Occlusion for implant-supported fixed dental prostheses in partially edentulous patients: a literature review and current concepts

PubMed Central

Sukotjo, Cortino

2013-01-01

Implant treatment has become the treatment of choice to replace missing teeth in partially edentulous areas. Dental implants present different biological and biomechanical characteristics than natural teeth. Occlusion is considered to be one of the most important factors contributing to implant success. Most literature on implant occlusal concepts is based on expert opinion, anecdotal experiences, in vitro and animal studies, and only limited clinical research. Furthermore, scientific literature regarding implant occlusion, particularly in implant-supported fixed dental prostheses remains controversial. In this study, the current status of implant occlusion was reviewed and discussed. Further randomized clinical research to investigate the correlation between implant occlusion, the implant success rate, and its risk factors is warranted to determine best clinical practices. PMID:23678387

Percutaneous endovascular therapy for symptomatic chronic total occlusion of the left subclavian artery.

PubMed

Akif Cakar, Mehmet; Tatli, Ersun; Tokatli, Alptug; Kilic, Harun; Gunduz, Huseyin; Akdemir, Ramazan

2018-03-16

Percutaneous endovascular therapy is an accepted and preferred procedure for symptomatic subclavian artery disease. However, the technical feasibility and effectiveness of treating chronic total occlusion of the subclavian artery with this approach is uncertain. We aimed to evaluate the initial and mid-term results of endovascular therapy for patients with symptomatic chronic total occlusion of the left subclavian artery. Consecutive patients who underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery between January 2010 and February 2014 were included. Overall, 16 patients (10 male, 6 female; mean age 56 ± 13 years) underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery - 6 (37.5%) had arm claudication, 8 (50.0%) had vertebrobasilar insufficiency and 2 (12.5%) had coronary steal. 18 balloon-expandable stents were implanted to 15 patients. The central luminal passage was not achieved in one patient because of the subintimal position of guidewire (procedural success rate 93.8%). There were no procedure-related complications. Mean preprocedural and postprocedural systolic blood pressure differences between the upper extremities were 37 ± 13 (range 25-60) mmHg and 11 ± 9 (range 5-38) mmHg, respectively; the improvement was statistically significant. Outpatient follow-up revealed one asymptomatic restenosis at two years. Patency rate at two years was 93.3%. Balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery is safe and effective, with good acute success rate and mid-term patency. Prospective randomised studies on larger patient populations would provide more precise results.

Hemihepatic versus total hepatic inflow occlusion during hepatectomy: a systematic review and meta-analysis.

PubMed

Wang, Hai-Qing; Yang, Jia-Yin; Yan, Lu-Nan

2011-07-14

To evaluate the clinical outcomes of patients undergoing hepatectomy with hemihepatic vascular occlusion (HHO) compared with total hepatic inflow occlusion (THO). Randomized controlled trials (RCTs) comparing hemihepatic vascular occlusion and total hepatic inflow occlusion were included by a systematic literature search. Two authors independently assessed the trials for inclusion and extracted the data. A meta-analysis was conducted to estimate blood loss, transfusion requirement, and liver injury based on the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Either the fixed effects model or random effects model was used. Four RCTs including 338 patients met the predefined inclusion criteria. A total of 167 patients were treated with THO and 171 with HHO. Meta-analysis of AST levels on postoperative day 1 indicated higher levels in the THO group with weighted mean difference (WMD) 342.27; 95% confidence intervals (CI) 217.28-467.26; P = 0.00 001; I(2) = 16%. Meta-analysis showed no significant difference between THO group and HHO group on blood loss, transfusion requirement, mortality, morbidity, operating time, ischemic duration, hospital stay, ALT levels on postoperative day 1, 3 and 7 and AST levels on postoperative day 3 and 7. Hemihepatic vascular occlusion does not offer satisfying benefit to the patients undergoing hepatic resection. However, they have less liver injury after liver resections.

Hemihepatic versus total hepatic inflow occlusion during hepatectomy: A systematic review and meta-analysis

PubMed Central

Wang, Hai-Qing; Yang, Jia-Yin; Yan, Lu-Nan

2011-01-01

AIM: To evaluate the clinical outcomes of patients undergoing hepatectomy with hemihepatic vascular occlusion (HHO) compared with total hepatic inflow occlusion (THO). METHODS: Randomized controlled trials (RCTs) comparing hemihepatic vascular occlusion and total hepatic inflow occlusion were included by a systematic literature search. Two authors independently assessed the trials for inclusion and extracted the data. A meta-analysis was conducted to estimate blood loss, transfusion requirement, and liver injury based on the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Either the fixed effects model or random effects model was used. RESULTS: Four RCTs including 338 patients met the predefined inclusion criteria. A total of 167 patients were treated with THO and 171 with HHO. Meta-analysis of AST levels on postoperative day 1 indicated higher levels in the THO group with weighted mean difference (WMD) 342.27; 95% confidence intervals (CI) 217.28-467.26; P = 0.00 001; I2 = 16%. Meta-analysis showed no significant difference between THO group and HHO group on blood loss, transfusion requirement, mortality, morbidity, operating time, ischemic duration, hospital stay, ALT levels on postoperative day 1, 3 and 7 and AST levels on postoperative day 3 and 7. CONCLUSION: Hemihepatic vascular occlusion does not offer satisfying benefit to the patients undergoing hepatic resection. However, they have less liver injury after liver resections. PMID:21912460

Evaluation of the need for chest X-rays in the management of asymptomatic, intraluminal vascular access device occlusion in childhood cancer.

PubMed

Stammers, David; Connolly, Bairbre; Brandão, Leonardo R; Zupanec, Sue; Gupta, Sumit

2017-07-01

Venous access device (VAD) occlusion from intraluminal thrombus is a common complication during childhood cancer treatment. Current practice at many institutions is to assess VAD position with a chest X-ray (CXR) prior to intraluminal administration of tissue plasminogen activator (tPA). We aimed to determine the utility of this practice. A retrospective chart review of children with newly diagnosed cancer with a VAD, treated at The Hospital for Sick Children between 2010 and 2011, was performed. Episodes of line occlusion were identified both by reviewing patient CXRs for indication and identifying tPA doses dispensed. These episodes were reviewed to determine whether CXR findings resulted in management other than tPA. Cases in which the X-ray resulted in a change in management were further reviewed to determine whether administration of tPA could have resulted in potential patient harm. A total of 330 patients with newly diagnosed cancer with VADs were identified. Eighty-five (25.8%) patients experienced 123 episodes of VAD occlusion. VAD occlusions occurred more frequently in patients with tunneled external central venous lines (16/39, 41.5%) and peripherally inserted central catheters (PICC) (27/73, 37.0%) versus PORT (42/216, 19.4%; P = 0.001). There were nine (8.1%) episodes of VAD occlusion evaluated with a CXR in which the findings led to a change in management other than administering tPA. In each case, multiple specialists independently concluded that administration of tPA would have been unlikely to cause patient harm. Routine CXRs prior to the administration of tPA for asymptomatic VAD occlusion can safely be omitted. © 2016 Wiley Periodicals, Inc.

Impact of the Occlusion Duration on the Performance of J-CTO Score in Predicting Failure of Percutaneous Coronary Intervention for Chronic Total Occlusion.

PubMed

de Castro-Filho, Antonio; Lamas, Edgar Stroppa; Meneguz-Moreno, Rafael A; Staico, Rodolfo; Siqueira, Dimytri; Costa, Ricardo A; Braga, Sergio N; Costa, J Ribamar; Chamié, Daniel; Abizaid, Alexandre

2017-06-01

The present study examined the association between Multicenter CTO Registry in Japan (J-CTO) score in predicting failure of percutaneous coronary intervention (PCI) correlating with the estimated duration of chronic total occlusion (CTO). The J-CTO score does not incorporate estimated duration of the occlusion. This was an observational retrospective study that involved all consecutive procedures performed at a single tertiary-care cardiology center between January 2009 and December 2014. A total of 174 patients, median age 59.5 years (interquartile range [IQR], 53-65 years), undergoing CTO-PCI were included. The median estimated occlusion duration was 7.5 months (IQR, 4.0-12.0 months). The lesions were classified as easy (score = 0), intermediate (score = 1), difficult (score = 2), and very difficult (score ≥3) in 51.1%, 33.9%, 9.2%, and 5.7% of the patients, respectively. Failure rate significantly increased with higher J-CTO score (7.9%, 20.3%, 50.0%, and 70.0% in groups with J-CTO scores of 0, 1, 2, and ≥3, respectively; P<.001). There was no significant difference in success rate according to estimated duration of occlusion (P=.63). Indeed, J-CTO score predicted failure of CTO-PCI independently of the estimated occlusion duration (P=.24). Areas under receiver-operating characteristic curves were computed and it was observed that for each occlusion time period, the discriminatory capacity of the J-CTO score in predicting CTO-PCI failure was good, with a C-statistic >0.70. The estimated duration of occlusion had no influence on the J-CTO score performance in predicting failure of PCI in CTO lesions. The probability of failure was mainly determined by grade of lesion complexity.

Combined transpedal and transradial approach for treatment of iliac artery chronic total occlusion.

PubMed

Auguste, Uschi; Rosero, Hugo; Bertrand, Olivier F; Kwan, Tak W

2015-09-01

We present a case of a patient with total chronic occlusion of the right common iliac artery that underwent percutaneous stenting with combined transpedal and transradial approaches. With this novel strategy, femoral access can be avoided. Published by Elsevier Inc.

Successful revascularization of chronic total occlusion of lower extremity arteries: a wire only and bail out use of re-entry device approach.

PubMed

Langhoff, R; Stumpe, S; Treitl, M; Schulte, K L

2013-10-01

The management of progressive peripheral artery disease experienced a vast change in paradigms over the last decades for the benefit of minimal invasive therapy as a first-line strategy. With the constant development of new devices, materials and dedicated access strategies, more complex lesions can be managed but the limitations to successfully treat chronic total occlusions are still the challenge to re-enter the true lumen. The aim of this retrospective study was to investigate, if a "wire only" strategy leads to an acceptable success rate in a mixed cohort of CTO lesions and to what extend re-entry devices are used. We retrospectively analyzed patients treated at the Vascular Center Berlin between 2011 and 2013 with chronic total occlusion out of a prospective conducted database (Endovascular MILestones - EMIL) for demographics, risk factors, co-morbidities, technical success rates, lesion characteristics and use of guidewires as well as re-entry systems. A total of 128 patients with 146 lesions, which represent a subgroup of all the cases performed in our center, following a predefined treatment algorithm for chronic total occlusions (CTOs), have been analyzed. We achieved a technical success in 133 (91.1%) of all cases following a "wire only" strategy. Out of 13 (8.9%) CTOs with technical failure in 7 (53.9%) CTOs a re-entry device (Off-Road®) with a 100% technical success has been used. In 91.1% of chronic total occlusion lesions the use of 2 wires only (88.7%) led to a successful recanalization. A "wire only" strategy followed by the use of a re-entry device as a bail out strategy, led to a total of 140 (96%) lesions to be successfully recanalized. In more than 90% of all cases with chronic total occlusion of peripheral lower extremity arteries, endovascular intervention has been successful following a "wire only" strategy. When deciding to use a re-entry device, in case of a failure of a proper wire re-entry at the reconstitution point, a technical success rate of 100% was achieved. Therefore following a strict wire algorithm and considering the use of a re-entry system as a bail out strategy will lead to a successful minimal invasive management of chronic total occlusion in nearly 100% of the cases with TASC II A - D lesions.

Selective Hemihepatic Vascular Occlusion Versus Pringle Maneuver in Hepatectomy for Primary Liver Cancer.

PubMed

Li, Minghao; Zhang, Tao; Wang, Liyun; Li, Baoding; Ding, Yang; Zhang, Chunyan; He, Saiwu; Yang, Zhiqi

2017-05-09

BACKGROUND This study was conducted to compare the clinical effects of two techniques used for inflow occlusion during hepatectomy (selective hemihepatic vascular occlusion vs. Pringle maneuver) for the treatment of primary liver cancer. MATERIAL AND METHODS A total of 63 patients with primary hepatocellular carcinoma who underwent hepatectomy during June 2006 and June 2011 were included in this retrospective study. A total of 26 patients in group A accepted selective hemihepatic vascular occlusion, and 37 patients in group B underwent the Pringle maneuver during hepatectomy. The intraoperative conditions, postoperative liver function recovery, and complication rates were compared between these two groups. RESULTS There were no significant differences in intraoperative blood loss, blood transfusion, occlusion time, and postoperative complication rates between group A and group B (P>0.05). However, postoperative serum levels of alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), and albumin (ALB) in group A were significantly lower than those in group B (P<0.05). Moreover, there were noteworthy differences in peripheral artery pressure and sphygmus (P<0.05). CONCLUSIONS During hepatectomy, selective hemihepatic vascular occlusion benefits the patients with primary hepatocellular carcinoma by reducing the hepatic damage and improving postoperative hepatic function recovery, compared with the Pringle maneuver.

Chronic total occlusion successfully treated with a bioresorbable everolimus-eluting vascular scaffold

PubMed Central

Mattesini, Alessio; Dall'Ara, Gianni; Mario, Carlo Di

2014-01-01

Fully bioresorbable vascular scaffolds (BVS) are a new approach to the percutaneous treatment of coronary artery disease. The BVS have not yet been fully tested in complex lesions, including chronic total occlusion (CTO). We report a CTO case successfully treated with a second-generation bioabsorbable drug-eluting scaffold. PMID:25061461

The Effect of Molar Axial Wall Height on CAD/CAM Ceramic Crowns With Moderate Occlusal Convergence

DTIC Science & Technology

2006-05-01

CEREC e.max* CAD crowns on preparations with moderate total occlusal convergence (16 degrees). Methods: 60 recently-extracted maxillary third molars ...The Effect of Molar Axial Wall Height on CAD/CAM Ceramic Crowns With Moderate Occlusal Convergence Wyeth L. Hoopes The Effect of Molar Axial Wall... Molar Axial Wall Height on CAD/CAM Ceramic Crowns With Moderate Occlusal Convergence is appropria tely acknowledged and beyond brief excerpts, is with

Systematic assessment of the various controversies, difficulties, and current trends in the reestablishment of lost occlusal planes in edentulous patients.

PubMed

Sahoo, S; Singh, D; Raghav, D; Singh, G; Sarin, A; Kumar, P

2014-05-01

Accurate occlusal plane orientation is an essential factor in the fabrication of complete denture prosthesis. Over the years, it has received a number of methodologies by several researchers utilizing various anatomical landmarks however none of them is considered as perfect that could orient ideal occlusal plane. The presented literature review is an attempt to enlighten historical perspectives, pioneer researches, different controversies, difficulties and current trends for re-establishment of lost occlusal plane in edentulous patients. An extensive literature search was performed using Medline/PubMed interface and other scholarly research bibliographic databases using Medical Subject Headings. Studies describing research studies, case series and assorted clinical reports were retrieved and evaluated from 1963 to 2013. Most of the studies have suggest and evidence to consider Camper's plane for artificial orientation of occlusal plane however there is a substantial lack of genuine long term studies and authentic data that could recommend a single reliable landmark for perfect occlusal plane reorientation in a variety of cases.

Feasibility and Safety of Distal and Proximal Combined Endovascular Approach with a Balloon-Guiding Catheter for Subclavian Artery Total Occlusion.

PubMed

Yamamoto, Taiki; Ohshima, Tomotaka; Ishikawa, Kojiro; Goto, Shunsaku; Tamari, Yosuke

2017-04-01

Symptomatic subclavian artery total occlusion is widely treated with an endovascular procedure that often results in distal vertebral artery embolism. Therefore, protection devices are important. Establishing a filter or balloon device in the vertebral artery can protect against this distal embolism. However, the use of embolic protection devices is not easy, and it makes the procedure more complicated. Here, we report a case of symptomatic subclavian artery total occlusion that was treated successfully with a balloon-guiding catheter and the pull-through technique. A 67-year-old man developed intermittent motor weakness in his left arm. Aortic angiography demonstrated a complete occlusion of the left proximal subclavian artery and a retrograde flow through the left vertebral artery to the distal brachial artery. In this case, we used a balloon-guiding catheter and the pull-through technique to prevent distal embolism. The balloon-guiding system was useful not only for embolic protection but also for scaffold during excavation and for the centering effect against invisible vessels. The pull-through technique enabled our devices to deliver easily and smoothly. The patient was treated successfully without complications. The distal and proximal combined endovascular treatment with a transbrachial balloon-guiding catheter is a beneficial treatment option for patients with subclavian artery total occlusion. Copyright © 2017 Elsevier Inc. All rights reserved.

Advances in Retrograde Technique for Coronary Chronic Total Occlusions

PubMed Central

DeMartini, Tony J.

2014-01-01

Despite a short lag period since its development the retrograde approach has been increasingly integrated within the treatment strategies for the percutaneous treatment of coronary chronic total occlusions. This review article discuss which anatomical features argue most powerfully for its use, the specific skills required for its uptake and the technology which has facilitated these developments. PMID:25311005

Combining technologies: a computerized occlusal analysis system synchronized with a computerized electromyography system.

PubMed

Kerstein, Robert B

2004-04-01

Current advances in computer technologies have afforded dentists precision ways to examine occlusal contacts and muscle function. Recently, two separate computer technologies have been synchronized together, so that an operator can record their separate diagnostic data simultaneously. The two systems are: the T Scan II Occlusal Analysis System and the Biopak Electromyography Recording System. The simultaneous recording and playback capacity of these two computer systems allows the operator to analyze and correlate specific occlusal moments to specific electromyographic changes that result from these occlusal moments. This synchronization provides unparalleled evidence of the effect occlusal contact arrangement has on muscle function. Therefore, the occlusal condition of an inserted dental prosthesis or the occlusal scheme of the natural teeth (before and after corrective occlusal adjustments) can be readily evaluated, documented, and quantified for both, quality of occlusal parameters and muscle activity and the responses to the quality of the occlusal condition. This article describes their synchronization and illustrates their use in performing precision occlusal adjustment procedures on two patients: one who demonstrates occlusal disharmony while exhibiting the signs and symptoms of chronic myofascial pain dysfunction syndrome, and the other who had extensive restorative work accomplished but exhibits occlusal discomfort post-operatively.

Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale.

PubMed

Kim, Yongsik; Oh, Tae-Ju; Misch, Carl E; Wang, Hom-Lay

2005-02-01

Due to lack of the periodontal ligament, osseointegrated implants, unlike natural teeth, react biomechanically in a different fashion to occlusal force. It is therefore believed that dental implants may be more prone to occlusal overloading, which is often regarded as one of the potential causes for peri-implant bone loss and failure of the implant/implant prosthesis. Overloading factors that may negatively influence on implant longevity include large cantilevers, parafunctions, improper occlusal designs, and premature contacts. Hence, it is important to control implant occlusion within physiologic limit and thus provide optimal implant load to ensure a long-term implant success. The purposes of this paper are to discuss the importance of implant occlusion for implant longevity and to provide clinical guidelines of optimal implant occlusion and possible solutions managing complications related to implant occlusion. It must be emphasized that currently there is no evidence-based, implant-specific concept of occlusion. Future studies in this area are needed to clarify the relationship between occlusion and implant success.

Treatment of Ruptured Vertebral Artery Dissecting Aneurysms Distal to the Posterior Inferior Cerebellar Artery: Stenting or Trapping?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fang, Yi-Bin, E-mail: fangyibin@163.com; Zhao, Kai-Jun, E-mail: zkjwcfzwh@163.com; Wu, Yi-Na, E-mail: wuyina0923@163.com

2015-06-15

PurposeThe treatment of ruptured vertebral artery dissecting aneurysms (VADAs) continues to be controversial. Our goal was to evaluate the safety, efficacy, and long-term outcomes of internal trapping and stent-assisted coiling (SAC) for ruptured VADAs distal to the posterior inferior cerebellar artery (supra-PICA VADAs), which is the most common subset.MethodsA retrospective review was conducted of 39 consecutive ruptured supra-PICA VADAs treated with internal trapping (n = 20) or with SAC (n = 19) at our institution. The clinical and angiographic data were retrospectively compared.ResultsThe immediate total occlusion rate of the VADAs was 80 % in the trapping group, which improved to 88.9 % at the follow-ups (45 monthsmore » on average). Unwanted occlusions of the posterior inferior cerebellar artery (PICA) were detected in three trapped cases. Incomplete obliteration of the VADA or unwanted occlusions of the PICA were detected primarily in the VADAs closest to the PICA. In the stenting group, the immediate total occlusion rate was 47.4 %, which improved to 100 % at the follow-ups (39 months on average). The immediate total occlusion rate of the VADAs was higher in the trapping group (p < 0.05), but the later total occlusion was slightly higher in the stenting group (p > 0.05).ConclusionsOur preliminary results showed that internal trapping and stent-assisted coiling are both technically feasible for treating ruptured supra-PICA VADAs. Although not statistically significant, procedural related complications occurred more frequently in the trapping group. When the VADAs are close to the PICA, we suggest that the lesions should be treated using SAC.« less

Chronic total occlusion in ostium of right coronary artery – retrograde approach as the first-choice method of revascularization?

PubMed Central

Kameczura, Tomasz; Surowiec, Sławomir; Januś, Bogdan; Derlaga, Bogusław; Dudek, Dariusz; Czarnecka, Danuta

2013-01-01

Recanalization of chronic total occlusion (CTO) located in the ostium may require the operator's ability to use the retrograde approach. We present a case of opening a chronically occluded right coronary artery (RCA) by the retrograde approach after an unsuccessful attempt of recanalization by classic antegrade technique. PMID:24570749

Systematic Assessment of the Various Controversies, Difficulties, and Current Trends in the Reestablishment of Lost Occlusal Planes in Edentulous Patients

PubMed Central

Sahoo, S; Singh, D; Raghav, D; Singh, G; Sarin, A; Kumar, P

2014-01-01

Accurate occlusal plane orientation is an essential factor in the fabrication of complete denture prosthesis. Over the years, it has received a number of methodologies by several researchers utilizing various anatomical landmarks however none of them is considered as perfect that could orient ideal occlusal plane. The presented literature review is an attempt to enlighten historical perspectives, pioneer researches, different controversies, difficulties and current trends for re-establishment of lost occlusal plane in edentulous patients. An extensive literature search was performed using Medline/PubMed interface and other scholarly research bibliographic databases using Medical Subject Headings. Studies describing research studies, case series and assorted clinical reports were retrieved and evaluated from 1963 to 2013. Most of the studies have suggest and evidence to consider Camper's plane for artificial orientation of occlusal plane however there is a substantial lack of genuine long term studies and authentic data that could recommend a single reliable landmark for perfect occlusal plane reorientation in a variety of cases. PMID:24971200

The BridgePoint devices to facilitate recanalization of chronic total coronary occlusions through controlled subintimal reentry.

