scholarly journals Using Ultrasonography and Doppler Application for Evaluating Vascular Axes and Prevention of Compartmental Syndrome

2018 ◽  
Vol 3 (4) ◽  
pp. 981-989
Author(s):  
Rubén Algieri ◽  
Juan Fernández ◽  
María Ferrante ◽  
Paulo Paglilla ◽  
Nicolás Ahualli
Keyword(s):  
Evaluation Method ◽  
Early Recognition ◽  
Vascular Lesion ◽  
Vascular Trauma ◽  
Systematic Evaluation ◽  
Peripheral Vascular ◽  
Vascular Tree ◽  
Compartmental Syndrome ◽  
Ultrasound Evaluation ◽  
Patients At Risk

Ultrasonography is with adequate training, a fast and effective evaluation method in emergency departments. Peripheral vascular injury is frequent in trauma and should have a rapid diagnosis andtreatment,asrisksinclude:opensores,bleeding;closedinjuriesandcompartmentalsyndrome. Prompt evaluation of the integrity in the vascular tree becomes important in preventing events that require surgical intervention (repair and / or fasciotomy). The aim of this work is to demonstrate the usefulness of knowledge of peripheral vascular tree, ultrasound evaluation and Doppler for peripheral vascular trauma management, using checklists for the systematic evaluation of the vasculature. Systematic evaluations were realized in 10 general surgery residents. Initially, using inanimate and animate models which were then evaluated in trauma situations. Divided into periods (February / April 2016 – May/August 2016). The findings with previous criteria made the verification list and subsequent connection with the development of compartment syndrome that were established by correlation. Evaluation animated models: 1st assessment: Recognition of structures> 60 % =6 residents. > 80 % =4 residents. The 2nd assessment: Recognition of structures > 60 % = 3 residents. > 80 % = 7 residents. In the care of multiple trauma: recognition structures > 60% =3 residents. >80 % =7 residents. Patients at risk for compartmental syndrome (n=77)=11 (14.78 %). Resolution: Vascular Lesion 1 (1.3 %) compartmental syndrome: 1 (1.3 %) with surgical resolution. The use of ultrasonography and Doppler for peripheral vascular evaluation is useful for early recognition of risk from developing a single vascular lesion, to compartmental syndrome. The use of the checklists during simulation for the generation of criteria is useful in the training of surgical residents.

scholarly journals Pilot Study: Quantitative Photoacoustic Evaluation of Peripheral Vascular Dynamics Induced by Carfilzomib In Vivo

Sensors ◽  
2021 ◽  
Vol 21 (3) ◽  
pp. 836
Author(s):  
Thi Thao Mai ◽  
Manh-Cuong Vo ◽  
Tan-Huy Chu ◽  
Jin Young Kim ◽  
Chulhong Kim ◽  
...  
Keyword(s):  
Pilot Study ◽  
Side Effects ◽  
Cardiovascular Events ◽  
Evaluation Method ◽  
Vascular System ◽  
Maximum Amplitude ◽  
Peripheral Vascular ◽  
Peripheral Vasculature ◽  
Mouse Ear

Carfilzomib is mainly used to treat multiple myeloma. Several side effects have been reported in patients treated with carfilzomib, especially those associated with cardiovascular events, such as hypertension, congestive heart failure, and coronary artery disease. However, the side effects, especially the manifestation of cardiovascular events through capillaries, have not been fully investigated. Here, we performed a pilot experiment to monitor peripheral vascular dynamics in a mouse ear under the effects of carfilzomib using a quantitative photoacoustic vascular evaluation method. Before and after injecting the carfilzomib, bortezomib, and PBS solutions, we acquired high-resolution three-dimensional PAM data of the peripheral vasculature of the mouse ear during each experiment for 10 h. Then, the PAM maximum amplitude projection (MAP) images and five quantitative vascular parameters, i.e., photoacoustic (PA) signal, diameter, density, length fraction, and fractal dimension, were estimated. Quantitative results showed that carfilzomib induces a strong effect on the peripheral vascular system through a significant increase in all vascular parameters up to 50%, especially during the first 30 min after injection. Meanwhile, bortezomib and PBS do not have much impact on the peripheral vascular system. This pilot study verified PAM as a comprehensive method to investigate peripheral vasculature, along with the effects of carfilzomib. Therefore, we expect that PAM may be useful to predict cardiovascular events caused by carfilzomib.

