosomal recessive trait. These patients have a high incidence of congenital cardiac disease but their risk of coronary artery disease is similar to that of the general population. We report what is, to our knowledge, the first case of total triple-vessel coronary revascularization by percutaneous stent implantation in a 79-year-old woman with situs inversus dextrocardia. We describe the successful use of standard diagnostic and interventional guide catheters with counter rotation and transversely inversed image acquisition techniques. The case also highlights that the right precordial pain may represent cardiac ischemia in this population.

  2. Best way to revascularize patients with main stem and three vessel lesions: patients should undergo PCI!

    Science.gov (United States)

    Schächinger, Volker; Herdeg, Christian; Scheller, Bruno

    2010-09-01

    The optimal revascularization strategy for multivessel disease is under controversial discussion for long time. Until now, technical innovations have been faster than performance of clinical trials, making results of randomized studies outdated at the time of appearance. Recently, the SYNTAX trial has been published, which compared drug elutings stents (DES) implantation with Coronary artery bypass graft (CABG) patients with multivessel or left main disease in a clinically stable population. Overall, CABG was superior with respect to the clinical endpoint of death, myocardial infarction, stroke, or revascularization. However, the difference is driven by the "weakest" end point, namely repeated revascularization, whereas combined "hard" events did not demonstrate a difference. More detailed analysis demonstrates that only patients with most complex coronary anatomy gain definite benefit from CABG. In addition, SYNTAX demonstrated that left main disease is no longer a domain of CABG, since DES implantation revealed comparable results, as long as there is no concomitant multivessel disease. Regardless the results of SYNTAX, one should not forget that SYNTAX represents only a minority of daily patients in a catheterization laboratory, excluding patients with one- or two-vessel disease and those with an acute coronary syndrome. Especially in the latter, percutaneous coronary intervention has demonstrated to improve prognosis.

  3. The POST trial: initial post-market experience of the Penumbra system: revascularization of large vessel occlusion in acute ischemic stroke in the United States and Europe.

    Science.gov (United States)

    Tarr, Robert; Hsu, Dan; Kulcsar, Zsolt; Bonvin, Christophe; Rufenacht, Daniel; Alfke, Karsten; Stingele, Robert; Jansen, Olav; Frei, Donald; Bellon, Richard; Madison, Michael; Struffert, Tobias; Dorfler, Arnd; Grunwald, Iris Q; Reith, Wolfgang; Haass, Anton

    2010-12-01

    The purpose of this study was to assess the initial post-market experience of the device and how it is compared with the Penumbra Pivotal trial used to support the 510k application. A retrospective case review of 157 consecutive patients treated with the Penumbra system at seven international centers was performed. Primary endpoints were revascularization of the target vessel (TIMI score of 2 or 3), good functional outcome as defined by a modified Rankin scale (mRS) score of ≤2 and incidence of procedural serious adverse events. Results were compared with those of the Penumbra pivotal trial. A total of 157 vessels were treated. Mean baseline values at enrollment were: age 65 years, NIHSS score 16. After use of the Penumbra system, 87% of the treated vessels were revascularized to TIMI 2 (54%) or 3 (33%) as compared with 82% reported in the Pivotal trial. Nine procedural serious adverse events were reported in 157 patients (5.7%). All-cause mortality was 20% (32/157), and 41% had a mRS of ≤2 at 90-day follow-up as compared with only 25% in the Pivotal trial. Patients who were successfully revascularized by the Penumbra system had significantly better outcomes than those who were not. Initial post-market experience of the Penumbra system revealed that the revascularization rate and safety profile of the device are comparable to those reported in the Pivotal trial. However, the proportion of patients who had good functional outcome was higher than expected.

  4. Targeting Therapy Resistant Tumor Vessels

    Science.gov (United States)

    2008-08-01

    Morris LS. Hysterectomy vs. resectoscopic endometrial ablation for the control of abnormal uterine bleeding . A cost-comparative study. J Reprod Med 1994;39...after the antibody treatment contain a pericyte coat, vessel architecture is normal, the diameter of the vessels is smaller (dilated, abnormal vessels...involvement of proteases from inflammatory mast cells and functionally abnormal (Carmeliet and Jain, 2000; Pasqualini (Coussens et al., 1999) and other bone

  5. Failure probability analysis on mercury target vessel

    International Nuclear Information System (INIS)

    Ishikura, Syuichi; Futakawa, Masatoshi; Kogawa, Hiroyuki; Sato, Hiroshi; Haga, Katsuhiro; Ikeda, Yujiro

    2005-03-01

    Failure probability analysis was carried out to estimate the lifetime of the mercury target which will be installed into the JSNS (Japan spallation neutron source) in J-PARC (Japan Proton Accelerator Research Complex). The lifetime was estimated as taking loading condition and materials degradation into account. Considered loads imposed on the target vessel were the static stresses due to thermal expansion and static pre-pressure on He-gas and mercury and the dynamic stresses due to the thermally shocked pressure waves generated repeatedly at 25 Hz. Materials used in target vessel will be degraded by the fatigue, neutron and proton irradiation, mercury immersion and pitting damages, etc. The imposed stresses were evaluated through static and dynamic structural analyses. The material-degradations were deduced based on published experimental data. As a result, it was quantitatively confirmed that the failure probability for the lifetime expected in the design is very much lower, 10 -11 in the safety hull, meaning that it will be hardly failed during the design lifetime. On the other hand, the beam window of mercury vessel suffered with high-pressure waves exhibits the failure probability of 12%. It was concluded, therefore, that the leaked mercury from the failed area at the beam window is adequately kept in the space between the safety hull and the mercury vessel by using mercury-leakage sensors. (author)

  6. Cavitation damage prediction for the JSNS mercury target vessel

    Energy Technology Data Exchange (ETDEWEB)

    Naoe, Takashi, E-mail: naoe.takashi@jaea.go.jp; Kogawa, Hiroyuki; Wakui, Takashi; Haga, Katsuhiro; Teshigawara, Makoto; Kinoshita, Hidetaka; Takada, Hiroshi; Futakawa, Masatoshi

    2016-01-15

    The liquid mercury target system for the Japan Spallation Neutron Source (JSNS) at the Materials and Life science experimental Facility (MLF) in the Japan Proton Accelerator Research Complex (J-PARC) is designed to produce pulsed neutrons. The mercury target vessel in this system, which is made of type 316L stainless steel, is damaged by pressure wave-induced cavitation due to proton beam bombardment. Currently, cavitation damage is considered to be the dominant factor influencing the service life of the target vessel rather than radiation damage. In this study, cavitation damage to the interior surface of the target vessel was predicted on the basis of accumulated damage data from off-beam and on-beam experiments. The predicted damage was compared with the damage observed in a used target vessel. Furthermore, the effect of injecting gas microbubbles on cavitation damage was predicted through the measurement of the acoustic vibration of the target vessel. It was shown that the predicted depth of cavitation damage is reasonably coincident with the observed results. Moreover, it was confirmed that the injection of gas microbubbles had an effect on cavitation damage.

  7. Determinants of Vessel Targeting in Vasculitis

    Directory of Open Access Journals (Sweden)

    Gary S. Hoffman

    2004-01-01

    Full Text Available Studies of autoimmune diseases have not yet elucidated why certain organs or vessels become the objects of injury while others are spared. This paper will explore the hypothesis that important differences exist in regions of the aorta that determine vulnerability to diseases, such as atherosclerosis, aortitis, giant cell arteritis and Takayasu's disease. The reader is invited to reassess; (1 whether the aorta is indeed a single homogeneous structure, and (2 whether the initial stage of aortitis (and indeed other diseases considered “autoimmune” may be primarily due to acquired alterations of substrate, that influence unique immune profiles, which by themselves may not be pathogenic. Disease susceptibility and patterns are influenced by many factors that are inborn and acquired. Examples include genetic background, gender, ethnicity, aging, prior and concomitant illnesses, habits, diet, toxin and environmental exposures. Studies of vascular diseases must assess how such variables may affect regional differences in endothelial cells, subendothelial matrix, vascular smooth muscle and the response of each to a variety of stimuli.

  8. Target vessel detection by epicardial ultrasound in off-pump coronary bypass surgery.

    Science.gov (United States)

    Hayakawa, Masato; Asai, Tohru; Kinoshita, Takeshi; Suzuki, Tomoaki; Shiraishi, Shoichiro

    2013-01-01

    The detection of embedded coronary arteries is difficult especially in off-pump coronary bypass surgery. From June 2010, we introduced high-frequency epicardial ultrasound (ECUS) to assess and evaluate embedded arteries during off-pump coronary bypass surgery. Between June 2010 and June 2011, a total of 89 consecutive patients underwent isolated coronary bypass surgery at our institution. The patients consisted of 72 men and 17 women with a mean age of 67.9 years. We routinely use the VeriQC system (MediStim, Oslo, Norway) to detect the target vessels in the operation. The patients were assigned to one of two groups, depending on whether ECUS was used in the operation (n = 10, ECUS group) or not (n = 79, non-ECUS group). We analyzed the impact of introducing the ECUS in terms of operative outcome. All patients underwent revascularization using the off-pump technique without emergent conversion to cardiopulmonary bypass during surgery. The total number of distal anastomoses was 299, and 12 target vessels could not be identified either visually or on palpation. Thus, the frequency of the embedded coronary arteries was 4.01% (12/299 cases). The preoperative profiles of the two groups were not significantly different. Operation time was significantly longer in the ECUS group (P = 0.02). There were no significant differences in postoperative outcome between the two groups. In the present study, in which the target coronary arteries could not be detected either visually or on palpation in 12 (4.01%) of 299 cases, the use of high-frequency ECUS allowed all patients to undergo off-pump coronary bypass surgery without conversion to cardiopulmonary bypass during the operation. High-frequency ECUS is therefore useful in off-pump coronary bypass surgery.

  9. Aminopeptidase A is a functional target in angiogenic blood vessels.

    Science.gov (United States)

    Marchiò, Serena; Lahdenranta, Johanna; Schlingemann, Reinier O; Valdembri, Donatella; Wesseling, Pieter; Arap, Marco A; Hajitou, Amin; Ozawa, Michael G; Trepel, Martin; Giordano, Ricardo J; Nanus, David M; Dijkman, Henri B P M; Oosterwijk, Egbert; Sidman, Richard L; Cooper, Max D; Bussolino, Federico; Pasqualini, Renata; Arap, Wadih

    2004-02-01

    We show that a membrane-associated protease, aminopeptidase A (APA), is upregulated and enzymatically active in blood vessels of human tumors. To gain mechanistic insight, we evaluated angiogenesis in APA null mice. We found that, although these mice develop normally, they fail to mount the expected angiogenic response to hypoxia or growth factors. We then isolated peptide inhibitors of APA from a peptide library and show that they specifically bind to and inhibit APA, suppress migration and proliferation of endothelial cells, inhibit angiogenesis, and home to tumor blood vessels. Finally, we successfully treated tumor-bearing mice with APA binding peptides or anti-APA blocking monoclonal antibodies. These data show that APA is a regulator of blood vessel formation, and can serve as a functional vascular target.

  10. Comparison of Five-Year Outcome of Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting in Triple-Vessel Coronary Artery Disease (from the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2).

    Science.gov (United States)

    Shiomi, Hiroki; Morimoto, Takeshi; Furukawa, Yutaka; Nakagawa, Yoshihisa; Tazaki, Junichi; Sakata, Ryuzo; Okabayashi, Hitoshi; Hanyu, Michiya; Shimamoto, Mitsuomi; Nishiwaki, Noboru; Komiya, Tatsuhiko; Kimura, Takeshi

    2015-07-01

    Studies evaluating long-term (≥5 years) outcomes of percutaneous coronary intervention (PCI) using drug-eluting stents compared with coronary artery bypass grafting (CABG) in patients with triple-vessel coronary artery disease (TVD) are still limited. We identified 2,978 patients with TVD (PCI: n = 1,824, CABG: n = 1,154) of 15,939 patients with first coronary revascularization enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2. The primary outcome measure in the present analysis was a composite of death, myocardial infarction (MI), and stroke. Median follow-up duration for the surviving patients was 1,973 days (interquartile range 1,700 to 2,244). The cumulative 5-year incidence of death/MI/stroke was significantly higher in the PCI group than in the CABG group (28.2% vs 24.0%, log-rank p = 0.006). After adjusting for confounders, the excess risk of PCI relative to CABG for death/MI/stroke remained significant (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.13 to 1.68, p = 0.002). The excess risks of PCI relative to CABG for all-cause death, MI, and any coronary revascularization were also significant (HR 1.38, 95% CI 1.10 to 1.74, p = 0.006; HR 2.81, 95% CI 1.69 to 4.66, p PCI and CABG groups (HR 0.88, 95% CI 0.61 to 1.26, p = 0.48). There were no interactions for the primary outcome measure between the mode of revascularization (PCI or CABG) and the subgroup factors such as age, diabetes, and Synergy Between PCI With Taxus and Cardiac Surgery score. In conclusion, CABG compared with PCI was associated with better long-term outcome in patients with TVD. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Conceptual design of the handling and storage system for spent target vessel

    Energy Technology Data Exchange (ETDEWEB)

    Adachi, Junichi; Sasaki, Shinobu; Kaminaga, Masanori; Hino, Ryutaro [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

    2001-03-01

    A conceptual design of a handling and storage system for spent target vessels has been carried out, in order to establish spent target technology for the neutron scattering facility. The spent target vessels must be treated remotely with high reliability and safety, since they are highly activated and contain the poisonous mercury. The system is composed of a target exchange trolley to exchange the target vessel, remote handling equipment such as manipulators, airtight casks for the spent target vessel, storage pits and so on. This report presents the results of conceptual design study on a basic plan, a handling procedure, main devices and their arrangement of a handling and storage system for the spent target vessels. (author)

  12. 40 CFR 229.2 - Transport of target vessels.

    Science.gov (United States)

    2010-07-01

    ... marine navigation is not otherwise impaired by the sunk vessel; (3) All such vessel sinkings shall be... may degrade the marine environment, -including without limitation (i) emptying of all fuel tanks and... free of petroleum, and (ii) removing from the hulls other pollutants and all readily detachable...

  13. B-type natriuretic peptide as predictor of heart failure in patients with acute ST elevation myocardial infarction, single-vessel disease, and complete revascularization: follow-up study.

    LENUS (Irish Health Repository)

    Manola, Sime

    2012-01-31

    AIM: To assess the concentration of B-type natriuretic peptide (BNP) as a predictor of heart failure in patients with acute ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) with successful and complete revascularization. METHODS: Out of a total of 220 patients with acute STEMI admitted to the Sisters of Mercy University Hospital in the period January 1 to December 31, 2007, only patients with acute STEMI undergoing primary PCI who had single vessel disease and were successfully revascularized were included in the study. Selected patients had no history of myocardial infarction or heart failure and a normal or near-normal left ventricular ejection fraction (> or =50%) assessed by left ventriculography at admission. Only 58 patients met the inclusion criteria for the study. Out of those, 6 patients refused to participate in the study, and another 5 could not be followed up, so a total of 47 patients were evaluated. Blood samples were taken for measurement of BNP levels at admission, 24 hours later, and 7 days later. Patients were followed up for 1 year. The primary outcome was reduction in left ventricular ejection fraction (LVEF) to <50% after 1 year. RESULTS: Patients who developed echocardiographic signs of reduced systolic function defined as LVEF<50% had significantly higher values of BNP (> or =80 pg\\/mL) at 24 hours (P=0.001) and 7 days (P=0.020) after STEMI and successful reperfusion. Patients who had BNP levels > or =80 pg\\/mL after 7 days were 21 times more likely to develop LVEF<50 (odds ratio, 20.8; 95% confidence interval, 2.2-195.2; P=0.008). CONCLUSION: BNP can be used as a predictor of reduced systolic function in patients with STEMI who underwent successful reperfusion and had normal ejection fraction at admission.

  14. Anatomic changes of target vessels after fenestrated and branched aortic aneurysm repair.

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    Kalder, J; Keschenau, P; Tamm, M; Jalaie, H; Jacobs, M J; Greiner, A

    2014-04-01

    Objective of this study was to evaluate the anatomic changes of the stented target vessels after endovascular repair of complex aortic aneurysms. Between July 2011 and December 2013, 53 aortic aneurysms were treated in our department with fenestrated and branched stent-graft devices. Forty-two of these patients were pre- and postoperatively scanned with a high resolution computer tomography (CT) (Cook Zenith® fenestrated or branched, Australia Pty. Ltd., Brisbane, Australia: N.=19; AnacondaTM fenestrated, Vascutek, Glasgow, Scotland, UK: N.=23). The other 11 out of the 53 patients did not receive a CT scan, because of a pre-existing renal failure. In the CT scans we retrospectively evaluated the anatomic vessel deviation at the origin of the target vessel and the vessel shift distal to the stent. For the first measurement the CT scans were loaded into OsiriX MD®, and the pre- and postoperative angles of the target vessels were measured and subtracted. For matching, the CT-scans were normalized at vertebral body lumbar 2. The second measured angle was the maximal measured angle distal to the target vessel stent-graft. Altogether, 113 target vessels were stented (celiac trunk [CT] 15, superior mesenteric arteries [SMA] 26, renal arteries [RA] 72), with 97 balloon-expandable PTFE stents: 90 Atrium V12 (Maquet Getinge group, Hudson, NH, USA), 7 BeGrafts (Bentley InnoMed, Hechingen, Germany) and 16 self-expandable fluency PTFE stents (Bard, Karlsruhe, Germany). The mean anatomic deviation at the target vessel origin was 28±17.3 and the mean vessel shift distal to the stent was 36.3±18.8. There were no significant differences between the main device and the target vessel stent types. Fenestrated and branched stent-graft solutions for aortic aneurysm repair induce changes of the target vessel anatomy. We did not observe significant differences between the several devices.

  15. Is right coronary artery chronic total vessel occlusion impacting the surgical revascularization results of patients with multivessel disease? A retrospective study

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    Janusz Konstanty-Kalandyk

    2018-06-01

    Full Text Available Introduction Chronic total occlusion (CTO is common in the presence of other significantly narrowed coronary arteries. The impact of total occlusion and its association with completeness of revascularization on patients with multivessel disease undergoing coronary artery bypass graft (CABG remains largely unknown. Aim The aim of our study was to compare CABG operation characteristics, as well as 30-day mortality, incidence of post-operative major adverse cardiac and cerebrovascular events (MACCE between patients with and without CTO in right coronary artery (RCA. Materials and Methods A total of 156 consecutive patients were included in the analysis. CTO of RCA or right posterior descending artery (RPD was diagnosed in 57 patients (CTO-RCA group. Coronary stenosis without CTO in RCA was diagnosed in 99 patients (nonCTO-RCA group. Baseline characteristics were comparable in both groups. Results The majority of patients had class II (49.1% vs. 46%, p = 0.86 or class III (42.1% vs. 43%, p = 1.0 Canadian Cardiovascular Society grading system symptoms. Patients in the CTO-RCA group had in average 2.2 grafts implanted, as opposed to 2.4 grafts in patients in the nonCTO-RCA group (p = 0.003. Graft to the RCA was performed in 40.3% patients in the CTO-RCA group and in 81% patients in the nonCTO-RCA group (p = 0.001. The 30-day mortality from any cause or cardiac cause did not differ between groups (7% vs. 2%, p = 0.14 and 3.5% vs. 2%, p = 0.57 respectively. In a multivariate analysis CTO in RCA or RPD and peripheral artery disease were independent predictors of post-operative MACCE (7.9 (1.434–43.045 p = 0.02; 18.8 (3.451–101.833 p < 0.01, respectively. Conclusions Chronic total occlusion of RCA was found to be associated with smaller number of grafts performed during the CABG procedure. Although mortality between patients in the CTO-RCA and nonCTO-RCA groups did not differ, patients in the CTO-RCA group had higher incidence of post-operative MACCE.

  16. Aminopeptidase A is a functional target in angiogenic blood vessels

    NARCIS (Netherlands)

    Marchiò, Serena; Lahdenranta, Johanna; Schlingemann, Reinier O.; Valdembri, Donatella; Wesseling, Pieter; Arap, Marco A.; Hajitou, Amin; Ozawa, Michael G.; Trepel, Martin; Giordano, Ricardo J.; Nanus, David M.; Dijkman, Henri B. P. M.; Oosterwijk, Egbert; Sidman, Richard L.; Cooper, Max D.; Bussolino, Federico; Pasqualini, Renata; Arap, Wadih

    2004-01-01

    We show that a membrane-associated protease, aminopeptidase A (APA), is upregulated and enzymatically active in blood vessels of human tumors. To gain mechanistic insight, we evaluated angiogenesis in APA null mice. We found that, although these mice develop normally, they fail to mount the expected

  17. Aminopeptidase A is a functional target in angiogenic blood vessels.

    NARCIS (Netherlands)

    Marchio, S.; Lahdenranta, J.; Schlingemann, R.O.; Valdembri, D.; Wesseling, P.; Arap, M.A.; Hajitou, A.; Ozawa, M.G.; Trepel, M.; Giordano, R.J.; Nanus, D.M.; Dijkman, H.B.P.M.; Oosterwijk, E.; Sidman, R.L.; Cooper, M.D.; Bussolino, F.; Pasqualini, R.; Arap, W.

    2004-01-01

    We show that a membrane-associated protease, aminopeptidase A (APA), is upregulated and enzymatically active in blood vessels of human tumors. To gain mechanistic insight, we evaluated angiogenesis in APA null mice. We found that, although these mice develop normally, they fail to mount the expected

  18. Intracranial arterial aneurysm vasculopathies: targeting the outer vessel wall

    International Nuclear Information System (INIS)

    Krings, Timo; Piske, Ronie L.; Lasjaunias, Pierre L.

    2005-01-01

    The pathogenesis of intracranial arterial aneurysms (AA) remains unclear, despite their clinical importance. An improved understanding of this disease is important in choosing therapeutic options. In addition to the ''classical'' berry-type aneurysm, there are various other types of intracranial AA such as infectious, dissecting or giant, partially-thrombosed aneurysms. From the clinician's perspective, the hypothesis that some of these intracranial AA might be due to abluminal factors has been proposed for several years. Indeed, this hypothesis and the empirical use of anti-inflammatory drugs in giant intracranial aneurysms have been confirmed by recent studies reporting that an enzyme involved in the inflammatory cascade (5-lipoxygenase or 5-LO) promotes the pathogenesis of specific aneurysms in humans. 5-LO generates different forms of leukotrienes which are potent mediators of inflammation. Adventitial inflammation leads to a weakening of the media from the abluminal part of the vessel wall due to the release of proinflammatory factors that invade the media, thereby degrading the extracellular matrix, the elastic lamina of the vascular wall, and, finally, the integrity of the vessel lumen. This in turn results in a dilation of the vessel and aneurysm formation. Moreover, neoangiogenesis of vasa vasorum is found in close proximity to 5-LO activated macrophages. In addition to this biological cascade, we argue that repeated subadventitial haemorrhages from the new vasa vasorum play an important role in aneurysm pathogenesis, due to a progressive increase in size mediated by the apposition of new layers of intramural haematoma within the vessel wall. Intracranial giant AA can therefore be regarded as a proliferative disease of the vessel wall induced by extravascular activity. (orig.)

  19. Peptide-Mediated Liposomal Drug Delivery System Targeting Tumor Blood Vessels in Anticancer Therapy

    Directory of Open Access Journals (Sweden)

    Han-Chung Wu

    2010-01-01

    Full Text Available Solid tumors are known to recruit new blood vessels to support their growth. Therefore, unique molecules expressed on tumor endothelial cells can function as targets for the antiangiogenic therapy of cancer. Current efforts are focusing on developing therapeutic agents capable of specifically targeting cancer cells and tumor-associated microenvironments including tumor blood vessels. These therapies hold the promise of high efficacy and low toxicity. One recognized strategy for improving the therapeutic effectiveness of conventional chemotherapeutics is to encapsulate anticancer drugs into targeting liposomes that bind to the cell surface receptors expressed on tumor-associated endothelial cells. These anti-angiogenic drug delivery systems could be used to target both tumor blood vessels as well as the tumor cells, themselves. This article reviews the mechanisms and advantages of various present and potential methods using peptide-conjugated liposomes to specifically destroy tumor blood vessels in anticancer therapy.

  20. Optimization study on structural analyses for the J-PARC mercury target vessel

    Science.gov (United States)

    Guan, Wenhai; Wakai, Eiichi; Naoe, Takashi; Kogawa, Hiroyuki; Wakui, Takashi; Haga, Katsuhiro; Takada, Hiroshi; Futakawa, Masatoshi

    2018-06-01

    The spallation neutron source at the Japan Proton Accelerator Research Complex (J-PARC) mercury target vessel is used for various materials science studies, work is underway to achieve stable operation at 1 MW. This is very important for enhancing the structural integrity and durability of the target vessel, which is being developed for 1 MW operation. In the present study, to reduce thermal stress and relax stress concentrations more effectively in the existing target vessel in J-PARC, an optimization approach called the Taguchi method (TM) is applied to thermo-mechanical analysis. The ribs and their relative parameters, as well as the thickness of the mercury vessel and shrouds, were selected as important design parameters for this investigation. According to the analytical results of 18 model types designed using the TM, the optimal design was determined. It is characterized by discrete ribs and a thicker vessel wall than the current design. The maximum thermal stresses in the mercury vessel and the outer shroud were reduced by 14% and 15%, respectively. Furthermore, it was indicated that variations in rib width, left/right rib intervals, and shroud thickness could influence the maximum thermal stress performance. It is therefore concluded that the TM was useful for optimizing the structure of the target vessel and to reduce the thermal stress in a small number of calculation cases.

  1. Theoretical modelling of physiologically stretched vessel in magnetisable stent assisted magnetic drug targeting application

    International Nuclear Information System (INIS)

    Mardinoglu, Adil; Cregg, P.J.; Murphy, Kieran; Curtin, Maurice; Prina-Mello, Adriele

    2011-01-01

    The magnetisable stent assisted magnetic targeted drug delivery system in a physiologically stretched vessel is considered theoretically. The changes in the mechanical behaviour of the vessel are analysed under the influence of mechanical forces generated by blood pressure. In this 2D mathematical model a ferromagnetic, coiled wire stent is implanted to aid collection of magnetic drug carrier particles in an elastic tube, which has similar mechanical properties to the blood vessel. A cyclic mechanical force is applied to the elastic tube to mimic the mechanical stress and strain of both the stent and vessel while in the body due to pulsatile blood circulation. The magnetic dipole-dipole and hydrodynamic interactions for multiple particles are included and agglomeration of particles is also modelled. The resulting collection efficiency of the mathematical model shows that the system performance can decrease by as much as 10% due to the effects of the pulsatile blood circulation. - Research highlights: →Theoretical modelling of magnetic drug targeting on a physiologically stretched stent-vessel system. →Cyclic mechanical force applied to mimic the mechanical stress and strain of both stent and vessel. →The magnetic dipole-dipole and hydrodynamic interactions for multiple particles is modelled. →Collection efficiency of the mathematical model is calculated for different physiological blood flow and magnetic field strength.

  2. Extra-Anatomic Revascularization of Extensive Coral Reef Aorta.

    Science.gov (United States)

    Gaggiano, Andrea; Kasemi, Holta; Monti, Andrea; Laurito, Antonella; Maselli, Mauro; Manzo, Paola; Quaglino, Simone; Tavolini, Valeria

    2017-10-01

    Coral reef aorta (CRA) is a rare, potential lethal disease of the visceral aorta as it can cause visceral and renal infarction. Various surgical approaches have been proposed for the CRA treatment. The purpose of this article is to report different extensive extra-anatomic CRA treatment modalities tailored on the patients' clinical and anatomic presentation. From April 2006 to October 2012, 4 symptomatic patients with extensive CRA were treated at our department. Extra-anatomic aortic revascularization with selective visceral vessels clamping was performed in all cases. Technical success was 100%. No perioperative death was registered. All patients remained asymptomatic during the follow-up period (62, 49, 25, and 94 months, respectively), with bypasses and target vessels patency. The extra-anatomic bypass with selective visceral vessels clamping reduces the aortic occlusion time and the risk of organ ischemia. All approaches available should be considered on a case-by-case basis and in high-volume centers. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Conceptual design of the handling and storage system of the spent target vessel for neutron scattering facility 2

    International Nuclear Information System (INIS)

    Adachi, Junichi; Kaminaga, Masanori; Sasaki, Shinobu; Haga, Katsuhiro; Aso, Tomokazu; Kinoshita, Hidetaka; Hino, Ryutaro

    2002-01-01

    In designing the neutron scattering facility, a spent target vessel should be replaced with remote handling devices in order to protect radioactive exposure, since it would be highly activated through the high energy neutron irradiation caused by the spallation reaction between mercury of the target material and the MW-class proton beam. In the storage of the spent target vessel, it is necessary to consider decay heat of the target vessel and mercury contamination caused by vaporization of the residual mercury in the vessel. A conceptual design has been carried out to establish basic concept and to clarify its specification of main equipments on handling and storage systems for the spent target vessel. This report presents the basic concept and a system plot plan based on latest design works of remote handling devices such as a spent target vessel storage cask and a target vessel exchange trolley, which aim at reasonability and simplification. In addition, storage systems for the spent moderator vessel, the spent proton beam window and the spent reflector vessel are also investigated based on the plot plan. (author)

  4. High pressure deuterium-tritium gas target vessels for muon-catalyzed fusion experiments

    International Nuclear Information System (INIS)

    Caffrey, A.J.; Spaletta, H.W.; Ware, A.G.; Zabriskie, J.M.; Hardwick, D.A.; Maltrud, H.R.; Paciotti, M.A.

    1989-01-01

    In experimental studies of muon-catalyzed fusion, the density of the hydrogen gas mixture is an important parameter. Catalysis of up to 150 fusions per muon has been observed in deuterium-tritium gas mixtures at liquid hydrogen density; at room temperature, such densities require a target gas pressure of the order of 1000 atmospheres (100 MPa, 15,000 psi). We report here the design considerations for hydrogen gas target vessels for muon-catalyzed fusion experiments that operate at 1000 and 10,000 atmospheres. The 1000 atmosphere high pressure target vessels are fabricated of Type A-286 stainless steel and lined with oxygen-free, high-conductivity (OFHC) copper to provide a barrier to hydrogen permeation of the stainless steel. The 10,000 atmosphere ultrahigh pressure target vessels are made from 18Ni (200 grade) maraging steel and are lined with OFHC copper, again to prevent hydrogen permeation of the steel. In addition to target design features, operating requirements, fabrication procedures, and secondary containment are discussed. 13 refs., 3 figs., 1 tab

  5. Gigacycle fatigue behaviour of austenitic stainless steels used for mercury target vessels

    International Nuclear Information System (INIS)

    Naoe, Takashi; Xiong, Zhihong; Futakawa, Masatoshi

    2016-01-01

    A mercury enclosure vessel for the pulsed spallation neutron source manufactured from a type 316L austenitic stainless steel, a so-called target vessel, suffers the cyclic loading caused by the proton beam induced pressure waves. A design criteria of the JSNS target vessel which is defined based on the irradiation damage is 2500 h at 1 MW with a repetition rate of 25 Hz, that is, the target vessel suffers approximately 10 9 cyclic loading while in operation. Furthermore, strain rate of the beam window of the target vessel reaches 50 s −1 at the maximum, which is much higher than that of the conventional fatigue. Gigacycle fatigue strength up to 10 9 cycles for solution annealed 316L (SA) and cold-worked 316L (CW) were investigated through the ultrasonic fatigue tests. Fatigue tests were performed under room temperature and 250 °C which is the maximum temperature evaluated at the beam window in order to investigate the effect of temperature on fatigue strength of SA and CW 316L. The results showed that the fatigue strength at 250 °C is clearly reduced in comparison with room temperature, regardless of cold work level. In addition, residual strength and microhardness of the fatigue tested specimen were measured to investigate the change in mechanical properties by cyclic loading. Cyclic hardening was observed in both the SA and CW 316L, and cyclic softening was observed in the initial stage of cyclic loading in CW 316L. Furthermore, abrupt temperature rising just before fatigue failure was observed regardless of testing conditions.

  6. Blood vessel damage correlated with irradiance for in vivo vascular targeted photodynamic therapy

    Science.gov (United States)

    Zhang, Jinde; Tan, Zou; Niu, Xiangyu; Lin, Linsheng; Lin, Huiyun; Li, Buhong

    2016-10-01

    Vascular targeted photodynamic therapy (V-PDT) has been widely utilized for the prevention or treatment of vascular-related diseases, including age-related macular degeneration, port-wine stains and prostate cancer. In order to quantitative assessment the blood vessel damage during V-PDT, nude mice were implanted with Titanium dorsal skin window chambers for in vivo V-PDT studies. For treatments, various irradiances including 50, 75, 100 and 200 mW/cm2 provided by a 532 nm semiconductor laser were performed with the same total light dose of 30 J/cm2 after the mice were intravenously injection of Rose Bengal for 25 mg/Kg body weight. Laser speckle imaging and microscope were used to monitor blood flow dynamics and vessel constriction during and after V-PDT, respectively. The V-PDT induced vessel damages between different groups were compared. The results show that significant difference in blood vessel damage was found between the lower irradiances (50, 75 and 100 mW/cm2) and higher irradiance (200 mW/cm2), and the blood vessel damage induced by V-PDT is positively correlated with irradiance. This study implies that the optimization of irradiance is required for enhancing V-PDT therapeutic efficiency.

  7. Pharmacological and physical vessel modulation strategies to improve EPR-mediated drug targeting to tumors.

    Science.gov (United States)

    Ojha, Tarun; Pathak, Vertika; Shi, Yang; Hennink, Wim E; Moonen, Chrit T W; Storm, Gert; Kiessling, Fabian; Lammers, Twan

    2017-09-15

    The performance of nanomedicine formulations depends on the Enhanced Permeability and Retention (EPR) effect. Prototypic nanomedicine-based drug delivery systems, such as liposomes, polymers and micelles, aim to exploit the EPR effect to accumulate at pathological sites, to thereby improve the balance between drug efficacy and toxicity. Thus far, however, tumor-targeted nanomedicines have not yet managed to achieve convincing therapeutic results, at least not in large cohorts of patients. This is likely mostly due to high inter- and intra-patient heterogeneity in EPR. Besides developing (imaging) biomarkers to monitor and predict EPR, another strategy to address this heterogeneity is the establishment of vessel modulation strategies to homogenize and improve EPR. Over the years, several pharmacological and physical co-treatments have been evaluated to improve EPR-mediated tumor targeting. These include pharmacological strategies, such as vessel permeabilization, normalization, disruption and promotion, as well as physical EPR enhancement via hyperthermia, radiotherapy, sonoporation and phototherapy. In the present manuscript, we summarize exemplary studies showing that pharmacological and physical vessel modulation strategies can be used to improve tumor-targeted drug delivery, and we discuss how these advanced combination regimens can be optimally employed to enhance the (pre-) clinical performance of tumor-targeted nanomedicines. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Revascularization of autogenous skin grafts placed on irradiated tissue

    International Nuclear Information System (INIS)

    Ueda, M.; Torii, S.; Kaneda, T.; Oka, T.

    1982-01-01

    Vascular changes in rat skin after irradiation were examined microangiographically. Revascularization of the skin transplanted during the chronic stage after irradiation was also studied. The results obtained through these examinations revealed higher vascular densities at the acute and the subacute stages, and low values at the chronic stages compared with those of the control. Furthermore, when the skin grafts were transplanted to the irradiated beds in the chronic stage, primary revascularization was scant, and the inhibited capillary proliferation in the recipient sites prevented new vessel penetration. This explains why grafts transplanted to previously irradiated beds fail to survive

  9. Dichotomy in Hedgehog Signaling between Human Healthy Vessel and Atherosclerotic Plaques

    NARCIS (Netherlands)

    Queiroz, Karla C. S.; Bijlsma, Maarten F.; Tio, René A.; Zeebregts, Clark J.; Dunaeva, Marina; Ferreira, Carmen V.; Fuhler, Gwenny M.; Kuipers, Ernst J.; Alves, Maria M.; Rezaee, Farhad; Spek, C. Arnold; Peppelenbosch, Maikel P.

    2012-01-01

    The major cause for plaque instability in atherosclerotic disease is neoangiogenic revascularization, but the factors controlling this process remain only partly understood. Hedgehog (HH) is a morphogen with important functions in revascularization, but its function in human healthy vessel biology

  10. The Use of the Profunda Femoral Artery as the Sole Target Vessel to Bypass Aortoiliac Disease in Patients with Critical Limb Ischemia and Concomitant Unreconstructable Infrainguinal Disease.

    Science.gov (United States)

    Kontopodis, Nikolaos; Lioudaki, Stella; Chronis, Christos; Kalogerakos, Paris; Lazopoulos, George; Papaioannou, Alexandra; Ioannou, Christos V

    2018-04-01

    Critical limb ischemia (CLI) often results from multilevel occlusive disease. There are occasions where a patent profunda femoral artery (PFA) is the only target artery that can be used as outflow during reconstruction to bypass aortoiliac disease (AOID), with no further option for infrainguinal revascularization. We aim to report results of the use of PFA as the sole target vessel for the treatment of these patients. This is a retrospective, single-center study including CLI patients treated during 36 months. All procedures were included regardless of inflow site. The outcomes examined were hemodynamic improvement, clinical status change, amputation-free and overall survival, and patency of the prosthesis. Univariate analysis was performed to identify possible predictors of adverse outcomes. Twenty-three patients and 27 limbs were included (2 female, mean age 70.6). Sixteen limbs presented rest pain and 11 tissue loss. Inflow was obtained from the axillary (n = 9), contralateral femoral (n = 8), abdominal aorta (n = 2), thoracic aorta (n = 1), ipsilateral external iliac (n = 2), and contralateral external iliac artery (n = 1). Immediately postoperatively ankle-brachial index significantly increased from 0.15 (0-0.5) to 0.50 (0.25-0.9), (P-value limbs presented clinical improvement (3 minimally, 18 moderately, and 3 markedly improved) and 3 presented no change. During a mean follow-up of 15.8 (2-36) months, we recorded 4 deaths and 4 major amputations. Mean predicted overall survival and amputation-free survival were 29.8 (95% confidence interval [CI] 24.5-35.1) and 26.5 months (95% CI 21.1-31.8), respectively. Predicted primary patency was 76% at 3 years. Univariate analysis revealed significant associations only between bypass patency and limp loss (P-value = 0.021). In the presence of CLI due to AOID and unreconstructable infrainguinal disease, the use of PFA as the sole target vessel during bypass is associated with significant rates of clinical

  11. Postischemic revascularization: from cellular and molecular mechanisms to clinical applications.

    Science.gov (United States)

    Silvestre, Jean-Sébastien; Smadja, David M; Lévy, Bernard I

    2013-10-01

    After the onset of ischemia, cardiac or skeletal muscle undergoes a continuum of molecular, cellular, and extracellular responses that determine the function and the remodeling of the ischemic tissue. Hypoxia-related pathways, immunoinflammatory balance, circulating or local vascular progenitor cells, as well as changes in hemodynamical forces within vascular wall trigger all the processes regulating vascular homeostasis, including vasculogenesis, angiogenesis, arteriogenesis, and collateral growth, which act in concert to establish a functional vascular network in ischemic zones. In patients with ischemic diseases, most of the cellular (mainly those involving bone marrow-derived cells and local stem/progenitor cells) and molecular mechanisms involved in the activation of vessel growth and vascular remodeling are markedly impaired by the deleterious microenvironment characterized by fibrosis, inflammation, hypoperfusion, and inhibition of endogenous angiogenic and regenerative programs. Furthermore, cardiovascular risk factors, including diabetes, hypercholesterolemia, hypertension, diabetes, and aging, constitute a deleterious macroenvironment that participates to the abrogation of postischemic revascularization and tissue regeneration observed in these patient populations. Thus stimulation of vessel growth and/or remodeling has emerged as a new therapeutic option in patients with ischemic diseases. Many strategies of therapeutic revascularization, based on the administration of growth factors or stem/progenitor cells from diverse sources, have been proposed and are currently tested in patients with peripheral arterial disease or cardiac diseases. This review provides an overview from our current knowledge regarding molecular and cellular mechanisms involved in postischemic revascularization, as well as advances in the clinical application of such strategies of therapeutic revascularization.

  12. Transmyocardial laser revascularization. Early clinical experience

    Directory of Open Access Journals (Sweden)

    Oliveira Sérgio Almeida de

    1999-01-01

    Full Text Available OBJECTIVE: To analyze the initial clinical experience of transmyocardial laser revascularization (TMLR in patients with severe diffuse coronary artery disease. METHODS: Between February, 1998 and February, 1999, 20 patients were submitted to TMLR at the Heart Institute (InCor, University of São Paulo Medical School, Brazil, isolated or in association with conventional coronary artery bypass graft (CABG. All patients had severe diffuse coronary artery disease, with angina functional class III/IV (Canadian Cardiovascular Society score unresponsive to medical therapy. Fourteen patients were submitted to TMLR as the sole therapy, whereas 6 underwent concomitant CABG. Fifty per cent of the patients had either been previously submitted to a CABG or to a percutaneous transluminal coronary angioplasty (PTCA. Mean age was 60 years, ranging from 45 to 74 years. RESULTS: All patients had three-vessel disease, with normal or mildly impaired left ventricular global function. Follow-up ranged from 1 to 13 months (mean 6.6 months, with no postoperative short or long term mortality. There was significant symptom improvement after the procedure, with 85% of the patients free of angina, and the remaining 15 % of the patients showing improvement in functional class, as well as in exercise tolerance. CONCLUSION: This novel technique can be considered a low risk alternative for a highly selected group of patients not suitable for conventional revascularization procedures.

  13. Virus Capsids as Targeted Nanoscale Delivery Vessels of Photoactive Compounds for Site-Specific Photodynamic Therapy

    Science.gov (United States)

    Cohen, Brian A.

    The research presented in this work details the use of a viral capsid as an addressable delivery vessel of photoactive compounds for use in photodynamic therapy. Photodynamic therapy is a treatment that involves the interaction of light with a photosensitizing molecule to create singlet oxygen, a reactive oxygen species. Overproduction of singlet oxygen in cells can cause oxidative damage leading to cytotoxicity and eventually cell death. Challenges with the current generation of FDA-approved photosensitizers for photodynamic therapy primarily stem from their lack of tissue specificity. This work describes the packaging of photoactive cationic porphyrins inside the MS2 bacteriophage capsid, followed by external modification of the capsid with cancer cell-targeting G-quadruplex DNA aptamers to generate a tumor-specific photosensitizing agent. First, a cationic porphyrin is loaded into the capsids via nucleotide-driven packaging, a process that involves charge interaction between the porphyrin and the RNA inside the capsid. Results show that over 250 porphyrin molecules associate with the RNA within each MS2 capsid. Removal of RNA from the capsid severely inhibits the packaging of the cationic porphyrins. Porphyrin-virus constructs were then shown to photogenerate singlet oxygen, and cytotoxicity in non-targeted photodynamic treatment experiments. Next, each porphyrin-loaded capsid is externally modified with approximately 60 targeting DNA aptamers by employing a heterobifunctional crosslinking agent. The targeting aptamer is known to bind the protein nucleolin, a ubiquitous protein that is overexpressed on the cell surface by many cancer cell types. MCF-7 human breast carcinoma cells and MCF-10A human mammary epithelial cells were selected as an in vitro model for breast cancer and normal tissue, respectively. Fluorescently tagged virus-aptamer constructs are shown to selectively target MCF-7 cells versus MCF-10A cells. Finally, results are shown in which porphyrin

  14. Reducing Microvascular Dysfunction in Revascularized Patients with ST-Elevation Myocardial Infarction by Off-Target Properties of Ticagrelor versus Prasugrel. Rationale and Design of the REDUCE-MVI Study

    NARCIS (Netherlands)

    G.N. Janssens (Gladys N.); M.A.H. van Leeuwen (Maarten); N.W. van der Hoeven (Nina W.); G.A. de Waard (Guus); R. Nijveldt (Robin); R. Diletti (Roberto); F. Zijlstra (Felix); C. Von Birgelen (Clemens); J. Escaned (Javier); M. Valgimigli (Marco); N. van Royen (Niels)

    2016-01-01

    textabstractMicrovascular injury is present in a large proportion of patients with ST-elevation myocardial infarction (STEMI) despite successful revascularization. Ticagrelor potentially mitigates this process by exerting additional adenosine-mediated effects. This study aims to determine whether

  15. Benefit of cardiac rehabilitation programme in revascularized coronary patient

    Directory of Open Access Journals (Sweden)

    Laura Crăciun

    2009-06-01

    Full Text Available Objective: Evaluating the cardiovascular risk profile in revascularized coronary patients at 16 months after revascularization(PCI+CABG. Material and method: We evaluated the cardiovascular risk profile, compliance to the secondary preventionmeasures and reaching guideline targets in revascularized coronary patients included in EuroASpire III Romania. The patientswere divided in two groups: the selection criteria was the adherence to cardiac rehabilitation programme (CRP+/CRP-. Result:The prevelence of cardiovascular risk factors was about 76%, with an increased significance in CRP- group (p0.05, OR>1. Conclusion: At 16 months after revascularisation, the patientsstill present a high risk. The level of cardio-metabolic and hemodynamic risk are maintained the same by unreaching thetargeted values recomended by ESC prevention guideline. The patients in CPR+ group had a significant improvement ofcardiovascular risk factors. Indication but also compliance to structured cardiac rehabilitation programme after myocardialrevascularisation remains at a suboptimal level.

  16. Investigation of magnetic nanoparticle targeting in a simplified model of small vessel aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Mirzababaei, S.N. [Department of Chemical Engineering, Noshirvani Babol University of Technology, Babol (Iran, Islamic Republic of); Gorji, Tahereh B., E-mail: gorji.tahereh@stu.nit.ac.ir [Department of Mechanical Engineering, Noshirvani Babol University of Technology, Babol (Iran, Islamic Republic of); Baou, M.; Gorji-Bandpy, M. [Department of Mechanical Engineering, Noshirvani Babol University of Technology, Babol (Iran, Islamic Republic of); Fatouraee, Nasser [Department of Biomedical Engineering, Amirkabir University of Technology, Tehran (Iran, Islamic Republic of)

    2017-03-15

    An in simulacra study was conducted to investigate the capture efficiency (CE) of magnetic nanoparticles (MNPs) in aneurysm model, under the effect of a bipolar permanent magnetic system positioned at the vicinity of the model vessel. The bipolar magnetic system with an active space of 9 cm was designed by FEMM software. The MNPs were magnetite nanoparticles synthesized by the hydrothermal method which were characterized by X-ray diffraction, Fourier transform infrared spectroscopy, scanning electron microscope and magnetometer measurements. Ferrofluid velocity, magnetic field strength, and aneurysm volume all proved to be important parameters which affect the capturing of MNPs. Overall, the results of this in simulacra study confirmed the effectiveness of magnetic targeting for possible aneurysm embolization. - Highlights: • An in simulacra investigation of the magnetic targeting in mechanical aneurysm embolization was conducted. • A bipolar permanent magnetic system with an active space of 9 cm was designed by FEMM software. • Magnetic nanofluid was synthetized and applied in an experimental setup to study the effect of different flow, magnetic field and geometry parameters on the capture efficiency of the magnetic particles acting as a dug carrier agent.

  17. Optimal management of radial artery grafts in CABG: Patient and target vessel selection and anti-spasm therapy.

    Science.gov (United States)

    Schwann, Thomas A; Gaudino, Mario; Baldawi, Mustafa; Tranbaugh, Robert; Schwann, Alexandra N; Habib, Robert H

    2018-05-01

    The current literature on radial artery grafting is reviewed focusing on the optimal deployment of radial artery grafts in coronary artery bypass surgery with specific attention to the selection of patients and target vessels for radial artery grafting. © 2018 Wiley Periodicals, Inc.

  18. Tacrolimus inhibits the revascularization of isolated pancreatic islets.

    Directory of Open Access Journals (Sweden)

    Ryuichi Nishimura

    Full Text Available AIMS: Immunosuppressive drugs could be crucial factors for a poor outcome after islet allotransplantation. Unlike rapamycin, the effects of tacrolimus, the current standard immunosuppressant used in islet transplantation, on graft revascularization remain unclear. We examined the effects of tacrolimus on islet revascularization using a highly sensitive imaging system, and analyzed the gene expression in transplanted islets by introducing laser microdissection techniques. METHODS: Islets isolated from C57BL/6-Tg (CAG-EGFP mice were transplanted into the nonmetallic dorsal skinfold chamber on the recipients. Balb/c athymic mice were used as recipients and were divided into two groups: including a control group (n = 9 and tacrolimus-treated group (n = 7. The changes in the newly-formed vessels surrounding the islet grafts were imaged and semi-quantified using multi-photon laser-scanning microscopy and a Volocity system. Gene expression in transplanted islets was analyzed by the BioMark dynamic system. RESULTS: The revascularization process was completed within 14 days after pancreatic islet transplantation at subcutaneous sites. The newly-formed vascular volume surrounding the transplanted islets in the tacrolimus-treated group was significantly less than that in the control group (p<0.05. Although the expression of Vegfa (p<0.05 and Ccnd1 (p<0.05 was significantly upregulated in the tacrolimus-treated group compared with that of the control group, no differences were observed between the groups in terms of other types of gene expression. CONCLUSIONS: The present study demonstrates that tacrolimus inhibits the revascularization of isolated pancreatic islets without affecting the characteristics of the transplanted grafts. Further refinements of this immunosuppressive regimen, especially regarding the revascularization of islet grafts, could improve the outcome of islet allotransplantation.

  19. Vascular targeting of LIGHT normalizes blood vessels in primary brain cancer and induces intratumoural high endothelial venules.

    Science.gov (United States)

    He, Bo; Jabouille, Arnaud; Steri, Veronica; Johansson-Percival, Anna; Michael, Iacovos P; Kotamraju, Venkata Ramana; Junckerstorff, Reimar; Nowak, Anna K; Hamzah, Juliana; Lee, Gabriel; Bergers, Gabriele; Ganss, Ruth

    2018-06-01

    High-grade brain cancer such as glioblastoma (GBM) remains an incurable disease. A common feature of GBM is the angiogenic vasculature, which can be targeted with selected peptides for payload delivery. We assessed the ability of micelle-tagged, vascular homing peptides RGR, CGKRK and NGR to specifically bind to blood vessels in syngeneic orthotopic GBM models. By using the peptide CGKRK to deliver the tumour necrosis factor (TNF) superfamily member LIGHT (also known as TNF superfamily member 14; TNFSF14) to angiogenic tumour vessels, we have generated a reagent that normalizes the brain cancer vasculature by inducing pericyte contractility and re-establishing endothelial barrier integrity. LIGHT-mediated vascular remodelling also activates endothelia and induces intratumoural high endothelial venules (HEVs), which are specialized blood vessels for lymphocyte infiltration. Combining CGKRK-LIGHT with anti-vascular endothelial growth factor and checkpoint blockade amplified HEV frequency and T-cell accumulation in GBM, which is often sparsely infiltrated by immune effector cells, and reduced tumour burden. Furthermore, CGKRK and RGR peptides strongly bound to blood vessels in freshly resected human GBM, demonstrating shared peptide-binding activities in mouse and human primary brain tumour vessels. Thus, peptide-mediated LIGHT targeting is a highly translatable approach in primary brain cancer to reduce vascular leakiness and enhance immunotherapy. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

  20. Primary nerve grafting: A study of revascularization.

    Science.gov (United States)

    Chalfoun, Charbel; Scholz, Thomas; Cole, Matthew D; Steward, Earl; Vanderkam, Victoria; Evans, Gregory R D

    2003-01-01

    It was the purpose of this study to evaluate the revascularization of primary nerve repair and grafts using orthogonal polarization spectral (OPS) (Cytometrix, Inc.) imaging, a novel method for real-time evaluation of microcirculatory blood flow. Twenty male Sprague Dawley rats (250 g) were anesthetized with vaporized halothane and surgically prepared for common peroneal nerve resection. Group I animals (n = 10) underwent primary neurorraphy following transection, utilizing a microsurgical technique with 10-0 nylon suture. Group II (n = 10) animals had a 7-mm segment of nerve excised, reversed, and subsequently replaced as a nerve graft under similar techniques. All animals were evaluated using the OPS imaging system on three portions (proximal, transection site/graft, and distal) of the nerve following repair or grafting. Reevaluation of 5 animals randomly selected from each group using the OPS imaging system was again performed on days 14 and 28 following microsurgical repair/grafting. Values were determined by percent change in vascularity of the common peroneal nerve at 0 hr following surgery. Real-time evaluation of blood flow was utilized as an additional objective criterion. Percent vascularity in group I and II animals increased from baseline in all segments at day 14. By day 28, vascularity in nerves of group I rats decreased in all segments to values below baseline, with the exception of the transection site, which remained at a higher value than obtained directly after surgical repair. In group II animals, vascularity remained above baseline in all segments except the distal segment, which returned to vascularity levels similar to those at 0 hr. Further, occlusion of the vessels demonstrated in the graft and distal segments following initial transection appeared to be corrected. This study suggests that revascularization may occur via bidirectional inosculation with favored proximal vascular growth advancement. The use of real-time imaging offers a

  1. Revascularization for acute mesenteric ischemia.

    Science.gov (United States)

    Ryer, Evan J; Kalra, Manju; Oderich, Gustavo S; Duncan, Audra A; Gloviczki, Peter; Cha, Stephen; Bower, Thomas C

    2012-06-01

    Acute mesenteric ischemia (AMI) remains difficult to diagnose, carries a high rate of complications, and is associated with significant mortality. We evaluated our experience with AMI over the last 2 decades to evaluate changes in management and assess current outcomes. Data from consecutive patients who underwent arterial revascularization for AMI over a 20-year period (January 1990-January 2010) were retrospectively reviewed. Patient demographics, treatment modalities, and outcomes over the last decade (2000-2010) were compared with those of the preceding decade (1990-1999) previously reported. Over the last 2 decades, 93 patients with AMI underwent emergency arterial revascularization. Forty-five patients were treated during the 1990s and 48 during the 2000s. The majority of these patients were transferred from outside facilities. Patient demographics and risk factors were similar between the 2 decades with the exception that the more contemporary patients were significantly older (65.1 ± 14 vs 71.3 ± 14; P = .04). Etiology remained constant between the groups with in situ thrombosis being the most common followed by arterial embolus. The majority of patients were treated with open revascularization. Endovascular therapy alone or as a hybrid procedure was used in 11 total patients, eight of which were treated in the last 10 years. The use of second-look laparotomy was much more liberal in the last decade (80% vs 48%; P = .003) Thirty-day mortality was 27% in the 1990s and 17% during the 2000s (P = 0.28). Major adverse events occurred in 47% of patients with no difference between decades. There was no significant difference in outcomes between open and endovascular revascularization. On univariate analysis, elevated SVS comorbidity score, congestive heart failure, and chronic kidney disease predicted early death, while a history of chronic mesenteric ischemia appeared protective. On multivariate analysis, no factor independently predicted perioperative

  2. Influence of the Target Vessel on the Location and Area of Maximum Skin Dose during Percutaneous Coronary Intervention

    International Nuclear Information System (INIS)

    Chida, K.; Fuda, K.; Kagaya, Y.; Saito, H.; Takai, Y.; Kohzuki, M.; Takahash i, S.; Yamada, S.; Zuguchi, M.

    2007-01-01

    Background: A number of cases involving radiation-associated patient skin injury attributable to percutaneous coronary intervention (PCI) have been reported. Knowledge of the location and area of the patient's maximum skin dose (MSD) in PCI is necessary to reduce the risk of skin injury. Purpose: To determine the location and area of the MSD in PCI, and separately analyze the effects of different target vessels. Material and Methods: 197 consecutive PCI procedures were studied, and the location and area of the MSD were calculated by a skin-dose mapping software program: Caregraph. The target vessels of the PCI procedures were divided into four groups based on the American Heart Association (AHA) classification. Results: The sites of the MSD for AHA no.1-3, AHA no.4, and AHA no.11-15 were located mainly on the right back skin, the lower right or center back skin, and the upper back skin areas, respectively, whereas the MSD sites for the AHA no. 5-10 PCI were widely spread. The MSD area for the AHA no. 4 PCI was larger than that for the AHA no. 11-15 PCI (P<0.0001). Conclusion: Although the radiation associated with PCI can be widely spread and variable, we observed a tendency regarding the location and area of the MSD when we separately analyzed the data for different target vessels. We recommend the use of a smaller radiation field size and the elimination of overlapping fields during PCI

  3. Targeted Vessel Ablation for More Efficient Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Voogt, Marianne J., E-mail: m.voogt@umcutrecht.nl [University Medical Center Utrecht, Department of Radiology (Netherlands); Stralen, Marijn van [University Medical Center Utrecht, Image Sciences Institute (Netherlands); Ikink, Marlijne E. [University Medical Center Utrecht, Department of Radiology (Netherlands); Deckers, Roel; Vincken, Koen L.; Bartels, Lambertus W. [University Medical Center Utrecht, Image Sciences Institute (Netherlands); Mali, Willem P. Th. M.; Bosch, Maurice A. A. J. van den [University Medical Center Utrecht, Department of Radiology (Netherlands)

    2012-10-15

    Purpose: To report the first clinical experience with targeted vessel ablation during magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) treatment of symptomatic uterine fibroids. Methods: Pretreatment T1-weighted contrast-enhanced magnetic resonance angiography was used to create a detailed map of the uterine arteries and feeding branches to the fibroids. A three-dimensional overlay of the magnetic resonance angiography images was registered on 3D T2-weighted pretreatment imaging data. Treatment was focused primarily on locations where supplying vessels entered the fibroid. Patients were followed 6 months after treatment with a questionnaire to assess symptoms and quality of life (Uterine Fibroid Symptom and Quality of Life) and magnetic resonance imaging to quantify shrinkage of fibroid volumes. Results: In two patients, three fibroids were treated with targeted vessel ablation during MR-HIFU. The treatments resulted in almost total fibroid devascularization with nonperfused volume to total fibroid volume ratios of 84, 68, and 86%, respectively, of treated fibroids. The predicted ablated volumes during MR-HIFU in patients 1 and 2 were 45, 40, and 82 ml, respectively, while the nonperfused volumes determined immediately after treatment were 195, 92, and 190 ml respectively, which is 4.3 (patient 1) and 2.3 (patient 2) times higher than expected based on the thermal dose distribution. Fibroid-related symptoms reduced after treatment, and quality of life improved. Fibroid volume reduction ranged 31-59% at 6 months after treatment. Conclusion: Targeted vessel ablation during MR-HIFU allowed nearly complete fibroid ablation in both patients. This technique may enhance the use of MR-HIFU for fibroid treatment in clinical practice.

  4. Combination of Vessel-Targeting Agents and Fractionated Radiation Therapy: The Role of the SDF-1/CXCR4 Pathway

    International Nuclear Information System (INIS)

    Chen, Fang-Hsin; Fu, Sheng-Yung; Yang, Ying-Chieh; Wang, Chun-Chieh; Chiang, Chi-Shiun; Hong, Ji-Hong

    2013-01-01

    Purpose: To investigate vascular responses during fractionated radiation therapy (F-RT) and the effects of targeting pericytes or bone marrow-derived cells (BMDCs) on the efficacy of F-RT. Methods and Materials: Murine prostate TRAMP-C1 tumors were grown in control mice or mice transplanted with green fluorescent protein-tagged bone marrow (GFP-BM), and irradiated with 60 Gy in 15 fractions. Mice were also treated with gefitinib (an epidermal growth factor receptor inhibitor) or AMD3100 (a CXCR4 antagonist) to examine the effects of combination treatment. The responses of tumor vasculatures to these treatments and changes of tumor microenvironment were assessed. Results: After F-RT, the tumor microvascular density (MVD) was reduced; however, the surviving vessels were dilated, incorporated with GFP-positive cells, tightly adhered to pericytes, and well perfused with Hoechst 33342, suggesting a more mature structure formed primarily via vasculogenesis. Although the gefitinib+F-RT combination affected the vascular structure by dissociating pericytes from the vascular wall, it did not further delay tumor growth. These tumors had higher MVD and better vascular perfusion function, leading to less hypoxia and tumor necrosis. By contrast, the AMD3100+F-RT combination significantly enhanced tumor growth delay more than F-RT alone, and these tumors had lower MVD and poorer vascular perfusion function, resulting in increased hypoxia. These tumor vessels were rarely covered by pericytes and free of GFP-positive cells. Conclusions: Vasculogenesis is a major mechanism for tumor vessel survival during F-RT. Complex interactions occur between vessel-targeting agents and F-RT, and a synergistic effect may not always exist. To enhance F-RT, using CXCR4 inhibitor to block BM cell influx and the vasculogenesis process is a better strategy than targeting pericytes by epidermal growth factor receptor inhibitor

  5. Mechanical Revascularization for Acute Ischemic Stroke: A Single-Center, Retrospective Analysis

    International Nuclear Information System (INIS)

    Jeromel, Miran; Milosevic, Z. V.; Kocijancic, I. J.; Lovric, D.; Svigelj, V.; Zvan, B.

    2013-01-01

    BackgroundEndovascular mechanical revascularization (thrombectomy) is an increasingly used method for intracranial large vessel recanalization in acute stroke. The purpose of the study was to analyze the recanalization rate, clinical outcome, and complication rate in our stroke patients treated with mechanical revascularization. A total of 57 patients with large vessel stroke (within 3 h for anterior and 12 h for posterior circulation) were treated with mechanical revascularization at a single center during 24 months. The primary goal of endovascular treatment using different mechanical devices was recanalization of the occluded vessel. Recanalization rate (reported as thrombolysis in cerebral infarction [TICI] score), clinical outcome (reported as National Institutes of Health Stroke Scale [NIHSS] score and modified Rankin scale [mRS] score), as well as periprocedural complications were analyzed. The mean age of the patients was 63.1 ± 12.9 years, with baseline median NIHSS score of 14 (interquartile range, 9.5–19). Successful recanalization (TICI 2b or 3) was achieved in 41 (72 %) patients. Twenty patients (35 %) presented with favorable outcome (mRS ≤2) 30 days after stroke. Overall, significant neurological improvement (≥4 NIHSS point reduction) occurred in 36 (63 %) patients. A clinically significant procedure-related adverse events (vessel disruption, peri/postprocedural intracranial bleeding) defined with decline in NIHSS of ≥4 or death occurred in three (5 %) patients. The study showed a high recanalization rate with improved clinical outcome and a low rate of periprocedural complications in our stroke patients treated with mechanical revascularization. Therefore, we could conclude that endovascular revascularization (primary or in combination with a bridging thrombolysis) was an effective and safe procedure for intracranial large vessel recanalization in acute stroke.

  6. 3-D MDT with spherical targets by bilinear interpolation for determining blood velocity profiles including the vessel wall effect

    Science.gov (United States)

    Choomphon-anomakhun, Natthaphon; Natenapit, Mayuree

    2018-02-01

    A numerical simulation of three-dimensional (3-D) implant assisted-magnetic drug targeting (IA-MDT) using ferromagnetic spherical targets, including the effect from the vessel wall on the blood flow, is presented. The targets were implanted within arterioles and subjected to an externally uniform applied magnetic field in order to increase the effectiveness of targeting magnetic drug carrier particles (MDCPs). The capture area (As) of the MDCPs was determined by inspection of the particle trajectories simulated from the particle equations of motion. The blood flow velocities at any particle position around the target were obtained by applying bilinear interpolation to the numerical blood velocity data. The effects on As of the type of ferromagnetic materials in the targets and MDCPs, average blood flow rates, mass fraction of the ferromagnetic material in the MDCPs, average radii of MDCPs (Rp) and the externally applied magnetic field strength (μ0H0) were evaluated. Furthermore, the appropriate μ0H0 and Rp for the IA-MDT design is suggested. In the case of the SS409 target and magnetite MDCPs, dimensionless capture areas ranging from 4.1- to 12.4 and corresponding to particle capture efficiencies of 31-94% were obtained with Rp ranging from 100- to 500 nm, weight fraction of 80%, μ0H0 of 0.6 T and an average blood flow rate of 0.01 ms-1. In addition, the more general 3-D modelling of IA-MDT in this work is applicable to IA-MDT using spherical targets implanted within blood vessels for both laminar and potential blood flows including the wall effect.

  7. Stent revascularization restores cortical blood flow and reverses tissue hypoxia in atherosclerotic renal artery stenosis but fails to reverse inflammatory pathways or glomerular filtration rate.

    Science.gov (United States)

    Saad, Ahmed; Herrmann, Sandra M S; Crane, John; Glockner, James F; McKusick, Michael A; Misra, Sanjay; Eirin, Alfonso; Ebrahimi, Behzad; Lerman, Lilach O; Textor, Stephen C

    2013-08-01

    Atherosclerotic renal artery stenosis (ARAS) is known to reduce renal blood flow, glomerular filtration rate (GFR) and amplify kidney hypoxia, but the relationships between these factors and tubulointerstitial injury in the poststenotic kidney are poorly understood. The purpose of this study was to examine the effect of renal revascularization in ARAS on renal tissue hypoxia and renal injury. Inpatient studies were performed in patients with ARAS (n=17; >60% occlusion) before and 3 months after stent revascularization, or in patients with essential hypertension (n=32), during fixed Na(+) intake and angiotensin converting enzyme/angiotensin receptors blockers Rx. Single kidney cortical, medullary perfusion, and renal blood flow were measured using multidetector computed tomography, and GFR by iothalamate clearance. Tissue deoxyhemoglobin levels (R(2)*) were measured by blood oxygen level-dependent MRI at 3T, as was fractional kidney hypoxia (percentage of axial area with R(2)*>30/s). In addition, we measured renal vein levels of neutrophil gelatinase-associated lipocalin, monocyte chemoattractant protein-1, and tumor necrosis factor-α. Pre-stent single kidney renal blood flow, perfusion, and GFR were reduced in the poststenotic kidney. Renal vein neutrophil gelatinase-associated lipocalin, tumor necrosis factor-α, monocyte chemoattractant protein-1, and fractional hypoxia were higher in untreated ARAS than in essential hypertension. After stent revascularization, fractional hypoxia fell (Pblood flow, whereas GFR and neutrophil gelatinase-associated lipocalin, monocyte chemoattractant protein-1, and tumor necrosis factor-α remained unchanged. These data demonstrate that despite reversal of renal hypoxia and partial restoration of renal blood flow after revascularization, inflammatory cytokines and injury biomarkers remained elevated and GFR failed to recover in ARAS. Restoration of vessel patency alone failed to reverse tubulointerstitial damage and partly

  8. Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug-Eluting Stent Era.

    Science.gov (United States)

    Kim, Jihoon; Lee, Joo Myung; Choi, Ki Hong; Rhee, Tae-Min; Hwang, Doyeon; Park, Jonghanne; Ahn, Chul; Park, Taek Kyu; Yang, Jeong Hoon; Song, Young Bin; Choi, Jin-Ho; Hahn, Joo-Yong; Choi, Seung-Hyuk; Gwon, Hyeon-Cheol

    2018-02-15

    There are limited data regarding the prognostic impact of angiographic complete revascularization (CR) in patients with chronic kidney disease (CKD). We sought to investigate the differential prognostic impact of angiographic CR over incomplete revascularization (IR), according to the presence of CKD in the drug-eluting stent era. Between 2003 and 2011 at Samsung Medical Center, consecutive patients with multivessel disease were stratified by the presence of CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m 2 ) and classified according to angiographic CR (residual SYNTAX score=0) or IR. Clinical outcomes were compared between angiographic CR and IR, stratified by the presence of CKD. Primary outcome was patient-oriented composite outcomes (POCO, a composite of all-cause death, myocardial infarction, any revascularization) at 3 years. Inverse probability weighting was performed between the CR and IR groups. A total of 3224 patients were eligible for analysis: 2295 without CKD; 929 with CKD. Among non-CKD patients, angiographic CR showed a significantly lower risk of POCO than IR (17.2% versus 21.7%, adjusted hazard ratio 0.76, 95% confidence interval, 0.62-0.95, P =0.014), mainly driven by a significantly lower risk of any revascularization. Among CKD patients, however, angiographic CR was associated with a significantly higher risk of POCO than IR (37.7% versus 28.4%, adjusted hazard ratio 1.42, 95% confidence interval, 1.08%-1.85%, P =0.011), mainly driven by a significantly higher risk of nonfatal target vessel myocardial infarction. Angiographic CR was associated with reduced risk of POCO than IR in patients without CKD; however, it was associated with a significantly higher risk of POCO and nonfatal myocardial infarction in CKD patients. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  9. First-in-man experience with the ReVive PV peripheral thrombectomy device for the revascularization of below-the-knee embolic occlusions.

    Science.gov (United States)

    Landau, David; Moomey, Charles; Fiorella, David

    2014-10-01

    To report the initial use of a novel thrombectomy device for revascularization of below-the-knee thromboembolic occlusions encountered during proximal revascularization procedures. The ReVive PV Peripheral Thrombectomy Device is a non-detachable, self-expanding stent-like device recently approved for peripheral thrombectomy. Four patients (3 women; mean age 68.8 years) undergoing proximal revascularization procedures experienced embolic occlusions of all 3 trifurcation vessels in 1 patient, the tibioperoneal trunk alone in 2 cases, and the peroneal artery alone in the last patient. In all cases, the involved arteries represented the primary or sole vessel(s) providing outflow to the lower extremity. In each case, the ReVive PV device was used to successfully extract the thrombus and restore flow to the distal extremity. No complications were encountered during any of the procedures. The ReVive PV peripheral thrombectomy device may facilitate the safe and efficient revascularization of distal arterial embolic occlusions.

  10. Current status of hybrid coronary revascularization.

    Science.gov (United States)

    Jaik, Nikhil P; Umakanthan, Ramanan; Leacche, Marzia; Solenkova, Natalia; Balaguer, Jorge M; Hoff, Steven J; Ball, Stephen K; Zhao, David X; Byrne, John G

    2011-10-01

    Hybrid coronary revascularization combines coronary artery bypass surgery with percutaneous coronary intervention techniques to treat coronary artery disease. The potential benefits of such a technique are to offer the patients the best available treatments for coronary artery disease while minimizing the risks of the surgery. Hybrid coronary revascularization has resulted in the establishment of new 'hybrid operating suites', which incorporate and integrate the capabilities of a cardiac surgery operating room with that of an interventional cardiology laboratory. Hybrid coronary revascularization has greatly augmented teamwork and cooperation between both fields and has demonstrated encouraging as well as good initial outcomes.

  11. A study on accumulation of magnetic drug in the capillary vessel of target organ using superconducting MDDS

    International Nuclear Information System (INIS)

    Mishima, F.; Akiyama, Y.; Nishijima, S.

    2010-01-01

    Magnetic Drug Delivery System (MDDS) is one of the drug therapy technologies to accumulate the drug at the targeted part efficiently. The ferromagnetic particle is attached to the medicine, antibody, hormones and so on. The magnetic seeded drug is injected into the blood vessel, and then is accumulated in capillary vessel of target organ by magnetic field generated by the superconducting magnet placed outside of the body. The technology is great prospective for not only human medical treatment but also stockbreeding field. Treatment for cow ovarian diseases (decay of ovarian hormone secretion) requires an improvement in suppression of the drug diffusion to non-diseased part by the blood flow. In order to solve the problem, the applicability of the MDDS was examined. The behavior of the magnetic drug under the magnetic field generated by high temperature superconducting (HTS) bulk magnet were studied by the model experiment and computer simulation with the capillary model of the corpus luteum. As a result, it was shown that MDDS is able to apply to the capillaries of the corpus luteum (yellow body).

  12. Small-target leak detection for a closed vessel via infrared image sequences

    Science.gov (United States)

    Zhao, Ling; Yang, Hongjiu

    2017-03-01

    This paper focus on a leak diagnosis and localization method based on infrared image sequences. Some problems on high probability of false warning and negative affect for marginal information are solved by leak detection. An experimental model is established for leak diagnosis and localization on infrared image sequences. The differential background prediction is presented to eliminate the negative affect of marginal information on test vessel based on a kernel regression method. A pipeline filter based on layering voting is designed to reduce probability of leak point false warning. A synthesize leak diagnosis and localization algorithm is proposed based on infrared image sequences. The effectiveness and potential are shown for developed techniques through experimental results.