PubMed

Werner, Gerald S

2011-01-01

In view of the improved long-term patency with drug-eluting stents, the challenge with chronic total coronary occlusion remains a low primary success rate. Modes of failure to open a chronic total coronary occlusion are mainly related to the inability to pass a wire through the proximal occlusion cap, and the most difficult part of the procedure is to guide the wire into the distal true lumen. A frequent situation is a subintimal wire position. The BridgePoint (BridgePoint Medical, MN, USA) family of devices is designed to cope with both of these problems. First, the CrossBoss™ catheter aims at passing through the proximal cap by manual rotation of a blunt proximal tip, and second, in case of a subintimal position, the Stingray™ balloon enables guided reentry from the subintimal space into the true lumen. Certain features of an occlusion might favor the CrossBoss device, while the reentry approach may also be used as a standalone bailout method. The aim is to provide a means to resolve otherwise failed attempts and to make it unnecessary to resort to the more complex and time-consuming retrograde wire techniques through collateral channels with the associated potential higher procedural risks.

Endovascular Treatment of Totally Occluded Superior Mesenteric Artery by Retrograde Crossing via the Villemin Arcade

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ferro, Carlo; Rossi, Umberto G., E-mail: urossi76@hotmail.com; Seitun, Sara

2013-06-15

Chronic mesenteric ischemia (CMI) is a rare disorder that is commonly caused by progressive atherosclerotic stenosis or occlusion of one or more mesenteric arteries. Endovascular treatment for symptomatic CMI represents a viable option, especially in high-operative risk patients. We report a case of acute symptomatic CMI with chronic totally occlusion of the superior mesenteric artery (SMA) associated with significant stenosis of celiac trunk (CT) and inferior mesenteric artery (IMA) that underwent endovascular treatment of all the three mesenteric arteries: stenting of CT and IMA stenosis, and recanalization of the SMA occlusion by retrograde crossing via the Villemin arcade.

Psychosocial distress of part-time occlusion in children with intermittent exotropia.

PubMed

Kim, Ungsoo Samuel; Park, Subin; Yoo, Hee Jeong; Hwang, Jeong-Min

2013-01-01

To evaluate the psychosocial distress of part-time occlusion therapy in intermittent exotropia. A total of 25 children (15 males and 10 females, aged 3 to 7 years, mean age 4.7 years) with intermittent exotropia were enrolled. Behavioral and psychosocial problems were assessed by the Korean Child Behavior Checklist (K-CBCL), which consists of eight categories of withdrawal, somatic problems, depression/anxiety, social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior, and the Amblyopia Treatment Index (ATI). The ATI was designed to evaluate the three factors of compliance, adverse effect, and social stigma. The Parenting Stress Index (PSI) is a parent self-report designed to identify potentially dysfunctional parent-child systems. The K-CBCL was obtained before and after occlusion therapy, and the ATI and PSI were taken from parents only after occlusion therapy. We evaluated the change on the K-CBCL and the correlation between the K-CBCL and ATI. The attention problem assessed by the K-CBCL significantly decreased after occlusion therapy. On the ATI, the social stigma was relatively lower than compliance and adverse effect factors (Likert scale 2.64, 3.11, and 3.11, respectively). The somatic problem assessed by the K-CBCL and compliance on the ATI were significantly correlated (p = 0.014). There was no significant change in percentile scores of each subscale (parental dominant scale and child dominant scale) of the PSI. Total stress index before and after occlusion therapy was 97.16 ± 8.38 and 97.00 ± 8.16 respectively (p = 0.382). Occlusion therapy may influence the psychosocial impact on intermittent exotropia patients. Part-time occlusion significantly decreased the attention problem in children with intermittent strabismus. Children with a high somatic problem score on the KCBCL showed poor compliance to the part-time occlusion.

Comparison of transfemoral vs transbrachial approach for angioplastic reconstruction of chronic total aortoiliac occlusion.

PubMed

Damera, Sheshagiri Rao; Barik, Ramachandra; Prasad, Akula Siva

2016-09-01

The angioplasty of chronic total aortoiliac occlusion using transfemoral is controversial. From March 2014 to December 2015, four consecutive patients (4 males; mean age 58.2±6.8 years; age of range 51-65 years) underwent angioplasty and stenting of TASC-D occlusion. In all the cases, we failed to cross from femoral approach. On switching over to left brachial access, angioplasty was done successfully in all. There was no procedural site complication or clinical evidence cerebral thromboembolism. Self-expandable stents were implanted in all with adequate pre and post dilation. Complete revascularisation was achieved in two cases and in other two cases, the angioplasty to the left aortoiliac carina was staged. Therefore, it is better to avoid femoral approach as initial step to cross chronic TASC 2007 type D (chronic total aortoiliac occlusion or called extensive aortoiliac disease) because of failure to cross retrogradely due to subintimal course of guide wire leading to retrograde aortic dissection. Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Recent advances in managing vascular occlusions in the cardiac catheterization laboratory

PubMed Central

Qureshi, Athar M.; Mullins, Charles E.; Latson, Larry A.

2018-01-01

Vascular occlusions continue to be a significant cause of morbidity and mortality. The management of vascular occlusions in patients is complex, requiring specialized expertise in the cardiac catheterization laboratory and from other disciplines. Knowledge of currently available tools at the operator’s disposal is important to optimize the success of these procedures. In this review, we discuss some of the recent advances in recanalization procedures of vascular occlusions and thrombotic lesions in the cardiac catheterization laboratory. PMID:29770200

Retinal vein occlusion: pathophysiology and treatment options.

PubMed

Karia, Niral

2010-07-30

This paper reviews the current thinking about retinal vein occlusion. It gives an overview of its pathophysiology and discusses the evidence behind the various established and emerging treatment paradigms.

Impact of diabetes mellitus on acute outcomes of percutaneous coronary intervention in chronic total occlusions: insights from a US multicentre registry.

PubMed

Martinez-Parachini, J R; Karatasakis, A; Karmpaliotis, D; Alaswad, K; Jaffer, F A; Yeh, R W; Patel, M; Bahadorani, J; Doing, A; Nguyen-Trong, P-K; Danek, B A; Karacsonyi, J; Alame, A; Rangan, B V; Thompson, C A; Banerjee, S; Brilakis, E S

2017-04-01

To examine the impact of diabetes mellitus on procedural outcomes of patients who underwent percutaneous coronary intervention for chronic total occlusion. We assessed the impact of diabetes mellitus on the outcomes of percutaneous coronary intervention for chronic total occlusion among 1308 people who underwent such procedures at 11 US centres between 2012 and 2015. The participants' mean ± sd age was 66 ± 10 years, 84% of the participants were men and 44.6% had diabetes. As compared with participants without diabetes, participants with diabetes were more likely to have undergone coronary artery bypass graft surgery (38 vs 31%; P = 0.006), and to have had previous heart failure (35 vs 22%; P = 0.0001) and peripheral arterial disease (19 vs 13%; P = 0.002). They also had a higher BMI (31 ± 6 kg/m 2 vs 29 ± 6 kg/m 2 ; P = 0.001), similar Japanese chronic total occlusion scores (2.6 ± 1.2 vs 2.5 ± 1.2; P = 0.82) and similar final successful crossing technique: antegrade wire escalation (46 vs 47%; P = 0.66), retrograde (30 vs 28%; P = 0.66) and antegrade dissection re-entry (24 vs 25%; P = 0.66). Technical (91 vs 90%; P = 0.80) and procedural (89 vs 89%; P = 0.93) success was similar in the two groups, as was the incidence of major adverse cardiac events (2.2 vs 2.5%; P = 0.61). In a contemporary cohort of people undergoing percutaneous coronary intervention for chronic total occlusion, nearly one in two (45%) had diabetes mellitus. Procedural success and complication rates were similar in people with and without diabetes. © 2016 Diabetes UK.

Coronary Intervention for Persistent Occlusion after Myocardial Infarction

PubMed Central

Hochman, Judith S.; Lamas, Gervasio A.; Buller, Christopher E.; Dzavik, Vladimir; Reynolds, Harmony R.; Abramsky, Staci J.; Forman, Sandra; Ruzyllo, Witold; Maggioni, Aldo P.; White, Harvey; Sadowski, Zygmunt; Carvalho, Antonio C.; Rankin, Jamie M.; Renkin, Jean P.; Steg, P. Gabriel; Mascette, Alice M.; Sopko, George; Pfisterer, Matthias E.; Leor, Jonathan; Fridrich, Viliam; Mark, Daniel B.; Knatterud, Genell L.

2007-01-01

BACKGROUND It is unclear whether stable, high-risk patients with persistent total occlusion of the infarct-related coronary artery identified after the currently accepted period for myocardial salvage has passed should undergo percutaneous coronary intervention (PCI) in addition to receiving optimal medical therapy to reduce the risk of subsequent events. METHODS We conducted a randomized study involving 2166 stable patients who had total occlusion of the infarct-related artery 3 to 28 days after myocardial infarction and who met a high-risk criterion (an ejection fraction of <50% or proximal occlusion). Of these patients, 1082 were assigned to routine PCI and stenting with optimal medical therapy, and 1084 were assigned to optimal medical therapy alone. The primary end point was a composite of death, myocardial reinfarction, or New York Heart Association (NYHA) class IV heart failure. RESULTS The 4-year cumulative primary event rate was 17.2% in the PCI group and 15.6% in the medical therapy group (hazard ratio for death, reinfarction, or heart failure in the PCI group as compared with the medical therapy group, 1.16; 95% confidence interval [CI], 0.92 to 1.45; P = 0.20). Rates of myocardial reinfarction (fatal and nonfatal) were 7.0% and 5.3% in the two groups, respectively (hazard ratio, 1.36; 95% CI, 0.92 to 2.00; P = 0.13). Rates of nonfatal reinfarction were 6.9% and 5.0%, respectively (hazard ratio, 1.44; 95% CI, 0.96 to 2.16; P = 0.08); only six reinfarctions (0.6%) were related to assigned PCI procedures. Rates of NYHA class IV heart failure (4.4% vs. 4.5%) and death (9.1% vs. 9.4%) were similar. There was no interaction between treatment effect and any subgroup variable (age, sex, race or ethnic group, infarct-related artery, ejection fraction, diabetes, Killip class, and the time from myocardial infarction to randomization). CONCLUSIONS PCI did not reduce the occurrence of death, reinfarction, or heart failure, and there was a trend toward excess reinfarction during 4 years of follow-up in stable patients with occlusion of the infarct-related artery 3 to 28 days after myocardial infarction. (ClinicalTrials.gov number, NCT00004562.) PMID:17105759

Retinal vein occlusion: pathophysiology and treatment options

PubMed Central

Karia, Niral

2010-01-01

This paper reviews the current thinking about retinal vein occlusion. It gives an overview of its pathophysiology and discusses the evidence behind the various established and emerging treatment paradigms. PMID:20689798

Management of Infrapopliteal Arterial Disease: Critical Limb Ischemia.

PubMed

Mustapha, Jihad A; Diaz-Sandoval, Larry J

2014-10-01

According to the TransAtlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease, "there is increasing evidence to support a recommendation for angioplasty in patients with critical limb ischemia and infrapopliteal artery occlusion." Management of infrapopliteal artery disease starts with diagnosis using modern preprocedural noninvasive and invasive imaging. Interventionalists need to learn the role of chronic total occlusion cap analysis and collateral zone recognition in angiosome-directed interventions for management of critical limb ischemia and be familiar with equipment and device selection and a stepwise approach for endovascular interventions. Interventionalists need to know which crossing tools to use to successfully cross-complex chronic total occlusion caps. Copyright © 2014 Elsevier Inc. All rights reserved.

A prospective randomized comparison of continuous hemihepatic with intermittent total hepatic inflow occlusion in hepatectomy for liver tumors.

PubMed

Liang, Guanlin; Wen, Tianfu; Yan, Lunan; Li, B O; Wu, Guochang; Yang, Jian; Lu, Bo; Chen, Zheyu; Liao, Zhixue; Ran, Shun; Yu, Zhang

2009-01-01

To evaluate whether continuous hemihepatic inflow occlusion (HHO) during hepatectomy can be safer than and be as effective as intermittent total hepatic inflow occlusion (THO) in reducing blood loss. Eighty patients undergoing liver resections were included in a prospective randomized study comparing the intra- and postoperative course under THO (n=40) or HHO (n=40). THO was performed with periods of 20 minutes of occlusion and 5 minutes of releasing, while HHO was performed with continuous occlusion. The surface area of liver transection, amount of blood loss, measurements of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and postoperative evolution were recorded. The two groups were similar at entry in terms of preoperative liver function and in the proportion of patients experiencing major hepatectomy. The total ischemic time of the two groups was similar (p=0.37), but the operative time in the THO group was longer than in the HHO group (p=0.02). No significant difference was found between the HHO and THO group in blood loss during liver parenchyma transection (p=0.14), the elevations of ALT and AST on the first postoperative day (ALT: p=0.12; AST: p=0.66) and postoperative morbidity (p=0.35). On the basis of our findings, if it is feasible, continuous HHO is recommended for complex liver resection.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ozkan, Ugur, E-mail: radugur@yahoo.com; Oguzkurt, Levent, E-mail: loguzkurt@yahoo.com; Tercan, Fahri, E-mail: ftercan@yahoo.com

The aim of this study was to report our experience in endovascular treatment of total aortoiliac occlusion. Five patients who underwent endovascular recanalization procedures including manual aspiration thrombectomy, balloon angioplasty, and stent placement for total aortoiliac occlusion in a 4-year period were reviewed retrospectively. The mean age of patients was 51 years (range, 43 to 58 years). All patients had abdominal aorta and bilateral common iliac artery occlusion with or without external iliac artery occlusion. All patients either had a contraindication to surgery or refused it. Initial technical success was obtained in four of five (80%) patients. Endovascular techniques weremore » successful in four patients who had good distal runoff and short-segment aortoiliac occlusion, but failed in a patient who had the worst distal runoff and long-segment aortoiliac occlusion. We observed two major complications, one of which was bilateral rupture of the common iliac arteries treated with covered stent placement. Another patient had extension of intra-aortic thrombus into the iliac stent after primary stenting. This was successfully treated with manual aspiration thrombectomy. Aortic and iliac stents remained patent during the follow-up period (median, 18 months; range, 3 to 26 months) in four patients. Primary patency rates at 6, 12, and 24 months were all 80%. In conclusion, endovascular treatment can be an alternative for aortoiliac occlusion in selected patients. Short- to midterm follow-up so far is satisfactory. Removal of intra-aortic thrombus with manual aspiration thrombectomy before balloon angioplasty and/or stenting is possible and a good alternative to thrombolysis.« less

Influence of oxidative stress on the development of collateral circulation in total coronary occlusions.

PubMed

Demirbag, Recep; Gur, Mustafa; Yilmaz, Remzi; Kunt, Alper Sami; Erel, Ozcan; Andac, M Halit

2007-03-02

The purpose of this study was to investigate whether the levels of total antioxidant capacity (TAC), total peroxide and oxidative stress index (OSI) are associated with the development of collaterals in total coronary occlusions. Our study group contained 176 consecutive men patients with single-vessel TCO, 94 of whom had poorly developed coronary collateral, while 82 had well-developed coronary collateral. TAC and total peroxide concentration were measured of plasma. The ratio of TAC to total peroxide was accepted as an indicator of oxidative stress. The values of total peroxide and OSI in the Group I were significantly lower than that in Group II (p<0.001, for both). TAC levels were significantly higher in patients with poorly developed collaterals than in well-developed collateral group (p<0.001). OSI values were also significantly different among the Rentrop class-0, -1, -2 and -3 (ANOVA p<0.001). We found significant correlations between collaterals score and TAC, total peroxide and OSI levels (p<0.001 for all). In multiple linear regression analysis, total peroxide and OSI were independent predictors of collaterals score (p=0.006 and p<0.001 respectively). This study clearly demonstrates that the level of OSI is independently and positively associated with the presence of collateral circulation in total coronary occlusion patients.

Investigation of membranous ventricular septal defect complicated with tricuspid regurgitation in ventricular septal defect occlusion

PubMed Central

LIU, SHU-PING; LI, LI; YAO, KE-CHUN; WANG, NA; WANG, JIAN-CHANG

2013-01-01

This study aimed to explore the mechanism of membranous ventricular septal defect complicated with tricuspid regurgitation and the significance of ventricular septal defect occlusion by echocardiography. A total of 43 patients with membranous ventricular septal defect complicated with tricuspid regurgitation were observed by echocardiography and the changes in length, area and volume of tricuspid regurgitation prior to and following ventricular septal defect occlusion were measured. There were four different mechanisms of membranous ventricular septal defect complicated with tricuspid regurgitation. The various indices of tricuspid regurgitation volume were significantly reduced following occlusion. Ventricular septal defect occlusion significantly reduces tricuspid regurgitation volume complicated with membranous ventricular septal defect and echocardiography is an ideal method to detect these changes. PMID:23404058

Total venous inflow occlusion and pericardial auto-graft reconstruction for right atrial hemangiosarcoma resection in a dog.

PubMed

Verbeke, Fei; Binst, Dominique; Stegen, Ludo; Waelbers, Tim; de Rooster, Hilde; Van Goethem, Bart

2012-10-01

A sizeable right atrial hemangiosarcoma in a 6-year-old Bordeaux dog, World Health Organization (WHO) stage 2, was excised using total venous inflow occlusion. The defect was restored with a non-vascularized pericardial auto-graft. The dog had a disease-free interval of 7 mo. The dog was euthanized 9 months later, at which time there were distant metastases but no indication of local recurrence.

Minimum Error Bounded Efficient L1 Tracker with Occlusion Detection (PREPRINT)

DTIC Science & Technology

2011-01-01

Minimum Error Bounded Efficient `1 Tracker with Occlusion Detection Xue Mei\\ ∗ Haibin Ling† Yi Wu†[ Erik Blasch‡ Li Bai] \\Assembly Test Technology...proposed BPR-L1 tracker is tested on several challenging benchmark sequences involving chal- lenges such as occlusion and illumination changes. In all...point method de - pends on the value of the regularization parameter λ. In the experiments, we found that the total number of PCG is a few hundred. The

Intracranial vascular stenosis and occlusion: Diagnostic accuracy of three-dimensional, fourier transform, time-of-flight MR angiography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Korogi, Yukunori; Takahashi, Mutsumasa; Mabuchi, Nobuhisa

1994-10-01

To assess the accuracy of three-dimensional, Fourier transform, time-of-flight magnetic resonance (MR) angiography in the detection of intracranial steno-occlusive diseases. One hundred thirty-one patients (62 male and 69 female patients, aged 6-77 years [mean, 53 years 8 months]) underwent MR and conventional angiography for evaluation of possible intracranial vascular disease. A total of 502 arteries were assessed. Eight projections and a collapsed image postprocessed by means of a maximum-intensity projection algorithm were reviewed by five observers in a blinded manner, with conventional angiography as the standard. A total of 32 steno-occlusive lesions were available for review. Receiver operating characteristic analysismore » from the pooled data revealed overall sensitivities of 85% and 88% and specificities of 96% and 97% for the internal carotid artery and the middle cerebral artery, respectively. MR angiography is useful as the primary diagnostic tool for evaluating suspected intracranial steno-occlusive disease. 22 refs., 7 figs., 5 tabs.« less

The critical role of the external carotid artery in cerebral perfusion of patients with total occlusion of the internal carotid artery.

PubMed

Dalainas, I; Avgerinos, E D; Daskalopoulos, M E; Papapetrou, A; Papasideris, C P; Katsikas, V; Xiromeritis, K; Moulakakis, K; Gianakopoulos, T; Liapis, C D

2012-02-01

The ipsilateral external carotid artery (ECA) can potentially provide an important collateral pathway for cerebral blood flow in the presence of occlusion or severe stenosis of the internal carotid artery (ICA), recovering up to 15% of the middle cerebral arterial flow. The aim of the study is to elucidate the role of ECA in cerebral flow of patients with total ICA occlusion. Retrospective study of prospectively collected data of 139 patients with total ICA occlusions. The patients were divided to symptomatic and asymptomatic and were categorized in four subgroups according to the stenosis rates: A) ipsilateral ECA<70% and contralateral internal carotid artery stenosis <70%; B) ipsilateral ECA stenosis <70% and contralateral internal carotid artery stenosis ≥70%; C) ipsilateral ECA stenosis ≥70% and contralateral ICA stenosis <70%; D) ipsilateral ECA stenosis ≥70% and contralateral ICA stenosis ≥75%. Fifty eight (41.7%) patients were asymptomatic. The highest rate (48.2%) of asymptomatic patients was in Group A. Among patients with strokes, the highest rate belonged in groups C and D (44.4% and 50% respectively) where ipsilateral ECA stenosis was ≥70% irrespectively of the contralateral ICA patency. Ipsilateral external carotid artery stenosis ≥70% proved to be and independent risk factor for symptom presentation (P=0.013). The study reveals the significant role of ECA patency in cerebral flow in patients with ICA occlusion.