scholarly journals Evaluating process-based integrated assessment models of climate change mitigation

2021 ◽  
Vol 166 (1-2) ◽  
Author(s):  
Charlie Wilson ◽  
Céline Guivarch ◽  
Elmar Kriegler ◽  
Bas van Ruijven ◽  
Detlef P. van Vuuren ◽  
...  
Keyword(s):  
Climate Change ◽  
Integrated Assessment ◽  
Climate Change Mitigation ◽  
Evaluation Method ◽  
Evaluation Research ◽  
Evaluation Framework ◽  
Systematic Evaluation ◽  
Integrated Assessment Models ◽  
Wide Range ◽  
Change Mitigation

AbstractProcess-based integrated assessment models (IAMs) project long-term transformation pathways in energy and land-use systems under what-if assumptions. IAM evaluation is necessary to improve the models’ usefulness as scientific tools applicable in the complex and contested domain of climate change mitigation. We contribute the first comprehensive synthesis of process-based IAM evaluation research, drawing on a wide range of examples across six different evaluation methods including historical simulations, stylised facts, and model diagnostics. For each evaluation method, we identify progress and milestones to date, and draw out lessons learnt as well as challenges remaining. We find that each evaluation method has distinctive strengths, as well as constraints on its application. We use these insights to propose a systematic evaluation framework combining multiple methods to establish the appropriateness, interpretability, credibility, and relevance of process-based IAMs as useful scientific tools for informing climate policy. We also set out a programme of evaluation research to be mainstreamed both within and outside the IAM community.

A Biodegradable Stent Based on Poly(L-Lactide) and Poly(4-Hydroxybutyrate) for Peripheral Vascular Application: Preliminary Experience in the Pig

2007 ◽  
Vol 14 (5) ◽  
pp. 725-733 ◽  
Author(s):  
Carsten Michael Bünger ◽  
Niels Grabow ◽  
Katrin Sternberg ◽  
Martin Goosmann ◽  
Klaus-Peter Schmitz ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Mechanical Stability ◽  
Vascular Trauma ◽  
Metal Stents ◽  
Peripheral Vascular ◽  
Abdominal Incision ◽  
Biodegradable Stent ◽  
Balloon Catheters ◽  
Future Work

Purpose: To assess the technical feasibility and biocompatibility of a novel stent based on poly(L-lactide) (PLLA) and poly(4-hydroxybutyrate) (P4HB) for peripheral vascular applications. Methods: A polytetrafluoroethylene aortobi-iliac graft was implanted in 5 pigs through a midline abdominal incision. After transverse graft limb incision, 5 PLLA/P4HB stents and 5 metal stents (316L stainless steel) were randomly deployed at both iliac anastomotic sites with 6-mm balloon catheters. Angiography was performed to determine patency prior to sacrifice at 6 weeks. Stented segments were surgically explanted and processed for quantitative histomorphometry. Vascular injury and inflammation scores were assigned to the stented iliac segments. Results: No animals were lost during follow-up. All PLLA/P4HB stents were deployed within 2 minutes by balloon inflation to 8 bars without rupture of the stent struts or anastomotic suture. All stents were patent on postprocedural angiography. Histological analysis showed no signs of excessive recoiling or collapse. PLLA/P4HB stents demonstrated decreased residual lumen area and increased neointimal area after 6 weeks (12.27±0.62 and 8.40±1.03 mm2, respectively) compared to 316L stents (13.54±0.84 and 6.90±1.11 mm2, respectively) as the result of differences in stent areas (PLLA/P4HB: 4.31±0.15 mm2; 316L: 2.73±0.29 mm2). Vascular injury scores showed only mild vascular trauma for all stents (PLLA/P4HB: 0.41±0.59; 316L: 0.32±0.47). Inflammatory reaction was slightly higher around PLLA/P4HB stent struts (1.39±0.52) compared to 316L (1.09±0.50). Conclusion: Rapid balloon expansion of PLLA/P4HB stents is feasible without risk of strut rupture. PLLA/P4HB stents provide adequate mechanical stability after iliac anastomotic stenting in pigs. Smaller residual luminal areas in the PLLA/P4HB stents might have been caused by tissue ingrowth into the larger strut interspaces due to higher strut thickness (stent area) in this group. This limitation needs to be addressed in future work on the stent design.