  13. Ligand-directed targeting of lymphatic vessels uncovers mechanistic insights in melanoma metastasis.

    Science.gov (United States)

    Christianson, Dawn R; Dobroff, Andrey S; Proneth, Bettina; Zurita, Amado J; Salameh, Ahmad; Dondossola, Eleonora; Makino, Jun; Bologa, Cristian G; Smith, Tracey L; Yao, Virginia J; Calderone, Tiffany L; O'Connell, David J; Oprea, Tudor I; Kataoka, Kazunori; Cahill, Dolores J; Gershenwald, Jeffrey E; Sidman, Richard L; Arap, Wadih; Pasqualini, Renata

    2015-02-24

    Metastasis is the most lethal step of cancer progression in patients with invasive melanoma. In most human cancers, including melanoma, tumor dissemination through the lymphatic vasculature provides a major route for tumor metastasis. Unfortunately, molecular mechanisms that facilitate interactions between melanoma cells and lymphatic vessels are unknown. Here, we developed an unbiased approach based on molecular mimicry to identify specific receptors that mediate lymphatic endothelial-melanoma cell interactions and metastasis. By screening combinatorial peptide libraries directly on afferent lymphatic vessels resected from melanoma patients during sentinel lymphatic mapping and lymph node biopsies, we identified a significant cohort of melanoma and lymphatic surface binding peptide sequences. The screening approach was designed so that lymphatic endothelium binding peptides mimic cell surface proteins on tumor cells. Therefore, relevant metastasis and lymphatic markers were biochemically identified, and a comprehensive molecular profile of the lymphatic endothelium during melanoma metastasis was generated. Our results identified expression of the phosphatase 2 regulatory subunit A, α-isoform (PPP2R1A) on the cell surfaces of both melanoma cells and lymphatic endothelial cells. Validation experiments showed that PPP2R1A is expressed on the cell surfaces of both melanoma and lymphatic endothelial cells in vitro as well as independent melanoma patient samples. More importantly, PPP2R1A-PPP2R1A homodimers occur at the cellular level to mediate cell-cell interactions at the lymphatic-tumor interface. Our results revealed that PPP2R1A is a new biomarker for melanoma metastasis and show, for the first time to our knowledge, an active interaction between the lymphatic vasculature and melanoma cells during tumor progression.

  14. Predicting target vessel location on robot-assisted coronary artery bypass graft using CT to ultrasound registration

    International Nuclear Information System (INIS)

    Cho, Daniel S.; Linte, Cristian; Chen, Elvis C. S.; Bainbridge, Daniel; Wedlake, Chris; Moore, John; Barron, John; Patel, Rajni; Peters, Terry

    2012-01-01

    Purpose: Although robot-assisted coronary artery bypass grafting (RA-CABG) has gained more acceptance worldwide, its success still depends on the surgeon's experience and expertise, and the conversion rate to full sternotomy is in the order of 15%-25%. One of the reasons for conversion is poor pre-operative planning, which is based solely on pre-operative computed tomography (CT) images. In this paper, the authors propose a technique to estimate the global peri-operative displacement of the heart and to predict the intra-operative target vessel location, validated via both an in vitro and a clinical study. Methods: As the peri-operative heart migration during RA-CABG has never been reported in the literatures, a simple in vitro validation study was conducted using a heart phantom. To mimic the clinical workflow, a pre-operative CT as well as peri-operative ultrasound images at three different stages in the procedure (Stage 0 --following intubation; Stage 1 --following lung deflation; and Stage 2 --following thoracic insufflation) were acquired during the experiment. Following image acquisition, a rigid-body registration using iterative closest point algorithm with the robust estimator was employed to map the pre-operative stage to each of the peri-operative ones, to estimate the heart migration and predict the peri-operative target vessel location. Moreover, a clinical validation of this technique was conducted using offline patient data, where a Monte Carlo simulation was used to overcome the limitations arising due to the invisibility of the target vessel in the peri-operative ultrasound images. Results: For the in vitro study, the computed target registration error (TRE) at Stage 0 , Stage 1 , and Stage 2 was 2.1, 3.3, and 2.6 mm, respectively. According to the offline clinical validation study, the maximum TRE at the left anterior descending (LAD) coronary artery was 4.1 mm at Stage 0 , 5.1 mm at Stage 1 , and 3.4 mm at Stage 2 . Conclusions: The authors

  15. Surgical myocardial revascularization without extracorporeal circulation

    Directory of Open Access Journals (Sweden)

    Salomón Soriano Ordinola Rojas

    2003-05-01

    Full Text Available OBJECTIVE: To assess the immediate postoperative period of patients undergoing myocardial revascularization without extracorporeal circulation with different types of grafts. METHODS: One hundred and twelve patients, 89 (79.5% of whom were males, were revascularized without extracorporeal circulation. Their ages ranged from 39 to 85 years. The criteria for indicating myocardial revascularization without extracorporeal circulation were as follows: revascularized coronary artery caliber > 1.5 mm, lack of intramyocardial trajectory on coronary angiography, noncalcified coronary arteries, and tolerance of the heart to the different rotation maneuvers. RESULTS: Myocardial revascularization without extracorporeal circulation was performed in 112 patients. Three were converted to extracorporeal circulation, which required a longer hospital stay but did not impact mortality. During the procedure, the following events were observed: atrial fibrillation in 10 patients, ventricular fibrillation in 4, total transient atrioventricular block in 2, ventricular extrasystoles in 58, use of a device to retrieve red blood cells in 53, blood transfusion in 8, and arterial hypotension in 89 patients. Coronary angiography was performed in 20 patients on the seventh postoperative day when the grafts were patent. CONCLUSION: Myocardial revascularization without extracorporeal circulation is a reproducible technique that is an alternative for treating ischemic heart disease.

  16. Coronary artery bypass grafting versus percutaneous intervention in coronary revascularization: a historical perspective and review

    Directory of Open Access Journals (Sweden)

    Burgess SN

    2015-06-01

    Full Text Available Sonya N Burgess,1 John J Edmond,2 Craig P Juergens,1 John K French11Department of Cardiology, Liverpool Hospital and South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; 2Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand Background: Coronary artery bypass graft surgery is arguably the most intensively studied surgical procedure, and percutaneous coronary intervention (PCI has been subjected to more randomized clinical trials than any other interventional procedure. Changes seen in revascularization techniques have been numerous. The rapid evolution of evidence-based revascularization procedures has occurred as a result of many pivotal large randomized clinical trials. Objective: This review compares and contrasts outcomes from two coronary revascularization techniques, coronary artery bypass grafting (CABG and PCI, with particular reference to the landmark trials that inform practice guidelines. Methods: We undertook a comprehensive review of published literature addressing trials in this field performed to address current knowledge both in the predrug-eluting stent and postdrug-eluting stent era. Results and discussion: Surgical and percutaneous revascularization strategies have different strengths and weaknesses, and neither strategy is superior in all patients, clinical presentations, or anatomical subgroups. Current data support the use of percutaneous intervention in ST elevation myocardial infarction and in single-vessel disease. In noncomplex multivessel disease and isolated left main stem PCI, the data support non-inferiority of PCI compared to CABG as reflected in the 2014 European Society of Cardiology guidelines. Landmark revascularization trials of multivessel disease comparing CABG to PCI found no survival benefit to CABG over PCI, except in patients with complex disease. In these trials, revascularization drove differences in primary endpoints and in all but the

  17. Structured oligonucleotides for target indexing to allow single-vessel PCR amplification and solid support microarray hybridization.

    Science.gov (United States)

    Girard, Laurie D; Boissinot, Karel; Peytavi, Régis; Boissinot, Maurice; Bergeron, Michel G

    2015-02-07

    The combination of molecular diagnostic technologies is increasingly used to overcome limitations on sensitivity, specificity or multiplexing capabilities, and provide efficient lab-on-chip devices. Two such techniques, PCR amplification and microarray hybridization are used serially to take advantage of the high sensitivity and specificity of the former combined with high multiplexing capacities of the latter. These methods are usually performed in different buffers and reaction chambers. However, these elaborate methods have high complexity and cost related to reagent requirements, liquid storage and the number of reaction chambers to integrate into automated devices. Furthermore, microarray hybridizations have a sequence dependent efficiency not always predictable. In this work, we have developed the concept of a structured oligonucleotide probe which is activated by cleavage from polymerase exonuclease activity. This technology is called SCISSOHR for Structured Cleavage Induced Single-Stranded Oligonucleotide Hybridization Reaction. The SCISSOHR probes enable indexing the target sequence to a tag sequence. The SCISSOHR technology also allows the combination of nucleic acid amplification and microarray hybridization in a single vessel in presence of the PCR buffer only. The SCISSOHR technology uses an amplification probe that is irreversibly modified in presence of the target, releasing a single-stranded DNA tag for microarray hybridization. Each tag is composed of a 3-nucleotide sequence-dependent segment and a unique "target sequence-independent" 14-nucleotide segment allowing for optimal hybridization with minimal cross-hybridization. We evaluated the performance of five (5) PCR buffers to support microarray hybridization, compared to a conventional hybridization buffer. Finally, as a proof of concept, we developed a multiplexed assay for the amplification, detection, and identification of three (3) DNA targets. This new technology will facilitate the design

  18. Surgical revascularization induces angiogenesis in orthotopic bone allograft

    NARCIS (Netherlands)

    Willems, Wouter F.; Kremer, Thomas; Friedrich, Patricia; Bishop, Allen T.

    2012-01-01

    Remodeling of structural bone allografts relies on adequate revascularization, which can theoretically be induced by surgical revascularization. We developed a new orthotopic animal model to determine the technical feasibility of axial arteriovenous bundle implantation and resultant angiogenesis. We

  19. Comparison of Outcomes in Patients With Versus Without Diabetes Mellitus After Revascularization With Everolimus- and Sirolimus-Eluting Stents (from the SORT OUT IV Trial)

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Thayssen, Per; Junker, Anders

    2012-01-01

    Diabetes is associated with increased risk of major adverse cardiac events (MACEs) after percutaneous coronary intervention. The purpose of this substudy of the SORT OUT IV trial was to compare clinical outcomes in patients with and without diabetes mellitus treated with everolimus-eluting stents...... (EESs) or sirolimus-eluting stents (SESs). In total 2,774 patients (390 with diabetes, 14.1%) were randomized to stent implantation with EESs (n = 1,390, diabetes in 14.0%) or SESs (n = 1,384, diabetes in 14.2%). Randomization was stratified by presence/absence of diabetes. The primary end point...... was MACEs, a composite of cardiac death, myocardial infarction, definite stent thrombosis, or target vessel revascularization within 18 months. MACEs were higher in diabetic than in nondiabetic patients (13.1% vs 6.4%, hazard ratio [HR] 2.08, 95% confidence interval [CI] 1.51 to 2.86). In diabetic patients...

  20. Adverse events while awaiting myocardial revascularization

    DEFF Research Database (Denmark)

    Head, Stuart J.; da Costa, Bruno R.; Beumer, Berend

    2017-01-01

    OBJECTIVES: The aim of the current study was to estimate adverse event rates while awaiting myocardial revascularization and review criteria for prioritizing patients. METHODS: A PubMed search was performed on 19 January 2015, to identify English-language, original, observational studies reportin...

  1. Carotid artery revascularization : Surgical and endovascular developments

    NARCIS (Netherlands)

    Borst, G.J. de

    2007-01-01

    Carotid artery revascularization. Surgical and endovascular developments. Stroke is among the most disabling chronic diseases and the third major cause of death in the Western world. In the Netherlands around 12 per 1000 inhabitants suffers a stroke, and in 2005 over 10.000 people died as a result

  2. Preoperative evaluation of myocardial viability by thallium-201 imaging in patients with old myocardial infarction who underwent coronary revascularization

    International Nuclear Information System (INIS)

    Naruse, Hitoshi; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Miyamoto, Takashi; Fukuchi, Minoru

    1992-01-01

    The myocardial uptake and redistribution in thallium scintigraphy and the regional wall motion by echocardiography were evaluated by a semi-quantitative method in 42 patients who previously had myocardial infarction (50 target vessels) and underwent coronary revascularization. The aim of this study was to elucidate the significance of the initial image, delayed image and redistribution on thallium-201 scintigraphy for clinical diagnosis of the myocardial viability. As a semi-quantitative analysis, we used a bull's-eye display for thallium image and centerline method for echocardiographic wall motion, and compared the results before and after revascularization. As a result, the thallium grade improved postoperatively in all 17 areas which preoperatively had showed redistribution, and also in 11 of the 32 areas without preoperative redistribution. The sensitivity, specificity and accuracy of preoperative thallium redistribution for predicting myocardial viability were 61%, 100% and 78%, respectively, when the postoperative improvement in the thallium grade was used as the standard. The postoperative probability of improvement in the thallium grade increased in proportion to the preoperative grade (delayed image)(p<0.01). There was no correlation between the preoperative thallium delayed image and postoperative improvement in wall motion. Postoperative improvement in thallium image and wall motion could not be predicted from the preoperative wall motion. Thus, postoperative improvement in thallium images can be anticipated if redistribution is present on the preoperative thallium image, and the preoperative thallium delayed image is useful for predicting myocardial viability. Improvement in wall motion could not be predicted preoperatively by these methods. (author)

  3. Mechanism of neoangiogenesis development after transmyocardial laser revascularization

    Science.gov (United States)

    Popov, Gennady K.; Golovneva, Elena S.

    2000-05-01

    Pathophysiological mechanisms of transmyocardial laser revascularization (TLMR) remain insufficiently clear. Since the laser transmyocardial channels soon after their formation are closed and then substituted by the connective tissue, the laser effect is caused by neoangiogenesis in the place of injury. We have carried out TLMR in 250 Vistar rats with the help of Nd:YAG laser. In the point of lesion the development of inflammatory process with feebly marked, exudation reaction was registered. A connective tissue scar have been forming in the place of the lasers channel. The substantial growth of small vessels number is shown morphometrically in this place. The number of mast cells in have been increasing since the first hours after operation. The most part of the mast cells were degranulated, that indicates the release of bioactive substances into the extracellular space. The signs of activation of fibroblasts in the place of myocardium damage (abrupt hyperplasia of granular endoplasm reticulum on the electron microphotographs) were evident by the 5 - 6 day. At the first hours and days the platelets in the laser damaged vessels aggregated and the number of (alpha) granules decreased. It also points at the presence of bioactive substances, secreted by platelets. Zymography showed, that the activity of collagenase have been sharply increasing, with its peak on the 10 day after operation. Thus, the activation of noncontracting elements of myocardium during TMR may be the source of growth factors and proteases necessary for neoangiogenesis.

  4. Revascularization of femoral head ischemic necrosis with vascularized bone graft: A CT scan experimental study

    International Nuclear Information System (INIS)

    Gonzalez del Pino, J.; Knapp, K.; Gomez Castresana, F.; Benito, M.

    1990-01-01

    An ischemic necrosis of the femoral head was induced in 15 mongrel adult dogs using the technique described by Gartsman et al. Five weeks later, a free vascularized rib graft was transferred into the previously induced ischemic femoral head. High resolution computed tomographic scanning was used to evaluate revascularization 4, 8 and 12 weeks after grafting. The femoral head exhibited new vessel formation throughout the study. Arterial terminal branches arising from the rib graft medullary and periosteal circulations extended beyond the rib graft, entered the head, and reached the subchondral plate. Even where the rib graft did not replenish the central core of the head, there was vascular supply from the grafted bone's vascular tree. These results suggest that a free vascularized bone graft is able to revascularize an experimentally induced ischemic femoral head necrosis. (orig.)

  5. Combined Microencapsulated Islet Transplantation and Revascularization of Aortorenal Bypass in a Diabetic Nephropathy Rat Model

    Directory of Open Access Journals (Sweden)

    Yunqiang He

    2016-01-01

    Full Text Available Objective. Revascularization of aortorenal bypass is a preferred technique for renal artery stenosis (RAS in diabetic nephropathy (DN patients. Restenosis of graft vessels also should be considered in patients lacking good control of blood glucose. In this study, we explored a combined strategy to prevent the recurrence of RAS in the DN rat model. Methods. A model of DN was established by intraperitoneal injection of streptozotocin. Rats were divided into 4 groups: SR group, MIT group, Com group, and the untreated group. The levels of blood glucose and urine protein were measured, and changes in renal pathology were observed. The expression of monocyte chemoattractant protein-1 (MCP-1 in graft vessels was assessed by immunohistochemical staining. Histopathological staining was performed to assess the pathological changes of glomeruli and tubules. Results. The levels of urine protein and the expression of MCP-1 in graft vessels were decreased after islet transplantation. The injury of glomerular basement membrane and podocytes was significantly ameliorated. Conclusions. The combined strategy of revascularization and microencapsulated islet transplantation had multiple protective effects on diabetic nephropathy, including preventing atherosclerosis in the graft vessels and alleviating injury to the glomerular filtration barrier. This combined strategy may be helpful for DN patients with RAS.

  6. Evaluation of Sidestream Darkfield Microscopy for Real-Time Imaging Acellular Dermal Matrix Revascularization.

    Science.gov (United States)

    DeGeorge, Brent R; Olenczak, J Bryce; Cottler, Patrick S; Drake, David B; Lin, Kant Y; Morgan, Raymond F; Campbell, Christopher A

    2016-06-01

    Acellular dermal matrices (ADMs) serve as a regenerative framework for host cell integration and collagen deposition to augment the soft tissue envelope in ADM-assisted breast reconstruction-a process dependent on vascular ingrowth. To date noninvasive intra-operative imaging techniques have been inadequate to evaluate the revascularization of ADM. We investigated the safety, feasibility, and efficacy of sidestream darkfield (SDF) microscopy to assess the status of ADM microvascular architecture in 8 patients at the time of tissue expander to permanent implant exchange during 2-stage ADM-assisted breast reconstruction. The SDF microscopy is a handheld device, which can be used intraoperatively for the real-time assessment of ADM blood flow, vessel density, vessel size, and branching pattern. The SDF microscopy was used to assess the microvascular architecture in the center and border zone of the ADM and to compare the native, non-ADM-associated capsule in each patient as a within-subject control. No incidences of periprosthetic infection, explantation, or adverse events were reported after SDF image acquisition. Native capsules demonstrate a complex, layered architecture with an average vessel area density of 14.9 mm/mm and total vessel length density of 12.3 mm/mm. In contrast to native periprosthetic capsules, ADM-associated capsules are not uniformly vascularized structures and demonstrate 2 zones of microvascular architecture. The ADM and native capsule border zone demonstrates palisading peripheral vascular arcades with continuous antegrade flow. The central zone of the ADM demonstrates punctate perforating vascular plexi with intermittent, sluggish flow, and intervening 2- to 3-cm watershed zones. Sidestream darkfield microscopy allows for real-time intraoperative assessment of ADM revascularization and serves as a potential methodology to compare revascularization parameters among commercially available ADMs. Thr SDF microscopy demonstrates that the

  7. Matrix metalloproteinases 2 and 3 gene polymorphisms and the risk of target vessel revascularization after percutaneous coronary intervention: Is there still room for determining genetic variation of MMPs for assessment of an increased risk of restenosis?

    NARCIS (Netherlands)

    Verschuren, J. J. W.; Sampietro, M. L.; Pons, D.; Trompet, S.; Ewing, M. M.; Quax, P. H. A.; de Knijff, P.; Zwinderman, A. H.; de Winter, R. J.; Tio, R. A.; de Maat, M. P.; Doevendans, P. A. F. M.; Jukema, J. W.

    2010-01-01

    Objective: Mixed results have been reported of matrix metalloproteinases (MMP) and their association with restenosis after percutaneous coronary intervention (PCI). The current study examines whether multiple single nucleotide polymorphisms (SNPs), covering the full genomic region of MMP2 and MMP3,

  8. Matrix Metalloproteinases 2 and 3 Gene Polymorphisms and the Risk of Target Vessel Revascularization after Percutaneous Coronary Intervention: Is There Still Room for Determining Genetic Variation of MMPs for Assessment of an Increased Risk of Restenosis?

    Directory of Open Access Journals (Sweden)

    J.J.W. Verschuren

    2010-01-01

    Full Text Available Objective: Mixed results have been reported of matrix metalloproteinases (MMP and their association with restenosis after percutaneous coronary intervention (PCI. The current study examines whether multiple single nucleotide polymorphisms (SNPs, covering the full genomic region of MMP2 and MMP3, were associated with restenosis in the GENDER study population.

  9. A comparison of hybrid coronary revascularization and off-pump coronary revascularization.

    Science.gov (United States)

    Umakanthan, Ramanan; Leacche, Marzia; Gallion, Anna H; Byrne, John G

    2013-04-01

    Minimally invasive approaches to treat vascular disease have been accruing significant popularity over the last several decades. Due to progressive advances in technology, a variety of techniques are being now utilized in the field of cardiovascular surgery. The objectives of minimally invasive techniques are to curtail operative trauma and minimize perioperative morbidity without decreasing the quality of the treatment. The standard surgical approach for the treatment of coronary artery disease has traditionally been coronary artery bypass grafting surgery via median sternotomy. Off-pump coronary artery bypass grafting surgery offers a less invasive alternative and enables coronary revascularization to be performed without cardiopulmonary bypass. Hybrid coronary revascularization offers an even less invasive option in which minimally invasive direct coronary artery bypass can be combined with percutaneous coronary intervention. In this article, the authors review a recent publication comparing hybrid coronary revascularization and off-pump coronary artery bypass grafting surgery.

  10. Vessel Operating Units (Vessels)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains data for vessels that are greater than five net tons and have a current US Coast Guard documentation number. Beginning in1979, the NMFS...

  11. Follow-up of renal and mesenteric artery revascularization with duplex ultrasonography

    Science.gov (United States)

    Taylor, David C.; Houston, Gordon T.M.; Anderson, Caroline; Jameson, Margot; Popatia, Shelley

    1996-01-01

    Objective To evaluate the long-term anatomic results of renal revascularization procedures using duplex ultrasonography. Design A case series. Setting A university-affiliated hospital. Patients Twenty-five patients who had undergone renal percutaneous transluminal angioplasty (PTA) (18 arteries), renal bypass (10 arteries) and mesenteric bypass (6 arteries). The mean follow-up was 22 months (range from 3 to 48 months) for those who underwent renal PTA, 23 months (range from 1.5 to 70 months) for those who underwent renal bypass and 34 months (range from 8 to 144 months) for those who underwent mesenteric bypass. Main Outcome Measures Patency rates for the three procedures as assessed by duplex ultrasonography. Results Duplex ultrasonography demonstrated patency without stenosis after renal and mesenteric artery revascularization in 14 arteries subjected to renal PTA, 9 arteries subjected to renal bypass and 6 arteries subjected to mesenteric bypass. Three arteries that had renal PTA had recurrent vessel stenosis and one had occlusion. One artery that had renal bypass showed occlusion. Conclusions Renal PTA, renal bypass and mesenteric bypass are durable procedures at 2 years of follow-up, and duplex ultrasonography is a valuable method for assessing the patency of arteries after renal and mesenteric revascularization. PMID:8599785

  12. Replantation and revascularization vs. amputation in injured digits

    NARCIS (Netherlands)

    Mulders, Marjolein A. M.; Neuhaus, Valentin; Becker, Stéphanie J. E.; Lee, Sang-Gil; Ring, David C.

    2013-01-01

    The purpose of this study was to analyze factors associated with the decision to replant or revascularize rather than amputate an injured digit as well as factors associated with successful replantation or revascularization. We reviewed 315 complete and subtotal amputations at or proximal to the

  13. Defining the target volume for post-operative radiotherapy after D2 dissection in gastric cancer by CT-based vessel-guided delineation

    International Nuclear Information System (INIS)

    Yoon, Hong In; Chang, Jee Suk; Lim, Joon Seok; Noh, Sung Hoon; Hyung, Woo Jin; An, Ji Yeong; Lee, Yong Chan; Rha, Sun Young; Kim, Kyung Hwan; Koom, Woong Sub

    2013-01-01

    Purpose: To determine the recurrent nodal gross tumor volume (rnGTV) based on CT-guided vascular structure to refine the clinical target volume (CTV) delineation in postoperative radiotherapy for advanced gastric cancer following radical gastrectomy with D2 dissection. Materials and methods: We retrospectively reviewed follow-up images from 91 patients with their first regional recurrence after D2 dissection in stage III gastric cancer with N3 disease. We defined rnGTV as recurrent nodes shown in follow-up CT images, in which one diagnostic radiologist with specialty of gastrointestinal tract investigated. We drew rnGTVs at the equivalent location based on the same vessels of reference comparing CT images to recurrence CT images. Results: We propose vessel-based locations of rnGTVs on CT images with axial and coronal views. We show different patterns of regional recurrence according to the location of primary gastric cancer using CT and digitally reconstructed radiograph (DRR) images. Frequently recurred sites, overlapped by more than five rnGTVs, are depicted in a DRR image. Conclusions: This study suggests vessel-based delineations of rnGTVs on CT images depending on nodal recurrence sites from follow-up images after D2 lymphadenectomy. Our results could help reduce the inter-observer variation of CTV delineation after D2 dissection in gastric cancer

  14. Therapies targeting inflammation after stent implantation.

    Science.gov (United States)

    Okura, Hiroyuki; Takagi, Tsutomu; Yoshida, Kiyoshi

    2013-07-01

    Since the introduction of coronary vessel scaffold by metallic stent, percutaneous coronary intervention has become widely performed all over the world. Although drug-eluting stent technology has further decrease the incidence of in-stent restenosis, there still remaining issues related to stent implantation. Vessel inflammation is one of the causes that may be related to stent restenosis as well as stent thrombosis. Therefore, systemic therapies targeting inflammation emerged as adjunctive pharmacological intervention to improve outcome. Statins, corticosteroids, antiplatelets, and immunosuppresive or anti-cancer drugs are reported to favorably impact outcome after bare-metal stent implantation. In type 2 diabetic patients, pioglitazone may be the most promising drug that can lower neointimal proliferation and, as a result, lower incidence of restenosis and target lesion revascularization. On the other hand, several new stent platforms that might decrease inflammatory response after drug-eluting stent implantation have been introduced. Because durable polymer used in the first generation drug-eluting stents are recognized to be responsible for unfavorable vessel response, biocompatible or bioabsorbable polymer has been introduce and already used clinically. Furthermore, polymer-free drug-eluting stent and bioresorbable scaffold are under investigation. Although vessel inflammation may be reduced by using these new drug-eluting stents or scaffold, long-term impact needs to be investigated further.

  15. Vascular infarction by subcutaneous application of tissue factor targeted to tumor vessels with NGR-peptides: activity and toxicity profile.

    Science.gov (United States)

    Dreischalück, Johannes; Schwöppe, Christian; Spieker, Tilmann; Kessler, Torsten; Tiemann, Klaus; Liersch, Ruediger; Schliemann, Christoph; Kreuter, Michael; Kolkmeyer, Astrid; Hintelmann, Heike; Mesters, Rolf M; Berdel, Wolfgang E

    2010-12-01

    tTF-NGR consists of the extracellular domain of the (truncated) tissue factor (tTF), a central molecule for coagulation in vivo, and the peptide GNGRAHA (NGR), a ligand of the surface protein aminopeptidase N (CD13). After deamidation of the NGR-peptide moiety, the fusion protein is also a ligand for integrin αvβ3 (CD51/CD61). Both surface proteins are upregulated on endothelial cells of tumor vessels. tTF-NGR showed binding to specific binding sites on endothelial cells in vitro as shown by flow cytometry. Subcutaneous injection of tTF-NGR into athymic mice bearing human HT1080 fibrosarcoma tumors induced tumor growth retardation and delay. Contrast enhanced ultrasound detected a decrease in tumor blood flow in vivo after application of tTF-NGR. Histological analysis of the tumors revealed vascular disruption due to blood pooling and thrombotic occlusion of tumor vessels. Furthermore, a lack of resistance was shown by re-exposure of tumor-bearing mice to tTF-NGR after regrowth following a first cycle of treatment. However, after subcutaneous (s.c.) push injection with therapeutic doses (1-5 mg/kg bw) side effects have been observed, such as skin bleeding and reduced performance. Since lethality started within the therapeutic dose range (LD10 approximately 2 mg/kg bw) no safe therapeutic window could be found. Limiting toxicity was represented by thrombo-embolic events in major organ systems as demonstrated by histology. Thus, subcutaneous injection of tTF-NGR represents an active, but toxic application procedure and compares unfavourably to intravenous infusion.

  16. Evaluation of RGD-targeted albumin carriers for specific delivery of auristatin E to tumor blood vessels

    NARCIS (Netherlands)

    Temming, Kai; Meyer, Damon L.; Zabinski, Roger; Dijkers, Eli C. F.; Poelstra, Klaas; Molema, Grietje; Kok, Robbert J.

    2006-01-01

    Induction of apoptosis in endothelial cells is considered an attractive strategy to therapeutically interfere with a solid tumor's blood supply. In the present paper, we constructed cytotoxic conjugates that specifically target angiogenic endothelial cells, thus preventing typical side effects of

  17. Transmyocardial laser revascularization - first experiences of imaging in MRT

    International Nuclear Information System (INIS)

    Weber, C.; Maas, R.; Steiner, P.; Beese, M.; Hvalic, M.; Buecheler, E.; Stubbe, M.

    1998-01-01

    Purpose: Imaging of myocardial signal alteration and perfusion differences after transmyocardial laser revascularization (TMLR). Methods and Material: 5 patients suffering from coronary vessel disease underwent MRI (0.5 T) pre- and 4-7 d post-TMLR. T 1 -weighted spin echo sequences were acquired ECG-triggered native and after injection of gadolinium. Qualitative analysis was performed on both native and contrast-enhanced images. Myocardial signal alterations and wall changes were evaluated. Qualitative and quantitative analyses of contrast-enhanced images were performed with regard of post therapeutic perfusion differences. Analysis was based on contrast-to-noise (C/N) data obtained from operator defined 'regions of interest'. Results: Visualization of laser-induced channels was not possible. Native scans obtained before and after TMLR revealed no significant change with regard to the qualitative analysis. Both qualitative and quantitative analyses demonstrated a posttherapeutic increase of C/N in both the left ventricular myocardium (64.4 pre-TMLR; 89.1 post-TMLR; p=0.06) and the septum in the majority of cases. No significant difference between laser-treated left myocardium and untreated septum was observed (p>0.05). Discussion: Single myocardial laser channels could not be visualized with a 0.5-T MRI. However, visualization of increased myocardial contrast enhancement in laser-treated left ventricular myocardium was evident in the majority of cases on the basis of qualitative and quantitative analyses. Conclusions: The MRI technique used enabled a first, limited depiction of TMLR-induced myocardial changes. The clinical value and impact still have to be defined. (orig.) [de

  18. Prognostic Implication of Functional Incomplete Revascularization and Residual Functional SYNTAX Score in Patients With Coronary Artery Disease.

    Science.gov (United States)

    Choi, Ki Hong; Lee, Joo Myung; Koo, Bon-Kwon; Nam, Chang-Wook; Shin, Eun-Seok; Doh, Joon-Hyung; Rhee, Tae-Min; Hwang, Doyeon; Park, Jonghanne; Zhang, Jinlong; Kim, Kyung-Jin; Hu, Xinyang; Wang, Jianan; Ye, Fei; Chen, Shaoliang; Yang, Junqing; Chen, Jiyan; Tanaka, Nobuhiro; Yokoi, Hiroyoshi; Matsuo, Hitoshi; Takashima, Hiroaki; Shiono, Yasutsugu; Akasaka, Takashi

    2018-02-12

    The aim of this study was to investigate the prognostic implication of functional incomplete revascularization (IR) and residual functional SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (rFSS) in comparison with 3-vessel fractional flow reserve (FFR) and residual SYNTAX score. IR is associated with poor clinical outcomes in patients who underwent percutaneous coronary intervention. A total of 385 patients who underwent 3-vessel FFR measurement after stent implantation were included in this study. The rFSS was defined as residual SYNTAX score measured only in vessels with FFR ≤0.8. The study population was divided into the functional IR group (rFSS ≥1) and the functional complete revascularization (CR) group (rFSS = 0). The primary outcome was major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization) at 2 years. Functional CR was achieved in 283 patients (73.5%). At 2-year follow-up, the functional IR group showed a significantly higher risk for MACEs (functional IR vs. CR, 14.6% vs. 4.2%; hazard ratio: 4.09; 95% confidence interval: 1.82 to 9.21; p system (rFSS) after stent implantation better discriminated the risk for adverse events than anatomic or physiological assessment alone. (Clinical Implication of 3-Vessel Fractional Flow Reserve [FFR]; NCT01621438). Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  19. Revascularization and Apical Plug in an Immature Molar

    Science.gov (United States)

    Roghanizadeh, Leyla; Fazlyab, Mahta

    2018-01-01

    Managing of necrotic permanent teeth with immature apices is a treatment challenges. Treatment of such teeth includes apexification, apical plug and more recently, revascularization technique with the probable advantage of continuation of root development. In the present case report the referred patient had discomfort with a necrotic immature mandibular first molar. Periapical radiography showed a rather large apical lesion around immature roots. Revascularization protocol using calcium-enriched mixture (CEM) cement was indicated for the mesial root. However, in distal canal apical plug technique was applied. At 2-year follow-up, both procedures were successful in relieving patient’s symptoms. Dentin formation and increase in length of the mesial root was obvious. Apical plug and revascularization technique proved to be successful in management of necrotic immature teeth; moreover, revascularization carried the advantage of continuation of root development. PMID:29692851

  20. Evaluation of RGD-targeted albumin carriers for specific delivery of auristatin E to tumor blood vessels.

    Science.gov (United States)

    Temming, Kai; Meyer, Damon L; Zabinski, Roger; Dijkers, Eli C F; Poelstra, Klaas; Molema, Grietje; Kok, Robbert J

    2006-01-01

    Induction of apoptosis in endothelial cells is considered an attractive strategy to therapeutically interfere with a solid tumor's blood supply. In the present paper, we constructed cytotoxic conjugates that specifically target angiogenic endothelial cells, thus preventing typical side effects of apoptosis-inducing drugs. For this purpose, we conjugated the potent antimitotic agent monomethyl-auristatin-E (MMAE) via a lysosomal cleavable linker to human serum albumin (HSA) and further equipped this drug-albumin conjugate with cyclic c(RGDfK) peptides for multivalent interaction with alphavbeta3-integrin. The RGD-peptides were conjugated via either an extended poly(ethylene glycol) linker or a short alkyl linker. The resulting drug-targeting conjugates RGDPEG-MMAE-HSA and RGD-MMAE-HSA demonstrated high binding affinity and specificity for alphavbeta3-integrin expressing human umbilical vein endothelial cells (HUVEC). Both types of conjugates were internalized by endothelial cells and killed the target cells at low nM concentrations. Furthermore, we observed RGD-dependent binding of the conjugates to C26 carcinoma. Upon i.v. administration to C26-tumor bearing mice, both drug-targeting conjugates displayed excellent tumor homing properties. Our results demonstrate that RGD-modified albumins are suitable carriers for cell selective intracellular delivery of cytotoxic compounds, and further studies will be conducted to assess the antivascular and tumor inhibitory potential of RGDPEG-MMAE-HSA and RGD-MMAE-HSA.

  1. Acute mesenteric ischemia of arterial origin: importance of early revascularization.

    Science.gov (United States)

    Plumereau, F; Mucci, S; Le Naoures, P; Finel, J B; Hamy, A

    2015-02-01

    The goal of our study was to show that survival was better when early revascularization was performed rather than gastrointestinal resection in the management of acute mesenteric ischemia of arterial origin. The reports of patients managed in our center between January 2005 and May 2012 for acute mesenteric ischemia of arterial origin were analyzed retrospectively. Data on clinical, laboratory and radiologic findings, the interval before treatment, the operative findings and the surgical procedures were collected. Follow-up information included the postoperative course, and mortality at 48 h, 30 days and 1 year, the latter being compared between patients undergoing revascularization versus gastrointestinal resection. Of 43 patients treated during this period, 20 had gastrointestinal lesions deemed to be beyond all therapeutic resources, 13 were treated with gastrointestinal resection without revascularization, while 10 underwent early revascularization. There were no statistically significant differences found in the extent of involvement between the two groups (P=0.22). Mortality at 48 h, 30 days and 1 year was 8% (n=1), 30% (n=4) and 68% (n=8) in patients who underwent enterectomy vs. 0% (n=0), 0% (n=0) and 10% (n=1) in patients who underwent revascularization procedures. The difference at 1 year was statistically significant (P=0.02). At 1 year, two patients in the revascularized group had a short bowel syndrome vs. one in the non-revascularized group. Acute mesenteric ischemia of arterial origin is associated with high morbidity and mortality. Optimal management should include early revascularization. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  2. [Revascularization of the carotid and vertebral arteries in the elderly].

    Science.gov (United States)

    Illuminati, G; Bezzi, M; D'Urso, A; Giacobbi, D; Ceccanei, G; Vietri, F

    2004-01-01

    From January 1994 to July 2004, 323 patients underwent 348 revascularization of carotid bifurcation for atherosclerotic stenoses. Eighty eight patients (group A) were 75 year-old or older, whereas 235 (group B) were younger than 75 years. Postoperative mortality/neurologic morbidity rate was 1% in group A, and 1.4% in group B. At 5 years, patency and freedom from symptoms/stroke were, respectively, 91% and 92% in group A, and 89% and 91% in group B. None of these differences was statistically significant. In the same time period, 26 internal carotid arteries were revascularized in 24 patients, 75 or more aged, for a symptomatic kinking. Postoperative mortality/morbidity rate was absent, whereas, at 5 years, patency and freedom from symptoms/stroke were, respectively, 88% and 92%. Twelve vertebral arteries were revascularized in 12 patients, 75 or more aged, for invalidating symptoms of vertebrobasilar insufficiency. Postoperative mortality/neurologic morbidity rate was absent. In one case postoperative recurrence of symptoms occurred, despite a patent revascularization. Patency and freedom from symptoms/stroke were 84% and 75%, at 5 years. Revascularization of carotid and vertebral arteries in the elderly can be accomplished with good results, superposable to those of standard revascularization of carotid bifurcation in a younger patients' population.

  3. Research vessels

    Digital Repository Service at National Institute of Oceanography (India)

    Rao, P.S.

    The role of the research vessels as a tool for marine research and exploration is very important. Technical requirements of a suitable vessel and the laboratories needed on board are discussed. The history and the research work carried out...

  4. Lutein facilitates physiological revascularization in a mouse model of retinopathy of prematurity.

    Science.gov (United States)

    Fu, Zhongjie; Meng, Steven S; Burnim, Samuel B; Smith, Lois Eh; Lo, Amy Cy

    2017-07-01

    Retinopathy of prematurity is one of the leading causes of childhood blindness worldwide, with vessel growth cessation and vessel loss in phase I followed by neovascularization in phase II. Ischaemia contributes to its pathogenesis, and lutein protects against ischaemia-induced retinal damages. We aimed to investigate the effects of lutein on a murine model of oxygen-induced retinopathy. Mouse pups were exposed to 75% oxygen for 5 days and returned to room air for another 5 days. Vascular obliteration, neovascularization and blood vessel leakage were examined. Immunohistochemistry for glial cells and microglia were performed. Compared with vehicle controls, mouse pups receiving lutein treatment displayed smaller central vaso-obliterated area and reduced blood vessel leakage. No significant difference in neovascular area was found between lutein and vehicle controls. Lutein promoted endothelial tip cell formation and maintained the astrocytic template in the avascular area in oxygen-induced retinopathy. No significant changes in Müller cell gliosis and microglial activation in the central avascular area were found in lutein-treated pups. Our observations indicated that lutein significantly promoted normal retinal vascular regrowth in the central avascular area, possibly through promoting endothelial tip cell formation and preserving astrocytic template. Our results indicated that lutein might be considered as a supplement for the treatment of proliferative retinopathy of prematurity because of its role in facilitating the revascularization of normal vasculature. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

  5. Paraplegia after myocardial revascularization. Case report.

    Science.gov (United States)

    Nigro Neto, Caetano; Iza, Milton Patricio Chango; Tardelli, Maria Angela

    2010-01-01

    Developments in anesthesiology have improved safety indices. Several techniques and agents are used to control the hemodynamic response and minimize adverse effects triggered by surgical stimuli in patients undergoing cardiac procedures. This is a 70 years old male patient, 1.74 m, 75 kg, ASA III, and NYHA II. The patient had controlled dyslipedemia, type II diabetes mellitus, and hypertension; history of smoking, peripheral vascular disease, and myocardial infarction 20 years ago. The patient underwent revascularization with the left internal mammary artery and saphenous grafts with extracorporeal circulation with intermittent clamping of the aorta. During the first 24 hours in the ICU, the patient developed hemodynamic instability, sudden hypotension, and atrial fibrillation. Twenty-six hours after the end of the surgery, the patient was awake, hemodynamically stable, and with good respiratory dynamics, being extubated. The patient was talkative and oriented, but immobile and negative reflexes in the lower limbs. Neurological evaluation showed: cranial nerves without changes, no complaints of pain below the hips, preserved superficial and deep sensitivity, adequate distal perfusion without edema, and flaccid paraplegia below T8. The echocardiogram did not show any changes. CT scan of the lumbosacral spine was negative for compressive mass in the epidural space or adjacent to it. Anterior spinal artery syndrome should be considered in procedures with manipulation of the aorta. Prevention, especially in patients at risk, is necessary. Computed tomography, for the differential diagnosis, and MRI, to localize the lesion, are important.

  6. Angioplastia con stent vs. cirugía de revascularización coronaria en enfermedad multivaso (ACIRE Coronary angioplasty with stenting vs. coronary bypass revascularization surgery in multivessel disease

    Directory of Open Access Journals (Sweden)

    Andrés Fernández

    2009-04-01

    the percutaneous group (19,2%; p = 0,045. This difference can be explained by a furthermore need of revascularization due to failure in the target vessel in the percutaneous coronary intervention group. Target vessel (s failure was 4% at 30 days (p = 0.059, 12% at 6 months (p = 0.001 and 18% at 12 months of follow-up (p < 0.0001 in the stenting group versus 0% at any time in the surgical group. There was no statistical difference in mortality at 12 months. Conclusions: in this cohort of patients with two or more vessel-coronary disease, surgical revascularization offers a statistically significant higher risk of in-hospital morbidity without compromising mortality up till 12 months after the procedure. Coronary stenting was found to offer a better post-procedural morbidity profile and higher risk of vessel reintervention at 6 and 12 months due to target vessel failure. Both coronary surgical revascularization and coronary stenting offer equivalent mortality rates and MACE incidence up to 1 year of follow-up.

  7. Tumor Blood Vessel Dynamics

    Science.gov (United States)

    Munn, Lance

    2009-11-01

    ``Normalization'' of tumor blood vessels has shown promise to improve the efficacy of chemotherapeutics. In theory, anti-angiogenic drugs targeting endothelial VEGF signaling can improve vessel network structure and function, enhancing the transport of subsequent cytotoxic drugs to cancer cells. In practice, the effects are unpredictable, with varying levels of success. The predominant effects of anti-VEGF therapies are decreased vessel leakiness (hydraulic conductivity), decreased vessel diameters and pruning of the immature vessel network. It is thought that each of these can influence perfusion of the vessel network, inducing flow in regions that were previously sluggish or stagnant. Unfortunately, when anti-VEGF therapies affect vessel structure and function, the changes are dynamic and overlapping in time, and it has been difficult to identify a consistent and predictable normalization ``window'' during which perfusion and subsequent drug delivery is optimal. This is largely due to the non-linearity in the system, and the inability to distinguish the effects of decreased vessel leakiness from those due to network structural changes in clinical trials or animal studies. We have developed a mathematical model to calculate blood flow in complex tumor networks imaged by two-photon microscopy. The model incorporates the necessary and sufficient components for addressing the problem of normalization of tumor vasculature: i) lattice-Boltzmann calculations of the full flow field within the vasculature and within the tissue, ii) diffusion and convection of soluble species such as oxygen or drugs within vessels and the tissue domain, iii) distinct and spatially-resolved vessel hydraulic conductivities and permeabilities for each species, iv) erythrocyte particles advecting in the flow and delivering oxygen with real oxygen release kinetics, v) shear stress-mediated vascular remodeling. This model, guided by multi-parameter intravital imaging of tumor vessel structure

  8. VEGF-B is dispensable for blood vessel growth but critical for their survival, and VEGF-B targeting inhibits pathological angiogenesis

    Science.gov (United States)

    Zhang, Fan; Tang, Zhongshu; Hou, Xu; Lennartsson, Johan; Li, Yang; Koch, Alexander W.; Scotney, Pierre; Lee, Chunsik; Arjunan, Pachiappan; Dong, Lijin; Kumar, Anil; Rissanen, Tuomas T.; Wang, Bin; Nagai, Nobuo; Fons, Pierre; Fariss, Robert; Zhang, Yongqing; Wawrousek, Eric; Tansey, Ginger; Raber, James; Fong, Guo-Hua; Ding, Hao; Greenberg, David A.; Becker, Kevin G.; Herbert, Jean-Marc; Nash, Andrew; Yla-Herttuala, Seppo; Cao, Yihai; Watts, Ryan J.; Li, Xuri

    2009-01-01

    VEGF-B, a homolog of VEGF discovered a long time ago, has not been considered an important target in antiangiogenic therapy. Instead, it has received little attention from the field. In this study, using different animal models and multiple types of vascular cells, we revealed that although VEGF-B is dispensable for blood vessel growth, it is critical for their survival. Importantly, the survival effect of VEGF-B is not only on vascular endothelial cells, but also on pericytes, smooth muscle cells, and vascular stem/progenitor cells. In vivo, VEGF-B targeting inhibited both choroidal and retinal neovascularization. Mechanistically, we found that the vascular survival effect of VEGF-B is achieved by regulating the expression of many vascular prosurvival genes via both NP-1 and VEGFR-1. Our work thus indicates that the function of VEGF-B in the vascular system is to act as a “survival,” rather than an “angiogenic” factor and that VEGF-B inhibition may offer new therapeutic opportunities to treat neovascular diseases. PMID:19369214

  9. Dental Pulp Revascularization of Necrotic Permanent Teeth with Immature Apices.

    Science.gov (United States)

    El Ashiry, Eman A; Farsi, Najat M; Abuzeid, Sawsan T; El Ashiry, Mohamed M; Bahammam, Hammam A

    The treatment of immature necrotic teeth with apical periodontitis presents challenges in endodontic and pediatric dentistry. Revascularization is a recent treatment for such cases as an alternative to conventional apexification. The purpose is to examine the effect of a pulpal revascularization procedure on immature necrotic teeth with apical periodontitis. Twenty patients were enrolled for pulp revascularization procedure by root canal disinfection using a triple antibiotic mixture for 1-2 weeks, followed by creating a blood clot, sealing the root canal orifice using white mineral trioxide aggregate and a coronal seal of composite resin. Patients were recalled periodically for up to 24 months. During follow-up, all patients were asymptomatic. Three cases of chronic apical periodontitis showed clinical disappearance of the sinus tract 2 weeks after treatment. Radiography revealed progressive periapical radiolucency resolution within the first 12 months. Within 12-24 months, the treated teeth showed progressive increases in dentinal wall thickness, root length and continued root development. Clinical and radiographic evidence showed successful revascularization treatments of immature necrotic permanent teeth with apical periodontitis. More studies are necessary to understand the underlying mechanisms and to perform histopathology of the pulp space contents after revascularization procedures.

  10. Surgical revascularization of posterior coronary arteries without cardiopulomonary bypass

    Directory of Open Access Journals (Sweden)

    Lobo Filho J. Glauco

    1999-01-01

    Full Text Available OBJECTIVE: To assess the results observed during the early postoperative period in patients who had the posterior coronary arteries revascularized without cardiopulmonary bypass (CPB, in regard to the following parameters: age, sex,bypass grafts types, morbidity and mortality. METHODS: From January 1995 to June 1998, 673 patients underwent myocardial revascularization (MR. Of this total, 607 (90.20% MR procedures were performed without CPB. The posterior coronary arteries (PCA were revascularized in 298 (44.27% patients, 280 (93.95% without CPB. The age of the patients ranged from 37 to 88 years (mean, 61 years. The male gender predominated, with 198 men (70.7%. The revascularization of the posterior coronary arteries had the following distribution: diagonalis artery (31 patients, 10%; marginal branches of the circumflex artery (243 patients, 78.7%; posterior ventricular artery (4 patients, 1.3%; and posterior descending artery (31 patients, 10%. RESULTS: Procedure-related complications without death occurred in 7 cases, giving a morbidity of 2.5%. There were 11 deaths in the early postoperative period (mortality of 3.9%. CONCLUSION: Similarly to the anterior coronary arteries, the posterior coronary arteries may benefit from myocardial revascularization without CPB.

  11. Combining PCI and CABG: the role of hybrid revascularization.

    Science.gov (United States)

    Green, Kelly D; Lynch, Donald R; Chen, Tyffany P; Zhao, David

    2013-04-01

    Hybrid coronary revascularization combines the benefits of both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in the treatment of multivessel coronary artery disease (CAD) by combining the benefits of the LIMA-to-LAD graft and drug eluting stent (DES) to non-LAD regions. Through this approach, a patient receives the long-term benefit of the LIMA graft and avoids the morbidity of a full sternotomy and saphenous vein grafts. Available data related to outcomes following hybrid revascularization is limited to small studies. In this review we seek to provide an overview of hybrid revascularization in the era of modern drug eluting stent technology, discuss appropriate patient selection, and comment on future trial design. Additionally, we review the recent literature pertaining to the hybrid approach.

  12. Thallium imaging in management of post-revascularization patients

    International Nuclear Information System (INIS)

    Alazraki, N.; Krawczynska, E.

    1996-01-01

    The role of myocardial perfusion imaging in the evaluation of post revascularization patients has not been well defined. Published data with special emphasis on the results from the Emory Angioplasty versus Surgery Trial (EAST) indicate that the frequency of adverse cardiac events (death, MI, repeat revascularization) following PTCA or CABG is equal in symptomatic and asymptomatic patients with ischemic thallium defects. Current American Heart Association Guidelines recommend radionuclide studies only in symptomatic patients. Recently reported data support the need for non invasive testing in asymptomatic as well as symptomatic patients at 1 year postrevascularization. Prognostic variables including transient and permanent left ventricular dilatation and thallium lung uptake in addition to stress perfusion defect reversibility on myocardial thallium SPECT scans are important prognostic indicators in post revascularization patients

  13. Detecting culprit vessel of coronary artery disease with SPECT 99Tcm-MIBI myocardial imaging

    International Nuclear Information System (INIS)

    Luan Zhaosheng; Zhou Wen; Peng Yong; Su Yuwen; Tian Jianhe; Gai lue; Sun Zhijun

    2002-01-01

    Objective: To assess the value of detecting culprit vessel of coronary artery disease (CAD) with SPECT 99 Tc m -MIBI myocardial imaging. Methods: Forty-six patients with CAD were studied. Every patients had multiple-vessel lesion showed by coronary arteriography and was treated by revascularization as percutaneous transluminal angioplasty (PTCA), coronary artery bypass graft (CABG) or laser holing. Exercise (EX), rest (RE) and intravenous infusion of nitroglycerine (NTG) SPECT 99 Tc m -MIBI myocardial imagings were performed before revascularization. Exercise and rest images revealed the myocardial ischemia. NTG images revealed myocardial viability. Culprit vessels were detected according to the defects showed by above mentioned images. The veracity of detected culprit vessels was tested with the outcome of the reperfusion therapy. Results: In this group, the coronary arteriography revealed 107 lesioned coronary arteries. Myocardial imaging detected 46 culprit vessels including 23 left anterior descending (LAD), 19 left circumflex coronary artery (LCX) and 4 right coronary artery (RCA). All 46 culprit vessels underwent revascularization and had nice outcome. The veracity of 99 Tc m -MIBI myocardial imaging detected culprit vessels was high according to patients' outcome. Conclusion: Exercise, rest and NTG 99 Tc m -MIBI myocardial imaging is a great method for detecting culprit vessels in multivessel coronary disease

  14. Neighborhood Variation in Rate of Revascularization among Acute Myocardial Infarction Patients in New York City

    Directory of Open Access Journals (Sweden)

    Abdissa Negassa

    2011-01-01

    Full Text Available Objective. To identify modifiable neighborhood factors and quantify their effect on the rate of revascularization among acute myocardial infarction (AMI patients. Method. Using the New York City hospital discharge records during 1998–2002, we employed a hierarchical regression model that integrates patient-level risk factors and neighborhood-level factors to retrospectively examine revascularization patterns among AMI patients. Results. Access to revascularization varied substantially (27%–88% among neighborhoods. Ready access to a hospital with on-site capacity of revascularization increased the likelihood of receiving the procedure after adjusting for individual-level sociodemographic factors and comorbidity. More than 64% of the variation in rate of revascularization is explained by access to revascularization. Conclusion. Optimizing the AMI patients' delivery system to hospitals with on-site capacity of revascularization might enhance access to needed care thereby help to alleviate the prevailing variation in the rate of revascularization among New York City neighborhoods.

  15. Sequential and simultaneous revascularization in adult orthotopic piggyback liver transplantation

    NARCIS (Netherlands)

    Polak, WG; Miyamoto, S; Nemes, BA; Peeters, PMJG; de Jong, KP; Porte, RJ; Slooff, MJH

    The aim of the study was to assess whether there is a difference in outcome after sequential or simultaneous revascularization during orthotopic liver transplantation (OLT) in terms of patient and graft survival, mortality, morbidity, and liver function. The study population consisted of 102 adult

  16. Reconstruction of congenital tibial pseudarthrosis by revascularized fibular transplants

    NARCIS (Netherlands)

    Bos, K. E.; Besselaar, P. P.; van der Eyken, J. W.; Taminiau, A. H.; Verbout, A. J.

    1993-01-01

    Seven patients with congenital Boyd type II pseudoarthrosis of the tibia and fibula were treated with a revascularized osteocutaneous fibular graft from the contralateral side. Follow-up ranged from 20 to 96 months (mean 67 months). All patients had previously undergone major surgery (mean three

  17. Left subclavian artery revascularization as part of thoracic stent grafting

    NARCIS (Netherlands)

    Saouti, N.; Hindori, V.; Morshuis, W.J.; Heijmen, R.H.

    2015-01-01

    OBJECTIVES: Intentional covering of the left subclavian artery (LSA) as part of thoracic endovascular aortic repair (TEVAR) can cause (posterior) strokes or left arm malperfusion. LSA revascularization can be done as prophylaxis against, or as treatment of, these complications. We report our

  18. Total Arterial Off‑pump Coronary Revascularization with a Bilateral ...

    African Journals Online (AJOL)

    Total Arterial Off‑pump Coronary Revascularization with a Bilateral Internal Mammary Artery Y Graft (208 cases). Jun-Feng Yang, Hong-Chao Zhang1, Cheng-Xiong Gu, Hua Wei. INTRODUCTION. AY graft is a graft formed by the left internal mammary artery (LIMA) connected to the left anterior descending (LAD) artery and ...

  19. Prasugrel versus clopidogrel for acute coronary syndromes without revascularization

    NARCIS (Netherlands)

    Roe, M.T.; Armstrong, P.W.; Fox, K.A.; White, H.D.; Prabhakaran, D.; Goodman, S.G.; Cornel, J.H.; Bhatt, D.L.; Clemmensen, P.; Martinez, F.; Ardissino, D.; Nicolau, J.C.; Boden, W.E.; Gurbel, P.A.; Ruzyllo, W.; Dalby, A.J.; McGuire, D.K.; Leiva-Pons, J.L.; Parkhomenko, A.; Gottlieb, S.; Topacio, G.O.; Hamm, C.; Pavlides, G.; Goudev, A.R.; Oto, A.; Tseng, C.D.; Merkely, B.; Gasparovic, V.; Corbalan, R.; Cinteza, M.; McLendon, R.C.; Winters, K.J.; Brown, E.B.; Lokhnygina, Y.; Aylward, P.E.; Huber, K.; Hochman, J.S.; Ohman, E.M.; Verheugt, F.W.A.; et al.,

    2012-01-01

    BACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243

  20. Comparably improved health-related quality of life after total arterial revascularization versus conventional coronary surgery--Copenhagen arterial revascularization randomized patency and outcome trial

    DEFF Research Database (Denmark)

    Damgaard, Sune; Lund, Jens T; Lilleør, Nikolaj B

    2011-01-01

    OBJECTIVE: We compared health-related quality of life up to 11 months after coronary artery bypass grafting using total arterial revascularization versus conventional coronary surgery. METHODS: In this randomized single-center trial, 161 patients underwent total arterial revascularization using.......01). For total arterial revascularization, there were also not statistically significant improvements for 'physical component summary' (P=0.09), 'bodily pain' (P=0.07) and 'vitality' (P=0.08). CONCLUSION: Health-related quality of life up to 1 year after total arterial revascularization is equal or slightly...... of the general Danish population. On all scales of the SF-36, there was statistically significant improvement at 3 and 11 months in both groups. For 'social functioning', the improvement following total arterial revascularization was significantly higher than following conventional revascularization (P=0...

  1. State of a large vessels and microcirculation - a new target for antihypertensive therapy in patients with hypertension and type 2 diabetes

    Directory of Open Access Journals (Sweden)

    M. E. Statsenko

    2016-01-01

    Full Text Available Aim. To evaluate the effect of 12 weeks of complex therapy with the fixed combination of enalapril and indapamide on indicators of vascular stiffness of large arteries and parameters of skin microcirculation (MC in patients with arterial hypertension (HT and diabetes mellitus (DM type 2.Material and methods. 30 patients with HT stage II-III in combination with DM type 2 aged 40-70 years were included into the study. The fixed combination of enalapril and indapamide in addition to lipid-lowering and hypoglycemic therapy was prescribed to all patients. Elastic properties of large arteries were assessed by analyzing the pulse wave velocity (PWV and the calculation of the index of aortic stiffness (IAS. Skin MC and level of glycated hemoglobin (HbA1c were also determined.Results. After the 12-week treatment all patients reached the target values of blood pressure (BP. Office systolic and diastolic BP levels decreased by 18.8 and 13.1% (p<0.05 for both, respectively. The treatment did not have a negative effect on glucose metabolism – HbA1C concentration decreased by 2.7%. PWV in the vessels of elastic and muscular types decreased by 10.8 and 10.1% (p<0.05 for both, respectively, and IAS decreased by 27.4% (p<0.05. Significant growth in factor myogenic regulation of MC and reduction in bypass indicator by 21.8% were found.Conclusion. Combined therapy with the inclusion of a fixed combination of enalapril and indapamide for 12 weeks had a high antihypertensive efficacy and good tolerability in patients with HT and DM type 2. Treatment significantly reduced the vascular stiffness of large arteries and improved the MC indices in these patients.

  2. A novel vascular-targeting peptide for gastric cancer delivers low-dose TNFα to normalize the blood vessels and improve the anti-cancer efficiency of 5-fluorouracil.

    Science.gov (United States)

    Lu, Lan; Li, Zhi Jie; Li, Long Fei; Shen, Jing; Zhang, Lin; Li, Ming Xing; Xiao, Zhan Gang; Wang, Jian Hao; Cho, Chi Hin

    2017-11-01

    Various vascular-targeted agents fused with tumor necrosis factor α (TNFα) have been shown to improve drug absorption into tumor tissues and enhance tumor vascular function. TCP-1 is a peptide selected through in vivo phage library biopanning against a mouse orthotopic colorectal cancer model and is a promising agent for drug delivery. This study further investigated the targeting ability of TCP-1 phage and peptide to blood vessels in an orthotopic gastric cancer model in mice and assessed the synergistic anti-cancer effect of 5-fluorouracil (5-FU) with subnanogram TNFα targeted delivered by TCP-1 peptide. In vivo phage targeting assay and in vivo colocalization analysis were carried out to test the targeting ability of TCP-1 phage/peptide. A targeted therapy for improvement of the therapeutic efficacy of 5-FU and vascular function was performed through administration of TCP-1/TNFα fusion protein in this model. TCP-1 phage exhibited strong homing ability to the orthotopic gastric cancer after phage injection. Immunohistochemical staining suggested that and TCP-1 phage/TCP-1 peptide could colocalize with tumor vascular endothelial cells. TCP-1/TNFα combined with 5-FU was found to synergistically inhibit tumor growth, induce apoptosis and reduce cell proliferation without evident toxicity. Simultaneously, subnanogram TCP-1/TNFα treatment normalized tumor blood vessels. Targeted delivery of low-dose TNFα by TCP-1 peptide can potentially modulate the vascular function of gastric cancer and increase the drug delivery of chemotherapeutic drugs. Copyright © 2017. Published by Elsevier Inc.

  3. Lower extremity revascularization without preoperative contrast arteriography: experience with duplex ultrasound arterial mapping in 485 cases.

    Science.gov (United States)

    Ascher, Enrico; Hingorani, Anil; Markevich, Natalia; Costa, Tatiana; Kallakuri, Shreedhar; Khanimoy, Yuri

    2002-01-01

    This study reviews our experience with duplex ultrasound arterial mapping (DUAM) for preoperative evaluation in 466 patients (262 men) who underwent 485 lower extremity revascularization procedures from January 1, 1998 to May 30, 2001. Preoperative imaging consisted of DUAM alone in 449 procedures and DUAM and contrast angiography (CA) in 36. An attempt to image from the distal aorta to the pedal arteries was made in all the patients. The selection of optimal inflow and outflow bypasses anastomotic sites was based on a schematic drawing following DUAM examination. Inflow disease was also assessed by intraoperative pressure gradient (IPG) between the distal anastomosis and radial arteries, and completion arteriography of the runoff vessels was obtained, which was correlated with the preoperative findings. Indications for surgery were severe claudication in 91 (19%) limbs, tissue loss in 197 (40%), rest pain in 113 (23%), acute ischemia in 46 (10%), popliteal aneurysm in 18 (4%), superficial femoral artery aneurysm in 1, abdominal aortic aneurysm with claudication in 1, and failing graft in 18 (4%). Age ranged from 30 to 97 years (mean 72 +/- 12 (SD) years) and risk factors such as diabetes, hypertension, use of tobacco, coronary artery disease, and end-stage renal disease were present in 45%, 45%, 44%, 44%, and 13% of the patients, respectively. One hundred twenty-one (25%) limbs had at least 1 previous ipsilateral revascularization. The mean DUAM time was 66 +/- 20 (SD) min (30-150 min). Additional preoperative imaging was deemed necessary in 36 cases due to extensive ulcers, edema, severe arterial wall calcification, and very poor runoff. The distal anastomosis was to the popliteal artery in 173 cases and to the tibial and pedal arteries in 255. Inflow procedures to the femoral arteries, embolectomy, thrombectomy, balloon angioplasty, and patch angioplasty accounted for the remaining 57 cases. Overall, 6-, 12-, and -24- month secondary patency rates were 86%, 80

  4. Voxel Based Analysis of Surgical Revascularization for Moyamoya Disease: Pre- and Postoperative SPECT Studies.

    Directory of Open Access Journals (Sweden)

    Yasutaka Fushimi

    Full Text Available Moyamoya disease (MMD is a chronic, progressive, cerebrovascular occlusive disease that causes abnormal enlargement of collateral pathways (moyamoya vessels in the region of the basal ganglia and thalamus. Cerebral revascularization procedures remain the preferred treatment for patients with MMD, improving the compromised cerebral blood flow (CBF. However, voxel based analysis (VBA of revascularization surgery for MMD based on data from pre- and postoperative data has not been established. The latest algorithm called as Diffeomorphic Anatomical Registration Through Exponentiated Lie Algebra (DARTEL has been introduced for VBA as the function of statistical parametric mapping (SPM8, and improved registration has been achieved by SPM8 with DARTEL. In this study, VBA was conducted to evaluate pre- and postoperative single photon emission computed tomography (SPECT images for MMD by SPM8 with DARTEL algorithm, and the results were compared with those from SPM8 without DARTEL (a conventional method. Thirty-two patients with MMD who underwent superficial temporal artery-middle cerebral artery (STA-MCA bypass surgery as the first surgery were included and all patients underwent pre- and postoperative 3D T1-weighted imaging and SPECT. Pre- and postoperative SPECT images were registered to 3D T1-weighted images, then VBA was conducted. Postoperative SPECT showed more statistically increased CBF areas in the bypassed side cerebral hemisphere by using SPM8 with DARTEL (58,989 voxels; P<0.001, and increased ratio of CBF after operation was less than 15%. Meanwhile, postoperative SPECT showed less CBF increased areas by SPM8 without DARTEL. In conclusion, VBA was conducted for patients with MMD, and SPM8 with DARTEL revealed that postoperative SPECT showed statistically significant CBF increases over a relatively large area and with at most 15% increase ratio.

  5. Delayed revascularization of islets after transplantation by IL-6 blockade in pig to non-human primate islet xenotransplantation model.

    Science.gov (United States)

    Min, Byoung-Hoon; Shin, Jun-Seop; Kim, Jong-Min; Kang, Seong-Jun; Kim, Hyun-Je; Yoon, Il-Hee; Park, Su-Kyoung; Choi, Ji-Won; Lee, Min-Suk; Park, Chung-Gyu

    2018-01-01

    Pancreatic islet transplantation is currently proven as a promising treatment for type 1 diabetes patients with labile glycemic control and severe hypoglycemia unawareness. Upon islet transplantation, revascularization is essential for proper functioning of the transplanted islets. As IL-6 is important for endothelial cell survival and systemic inflammation related to xenograft, the effect of IL-6 receptor antagonist, tocilizumab, on revascularization of the transplanted islets was examined in pig to non-human primate islet xenotransplantation model. Also, the endothelial cell origin in a new vessel of the transplanted pig islets was determined. Pig islets were isolated from designated pathogen-free (DPF) SNU miniature pigs and transplanted via portal vein into five streptozotocin-induced diabetic monkeys. One group (n = 2, basal group) was treated with anti-thymoglobulin (ATG), anti-CD40 antibody (2C10R4), sirolimus, and tacrolimus, and the other group was additionally given tocilizumab on top of basal immunosuppression (n = 3, Tocilizumab group). To confirm IL-6 blocking effect, C-reactive protein (CRP) levels and serum IL-6 concentration were measured. Scheduled biopsy of the margin of the posterior segment right lobe inferior of the liver was performed at 3 weeks after transplantation to assess the degree of revascularization of the transplanted islets. Immunohistochemical staining using anti-insulin, anti-CD31 antibodies, and lectin IB4 was conducted to find the origin of endothelial cells in the islet graft. CRP significantly increased at 1~2 days after transplantation in Basal group, but not in Tocilizumab group, and higher serum IL-6 concentration was measured in latter group, showing the biological potency of tocilizumab. In Basal group, well-developed endothelial cells were observed on the peri- and intraislet area, whereas the number of CD31 + cells in the intraislet space was significantly reduced in Tocilizumab group. Finally, new endothelial

  6. Critical role of tissue kallikrein in vessel formation and maturation : Implications for therapeutic revascularization

    NARCIS (Netherlands)

    Stone, O.A.; Richer, C.; Emanueli, C.; Weel, V. van; Quax, P.H.A.; Katare, R.; Kraenkel, N.; Campagnolo, P.; Barcelos, L.S.; Siragusa, M.; Sala-Newby, G.B.; Baldessari, D.; Mione, M.; Vincent, M.P.; Benest, A.V.; Al Haj Zen, A.; Gonzalez, J.; Bates, D.O.; Alhenc-Gelas, F.; Madeddu, P.

    2009-01-01

    OBJECTIVE : Human Tissue Kallikrein (hKLK1) overexpression promotes an enduring neovascularization of ischemic tissue, yet the cellular mechanisms of hKLK1-induced arteriogenesis remain unknown. Furthermore, no previous study has compared the angiogenic potency of hKLK1, with its loss of function

  7. Endovascular Revascularization of Symptomatic Infrapopliteal Arteriosclerotic Occlusive Disease: Comparison of Atherectomy and Angioplasty

    Science.gov (United States)

    Tan, Tze-Woei; Semaan, Elie; Nasr, Wael; Eberhardt, Robert T.; Hamburg, Naomi; Doros, Gheorghe; Rybin, Denis; Shaw, Palma M.; Farber, Alik

    2011-01-01

    The preferred method for revascularization of symptomatic infrapopliteal arterial occlusive disease (IPAD) has traditionally been open vascular bypass. Endovascular techniques have been increasingly applied to treat tibial disease with mixed results. We evaluated the short-term outcome of percutaneous infrapopliteal intervention and compared the different techniques used. A retrospective analysis of consecutive patients undergoing endovascular treatment for infrapopliteal arterial occlusive lesions between 2003 and 2007 in a tertiary teaching hospital was performed. Patient demographic data, indication for intervention, and periprocedural complications were recorded. Periprocedural and short-term outcomes were measured and compared. Forty-nine infrapopliteal arteries in 35 patients were treated. Twenty vessels (15 patients) underwent angioplasty and 29 vessels (20 patients) were treated with atherectomy. Demographic and angiographic characteristics were similar between the groups. Twenty-six patients had concurrent femoral and/or popliteal artery interventions. Overall, technical success was 90% and similar between angioplasty and atherectomy groups (85% versus 93%, p = NS). The vessel-specific complication rate was 10% and was similar between both groups (angioplasty 5% versus atherectomy 14%, p = NS). One dissection occurred in the angioplasty group; one perforation and three thromboembolic events occurred in the atherectomy group. Limb salvage and freedom from reintervention at 6 months were 81% and 68%, respectively, and were not significantly different between the angioplasty and atherectomy groups. Endovascular intervention for IPAD had acceptable periprocedural and short-term success rates in our high-risk patient population. Both atherectomy and angioplasty can be used successfully to treat symptomatic IPAD. PMID:22532766

  8. An everolimus-eluting stent versus a paclitaxel-eluting stent in small vessel coronary artery disease: a pooled analysis from the SPIRIT II and SPIRIT III trials.

    Science.gov (United States)

    Bartorelli, Antonio L; Serruys, Patrick W; Miquel-Hébert, Karine; Yu, Shui; Pierson, Wes; Stone, Gregg W

    2010-07-01

    To evaluate the safety and efficacy of the XIENCE V everolimus-eluting stent compared to the TAXUS paclitaxel-eluting stent in small vessels. The XIENCE V everolimus-eluting stent (EES) has been shown to improve angiographic and clinical outcomes after percutaneous myocardial revascularization, but its performance in small coronary arteries has not been investigated. In this pooled analysis, we studied a cohort of 541 patients with small coronary vessels (reference diameter SPIRIT II and SPIRIT III studies. TAXUS Express (73% of lesions) and TAXUS Liberté (27% of lesions) paclitaxel-eluting stents (PES) were used as controls in SPIRIT II. In SPIRIT III, Taxus Express(2) PES was the control. Mean angiographic in-stent and in-segment late loss was significantly less in the EES group compared with the PES group, (0.15 +/- 0.37 mm vs. 0.30 +/- 0.44 mm; P = 0.011 for in-stent; 0.10 +/- 0.38 mm vs. 0.21 +/- 0.34 mm; P = 0.034 for in-segment). EES also resulted in a significant reduction in composite major adverse cardiac events at 1 year (19/366 [5.2%] vs. 17/159 [10.7%]; P = 0.037), due to fewer non-Q-wave myocardial infarctions and target lesion revascularizations. At 1 year, the rate of non-Q-wave myocardial infarction was significantly lower in the EES group compared with that of the PES group (6/366 [1.6%] vs. 8/159 [5.0%]; P = 0.037). In patients with small vessel coronary arteries, the XIENCE V EES was superior to the TAXUS PES. (c) 2010 Wiley-Liss, Inc.

  9. Indirect revascularization surgery for moyamoya disease in children and its special considerations

    Directory of Open Access Journals (Sweden)

    Kyu-Chang Wang

    2012-11-01

    Full Text Available Moyamoya disease (MMD is the most common pediatric cerebrovascular disease in Far Eastern countries. In children, MMD frequently manifests as ischemic symptomatology. Cerebral perfusion gradually decreases as the disease progresses, which often leads to cerebral infarction. The benefits of revascularization surgery, whether direct or indirect, have been well established in MMD patients with ischemic symptoms. In adults, the increase in cerebral blood flow achieved with indirect revascularization is often unsatisfactory, and direct revascularization is usually feasible. In children, however, direct revascularization is frequently technically not feasible, whereas the response to indirect revascularization is excellent, although 1 or 2 weeks are required for stabilization of symptoms. The authors describe surgical procedures and perioperative care in indirect revascularization for MMD. In addition, special considerations with regard to very young patients, patients with recent cerebral infarction, and patients with hyperthyroidism are discussed.

  10. Invasive angiography and revascularization in patients with stable angina following prior coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Joshi, Francis R; Biasco, Luigi; Pedersen, Frants

    2017-01-01

    . Follow-up data were available for all patients, by means of records linked to each Danish social security number. RESULTS: In patients with prior CABG and stable angina (n = 2,309), diagnostic angiography led to revascularization in 574 (24.9%) cases. Chronic kidney disease (HR 1.93 [1.08-3.44], P = 0......BACKGROUND: There are limited data to guide the optimum approach to patients presenting with angina after coronary artery bypass grafting (CABG). Although often referred for invasive angiography, the effectiveness of this is unknown; angina may also result from diffuse distal or micro......-vascular coronary disease and it is not known how often targets for intervention are identified. METHODS: Retrospective review of 50,460 patients undergoing angiography in East Denmark between January 2010 and December 2014. Clinical and procedural data were prospectively stored in a regional electronic database...

  11. Containment vessel

    International Nuclear Information System (INIS)

    Zbirohowski-Koscia, K.F.; Roberts, A.C.