Total venous inflow occlusion and pericardial auto-graft reconstruction for right atrial hemangiosarcoma resection in a dog

PubMed Central

Verbeke, Fei; Binst, Dominique; Stegen, Ludo; Waelbers, Tim; de Rooster, Hilde; Van Goethem, Bart

2012-01-01

A sizeable right atrial hemangiosarcoma in a 6-year-old Bordeaux dog, World Health Organization (WHO) stage 2, was excised using total venous inflow occlusion. The defect was restored with a non-vascularized pericardial auto-graft. The dog had a disease-free interval of 7 mo. The dog was euthanized 9 months later, at which time there were distant metastases but no indication of local recurrence. PMID:23543933

Complications of Recanalization of Chronic Total Occlusion

PubMed Central

Kalyanasundaram, Arun; Lombardi, William L.

2015-01-01

Percutaneous Coronary Intervention (PCI) of Chronic Total Occlusions (CTO) is an accepted revascularization procedure. These complex procedures carry with them certain risks and potential complications. Complications of PCI such as contrast induced renal dysfunction, radiation, etc, assume more relevance given the length and complexity of these procedures. Further, certain complications such as donor vessel injury, foreign body entrapment are unique to CTO PCI. A thorough understanding of the potential complications is important in mitigating risk during these complex procedures.

Percutaneous intervention of chronic total occlusion of anomalous right coronary artery originating from left sinus – Use of mother and child technique using guideliner

PubMed Central

Senguttuvan, Nagendra Boopathy; Sharma, Samin K.; Kini, Annapoorna

2015-01-01

Anomalous origin of right coronary artery (RCA) from left sinus is a rare clinical entity. Percutaneous coronary intervention of such an anomalous RCA, which is chronically occluded, is difficult and is rarely described. We describe such an intervention in a patient, who had a chronic total occlusion of anomalous RCA and discuss the technical issues associated with such interventions. PMID:26995429

A possible association of idiopathic osteosclerosis with excessive occlusal forces.

PubMed

Misirlioglu, Melda; Nalcaci, Rana; Baran, Ilgi; Adisen, Mehmet Zahit; Yilmaz, Selmi

2014-03-01

The aim of the study was to determine the relationship between idiopathic osteosclerotic lesions and occlusal forces using the T-Scan II computerized occlusal analysis device, and to test the sensitivity of the system in occlusal analysis. The study was conducted with 21 volunteers with idiopathic osteosclerosis (IO; 14 women, 7 men) aged between 17 and 62 years (mean 29.95). For every patient, seven or eight recordings were made with the T-Scan II occlusal analysis device in maximum intercuspation, and the last two (excluding any with technical problems) were chosen for evaluation. For each lesion-related area, the distribution of high occlusal forces from two different movies was analyzed. In 18 patients (85.71%), lesions were observed in an area of high occlusal force, and in 13 patients (61.9%), the lesions were located at the first area subjected to high occlusal forces. The percentage distribution of high forces at a lesion related area ranged from 0% to 88%. On average, the high forces at an osteosclerotic lesion area accounted for 20% of the maximum total force. No statistical differences were observed between the measurements of the two selected recordings (P > .05). The findings of this study suggest a possible relationship between IO and occlusal forces and primary contacts. T-Scan II was found to be a successful diagnostic device for detecting primary contacts and excessive occlusal forces.

Dental cervical lesions associated with occlusal erosion and attrition.

PubMed

Khan, F; Young, W G; Shahabi, S; Daley, T J

1999-09-01

Acid demineralization of teeth causes occlusal erosion and attrition, and shallow and wedge-shaped cervical lesions putatively involving abfraction. From 250 patients with tooth wear, 122 with cervical lesions were identified. From epoxy resin replicas of their dentitions, associations of occlusal attrition or erosion or no wear with cervical lesions were recorded at 24 tooth sites (total 2928 sites). Criteria used to discriminate occlusal attrition from erosion, and shallow from grooved, wedge-shaped or restored cervical lesions were delineated by scanning electron microscopy. A 96 per cent association was found between occlusal and cervical pathology. Shallow cervical lesions were more commonly found in association with occlusal erosion. Wedge-shaped lesions were found equally commonly in association with occlusal erosion, as with attrition. Grooved and restored cervical lesions were uncommon. Differences were appreciated in the associations within incisor, canine, premolar and molar tooth sites which related more to the site-specificity of dental erosion than to attrition from occlusal forces. Non-carious lesions on teeth then have multifactorial aetiology and pathogenesis in which erosion and salivary protection play central roles. Dentists should primarily consider erosion in the diagnosis, prevention and treatment of tooth wear.

Limitations of the Outback LTD re-entry device in femoropopliteal chronic total occlusions.

PubMed

Shin, Susanna H; Baril, Donald; Chaer, Rabih; Rhee, Robert; Makaroun, Michel; Marone, Luke

2011-05-01

Subintimal recanalization for the treatment of femoropopliteal chronic total occlusions (CTO) occasionally requires re-entry devices to access the true lumen distally, but limited information is available on factors predicting the success or failure of these devices. We evaluated the Outback LTD re-entry device (LuMend, Redwood City, Calif; acquired by Cordis Corp, Miami Lakes, Fla). A retrospective review of patients with femoropopliteal CTO from August 2006 to August 2009 was performed. Age, gender, occlusion length, site of re-entry, and the angle of the aortic bifurcation were recorded. Procedural angiograms were used to assign a calcification score (none, mild, moderate, severe) at the re-entry site. Univariate and multivariate logistic regression analyses were used to identify factors predicting failure of re-entry into the true lumen. Of 249 CTOs treated, the re-entry device was used 52 times (20.9%): 47 superficial femoral artery (SFA) occlusions and 5 combined SFA and popliteal artery occlusions (33 TransAtlantic InterSociety Consensus II type C and 18 type D lesions). Of 48 procedures with available angiograms for review, the target re-entry site was at the adductor canal in 30 (62.5%), the above-knee popliteal artery in 13 (27.1%), behind the knee joint in 4 (8.3%), and the mid-SFA in 2 (4.2%). Patients (54% men) were a mean age of 73.1 years. Re-entry was successful in 34 attempts (64.5%). Causes of failure included inability to re-enter the true lumen in 11 (61.1%), difficulty tracking the device over a wire in 3 (16.7%), acute angle of aortic bifurcation in 2 (11.1%), mechanical failure of the device in 1 (5.6%), and difficulty tracking the device through the lesion in 1 (5.6%). Moderate or severe calcification at the site of re-entry was the only significant predictor of failure (odds ratio, 6.3; 95% confidence interval, 1.45-24.48; P = .01). An aortic bifurcation angle ≥40° did trend toward predicting success (odds ratio, 0.23; 95% confidence interval, 0.05-1.02; P = .054). Although the Outback re-entry device can be successful in extending the applicability of endovascular management to difficult femoropopliteal occlusions, it is not uniformly successful in current clinical practice. Significant calcification at the proposed re-entry site is a strong predictor of failure. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Antegrade Dissection and Reentry as Part of the Hybrid Chronic Total Occlusion Revascularization Strategy: A Subanalysis of the RECHARGE Registry (Registry of CrossBoss and Hybrid Procedures in France, the Netherlands, Belgium and United Kingdom).

PubMed

Maeremans, Joren; Dens, Jo; Spratt, James C; Bagnall, Alan J; Stuijfzand, Wynand; Nap, Alexander; Agostoni, Pierfrancesco; Wilson, William; Hanratty, Colm G; Wilson, Simon; Faurie, Benjamin; Avran, Alexandre; Bressollette, Erwan; Egred, Mohaned; Knaapen, Paul; Walsh, Simon

2017-06-01

Development of the CrossBoss and Stingray devices for antegrade dissection and reentry (ADR) of chronic total occlusions has improved historically suboptimal outcomes. However, the outcomes, safety, and failure modes of the technique have to be studied in a larger patient cohort. This preplanned substudy of the RECHARGE registry (Registry of CrossBoss and Hybrid Procedures in France, the Netherlands, Belgium and United Kingdom) aims to evaluate the value and use of ADR and determine its future position in contemporary chronic total occlusion intervention. Patients were selected if an ADR strategy was applied. Outcomes, safety, and failure modes of the technique were assessed. The ADR technique was used in 23% (n=292/1253) of the RECHARGE registry and was mainly applied for complex lesions (Japanese chronic total occlusion score=2.7±1.1). ADR was the primary strategy in 30% (n=88/292), of which 67% were successful. Bail-out ADR strategies were successful in 63% (n=133/210). The Controlled ADR (ie, combined CrossBoss-Stingray) subtype was applied most frequently (32%; n=93/292) and successfully (81%; n=75/93). Overall per-lesion success rate was 78% (n=229/292), after use of additional bail-out strategies. The inability to reach the distal target zone (n=48/100) or to reenter (n=43/100) most commonly led to failure. ADR-associated major events occurred in 3.4% (n=10/292). Although mostly applied as a bail-out strategy for complex lesions, the frequency, outcomes, and low complication rate of the ADR technique and its subtypes confirm the benefit and value of the technique in hybrid chronic total occlusion percutaneous coronary intervention, especially when antegrade wiring or retrograde approaches are not feasible. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02075372. © 2017 American Heart Association, Inc.

Development and Validation of a Novel Scoring System for Predicting Technical Success of Chronic Total Occlusion Percutaneous Coronary Interventions: The PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Score.

PubMed

Christopoulos, Georgios; Kandzari, David E; Yeh, Robert W; Jaffer, Farouc A; Karmpaliotis, Dimitri; Wyman, Michael R; Alaswad, Khaldoon; Lombardi, William; Grantham, J Aaron; Moses, Jeffrey; Christakopoulos, Georgios; Tarar, Muhammad Nauman J; Rangan, Bavana V; Lembo, Nicholas; Garcia, Santiago; Cipher, Daisha; Thompson, Craig A; Banerjee, Subhash; Brilakis, Emmanouil S

2016-01-11

This study sought to develop a novel parsimonious score for predicting technical success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) performed using the hybrid approach. Predicting technical success of CTO PCI can facilitate clinical decision making and procedural planning. We analyzed clinical and angiographic parameters from 781 CTO PCIs included in PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) using a derivation and validation cohort (2:1 sampling ratio). Variables with strong association with technical success in multivariable analysis were assigned 1 point, and a 4-point score was developed from summing all points. The PROGRESS CTO score was subsequently compared with the J-CTO (Multicenter Chronic Total Occlusion Registry in Japan) score in the validation cohort. Technical success was 92.9%. On multivariable analysis, factors associated with technical success included proximal cap ambiguity (beta coefficient [b] = 0.88), moderate/severe tortuosity (b = 1.18), circumflex artery CTO (b = 0.99), and absence of "interventional" collaterals (b = 0.88). The resulting score demonstrated good calibration and discriminatory capacity in the derivation (Hosmer-Lemeshow chi-square = 2.633; p = 0.268, and receiver-operator characteristic [ROC] area = 0.778) and validation (Hosmer-Lemeshow chi-square = 5.333; p = 0.070, and ROC area = 0.720) subset. In the validation cohort, the PROGRESS CTO and J-CTO scores performed similarly in predicting technical success (ROC area 0.720 vs. 0.746, area under the curve difference = 0.026, 95% confidence interval = -0.093 to 0.144). The PROGRESS CTO score is a novel useful tool for estimating technical success in CTO PCI performed using the hybrid approach. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Outcomes of spot stenting versus long stenting after intentional subintimal approach for long chronic total occlusions of the femoropopliteal artery.

PubMed

Hong, Sung-Jin; Ko, Young-Guk; Shin, Dong-Ho; Kim, Jung-Sun; Kim, Byeong-Keuk; Choi, Donghoon; Hong, Myeong-Ki; Jang, Yangsoo

2015-03-01

This study sought to compare the outcomes of spot stenting versus long stenting after intentional subintimal approach for long femoropopliteal chronic total occlusions (CTO). The optimal stenting strategy following the subintimal recanalization of long femoropopliteal chronic total occlusions has not been investigated. A total of 196 limbs in 163 patients, implanted with bare nitinol stents after subintimal approach in long femoropopliteal occlusions (lesion length 25 ± 8 cm), were retrospectively analyzed. The primary patency was compared between spot stenting (n = 129) and long stenting (n = 67). Baseline characteristics and immediate procedural results were similar between groups. Adjusted-primary patency (47% vs. 77%, p < 0.001) and adjusted-freedom from target lesion revascularization (52% vs. 84%, p < 0.001) at 2 years were significantly lower in the long stenting group than in the spot stenting group. The incidence of stent fracture, fracture type, and restenosis pattern did not differ between groups. Long stenting was an independent predictor of restenosis (hazard ratio [HR]: 2.0) along with other risk factors such as nonuse of clopidogrel (HR: 3.3) or cilostazol (HR: 2.2), small stent diameter (HR: 0.6), poor run-off (HR: 1.9), and post-procedural ankle-brachial index (HR: 0.1). Compared with spot stenting after adjustment using inverse probability of treatment weighting, long stenting, especially involving the P2 or P3 segment of the popliteal artery, was independently associated with 7.5-fold increases in restenosis risk (p < 0.001). The primary patency was significantly higher with spot stenting than with long stenting following subintimal approach for long femoropopliteal chronic total occlusions. The risk of restenosis was especially higher when long stenting was extended to the distal popliteal artery. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

The unsuitability of implantable Doppler probes for the early detection of renal vascular complications – a porcine model for prevention of renal transplant loss

PubMed Central

Jespersen, Bente; Møldrup, Ulla; Keller, Anna K.

2017-01-01

Background Vascular occlusion is a rare, but serious complication after kidney transplantation often resulting in graft loss. We therefore aimed to develop an experimental porcine model for stepwise reduction of the renal venous blood flow and to compare an implantable Doppler probe and microdialysis for fast detection of vascular occlusion. Methods In 20 pigs, implantable Doppler probes were placed on the renal artery and vein and a microdialysis catheter was placed in the renal cortex. An arterial flowprobe served as gold standard. Following two-hour baseline measurements, the pigs were randomised to stepwise venous occlusion, complete venous occlusion, complete arterial occlusion or controls. Results All parameters were stable through baseline measurements. Glutamate and lactate measured by microdialysis increased significantly (p = 0.02 and p = 0.03 respectively) 30 minutes after a 2/3 (66%) reduction in renal blood flow. The implantable Doppler probe was not able to detect flow changes until there was total venous occlusion. Microdialysis detected changes in local metabolism after both arterial and venous occlusion; the implantable Doppler probe could only detect vascular occlusions on the vessel it was placed. Conclusions We developed a new model for stepwise renal venous blood flow occlusion. Furthermore, the first comparison of the implantable Doppler probe and microdialysis for detection of renal vascular occlusions was made. The implantable Doppler probe could only detect flow changes after a complete occlusion, whereas microdialysis detected changes earlier, and could detect both arterial and venous occlusion. Based on these results, the implantable Doppler probe for early detection of vascular occlusions cannot be recommended. PMID:28542429

Novel use of cutting balloon to treat subintimal hematomas during chronic total occlusion interventions.

PubMed

Vo, Minh N; Brilakis, Emmanouil S; Grantham, J Aaron

2018-01-01

Contemporary chronic total occlusion (CTO) percutaneous coronary interventional (PCI) techniques are increasingly dependent upon dissection and reentry techniques (DARTs) especially for long occluded lesions. DARTs can result in compressive hematomas during CTO interventions and traditional treatment with balloon angioplasty and/or coronary stenting are often suboptimal and may extend the hematoma distally. We describe the novel use of a cutting balloon to "express" these compressive hematomas and restore antegrade coronary blood flow. © 2017 Wiley Periodicals, Inc.

Interventricular Septal Hematoma and Coronary-Ventricular Fistula: A Complication of Retrograde Chronic Total Occlusion Intervention

PubMed Central

Abdel-karim, Abdul-rahman R.; Main, Michael L.

2016-01-01

Interventricular septal hematoma is a rare complication of retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCI) with a typically benign course. Here we report two cases of interventricular septal hematoma and coronary-cameral fistula development after right coronary artery (RCA) CTO-PCI using a retrograde approach. Both were complicated by development of ST-segment elevation and chest pain. One case was managed actively and the other conservatively, both with a favorable outcome. PMID:27668097

Missed Total Occlusion Due to the Occipital Artery Arising from the Internal Carotid Artery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ustunsoz, Bahri, E-mail: bustunsoz2000@yahoo.com; Gumus, Burcak; Koksal, Ali

2007-02-15

A 56-year-old man was referred for digital subtraction angiography (DSA) with an ultrasound diagnosis of right proximal internal carotid artery (ICA) stenosis for possible carotid artery stenting. DSA revealed total occlusion of the ICA and an occipital artery arising from the stump and simulating continuation of the ICA. An ascending pharyngeal artery also arose from the same occipital artery. This case is of interest because this is a rare variation besides being a cause of misdiagnosis at carotid ultrasound.

Analysis of occlusal variables, dental attrition, and age for distinguishing healthy controls from female patients with intracapsular temporomandibular disorders.

PubMed

Seligman, D A; Pullinger, A G

2000-01-01

Confusion about the relationship of occlusion to temporomandibular disorders (TMD) persists. This study attempted to identify occlusal and attrition factors plus age that would characterize asymptomatic normal female subjects. A total of 124 female patients with intracapsular TMD were compared with 47 asymptomatic female controls for associations to 9 occlusal factors, 3 attrition severity measures, and age using classification tree, multiple stepwise logistic regression, and univariate analyses. Models were tested for accuracy (sensitivity and specificity) and total contribution to the variance. The classification tree model had 4 terminal nodes that used only anterior attrition and age. "Normals" were mainly characterized by low attrition levels, whereas patients had higher attrition and tended to be younger. The tree model was only moderately useful (sensitivity 63%, specificity 94%) in predicting normals. The logistic regression model incorporated unilateral posterior crossbite and mediotrusive attrition severity in addition to the 2 factors in the tree, but was slightly less accurate than the tree (sensitivity 51%, specificity 90%). When only occlusal factors were considered in the analysis, normals were additionally characterized by a lack of anterior open bite, smaller overjet, and smaller RCP-ICP slides. The log likelihood accounted for was similar for both the tree (pseudo R(2) = 29.38%; mean deviance = 0.95) and the multiple logistic regression (Cox Snell R(2) = 30.3%, mean deviance = 0.84) models. The occlusal and attrition factors studied were only moderately useful in differentiating normals from TMD patients.

Endovascular management of inferior vena cava filter thrombotic occlusion.

PubMed

Branco, Bernardino C; Montero-Baker, Miguel F; Espinoza, Eduardo; Gamero, Maria; Zea-Vera, Rodrigo; Labropoulos, Nicos; Leon, Luis R

2018-01-01

Objective Inferior vena cava occlusion is a potentially life-threatening complication related to caval filters. We present our experience with filter-induced inferior vena cava occlusion in order to assess the feasibility, safety, and effectiveness of endovascular management. Methods A retrospective review of all patients undergoing inferior vena cava filter placement over a 60-month study period was performed. From this cohort, a total of 10 cases of inferior vena cava occlusion after filter placement were identified. Demographics, clinical data, procedures, and outcomes were extracted. Patients were followed to the last clinic visit or until they died. Results One-hundred eighty filters were placed by our group practice during the study period. Of those, a total of 10 patients were identified. Overall, there were 7 males; the mean age was 57.1 years (25-78 years). The median time between inferior vena cava filter placement and filter occlusion was 105 days (range 5-4745 days). All patients were clinically symptomatic at the time of their presentation. Nine out of 10 patients were successfully managed endovascularly. Trellis™-8 thrombectomy was the most common endovascular strategy performed ( n = 9). Four patients had balloon angioplasty, two of those with stent placement for chronically occluded inferior vena cava/iliac veins. No thromboembolic complications developed during a median follow-up period of 233 days (range 4-1083 days). Conclusions Endovascular management of inferior vena cava occlusion is feasible, safe, and effective in decreasing thrombus burden in the presence of an inferior vena cava filter. Further studies evaluating long-term inferior vena cava patency and optimal surveillance regimen after endovascular management of filter-related inferior vena cava occlusion are warranted.

Direct observation of mineral–organic composite formation reveals occlusion mechanism

DOE PAGES

Cho, Kang Rae; Kim, Yi -Yeoun; Yang, Pengcheng; ...

2016-01-06

Manipulation of inorganic materials with organic macromolecules enables organisms to create biominerals such as bones and seashells, where occlusion of biomacromolecules within individual crystals generates superior mechanical properties. Current understanding of this process largely comes from studying the entrapment of micron-size particles in cooling melts. Here, by investigating micelle incorporation in calcite with atomic force microscopy and micromechanical simulations, we show that different mechanisms govern nanoscale occlusion. By simultaneously visualizing the micelles and propagating step edges, we demonstrate that the micelles experience significant compression during occlusion, which is accompanied by cavity formation. This generates local lattice strain, leading to enhancedmore » mechanical properties. Furthermore, these results give new insight into the formation of occlusions in natural and synthetic crystals, and will facilitate the synthesis of multifunctional nanocomposite crystals.« less

Acute Central Retinal Vein Occlusion Secondary to Reactive Thrombocytosis after Splenectomy

PubMed Central

Oncel Acir, Nursen; Borazan, Mehmet

2014-01-01

The diagnosis and treatment of central retinal vein occlusion was reported in a young patient. Central retinal vein occlusion was probably related to secondary to reactive thrombocytosis after splenectomy. The patient was treated with steroids for papilledema and administered coumadin and aspirin. The symptoms resolved, and the findings returned to normal within three weeks. Current paper emphasizes that, besides other well-known thrombotic events, reactive thrombocytosis after splenectomy may cause central retinal vein occlusion, which may be the principal symptom of this risky complication. Thus, it can be concluded that followup for thrombocytosis and antithrombotic treatment, when necessary, are essential for these cases. PMID:25276452

Simultaneous total occlusion of two coronary arteries associated with use of drospirenone-ethinyl estradiol (oral contraceptive).