Danger of bacterial translocation for a surgical patient

2021 ◽  
Vol 100 (1) ◽  
Keyword(s):  
Early Recognition ◽  
Ischemia Reperfusion ◽  
Venous Blood ◽  
Intestinal Barrier ◽  
Perioperative Period ◽  
Infectious Complications ◽  
Lymphatic Transport ◽  
Surgical Patient ◽  
Toxic Substances ◽  
Patients At Risk

Intestinal barrier disorder manifestation occurs in connection with surgery in conditions of shock ischemia-reperfusion of the intestine or deterioration of an already damaged barrier due to chronic disease. The result is infectious complications caused by the transport of pathogens through the venous blood, most often postoperative pneumonia and sepsis. However, a more frequent manifestation is the intensification of the postoperative systemic inflammatory response through the lymphatic transport of toxic substances, inanimate antigens and cytokines through the lymphatic system of the splanchnic area (gut-lymph axis). The problem can affect up to half of patients with abdominal surgery. Preventive measures consist of strengthening the intestinal barrier before surgery and alleviating the loss of the intestinal barrier in the perioperative period. In the treatment of infectious complications, an early recognition indication for the therapeutic administration of antibiotics based on preoperative microbial screening of patients at risk may help.

Early determination of clopidogrel responsiveness by platelet reactivity index identifies patients at risk for cardiovascular events after myocardial infarction

2011 ◽  
Vol 106 (07) ◽  
pp. 141-148 ◽  
Author(s):  
Andreas Schäfer ◽  
Ulrike Flierl ◽  
Jürgen Kössler ◽  
Nora Seydelmann ◽  
Anna Kobsar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Platelet Reactivity ◽  
Density Lipoprotein ◽  
Coronary Intervention ◽  
Platelet Inhibition ◽  
Systematic Evaluation ◽  
Reactivity Index ◽  
Operating Characteristics ◽  
Patients At Risk ◽  
Acute Mi

SummaryWhile acute myocardial infarction (MI) is associated with impaired clopidogrel responsiveness, systematic evaluation is lacking due to the inability of functional aggregation-based assays to analyse clopidogrel responsiveness in the presence of glycoprotein IIb/IIIa inhibitors. Using the P2Y12-specific, non-aggregation-based platelet-reactivity-index (PRI) we assessed clopidogrel responsiveness in patients with acute MI. Clopidogrel responsiveness was determined 24 hours (h) after loading with 600 mg clopidogrel in 54 patients with acute MI admitted for coronary intervention. A PRI > 50% was considered as suboptimal inhibition. Overall response in MI patients was suboptimal with a median PRI of 58%. Diabetes, low high-density lipoprotein and pre-hospital clopidogrel loading were associated with impaired clopidogrel responsiveness. Patients loaded at first medical contact had a significantly weaker platelet inhibition by clopidogrel after 24 h (PRI 63%) compared to those loaded peri-interventionally (PRI 54%, p=0.014). Clinical outcome was assessed as a combination of cardiac death, non-fatal MI, stent thrombosis, ischaemic stroke, and urgent target vessel revascularisation after 12 months. The pre-selected cut-off of PRI ≤ 50% yielded a sensitivity of 87% at a specificity of 26%, whereas a PRI ≤ 57% determined by receiver-operating characteristics (ROC)-analysis yielded a sensitivity of 80% at a specificity of 56% (event rate: PRI ≤ 57%: 12.0%; PRI > 57%: 41.4%, p=0.0136). In conclusion, PRI detects clopidogrel responsiveness in acute MI patients requiring glycoprotein IIb/IIIa antagonism; and impaired clopidogrel responsiveness predisposes to clinical events. Pre-hospital clopidogrel loading was associated with impaired response and more adverse events challenging the concept of earliest oral clopidogrel loading in MI patients.