    1980-01-01

    A concrete containment vessel for nuclear reactors is disclosed that is spherical and that has prestressing tendons disposed in first, second and third sets, the tendons of each set being all substantially concentric and centred around a respective one of the three orthogonal axes of the sphere; the tendons of the first set being anchored at each end at a first anchor rib running around a circumference of the vessel, the tendons of the second set being anchored at each end at a second anchor rib running around a circumference of the sphere and disposed at 90 0 to the first rib, and the tendons of the third set being anchored some to the first rib and the remainder to the second rib. (author)

  12. Five-year outcomes of percutaneous versus surgical coronary revascularization in patients with diabetes mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2).

    Science.gov (United States)

    Marui, Akira; Kimura, Takeshi; Nishiwaki, Noboru; Mitsudo, Kazuaki; Komiya, Tatsuhiko; Hanyu, Michiya; Shiomi, Hiroki; Tanaka, Shiro; Sakata, Ryuzo

    2015-04-15

    We investigated the impact of diabetes mellitus on long-term outcomes of percutaneous coronary intervention (PCI) in the drug-eluting stent era versus coronary artery bypass grafting (CABG) in a real-world population with advanced coronary disease. We identified 3,982 patients with 3-vessel and/or left main disease of 15,939 patients with first coronary revascularization enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2 (patients without diabetes: n = 1,984 [PCI: n = 1,123 and CABG: n = 861], and patients with diabetes: n = 1,998 [PCI: n = 1,065 and CABG: n = 933]). Cumulative 5-year incidence of all-cause death after PCI was significantly higher than after CABG both in patients without and with diabetes (19.8% vs 16.2%, p = 0.01, and 22.9% vs 19.0%, p = 0.046, respectively). After adjusting confounders, the excess mortality risk of PCI relative to CABG was no longer significant (hazard ratio [HR] 1.16; 95% confidence interval [CI] 0.88 to 1.54; p = 0.29) in patients without diabetes, whereas it remained significant (HR 1.31; 95% CI 1.01 to 1.70; p = 0.04) in patients with diabetes. The excess adjusted risks of PCI relative to CABG for cardiac death, myocardial infarction (MI), and any coronary revascularization were significant in both patients without (HR 1.59, 95% CI 1.01 to 2.51, p = 0.047; HR 2.16, 95% CI 1.20 to 3.87, p = 0.01; and HR 3.30, 95% CI 2.55 to 4.25, p PCI relative to CABG for all-cause death, cardiac death, MI, and any revascularization. In conclusion, in both patients without and with diabetes with 3-vessel and/or left main disease, CABG compared with PCI was associated with better 5-year outcomes in terms of cardiac death, MI, and any coronary revascularization. There was no difference in the direction and magnitude of treatment effect of CABG relative to PCI regardless of diabetic status. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Myocardial revascularization in patient with situs inversus totalis: case report

    Directory of Open Access Journals (Sweden)

    Soncini da Rosa George Ronald

    2002-01-01

    Full Text Available This is a report of an unusual case of a patient, with dextrocardia and a "situs inversus totalis". She presented angina pectoris during an ECG stress test. The coronary arteriography revealed severe obstruction in the main left coronary artery. The patient underwent coronary artery bypass grafting surgery. We did not find a similar case in the national medical literature. The myocardial revascularization performed utilizing the right mammary artery for anterior descending artery and saphenous vein grafts for first diagonal branch and first marginal branch.

  14. Lower extremity computed tomography angiography can help predict technical success of endovascular revascularization in the superficial femoral and popliteal artery.

    Science.gov (United States)

    Itoga, Nathan K; Kim, Tanner; Sailer, Anna M; Fleischmann, Dominik; Mell, Matthew W

    2017-09-01

    Preprocedural computed tomography angiography (CTA) assists in evaluating vascular morphology and disease distribution and in treatment planning for patients with lower extremity peripheral artery disease (PAD). The aim of the study was to determine the predictive value of radiographic findings on CTA and technical success of endovascular revascularization of occlusions in the superficial femoral artery-popliteal (SFA-pop) region. Medical records and available imaging studies were reviewed for patients undergoing endovascular intervention for PAD between January 2013 and December 2015 at a single academic institution. Radiologists reviewed preoperative CTA scans of patients with occlusions in the SFA-pop region. Radiographic criteria previously used to evaluate chronic occlusions in the coronary arteries were used. Technical success, defined as restoration of inline flow through the SFA-pop region with technical failure (P = .014). Longer lengths of occlusion were also associated with technical failure (P = .042). Multiple occlusions (P = .55), negative remodeling (P = .69), vessel runoff (P = .56), and percentage of vessel calcification (P = .059) were not associated with failure. On multivariable analysis, 100% calcification remained the only significant predictor of technical failure (odds ratio, 9.0; 95% confidence interval, 1.8-45.8; P = .008). Analysis of preoperative CTA shows 100% calcification as the best predictor of technical failure of endovascular revascularization of occlusions in the SFA-pop region. Further studies are needed to determine the cost-effectiveness of obtaining preoperative CTA for lower extremity PAD. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  15. Blood Vessels in Allotransplantation.

    Science.gov (United States)

    Abrahimi, P; Liu, R; Pober, J S

    2015-07-01

    Human vascularized allografts are perfused through blood vessels composed of cells (endothelium, pericytes, and smooth muscle cells) that remain largely of graft origin and are thus subject to host alloimmune responses. Graft vessels must be healthy to maintain homeostatic functions including control of perfusion, maintenance of permselectivity, prevention of thrombosis, and participation in immune surveillance. Vascular cell injury can cause dysfunction that interferes with these processes. Graft vascular cells can be activated by mediators of innate and adaptive immunity to participate in graft inflammation contributing to both ischemia/reperfusion injury and allograft rejection. Different forms of rejection may affect graft vessels in different ways, ranging from thrombosis and neutrophilic inflammation in hyperacute rejection, to endothelialitis/intimal arteritis and fibrinoid necrosis in acute cell-mediated or antibody-mediated rejection, respectively, and to diffuse luminal stenosis in chronic rejection. While some current therapies targeting the host immune system do affect graft vascular cells, direct targeting of the graft vasculature may create new opportunities for preventing allograft injury and loss. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  16. Histologic study of a human immature permanent premolar with chronic apical abscess after revascularization/revitalization.

    Science.gov (United States)

    Becerra, Patricia; Ricucci, Domenico; Loghin, Simona; Gibbs, Jennifer L; Lin, Louis M

    2014-01-01

    Histologic studies of teeth from animal models of revascularization/revitalization are available; however, specimens from human studies are lacking. The nature of tissues formed in the canal of human revascularized/revitalized teeth was not well established. An immature mandibular premolar with infected necrotic pulp and a chronic apical abscess was treated with revascularization/revitalization procedures. At both the 18-month and 2-year follow-up visits, radiographic examination showed complete resolution of the periapical lesion, narrowing of the root apex without root lengthening, and minimal thickening of the canal walls. The revascularized/revitalized tooth was removed because of orthodontic treatment and processed for histologic examination. The large canal space of revascularized/revitalized tooth was not empty and filled with fibrous connective tissue. The apical closure was caused by cementum deposition without dentin. Some cementum-like tissue was formed on the canal dentin walls. Inflammatory cells were observed in the coronal and middle third of revascularized/revitalized tissue. In the present case, the tissue formed in the canal of a human revascularized/revitalized tooth was soft connective tissue similar to that in the periodontal ligament and cementum-like or bone-like hard tissue, which is comparable with the histology observed in the canals of teeth from animal models of revascularization/revitalization. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  17. Prognostic significance of nonsustained ventricular tachycardia after revascularization.

    Science.gov (United States)

    Mittal, Suneet; Lomnitz, David J; Mirchandani, Sunil; Stein, Kenneth M; Markowitz, Steven M; Slotwiner, David J; Iwai, Sei; Das, Mithilesh K; Lerman, Bruce B

    2002-04-01

    Two randomized trials (Multicenter Automatic Defibrillator Implantation Trial [MADIT] and Multicenter Unsustained Tachycardia Trial [MUSTT]) suggest that implantable cardioverter defibrillator (ICD) placement is associated with improved survival in patients with coronary artery disease, depressed left ventricular function, and nonsustained ventricular tachycardia (VT) who also have inducible sustained VT. However, neither study directly addresses the management of such patients who develop nonsustained VT early after revascularization. We evaluated 109 consecutive patients who underwent electrophysiologic testing to evaluate nonsustained VT, which occurred 5 +/- 4 days following revascularization. Sustained monomorphic VT was inducible in 46 (42%) patients; these patients received an ICD. The remaining 63 (58%) noninducible patients received neither antiarrhythmic drug therapy nor an ICD. During 27 +/- 12 months of follow-up, 15 (33%) of 45 patients with an implanted ICD received at least one appropriate therapy from the device and 26 (24%) of the 109 study patients died. The 1- and 2-year freedom from ventricular tachycardia/fibrillation or sudden death in noninducible patients (97% and 93%) was significantly greater than that of inducible patients (84% and 71%; P = 0.001). However, no difference was observed in total mortality. Patients with nonsustained VT during the early postrevascularization period who have inducible VT have a high incidence of arrhythmic events. Although this study was not designed to assess the impact of ICD placement on the total mortality of inducible patients, the finding that one third of these patients received appropriate ICD therapy suggests that the device may have a protective effect in these patients.

  18. Revascularization of diaphyseal bone segments by vascular bundle implantation.

    Science.gov (United States)

    Nagi, O N

    2005-11-01

    Vascularized bone transfer is an effective, established treatment for avascular necrosis and atrophic or infected nonunions. However, limited donor sites and technical difficulty limit its application. Vascular bundle transplantation may provide an alternative. However, even if vascular ingrowth is presumed to occur in such situations, its extent in aiding revascularization for ultimate graft incorporation is not well understood. A rabbit tibia model was used to study and compare vascularized, segmental, diaphyseal, nonvascularized conventional, and vascular bundle-implanted grafts with a combination of angiographic, radiographic, histopathologic, and bone scanning techniques. Complete graft incorporation in conventional grafts was observed at 6 months, whereas it was 8 to 12 weeks with either of the vascularized grafts. The pattern of radionuclide uptake and the duration of graft incorporation between vascular segmental bone grafts (with intact endosteal blood supply) and vascular bundle-implanted segmental grafts were similar. A vascular bundle implanted in the recipient bone was found to anastomose extensively with the intraosseous circulation at 6 weeks. Effective revascularization of bone could be seen when a simple vascular bundle was introduced into a segment of bone deprived of its normal blood supply. This simple technique offers promise for improvement of bone graft survival in clinical circumstances.

  19. [Face replantation using labial artery for revascularization. Case report].

    Science.gov (United States)

    de la Parra-Márquez, Miguel; Mondragón-González, Sergio; López-Palazuelos, Jaime; Naal-Mendoza, Norberto; Rangel-Flores, Jesús María

    2013-01-01

    Restoration of the face function and cosmetic appearance after a traumatic complex wound is a challenge for the plastic surgeon. Worldwide, few cases have been reported about face replantation. To present the case of the first partial face replantation reported in the national bibliography, using the labial artery for revascularization. On June 19th 2011, a 7 years old male presented to the emergency room of the Mexican Institute of Social Security at Monterrey, Mexico, 4 hours after a partial face amputation secondary to a dog bite. The amputated segment was composed of 75% of the upper lip, 33% of the lower lip, oral commissure and 75% of the left cheek. The labial coronary artery and vein were anastomosed with 11-0 nylon sutures and the miorraphy of the orbicularis oris, the depressor anguli oris and the depressor labii inferioris with 4-0 vycril sutures. Six months after the surgery, the functional and aesthetic outcomes were excellent with reestablishment of total labial continence and total recovery of articulation of words. amputations of any facial component should be initially managed with replantation. The function and cosmetics are better than any other technique of reconstruction. The labial coronary artery is an excellent choice for revascularization up to 25% of the face (lips and cheek).

  20. Molecular nuclear imaging of tumoral angio genesis using a rgd-containing tracer, Raft-RGD, targeted at the neo vessel-specific integrin αvβ3

    International Nuclear Information System (INIS)

    Sancey, L.

    2006-06-01

    Tumoral neo-angio genesis targeting is currently a major field of research for the diagnostic and treatment of solid tumors. Endothelial cells from neo vessels over express several specific markers such as the α v β 3 integrin, which binds RGD (-Arg-Gly-Asp-)- containing peptides. We evaluated the potential of a novel radiotracer - RAFT-RGD - for the molecular nuclear imaging of neo vessels. In vitro, the coupling of 4 c(RGDfK) to the RAFT platform resulted in an increased cellular uptake of the tracer by α v β 3 positive cells when compared to c(RGDfK). Furthermore, RAFTRGD has a higher affinity than c(RGDfK) and similar properties for angio genesis inhibition. In vivo, both α v β 3 positive and negative tumors were visible by non invasive whole body planar and tomographic imaging from 30 min to 24 h post-injection, using a gamma camera dedicated to small animal imaging. Despite a lack of significant contrast improvement compare with c(RGDfK), RAFT-RGD could represent a promising tracer for tumoral angio genesis since it could provide invaluable information about tumor development and treatment efficacy in Nuclear Medicine departments. Furthermore, thanks to its chemical structure, RAFT-RGD can be labelled with a variety of radioisotopes including γ and β - emitters, allowing interesting therapeutical applications such as internal targeted radiotherapy. (author)

  1. Myocutaneous revascularization following graded ischemia in lean and obese mice

    Directory of Open Access Journals (Sweden)

    Clark RM

    2016-09-01

    Full Text Available Ross M Clark,1 Brittany Coffman,2 Paul G McGuire,3 Thomas R Howdieshell1,3 1Department of Surgery, 2Department of Pathology, 3Department of Cell Biology and Vascular Physiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA Background: Murine models of diabetes and obesity have provided insight into the pathogenesis of impaired epithelialization of excisional skin wounds. However, knowledge of postischemic myocutaneous revascularization in these models is limited. Materials and methods: A myocutaneous flap was created on the dorsum of wild type (C57BL/6, genetically obese and diabetic (ob/ob, db/db, complementary heterozygous (ob+/ob− , db+/db−, and diet-induced obese (DIO mice (n=48 total; five operative mice per strain and three unoperated mice per strain as controls. Flap perfusion was documented by laser speckle contrast imaging. Local gene expression in control and postoperative flap tissue specimens was determined by quantitative reverse transcription polymerase chain reaction (RT-PCR. Image analysis of immunochemically stained histologic sections confirmed microvascular density and macrophage presence. Results: Day 10 planimetric analysis revealed mean flap surface area necrosis values of 10.8%, 12.9%, 9.9%, 0.4%, 1.4%, and 23.0% for wild type, db+/db−, ob+/ob−, db/db, ob/ob, and DIO flaps, respectively. Over 10 days, laser speckle imaging documented increased perfusion at all time points with revascularization to supranormal perfusion in db/db and ob/ob flaps. In contrast, wild type, heterozygous, and DIO flaps displayed expected graded ischemia with failure of perfusion to return to baseline values. RT-PCR demonstrated statistically significant differences in angiogenic gene expression between lean and obese mice at baseline (unoperated and at day 10. Conclusion: Unexpected increased baseline skin perfusion and augmented myocutaneous revascularization accompanied by a control proangiogenic transcriptional

  2. First-in-Man Computed Tomography-Guided Percutaneous Revascularization of Coronary Chronic Total Occlusion Using a Wearable Computer: Proof of Concept.

    Science.gov (United States)

    Opolski, Maksymilian P; Debski, Artur; Borucki, Bartosz A; Szpak, Marcin; Staruch, Adam D; Kepka, Cezary; Witkowski, Adam

    2016-06-01

    We report a case of successful computed tomography-guided percutaneous revascularization of a chronically occluded right coronary artery using a wearable, hands-free computer with a head-mounted display worn by interventional cardiologists in the catheterization laboratory. The projection of 3-dimensional computed tomographic reconstructions onto the screen of virtual reality glass allowed the operators to clearly visualize the distal coronary vessel, and verify the direction of the guide wire advancement relative to the course of the occluded vessel segment. This case provides proof of concept that wearable computers can improve operator comfort and procedure efficiency in interventional cardiology. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  3. Sequential vs simultaneous revascularization in patients undergoing liver transplantation: A meta-analysis.

    Science.gov (United States)

    Wang, Jia-Zhong; Liu, Yang; Wang, Jin-Long; Lu, Le; Zhang, Ya-Fei; Lu, Hong-Wei; Li, Yi-Ming

    2015-06-14

    We undertook this meta-analysis to investigate the relationship between revascularization and outcomes after liver transplantation. A literature search was performed using MeSH and key words. The quality of the included studies was assessed using the Jadad Score and the Newcastle-Ottawa Scale. Heterogeneity was evaluated by the χ(2) and I (2) tests. The risk of publication bias was assessed using a funnel plot and Egger's test, and the risk of bias was assessed using a domain-based assessment tool. A sensitivity analysis was conducted by reanalyzing the data using different statistical approaches. Six studies with a total of 467 patients were included. Ischemic-type biliary lesions were significantly reduced in the simultaneous revascularization group compared with the sequential revascularization group (OR = 4.97, 95%CI: 2.45-10.07; P simultaneous revascularization group. Although warm ischemia time was prolonged in simultaneous revascularization group (MD = -25.84, 95%CI: -29.28-22.40; P sequential and simultaneous revascularization groups. Assessment of the risk of bias showed that the methods of random sequence generation and blinding might have been a source of bias. The sensitivity analysis strengthened the reliability of the results of this meta-analysis. The results of this study indicate that simultaneous revascularization in liver transplantation may reduce the incidence of ischemic-type biliary lesions and length of stay of patients in the ICU.

  4. Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency

    Science.gov (United States)

    Langhoff, Ralf; Rocha-Singh, Krishna J.; Jaff, Michael R.; Blessing, Erwin; Amann-Vesti, Beatrice; Krzanowski, Marek; Peeters, Patrick; Scheinert, Dierk; Torsello, Giovanni; Sixt, Sebastian; Tepe, Gunnar

    2017-01-01

    Background— Studies assessing drug-coated balloons (DCB) for the treatment of femoropopliteal artery disease are encouraging. However, challenging lesions, such as severely calcified, remain difficult to treat with DCB alone. Vessel preparation with directional atherectomy (DA) potentially improves outcomes of DCB. Methods and Results— DEFINITIVE AR study (Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency—A Pilot Study of Anti-Restenosis Treatment) was a multicenter randomized trial designed to estimate the effect of DA before DCB to facilitate the development of future end point-driven randomized studies. One hundred two patients with claudication or rest pain were randomly assigned 1:1 to DA+DCB (n=48) or DCB alone (n=54), and 19 additional patients with severely calcified lesions were treated with DA+DCB. Mean lesion length was 11.2±4.0 cm for DA+DCB and 9.7±4.1 cm for DCB (P=0.05). Predilation rate was 16.7% for DA+DCB versus 74.1% for DCB; postdilation rate was 6.3% for DA+DCB versus 33.3% for DCB. Technical success was superior for DA+DCB (89.6% versus 64.2%; P=0.004). Overall bail-out stenting rate was 3.7%, and rate of flow-limiting dissections was 19% for DCB and 2% for DA+DCB (P=0.01). One-year primary outcome of angiographic percent diameter stenosis was 33.6±17.7% for DA+DCB versus 36.4±17.6% for DCB (P=0.48), and clinically driven target lesion revascularization was 7.3% for DA+DCB and 8.0% for DCB (P=0.90). Duplex ultrasound patency was 84.6% for DA+DCB, 81.3% for DCB (P=0.78), and 68.8% for calcified lesions. Freedom from major adverse events at 1 year was 89.3% for DA+DCB and 90.0% for DCB (P=0.86). Conclusions— DA+DCB treatment was effective and safe, but the study was not powered to show significant differences between the 2 methods of revascularization in 1-year follow-up. An adequately powered randomized trial is warranted. Clinical Trial Registration— http

  5. Vessel Operator System

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Operator cards are required for any operator of a charter/party boat and or a commercial vessel (including carrier and processor vessels) issued a vessel permit from...

  6. Tumor Vessel Development and Expansion in Ewing's Sarcoma: A Review of the Vasculogenesis Process and Clinical Trials with Vascular-Targeting Agents

    Science.gov (United States)

    Stewart, Keri S.; Kleinerman, Eugenie S.

    2011-01-01

    Ewing's sarcoma accounts for a disproportionately high portion of the overall pediatric mortality rate compared to its rare incidence in the pediatric population. Little progress has been made since the introduction of traditional chemotherapies, and understanding the biology of the tumor is critical for developing new therapies. Ewing's sarcomas rely on a functional vascular supply, which is formed by a combination of angiogenesis and vasculogenesis. Recent insights into the molecular regulation of bone marrow (BM) cell participation in vascular development have identified VEGF, SDF-1α, and DLL4 as critical players in the vasculogenesis process. Clinical trials using vascular targeting agents, specifically targeting VEGF or DLL4, are underway. PMID:21785569

  7. Immunological quality and performance of tumor vessel-targeting CAR-T cells prepared by mRNA-EP for clinical research.

    Science.gov (United States)

    Inoo, Kanako; Inagaki, Ryo; Fujiwara, Kento; Sasawatari, Shigemi; Kamigaki, Takashi; Nakagawa, Shinsaku; Okada, Naoki

    2016-01-01

    We previously reported that tumor vessel-redirected T cells, which were genetically engineered with chimeric antigen receptor (CAR) specific for vascular endothelial growth factor receptor 2 (VEGFR2), demonstrated significant antitumor effects in various murine solid tumor models. In the present study, we prepared anti-VEGFR2 CAR-T cells by CAR-coding mRNA electroporation (mRNA-EP) and analyzed their immunological characteristics and functions for use in clinical research. The expression of anti-VEGFR2 CAR on murine and human T cells was detected with approximately 100% efficiency for a few days, after peaking 6-12 hours after mRNA-EP. Triple transfer of murine anti-VEGFR2 CAR-T cells into B16BL6 tumor-bearing mice demonstrated an antitumor effect comparable to that for the single transfer of CAR-T cells engineered with retroviral vector. The mRNA-EP did not cause any damage or defects to human T-cell characteristics, as determined by viability, growth, and phenotypic parameters. Additionally, two kinds of human anti-VEGFR2 CAR-T cells, which expressed different CAR construction, differentiated to effector phase with cytokine secretion and cytotoxic activity in antigen-specific manner. These results indicate that our anti-VEGFR2 CAR-T cells prepared by mRNA-EP have the potential in terms of quality and performance to offer the prospect of safety and efficacy in clinical research as cellular medicine.

  8. Revascularization for a necrotic immature permanent lateral incisor: a case report and literature review.

    Science.gov (United States)

    Kottoor, Jojo; Velmurugan, Natanasabapathy

    2013-07-01

    Revascularization is a valuable treatment in immature necrotic teeth that allows the continuation of root development. This article describes the successful revascularization treatment of an immature maxillary lateral incisor that was initially diagnosed with apical periodontitis. The tooth was asymptomatic and functional clinically and radiographically during the follow-up period of 5 years. The follow-up showed evidence of progressive thickening of the dentinal walls, development of root length and apical closure. The article also discusses the currently available literature regarding revascularization of immature permanent teeth. © 2012 John Wiley & Sons Ltd, BSPD and IAPD.

  9. Fibroblasts accelerate islet revascularization and improve long-term graft survival in a mouse model of subcutaneous islet transplantation.

    Directory of Open Access Journals (Sweden)

    Marcos Perez-Basterrechea

    Full Text Available Pancreatic islet transplantation has been considered for many years a promising therapy for beta-cell replacement in patients with type-1 diabetes despite that long-term clinical results are not as satisfactory. This fact points to the necessity of designing strategies to improve and accelerate islets engraftment, paying special attention to events assuring their revascularization. Fibroblasts constitute a cell population that collaborates on tissue homeostasis, keeping the equilibrium between production and degradation of structural components as well as maintaining the required amount of survival factors. Our group has developed a model for subcutaneous islet transplantation using a plasma-based scaffold containing fibroblasts as accessory cells that allowed achieving glycemic control in diabetic mice. Transplanted tissue engraftment is critical during the first days after transplantation, thus we have gone in depth into the graft-supporting role of fibroblasts during the first ten days after islet transplantation. All mice transplanted with islets embedded in the plasma-based scaffold reversed hyperglycemia, although long-term glycemic control was maintained only in the group transplanted with the fibroblasts-containing scaffold. By gene expression analysis and histology examination during the first days we could conclude that these differences might be explained by overexpression of genes involved in vessel development as well as in β-cell regeneration that were detected when fibroblasts were present in the graft. Furthermore, fibroblasts presence correlated with a faster graft re-vascularization, a higher insulin-positive area and a lower cell death. Therefore, this work underlines the importance of fibroblasts as accessory cells in islet transplantation, and suggests its possible use in other graft-supporting strategies.

  10. Fibroblasts accelerate islet revascularization and improve long-term graft survival in a mouse model of subcutaneous islet transplantation.

    Science.gov (United States)

    Perez-Basterrechea, Marcos; Esteban, Manuel Martinez; Alvarez-Viejo, Maria; Fontanil, Tania; Cal, Santiago; Sanchez Pitiot, Marta; Otero, Jesus; Obaya, Alvaro Jesus

    2017-01-01

    Pancreatic islet transplantation has been considered for many years a promising therapy for beta-cell replacement in patients with type-1 diabetes despite that long-term clinical results are not as satisfactory. This fact points to the necessity of designing strategies to improve and accelerate islets engraftment, paying special attention to events assuring their revascularization. Fibroblasts constitute a cell population that collaborates on tissue homeostasis, keeping the equilibrium between production and degradation of structural components as well as maintaining the required amount of survival factors. Our group has developed a model for subcutaneous islet transplantation using a plasma-based scaffold containing fibroblasts as accessory cells that allowed achieving glycemic control in diabetic mice. Transplanted tissue engraftment is critical during the first days after transplantation, thus we have gone in depth into the graft-supporting role of fibroblasts during the first ten days after islet transplantation. All mice transplanted with islets embedded in the plasma-based scaffold reversed hyperglycemia, although long-term glycemic control was maintained only in the group transplanted with the fibroblasts-containing scaffold. By gene expression analysis and histology examination during the first days we could conclude that these differences might be explained by overexpression of genes involved in vessel development as well as in β-cell regeneration that were detected when fibroblasts were present in the graft. Furthermore, fibroblasts presence correlated with a faster graft re-vascularization, a higher insulin-positive area and a lower cell death. Therefore, this work underlines the importance of fibroblasts as accessory cells in islet transplantation, and suggests its possible use in other graft-supporting strategies.

  11. Hospital patterns of medical management strategy use for patients with non-ST-elevation myocardial infarction and 3-vessel or left main coronary artery disease

    NARCIS (Netherlands)

    Harskamp, Ralf E.; Wang, Tracy Y.; Bhatt, Deepak L.; Wiviott, Stephen D.; Amsterdam, Ezra A.; Li, Shuang; Thomas, Laine; de Winter, Robbert J.; Roe, Matthew T.

    2014-01-01

    Patients with non-ST-elevation myocardial infarction (NSTEMI) and three-vessel or left main coronary disease (3VD/LMD) have a high risk of long-term mortality when treated with a medical management strategy (MMS) compared with revascularization. We evaluated patterns of use and patient features

  12. Immunological quality and performance of tumor vessel-targeting CAR-T cells prepared by mRNA-EP for clinical research

    Directory of Open Access Journals (Sweden)

    Kanako Inoo

    2016-01-01

    Full Text Available We previously reported that tumor vessel-redirected T cells, which were genetically engineered with chimeric antigen receptor (CAR specific for vascular endothelial growth factor receptor 2 (VEGFR2, demonstrated significant antitumor effects in various murine solid tumor models. In the present study, we prepared anti-VEGFR2 CAR-T cells by CAR-coding mRNA electroporation (mRNA-EP and analyzed their immunological characteristics and functions for use in clinical research. The expression of anti-VEGFR2 CAR on murine and human T cells was detected with approximately 100% efficiency for a few days, after peaking 6–12 hours after mRNA-EP. Triple transfer of murine anti-VEGFR2 CAR-T cells into B16BL6 tumor-bearing mice demonstrated an antitumor effect comparable to that for the single transfer of CAR-T cells engineered with retroviral vector. The mRNA-EP did not cause any damage or defects to human T-cell characteristics, as determined by viability, growth, and phenotypic parameters. Additionally, two kinds of human anti-VEGFR2 CAR-T cells, which expressed different CAR construction, differentiated to effector phase with cytokine secretion and cytotoxic activity in antigen-specific manner. These results indicate that our anti-VEGFR2 CAR-T cells prepared by mRNA-EP have the potential in terms of quality and performance to offer the prospect of safety and efficacy in clinical research as cellular medicine.

  13. Root canal revascularization. The beginning of a new era in endodontics.

    Science.gov (United States)

    Alrahabi, Mothanna K; Ali, Mahmoud M

    2014-05-01

    Endodontic management of immature anterior teeth with necrotic pulps is a great challenge. Although there are different treatment procedures to deal with this problem such as apexification by using calcium hydroxide dressings or applying a barrier of mineral trioxide aggregate and gutta-percha obturation, the outcomes are still unsatisfactory and the root might still be weak. Recently, a new treatment protocol by revascularization of immature non-vital, infected teeth was introduced to regenerate dental structure and complete the root maturation. However, larger case series with longer follow-up periods are required to accept revascularization as the standard protocol for management of immature non-vital, infected teeth. In this review, we discuss the concept of root canal revascularization, revascularization mechanisms, and the structure of the regenerated tissues.

  14. Risk Factors for Incident Carotid Artery Revascularization among Older Adults: The Cardiovascular Health Study

    Directory of Open Access Journals (Sweden)

    Parveen K. Garg

    2016-11-01

    Full Text Available Background: Population-based risk factors for carotid artery revascularization are not known. We investigated the association between demographic and clinical characteristics and incident carotid artery revascularization in a cohort of older adults. Methods: Among Cardiovascular Health Study participants, a population-based cohort of 5,888 adults aged 65 years or older enrolled in two waves (1989-1990 and 1992-1993, 5,107 participants without a prior history of carotid endarterectomy (CEA or cerebrovascular disease had a carotid ultrasound at baseline and were included in these analyses. Cox proportional hazards multivariable analysis was used to determine independent risk factors for incident carotid artery revascularization. Results: Over a mean follow-up of 13.5 years, 141 participants underwent carotid artery revascularization, 97% were CEA. Baseline degree of stenosis and incident ischemic cerebral events occurring during follow-up were the strongest predictors of incident revascularization. After adjustment for these, factors independently associated with an increased risk of incident revascularization were: hypertension (HR 1.53; 95% CI: 1.05-2.23, peripheral arterial disease (HR 2.57; 95% CI: 1.34-4.93, and low-density lipoprotein cholesterol (HR 1.23 per standard deviation [SD] increment [35.4 mg/dL]; 95% CI: 1.04-1.46. Factors independently associated with a lower risk of incident revascularization were: female gender (HR 0.51; 95% CI: 0.34-0.77 and older age (HR 0.69 per SD increment [5.5 years]; 95% CI: 0.56-0.86. Conclusions: Even after accounting for carotid stenosis and incident cerebral ischemic events, carotid revascularization is related to age, gender, and cardiovascular risk factors. Further study of these demographic disparities and the role of risk factor control is warranted.

  15. Quality of life and functional status after revascularization or conservative treatment in patients with intermittent claudication

    DEFF Research Database (Denmark)

    Hedeager Momsen, Anne-Mette; Bach Jensen, Martin; Norager, Charlotte Buchard

    2011-01-01

    Revascularization of patients with intermittent claudication (IC) is recommended only for selected patients who have chronic pain or disabling disease. However, improvement in the quality of life (QoL) could justify more widespread use.......Revascularization of patients with intermittent claudication (IC) is recommended only for selected patients who have chronic pain or disabling disease. However, improvement in the quality of life (QoL) could justify more widespread use....

  16. Improved myocardial perfusion after transmyocardial laser revascularization in a patient with microvascular coronary artery disease

    Directory of Open Access Journals (Sweden)

    Peyman Mesbah Oskui

    2014-03-01

    Full Text Available We report the case of a 59-year-old woman who presented with symptoms of angina that was refractory to medical management. Although her cardiac catheterization revealed microvascular coronary artery disease, her symptoms were refractory to optimal medical management that included ranolazine. After undergoing transmyocardial revascularization, her myocardial ischemia completely resolved and her symptoms dramatically improved. This case suggests that combination of ranolazine and transmyocardial revascularization can be applied to patients with microvascular coronary artery disease.

  17. A novel delivery vector for targeted delivery of the antiangiogenic drug paclitaxel to angiogenic blood vessels: TLTYTWS-conjugated PEG–PLA nanoparticles

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Fei, E-mail: tanfeivip@126.com; Mo, Xiao-hui, E-mail: 675382206@qq.com [Shanghai Skin Disease Hospital (China); Zhao, Jian, E-mail: 22459402@qq.com [Karolinska University Hospital Solna, Department of Oncology-Pathology, Karolinska Institutet, CCK (Sweden); Liang, Hui, E-mail: nanotan@126.com [People' s Hospital of Longhua New District Shenzhen, Department of urology (China); Chen, Zhong-jian, E-mail: pfjk927627702@126.com; Wang, Xiu-li, E-mail: tanfeit@126.com [Shanghai Skin Disease Hospital (China)

    2017-02-15

    Antiangiogenesis has been widely accepted as an attractive strategy to combat tumor growth, invasion, and metastasis. An actively targeting nanoparticle-based drug delivery system (nano-DDS) would provide an alternative method to achieve antiangiogenic antitumor therapy. In the present study, our group fabricated novel nano-DDS, TLTYTWS (TS) peptide-modified poly(ethylene glycol)–poly(lactic acid) (PEG–PLA) nanoparticles (TS-NPs) encapsulating a drug with antiangiogenic potential, paclitaxel (Ptx) (TS-Ptx-NPs). The nanoparticles were uniformly spherical and had a unimodal particle size distribution and slightly negative zeta potential. TS-NPs accumulated significantly in human umbilical vein endothelial cells (HUVECs) via energy-dependent and caveolae- and lipid raft-mediated endocytosis and improved the antiproliferative, antimigratory, and antitube-forming abilities of paclitaxel in vitro. Following intravenous administration, TS-Ptx-NPs presented favorable pharmacokinetic profiles. Melanoma distribution assays confirmed that TS-NPs achieved higher accumulation and penetration at melanoma sites. These results collectively indicated that TLTYTWS-decorated nanoparticles can be considered to be a promising nano-DDS for chemotherapies targeting tumor angiogenesis and have great potential to improve the efficacy of antiangiogenic therapy in melanoma tumor-bearing nude mice.

  18. A novel delivery vector for targeted delivery of the antiangiogenic drug paclitaxel to angiogenic blood vessels: TLTYTWS-conjugated PEG–PLA nanoparticles

    International Nuclear Information System (INIS)

    Tan, Fei; Mo, Xiao-hui; Zhao, Jian; Liang, Hui; Chen, Zhong-jian; Wang, Xiu-li

    2017-01-01

    Antiangiogenesis has been widely accepted as an attractive strategy to combat tumor growth, invasion, and metastasis. An actively targeting nanoparticle-based drug delivery system (nano-DDS) would provide an alternative method to achieve antiangiogenic antitumor therapy. In the present study, our group fabricated novel nano-DDS, TLTYTWS (TS) peptide-modified poly(ethylene glycol)–poly(lactic acid) (PEG–PLA) nanoparticles (TS-NPs) encapsulating a drug with antiangiogenic potential, paclitaxel (Ptx) (TS-Ptx-NPs). The nanoparticles were uniformly spherical and had a unimodal particle size distribution and slightly negative zeta potential. TS-NPs accumulated significantly in human umbilical vein endothelial cells (HUVECs) via energy-dependent and caveolae- and lipid raft-mediated endocytosis and improved the antiproliferative, antimigratory, and antitube-forming abilities of paclitaxel in vitro. Following intravenous administration, TS-Ptx-NPs presented favorable pharmacokinetic profiles. Melanoma distribution assays confirmed that TS-NPs achieved higher accumulation and penetration at melanoma sites. These results collectively indicated that TLTYTWS-decorated nanoparticles can be considered to be a promising nano-DDS for chemotherapies targeting tumor angiogenesis and have great potential to improve the efficacy of antiangiogenic therapy in melanoma tumor-bearing nude mice.

  19. Retrograde Wiring of Collateral Channels of the Heart in Chronic Total Occlusions: A Systematic Review and Meta-Analysis of Safety, Feasibility, and Incremental Value in Achieving Revascularization.

    Science.gov (United States)

    Khand, Aleem; Patel, Bilal; Palmer, Nicholas; Jones, Julia; Andron, Mohammed; Perry, Raph; Mehrotra, Sanjay; Mitsudo, Kazuaki

    2015-11-01

    To conduct a systematic review and meta-analysis on retrograde wiring in chronic total occlusions (CTOs) with focus on its safety and feasibility. We searched publications from 1990 to December 2013 in PubMed, Ovid, EMBASE, and the Cochrane database inserting a number of terms relating to the collateral circulation of the heart in CTOs. A total of 18 case series (n range17-462) with a total of 2280 CTO revascularization attempts fulfilled criteria for a study of retrograde wiring of collateral channels in CTOs. There were no randomized studies comparing a primary antegrade with a primary retrograde approach. Procedural CTO revascularization rates ranged from 67% to 90.6% with a large proportion having previously failed an "antegrade" approach. The septal perforator collaterals and epicardial channels were used in 73.2% (n = 1670) and 21.7% (n = 495) of cases. Although collateral/coronary perforation was not infrequent (n = 90, 5%), serious acute complications were uncommon; in the combined population 18 cases of cardiac tamponade (0.8%) and 3 deaths (0.1%). Septal perforating wiring (79.3%) was significantly more likely to be successful compared to epicardial coronary artery wiring (72.5%) when chosen by the operator as a route of retrograde access to the CTO body (relative risk 1.11 [95% confidence interval: 1.02-1.20; P = .013]). Successful retrograde wiring of collateral channels in selected patients undertaken by "CTO dedicated" operators can significantly enhance the chances of revascularization of complex CTOs with a low risk of acute serious complications. Septal perforator channels are significantly more likely to be successfully retrogradely wired compared to epicardial vessels when either is selected, by reference to their anatomical suitability by the operator, as a route of access. © The Author(s) 2015.

  20. Emergent revascularization of acute tandem vertebrobasilar occlusions: Endovascular approaches and technical considerations-Confirming the role of vertebral artery ostium stenosis as a cause of vertebrobasilar stroke.

    Science.gov (United States)

    Cohen, José E; Leker, Ronen R; Gomori, J Moshe; Eichel, Roni; Rajz, Gustavo; Moscovici, Samuel; Itshayek, Eyal

    2016-12-01

    Patients suffering from acute atherothrombotic occlusion of the proximal vertebral artery (VA) and concomitant basilar artery (BA) occlusion present a grim prognosis. We describe our experience in the endovascular recanalization of tandem vertebrobasilar occlusions using endovascular techniques. The BA was accessed through the normal VA (clean-road) or the occluded, thrombotic VA (dirty-road), and stentriever-based thrombectomy was performed using antegrade or reverse revascularization variants. Seven patients underwent successful stentriever-assisted mechanical thrombectomy of the BA and five sustained concomitant VA revascularization. Stroke onset to endovascular intervention initiation (time-to-treatment) ranged from 4.5-13hours (mean 8.6). In two of seven patients, the BA occlusion was approached with a 'clean-road' approach via the contralateral VA; in five of seven patients, a 'dirty-road' approach via the occluded VA was used. Mean time-to-recanalization was 66minutes (range 55-82). There were no perforations, iatrogenic vessel dissections, or other technical complications. Four patients presented mild-to-moderate disability (modified Rankin Scale [mRS] 0-3) at 3months, one remained with moderate-to-severe disability (mRS 4), and two patients died on days 9 and 23 after their strokes. Follow-up ranged from 6-45months (mean 24months). In selected patients with acute VA-BA occlusion, stentriever-based thrombectomy performed through either the patent or the occluded VA, may be feasible, effective, and safe. Clinical outcomes in these patients seem to equipoise the neurological outcome of patients with successful revascularization for isolated BA occlusion. This unique pair of occlusions confirms the role of VA ostium stenosis as a cause of vertebrobasilar stroke. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Quality of life of patients who undergone myocardial revascularization surgery

    Directory of Open Access Journals (Sweden)

    Hirla Vanessa Soares de Araújo

    Full Text Available ABSTRACT Objective: to evaluate the quality of life of patients who underwent revascularization surgery. Method: a descriptive, cross sectional study, with quantitative approach carried out with 75 patients. The questionnaire WHOQOL-Bref was used to evaluate the quality of life (QOL. Results: patients' QOL evaluation presented a moderate result, with need of improvement of all domains. Low income patients had the worst evaluation of QOL in the domain environment (p=0,021, and the ones from Recife/metropolitan area, in the domain social relationship (p=0,021. Smoker (p=0,047, diabetic (p=0,002 and alcohol consumption (p=0,035 patients presented the worst evaluation of the physical domain. Renal patients presented the worst evaluation of QOL in the physical (P=0,037, psychological (p=0,008, social relationship (p=0,006 domains and total score (p=0,009. Conclusion: the improvement of QOL depends on the individual's process of behavioral change and the participation of health professionals is essential to formulate strategies to approach these patients, especially concerning health education.

  2. Apical Revascularization after Delayed Tooth Replantation: An Unusual Case

    Directory of Open Access Journals (Sweden)

    Marília Pacífico Lucisano

    2016-01-01

    Full Text Available The aim of this paper is to present the clinical and radiological outcome of the treatment involving a delayed tooth replantation after an avulsed immature permanent incisor, with a follow-up of 1 year and 6 months. An 8-year-old boy was referred after dental trauma that occurred on the previous day. The permanent maxillary right central incisor (tooth 11 had been avulsed. The tooth was hand-held during endodontic therapy and an intracanal medication application with calcium hydroxide-based paste was performed. An apical plug with mineral trioxide aggregate (MTA was introduced into the apical portion of the canal. When the avulsed tooth was replanted with digital pressure, a blood clot had formed within the socket, which moved the MTA apical plug about 2 mm inside of the root canal. These procedures developed apical revascularization, which promoted a successful endodontic outcome, evidenced by apical closure, slight increase in root length, and absence of signs of external root resorption, during a follow-up of 1 year and 6 months.

  3. Hyperperfusion on Perfusion Computed Tomography Following Revascularization for Acute Stroke

    International Nuclear Information System (INIS)

    Nguyen, T.B.; Lum, C.; Eastwood, J.D.; Stys, P.K.; Hogan, M.; Goyal, M.

    2005-01-01

    Purpose: To describe the findings of hyperperfusion on perfusion computed tomography (CT) in four patients following revascularization for acute stroke. Material and Methods: In 2002-2003, among a series of 6 patients presenting with an acute stroke and treated with intra-arterial thrombolysis, we observed the presence of hyperperfusion in 3 patients on the follow-up CT perfusion. We included an additional patient who was treated with intravenous thrombolysis and who had hyperperfusion on the follow-up CT perfusion. We retrospectively analyzed their CT perfusion maps. Cerebral blood volume (CBV) and cerebral blood flow (CBF) maps were compared between the affected territory and the normal contralateral hemisphere. Results: In the four patients, the mean CBV and CBF were 3.6±2.0 ml/100 g and 39±25 ml/100 g/min in the affected territory compared to the normal side (mean CBV 2.7±2.1 ml/100 g, mean CBF = 27±23 ml/100 g/min). There was no intracranial hemorrhage in the hyperperfused territories. At follow-up CT, some hyperperfused brain areas progressed to infarction, while others retained normal white to gray matter differentiation. Conclusion: CT perfusion can demonstrate hyperperfusion, which can be seen in an ischemic brain territory following recanalization

  4. Multiple shell pressure vessel

    International Nuclear Information System (INIS)

    Wedellsborg, B.W.

    1988-01-01

    A method is described of fabricating a pressure vessel comprising the steps of: attaching a first inner pressure vessel having means defining inlet and outlet openings to a top flange, placing a second inner pressure vessel, having means defining inlet and outlet opening, concentric with and spaced about the first inner pressure vessel and attaching the second inner pressure vessel to the top flange, placing an outer pressure vessel, having inlet and outlet openings, concentric with and spaced apart about the second inner pressure vessel and attaching the outer pressure vessel to the top flange, attaching a generally cylindrical inner inlet conduit and a generally cylindrical inner outlet conduit respectively to the inlet and outlet openings in the first inner pressure vessel, attaching a generally cylindrical outer inlet conduit and a generally cylindrical outer outlet conduit respectively to the inlet and outlet opening in the second inner pressure vessel, heating the assembled pressure vessel to a temperature above the melting point of a material selected from the group, lead, tin, antimony, bismuth, potassium, sodium, boron and mixtures thereof, filling the space between the first inner pressure vessel and the second inner pressure vessel with material selected from the group, filling the space between the second inner pressure vessel and the outer pressure vessel with material selected from the group, and pressurizing the material filling the spaces between the pressure vessels to a predetermined pressure, the step comprising: pressurizing the spaces to a pressure whereby the wall of the first inner pressure vessel is maintained in compression during steady state operation of the pressure vessel

  5. Perspectives on the 2014 ESC/EACTS Guidelines on Myocardial Revascularization: Fifty Years of Revascularization: Where Are We and Where Are We Heading?

    NARCIS (Netherlands)

    F. Costa (Francesco); S. Ariotti (Sara); M. Valgimigli (Marco); P.H. Kolh (Philippe); S.W. Windecker (Stephan)

    2015-01-01

    textabstractThe joint European Society of Cardiology and European Association of Cardio-Thoracic Surgery (ESC/EACTS) guidelines on myocardial revascularization collect and summarize the evidence regarding decision-making, diagnostics, and therapeutics in various clinical scenarios of coronary artery

  6. Targeted Endovascular Temporary Vessel Occlusion with a Reverse Thermosensitive Polymer for Near-Bloodless Partial Nephrectomy: Comparison to Standard Surgical Clamping Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Flacke, Sebastian, E-mail: Sebastian.Flacke@lahey.org [Lahey Clinic, Tuft University Medical School, Department of Radiology (United States); Harty, Niall J.; Laskey, Daniel H.; Moinzadeh, Alireza [Lahey Clinic, Tuft University Medical School, Department of Urology (United States); Benn, James A. [Pluromed Inc (United States); Villani, Rosanna [DaVinci Biomedical Research Products (United States); Kalra, Aarti [Lahey Clinic, Tuft University Medical School, Department of Pathology (United States); Libertino, John A.; Madras, Peter N. [Lahey Clinic, Tuft University Medical School, Department of Urology (United States)

    2012-10-15

    Purpose: To determine whether reversible blood flow interruption to a randomly chosen target region of the kidney may be achieved with the injection of a reverse thermoplastic polymer through an angiographic catheter, thereby facilitating partial nephrectomy without compromising blood flow to the remaining kidney or adding risks beyond those encountered by the use of hilar clamping. Methods: Fifteen pigs underwent partial nephrectomy after blood flow interruption by vascular cross-clamping or injection of polymer (Lumagel Trade-Mark-Sign ) into a segmental artery. Five animals were euthanized after surgery (three open and two laparoscopic resection, cross-clamping n = 2), and 10 (open resection, cross-clamping n = 4) were euthanized after 6 weeks' survival. Blood specimens were obtained periodically, and angiogram and necropsy were performed at 6 weeks. Results: Selective renal ischemia was achieved in all cases. Surgical resection time averaged 9 and 24.5 min in the open and laparoscopic groups, respectively. Estimated blood loss was negligible with the exception of one case where an accessory renal artery was originally overlooked. Reversal of the polymer to a liquid state was consistent angiographically and visually in all cases. Time to complete flow return averaged 7.4 and 2 min for polymer and clamping, respectively. Angiography at 6 weeks revealed no evidence of vascular injury. Laboratory data and necropsies revealed no differences between animals undergoing vascular clamping or polymer injection. Conclusion: Lumagel was as effective as vascular clamping in producing a near bloodless operative field for partial nephrectomy while maintaining flow to the uninvolved portion of the affected kidney.

  7. Revascularization for critical limb ischemia using the SpiderFX embolic protection device in the below-the-knee circulation: initial results.

    Science.gov (United States)

    Ward, Thomas J; Piechowiak, Rachel L; Patel, Rahul S; Fischman, Aaron M; Nowakowski, F Scott; Kim, Edward; Ellozy, Sharif H; Faries, Peter L; Lookstein, Robert A

    2014-10-01

    To examine the safety and efficacy of the SpiderFX embolic protection device (EPD) in the below-the-knee (BTK) circulation in patients with critical limb ischemia (CLI). A single-center retrospective review was performed to identify patients with CLI and single-vessel runoff in whom the SpiderFX EPD was used in the BTK circulation. Technical success and device-related complications were the primary endpoints. Retrieval of macroscopic debris in the EPD, 1-year freedom from major adverse limb events (MALEs), and 30-day perioperative death were also evaluated. A major amputation, surgical bypass, endovascular thrombectomy, or endovascular thrombolysis was considered a MALE. Thirty-six patients (21 men; mean age, 75.8 y) treated between 2008 and 2013 had endovascular revascularization with use of the SpiderFX EPD in the BTK circulation. The SpiderFX EPD was successfully deployed in all cases; the technical success rate of revascularization was 100%. Two minor and zero major complications were observed related to the SpiderFX. Two MALEs, a major amputation and a subsequent surgical bypass, were observed in the cohort. All MALEs occurred within 1 year of treatment (1-y freedom from MALE rate, 90%). Debris was retrieved in the SpiderFX device in 47% of patients. The use of the SpiderFX EPD in the BTK circulation in patients with CLI is safe and frequently retrieves debris. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  8. Direct versus indirect revascularization procedures for moyamoya disease: a comparative effectiveness study.

    Science.gov (United States)

    Macyszyn, Luke; Attiah, Mark; Ma, Tracy S; Ali, Zarina; Faught, Ryan; Hossain, Alisha; Man, Karen; Patel, Hiren; Sobota, Rosanna; Zager, Eric L; Stein, Sherman C

    2017-05-01

    OBJECTIVE Moyamoya disease (MMD) is a chronic cerebrovascular disease that can lead to devastating neurological outcomes. Surgical intervention is the definitive treatment, with direct, indirect, and combined revascularization procedures currently employed by surgeons. The optimal surgical approach, however, remains unclear. In this decision analysis, the authors compared the effectiveness of revascularization procedures in both adult and pediatric patients with MMD. METHODS A comprehensive literature search was performed for studies of MMD. Using complication and success rates from the literature, the authors constructed a decision analysis model for treatment using a direct and indirect revascularization technique. Utility values for the various outcomes and complications were extracted from the literature examining preferences in similar clinical conditions. Sensitivity analysis was performed. RESULTS A structured literature search yielded 33 studies involving 4197 cases. Cases were divided into adult and pediatric populations. These were further subdivided into 3 different treatment groups: indirect, direct, and combined revascularization procedures. In the pediatric population at 5- and 10-year follow-up, there was no significant difference between indirect and combination procedures, but both were superior to direct revascularization. In adults at 4-year follow-up, indirect was superior to direct revascularization. CONCLUSIONS In the absence of factors that dictate a specific approach, the present decision analysis suggests that direct revascularization procedures are inferior in terms of quality-adjusted life years in both adults at 4 years and children at 5 and 10 years postoperatively, respectively. These findings were statistically significant (p indirect and combination procedures may offer optimal results at long-term follow-up.

  9. Global Positioning System Use in the Community to Evaluate Improvements in Walking After Revascularization

    Science.gov (United States)

    Gernigon, Marie; Le Faucheur, Alexis; Fradin, Dominique; Noury-Desvaux, Bénédicte; Landron, Cédric; Mahe, Guillaume; Abraham, Pierre

    2015-01-01

    Abstract Revascularization aims at improving walking ability in patients with arterial claudication. The highest measured distance between 2 stops (highest-MDCW), the average walking speed (average-WSCW), and the average stop duration (average-DSCW) can be measured by global positioning system, but their evolution after revascularization is unknown. We included 251 peripheral artery diseased patients with self-reported limiting claudication. The patients performed a 1-hour stroll, recorded by a global positioning system receiver. Patients (n = 172) with confirmed limitation (highest-MDCW the follow-up period were compared with reference patients (ie, with unchanged lifestyle medical or surgical status). Other patients (lost to follow-up or treatment change) were excluded (n = 89). We studied 44 revascularized and 39 reference patients. Changes in highest-MDCW (+442 vs. +13 m) and average-WSCW (+0.3 vs. −0.2 km h−1) were greater in revascularized than in reference patients (both P the groups. Among the revascularized patients, 13 (29.5%) had a change in average-WSCW, but not in highest-MDCW, greater than the mean + 1 standard deviation of the change observed for reference patients. Revascularization may improve highest-MDCW and/or average-WSCW. This first report of changes in community walking ability in revascularized patients suggests that, beyond measuring walking distances, average-WSCW measurement is essential to monitor these changes. Applicability to other surgical populations remains to be evaluated. Registration: http://www.clinicaltrials.gov/ct2/show/NCT01141361 PMID:25950694

  10. Correlation between Patient-Reported Symptoms and Ankle-Brachial Index after Revascularization for Peripheral Arterial Disease

    Directory of Open Access Journals (Sweden)

    Hyung Gon Je

    2015-05-01

    Full Text Available Improvement in quality of life (QoL is a primary treatment goal for patients with peripheral arterial disease (PAD. The current study aimed to quantify improvement in the health status of PAD patients following peripheral revascularization using the peripheral artery questionnaire (PAQ and ankle-brachial index (ABI, and to evaluate possible correlation between the two methods. The PAQ and ABI were assessed in 149 symptomatic PAD patients before, and three months after peripheral revascularization. Mean PAQ summary scores improved significantly three months after revascularization (+49.3 ± 15 points, p < 0.001. PAQ scores relating to patient symptoms showed the largest improvement following revascularization. The smallest increases were seen in reported treatment satisfaction (all p’s < 0.001. As expected the ABI of treated limbs showed significant improvement post-revascularization (p < 0.001. ABI after revascularization correlated with patient-reported changes in the physical function and QoL domains of the PAQ. Twenty-two percent of PAD patients were identified as having a poor response to revascularization (increase in ABI < 0.15. Interestingly, poor responders reported improvement in symptoms on the PAQ, although this was less marked than in patients with an increase in ABI > 0.15 following revascularization. In conclusion, data from the current study suggest a significant correlation between improvement in patient-reported outcomes assessed by PAQ and ABI in symptomatic PAD patients undergoing peripheral revascularization.

  11. Marked hypercapnia during cardiopulmonary bypass for myocardial revascularization. Case report.

    Science.gov (United States)

    Nascimento, Maurício Serrano; Bernardes, Cassiano Franco; de Medeiros, Roberta Louro

    2002-04-01

    Bypassing heart blood and returning it oxygenated to systemic circulation is achieved at the expenses of major cardiopulmonary physiologic changes. The aim of this report was to present an anesthetic complication during CPB and to warn for the need of interaction of the whole anesthetic-surgical team to prevent adverse perioperative events. A brown female patient, 56 years old, 95 kg, height 1.65 m, physical status ASA IV, with chronic renal failure under hemodialysis was admitted for myocardial revascularization. Monitoring consisted of ECG, invasive blood pressure, pulse oximetry, capnography, esophageal temperature, central venous pressure and anesthetic gases analysis. Patient was premedicated with intravenous midazolam (0.05 mg kg(-1)). Anesthesia was induced with fentanyl (16 microg kg(-1)), etomidate (0.3 mg kg(-1)) and pancuronium (0.1 mg kg(-1)), and was maintained with O2, isoflurane (0.5 - 1 MAC) and fentanyl continuous infusion. Blood gas analysis after induction has shown: pH: 7.41; PaO2: 288 mmHg; PaCO2: 38 mmHg; HCO3: 24 mmol L(-1); BE: 0 mmol L(-1); SatO2 100%. A second blood gases analysis, sampled soon after CPB, returned in 30 minutes, showing: pH 7.15; PaO2: 86 mmHg; PaCO2 224 mmHg; HCO3: 29 mmol L(-1); BE: -3 mmol L(-1); SatO2 99%. Thorough and urgent checking of anesthetic and perfusion equipment was performed and revealed that the gas blender was connected to the O2 line and to a CO2 cylinder, when it should be connected to the compressed air cylinder. Bypass circuit mechanical problems may occur in the intraoperative period, and demand prompt repairs. Technological advances in anesthesia equipment, monitoring and safety standards will lessen the possibility of cases such as this to be repeated, but will never replace anesthesiologists surveillance.

  12. Probabilistic retinal vessel segmentation

    Science.gov (United States)

    Wu, Chang-Hua; Agam, Gady

    2007-03-01

    Optic fundus assessment is widely used for diagnosing vascular and non-vascular pathology. Inspection of the retinal vasculature may reveal hypertension, diabetes, arteriosclerosis, cardiovascular disease and stroke. Due to various imaging conditions retinal images may be degraded. Consequently, the enhancement of such images and vessels in them is an important task with direct clinical applications. We propose a novel technique for vessel enhancement in retinal images that is capable of enhancing vessel junctions in addition to linear vessel segments. This is an extension of vessel filters we have previously developed for vessel enhancement in thoracic CT scans. The proposed approach is based on probabilistic models which can discern vessels and junctions. Evaluation shows the proposed filter is better than several known techniques and is comparable to the state of the art when evaluated on a standard dataset. A ridge-based vessel tracking process is applied on the enhanced image to demonstrate the effectiveness of the enhancement filter.

  13. Improvement to reactor vessel

    International Nuclear Information System (INIS)

    1974-01-01

    The vessel described includes a prestressed concrete vessel containing a chamber and a removable cover closing this chamber. The cover is in concrete and is kept in its closed position by main and auxiliary retainers, comprising fittings integral with the concrete of the vessel. The auxiliary retainers pass through the concrete of the cover. This improvement may be applied to BWR, PWR and LMFBR type reactor vessel [fr

  14. Evaluation of the patients with renovascular hypertension after percutaneous revascularization by Doppler ultrasonography

    International Nuclear Information System (INIS)

    Akan, Huseyin; Arik, Nurol; Saglam, Seher; Danaci, Murat; Incesu, Lutfi; Selcuk, Mustafa Bekir

    2003-01-01

    Objective: Evaluation of the effectiveness of percutaneous revascularization is based primarily on clinical criteria, and laboratory findings rather than direct investigation of luminal width. The purpose of this study was to evaluate the success of endovascular revascularization with serial Doppler ultrasound (US) examinations. Methods and material: 19 patients (14 were atherosclerotic, five were with fibromuscular dysplasia) with suspected renovascular hypertension treated by percutaneous revascularization were included in a prospective study. Patients had 23 renal artery stenoses reducing the diameter by more than 50%. Doppler US examinations were performed before intervention, and 1 day, 3 and 6 months after intervention. Results: Initial revascularization was technically successful in 21 of 23 stenoses (91.3%) (18 PTRA, three stent placement). Hypertension was cured in five atherosclerotic and in five fibromuscular dysplasia (FMD) patients, and improved in four atherosclerotic patients. Residual stenosis was determined in six patients and the others were evaluated as normal by initial postprocedure Doppler US. As based on Doppler US, restenosis (>60%-narrowing) was depicted in four of six (66.6%) renal arteries with residual stenosis, and one of 15 (6.6%) normal renal arteries at 1 year. This difference in restenosis rates (residual stenosis vs. normal) was significant (P<0.05). Conclusion: Positive predictor for recurrence was a residual renal artery stenosis documented by Doppler US 1 day after percutaneous revascularization in atherosclerotic cases

  15. ALICE HMPID Radiator Vessel

    CERN Document Server

    2003-01-01

    View of the radiator vessels of the ALICE/HMPID mounted on the support frame. Each HMPID module is equipped with 3 indipendent radiator vessels made out of neoceram and fused silica (quartz) windows glued together. The spacers inside the vessel are needed to stand the hydrostatic pressure. http://alice-hmpid.web.cern.ch/alice-hmpid

  16. Peripheral arterial disease and revascularization of the diabetic foot.

    Science.gov (United States)

    Forsythe, R O; Brownrigg, J; Hinchliffe, R J

    2015-05-01

    Diabetes is a complex disease with many serious potential sequelae, including large vessel arterial disease and microvascular dysfunction. Peripheral arterial disease is a common large vessel complication of diabetes, implicated in the development of tissue loss in up to half of patients with diabetic foot ulceration. In addition to peripheral arterial disease, functional changes in the microcirculation also contribute to the development of a diabetic foot ulcer, along with other factors such as infection, oedema and abnormal biomechanical loading. Peripheral arterial disease typically affects the distal vessels, resulting in multi-level occlusions and diffuse disease, which often necessitates challenging distal revascularisation surgery or angioplasty in order to improve blood flow. However, technically successful revascularisation does not always result in wound healing. The confounding effects of microvascular dysfunction must be recognised--treatment of a patient with a diabetic foot ulcer and peripheral arterial disease should address this complex interplay of pathophysiological changes. In the case of non-revascularisable peripheral arterial disease or poor response to conventional treatment, alternative approaches such as cell-based treatment, hyperbaric oxygen therapy and the use of vasodilators may appear attractive, however more robust evidence is required to justify these novel approaches. © 2014 John Wiley & Sons Ltd.

  17. Neurotrophins promote revascularization by local recruitment of TrkB+ endothelial cells and systemic mobilization of hematopoietic progenitors

    Science.gov (United States)

    Kermani, Pouneh; Rafii, Dahlia; Jin, David K.; Whitlock, Paul; Schaffer, Wendy; Chiang, Anne; Vincent, Loic; Friedrich, Matthias; Shido, Koji; Hackett, Neil R.; Crystal, Ronald G.; Rafii, Shahin; Hempstead, Barbara L.

    2005-01-01

    The neurotrophin brain-derived neurotrophic factor (BDNF) is required for the maintenance of cardiac vessel wall stability during embryonic development through direct angiogenic actions on endothelial cells expressing the tropomysin receptor kinase B (TrkB). However, the role of BDNF and a related neurotrophin ligand, neurotrophin-4 (NT-4), in the regulation of revascularization of the adult tissues is unknown. To study the potential angiogenic capacity of BDNF in mediating the neovascularization of ischemic and non-ischemic adult mouse tissues, we utilized a hindlimb ischemia and a subcutaneous Matrigel model. Recruitment of endothelial cells and promotion of channel formation within the Matrigel plug by BDNF and NT-4 was comparable to that induced by VEGF-A. The introduction of BDNF into non-ischemic ears or ischemic limbs induced neoangiogenesis, with a 2-fold increase in the capillary density. Remarkably, treatment with BDNF progressively increased blood flow in the ischemic limb over 21 days, similar to treatment with VEGF-A. The mechanism by which BDNF enhances capillary formation is mediated in part through local activation of the TrkB receptor and also by recruitment of Sca-1+CD11b+ pro-angiogenic hematopoietic cells. BDNF induces a potent direct chemokinetic action on subsets of marrow-derived Sca-1+ hematopoietic cells co-expressing TrkB. These studies suggest that local regional delivery of BDNF may provide a novel mechanism for inducing neoangiogenesis through both direct actions on local TrkB-expressing endothelial cells in skeletal muscle and recruitment of specific subsets of TrkB+ bone marrow–derived hematopoietic cells to provide peri-endothelial support for the newly formed vessels. PMID:15765148

  18. Application of radionuclide infarct scintigraphy to diagnose perioperative myocardial infarction following revascularization

    International Nuclear Information System (INIS)

    Klausner, S.C.; Botvinick, E.H.; Shames, D.; Ullyot, D.J.; Fishman, N.H.; Roe, B.B.; Ebert, P.A.; Chatterjee, K.; Parmley, W.W.

    1977-01-01

    To evaluate the application of radionuclide infarct scintigraphy to diagnose myocardial infarction after revascularization, we obtained postoperative technetium 99m pyrophosphate myocardial scintigrams, serial electrocardiograms and CPK-MB isoenzymes in ten control and 51 revascularized patients. All control patients had negative electrocardiograms and scintigrams, but eight had positive isoenzymes. Eight revascularized patients had positive electrocardiograms, images and enzymes and two had positive scintigrams and enzymes with negative electrocardiograms. Thirty-four patients with negative electrocardiograms and scintigrams had positive isoenzymes; in only seven patients were all tests negative. Our data suggest radionuclide infarct scintigraphy is a useful adjunct to the electrocardiogram in diagnosing perioperative infarction. The frequent presence of CPK-MB in postoperative patients without other evidence of infarction suggests that further studies are required to identify all factors responsible for its release

  19. The role of endothelial cells on islet function and revascularization after islet transplantation.

    Science.gov (United States)

    Del Toro-Arreola, Alicia; Robles-Murillo, Ana Karina; Daneri-Navarro, Adrian; Rivas-Carrillo, Jorge David

    2016-01-02

    Islet transplantation has become a widely accepted therapeutic option for selected patients with type 1 diabetes mellitus. However, in order to achieve insulin independence a great number of islets are often pooled from 2 to 4 pancreata donors. Mostly, it is due to the massive loss of islets immediately after transplant. The endothelium plays a key role in the function of native islets and during the revascularization process after islet transplantation. However, if a delayed revascularization occurs, even the remaining islets will also undergo to cell death and late graft dysfunction. Therefore, it is essential to understand how the signals are released from endothelial cells, which might regulate both differentiation of pancreatic progenitors and thereby maintenance of the graft function. New strategies to facilitate islet engraftment and a prompt revascularization could be designed to intervene and might lead to improve future results of islet transplantation.

  20. Revascularization of calvarial, mandibular, tibial, and iliac bone grafts in rats

    DEFF Research Database (Denmark)

    Pinholt, E M; Solheim, E; Talsnes, O

    1994-01-01

    Some studies have suggested that membranous bone grafts undergo less resorption than endochondral grafts, and faster revascularization of the former has been proposed as the explanation. We studied fresh syngeneic full-thickness bone grafts from calvaria, mandibula, tibia diaphysis, and iliac bone...... implanted in the back muscles of young Lewis rats. As a measure of the quantity of cancellous bone in grafts before implantation, the ratio of the total area of soft-tissue spaces to the total area of the graft was measured histomorphometrically. Revascularization in grafts 3 weeks postoperatively...... was evaluated by deposit of 141Ce-labeled microspheres. Both the quantity of cancellous bone (before implantation) and the revascularization (3 weeks postoperatively) were greater in the mandibular and iliac bone grafts than in the calvarial and tibia diaphyseal grafts. The results suggest that the anatomical...

  1. National priorities partnership focus on eliminating overuse: applications to cardiac revascularization.

    Science.gov (United States)

    Ballard, David J; Leonard, Bradley M

    2011-01-01

    As one of several initiatives to transform health care delivery across the United States, the National Priorities Partnership has identified "eliminating overuse while ensuring the delivery of appropriate care" as a top priority. Cardiac revascularization procedures, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), constitute one area of focus for reduction of overuse. Despite the multiyear development of clinical guidelines to define appropriate use of cardiac revascularization, substantial variability in the application of these procedures is observed. Concurrent data collection tools to support real-time clinical decision making regarding appropriateness are needed and can be used, along with financial incentives such as pay-for-performance programs and public reporting of performance information, to support more appropriate use of cardiac revascularization. Efforts to achieve more rational use of CABG and PCI should be made carefully and with the goal that patients receive the most appropriate and effective care.

  2. Patient and physician preferences for attributes of coronary revascularization

    Directory of Open Access Journals (Sweden)

    Magliano CAS

    2018-05-01

    Full Text Available Carlos Alberto da Silva Magliano,1 Andrea Liborio Monteiro,2 Bernardo Rangel Tura,1 Claudia Silvia Rocha Oliveira,1 Amanda Rebeca de Oliveira Rebelo,1 Claudia Cristina de Aguiar Pereira3 1HTA Department, National Institute of Cardiology, Rio de Janeiro, Brazil; 2Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA; 3The National School of Public Health Sergio Arouca ENSP/Fiocruz, Rio de Janeiro, Brazil Background: Patients with a diagnosis of coronary artery disease (CAD may face important decisions regarding treatment options, with the “right choice” depending on the relative weights of risks and benefits. Studies performed as discrete choice experiments are used to estimate these weights, and attribute selection is an essential step in the design of these studies. Attributes not included in the design cannot be analyzed. In this study, we aimed to elicit, rank, and rate attributes that may be considered important to patients and physicians who must choose between angioplasty and surgery for coronary revascularization. Methods: The elicitation process involved performing a systematic review to search for attributes cited in declared preference studies in addition to face-to-face interviews with cardiologists and experts. The interviews were audio-recorded in digital format, and the collected data were transcribed and searched to identify new attributes. The criterion used to finish the data collection process was sampling saturation. Results: A systematic review resulted in the selection of the following 14 attributes: atrial fibrillation, heart failure, incision scar, length of stay, long-term survival, myocardial infarction, periprocedural death, postoperative infection, postprocedural angina, pseudoaneurysm, renal failure, repeat coronary artery bypass grafting, repeat percutaneous coronary intervention, and stroke. The interviews added no new attributes. After

  3. Re-OPCAB vs. Re-CABG for myocardial revascularization.

    Science.gov (United States)

    Schütz, A; Mair, H; Wildhirt, S M; Gillrath, G; Lamm, P; Kilger, E; Reichart, B

    2001-06-01

    The present study compared redo coronary artery bypass grafting (Re-OPCAB) techniques with conventional redo coronary artery bypass grafting (Re-CABG) with particular focus on myocardial damage and clinical outcome parameters. Redo OPCAB (Re-OPCAB) was performed on 20 consecutive patients (15 males, mean age 63.2 +/- 9.3 years) using either the anterolateral approach for minimally invasive direct coronary artery bypass (n = 4) or the Octopus technique with regular sternotomy (n = 16). The Re-CABG group consisted of 20 consecutive patients (18 males, mean age 67.1 +/- 6.6 years). Groups did not differ in the number of atherosclerotic risk factors, or left ventricular, renal or liver function. Duration of surgery, number of bypass grafts and amount of transfused red blood cells did not differ significantly between both groups. Requirement of epinephrine (mg/h) within the first 24 h was lower in the Re-OPCAB group (Re-OPCAB: 0.14 +/- 0.22 vs. CABG: 0.88 +/- 0.97; p<0.01). In addition, CKMB levels at 24 h after operation were lower in the Re-OPCAB group (Re-OPCAB: 10.0 +/- 10.1 vs. Re-CABG: 38.7 +/- 28.1 U/l, p<0.001). There were no acute myocardial infarctions or deaths in the perioperative period. In the CABG group, there was a longer time period to extubation (hours) (Re-OPCAB: 9.8 +/- 3.9 vs. Re-CABG: 28.7 +/- 25.5; p<0.001), and the length of ICU stay was significantly prolonged (OPCAB: 1.3 +/- 0.5 versus Re-CABG: 4.4 +/- 8.7; p<0.001). The graft patency rate at follow-up was 95% in the Re-OPCAB group. Re-OPCAB results in decreased cardiac specific enzyme release, reduced requirement of inotropes and comparable clinical outcome in the early postoperative period. It is an appropriate alternative to conventional Re-CABG in selected patients awaiting reoperation for myocardial revascularization. Larger prospective and randomized trials are required to select the appropriate patient who benefits most from one or the other treatment regime.

  4. [Stem and progenitor cells in biostructure of blood vessel walls].

    Science.gov (United States)

    Korta, Krzysztof; Kupczyk, Piotr; Skóra, Jan; Pupka, Artur; Zejler, Paweł; Hołysz, Marcin; Gajda, Mariusz; Nowakowska, Beata; Barć, Piotr; Dorobisz, Andrzej T; Dawiskiba, Tomasz; Szyber, Piotr; Bar, Julia

    2013-09-18

    Development of vascular and hematopoietic systems during organogenesis occurs at the same time. During vasculogenesis, a small part of cells does not undergo complete differentiation but stays on this level, "anchored" in tissue structures described as stem cell niches. The presence of blood vessels within tissue stem cell niches is typical and led to identification of niches and ensures that they are functioning. The three-layer biostructure of vessel walls for artery and vein, tunica: intima, media and adventitia, for a long time was defined as a mechanical barrier between vessel light and the local tissue environment. Recent findings from vascular biology studies indicate that vessel walls are dynamic biostructures, which are equipped with stem and progenitor cells, described as vascular wall-resident stem cells/progenitor cells (VW-SC/PC). Distinct zones for vessel wall harbor heterogeneous subpopulations of VW-SC/PC, which are described as "subendothelial or vasculogenic zones". Recent evidence from in vitro and in vivo studies show that prenatal activity of stem and progenitor cells is not only limited to organogenesis but also exists in postnatal life, where it is responsible for vessel wall homeostasis, remodeling and regeneration. It is believed that VW-SC/PC could be engaged in progression of vascular disorders and development of neointima. We would like to summarize current knowledge about mesenchymal and progenitor stem cell phenotype with special attention to distribution and biological properties of VW-SC/PC in biostructures of intima, media and adventitia niches. It is postulated that in the near future, niches for VW-SC/PC could be a good source of stem and progenitor cells, especially in the context of vessel tissue bioengineering as a new alternative to traditional revascularization therapies.