PubMed

Atmaca, Hüsnü; Köprülü, Diyar; Kiriş, Tuncay; Zeren, Gönül; Şahin, İrfan

2018-01-01

Although the use of oral contraceptives is associated with an increased risk of venous thromboembolic disease, the risk of myocardial infarction (MI) is unclear. A new, third-generation contraceptive agent, drospirenone-ethinyl estradiol, which contains less estrogen and a new progestogen, drospirenone, in a different combination, has been considered more reliable in terms of risk of MI. However, there have been some cases of MI associated with the use of drospirenone-ethinyl estradiol, despite the protective effects of this oral contraceptive. In this report, a 33-year-old woman who had used drospirenone-ethinyl estradiol for 6 months was admitted with MI and symptoms of cardiogenic shock. Coronary angiography revealed the total occlusion of 2 coronary arteries and so percutaneous coronary intervention was performed. To the best of our knowledge, this is the first case report of simultaneous total occlusion of 2 coronary arteries associated with the use of drospirenone-ethinyl estradiol in the English-language medical literature.

Novel Evidence-Based Classification of Cavernous Venous Occlusive Disease.

PubMed

Pathak, Ram A; Rawal, Bhupendra; Li, Zhuo; Broderick, Gregory A

2016-10-01

The primary aim of our study was to determine whether an evidence-based rationale could categorize cavernous venous occlusive disease into mild, moderate and severe erectile dysfunction. A total of 863 patients underwent color duplex Doppler ultrasound from January 2010 to June 2013 performed by a single urologist. We identified a cohort of 75 patients (8.7%) with a diagnosis of cavernous venous occlusive disease based on a unilateral resistive index less than 0.9, and right and left peak systolic velocity 35 cm per second or less after visual sexual stimulation. At a median followup of 13 months patients were evaluated for treatment efficacy. A total of 75 patients with a median age of 60 years (range 19 to 83) and a mean body mass index of 26.3 kg/m(2) (range 19.0 to 39.3) satisfied the criteria of cavernous venous occlusive disease. When substratified into tertiles, resistive index cutoffs were obtained, including mild cavernous venous occlusive disease-81.6 to 94.0, moderate disease-72.6 to 81.5 and severe disease-59.5 to 72.5. Using these 3 groups the phosphodiesterase type 5-inhibitor failure rate (p = 0.017) and SHIM (Sexual Health Inventory for Men) score categories (1 to 10 vs 11 to 20, p = 0.030) were statistically significantly different for mild, moderate and severe cavernous venous occlusive disease. Treatment satisfaction was also statistically significantly different. Penile prosthetic placement was a more common outcome among patients with erectile dysfunction and more severe cavernous venous occlusive disease. Our retrospective analysis supports a correlation between the phosphodiesterase type 5 inhibitor failure rate, SHIM score and the rate of surgical intervention using resistive index values. Our data further suggest that an evidence-based classification of cavernous venous occlusive disease by color Doppler ultrasound is possible and can triage patients to penile prosthetic placement. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Predictors of early stent occlusion among plastic biliary stents.

PubMed

Khashab, Mouen A; Kim, Katherine; Hutfless, Susan; Lennon, Anne Marie; Kalloo, Anthony N; Singh, Vikesh K

2012-09-01

A major disadvantage of plastic biliary stents is their short patency rates. The aim of this study was to identify predictors of early stent occlusion among patients receiving conventional plastic biliary stents. Early stent occlusion was defined as worsening cholestatic liver test results of a severity sufficiently significant to warrant ERCP with stent exchange prior to the planned stent exchange, or as symptoms of cholangitis. The association of cumulative stent diameter, demographics, stricture location, procedure indication, Charlson comorbidity index, history of prior early stent occlusion, presence of gallbladder, and performance of sphincteromy with the occurrence of early stent occlusion was studied using logistic regression and multivariate analysis. Our patient cohort comprised 343 patients (mean age 59.3 years) who underwent 561 ERCP procedures with the placement of one or more plastic biliary stents (mean number of stents per procedure 1.2, mean total diameter of stents per procedure 12 Fr). Early stent occlusion occurred in 73 (13 %) procedures. Female gender was protective against early stent occlusion (adjusted OR 0.54, 95 % CI 0.32-0.90, p = 0.02), while hilar stricture location was independently associated with a significantly increased risk of early stent occlusion (adjusted OR 3.41, 95 % CI 1.68-6.90, p = 0.0007). Early occlusion of conventional biliary stents occurred in 13 % of cases. While female gender decreased the risk of early stent occlusion, hilar stricture location was a significant predictor of early stent occlusion. Our results suggest that physicians should consider early elective stent exchange in patients with hilar strictures.

Inheritance of Occlusal Topography: A Twin Study

PubMed Central

Su, C-Y.; Corby, P.M.; Elliot, M.A.; Studen-Pavlovich, D.A.; Ranalli, D.N.; Rosa, B.; Wessel, J.; Schork, N.J.; Hart, T.C.; Bretz, W.A.

2011-01-01

Aim This was to determine the relative contribution of genetic factors on the morphology of occlusal surfaces of mandibular primary first molars by employing the twin study model. Methods The occlusal morphology of mandibular primary first molar teeth from dental casts of 9 monozygotic (MZ) twin pairs and 12 dizygotic (DZ) twin pairs 4 to 7 years old, were digitized by contact-type three-dimensional (3D) scanner. To compare the similarity of occlusal morphology between twin sets, each twin pair of occlusal surfaces was superimposed to establish the best fit by using computerized least squared techniques. Heritability was computed using a variance component model, adjusted for age and gender. Results DZ pairs demonstrated a greater degree of occlusal morphology variance. The total amount of difference in surface overlap was 0.0508 mm (0.0018 (inches) for the MZ (n=18) sample and 0.095 mm (0.0034 inches) for the DZ (n=24) sample and were not statistically significant (p=0.2203). The transformed mean differences were not statistically significantly different (p=0.2203). Heritability estimates of occlusal surface areas for right and left mandibular primary first molars were 97.5% and 98.2% (p<0.0001), respectively. Conclusions Occlusal morphology of DZ twin pairs was more variable than that of MZ twin pairs. Heritability estimates revealed that genetic factors strongly influence occlusal morphology of mandibular primary first molars. PMID:18328234

Bilateral Internal Carotid Artery Occlusion, External Carotid Artery Stenosis, and Vertebral Artery Kinking: May It Be Asymptomatic?

PubMed

Fatic, Nikola; Jaffer, Usman; Ivana, Saicic; Gordana, Globarevic-Vukcevic; Markovic, Dragan; Kostic, Dusan; Davidovic, Lazar

2017-10-01

The clinical spectrum of internal carotid artery occlusion ranges from being a completely asymptomatic occlusion to a devastating stroke or death. The prevalence of asymptomatic internal carotid artery occlusion is unknown, particularly for bilateral occlusion. The distal branches of the external carotid artery anastomose with distal branches of the internal carotid artery provide important sources of collateral circulation to the brain. Stenosis of the external carotid artery with ipsilateral/bilateral internal occlusion may result in ischemic sequelae. Coiling or kinking of the vertebral artery is a rare morphological entity that is infrequently reported because it remains asymptomatic and has no clinical relevance. Currently, there is little evidence to support management strategies for this disease entity and no official recommendations for asymptomatic bilateral carotid artery occlusion. We present a case of a 62-year-old female with asymptomatic bilateral internal carotid artery occlusion, bilateral external carotid artery stenoses, and bilateral kinking of the vertebral artery at the V2 segment, who has been successfully managed conservatively for over 5 years. An individualized approach to management of patients with bilateral internal carotid artery occlusion, especially in combination with external carotid artery stenosis and elongation malformations of the vertebral artery is key to a successful strategy. Copyright © 2017 Elsevier Inc. All rights reserved.

Personalized versus standardized dosing strategies for the treatment of childhood amblyopia: study protocol for a randomized controlled trial.

PubMed

Moseley, Merrick J; Wallace, Michael P; Stephens, David A; Fielder, Alistair R; Smith, Laura C; Stewart, Catherine E

2015-04-25

Amblyopia is the commonest visual disorder of childhood in Western societies, affecting, predominantly, spatial visual function. Treatment typically requires a period of refractive correction ('optical treatment') followed by occlusion: covering the nonamblyopic eye with a fabric patch for varying daily durations. Recent studies have provided insight into the optimal amount of patching ('dose'), leading to the adoption of standardized dosing strategies, which, though an advance on previous ad-hoc regimens, take little account of individual patient characteristics. This trial compares the effectiveness of a standardized dosing strategy (that is, a fixed daily occlusion dose based on disease severity) with a personalized dosing strategy (derived from known treatment dose-response functions), in which an initially prescribed occlusion dose is modulated, in a systematic manner, dependent on treatment compliance. A total of 120 children aged between 3 and 8 years of age diagnosed with amblyopia in association with either anisometropia or strabismus, or both, will be randomized to receive either a standardized or a personalized occlusion dose regimen. To avoid confounding by the known benefits of refractive correction, participants will not be randomized until they have completed an optical treatment phase. The primary study objective is to determine whether, at trial endpoint, participants receiving a personalized dosing strategy require fewer hours of occlusion than those in receipt of a standardized dosing strategy. Secondary objectives are to quantify the relationship between observed changes in visual acuity (logMAR, logarithm of the Minimum Angle of Resolution) with age, amblyopia type, and severity of amblyopic visual acuity deficit. This is the first randomized controlled trial of occlusion therapy for amblyopia to compare a treatment arm representative of current best practice with an arm representative of an entirely novel treatment regimen based on statistical modelling of previous trial outcome data. Should the personalized dosing strategy demonstrate superiority over the standardized dosing strategy, then its adoption into routine practice could bring practical benefits in reducing the duration of treatment needed to achieve an optimal outcome. ISRCTN ISRCTN12292232.

Splanchnic vasoconstriction in hyperthermic man - Role of falling blood pressure.

NASA Technical Reports Server (NTRS)

Rowell, L. B.; Profant, G. R.; Wyss, C.; Detry, J.-M. R.

1971-01-01

Results of a study in which six supine resting subjects, wearing water-perfused suits, had body skin temperature controlled at 35 C for 30 min (control period), then rapidly increased to 40.5 C for 43 to 50 min (heating period) in a two-part experiment. In the first part of the experiment arterial mean pressure (MP) in three men was increased back to, or above control levels at the 30 to 35th min of heating by total occlusion of both legs for 8 to 10 min. Splanchnic blood flow (SBF), which had fallen from 1.4 to 0.9 L/min at occlusion, rose only 0.05 L/min during occlusion. Splanchnic vascular resistance (SVR) rose throughout heating and occlusion. In the second part of the experiment (three men) SBF fell despite a spontaneous rise in MP and aortic pulse pressure prior to leg occlusion. Cardiac output (CO) was measured just before, during and after occlusion. Occlusion raised MP 10 to 15 mm Hg and reduced CO only slightly. It is concluded that falling MP or aortic pulse pressure are not major causes of the splanchnic vasoconstriction in response to heating man.

Evaluation of in-vehicle HMI using occlusion techniques: experimental results and practical implications.

PubMed

Baumann, Martin; Keinath, Andreas; Krems, Josef F; Bengler, Klaus

2004-05-01

Despite the usefulness of new on-board information systems one has to be concerned about the potential distraction effects that they impose on the driver. Therefore, methods and procedures are necessary to assess the visual demand that is connected to the usage of an on-board system. The occlusion-method is considered a strong candidate as a procedure for evaluating display designs with regard to their visual demand. This paper reports results from two experimental studies conducted to further evaluate this method. In the first study, performance in using an in-car navigation system was measured under three conditions: static (parking lot), occlusion (shutter glasses), and driving. The results show that the occlusion-procedure can be used to simulate visual requirements of real traffic conditions. In a second study the occlusion method was compared to a global evaluation criterion based on the total task time. It can be demonstrated that the occlusion method can identify tasks which meet this criterion, but are yet irresolvable under driving conditions. It is concluded that the occlusion technique seems to be a reliable and valid method for evaluating visual and dialogue aspects of in-car information systems.

Comparative Evaluation of Efficacy of Iontophoresis with 0.33% Sodium Fluoride Gel and Diode Laser Alone on Occlusion of Dentinal Tubules

PubMed Central

Varma, Siddhartha; Suragimath, Girish; Abbayya, Keshava; Zope, Sameer Anil; Kale, Vishwajeet

2017-01-01

Introduction Dentinal Hypersensitivity (DH) is one of the most commonly encountered clinical problems. Literature reveals no specific therapy to satisfactorily eliminate dentinal hypersensitivity. Aim The aim of this study was to assess and compare the efficacy of iontophoresis with 0.33% Sodium Fluoride (NaF) gel and diode laser alone in dentinal tubule occlusion. Materials and Methods This in vitro study included 20 teeth with intact root surfaces unaltered by extraction procedure for specimen preparation. Each tooth was cleaned, air dried and cut into three sections. Total 60 sections were prepared (30 longitudinal and 30 transverse sections), which were acid etched. In control group, no treatment was carried. In iontophoresis treatment group, samples were inserted into a foam tray containing 0.33 % NaF Gel and subjected to 1.5 mA output current for three minutes. In laser treatment group, specimens were lased with 980 nm diode laser at 0.5 W/PW (62.2J /cm2) in a noncontact mode for 30 seconds. Specimens were evaluated under Scanning Electron Microscope (SEM) at 10KV to 20KV under x 2000, x5000 magnification for surface characteristics and patency of dentinal tubules. Total number of tubules visible, open, completely and partially occluded were recorded in each microphotograph and compared. Results On comparison, laser group showed the least number of open tubules i.e., 130 (31.1%) followed by iontophoresis group, 155 (51.32%) and control group 417 (100%). Conclusion Diode laser application provided better results as compared to iontophoresis on occlusion of dentinal tubules. Hence, it can be used to treat the patients with DH. PMID:28969290

Comparative Evaluation of Efficacy of Iontophoresis with 0.33% Sodium Fluoride Gel and Diode Laser Alone on Occlusion of Dentinal Tubules.

PubMed

Patil, Anup Raghunath; Varma, Siddhartha; Suragimath, Girish; Abbayya, Keshava; Zope, Sameer Anil; Kale, Vishwajeet

2017-08-01

Dentinal Hypersensitivity (DH) is one of the most commonly encountered clinical problems. Literature reveals no specific therapy to satisfactorily eliminate dentinal hypersensitivity. The aim of this study was to assess and compare the efficacy of iontophoresis with 0.33% Sodium Fluoride (NaF) gel and diode laser alone in dentinal tubule occlusion. This in vitro study included 20 teeth with intact root surfaces unaltered by extraction procedure for specimen preparation. Each tooth was cleaned, air dried and cut into three sections. Total 60 sections were prepared (30 longitudinal and 30 transverse sections), which were acid etched. In control group, no treatment was carried. In iontophoresis treatment group, samples were inserted into a foam tray containing 0.33 % NaF Gel and subjected to 1.5 mA output current for three minutes. In laser treatment group, specimens were lased with 980 nm diode laser at 0.5 W/PW (62.2J /cm 2 ) in a noncontact mode for 30 seconds. Specimens were evaluated under Scanning Electron Microscope (SEM) at 10KV to 20KV under x 2000, x5000 magnification for surface characteristics and patency of dentinal tubules. Total number of tubules visible, open, completely and partially occluded were recorded in each microphotograph and compared. On comparison, laser group showed the least number of open tubules i.e., 130 (31.1%) followed by iontophoresis group, 155 (51.32%) and control group 417 (100%). Diode laser application provided better results as compared to iontophoresis on occlusion of dentinal tubules. Hence, it can be used to treat the patients with DH.

What do Polish interventional cardiologists know about indications and qualification for recanalisation of chronic total coronary artery occlusions?

PubMed

Bryniarski, Krzysztof L; Zabojszcz, Michał; Dębski, Grzegorz; Marchewka, Jakub; Legutko, Jacek; Jankowski, Piotr; Siudak, Zbigniew; Żmudka, Krzysztof; Dudek, Dariusz; Bryniarski, Leszek

2015-01-01

Chronic total occlusions (CTO) are diagnosed in about 20% of patients with significant coronary artery disease. A disproportion between the high prevalence of CTOs and low rate of invasive treatment still exists. Technical difficulties, clinical uncertainties whether patients benefit from recanalisation, and a lack of knowledge of CTO may be responsible for this fact. To assess the knowledge of coronary arteries CTO among Polish interventional cardiologists. A self-designed questionnaire was used during two major Polish invasive cardiology workshops held in 2014. The study included 113 physicians, mostly cardiologists certified as independent operators. Average self-declared efficacy of CTO recanalisation was 63.5%. Most of the respondents agreed that the operator involved in the CTO recanalisation program should perform at least 30-50 procedures per year. Only 67% stated that before CTO revascularisation the evaluation of myocardial viability should be performed with dobutamine stress echocardiography as a preferred test. One third of the physicians agreed that CTO percutaneous coronary intervention (PCI) should not be performed directly after diagnostic angiography, and 51.5% believed that in patients with multi-vessel coronary artery disease PCI of CTO should be performed first. Multi-slice spiral computed tomography during the qualification and planning of the CTO revascularisation, in the opinion of 91% of the responders, should not be used before each procedure but could be useful in selected cases. Polish interventional cardiologists remains in compliance with current opinions about recanalisation of chronic coronary artery occlusions and the consensus of the EuroCTO Club, but there is still an unceasing need for further education and promotion of knowledge about CTOs.

Conservative Management of an Epicardial Collateral Perforation During Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention.

PubMed

Ngo, Christian; Christopoulos, George; Brilakis, Emmanouil S

2016-01-01

Coronary artery perforation is a highly feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and can lead to pericardial effusion, tamponade, and, rarely, emergent cardiac surgery. Perforation of epicardial collaterals during retrograde CTO-PCI may be particularly challenging to treat, as embolization from both sides of the perforation may be required to control the bleeding. However, conservative measures can occasionally be effective. We present a case of epicardial collateral vessel perforation that was managed conservatively with anticoagulation reversal.

“Spiral stenting”—creating a subintimal neo-luminal helix around a massively calcified ostial chronic total occlusion of the right coronary artery in a patient with recurrent ventricular tachycardia

PubMed Central

Valuckiene, Zivile; Neuser, Hans; Walter, Marlon; Gappmaier, Wolfgang; Kaiser, Thomas; Neumann, Franz-Josef; Akin, Ibrahim; Behnes, Michael

2016-01-01

This case report describes a successful percutaneous coronary intervention (PCI) of a severely calcified aorto-ostial chronic total occlusion (CTO) of the right coronary artery (RCA). The lesion was treated by a retrograde approach implementing long spiral subintimal wire tracking and final coronary stenting creating a subintimal neo-luminal helix around the natively occluded RCA. After 6 months of follow-up valuable angiographic results were proven. PMID:28066662

Coronary perforation with tamponade successfully managed by retrograde and antegrade coil embolization

PubMed Central

Boukhris, Marouane; Tomasello, Salvatore Davide; Azzarelli, Salvatore; Elhadj, Zied Ibn; Marzà, Francesco; Galassi, Alfredo Ruggero

2015-01-01

In recent years, retrograde approach for chronic total occlusions has rapidly evolved, enabling a higher rate of revascularization success. Compared to septal channels, epicardial collaterals tend to be more tortuous, more difficult to negotiate, and more prone to rupture. Coronary perforation is a rare but potentially life-threatening complication of coronary angioplasty, often leading to emergency cardiac surgery. We report a case of a retrograde chronic total occlusion revascularization through epicardial collaterals, complicated by both retrograde and antegrade coronary perforation with tamponade, and successfully managed by coil embolization. PMID:26136637

Endovascular intervention for central venous cannulation in patients with vascular occlusion after previous catheterization.

PubMed

Pikwer, Andreas; Acosta, Stefan; Kölbel, Tilo; Åkeson, Jonas

2010-01-01

This study was designed to assess endovascular intervention for central venous cannulation in patients with vascular occlusion after previous catheterization. Patients referred for endovascular management of central venous occlusion during a 42-month period were identified from a regional endovascular database, providing prospective information on techniques and clinical outcome. Corresponding patient records, angiograms, and radiographic reports were analyzed retrospectively. Sixteen patients aged 48 years (range 0.5-76), including 11 females, were included. All patients but 1 had had multiple central venous catheters with a median total indwelling time of 37 months. Eleven patients cannulated for hemodialysis had had significantly fewer individual catheters inserted compared with 5 patients cannulated for nutritional support (mean 3.6 vs. 10.2, p<0.001) before endovascular intervention. Preoperative imaging by magnetic resonance tomography (MRT) in 8 patients, computed tomography (CT) venography in 3, conventional angiography in 6, and/or ultrasonography in 8, verified 15 brachiocephalic, 13 internal jugular, 3 superior caval, and/or 3 subclavian venous occlusions. Patients were subjected to recanalization (n=2), recanalization and percutaneous transluminal angioplasty (n=5), or stenting for vena cava superior syndrome (n=1) prior to catheter insertion. The remaining 8 patients were cannulated by avoiding the occluded route. Central venous occlusion occurs particularly in patients under hemodialysis and with a history of multiple central venous catheterizations with large-diameter catheters and/or long total indwelling time periods. Patients with central venous occlusion verified by CT or MRT venography and need for central venous access should be referred for endovascular intervention.

Analysis of decrease in lung perfusion blood volume with occlusive and non-occlusive pulmonary embolisms.