scholarly journals Mathematical modelling of FEV1% allows early recognition of patients at risk

2009 ◽  
Vol 8 ◽  
pp. S58
Author(s):  
F. Gatti ◽  
A. Pugliese ◽  
P. Iansa ◽  
B.M. Assael
Keyword(s):  
At Risk ◽  
Mathematical Modelling ◽  
Early Recognition ◽  
Patients At Risk

scholarly journals An Evaluation Method of Green Development for Chemical Enterprises

2019 ◽  
Vol 11 (22) ◽  
pp. 6491 ◽  
Author(s):  
Yitong Chen ◽  
Shanying Hu ◽  
Dingjiang Chen ◽  
Hongxuan Zhai ◽  
Shutao Bao ◽  
...  
Keyword(s):  
Evaluation Method ◽  
Daily Life ◽  
National Average ◽  
Systematic Evaluation ◽  
Analytic Hierarchy ◽  
Green Development ◽  
Improvement Measures ◽  
Enterprise Groups ◽  
Hierarchy Process ◽  
Comprehensive Indicator

Chemical enterprises in China make important contributions to daily life and the national economy. Since “green development” has been treated as one of the most important developmental strategies in China, scientifically evaluating the level of green development is extremely important for chemical enterprises. In this study, a systematic evaluation method is proposed for chemical enterprises by analytic hierarchy process (AHP). The key to this evaluation method is a new comprehensive indicator, the Green Development Degree (GDD). As an example, Shandong Lubei Enterprise, that has the process of phosphogypsum to sulfuric acid and cement (PSC), is analyzed by GDD. The results show that GDD would increase with the improvement of the PSC process’s green evolution. When compared with the national average level, the GDD of the case enterprise increases from 50 to 133. In addition, experience regarding the green development for chemical enterprises is proposed. This study aims to guide the green development of chemical enterprises, help enterprise groups to assess subsidiary corporations and adjust improvement measures, and achieve the national macro-control of chemical enterprises.

Meningiomas: genetics, malignancy, and the role of radiation in induction and treatment

1994 ◽  
Vol 81 (5) ◽  
pp. 666-675 ◽  
Author(s):  
Charles B. Wilson
Keyword(s):  
San Francisco ◽  
Early Recognition ◽  
Neurological Injury ◽  
High Dose ◽  
Content Type ◽  
Parasellar Region ◽  
Patients At Risk ◽  
Radiation Induced ◽  
Malignant Lesions ◽  
The University

✓ The author reviews the molecular genetics, pathology, and cell kinetics of meningiomas and the role that regional multiplicity in the dura mater may play in their recurrence. Malignant and radiation-induced meningiomas are discussed, with summaries of series of 60 patients with frankly malignant lesions treated over a period of 22 years at the University of California, San Francisco, and of 10 patients with meningiomas induced by high-dose radiation therapy. Reviewing a 23-year series of 140 patients with subtotally removed meningiomas who were treated postoperatively with radiation, the author recommends that, with meticulous technique, irradiation is effective in preventing the regrowth of subtotally removed benign meningiomas and of all malignant meningiomas. Adoption of both the microscopical cytological grading system proposed by Jääskeläinen's group in Helsinki and the classification of operations proposed by Donald Simpson is also recommended. Wide removal of dura adjacent to meningioma reduces the risk of recurrence, and determination of the bromodeoxyuridine labeling index provides a valid basis for planning treatment and follow-up evaluations. Increased awareness is necessary for early recognition of radiation-induced meningiomas in patients at risk for developing such tumors. For meningiomas in such sites as the parasellar region and the posterior fossa, conservative removal of tumor followed by irradiation is advocated in preference to a radical operation that may cause neurological injury without being curative.

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