  5. Stem and progenitor cells in biostructure of blood vessel walls

    Directory of Open Access Journals (Sweden)

    Krzysztof Korta

    2013-09-01

    Full Text Available Development of vascular and hematopoietic systems during organogenesis occurs at the same time. During vasculogenesis, a small part of cells does not undergo complete differentiation but stays on this level, “anchored” in tissue structures described as stem cell niches. The presence of blood vessels within tissue stem cell niches is typical and led to identification of niches and ensures that they are functioning. The three-layer biostructure of vessel walls for artery and vein, tunica: intima, media and adventitia, for a long time was defined as a mechanical barrier between vessel light and the local tissue environment. Recent findings from vascular biology studies indicate that vessel walls are dynamic biostructures, which are equipped with stem and progenitor cells, described as vascular wall-resident stem cells/progenitor cells (VW-SC/PC. Distinct zones for vessel wall harbor heterogeneous subpopulations of VW-SC/PC, which are described as “subendothelial or vasculogenic zones”. Recent evidence from in vitro and in vivo studies show that prenatal activity of stem and progenitor cells is not only limited to organogenesis but also exists in postnatal life, where it is responsible for vessel wall homeostasis, remodeling and regeneration. It is believed that VW-SC/PC could be engaged in progression of vascular disorders and development of neointima. We would like to summarize current knowledge about mesenchymal and progenitor stem cell phenotype with special attention to distribution and biological properties of VW-SC/PC in biostructures of intima, media and adventitia niches. It is postulated that in the near future, niches for VW-SC/PC could be a good source of stem and progenitor cells, especially in the context of vessel tissue bioengineering as a new alternative to traditional revascularization therapies.

  6. Revascularization experience and results in ischaemic cerebrovascular disease: Moyamoya disease and carotid occlusion.

    Science.gov (United States)

    Arikan, Fuat; Rubiera, Marta; Serena, Joaquín; Rodríguez-Hernández, Ana; Gándara, Darío; Lorenzo-Bosquet, Carles; Tomasello, Alejandro; Chocrón, Ivette; Quintana-Corvalan, Maximiliano; Sahuquillo, Juan

    2018-03-14

    Cerebral revascularization techniques are an indispensable tool in the current armamentarium of vascular neurosurgeons. We present revascularization surgery experience and results in both moyamoya disease and occlusive cerebral ischaemia. Patients with ischaemic occlusive disease and moyamoya disease who underwent microsurgical revascularization between October 2014 and September 2017 were analysed. In the study period, 23 patients with occlusive ischaemic disease underwent microsurgical revascularization. Three patients presented with serious postoperative complications (2 intraparenchymal haemorrhages in the immediate postoperative period and one thrombosis of the femoral artery). All patients, except one, achieved normalization of the cerebral hemodynamic reserve (CHR) in the SPECT study. Twenty patients had a good neurological result, with no ischaemic recurrence of the revascularized territory. Among patients with moyamoya, 20 had moyamoya disease and 5 had moyamoya syndrome with unilateral involvement. Five patients were treated at paediatric age. Haemorrhagic onset occurred in 2 patients. The CHR study showed hemodynamic compromise in all patients. Cerebral SPECT at one year showed resolution of the hemodynamic failure in all patients. There have been 4 postoperative complications (acute subdural hematoma, two subdural collections and one dehiscence of the surgical wound). No patient presented with neurological worsening at 6 and 12months of follow-up. Cerebral revascularization through end-to-side anastomosis between the superficial temporal artery and a cortical branch of the middle cerebral artery is an indisputable technique in the treatment of moyamoya disease and possibly in a subgroup of patients with symptomatic occlusive ischaemic cerebrovascular disease. Copyright © 2018 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Disability pension after coronary revascularization: a prospective nationwide register-based Swedish cohort study.

    Science.gov (United States)

    Zetterström, Katharina; Vaez, Marjan; Alexanderson, Kristina; Ivert, Torbjörn; Pehrsson, Kenneth; Hammar, Niklas; Voss, Margaretha

    2015-03-01

    Scientific knowledge on disability pension (DP) after revascularization by coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) is scarce. The aim was to study the incidence of and risk factors for being granted DP in the 5 years following a first CABG or PCI, accounting for socio-demographic and medical factors. This is a nationwide population-based study using Swedish registers including all patients 30-63 years of age (n = 34,643, 16.4% women) who had a first CABG (n = 14,107) or PCI (n = 20,536) during 1994-2003. All were alive and without reintervention 30 days after the procedure and were not on DP or old-age pension. Multivariable adjusted Cox proportional hazard ratios (HR) for DP were estimated with 95% confidence intervals (CI). In 5 years following revascularization, 32.4% had been granted DP and the hazard ratio (HR) was higher in women (HR 1.55, 95% CI 1.48-1.62), and in CABG patients compared with PCI patients (HR 1.35, 95% CI 1.30-1.40). Long-term sick leave in the year before intervention was the strongest predictor for DP following revascularization. After adjustments for socio-demographic factors and sick-leave days in the 12 months before revascularization, HR remained high in all patients with diabetes mellitus regardless of type of revascularization. DP after coronary revascularization was common, especially among women and CABG patients. Most studied medical covariates, including mental and musculoskeletal disorders, were risk factors for future DP, especially long-term sickness absence. © The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  8. Arterial hypertension and associated factors in patients submitted to myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Flávia Cortez Colósimo

    2015-04-01

    Full Text Available OBJECTIVE To identify the prevalence of arterial hypertension and associated factors in patients submitted to myocardial revascularization. METHOD Cross-sectional study using the database of a hospital in São Paulo (SP, Brazil containing 3010 patients with coronary artery disease submitted to myocardial revascularization. A multiple logistic regression was performed to identify variables independently associated with hypertension (statistical significance: p1.3: (OR=1.37;CI:1.09-1.72. CONCLUSION A high prevalence of arterial hypertension and association with both non-modifiable and modifiable factors was observed.

  9. Current strategies in surgical myocardial revascularization: Indian perspective

    Directory of Open Access Journals (Sweden)

    Sameer Kumar

    2013-01-01

    A retrospective analysis was carried out of 172 patients who underwent CABG at INHS Asvini between 01 Jan 2008 and 31 May 2013.39% had Left Main Coronary artery disease, 85% patient had triple vessel disease, 56% were diabetics, 12% had undergone stenting in recent past. Beating heart strategy was used in 10%, average no of grafts per patient was 2.3 with LIMA and Radial artery being used as a conduit in 84% and 4% respectively. 4.6% patients succumbed in post-operative period.

  10. Pressure vessel design manual

    CERN Document Server

    Moss, Dennis R

    2013-01-01

    Pressure vessels are closed containers designed to hold gases or liquids at a pressure substantially different from the ambient pressure. They have a variety of applications in industry, including in oil refineries, nuclear reactors, vehicle airbrake reservoirs, and more. The pressure differential with such vessels is dangerous, and due to the risk of accident and fatality around their use, the design, manufacture, operation and inspection of pressure vessels is regulated by engineering authorities and guided by legal codes and standards. Pressure Vessel Design Manual is a solutions-focused guide to the many problems and technical challenges involved in the design of pressure vessels to match stringent standards and codes. It brings together otherwise scattered information and explanations into one easy-to-use resource to minimize research and take readers from problem to solution in the most direct manner possible. * Covers almost all problems that a working pressure vessel designer can expect to face, with ...

  11. Maury Journals - German Vessels

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — German vessels observations, after the 1853 Brussels Conference that set International Maritime Standards, modeled after Maury Marine Standard Observations.

  12. Immediate Revascularization of A Traumatic Limb Vascular Injury associated with Major Pelvic Injuries

    Directory of Open Access Journals (Sweden)

    Hanifah J

    2015-11-01

    Full Text Available High velocity pelvic injury with limb vascular injury poses difficulties as immediate surgery for limb reperfusion is indicated. However immediate vascular intervention deviates from conventional principles of damage control following major injuries. We present two cases of this rare combination of injuries. In both cases, early limb revascularization is possible despite presented with multiple injuries and pelvic fracture.

  13. Myocardial revascularization with coronary endarterectomy. Stratification of risk factors for early mortality

    Directory of Open Access Journals (Sweden)

    Atik Fernando Antibas

    2000-01-01

    Full Text Available OBJECTIVE: To determine the risk factors for mortality related to myocardial revascularization when performed in association with coronary endarterectomy. METHODS: We assessed retrospectively 353 patients who underwent 373 coronary endarterectomies between January '89 and November '98, representing 3.73% of the myocardial revascularizations in this period of time. The arteries involved were as follows: right coronary artery in 218 patients (58.45%; left anterior descending in 102 patients (27.35%; circumflex artery in 39 patients (10.46%; and diagonal artery in 14 patients (3.74%. We used 320 (85.79% venous grafts and 53 (14.21% arterial grafts. RESULTS: In-hospital mortality among our patients was 9.3% as compared with 5.7% in patients with myocardial revascularizations without endarterectomy (p=0.003. Cause of death was related to acute myocardial infarction in 18 (54.55% patients. The most significant risk factors for mortality identified were as follows: diabetes mellitus (p=0.001; odds ratio =7.168, left main disease (<0.001; 9.283, female sex (0.01; 3.111, acute myocardial infarction (0.02; 3.546, ejection fraction <35% (<0.001; 5.89, and previous myocardial revascularization (<0.001; 4.295. CONCLUSION: Coronary endarterectomy is related to higher mortality, and the risk factors involved are important elements of a poor outcome.

  14. Quantification of reversible perfusion abnormality using exercise-stress thallium SPECT before and after coronary revascularization

    International Nuclear Information System (INIS)

    Nagao, Kazuhiko; Nakata, Tomoaki; Tsuchihashi, Kazufumi

    1994-01-01

    Reversible myocardial perfusion abnormality was quantified by bull's eye and unfolded surface mapping methods in exercise thallium SPECT before and after coronary revascularization in 47 patients with angina pectoris, including 34 patients with previous myocardial infarction (PMI) and 13 with effort angina (AP). There was no difference in the incidence or extent of myocardial ischemia between the 2 groups before revascularization. However, the ischemic scores were significantly smaller in PMI group preoperatively than the reductions of the ischemic scores after revascularization. The ischemic scores, preoperatively estimated reversible perfusion abnormality was 32%, 69% and 48% of the improvement of the ischemic score (extent score, severity score, and ischemic area, respectively). Using the 3 ischemic scores, the improvement of perfusion abnormality was well predicted in 70-89% of AP patients but 35-57% of PMI patients. Thus, quantitative analysis in stress thallium SPECT is useful for detecting myocardial ischemia and evaluating the effect of coronary revascularization. However, about a half of myocardial viability was underestimated in one third of PMI patients by the conventional exercise-stress thallium SPECT study. (author)

  15. Endovascular Therapy as a Primary Revascularization Modality in Acute Mesenteric Ischemia

    International Nuclear Information System (INIS)

    Kärkkäinen, Jussi M.; Lehtimäki, Tiina T.; Saari, Petri; Hartikainen, Juha; Rantanen, Tuomo; Paajanen, Hannu; Manninen, Hannu

    2015-01-01

    PurposeTo evaluate endovascular therapy (EVT) as the primary revascularization method for acute mesenteric ischemia (AMI).MethodsA retrospective review was performed on all consecutive patients treated for AMI during a 5-year period (January 2009 to December 2013). EVT was attempted in all patients referred for emergent revascularization. Surgical revascularization was performed selectively after failure of EVT. Patient characteristics, clinical presentation, and outcomes were studied. Failures and complications of EVT were recorded.ResultsFifty patients, aged 79 ± 9 years (mean ± SD), out of 66 consecutive patients with AMI secondary to embolic or thrombotic obstruction of the superior mesenteric artery were referred for revascularization. The etiology of AMI was embolism in 18 (36 %) and thrombosis in 32 (64 %) patients. EVT was technically successful in 44 (88 %) patients. Mortality after successful or failed EVT was 32 %. The rates of emergency laparotomy, bowel resection, and EVT-related complication were 40, 34, and 10 %, respectively. Three out of six patients with failure of EVT were treated with surgical bypass. EVT failure did not significantly affect survival.ConclusionsEVT is feasible in most cases of AMI, with favorable patient outcome and acceptable complication rate

  16. Coronary artery disease, revascularization, and clinical outcomes in transcatheter aortic valve replacement

    DEFF Research Database (Denmark)

    Millan-Iturbe, Oscar; Sawaya, Fadi J; Lønborg, Jacob

    2018-01-01

    /or chronic total occlusion(s). In conclusion, CAD is prevalent in TAVR patients and pre-TAVR coronary revascularization is typically focused on treating proximal and high-grade stenosis. A selective pre-TAVR PCI strategy results in favorable clinical outcomes with very low rates of post-TAVR coronary...

  17. Endovascular Therapy as a Primary Revascularization Modality in Acute Mesenteric Ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Kärkkäinen, Jussi M., E-mail: jkarkkai@gmail.com [Kuopio University Hospital, Heart Center (Finland); Lehtimäki, Tiina T., E-mail: tiina.lehtimaki@kuh.fi; Saari, Petri, E-mail: petri.saari@kuh.fi [Kuopio University Hospital, Department of Clinical Radiology (Finland); Hartikainen, Juha, E-mail: juha.hartikainen@kuh.fi [Kuopio University Hospital, Heart Center (Finland); Rantanen, Tuomo, E-mail: tuomo.rantanen@kuh.fi; Paajanen, Hannu, E-mail: hannu.paajanen@kuh.fi [Kuopio University Hospital, Department of Gastrointestinal Surgery (Finland); Manninen, Hannu, E-mail: hannu.manninen@kuh.fi [Kuopio University Hospital, Department of Clinical Radiology (Finland)

    2015-10-15

    PurposeTo evaluate endovascular therapy (EVT) as the primary revascularization method for acute mesenteric ischemia (AMI).MethodsA retrospective review was performed on all consecutive patients treated for AMI during a 5-year period (January 2009 to December 2013). EVT was attempted in all patients referred for emergent revascularization. Surgical revascularization was performed selectively after failure of EVT. Patient characteristics, clinical presentation, and outcomes were studied. Failures and complications of EVT were recorded.ResultsFifty patients, aged 79 ± 9 years (mean ± SD), out of 66 consecutive patients with AMI secondary to embolic or thrombotic obstruction of the superior mesenteric artery were referred for revascularization. The etiology of AMI was embolism in 18 (36 %) and thrombosis in 32 (64 %) patients. EVT was technically successful in 44 (88 %) patients. Mortality after successful or failed EVT was 32 %. The rates of emergency laparotomy, bowel resection, and EVT-related complication were 40, 34, and 10 %, respectively. Three out of six patients with failure of EVT were treated with surgical bypass. EVT failure did not significantly affect survival.ConclusionsEVT is feasible in most cases of AMI, with favorable patient outcome and acceptable complication rate.

  18. Surgical myocardial revascularization in patients with reduced systolic left ventricular function.

    Science.gov (United States)

    Bruno, Piergiorgio; Iafrancesco, Mauro; Massetti, Massimo

    2018-04-20

    Surgical myocardial revascularization in patients with reduced left ventricular function has been a matter of debate for decades. Recently published 10-years extension follow-up of the STICH trial have conclusively demonstrated benefit of surgical myocardial revascularization in patients with significant coronary artery disease and low left ventricular ejection fraction. However, selection of patients for surgery remains challenging as well as decision to perform percutaneous rather than surgical revascularization in this class of patients. New evidence helped to clarify the role of preoperative patients' characteristics as risk factors for surgery and to identify those patients who may benefit the most from surgery. Focus of this review is to review epidemiology, aetiology and pathophysiology of coronary artery disease in patients with reduced left ventricular function, role of viability and results of observational and investigational studies on revascularization in patients with reduced left ventricular function with a particular emphasis on relative indication of coronary artery bypass grafting and percutaneous coronary intervention and the surgical implications of development of ischemic mitral regurgitation or ischemic left ventricular aneurysm.

  19. Pulp Revascularization on Permanent Teeth with Open Apices in a Middle-aged Patient.

    Science.gov (United States)

    Wang, Yu; Zhu, Xiaofei; Zhang, Chengfei

    2015-09-01

    Pulp revascularization is a promising procedure for the treatment of adolescents' immature permanent teeth with necrotic pulp and/or apical periodontitis. However, the ability to successfully perform pulp revascularization in a middle-aged patient remains unclear. A 39-year-old woman was referred for treatment of teeth #20 and #29 with necrotic pulp, extensive periapical radiolucencies, and incomplete apices. Pulp revascularization procedures were attempted, including root canal debridement, triple antibiotic paste medication, and platelet-rich plasma transplantation to act as a scaffold. Periapical radiographic and cone-beam computed tomographic examinations were used to review the changes in the apical lesions and root apex configuration. The patient remained asymptomatic throughout the 30-month follow-up. Periapical radiographic examination revealed no change in the apical lesions of either tooth at 8 months. The periapical radiolucency disappeared on tooth #20 and significantly decreased on tooth #29 by the 30-month follow-up, findings that were also confirmed by cone-beam computed tomographic imaging. No evidence of root lengthening or thickening was observed. Successful revascularization was achieved in a middle-aged patient's teeth. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  20. Natural History of Moderate Coronary Artery Stenosis After Surgical Revascularization.

    Science.gov (United States)

    Raza, Sajjad; Blackstone, Eugene H; Houghtaling, Penny L; Olivares, Gabriel; Ravichandren, Kirthi; Koprivanac, Marijan; Bakaeen, Faisal G; Sabik, Joseph F

    2018-03-01

    It remains controversial whether grafting moderately stenosed coronary arteries (MSCAs) influences native-vessel disease progression and whether grafting may protect against late myocardial ischemia. From 1972 to 2011, 55,567 patients underwent primary isolated coronary artery bypass grafting (CABG); 1,902 had a single coronary artery with angiographically moderate (50% to 69%) stenosis and ≥1 postoperative angiogram. Disease progression was studied in 489 nongrafted, 371 internal thoracic artery (ITA)-grafted, and 957 saphenous vein (SV)-grafted MSCAs, as well as patency of 376 ITA and 1,016 SV grafts to these MSCAs. At 1, 5, 10, and 15 years, native-vessel disease progressed from moderate to severe stenosis/occlusion in 32%, 52%, 66%, and 72% of nongrafted MSCAs; 55%, 73%, 84%, and 87% of ITA-grafted MSCAs; and 67%, 82%, 90%, and 92% of SV-grafted MSCAs. After adjusting for patient characteristics, MSCA disease progressed 3.6 times faster with ITA and 10 times faster with SV grafting compared with nongrafting. At these same time points, occlusion of ITA grafts to MSCAs was 8%, 9%, 11%, and 15% and for SV grafts, 13%, 32%, 46%, and 56%; protection from myocardial ischemia by ITA-grafted versus nongrafted MSCAs was 29%, 47%, 59%, and 61%. Most MSCAs progress to severe stenosis or occlusion in the long term. Progression is faster in grafted than nongrafted MSCAs, more so with SV than ITA grafts. However, ITA grafts to such arteries have excellent patency, providing long-term protection from myocardial ischemia. Therefore, ITA grafting of MSCAs should be considered. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Pulp revascularization after root canal decontamination with calcium hydroxide and 2% chlorhexidine gel.

    Science.gov (United States)

    Soares, Adriana de Jesus; Lins, Fernanda Freitas; Nagata, Juliana Yuri; Gomes, Brenda Paula Figueiredo de Almeida; Zaia, Alexandre Augusto; Ferraz, Caio Cezar Randi; de Almeida, José Flávio Affonso; de Souza-Filho, Francisco José

    2013-03-01

    Pulp revascularization may be considered a promising alternative for necrotic immature teeth. Many studies have accomplished passive decontamination associated with an antibiotic paste. To date, there is no report evaluating calcium hydroxide associated with 2% chlorhexidine gel for revascularization therapy. The aim of this case report was to describe a new proposal for pulp revascularization with mechanical decontamination and intracanal medication composed of calcium hydroxide and 2% chlorhexidine gel. The patient, a 9-year-old girl, suffered an intrusion associated with pulp exposure caused by an enamel-dentin fracture in her maxillary left central incisor. After diagnosis, treatment consisted of revascularization therapy with gentle manual instrumentation of the cervical and medium thirds of the root in addition to intracanal medication with calcium hydroxide and 2% chlorhexidine gel for 21 days. In the second session, a blood clot was stimulated up to the cervical third of the root canal. Mineral trioxide aggregate (MTA; Angelus, Londrina, Paraná, Brazil) was used for cervical sealing of the canal. Coronal sealing was performed with temporary filling material and composite resin. During the follow-up period, the root canal space showed a progressive decrease in width, mineralized tissue deposition on root canal walls, and apical closure. A cone-beam computed tomography scan taken at the 2-year follow-up confirmed these findings and did not show complete root canal calcification. This new proposal for revascularization therapy with 2% chlorhexidine gel may be used for the treatment of necrotic immature root canals. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  2. [Retrospective analysis of pulp revascularization in immature permanent teeth with diffuse pulpitis].

    Science.gov (United States)

    Peng, C F; Zhao, Y M; Yang, Y; Liu, H; Qin, M

    2017-01-09

    Objective: To evaluate the treatment effectiveness of revascularization in immature permanent teeth with diffuse pulpitis and to provide an alternative approach for the treatment of these teeth. Methods: Clinical and radiographic data were collected from 17 immature permanent teeth which were diagnosed as diffuse pulpitis and with their pulp extirpated at Emergency Department of Peking University School and Hospital of Stomatology. All these teeth were treated using pulp revascularization at Department of Pediatric Dentistry. Clinical success rate was then evaluated based on the clinical and radiographic findings. The increase of root length and dentin wall thickness of the revascularized teeth and the contralateral control teeth were measured and compared according to the preoperative and recall periapical radiographs. Results: The average follow-uptime is (25.8±9.9) months (12-46 months). Totally 13 out of the 17 teeth showed normal clinical and radiographic manifestation and achieved the increasein root length and dentin wall thickness. They met criteria for success treatment. The rest 4 out of the 17 teeth also showed root length and dentin wall thickness increaseand apical foramen closure. However, periapical inflammations were observed during 12 to 36 monthfollow-ups. These cases were recognized as failed. In all the17 teeth, the increase of root length and dentin wall thickness was not significantly different between the revascularized teeth and the contralateral control teeth ( P> 0.05). Conclusions: Pulp revascularization in young permanent teeth with diffuse pulpitis resulted in similar clinical outcomes in root development and root canal wall formation compared with the contralateral control teeth. However, reinfection might occur during long-term follow-up.

  3. Cytokine-mediated deployment of SDF-1 induces revascularization through recruitment of CXCR4+ hemangiocytes

    Science.gov (United States)

    Jin, David K; Shido, Koji; Kopp, Hans-Georg; Petit, Isabelle; Shmelkov, Sergey V; Young, Lauren M; Hooper, Andrea T; Amano, Hideki; Avecilla, Scott T; Heissig, Beate; Hattori, Koichi; Zhang, Fan; Hicklin, Daniel J; Wu, Yan; Zhu, Zhenping; Dunn, Ashley; Salari, Hassan; Werb, Zena; Hackett, Neil R; Crystal, Ronald G; Lyden, David; Rafii, Shahin

    2009-01-01

    The mechanisms through which hematopoietic cytokines accelerate revascularization are unknown. Here, we show that the magnitude of cytokine-mediated release of SDF-1 from platelets and the recruitment of nonendothelial CXCR4+VEGFR1+ hematopoietic progenitors, ‘hemangiocytes,’ constitute the major determinant of revascularization. Soluble Kit-ligand (sKitL), thrombopoietin (TPO, encoded by Thpo) and, to a lesser extent, erythropoietin (EPO) and granulocyte-macrophage colony-stimulating factor (GM-CSF) induced the release of SDF-1 from platelets, enhancing neovascularization through mobilization of CXCR4+VEGFR1+ hemangiocytes. Although revascularization of ischemic hindlimbs was partially diminished in mice deficient in both GM-CSF and G-CSF (Csf2−/−Csf3−/−), profound impairment in neovascularization was detected in sKitL-deficient Mmp9−/− as well as thrombocytopenic Thpo−/− and TPO receptor–deficient (Mpl−/−) mice. SDF-1–mediated mobilization and incorporation of hemangiocytes into ischemic limbs were impaired in Thpo−/−, Mpl−/− and Mmp9−/− mice. Transplantation of CXCR4+VEGFR1+ hemangiocytes into Mmp9−/− mice restored revascularization, whereas inhibition of CXCR4 abrogated cytokine- and VEGF-A–mediated mobilization of CXCR4+VEGFR1+ cells and suppressed angiogenesis. In conclusion, hematopoietic cytokines, through graded deployment of SDF-1 from platelets, support mobilization and recruitment of CXCR4+VEGFR1+ hemangiocytes, whereas VEGFR1 is essential for their angiogenic competency for augmenting revascularization. Delivery of SDF-1 may be effective in restoring angiogenesis in individuals with vasculopathies. PMID:16648859

  4. One step pulp revascularization treatment of an immature permanent tooth with chronic apical abscess: a case report.

    Science.gov (United States)

    Shin, S Y; Albert, J S; Mortman, R E

    2009-12-01

    To describe a case in which a mandibular right second premolar with a necrotic pulp, sinus tract, periradicular radiolucency and an immature apex underwent revascularization via a single treatment approach. Revascularization procedures have the potential to heal a partially necrotic pulp, which can be beneficial for the continued root development of immature teeth. However, it is not clear which revascularization protocols are the most effective. This case report details the outcome of a successful revascularization procedure on tooth 45 (FDI) in a 12-year-old patient, eliminating the associated periapical pathosis within 19 months. The tooth was treated using coronal root irrigation with 6% NaOCl and 2% chlorhexidine without instrumentation in a single visit. The successful outcome of this case report suggests that this conservative revascularization treatment approach can preserve the vitality of the dental pulp stem cells and create a suitable environment for pulp regeneration, resulting in the completion of root maturation. The noninstrumentation procedure using 6% NaOCl and 2% chlorhexidine coronal irrigation may help preserve the remaining vital dental pulp stem cells believed to be critical for pulp revascularization. A single visit pulp revascularization protocol can be a favourable treatment option for an immature permanent tooth with a partially necrotic pulp.

  5. Correlation between Patient-Reported Symptoms and Ankle-Brachial Index after Revascularization for Peripheral Arterial Disease.

    Science.gov (United States)

    Je, Hyung Gon; Kim, Bo Hyun; Cho, Kyoung Im; Jang, Jae Sik; Park, Yong Hyun; Spertus, John

    2015-05-18

    Improvement in quality of life (QoL) is a primary treatment goal for patients with peripheral arterial disease (PAD). The current study aimed to quantify improvement in the health status of PAD patients following peripheral revascularization using the peripheral artery questionnaire (PAQ) and ankle-brachial index (ABI), and to evaluate possible correlation between the two methods. The PAQ and ABI were assessed in 149 symptomatic PAD patients before, and three months after peripheral revascularization. Mean PAQ summary scores improved significantly three months after revascularization (+49.3 ± 15 points, p PAQ scores relating to patient symptoms showed the largest improvement following revascularization. The smallest increases were seen in reported treatment satisfaction (all p's PAQ. Twenty-two percent of PAD patients were identified as having a poor response to revascularization (increase in ABI PAQ, although this was less marked than in patients with an increase in ABI > 0.15 following revascularization. In conclusion, data from the current study suggest a significant correlation between improvement in patient-reported outcomes assessed by PAQ and ABI in symptomatic PAD patients undergoing peripheral revascularization.

  6. Reactor vessel sealing plug

    International Nuclear Information System (INIS)

    Dooley, R.A.

    1986-01-01

    This invention relates to an apparatus and method for sealing the cold leg nozzles of a nuclear reactor pressure vessel from a remote location during maintenance and inspection of associated steam generators and pumps while the pressure vessel and refueling canal are filled with water. The apparatus includes a sealing plug for mechanically sealing the cold leg nozzle from the inside of a reactor pressure vessel. The sealing plugs include a primary and a secondary O-ring. An installation tool is suspended within the reactor vessel and carries the sealing plug. The tool telescopes to insert the sealing plug within the cold leg nozzle, and to subsequently remove the plug. Hydraulic means are used to activate the sealing plug, and support means serve to suspend the installation tool within the reactor vessel during installation and removal of the sealing plug

  7. Containment vessel drain system

    Science.gov (United States)

    Harris, Scott G.

    2018-01-30

    A system for draining a containment vessel may include a drain inlet located in a lower portion of the containment vessel. The containment vessel may be at least partially filled with a liquid, and the drain inlet may be located below a surface of the liquid. The system may further comprise an inlet located in an upper portion of the containment vessel. The inlet may be configured to insert pressurized gas into the containment vessel to form a pressurized region above the surface of the liquid, and the pressurized region may operate to apply a surface pressure that forces the liquid into the drain inlet. Additionally, a fluid separation device may be operatively connected to the drain inlet. The fluid separation device may be configured to separate the liquid from the pressurized gas that enters the drain inlet after the surface of the liquid falls below the drain inlet.

  8. Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency: Twelve-Month Results of the DEFINITIVE AR Study.

    Science.gov (United States)

    Zeller, Thomas; Langhoff, Ralf; Rocha-Singh, Krishna J; Jaff, Michael R; Blessing, Erwin; Amann-Vesti, Beatrice; Krzanowski, Marek; Peeters, Patrick; Scheinert, Dierk; Torsello, Giovanni; Sixt, Sebastian; Tepe, Gunnar

    2017-09-01

    Studies assessing drug-coated balloons (DCB) for the treatment of femoropopliteal artery disease are encouraging. However, challenging lesions, such as severely calcified, remain difficult to treat with DCB alone. Vessel preparation with directional atherectomy (DA) potentially improves outcomes of DCB. DEFINITIVE AR study (Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency-A Pilot Study of Anti-Restenosis Treatment) was a multicenter randomized trial designed to estimate the effect of DA before DCB to facilitate the development of future end point-driven randomized studies. One hundred two patients with claudication or rest pain were randomly assigned 1:1 to DA+DCB (n=48) or DCB alone (n=54), and 19 additional patients with severely calcified lesions were treated with DA+DCB. Mean lesion length was 11.2±4.0 cm for DA+DCB and 9.7±4.1 cm for DCB ( P =0.05). Predilation rate was 16.7% for DA+DCB versus 74.1% for DCB; postdilation rate was 6.3% for DA+DCB versus 33.3% for DCB. Technical success was superior for DA+DCB (89.6% versus 64.2%; P =0.004). Overall bail-out stenting rate was 3.7%, and rate of flow-limiting dissections was 19% for DCB and 2% for DA+DCB ( P =0.01). One-year primary outcome of angiographic percent diameter stenosis was 33.6±17.7% for DA+DCB versus 36.4±17.6% for DCB ( P =0.48), and clinically driven target lesion revascularization was 7.3% for DA+DCB and 8.0% for DCB ( P =0.90). Duplex ultrasound patency was 84.6% for DA+DCB, 81.3% for DCB ( P =0.78), and 68.8% for calcified lesions. Freedom from major adverse events at 1 year was 89.3% for DA+DCB and 90.0% for DCB ( P =0.86). DA+DCB treatment was effective and safe, but the study was not powered to show significant differences between the 2 methods of revascularization in 1-year follow-up. An adequately powered randomized trial is warranted. http://www.clinicaltrials.gov. Unique Identifier: NCT01366482. Copyright © 2017 The

  9. NCSX Vacuum Vessel Fabrication

    International Nuclear Information System (INIS)

    Viola ME; Brown T; Heitzenroeder P; Malinowski F; Reiersen W; Sutton L; Goranson P; Nelson B; Cole M; Manuel M; McCorkle D.

    2005-01-01

    The National Compact Stellarator Experiment (NCSX) is being constructed at the Princeton Plasma Physics Laboratory (PPPL) in conjunction with the Oak Ridge National Laboratory (ORNL). The goal of this experiment is to develop a device which has the steady state properties of a traditional stellarator along with the high performance characteristics of a tokamak. A key element of this device is its highly shaped Inconel 625 vacuum vessel. This paper describes the manufacturing of the vessel. The vessel is being fabricated by Major Tool and Machine, Inc. (MTM) in three identical 120 o vessel segments, corresponding to the three NCSX field periods, in order to accommodate assembly of the device. The port extensions are welded on, leak checked, cut off within 1-inch of the vessel surface at MTM and then reattached at PPPL, to accommodate assembly of the close-fitting modular coils that surround the vessel. The 120 o vessel segments are formed by welding two 60 o segments together. Each 60 o segment is fabricated by welding ten press-formed panels together over a collapsible welding fixture which is needed to precisely position the panels. The vessel is joined at assembly by welding via custom machined 8-inch (20.3 cm) wide spacer ''spool pieces''. The vessel must have a total leak rate less than 5 X 10 -6 t-l/s, magnetic permeability less than 1.02(micro), and its contours must be within 0.188-inch (4.76 mm). It is scheduled for completion in January 2006

  10. Acute Stroke and Obstruction of the Extracranial Carotid Artery Combined with Intracranial Tandem Occlusion: Results of Interventional Revascularization

    International Nuclear Information System (INIS)

    Lescher, Stephanie; Czeppan, Katja; Porto, Luciana; Singer, Oliver C.; Berkefeld, Joachim

    2015-01-01

    PurposeDue to high thrombus load, acute stroke patients with tandem obstructions of the extra- and intracranial carotid arteries or the middle cerebral artery show a very limited response to systemic thrombolysis. Interventional treatment with mechanical thrombectomy—often in combination with acute stenting of underlying atherosclerotic stenosis or dissection—is increasingly used. It has been shown that such complex interventions are technically feasible. The lack of optimal management strategies and clinical data encouraged us to review our acute stroke interventions in patient with anterior circulation tandem lesions to determine lesion patterns, interventional approaches, and angiographic or clinical outcomes.Patients and MethodsWe retrospectively analyzed a series of 39 consecutive patients with intracranial vessel occlusion of the anterior circulation simultaneously presenting with high-grade cervical internal carotid artery (ICA) stenosis or occlusion.ResultsEmergency ICA stent implantation was technically feasible in all patients, and intracranial recanalization with TICI ≥ 2b was reached in a large number of patients (64 %). Good clinical outcomes (mRS ≤ 2 at 3 months) were achieved in one third of the patients (36 %). Symptomatic hemorrhages occurred in four patients (10 %). Mortality was 10 %.ConclusionEndovascular recanalization of acute cervical carotid artery occlusion was technically feasible in all patients, and resulted in high extra- and intracranial revascularization rates. A trend for favorable clinical outcome was seen in a higher TICI score, younger age, good collateral status, and combined IV rTPA and endovascular therapy

  11. Prediction of revascularization after myocardial perfusion SPECT by machine learning in a large population.

    Science.gov (United States)

    Arsanjani, Reza; Dey, Damini; Khachatryan, Tigran; Shalev, Aryeh; Hayes, Sean W; Fish, Mathews; Nakanishi, Rine; Germano, Guido; Berman, Daniel S; Slomka, Piotr

    2015-10-01

    We aimed to investigate if early revascularization in patients with suspected coronary artery disease can be effectively predicted by integrating clinical data and quantitative image features derived from perfusion SPECT (MPS) by machine learning (ML) approach. 713 rest (201)Thallium/stress (99m)Technetium MPS studies with correlating invasive angiography with 372 revascularization events (275 PCI/97 CABG) within 90 days after MPS (91% within 30 days) were considered. Transient ischemic dilation, stress combined supine/prone total perfusion deficit (TPD), supine rest and stress TPD, exercise ejection fraction, and end-systolic volume, along with clinical parameters including patient gender, history of hypertension and diabetes mellitus, ST-depression on baseline ECG, ECG and clinical response during stress, and post-ECG probability by boosted ensemble ML algorithm (LogitBoost) to predict revascularization events. These features were selected using an automated feature selection algorithm from all available clinical and quantitative data (33 parameters). Tenfold cross-validation was utilized to train and test the prediction model. The prediction of revascularization by ML algorithm was compared to standalone measures of perfusion and visual analysis by two experienced readers utilizing all imaging, quantitative, and clinical data. The sensitivity of machine learning (ML) (73.6% ± 4.3%) for prediction of revascularization was similar to one reader (73.9% ± 4.6%) and standalone measures of perfusion (75.5% ± 4.5%). The specificity of ML (74.7% ± 4.2%) was also better than both expert readers (67.2% ± 4.9% and 66.0% ± 5.0%, P < .05), but was similar to ischemic TPD (68.3% ± 4.9%, P < .05). The receiver operator characteristics areas under curve for ML (0.81 ± 0.02) was similar to reader 1 (0.81 ± 0.02) but superior to reader 2 (0.72 ± 0.02, P < .01) and standalone measure of perfusion (0.77 ± 0.02, P < .01). ML approach is comparable or better than

  12. Radioactive waste processing vessel

    International Nuclear Information System (INIS)

    Hayashi, Masaru; Suzuki, Osamu; Ishizaki, Kanjiro.

    1987-01-01

    Purpose: To obtain a vessel of a reduced weight and with no external leaching of radioactive materials. Constitution: The vessel main body is constituted, for example, with light weight concretes or foamed concretes, particularly, foamed concretes containing fine closed bubbles in the inside. Then, layers having dense texture made of synthetic resin such as polystylene, vinylchloride resin, etc. or metal plate such as stainless plate are integrally disposed to the inner surface of the vessel main body. The cover member also has the same structure. (Sekiya, K.)

  13. Tempest in a vessel

    International Nuclear Information System (INIS)

    Barre, Bertrand

    2015-01-01

    As the ASN made some statements about anomalies of carbon content in the EPR vessel bottom and top, the author recalls and comments some technical issues to better understand the information published on this topic. He notably addresses the role of the vessel, briefly indicates its operating conditions, shape and structure, and mechanical components for the top, its material and mechanical properties, and test samples used to assess mechanical properties. He also comments the phenomenon of radio-induced embrittlement, the vessel manufacturing process, and evokes the applicable regulations. He quotes and comments statements made by the ASN and Areva which evoke further assessments of the concerned components

  14. Targeted Cancer Therapies

    Science.gov (United States)

    ... are sometimes referred to as the product of "rational" drug design.) One approach to identify potential targets ... molecules that stimulate new blood vessel growth. Immunotherapies trigger the immune system to destroy cancer cells. Some ...

  15. Modified distal revascularization with interval ligation procedure for steal syndrome after arteriovenous fistula creation for hemodialysis access

    NARCIS (Netherlands)

    van der Meer, Saskia; Zeebregts, Clark; Tielliu, Ignacc; Verhoeven, Eric; van den Dungen, Jan

    2007-01-01

    Patients diagnosed with steal syndrome after hemodialysis access surgery have a few options for symptom relief while maintaining vascular access. These include fistula lengthening, banding, distal revascularization with interval ligation (DRIL), revision using distal inflow (RUDI) or proximalization

  16. Cheboygan Vessel Base

    Data.gov (United States)

    Federal Laboratory Consortium — Cheboygan Vessel Base (CVB), located in Cheboygan, Michigan, is a field station of the USGS Great Lakes Science Center (GLSC). CVB was established by congressional...

  17. High Performance Marine Vessels

    CERN Document Server

    Yun, Liang

    2012-01-01

    High Performance Marine Vessels (HPMVs) range from the Fast Ferries to the latest high speed Navy Craft, including competition power boats and hydroplanes, hydrofoils, hovercraft, catamarans and other multi-hull craft. High Performance Marine Vessels covers the main concepts of HPMVs and discusses historical background, design features, services that have been successful and not so successful, and some sample data of the range of HPMVs to date. Included is a comparison of all HPMVs craft and the differences between them and descriptions of performance (hydrodynamics and aerodynamics). Readers will find a comprehensive overview of the design, development and building of HPMVs. In summary, this book: Focuses on technology at the aero-marine interface Covers the full range of high performance marine vessel concepts Explains the historical development of various HPMVs Discusses ferries, racing and pleasure craft, as well as utility and military missions High Performance Marine Vessels is an ideal book for student...

  18. 2011 Vessel Density

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  19. 2011 Fishing Vessel Density

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  20. Pressurized Vessel Slurry Pumping

    International Nuclear Information System (INIS)

    Pound, C.R.

    2001-01-01

    This report summarizes testing of an alternate ''pressurized vessel slurry pumping'' apparatus. The principle is similar to rural domestic water systems and ''acid eggs'' used in chemical laboratories in that material is extruded by displacement with compressed air

  1. 2013 Tanker Vessel Density

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  2. Maury Journals - US Vessels

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — U.S. vessels observations, after the 1853 Brussels Conference that set International Maritime Standards, modeled after Maury Marine Standard Observations.

  3. Coastal Logbook Survey (Vessels)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains catch (landed catch) and effort for fishing trips made by vessels that have been issued a Federal permit for the Gulf of Mexico reef fish,...

  4. In-vessel tritium

    International Nuclear Information System (INIS)

    Ueda, Yoshio; Ohya, Kaoru; Ashikawa, Naoko; Ito, Atsushi M.; Kato, Daiji; Kawamura, Gakushi; Takayama, Arimichi; Tomita, Yukihiro; Nakamura, Hiroaki; Ono, Tadayoshi; Kawashima, Hisato; Shimizu, Katsuhiro; Takizuka, Tomonori; Nakano, Tomohide; Nakamura, Makoto; Hoshino, Kazuo; Kenmotsu, Takahiro; Wada, Motoi; Saito, Seiki; Takagi, Ikuji; Tanaka, Yasunori; Tanabe, Tetsuo; Yoshida, Masafumi; Toma, Mitsunori; Hatayama, Akiyoshi; Homma, Yuki; Tolstikhina, Inga Yu.

    2012-01-01

    The in-vessel tritium research is closely related to the plasma-materials interaction. It deals with the edge-plasma-wall interaction, the wall erosion, transport and re-deposition of neutral particles and the effect of neutral particles on the fuel recycling. Since the in-vessel tritium shows a complex nonlinear behavior, there remain many unsolved problems. So far, behaviors of in-vessel tritium have been investigated by two groups A01 and A02. The A01 group performed experiments on accumulation and recovery of tritium in thermonuclear fusion reactors and the A02 group studied theory and simulation on the in-vessel tritium behavior. In the present article, outcomes of the research are reviewed. (author)

  5. Reactor pressure vessel support

    International Nuclear Information System (INIS)

    Butti, J.P.

    1977-01-01

    A link and pin support system provides the primary vertical and lateral support for a nuclear reactor pressure vessel without restricting thermally induced radial and vertical expansion and contraction. (Auth.)

  6. 2013 Cargo Vessel Density

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  7. 2013 Fishing Vessel Density

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  8. 2013 Vessel Density

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  9. Ocean Station Vessel

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Ocean Station Vessels (OSV) or Weather Ships captured atmospheric conditions while being stationed continuously in a single location. While While most of the...

  10. Vessel Sewage Discharges

    Science.gov (United States)

    Vessel sewage discharges are regulated under Section 312 of the Clean Water Act, which is jointly implemented by the EPA and Coast Guard. This homepage links to information on marine sanitation devices and no discharge zones.

  11. Reactor pressure vessel design

    International Nuclear Information System (INIS)

    Foehl, J.

    1998-01-01

    As a result of the popularity of the Agencies report 'Neutron Irradiation Embrittlement of Reactor Pressure Vessel Steels' of 1975, it was decided that another report on this broad subject would be of use. In this report, background and contemporary views on specially identified areas of the subject are considered as self-contained chapters, written by experts. In chapter 2, the general principles of reactor pressure vessel design are elaborated. Crack and fracture initiation and propagation are treated in some detail

  12. Graywater Discharges from Vessels

    Science.gov (United States)

    2011-11-01

    metals (e.g., cadmium, chromium, lead, copper , zinc, silver, nickel, and mercury), solids, and nutrients (USEPA, 2008b; USEPA 2010). Wastewater from... flotation ), and disinfection (using ultraviolet light) as compared to traditional Type II MSDs that use either simple maceration and chlorination, or...Coliform Naval Vessels Oceanographic Vessels Small Cruise Ships 25a Vendor 2 Hamann AG Biological Treatment with Dissolved Air Flotation and

  13. LANL Robotic Vessel Scanning

    Energy Technology Data Exchange (ETDEWEB)

    Webber, Nels W. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-11-25

    Los Alamos National Laboratory in J-1 DARHT Operations Group uses 6ft spherical vessels to contain hazardous materials produced in a hydrodynamic experiment. These contaminated vessels must be analyzed by means of a worker entering the vessel to locate, measure, and document every penetration mark on the vessel. If the worker can be replaced by a highly automated robotic system with a high precision scanner, it will eliminate the risks to the worker and provide management with an accurate 3D model of the vessel presenting the existing damage with the flexibility to manipulate the model for better and more in-depth assessment.The project was successful in meeting the primary goal of installing an automated system which scanned a 6ft vessel with an elapsed time of 45 minutes. This robotic system reduces the total time for the original scope of work by 75 minutes and results in excellent data accumulation and transmission to the 3D model imaging program.

  14. Supraventricular tachyarrhythmias after myocardial revascularization: a randomized trial of prophylactic digitalization.

    Science.gov (United States)

    Tyras, D H; Stothert, J C; Kaiser, G C; Barner, H B; Codd, J E; Willman, V L

    1979-02-01

    The success of prophylactic digitalization in reducing the incidence of supraventricular tachyarrhythmias (SVT) was studied in 140 randomly grouped, consecutive patients undergoing myocardial revascularization operations. The test group received either 1 or 1.5 mg. of digoxin the day before operation and were maintained postoperatively on 0.25 mg. of digoxin daily. There was a significant increase (p less than 0.05) in the incidence of SVT in the treated patients (17 of 61 or 27.8 percent) vs. the untreated patients (nine of 79 or 11.4 percent). There was no significant difference in SVT with the two digitalization dosage levels (31.6 percent with 1 mg. vs. 21.7 percent with 1.5 mg.). Prophylactic digitalization demonstrates no benefit in the prevention of SVT following myocardial revascularization and may, in fact, predispose the patient to these arrhythmias.

  15. Vital Pulp Therapy—Current Progress of Dental Pulp Regeneration and Revascularization

    Directory of Open Access Journals (Sweden)

    Weibo Zhang

    2010-01-01

    Full Text Available Pulp vitality is extremely important for the tooth viability, since it provides nutrition and acts as biosensor to detect pathogenic stimuli. In the dental clinic, most dental pulp infections are irreversible due to its anatomical position and organization. It is difficult for the body to eliminate the infection, which subsequently persists and worsens. The widely used strategy currently in the clinic is to partly or fully remove the contaminated pulp tissue, and fill and seal the void space with synthetic material. Over time, the pulpless tooth, now lacking proper blood supply and nervous system, becomes more vulnerable to injury. Recently, potential for successful pulp regeneration and revascularization therapies is increasing due to accumulated knowledge of stem cells, especially dental pulp stem cells. This paper will review current progress and feasible strategies for dental pulp regeneration and revascularization.

  16. Evaluation of Blood Hemodynamics in Vascular Grafts after Total Arterial Coronary Revascularization

    Directory of Open Access Journals (Sweden)

    Ahmad Ali Amirghofran

    2016-07-01

    Full Text Available Arterial grafting has increasingly been advocated for the treatment of coronary artery disease in an attempt to improve the long-term results. In the quest to perform routine total arterial revascularization, composite Y graft methods are gaining popularity. The aim of our study was to evaluate whether blood flow in the left internal thoracic artery can provide sufficient perfusion to the entire cardiac muscle per se. Twenty patients with severe coronary artery stenosis who underwent complete arterial coronary revascularization using a composite graft entered our study. Blood flow in thoracic trunk was evaluated in three phases: cross-clamp on, cross-clamp off, and after weaning the patient from cardiopulmonary bypass. Mean arterial blood pressure in the thoracic trunk in these various positions was 62.7±3.7. left internal thora cic artery can provide sufficient blood flow to the cardiac muscles for both rest and exercise conditions.

  17. Revascularization of immature mandibular premolar with pulpal necrosis - a case report.

    Science.gov (United States)

    Raju, S Murali Krishna; Yadav, Sarjeev Singh; Kumar M, Sita Rama

    2014-09-01

    This case report describes the Revascularization of a Permanent Immature Mandibular Premolar with Pulp Necrosis and apical periodontitis. Access opening was done & the canal was disinfected with copious irrigation using 2.5% NaOCl and triple antibiotic paste (Ciprofloxacin, Metronidazole, and Minocycline) as intracanal medicament. After the disinfection protocol is complete, it is followed by revascularization procedure. The apex was mechanically irritated to initiate bleeding into the canal to produce a blood clot to the level just below the level of cementoenamel junction. Mineral trioxide aggregate was placed over the blood clot followed by bonded resin restoration above it. After one year follow up; the patient was asymptomatic, no sinus tract was evident. Apical periodontitis was resolved, and there was radiographic evidence of continuing thickness of dentinal walls.

  18. Bone scintigraphy in evaluating the viability of composite bone grafts revascularized by microvascular anastomoses, conventional autogenous bone grafts, and free non-revascularized periosteal grafts

    International Nuclear Information System (INIS)

    Berggren, A.; Weiland, A.J.; Ostrup, L.T.

    1982-01-01

    Researchers studied the value of bone scintigraphy in the assessment of anastomotic patency and bone-cell viability in free bone grafts revascularized by microvascular anastomoses in twenty-seven dogs. The dogs were divided into three different groups, and scintigraphy was carried out using technetium-labeled methylene diphosphonate in composite bone grafts revascularized by microvascular anastomoses, conventional autogenous bone grafts, and periosteal grafts placed in different recipient beds. The viability of the grafts were evaluated by histological examination and fluorescence microscopy after triple labeling with oxytetracycline on the first postoperative day, alizarin complexone on the fourth postoperative day, and DCAF on the eleventh postoperative day. A positive scintiscan within the first week following surgery indicated patent microvascular anastomoses, and histological study and fluorescence microscopy confirmed that bone throughout the graft was viable. A positive scintiscan one week after surgery or later does not necessarily indicate microvascular patency or bone-cell survival, because new bone formed by creeping substitution on the surface of a dead bone graft can result in this finding

  19. FFTF and CRBRP reactor vessels

    International Nuclear Information System (INIS)

    Morgan, R.E.

    1977-01-01

    The Fast Flux Test Facility (FFTF) reactor vessel and the Clinch River Breeder Reactor Plant (CRBRP) reactor vessel each serve to enclose a fast spectrum reactor core, contain the sodium coolant, and provide support and positioning for the closure head and internal structure. Each vessel is located in its reactor cavity and is protected by a guard vessel which would ensure continued decay heat removal capability should a major system leak develop. Although the two plants have significantly different thermal power ratings, 400 megawatts for FFTF and 975 megawatts for CRBRP, the two reactor vessels are comparable in size, the CRBRP vessel being approximately 28% longer than the FFTF vessel. The FFTF vessel diameter was controlled by the space required for the three individual In-Vessel Handling Machines and Instrument Trees. Utilization of the triple rotating plug scheme for CRBRP refueling enables packaging of the larger CRBRP core in a vessel the same diameter as the FFTF vessel

  20. Absence of bias against smokers in access to coronary revascularization after cardiac catheterization

    OpenAIRE

    Cornuz, Jacques; Faris, Peter D.; Galbraith, P. Diane; Knudtson, Merril L.; Ghali, William A.

    2017-01-01

    Objective. Many consider smoking to be a personal choice for which individuals should be held accountable. We assessed whether there is any evidence of bias against smokers in cardiac care decision-making by determining whether smokers were as likely as non-smokers to undergo revascularization procedures after cardiac catheterization. Design. Prospective cohort study. Subjects and setting. All patients undergoing cardiac catheterization in Alberta, Canada. Main measures. Patients were categor...

  1. Sex-related differences in coronary revascularization practices: the perspective from a Canadian queue management project.

    Science.gov (United States)

    Naylor, C D; Levinton, C M

    1993-10-01

    To assess sex-related differences in coronary revascularization practices in a Canadian setting. Prospective analytic cohort study. Regional referral office in Toronto. A selected but consecutive group of 131 women and 440 men referred by cardiologists for revascularization procedures between Jan. 3, 1989, and June 30, 1991. Coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA). Nurse-coordinators placed the referral with a surgeon or interventional cardiologist at one of three hospitals, who then communicated directly with the referring cardiologist. Symptom status at referral, procedures requested and performed, and time from referral to procedure. Although the women were more likely than the men to have unstable angina at the time of referral (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.38 to 3.79, p = 0.0006), more women than men (16.8% v. 12.1%) were turned down for a procedure. Significant sex-related differences in practice patterns (p management; sex was the only other significant variable (p = 0.016). The referring physicians requested CABG more often for men than for women (p = 0.009), and the men accepted for a procedure were much more likely to undergo CABG than the women (OR 2.40, CI 1.47 to 3.93, p = 0.0002). Although the women undergoing CABG waited shorter periods than the men (p = 0.0035), this difference was attributable to their more severe symptoms. In this selected group women had more serious symptoms before referral but were turned down for revascularization more often than men. Reduced use of CABG rather than PTCA largely accounted for the sex-related differences in revascularization. Once accepted for a procedure women had shorter waiting times, which was appropriate given their more severe symptoms.

  2. Effectiveness of revascularization surgery evaluated by proton magnetic resonance spectroscopy and single photon emission computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Uno, Masaaki; Ueda, Shin; Hondo, Hideki; Matsumoto, Keizo; Harada, Masafumi [Tokushima Univ. (Japan). School of Medicine

    1996-08-01

    Proton magnetic resonance spectroscopy (MRS) and single photon emission computed tomography (SPECT) were used to evaluate chronic ischemic regions in 26 stroke patients before and 1, 3, and 6 months after revascularization surgery. The volume of interest for proton MRS was placed in an area including part of the frontal and temporal opercula, insular cortex, and basal ganglia. Twenty healthy volunteers served as controls for proton MRS. Patients were divided into three groups according to the preoperative proton MRS. Group A (n=12) had significantly lower N-acetylaspartate/choline (NAA/Cho) and N-acetylaspartate/creatine (NAA/Cr) ratios on the operative side compared to those on the contralateral side, and also lower than those in normal subjects. In seven patients in Group A, postoperative serial proton MRS demonstrated no recovery of these ratios on the operative side. However, proton MRS of the other five patients indicated gradual improvement in these ratios on the operative side at 3 to 6 months after surgery, and SPECT indicated an increase in cerebral blood flow on the operative side in four of these five patients. In Group B (n=9), proton MRS and SPECT showed no laterality before revascularization and no remarkable change during the postoperative course. In Group C (n=5), NAA/Cho or NAA/Cr decreased on the contralateral side preoperatively. Two patients showed fluctuating values of NAA/Cho or NAA/Cr during the postoperative period. Serial proton MRS and SPECT Studies may be useful for the evaluation of revascularization surgery on ischemic regions. The efficacy of revascularization surgery on the metabolism may appear gradually within 3-6 months. (author)

  3. Population-level differences in revascularization treatment and outcomes among various United States subpopulations

    Institute of Scientific and Technical Information of China (English)

    Garth Graham; Yang-Yu Karen Xiao; Dan Rappoport; Saima Siddiqi

    2016-01-01

    Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction(MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to

  4. Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study

    Directory of Open Access Journals (Sweden)

    Ramkumar Nirupama

    2005-03-01

    Full Text Available Abstract Background Surgical treatment of peripheral vascular disease (PVD in dialysis patients is controversial. Methods We examined the post-operative morbidity and mortality of surgical revascularization or amputation for PVD in a retrospective analysis of United States Renal Data System. Propensity scores for undergoing amputation were derived from a multivariable logistic regression model of amputation. Results Of the Medicare patients initiated on dialysis from Jan 1, 1995 to Dec 31, 1999, patients underwent surgical revascularization (n = 1,896 or amputation (n = 2,046 in the first 6 months following initiation of dialysis were studied. In the logistic regression model, compared to claudication, presence of gangrene had a strong association with amputation [odds ratio (OR 19.0, 95% CI (confidence interval 13.86–25.95]. The odds of dying within 30 days and within1 year were higher (30 day OR: 1.85, 95% CI: 1.45–2.36; 1 yr OR: 1.46, 95% CI: 1.25–1.71 in the amputation group in logistic regression model adjusted for propensity scores and other baseline factors. Amputation was associated with increased odds of death in patients with low likelihood of amputation (rd percentile of propensity score and moderate likelihood of amputation (33rd to 66th percentile but not in high likelihood group (>66th percentile. The number of hospital days in the amputation and revascularization groups was not different. Conclusion Amputation might be associated with higher mortality in dialysis patients. Where feasible, revascularization might be preferable over amputation in dialysis patients.

  5. Comparison of Early Outcomes with Three Approaches for Combined Coronary Revascularization and Carotid Endarterectomy

    Directory of Open Access Journals (Sweden)

    Arzu Antal Dönmez

    Full Text Available Abstract Objective: This study aims to compare three different surgical approaches for combined coronary and carotid artery stenosis as a single stage procedure and to assess effect of operative strategy on mortality and neurological complications. Methods: This retrospective study involves 136 patients who had synchronous coronary artery revascularization and carotid endarterectomy in our institution, between January 2002 and December 2012. Patients were divided into 3 groups according to the surgical technique used. Group I included 70 patients who had carotid endarterectomy, followed by coronary revascularization with on-pump technique, group II included 29 patients who had carotid endarterectomy, followed by coronary revascularization with off-pump technique, group III included 37 patients who had coronary revascularization with on-pump technique followed by carotid endarterectomy under aortic cross-clamp and systemic hypothermia (22-27ºC. Postoperative outcomes were evaluated. Results: Overall early mortality and stroke rate was 5.1% for both. There were 3 (4.3% deaths in group I, 2 (6.9% deaths in group II and 2 (5.4% deaths in group III. Stroke was observed in 5 (7.1% patients in group I and 2 (6.9% in group II. Stroke was not observed in group III. No statistically significant difference was observed for mortality and stroke rates among the groups. Conclusion: We identified no significant difference in mortality or neurologic complications among three approaches for synchronous surgery for coronary and carotid disease. Therefore it is impossible to conclude that a single principle might be adapted into standard practice. Patient specific risk factors and clinical conditions might be important in determining the surgical tecnnique.

  6. [Surgical treatment of ishemic mitral regurgitation: repair, replacement or revascularization alone?].

    Science.gov (United States)

    Vrenes, Mile; Velinović, Milos; Kocica, Mladen; Mikić, Aleksandar; Putnik, Svetozar; Djukić, Petar; Djordjević, Aleksandar

    2010-01-01

    Treatment of ischemic mitral regurgitation in patients that require revascularization of myocardium is still debatable. The aim of this study was to compare three surgical approaches: valve repair and revascularization; valve replacement and revascularization, and revascularization alone. In 2006 and 2007 at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, 1,040 patients with coronary disease underwent surgery. Forty-three patients (4.3%) had also mitral insufficiency 3-4+. The patients were examined clinically, echocardiographically and haemodynamically. In group I there were 14 (32.3%) patients, in group II 16 (37.2%) patients and in group III 3 (30.5%) patients. Ninety-three per cent of patients were classified as New York Heart Association (NYHA) class III and IV, and three (7%) patients had congestive heart weakness with ejection fraction < or =30%. The decision as to surgical procedure was made by the surgeon. Postoperatively, patients were checked clinically and echocardiographically after 3, 6 and 12 months. The follow-up period was approximately 15 months (8-20). Hospital mortality for the whole group was 6.9% (3 patients). In group I mortality was 14.2% (2 patients), in group II 6.25% and in group III there was no mortality. Long term results, up to 15 months, showed 100% survival in groups I and II, and in group III one patient died (7.7%). Short term results upto 30 days were best in group III, but longer term results were better in groups I and II.

  7. The influence of polymorbidity, revascularization, and wound therapy on the healing of arterial ulceration

    Directory of Open Access Journals (Sweden)

    Joerg Tautenhahn

    2008-06-01

    Full Text Available Joerg Tautenhahn1, Ralf Lobmann2, Brigitte Koenig3, Zuhir Halloul1, Hans Lippert1, Thomas Buerger11Department of General, Visceral and Vascular Surgery; 2Department of Endocrinology and Metabolism; 3Institute for Medical Microbiology, Medical School, Otto-von-Guericke University, Magdeburg, GermanyObjective: An ulcer categorized as Fontaine’s stage IV represents a chronic wound, risk factor of arteriosclerosis, and co-morbidities which disturb wound healing. Our objective was to analyze wound healing and to assess potential factors affecting the healing process.Methods: 199 patients were included in this 5-year study. The significance levels were determined by chi-squared and log-rank tests. The calculation of patency rate followed the Kaplan-Meier method.Results: Mean age and co-morbidities did not differ from those in current epidemiological studies. Of the patients with ulcer latency of more than 13 weeks (up to one year, 40% required vascular surgery. Vascular surgery was not possible for 53 patients and they were treated conservatively. The amputation rate in the conservatively treated group was 37%, whereas in the revascularizated group it was only 16%. Ulcers in patients with revascularization healed in 92% of cases after 24 weeks. In contrast, we found a healing rate of only 40% in the conservatively treated group (p < 0.001. Revascularization appeared more often in diabetic patients (n = 110; p < 0.01 and the wound size and number of infections were elevated (p = 0.03. Among those treated conservatively, wound healing was decelerated (p = 0.01/0.02; χ² test.Conclusions: The success of revascularization, presence of diabetes mellitus, and wound treatment proved to be prognostic factors for wound healing in arterial ulcers.Keywords: arterial leg ulcer, wound management, risk factors, revascularization

  8. Microdialysis assessment of peripheral metabolism in critical limb ischemia after endovascular revascularization

    OpenAIRE

    Tozzi, Matteo; Muscianisi, Elisa; Piffaretti, Gabriele; Castelli, Patrizio

    2009-01-01

    Abstract Background Critical limb ischemia is a chronic pathologic condition defined by the lack of blood flow in peripheral circulation. Microdialysis is a well-known and sensitive method for the early detection of tissue ischemia. The aim of the present study was to use microdialysis in order to analyse cellular metabolism changes after peripheral endovascular revascularization. Methods Ten patients diagnosed with critical limb ischemia was enrolled. CMA 60 (CMA® - Solna, Sweden) catheter w...

  9. The anterior temporal artery: an underutilized but robust donor for revascularization of the distal middle cerebral artery.

    Science.gov (United States)

    Tayebi Meybodi, Ali; Lawton, Michael T; Griswold, Dylan; Mokhtari, Pooneh; Payman, Andre; Benet, Arnau

    2017-10-01

    OBJECTIVE The anterior temporal artery (ATA) supplies an area of the brain that, if sacrificed, does not cause a noticeable loss of function. Therefore, the ATA may be used as a donor in intracranial-intracranial (IC-IC) bypass procedures. The capacities of the ATA as a donor have not been studied previously. In this study, the authors assessed the feasibility of using the ATA as a donor for revascularization of different segments of the distal middle cerebral artery (MCA). METHODS The ATA was studied in 15 cadaveric specimens (8 heads, excluding 1 side). First, the cisternal segment of the artery was untethered from arachnoid adhesions and small branches feeding the anterior temporal lobe and insular cortex, to evaluate its capacity for a side-to-side bypass to insular, opercular, and cortical segments of the MCA. Any branch entering the anterior perforated substance was preserved. Then, the ATA was cut at the opercular-cortical junction and the capacity for an end-to-side bypass was assessed. RESULTS From a total of 17 ATAs, 4 (23.5%) arose as an early MCA branch. The anterior insular zone and the frontal parasylvian cortical arteries were the best targets (in terms of mobility and caliber match) for a side-to-side bypass. Most of the insula was accessible for end-to-side bypass, but anterior zones of the insula were more accessible than posterior zones. End-to-side bypass was feasible for most recipient cortical arteries along the opercula, except for posterior temporal and parietal regions. Early ATAs reached significantly farther on the insular MCA recipients than non-early ATAs for both side-to-side and end-to-side bypasses. CONCLUSIONS The ATA is a robust arterial donor for IC-IC bypass procedures, including side-to-side and end-to-side techniques. The evidence provided in this work supports the use of the ATA as a donor for distal MCA revascularization in well-selected patients.

  10. Localized 1H-MR spectroscopy in moyamoya disease before and after revascularization surgery

    International Nuclear Information System (INIS)

    Lim, Soo Mee; Choi, Hye Young; Suh, Jung Soo; Lee, Jung Hee; Lim, Keun Ho; Suh, Dae Chul; Lee, Ho Kyu; Lim, Tae Hwan; Ra, Young Shin

    2003-01-01

    To evaluate, using localized proton magnetic resonance spectroscopy (1H-MRS), the cerebral metabolic change apparent after revascularization surgery in patients with moyamoya disease. Sixteen children with moyamoya disease and eight age-matched normal controls underwent MR imaging, MR angiography, conventional angiography, and 99m Tc- ECD SPECT. Frontal white matter and the basal ganglia of both hemispheres were subjected to localized 1 H-MRS, and after revascularization surgery, four patients underwent follow-up 1 H-MRS. Decreased NAA/Cr ratios (1.35±0.14 in patients vs. 1.55±0.24 in controls) and Cho/Cr ratios (0.96±0.13 in patients vs. 1.10±0.11 in controls) were observed in frontal white matter. After revascularization surgery, NAA/Cr and Cho/Cr ratios in this region increased. In the basal ganglia, there is no abnormal metabolic ratios. Localized 1H-MRS revealed abnormal metabolic change in both hemispheres of children with moyamoya disease. Because of its non-invasive nature, 1 H-MRS is potentially useful for the preoperative evaluation of metabolic abnormalities and their postoperative monitoring

  11. Localized 1H-MR spectroscopy in moyamoya disease before and after revascularization surgery

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Soo Mee; Choi, Hye Young; Suh, Jung Soo [Ewha Womans University Hospital, Seoul (Korea, Republic of); Lee, Jung Hee; Lim, Keun Ho; Suh, Dae Chul; Lee, Ho Kyu; Lim, Tae Hwan; Ra, Young Shin [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2003-06-01

    To evaluate, using localized proton magnetic resonance spectroscopy (1H-MRS), the cerebral metabolic change apparent after revascularization surgery in patients with moyamoya disease. Sixteen children with moyamoya disease and eight age-matched normal controls underwent MR imaging, MR angiography, conventional angiography, and {sup 99m}Tc- ECD SPECT. Frontal white matter and the basal ganglia of both hemispheres were subjected to localized {sup 1}H-MRS, and after revascularization surgery, four patients underwent follow-up {sup 1}H-MRS. Decreased NAA/Cr ratios (1.35{+-}0.14 in patients vs. 1.55{+-}0.24 in controls) and Cho/Cr ratios (0.96{+-}0.13 in patients vs. 1.10{+-}0.11 in controls) were observed in frontal white matter. After revascularization surgery, NAA/Cr and Cho/Cr ratios in this region increased. In the basal ganglia, there is no abnormal metabolic ratios. Localized 1H-MRS revealed abnormal metabolic change in both hemispheres of children with moyamoya disease. Because of its non-invasive nature, {sup 1}H-MRS is potentially useful for the preoperative evaluation of metabolic abnormalities and their postoperative monitoring.

  12. Persistent smoking rate after coronary revascularization and factors related to smoking cessation in Turkey.

    Science.gov (United States)

    Keskin, Kudret; Sezai Yildiz, Süleyman; Çetinkal, Gökhan; Çetin, Sükrü; Sigirci, Serhat; Kilci, Hakan; Aksan, Gökhan; Helvaci, Füsun; Gürdal, Ahmet; Balaban Kocas, Betül; Arslan, Sükrü; Orta Kiliçkesmez, Kadriye

    2017-11-22

    Although smoking is an established risk factor for coronary artery disease, smoking cessation efforts, as part of a lifestyle change, have been disappointing so far. Therefore, assessing current smoking trends and identifying patients who are at risk of smoking continuation is of paramount importance. In this study, our aim was to assess current smoking rates after coronary revascularization as of 2017, and to define factors that potentially affect smoking cessation. Overall, 350 patients who had undergone coronary revascularization, either by percutaneous coronary intervention or bypass surgery were included in this cross-sectional, observational study. Patients were queried for various sociodemographic characteristics and smoking habits. Disease related data were obtained from the hospital archives. The overall smoking rate was 57% after coronary revascularization. Age, bypass surgery and the occurrence of in-hospital adverse events were found to be independent predictors of smoking cessation in multivariate analysis. Despite efforts, smoking rates after coronary intervention remain substantially high. Therefore, a multidisciplinary approach to smoking cessation that incorporates cardiac rehabilitation programs and medications should be implemented in clinical practice. © The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  13. [Revascularization surgery of an anuric solitary kidney using the left colic artery as a free graft].

    Science.gov (United States)

    da Gama, A Dinis; Nunes, J Silva; Cunha e Sá, Diogo; Pedro, Luís Mendes

    2003-01-01

    The thrombotic occlusion of one renal artery may become completely asymptomatic, due to the functionality of the contralateral kidney. However, in rare circumstances, such is the case of individuals with a solitary kidney, a situation of anuria and acute renal failure may constitute the main presentation of the condition. The authors report the clinical case of a 43 year old male patient, with the previous diagnosis of an infrarenal aortic occlusion and a single left kidney, who developed a thrombotic occlusion of the renal artery, with anuria and acute renal failure. The patient underwent an emergency revascularization procedure, consisting in the implantation of a prosthetic bypass graft from the superceliac aorta to the renal artery, with immediate recovery of the diuresis and renal function. Seventeen months later as a consequence of an anastomotic hyperplasia, an occlusion of the bypass graft occurred, again with anuria and acute renal failure. The patient was reoperated on and due to the inadequacy of both saphenous veins to be used as the material of choice for the revascularization procedure, a redundant segment of the left colic artery (Riolan's arcade) was removed and used as an interposition graft, from the middle colic artery to the renal artery, followed by an immediate restoration of diuresis and renal function. The singular and recurrent character of this clinical condition and the utilization of an original, eventually unique and well succeeded revascularization procedure, prompted its presentation and divulgation.

  14. Coronary Revascularization in Children at a Mexican Cardiac Center: Thirteen-Year Outcomes.

    Science.gov (United States)

    Ramírez-Marroquín, Samuel E; Iturriaga-Hernández, Alejandra; Calderón-Colmenero, Juan; Benita-Bordes, Antonio; Cervantes-Salazar, Jorge L

    2017-09-01

    The indications for pediatric coronary revascularization are diverse. There are a large proportion of patients with sequelae of severe inflammatory diseases such as Kawasaki disease, and other less common causes. Retrospective review of ten pediatric patients undergoing coronary artery bypass surgery from January 2004 to December 2016. Ten children and adolescents ranging in age from 2 to 17 (median, 6) years at operation were followed up for as long as 13 years with a median follow-up of 2 years. The surgical indications include ischemia symptoms and/or coronary stenosis angiographically documented. Diagnoses include Kawasaki disease, anomalous origin of the left coronary artery from the pulmonary artery, and iatrogenic lesion of the right coronary artery. All the surgical procedures were performed with cardiopulmonary bypass with crystalloid cardioplegic arrest. The number of distal anastomoses was 1.6 per patient, and the left internal thoracic artery was used in one patient, the right internal thoracic artery in four patients, bilateral internal thoracic artery in four patients, and bilateral internal thoracic artery plus left radial artery in one patient, most frequently for right coronary artery revascularization. The patients underwent noninvasive diagnostic study during follow-up to evaluate their coronary status. The ten patients had no symptoms, and there was no mortality. Although survival was excellent after pediatric coronary bypass in our center, we need to continue the follow-up. Coronary revascularization by means of arterial grafting is a safe and reliable surgical modality for coronary disease in children.

  15. Small Islets Transplantation Superiority to Large Ones: Implications from Islet Microcirculation and Revascularization

    Directory of Open Access Journals (Sweden)

    Wenjuan Li

    2014-01-01

    Full Text Available Pancreatic islet transplantation is a promising therapy to regain glycemic control in diabetic patients. The selection of ideal grafts is the basis to guarantee short-term effectivity and longevity of the transplanted islets. Contradictory to the traditional notion, recent findings implied the superiority of small islets for better transplantation outcomes rather than the large and intact ones. However, the mechanisms remain to be elucidated. Recent evidences emphasized the major impact of microcirculation on islet β-cell mass and function. And potentials in islet graft revascularization are crucial for their survival and preserved function in the recipient. In this study, we verified the distinct histological phenotype and functionality of small islets versus large ones both in vitro and in vivo. With efforts to exploring the differences in microcirculation and revascularization of islet grafts, we further evaluated local expressions of angiotensin and vascular endothelial growth factor A (VEGF-A at different levels. Our findings reveal that, apart from the higher density of insulin-producing β-cells, small islets express less angiotensin and more angiotrophic VEGF-A. We therefore hypothesized a logical explanation of the small islet superiority for transplantation outcome from the aspects of facilitated microcirculation and revascularization intrinsically in small islets.