PubMed

Ikeda, Yohei; Yoshimura, Norihiko; Hori, Yoshiro; Horii, Yosuke; Ishikawa, Hiroyuki; Yamazaki, Motohiko; Noto, Yoshiyuki; Aoyama, Hidefumi

2014-12-01

The aim of this study was to determine if lung perfusion blood volume (lung PBV) with non-occlusive pulmonary embolism (PE) differs quantitatively and visually from that with occlusive PE and to investigate if lung PBV with non-occlusive PE remains the same as that without PE. Totally, 108 patients suspected of having acute PE underwent pulmonary dual-energy computed tomography angiography (DECTA) between April 2011 and January 2012. Presence of PE on DECTA was evaluated by one radiologist. Two radiologists visually evaluated the PE distribution (segmental or subsegmental) and its nature (occlusive or non-occlusive) on DECTA and classified perfusion in lung PBV as "decreased," "slightly decreased," and "preserved". Two radiologists used a lung PBV application to set a region of interest (ROI) in the center of the lesion and measured HU values of an iodine map. In the same slice as the ROI of the lesion and close to the lesion, another ROI was set in the normal perfusion area without PE, and HUs were measured. The proportion of lesions was compared between the occlusive and non-occlusive groups. HUs were compared among the occlusive, non-occlusive, and corresponding normal groups. Twenty-five patients had 80 segmental or subsegmental lesions. There were 37 and 43 lesions in the occlusive and non-occlusive groups, respectively. The proportion of decreased lesions was 73.0% (27/37) in the occlusive group, while that of preserved lesions in the non-occlusive group was 76.7% (33/43). There was a significant difference in the proportion of lesions (P<0.001) between the two groups. HUs of the iodine map were significantly higher in the non-occlusive group than in the occlusive group (33.8 ± 8.2 HU vs. 11.9 ± 6.1 HU, P<0.001). There was no significant difference in HUs for the entire lesion between the non-occlusive (33.8 ± 8.2 HU) and corresponding normal group (34.5 ± 6.8 HU; P=0.294). Iodine perfusion tended to be visually and quantitatively preserved in lungs with nonocclusive PE. Lung PBV is required to evaluate pulmonary blood flow. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Influence of collaterals on the left ventricular end-diastolic pressure and serum NT-proBNP levels in patients with coronary chronic total occlusion.

PubMed

Samadov, Fuad; Yesildag, Osman; Sari, Ibrahim; Atas, Halil; Akhundova, Aysel; Basaran, Yelda

2017-06-01

Although numerous studies have shown the protective effects of the well-developed coronary collaterals on left ventricular functions, the relationship between collateral grade and left ventricular end diastolic pressure has not been studied in chronic total occlusion patients. Also, there are conflicting data on the effect of collaterals on NT-proBNP levels. The aim of our study was to evaluate the relationship between coronary collateral circulation and left ventricular end diastolic pressure and NT-proBNP levels in chronic total occlusion patients. Study group was retrospectively selected from the patients who had undergone coronary angiography at our hospital between June 2011 and March 2013. Clinical, biochemical, angiographic and hemodynamic data of 199 consecutive patients having at least one totally occluded major epicardial coronary artery were evaluated. Coronary collateral circulation was graded according to Rentrop classification. While Rentrop grade 3 was defined as well-developed, all the remaining collateral grades were regarded as poor collaterals. Overall 87 patients were found to have good collaterals and 112 patients had poor collaterals. There was no significant difference between the patients with well- or poorly developed coronary collaterals with regard to left ventricular end diastolic pressure (16.84 ± 5.40 mmHg vs 16.10 ± 6.09, respectively, p  = 0,632) and log NT-proBNP (2.46 ± 0.58 vs 2.59 ± 0.76, respectively, p  = 0,335). In patients with coronary chronic total occlusion even well-developed coronary collaterals are not capable of protecting the rise of left ventricular end diastolic pressure and NT-proBNP levels which are reliable markers of the left ventricular dysfunction.

Part-time occlusion therapy for amblyopia in older children.

PubMed

Singh, Inderpreet; Sachdev, Nishant; Brar, Gagandeep S; Kaushik, Sushmita

2008-01-01

To compare the efficacy of part-time versus full-time occlusion for treatment of amblyopia in children aged 7-12 years. Prospective interventional case series. One hundred children between 7-12 years of age with anisometropic (57), strabismic (25) and mixed (18) unilateral amblyopia were randomized (simple randomization) into four groups (25 each) to receive two hours, four hours, six hours or full-time occlusion therapy. Children were regularly followed up at six-weekly intervals for a minimum of three visits. Intragroup visual improvement was analyzed using paired t-test while intergroup comparisons were done using ANOVA and unpaired t-test. All four groups showed significant visual improvement after 18 weeks of occlusion therapy ( P < 0.001). Seventy-three (73%) of the total 100 eyes responded to amblyopia therapy with 11 eyes (44%), 17 eyes (68%), 22 eyes (88%) and 23 eyes (92%) being amblyopia responders in the four groups respectively, with the least number of responders in the two hours group. In mild to moderate amblyopia (vision 20/30 to 20/80), there was no significant difference in visual outcome among the four groups ( P =0.083). However, in severe amblyopia (vision 20/100 or worse), six hours ( P =0.048) and full-time occlusion ( P =0.027) treatment were significantly more effective than two hours occlusion. All grades of part-time occlusion are comparable to full-time occlusion in effectiveness of treatment for mild to moderate amblyopia in children between 7-12 years of age unlike in severe amblyopia, where six hours and full-time occlusion were more effective than two hours occlusion therapy.

A New Occlusion Device: Application of the ArtVentive Endoluminal Occlusion System (EOS)—First in Human Clinical Trial

DOE Office of Scientific and Technical Information (OSTI.GOV)

Venbrux, Anthony C., E-mail: avenbrux@mfa.gwu.edu; Rudakov, Leon, E-mail: leonrudakov@artventivemedical.com; Plass, Andre, E-mail: andre.plass@usz.ch

2013-05-24

PurposeThe purpose of this study was to determine the safety and efficacy of a new endoluminal occlusion device, ArtVentive endoluminal occlusion system (EOS), to occlude the spermatic vein in symptomatic males with varicoceles.MethodsThe ArtVentive EOS device has been developed for percutaneous, peripheral occlusion of the peripheral arterial and venous vasculature. The system is comprised of an implantable occlusion device and a delivery catheter. At present, there are two device sizes: (a) size 1 for target vessels ranging between 3.5 and 5.5 mm in diameter, and (b) size 2 for target vessels 5.5–8.5 mm in diameter. The treatment group included six adult males,more » ages 22–34 years. Nine target vessels were occluded. A total of 20 devices were implanted in six subjects.ResultsThe acute occlusion rate at the end of the procedure was 100 % occurring in nine of nine vessels. The spermatic veins of all patients remained occluded on venography at 30 days follow-up. Pain scores related to varicoceles decreased in five of six patients.ConclusionsAlthough we recognize this study is limited, initial experience indicates that the ArtVentive EOS is a safe and effective new device for occlusion of vessels (varicoceles). The device has potential applications in other clinical conditions requiring occlusion of veins or arteries.« less

The impact of occlusal plane cant along with gingival display on smile attractiveness.

PubMed

Kaya, B; Uyar, R

2016-05-01

To evaluate the influence of occlusal plane cant in conjunction with maxillary gingival display on perception of smile attractiveness by orthodontists, dentists, and laypersons. Faculty of Dentistry at Baskent University. A total of 204 raters for smile attractiveness. A frontal intra-oral photograph of aligned teeth was modified using image processing software. Six different occlusal lines representing 0° to 5° cants were obtained by tilting the photographs. Each occlusal cant was adjusted in five manners resulting in five different gingival display amounts. Attractiveness of the 30 different smiles was evaluated by 204 raters divided into three groups (n = 68 in each group). Both occlusal cant (p < 0.001) and gingival display amount (p < 0.001) had a statistically significant influence on smile attractiveness. Smile attractiveness scores with reference to amount of gingival display showed a significant difference between rater groups (p < 0.001). Orthodontists preferred 1-mm coverage of upper central incisors by the upper lip, whereas dentists and laypersons preferred 2 mm. Significant (p < 0.001) interaction was observed between occlusal cant and gingival display amount, which influenced smile attractiveness. Increase in both occlusal plane cant and gingival display negatively influences smile attractiveness. The influence of occlusal plane cant becomes less when gingival display increases, whereas the influence of gingival display decreases when occlusal cant increases. Dentists are more generous than orthodontists, while laypersons are the most generous regarding smile attractiveness scores. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Incremental balloon deflation following complete resuscitative endovascular balloon occlusion of the aorta results in steep inflection of flow and rapid reperfusion in a large animal model of hemorrhagic shock.

PubMed

Davidson, Anders J; Russo, Rachel M; Ferencz, Sarah-Ashley E; Cannon, Jeremy W; Rasmussen, Todd E; Neff, Lucas P; Johnson, M Austin; Williams, Timothy K

2017-07-01

To avoid potential cardiovascular collapse after resuscitative endovascular balloon occlusion of the aorta (REBOA), current guidelines recommend methodically deflating the balloon for 5 minutes to gradually reperfuse distal tissue beds. However, anecdotal evidence suggests that this approach may still result in unpredictable aortic flow rates and hemodynamic instability. We sought to characterize aortic flow dynamics following REBOA as the balloon is deflated in accordance with current practice guidelines. Eight Yorkshire-cross swine were splenectomized, instrumented, and subjected to rapid 25% total blood volume hemorrhage. After 30 minutes of shock, animals received 60 minutes of Zone 1 REBOA with a low-profile REBOA catheter. During subsequent resuscitation with shed blood, the aortic occlusion balloon was gradually deflated in stepwise fashion at the rate of 0.5 mL every 30 seconds until completely deflated. Aortic flow rate and proximal mean arterial pressure (MAP) were measured continuously over the period of balloon deflation. Graded balloon deflation resulted in variable initial return of aortic flow (median, 78 seconds; interquartile range [IQR], 68-105 seconds). A rapid increase in aortic flow during a single-balloon deflation step was observed in all animals (median, 819 mL/min; IQR, 664-1241 mL/min) and corresponded with an immediate decrease in proximal MAP (median, 30 mm Hg; IQR, 14.5-37 mm Hg). Total balloon volume and time to return of flow demonstrated no correlation (r = 0.016). This study is the first to characterize aortic flow during balloon deflation following REBOA. A steep inflection point occurs during balloon deflation that results in an abrupt increase in aortic flow and a concomitant decrease in MAP. Furthermore, the onset of distal aortic flow was inconsistent across study animals and did not correlate with initial balloon volume or relative deflation volume. Future studies to define the factors that affect aortic flow during balloon deflation are needed to facilitate controlled reperfusion following REBOA.

Incidence and Determinants of Port Occlusions in Cancer Outpatients: A Prospective Cohort Study.

PubMed

Milani, Alessandra; Mazzocco, Ketti; Gandini, Sara; Pravettoni, Gabriella; Libutti, Livio; Zencovich, Claudia; Sbriglia, Ada; Pari, Chiara; Magon, Giorgio; Saiani, Luisa

Normal saline is considered a safe alternative for heparin as a locking solution in totally implantable venous access devices. The incidence rate of partial occlusion with the use of normal saline (easy injection, impossible aspiration) is estimated at 4%. The aim of this study was to investigate determinants of partial occlusions with the use of normal saline solution and the maintenance of positive pressure in the catheter. We enrolled 218 patients with different solid tumors who underwent pharmacologic treatment through the port with different frequencies: from once every week to at least once every month. The port was flushed with normal saline solution keeping a positive pressure in the catheter. We performed 4111 observations and documented normal port functioning in 99% of observations (n = 4057) and partial occlusions in 1% of observations (n = 54). Partial occlusions were significantly associated with frequency of port flushing (P < .05), chemotherapy (P < .001), and blood sample collection (P < .001). The use of positive pressure in addition to normal saline reduces the incidence rate of partial occlusions. The type of treatment, blood sample collection, and treatment schedule are important determinants of partial occlusions. Nurses play a key role in maintaining a functioning port using positive pressure during the flushing techniques. Certain risk factors must be monitored to prevent partial occlusions, and certain patients are more likely to present with port-related problems.

A successful retrograde re-entry at aorta using the Outback LTD catheter for a bilateral common iliac artery occlusion.

PubMed

Kim, Tae-Hoon; Ahn, Ji-Hun; Kim, Do-Hoi

2013-05-01

The Outback LTD re-entry catheter system has become a valuable tool for peripheral intervention and it has been widely used for variable peripheral chronic total occlusion (CTO). However, its use in the setting of the aorta was restricted because of concerns of bleeding risks resulting from re-entry puncture or ballooning. This report presents a case of successful re-entry using the Outback LTD Re-Entry Catheter (Cordis, Bridgewater, New Jersy) at the aorta in a patient with bilateral common iliac artery occlusion. Copyright © 2012 Wiley Periodicals, Inc.

Subclavian steal: Endovascular treatment of total occlusions of the subclavian artery using a retrograde transradial subintimal approach

PubMed Central

Golwala, Sohil N; Vance, Ansar Z; Tuerff, Sonya N

2016-01-01

Introduction In symptomatic subclavian steal syndrome, endovascular treatment is the first line of therapy prior to extra-anatomic surgical bypass procedures. Subintimal recanalization has been well described in the literature for the coronary arteries, and more recently, in the lower extremities. By modifying this approach, we present a unique retrograde technique using a heavy tip microwire to perform controlled subintimal dissection. Methods We present two cases of symptomatic subclavian steal related to chronic total occlusion of the left subclavian artery and right innominate artery, respectively. Standard crossing techniques were unsuccessful. Commonly at this point, the procedures would be aborted and open surgical intervention would have to be pursued. In our cases, retrograde access was easily achieved via an ipsilateral retrograde radial artery, using controlled subintimal dissection and a heavy-tipped wire. Results We were able to easily achieve recanalization in both attempted cases of chronic total occlusion of the subclavian and innominate artery, using a retrograde radial subintimal approach. Subsequent stent-supported angioplasty resulted in complete revascularization. No major complications were encountered during the procedures; however, one patient did develop thromboembolic stroke secondary to platelet aggregation to the stent graft, 9 days post-procedure. Conclusions Endovascular treatment is considered the first-line intervention in medically refractory patients with symptomatic subclavian steal syndrome. In the setting of chronic total occlusions, a retrograde radial subintimal approach using a heavy tip wire for controlled subintimal dissection is a novel technique that may be considered when standard approaches and wires have failed. PMID:26861024

Compliance with the prescribed occlusion treatment for amblyopia.

PubMed

Vagge, Aldo; Nelson, Leonard B

2017-09-01

The present review article is an update on the current evidence about compliance to the prescribed occlusion treatment for amblyopia. In particular, the authors focus on the predictors and causes of noncompliance and possible interventions to increase it. Compliance with prescribed occlusion treatment is often challenging. Reported rates of compliance range widely from 49% to 87%. Objective monitoring of occlusion has opened up new research opportunities and allow the design of effective therapeutic regimens. Also, predictors and causes of noncompliance have been investigated and their knowledge may help the clinician to improved compliance with prescribed occlusion treatment for amblyopia. Although many of the studies assessing the effectiveness of interventions to increase compliance to patching treatment for amblyopia have many limitations, evidences support that use of educational supports, parents, and patient understanding on the importance of patching and written information should be considered to increase compliance with patching.

Acute vascular effects of waterpipe smoking: Importance of physical activity and fitness status.

PubMed

Alomari, Mahmoud A; Khabour, Omar F; Alzoubi, Karem H; Shqair, Dana M; Stoner, Lee

2015-06-01

While new forms of tobacco, including waterpipe (WP) smoking, continue to gain popularity, limited literature has examined the vascular health consequences. The purpose of the current study was to examine: (i) the acute WP-induced changes in vascular function; (ii) whether acute changes in vascular function are modified by lifestyle behaviors (habitual physical activity, physical fitness). Fifty three (22.7 y, 36% F, 23.4 kg/m(2)) otherwise healthy WP smokers were recruited. Strain-gauge plethysmography was used to measure forearm blood flow, vascular resistance, venous capacitance, and venous outflow at rest and following occlusion. Habitual physical activity was determined using the Arabic version of short-form international physical activity questionnaire, while physical fitness was assessed using the 6 min walk test and handgrip strength. Partial correlations were used to examine the relationships between post-smoking vascular function and lifestyle behaviors, controlling for pre-smoking vascular measures. (i) WP had a small effect on forearm post-occlusion blood flow (d = -0.19), a moderate effect on venous outflow (d = 0.30), and a moderate effect on post-occlusion vascular resistance (d = 0.32). (ii) Total habitual physical activity strongly correlated with resting blood flow (r = 0.50) and moderately with vascular resistance (r = -0.40). Handgrip strength moderately correlated with venous capacitance (r = 0.30) and post-occlusion blood flow (r = 0.30), while 6 min walked distance moderately correlated with resting venous capacitance (r = 0.30). Waterpipe smoking is associated with immediate changes in vascular function, which are exacerbated in individuals with low habitual physical activity and physical fitness levels in young otherwise healthy individuals. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Insulin resistance is associated with a poor response to intravenous thrombolysis in acute ischemic stroke.

PubMed

Calleja, Ana I; García-Bermejo, Pablo; Cortijo, Elisa; Bustamante, Rosa; Rojo Martínez, Esther; González Sarmiento, Enrique; Fernández-Herranz, Rosa; Arenillas, Juan F

2011-11-01

Insulin resistance (IR) may not only increase stroke risk, but could also contribute to aggravate stroke prognosis. Mainly through a derangement in endogenous fibrinolysis, IR could affect the response to intravenous thrombolysis, currently the only therapy proved to be efficacious for acute ischemic stroke. We hypothesized that high IR is associated with more persistent arterial occlusions and poorer long-term outcome after stroke thrombolysis. We performed a prospective, observational, longitudinal study in consecutive acute ischemic stroke patients presenting with middle cerebral artery (MCA) occlusion who received intravenous thrombolysis. Patients with acute hyperglycemia (≥155 mg/dL) receiving insulin were excluded. IR was determined during admission by the homeostatic model assessment index (HOMA-IR). Poor long-term outcome, as defined by a day 90 modified Rankin scale score ≥ 3, was considered the primary outcome variable. Transcranial Duplex-assessed resistance to MCA recanalization and symptomatic hemorrhagic transformation were considered secondary end points. A total of 109 thrombolysed MCA ischemic stroke patients were included (43.1% women, mean age 71 years). The HOMA-IR was higher in the group of patients with poor outcome (P = 0.02). The probability of good outcome decreased gradually with increasing HOMA-IR tertiles (80.6%, 1st tertile; 71.4%, 2nd tertile; and 55.3%, upper tertile). A HOMA-IR in the upper tertile was independently associated with poor outcome when compared with the lower tertile (odds ratio [OR] 8.54 [95% CI 1.67-43.55]; P = 0.01) and was associated with more persistent MCA occlusions (OR 8.2 [1.23-54.44]; P = 0.029). High IR may be associated with more persistent arterial occlusions and worse long-term outcome after acute ischemic stroke thrombolysis.

Insulin Resistance Is Associated With a Poor Response to Intravenous Thrombolysis in Acute Ischemic Stroke

PubMed Central

Calleja, Ana I.; García-Bermejo, Pablo; Cortijo, Elisa; Bustamante, Rosa; Rojo Martínez, Esther; González Sarmiento, Enrique; Fernández-Herranz, Rosa; Arenillas, Juan F.

2011-01-01

OBJECTIVE Insulin resistance (IR) may not only increase stroke risk, but could also contribute to aggravate stroke prognosis. Mainly through a derangement in endogenous fibrinolysis, IR could affect the response to intravenous thrombolysis, currently the only therapy proved to be efficacious for acute ischemic stroke. We hypothesized that high IR is associated with more persistent arterial occlusions and poorer long-term outcome after stroke thrombolysis. RESEARCH DESIGN AND METHODS We performed a prospective, observational, longitudinal study in consecutive acute ischemic stroke patients presenting with middle cerebral artery (MCA) occlusion who received intravenous thrombolysis. Patients with acute hyperglycemia (≥155 mg/dL) receiving insulin were excluded. IR was determined during admission by the homeostatic model assessment index (HOMA-IR). Poor long-term outcome, as defined by a day 90 modified Rankin scale score ≥3, was considered the primary outcome variable. Transcranial Duplex-assessed resistance to MCA recanalization and symptomatic hemorrhagic transformation were considered secondary end points. RESULTS A total of 109 thrombolysed MCA ischemic stroke patients were included (43.1% women, mean age 71 years). The HOMA-IR was higher in the group of patients with poor outcome (P = 0.02). The probability of good outcome decreased gradually with increasing HOMA-IR tertiles (80.6%, 1st tertile; 71.4%, 2nd tertile; and 55.3%, upper tertile). A HOMA-IR in the upper tertile was independently associated with poor outcome when compared with the lower tertile (odds ratio [OR] 8.54 [95% CI 1.67–43.55]; P = 0.01) and was associated with more persistent MCA occlusions (OR 8.2 [1.23–54.44]; P = 0.029). CONCLUSIONS High IR may be associated with more persistent arterial occlusions and worse long-term outcome after acute ischemic stroke thrombolysis. PMID:21911778

Preclinical assessment of a modified Occlutech left atrial appendage closure device in a canine model.

PubMed

Kim, Jung-Sun; Lee, Seul-Gee; Bong, Sung-Kyung; Park, Se-Il; Hong, Sung-Yu; Shin, Sanghoon; Shim, Chi Young; Hong, Geu-Ru; Choi, Donghoon; Jang, Yangsoo; Park, Jai-Wun

2016-10-15

LAA occlusion has a similar stroke prevention efficacy compared to anticoagulation treatment for non-valvular atrial fibrillation. The objective of this study was to assess the feasibility and safety of a modified Occlutech® left atrial appendage (LAA) closure device in a canine model. The device was implanted in 10 dogs (33±1kg) using fluoroscopy and transesophageal echocardiography (TEE) guidance. The modified Occlutech® LAA occlusion device was compared with the current version, the Watchman device, and the Amplazter cardiac plug (ACP). LAA occlusion and anchoring to the LAA were evaluated. All dogs were assessed using angiography, TEE, and a gross anatomy examination. The 10 LAA occlusion devices were to be implanted into 10 dogs (5 modified Occlutech devices, 3 current version of Occlutech devices, 1 Watchman, and 1 ACP). LAA implantation was not performed in one dog due to transeptal puncture failure. The three current version of Occlutech devices were embolized immediately after implantation, so three modified devices of the same size were implanted securely without embolization. The mean implant size was 20.1±2.0mm. The devices chosen were a mean of 23.3±10.6% larger than the measured landing zone diameters. Post-implant angiography and TEE revealed well-positioned devices without pericardial effusion or impingement on surrounding structures. The results of this acute animal study suggested that a modified Occlutech® LAA occlusion device was feasible and had greater anchoring performance in canines. Additional large clinical studies are needed to evaluate safety and efficacy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Subadventitial techniques for chronic total occlusion percutaneous coronary intervention: The concept of "vessel architecture".

PubMed

Azzalini, Lorenzo; Carlino, Mauro; Brilakis, Emmanouil S; Vo, Minh; Rinfret, Stéphane; Uretsky, Barry F; Karmpaliotis, Dimitri; Colombo, Antonio

2018-03-01

Despite improvements in guidewire technologies, the traditional antegrade wire escalation approach to chronic total occlusion (CTO) recanalization is successful in only 60-80% of selected cases. In particular, long, calcified, and tortuous occlusions are less successfully approached with a true-to-true lumen approach. Frequently, the guidewire tracks into the subadventitial space, with no guarantee of distal re-entry into the true lumen. The ability to manage the subadventitial space has been a key step in the tremendous improvement in success rates of contemporary CTO percutaneous coronary intervention (PCI), whether operating antegradely or retrogradely. A modern approach to CTO PCI involves understanding the concept of "vessel architecture," which is based on the distinction between coronary structures (occlusive plaque, comprising the disrupted intima and media, and the outer adventitia) and extravascular space. The vessel architecture represents a safe work environment for guidewire and device manipulation. This review provides an anatomy-based description of the concept of vessel architecture, along with a historical perspective of subadventitial techniques for CTO PCI, and outcome data of CTO PCI utilizing the subadventitial space. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

The Integration of Occlusion and Disparity Information for Judging Depth in Autism Spectrum Disorder

ERIC Educational Resources Information Center

Smith, Danielle; Ropar, Danielle; Allen, Harriet A.

2017-01-01

In autism spectrum disorder (ASD), atypical integration of visual depth cues may be due to flattened perceptual priors or selective fusion. The current study attempts to disentangle these explanations by psychophysically assessing within-modality integration of ordinal (occlusion) and metric (disparity) depth cues while accounting for sensitivity…

Why bundled payments could drive innovation: an example from interventional oncology.

PubMed

Steele, Joseph R; Jones, A Kyle; Ninan, Elizabeth P; Clarke, Ryan K; Odisio, Bruno C; Avritscher, Rony; Murthy, Ravi; Mahvash, Armeen

2015-03-01

Some have suggested that the current fee-for-service health care payment system in the United States stifles innovation. However, there are few published examples supporting this concept. We implemented an innovative temporary balloon occlusion technique for yttrium 90 radioembolization of nonresectable liver cancer. Although our balloon occlusion technique was associated with similar patient outcomes, lower cost, and faster procedure times compared with the standard-of-care coil embolization technique, our technique failed to gain widespread acceptance. Financial analysis revealed that because the balloon occlusion technique avoided a procedural step associated with a lucrative Current Procedural Terminology billing code, this new technique resulted in a significant decrease in hospital and physician revenue in the current fee-for-service payment system, even though the new technique would provide a revenue enhancement through cost savings in a bundled payment system. Our analysis illustrates how in a fee-for-service payment system, financial disincentives can stifle innovation and advancement of health care delivery. Copyright © 2015 by American Society of Clinical Oncology.

Progressive Occlusion of Small Saccular Aneurysms Incompletely Occluded After Stent-Assisted Coil Embolization : Analysis of Related Factors and Long-Term Outcomes.

PubMed

Lim, Jeong Wook; Lee, Jeongjun; Cho, Young Dae

2017-08-08

Incompletely occluded aneurysms after coil embolization are subject to recanalization but occasionally progress to a totally occluded state. Deployed stents may actually promote thrombosis of coiled aneurysms. We evaluated outcomes of small aneurysms (<10 mm) wherein saccular filling with contrast medium was evident after stent-assisted coiling, assessing factors implicated in subsequent progressive occlusion. Between September 2012 and June 2016, a total of 463 intracranial aneurysms were treated by stent-assisted coil embolization. Of these, 132 small saccular aneurysms displayed saccular filling with contrast medium in the immediate aftermath of coiling. Progressive thrombosis was defined as complete aneurysmal occlusion at the 6‑month follow-up point. Rates of progressive occlusion and factors predisposing to this were analyzed via binary logistic regression. In 101 (76.5%) of the 132 intracranial aneurysms, complete occlusion was observed in follow-up imaging studies at 6 months. Binary logistic regression analysis indicated that progressive occlusion was linked to smaller neck diameter (odds ratio [OR] = 1.533; p = 0.003), hyperlipidemia (OR = 3.329; p = 0.036) and stent type (p = 0.031). The LVIS stent is especially susceptible to progressive thrombosis, more so than Neuroform (OR = 0.098; p = 0.008) or Enterprise (OR = 0.317; p = 0.098) stents. In 57 instances of progressive thrombosis, followed for ≥12 months (mean 25.0 ± 10.7 months), 56 (98.2%) were stable, with minor recanalization noted once (1.8%) and no major recanalization. Aneurysms associated with smaller diameter necks, hyperlipidemic states and LVIS stent deployment may be inclined to possible thrombosis, if occlusion immediately after stent-assisted coil embolization is incomplete. In such instances, excellent long-term durability is anticipated.

Part-time occlusion therapy for amblyopia in older children

PubMed Central

Singh, Inderpreet; Sachdev, Nishant; Kaushik, Sushmita

2008-01-01

Aim: To compare the efficacy of part-time versus full-time occlusion for treatment of amblyopia in children aged 7-12 years. Materials and Methods: Prospective interventional case series. One hundred children between 7-12 years of age with anisometropic (57), strabismic (25) and mixed (18) unilateral amblyopia were randomized (simple randomization) into four groups (25 each) to receive two hours, four hours, six hours or full-time occlusion therapy. Children were regularly followed up at six-weekly intervals for a minimum of three visits. Statistical Analysis: Intragroup visual improvement was analyzed using paired t-test while intergroup comparisons were done using ANOVA and unpaired t-test. Results: All four groups showed significant visual improvement after 18 weeks of occlusion therapy (P<0.001). Seventy-three (73%) of the total 100 eyes responded to amblyopia therapy with 11 eyes (44%), 17 eyes (68%), 22 eyes (88%) and 23 eyes (92%) being amblyopia responders in the four groups respectively, with the least number of responders in the two hours group. In mild to moderate amblyopia (vision 20/30 to 20/80), there was no significant difference in visual outcome among the four groups (P=0.083). However, in severe amblyopia (vision 20/100 or worse), six hours (P=0.048) and full-time occlusion (P=0.027) treatment were significantly more effective than two hours occlusion. Conclusion: All grades of part-time occlusion are comparable to full-time occlusion in effectiveness of treatment for mild to moderate amblyopia in children between 7-12 years of age unlike in severe amblyopia, where six hours and full-time occlusion were more effective than two hours occlusion therapy. PMID:18974515

Posterior teeth occlusion and dysphagia risk in older nursing home residents: a cross-sectional observational study.

PubMed

Okabe, Y; Takeuchi, K; Izumi, M; Furuta, M; Takeshita, T; Shibata, Y; Kageyama, S; Ganaha, S; Yamashita, Y

2017-02-01

The total number of natural teeth was related to swallowing function among older adults; however, limited information is available regarding the impact of occluding pairs of teeth on swallowing function. This study aimed to examine the association between posterior teeth occlusion and dysphagia risk in older nursing home residents. This cross-sectional study included 238 residents aged ≥60 years from eight nursing homes in Aso City, Japan. Swallowing function was evaluated using the modified water swallowing test (MWST); the primary outcome was dysphagia risk (MWST score ≤3). Posterior teeth occlusion was assessed using number of functional tooth units (FTUs), determined based on number and location of the remaining natural and artificial teeth on implant-supported, fixed or removable prostheses. Univariate and multivariate logistic regression analyses were performed to examine the association between posterior teeth occlusion and dysphagia risk, adjusted for the covariates of number of natural teeth, demographic characteristics, comorbidities, physical function, body mass index and cognitive function. Of the 238 subjects, 44 (18·5%) were determined to be at risk of dysphagia based on the MWST scores. The odds ratio (OR) of dysphagia risk decreased in subjects with higher total FTUs [OR = 0·92, 95% confidence interval (CI) 0·87-0·98]. After adjusting for covariates, this association remained significant (OR = 0·90, 95% CI 0·84-0·97). Loss of posterior teeth occlusion was independently associated with dysphagia risk in older nursing home residents. Maintaining and restoring posterior teeth occlusion may be an effective measure to prevent dysphagia. © 2016 John Wiley & Sons Ltd.

Retention and penetration of a conventional resin-based sealant and a photochromatic flowable composite resin placed on occlusal pits and fissures.

PubMed

Aguilar, F G; Drubi-Filho, B; Casemiro, L A; Watanabe, M G C; Pires-de-Souza, F C P

2007-01-01

This study compares the retention and penetration of a conventional resin-based sealant (Fluroshield) and a photochromatic flowable composite resin (Tetric Flow Chroma) placed on occlusal pits and fissures and submitted to thermal or chemical cycling regimens. Penetration assessment--ten premolars were sealed with each material, isolated (except for the sealed surface) and immersed in 0.2% Rhodamine B. The teeth were serially sectioned in a mesiodistal direction. The images of the sections were digitized and analyzed (ImageLab). The distance between the most superficial and the deepest points on the occlusal central groove was calculated to determine the groove's total depth. The length of the central groove filled with the sealant was divided by its total depth to obtain the percentage of sealing of the occlusal groove. Retention assessment--30 premolars were sealed, their occlusal surfaces were photographed and the area occupied by the sealing materials was demarcated (ImageLab). The teeth were submitted to different treatments: thermocycled, stored in artificial saliva and immersed in acetic acid and saliva (10 cycles/day protocol for 30 days). New photographs were taken to assess the final area occupied by the materials. The difference between the final and initial area was calculated to obtain the material loss. The data was analyzed (two-way ANOVA and Tukey's test P<0.05). Both materials presented similar penetration of the occlusal central groove. After thermal and chemical cycling, the materials did not differ with respect to retention, except for immersion in acetic acid. In this case, Tetric Flow Chroma presented greater retention than Fluoroshield.

Usefulness of the Corsair microcatheter for treatment of complex chronic total occlusion.

PubMed

Otsuka, Yoritaka; Nakamura, Keita; Saito, Taro

2012-02-01

Percutaneous coronary intervention (PCI) for the treatment of chronic total occlusion (CTO) is one of the most technically challenging areas of interventional cardiology. When CTO is combined with angulation and tortuosity of the coronary artery, the technical complexity of PCI for CTO is magnified. In this report, we describe a case of successful revascularization of a CTO lesion in the complex circumflex anatomy using a novel microcatheter (the Corsair catheter) along with an antegrade approach to facilitate guidewire passage through a proximal steep angulation and to cross the circumflex CTO lesion that was unresponsive with conventional microcatheters.

Optical Coherence Tomography and Stent Boost Imaging Guided Bioresorbable Vascular Scaffold Overlapping for Coronary Chronic Total Occlusion Lesion

PubMed Central

Li, Hu; Choi, Cheol Ung; Oh, Dong Joo

2017-01-01

We report herein the optical coherence tomography (OCT) and stent boost imaging guided bioresorbable vascular scaffold (BVS) implantation for right coronary artery (RCA) chronic total occlusion (CTO) lesion. The gold standard for evaluating BVS expansion after percutaneous coronary intervention is OCT. However, stent boost imaging is a new technique that improves fluoroscopy-based assessments of stent overlapping, and the present case shows clinical usefulness of OCT and stent boost imaging guided ‘overlapping’ BVS implantation via antegrade approach for a typical RCA CTO lesion. PMID:28792157

The effect of occlusion therapy on motion perception deficits in amblyopia.

PubMed

Giaschi, Deborah; Chapman, Christine; Meier, Kimberly; Narasimhan, Sathyasri; Regan, David

2015-09-01

There is growing evidence for deficits in motion perception in amblyopia, but these are rarely assessed clinically. In this prospective study we examined the effect of occlusion therapy on motion-defined form perception and multiple-object tracking. Participants included children (3-10years old) with unilateral anisometropic and/or strabismic amblyopia who were currently undergoing occlusion therapy and age-matched control children with normal vision. At the start of the study, deficits in motion-defined form perception were present in at least one eye in 69% of the children with amblyopia. These deficits were still present at the end of the study in 55% of the amblyopia group. For multiple-object tracking, deficits were present initially in 64% and finally in 55% of the children with amblyopia, even after completion of occlusion therapy. Many of these deficits persisted in spite of an improvement in amblyopic eye visual acuity in response to occlusion therapy. The prevalence of motion perception deficits in amblyopia as well as their resistance to occlusion therapy, support the need for new approaches to amblyopia treatment. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effect of resistance exercise training combined with relatively low vascular occlusion.

PubMed

Sumide, Takahiro; Sakuraba, Keishoku; Sawaki, Keisuke; Ohmura, Hirotoshi; Tamura, Yoshifumi

2009-01-01

Previous studies have demonstrated that a low-intensity resistance exercise, combined with vascular occlusion, results in a marked increase in muscular size and strength. We investigated the optimal pressure for reduction of muscle blood flow with resistance exercise to increase the muscular strength and endurance. Twenty-one subjects were randomly divided into four groups by the different application of vascular occlusion pressure at the proximal of thigh: without any pressure (0-pressure group), with a pressure of 50mmHg (50-pressure group), with a pressure of 150mmHg (150-pressure group), and with a pressure of 250mmHg (250-pressure group). The isokinetic muscle strength at angular velocities of 60 and 180 degrees /s, total muscle work, and the cross-sectional knee extensor muscle area were assessed before and after exercise. Exercise was performed three times a week over an 8-week period at an intensity of approximately 20% of one-repetition maximum for straight leg raising and hip joint adduction and maximum force for abduction training. A significant increase in strength at 180 degrees /s was noted after exercise in all subjects who exercised under vascular occlusion. Total muscle work increased significantly in the 50- and 150-pressure groups (P<0.05, P<0.01, respectively). There was no significant increase in cross-sectional knee extensor muscle area in any groups. In conclusion, resistance exercise with relatively low vascular occlusion pressure is potentially useful to increase muscle strength and endurance without discomfort.

Near-infrared spectroscopic assessment of oxygen delivery to free flaps on monkeys following vascular occlusions and inhalation of pure oxygen

NASA Astrophysics Data System (ADS)

Tian, Fenghua; Ding, Haishu; Cai, Zhigang; Wang, Guangzhi; Zhao, Fuyun

2002-04-01

In recent studies, near-infrared spectroscopy (NIRS) has been considered as a potentially ideal noninvasive technique for the postoperative monitoring of plastic surgery. In this study, free flaps were raised on rhesus monkeys' forearms and oxygen delivery to these flaps was monitored following vascular occlusions and inhalation of pure oxygen. Optical fibers were adopted in the probe of the oximeter so that the detection could be performed in reflectance mode. The distance between emitter and detector can be adjusted easily to achieve the best efficacy. Different and repeatable patterns of changes were measured following vascular occlusions (arterial occlusion, venous occlusion and total occlusion) on flaps. It is clear that the near-infrared spectroscopy is capable of postoperatively monitoring vascular problems in flaps. NIRS showed high sensitivity to detect the dynamic changes in flaps induced by inhalation of pure oxygen in this study. The experimental results indicated that it was potential to assess tissue viability utilizing the dynamic changes induced by a noninvasive stimulation. It may be a new assessing method that is rapid, little influenced by other factors and brings less discomfort to patients.

Increased carboxyhemoglobin level during liver resection with inflow occlusion.

PubMed

Godai, Kohei; Hasegawa-Moriyama, Maiko; Kuniyoshi, Tamotsu; Matsunaga, Akira; Kanmura, Yuichi

2013-04-01

Controlling stress responses associated with ischemic changes due to bleeding and ischemia/reperfusion injury is essential for anesthetic management. Endogenous carboxyhemoglobin (COHb) is produced in the oxidative degradation of heme proteins by the stress-response enzyme heme oxygenase. Although the COHb level is elevated in critically ill patients, changes in endogenous COHb during anesthesia have not been well investigated. Therefore, we evaluated changes in endogenous COHb levels in patients undergoing liver resections with inflow occlusion. Levels of COHb were significantly increased after the Pringle maneuver. The inflow occlusion time in patients with increased COHb after the Pringle maneuver (∆COHb > 0.3 %) was significantly longer than in patients without increased COHb (∆COHb < 0.3 %) (P = 0.01). In addition, COHb changes were correlated with inflow occlusion time (P = 0.005, R(2) = 0.21). Neither total blood loss, transfusion volume of packed red blood cells, operation time, nor anesthetic time differed between patients with and without increased COHb. The results indicated that endogenous COHb levels were increased by inflow occlusion in patients undergoing liver resections, which suggests that changes in COHb may correlate with hepatic ischemia/reperfusion injury induced by inflow occlusion.

Object Correspondence across Brief Occlusion Is Established on the Basis of both Spatiotemporal and Surface Feature Cues

ERIC Educational Resources Information Center

Hollingworth, Andrew; Franconeri, Steven L.

2009-01-01

The "correspondence problem" is a classic issue in vision and cognition. Frequent perceptual disruptions, such as saccades and brief occlusion, create gaps in perceptual input. How does the visual system establish correspondence between objects visible before and after the disruption? Current theories hold that object correspondence is established…

Detection of questionable occlusal carious lesions using an electrical bioimpedance method with fractional electrical model

NASA Astrophysics Data System (ADS)

Morais, A. P.; Pino, A. V.; Souza, M. N.

2016-08-01

This in vitro study evaluated the diagnostic performance of an alternative electric bioimpedance spectroscopy technique (BIS-STEP) detect questionable occlusal carious lesions. Six specialists carried out the visual (V), radiography (R), and combined (VR) exams of 57 sound or non-cavitated occlusal carious lesion teeth classifying the occlusal surfaces in sound surface (H), enamel caries (EC), and dentinal caries (DC). Measurements were based on the current response to a step voltage excitation (BIS-STEP). A fractional electrical model was used to predict the current response in the time domain and to estimate the model parameters: Rs and Rp (resistive parameters), and C and α (fractional parameters). Histological analysis showed caries prevalence of 33.3% being 15.8% hidden caries. Combined examination obtained the best traditional diagnostic results with specificity = 59.0%, sensitivity = 70.9%, and accuracy = 60.8%. There were statistically significant differences in bioimpedance parameters between the H and EC groups (p = 0.016) and between the H and DC groups (Rs, p = 0.006; Rp, p = 0.022, and α, p = 0.041). Using a suitable threshold for the Rs, we obtained specificity = 60.7%, sensitivity = 77.9%, accuracy = 73.2%, and 100% of detection for deep lesions. It can be concluded that BIS-STEP method could be an important tool to improve the detection and management of occlusal non-cavitated primary caries and pigmented sites.

Reliable porcine coronary model of chronic total occlusion using copper wire stents and bioabsorbable levo-polylactic acid polymer.

PubMed

Sim, Doo Sun; Jeong, Myung Ho; Cha, Kyoung Rae; Park, Suk Ho; Park, Jong Oh; Shin, Young Min; Shin, Heungsoo; Hong, Young Joon; Ahn, Youngkeun; Schwartz, Robert S; Kang, Jung Chaee

2012-12-01

Chronic total occlusion (CTO) remains a challenge in interventional cardiology. We investigated the feasibility and reliability of copper wire stents and levo-polylactic acid (l-PLA) as a means of CTO induction in a porcine model. In one group of 20 swine, copper stents were crimped on a 3.0mm angioplasty balloon and inserted into the mid-left anterior descending coronary artery (LAD). In the other group of 20 swine, l-PLA was wrapped on a guidewire and pushed into the distal LAD with a 3.0mm balloon catheter to induce embolization. Of 20 swine which underwent copper stent implantation, 13 died of stent thrombosis. In the remaining 7 swine, total or near total occlusion with collateral circulation was observed at 5 weeks. Of 20 swine which underwent l-PLA embolization, 4 died of ventricular fibrillation during or shortly after the procedure. Serial histopathologic studies showed complete absorption of the polymer with replacement by fibrotic tissue approximately 4 weeks following the polymer implantation. CTO could be reliably induced in porcine coronary arteries by copper stents and l-PLA. These models may support investigation of new percutaneous devices to facilitate CTO interventions. Copyright © 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

[Occlusion: current situation and prospect in view of holistic integrative medicine].

PubMed

Wang, M Q; Liu, X D

2017-08-09

The rise of holistic integrative medicine (HIM) is an inevitable consequence of modern medical development which emphasizes the change from specialization to integration of the most advanced medical knowledge. It does not mean a simple collection of the medical theories, but means the digestion of those theories for the clinical practical application. Because occlusal therapy is characterized as not only a high level of individualization, but also a relation to many stomatology and other disciplines, such as plastic surgery, orthopedics, neurosciences and psychology. It needs the HIM to guide the clinical practice. With undertaking occlusal therapy, to avoid the limitation due to the excessive specialized disciplines, and to provide effective treatment plans for abnormal occlusion induced diseases, it is necessary to develop the discipline of the holistic integrative stomatology.

Partial white and grey matter protection with prolonged infusion of recombinant human erythropoietin after asphyxia in preterm fetal sheep.

PubMed

Wassink, Guido; Davidson, Joanne O; Dhillon, Simerdeep K; Fraser, Mhoyra; Galinsky, Robert; Bennet, Laura; Gunn, Alistair J

2017-03-01

Perinatal asphyxia in preterm infants remains a significant contributor to abnormal long-term neurodevelopmental outcomes. Recombinant human erythropoietin has potent non-haematopoietic neuroprotective properties, but there is limited evidence for protection in the preterm brain. Preterm (0.7 gestation) fetal sheep received sham asphyxia (sham occlusion) or asphyxia induced by umbilical cord occlusion for 25 min, followed by an intravenous infusion of vehicle (occlusion-vehicle) or recombinant human erythropoietin (occlusion-Epo, 5000 international units by slow push, then 832.5 IU/h), starting 30 min after asphyxia and continued until 72 h. Recombinant human erythropoietin reduced neuronal loss and numbers of caspase-3-positive cells in the striatal caudate nucleus, CA3 and dentate gyrus of the hippocampus, and thalamic medial nucleus ( P < 0.05 vs. occlusion-vehicle). In the white matter tracts, recombinant human erythropoietin increased total, but not immature/mature oligodendrocytes ( P < 0.05 vs. occlusion-vehicle), with increased cell proliferation and reduced induction of activated caspase-3, microglia and astrocytes ( P < 0.05). Finally, occlusion-Epo reduced seizure burden, with more rapid recovery of electroencephalogram power, spectral edge frequency, and carotid blood flow. In summary, prolonged infusion of recombinant human erythropoietin after severe asphyxia in preterm fetal sheep was partially neuroprotective and improved electrophysiological and cerebrovascular recovery, in association with reduced apoptosis and inflammation.