  16. Thrombospondins deployed by thrombopoietic cells determine angiogenic switch and extent of revascularization

    Science.gov (United States)

    Kopp, Hans-Georg; Hooper, Andrea T.; Broekman, M. Johan; Avecilla, Scott T.; Petit, Isabelle; Luo, Min; Milde, Till; Ramos, Carlos A.; Zhang, Fan; Kopp, Tabitha; Bornstein, Paul; Jin, David K.; Marcus, Aaron J.; Rafii, Shahin

    2006-01-01

    Thrombopoietic cells may differentially promote or inhibit tissue vascularization by releasing both pro- and antiangiogenic factors. However, the molecular determinants controlling the angiogenic phenotype of thrombopoietic cells remain unknown. Here, we show that expression and release of thrombospondins (TSPs) by megakaryocytes and platelets function as a major antiangiogenic switch. TSPs inhibited thrombopoiesis, diminished bone marrow microvascular reconstruction following myelosuppression, and limited the extent of revascularization in a model of hind limb ischemia. We demonstrate that thrombopoietic recovery following myelosuppression was significantly enhanced in mice deficient in both TSP1 and TSP2 (TSP-DKO mice) in comparison with WT mice. Megakaryocyte and platelet levels in TSP-DKO mice were rapidly restored, thereby accelerating revascularization of myelosuppressed bone marrow and ischemic hind limbs. In addition, thrombopoietic cells derived from TSP-DKO mice were more effective in supporting neoangiogenesis in Matrigel plugs. The proangiogenic activity of TSP-DKO thrombopoietic cells was mediated through activation of MMP-9 and enhanced release of stromal cell–derived factor 1. Thus, TSP-deficient thrombopoietic cells function as proangiogenic agents, accelerating hemangiogenesis within the marrow and revascularization of ischemic hind limbs. As such, interference with the release of cellular stores of TSPs may be clinically effective in augmenting neoangiogenesis. PMID:17143334

  17. Antiangiogenic immunotherapy targeting Flk-1, DNA vaccine and adoptive T cell transfer, inhibits ocular neovascularization

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Han [Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582 (Japan); Sonoda, Koh-Hei, E-mail: sonodak@med.kyushu-u.ac.jp [Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582 (Japan); Hijioka, Kuniaki; Qiao, Hong; Oshima, Yuji; Ishibashi, Tatsuro [Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582 (Japan)

    2009-04-17

    Ocular neovascularization (NV) is the primary cause of blindness in a wide range of ocular diseases. The exact mechanism underlying the pathogenesis of ocular NV is not yet well understood, and so there is no satisfactory therapy for ocular NV. Here, we describe a strategy targeting Flk-1, a self-antigen overexpressed on proliferating endothelial cells in ocular NV, by antiangiogenic immunotherapy-DNA vaccine and adoptive T cell therapy. An oral DNA vaccine encoding Flk-1 carried by attenuated Salmonella typhimurium markedly suppressed development of laser-induced choroidal NV. We further demonstrated that adoptive transfer of vaccine-induced CD8{sup +} T cells reduced pathological preretinal NV, with a concomitant facilitation of physiological revascularization after oxygen-induced retinal vessel obliteration. However, physiological retinal vascular development was unaffected in neonatal mice transferred with vaccine-induced CD8{sup +} T cells. These findings suggested that antiangiogenic immunotherapy targeting Flk-1 such as vaccination and adoptive immunotherapy may contribute to future therapies for ocular NV.

  18. Antiangiogenic immunotherapy targeting Flk-1, DNA vaccine and adoptive T cell transfer, inhibits ocular neovascularization

    International Nuclear Information System (INIS)

    Zhang, Han; Sonoda, Koh-Hei; Hijioka, Kuniaki; Qiao, Hong; Oshima, Yuji; Ishibashi, Tatsuro

    2009-01-01

    Ocular neovascularization (NV) is the primary cause of blindness in a wide range of ocular diseases. The exact mechanism underlying the pathogenesis of ocular NV is not yet well understood, and so there is no satisfactory therapy for ocular NV. Here, we describe a strategy targeting Flk-1, a self-antigen overexpressed on proliferating endothelial cells in ocular NV, by antiangiogenic immunotherapy-DNA vaccine and adoptive T cell therapy. An oral DNA vaccine encoding Flk-1 carried by attenuated Salmonella typhimurium markedly suppressed development of laser-induced choroidal NV. We further demonstrated that adoptive transfer of vaccine-induced CD8 + T cells reduced pathological preretinal NV, with a concomitant facilitation of physiological revascularization after oxygen-induced retinal vessel obliteration. However, physiological retinal vascular development was unaffected in neonatal mice transferred with vaccine-induced CD8 + T cells. These findings suggested that antiangiogenic immunotherapy targeting Flk-1 such as vaccination and adoptive immunotherapy may contribute to future therapies for ocular NV.

  19. The JET high temperature in-vessel inspection system

    International Nuclear Information System (INIS)

    Businaro, T.; Cusack, R.; Calbiati, L.; Raimondi, T.

    1989-01-01

    The JET In-vessel Inspection System (IVIS) has been enhanced for operation under the following nominal conditions: vacuum vessel at 350 degC; vacuum vessel evacuated (∼10 -9 mbar); radiation dose during D-T phase 10 rads. The target resolution of the pictures is 2 mm at 5 m distance and tests on radiation resistance of the IVIS system are being carried out. Since June 1988, the new system is installed in the JET machine and the first inspections of the intire vessel at 250 degC have been satisfactory done. (author). 3 refs.; 6 figs.; 1 tab

  20. Description of a Heart Team approach to coronary revascularization and its beneficial long-term effect on clinical events after PCI.

    Science.gov (United States)

    Bonzel, Tassilo; Schächinger, Volker; Dörge, Hilmar

    2016-05-01

    We present a first description of a Heart Team (HT)-guided approach to coronary revascularization and its long-term effect on clinical events after percutaneous coronary intervention (PCI). The HT approach is a structured process to decide for coronary bypass grafting (CABG), PCI or conservative therapy in ad hoc situations as well as in HT conferences. As a hypothesis, during the long-term course after a PCI performed according to HT rules, a low number of late revascularizations, especially CABGs, are expected (F-PCI study). In this monocentric study, the HT approach to an all-comer population was first analyzed and described in general with the help of a database. Next the use of a HT approach was described for a more homogeneous subgroup with newly detected CAD (1.CAD). Those patients in whom the HT decision was PCI (which was a 1.PCI) were then studied with the help of questionnaires for clinical events during a very long-term follow-up. Events were CABG, PCI, diagnostic catheterization (DCath) and death. A significant number of patients were presented to HT conferences: 22 % out of all 11,174 catheterizations, 24 % out of all 7867 CAD cases and 35 % out of 3408 1.CAD cases. Most of these patients had multi-vessel disease (MVD). Conference decisions were isolated CABG in 46-66 %, PCI in 10-14 %, valvular surgery in 9-16 %, HTx in 10-21 % (Endstage heart failure candidates for surgery) and conservative therapy (Medical or no therapy, additional diagnostic procedures or no adherence to recommended therapy) in 2-3 %. However, most PCIs, ad hoc and elective, were performed under Heart Team rules, but without conference. During follow-up of 1.PCI patients (Kaplan-Meier analysis), CABG occurred in only 15 % of patients, PCI in 37 % and DCath in 65 %; mortality of any course was 51 %. Mortalities were similar in one-vessel disease and in a population of the same year, matched for age and sex (p PCI patients with MVD (p PCI) rates after a 1.PCI, without

  1. Microdialysis assessment of peripheral metabolism in critical limb ischemia after endovascular revascularization.

    Science.gov (United States)

    Tozzi, Matteo; Muscianisi, Elisa; Piffaretti, Gabriele; Castelli, Patrizio

    2009-12-31

    Critical limb ischemia is a chronic pathologic condition defined by the lack of blood flow in peripheral circulation. Microdialysis is a well-known and sensitive method for the early detection of tissue ischemia. The aim of the present study was to use microdialysis in order to analyse cellular metabolism changes after peripheral endovascular revascularization. Ten patients diagnosed with critical limb ischemia was enrolled. CMA 60 (CMA-Solna, Sweden) catheter with a 20 kDa cut-off was placed subcutaneously on the anterior aspect of the foot of both limbs. Samples were collected starting 12-hours before surgery and throughout the following 72-hours, using a CMA 600 (CMA-Solna, Sweden) microdialysis analyser. Technical revascularization was successful in all cases. The cannulation was well tolerated in all patients. The site of catheter insertion healed easily in few days without infective complications in any case. Two patients underwent major amputation. After revascularization, glucose showed a strong increase (mean, 5.86 +/- 1.52 mMol/L, p = .008). No restoration of the circadian rhythm was noted in patients who underwent major amputation. Glycerol concentration curves were not deductibles in both the ischemic and the control limbs (mean, 148.43 +/- 42.13 mMol/L vs 178.44 +/- 75.93 mMol/L, p = .348). Within the first 24-hours after revascularization, lactate concentration raised strongly (6.58 +/- 1.56 mMol/L, p = .002): thereafter, it immediately decreased to a concentration similar to the control level (1.71 +/- 1.69 mMol/L). In both patients who underwent major amputation, lactate did not show the typical peak of the successful revascularization. The trend of the lactate/pyruvate ratio after a brief initial decrease of the ratio increased again in both the patients who finally underwent amputation. Restoration of glucose and glycerol circadian rhythm, coupled with low lactate concentration and lactate/pyruvate ratio seemed to be linked to good surgical

  2. Acrylic vessel cleaning tests

    International Nuclear Information System (INIS)

    Earle, D.; Hahn, R.L.; Boger, J.; Bonvin, E.

    1997-01-01

    The acrylic vessel as constructed is dirty. The dirt includes blue tape, Al tape, grease pencil, gemak, the glue or residue form these tapes, finger prints and dust of an unknown composition but probably mostly acrylic dust. This dirt has to be removed and once removed, the vessel has to be kept clean or at least to be easily cleanable at some future stage when access becomes much more difficult. The authors report on the results of a series of tests designed: (a) to prepare typical dirty samples of acrylic; (b) to remove dirt stuck to the acrylic surface; and (c) to measure the optical quality and Th concentration after cleaning. Specifications of the vessel call for very low levels of Th which could come from tape residues, the grease pencil, or other sources of dirt. This report does not address the concerns of how to keep the vessel clean after an initial cleaning and during the removal of the scaffolding. Alconox is recommended as the cleaner of choice. This acrylic vessel will be used in the Sudbury Neutrino Observatory

  3. Pre-discharge exercise test for evaluation of patients with complete or incomplete revascularization following primary percutaneous coronary intervention: a DANAMI-2 sub-study

    DEFF Research Database (Denmark)

    Valeur, N.; Clemmensen, P.; Grande, P.

    2008-01-01

    revascularization had lower exercise capacity [6.5 (95% CI: 1.9-12.8) vs. 7.0 (95% CI: 2.1-14.0) METs, p = 0.004] and more frequently ST depression [43 (20%) vs. 39 (13%), p = 0.02] compared to patients with complete revascularization. ST depression was not predictive of outcome in either groups, while...... with complete revascularization. CONCLUSIONS: Exercise capacity was prognostic of reinfarction and/or death in patients with incomplete revascularization, but not in completely revascularized patients. ST segment depression alone did not predict residual coronary stenosis or dismal prognosis Udgivelsesdato......OBJECTIVES: It is unclear whether the completeness of revascularization impacts on the prognostic value of an exercise test after primary percutaneous coronary intervention (PCI). METHODS: The DANAMI-2 trial included patients with ST elevation acute myocardial infarction randomized to primary PCI...

  4. Dynamic stroma reorganization drives blood vessel dysmorphia during glioma growth.

    Science.gov (United States)

    Mathivet, Thomas; Bouleti, Claire; Van Woensel, Matthias; Stanchi, Fabio; Verschuere, Tina; Phng, Li-Kun; Dejaegher, Joost; Balcer, Marly; Matsumoto, Ken; Georgieva, Petya B; Belmans, Jochen; Sciot, Raf; Stockmann, Christian; Mazzone, Massimiliano; De Vleeschouwer, Steven; Gerhardt, Holger

    2017-12-01

    Glioma growth and progression are characterized by abundant development of blood vessels that are highly aberrant and poorly functional, with detrimental consequences for drug delivery efficacy. The mechanisms driving this vessel dysmorphia during tumor progression are poorly understood. Using longitudinal intravital imaging in a mouse glioma model, we identify that dynamic sprouting and functional morphogenesis of a highly branched vessel network characterize the initial tumor growth, dramatically changing to vessel expansion, leakage, and loss of branching complexity in the later stages. This vascular phenotype transition was accompanied by recruitment of predominantly pro-inflammatory M1-like macrophages in the early stages, followed by in situ repolarization to M2-like macrophages, which produced VEGF-A and relocate to perivascular areas. A similar enrichment and perivascular accumulation of M2 versus M1 macrophages correlated with vessel dilation and malignancy in human glioma samples of different WHO malignancy grade. Targeting macrophages using anti-CSF1 treatment restored normal blood vessel patterning and function. Combination treatment with chemotherapy showed survival benefit, suggesting that targeting macrophages as the key driver of blood vessel dysmorphia in glioma progression presents opportunities to improve efficacy of chemotherapeutic agents. We propose that vessel dysfunction is not simply a general feature of tumor vessel formation, but rather an emergent property resulting from a dynamic and functional reorganization of the tumor stroma and its angiogenic influences. © 2017 The Authors. Published under the terms of the CC BY 4.0 license.

  5. Emergent intracranial balloon angioplasty and bailout self-expandable stent placement in acute large vessel occlusion of the anterior circulation: Experience of a single institution

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Young Jin; Seo, Jung Hwa; Jeong, Hae Woong [Busan Paik Hospital, Inje University, Busan (Korea, Republic of)

    2017-06-15

    To evaluate the outcomes of angioplasty for recanalization after acute ischemic stroke (AIS). The study population was selected from 134 patients who underwent endovascular revascularization therapy (ERT) for AIS between October 2011 and May 2014. Of those 134 patients, 39 who underwent balloon angioplasty with or without stent insertion were included in this study. Balloon angioplasty was the primary treatment for nine patients and a rescue method for 30 patients. The revascularization rate at 7 days, procedure-related complications, and clinical outcomes at 3 months were analyzed. The occlusion sites were the middle cerebral artery (n = 26), intracranial internal carotid artery (n = 10), and middle cerebral artery branch (n = 3). Angioplasty achieved successful revascularization (Thrombolysis in Cerebral Ischemia grade 2b–3) in 76.9% of patients. Computed tomography angiography performed 7 days post-procedure revealed a maintained reperfusion in 82.8% of successful cases. Only two patients had symptomatic intracerebral hemorrhage. At the 3-month follow-up, 18 (48.6%) and 10 (27.0%) patients showed good and poor functional outcomes, respectively (modified Rankin Scale scores, 0–2 and 5–6). Emergent balloon angioplasty and bailout self-expandable stent placement may be safe and effective for achieving successful revascularization in acute large vessel occlusion of the anterior circulation. It could be a feasible rescue method as well as a primary method for ERT.

  6. Emergent intracranial balloon angioplasty and bailout self-expandable stent placement in acute large vessel occlusion of the anterior circulation: Experience of a single institution

    International Nuclear Information System (INIS)

    Heo, Young Jin; Seo, Jung Hwa; Jeong, Hae Woong

    2017-01-01

    To evaluate the outcomes of angioplasty for recanalization after acute ischemic stroke (AIS). The study population was selected from 134 patients who underwent endovascular revascularization therapy (ERT) for AIS between October 2011 and May 2014. Of those 134 patients, 39 who underwent balloon angioplasty with or without stent insertion were included in this study. Balloon angioplasty was the primary treatment for nine patients and a rescue method for 30 patients. The revascularization rate at 7 days, procedure-related complications, and clinical outcomes at 3 months were analyzed. The occlusion sites were the middle cerebral artery (n = 26), intracranial internal carotid artery (n = 10), and middle cerebral artery branch (n = 3). Angioplasty achieved successful revascularization (Thrombolysis in Cerebral Ischemia grade 2b–3) in 76.9% of patients. Computed tomography angiography performed 7 days post-procedure revealed a maintained reperfusion in 82.8% of successful cases. Only two patients had symptomatic intracerebral hemorrhage. At the 3-month follow-up, 18 (48.6%) and 10 (27.0%) patients showed good and poor functional outcomes, respectively (modified Rankin Scale scores, 0–2 and 5–6). Emergent balloon angioplasty and bailout self-expandable stent placement may be safe and effective for achieving successful revascularization in acute large vessel occlusion of the anterior circulation. It could be a feasible rescue method as well as a primary method for ERT

  7. Radioactive liquid containing vessel

    International Nuclear Information System (INIS)

    Sakurada, Tetsuo; Kawamura, Hironobu.

    1993-01-01

    Cooling jackets are coiled around the outer circumference of a container vessel, and the outer circumference thereof is covered with a surrounding plate. A liquid of good conductivity (for example, water) is filled between the cooling jackets and the surrounding plate. A radioactive liquid is supplied to the container vessel passing through a supply pipe and discharged passing through a discharge pipe. Cooling water at high pressure is passed through the cooling water jackets in order to remove the heat generated from the radioactive liquid. Since cooling water at high pressure is thus passed through the coiled pipes, the wall thickness of the container vessel and the cooling water jackets can be reduced, thereby enabling to reduce the cost. Further, even if the radioactive liquid is leaked, there is no worry of contaminating cooling water, to prevent contamination. (I.N.)

  8. Mechanical Thrombectomy using a solitaire stent in acute ischemic stroke; The relationship between the visible antegrade flow on first device deployment and final success in revascularization

    International Nuclear Information System (INIS)

    Lee, Sung Ho; Lee, Byung Hon; Hwang, Yoon Joon; Kim, Su Young; Lee, Ji Young; Hong, Keun Sik; Cho, Yong Jin

    2015-01-01

    The purpose of the study was to evaluate the relationship between the successful revascularization on the first Solitaire stent deployment and the successful revascularization on the final angiography in acute ischemic stroke. From February 2012 to April 2014, 24 patients who underwent Solitaire stent thrombectomy as the first thrombectomy method for treatment of acute ischemic strokes were retrospectively reviewed. When the first Solitaire stent was deployed, 9 patients showed revascularization (Group 1) and 15 patients did not show revascularization (Group 2). Revascularization immediately after the first Solitaire stent removal and on the final angiography were comparatively assessed between the 2 groups. Statistical analysis was performed by the Fisher exact test and Student's t-test. The rates of revascularization maintenance immediately after the first Solitaire stent removal were 89% in Group 1 and 27% in Group 2, respectively (p = 0.009), and the rates of final successful revascularization were 100% in Group 1 and 47% in Group 2, respectively (p = 0.009). There was a statistically significant difference between the 2 groups. Revascularization on the first Solitaire stent deployment can be a useful predictor in evaluating the success of final revascularization in the treatment of acute ischemic stroke.

  9. Pressure vessel integrity 1991

    International Nuclear Information System (INIS)

    Bhandari, S.; Doney, R.O.; McDonald, M.S.; Jones, D.P.; Wilson, W.K.; Pennell, W.E.

    1991-01-01

    This volume contains papers relating to the structural integrity assessment of pressure vessels and piping, with special emphasis on nuclear industry applications. The papers were prepared for technical sessions developed under the sponsorship of the ASME Pressure Vessels and Piping Division Committees for Codes and Standards, Computer Technology, Design and Analysis, and Materials Fabrication. They were presented at the 1991 Pressure Vessels and Piping Division Conference in San Diego, California, June 23-27. The primary objective of the sponsoring organization is to provide a forum for the dissemination and discussion of information on development and application of technology for the structural integrity assessment of pressure vessels and piping. This publication includes contributions from authors from Australia, France, Japan, Sweden, Switzerland, the United Kingdom, and the United States. The papers here are organized in six sections, each with a particular emphasis as indicated in the following section titles: Fracture Technology Status and Application Experience; Crack Initiation, Propagation and Arrest; Ductile Tearing; Constraint, Stress State, and Local-Brittle-Zones Effects; Computational Techniques for Fracture and Corrosion Fatigue; and Codes and Standards for Fatigue, Fracture and Erosion/Corrosion

  10. The reactor vessel steels

    International Nuclear Information System (INIS)

    Bilous, W.; Hajewska, E.; Szteke, W.; Przyborska, M.; Wasiak, J.; Wieczorkowski, M.

    2005-01-01

    In the paper the fundamental steels using in the construction of pressure vessel water reactor are discussed. The properties of these steels as well as the influence of neutron irradiation on its degradation in the time of exploitation are also done. (authors)

  11. Vacuum distilling vessel

    Energy Technology Data Exchange (ETDEWEB)

    Reik, H

    1928-12-27

    Vacuum distilling vessel for mineral oil and the like, characterized by the ring-form or polyconal stiffeners arranged inside, suitably eccentric to the casing, being held at a distance from the casing by connecting members of such a height that in the resulting space if necessary can be arranged vapor-distributing pipes and a complete removal of the residue is possible.

  12. Visualization of vessel traffic

    NARCIS (Netherlands)

    Willems, C.M.E.

    2011-01-01

    Moving objects are captured in multivariate trajectories, often large data with multiple attributes. We focus on vessel traffic as a source of such data. Patterns appearing from visually analyzing attributes are used to explain why certain movements have occurred. In this research, we have developed

  13. GOLD PRESSURE VESSEL SEAL

    Science.gov (United States)

    Smith, A.E.

    1963-11-26

    An improved seal between the piston and die member of a piston-cylinder type pressure vessel is presented. A layer of gold, of sufficient thickness to provide an interference fit between the piston and die member, is plated on the contacting surface of at least one of the members. (AEC)

  14. Reactor vessel stud tensioner

    International Nuclear Information System (INIS)

    Malandra, L.J.; Beer, R.W.; Salton, R.B.; Spiegelman, S.R.; Cognevich, M.L.

    1982-01-01

    A quick-acting stud tensioner, for facilitating the loosening or tightening of a stud nut on a reactor vessel stud, has gripper jaws which when the tensioner is lowered into engagement with the upper end of the stud are moved inwards to grip the upper end and which when the tensioner is lifted move outward to release the upper end. (author)

  15. PDX vacuum vessel stress analysis

    International Nuclear Information System (INIS)

    Nikodem, Z.D.

    1975-01-01

    A stress analysis of PDX vacuum vessel is described and the summary of results is presented. The vacuum vessel is treated as a toroidal shell of revolution subjected to an internal vacuum. The critical buckling pressure is calculated. The effects of the geometrical discontinuity at the juncture of toroidal shell head and cylindrical outside wall, and the concavity of the cylindrical wall are examined. An effect of the poloidal field coil supports and the vessel outside supports on the stress distribution in the vacuum vessel is determined. A method evaluating the influence of circular ports in the vessel wall on the stress level in the vessel is outlined

  16. Revascularization for Left Main and Multivessel Coronary Artery Disease: Current Status and Future Prospects after the EXCEL and NOBLE Trials.

    Science.gov (United States)

    Al-Hijji, Mohammed; El Sabbagh, Abdallah; Holmes, David R

    2018-06-01

    Revascularization of severe left main and multivessel coronary artery disease has been shown to improve survival in both stable ischemic heart disease and acute coronary syndrome. While revascularization with coronary artery bypass surgery for these disease entities carries class I recommendation in most current guidelines, recent trials has shown potential comparable survival and cardiovascular outcomes between percutaneous and surgical interventions in patients with less complex coronary anatomy. Despite the conflicting results observed in the most recent left main revascularization trials, Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease (EXCEL) and Nordic-Baltic-British left main revascularization (NOBLE), both treatment strategies remain important for the management of left main disease (LMD) and multivessel disease (MVD) reflecting on the importance of heart team discussion. This review is focused on revascularization of LMD and MVD in patients who are not presenting with ST-segment elevation myocardial infarction, encompassing the evidence from historic and contemporary trials which shaped up current practices. This review discusses the heart team approach to guide decision making, including special populations that are not represented in clinical trials. Copyright © 2018. The Korean Society of Cardiology.

  17. Plain computed tomography for assessment of early coronary microcirculatory damage after revascularization therapy in acute myocardial infarction

    International Nuclear Information System (INIS)

    Kato, Masaya; Dote, Keigo; Sasaki, Shota

    2006-01-01

    Coronary microcirculatory damage is an important factor for the prognosis for acute myocardial infarction (MI) after revascularization. The myocardial enhancement area with contrast media infused during coronary revascularization therapy, detected by computed tomography (CT) just after revascularization, has been reported to correspond to the area of hemorrhagic infarction. The relationship between myocardial contrast enhancement and coronary microcirculatory damage was investigated in the present study. Thirteen patients with acute anterior MI underwent successful coronary revascularization within 6 h of symptom onset were enrolled. The coronary flow velocity pattern was measured using a Doppler guidewire and chest CT assessments were performed immediately after coronary revascularization. The ratio of mean CT number of the highest-enhanced myocardial area and the lumen of the left ventricle was defined as a relative CT number. The relative CT number significantly correlated with coronary diastolic deceleration time (r=-0.78, p<0.002) and coronary diastolic deceleration rate (r=0.74, p<0.04). It also correlated with peak myocardial enzyme release in plasma. Myocardial contrast enhancement detected using plain CT just after coronary reperfusion therapy implies coronary microcirculatory damage in acute MI. The relative CT number is useful in evaluating the impaired coronary microcirculatory state. (author)

  18. Functional outcomes of transmetatarsal amputation in the diabetic foot: timing of revascularization, wound healing and ambulatory status.

    Science.gov (United States)

    Mandolfino, T; Canciglia, A; Salibra, M; Ricciardello, D; Cuticone, G

    2016-12-01

    Transmetatarsal amputation (TMA) is an effective surgical approach to treat forefoot infection and gangrene in diabetic patients. However, a high rate of complications and failure to heal require reamputation in a large number of cases. We analysed the outcomes of TMA to define the role of revascularization, wound healing and ambulatory status. From January 2008 to January 2013, 218 diabetic patients with foot infection and gangrene, submitted to TMA associated to revascularization were followed until healing, amputation or death. Revascularization was done in 202 (92 %) cases. In 16 (7 %) no revascularization was required. The TMA was closed in 135 (62 %) and left open in 83 (38 %) cases. The reamputation rate was 34 % and major amputation 12.6 % at 1-year follow-up. Patient following ranged 2-30 months with a mean of 15 months. The functional outcomes, living at home and ambulation outdoors, were 60 and 36 % at hospital discharge after TMA, 81 and 77 % at 1-year follow-up. TMA associated to revascularization can provide an effective limb salvage and functional results in diabetic patients with forefoot tissue loss and infection.

  19. Lowering risk score profile during PCI in multiple vessel disease is associated with low adverse events: The ERACI risk score.

    Science.gov (United States)

    Rodriguez, Alfredo E; Fernandez-Pereira, Carlos; Mieres, Juan; Pavlovsky, Hernan; Del Pozo, Juan; Rodriguez-Granillo, Alfredo M; Antoniucci, David

    2018-02-13

    In recent years angiographic risk scores have been introduced in clinical practice to stratify different levels of risk after percutaneous coronary interventions (PCI). The SYNTAX score included all intermediate lesions in vessels ≥1.5 mm, consequently, multiple stent implantation was required. Four years ago, we built a new angiographic score in order to guide PCI strategy avoiding stent deployment both in intermediate stenosis as in small vessels, therefore these were not scored (ERACI risk score). The purpose of this mini review is to validate the strategy of PCI guided by this scoring, taking into account long term follow up outcomes of two observational and prospective registries where this policy was used. With this new risk score we have modified risk profile of our patient's candidates for PCI or coronary artery bypass surgery lowering the risk and PCI. The simple exclusion of small vessels and intermediate stenosis from the revascularization approach resulted in clinical outcome comparable with the one of fractional flow reserve guided revascularization. Low events rate at late follow up observed in both studies was also in agreement with guided PCI by functional lesion assessment observed by Syntax II registry, where investigators found lower events rate in spite of a few number of stents implanted per patient. use of ERACI risk scores may significantly reclassify patients into a lower risk category and be associated with low adverse events rate. Copyright © 2018. Published by Elsevier Inc.

  20. CONDUCCIÓN ANESTÉSICA DE LA REVASCULARIZACIÓN MIOCÁRDICA VIDEO-ASISTIDA. INFORME DE CINCO CASOS / Anesthetic conduction of video-assisted myocardial revascularization. Report of five cases

    Directory of Open Access Journals (Sweden)

    Elizabeth Rodríguez Rosales

    2011-06-01

    Full Text Available The advantages of video-assisted cardiac surgery are very necessary for high-risk patients, but subjecting them to possible complications is a big responsibility and a challenge for the cardiovascular anesthesiologist. This article presents the first five cases of video-assisted coronary artery bypass grafting in the country, and describes the anesthetic techniques and results. Also, the advantages of this surgical technique are discussed: less invasive, less postoperative pain, less duration of postoperative intubation and ventilation, minimal risk of infection and bleeding, reduced need for transfusions, and better healing and aesthetics of the wound. It was concluded that although this series is small, we consider it a good option for patients with ischemic heart disease and a single-vessel (anterior descending artery revascularization criterion, not accessible to intervention.

  1. Revascularization surgery for pediatric moyamoya disease. Significance of peri-operative management to avoid surgical complication

    International Nuclear Information System (INIS)

    Fujimura, Miki; Tominaga, Teiji

    2011-01-01

    Moyamoya disease is a chronic occlusive cerebrovascular disease with unknown etiology, which is one of the most common causes of child-onset stroke in Japan. Surgical revascularizations, both direct and indirect procedures, prevent cerebral ischemic attack by improving cerebral blood flow, while neurological deterioration during the acute stage after revascularization is not rare. The objective of this study was to clarify the concept of revascularization surgery for pediatric moyamoya disease while considering the risk of surgical complications in the acute stage. The present study includes 19 consecutive patients with moyamoya disease aged from 2 to 14 years old (mean 8.5), who underwent superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis with indirect pial synangiosis for 32 affected hemispheres. Single-photon emission computed tomography (SPECT) was performed 1 and 7 days after surgery in all cases to evaluate hemodynamic alteration after surgery. Long-term outcome was evaluated by the neurological status 3 months after surgery, and the underlying pathology of surgical complications in the acute stage was diagnosed based on SPECT and magnetic resonance findings. In 28 of 32 hemispheres (87.5%), patients showed a complete disappearance of ischemic attack, 4 of 32 hemispheres (12.5%) showed a reduction of ischemic attack, while none showed deterioration of their symptoms (0%). Transient focal neurologic deterioration due to cerebral hyperperfusion was evident in 2 patients (6.3%), and was resolved by blood pressure lowering. One patient developed pseudo-laminar necrosis probably due to a thrombosis one week after surgery (3.1%), which did not affect his long-term outcome. STA-MCA anastomosis with pial synangiosis is a safe and effective treatment for pediatric moyamoya disease. Routine cerebral blood flow measurement in the acute stage is essential to avoid surgical complications including both cerebral ischemia and hyperperfusion. (author)

  2. Myocardial revascularization in the elderly patient: with or without cardiopulmonary bypass?

    Directory of Open Access Journals (Sweden)

    Iglézias José Carlos Rossini

    2003-01-01

    Full Text Available OBJECTIVE: To verify if there is advantage in myocardial revascularization the elderly without cardiopulmonary bypass (CPB in relation to the use of the same, being considered the viability of complete myocardial revascularization (MR and the hospital morbidity and mortality. METHOD: We prospectively studied a hundred consecutive, no randomized patients, with age > or = 70 years, submitted to the primary and isolated myocardial revascularization between January and December of 2000. The patients were divided in two groups, G1 - 50 patients operated with CPB and G2 - 50 patients operated without CPB. Univariate testing of variables was performed with chi-squared analysis in the SPSS 10.0 Program and a p value less than 0.005 was considered significant. RESULTS: There was no renal failure or myocardial infarction (MI in both groups; the incidence of respiratory failure was identical in the two groups (4%; two patient of G1 they had Strokes, and 12 presented low output syndrome, occurrences not registered in G2. The need of ventilatory support > 24 hs was not significant between groups. Medium time of hospital stay was 21.8 and 11.7 days respectively (NS and the survival after 30 days were similar in the two groups. The patients' of G1 eighty percent had more than two approached arteries, against only 48% of G2 (p < 0.0001. CONCLUSION: Because the largest number of grafts in the patients of G1, we can affirm that the use of CPB can provide a larger probability of complete RM.

  3. Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery.

    Science.gov (United States)

    Lazzeroni, Davide; Bini, Matteo; Camaiora, Umberto; Castiglioni, Paolo; Moderato, Luca; Bosi, Davide; Geroldi, Simone; Ugolotti, Pietro T; Brambilla, Lorenzo; Brambilla, Valerio; Coruzzi, Paolo

    2018-01-01

    Background High levels of serum uric acid have been associated with adverse outcomes in cardiovascular diseases such as myocardial infarction and heart failure. The aim of the current study was to evaluate the prognostic role of serum uric acid levels in patients undergoing cardiac rehabilitation after myocardial revascularization and/or cardiac valve surgery. Design We performed an observational prospective cohort study. Methods The study included 1440 patients with available serum uric acid levels, prospectively followed for 50 ± 17 months. Mean age was 67 ± 11 years; 781 patients (54%) underwent myocardial revascularization, 474 (33%) cardiac valve surgery and 185 (13%) valve-plus-coronary artery by-pass graft surgery. The primary endpoints were overall and cardiovascular mortality while secondary end-points were combined major adverse cardiac and cerebrovascular events. Results Serum uric acid level mean values were 286 ± 95 µmol/l and elevated serum uric acid levels (≥360 µmol/l or 6 mg/dl) were found in 275 patients (19%). Overall mortality (hazard ratio = 2.1; 95% confidence interval: 1.5-3.0; p uric acid levels, even after adjustment for age, gender, arterial hypertension, diabetes, glomerular filtration rate, atrial fibrillation and medical therapy. Moreover, strong positive correlations between serum uric acid level and probability of overall mortality ( p uric acid levels predict mortality and adverse cardiovascular outcome in patients undergoing myocardial revascularization and/or cardiac valve surgery even after the adjustment for age, gender, arterial hypertension, diabetes, glomerular filtration rate and medical therapy.

  4. Penile artery shunt syndrome: a novel cause of erectile dysfunction after penile revascularization surgery.

    Science.gov (United States)

    Pavlinec, Jonathan G; Hakky, Tariq S; Yang, Christopher; Massis, Kamal; Munarriz, Ricardo; Carrion, Rafael E

    2014-09-01

    Penile revascularization is a surgical treatment option for erectile dysfunction (ED) in healthy individuals due to a focal arterial occlusion in the absence of generalized vascular disease. Most described failures have been attributed to graft stenosis or disruption of the anastomosis. We report a novel phenomenon called Penile Artery Shunt Syndrome that contributed to persistent ED in a patient after penile microvascular arterial bypass surgery. A 26-year-old man presented for evaluation of long-standing ED, which was attributed to trauma sustained 12 years earlier. He had difficulty obtaining and maintaining erections despite oral pharmacotherapy. Clinical data related to the case were studied, analyzed, and reviewed with urologic and radiologic specialists at multiple centers that collaborated in the care of this patient. Penile duplex ultrasound peak systolic velocities and five-item International Index for Erectile Function questionnaire scores were the main outcome measures. Initial diagnostic workup of the patient confirmed severe insufficiency of the left cavernosal artery, with no evidence of venous leak. The patient underwent penile microvascular arterial bypass surgery with anastomosis of the left inferior epigastric artery to the left dorsal penile artery. The patient had persistence of severe ED despite patent anastomosis by penile duplex ultrasound. Subsequent arteriography revealed an arterial shunt due to an aberrant obturator artery arising from the donor inferior epigastric artery. The patient underwent embolization of the aberrant obturator artery, with resolution of the shunt and marked improvement in erectile function. The presence of an aberrant obturator artery arising from the inferior epigastric artery may predispose to persistent ED after revascularization due to the creation of a shunt phenomenon. Pelvic arteriography may be useful in identifying anomalous anatomic considerations prior to penile revascularization and to evaluate patients

  5. Revascularization of the upper posterior circulation with the anterior temporal artery: an anatomical feasibility study.

    Science.gov (United States)

    Tayebi Meybodi, Ali; Lawton, Michael T; Griswold, Dylan; Mokhtari, Pooneh; Payman, Andre; Tabani, Halima; Yousef, Sonia; Benet, Arnau

    2017-09-22

    OBJECTIVE In various disease processes, including unclippable aneurysms, a bypass to the upper posterior circulation (UPC) including the superior cerebellar artery (SCA) and posterior cerebral artery (PCA) may be needed. Various revascularization options exist, but the role of intracranial (IC) donors has not been scrutinized. The objective of this study was to evaluate the anatomical feasibility of utilizing the anterior temporal artery (ATA) for revascularization of the UPC. METHODS ATA-SCA and ATA-PCA bypasses were performed on 14 cadaver specimens. After performing an orbitozygomatic craniotomy and opening the basal cisterns, the ATA was divided at the M 3 -M 4 junction and mobilized to the crural cistern to complete an end-to-side bypass to the SCA and PCA. The length of the recipient artery between the anastomosis and origin was measured. RESULTS Seventeen ATAs were found. Successful anastomosis was performed in 14 (82%) of the ATAs. The anastomosis point on the PCA was 14.2 mm from its origin on the basilar artery. The SCA anastomosis point was 10.1 mm from its origin. Three ATAs did not reach the UPC region due to a common opercular origin with the middle temporal artery. The ATA-SCA bypass was also applied to the management of an incompletely coiled SCA aneurysm. CONCLUSIONS The ATA is a promising IC donor for UPC revascularization. The ATA is exposed en route to the proximal SCA and PCA through the pterional-orbitozygomatic approach. Also, the end-to-side anastomosis provides an efficient and straightforward bypass without the need to harvest a graft or perform multiple or difficult anastomoses.

  6. Racial disparities in the use of cardiac revascularization: does local hospital capacity matter?

    Directory of Open Access Journals (Sweden)

    Suhui Li

    Full Text Available To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4 between 1995 and 2006.The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI. We identified the use of coronary artery bypass graft (CABG and percutaneous coronary intervention (PCI procedures within three months after the patient's initial admission for AMI. Multi-level hierarchical models were used to determine the extent to which racial disparities in procedure use were attributable to the variation in local hospital capacity.Blacks were less likely than whites to receive CABG (9.1% vs. 5.8%; p<0.001 and PCI (15.7% vs. 14.2%; p<0.001. The state-level racial disparity in use rate decreases for CABG, and increases for PCI, with the county adjustment. Higher number of revascularization hospitals per 1,000 AMI patients was associated with smaller within-county racial differences in CABG and PCI rates. Meanwhile, very low capacity of catheterization suites and AMI hospitals contributed to significantly wider racial gap in PCI rate.County variation in cardiac revascularization use rates helps explain the observed racial disparities. While smaller hospital capacity is associated with lower procedure rates for both racial groups, the impact is found to be larger on blacks. Therefore, consequences of fewer medical resources may be particularly pronounced for blacks, compared with whites.

  7. Revascularização total do miocárdio sem circulação extracorpórea: cinco anos de experiência Total myocardium revascularization without extracorporeal circulation: five-year experience

    Directory of Open Access Journals (Sweden)

    Rodrigo Milani

    2005-03-01

    sugerem que a operação para revascularização do miocárdio é segura e eficaz, podendo ser aplicada em todos os pacientes que necessitem de cirurgia coronariana com baixos índices de complicações e mortalidade.OBJECTIVE: To evaluate the immediate postoperative results of off-pump myocardium revascularization surgery by analyzing complications and mortality. METHOD: A total of 1440 patients were submitted to off-pump myocardium revascularization. The surgical technique is consisted in proximal occlusion of the approached artery, the application of the LIMA graft in the posterior pericardial deflection and stabilization of the target artery with a suction stabilizer. The distal anastomoses were performed first. RESULTS: Among the patients evaluated, 924 were male and 516 were female,with a mean age of 63.12 ± 8.76 years. The ejection fraction was normal in 749 patients, 740 (51.4% patients had suffered previous myocardial infarction and 687 (47.6% patients were in functional class III or IV. The mean EuroSCORE was 4.93 ± 3.32. The mean number of dial anastomoses was 3.12 ± 1.23 per patient. A total of 1173 (81.5% patients remained less than 12 hours on mechanical ventilation and among them, 888 (61.7% remained for less than six hours. The stay in the ICU was of one night for 330 (22.8% patients, for two nights for 930 (64.6% patients and 182 (12.4% patients remained three or more nights. In regards to complications, three (0.2% patients presented with renal insufficiency, six (0.4% patients suffered stroke, 19 (1.3% patients were reoperated for bleeding, 19 (1.3% patients had mediastinitis, 18 (1.25% patients suffered severe myocardial infarction and 212 (14.7% presented atrial fibrillation. There were 50 (3.5% deaths, 29 (2.5% of them being among the 1148 operated electively, nine (4.7% among 190 patients submitted to coronary re-operation and 12 (11.7% among 102 patients undergoing emergency operations. CONCLUSION: With the evolution of biomedical technological

  8. Laser plant "Iguana" for transmyocardial revascularization based on kW-level waveguide CO2 laser

    Science.gov (United States)

    Panchenko, Vladislav Y.; Bockeria, L. A.; Berishvili, I. I.; Vasiltsov, Victor V.; Golubev, Vladimir S.; Ul'yanov, Valery A.

    2001-05-01

    For many years the Institute on Laser and Information Technologies RAN has been developing a concept of high-power industrial CO2 lasers with diffusion cooling of the working medium. The paper gives a description of the laser medical system Iguana for transmyocardial laser revascularization (TMLR) as an example of various applications of high-power waveguide CO2 lasers. The clinical results of the TMLR method application in surgical treatment are presented. The methods of determination of the time, when the laser beam passes through the demarcation line between myocardium tissue and blood, are discussed.

  9. Mechanisms of thrombogenesis associated with diabetes mellitus: what defines the prognosis of invasive myocardial revascularization methods?

    Directory of Open Access Journals (Sweden)

    Irina Ziyatovna Bondarenko

    2013-11-01

    Full Text Available Cardiovascular intervention for myocardial revascularization dominates modern treatment of ischaemic heart disease (IHD. Current efficiency and safety of this method could never be achieved without the development of antiplatelet agents that provide indispensable protection for endovascular interventions. However, antithrombotic therapy is generally less effective in diabetes mellitus (DM, affecting prognosis for transcutaneous intervention. This trend is probably due to alteration of cellular homeostasis during hyperglycemia and correlates with its severity and persistence. This paper addresses modern understanding of factors affecting thrombogenesis in patients with DM.

  10. The Use of Bilateral Internal Mammary Arteries for Coronary Revascularization in Patients with COPD: Is It a Good Idea?

    Science.gov (United States)

    Hegazy, Yasser Yehia; Sodian, Ralf; Hassanein, Wael; Rayan, Amr; Ennker, Juergen

    2016-10-31

    The use of bilateral internal mammary arteries (BIMA) is limited worldwide, especially in patients with chronic obstructive pulmonary disease (COPD). Thus, we assessed the safety of the use of BIMA in COPD patients. From cohorts of 8846 patients operated on at our center for primary isolated multi-vessel coronary bypass operations between 2002 and 2012, we studied two propensity-matched groups of patients with COPD who received either single internal mammary artery and saphenous vein grafts (SIMA group: 137 patients) or exclusively BIMA (BIMA group: 137 patients). Preoperative data were similar regarding age (63.59 ± 10.62 versus 65.55 ± 9.61 years; P = .10), body mass index (BMI) (28.6 ± 4.71 versus 28.42 ± 3.86 kg/m2; P = .72), diabetes mellitus (32% versus 27%; P = .08), EuroSCORE (4.34 ± 2.23 versus 4.8 ± 2.52; P = .09) and ejection fraction (58.7 ± 13.08% versus 60.29 ± 14.13%; P = .32). No significant differences were noticed between the two groups regarding the number of peripheral anastomoses (3.07 ± 0.77 versus 3.06 ± 0.85; P = .90), total operation time (192.17 ± 43.06 versus 200.63 ± 39.24 min; P = .08), postoperative stroke (0.7% versus 0%; P = .29), myocardial infarction (2.92% versus 3.6%; P = .81), reintubation (2.9% versus 4.4%; P = .66), reexploration (0.7% versus 2.2%; P = .32), deep sternal wound infection (2.9% versus 3.6%; P = .81) and 30-day mortality (2.2% versus 2.9%; P = .77). However, postoperative blood loss (726.1 ± 468.35  versus 907 ± 890.58 mL; P = .03) was higher in the BIMA group. COPD patients can benefit from coronary artery revascularization with BIMA; however, postoperative blood loss can be higher using this technique.

  11. Vessels in Transit - Web Tool

    Data.gov (United States)

    Department of Transportation — A web tool that provides real-time information on vessels transiting the Saint Lawrence Seaway. Visitors may sort by order of turn, vessel name, or last location in...

  12. Revascularization of an impacted, immature dilacerated permanent maxillary central incisor associated with odontoma and a supernumerary tooth

    Directory of Open Access Journals (Sweden)

    Priya Subramaniam

    2013-01-01

    Full Text Available To intentionally replant an impacted immature permanent maxillary central incisor in the mixed dentition period followed by revascularization in order to achieve apical root closure. A 9-year-old boy presented with retained maxillary left primary incisors. Radiographic evaluation revealed the presence of a supernumerary tooth and an odontoma associated with an impacted permanent maxillary left central incisor, having root dilaceration. Treatment included surgical removal of mesiodens and odontoma. The impacted dilacerated permanent central incisor was removed and intentionally replanted, followed by revascularization of pulp. During the follow-up, root end closure with narrowing of canal space was observed, patient has been asymptomatic and the tooth remains vital. Revascularization of the immature reimplanted tooth showed continued root development and thickening of the lateral dentinal walls through deposition of new hard tissue and narrowing of the canal space.

  13. Reactor vessel sealing plug

    International Nuclear Information System (INIS)

    Dooley, R.A.

    1986-01-01

    An apparatus is described for sealing a cold leg nozzle of a nuclear reactor pressure vessel from a remote location comprising: at least one sealing plug for mechanically sealing the nozzle from the inside of the reactor pressure vessel. The sealing plug includes a plate and a cone assembly having an end part receptive in the nozzle, the plate being axially moveable relative to the cone assembly. The plate and cone assembly have confronting bevelled edges defining an opening therebetween. A primary O-ring is disposed about the opening and is supported on the bevelled edges, the plate being guidably mounted to the cone assembly for movement toward the cone assembly to radially expand the primary O-ring into sealing engagement with the nozzle. A means is included for providing relative movement between the outer plate and the cone assembly

  14. Mobile nuclear reactor containment vessel

    International Nuclear Information System (INIS)

    Thompson, R.E.; Spurrier, F.R.; Jones, A.R.

    1978-01-01

    A containment vessel for use in mobile nuclear reactor installations is described. The containment vessel completely surrounds the entire primary system, and is located as close to the reactor primary system components as is possible in order to minimize weight. In addition to being designed to withstand a specified internal pressure, the containment vessel is also designed to maintain integrity as a containment vessel in case of a possible collision accident

  15. Nuclear reactor vessel inspection apparatus

    International Nuclear Information System (INIS)

    Blackstone, E.G.; Lofy, R.A.; Williams, L.P.

    1979-01-01

    Apparatus for the in situ inspection of a nuclear reactor vessel to detect the location and character of flaws in the walls of the vessel, in the welds joining the various sections of the vessel, in the welds joining attachments such as nozzles, elbows and the like to the reactor vessel and in such attachments wherein an inspection head carrying one or more ultrasonic transducers follows predetermined paths in scanning the various reactor sections, welds and attachments

  16. Reactor vessel stud closure system

    International Nuclear Information System (INIS)

    Spiegelman, S.R.; Salton, R.B.; Beer, R.W.; Malandra, L.J.; Cognevich, M.L.

    1982-01-01

    A quick-acting stud tensioner apparatus for enabling the loosening or tightening of a stud nut on a reactor vessel stud. The apparatus is adapted to engage the vessel stud by closing a gripper around an upper end of the vessel stud when the apparatus is seated on the stud. Upon lifting the apparatus, the gripper releases the vessel stud so that the apparatus can be removed

  17. Long-term clinical and angiographic results of Sirolimus-Eluting Stent in Complex Coronary Chronic Total Occlusion Revascularization: the SECTOR registry.

    Science.gov (United States)

    Galassi, Alfredo R; Tomasello, Salvatore D; Costanzo, Luca; Campisano, Maria B; Barrano, Giombattista; Tamburino, Corrado

    2011-10-01

    Drug-eluting stents showed a better angiographic and clinical outcome in comparison with bare metal stent in chronic total occlusions (CTOs) percutaneous revascularization, however, great concerns still remain regarding the rate of restenosis and reocclusion in comparison with nonocclusive lesions. To evaluate angiographic and clinical outcomes after sirolimus-eluting stent (SES) implantation in the setting of a "real world" series of complex CTOs. From January 2006 to December 2008, 172 consecutive patients with 179 CTO lesions were enrolled into registry. Among these, successful recanalization was obtained in 144 lesions (80.4%) with exclusive SES implantation in 104 lesions. The 9-12 months angiographic follow-up was executed in 85.5% of lesions with evidence of angiographic binary restenosis in 16.8% of lesions. Total stent length and number of stent implanted were recognized as independent predictors of restenosis (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.28-107.09, P = 0.02) and (OR 5.8, 95% CI 1.39-23.55, P = 0.01), respectively.The 2-year clinical follow-up showed rates of target lesion revascularization, non-Q wave myocardial infarction, and total major adverse cardiovascular events (MACEs) of 11.1%, 2%, and 13.1%, respectively. Cox proportional-hazard analysis showed diabetes as independent predictor of MACEs (hazard ratio [HR] 4.832; 95% CI, 0.730-0.861; P = 0.028). Data from this registry demonstrate the long-term efficacy and safety of SES implantation after complex CTOs recanalization. ©2011, Wiley Periodicals, Inc.

  18. Reactor pressure vessel steels

    International Nuclear Information System (INIS)

    Van De Velde, J.; Fabry, A.; Van Walle, E.; Chaouuadi, R.

    1998-01-01

    Research and development activities related to reactor pressure vessel steels during 1997 are reported. The objectives of activities of the Belgian Nuclear Research Centre SCK/CEN in this domain are: (1) to develop enhanced surveillance concepts by applying micromechanics and fracture-toughness tests to small specimens, and by performing damage modelling and microstructure characterization; (2) to demonstrate a methodology on a broad database; (3) to achieve regulatory acceptance and industrial use

  19. Reactor Pressure Vessel Steels

    Energy Technology Data Exchange (ETDEWEB)

    Van de Velde, J.; Fabry, A.; Van Walle, E.; Chaoudi, R

    1998-07-01

    SCK-CEN's R and D programme on Reactor Pressure Vessel (RPV) Steels in performed in support of the RVP integrity assessment. Its main objectives are: (1) to develop enhanced surveillance concepts by applying micromechanics and fracture-toughness tests to small specimens, and by performing damage modelling and microstructure characterization; (2) to demonstrate the applied methodology on a broad database; (3) to achieve regulatory acceptance and industrial use. Progress and achievements in 1999 are reported.

  20. Phenomenological vessel burst investigations

    International Nuclear Information System (INIS)

    Hippelein, K.W.; Julisch, P.; Muz, J.; Schiedermaier, J.

    1985-07-01

    Fourteen burst experiments have been carried out using vessels with circumferential and longitudinal flaws, for investigation of the fracture behaviour, i.e. the time-related fracture opening. The vessels had dimensions (outer diameter x wall thickness = 800 x 47 mm) which correspond to the dimensions of the main coolant piping of a 1300 MW e PWR. The test specimens had been made of the base-safe material 20 MnMoNi 55 and of a special, 22 NiMoCr 37 base alloy. The experimental conditions with regard to pressure and temperature have been chosen so as to correspond to normal operating conditions of a PWR (p∝17.5 MPa, T∝300 0 C), i.e. the flaws have been so dimensioned that failure was to be expected at a pressure of p∝17.5 MPa. As a rule, water has been used as the pressure medium, or in some cases air, in order to influence the time-dependent pressure decrease. Fluid and structural dynamics calculations have also been made. In order to determine the impact of a fast propagating crack on the leak-to-fracture curve, which normally is defined by quasistationary experiments, suitable tests have been made with large-volume, cylindrical vessels (outer diameter x wall thickness x length = 3000 x 21 x 14000 mm) made of the material WSt E 43. The leak-before-fracture criterion has been confirmed. (orig./HP) [de

  1. Ionizing radiations and blood vessels

    International Nuclear Information System (INIS)

    Vorob'ev, E.I.; Stepanov, R.P.

    1985-01-01

    Data on phenomenology of radiation-induced changes in blood vessels are systematized and authors' experience is generalized. Modern concepts about processes leading to vessel structure injury after irradiation is critically analyzed. Special attention is paid to reparation and compensation of X-ray vessel injury, consideration of which is not yet sufficiently elucidated in literature

  2. Ionizing radiations and blood vessels

    International Nuclear Information System (INIS)

    Vorob'ev, E.I.; Stepanov, R.P.

    1985-01-01

    Data on phenomeology of radiation changes of blood vessels are systemized and the authors' experience is generalyzed. A critical analysis of modern conceptions on processes resulting in vessel structure damage after irradiation, is given. Special attention is paid to reparation and compensation of radiation injury of vessels

  3. Targeting VEGF in canine oxygen-induced retinopathy - a model for human retinopathy of prematurity

    Directory of Open Access Journals (Sweden)

    McLeod DS

    2016-05-01

    Full Text Available D Scott McLeod, Gerard A Lutty Department of Ophthalmology, Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, USA Abstract: Development of the dog superficial retinal vasculature is similar to the mechanism of human retinal vasculature development; they both develop by vasculogenesis, differentiation, and assembly of vascular precursors called angioblasts. Canine oxygen-induced retinopathy (OIR was first developed by Arnall Patz in an effort to experimentally determine the effects of hyperoxia on the development of the retinal vasculature. The canine OIR model has many characteristics in common with human retinopathy of prematurity. Exposure of 1-day-old dogs to hyperoxia for 4 days causes a vaso-obliteration throughout the retina. Vasoproliferation, after the animals have returned to room air, is robust. The initial small preretinal neovascular formations anastomose to form large preretinal membranes that eventually cause tractional retinal folds. The end-stage pathology of the canine model is similar to stage IV human retinopathy of prematurity. Therefore, canine OIR is an excellent forum to evaluate the response to drugs targeting VEGF and its receptors. Evaluation of an antibody to VEGF-R2 and the VEGF-Trap demonstrated that doses should be titered down so that preretinal neovascularization is inhibited but retinal revascularization is able to proceed, vascularizing peripheral retina and preventing it from being a source of VEGF. Keywords: angioblasts, blood vessels, endothelial cells, oxygen, retinopathy, retina, vascular endothelial cell growth factor

  4. PREVENTION OF LEFT VENTRICLE SYSTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION AFTER CARDIAC REVASCULARIZATION

    OpenAIRE

    A. L. Alyavi; B. A. Alyavi; M. L. Kenzhaev; S. R. Kenzhaev

    2009-01-01

    Aim. To study effects of bioflavonoid quercetin (corvitin) on left ventricle (LV) systolic dysfunction in patients with acute coronary syndrome with ST segment elevation (ACS+ST) after cardiac revascularization.Material and methods. 60 patients with ACS+ST (44,2±1,3 y.o.) were examined. Patients were admitted to hospital within 6 hours after complaints beginning. Patients were randomized in two groups. 30 patients of group A had standard therapy and cardiac revascularization. 30 patients of g...

  5. Hepatorenal bypass using autogenous, free internal iliac artery graft: An attractive alternative to revascularize the right kidney in Takayasu's disease.

    Science.gov (United States)

    Khattar, Nikhil; Guleria, Sandeep; Sharma, Sanjeev

    2012-04-01

    Nonspecific aortoarteritis or Takayasu's disease (TD) is a chronic pan endarteritis of unknown origin involving the aorta and its major branches affecting young adults especially women. The disease is more common in eastern Asian countries. Hypertension in these patients generally reflects as renal artery stenosis, which is seen in 28-75% of patients. Surgical revascularization is occasionally needed in patients with failed medical management or endovascular interventions. We report two cases of Takayasu's arteritis in young women where renal revascularization was done using free internal iliac artery hepatorenal bypass graft with excellent control of hypertension in the postoperative period.

  6. Revascularization of the internal carotid artery for isolated, stenotic, and symptomatic kinking.

    Science.gov (United States)

    Illuminati, Giulio; Calió, Francesco G; Papaspyropoulos, Vassilios; Montesano, Giuseppe; D'Urso, Antonio

    2003-02-01

    The operation for isolated, stenotic, and symptomatic kinking of the internal carotid artery is safe and effective in preventing stroke and relieving the symptoms of cerebral ischemia. A consecutive sample clinical study with a mean follow-up of 44 months. The surgical department of an academic tertiary care center and an affiliated secondary care center. Fifty-four patients with a mean age of 67 years underwent 55 revascularizations of the internal carotid artery. The surgical procedures consisted of the following: shortening and reimplantation in the common carotid artery in 36 cases, bypass grafting in 15 cases, and transposition into the external carotid artery in 4 cases. Cumulative survival, primary patency, and stroke-free and neurologic symptom-free rates expressed by standard life-table analysis. No patients died in the postoperative period. The postoperative stroke rate was 1.8%. The cumulative rates (SEs) at 5 years were as follows: survival, 70% (10.2%); primary patency, 89% (7.8%); overall stroke free, 92% (6.8%); ipsilateral stroke free, 96% (5.3%); neurologic symptom free, 90% (7.5%); and ipsilateral symptom free, 93% (6.5%). Revascularization of the internal carotid artery for the treatment of isolated, stenotic, and symptomatic kinking is safe and effective in preventing stroke and relieving symptoms of cerebrovascular insufficiency.

  7. Revascularization of Immature Necrotic Teeth: Platelet rich Fibrin an Edge over Platelet rich Plasma

    Directory of Open Access Journals (Sweden)

    Neelam Mittal

    2012-03-01

    Full Text Available Introduction: Revascularization is one such entity that has found its clinical application in the field of endodontics for the manage-ment of immature permanent necrotic teeth. The protocols for revascularization of such teeth focus especially on delivery of stem cells and scaffolds in a nonsurgical manner rather than concentrated growth micro molecules.The hypothesis: This article proposes the role of platelet concentrates such as platelet rich fibrin (PRF and platelet rich plasma (PRP in accelerating the regenerative process in such teeth. PRF unlike PRP is associated with slow, continuous and substantial re-lease of morphogens. It is hypothesized further if PRF instead of PRP when placed through immature apices in an orthograde manner can open newer gates for fast and controlled growth in young, ne-crotic, non-infected teeth.Evaluation of the hypothesis: Enhancement of the healing kinetics can be evaluated by change in size of periapical radiolucency, thickness of the dentinal walls, root elongation and apical closure compared between preoperative and postoperative standardized two dimensional/three dimensional radiographs taken on regular follow ups.

  8. Evaluation of diffusion-perfusion mismatch for determining indication for emergency endovascular revascularization

    International Nuclear Information System (INIS)

    Masuda, Atsushi; Miki, Takanori; Matsumoto, Hiroaki

    2010-01-01

    We evaluated the usefulness of assessing by diffusion-perfusion mismatch (D/P mismatch) whether there is adaptation of neuroendovascular revascularization for acute ischemic stroke out of intravenous tissue plasminogen activator (IV t-PA). We retrospectively analyzed 24 patients who underwent D/P mismatch and endovascular treatment between October 2005 and September 2008. This investigation included stroke patients with a National Institutes of Health Stroke Scale (NIHSS) score less than 4. Sixteen acute ischemic stroke patients had an NIHSS score greater than 5. Eight patients (50%) had a favorable neurological outcome (modified Rankin Scale 0 to 2). Eight acute ischemic stroke patients had an NIHSS score equal to or less than 4. Four patients who underwent emergency endovascular treatment on admission had a favorable neurological outcome, but 3 patients treated for progressive stroke after admission all had a poor prognosis. Evaluating D/P mismatch was useful for determining the adaptation of emergency neuroendovascular revascularization for acute ischemic stroke out of IV t-PA. Acute ischemic stroke patients with an NIHSS score equal to or less than 4 and diffusion/perfusion mismatch need careful observation to enable endovascular treatment immediately after progressive stroke. (author)

  9. Long-term follow up of revascularization using platelet-rich fibrin.

    Science.gov (United States)

    Ray, Herbert L; Marcelino, Janel; Braga, Raquel; Horwat, Richard; Lisien, Michael; Khaliq, Shahryar

    2016-02-01

    Trauma is one of the primary causes of tooth loss and pulpal injury in adolescents and children. Prior to regenerative endodontics, treatment of necrotic, immature teeth with open apices was limited to long-term calcium hydroxide (Ca(OH)2 ) apexification and subsequent root canal therapy or extraction. Through revascularization, retention of these teeth can be achieved and the elimination of patient symptoms and the radiographic appearance of continued root development were obtained. This report illustrates a revascularization protocol through a case where platelet-rich fibrin (PRF) was utilized as an autologous scaffold for traumatized, necrotic, immature teeth with incomplete root development. Through consistent follow-up reports, comprising of both clinical examination and radiographs, marked improvement in the condition of the traumatized tooth was noted. This case demonstrates the feasibility of utilizing PRF as an effective treatment protocol for traumatized teeth in lieu of traditional treatment protocols, such as long-term calcium hydroxide (Ca(OH)2 ) apexification or extraction. The choice of utilizing PRF, as opposed to other platelet concentrates, such as platelet-rich plasma (PRP) or a blood clot, lies in PRF's ability to allow for a slow, long-term release of autologous growth factors. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Revascularization procedure in an open apex tooth with external root resorption: A case report

    Directory of Open Access Journals (Sweden)

    Mahsa Dastpak

    2017-06-01

    Full Text Available External inflammatory root resorption (EIR represents a challenge in endodontic practice. EIR commonly occurs after dental trauma that results in periodontal ligament injury, pulp necrosis and subsequent infection.  Treatment of EIR is based on disinfecting the root canal system through chemomechanical procedures and then filling it with calcium hydroxide or triple antibiotic paste. Dental trauma commonly occurs in young patients whose teeth are not fully formed and have thin dentinal walls and open apices. Revascularization therapy has proven to be suitable for treatment of root canals of teeth with pulp necrosis and open apices. This case report presents successful revascularization treatment of a permanent immature tooth with external root resorption and chronic apical periodontitis. The tooth was treated by the protocol suggested by the American Association of Endodontics (AAE, consisted of disinfecting the root canal system, filling it with blood clot and sealing the root canal with mineral trioxide aggregate followed by bonded resin restoration. The symptoms disappeared, the size of the periapical lesion reduced and the tooth was asymptomatic during the 12 month follow up period.

  11. Incidence and predictors of target lesion failure in a multiethnic Asian population receiving the SYNERGY coronary stent: A prospective all-comers registry.

    Science.gov (United States)

    Ananthakrishna, Rajiv; Kristanto, William; Liu, Li; Chan, Siew-Pang; Loh, Poay Huan; Tay, Edgar L; Chan, Koo Hui; Chan, Mark Y; Lee, Chi-Hang; Low, Adrian F; Tan, Huay Cheem; Loh, Joshua P

    2018-03-07

    To evaluate the target lesion failure (TLF) rate of the SYNERGY stent in all-comers, multiethnic Asian population. Currently, most drug eluting stents deliver anti-proliferative drugs from a durable polymer which is associated with a risk of late stent thrombosis. The novel everolimus-eluting, platinum chromium SYNERGY stent is coated with a bioabsorbable abluminal polymer that resolves within 4 months. This was a prospective, single center registry of consecutive patients treated with the SYNERGY stent between December 2012 and April 2015. The primary outcome was the incidence of TLF, defined as the combination of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization (TLR) at 1 year. A total of 807 patients received the SYNERGY stent during the study period. One-year clinical outcome data was available for 765 patients (94.8%) and were considered for statistical analysis. The mean age was 60.7 ± 10.8 years, and 83.4% were males. Patients with acute myocardial infarction consisted of 50.3% (ST-segment elevation myocardial infarction: 23.0%, Non-ST-segment elevation myocardial infarction: 27.3%) of the study population. The treated lesions were complex (ACC/AHA type B2/C: 72.7%). The primary end point of TLF at 1 year was 5.8%. Rates of cardiac mortality, target vessel myocardial infarction, and TLR were 4.2, 1.0, and 1.3%, respectively, at 1 year. Predictors of the incidence and time to early TLF were female gender, Malay ethnicity, diabetes mellitus, acute myocardial infarction at presentation, a prior history of coronary artery bypass surgery and the presence of lesion calcification. The incidence of definite stent thrombosis was 0.4% at 1 year. In this registry, the use of the SYNERGY stent was associated with low rates of TLF at 1 year. © 2018 Wiley Periodicals, Inc.

  12. Liquid hydrogen and deuterium targets

    International Nuclear Information System (INIS)

    Bougon, M.; Marquet, M.; Prugne, P.

    1961-01-01

    A description is given of 1) Atmospheric pressure target: liquid hydrogen, 400 mm thickness; thermal insulation: styrofoam; the hydrogen vapors are used to improve the target cooling; Mylar windows. 2) Vacuum target: 12 liter content: hydrogen or deuterium; liquid thickness 400 mm; thermal insulation is afforded by a vacuum vessel and a liquid nitrogen shield. Recovery and liquefaction of deuterium vapors are managed in the vacuum vessel which holds the target. The target emptying system is designed for operating in a few minutes. (author) [fr

  13. Pressure vessel lid

    International Nuclear Information System (INIS)

    Schoening, J.; Elter, C.; Becker, G.; Pertiller, S.

    1986-01-01

    The invention concerns a lid for closing openings in reactor pressure vessels containing helium, which is made as a circular casting with hollow spaces and a flat floor and is set on the opening and kept down. It consists of helium-tight metal cast material with sufficient temperature resistance. There are at least two concentric heat resistant seals let into the bottom of the lid. The bottom is in immediate contact with the container atmosphere and has hollow spaces in its inside in the area opposite to the opening. (orig./HP) [de

  14. [Small vessel cerebrovascular disease].

    Science.gov (United States)

    Cardona Portela, P; Escrig Avellaneda, A

    2018-05-09

    Small vessel vascular disease is a spectrum of different conditions that includes lacunar infarction, alteration of deep white matter, or microbleeds. Hypertension is the main risk factor, although the atherothrombotic lesion may be present, particularly in large-sized lacunar infarctions along with other vascular risk factors. MRI findings are characteristic and the lesions authentic biomarkers that allow differentiating the value of risk factors and defining their prognostic value. Copyright © 2018 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. [Clinical features of 32 patients with cutaneous small vessel vasculitis].

    Science.gov (United States)

    López de Maturana, Donaldo; Amaro, Patricio; Segovia, Laura; Balestrini, Claudia

    2004-02-01

    The skin is a common target of small vessel vasculitis, with a wide assortment of pathological changes. This condition is usually associated to systemic diseases. To report the clinical and pathological features of patients with cutaneous small vessel vasculitis. A retrospective review of 32 patients with a pathological diagnosis of cutaneous vasculitis. Seventy two percent of patients were women. Cutaneous lesions were mainly located in the lower limbs (94%). The most common lesion was palpable purpura (62%). Connective tissue diseases and systemic vasculitis were the most commonly associated systemic diseases. Palpable purpura is the most common manifestation of cutaneous small vessel vasculitis, that is usually associated to connective tissue diseases or systemic vasculitis.

  16. Prophylactic administration of recombinant activated factor VII in coronary revascularization surgery

    Directory of Open Access Journals (Sweden)

    Mohamed Essam Abdel-Meguid

    2013-01-01

    Full Text Available Objective: The objective of this clinical trial is to study the effectiveness of administering recombinant activated factor VII (rFVIIa in reducing the amount of bleeding and the need for homologous blood and products transfusion in cardiac surgical coronary revascularization procedures done under cardiopulmonary bypass (CPB. Methods: In a randomized controlled prospective observational study, 30 patients were scheduled for elective cardiac revascularization under CPB. Patients were randomly allocated into two groups. In Group I (Control group, no rFVIIa was administered following CPB. In Group II (Study group, a dose of 90 ug/Kg of rFVIIa was administered following weaning off CPB. The total amount of chest tube drain during the 1 st 24 h following surgery was recorded as well as the qualitative and quantitative assessments of homologous blood and products transfusion. Serial analysis of hematological parameters including hemoglobin level and coagulation test in a definite data points was done. T0=baseline readings prior to CPB, T1=off CPB after protamine administration and before administration of the study drug, T2=on Cardiac Intensive Care Unit (CICU admission, T3=12 h post-CICU admission, and T4=24 h post-CICU admission. Results: Considering the total chest tube drainage, mean values showed statistically significant results with a P value of 0.001. Homologous blood and products transfusion were statistically lower in the study group. Regarding the mean values for hematological assessment, results showed statistically lower International Normalized Ratio values at CICU admission and 12 h post-CICU admission with a P value of 0.018 and 0.004, respectively. Also, the Partial Thromboplastin Time mean values were statistically lower at same timings with estimated P values of 0.04 and 0.001, respectively. Conclusion: It is concluded that the prophylactic use of rFVIIa in patients undergoing coronary revascularization surgery under the management

  17. Incessant ventricular tachycardia early after acute myocardial infarction: efficacy of radiofrequency catheter ablation but not of optimal coronary revascularization.

    Science.gov (United States)

    Bonanno, C; Ometto, R; Finocchi, G; Rulfo, F; La Vecchia, L; Vincenzi, M

    1999-12-01

    Incessant ventricular tachycardia is an arrhythmia refractory to conventional antiarrhythmic treatment. We describe the case of 55-year-old man who presented incessant ventricular tachycardia in the early post-acute phase of myocardial infarction. Optimal coronary revascularization was not effective, but radiofrequency catheter ablation was able to eliminate the anatomic substrate and clinical arrhythmic recurrence.

  18. Diagnosis of myocardial infarction using the new universal definition: is it enough for risk stratification and guiding decision for revascularization?

    Science.gov (United States)

    Calé, Rita; Ferreira, Jorge; Aguiar, Carlos; Santos, Nuno; Carmo, Pedro; Figueira, João; Raposo, Luis; Gonçalves, Pedro; Silva, José Aniceto

    2010-12-01

    Abstract Objectives: Evaluate the new ESC/ACCF/AHA/WHF universal definition of myocardial infarction (MI) in relation to its prognostic implications and the role for guiding decision for revascularization. It was also compared with the multivariable based GRACE Risk Score (GRS). Single centre registry of 389 consecutive patients admitted with non-ST-segment elevation (NSTE) ACS. We calculated the adjusted HR & 95%CI for death/MI at 30-days and one-year follow-up, between the presence or absence of MI using: (1) universal definition: > 99th URL for cTnI (> 0.06 ng/ml) or MBm (> 3.2 ng/ml); (2) MBm > 2 × URL (> 12.2 ng/ml); 3) old WHO: MBact > 2 × URL (> 32U/l). Logistic analysis was performed to test the interaction between tertiles of biomarkers or GRS and the effect of revascularization on the outcome. The universal definition increased the incidence of MI in 3.5-fold for cTnI, but was not an independent predictor of outcome. The GRS was the only independent predictor of prognosis at 30-days and one-year. The interaction with the prognostic impact of revascularization was only present for the GRS categorized by tertiles. In a contemporary unselected population with NSTE-ACS, the universal definition of MI alone was not adequate for risk assessment and revascularization decision making. These purposes were fully addressed with the GRS.

  19. Use of a halo frame for optimum intra- and post-operative management after scalp replantation/revascularization.

    Science.gov (United States)

    Koul, Ashok R; Nahar, Sushil; Valandi, Beena; Praveen, Kumar H P

    2012-09-01

    We present a new technique for stabilizing an avulsed scalp during and after replantation/revascularization. We used an aluminium "halo" frame with 4 screws. This technique can rigidly stabilize an avulsed scalp and eliminate the possibility of shearing/pressure necrosis. This device can make perioperative management easier and more comfortable for the patient and caregivers.

  20. Free Radical Damage in Ischemia-Reperfusion Injury: An Obstacle in Acute Ischemic Stroke after Revascularization Therapy

    Directory of Open Access Journals (Sweden)

    Ming-Shuo Sun

    2018-01-01

    Full Text Available Acute ischemic stroke is a common cause of morbidity and mortality worldwide. Thrombolysis with recombinant tissue plasminogen activator and endovascular thrombectomy are the main revascularization therapies for acute ischemic stroke. However, ischemia-reperfusion injury after revascularization therapy can result in worsening outcomes. Among all possible pathological mechanisms of ischemia-reperfusion injury, free radical damage (mainly oxidative/nitrosative stress injury has been found to play a key role in the process. Free radicals lead to protein dysfunction, DNA damage, and lipid peroxidation, resulting in cell death. Additionally, free radical damage has a strong connection with inducing hemorrhagic transformation and cerebral edema, which are the major complications of revascularization therapy, and mainly influencing neurological outcomes due to the disruption of the blood-brain barrier. In order to get a better clinical prognosis, more and more studies focus on the pharmaceutical and nonpharmaceutical neuroprotective therapies against free radical damage. This review discusses the pathological mechanisms of free radicals in ischemia-reperfusion injury and adjunctive neuroprotective therapies combined with revascularization therapy against free radical damage.

  1. An automated vessel segmentation of retinal images using multiscale vesselness

    International Nuclear Information System (INIS)

    Ben Abdallah, M.; Malek, J.; Tourki, R.; Krissian, K.