Partial white and grey matter protection with prolonged infusion of recombinant human erythropoietin after asphyxia in preterm fetal sheep

PubMed Central

Wassink, Guido; Davidson, Joanne O; Dhillon, Simerdeep K; Fraser, Mhoyra; Galinsky, Robert; Bennet, Laura

2016-01-01

Perinatal asphyxia in preterm infants remains a significant contributor to abnormal long-term neurodevelopmental outcomes. Recombinant human erythropoietin has potent non-haematopoietic neuroprotective properties, but there is limited evidence for protection in the preterm brain. Preterm (0.7 gestation) fetal sheep received sham asphyxia (sham occlusion) or asphyxia induced by umbilical cord occlusion for 25 min, followed by an intravenous infusion of vehicle (occlusion-vehicle) or recombinant human erythropoietin (occlusion-Epo, 5000 international units by slow push, then 832.5 IU/h), starting 30 min after asphyxia and continued until 72 h. Recombinant human erythropoietin reduced neuronal loss and numbers of caspase-3-positive cells in the striatal caudate nucleus, CA3 and dentate gyrus of the hippocampus, and thalamic medial nucleus (P < 0.05 vs. occlusion-vehicle). In the white matter tracts, recombinant human erythropoietin increased total, but not immature/mature oligodendrocytes (P < 0.05 vs. occlusion-vehicle), with increased cell proliferation and reduced induction of activated caspase-3, microglia and astrocytes (P < 0.05). Finally, occlusion-Epo reduced seizure burden, with more rapid recovery of electroencephalogram power, spectral edge frequency, and carotid blood flow. In summary, prolonged infusion of recombinant human erythropoietin after severe asphyxia in preterm fetal sheep was partially neuroprotective and improved electrophysiological and cerebrovascular recovery, in association with reduced apoptosis and inflammation. PMID:27207167

Exacerbation of oxidative stress during sickle vaso-occlusive crisis is associated with decreased anti-band 3 autoantibodies rate and increased red blood cell-derived microparticle level: a prospective study.

PubMed

Hierso, Régine; Lemonne, Nathalie; Villaescusa, Rinaldo; Lalanne-Mistrih, Marie-Laure; Charlot, Keyne; Etienne-Julan, Maryse; Tressières, Benoit; Lamarre, Yann; Tarer, Vanessa; Garnier, Yohann; Hernandez, Ada Arce; Ferracci, Serge; Connes, Philippe; Romana, Marc; Hardy-Dessources, Marie-Dominique

2017-03-01

Painful vaso-occlusive crisis, a hallmark of sickle cell anaemia, results from complex, incompletely understood mechanisms. Red blood cell (RBC) damage caused by continuous endogenous and exogenous oxidative stress may precipitate the occurrence of vaso-occlusive crises. In order to gain insight into the relevance of oxidative stress in vaso-occlusive crisis occurrence, we prospectively compared the expression levels of various oxidative markers in 32 adults with sickle cell anaemia during vaso-occlusive crisis and steady-state conditions. Compared to steady-state condition, plasma levels of free haem, advanced oxidation protein products and myeloperoxidase, RBC caspase-3 activity, as well as the concentrations of total, neutrophil- and RBC-derived microparticles were increased during vaso-occlusive crises, whereas the reduced glutathione content was decreased in RBCs. In addition, natural anti-band 3 autoantibodies levels decreased during crisis and were negatively correlated with the rise in plasma advanced oxidation protein products and RBC caspase-3 activity. These data showed an exacerbation of the oxidative stress during vaso-occlusive crises in sickle cell anaemia patients and strongly suggest that the higher concentration of harmful circulating RBC-derived microparticles and the reduced anti-band 3 autoantibodies levels may be both related to the recruitment of oxidized band 3 into membrane aggregates. © 2016 John Wiley & Sons Ltd.

Diagnosis of occlusal dysesthesia utilizing prefrontal hemodynamic activity with slight occlusal interference.

PubMed

Ono, Yumie; Ishikawa, Yu; Munakata, Motohiro; Shibuya, Tomoaki; Shimada, Atsushi; Miyachi, Hideo; Wake, Hiroyuki; Tamaki, Katsushi

2016-11-01

Clinical diagnosis of occlusal dysesthesia (OD), also referred to as phantom bite syndrome, is currently based on the absence of objective occlusal discrepancy despite the persistent complaint of uncomfortable bite sensation. We previously demonstrated that the subjective feeling of occlusal discomfort generated by artificial occlusal interference can be objectively evaluated using prefrontal hemodynamic activity in young healthy individuals. The aim of this study was to investigate whether dental patients with and without OD show distinct prefrontal activity during grinding behavior with an occlusal interference. Six dental patients with OD (OD group) and eight patients without OD (control group) grinded piled occlusal strips placed between their first molars and reported their perception and discomfort thresholds during continuous monitoring of prefrontal hemodynamic activity with a portable functional near-infrared spectroscopy. Although patients without OD showed the typical hemodynamic pattern of increased oxyhemoglobin and reduced deoxyhemoglobin (HHb) concentration, those with OD showed persistent incremental increases of HHb concentration that began at the loading of occlusal strips on their molars before they executed grinding. The intensities of the task-related HHb activities showed statistically significant differences between OD and control groups, particularly at channel 3, arranged over the left frontal pole cortex. When the discrimination criterion was set using the intensity values of channel 3 from both groups, the overall accuracy of the OD discrimination was 92.9%. Although physiological interpretation has yet to be elucidated, the task-related response of an increase in HHb may be a useful neuronal signature to characterize dental patients with OD.

Diagnosis of occlusal dysesthesia utilizing prefrontal hemodynamic activity with slight occlusal interference

PubMed Central

Ishikawa, Yu; Munakata, Motohiro; Shibuya, Tomoaki; Shimada, Atsushi; Miyachi, Hideo; Wake, Hiroyuki; Tamaki, Katsushi

2016-01-01

Clinical diagnosis of occlusal dysesthesia (OD), also referred to as phantom bite syndrome, is currently based on the absence of objective occlusal discrepancy despite the persistent complaint of uncomfortable bite sensation. We previously demonstrated that the subjective feeling of occlusal discomfort generated by artificial occlusal interference can be objectively evaluated using prefrontal hemodynamic activity in young healthy individuals. The aim of this study was to investigate whether dental patients with and without OD show distinct prefrontal activity during grinding behavior with an occlusal interference. Six dental patients with OD (OD group) and eight patients without OD (control group) grinded piled occlusal strips placed between their first molars and reported their perception and discomfort thresholds during continuous monitoring of prefrontal hemodynamic activity with a portable functional near‐infrared spectroscopy. Although patients without OD showed the typical hemodynamic pattern of increased oxyhemoglobin and reduced deoxyhemoglobin (HHb) concentration, those with OD showed persistent incremental increases of HHb concentration that began at the loading of occlusal strips on their molars before they executed grinding. The intensities of the task‐related HHb activities showed statistically significant differences between OD and control groups, particularly at channel 3, arranged over the left frontal pole cortex. When the discrimination criterion was set using the intensity values of channel 3 from both groups, the overall accuracy of the OD discrimination was 92.9%. Although physiological interpretation has yet to be elucidated, the task‐related response of an increase in HHb may be a useful neuronal signature to characterize dental patients with OD. PMID:29744159

Rescue percutaneous coronary recanalization of right coronary artery by retrograde approach

PubMed Central

Kameczura, Tomasz; Surowiec, Sławomir; Dudek, Dariusz; Czarnecka, Danuta

2013-01-01

We describe the case of a 62-year-old female patient in whom there was an occlusion of collaterals and acute inferior wall ischemia during the opening procedure of right coronary artery (RCA) chronic total occlusion. Rescue percutaneous coronary intervention (PCI) of RCA by the retrograde approach was performed preventing heart muscle damage. In this article we discuss the issue of PCI by the retrograde technique. PMID:24570712

Eye-hand exercise: new variant in amblyopia management.

PubMed

Svĕrák, J; Peregrin, J; Juran, J

1990-01-01

A total of 50 children with unilateral amblyopia was treated by short term 10 minute-lasting weekly occlusions of visually well eye. During the occlusion the child is providing the intensive detailed activities under patient's supervision. After an approximately half-a-year lasting interval, the "eye-hand" exercise resulted in the mean improvement of visual acuity for 2.44 normalised lines. The visual motor factor is involved in amblyopia treatment.

The Aortic Bifurcation Angle as a Factor in Application of the Outback for Femoropopliteal Lesions in Ipsilateral Versus Contralateral Approaches.

PubMed

Raskin, Daniel; Khaitovich, Boris; Balan, Shmuel; Silverberg, Daniel; Halak, Moshe; Rimon, Uri

2018-01-01

To assess the technical success of the Outback reentry device in contralateral versus ipsilateral approaches for femoropopliteal arterial occlusion. A retrospective review of patients treated for critical limb ischemia (CLI) using the Outback between January 2013 and July 2016 was performed. Age, gender, length and site of the occlusion, approach site, aortic bifurcation angle, and reentry site were recorded. Calcification score was assigned at both aortic bifurcation and reentry site. Technical success was assessed. During the study period, a total of 1300 endovascular procedures were performed on 489 patients for CLI. The Outback was applied on 50 femoropopliteal chronic total occlusions. Thirty-nine contralateral and 11 ipsilateral antegrade femoral were accessed. The device was used successfully in 41 patients (82%). There were nine failures, all in the contralateral approach group. Six due to inability to deliver the device due to acute aortic bifurcation angle and three due to failure to achieve luminal reentry. Procedural success was significantly affected by the aortic bifurcation angle (p = 0.013). The Outback has high technical success rates in treatment of femoropopliteal occlusion, when applied from either an ipsi- or contralateral approach. When applied in contralateral access, acute aortic bifurcation angle predicts procedural failure.

Retrograde Coronary Chronic Total Occlusion Intervention

PubMed Central

Dash, Debabrata

2015-01-01

Coronary chronic total occlusion (CTO) is a frequent finding in patients with coronary artery disease. It remains one of the most challenging subsets, accounting for 10-20% of all percutaneous coronary interventions (PCI). Although remarkable progress in PCI has been made, it is reasonable to state that successful recanalization of CTO represents the “last frontier” of PCI. PCI of CTOs has been limited historically by technical success rates of 50-70%. The introduction of enhanced guidewires, microcatheter, channel dilatator with increasing operator experience, and innovative techniques such as the retrograde approach have raised hopes for better outcomes. This article goes into depth into various strategies of retrograde approach in CTO.

Challenges in Complicated Coronary Chronic Total Occlusion Recanalisation

PubMed Central

Reifart, Nicolaus

2013-01-01

Percutaneous coronary intervention for chronic total occlusions (CTOs) is still today a challenge even for experienced operators. In the hands of the most experienced the success rate increased from about 60 to 90 % in the past 10 years; paralleled by a long-term patency with drug-eluting stents exceeding 90 %. These results are comparable or even superior to surgical revascularisation. Thanks to Japanese and European CTO club online registries and live courses we are able to rapidly understand and adopt new strategies, techniques and materials to master morphology deemed untreatable 10 years ago. Several of the persistent challenges and solutions unique to CTO interventions are discussed. PMID:29588761

Influence of occlusal plane inclination and mandibular deviation on esthetics

PubMed Central

Corte, Cristiane Cherobini Dalla; da Silveira, Bruno Lopes; Marquezan, Mariana

2015-01-01

Objective: The aim of this study was to assess the degree of perception of occlusal plane inclination and mandibular deviation in facial esthetics, assessed by laypeople, dentists and orthodontists. Methods: A woman with 5.88° of inclination and 5.54 mm of mandibular deviation was selected and, based on her original photograph, four new images were created correcting the deviations and creating more symmetric faces and smiles. Examiners assessed the images by means of a questionnaire. Their opinions were compared by qualitative and quantitative analyses. Results: A total of 45 laypeople, 27 dentists and 31 orthodontists filled out the questionnaires. All groups were able to perceive the asymmetry; however, orthodontists were more sensitive, identifying asymmetries as from 4.32° of occlusal plane inclination and 4.155 mm of mandibular deviation (p< 0.05). The other categories of evaluators identified asymmetries and assigned significantly lower grades, starting from 5.88° of occlusal plane inclination and 5.54 mm of mandibular deviation (p< 0.05). Conclusion: Occlusal plane inclination and mandibular deviation were perceived by all groups, but orthodontists presented higher perception of deviations. PMID:26560821

Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems.

PubMed

Sharif-Kashani, Pooria; Fanney, Douglas; Injev, Val

2014-07-30

Occlusion break surge during phacoemulsification cataract surgery can lead to potential surgical complications. The purpose of this study was to quantify occlusion break surge and vacuum rise time of current phacoemulsification systems used in cataract surgery. Occlusion break surge at vacuum pressures between 200 and 600 mmHg was assessed with the Infiniti® Vision System, the WhiteStar Signature® Phacoemulsification System, and the Centurion® Vision System using gravity-fed fluidics. Centurion Active FluidicsTM were also tested at multiple intraoperative pressure target settings. Vacuum rise time was evaluated for Infiniti, WhiteStar Signature, Centurion, and Stellaris® Vision Enhancement systems. Rise time to vacuum limits of 400 and 600 mmHg was assessed at flow rates of 30 and 60 cc/minute. Occlusion break surge was analyzed by 2-way analysis of variance. The Centurion system exhibited substantially less occlusion break surge than the other systems tested. Surge area with Centurion Active Fluidics was similar to gravity fluidics at an equivalent bottle height. At all Centurion Active Fluidics intraoperative pressure target settings tested, surge was smaller than with Infiniti and WhiteStar Signature. Infiniti had the fastest vacuum rise time and Stellaris had the slowest. No system tested reached the 600-mmHg vacuum limit. In this laboratory study, Centurion had the least occlusion break surge and similar vacuum rise times compared with the other systems tested. Reducing occlusion break surge may increase safety of phacoemulsification cataract surgery.

Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems

PubMed Central

2014-01-01

Background Occlusion break surge during phacoemulsification cataract surgery can lead to potential surgical complications. The purpose of this study was to quantify occlusion break surge and vacuum rise time of current phacoemulsification systems used in cataract surgery. Methods Occlusion break surge at vacuum pressures between 200 and 600 mmHg was assessed with the Infiniti® Vision System, the WhiteStar Signature® Phacoemulsification System, and the Centurion® Vision System using gravity-fed fluidics. Centurion Active FluidicsTM were also tested at multiple intraoperative pressure target settings. Vacuum rise time was evaluated for Infiniti, WhiteStar Signature, Centurion, and Stellaris® Vision Enhancement systems. Rise time to vacuum limits of 400 and 600 mmHg was assessed at flow rates of 30 and 60 cc/minute. Occlusion break surge was analyzed by 2-way analysis of variance. Results The Centurion system exhibited substantially less occlusion break surge than the other systems tested. Surge area with Centurion Active Fluidics was similar to gravity fluidics at an equivalent bottle height. At all Centurion Active Fluidics intraoperative pressure target settings tested, surge was smaller than with Infiniti and WhiteStar Signature. Infiniti had the fastest vacuum rise time and Stellaris had the slowest. No system tested reached the 600-mmHg vacuum limit. Conclusions In this laboratory study, Centurion had the least occlusion break surge and similar vacuum rise times compared with the other systems tested. Reducing occlusion break surge may increase safety of phacoemulsification cataract surgery. PMID:25074069

Differences between Subjective Balanced Occlusion and Measurements Reported With T-Scan III

PubMed Central

Lila-Krasniqi, Zana; Shala, Kujtim; Krasniqi, Teuta Pustina; Bicaj, Teuta; Ahmedi, Enis; Dula, Linda; Dragusha, Arlinda Tmava; Guguvcevski, Ljuben

2017-01-01

BACKGROUND: The aetiology of Temporomandibular disorder is multifactorial, and numerous studies have addressed that occlusion may be of great importance in the pathogenesis of Temporomandibular disorder. AIM: The aim of this study is to determine if any direct relationship exists between balanced occlusion and Temporomandibular disorder and to evaluate the differences between subjective balanced occlusion and measurements reported with T-scan III electronic system. MATERIAL AND METHODS: A total of 54 subjects were divided into three groups, selection based on anamnesis-responded to a Fonseca questionnaire and clinical measurements analysed with electronic system T-scan III. In the I study group were participants with fixed dentures with prosthetic ceramic restorations. In the II study group were symptomatic participants with TMD. In the third control group were healthy participants with full arch dentition that completed a subjective questionnaire that documented the absence of jaw pain, joint noise, locking and subjects without a history of TMD. The occlusal balance was reported subjectively through Fonseca questionnaire and compared with occlusion analysed with electronic system T-scan III. RESULTS: For attributive data were used percentage of the structure. Differences in P < 0.05 were considered significant. After distributing attributive data of occlusal balance subjectively reported and compared with measurements analysed with electronic system T-scan III were found significant difference P < 0.001 in all three groups. CONCLUSION: In our study, it was concluded that there were statistically significant differences of balanced occlusion in all three groups. Also it was concluded that subjective data are not exact with measurements reported with electronic device T-scan III. PMID:28932311

Microfluidics for investigating vaso-occlusions in sickle cell disease.

PubMed

Horton, Renita E

2017-07-01

SCD stems from amutation in the beta globin gene. Upon deoxygenation, hemoglobin polymerizes and triggers RBC remodeling. This phenomenon is central to SCD pathogenesis as individuals suffering from the disease are plagued by painful vaso-occlusive crises episodes. These episodes are the result of a combination of processes including inflammation, thrombosis, and blood cell adhesion to the vascular wall which leads to blockages within the vasculature termed vaso-occlusions. Vaso-occlusive episodes deprive tissues of oxygen and are a major contributor to SCD-related complications; unfortunately, the complex mechanisms that contribute to vaso-occlusions are not well understood. Vaso-occlusions can occur in post-capillary venules; hence, the microvasculature is a prime target for SCD therapies. Traditional in vitro systems poorly recapitulate architectural and dynamic flow properties of in vivo systems. However, microfluidic devices can capture features of the native vasculature such as cellular composition, flow, geometry, and ECM presentation. This review, although not comprehensive, highlights microfluidic approaches that aim to improve our current understanding of the pathophysiological mechanisms surrounding SCD. Microfluidic platforms can aid in identifying factors that may contribute to disease severity and can serve as suitable test beds for novel treatment strategies which may improve patient outcomes. © 2017 John Wiley & Sons Ltd.

Results of a customer-based, post-market surveillance survey of the HeRO access device.

PubMed

Fusselman, Maureen

2010-08-01

In order to supplement post-market surveillance data on the HeRO vascular access device, a non-scientific customer survey was conducted to obtain quantitative data from dialysis providers caring for patients implanted with the device. Dialysis nurses involved in the care of HeRO patients were contacted in order to obtain post-implant device performance information for 10% of patients implanted with the device at the time of the survey. Thirty-eight dialysis units with a total of 65 HeRO patients participated in the survey. The total duration of HeRO device use was 348.4 months with an average use of 5.4 months. Thirty-eight of the 65 HeRO patients (58.5%) were reported to not have experienced any performance issues. There were 28 device performance incidents reported for the remaining 27 patients included in the survey. Occlusion was the single most commonly reported device-related performance issue with 18 patients (27.7%) experiencing 25 occlusive episodes. The majority of the patients who had an occlusion (66.7%) only experienced one occlusive event. Infections occurred in 4 patients (6.2%) with an overall infection rate of 0.38 per 1,000 patient days. Post-market clinical experience during the first 18 months of commercialization of the HeRO device were in line with expectations based on the results from initial clinical studies with the device. Device occlusion remains the most commonly reported performance issue with the reported rate in this survey less than that which was reported in earlier published studies with the device.

Optimal occlusion uniformly partitions red blood cells fluxes within a microvascular network

PubMed Central

Tu, Shenyinying; Liu, Yu-Hsiu; Savage, Van M.; Hsiai, Tzung K.; Roper, Marcus

2017-01-01

In animals, gas exchange between blood and tissues occurs in narrow vessels, whose diameter is comparable to that of a red blood cell. Red blood cells must deform to squeeze through these narrow vessels, transiently blocking or occluding the vessels they pass through. Although the dynamics of vessel occlusion have been studied extensively, it remains an open question why microvessels need to be so narrow. We study occlusive dynamics within a model microvascular network: the embryonic zebrafish trunk. We show that pressure feedbacks created when red blood cells enter the finest vessels of the trunk act together to uniformly partition red blood cells through the microvasculature. Using mathematical models as well as direct observation, we show that these occlusive feedbacks are tuned throughout the trunk network to prevent the vessels closest to the heart from short-circuiting the network. Thus occlusion is linked with another open question of microvascular function: how are red blood cells delivered at the same rate to each micro-vessel? Our analysis shows that tuning of occlusive feedbacks increase the total dissipation within the network by a factor of 11, showing that uniformity of flows rather than minimization of transport costs may be prioritized by the microvascular network. PMID:29244812

Accuracy and precision of occlusal contacts of stereolithographic casts mounted by digital interocclusal registrations.