    2011-01-01

    The ocular fundus image can provide information on pathological changes caused by local ocular diseases and early signs of certain systemic diseases, such as diabetes and hypertension. Automated analysis and interpretation of fundus images has become a necessary and important diagnostic procedure in ophthalmology. The extraction of blood vessels from retinal images is an important and challenging task in medical analysis and diagnosis. In this paper, we introduce an implementation of the anisotropic diffusion which allows reducing the noise and better preserving small structures like vessels in 2D images. A vessel detection filter, based on a multi-scale vesselness function, is then applied to enhance vascular structures.

  2. Lower extremity revascularization using directional atherectomy: 12-month prospective results of the DEFINITIVE LE study.

    Science.gov (United States)

    McKinsey, James F; Zeller, Thomas; Rocha-Singh, Krishna J; Jaff, Michael R; Garcia, Lawrence A

    2014-08-01

    The aim of this study was to assess the safety and effectiveness of directional atherectomy (DA) for endovascular treatment of peripheral arterial disease (PAD) in infrainguinal arteries in patients with claudication or critical limb ischemia. To date, no prospective, multicenter, independently-adjudicated study has evaluated the effectiveness and durability of DA in the treatment of PAD. Previous DA studies have not been prospectively powered to evaluate any differences in outcomes in patients with and without diabetes. DEFINITIVE LE (Determination of EFfectiveness of the SilverHawk(®) PerIpheral Plaque ExcisioN System (SIlverHawk Device) for the Treatment of Infrainguinal VEssels / Lower Extremities) prospectively enrolled subjects at 47 multinational centers with an infrainguinal lesion length up to 20 cm. Primary endpoints were defined as primary patency at 12 months for claudicants and freedom from major unplanned amputation for critical limb ischemia (CLI) subjects. A pre-specified statistical hypothesis evaluated noninferiority of primary patency in diabetic versus nondiabetic claudicants. Independent angiographic and sonographic core laboratories assessed outcomes, and events were adjudicated by a clinical events committee. A total of 800 subjects were enrolled. The 12-month primary patency was 78% (95% confidence interval: 74.0% to 80.6%) in claudicants, with a 77% rate in the diabetic subgroup versus 78% in the nondiabetic subgroup (noninferior, p < 0.001). The rate of freedom from major unplanned amputation of the target limb at 12 months in CLI subjects was 95% (95% confidence interval: 90.7% to 97.4%). Periprocedural adverse events included embolization (3.8%), perforation (5.3%), and abrupt closure (2.0%). The bail-out stent rate was 3.2%. The DEFINITIVE LE study demonstrated that DA is a safe and effective treatment modality at 12 months for a diverse patient population with either claudication or CLI. Furthermore, DA was shown to be noninferior for

  3. Superior long term outcome associated with native vessel versus graft vessel PCI following secondary PCI in patients with prior CABG.

    Science.gov (United States)

    Mavroudis, Chrysostomos A; Kotecha, Tushar; Chehab, Omar; Hudson, Jonathan; Rakhit, Roby D

    2017-02-01

    Secondary percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass graft surgery is increasingly common. Graft vessel PCI has higher rates of adverse events compared with native coronary vessel PCI. To investigate the clinical outcomes of patients with prior CABG who underwent secondary PCI of either a graft vessel (GV), a native coronary vessel (NV) or both graft and native (NG) vessels. 220 patients (84% male) who underwent PCI in our institution to either GV (n=89), NV (n=103) or both GV and NV (NG group) (n=28) were studied. The study population underwent 378 procedures (GV group; n=126, NV group; n=164 and NG group; n=88). Median follow up was for 36months [range 2-75months]. Target vessel revascularisation (TVR) occurred in 12.5% of the GV group and 3.6% in the NV group [p=0.0004], and was predominantly due to in-stent restenosis. Patients who had PCI due to TVR were more likely to suffer from diabetes and peripheral vascular disease. History of chronic renal failure was associated with higher risk (HR 2.21, p=0.005) whereas preserved left ventricular ejection fraction (LVEF) with lower risk (HR 0.17, p=0.0007) of death. The median survival (interval between CABG and end of follow-up period) was lower in the GV compared with the NV group (315 vs 372months p=0.005). This registry demonstrates inferior long term outcome for patients undergoing secondary PCI of GV versus NV. Where possible, a strategy of NV rather than GV target PCI should be considered in patients with prior CABG. Secondary PCI in patients with prior CABG surgery is increasingly common. Graft vessel PCI has inferior outcomes with high rates of restenosis and occlusion compared with native coronary vessel PCI. We studied the clinical outcomes of 220 patients with prior CABG who underwent secondary PCI to either a graft vessel (GV), a native coronary vessel (NV) or both graft and native (NG) vessels. Target vessel revascularisation was 5 times higher in the GV

  4. Inpatient and outpatient cardiac rehabilitation programmes improve cardiometabolic risk in revascularized coronary patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Claudiu Avram

    2010-12-01

    Full Text Available The purpose of this paper is to evaluate cardiometabolic risk reduction of diabetic patients following coronary revascularizationprocedures after participation in outpatients or inpatients cardiac rehabilitation programmes. Materials and methods: weperformed a retrospective analytical study which included a group of 103 revascularized coronary patients with diabetesmellitus. Depending on participation in a cardiac rehabilitation program we have defined the following subgroups of patients:Group O (N=37 - attended the outpatient cardiac rehabilitation program; Group H (N=37 - attended the inpatient cardiacrehabilitation program; Group C (N=34 - did not participate in any cardiac rehabilitation program. Between those two momentsof assessment: T0 - revascularization / early post-revascularization and T1 - time of the interview (16±2.3 months afterrevascularization, patients in groups A and S participated in outpatient cardiac rehabilitation program (12 weeks, 3sessions/week of exercise training, with clinical and paraclinical evaluation scheduled at 1, 6, 12 months afterrevascularization, or inpatient cardiac rehabilitation program (3 weeks, intensive sessions, scheduled at 1, 3, 6 and 12months after revascularization. Results: at the end of the study, we found significant differences among the three groups forthe following parameters: body mass index (p=0.01, systolic blood pressure (p=0.002, total cholesterol (p<0.001, LDLcholesterol(p<0.001 and non-HDL cholesterol (p=0.004 in favor of groups A and S, that have participated in comprehensivecardiac rehabilitation programs. Conclusions: comprehensive cardiac rehabilitation programmes, performed outpatient orinpatient, are effective methods of reducing the high cardiometabolic risk, specific in revascularized coronary patients withdiabetes.

  5. Revascularization with percutaneous coronary intervention does not affect androgen status in males with chronic stable angina pectoris.

    Science.gov (United States)

    Gosai, J N; Charalampidis, P; Nikolaidou, T; Parviz, Y; Morris, P D; Channer, K S; Jones, T H; Grech, E D

    2016-05-01

    There is a clear association between low serum testosterone and coronary artery disease (CAD) in men. Hypotestosteronaemia is associated with accelerated atherosclerosis and a quarter of men with CAD are biochemically hypogonadal. Amongst those with CAD, hypotestosteronaemia is associated with increased mortality. Testosterone vasodilates coronary arteries, and exogenous testosterone reduces ischaemia. Whether hypotestosteronaemia is a cause or a consequence of CAD remains unanswered. The aim of this prospective observational study was to investigate whether coronary revascularization affected androgen status in men with stable angina pectoris. Twenty five men (mean age 62.7, SD 9.18) with angiographically significant CAD and symptomatic angina underwent full coronary revascularization by percutaneous coronary intervention. Androgen status and symptoms of angina, stress, depression and sexual function were assessed before, and at one and 6 months after the coronary revascularization. All patients underwent complete revascularization which was associated with a significant reduction in angina symptoms and ischaemia. No significant difference was seen in total testosterone (11.33 nmol/L baseline; 12.56, 1 month post; 13.04 at 6 months; p = 0.08). A significant and sustained rise in sex hormone-binding globulin was seen (33.99 nm/L baseline; 36.11 nm/L 1 month post PCI; 37.94 nm/L at 6 months; p = 0.03) Overall, there was no significant alteration in any other marker of androgen status including free testosterone or bioavailable testosterone. There was no change in symptoms of anxiety, depression or sexual function. Coronary revascularization has no sustained effect on androgen status. This supports the hypothesis that hypotestosteronaemia is not a consequence of angina pectoris or myocardial ischaemia. © 2016 American Society of Andrology and European Academy of Andrology.

  6. [Ischemic origin of diabetic foot disease. Epidemiology, difficulties of diagnosis, options for prevention and revascularization].

    Science.gov (United States)

    Kolossváry, Endre; Bánsághi, Zoltán; Szabó, Gábor Viktor; Járai, Zoltán; Farkas, Katalin

    2017-02-01

    "Diabetic foot" as definition covers a multifactorial clinical condition. According to the recent epidemiological data, the role of lower limb ischemia is getting more influential over other pathological causes, like neuropathy, infections and bone or soft tissue deformity. In diabetes, vascular disease leads to increased risk for leg ulcers and minor or major amputations. The traditional diagnostic tools for recognition of peripheral arterial disease have limited value because of diabetes specific clinical manifestations. Available vascular centers with special expertise and diagnostic tools are the prerequisite for efficient diagnosis supporting timely recognition of peripheral arterial disease. In course of treatment of diabetic foot with ischemic origin, beyond effective medical treatment revascularization (open vascular surgery or endovascular procedures) has paramount importance for prevention of limb loss. Vascular teams of vascular specialists, vascular surgeons and interventional radiologist in dedicated centers in multidisciplinary cooperation with other professions represent public health issue in effective prevention. Orv. Hetil., 2017, 158(6), 203-211.

  7. Diffusion-cooled high-power single-mode waveguide CO2 laser for transmyocardial revascularization

    Science.gov (United States)

    Berishvili, I. I.; Bockeria, L. A.; Egorov, E. N.; Golubev, Vladimir S.; Galushkin, Michail G.; Kheliminsky, A. A.; Panchenko, Vladislav Y.; Roshin, A. P.; Sigaev, I. Y.; Vachromeeva, M. N.; Vasiltsov, Victor V.; Yoshina, V. I.; Zabelin, Alexandre M.; Zelenov, Evgenii V.

    1999-01-01

    The paper presents the results on investigations and development of multichannel waveguide CO2 laser with diffusion cooling of active medium excited by discharge of audio-frequency alternating current. The description of high-power single-mode CO2 laser with average beam power up to 1 kW is presented. The result of measurement of the laser basic parameters are offered, as well as the outcomes of performances of the laser head with long active zone, operating in waveguide mode. As an example of application of these laser, various capabilities a description of the developed medical system 'Genom' used in the transmyocardial laser revascularization (TMLR) procedure and clinical results of the possibilities of the TMLR in the surgical treatment are presented.

  8. One-year results of total arterial revascularization vs. conventional coronary surgery: CARRPO trial

    DEFF Research Database (Denmark)

    Damgaard, Sune; Wetterslev, Jørn; Lund, Jens T

    2009-01-01

    +/- 18% in the conventional group (P = 0.52). In 72% of TAR patients and 67% of the conventional group, all grafts were patent (P = 0.45). Multiple imputation of missing angiographic data did not influence on results. Within 1 year, 37 (23%) TAR patients and 43 (25%) conventional group patients suffered...... cardiac events (HR 1.09, 95% CI 0.70-1.69, P = 0.70). One patient (0.6%) in the TAR group and two (1.2%) in the conventional group died (P = 1.00). CONCLUSION: Within 1 year post-operatively, TAR seems at least as safe and effective as CR. Prolonged follow-up will reveal whether this is sustained......AIMS: To investigate clinical and angiographic outcomes after coronary surgery using total arterial revascularization (TAR). METHODS AND RESULTS: We randomized 331 patients with multivessel or isolated left main disease to TAR [internal thoracic (ITA) and radial arteries] vs. conventional...

  9. Overweight And Obesity Repercussion In The Postoperative Of Myocardial Revascularization Surgery

    Directory of Open Access Journals (Sweden)

    Nyagra Ribeiro de Araújo

    2014-04-01

    Full Text Available This is a descriptive, retrospective study with cross-sectional quantitative approach, which aimed to relate the body mass index with events in the postoperative period of the myocardial revascularization surgery with use of extracorporeal circulation. The data collection period was between April and June/2012. Patients were divided according to the body mass index and classified as without excess of weight, overweight or obese. The data analysis was based on the descriptive statistics. The patients without excess of weight had more complications, especially those related to the lungs. Among overweight and obese individuals, the cardiovascular complications stood out. The obese subjects had the worse prognostic. Obesity and overweight did not have statistically significant association with a higher frequency of postoperative complications, in spite of the occurrence of cardiovascular complications in this group. The patients without excess of weight had higher risks of developing neurological events.

  10. The vessel fluence; Fluence cuve

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-07-01

    This book presents the proceedings of the technical meeting on the reactors vessels fluence. They are grouped in eight sessions: the industrial context and the stakes of the vessels control; the organization and the methodology for the fluence computation; the concerned physical properties; the reference computation methods; the fluence monitoring in an industrial context; vessels monitoring under irradiation; others methods in the world; the research and development programs. (A.L.B.)

  11. Role of arginase in vessel wall remodeling

    Directory of Open Access Journals (Sweden)

    William eDurante

    2013-05-01

    Full Text Available Arginase metabolizes the semi-essential amino acid L-arginine to L-ornithine and urea. There are two distinct isoforms of arginase, arginase I and II, which are encoded by separate genes and display differences in tissue distribution, subcellular localization, and molecular regulation. Blood vessels express both arginase I and II but their distribution appears to be cell-, vessel-, and species-specific. Both isoforms of arginase are induced by numerous pathologic stimuli and contribute to vascular cell dysfunction and vessel wall remodeling in several diseases. Clinical and experimental studies have documented increases in the expression and/or activity of arginase I or II in blood vessels following arterial injury and in pulmonary and arterial hypertension, aging, and atherosclerosis. Significantly, pharmacological inhibition or genetic ablation of arginase in animals ameliorates abnormalities in vascular cells and normalizes blood vessel architecture and function in all of these pathological states. The detrimental effect of arginase in vascular remodeling is attributable to its ability to stimulate vascular smooth muscle cell and endothelial cell proliferation, and collagen deposition by promoting the synthesis of polyamines and L-proline, respectively. In addition, arginase adversely impacts arterial remodeling by directing macrophages towards an inflammatory phenotype. Moreover, the proliferative, fibrotic, and inflammatory actions of arginase in the vasculature are further amplified by its capacity to inhibit nitric oxide synthesis by competing with nitric oxide synthase for substrate, L-arginine. Pharmacologic or molecular approaches targeting specific isoforms of arginase represent a promising strategy in treating obstructive fibroproliferative vascular disease.

  12. [Clinical results of double versus single mammary artery myocardiac revascularization: 15 years of follow-up].

    Science.gov (United States)

    López Rodríguez, F J; Voces, R; Lima, P; Reyes, G; Silva, J; Ruiz, M; Rico, M; González De Diego, F; Fortuny, R; Garrido, G; González Santos, J M; Albertos, J; Fernández Calella, D; Vallejo, J L

    2001-07-01

    Use of the left internal mammary artery to bypass the left anterior descending coronary artery reduces cardiac events and increases survival. However, there is some controversy as to the benefits of using both mammary arteries. To assess the long-term outcome of the use of both mammary arteries in comparison with the use of only one. A retrospective cohort study with a mean follow-up of 9.0 +/- 4.2 years was performed including 108 patients consecutively revascularized using both mammary arteries (II) and 108 patients randomly chosen in whom one mammary artery (I) was used for this purpose. Both groups were similar. There were no differences between the groups in operative morbidity or mortality. The survival at 10 years was similar (II: 84.61 +/- 4%; I: 85.18 +/- 3.8%), whereas recurrence of angina (II: 29.63 +/- 5.3%; I: 47.55 +/- 5.6%) (p = 0.012), the requirement for percutaneous angioplasty (II: 3.98 +/- 2%; I: 12.99 +/- 4.1%) (p = 0.009) and cardiologic events (II: 33.48 +/- 5.5%; I: 48.48 +/- 5.5%)(p = 0.022) were all lower in the group in which both mammary arteries were used. In the multivariate analysis, the use of both mammary arteries was an independent protective factor against angina recurrence (RR = 0.55), angioplasty (RR = 0.18) and cardiologic event (RR = 0.60). The use of both mammary arteries for revascularization does not increase operative morbidity. Since this procedure acts as an independent factor against angina recurrence, angioplasty and cardiologic event

  13. Americium behaviour in plastic vessels

    International Nuclear Information System (INIS)

    Legarda, F.; Herranz, M.; Idoeta, R.; Abelairas, A.

    2010-01-01

    The adsorption of 241 Am dissolved in water in different plastic storage vessels was determined. Three different plastics were investigated with natural and distilled waters and the retention of 241 Am by these plastics was studied. The same was done by varying vessel agitation time, vessel agitation speed, surface/volume ratio of water in the vessels and water pH. Adsorptions were measured to be between 0% and 70%. The adsorption of 241 Am is minimized with no water agitation, with PET or PVC plastics, and by water acidification.

  14. Americium behaviour in plastic vessels

    Energy Technology Data Exchange (ETDEWEB)

    Legarda, F.; Herranz, M. [Departamento de Ingenieria Nuclear y Mecanica de Fluidos, Escuela Tecnica Superior de Ingenieria de Bilbao, Universidad del Pais Vasco (UPV/EHU), Alameda de Urquijo s/n, 48013 Bilbao (Spain); Idoeta, R., E-mail: raquel.idoeta@ehu.e [Departamento de Ingenieria Nuclear y Mecanica de Fluidos, Escuela Tecnica Superior de Ingenieria de Bilbao, Universidad del Pais Vasco (UPV/EHU), Alameda de Urquijo s/n, 48013 Bilbao (Spain); Abelairas, A. [Departamento de Ingenieria Nuclear y Mecanica de Fluidos, Escuela Tecnica Superior de Ingenieria de Bilbao, Universidad del Pais Vasco (UPV/EHU), Alameda de Urquijo s/n, 48013 Bilbao (Spain)

    2010-07-15

    The adsorption of {sup 241}Am dissolved in water in different plastic storage vessels was determined. Three different plastics were investigated with natural and distilled waters and the retention of {sup 241}Am by these plastics was studied. The same was done by varying vessel agitation time, vessel agitation speed, surface/volume ratio of water in the vessels and water pH. Adsorptions were measured to be between 0% and 70%. The adsorption of {sup 241}Am is minimized with no water agitation, with PET or PVC plastics, and by water acidification.

  15. Americium behaviour in plastic vessels.

    Science.gov (United States)

    Legarda, F; Herranz, M; Idoeta, R; Abelairas, A

    2010-01-01

    The adsorption of (241)Am dissolved in water in different plastic storage vessels was determined. Three different plastics were investigated with natural and distilled waters and the retention of (241)Am by these plastics was studied. The same was done by varying vessel agitation time, vessel agitation speed, surface/volume ratio of water in the vessels and water pH. Adsorptions were measured to be between 0% and 70%. The adsorption of (241)Am is minimized with no water agitation, with PET or PVC plastics, and by water acidification. Copyright 2009 Elsevier Ltd. All rights reserved.

  16. Long-Term Effectiveness of the Zilver PTX Drug-Eluting Stent for Femoropopliteal Peripheral Artery Disease in Patients with No Patent Tibial Runoff Vessels-Results from the Zilver PTX Japan Post-Market Surveillance Study.

    Science.gov (United States)

    Cipollari, Stefano; Yokoi, Hiroyoshi; Ohki, Takao; Kichikawa, Kimihiko; Nakamura, Masato; Komori, Kimihiro; Nanto, Shinsuke; O'Leary, Erin E; Lottes, Aaron E; Saunders, Alan T; Dake, Michael D

    2018-01-01

    To evaluate 2-year results of the Zilver PTX (Cook Medical, Bloomington, Indiana) drug-eluting stent (DES) for femoropopliteal peripheral artery disease (PAD) in patients with no continuous patent infrapopliteal runoff arteries compared with patients with ≥ 1 continuous patent runoff vessels. A retrospective analysis of patients with femoropopliteal PAD enrolled in the Zilver PTX Post-Market Surveillance Study in Japan was performed. There were no exclusion criteria. Outcomes, including freedom from target lesion revascularization (TLR), patency, and clinical benefit, for the no-runoff group (n = 54) were compared with the runoff group (n = 846). The 2 groups were similar in terms of demographics, lesion characteristics, and comorbidities (P > .05). There was a higher incidence of critical limb ischemia in the no-runoff group compared with the runoff group (44.8% vs 19.7%; P < .01). There were 3 amputations (5.6%) in the no-runoff group versus 7 amputations (0.8%) in the runoff group (P = .02). At 2 years, freedom from TLR rates were 81.3% versus 83.8% (P = .87), patency rates were 68.4% versus 70.7% (P = .95), and clinical benefit rates were 73.7% versus 80.0% (P = .16) in the no-runoff versus runoff group, respectively. Results in patients with no continuous patent tibial runoff were favorable through 2 years and similar to results for patients with ≥ 1 continuous patent runoff vessels, indicating that the Zilver PTX DES may be a valid treatment option for patients with these difficult-to-treat lesions. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  17. [Large vessel vasculitides].

    Science.gov (United States)

    Morović-Vergles, Jadranka; Puksić, Silva; Gracanin, Ana Gudelj

    2013-01-01

    Large vessel vasculitis includes Giant cell arteritis and Takayasu arteritis. Giant cell arteritis is the most common form of vasculitis affect patients aged 50 years or over. The diagnosis should be considered in older patients who present with new onset of headache, visual disturbance, polymyalgia rheumatica and/or fever unknown cause. Glucocorticoides remain the cornerstone of therapy. Takayasu arteritis is a chronic panarteritis of the aorta ant its major branches presenting commonly in young ages. Although all large arteries can be affected, the aorta, subclavian and carotid arteries are most commonly involved. The most common symptoms included upper extremity claudication, hypertension, pain over the carotid arteries (carotidynia), dizziness and visual disturbances. Early diagnosis and treatment has improved the outcome in patients with TA.

  18. Reactor pressure vessel embrittlement

    International Nuclear Information System (INIS)

    1992-07-01

    Within the framework of the IAEA extrabudgetary programme on the Safety of WWER-440/230 NPPs, a list of safety issues requiring broad studies of generic interest have been agreed upon by an Advisory Group who met in Vienna in September 1990. The list was later revised in the light of the programme findings. The information on the status of the issues, and on the amount of work already completed and under way in the various countries, needs to be compiled. Moreover, an evaluation of what further work is required to resolve each one of the issues is also necessary. In view of this, the IAEA has started the preparation of a series of status reports on the various issues. This report on the generic safety issue ''Reactor Pressure Vessel Embrittlement'' presents a comprehensive survey of technical information available in the field and identifies those aspects which require further investigation. 39 refs, 21 figs, 4 tabs

  19. Reactor containment vessel

    International Nuclear Information System (INIS)

    Ochiai, Kanehiro; Hayagumo, Sunao; Morikawa, Matsuo.

    1981-01-01

    Purpose: To safety and simplify the structure in a reactor containment vessel. Constitution: Steam flow channels with steam jetting ports communicating to coolants are provided between a communication channel and coolants in a pressure suppression chamber. Upon loss of coolant accidents, pressure in a dry well will increase, then force downwards water in an annulus portion and further flow out the water through steam jetting ports into a suppression pool. Thus, the steam flow channel is filled with steams or airs present in the dry well, which are released through the steam jetting ports into the pressure suppression chamber. Even though water is violently vibrated owing to the upward movement of air bubbles and condensation of steam bubbles, the annular portion and the steam jetting ports are filled with steams or the like, direct dynamic loads onto the structures such as communication channels can be avoided. (J.P.N.)

  20. Pressure vessel for nuclear reactors

    International Nuclear Information System (INIS)

    1975-01-01

    The invention applies to a pressure vessel for nuclear reactors whose shell, made of cast metal segments, has a steel liner. This liner must be constructed to withstand all operational stresses and to be easily repairable. The invention solves this problem by installing the liner at a certain distance from the inner wall of the pressure vessel shell and by filling this clearance with supporting concrete. Both the concrete and the steel liner must have a lower prestress than the pressure vessel shell. In order to avoid damage to the liner when prestressing the pressure vessel shell, special connecting elements are provided which consist of welded-on fastening elements projecting into recesses in the cast metal segments of the pressure vessel. Their design is described in detail. (TK) [de

  1. Systematic review: comparative effectiveness of adjunctive devices in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention of native vessels

    Directory of Open Access Journals (Sweden)

    Sobieraj Diana M

    2011-12-01

    Full Text Available Abstract Background During percutaneous coronary intervention (PCI, dislodgement of atherothrombotic material from coronary lesions can result in distal embolization, and may lead to increased major adverse cardiovascular events (MACE and mortality. We sought to systematically review the comparative effectiveness of adjunctive devices to remove thrombi or protect against distal embolization in patients with ST-segment elevation myocardial infarction (STEMI undergoing PCI of native vessels. Methods We conducted a systematic literature search of Medline, the Cochrane Database, and Web of Science (January 1996-March 2011, http://www.clinicaltrials.gov, abstracts from major cardiology meetings, TCTMD, and CardioSource Plus. Two investigators independently screened citations and extracted data from randomized controlled trials (RCTs that compared the use of adjunctive devices plus PCI to PCI alone, evaluated patients with STEMI, enrolled a population with 95% of target lesion(s in native vessels, and reported data on at least one pre-specified outcome. Quality was graded as good, fair or poor and the strength of evidence was rated as high, moderate, low or insufficient. Disagreement was resolved through consensus. Results 37 trials met inclusion criteria. At the maximal duration of follow-up, catheter aspiration devices plus PCI significantly decreased the risk of MACE by 27% compared to PCI alone. Catheter aspiration devices also significantly increased the achievement of ST-segment resolution by 49%, myocardial blush grade of 3 (MBG-3 by 39%, and thrombolysis in myocardial infarction (TIMI 3 flow by 8%, while reducing the risk of distal embolization by 44%, no reflow by 48% and coronary dissection by 70% versus standard PCI alone. In a majority of trials, the use of catheter aspiration devices increased procedural time upon qualitative assessment. Distal filter embolic protection devices significantly increased the risk of target revascularization

  2. Containment vessel stability analysis

    International Nuclear Information System (INIS)

    Harstead, G.A.; Morris, N.F.; Unsal, A.I.

    1983-01-01

    The stability analysis for a steel containment shell is presented herein. The containment is a freestanding shell consisting of a vertical cylinder with a hemispherical dome. It is stiffened by large ring stiffeners and relatively small longitudinal stiffeners. The containment vessel is subjected to both static and dynamic loads which can cause buckling. These loads must be combined prior to their use in a stability analysis. The buckling loads were computed with the aid of the ASME Code case N-284 used in conjunction with general purpose computer codes and in-house programs. The equations contained in the Code case were used to compute the knockdown factors due to shell imperfections. After these knockdown factors were applied to the critical stress states determined by freezing the maximum dynamic stresses and combining them with other static stresses, a linear bifurcation analysis was carried out with the aid of the BOSOR4 program. Since the containment shell contained large penetrations, the Code case had to be supplemented by a local buckling analysis of the shell area surrounding the largest penetration. This analysis was carried out with the aid of the NASTRAN program. Although the factor of safety against buckling obtained in this analysis was satisfactory, it is claimed that the use of the Code case knockdown factors are unduly conservative when applied to the analysis of buckling around penetrations. (orig.)

  3. Pressure vessel design

    International Nuclear Information System (INIS)

    Annaratone, D.

    2007-01-01

    This book guides through general and fundamental problems of pressure vessel design. It moreover considers problems which seem to be of lower importance but which turn out to be crucial in the design phase. The basic approach is rigorously scientific with a complete theoretical development of the topics treated, but the analysis is always pushed so far as to offer concrete and precise calculation criteria that can be immediately applied to actual designs. This is accomplished through appropriate algorithms that lead to final equations or to characteristic parameters defined through mathematical equations. The first chapter describes how to achieve verification criteria, the second analyzes a few general problems, such as stresses of the membrane in revolution solids and edge effects. The third chapter deals with cylinders under pressure from the inside, while the fourth focuses on cylinders under pressure from the outside. The fifth chapter covers spheres, and the sixth is about all types of heads. Chapter seven discusses different components of particular shape as well as pipes, with special attention to flanges. The eighth chapter discusses the influence of holes, while the ninth is devoted to the influence of supports. Finally, chapter ten illustrates the fundamental criteria regarding fatigue analysis. Besides the unique approach to the entire work, original contributions can be found in most chapters, thanks to the author's numerous publications on the topic and to studies performed ad hoc for this book. (orig.)

  4. Modified ITER In-Vessel Viewing System

    International Nuclear Information System (INIS)

    Ahola, H.; Heikkinen, V.; Keraenen, K.; Suomela, J.

    2001-01-01

    The original ITER In-Vessel Viewing System (IVVS) prototype (Proc. of the 20th SOFT, vol. 2 (1998) 1051), which demonstrates the feasibility of linear fibre arrays for ITER in-vessel viewing, has been modified. In order to reduce the viewing time and to improve the image quality the beam dispersing mirrors was replaced by a diffractive optics element (DOE), which enhanced the laser illumination considerably. The performance of the system was tested using various target surfaces: the results obtained clearly indicate its adequacy for in-vessel viewing. Mechanical damage on smooth metal surfaces (scratches etc.) can be easily distinguished and the viewing resolution at a distance of 2 m is better than 1 mm. The IVVS has been re-designed to be compatible with the new ITER-FEAT. A conceptual study which covers all the functions and subsystems required for viewing has been completed. These results will be used to further modify the prototype: items to be tested include horizontal probe operation and laser illumination with an optical fibre

  5. Percutaneous Coronary Intervention of Left Main Disease: Pre- and Post-EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) and NOBLE (Nordic-Baltic-British Left Main Revascularization Study) Era.

    Science.gov (United States)

    Park, Duk-Woo; Park, Seung-Jung

    2017-06-01

    For nearly half a century, coronary artery bypass grafting has been the standard treatment for patients with obstructive left main coronary artery (LMCA) disease. However, there has been considerable evolution in the field of percutaneous coronary intervention, and especially, percutaneous coronary intervention for LMCA disease has been rapidly expanded with adoption of drug-eluting stents. Some, but not all randomized trials, have shown that percutaneous coronary intervention with drug-eluting stents might be a suitable alternative for selected patients with LMCA disease instead of bypass surgery. However, none of previous trials involving early-generation drug-eluting stents was sufficiently powered and comparative trials using contemporary drug-eluting stents were limited. Recently, primary results of 2 new trials of EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) and NOBLE (Nordic-Baltic-British Left Main Revascularization Study) were reported. However, these trials showed conflicting results, which might pose uncertainty on the optimal revascularization strategy for LMCA disease. In this article, with the incorporation of a key review on evolution of LMCA treatment, we summarize the similarity or disparity of the EXCEL and NOBLE trials, focus on how they relate to previous trials in the field, and finally speculate on how the treatment strategy may be changed or recommended for LMCA treatment. © 2017 American Heart Association, Inc.

  6. PWR vessel flaw distribution development

    International Nuclear Information System (INIS)

    Rosinski, S.T.; Kennedy, E.L.; Foulds, J.R.; Kinsman, K.M.

    1990-01-01

    This paper reports on PWR pressure vessels which operate under NRC rules and regulatory guides intended to prevent failure of the vessels. Plants failing to meet the operating criteria specified under these rules and regulations are required to analytically demonstrate fitness for service in order to continue operation. The initial flaw size or distribution of initial vessel flaws is a key input to the required vessel integrity analyses. However, the flaw distribution assumed in the development of the NRC Regulations and recommended for the plant specific analyses is potentially over-conservative. This is because the distribution is based on the limited amount of vessel inspection data available at the time the criteria were being developed and does not take full advantage of the more recent and reliable domestic vessel inspection results. The U.S. Department of Energy is funding an effort through Sandia National Laboratories to investigate the possibility of developing a new flaw distribution based on the increased amount and improved reliability of domestic vessel inspection data. Results of Phase I of the program indicate that state-of-the-art NDE systems' capabilities are sufficient for development of a new flaw distribution that could ultimately provide life extension benefits over the presently required operating practice

  7. Nuclear reactor vessel decontamination systems

    International Nuclear Information System (INIS)

    McGuire, P. J.

    1985-01-01

    There is disclosed in the present application, a decontamination system for reactor vessels. The system is operatable without entry by personnel into the contaminated vessel before the decontamination operation is carried out and comprises an assembly which is introduced into the vertical cylindrical vessel of the typical boiling water reactor through the open top. The assembly includes a circular track which is centered by guideways permanently installed in the reactor vessel and the track guides opposed pairs of nozzles through which water under very high pressure is directed at the wall for progressively cutting and sweeping a tenacious radioactive coating as the nozzles are driven around the track in close proximity to the vessel wall. The whole assembly is hoisted to a level above the top of the vessel by a crane, outboard slides on the assembly brought into engagement with the permanent guideways and the assembly progressively lowered in the vessel as the decontamination operation progresses. The assembly also includes a low pressure nozzle which forms a spray umbrella above the high pressure nozzles to contain radioactive particles dislodged during the decontamination

  8. Predictive ability of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system after first-time lower extremity revascularizations

    OpenAIRE

    Darling, Jeremy; McCallum, John C.; Soden, Peter A.; Guzman, R.J. (Raul J.); Wyers, M.C. (Mark C.); Hamdan, A.D. (Allen D.); Verhagen, Hence; Schermerhorn, Marc

    2017-01-01

    markdownabstract__Objective:__ The Society for Vascular Surgery (SVS) Wound, Ischemia and foot Infection (WIfI) classification system was proposed to predict 1-year amputation risk and potential benefit from revascularization. Our goal was to evaluate the predictive ability of this scale in a real-world selection of patients undergoing a first-time lower extremity revascularization for chronic limb-threatening ischemia (CLTI). __Methods:__ From 2005 to 2014, 1336 limbs underwent a first-time ...

  9. Use of the Boomerang catalyst advantage closure device to facilitate complex multistaged percutaneous revascularization procedures for the treatment of critical limb ischemia.

    Science.gov (United States)

    Garcia, Joel A; Casserly, Ivan P

    2009-07-01

    An increasing spectrum of complex peripheral arterial disease may be successfully treated using percutaneous revascularization techniques. A pair of challenging peripheral revascularization procedures in patients with critical limb ischemia is presented, where an array of interventional tools and techniques were required, and the off-label use of the Boomerang catalyst system closure device was important in managing a variety of complex arterial access issues and ultimately allowing procedural success. Copyright 2009 Wiley-Liss, Inc.

  10. Association of left subclavian artery coverage without revascularization and spinal cord ischemia in patients undergoing thoracic endovascular aortic repair: A Vascular Quality Initiative® analysis.

    Science.gov (United States)

    Teixeira, Pedro Gr; Woo, Karen; Beck, Adam W; Scali, Salvatore T; Weaver, Fred A

    2017-12-01

    Objectives Investigate the impact of left subclavian artery coverage without revascularization on spinal cord ischemia development in patients undergoing thoracic endovascular aortic repair. Methods The Vascular Quality Initiative thoracic endovascular aortic repair module (April 2011-July 2014) was analyzed. Patients undergoing left subclavian artery coverage were divided into two groups according to revascularization status. The association between left subclavian artery revascularization with the primary outcome of spinal cord ischemia and the secondary outcome of stroke was assessed with multivariable analysis adjusting for between-group baseline differences. Results The left subclavian artery was covered in 508 (24.6%) of the 2063 thoracic endovascular aortic repairs performed. Among patients with left subclavian artery coverage, 58.9% underwent revascularization. Spinal cord ischemia incidence was 12.1% in the group without revascularization compared to 8.5% in the group undergoing left subclavian artery revascularization (odds ratio (95%CI): 1.48(0.82-2.68), P = 0.189). Multivariable analysis adjustment identified an independent association between left subclavian artery coverage without revascularization and the incidence of spinal cord ischemia (adjusted odds ratio (95%CI): 2.29(1.03-5.14), P = 0.043). Although the incidence of stroke was also higher for the group with a covered and nonrevascularized left subclavian artery (12.1% versus 8.5%), this difference was not statistically significant after multivariable analysis (adjusted odds ratio (95%CI): 1.55(0.74-3.26), P = 0.244). Conclusion For patients undergoing left subclavian artery coverage during thoracic endovascular aortic repair, the addition of a revascularization procedure was associated with a significantly lower incidence of spinal cord ischemia.

  11. Revascularization Induced Maturogenesis of Non-Vital Immature Permanent Tooth Using Platelet-Rich-Fibrin: A Case Report.

    Science.gov (United States)

    Nagaveni, N B; Pathak, Sidhant; Poornima, P; Joshi, Jooie S

    2016-01-01

    The aim of this report is to describe a novel method of revascularization therapy done in a non-vital, immature permanent tooth using Platelet-rich fibrin (PRF),in a recently developed scaffold material to overcome limitations associated with the traditional method of revascularization using natural blood clot. PRF prepared from autologous blood was placed in the root canal and patient was followed up regularly at one, three, six, nine and 12 months for detailed clinical and radiographic evaluation. At 12 months, radiographic examination revealed root elongation, root end closure, continued thickening of the root dentinal walls, obliteration of root canal space, and normal periradicular anatomy. However, more long term prospective trials and histological studies are highly needed before to testify PRF a panacea for the regenerative endodontic therapy in children.

  12. Gammatography of thick lead vessels

    International Nuclear Information System (INIS)

    Raghunath, V.M.; Bhatnagar, P.K.; Sundaram, V.M.

    1979-01-01

    Radiography, scintillation and GM counting and dose measurements using ionisation chamber equipment are commonly used for detecting flaws/voids in materials. The first method is mostly used for steel vessels and to a lesser extent thin lead vessels also and is essentially qualitative. Dose measuring techniques are used for very thick and large lead vessels for which high strength radioactive sources are required, with its inherent handling problems. For vessels of intermediate thicknesses, it is ideal to use a small strength source and a GM or scintillation counter assembly. At the Reactor Research Centre, Kalpakkam, such a system was used for checking three lead vessels of thicknesses varying from 38mm to 65mm. The tolerances specified were +- 4% variation in lead thickness. The measurements also revealed the non concentricity of one vessel which had a thickness varying from 38mm to 44mm. The second vessel was patently non-concentric and the dimensional variation was truly reproduced in the measurements. A third vessel was fabricated with careful control of dimensions and the measurements exhibited good concentricity. Small deviations were observed, attributable to imperfect bondings between steel and lead. This technique has the following advantages: (a) weaker sources used result in less handling problems reducing the personnel exposures considerably; (b) the sensitivity of the instrument is quite good because of better statistics; (c) the time required for scanning a small vessel is more, but a judicious use of a scintillometer for initial fast scan will help in reducing the total scanning time; (d) this method can take advantage of the dimensional variations themselves to get the calibration and to estimate the deviations from specified tolerances. (auth.)

  13. Safety and efficacy of extracorporeal shock wave myocardial revascularization therapy for refractory angina pectoris.

    Science.gov (United States)

    Cassar, Andrew; Prasad, Megha; Rodriguez-Porcel, Martin; Reeder, Guy S; Karia, Darshak; DeMaria, Anthony N; Lerman, Amir

    2014-03-01

    To assess the safety and efficacy of extracorporeal shockwave myocardial revascularization (ESMR) therapy in treating patients with refractory angina pectoris. A single-arm multicenter prospective trial to assess safety and efficacy of the ESMR therapy in patients with refractory angina (class III/IV angina) was performed. Screening exercise treadmill tests and pharmacological single-photon emission computed tomography (SPECT) were performed for all patients to assess exercise capacity and ischemic burden. Patients were treated with 9 sessions of ESMR to ischemic areas over 9 weeks. Efficacy end points were exercise capacity by using treadmill test as well as ischemic burden on pharmacological SPECT at 4 months after the last ESMR treatment. Safety measures included electrocardiography, echocardiography, troponin, creatine kinase, and brain natriuretic peptide testing, and pain questionnaires. Fifteen patients with medically refractory angina and no revascularization options were enrolled. There was a statistically significant mean increase of 122.3±156.9 seconds (38% increase compared with baseline; P=.01) in exercise treadmill time from baseline (319.8±157.2 seconds) to last follow-up after the ESMR treatment (422.1±183.3 seconds). There was no improvement in the summed stress perfusion scores after pharmacologically induced stress SPECT at 4 months after the last ESMR treatment in comparison to that at screening; however, SPECT summed stress score revealed that untreated areas had greater progression in ischemic burden vs treated areas (3.69±6.2 vs 0.31±4.5; P=.03). There was no significant change in the mean summed echo score from baseline to posttreatment (0.4±5.1; P=.70). The ESMR therapy was performed safely without any adverse events in electrocardiography, echocardiography, troponins, creatine kinase, or brain natriuretic peptide. Pain during the ESMR treatment was minimal (a score of 0.5±1.2 to 1.1±1.2 out of 10). In this multicenter feasibility

  14. BY FRUSTUM CONFINING VESSEL

    Directory of Open Access Journals (Sweden)

    Javad Khazaei

    2016-09-01

    Full Text Available Helical piles are environmentally friendly and economical deep foundations that, due to environmental considerations, are excellent additions to a variety of deep foundation alternatives available to the practitioner. Helical piles performance depends on soil properties, the pile geometry and soil-pile interaction. Helical piles can be a proper alternative in sensitive environmental sites if their bearing capacity is sufficient to support applied loads. The failure capacity of helical piles in this study was measured via an experimental research program that was carried out by Frustum Confining Vessel (FCV. FCV is a frustum chamber by approximately linear increase in vertical and lateral stresses along depth from top to bottom. Due to special geometry and applied bottom pressure, this apparatus is a proper choice to test small model piles which can simulate field stress conditions. Small scale helical piles are made with either single helix or more helixes and installed in fine grained sand with three various densities. Axial loading tests including compression and tension tests were performed to achieve pile ultimate capacity. The results indicate the helical piles behavior depends essentially on pile geometric characteristics, i.e. helix configuration and soil properties. According to the achievements, axial uplift capacity of helical model piles is about equal to usual steel model piles that have the helixes diameter. Helical pile compression bearing capacity is too sufficient to act as a medium pile, thus it can be substituted other piles in special geoenvironmental conditions. The bearing capacity also depends on spacing ratio, S/D, and helixes diameter.

  15. Vacuum vessel for thermonuclear device

    International Nuclear Information System (INIS)

    Hagiwara, Koji; Imura, Yasuya.

    1979-01-01

    Purpose: To provide constituted method for easily performing baking of vacuum vessel, using short-circuiting segments. Constitution: At the time of baking, one turn circuit is formed by the vacuum vessel and short-circuiting segments, and current transformer converting the one turn circuit into a secondary circuit by the primary coil and iron core is formed, and the vacuum vessel is Joule heated by an induction current from the primary coil. After completion of baking, the short-circuiting segments are removed. (Kamimura, M.)

  16. PWR vessel inspection performance improvements

    International Nuclear Information System (INIS)

    Blair Fairbrother, D.; Bodson, Francis

    1998-01-01

    A compact robot for ultrasonic inspection of reactor vessels has been developed that reduces setup logistics and schedule time for mandatory code inspections. Rather than installing a large structure to access the entire weld inspection area from its flange attachment, the compact robot examines welds in overlapping patches from a suction cup anchor to the shell wall. The compact robot size allows two robots to be operated in the vessel simultaneously. This significantly reduces the time required to complete the inspection. Experience to date indicates that time for vessel examinations can be reduced to fewer than four days. (author)

  17. Relationship between target organ damage and blood pressure, retinal vessel calibre, oxidative stress and polymorphisms in VAV-2 and VAV-3 genes in patients with hypertension: a case–control study protocol (LOD-Hipertensión)

    Science.gov (United States)

    Gomez-Marcos, Manuel A; Gonzalez-Sarmiento, Rogelio; Recio-Rodríguez, José I; Agudo-Conde, Cristina; Gamella-Pozuelo, Luis; Perretta-Tejedor, Nuria; Martínez-Salgado, Carlos; García-Ortiz, Luis

    2014-01-01

    Introduction Target organ damage (TOD) is associated with increased cardiovascular risk. The study objectives were to analyse the relationship of TOD to blood pressure, size of retinal arteries and veins, oxidative stress and different polymorphisms in the VAV-2 and VAV-3 genes in participants with hypertension. Methods and analysis A case–control study to analyse the relationship between clinical, biochemical and genetic parameters and presence of cardiac, vascular and renal TOD in 486 patients with hypertension. Participants with TOD will be considered as cases, and those without TOD will be enrolled as controls. This will be a collaborative study conducted by the groups of Primary Care, Cardiovascular and Metabolic and Degenerative Diseases of the Instituto de Investigación Biomédica of Salamanca (IBSAL). Assessment of cardiac, renal and vascular TOD. Measurement of peripheral and central blood pressure, size of eye fundus arteries and veins, and oxidative stress, and polymorphisms in the VAV-2 and VAV-3 genes. Ethics and dissemination The study will be conducted after approval is obtained from the Ethics Committee of Hospital Clínico Universitario of Salamanca. All study participants will sign an informed consent to agree to participate in the study, and another consent to agree on the genetic study, in compliance with the Declaration of Helsinki and the WHO standards for observational studies. The results of this study will allow for an understanding of the relationship of the different TODs with blood pressure, retinal artery and vein diameters, oxidative stress and polymorphisms in VAV-2 and VAV-3 genes. Trial registration number Clinical Trials. gov Identifier: NCT02022618. PMID:24699462

  18. Relationship between target organ damage and blood pressure, retinal vessel calibre, oxidative stress and polymorphisms in VAV-2 and VAV-3 genes in patients with hypertension: a case-control study protocol (LOD-Hipertension).

    Science.gov (United States)

    Gomez-Marcos, Manuel A; Gonzalez-Sarmiento, Rogelio; Recio-Rodríguez, José I; Agudo-Conde, Cristina; Gamella-Pozuelo, Luis; Perretta-Tejedor, Nuria; Martínez-Salgado, Carlos; García-Ortiz, Luis

    2014-04-03

    Target organ damage (TOD) is associated with increased cardiovascular risk. The study objectives were to analyse the relationship of TOD to blood pressure, size of retinal arteries and veins, oxidative stress and different polymorphisms in the VAV-2 and VAV-3 genes in participants with hypertension. A case-control study to analyse the relationship between clinical, biochemical and genetic parameters and presence of cardiac, vascular and renal TOD in 486 patients with hypertension. Participants with TOD will be considered as cases, and those without TOD will be enrolled as controls. This will be a collaborative study conducted by the groups of Primary Care, Cardiovascular and Metabolic and Degenerative Diseases of the Instituto de Investigación Biomédica of Salamanca (IBSAL). Assessment of cardiac, renal and vascular TOD. Measurement of peripheral and central blood pressure, size of eye fundus arteries and veins, and oxidative stress, and polymorphisms in the VAV-2 and VAV-3 genes. The study will be conducted after approval is obtained from the Ethics Committee of Hospital Clínico Universitario of Salamanca. All study participants will sign an informed consent to agree to participate in the study, and another consent to agree on the genetic study, in compliance with the Declaration of Helsinki and the WHO standards for observational studies. The results of this study will allow for an understanding of the relationship of the different TODs with blood pressure, retinal artery and vein diameters, oxidative stress and polymorphisms in VAV-2 and VAV-3 genes. Clinical Trials. gov Identifier: NCT02022618.

  19. Health insurance status and control of diabetes and coronary artery disease risk factors on enrollment into the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial.

    Science.gov (United States)

    Grogan, Mary; Jenkins, Margaret; Sansing, Veronica V; MacGregor, Joan; Brooks, Maria Mori; Julien-Williams, Patricia; Amendola, Angela; Abbott, J Dawn

    2010-01-01

    The purpose of this study was to examine measures of chronic disease severity and treatment according to insurance status in a clinical trial setting. Baseline insurance status of 776 patients with type 2 diabetes and stable coronary artery disease (CAD) enrolled in the United States in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial was analyzed with regard to measures of metabolic and cardiovascular risk factor control. Compared with patients with private or public insurance, the uninsured were younger, more often female, and less often white non-Hispanic. Uninsured patients had the greatest burden of CAD. Patients with public insurance were treated with the greatest number of medications, had the greatest self-reported functional status, and the lowest mean glycosylated hemoglobin and low-density lipoprotein (LDL) cholesterol values. Overall, for 5 measured risk factor targets, the mean number above goal was 2.49 ± 1.18. After adjustment for demographic and clinical variables, insurance status was not associated with a difference in risk factor control. In the BARI 2D trial, we did not observe a difference in baseline cardiovascular risk factor control according to insurance status. An important observation, however, was that risk factor control overall was suboptimal, which highlights the difficulty in treating type 2 diabetes and CAD irrespective of insurance status.

  20. Special enclosure for a pressure vessel

    International Nuclear Information System (INIS)

    Wedellsborg, B.W.; Wedellsborg, U.W.

    1993-01-01

    A pressure vessel enclosure is described comprising a primary pressure vessel, a first pressure vessel containment assembly adapted to enclose said primary pressure vessel and be spaced apart therefrom, a first upper pressure vessel jacket adapted to enclose the upper half of said first pressure vessel containment assembly and be spaced apart therefrom, said upper pressure vessel jacket having an upper rim and a lower rim, each of said rims connected in a slidable relationship to the outer surface of said first pressure vessel containment assembly, mean for connecting in a sealable relationship said upper rim of said first upper pressure vessel jacket to the outer surface of said first pressure vessel containment assembly, means for connecting in a sealable relationship said lower rim of said first upper pressure vessel jacket to the outer surface of said first pressure vessel containment assembly, a first lower pressure vessel jacket adapted to enclose the lower half of said first pressure vessel containment assembly and be spaced apart therefrom, said lower pressure vessel jacket having an upper rim connected in a slidable relationship to the outer surface of said first pressure vessel containment assembly, and means for connecting in a sealable relationship said upper rim of said first lower pressure vessel jacket to the outer surface of said first pressure vessel containment assembly, a second upper pressure vessel jacket adapted to enclose said first upper pressure vessel jacket and be spaced apart therefrom, said second upper pressure vessel jacket having an upper rim and a lower rim, each of said rims adapted to slidably engage the outer surface of said first upper pressure vessel jacket, means for sealing said rims, a second lower pressure vessel jacket adapted to enclose said first lower pressure vessel jacket and be spaced apart therefrom

  1. PREVENTION OF LEFT VENTRICLE SYSTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION AFTER CARDIAC REVASCULARIZATION

    Directory of Open Access Journals (Sweden)

    A. L. Alyavi

    2016-01-01

    Full Text Available Aim. To study effects of bioflavonoid quercetin (corvitin on left ventricle (LV systolic dysfunction in patients with acute coronary syndrome with ST segment elevation (ACS+ST after cardiac revascularization.Material and methods. 60 patients with ACS+ST (44,2±1,3 y.o. were examined. Patients were admitted to hospital within 6 hours after complaints beginning. Patients were randomized in two groups. 30 patients of group A had standard therapy and cardiac revascularization. 30 patients of group B received corvitin additionally to standard therapy before cardiac revascularization. Echocardiography initially and stress-echocardiography with dobutamine after status stabilization (at 8-10 days of disease were performed.Results. Dobutamine test (with low and high doses showed myocardial viability in patients of group B. Patients of group A had irreversible LV systolic dysfunction in 32 % of segments. Corvitin slowed down LV dilatation progression in patients with ACS+ST. It resulted in the end-diastolic and end-systolic indexes did not change within 10 days. The LV ejection fraction was more increased in patients of group B in comparison with patients of group A.Conclusion. The early corvitin prescribing has positive effects on LV systolic function and prevents post-reperfusion complications. 

  2. PREVENTION OF LEFT VENTRICLE SYSTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION AFTER CARDIAC REVASCULARIZATION

    Directory of Open Access Journals (Sweden)

    A. L. Alyavi

    2009-01-01

    Full Text Available Aim. To study effects of bioflavonoid quercetin (corvitin on left ventricle (LV systolic dysfunction in patients with acute coronary syndrome with ST segment elevation (ACS+ST after cardiac revascularization.Material and methods. 60 patients with ACS+ST (44,2±1,3 y.o. were examined. Patients were admitted to hospital within 6 hours after complaints beginning. Patients were randomized in two groups. 30 patients of group A had standard therapy and cardiac revascularization. 30 patients of group B received corvitin additionally to standard therapy before cardiac revascularization. Echocardiography initially and stress-echocardiography with dobutamine after status stabilization (at 8-10 days of disease were performed.Results. Dobutamine test (with low and high doses showed myocardial viability in patients of group B. Patients of group A had irreversible LV systolic dysfunction in 32 % of segments. Corvitin slowed down LV dilatation progression in patients with ACS+ST. It resulted in the end-diastolic and end-systolic indexes did not change within 10 days. The LV ejection fraction was more increased in patients of group B in comparison with patients of group A.Conclusion. The early corvitin prescribing has positive effects on LV systolic function and prevents post-reperfusion complications. 

  3. Endovascular Repair of Acute Symptomatic Pararenal Aortic Aneurysm With Three Chimney and One Periscope Graft for Complete Visceral Artery Revascularization

    International Nuclear Information System (INIS)

    Brechtel, Klaus; Ketelsen, Dominik; Endisch, Andrea; Heller, Stephan; Heuschmid, Martin; Stock, Ulrich A.; Kalender, Guenay

    2012-01-01

    PurposeTo describe a modified endovascular technique for complete revascularization of visceral and renal arteries in symptomatic pararenal aortic aneurysm (PRAA).TechniqueArterial access was surgically established in both common femoral arteries (CFAs) and the left subclavian artery (LSA). Revascularization of the left renal artery, the celiac trunk, and the superior mesenteric artery was performed through one single sheath via the LSA. Suitable covered stents were put in the aortic branches but not deployed. The right renal artery was accessed over the left CFA. Due to the longitudinal extension of the presented aneurysm two stent-grafts were introduced via the right CFA. After deploying the aortic stent-grafts, all covered stents in the side branches were deployed consecutively with a minimum overlap of 5 mm over the cranial and caudal stent-graft edges. Simultaneous ballooning was performed to fully expand all stent-grafts and warranty patency. Conclusion: This is the first report in the literature of chimney grafting in PRAA for complete revascularization of visceral and renal branches by using more than two covered stents introduced from one side through one single sheath. However this technique is modified, it should be used only in bailout situations when branched stent-grafts are not available and/or surgery is not suitable.

  4. Autologus Platelet Rich Fibrin aided Revascularization of an immature, non-vital permanent tooth with apical periodontitis: A case report.

    Science.gov (United States)

    Jadhav, Ganesh Ranganath; Shah, Dipali; Raghvendra, Srinidhi Surya

    2015-01-01

    Caries or trauma induced non-vital immature permanent tooth with blunderbuss, thin root which are very common among childrens are corrected using regenerative endodontic (revascularization) procedures. In the presented case, a 16-year-old boy reported with chief complaint of pain in maxillary left central incisor (Tooth #21). Tooth #21 showed grade III mobility, draining labial sinus, and short blunderbuss root with diffuse periapical radiolucency. Patient was explained the treatment plan and written informed consent was taken. Platelet rich fibrin (PRF) was prepared according to standard protocol. Autologous PRF was carried to the apical portion of the root canal after inducing revascularization. Access opening was double sealed with MTA and resin modified glass ionomer cement (RMGI). Baseline, 12 month and 18 month follow-up intraoral radiographs were taken. Clinically case was asymptomatic with complete resolution of intraoral sinus. Periapical healing, apical closure, root lengthening and dentinal wall thickening were uneventful. Thus PRF supplementation hastens the predictability and rate of revascularization in non-vital immature permanent teeth.

  5. 2013 West Coast Vessel Tracklines

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  6. 2011 West Coast Vessel Tracklines

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  7. 2013 Great Lakes Vessel Tracklines

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  8. 2011 Great Lakes Vessel Tracklines

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  9. 2011 East Coast Vessel Tracklines

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  10. Coastal Discard Logbook Survey (Vessels)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains data on the type and amount of marine resources that are discarded or interacted with by vessels that are selected to report to the Southeast...

  11. SC/OQ Vessel Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Data tables holding information for the Surf Clam/Ocean Quahog vessel and dealer/processor logbooks (negative and positive), as well as individual tag information...

  12. Vessel Permit System Data Set

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — GARFO issues federal fishing permits annually to owners of fishing vessels who fish in the Greater Atlantic region, as required by federal regulation. These permits...

  13. Reactor pressure vessel status report

    International Nuclear Information System (INIS)

    Strosnider, J.; Wichman, K.; Elliot, B.

    1994-12-01

    This report gives a brief description of the reactor pressure vessel (RPV), followed by a discussion of the radiation embrittlement of RPV beltline materials and the two indicators for measuring embrittlement, the end-of-license (EOL) reference temperature and the EOL upper-shelf energy. It also summarizes the GL 92-01 effort and presents, for all 37 boiling water reactor plants and 74 pressurized water reactor plants in the United States, the current status of compliance with regulatory requirements related to ensuring RPV integrity. The staff has evaluated the material data needed to predict neutron embrittlement of the reactor vessel beltline materials. These data will be stored in a computer database entitled the reactor vessel integrity database (RVID). This database will be updated annually to reflect the changes made by the licensees in future submittals and will be used by the NRC staff to assess the issues related to vessel structural integrity

  14. Reactor-vessel-sectioning demonstration

    International Nuclear Information System (INIS)

    Lundgren, R.A.

    1981-07-01

    A successful technical demonstration of simulated reactor vessel sectioning was completed using the combined techniques of air arc gouging and flame cutting. A 4-ft x 3-ft x 9-in. thick sample was fabricated of A36 carbon steel to simulate a reactor vessel wall. A 1/4-in layer of stainless steel (SS) was tungsten inert gas (TIG)-welded to the carbon steel. Several techniques were considered to section the simulated reactor vessel: an air arc gouger was chosen to penetrate the stainless steel, and flame cutting was selected to sever the carbon steel. After the simulated vessel was successfully cut from the SS side, another cut was made, starting from the carbon steel side. This cut was also successful. Cutting from the carbon steel side has the advantages of cost reduction since the air arc gouging step is eliminated and contamination controlled because the molten metal is blown inward

  15. Endovascular revascularization of TASC C and D femoropopliteal occlusive disease using carbon dioxide as contrast

    Energy Technology Data Exchange (ETDEWEB)

    Mendes, Cynthia de Almeida; Teivelis, Marcelo Passos; Kuzniec, Sergio; Fukuda, Juliana Maria; Wolosker, Nelson [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil)

    2016-07-01

    To analyze the results of ten angioplasties of TASC C and D femoropopliteal lesions using CO{sub 2} as primary contrast in patients with no formal contraindication to iodine, aiming to decrease allergic reactions and potential nephrotoxicity in high-risk patients. We describe the results of ten angioplasties of TASC C and D femoropopliteal lesions using CO{sub 2} as primary contrast in patients with high risk for open revascularization and no formal contraindication to iodine. We analyzed feasibility of the procedures, complications, quality of the angiographic images, clinical and surgical outcomes, and costs of C and D lesions treated using CO{sub 2} as contrast medium. The use of CO{sub 2} in C and D lesions needed iodine complementation in most of the cases (nine cases) but decreased the potential nephrotoxicity of iodine contrast medium by the reduction of its volume in this group of high-risk patients. The extension of the arterial lesions was the factor that most contributed to the need for iodine supplementation due to the difficulty to visualize the refill after a long arterial occlusion. The use of CO{sub 2} as contrast in patients with C and D lesions with no restriction for iodine contrast medium was an alternative that did not dismiss the need of iodine supplementation in most of the cases, but could decrease the potential nephrotoxicity of iodine constrast medium.

  16. Endostatin improves radioresponse and blocks tumor revascularization after radiation therapy for A431 xenografts in mice

    International Nuclear Information System (INIS)

    Itasaka, Satoshi; Komaki, Ritsuko; Herbst, Roy S.; Shibuya, Keiko; Shintani, Tomoaki D.D.S.; Hunter, Nancy R. M.S.; Onn, Amir; Bucana, Corazon D.; Milas, Luka; Ang, K. Kian; O'Reilly, Michael S.

    2007-01-01

    Purpose: Clinical trials of antiangiogenic agents used alone for advanced malignancy have been disappointing but preclinical studies suggest that the addition of radiation therapy could improve antitumor efficacy. To test the hypothesis that antiangiogenic therapy combined with radiation therapy can overcome the limitations of antiangiogenic monotherapy, we studied the effects of endostatin combined with radiation on the growth and vascularization of A431 human epidermoid carcinomas growing intramuscularly in the legs of mice. Methods and Materials: Mice with established A431 human epidermoid leg tumors were treated with radiation, endostatin, both radiation and endostatin, or vehicle control. The experiment was repeated and mice from each group were killed at 2, 7, and 10 days after irradiation so that tumor tissue could be obtained to further analyze the kinetics of the antitumor, antivascular, and antiangiogenic response to therapy. Results: Endostatin enhanced the antitumor effects of radiation, and prolonged disease-free survival was observed in the combined treatment group. Endothelial cell proliferation was increased in tumors after irradiation but was blocked by the concurrent administration of endostatin, and the combination of endostatin with radiation enhanced endothelial cell apoptosis within 48 h after irradiation. Expression of vascular endothelial growth factor, interleukin-8, and matrix metalloproteinase-2 were increased in tumors after irradiation, and this increase was blocked by concurrent administration of endostatin. Conclusion: These data indicate that endostatin can block tumor revascularization after radiation therapy and thereby augment radioresponse

  17. The Effect of Endovascular Revascularization of Common Iliac Artery Occlusions on Erectile Function

    International Nuclear Information System (INIS)

    Gur, Serkan; Ozkan, Uğur; Onder, Hakan; Tekbas, Güven; Oguzkurt, Levent

    2013-01-01

    To determine the incidence of erectile dysfunction in patients with common iliac artery (CIA) occlusive disease and the effect of revascularization on erectile function using the sexual health inventory for males (SHIM) questionnaire. All patients (35 men; mean age 57 ± 5 years; range 42–67 years) were asked to recall their sexual function before and 1 month after iliac recanalization. Univariate and multivariate analyses were performed to determine variables effecting improvement of impotence. The incidence of impotence in patients with CIA occlusion was 74% (26 of 35) preoperatively. Overall 16 (46%) of 35 patients reported improved erectile function after iliac recanalization. The rate of improvement of impotence was 61.5% (16 of 26 impotent patients). Sixteen patients (46%), including seven with normal erectile function before the procedure, had no change. Three patients (8%) reported deterioration of their sexual function, two of whom (6%) had normal erectile function before the procedure. The median SHIM score increased from 14 (range 4–25) before the procedure to 20 (range 1–25) after the procedure (P = 0.005). The type of recanalization, the age of the patients, and the length of occlusion were related to erectile function improvement in univariate analysis. However, these factors were not independent factors for improvement of erectile dysfunction in multivariate analysis (P > 0.05). Endovascular recanalization of CIA occlusions clearly improves sexual function. More than half of the patients with erectile dysfunction who underwent endovascular recanalization of the CIA experienced improvement.

  18. Assessment of the swallowing function in older individuals referred to myocardial revascularization surgery.

    Science.gov (United States)

    Dantas, Mara de Oliveira Rodrigues Luiz; Auler, José Otávio Costa; Andrade, Claudia Regina Furquim de

    2010-01-01

    Swallowing evaluation of older individuals with coronary disease referred to heart surgery. To identify the characteristics of the swallowing function in older individuals referred to myocardial revascularization surgery (MR), using an evaluating protocol composed by a water test, cervical auscultation and pulse oximetry. The Assessment Protocol for Dysphagia Risk through a Combined Swallowing test and Vital Signs monitoring was used (PADTC)--measurements of HR and SpO2 (heart rate and oxygen saturation), water swallowing test with 1, 3, 5, 10, 15 e 20 ml, measurement of respiratory rate and cervical auscultation. The electronic stethoscope was used to analyze the number of swallows, response time and swallowing sound classification. In the Research Group (RG) older individuals with heart disease who were referred to MR were included. In the Control Group (CG) healthy older individuals were included. 38 older individuals were evaluated in the RG (mean age 68 years). In the CG, 30 older individuals were evaluated (mean age 70 years). There was a significant difference for the swallowing response time in older individuals with heart disease who presented HR below 60: swallowing response was shorter for 3 ml, 10 ml, 15 ml e 20 ml. HR was lower for individuals with heart disease. No significant difference was found between the groups for the other analyzed parameters. Older individuals with heart disease presented differences in the swallowing function when compared to healthy older individuals. Older individuals with heart disease presented alterations in the temporal coordination between breathing and swallowing, thus indicating risk for dysphagia.

  19. Disparities in Revascularization After ST Elevation Myocardial Infarction (STEMI) Before and After the 2002 IOM Report.

    Science.gov (United States)

    Bolorunduro, Oluwaseyi B; Kiladejo, Adekunle V; Animashaun, Islamiyat Babs; Akinboboye, Olakunle O

    2016-05-01

    To examine nationwide trends for racial disparities in Percutaneous Coronary Intervention after ST elevated Myocardial Infarction (STEMI). The Institute of Medicine (IOM) report published in 2002 showed that African Americans were less likely to receive coronary revascularization such as CABG and stents even after controlling for socioeconomics. It recommended increased awareness of these disparities among health professionals to reduce this. We hypothesized that increased awareness of disparities since this report would have translated to reduction in racial disparities in percutaneous coronary intervention. A retrospective analysis was conducted using data from the Agency of Healthcare Research and Quality's (AHRQ) National Inpatient Sample (NIS) 1998-2007. All patients with STEMI during this period were identified. The proportion that received Percutaneous Coronary Intervention (PCI) during the incident admission was compared by different ethnicities over the time period. Multivariable regression for each year was conducted using Poisson regression with robust variances. The analysis controlled for gender, insurance status, co-morbidities, hospital bed size, location and teaching status. Based on the database, about 2.04 million patients were managed for acute Myocardial Infarction from 1998 to 2007, of these 938,176 had STEMI. The primary PCI rate after STEMI among Caucasians was 29.1%, African Americans-23.3% and Hispanics-28.3% [P IOM report. Copyright © 2016 National Medical Association. Published by Elsevier Inc. All rights reserved.

  20. Revascularization and Muscle Adaptation to Limb Demand Ischemia in Diet Induced Obese Mice

    Science.gov (United States)

    Albadawi, Hassan; Tzika, Aria; Rask-Madsen, Christian; Crowley, Lindsey M.; Koulopoulos, Michael W.; Yoo, Hyung-Jin; Watkins, Michael T.

    2016-01-01

    Background Obesity and type 2 diabetes are major risk factors for peripheral arterial disease (PAD) in humans which can result in lower limb demand ischemia and exercise intolerance. Exercise triggers skeletal muscle adaptation including increased vasculogenesis. The goal of this study was to determine whether demand ischemia modulates revascularization, fiber size, and signaling pathways in the ischemic hind limb muscles of mice with diet-induced obesity (DIO). Materials and Methods DIO mice (n=7) underwent unilateral femoral artery ligation (FAL) and recovered for 2-weeks followed by 4-weeks with daily treadmill exercise to induce demand ischemia. A parallel sedentary ischemia group (n=7) had FAL without exercise. The contralateral limb muscles of sedentary ischemia served as control. Muscles were examined for capillary density, myofiber cross-sectional area (CSA), cytokine levels, and phosphorylation of STAT3 and ERK1/2. Results Exercise significantly enhanced capillary density (pdemand ischemia compared to sedentary ischemia. These findings coincided with a significant increase in G-CSF (pDemand ischemia increased the PGC1α mRNA (pdemands ischemia in the setting of DIO causes myofiber atrophy despite an increase in muscle capillary density. The combination of persistent increase in TNFα, lower VEGF and failure to increase PGC1α protein may reflect a deficient adaption to demand ischemia in DIO. PMID:27620999

  1. Clinical effectiveness of 99mTc-diphosphonate scintigraphy of revascularized iliac crest flaps

    International Nuclear Information System (INIS)

    Smeele, L.E.; Hoekstra, O.S.; Winters, H.A.H.; Leemans, C.R.

    1996-01-01

    Clinical assessment of the perfusion of the musculocutaneous portion of composite iliac crest free flaps was compared to 99m Tc-diphosphonate (HDP) uptake in 14 patients who underwent primary oromandibular reconstruction after ablative cancer surgery. Bone scanning was performed on average at the 9-10th postoperative day (range 4-48) 3 h after intravenous injection of 550 MBq 99m Tc-HDP. Eleven patients showed complete concordance between 99m Tc-HDP uptake and soft-tissue status. Two patients showed uptake and viable muscle in spite of necrotic skin. One patient had a viable musculocutaneous flap but a photopenic defect in the bone graft; 6 months later, a small corresponding part of the bone was sequestrated. In this study, bone scanning and clinical assessment of muscle perfusion were 100% accurate in predicting viability of bone graft. Skin viability was a less reliable parameter. It is concluded that bone scanning is not indicated as routine investigation for revascularized iliac crest flaps and that clinical assessment of muscle perfusion is a reliable monitor of the early function of such flaps. (au) 8 refs

  2. The Effect of Endovascular Revascularization of Common Iliac Artery Occlusions on Erectile Function

    Energy Technology Data Exchange (ETDEWEB)

    Gur, Serkan, E-mail: mserkangur@yahoo.com [Sifa Hospital, Department of Radiology (Turkey); Ozkan, Ugur [Baskent University, Department of Radiology, Faculty of Medicine (Turkey); Onder, Hakan; Tekbas, Gueven [Dicle University, Department of Radiology, Faculty of Medicine (Turkey); Oguzkurt, Levent [Baskent University, Department of Radiology, Faculty of Medicine (Turkey)

    2013-02-15

    To determine the incidence of erectile dysfunction in patients with common iliac artery (CIA) occlusive disease and the effect of revascularization on erectile function using the sexual health inventory for males (SHIM) questionnaire. All patients (35 men; mean age 57 {+-} 5 years; range 42-67 years) were asked to recall their sexual function before and 1 month after iliac recanalization. Univariate and multivariate analyses were performed to determine variables effecting improvement of impotence. The incidence of impotence in patients with CIA occlusion was 74% (26 of 35) preoperatively. Overall 16 (46%) of 35 patients reported improved erectile function after iliac recanalization. The rate of improvement of impotence was 61.5% (16 of 26 impotent patients). Sixteen patients (46%), including seven with normal erectile function before the procedure, had no change. Three patients (8%) reported deterioration of their sexual function, two of whom (6%) had normal erectile function before the procedure. The median SHIM score increased from 14 (range 4-25) before the procedure to 20 (range 1-25) after the procedure (P = 0.005). The type of recanalization, the age of the patients, and the length of occlusion were related to erectile function improvement in univariate analysis. However, these factors were not independent factors for improvement of erectile dysfunction in multivariate analysis (P > 0.05). Endovascular recanalization of CIA occlusions clearly improves sexual function. More than half of the patients with erectile dysfunction who underwent endovascular recanalization of the CIA experienced improvement.

  3. Power reactor pressure vessel benchmarks

    International Nuclear Information System (INIS)

    Rahn, F.J.

    1978-01-01

    A review is given of the current status of experimental and calculational benchmarks for use in understanding the radiation embrittlement effects in the pressure vessels of operating light water power reactors. The requirements of such benchmarks for application to pressure vessel dosimetry are stated. Recent developments in active and passive neutron detectors sensitive in the ranges of importance to embrittlement studies are summarized and recommendations for improvements in the benchmark are made. (author)

  4. Prosopomorphic vessels from Moesia Superior

    Directory of Open Access Journals (Sweden)

    Nikolić Snežana

    2008-01-01

    Full Text Available The prosopomorphic vessels from Moesia Superior had the form of beakers varying in outline but similar in size. They were wheel-thrown, mould-made or manufactured by using a combination of wheel-throwing and mould-made appliqués. Given that face vessels are considerably scarcer than other kinds of pottery, more than fifty finds from Moesia Superior make an enviable collection. In this and other provinces face vessels have been recovered from military camps, civilian settlements and necropolises, which suggests that they served more than one purpose. It is generally accepted that the faces-masks gave a protective role to the vessels, be it to protect the deceased or the family, their house and possessions. More than forty of all known finds from Moesia Superior come from Viminacium, a half of that number from necropolises. Although tangible evidence is lacking, there must have been several local workshops producing face vessels. The number and technological characteristics of the discovered vessels suggest that one of the workshops is likely to have been at Viminacium, an important pottery-making centre in the second and third centuries.

  5. Vacuum vessel for thermonuclear device

    International Nuclear Information System (INIS)

    Kikuchi, Mitsuru; Kurita, Gen-ichi; Onozuka, Masaki; Suzuki, Masaru.

    1997-01-01

    Heat of inner walls of a vacuum vessel that receive radiation heat from plasmas by way of first walls is removed by a cooling medium flowing in channels for cooling the inner walls. Nuclear heat generation of constitutional materials of the vacuum vessel caused by fast neutrons and γ rays is removed by a cooling medium flowing in cooling channels disposed in the vacuum vessel. Since the heat from plasmas and the nuclear heat generation are removed separately, the amount of the cooling medium flowing in the channels for cooling inner walls is increased for cooling a great amount of heat from plasmas while the amount of the cooling medium flowing in the channels for cooling the inside of the vacuum vessel is reduced for cooling the small amount of nuclear heat generation. Since the amount of the cooling medium can thus be optimized, the capacity of the facilities for circulating the cooling medium can be reduced. In addition, since the channels for cooling the inner walls and the channels of cooling medium formed in the vacuum vessel are disposed to the inner walls of the vacuum vessel on the side opposite to plasmas, integrity of the channels relative to leakage of the cooling medium can be ensured. (N.H.)

  6. Vacuum vessel for thermonuclear device

    Energy Technology Data Exchange (ETDEWEB)

    Kikuchi, Mitsuru; Kurita, Gen-ichi [Japan Atomic Energy Research Inst., Tokyo (Japan); Onozuka, Masaki; Suzuki, Masaru

    1997-07-31

    Heat of inner walls of a vacuum vessel that receive radiation heat from plasmas by way of first walls is removed by a cooling medium flowing in channels for cooling the inner walls. Nuclear heat generation of constitutional materials of the vacuum vessel caused by fast neutrons and {gamma} rays is removed by a cooling medium flowing in cooling channels disposed in the vacuum vessel. Since the heat from plasmas and the nuclear heat generation are removed separately, the amount of the cooling medium flowing in the channels for cooling inner walls is increased for cooling a great amount of heat from plasmas while the amount of the cooling medium flowing in the channels for cooling the inside of the vacuum vessel is reduced for cooling the small amount of nuclear heat generation. Since the amount of the cooling medium can thus be optimized, the capacity of the facilities for circulating the cooling medium can be reduced. In addition, since the channels for cooling the inner walls and the channels of cooling medium formed in the vacuum vessel are disposed to the inner walls of the vacuum vessel on the side opposite to plasmas, integrity of the channels relative to leakage of the cooling medium can be ensured. (N.H.)

  7. The Outcomes of Salvage Surgery for Vascular Injury in The Extremities: A Special Consideration For Delayed Revascularization

    Directory of Open Access Journals (Sweden)

    Jagdish Krishnan

    2014-03-01

    Full Text Available A seven years retrospective study was performed in 45 consecutive vascular injuries in the extremities to investigate the pattern of injuries, managements and outcomes. Motor-vehicle accidents were the leading cause of injuries (80%, followed by industrial injuries (11.1% and iatrogenic injuries (4.4%. Popliteal and brachial artery injuries were commonly involved (20%. Fifteen (33.3% patients had fractures, dislocation or fracture dislocation around the knee joint and 6 (13.3% patients had soft tissue injuries without fracture. Traumatic arterial transection accounted for 34 (75.6% cases, followed by laceration in 7 (15.6% and 9 (6.7% contusions. Associated nerve injuries were seen in 8 (17.8 % patients using intra-operative findings as the gold standard, both conventional angiogram (CA and computerized tomography angiogram (CTA had 100% specificity and 100% sensitivity in determining the site of arterial injuries. The mean ischemic time was 25.31 hours (4 - 278 hours. Thirty-three (73.3 % patients were treated more than 6 hours after injury and 6 patients underwent revascularization after 24 hours; all had good collateral circulation without distal pulses or evidence of ischemic neurological deficit. The mean ischemic time in 39 patients who underwent revascularization within 24 hours was 13.2 hours. Delayed amputation was performed in 5 patients (11.1%. Of the 6 patients who underwent delayed revascularization, one patient had early amputation, one -had delayed amputation following infection and multiple flap procedures while the rest of the patients’ limbs survived. Joint stiffness was noted in 10 patients (22.2% involving the knee joint, elbow and shoulder in two patients each. Infection was also noted in 5 patients (11.1% with two of them were due to infected implants. Other complications encountered included nonunion (2 patients, 4.4%, delayed union (1 patient, 2.2%, limb length discrepancy (1 patient, 2.2%, hematoma (1 patient, 2.2% and

  8. EFFICIENCY OF ENDOVASCULAR MYOCARDIAL REVASCULARIZATION AS A «BRIDGE» TO HEART TRANSPLANTATION IN PATIENTS WITH ISCHEMIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    A. B. Mironkov

    2016-01-01

    Full Text Available Aim: to estimate effi ciency of endovascular myocardial revascularization in patients with ischemic chronic heart failure, potential candidates for heart transplantation.Materials and methods. Survival of 108 patients with ischemic heart disease complicated by chronic heart failure (CHF after performance of endovascular myocardial revascularization by percutaneous coronary intervention (PCI is presented. The observation period composed 32.79 ± 6.2 (from 3 to 126 months, age from 33 to 72 (58.9 ± 0.64 years, 102 men, 6 women. Left ventricular (LV ejection fraction was 34.9 ± 0.6%, EDV 249.75 ± 4.9 ml, ESV 163.27 ± 3.7 ml, mitral regurgitation 1.51 ± 0.07 points. 73% of patients had NYHA Class III CHF, 27% had NYHA Class IV CHF. Duration and quality of life after revascularization were determined. In 2–3 days after PCI dynamics of LV ultrasound parameters were estimated.Results. At the time of the end of our research 88 from 108 patients (81% were alive, including 18 patients who underwent heart transplantation (HT. Repeated revascularization was carried out to 19 (17% patients. 20 patients died: 16 patients with cardiovascular disorders (15%, including 4% of stroke, 3 with pulmonary embolism and 1 with oncological disease. Survival of 90% of the patients composed 4.5 years, 50% survival composed 9 years. At the time of the end of our research the maximum observation period was equal to 126 months. The duration from the fi rst PCI to HT composed from 7.5 to 105 months, mean value – 37 ± 7.5 months. Average life expectancy after HT composed 54.9 ± 24.4 months. Life expectancy from the fi rst PCI composed 87.5 ± 36.9 months. All patients of this group were alive by the time of the end of this research.Conclusion. Endovascular revascularization in patients with ischemic heart failure in 20% of cases can serve as «bridge» to HT, in 50% of cases it can be considered as an alternative to heart transplantation.

  9. Automated method for identification and artery-venous classification of vessel trees in retinal vessel networks.

    Science.gov (United States)

    Joshi, Vinayak S; Reinhardt, Joseph M; Garvin, Mona K; Abramoff, Michael D

    2014-01-01

    The separation of the retinal vessel network into distinct arterial and venous vessel trees is of high interest. We propose an automated method for identification and separation of retinal vessel trees in a retinal color image by converting a vessel segmentation image into a vessel segment map and identifying the individual vessel trees by graph search. Orientation, width, and intensity of each vessel segment are utilized to find the optimal graph of vessel segments. The separated vessel trees are labeled as primary vessel or branches. We utilize the separated vessel trees for arterial-venous (AV) classification, based on the color properties of the vessels in each tree graph. We applied our approach to a dataset of 50 fundus images from 50 subjects. The proposed method resulted in an accuracy of 91.44% correctly classified vessel pixels as either artery or vein. The accuracy of correctly classified major vessel segments was 96.42%.

  10. The TPX vacuum vessel and in-vessel components

    International Nuclear Information System (INIS)

    Heitzenroeder, P.; Bialek, J.; Ellis, R.; Kessel, C.; Liew, S.

    1994-01-01

    The Tokamak Physics Experiment (TPX) is a superconducting tokamak with double-null diverters. TPX is designed for 1,000-second discharges with the capability of being upgraded to steady state operation. High neutron yields resulting from the long duration discharges require that special consideration be given to materials and maintainability. A unique feature of the TPX is the use of a low activation, titanium alloy vacuum vessel. Double-wall vessel construction is used since it offers an efficient solution for shielding, bakeout and cooling. Contained within the vacuum vessel are the passive coil system, Plasma Facing Components (PFCs), magnetic diagnostics, and the internal control coils. All PFCs utilize carbon-carbon composites for exposed surfaces

  11. The Contemporary Use of Angiography and Revascularization Among Patients With Non-ST-Segment Elevation Myocardial Infarction in the United States Compared With South Korea.

    Science.gov (United States)

    Kang, Hyun-Jae; Simon, Dajuanicia; Wang, Tracy Y; Alexander, Karen P; Jeong, Myung Ho; Kim, Hyo-Soo; Bates, Eric R; Henry, Timothy D; Peterson, Eric D; Roe, Matthew T

    2015-12-01

    Practice guidelines recommend an early invasive strategy for high-risk non-ST-segment elevation myocardial infarction (NSTEMI) patients, but international differences in the use of invasive strategies are unknown. Profiling NSTEMI patient management in the United States (U.S.) and South Korea could provide insight into how patients are triaged for an early invasive strategy in different health care environments and geographical regions. We evaluated the use of angiography and revascularization for NSTEMI patients treated at revascularization-capable hospitals (2007-2010) in both the ACTION Registry-GWTG (U.S.: n = 133,835; 433 hospitals) and KAMIR/KorMI Registry (South Korea: n = 7,901; 72 hospitals). Compared with South Korean patients, U.S. NSTEMI patients more commonly had established cardiovascular risk factors, disease, and prior cardiovascular events and procedures. From 2007-2010, the use of angiography for NSTEMI patients rose steadily in both countries, but the use of revascularization only rose in South Korea. Patients from South Korea more commonly underwent angiography and revascularization. Percutaneous coronary intervention was the most common type of revascularization in both countries, but coronary artery bypass grafting was less common in South Korea. The use of both angiography and revascularization was incrementally lower with a higher predicted mortality risk for patients from both countries, but greater differences between low- and high-risk patients occurred in the U.S. The profile, characteristics, and use of angiography and revascularization for NSTEMI patients in the U.S. vs South Korea differed substantially from 2007-2010, underscoring the heterogeneity of NSTEMI patients and treatment selection among different countries. © 2015 Wiley Periodicals, Inc.

  12. Clay Corner: Recreating Chinese Bronze Vessels.

    Science.gov (United States)

    Gamble, Harriet

    1998-01-01

    Presents a lesson where students make faux Chinese bronze vessels through slab or coil clay construction after they learn about the history, function, and design of these vessels. Utilizes a variety of glaze finishes in order to give the vessels an aged look. Gives detailed guidelines for creating the vessels. (CMK)

  13. Vacuum vessel for thermonuclear device

    International Nuclear Information System (INIS)

    Kikuchi, Mitsuru; Nagashima, Keisuke; Suzuki, Masaru; Onozuka, Masaki.

    1997-01-01

    A vacuum vessel main body and structural members at the inside and the outside of the vacuum vessel main body are constituted by structural materials activated by irradiation of neutrons from plasmas such as stainless steels. Shielding members comprising tungsten or molybdenum are disposed on the surface of the vacuum vessel main body and the structural members of the inside and the outside of the main body. The shielding members have a function also as first walls or a seat member for the first walls. Armor tiles may be disposed to the shielding members. The shielding members and the armor tiles are secured to a securing seat member disposed, for example, to an inner plate of the vacuum vessel main body by bolts. Since the shielding members are disposed, it is not necessary to constitute the vacuum vessel main body and the structural members at the inside and the outside thereof by using a low activation material which is less activated, such as a titanium alloy. (I.N.)

  14. Vacuum vessel for thermonuclear device

    Energy Technology Data Exchange (ETDEWEB)

    Kikuchi, Mitsuru; Nagashima, Keisuke [Japan Atomic Energy Research Inst., Tokyo (Japan); Suzuki, Masaru; Onozuka, Masaki

    1997-07-11

    A vacuum vessel main body and structural members at the inside and the outside of the vacuum vessel main body are constituted by structural materials activated by irradiation of neutrons from plasmas such as stainless steels. Shielding members comprising tungsten or molybdenum are disposed on the surface of the vacuum vessel main body and the structural members of the inside and the outside of the main body. The shielding members have a function also as first walls or a seat member for the first walls. Armor tiles may be disposed to the shielding members. The shielding members and the armor tiles are secured to a securing seat member disposed, for example, to an inner plate of the vacuum vessel main body by bolts. Since the shielding members are disposed, it is not necessary to constitute the vacuum vessel main body and the structural members at the inside and the outside thereof by using a low activation material which is less activated, such as a titanium alloy. (I.N.)

  15. Molten material-containing vessel

    International Nuclear Information System (INIS)

    Akagawa, Katsuhiko

    1998-01-01

    The molten material-containing vessel of the present invention comprises a vessel main body having an entrance opened at the upper end, a lid for closing the entrance, an outer tube having an upper end disposed at the lower surface of the lid, extended downwardly and having an closed lower end and an inner tube disposed coaxially with the outer tube. When a molten material is charged from the entrance to the inside of the vessel main body of the molten material-containing vessel and the entrance is closed by the lid, the outer tube and the inner tube are buried in the molten material in the vessel main body, accordingly, a fluid having its temperature elevated by absorption of the heat of the molten material rises along the inner circumferential surface of the outer tube, abuts against the lower surface of the lid and cooled by exchanging heat with the lid and forms a circulating flow. Since the heat in the molten material is continuously absorbed by the fluid, transferred to the lid and released from the lid to the atmospheric air, heat releasing efficiency can be improved compared with conventional cases. (N.H.)

  16. Manufacture, testing and assembly preparation of the JET vacuum vessel

    International Nuclear Information System (INIS)

    Arbez, J.; Baeumel, S.; Dean, J.R.; Duesling, G.; Froger, C.; Hemmerich, J.L.; Walravens, M.; Walter, K.; Winkel, T.

    1983-01-01

    To reach the target pressure of 10 -9 mbar, JET's double-walled Inconel vacuum vessel is being manufactured and assembled in clean conditions and with meticulous leak detection. Each octant (1/8 of the torus) is baked in an oven to 520 0 C and leak tested at 350 0 C to reveal leaks as small as 10 -9 mbar l/s, which are repaired. In service the vessel will be baked periodically to 500 0 C by CO 2 passing between its walls. The single-walled ports will be electrically heated. (author)

  17. Image processing algorithm for robot tracking in reactor vessel

    International Nuclear Information System (INIS)

    Kim, Tae Won; Choi, Young Soo; Lee, Sung Uk; Jeong, Kyung Min; Kim, Nam Kyun

    2011-01-01

    In this paper, we proposed an image processing algorithm to find the position of an underwater robot in the reactor vessel. Proposed algorithm is composed of Modified SURF(Speeded Up Robust Feature) based on Mean-Shift and CAMSHIFT(Continuously Adaptive Mean Shift Algorithm) based on color tracking algorithm. Noise filtering using luminosity blend method and color clipping are preprocessed. Initial tracking area for the CAMSHIFT is determined by using modified SURF. And then extracting the contour and corner points in the area of target tracked by CAMSHIFT method. Experiments are performed at the reactor vessel mockup and verified to use in the control of robot by visual tracking

  18. Inhaled Nitric Oxide for the Prevention of Impaired Arterial Oxygenation during Myocardial Revascularization with Extracorporeal Circulation

    Directory of Open Access Journals (Sweden)

    I. A. Kozlov

    2011-01-01

    Full Text Available Objective: to study the efficacy of inhaled nitric oxide used intraoperatively to prevent lung oxygenating dysfunction in patients with coronary heart disease after myocardial revascularization under extracorporeal circulation (EC. Subjects and methods. Thirty-two patients aged 55.0±2.0 years were examined. The inclusion criteria were the standard course of surgical intervention (the absence of hemorrhage, acute cardiovascular insufficiency, perioperative myocardial infarction, etc., a pulmonary artery wedge pressure of less than 15 – mm Hg throughout the study, and the baseline arterial partial oxygen tension/inspired mixture oxygen fraction (PaO2/FiO2 ratio of at least 350 mm Hg. There was a control group (n=21; Group 1 that used no special measures to prevent and/or to correct lung oxygenating dysfunction and Group 2 (n=11 that received inhaled nitric oxide. Ihe administration of inhaled nitric oxide at a concentration of 10 ppm was initiated after water anesthesia, stopped during EC, and resumed in the postperfusion period. Results. At the end, PaO2/FiO2 and intrapulmonary shunt fraction did not differ between the groups (p>0.05. Before EC, the patients receiving inhaled nitric oxide had a lower intrapulmonary blood shunting (8.9±0.7 and 11.7±1.0%; p<0.05. There were no intergroup differences in the values of PaO2/FiO2 at this stage. In the earliest postperfusion period, PaO2/FiO2 was higher in Group 2 than that in Group 1. At the end of operations, Groups 1 and 2 had a PaO2/FiO2 of 336.0±16.8 and 409.0±24.3 mm Hg, respectively (p<0.05 and an intrapulmonary shunt fraction of 14.5±1.0 and 10.4±1.0% (p<0.05. At the end of surgery, the rate of a reduction in PaO2/FiO2 to the level below 350 mm Hg was 52.4±11.1% in Group 1 and 18.2±11.6% in Group 2 (p<0.05. Six hours after surgery, PaO2/FiO2 values less than 300 mm Hg were diagnosed in 61.9±10.5% of Group 1 patients and in 27.3±13.4% of Group 2 ones (p<0.05. Conclusion. The

  19. Outcomes of Infrainguinal Revascularizations with Endovascular First Strategy in Critical Limb Ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Jens, Sjoerd, E-mail: s.jens@amc.uva.nl [Academic Medical Center, Department of Radiology (Netherlands); Conijn, Anne P., E-mail: a.p.conijn@amc.uva.nl; Frans, Franceline A., E-mail: f.a.frans@amc.uva.nl [Academic Medical Center, Departments of Radiology and Surgery (Netherlands); Nieuwenhuis, Marieke B. B., E-mail: m.b.nieuwenhuis@amc.uva.nl; Met, Rosemarie, E-mail: rosemariemet@hotmail.com [Academic Medical Center, Department of Radiology (Netherlands); Koelemay, Mark J. W., E-mail: m.j.koelemaij@amc.uva.nl; Legemate, Dink A., E-mail: d.a.legemate@amc.uva.nl [Academic Medical Center, Department of Surgery (Netherlands); Bipat, Shandra, E-mail: s.bipat@amc.uva.nl; Reekers, Jim A., E-mail: j.a.reekers@amc.uva.nl [Academic Medical Center, Department of Radiology (Netherlands)

    2015-06-15

    PurposeThis study was designed to study the outcome of infrainguinal revascularization in patients with critical limb ischemia (CLI) in an institution with a preference towards endovascular intervention first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age.MethodsA prospective, observational cohort study was conducted between May 2007 and May 2010 in patients presenting with CLI. At baseline, the optimal treatment was selected, i.e., endovascular or surgical treatment. In case of uncertainty about the preferred treatment, a multidisciplinary team (MDT) was consulted. Primary endpoints were quality of life and functional status 6 and 12 months after initial intervention, assessed by the VascuQol and AMC Linear Disability Score questionnaires, respectively.ResultsIn total, 113 patients were included; 86 had an endovascular intervention and 27 had surgery. During follow-up, 41 % underwent an additional ipsilateral revascularisation procedure. For the total population, and endovascular and surgery subgroups, the VascuQol sum scores improved after 6 and 12 months (p < 0.01 for all outcomes) compared with baseline. The functional status improved (p = 0.043) after 12 months compared with baseline for the total population. Functional status of the surgery subgroup improved significantly after 6 (p = 0.031) and 12 (p = 0.044) months, but not that of the endovascular subgroup.ConclusionsOverall, the strategy of performing endovascular treatment first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age has comparable or even slightly better results compared with the BASIL trial and other cohort studies. All vascular groups should discuss whether their treatment strategy should be directed at treating CLI patients preferably endovascular first and consider implementing an MDT to optimize patient outcomes.

  20. In-Hospital Outcomes of Atherectomy During Endovascular Lower Extremity Revascularization.

    Science.gov (United States)

    Panaich, Sidakpal S; Arora, Shilpkumar; Patel, Nilay; Patel, Nileshkumar J; Patel, Samir V; Savani, Chirag; Singh, Vikas; Jhamnani, Sunny; Sonani, Rajesh; Lahewala, Sopan; Thakkar, Badal; Patel, Achint; Dave, Abhishek; Shah, Harshil; Bhatt, Parth; Jaiswal, Radhika; Ghatak, Abhijit; Gupta, Vishal; Deshmukh, Abhishek; Kondur, Ashok; Schreiber, Theodore; Grines, Cindy; Badheka, Apurva O

    2016-02-15

    Contemporary data on clinical outcomes after utilization of atherectomy in lower extremity endovascular revascularization are sparse. The study cohort was derived from Healthcare Cost and Utilization Project nationwide inpatient sample database from the year 2012. Peripheral endovascular interventions including atherectomy were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. The subjects were divided and compared in 2 groups: atherectomy versus no atherectomy. Two-level hierarchical multivariate mixed models were created. The coprimary outcomes were in-hospital mortality and amputation; secondary outcome was a composite of in-hospital mortality and periprocedural complications. Hospitalization costs were also assessed. Atherectomy utilization (odds ratio, 95% CI, p value) was independently predictive of lower in-hospital mortality (0.46, 0.28 to 0.75, 0.002) and lower amputation rates (0.83, 0.71 to 0.97, 0.020). Atherectomy use was also predictive of significantly lower secondary composite outcome of in-hospital mortality and complications (0.79, 0.69 to 0.90, 0.001). In the propensity-matched cohort, atherectomy utilization was again associated with a lower rate of amputation (11.18% vs 12.92%, p = 0.029), in-hospital mortality (0.71% vs 1.53%, p 0.001), and any complication (13.24% vs 16.09%, p 0.001). However, atherectomy use was also associated with higher costs ($24,790 ± 397 vs $22635 ± 251, p Atherectomy use in conjunction with angioplasty (with or without stenting) was associated with improved in-hospital outcomes in terms of lower amputation rates, mortality, and postprocedural complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. The Relationship between Proliferative Scars and Endothelial Function in Surgically Revascularized Patients

    Directory of Open Access Journals (Sweden)

    Murat Ziyrek

    2015-12-01

    Full Text Available Background: Proliferative scars are benign fibrotic proliferations which demonstrate abnormal wound healing in response to skin injuries. As postulated in the “response to injury hypothesis”, atherosclerosis is also triggered by an endothelial injury. Keloid and atherosclerotic processes have many pathophysiological and cytological features in common. Aims: In this study, we investigated the relationship between proliferative scars and endothelial function in surgically revascularized patients. We aimed to test the hypothesis that atherosclerosis is a wound healing abnormality. Study Design: Cross-sectional study. Methods: Consecutive patients who were admitted to the cardiology outpatient clinic with a history of coronary artery bypass grafting operation were evaluated. Thirty-three patients with proliferative scars at the median sternotomy site formed the keloid group, and 36 age- and sex-matched patients with no proliferative scar at the median sternotomy site formed the control group. Endothelial function was evaluated by flow-mediated vasodilatation of the brachial artery via ultrasonograhic examination. Results: There is no signicant difference according to the demographic data, biochemical parameters, clinical parameters and number of grafts between keloid and control groups. Endothelial-dependent vasodilatory response was lower in the keloid group than the control group (9.30±3.5 and 18.68±8.2, respectively; p=0.001. Conclusion: This study showed that endothalial dysfunction, which is strongly correlated with atherosclerosis, was more prominent in patients with proliferative scars. As proliferative scars and atherosclerosis have many features in common, we might conclude that atherosclerosis is a wound healing abnormality.

  2. New Treatment Applying Low Level Laser Therapy for Acute Dehiscence Saphenectomy in Post Myocardial Revascularization.

    Science.gov (United States)

    Pinto, Nathali Cordeiro; Shoji, Nara; Junior, Mauro Favoretto; Muramatso, Mikiya; Chavantes, Maria Cristina; Stolf, Noedir A. G.

    2008-04-01

    Introduction: In Brazil, the main cause of death is the coronary heart disease and the surgical treatment applied in such cases is the Myocardial Revascularization (MR). Patients undergoing to MR through saphenous vein bypass development dehiscence in 10% of the cases. Dehiscence of surgical incision through Biomodulation treatment with Low Level Laser Therapy (LLLT) in patients who underwent to MR seems to be an unprecedented new therapy and a less invasive technique, which can benefit patients and Institutions, reducing costs. Methodology: It was analyzed 7 diabetic patients, mean age 51, 8 years old that post MR surgery presented dehiscence of the saphenectomy incision on lower limb with erithema, edema and pain. The wounds area varies from 2,2 until 34,8 cm and deep from 0,1 until 1,1 cm. It was used only Diode Laser C.W. (655 nm wavelength), Power = 25 mW, Time = 30 s, Fluence = 4 J/cm2 applied punctually around surgical wound's sore, by 2 cm distance. Results: It was observed granulated tissue all around the incision, as well as decreased inflammatory process, reduction fibrin and wound's size, besides analgesic effect since the first application. It was required in superficial wounds only 3 applications, while in the extensive wounds 8-10 applications were necessary. The LLLT has shown a remarkable role as a wound healing facilitated agent, reflecting the reduction of inflammatory process and improving analgesia. Conclusion: LLLT assisted dehiscence post saphenectomy showed a substantial improvement to the patient's quality of life, with a cost-effectiveness treatment that can benefit both patients and Institutions as an effective and less invasive therapy.

  3. Heart Rate Variability Analysis in Revascularized Individuals Submitted to an Anaerobic Potency Test

    Directory of Open Access Journals (Sweden)

    Geraldo Mendes Gutian Jr

    2007-10-01

    Full Text Available The objective of this study was to analyze the behavior of autonomic modulation before, during and after the Modified Wingate Test (WanMT, through the analysis of Heart Rate Variability (HRV. Six volunteers between the ages of 40 and 70, post-revascularization procedures (angioplasty and/or surgery, mean duration 10 months, were submitted to supervised training for at least 10 to 14 months. The following protocol, divided into 5 phases, was used: 1 Rest Phase (RP: 180 seconds; 2 Submaximum Phase (SP: 30 seconds; 3 Maximum Phase (MP: 30 seconds; 4 Active Recuperation Phase (ARP; 120 seconds and; 5 Passive Recuperation Phase (PRP: 180 seconds. For the WanMT Test, we selected the load of 3.75% of corporal weight for all volunteers. To analyze the HRV, we used the following parameters: the interval RRr, MNN, SDNN, RMSSD and PNN50. We only observed results for the group according to RMSSD parameters during the rest phase of the test protocol in which the group remained in vagal presence and during all other phases in vagal depression. However, when we analyzed the PNN50, we observed that the group was in medium vagal presence during all of the phases of the test though there was no statistically significant difference (p> 0.05 between the phases. Therefore, we can say that all of the individuals had a similar profile in the autonomic response to the WanMT, confirmed by the parameters studied in the analysis of the HRV in the time domain.

  4. Emergency venting of pressure vessels

    International Nuclear Information System (INIS)

    Steinkamp, H.

    1995-01-01

    With the numerical codes developed for safety analysis the venting of steam vessel can be simulated. ATHLET especially is able to predict the void fraction depending on the vessel height. Although these codes contain a one-dimensional model they allow the description of complex geometries due to the detailed nodalization of the considered apparatus. In chemical reactors, however, the venting process is not only influenced by the flashing behaviour but additionally by the running chemical reaction in the vessel. Therefore the codes used for modelling have to consider the kinetics of the chemical reaction. Further multi-component systems and dissolving processes have to be regarded. In order to preduct the fluid- and thermodynamic process it could be helpful to use 3-dimensional codes in combination with the one-dimensional codes as used in nuclear industry to get a more detailed describtion of the running processes. (orig./HP)

  5. Development of Catamaran Fishing Vessel

    Directory of Open Access Journals (Sweden)

    A. Jamaluddin

    2010-11-01

    Full Text Available Multihull due to a couple of advantages has been the topic of extensive research work in naval architecture. In this study, a series of investigation of fishing vessel to save fuel energy was carried out at ITS. Two types of ship models, monohull (round bilge and hard chine and catamaran, a boat with two hulls (symmetrical and asymmetrical were developed. Four models were produced physically and numerically, tested (towing tank and simulated numerically (CFD code. The results of the two approaches indicated that the catamaran mode might have drag (resistance smaller than those of monohull at the same displacement. A layout of catamaran fishing vessel, proposed here, indicates the freedom of setting the deck equipments for fishing vessel.

  6. 33 CFR 90.3 - Pushing vessel and vessel being pushed: Composite unit.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Pushing vessel and vessel being... HOMELAND SECURITY INLAND NAVIGATION RULES INLAND RULES: INTERPRETATIVE RULES § 90.3 Pushing vessel and vessel being pushed: Composite unit. Rule 24(b) of the Inland Rules states that when a pushing vessel and...

  7. 33 CFR 82.3 - Pushing vessel and vessel being pushed: Composite unit.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Pushing vessel and vessel being... HOMELAND SECURITY INTERNATIONAL NAVIGATION RULES 72 COLREGS: INTERPRETATIVE RULES § 82.3 Pushing vessel and vessel being pushed: Composite unit. Rule 24(b) of the 72 COLREGS states that when a pushing vessel and a...

  8. Study on the quality of FRP fishing vessel based on improved Fishbone Chart

    Science.gov (United States)

    Sui, J. H.; Yu, Y. F.; Du, Q. F.; Jiang, D. W.

    2018-01-01

    The construction quality of FRP fishing vessels influences their production, use and industry development. In order to explore the factors that affect the construction quality of FRP fishing vessels, key factors affecting the construction quality of FRP fishing vessels are determined based on the quality problems of FRP fishing vessels constructed. The improved Fishbone Chart is used to analyze the eight factors of “human, machine, material, process, environment, inspection, design and information”. Taking the factors that affect the construction quality of FRP fishing vessels as the central target, the eight influencing factors were condensed into five aspects and a composite Fishbone Chart is drawn. The Fishbone Chart is used as the basic model, the influencing factors are sorted, screened and discriminated, and the system model convenient for construction site management and control is established. Finally, the causes of poor construction of FRP fishing vessels are analyzed and discussed, and relevant suggestions are put forward.

  9. The balneoterapy in complex rehabilitation of patients with coronary heart diseases after surgical myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Olena Kolodenko

    2015-10-01

    оказана эффективность использования разработанных комплексов, а именно улучшение показателей толерантности к физической нагрузке (р<0,05, достоверное снижение уровня глюкозы натощак и через 2 часа после еды, снижение уровня инсулина, нормализация липидного обмена.   Ключевые слова: реабилитация, санаторно-курортное лечение, ишемическая болезнь сердца, хирургическая реваскуляризация миокарда, бальнеокинезотерапия.     Introduction: Coronary heart disease (CHD is one of the most common pathologies of the circulatory system in developed countries. Of all causes of death from cardiovascular diseases coronary heart disease is accounted for 53% of them. Despite the fact that great progress has been made in the surgical treatment of coronary artery disease, its effectiveness is directly related to the quality of postoperative rehabilitation. Even successfully carried myocardial revascularization does not prevent further progression of atherosclerosis, which makes the problem of secondary prevention of coronary heart disease even more important for these patients. This article considers rehabilitation of patients with coronary heart disease and concomitant diabetes mellitus, who underwent surgical myocardial revascularization. Purpose: To develop and examine the effectiveness of complex sanatorium treatment of patients with coronary artery disease after surgical myocardial revascularization. Materials and Methods: We observed 80 patients aged 58,7±8,9 with coronary artery disease, who underwent surgical myocardial revascularization and who were on rehabilitation at the sanatorium. We have developed the complexes of resort treatment for

  10. Containment vessel design and practice

    International Nuclear Information System (INIS)

    Bangash, Y.

    1983-01-01

    The state of the art of analysis and design of the concrete containment vessels required for BWR and PWR is reviewed. A step-by-step critical appraisal of the existing work is given. Elastic, inelastic and cracking conditions under extreme loads are fully discussed. Problems associated with these structures are highlighted. A three-dimensional finite element analysis is included to cater for service, overload and dynamic cracking of such structures. Missile impact and seismic effects are included in this work. The second analysis is known as the limit state analysis, which is given to design such vessels for any kind of load. (U.K.)

  11. Stress analysis of pressure vessels

    International Nuclear Information System (INIS)

    Kim, B.K.; Song, D.H.; Son, K.H.; Kim, K.S.; Park, K.B.; Song, H.K.; So, J.Y.

    1979-01-01

    This interim report contains the results of the effort to establish the stress report preparation capability under the research project ''Stress analysis of pressure vessels.'' 1978 was the first year in this effort to lay the foundation through the acquisition of SAP V structural analysis code and a graphic terminal system for improved efficiency of using such code. Software programming work was developed in pre- and post processing, such as graphic presentation of input FEM mesh geometry and output deformation or mode shope patterns, which was proven to be useful when using the FEM computer code. Also, a scheme to apply fracture mechanics concept was developed in fatigue analysis of pressure vessels. (author)

  12. Vessel dilatation in coronary angiograms

    International Nuclear Information System (INIS)

    Hinterauer, L.; Goebel, N.

    1983-01-01

    Amongst 166 patients with aneurysms, ectasia or megaloarteries shown on coronary angiograms, 86.1% had dilated vessels as part of generalised coronary sclerosis (usually in patients with three-vessel disease). In 9%, dilatation was of iatrogenic origin and in 4.8% it was idiopathic. One patient had Marfan's syndrome. Amongst 9 000 patients, there were eight with megalo-arteries without stenosis; six of these had atypical angina and three suffered an infarct. Patients with definite dilatation of the coronary artery and stagnation of contrast flow required treatment. (orig.) [de

  13. Vessel dilatation in coronary angiograms

    Energy Technology Data Exchange (ETDEWEB)

    Hinterauer, L.; Goebel, N.

    1983-11-01

    Amongst 166 patients with aneurysms, ectasia or megaloarteries shown on coronary angiograms, 86.1% had dilated vessels as part of generalised coronary sclerosis (usually in patients with three-vessel disease). In 9%, dilatation was of iatrogenic origin and in 4.8% it was idiopathic. One patient had Marfan's syndrome. Amongst 9 000 patients, there were eight with megalo-arteries without stenosis; six of these had atypical angina and three suffered an infarct. Patients with definite dilatation of the coronary artery and stagnation of contrast flow required treatment.

  14. Long-term survival benefit of revascularization compared with medical therapy in patients with coronary chronic total occlusion and well-developed collateral circulation.

    Science.gov (United States)

    Jang, Woo Jin; Yang, Jeong Hoon; Choi, Seung-Hyuk; Song, Young Bin; Hahn, Joo-Yong; Choi, Jin-Ho; Kim, Wook Sung; Lee, Young Tak; Gwon, Hyeon-Cheol

    2015-02-01

    The purpose of this study was to compare the long-term clinical outcomes of patients with chronic total occlusion (CTO) and well-developed collateral circulation treated with revascularization versus medical therapy. Little is known about the clinical outcomes and optimal treatment strategies of CTO with well-developed collateral circulation. We screened 2,024 consecutive patients with at least 1 CTO detected on coronary angiogram. Of these, we analyzed data from 738 patients with Rentrop 3 grade collateral circulation who were treated with medical therapy alone (n = 236), coronary artery bypass grafting (n = 170) or percutaneous coronary intervention (n = 332; 80.1% successful). Patients who underwent revascularization and medical therapy (revascularization group, n = 502) were compared with those who underwent medical therapy alone (medication group, n = 236) in terms of cardiac death and major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and repeat revascularization. During a median follow-up duration of 42 months, multivariate analysis revealed a significantly lower incidence of cardiac death (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p collateral circulation, aggressive revascularization may reduce the risk of cardiac mortality and MACE. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  15. An experimental system for the study of ultrasound exposure of isolated blood vessels

    International Nuclear Information System (INIS)

    Tokarczyk, Anna; Rivens, Ian; Symonds-Tayler, Richard; Ter Haar, Gail; Van Bavel, E

    2013-01-01

    An experimental system designed for the study of the effects of diagnostic or therapeutic ultrasound exposure on isolated blood vessels in the presence or absence of intraluminal contrast agent is described. The system comprised several components. A microscope was used to monitor vessel size (and thus vessel functionality), and potential leakage of intraluminal 70 kDa FITC-dextran fluorescence marker. A vessel chamber allowed the mounting of an isolated vessel whilst maintaining its viability, with pressure regulation for the control of intraluminal pressure and induction of flow for the infusion of contrast microbubbles. A fibre-optic hydrophone sensor mounted on the vessel chamber using a micromanipulator allowed pre-exposure targeting of the vessel to within 150 µm, and monitoring of acoustic cavitation emissions during exposures. Acoustic cavitation was also detected using changes in the ultrasound drive voltage and by detection of audible emissions using a submerged microphone. The suitability of this system for studying effects in the isolated vessel model has been demonstrated using a pilot study of 6 sham exposed and 18 high intensity focused ultrasound exposed vessels, with or without intraluminal contrast agent (SonoVue) within the vessels. (paper)

  16. Molecular nuclear imaging of tumoral angio genesis using a rgd-containing tracer, Raft-RGD, targeted at the neo vessel-specific integrin {alpha}{sub v}{beta}{sub 3}; Evaluation d'un radioligand de l'integrine {alpha}{sub v}{beta}{sub 3} (RAFT-RGD) pour l'imagerie moleculaire de l'angiogenese tumorale

    Energy Technology Data Exchange (ETDEWEB)

    Sancey, L

    2006-06-15

    Tumoral neo-angio genesis targeting is currently a major field of research for the diagnostic and treatment of solid tumors. Endothelial cells from neo vessels over express several specific markers such as the {alpha}{sub v}{beta}{sub 3} integrin, which binds RGD (-Arg-Gly-Asp-)- containing peptides. We evaluated the potential of a novel radiotracer - RAFT-RGD - for the molecular nuclear imaging of neo vessels. In vitro, the coupling of 4 c(RGDfK) to the RAFT platform resulted in an increased cellular uptake of the tracer by {alpha}{sub v}{beta}{sub 3} positive cells when compared to c(RGDfK). Furthermore, RAFTRGD has a higher affinity than c(RGDfK) and similar properties for angio genesis inhibition. In vivo, both {alpha}{sub v}{beta}{sub 3} positive and negative tumors were visible by non invasive whole body planar and tomographic imaging from 30 min to 24 h post-injection, using a gamma camera dedicated to small animal imaging. Despite a lack of significant contrast improvement compare with c(RGDfK), RAFT-RGD could represent a promising tracer for tumoral angio genesis since it could provide invaluable information about tumor development and treatment efficacy in Nuclear Medicine departments. Furthermore, thanks to its chemical structure, RAFT-RGD can be labelled with a variety of radioisotopes including {gamma} and {beta}{sup -} emitters, allowing interesting therapeutical applications such as internal targeted radiotherapy. (author)

  17. Ischemic Stroke in Young Adults with Moyamoya Disease: Prognostic Factors for Stroke Recurrence and Functional Outcome after Revascularization.

    Science.gov (United States)

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

    2017-07-01

    Stroke in young adults is uncommon and rarely described. Moyamoya disease is one of the leading causes of stroke in young adults. We aimed to study the prognostic factors for stroke recurrences and functional outcomes in young stroke patients with moyamoya disease after revascularization. We reviewed 696 consecutive patients with moyamoya disease admitted to our hospital from 2009-2015 and identified patients aged 18-45 years with first-ever stroke. Follow-up was conducted via face-to-face or structured telephone interviews. Outcome measures were recurrent stroke events and unfavorable functional outcomes (modified Rankin Scale >2). We included 121 young patients with moyamoya disease suffering from stroke (initial presentation age, 35.4 ± 7.5 years). All patients underwent revascularization after the acute phase of initial stroke events as the secondary prevention for recurrences. During follow-up (median, 40 months), 9 patients (7.4%) experienced recurrent strokes and 8 of them (6.6%) suffered unfavorable functional outcomes. In the multivariate analysis, diabetes was an independent predictor for stroke recurrences (hazard ratio 6.76; 95% confidence interval 1.30-35.11; P = 0.02) and was significantly associated with unfavorable functional outcomes (odds ratio 7.87; 95% confidence interval 1.42-38.74; P = 0.01). We identified diabetes as an independent risk factor for recurrent strokes and unfavorable functional outcomes after revascularization in young stroke patients with moyamoya disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Application of blood-pool agents in visualization of peripheral vessels

    International Nuclear Information System (INIS)

    Giovagnoni, A.; Catalano, C.

    2007-01-01

    Effective arterial imaging is essential in patients with peripheral arterial disease (PAD) in whom a revascularization procedure is planned. Digital subtraction angiography (DSA) has traditionally been regarded as the gold standard for imaging in peripheral arterial disease, but this technique is subject to certain limitations, such as the risks of adverse reactions associated with arterial catheterization and iodinated contrast agents. Contrast-enhanced magnetic resonance angiography is now recommended as an effective and useful imaging technique in peripheral arterial disease, since it offers high enhanced contrast between blood and stationary tissue and fast acquisition times. However, extracellular gadolinium contrast agents rapidly diffuse into the interstitial spaces, and thus are suitable only for first-pass imaging. This limitation can be overcome by the use of blood-pool (intravascular) contrast agents, such as gadofosveset trisodium (Vasovist, Bayer Schering Pharma AG, Berlin, Germany), which are retained within the blood vessels and hence facilitate both first-pass and steady-state imaging with high spatial resolution. Blood-pool agents, therefore, offer improved imaging, particularly of distal vessels, compared with extracellular contrast agents. Examples of first-pass and steady-state imaging with gadofosveset are presented. (orig.)

  19. An Unusual Case of Stent Migration After Celiac Trunk Endovascular Revascularization

    Energy Technology Data Exchange (ETDEWEB)

    Negri, Silvia; Ferraro, Stefania; Piffaretti, Gabriele, E-mail: gabriele.piffaretti@uninsubria.it; Rivolta, Nicola; Bossi, Matteo [University of Insubria School of Medicine, Vascular Surgery, Department of Surgical Sciences, Circolo University Hospital (Italy); Carrafiello, Gianpaolo [University of Insubria School of Medicine, Interventional Radiology, Department of Radiology, Circolo University Hospital (Italy); Castelli, Patrizio [University of Insubria School of Medicine, Vascular Surgery, Department of Surgical Sciences, Circolo University Hospital (Italy)

    2012-08-15

    A 61-year-old woman underwent celiac trunk stenting to treat abdominal angina. Three months later, she was readmitted for recurrent symptoms. Computed tomography control revealed the migration of the stent into the splenic artery. No sign of vessel injury or end-organ ischemia was detected. Repeat stenting of the celiac trunk was performed; the postoperative course was uneventful. 12 months later, the patient was asymptomatic with the second stent in its correct position, and she was asymptomatic for mesenteric ischemia.

  20. An Unusual Case of Stent Migration After Celiac Trunk Endovascular Revascularization

    International Nuclear Information System (INIS)

    Negri, Silvia; Ferraro, Stefania; Piffaretti, Gabriele; Rivolta, Nicola; Bossi, Matteo; Carrafiello, Gianpaolo; Castelli, Patrizio

    2012-01-01

    A 61-year-old woman underwent celiac trunk stenting to treat abdominal angina. Three months later, she was readmitted for recurrent symptoms. Computed tomography control revealed the migration of the stent into the splenic artery. No sign of vessel injury or end-organ ischemia was detected. Repeat stenting of the celiac trunk was performed; the postoperative course was uneventful. 12 months later, the patient was asymptomatic with the second stent in its correct position, and she was asymptomatic for mesenteric ischemia.

  1. Trajectory planning of tokamak flexible in-vessel inspection robot

    International Nuclear Information System (INIS)

    Wang, Hesheng; Chen, Weidong; Lai, Yinping; He, Tao

    2015-01-01

    Highlights: • A tokamak flexible in-vessel inspection robot is designed. • Two trajectory planning methods are used to ensure the full coverage of the first wall scanning. • The method is tested on a simulated platform of EAST with the flexible in-vessel inspection robot. • Experimental results show the effectiveness of the proposed algorithm. - Abstract: Tokamak flexible in-vessel inspection robot is mainly designed to carry a camera for close observation of the first wall of the vacuum vessel, which is essential for the maintenance of the future tokamak reactor without breaking the working condition of the vacuum vessel. A tokamak flexible in-vessel inspection robot is designed. In order to improve efficiency of the remote maintenance, it is necessary to design a corresponding trajectory planning algorithm to complete the automatic full coverage scanning of the complex tokamak cavity. Two different trajectory planning methods, RS (rough scanning) and FS (fine scanning), according to different demands of the task, are used to ensure the full coverage of the first wall scanning. To quickly locate the damage position, the first trajectory planning method is targeted for quick and wide-ranging scan of the tokamak D-shaped section, and the second one is for careful observation. Furthermore, both of the two different trajectory planning methods can ensure the full coverage of the first wall scanning with an optimal end posture. The method is tested on a simulated platform of EAST (Experimental Advanced Superconducting Tokamak) with the flexible in-vessel inspection robot, and the results show the effectiveness of the proposed algorithm.

  2. Trajectory planning of tokamak flexible in-vessel inspection robot

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Hesheng [Department of Automation, Shanghai Jiao Tong University, 200240 Shanghai (China); Key Laboratory of System Control and Information Processing, Ministry of Education of China, 200240 Shanghai (China); Chen, Weidong, E-mail: wdchen@sjtu.edu.cn [Department of Automation, Shanghai Jiao Tong University, 200240 Shanghai (China); Key Laboratory of System Control and Information Processing, Ministry of Education of China, 200240 Shanghai (China); Lai, Yinping; He, Tao [Department of Automation, Shanghai Jiao Tong University, 200240 Shanghai (China); Key Laboratory of System Control and Information Processing, Ministry of Education of China, 200240 Shanghai (China)

    2015-10-15

    Highlights: • A tokamak flexible in-vessel inspection robot is designed. • Two trajectory planning methods are used to ensure the full coverage of the first wall scanning. • The method is tested on a simulated platform of EAST with the flexible in-vessel inspection robot. • Experimental results show the effectiveness of the proposed algorithm. - Abstract: Tokamak flexible in-vessel inspection robot is mainly designed to carry a camera for close observation of the first wall of the vacuum vessel, which is essential for the maintenance of the future tokamak reactor without breaking the working condition of the vacuum vessel. A tokamak flexible in-vessel inspection robot is designed. In order to improve efficiency of the remote maintenance, it is necessary to design a corresponding trajectory planning algorithm to complete the automatic full coverage scanning of the complex tokamak cavity. Two different trajectory planning methods, RS (rough scanning) and FS (fine scanning), according to different demands of the task, are used to ensure the full coverage of the first wall scanning. To quickly locate the damage position, the first trajectory planning method is targeted for quick and wide-ranging scan of the tokamak D-shaped section, and the second one is for careful observation. Furthermore, both of the two different trajectory planning methods can ensure the full coverage of the first wall scanning with an optimal end posture. The method is tested on a simulated platform of EAST (Experimental Advanced Superconducting Tokamak) with the flexible in-vessel inspection robot, and the results show the effectiveness of the proposed algorithm.

  3. 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.

  4. Grounding Damage to Conventional Vessels

    DEFF Research Database (Denmark)

    Lützen, Marie; Simonsen, Bo Cerup

    2003-01-01

    The present paper is concerned with rational design of conventional vessels with regard to bottom damage generated in grounding accidents. The aim of the work described here is to improve the design basis, primarily through analysis of new statistical data for grounding damage. The current regula...

  5. PLANNING VESSEL BODY SECTION PRODUCTION

    Directory of Open Access Journals (Sweden)

    A. G. Grivachevsky

    2015-01-01

    Full Text Available A problem of planning production of a vessel body section is considered. The problem is reduced to the classic Johnson’s tree-machine flow-shop scheduling problem. A genetic algorithm and computer experiment to compare efficiency of this algorithm and the algorithm of full enumeration are described.

  6. Pressure vessel and method therefor

    Science.gov (United States)

    Saunders, Timothy

    2017-09-05

    A pressure vessel includes a pump having a passage that extends between an inlet and an outlet. A duct at the pump outlet includes at least one dimension that is adjustable to facilitate forming a dynamic seal that limits backflow of gas through the passage.

  7. Commercial Passenger Fishing Vessel Fishery

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains the logbook data from U.S.A. Commercial Passenger Fishing Vessels (CPFV) fishing in the U.S.A. EEZ and in waters off of Baja California, from...

  8. Comparación entre diferentes técnicas de revascularización miocárdica Comparison among different techniques of myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Manuel Nafeh Abi-Rezk

    2011-03-01

    ón miocárdica con corazón latiente resultó de elección en pacientes con mayor riesgo quirúrgico, en los que destacaron la edad avanzada, la comorbilidad y los factores de riesgo coronario. Presentó una incidencia baja de morbilidad y mortalidad posoperatoria asociada a menores complicaciones, tiempo quirúrgico y estadía hospitalaria general corta. Esta técnica aportó al país ventajas económicas y el ahorro de grandes sumas de dinero en moneda nacional y en dólares.OBJECTIVE. The objective of present research was to assess the results of the myocardial revascularization using different techniques: with beating heart, with extracorporeal circulation and anoxic arrest, and with assisted beating heart. METHODS. A prospective and descriptive study was conducted in the Cardiology Center of the "Hermanos Ameijeiras" Clinical Surgical Hospital between March, 2008 and March, 2009. Sample included 102 patients with clinical diagnosis of ischemic heart disease, admitted in such service and operated on using the standard techniques. RESULTS. There was predominance of ages over 60 (56,9%. The more associated coronary risk factors were smoking and dyslipidemia. The indication of beating heart revascularization was choose for patients presenting with disease in three coronary vessels and comorbid diseases, mainly the myocardial acute infarction and diabetes mellitus. The systolic function in postoperative stage was normal in most of cases with prevalence of hypokinesia as a segmentary alteration. The surgical time was less for the beating heart procedure (approximately 5,5 h with a great number of bridges and a minimum of cardiac complications in the postoperative stage. The arrhythmias and surgical wound sepsis were the more frequent complications; this latter extended the hospital stay. The patients underwent to assisted beating heart procedure have the longest time of mechanical ventilation and of hospital stay. There was predominance of mortality in theses cases (36

  9. Sodium bicarbonate does not prevent postoperative acute kidney injury after off-pump coronary revascularization: a double-blinded randomized controlled trial.

    Science.gov (United States)

    Soh, S; Song, J W; Shim, J K; Kim, J H; Kwak, Y L

    2016-10-01

    Acute kidney injury (AKI) is a common morbidity after off-pump coronary revascularization. We investigated whether perioperative administration of sodium bicarbonate, which might reduce renal injury by alleviating oxidative stress in renal tubules, prevents postoperative AKI in off-pump coronary revascularization patients having renal risk factors. Patients (n=162) having at least one of the following AKI risk factors were enrolled: (i) age >70 yr; (ii) diabetes mellitus; (iii) chronic renal disease; (iv) congestive heart failure or left ventricular ejection fraction 24 h) relative to the control group (20 vs 6, P=0.003). Perioperative sodium bicarbonate administration did not decrease the incidence of AKI after off-pump coronary revascularization in high-risk patients and might even be associated with a need for prolonged ventilatory care. NCT01840241. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  10. Development of PWR pressure vessel steels

    International Nuclear Information System (INIS)

    Druce, S.; Edwards, B.

    1982-01-01

    Requirements to be met by vessel steels for pressurized water reactors are analyzed. Chemicat composition of low-alloyed steels, mechanical properties of sheets and forgings made of these steels and changes in the composition and properties over the wall thickness of the reactor vessel are presented. Problems of the vessel manufacturing including welding and heat treatment processes of sheets and forgings are considered. Special attention is paid to steel embrittlement during vessel fabrication and operation (radiation embrittlement, thermal embrittlement). The role of non-metal inclusions and their effect on anisotropy of fracture toughness is discussed. Possible developments of vessel steels and procedures for producing reactor vessels are reviewed

  11. Development of PWR pressure vessel steels

    Energy Technology Data Exchange (ETDEWEB)

    Druce, S.; Edwards, B.

    1982-01-01

    Requirements to be met by vessel steels for pressurized water reactors are analyzed. Chemicat composition of low-alloyed steels, mechanical properties of sheets and forgings made of these steels and changes in the composition and properties over the wall thickness of the reactor vessel are presented. Problems of the vessel manufacturing including welding and heat treatment processes of sheets and forgings are considered. Special attention is paid to steel embrittlement during vessel fabrication and operation (radiation embrittlement, thermal embrittlement). The role of non-metal inclusions and their effect on anisotropy of fracture toughness is discussed. Possible developments of vessel steels and procedures for producing reactor vessels are reviewed.

  12. Pressure vessel for nuclear reactor plant consisting of several pre-stressed cast pressure vessels

    International Nuclear Information System (INIS)

    Bodmann, E.

    1984-01-01

    Several cylindrical pressure vessel components made of pressure castings are arranged on a sector of a circle around the cylindrical cast pressure vessel for accommodating the helium cooled HTR. Each component pressure vessel is connected to the reactor vessel by a horizontal gas duct. The contact surfaces between reactor and component pressure vessel are in one plane. In the spaces between the individual component pressure vessels, there are supporting blocks made of cast iron, which are hollow and also have flat surfaces. With the reactor vessel and the component pressure vessels they form a disc-shaped connecting part below and above the gas ducts. (orig./PW)

  13. Prediction of wall motion improvement after coronary revascularization in patients with postmyocardial infarction. Diagnostic value of dobutamine stress echocardiography and myocardial contrast echocardiography

    International Nuclear Information System (INIS)

    Waku, Sachiko; Ohkubo, Tomoyuki; Takada, Kiyoshi; Ishihara, Tadashi; Ohsawa, Nakaaki; Adachi, Itaru; Narabayashi, Isamu

    1997-01-01

    The diagnostic value of dobutamine stress echocardiography, myocardial contrast echocardiography and dipyridamole stress thallium-201 single photon emission computed tomography (SPECT) for predicting recovery of wall motion abnormality after revascularization was evaluated in 13 patients with postmyocardial infarction. Seventeen segments showed severe wall motion abnormalities before revascularization. Nine segments which had relatively good Tl uptake on delayed SPECT images despite severely abnormal wall motion were opacified during myocardial contrast echocardiography, and showed improved wall motion after revascularization. In contrast, three segments which had poor Tl uptake and severely abnormal wall motion were not opacified during myocardial contrast echocardiography, and showed no improvement in wall motion during dobutamine stress echocardiography and after revascularization. The following three findings were assumed to be signs of myocardial viability: good Tl uptake on delayed SPECT images, improved wall motion by dobutamine stress echocardiography, and positive opacification of the myocardium by myocardiai contrast echocardiography. Myocardial contrast echocardiography had the highest sensitivity (100%) and negative predictive value (100%). Delayed SPECT images had the highest specificity (100%) and positive predictive value (100%). Dobutamine stress echocardiography had a sensitivity of 83.0%, specificity of 80.0%, positive predictive value of 90.9%, and negative predictive value of 66.7%, respectively. Myocardial contrast echocardiography showed the lowest specificity (60.0%). The techniques of dobutamine stress echocardiography and SPECT, though noninvasive, may underestimate wall motion improvement after revascularization. Further examination by myocardial contrast echocardiography is recommended to assess myocardial viability for determining the indications for coronary revascularization in spite of its invasiveness. (author)

  14. Hepatorenal bypass using autogenous, free internal iliac artery graft: An attractive alternative to revascularize the right kidney in Takayasu′s disease

    Directory of Open Access Journals (Sweden)

    Nikhil Khattar

    2012-01-01

    Full Text Available Nonspecific aortoarteritis or Takayasu′s disease (TD is a chronic pan endarteritis of unknown origin involving the aorta and its major branches affecting young adults especially women. The disease is more common in eastern Asian countries. Hypertension in these patients generally reflects as renal artery stenosis, which is seen in 28-75% of patients. Surgical revascularization is occasionally needed in patients with failed medical management or endovascular interventions. We report two cases of Takayasu′s arteritis in young women where renal revascularization was done using free internal iliac artery hepatorenal bypass graft with excellent control of hypertension in the postoperative period.

  15. The impact of renal artery stent revascularization on blood pressure: 1-year follow-up of 110 cases

    International Nuclear Information System (INIS)

    Wang Chao; Zou Yinghua; Yang Min; Wang Jian; Tong Xiaoqiang; Song Li

    2007-01-01

    Objective: To investigate the effect of renal artery revascularization through renal artery stenting(PTRAS)on blood pressure in patients with renal artery stenosis. Methods: During April 2000 through May 2005 110 cases of renal artery stenosis received PTRAS and followed up for at least 1 year with blood pressure measurements pre-and 1 year post-PTRAS. Results: The technical success rate was 100% for all 110 cases. The renal artery stenosis were decreased from 60%-100% before PTRAS to 0%-15% after the stent placement. There was significant difference between blood pressure pre-and 1 year post PTRAS. Systolic pressures decreased from(153 ± 32) mmHg to(131 ± 27) mmHg and diastolic pressures from(87 ± 19) mmHg to(75 ± 19) mmHg. The administration of antihypertensive diugs reduced from(2.6 ± 0.9 ) sorts to(1.9 ± 0.9) sorts. Conclusions: PTRAS revascularization is an effective procedure for blood pressure control in renal vascular hypertension during one year follow up. (authors)

  16. [A reduction in the invasiveness during surgical revascularization: the harvesting of the great saphenous vein by a video endoscopic technic].

    Science.gov (United States)

    Terrini, A; Graffigna, A; Martinelli, L

    2000-05-01

    The authors report their preliminary experience of endoscopic saphenous vein harvesting as part of a program devoted to reducing the invasivity of surgical myocardial revascularization. This method allows us to minimize the cutaneous incisions in the inferior limbs necessary to harvest the saphenous vein, thus reducing the incidence of complications. The study includes 41 patients who underwent endoscopic saphenous vein harvesting from October 1998 to September 1999 and, as a control group, 20 patients with similar characteristics operated on with the traditional technique during the same period. The variables considered were: the time necessary to harvest the saphenous vein, the incidence of complications, and the postoperative mobilization. All the endoscopically harvested grafts were adequate for the scheduled procedure. The only complication occurred in a patient operated on with the traditional technique. The time of harvesting and the day of mobilization were similar in the two groups. The reduction of surgical trauma allowed a fast deambulation recovery and better esthetic results. When complete arterial revascularization is not feasible, the endoscopic harvesting of the required saphenous vein segment allows for a significant reduction in the invasivity of the procedure.

  17. Persistent socio-economic differences in revascularization after acute myocardial infarction despite a universal health care system

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe N; Rasmussen, Søren; Gislason, Gunnar H

    2007-01-01

    BACKGROUND: Use of invasive revascularization [percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)] after acute myocardial infarction (AMI) in Denmark increased between 1996 and 2004. We investigated how this affected socioeconomic differences in their use. MATERIALS...... months. Revascularization was stratified into CABG, acute PCI (within 2 days of admission) and non-acute PCI (after the third day). RESULTS: A total of 38,803 patients were included. In 1996-1998, 6.8% received CABG, 9.3% non-acute PCI and 2.4% acute PCI; in 2002-2004, these numbers were 11.8, 36.......1 and 29.1%. CABG was more likely to be performed for patients with a high income [hazard ratio (HR), 1.18; 95% confidence interval (CI), 1.08-1.28] or a medium income (HR, 1.16; 95% CI, 1.07-1.25) than for those with a low income throughout the period. A similar income gradient was seen for non-acute PCI...

  18. Muon-catalyzed fusion experiment target and detector system. Preliminary design report

    International Nuclear Information System (INIS)

    Jones, S.E.; Watts, K.D.; Caffrey, A.J.; Walter, J.B.

    1982-03-01

    We present detailed plans for the target and particle detector systems for the muon-catalyzed fusion experiment. Requirements imposed on the target vessel by experimental conditions and safety considerations are delineated. Preliminary designs for the target vessel capsule and secondary containment vessel have been developed which meet these requirements. In addition, the particle detection system is outlined, including associated fast electronics and on-line data acquisition. Computer programs developed to study the target and detector system designs are described

  19. AFSC/FMA/Vessel Assessment Logging

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Vessels fishing trawl gear, vessels fishing hook-and-line and pot gear that are also greater than 57.5 feet overall, and shoreside and floating processing facilities...

  20. 2013 EPA Vessels General Permit (VGP)

    Data.gov (United States)

    U.S. Environmental Protection Agency — Information for any vessel that submitted a Notice of Intent (NOI), Notice of Termination (NOT), or annual report under EPA's 2013 Vessel General Permit (VGP)....

  1. Fluid Dynamics of Magnetic Nanoparticles in Simulated Blood Vessels

    Science.gov (United States)

    Blue, Lauren; Sewell, Mary Kathryn; Brazel, Christopher S.

    2008-11-01

    Magnetic nanoparticles (MNPs) can be used to locally target therapies and offer the benefit of using an AC magnetic field to combine hyperthermia treatment with the triggered release of therapeutic agents. Here, we investigate localization of MNPs in a simulated environment to understand the relationship between magnetic field intensity and bulk fluid dynamics to determine MNP retention in a simulated blood vessel. As MNPs travel through blood vessels, they can be slowed or trapped in a specific area by applying a magnetic field. Magnetic cobalt ferrite nanoparticles were synthesized and labeled with a fluorescent rhodamine tag to visualize patterns in a flow cell, as monitored by a fluorescence microscope. Particle retention was determined as a function of flow rate, concentration, and magnetic field strength. Understanding the relationship between magnetic field intensity, flow behavior and nanoparticle characteristics will aid in the development of therapeutic systems specifically targeted to diseased tissue.

  2. Interstitial Cells of Blood Vessels

    Directory of Open Access Journals (Sweden)

    Vladimír Pucovský

    2010-01-01

    Full Text Available Blood vessels are made up of several distinct cell types. Although it was originally thought that the tunica media of blood vessels was composed of a homogeneous population of fully differentiated smooth muscle cells, more recent data suggest the existence of multiple smooth muscle cell subpopulations in the vascular wall. One of the cell types contributing to this heterogeneity is the novel, irregularly shaped, noncontractile cell with thin processes, termed interstitial cell, found in the tunica media of both veins and arteries. While the principal role of interstitial cells in veins seems to be pacemaking, the role of arterial interstitial cells is less clear. This review summarises the knowledge of the functional and structural properties of vascular interstitial cells accumulated so far, offers hypotheses on their physiological role, and proposes directions for future research.

  3. The Vessel Schedule Recovery Problem

    DEFF Research Database (Denmark)

    Brouer, Berit Dangaard; Plum, Christian Edinger Munk; Vaaben, Bo

    Maritime transportation is the backbone of world trade and is accountable for around 3% of the worlds CO2 emissions. We present the Vessel Schedule Recovery Problem (VSRP) to evaluate a given disruption scenario and to select a recovery action balancing the trade off between increased bunker cons...... consumption and the impact on the remaining network and the customer service level. The model is applied to 4 real cases from Maersk Line. Solutions are comparable or superior to those chosen by operations managers. Cost savings of up to 58% may be achieved.......Maritime transportation is the backbone of world trade and is accountable for around 3% of the worlds CO2 emissions. We present the Vessel Schedule Recovery Problem (VSRP) to evaluate a given disruption scenario and to select a recovery action balancing the trade off between increased bunker...

  4. Nuclear power plant pressure vessels. Inservice inspections

    International Nuclear Information System (INIS)

    1995-01-01

    The requirements for the planning and reporting of inservice inspections of nuclear power plant pressure vessels are presented. The guide specifically applies to inservice inspections of Safety class 1 and 2 nuclear power plant pressure vessels, piping, pumps and valves plus their supports and reactor pressure vessel internals by non- destructive examination methods (NDE). Inservice inspections according to the Pressure Vessel Degree (549/73) are discussed separately in the guide YVL 3.0. (4 refs.)

  5. Expanded Fermilab pressure vessel directory program

    Energy Technology Data Exchange (ETDEWEB)

    Tanner, A.

    1983-01-01

    Several procedures have been written to manage the information pertaining to the vacuum tanks and pressure vessels for which the laboratory is responsible. These procedures have been named TANK1 for the vessels belonging to the Accelerator Division, TANK2 and TANK3 for the vessels belonging to the Research Division and to Technical Support respectively, and TANK4 for the vessels belonging to the Business Division. The operating procedures are otherwise identical in every respect.

  6. Expanded Fermilab pressure vessel directory program

    International Nuclear Information System (INIS)

    Tanner, A.

    1983-01-01

    Several procedures have been written to manage the information pertaining to the vacuum tanks and pressure vessels for which the laboratory is responsible. These procedures have been named TANK1 for the vessels belonging to the Accelerator Division, TANK2 and TANK3 for the vessels belonging to the Research Division and to Technical Support respectively, and TANK4 for the vessels belonging to the Business Division. The operating procedures are otherwise identical in every respect

  7. Vacuum vessel for plasma devices

    International Nuclear Information System (INIS)

    Yamada, Masao; Taguchi, Masami.

    1975-01-01

    Object: To permit effective utility of the space in the inner and outer sides of the container wall and also permit repeated assembly for use. Structure: Vacuum vessel wall sections are sealed together by means of welding bellows, and also flange portions formed at the end of the wall sections are coupled together by bolts and are sealed together with a seal ring and a seal cap secured by welding. (Nakamura, S.)

  8. Reactor vessel head permanent shield

    International Nuclear Information System (INIS)

    Hankinson, M.F.; Leduc, R.J.; Richard, J.W.; Malandra, L.J.

    1989-01-01

    A nuclear reactor is described comprising: a nuclear reactor pressure vessel closure head; control rod drive mechanisms (CRDMs) disposed within the closure head so as to project vertically above the closure head; cooling air baffle means surrounding the control rod drive mechanisms for defining cooling air paths relative to the control rod drive mechanisms; means defined within the periphery of the closure head for accommodating fastening means for securing the closure head to its associated pressure vessel; lifting lugs fixedly secured to the closure head for facilitating lifting and lowering movements of the closure head relative to the pressure vessel; lift rods respectively operatively associated with the plurality of lifting lugs for transmitting load forces, developed during the lifting and lowering movements of the closure head, to the lifting lugs; upstanding radiation shield means interposed between the cooling air baffle means and the periphery of the enclosure head of shielding maintenance personnel operatively working upon the closure head fastening means from the effects of radiation which may emanate from the control rod drive mechanisms and the cooling air baffle means; and connecting systems respectively associated with each one of the lifting lugs and each one of the lifting rods for connecting each one of the lifting rods to a respective one of each one of the lifting lugs, and for simultaneously connecting a lower end portion of the upstanding radiation shield means to each one of the respective lifting lugs

  9. Reactor-vessel-sectioning demonstration

    International Nuclear Information System (INIS)

    Lundgren, R.A.

    1981-09-01

    A technical demonstration was successfully completed of simulated reactor vessel sectioning using the combined techniques of air arc gouging and flame cutting. A 4-ft x 3-ft x 9-in. thick sample was fabricated of A36 carbon steel to simulate a reactor vessel wall. A 1/4-in. layer of stainless steel (SS) was tungsten inert gas (TIG)-welded to the carbon steel. Several techniques were considered to section the simulated reactor vessel; air arc gouging was selected to penetrate the stainless steel, and flame cutting was selected to sever the carbon steel. Three sectioning operations were demonstrated. For all three, the operating parameters were the same; but the position of the sample was varied. For the first cut, the sample was placed in a horizontal position, and it was successfully severed from the SS side. For the second cut, the sample was turned over and cut from the carbon steel side. Cutting from the carbon steel side has the advantages of cost reduction

  10. 33 CFR 151.1512 - Vessel safety.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Vessel safety. 151.1512 Section... River § 151.1512 Vessel safety. Nothing in this subpart relieves the master of the responsibility for ensuring the safety and stability of the vessel or the safety of the crew and passengers, or any other...

  11. Reactor vessel supported by flexure member

    International Nuclear Information System (INIS)

    Crawford, J.D.; Pankow, B.

    1975-01-01

    A description is given of a reactor pressure vessel which is provided with vertical support means in the form of circumferentially spaced columns upon which the vessel is mounted. The columns are adapted to undergo flexure in order to accommodate the thermally induced displacements experienced by the vessel during operational transients

  12. 19 CFR 4.97 - Salvage vessels.

    Science.gov (United States)

    2010-04-01

    ... United States and Great Britain ‘concerning reciprocal rights for United States and Canada in the... meaning of this statute. (e) A Mexican vessel may engage in a salvage operation on a Mexican vessel in any territorial waters of the United States in which Mexican vessels are permitted to conduct such operations by...

  13. Model tests for prestressed concrete pressure vessels

    International Nuclear Information System (INIS)

    Stoever, R.

    1975-01-01

    Investigations with models of reactor pressure vessels are used to check results of three dimensional calculation methods and to predict the behaviour of the prototype. Model tests with 1:50 elastic pressure vessel models and with a 1:5 prestressed concrete pressure vessel are described and experimental results are presented. (orig.) [de

  14. 50 CFR 648.4 - Vessel permits.

    Science.gov (United States)

    2010-10-01

    ... carrying passengers for hire. (8) Atlantic bluefish vessels. (i) Commercial. Any vessel of the United... lands Atlantic bluefish in or from the EEZ in excess of the recreational possession limit specified at § 648.164 must have been issued and carry on board a valid commercial bluefish vessel permit. (ii) Party...

  15. Effect of non-Newtonian characteristics of blood on magnetic particle capture in occluded blood vessel

    Science.gov (United States)

    Bose, Sayan; Banerjee, Moloy

    2015-01-01

    Magnetic nanoparticles drug carriers continue to attract considerable interest for drug targeting in the treatment of cancer and other pathological conditions. Magnetic carrier particles with surface-bound drug molecules are injected into the vascular system upstream from the desired target site, and are captured at the target site via a local applied magnetic field. Herein, a numerical investigation of steady magnetic drug targeting (MDT) using functionalized magnetic micro-spheres in partly occluded blood vessel having a 90° bent is presented considering the effects of non-Newtonian characteristics of blood. An Eulerian-Lagrangian technique is adopted to resolve the hemodynamic flow and the motion of the magnetic particles in the flow using ANSYS FLUENT. An implantable infinitely long cylindrical current carrying conductor is used to create the requisite magnetic field. Targeted transport of the magnetic particles in a partly occluded vessel differs distinctly from the same in a regular unblocked vessel. Parametric investigation is conducted and the influence of the insert configuration and its position from the central plane of the artery (zoffset), particle size (dp) and its magnetic property (χ) and the magnitude of current (I) on the "capture efficiency" (CE) is reported. Analysis shows that there exists an optimum regime of operating parameters for which deposition of the drug carrying magnetic particles in a target zone on the partly occluded vessel wall can be maximized. The results provide useful design bases for in vitro set up for the investigation of MDT in stenosed blood vessels.

  16. Integrating Multiple Autonomous Underwater Vessels, Surface Vessels and Aircraft into Oceanographic Research Vessel Operations

    Science.gov (United States)

    McGillivary, P. A.; Borges de Sousa, J.; Martins, R.; Rajan, K.

    2012-12-01

    Autonomous platforms are increasingly used as components of Integrated Ocean Observing Systems and oceanographic research cruises. Systems deployed can include gliders or propeller-driven autonomous underwater vessels (AUVs), autonomous surface vessels (ASVs), and unmanned aircraft systems (UAS). Prior field campaigns have demonstrated successful communication, sensor data fusion and visualization for studies using gliders and AUVs. However, additional requirements exist for incorporating ASVs and UASs into ship operations. For these systems to be optimally integrated into research vessel data management and operational planning systems involves addressing three key issues: real-time field data availability, platform coordination, and data archiving for later analysis. A fleet of AUVs, ASVs and UAS deployed from a research vessel is best operated as a system integrated with the ship, provided communications among them can be sustained. For this purpose, Disruptive Tolerant Networking (DTN) software protocols for operation in communication-challenged environments help ensure reliable high-bandwidth communications. Additionally, system components need to have considerable onboard autonomy, namely adaptive sampling capabilities using their own onboard sensor data stream analysis. We discuss Oceanographic Decision Support System (ODSS) software currently used for situational awareness and planning onshore, and in the near future event detection and response will be coordinated among multiple vehicles. Results from recent field studies from oceanographic research vessels using AUVs, ASVs and UAS, including the Rapid Environmental Picture (REP-12) cruise, are presented describing methods and results for use of multi-vehicle communication and deliberative control networks, adaptive sampling with single and multiple platforms, issues relating to data management and archiving, and finally challenges that remain in addressing these technological issues. Significantly, the

  17. Triple –E Vessels: Tonnage Measurement and Suez Canal Dues Assessment

    Directory of Open Access Journals (Sweden)

    Elsayed Hussein Galall

    2015-08-01

    Full Text Available Container is growing faster than GDP, Shipping lines always attempt to augment efficiencyby reducing cost and by attracting larger volumes of containers. As a result rising containerfreight rates the lines have been driven to increase economic of scale, by building mega shipsand fewer mere efficient port calls. In 2011 Maersk line ordered up to 20 new “Triple- E “Class of container vessels deliversbetween 2013- 2015. These class of mega container vessels have its way through Suez Canal,other companies CMA, CGM also ordered this type of mega container vessels, in order toreach higher profits due to the achieved economics of scale It is believed that 20000 TEUcould be the next target size. Present mega container fleet and any future feasible potential vessel capacity expansionmore than 18000 TEU put Suez Canal route in strong competitive position. MeanwhilePanama Canal will not be able to handle vessels larger than 12600 TEU even after itsexpansion in 2015.

  18. Progress and Achievements on the R&D Activities for ITER Vacuum Vessel

    Energy Technology Data Exchange (ETDEWEB)

    Nakahira, M. [Japan Atomic Energy Research Institute (JAERI); Koizumi, K. [Japan Atomic Energy Research Institute (JAERI); Takahashi, H. [Japan Atomic Energy Research Institute (JAERI); Onozuka, M. [ITER Joint Central Team, Garching, Germany; Ioki, K. [ITER Joint Central Team, Garching, Germany; Kuzumin, E. [D.V. Efremov Scientific Research Institute, St. Petersburg, Russia; Krylov, V. [D.V. Efremov Scientific Research Institute, St. Petersburg, Russia; Maslakowski, J. [Oak Ridge National Laboratory (ORNL); Nelson, Brad E [ORNL; Jones, L. [Max-Planck Institute, Garching, Germany; Danner, W. [Max-Planck Institute, Garching, Germany; Maisonnier, D. [Max-Planck Institute, Garching, Germany

    2001-01-01

    The ITER vacuum vessel (VV) is designed to be large double-walled structure with a D-shaped crosssection. The achievable fabrication tolerance of this structure was unknown due to the size and complexity of shape. The Full-scale Sector Model of ITER Vacuum Vessel, which was 15m in height, was fabricated and tested to obtain the fabrication and assembly tolerances. The model was fabricated within the target tolerance of 5mm and welding deformation during assembly operation was obtained. The port structure was also connected using remotized welding tools to demonstrate the basic maintenance activity. In parallel, the tests of advanced welding, cutting and inspection system were performed to improve the efficiency of fabrication and maintenance of the Vacuum Vessel. These activities show the feasibility of ITER Vacuum Vessel as feasible in a realistic way. This paper describes the major progress, achievement and latest status of the R&D activities on the ITER vacuum vessel.

  19. Comparison of Accessibility, Cost, and Quality of Elective Coronary Revascularization Between Veterans Affairs and Community Care Hospitals.

    Science.gov (United States)

    Barnett, Paul G; Hong, Juliette S; Carey, Evan; Grunwald, Gary K; Joynt Maddox, Karen; Maddox, Thomas M

    2018-02-01

    The Veterans Affairs (VA) Community Care (CC) Program supplements VA care with community-based medical services. However, access gains and value provided by CC have not been well described. To compare the access, cost, and quality of elective coronary revascularization procedures between VA and CC hospitals and to evaluate if procedural volume or publicly reported quality data can be used to identify high-value care. Observational cohort study of veterans younger than 65 years undergoing an elective coronary revascularization, controlling for differences in risk factors using propensity adjustment. The setting was VA and CC hospitals. Participants were veterans undergoing elective percutaneous coronary intervention (PCI) and veterans undergoing coronary artery bypass graft (CABG) procedures between October 1, 2008, and September 30, 2011. The analysis was conducted between July 2014 and July 2017. Receipt of an elective coronary revascularization at a VA vs CC facility. Access to care as measured by travel distance, 30-day mortality, and costs. In the 3 years ending on September 30, 2011, a total of 13 237 elective PCIs (79.1% at the VA) and 5818 elective CABG procedures (83.6% at the VA) were performed in VA or CC hospitals among veterans meeting study inclusion criteria. On average, use of CC was associated with reduced net travel by 53.6 miles for PCI and by 73.3 miles for CABG surgery compared with VA-only care. Adjusted 30-day mortality after PCI was higher in CC compared with VA (1.54% for CC vs 0.65% for VA, P publicly reported mortality data identified hospitals that provided higher-value care with the exception that CABG mortality was lower in small-volume CC hospitals. In this veteran cohort, PCIs performed in CC hospitals were associated with shorter travel distance but with higher mortality, higher costs, and minimal travel savings compared with VA hospitals. The CABG procedures performed in CC hospitals were associated with shorter travel distance

  20. Predictive ability of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system after first-time lower extremity revascularizations

    NARCIS (Netherlands)

    J. Darling (Jeremy); J.C. McCallum (John C.); P.A. Soden (Peter A.); Guzman, R.J. (Raul J.); Wyers, M.C. (Mark C.); Hamdan, A.D. (Allen D.); H.J.M. Verhagen (Hence); M.L. Schermerhorn (Marc)

    2017-01-01

    markdownabstract__Objective:__ The Society for Vascular Surgery (SVS) Wound, Ischemia and foot Infection (WIfI) classification system was proposed to predict 1-year amputation risk and potential benefit from revascularization. Our goal was to evaluate the predictive ability of this scale in a

  1. Prognostic value of technetium-99m-labeled single-photon emission computerized tomography in the follow-up of patients after their first myocardial revascularization surgery

    Directory of Open Access Journals (Sweden)

    Márcia Maria Sales dos Santos

    2003-01-01

    Full Text Available OBJECTIVE: To assess the prognostic value of Technetium-99m-labeled single-photon emission computerized tomography (SPECT in the follow-up of patients who had undergone their first myocardial revascularization. METHODS: We carried out a retrospective study of 280 revascularized patients undergoing myocardial scintigraphy under stress (exercise or pharmacological stress with dipyridamole and at rest according to a 2-day protocol. A set of clinical, stress electrocardiographic and scintigraphic variables was assessed. Cardiac events were classified as "major" (death, infarction, unstable angina and "any" (major event or coronary angioplasty or new myocardial revascularization surgery. RESULTS: Thirty-six major events occurred as follows: 3 deaths, 11 infarctions, and 22 unstable anginas. In regard to any event, 22 angioplasties and 7 new surgeries occurred in addition to major events, resulting a total of 65 events. The sensitivity of scintigraphy in prognosticating a major event or any event was, respectively, 55% and 58%, showing a negative predictive value of 90% and 83%, respectively. Diabetes mellitus, inconclusive stress electrocardiography, and a scintigraphic visualization of left ventricular enlargement were significant variables for the occurrence of a major event. On multivariate analysis, abnormal myocardial scintigraphy was a predictor of any event. CONCLUSION: Myocardial perfusion tomography with Technetium-99m may be used to identify high-risk patients after their first myocardial revascularization surgery.

  2. The effect of infection and lag screw fixation on revascularization and new bone deposition in membranous bone grafts in a rabbit model.

    Science.gov (United States)

    Fialkov, J A; Phillips, J H; Walmsley, S L; Morava-Protzner, I

    1996-08-01

    We have suggested that rigid fixation of membranous bone grafts in the presence of infection may improve graft-recipient bone union by facilitating graft revascularzation. To test this hypothesis, we grafted autogenous membranous bone grafts to the mandibles of 94 New Zealand White rabbits. Lag screw fixation was applied in half the animals. The wounds were inoculated with a range of Staphylococcus aureus doses. Infected and noninfected rabbits were injected weekly over a 5-week course with fluorescein bone markers and with a marker of vascular endothelium (procion red) just prior to sacrifice. Revascularization and new bone deposition in the grafts were then quantified histologically for the 75 rabbits available for data collection. Infection decreased the amount of graft revascularized and the amount of new bone deposited for both rigidly fixated and nonfixated grafts. Grafts fixated with a lag screw showed a greater amount of revascularization and new bone deposition in the presence and absence of infection when compared with nonfixated grafts, supporting the hypothesis that rigid fixation of membranous bone grafts in the presence of infection may promote graft survival and union by improving revascularization and osteogenesis within the graft.

  3. Immediate effects of isolated transmyocardial laser revascularization procedures combined with intramyocardial injection of autologous bone marrow stem cells in patients with terminal stage of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Leo A. Bockeria

    2017-05-01

    Conclusions ― TMLR with intramyocardial autologous stem cells injections in patients with end-stage CAD is safe. This procedure can be done in the most severe group of patients who cannot be completely revascularized with either PCI or CABG surgery. Futher investigation is needed to assess the effectiveness of the procedure.

  4. Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Engstrøm, Thomas; Kelbæk, Henning

    2017-01-01

    , and severity of the noninfarct-related stenosis on the effect of fractional flow reserve-guided complete revascularization. METHODS AND RESULTS: In the DANAMI-3-PRIMULTI study (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete...

  5. Flaw distribution development from vessel ISI data

    International Nuclear Information System (INIS)

    Foulds, J.R.; Kennedy, E.L.; Basin, S.L.; Rosinski, S.T.

    1991-01-01

    Previous attempts to develop flaw distributions for use in the structural integrity evaluation of pressurized water reactor (PWR) vessels have aimed at the estimation of a ''generic'' distribution applicable to all vessels. In contrast, this paper describes the analysis of vessel-specific in-service inspection (ISI) data for the development of a flaw distribution reliably representative of the condition of the particular vessel inspected. The application of the methodology may be extended to other vessels, but has been primarily developed for PWR reactor vessels. For this study, the flaw data analyzed included data obtained from three recently performed PWR vessel ISIs and from laboratory inspection of selected weldment sections of the Midland reactor vessel. The variability in both the character of the reviewed data (size range of flaws, number of flaws) and the UT (ultrasonic test) inspection system performance identified a need for analyzing the inspection results on a vessel-, or data set-specific basis. For this purpose, traditional histogram-based methods were inadequate, and a new methodology that can accept a very small number of flaws (typical of vessel-specific ISI results) and that includes consideration of inspection system flaw detection reliability, flaw sizing accuracy and flaw detection threshold, was developed. Results of the application of the methodology to each of the four PWR reactor vessel cases studied are presented and discussed

  6. Revascularization and cardioprotective drug treatment in myocardial infarction patients: how do they impact on patients' survival when delivered as usual care

    Directory of Open Access Journals (Sweden)

    Courteau Josiane

    2006-05-01

    Full Text Available Abstract Background Randomized clinical trials showed the benefit of pharmacological and revascularization treatments in secondary prevention of myocardial infarction (MI, in selected population with highly controlled interventions. The objective of this study is to measure these treatments' impact on the cardiovascular (CV mortality rate among patients receiving usual care in the province of Quebec. Methods The study population consisted of a "naturalistic" cohort of all patients ≥ 65 years old living in the Quebec province, who survived a MI (ICD-9: 410 in 1998. The studied dependant variable was time to death from a CV disease. Independent variables were revascularization procedure and cardioprotective drugs. Death from a non CV disease was also studied for comparison. Revascularization procedure was defined as percutaneous transluminal coronary angioplasty (PTCA or coronary artery bypass graft (CABG. The exposure to cardioprotective drugs was defined as the number of cardioprotective drug classes (Acetylsalicylic Acid (ASA, Beta-Blockers, Angiotensin-Converting Enzyme (ACE Inhibitors, Statins claimed within the index period (first 30 days after the index hospitalization. Age, gender and a comorbidity index were used as covariates. Kaplan-Meier survival curves, Cox proportional hazard models, logistic regressions and regression trees were used. Results The study population totaled 5596 patients (3206 men; 2390 women. We observed 1128 deaths (20% within two years following index hospitalization, of them 603 from CV disease. The CV survival rate at two years is much greater for patients with revascularization, regardless of pharmacological treatments. For patients without revascularization, the CV survival rate increases with the number of cardioprotective drug classes claimed. Finally, Cox proportional hazard models, regression tree and logistic regression analyses all revealed that the absence of revascularization and, to a lower extent

  7. Primo vessel inside a lymph vessel emerging from a cancer tissue.

    Science.gov (United States)

    Lee, Sungwoo; Ryu, Yeonhee; Cha, Jinmyung; Lee, Jin-Kyu; Soh, Kwang-Sup; Kim, Sungchul; Lim, Jaekwan

    2012-10-01

    Primo vessels were observed inside the lymph vessels near the caudal vena cava of a rabbit and a rat and in the thoracic lymph duct of a mouse. In the current work we found a primo vessel inside the lymph vessel that came out from the tumor tissue of a mouse. A cancer model of a nude mouse was made with human lung cancer cell line NCI-H460. We injected fluorescent nanoparticles into the xenografted tumor tissue and studied their flow in blood, lymph, and primo vessels. Fluorescent nanoparticles flowed through the blood vessels quickly in few minutes, and but slowly in the lymph vessels. The bright fluorescent signals of nanoparticles disappeared within one hour in the blood vessels but remained much longer up to several hours in the case of lymph vessels. We found an exceptional case of lymph vessels that remained bright with fluorescence up to 24 hours. After detailed examination we found that the bright fluorescence was due to a putative primo vessel inside the lymph vessel. This rare observation is consistent with Bong-Han Kim's claim on the presence of a primo vascular system in lymph vessels. It provides a significant suggestion on the cancer metastasis through primo vessels and lymph vessels. Copyright © 2012. Published by Elsevier B.V.

  8. What is cerebral small vessel disease?

    International Nuclear Information System (INIS)

    Onodera, Osamu

    2011-01-01

    An accumulating amount of evidence suggests that the white matter hyperintensities on T 2 weighted brain magnetic resonance imaging predict an increased risk of dementia and gait disturbance. This state has been proposed as cerebral small vessel disease, including leukoaraiosis, Binswanger's disease, lacunar stroke and cerebral microbleeds. However, the concept of cerebral small vessel disease is still obscure. To understand the cerebral small vessel disease, the precise structure and function of cerebral small vessels must be clarified. Cerebral small vessels include several different arteries which have different anatomical structures and functions. Important functions of the cerebral small vessels are blood-brain barrier and perivasucular drainage of interstitial fluid from the brain parenchyma. Cerebral capillaries and glial endfeet, take an important role for these functions. However, the previous pathological investigations on cerebral small vessels have focused on larger arteries than capillaries. Therefore little is known about the pathology of capillaries in small vessel disease. The recent discoveries of genes which cause the cerebral small vessel disease indicate that the cerebral small vessel diseases are caused by a distinct molecular mechanism. One of the pathological findings in hereditary cerebral small vessel disease is the loss of smooth muscle cells, which is an also well-recognized finding in sporadic cerebral small vessel disease. Since pericytes have similar character with the smooth muscle cells, the pericytes should be investigated in these disorders. In addition, the loss of smooth muscle cells may result in dysfunction of drainage of interstitial fluid from capillaries. The precise correlation between the loss of smooth muscle cells and white matter disease is still unknown. However, the function that is specific to cerebral small vessel may be associated with the pathogenesis of cerebral small vessel disease. (author)

  9. 46 CFR 4.03-40 - Public vessels.

    Science.gov (United States)

    2010-10-01

    ... INVESTIGATIONS Definitions § 4.03-40 Public vessels. Public vessel means a vessel that— (a) Is owned, or demise... Department (except a vessel operated by the Coast Guard or Saint Lawrence Seaway Development Corporation...

  10. Gene expression analysis in human breast cancer associated blood vessels.

    Directory of Open Access Journals (Sweden)

    Dylan T Jones

    Full Text Available Angiogenesis is essential for solid tumour growth, whilst the molecular profiles of tumour blood vessels have been reported to be different between cancer types. Although presently available anti-angiogenic strategies are providing some promise for the treatment of some cancers it is perhaps not surprisingly that, none of the anti-angiogenic agents available work on all tumours. Thus, the discovery of novel anti-angiogenic targets, relevant to individual cancer types, is required. Using Affymetrix microarray analysis of laser-captured, CD31-positive blood vessels we have identified 63 genes that are upregulated significantly (5-72 fold in angiogenic blood vessels associated with human invasive ductal carcinoma (IDC of the breast as compared with blood vessels in normal human breast. We tested the angiogenic capacity of a subset of these genes. Genes were selected based on either their known cellular functions, their enriched expression in endothelial cells and/or their sensitivity to anti-VEGF treatment; all features implicating their involvement in angiogenesis. For example, RRM2, a ribonucleotide reductase involved in DNA synthesis, was upregulated 32-fold in IDC-associated blood vessels; ATF1, a nuclear activating transcription factor involved in cellular growth and survival was upregulated 23-fold in IDC-associated blood vessels and HEX-B, a hexosaminidase involved in the breakdown of GM2 gangliosides, was upregulated 8-fold in IDC-associated blood vessels. Furthermore, in silico analysis confirmed that AFT1 and HEX-B also were enriched in endothelial cells when compared with non-endothelial cells. None of these genes have been reported previously to be involved in neovascularisation. However, our data establish that siRNA depletion of Rrm2, Atf1 or Hex-B had significant anti-angiogenic effects in VEGF-stimulated ex vivo mouse aortic ring assays. Overall, our results provide proof-of-principle that our approach can identify a cohort of

  11. Progress of ITER vacuum vessel

    Energy Technology Data Exchange (ETDEWEB)

    Ioki, K., E-mail: Kimihiro.Ioki@iter.org [ITER Organization, Route de Vinon sur Verdon, 13115 St Paul-lez-Durance (France); Bayon, A. [F4E, c/ Josep Pla, No. 2, Torres Diagonal Litoral, Edificio B3, E-08019 Barcelona (Spain); Choi, C.H.; Daly, E.; Dani, S.; Davis, J.; Giraud, B.; Gribov, Y.; Hamlyn-Harris, C.; Jun, C.; Levesy, B. [ITER Organization, Route de Vinon sur Verdon, 13115 St Paul-lez-Durance (France); Kim, B.C. [NFRI, 52 Yeoeundong Yuseonggu, Daejeon 305-333 (Korea, Republic of); Kuzmin, E. [NTC “Sintez”, Efremov Inst., 189631 Metallostroy, St. Petersburg (Russian Federation); Le Barbier, R.; Martinez, J.-M. [ITER Organization, Route de Vinon sur Verdon, 13115 St Paul-lez-Durance (France); Pathak, H. [ITER-India, A-29, GIDC Electronic Estate, Sector 25, Gandhinagar 382025 (India); Preble, J. [ITER Organization, Route de Vinon sur Verdon, 13115 St Paul-lez-Durance (France); Sa, J.W. [NFRI, 52 Yeoeundong Yuseonggu, Daejeon 305-333 (Korea, Republic of); Terasawa, A.; Utin, Yu. [ITER Organization, Route de Vinon sur Verdon, 13115 St Paul-lez-Durance (France); and others

    2013-10-15

    Highlights: ► This covers the overall status and progress of the ITER vacuum vessel activities. ► It includes design, R and D, manufacturing and approval process of the regulators. ► The baseline design was completed and now manufacturing designs are on-going. ► R and D includes ISI, dynamic test of keys and lip-seal welding/cutting technology. ► The VV suppliers produced full-scale mock-ups and started VV manufacturing. -- Abstract: Design modifications were implemented in the vacuum vessel (VV) baseline design in 2011–2012 for finalization. The modifications are mostly due to interface components, such as support rails and feedthroughs for the in-vessel coils (IVC). Manufacturing designs are being developed at the domestic agencies (DAs) based on the baseline design. The VV support design was also finalized and tests on scale mock-ups are under preparation. Design of the in-wall shielding (IWS) has progressed, considering the assembly methods and the required tolerances. Further modifications are required to be consistent with the DAs’ manufacturing designs. Dynamic tests on the inter-modular and stub keys to support the blanket modules are being performed to measure the dynamic amplification factor (DAF). An in-service inspection (ISI) plan has been developed and R and D was launched for ISI. Conceptual design of the VV instrumentation has been developed. The VV baseline design was approved by the agreed notified body (ANB) in accordance with the French Nuclear Pressure Equipment Order procedure.

  12. Progress of ITER vacuum vessel

    International Nuclear Information System (INIS)

    Ioki, K.; Bayon, A.; Choi, C.H.; Daly, E.; Dani, S.; Davis, J.; Giraud, B.; Gribov, Y.; Hamlyn-Harris, C.; Jun, C.; Levesy, B.; Kim, B.C.; Kuzmin, E.; Le Barbier, R.; Martinez, J.-M.; Pathak, H.; Preble, J.; Sa, J.W.; Terasawa, A.; Utin, Yu.

    2013-01-01

    Highlights: ► This covers the overall status and progress of the ITER vacuum vessel activities. ► It includes design, R and D, manufacturing and approval process of the regulators. ► The baseline design was completed and now manufacturing designs are on-going. ► R and D includes ISI, dynamic test of keys and lip-seal welding/cutting technology. ► The VV suppliers produced full-scale mock-ups and started VV manufacturing. -- Abstract: Design modifications were implemented in the vacuum vessel (VV) baseline design in 2011–2012 for finalization. The modifications are mostly due to interface components, such as support rails and feedthroughs for the in-vessel coils (IVC). Manufacturing designs are being developed at the domestic agencies (DAs) based on the baseline design. The VV support design was also finalized and tests on scale mock-ups are under preparation. Design of the in-wall shielding (IWS) has progressed, considering the assembly methods and the required tolerances. Further modifications are required to be consistent with the DAs’ manufacturing designs. Dynamic tests on the inter-modular and stub keys to support the blanket modules are being performed to measure the dynamic amplification factor (DAF). An in-service inspection (ISI) plan has been developed and R and D was launched for ISI. Conceptual design of the VV instrumentation has been developed. The VV baseline design was approved by the agreed notified body (ANB) in accordance with the French Nuclear Pressure Equipment Order procedure

  13. Molecular imaging of tumor blood vessels in prostate cancer.

    Science.gov (United States)

    Tilki, Derya; Seitz, Michael; Singer, Bernhard B; Irmak, Ster; Stief, Christian G; Reich, Oliver; Ergün, Süleyman

    2009-05-01

    In the past three decades many efforts have been undertaken to understand the mechanisms of tumor angiogenesis. The introduction of anti-angiogenic drugs in tumor therapy during the last few years necessitates the establishment of new techniques enabling molecular imaging of tumor vascular remodelling. The determination of tumor size as commonly used is not appropriate since the extended necrosis under anti-angiogenic therapy does not necessarily result in the reduction of tumor diameter. The basis for the molecular imaging of tumor blood vessels is the remodelling of the tumor vessels under anti-angiogenic therapy which obviously occurs at an early stage and seems to be a convincing parameter. Beside the enormous progress in this field during the last few years the resolution is still not high enough to evaluate the remodelling of the micro tumor vessels. New imaging approaches combining specific molecular markers for tumor vessels with the different imaging techniques are needed to overcome this issue as exemplarily discussed for prostate cancer in this review. Molecular contrast agents targeting the vasculature will allow clinicians the visualization of vascular remodelling processes taking place under anti-angiogenic therapy and improve tumor diagnosis and follow-up.

  14. Tumor vessel normalization after aerobic exercise enhances chemotherapeutic efficacy.

    Science.gov (United States)

    Schadler, Keri L; Thomas, Nicholas J; Galie, Peter A; Bhang, Dong Ha; Roby, Kerry C; Addai, Prince; Till, Jacob E; Sturgeon, Kathleen; Zaslavsky, Alexander; Chen, Christopher S; Ryeom, Sandra

    2016-10-04

    Targeted therapies aimed at tumor vasculature are utilized in combination with chemotherapy to improve drug delivery and efficacy after tumor vascular normalization. Tumor vessels are highly disorganized with disrupted blood flow impeding drug delivery to cancer cells. Although pharmacologic anti-angiogenic therapy can remodel and normalize tumor vessels, there is a limited window of efficacy and these drugs are associated with severe side effects necessitating alternatives for vascular normalization. Recently, moderate aerobic exercise has been shown to induce vascular normalization in mouse models. Here, we provide a mechanistic explanation for the tumor vascular normalization induced by exercise. Shear stress, the mechanical stimuli exerted on endothelial cells by blood flow, modulates vascular integrity. Increasing vascular shear stress through aerobic exercise can alter and remodel blood vessels in normal tissues. Our data in mouse models indicate that activation of calcineurin-NFAT-TSP1 signaling in endothelial cells plays a critical role in exercise-induced shear stress mediated tumor vessel remodeling. We show that moderate aerobic exercise with chemotherapy caused a significantly greater decrease in tumor growth than chemotherapy alone through improved chemotherapy delivery after tumor vascular normalization. Our work suggests that the vascular normalizing effects of aerobic exercise can be an effective chemotherapy adjuvant.

  15. Cardiac rehabilitation improves the ischemic burden in patients with ischemic heart disease who are not suitable for revascularization

    Energy Technology Data Exchange (ETDEWEB)

    El Demerdash, Salah [Department of Cardiology, Ain Shams University Hospital, Cairo (Egypt); Khorshid, Hazem, E-mail: hazemkhorshid@yahoo.com [Department of Cardiology, Ain Shams University Hospital, Cairo (Egypt); Salah, Iman; Abdel-Rahman, Mohamed A. [Department of Cardiology, Ain Shams University Hospital, Cairo (Egypt); Salem, Alaa M. [Department of Internal Medicine, Medical Division, National Research Centre, Cairo (Egypt)

    2015-07-15

    Background: Ischemic heart diseases including stable angina & acute events, represent a huge burden on both the individual & the society and represent an important source of disability. Aim: We aimed to identify the effect of cardiac rehabilitation program (CRP) on the ischemic burden in patients with ischemic heart disease (IHD) unsuitable for coronary revascularization. Methods: The study included 40 patients with IHD who were not suitable for coronary revascularization either by PCI or CABG (due to unsuitable coronary anatomy, co morbidities, high surgical/procedural risk or patient preference). All patients were subjected to sophisticated CRP protocols, including patient education, nutritional, medical, psychological and sexual counseling and group smoking cessation. All patients participated in low intensity exercise program twice weekly. The patient’s symptoms, vitals and medications were evaluated at each visit and clinical and laboratory data, echocardiography and stress myocardial perfusion imaging (SPECT) were evaluated before and 3 months after the end of the study. Results: The mean age was 56.8 ± 3.1 years and only 2 patients (5%) were females. 22 (55%) patients were diabetic, 21 (53%) were hypertensive and 30 (75%) were smokers. It was found that 3 months after completion of CRP, there was a significant decrease in BMI (30.3 ± 2.9 vs. 31.2 ± 1.9, p < 0.001), and mean blood pressure (93.4 ± 11 vs. 105 ± 10.6 mmHg, p < 0.001). There was also a favorable effect on lipid profile and a significant improvement of the functional capacity in terms of NYHA functional class (2.1 ± 0.62 vs. 1.4 ± 0.6, p < 0.001). Despite that wall motion score index did not significantly change after CRP, there was a strong trend toward a better ejection fraction (53.7 ± 7.8 vs. 54.5 ± 6.3 %, p = 0.06) and significant improvement of Canadian cardiovascular class (1.42 ± 0.6 vs. 1.95 ± 0.5, p < 0.001) post CRP. Importantly, the difference between the SPECT

  16. Cardiac rehabilitation improves the ischemic burden in patients with ischemic heart disease who are not suitable for revascularization

    International Nuclear Information System (INIS)

    El Demerdash, Salah; Khorshid, Hazem; Salah, Iman; Abdel-Rahman, Mohamed A.; Salem, Alaa M.

    2015-01-01

    Background: Ischemic heart diseases including stable angina & acute events, represent a huge burden on both the individual & the society and represent an important source of disability. Aim: We aimed to identify the effect of cardiac rehabilitation program (CRP) on the ischemic burden in patients with ischemic heart disease (IHD) unsuitable for coronary revascularization. Methods: The study included 40 patients with IHD who were not suitable for coronary revascularization either by PCI or CABG (due to unsuitable coronary anatomy, co morbidities, high surgical/procedural risk or patient preference). All patients were subjected to sophisticated CRP protocols, including patient education, nutritional, medical, psychological and sexual counseling and group smoking cessation. All patients participated in low intensity exercise program twice weekly. The patient’s symptoms, vitals and medications were evaluated at each visit and clinical and laboratory data, echocardiography and stress myocardial perfusion imaging (SPECT) were evaluated before and 3 months after the end of the study. Results: The mean age was 56.8 ± 3.1 years and only 2 patients (5%) were females. 22 (55%) patients were diabetic, 21 (53%) were hypertensive and 30 (75%) were smokers. It was found that 3 months after completion of CRP, there was a significant decrease in BMI (30.3 ± 2.9 vs. 31.2 ± 1.9, p < 0.001), and mean blood pressure (93.4 ± 11 vs. 105 ± 10.6 mmHg, p < 0.001). There was also a favorable effect on lipid profile and a significant improvement of the functional capacity in terms of NYHA functional class (2.1 ± 0.62 vs. 1.4 ± 0.6, p < 0.001). Despite that wall motion score index did not significantly change after CRP, there was a strong trend toward a better ejection fraction (53.7 ± 7.8 vs. 54.5 ± 6.3 %, p = 0.06) and significant improvement of Canadian cardiovascular class (1.42 ± 0.6 vs. 1.95 ± 0.5, p < 0.001) post CRP. Importantly, the difference between the SPECT

  17. The use of the inferior epigastric artery for accessory lower polar artery revascularization in live donor renal transplantation.

    Science.gov (United States)

    El-Sherbiny, M; Abou-Elela, A; Morsy, A; Salah, M; Foda, A

    2008-01-01

    This study describes the surgical technique and outcomes of live donor renal allografts with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery after declamping. Between 1988 and 2004, 477 consecutive live donor renal transplants were performed, including 429 with single and 48 with multiple arteries. Anastomosis of the lower polar artery to the inferior epigastric artery was used for 15 grafts with multiple arteries. Successful revascularization of all areas of the transplanted graft was confirmed by Doppler ultrasonography in most patients and radionuclide renal scanning +/- MRA in some patients. In live donor renal transplantation with multiple arteries, the anastomosis of the lower polar artery to the inferior epigastric artery after declamping avoids prolongation of the ischemia time that occurs with other surgical and microsurgical techniques of intracorporeal and ex vivo surgeries.

  18. A Structured Review of Antithrombotic Therapy in Peripheral Artery Disease With a Focus on Revascularization: A TASC (InterSociety Consensus for the Management of Peripheral Artery Disease) Initiative.

    Science.gov (United States)

    Hess, Connie N; Norgren, Lars; Ansel, Gary M; Capell, Warren H; Fletcher, John P; Fowkes, F Gerry R; Gottsäter, Anders; Hitos, Kerry; Jaff, Michael R; Nordanstig, Joakim; Hiatt, William R

    2017-06-20

    Peripheral artery disease affects >200 million people worldwide and is associated with significant limb and cardiovascular morbidity and mortality. Limb revascularization is recommended to improve function and quality of life for symptomatic patients with peripheral artery disease with intermittent claudication who have not responded to medical treatment. For patients with critical limb ischemia, the goals of revascularization are to relieve pain, help wound healing, and prevent limb loss. The baseline risk of cardiovascular and limb-related events demonstrated among patients with stable peripheral artery disease is elevated after revascularization and related to atherothrombosis and restenosis. Both of these processes involve platelet activation and the coagulation cascade, forming the basis for the use of antiplatelet and anticoagulant therapies to optimize procedural success and reduce postprocedural cardiovascular risk. Unfortunately, few high-quality, randomized data to support use of these therapies after peripheral artery disease revascularization exist, and much of the rationale for the use of antiplatelet agents after endovascular peripheral revascularization is extrapolated from percutaneous coronary intervention literature. Consequently, guideline recommendations for antithrombotic therapy after lower limb revascularization are inconsistent and not always evidence-based. In this context, the purpose of this structured review is to assess the available randomized data for antithrombotic therapy after peripheral arterial revascularization, with a focus on clinical trial design issues that may affect interpretation of study results, and highlight areas that require further investigation. © 2017 American Heart Association, Inc.

  19. Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups.

    Science.gov (United States)

    Juul, Nikolai; Gislason, Gunnar; Olesen, Jonas Bjerring; Lamberts, Morten; Hansen, Morten Lock; Karasoy, Deniz; Christiansen, Christine Benn; Torp-Pedersen, Christian; Sorensen, Rikke

    2017-09-01

    Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization. Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population. A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7% males). Use of dual anti-platelet treatment decreased with age: 80% (79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users 79 years (HR=0.92; 95% CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged 79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population. Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.

  20. Time to Wound Healing and Major Adverse Limb Events in Patients with Critical Limb Ischemia Treated with Endovascular Revascularization.

    Science.gov (United States)

    Reed, Grant W; Salehi, Negar; Giglou, Pejman R; Kafa, Rami; Malik, Umair; Maier, Michael; Shishehbor, Mehdi H

    2016-10-01

    There are few studies that quantify the impact of time to wound healing on outcomes after endovascular revascularization of critical limb ischemia (CLI). In this retrospective study, 179 patients with CLI and tissue loss were assessed for adverse events after endovascular therapy. Associations between time to wound healing and outcomes were determined via Cox proportional hazards analysis. The long-term probability of events was assessed with Kaplan-Meier analysis. The primary end point was major adverse limb events (MALE-major amputation, surgical endarterectomy, or bypass). Secondary end points were major amputation, need for repeat endovascular therapy, and mortality. After multivariable adjustment for time-dependent wound healing, age, renal function, diabetes, and Rutherford class, independent predictors of MALE included the presence of an unhealed wound (hazard ratio [HR], 5.2; 95% confidence interval (CI), 2.3-11.8; P wounds compared with healed wounds (log-rank P wounds healed within 4 months had a lower probability of MALE than patients who did not heal by 4 months (log-rank, P = 0.04). Unhealed wounds were also independently associated with major amputation (HR, 9.0; 95% CI, 2.6-31.1; P = 0.0004), and patients whose wounds healed by 3 months had less major amputation (log-rank, P = 0.04). Unhealed wounds were independently associated with increased risk of mortality (HR, 42.7; 95% CI, 5.7-319.0; P = 0.002) but not repeat revascularization. Unhealed wounds are an independent risk factor for MALE, major amputation, and mortality after endovascular treatment of CLI. Wound healing within 3 months is associated with less risk of major amputation, and within 4 months less risk of MALE. A focus should be on achieving wound healing as fast as possible in this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Impact of Collateral Status on Successful Revascularization in Endovascular Treatment: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Leng, Xinyi; Fang, Hui; Leung, Thomas W H; Mao, Chen; Xu, Yuming; Miao, Zhongrong; Liu, Liping; Wong, K S Lawrence; Liebeskind, David S

    2016-01-01

    Pre-treatment collateral status may be associated with the rates of successful revascularization in acute ischemic stroke patients receiving endovascular treatment (EVT). We conducted a systematic review and meta-analysis to synthesize relevant evidence currently available. Relevant full-text articles published in English since January 1, 2000, reporting associations between collateral status and successful reperfusion and/or recanalization in acute ischemic stroke patients receiving EVT in cohort or case-control studies, or randomized clinical trials, were retrieved through search of PubMed. Study selection, data extraction and study quality assessment were carried out by 2 investigators. Risk ratios (RR) were pooled for good vs. poor collaterals for the outcomes of successful reperfusion and recanalization, based on random-effects models. Subgroup analyses were conducted to explore for potential factors that might interfere with the effects of pre-treatment collateral status on reperfusion by EVT. In total, 27 studies (2,366 subjects) were included in qualitative analysis, among which 24 studies (2,239 subjects) were quantitatively analyzed. Overall, good pre-treatment collaterals significantly increased the rate of both successful reperfusion (RR 1.28, 95% CI 1.17-1.40; p collaterals. Subgroup analyses revealed that the effects of collateral status on successful reperfusion by EVT might be different between populations with different ethnicities. Good pre-treatment collaterals may enhance the rates of successful reperfusion and recanalization in EVT for acute ischemic stroke. This may partly explain the favorable effects of good pre-treatment collaterals on clinical outcomes of stroke patients receiving EVT. Thus, it would be valuable to assess the collateral status prior to EVT in acute ischemic stroke. But studies are needed to further verify if the positive effects of good collaterals on revascularization by EVT are restricted to certain subgroups of patients

  2. Why are tumour blood vessels abnormal and why is it important to know?

    Science.gov (United States)

    Nagy, J A; Chang, S-H; Dvorak, A M; Dvorak, H F

    2009-01-01

    Tumour blood vessels differ from their normal counterparts for reasons that have received little attention. We report here that they are of at least six distinct types, we describe how each forms, and, looking forward, encourage the targeting of tumour vessel subsets that have lost their vascular endothelial growth factor-A (VEGF-A) dependency and so are likely unresponsive to anti-VEGF-A therapies. PMID:19240721

  3. Nuclear reactor pressure vessel flaw distribution development

    International Nuclear Information System (INIS)

    Kennedy, E.L.; Foulds, J.R.; Basin, S.L.

    1991-12-01

    Previous attempts to develop flaw distributions for probabilistic fracture mechanics analyses of pressurized water reactor (PWR) vessels have aimed at the estimation of a ''generic'' distribution applicable to all PWR vessels. In contrast, this report describes (1) a new flaw distribution development analytic methodology that can be applied to the analysis of vessel-specific inservice inspection (ISI) data, and (2) results of the application of the methodology to the analysis of flaw data for each vessel case (ISI data on three PWR vessels and laboratory inspection data on sections of the Midland reactor vessel). Results of this study show significant variation among the flaw distributions derived from the various data sets analyzed, strongly suggesting than a vessel-specific flaw distribution (for vessel integrity prediction under pressurized thermal shock) is preferred over a ''generic'' distribution. In addition, quantitative inspection system flaw sizing accuracy requirements have been identified for developing a flaw distribution from vessel ISI data. The new flaw data analysis methodology also permits quantifying the reliability of the flaw distribution estimate. Included in the report are identified needs for further development of several aspects of ISI data acquisition and vessel integrity prediction practice

  4. Revascularization Treatment of Emergency Patients with Acute ST-Segment Elevation Myocardial Infarction in Switzerland: Results from a Nationwide, Cross-Sectional Study in Switzerland for 2010-2011.

    Science.gov (United States)

    Berlin, Claudia; Jüni, Peter; Endrich, Olga; Zwahlen, Marcel

    2016-01-01

    Cardiovascular diseases are the leading cause of death worldwide and in Switzerland. When applied, treatment guidelines for patients with acute ST-segment elevation myocardial infarction (STEMI) improve the clinical outcome and should eliminate treatment differences by sex and age for patients whose clinical situations are identical. In Switzerland, the rate at which STEMI patients receive revascularization may vary by patient and hospital characteristics. To examine all hospitalizations in Switzerland from 2010-2011 to determine if patient or hospital characteristics affected the rate of revascularization (receiving either a percutaneous coronary intervention or a coronary artery bypass grafting) in acute STEMI patients. We used national data sets on hospital stays, and on hospital infrastructure and operating characteristics, for the years 2010 and 2011, to identify all emergency patients admitted with the main diagnosis of acute STEMI. We then calculated the proportion of patients who were treated with revascularization. We used multivariable multilevel Poisson regression to determine if receipt of revascularization varied by patient and hospital characteristics. Of the 9,696 cases we identified, 71.6% received revascularization. Patients were less likely to receive revascularization if they were female, and 80 years or older. In the multivariable multilevel Poisson regression analysis, there was a trend for small-volume hospitals performing fewer revascularizations but this was not statistically significant while being female (Relative Proportion = 0.91, 95% CI: 0.86 to 0.97) and being older than 80 years was still associated with less frequent revascularization. Female and older patients were less likely to receive revascularization. Further research needs to clarify whether this reflects differential application of treatment guidelines or limitations in this kind of routine data.

  5. Drug-eluting stents appear superior to bare metal stents for vein-graft PCI in vessels up to a stent diameter of 4 mm

    Directory of Open Access Journals (Sweden)

    Oliver P. Guttmann

    2016-05-01

    Full Text Available BackgroundResearch trials have shown improved short-term outcome with drug-eluting stents (DES over bare metal stents (BMS in saphenous vein graft (SVG percutaneous coronary intervention (PCI, primarily by reducing target vessel revascularization (TVR for in-stent restenosis. We compared the outcomes in patients undergoing SVG stent implantation treated with DES or BMS. In exploratory analyses we investigated the influence of stent generation and diameter.MethodsData were obtained from a prospective database of 657 patients who underwent PCI for SVG lesions between 2003 and 2011. A total of 344 patients had PCI with BMS and 313 with DES. Propensity scores were developed based on 15 observed baseline covariates in a logistic regression model with stent type as the dependent variable. The nearest-neighbour-matching algorithm with Greedy 5-1 Digit Matching was used to produce two patient cohorts of 313 patients each. We assessed major adverse cardiac events (MACE out to a median of 3.3 years (interquartile range: 2.1-4.1. MACE was defined as all-cause mortality, myocardial infarction (MI, TVR and stroke.ResultsThere was a significant difference in MACE between the two groups in favour of DES (17.9% DES vs. 31.2% BMS group; p = 0.0017 over the 5-year follow-up period. MACE was driven by increased TVR in the BMS group. There was no difference in death, MI or stroke. Adjusted Cox analysis confirmed a decreased risk of MACE for DES compared with BMS 0.75 (95% confidence interval (CI 0.52-0.94, with no difference in the hazard of all-cause mortality (hazard ratio: 1.08; 95% CI: 0.77-1.68. However, when looking at stent diameters greater than 4 mm, no difference was seen in MACE rates between BMS and DES.ConclusionsOverall in our cohort of patients who had PCI for SVG disease, DES use resulted in lower MACE rates compared with BMS over a 5-year follow-up period; however, for stent diameters over 4 mm no difference in MACE rates was seen.

  6. Pressure test method for reactor pressure vessel in construction field

    International Nuclear Information System (INIS)

    Takeda, Masakado; Ushiroda, Koichi; Miyahara, Ryohei; Takano, Hiroshi; Matsuura, Tadashi; Sato, Keiya.

    1998-01-01

    Plant constitutional parts as targets of both of a primary pressure test and a secondary pressure test are disposed in communication with a reactor pressure vessel, and a pressure of the primary pressure test is applied to the targets of both tests, so that the primary pressure test and the second pressure test are conducted together. Since the number of pressure tests can be reduced to promote construction, and the number of workers can also be reduced. A pressure exceeding the maximum pressure upon use is applied to the pressure vessel after disposing the incore structures, to continuously conduct the primary pressure test and the secondary pressure test joined together and an incore flowing test while closing the upper lid of the pressure vessel as it is in the construction field. The number of opening/closing of the upper lid upon conducting every test can be reduced, and since the pressure resistance test is conducted after arranging circumference conditions for the incore flowing test, the tests can be conducted collectively also in view of time. (N.H.)

  7. Hydrogen storage in insulated pressure vessels

    Energy Technology Data Exchange (ETDEWEB)

    Aceves, S.M.; Garcia-Villazana, O. [Lawrence Livermore National Lab., CA (United States)

    1998-08-01

    Insulated pressure vessels are cryogenic-capable pressure vessels that can be fueled with liquid hydrogen (LH{sub 2}) or ambient-temperature compressed hydrogen (CH{sub 2}). Insulated pressure vessels offer the advantages of liquid hydrogen tanks (low weight and volume), with reduced disadvantages (lower energy requirement for hydrogen liquefaction and reduced evaporative losses). This paper shows an evaluation of the applicability of the insulated pressure vessels for light-duty vehicles. The paper shows an evaluation of evaporative losses and insulation requirements and a description of the current analysis and experimental plans for testing insulated pressure vessels. The results show significant advantages to the use of insulated pressure vessels for light-duty vehicles.

  8. Neutron Assay System for Confinement Vessel Disposition

    International Nuclear Information System (INIS)

    Frame, Katherine C.; Bourne, Mark M.; Crooks, William J.; Evans, Louise; Mayo, Douglas R.; Miko, David K.; Salazar, William R.; Stange, Sy; Valdez, Jose I.; Vigil, Georgiana M.

    2012-01-01

    Los Alamos National Laboratory has a number of spherical confinement vessels (CVs) remaining from tests involving nuclear materials. These vessels have an inner diameter of 6 feet with 1-inch thick steel walls. The goal of the Confinement Vessel Disposition (CVD) project is to remove debris and reduce contamination inside the CVs. The Confinement Vessel Assay System (CVAS) was developed to measure the amount of special nuclear material (SNM) in CVs before and after cleanout. Prior to cleanout, the system will be used to perform a verification measurement of each vessel. After cleanout, the system will be used to perform safeguards-quality assays of (le)100-g 239 Pu equivalent in a vessel for safeguards termination. The CVAS has been tested and calibrated in preparation for verification and safeguards measurements.

  9. Automatic Vessel Segmentation on Retinal Images

    Institute of Scientific and Technical Information of China (English)

    Chun-Yuan Yu; Chia-Jen Chang; Yen-Ju Yao; Shyr-Shen Yu

    2014-01-01

    Several features of retinal vessels can be used to monitor the progression of diseases. Changes in vascular structures, for example, vessel caliber, branching angle, and tortuosity, are portents of many diseases such as diabetic retinopathy and arterial hyper-tension. This paper proposes an automatic retinal vessel segmentation method based on morphological closing and multi-scale line detection. First, an illumination correction is performed on the green band retinal image. Next, the morphological closing and subtraction processing are applied to obtain the crude retinal vessel image. Then, the multi-scale line detection is used to fine the vessel image. Finally, the binary vasculature is extracted by the Otsu algorithm. In this paper, for improving the drawbacks of multi-scale line detection, only the line detectors at 4 scales are used. The experimental results show that the accuracy is 0.939 for DRIVE (digital retinal images for vessel extraction) retinal database, which is much better than other methods.

  10. Electrical discharge machining for vessel sample removal

    International Nuclear Information System (INIS)

    Litka, T.J.

    1993-01-01

    Due to aging-related problems or essential metallurgy information (plant-life extension or decommissioning) of nuclear plants, sample removal from vessels may be required as part of an examination. Vessel or cladding samples with cracks may be removed to determine the cause of cracking. Vessel weld samples may be removed to determine the weld metallurgy. In all cases, an engineering analysis must be done prior to sample removal to determine the vessel's integrity upon sample removal. Electrical discharge machining (EDM) is being used for in-vessel nuclear power plant vessel sampling. Machining operations in reactor coolant system (RCS) components must be accomplished while collecting machining chips that could cause damage if they become part of the flow stream. The debris from EDM is a fine talclike particulate (no chips), which can be collected by flushing and filtration

  11. Exponential Stabilization of an Underactuated Surface Vessel

    Directory of Open Access Journals (Sweden)

    Kristin Y. Pettersen

    1997-07-01

    Full Text Available The paper shows that a large class of underactuated vehicles cannot be asymptotically stabilized by either continuous or discontinuous state feedback. Furthermore, stabilization of an underactuated surface vessel is considered. Controllability properties of the surface vessels is presented, and a continuous periodic time-varying feedback law is proposed. It is shown that this feedback law exponentially stabilizes the surface vessel to the origin, and this is illustrated by simulations.

  12. Computerized reactor pressure vessel materials information system

    International Nuclear Information System (INIS)

    Strosnider, J.; Monserrate, C.; Kenworthy, L.D.; Tether, C.D.

    1980-10-01

    A computerized information system for storage and retrieval of reactor pressure vessel materials data was established, as part of Task Action Plan A-11, Reactor Vessel Materials Toughness. Data stored in the system are necessary for evaluating the resistance of reactor pressure vessels to flaw-induced fracture. This report includes (1) a description of the information system; (2) guidance on accessing the system; and (3) a user's manual for the system

  13. Comparison of everolimus- and paclitaxel-eluting stents in patients with acute and stable coronary syndromes: pooled results from the SPIRIT (A Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System) and COMPARE (A Trial of Everolimus-Eluting Stents and Paclitaxel-Eluting Stents for Coronary Revascularization in Daily Practice) Trials.

    Science.gov (United States)

    Planer, David; Smits, Pieter C; Kereiakes, Dean J; Kedhi, Elvin; Fahy, Martin; Xu, Ke; Serruys, Patrick W; Stone, Gregg W

    2011-10-01

    This study sought to compare the clinical outcomes of everolimus-eluting stents (EES) versus paclitaxel-eluting stents (PES) in patients with acute coronary syndromes (ACS) and stable coronary artery disease (CAD). Although randomized trials have shown superiority of EES to PES, the safety and efficacy of EES in ACS is unknown. We performed a patient-level pooled analysis from the prospective, randomized SPIRIT (Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System) II, III, IV, and COMPARE (A Trial of Everolimus-Eluting Stents and Paclitaxel-Eluting Stents for Coronary Revascularization in Daily Practice) trials in which 2,381 patients with ACS and 4,404 patients with stable CAD were randomized to EES or to PES. Kaplan-Meier estimates of death, myocardial infarction (MI), ischemia-driven target lesion revascularization, and stent thrombosis were assessed at 2 years and stratified by clinical presentation (ACS vs. stable CAD). At 2 years, patients with ACS compared with stable CAD had higher rates of death (3.2% vs. 2.4%, hazard ratio [HR]: 1.37 [95% confidence interval (CI): 1.02 to 1.85], p = 0.04) and MI (4.9% vs. 3.4%, HR: 1.45 [95% CI: 1.14 to 1.85], p = 0.02). In patients with ACS, EES versus PES reduced the rate of death or MI (6.6% vs. 9.3%, HR: 0.70 [95% CI: 0.52 to 0.94], p = 0.02), stent thrombosis (0.7% vs. 2.9%, HR: 0.25 [95% CI: 0.12 to 0.52], p = 0.0002), and ischemia-driven target lesion revascularization (4.7% vs. 6.2%, HR: 0.69 [95% CI: 0.48 to 0.99], p = 0.04). In patients with stable CAD, EES reduced the rate of death or MI (4.5% vs. 7.1%, HR: 0.62 [95% CI: 0.48 to 0.80], p = 0.0002), stent thrombosis (0.7% vs. 1.8%, HR: 0.34 [95% CI: 0.19 to 0.62], p = 0.0002), and ischemia-driven target lesion revascularization (3.9% vs. 6.9%, HR: 0.55 [95% CI: 0.42 to 0.73], p SPIRIT II]; NCT00180310; SPIRIT III: A Clinical Evaluation of the Investigational Device XIENCE V Everolimus Eluting Coronary Stent System [EECSS] in the

  14. Using the Nova target chamber for high-yield targets

    International Nuclear Information System (INIS)

    Pitts, J.H.

    1987-01-01

    The existing 2.2-m-radius Nova aluminum target chamber, coated and lined with boron-seeded carbon shields, is proposed for use with 1000-MJ-yield targets in the next laser facility. The laser beam and diagnostic holes in the target chamber are left open and the desired 10 -2 Torr vacuum is maintained both inside and outside the target chamber; a larger target chamber room is the vacuum barrier to the atmosphere. The hole area available is three times that necessary to maintain a maximum fluence below 12 J/cm 2 on optics placed at a radius of 10 m. Maximum stress in the target chamber wall is 73 MPa, which complies with the intent of the ASME Pressure Vessel Code. However, shock waves passing through the inner carbon shield could cause it to comminute. We propose tests and analyses to ensure that the inner carbon shield survives the environment. 13 refs

  15. Deformable 4DCT lung registration with vessel bifurcations

    International Nuclear Information System (INIS)

    Hilsmann, A.; Vik, T.; Kaus, M.; Franks, K.; Bissonette, J.P.; Purdie, T.; Beziak, A.; Aach, T.

    2007-01-01

    In radiotherapy planning of lung cancer, breathing motion causes uncertainty in the determination of the target volume. Image registration makes it possible to get information about the deformation of the lung and the tumor movement in the respiratory cycle from a few images. A dedicated, automatic, landmark-based technique was developed that finds corresponding vessel bifurcations. Hereby, we developed criteria to characterize pronounced bifurcations for which correspondence finding was more stable and accurate. The bifurcations were extracted from automatically segmented vessel trees in maximum inhale and maximum exhale CT thorax data sets. To find corresponding bifurcations in both data sets we used the shape context approach of Belongie et al. Finally, a volumetric lung deformation was obtained using thin-plate spline interpolation and affine registration. The method is evaluated on 10 4D-CT data sets of patients with lung cancer. (orig.)

  16. Preparation of 235U target by electrodeposition

    International Nuclear Information System (INIS)

    Chen Qiping; Zhong Wenbin; Li Yougen

    2004-12-01

    A target for the production of fission 99 Mo in a nuclear reactor is composed of an enclosed, cylindrical vessel. Preferable vessel is comprised of stainless steel, having a thin, continuous, uniform layer of 235 U integrally bonded to its inner walls. Two processes are introduced for electrodepositing uranium on to the inner walls of the vessel. One processes is electrodepositing UO 2 from UO 2 (NO 3 ) 2 -(NH 4 ) 2 CO 4 ·H 2 O solution; the other is electrodepositing pure uranium metal from molten salt. Its plating efficiency and plating quantity from a molten bath is higher than UO 2 from the aqueous system. (authors)

  17. How to replace a reactor pressure vessel

    International Nuclear Information System (INIS)

    Huber, R.

    1996-01-01

    A potential life extending procedure for a nuclear reactor after, say, 40 years of service life, might in some circumstances be the replacement of the reactor pressure vessel. Neutron induced degradation of the vessel might make replacement by one of a different material composition desirable, for example. Although the replacement of heavy components, such as steam generators, has been possible for many years, the pressure vessel presents a much more demanding task if only because it is highly irradiated. Some preliminary feasibility studies by Siemens are reported for the two removal strategies that might be considered. These are removal of the entire pressure vessel in one piece and dismantling it into sections. (UK)

  18. Prestressed reactor vessel for nuclear power plants

    International Nuclear Information System (INIS)

    Schoening, J.; Schwiers, H.G.

    1982-01-01

    With usual pressure vessels for nuclear reactor plants, especially for gas-cooled nuclear reactors, the load occurring due to the inner overpressure, especially the tensile load affecting the vessel top and/or bottom, their axis of inertia being horizontal, shall be compensated without a supplementary modification in design of the top and/or the bottom. This is attained by choosing an appropriate prestressing system of the vessel wall in the field the top and/or the bottom, so that the top and/or the bottom form a tension vault directed towards the interior of the vessel. (orig.) [de

  19. Reactor vessel decommissioning project. Final report

    International Nuclear Information System (INIS)

    Schoonen, D.H.

    1984-09-01

    This report describes a reactor vessel decommissioning project; it documents and explains the project objectives, scope, performance results, and sodium removal process. The project was successfully completed in FY-1983, within budget and without significant problems or adverse impact on the environment. Waste generated by the operation included the reactor vessel, drained sodium, and liquid, solid, and gaseous wastes which were significantly less than project estimates. Personnel radiation exposures were minimized, such that the project total was one-half the predicted exposure level. Except for the sodium removed, the material remaining in the reactor vessel is essentially the same as when the vessel arrived for processing

  20. Safety vessels for explosive fusion reactor

    International Nuclear Information System (INIS)

    Mineev, V.

    1994-01-01

    The failure of several types of geometrically similar cylindrical and spherical steel and glass fibers vessels filled with water or air was investigated when an explosive charge of TNT was detonated in the center. Vessels had radius 50-1000 mm, thickness of walls 2-20%. The detonation on TNT imitated energy release. The parameter: K = M/mf is a measure of the strength of the vessel where M is the mass of the vessel, and mf is the mass of TNT for which the vessel fails. This demanded 2-4 destroyed and nondestroyed shots. It may be showed that: K=A/σ f where σ f is the fracture stress of the material vessel, and A = const = F(energy TNT, characteristic of elasticity of vessel material). The chief results are the following: (1) A similar increase in the geometrical dimensions of steel vessels by a factor of 10 leads to the increase of parameter K in about 5 times and to decrease of failure deformation in 7 times (scale effect). (2) For glass fibers, scale effect is absent. (3) This problem is solved in terms of theory energetic scale effect. (4) The concept of TNT equivalent explosive makes it possible to use these investigations to evaluate the response of safety vessels for explosive fusion reactor

  1. Determinants of injuries in passenger vessel accidents.

    Science.gov (United States)

    Yip, Tsz Leung; Jin, Di; Talley, Wayne K

    2015-09-01

    This paper investigates determinants of crew and passenger injuries in passenger vessel accidents. Crew and passenger injury equations are estimated for ferry, ocean cruise, and river cruise vessel accidents, utilizing detailed data of individual vessel accidents that were investigated by the U.S. Coast Guard during the time period 2001-2008. The estimation results provide empirical evidence (for the first time in the literature) that crew injuries are determinants of passenger injuries in passenger vessel accidents. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Increase of cyclic durability of pressure vessels

    International Nuclear Information System (INIS)

    Vorona, V.A.; Zvezdin, Yu.I.

    1980-01-01

    The durability of multilayer pressure vessels under cyclic loading is compared with single-layer vessels. The relative conditional durability is calculated taking into account the assumption on the consequent destruction of layers and viewing a vessel wall as an indefinite plate. It is established that the durability is mainly determined by the number of layers and to a lesser degree depends on the relative size of the defect for the given layer thickness. The advantage of the multilayer vessels is the possibility of selecting layer materials so that to exclude the effect of agressive corrosion media on the strength [ru

  3. Vessel size measurements in angiograms: Manual measurements

    International Nuclear Information System (INIS)

    Hoffmann, Kenneth R.; Dmochowski, Jacek; Nazareth, Daryl P.; Miskolczi, Laszlo; Nemes, Balazs; Gopal, Anant; Wang Zhou; Rudin, Stephen; Bednarek, Daniel R.

    2003-01-01

    Vessel size measurement is perhaps the most often performed quantitative analysis in diagnostic and interventional angiography. Although automated vessel sizing techniques are generally considered to have good accuracy and precision, we have observed that clinicians rarely use these techniques in standard clinical practice, choosing to indicate the edges of vessels and catheters to determine sizes and calibrate magnifications, i.e., manual measurements. Thus, we undertook an investigation of the accuracy and precision of vessel sizes calculated from manually indicated edges of vessels. Manual measurements were performed by three neuroradiologists and three physicists. Vessel sizes ranged from 0.1-3.0 mm in simulation studies and 0.3-6.4 mm in phantom studies. Simulation resolution functions had full-widths-at-half-maximum (FWHM) ranging from 0.0 to 0.5 mm. Phantom studies were performed with 4.5 in., 6 in., 9 in., and 12 in. image intensifier modes, magnification factor = 1, with and without zooming. The accuracy and reproducibility of the measurements ranged from 0.1 to 0.2 mm, depending on vessel size, resolution, and pixel size, and zoom. These results indicate that manual measurements may have accuracies comparable to automated techniques for vessels with sizes greater than 1 mm, but that automated techniques which take into account the resolution function should be used for vessels with sizes smaller than 1 mm

  4. Vessels for elevated temperature service

    International Nuclear Information System (INIS)

    O'Donnell, W.J.; Porowski, J.S.

    1983-01-01

    The subject is covered in chapters, entitled: introduction (background; elevated temperature concerns; design tools); design of pressure vessels for elevated temperature per ASME code; basic elevated temperature failure modes; allowable stresses and strains per ASME code (basic allowable stress limits; ASME code limits for bending; time-fraction summations; strain limits; buckling and instability; negligible creep and stress-rupture effects); combined membrane and bending stresses in creep regime; thermal stress cycles; bounding methods based on elastic core concept (bounds on accumulated strains; more accurate bounds; strain ranges; maximum stresses; strains at discontinuities); elastic follow-up; creep strain concentrations; time-dependent fatigue (combined creep rupture and fatigue damage; limits for inelastic design analyses; limits for elastic design analyses); flaw evaluation techniques; type 316 stainless steel; type 304 stainless steel; steel 2 1/4Cr1Mo; Inconel 718; Incolloy 800; Hastelloy X; detailed inelastic design analyses. (U.K.)

  5. Milestones in pressure vessel technology

    International Nuclear Information System (INIS)

    Spence, J.; Nash, D.H.

    2004-01-01

    The progress of pressure vessel technology over the years has been influenced by many important events. This paper identifies a number of 'milestones' which have provided a stimulus to analysis methods, manufacturing, operational processes and new pressure equipment. The formation of a milestone itself along with its subsequent development is often critically dependent on the work of many individuals. It is postulated that such developments takes place in cycles, namely, an initial idea, followed sometimes by unexpected failures, which in turn stimulate analysis or investigation, and when confidence is established, followed finally by the emergence of codes ad standards. Starting from the industrial revolution, key milestones are traced through to the present day and beyond

  6. Reactor pressure vessel thermal annealing

    International Nuclear Information System (INIS)

    Lee, A.D.

    1997-01-01

    The steel plates and/or forgings and welds in the beltline region of a reactor pressure vessel (RPV) are subject to embrittlement from neutron irradiation. This embrittlement causes the fracture toughness of the beltline materials to be less than the fracture toughness of the unirradiated material. Material properties of RPVs that have been irradiated and embrittled are recoverable through thermal annealing of the vessel. The amount of recovery primarily depends on the level of the irradiation embrittlement, the chemical composition of the steel, and the annealing temperature and time. Since annealing is an option for extending the service lives of RPVs or establishing less restrictive pressure-temperature (P-T) limits; the industry, the Department of Energy (DOE) and the Nuclear Regulatory Commission (NRC) have assisted in efforts to determine the viability of thermal annealing for embrittlement recovery. General guidance for in-service annealing is provided in American Society for Testing and Materials (ASTM) Standard E 509-86. In addition, the American Society of Mechanical Engineers (ASME) Code Case N-557 addresses annealing conditions (temperature and duration), temperature monitoring, evaluation of loadings, and non-destructive examination techniques. The NRC thermal annealing rule (10 CFR 50.66) was approved by the Commission and published in the Federal Register on December 19, 1995. The Regulatory Guide on thermal annealing (RG 1.162) was processed in parallel with the rule package and was published on February 15, 1996. RG 1.162 contains a listing of issues that need to be addressed for thermal annealing of an RPV. The RG also provides alternatives for predicting re-embrittlement trends after the thermal anneal has been completed. This paper gives an overview of methodology and recent technical references that are associated with thermal annealing. Results from the DOE annealing prototype demonstration project, as well as NRC activities related to the

  7. Motion correction for passive radiation imaging of small vessels in ship-to-ship inspections

    Energy Technology Data Exchange (ETDEWEB)

    Ziock, K.P., E-mail: ziockk@ornl.gov [Oak Ridge National Laboratory, Oak Ridge, TN (United States); Boehnen, C.B.; Ernst, J.M.; Fabris, L. [Oak Ridge National Laboratory, Oak Ridge, TN (United States); Hayward, J.P. [Oak Ridge National Laboratory, Oak Ridge, TN (United States); Department of Nuclear Engineering, University of Tennessee, Knoxville, TN (United States); Karnowski, T.P.; Paquit, V.C.; Patlolla, D.R. [Oak Ridge National Laboratory, Oak Ridge, TN (United States); Trombino, D.G. [Lawrence Livermore National Laboratory, Livermore, CA (United States)

    2016-01-01

    Passive radiation detection remains one of the most acceptable means of ascertaining the presence of illicit nuclear materials. In maritime applications it is most effective against small to moderately sized vessels, where attenuation in the target vessel is of less concern. Unfortunately, imaging methods that can remove source confusion, localize a source, and avoid other systematic detection issues cannot be easily applied in ship-to-ship inspections because relative motion of the vessels blurs the results over many pixels, significantly reducing system sensitivity. This is particularly true for the smaller watercraft, where passive inspections are most valuable. We have developed a combined gamma-ray, stereo visible-light imaging system that addresses this problem. Data from the stereo imager are used to track the relative location and orientation of the target vessel in the field of view of a coded-aperture gamma-ray imager. Using this information, short-exposure gamma-ray images are projected onto the target vessel using simple tomographic back-projection techniques, revealing the location of any sources within the target. The complex autonomous tracking and image reconstruction system runs in real time on a 48-core workstation that deploys with the system.

  8. Reducing catheter-related thrombosis using a risk reduction tool centered on catheter to vessel ratio.

    Science.gov (United States)

    Spencer, Timothy R; Mahoney, Keegan J

    2017-11-01

    In vascular access practices, the internal vessel size is considered important, and a catheter to vessel ratio (CVR) is recommended to assist clinicians in selecting the most appropriate-sized device for the vessel. In 2016, new practice recommendations stated that the CVR can increase from 33 to 45% of the vessels diameter. There has been evidence on larger diameter catheters and increased thrombosis risk in recent literature, while insufficient information established on what relationship to vessel size is appropriate for any intra-vascular device. Earlier references to clinical standards and guidelines did not clearly address vessel size in relation to the area consumed or external catheter diameter. The aim of this manuscript is to present catheter-related thrombosis evidence and develop a standardized process of ultrasound-guided vessel assessment, integrating CVR, Virchow's triad phenomenon and vessel health and preservation strategies, empowering an evidence-based approach to device placement. Through review, calculation and assessment on the areas of the 33 and 45% rule, a preliminary clinical tool was developed to assist clinicians make cognizant decisions when placing intravascular devices relating to target vessel size, focusing on potential reduction in catheter-related thrombosis. Increasing the understanding and utilization of CVRs will lead to a safer, more consistent approach to device placement, with potential thrombosis reduction strategies. The future of evidence-based data relies on the clinician to capture accurate vessel measurements and device-related outcomes. This will lead to a more dependable data pool, driving the relationship of catheter-related thrombosis and vascular assessment.

  9. Structural analysis of the KSTAR vacuum vessel

    Energy Technology Data Exchange (ETDEWEB)

    In, Sang Ryul; Yoon, Byeong Joo [Korea Atomic Energy Research Institute, Taejon (Korea)

    1998-10-01

    Structure analysis of the vacuum vessel for the KSTAR tokamak which, is in the end phase of the conceptual design have been performed. Mechanical stresses and deformations of the vessel produced by constant forces due to atmospheric pressure, dead weight, fluid pressure, etc and various transient electromagnetic forces induced during tokamak operations were calculated as well as modal characteristics and buckling properties were investigated. Influences of the temperature gradient and the constraint condition of the support on the thermal stress and deformation of the vessel were analyzed. The thermal stress due to the temperature distribution on the vessel as supplying the N{sub 2} gas of 400 deg C through poloidal channels according to the recent baking concept were calculated. No severe problem in the robustness of the vessel was found when applying the constant pressures on the vessel. However the mechanical stress due to the EM force induced by halo currents flowing on the vessel and the plasma facing components (PFCs) far exceeded the allowable limit. Some reinforcing components should be added on the boundary of the PFC support and the vessel, and that of the vessel support and the vessel. A steep temperature gradient in the vicinity of the inlet and oulet of the heating gas produced a thermal stress much higher than allowable. It is necessary to make the temperature of the vessel as uniform as possible and to develop a new support concept which is flexible enough to accommodate a thermal expansion of a few cm while sufficiently strong to resist mechanical impacts. (author). 5 refs., 41 figs., 9 tabs.

  10. Molecular Targets for Targeted Radionuclide Therapy

    International Nuclear Information System (INIS)

    Mather, S.J.

    2009-01-01

    radiolabelled regulatory peptides and their metabolically stabilised analogues. Antigen epitopes: Antibodies, as unlabelled biological drugs, are becoming of increasing interest. They exert an antibody-dependent cellular cytotoxicity which leads to lysis of tumour cells. Radiolabelled versions of these (and other) antibodies are being developed worldwide. The disadvantage of the long circulating time of antibodies can be solved by engineering fragments such as diabodies, bivalent single chain variable fragments (scFv), minibodies or by pretargeting approaches. Transmembrane transporters: Other interesting targets are transporters for radiolabelled amino acids and nutrients. Cancer cells require an increased supply of many such nutrients and obtain these by increased expression of some types of amino-acid transporter. A more detailed analysis of the relationship between amino-acid uptake and transporter expression in normal and malignant cells would be very valuable in identifying the clinical therapeutic potential of this class of tracer. Tumour blood supply: Tumours require an efficient blood supply to grow and metastatise and active angiogenesis of new blood vessels is a feature of many tumours. Specific receptors expressed during this process represent a novel class of targets for TRT. Extra-cellular matrix: Recently, another relevant class of target antigens has raised interest. Lectins, or carbohydrate binding proteins, recognize specific oligosaccharide structures on glycoproteins and glycolipids. It is well known that protein and lipid glycosylation are consistently altered in cancer cells for the aberrant activity of specific glycosyltransferase and glycosydases. Experimental evidence demonstrated that tumor growth and progression may depend, at least in part, on the presence of altered glycoproteins on the cell surface, which can mediate aberrant receptor-ligand interactions. (author)

  11. "STA-MCA bypass with encephalo-duro-myo-synangiosis combined with bifrontal encephalo-duro-periosteal-synangiosis" as a one-staged revascularization strategy for pediatric moyamoya vasculopathy

    NARCIS (Netherlands)

    Esposito, G.; Kronenburg, A.; Fierstra, J.; Braun, K.P.; Klijn, C.J.M.; Zwan, A. van der; Regli, L.

    2015-01-01

    PURPOSE: Moyamoya vasculopathy progressively compromises cerebral blood flow resulting in chronic hypoperfusion. The middle cerebral artery (MCA) territory and the bifrontal areas are the regions most frequently affected. Although most techniques aim to only revascularize the MCA territory,

  12. A computational algorithm addressing how vessel length might depend on vessel diameter

    Science.gov (United States)

    Jing Cai; Shuoxin Zhang; Melvin T. Tyree

    2010-01-01

    The objective of this method paper was to examine a computational algorithm that may reveal how vessel length might depend on vessel diameter within any given stem or species. The computational method requires the assumption that vessels remain approximately constant in diameter over their entire length. When this method is applied to three species or hybrids in the...

  13. Vessel classification method based on vessel behavior in the port of Rotterdam

    NARCIS (Netherlands)

    Zhou, Y.; Daamen, W.; Vellinga, T.; Hoogendoorn, S.P.

    2015-01-01

    AIS (Automatic Identification System) data have proven to be a valuable source to investigate vessel behavior. The analysis of AIS data provides a possibility to recognize vessel behavior patterns in a waterway area. Furthermore, AIS data can be used to classify vessel behavior into several

  14. Nuclear reactor with a suspended vessel

    International Nuclear Information System (INIS)

    Lemercier, Guy.

    1977-01-01

    This invention relates to a nuclear reactor with a suspended vessel and applies in particular when this is a fast reactor, the core or active part of the reactor being inside the vessel and immersed under a suitable volume of flowing liquid metal to cool it by extracting the calories released by the nuclear fission in the fuel assemblies forming this core [fr

  15. Fabrication of Separator Demonstration Facility process vessel

    International Nuclear Information System (INIS)

    Oberst, E.F.

    1985-01-01

    The process vessel system is the central element in the Separator Development Facility (SDF). It houses the two major process components, i.e., the laser-beam folding optics and the separators pods. This major subsystem is the critical-path procurement for the SDF project. Details of the vaious parts of the process vessel are given

  16. Irradiation embrittlement of reactor vessel steels

    International Nuclear Information System (INIS)

    Bros, J.

    2000-01-01

    From the historical decision of closing the Yankee Rowe NPP because of the uncertainties on the level of reactor pressure vessel neutron embrittlement, this paper reviews the technical-scientist bases of the degradation phenomena, and refers to the evolution of reactor pressure vessel radiation surveillance programs. (Author)

  17. Ultrasound periodic inspections of reactor pressure vessels

    International Nuclear Information System (INIS)

    Haniger, L.

    1980-01-01

    Two versions are described of ultrasonic equipment for periodic inspections of reactor pressure vessels. One uses the principle of exchangeable programmators with solid-state logic while the other uses programmable logic with semiconductor memories. The equipment is to be used for inspections of welded joints on the upper part of the V-1 reactor pressure vessel. (L.O.)

  18. Elastic plastic buckling of elliptical vessel heads

    International Nuclear Information System (INIS)

    Alix, M.; Roche, R.L.

    1981-08-01

    The risks of buckling of dished vessel head increase when the vessel is thin walled. This paper gives the last results on experimental tests of 3 elliptical heads and compares all the results with some empirical formula dealing with elastic and plastic buckling

  19. Analyzing Vessel Behavior Using Process Mining

    NARCIS (Netherlands)

    Maggi, F.M.; Mooij, A.J.; Aalst, W.M.P. van der

    2013-01-01

    In the maritime domain, electronic sensors such as AIS receivers and radars collect large amounts of data about the vessels in a certain geographical area. We investigate the use of process mining techniques for analyzing the behavior of the vessels based on these data. In the context of maritime

  20. FFR-guided multivessel stenting reduces urgent revascularization compared with infarct-related artery only stenting in ST-elevation myocardial infarction: A meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Gupta, Ankur; Bajaj, Navkaranbir S; Arora, Pankaj; Arora, Garima; Qamar, Arman; Bhatt, Deepak L

    2018-02-01

    Randomized controlled trials (RCTs) have shown fractional flow reserve-guided (FFR) multivessel stenting to be superior to infarct-related artery (IRA) only stenting in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease. This effect was mainly driven by a reduction in overall repeat revascularization. However, the ability to assess the effect of this strategy on urgent revascularization or reinfarction was underpowered in individual trials. We searched Pubmed, EMBASE, Cochrane CENTRAL, and Web of Science for RCTs of FFR-guided multivessel stenting versus IRA-only stenting in STEMI with multivessel disease. The outcomes of interest were death, reinfarction, urgent, and non-urgent repeat revascularization. Risk ratios (RR) were pooled using the DerSimonian and Laird random-effects model. After review of 786 citations, 2 RCTs were included. The pooled results demonstrated a significant reduction in the composite of death, reinfarction, or revascularization in the FFR-guided multivessel stenting group versus IRA-only stenting group (RR [95%, Confidence Interval]: 0.49 [0.33-0.72], p<0.001). This risk reduction was driven mainly by a reduction in repeat revascularization, both urgent (0.41 [0.24-0.71], p=0.002) and non-urgent revascularization (0.31 [0.19-0.50], p<0.001). Pooled RR for reinfarction was lower in the FFR-guided strategy, but was not statistically significant (0.71[0.39-1.31], p=0.28). This systematic review and meta-analysis suggests that a strategy of FFR-guided multivessel stenting in STEMI patients reduces not only overall repeat revascularization but also urgent revascularization. The effect on reinfarction needs to be evaluated in larger trials. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.