PubMed

Krahenbuhl, Jason T; Cho, Seok-Hwan; Irelan, Jon; Bansal, Naveen K

2016-08-01

Little peer-reviewed information is available regarding the accuracy and precision of the occlusal contact reproduction of digitally mounted stereolithographic casts. The purpose of this in vitro study was to evaluate the accuracy and precision of occlusal contacts among stereolithographic casts mounted by digital occlusal registrations. Four complete anatomic dentoforms were arbitrarily mounted on a semi-adjustable articulator in maximal intercuspal position and served as the 4 different simulated patients (SP). A total of 60 digital impressions and digital interocclusal registrations were made with a digital intraoral scanner to fabricate 15 sets of mounted stereolithographic (SLA) definitive casts for each dentoform. After receiving a total of 60 SLA casts, polyvinyl siloxane (PVS) interocclusal records were made for each set. The occlusal contacts for each set of SLA casts were measured by recording the amount of light transmitted through the interocclusal records. To evaluate the accuracy between the SP and their respective SLA casts, the areas of actual contact (AC) and near contact (NC) were calculated. For precision analysis, the coefficient of variation (CoV) was used. The data was analyzed with t tests for accuracy and the McKay and Vangel test for precision (α=.05). The accuracy analysis showed a statistically significant difference between the SP and the SLA cast of each dentoform (P<.05). For the AC in all dentoforms, a significant increase was found in the areas of actual contact of SLA casts compared with the contacts present in the SP (P<.05). Conversely, for the NC in all dentoforms, a significant decrease was found in the occlusal contact areas of the SLA casts compared with the contacts in the SP (P<.05). The precision analysis demonstrated the different CoV values between AC (5.8 to 8.8%) and NC (21.4 to 44.6%) of digitally mounted SLA casts, indicating that the overall precision of the SLA cast was low. For the accuracy evaluation, statistically significant differences were found between the occlusal contacts of all digitally mounted SLA casts groups, with an increase in AC values and a decrease in NC values. For the precision assessment, the CoV values of the AC and NC showed the digitally articulated cast's inability to reproduce the uniform occlusal contacts. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Detection of questionable occlusal carious lesions using an electrical bioimpedance method with fractional electrical model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morais, A. P.; Salgado de Oliveira University, Marechal Deodoro Street, 217 – Centro, Niterói, Rio de Janeiro; Pino, A. V.

This in vitro study evaluated the diagnostic performance of an alternative electric bioimpedance spectroscopy technique (BIS-STEP) detect questionable occlusal carious lesions. Six specialists carried out the visual (V), radiography (R), and combined (VR) exams of 57 sound or non-cavitated occlusal carious lesion teeth classifying the occlusal surfaces in sound surface (H), enamel caries (EC), and dentinal caries (DC). Measurements were based on the current response to a step voltage excitation (BIS-STEP). A fractional electrical model was used to predict the current response in the time domain and to estimate the model parameters: Rs and Rp (resistive parameters), and C andmore » α (fractional parameters). Histological analysis showed caries prevalence of 33.3% being 15.8% hidden caries. Combined examination obtained the best traditional diagnostic results with specificity = 59.0%, sensitivity = 70.9%, and accuracy = 60.8%. There were statistically significant differences in bioimpedance parameters between the H and EC groups (p = 0.016) and between the H and DC groups (Rs, p = 0.006; Rp, p = 0.022, and α, p = 0.041). Using a suitable threshold for the Rs, we obtained specificity = 60.7%, sensitivity = 77.9%, accuracy = 73.2%, and 100% of detection for deep lesions. It can be concluded that BIS-STEP method could be an important tool to improve the detection and management of occlusal non-cavitated primary caries and pigmented sites.« less

Language of CTO interventions - Focus on hardware.

PubMed

Mishra, Sundeep

2016-01-01

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse. Copyright © 2016. Published by Elsevier B.V.

Relationship between occlusal force and falls among community-dwelling elderly in Japan: a cross-sectional correlative study.

PubMed

Eto, Maki; Miyauchi, Shinji

2018-05-09

Falls may cause serious health conditions among older population. Fall-related physical factors are thought to be associated with occlusal conditions. However, few studies examined the relationship between occlusal force and falls. To identify the association between occlusal force and falls among community-dwelling elderly individuals in Japan, public health nurses conducted a cross-sectional descriptive study. We performed extensive physical assessments of five items: maximum occlusal force, handgrip strength, maximal knee extensor strength, one-leg standing time with eyes open and body sway. We also conducted a questionnaire survey concerning the participants' demographic characteristics, health status and fall experience during the past year. Mean scores and standard deviations were calculated for age and the total points of the index of activities of daily living. Associations were examined using Mann-Whitney tests and logistic regression. We examined 159 community-dwelling people aged ≥65 years, who were independent and active, including 38 participants (24.5%) with experience of falls in the past year. Maximum occlusal force had significant correlation with handgrip strength, maximal knee extensor strength, and one-leg standing time and body sway (P < .05, respectively). We found weak associations between participants with and without a history of falls in terms of the five physical measurements. Logistic regression analysis showed that fall experience was significantly associated with maximum occlusal force (P = 0.004). This is the first study, led by public health nursing researchers, to examine the associations between maximum occlusal force and falls among community-dwelling elderly in Japan. The results showed that maximum occlusal force was significantly related to the other four extensive physical assessments, and might also suggest that maximum occlusal force assessment by public health nurses could contribute to more sophisticated and precise prediction of fall risks among the community-dwelling elderly. The latest occlusal force measurement device is non-invasive and easy to use. Public health nurses can introduce it at periodical community health checkup assembly events, which might contribute to raising awareness among community-dwelling elderly individuals and public health nurses about fall prevention and prediction.

'TOTAL' (Tracheal Occlusion To Accelerate Lung Growth) Trial

ClinicalTrials.gov

2018-01-25

Hernia; Hernia, Diaphragmatic; Hernia, DIaphragmatic, Congenital; Pathological Conditions, Anatomical; Congenital Abnormalities; Congenital Diaphragmatic Hernia; Fetal Anomaly; Fetal Surgery; Pulmonary Hypoplasia

Effect of gender, facial dimensions, body mass index and type of functional occlusion on bite force.

PubMed

Koç, Duygu; Doğan, Arife; Bek, Bülent

2011-01-01

Some factors such as gender, age, craniofacial morphology, body structure, occlusal contact patterns may affect the maximum bite force. Thus, the purposes of this study were to determine the mean maximum bite force in individuals with normal occlusion, and to examine the effect of gender, facial dimensions, body mass index (BMI), type of functional occlusion (canine guidance and group function occlusion) and balancing side interferences on it. Thirty-four individuals aged 19-20 years-old were selected for this study. Maximum bite force was measured with strain-gauge transducers at first molar region. Facial dimensions were defined by standardized frontal photographs as follows: anterior total facial height (ATFH), bizygomathic facial width (BFW) and intergonial width (IGW). BMI was calculated using the equation weight/height². The type of functional occlusion and the balancing side interferences of the subjects were identified by clinical examination. Bite force was found to be significantly higher in men than women (p<0.05). While there was a negative correlation between the bite force and ATFH/BFW, ATFH/IGW ratios in men (p<0.05), women did not show any statistically significant correlation (p>0.05). BMI and bite force correlation was not statistically significant (p>0.05). The average bite force did not differ in subjects with canine guidance or group function occlusion and in the presence of balancing side interferences (p>0.05). Data suggest that bite force is affected by gender. However, BMI, type of functional occlusion and the presence of balancing side interferences did not exert a meaningful influence on bite force. In addition, transverse facial dimensions showed correlation with bite force in only men.

Treatment of Amblyopia Using Personalized Dosing Strategies: Statistical Modelling and Clinical Implementation.

PubMed

Wallace, Michael P; Stewart, Catherine E; Moseley, Merrick J; Stephens, David A; Fielder, Alistair R

2016-12-01

To generate a statistical model for personalizing a patient's occlusion therapy regimen. Statistical modelling was undertaken on a combined data set of the Monitored Occlusion Treatment of Amblyopia Study (MOTAS) and the Randomized Occlusion Treatment of Amblyopia Study (ROTAS). This exercise permits the calculation of future patients' total effective dose (TED)-that predicted to achieve their best attainable visual acuity. Daily patching regimens (hours/day) can be calculated from the TED. Occlusion data for 149 study participants with amblyopia (anisometropic in 50, strabismic in 43, and mixed in 56) were analyzed. Median time to best observed visual acuity was 63 days (25% and 75% quartiles; 28 and 91 days). Median visual acuity in the amblyopic eye at start of occlusion was 0.40 logMAR (quartiles 0.22 and 0.68 logMAR) and at end of occlusion was 0.12 (quartiles 0.025 and 0.32 logMAR). Median lower and upper estimates of TED were 120 hours (quartiles 34 and 242 hours), and 176 hours (quartiles 84 and 316 hours). The data suggest a piecewise linear relationship (P = 0.008) between patching dose-rate (hours/day) and TED with a single breakpoint estimated at 2.16 (standard error 0.51) hours/day, suggesting doses below 2.16 hours/day are less effective. We introduce the concept of TED of occlusion. Predictors for TED are visual acuity deficit, amblyopia type, and age at start of occlusion therapy. Dose-rates prescribed within the model range from 2.5 to 12 hours/day and can be revised dynamically throughout treatment in response to recorded patient compliance: a personalized dosing strategy.

Continuous full-time occlusion of the sound eye vs full-time occlusion of the sound eye periodically alternating with occlusion of the amblyopic eye in treatment of amblyopia: a prospective randomized study.

PubMed

Stanković, B; Milenković, S

2007-01-01

To compare continuous full-time (24 hours per day) occlusion of the sound eye with full-time occlusion (24 hours per day) of the sound eye 1 day more than the years of age periodically alternating with occlusion of the amblyopic eye for 1 day, as treatments for profound strabismic amblyopia in children older than 5 years. A total of 53 patients with visual acuity (VA) of 0.4 and less in the amblyopic eye (tested by crowded Landolt Cs) after previously being provided optimal optical correction were randomly assigned to receive either of the two patching regimens. VA and pattern reversal visual evoked potentials (PVEP) were recorded prospectively at 1-month intervals. Improvement in VA and the reduction in crowding difficulties (CD) were the main outcome measures of the treatment efficiency. Both treatment modalities were equally effective. Of the 51 subjects who completed the study, 21 (41.2%) were cured whereas 32 (62.7%) attained satisfactory improvement. Recovery of VA was related to age, with cure being obtained in 23.5% (4/17) and satisfactory improvement in 52.9% (9/17) of patients older than 9 years. Larger gain in VA influenced the stability of the vision over time. It can be concluded that in clinically monitored parameters both treatment modalities were equally effective without any statistical or clinical significance in the observed groups of patients. However, events like the "trade-off" effect, occurrence of occlusion amblyopia, or prolongation of PVEP latency of the sound eye indicate that full-time continuous occlusion possibly presents a more effective form of treatment.

Dental occlusion, body posture and temporomandibular disorders: where we are now and where we are heading for.

PubMed

Manfredini, D; Castroflorio, T; Perinetti, G; Guarda-Nardini, L

2012-06-01

The aim of this investigation was to perform a review of the literature dealing with the issue of relationships between dental occlusion, body posture and temporomandibular disorders (TMD). A search of the available literature was performed to determine what the current evidence is regarding: (i) The physiology of the dental occlusion-body posture relationship, (ii) The relationship of these two topics with TMD and (iii) The validity of the available clinical and instrumental devices (surface electromyography, kinesiography and postural platforms) to measure the dental occlusion-body posture-TMD relationship. The available posturographic techniques and devices have not consistently found any association between body posture and dental occlusion. This outcome is most likely due to the many compensation mechanisms occurring within the neuromuscular system regulating body balance. Furthermore, the literature shows that TMD are not often related to specific occlusal conditions, and they also do not have any detectable relationships with head and body posture. The use of clinical and instrumental approaches for assessing body posture is not supported by the wide majority of the literature, mainly because of wide variations in the measurable variables of posture. In conclusion, there is no evidence for the existence of a predictable relationship between occlusal and postural features, and it is clear that the presence of TMD pain is not related with the existence of measurable occluso-postural abnormalities. Therefore, the use instruments and techniques aiming to measure purported occlusal, electromyographic, kinesiographic or posturographic abnormalities cannot be justified in the evidence-based TMD practice. © 2012 Blackwell Publishing Ltd.

[Occlusion and posture: is there evidence of correlation?].

PubMed

Michelotti, A; Manzo, P; Farella, M; Martina, R

1999-11-01

The observation that the masticatory system and the postural body regulating system are anatomically and functionally related, has led to postulate several hypotheses of correlation between occlusal and postural disturbances. In the last decade, these arguments have gained a great social impact, also because they have been broadly spread by the mass-media. As a consequence, there has been a growing number of patients seeking concomitant occlusal and postural treatments. The aim of this study was to review critically the current evidence of correlation between the two systems; this in order to address clinical issues for the management of patients. Methodology of the studies reviewed has been evaluated according to the criteria suggested by Storey and Rugh 20 rif. Although there are some evidences of correlation between occlusion and posture, this appears limited to the cranio-cervical tract of the column and tends to disappear when descending in cranio-caudal direction. On the basis of this review of the literature, it's not advisable to treat postural imbalance by means of occlusal treatment or vice versa, particularly if the therapeutic modalities are irreversible.

Laser restoration of flow in occluded ventricular shunts for pediatric neurosurgery

NASA Astrophysics Data System (ADS)

Christens-Barry, William A.; Guarnieri, Michael; Carson, Benjamin S.

1998-01-01

We have investigated the use of short pulses of infrared ((lambda) equals 2.09 micrometers ) light from a Ho:YAG laser to photofragment occlusions and restore flow in ventricular shunts, which provide the sole means of maintaining proper intracranial pressure in hydrocephalus patients. These experiments employed model tissues, a polymeric model compound, and patient explants in order to determine appropriate pulse energies and delivery rates for removal of occlusions material. Laser energy doses and rates of occlusion removal were established for these materials. Laser energy doses that do not damage the shunt device or surrounding tissue were identified. Optical fibers (25 ga. or smaller) can be introduced through the dome of current shunt devices and threaded to the occlusion site. Clinical application will require the continued development of an introducer tool for the transcutaneous insertion of the optical fiber into the shunt device and irrigation techniques for removing the occlusion detritus generated by photofragmentation treatment. Using this approach, a minimally invasive and benign procedure for in situ restoration of flow in occluded neurological implant devices becomes possible.

Influence of blood flow occlusion on the development of peripheral and central fatigue during small muscle mass handgrip exercise

PubMed Central

Broxterman, R M; Craig, J C; Smith, J R; Wilcox, S L; Jia, C; Warren, S; Barstow, T J

2015-01-01

Abstract The influence of the muscle metabolic milieu on peripheral and central fatigue is currently unclear. Moreover, the relationships between peripheral and central fatigue and the curvature constant (W ′) have not been investigated. Six men (age: 25 ± 4 years, body mass: 82 ± 10 kg, height: 179 ± 4 cm) completed four constant power handgrip tests to exhaustion under conditions of control exercise (Con), blood flow occlusion exercise (Occ), Con with 5 min post-exercise blood flow occlusion (Con + Occ), and Occ with 5 min post-exercise blood flow occlusion (Occ + Occ). Neuromuscular fatigue measurements and W ′ were obtained for each subject. Each trial resulted in significant peripheral and central fatigue. Significantly greater peripheral (79.7 ± 5.1% vs. 22.7 ± 6.0%) and central (42.6 ± 3.9% vs. 4.9 ± 2.0%) fatigue occurred for Occ than for Con. In addition, significantly greater peripheral (83.0 ± 4.2% vs. 69.0 ± 6.2%) and central (65.5 ± 14.6% vs. 18.6 ± 4.1%) fatigue occurred for Occ + Occ than for Con + Occ. W ′ was significantly related to the magnitude of global (r = 0.91) and peripheral (r = 0.83) fatigue. The current findings demonstrate that blood flow occlusion exacerbated the development of both peripheral and central fatigue and that post-exercise blood flow occlusion prevented the recovery of both peripheral and central fatigue. Moreover, the current findings suggest that W ′ may be determined by the magnitude of fatigue accrued during exercise. Key points Critical power represents an important threshold for neuromuscular fatigue development and may, therefore, dictate intensities for which exercise tolerance is determined by the magnitude of fatigue accrued. Peripheral fatigue appears to be constant across O2 delivery conditions for large muscle mass exercise, but this consistency is equivocal for smaller muscle mass exercise. We sought to determine the influence of blood flow occlusion during handgrip exercise on neuromuscular fatigue development and to examine the relationship between neuromuscular fatigue development and W ′. Blood flow occlusion influenced the development of both peripheral and central fatigue, thus providing further evidence that the magnitude of peripheral fatigue is not constant across O2 delivery conditions for small muscle mass exercise. W ′ appears to be related to the magnitude of fatigue accrued during exercise, which may explain the reported consistency of intramuscular metabolic perturbations and work performed for severe-intensity exercise. PMID:26104881

Hypoplastic left heart syndrome and pulmonary veno-occlusive disease in an infant.

PubMed

D'Souza, Marise; Vergales, Jeffrey; Jayakumar, K Anitha

2013-01-01

This report describes an infant with heterotaxy syndrome and severe hypoplasia of the left heart who presented with profound cyanosis at birth despite a large patent ductus arteriosus. Pulmonary venous return was difficult to demonstrate by echocardiography. Angiography showed total anomalous pulmonary venous return via a plexus that drained through the paravertebral veins and bilateral superior vena cavae. Autopsy confirmed these findings, and histopathology demonstrated severe occlusive changes within the pulmonary veins.

Effective Intraluminal Shunt in Carotid Endarterectomy for Carotid Artery Near Occlusion: Technical Report.

PubMed

Kawamura, Yoichiro; Maruyama, Daisuke; Akagi, Yojiro; Iihara, Koji

2017-10-01

Carotid artery near occlusion is a critical degree of stenosis whereby blood flow is decreased and the distal cervical and intracranial internal carotid arteries (ICAs) are prone to collapse. Considering the diminished perfusion and risk of progression to total occlusion and periocclusive embolism, we performed carotid endarterectomy for carotid artery near occlusion. Accurate evaluation of tandem stenosis or patency of the poststenotic ICA in carotid artery near occlusion is often difficult preoperatively. Thus we performed carotid endarterectomy in a hybrid operating room where intraoperative digital subtraction angiography (DSA) and endovascular angioplasty or stenting for distal lesions can be performed if necessary. In addition, to evaluate the distal ICA intraoperatively, we used an intraluminal shunt for shunt angiography, with injection of contrast material through the shunt tube, as a replacement for conventional DSA. Furthermore, an intraluminal shunt held the collapsed lumen open and provided a scaffold for suturing, which prevented postoperative stenosis of the distal ICA. The present report is intended to underline the merits of intraluminal shunt as a replacement for conventional DSA and as a scaffold for suturing. Copyright © 2017 Elsevier Inc. All rights reserved.

Balloon-Assisted Occlusion of the Internal Iliac Arteries in Patients with Placenta Accreta/Percreta

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bodner, Leonard J.; Nosher, John L.; Gribbin, Christopher

2006-06-15

Background. Placenta accreta/percreta is a leading cause of third trimester hemorrhage and postpartum maternal death. The current treatment for third trimester hemorrhage due to placenta accreta/percreta is cesarean hysterectomy, which may be complicated by large volume blood loss. Purpose. To determine what role, if any, prophylactic temporary balloon occlusion and transcatheter embolization of the anterior division of the internal iliac arteries plays in the management of patients with placenta accreta/percreta. Methods. The records of 28 consecutive patients with a diagnosis of placenta accreta/percreta were retrospectively reviewed. Patients were divided into two groups. Six patients underwent prophylactic temporary balloon occlusion, followedmore » by cesarean section, transcatheter embolization of the anterior division of the internal iliac arteries and cesarean hysterectomy (n = 5) or uterine curettage (n = 1). Twenty-two patients underwent cesarean hysterectomy without endovascular intervention. The following parameters were compared in the two groups: patient age, gravidity, parity, gestational age at delivery, days in the intensive care unit after delivery, total hospital days, volume of transfused blood products, volume of fluid replacement intraoperatively, operating room time, estimated blood loss, and postoperative morbidity and mortality. Results. Patients in the embolization group had more frequent episodes of third trimester bleeding requiring admission and bedrest prior to delivery (16.7 days vs. 2.9 days), resulting in significantly more hospitalization time in the embolization group (23 days vs. 8.8 days) and delivery at an earlier gestational age than in those in the surgical group (32.5 weeks). There was no statistical difference in mean estimated blood loss, volume of replaced blood products, fluid replacement needs, operating room time or postoperative recovery time. Conclusion. Our findings do not support the contention that in patients with placenta accreta/percreta, prophylactic temporary balloon occlusion and embolization prior to hysterectomy diminishes intraoperative blood loss.« less

Large Vessel Occlusion Scales Increase Delivery to Endovascular Centers Without Excessive Harm From Misclassifications.

PubMed

Zhao, Henry; Coote, Skye; Pesavento, Lauren; Churilov, Leonid; Dewey, Helen M; Davis, Stephen M; Campbell, Bruce C V

2017-03-01

Clinical large vessel occlusion (LVO) triage scales were developed to identify and bypass LVO to endovascular centers. However, there are concerns that scale misclassification of patients may cause excessive harm. We studied the settings where misclassifications were likely to occur and the consequences of these misclassifications in a representative stroke population. Prospective data were collected from consecutive ambulance-initiated stroke alerts at 2 stroke centers, with patients stratified into typical (LVO with predefined severe syndrome and non-LVO without) or atypical presentations (opposite situations). Five scales (Rapid Arterial Occlusion Evaluation [RACE], Los Angeles Motor Scale [LAMS], Field Assessment Stroke Triage for Emergency Destination [FAST-ED], Prehospital Acute Stroke Severity scale [PASS], and Cincinnati Prehospital Stroke Severity Scale [CPSSS]) were derived from the baseline National Institutes of Health Stroke Scale scored by doctors and analyzed for diagnostic performance compared with imaging. Of a total of 565 patients, atypical presentations occurred in 31 LVO (38% of LVO) and 50 non-LVO cases (10%). Most scales correctly identified >95% of typical presentations but <20% of atypical presentations. Misclassification attributable to atypical presentations would have resulted in 4 M1/internal carotid artery occlusions, with National Institutes of Health Stroke Scale score ≥6 (5% of LVO) being missed and 9 non-LVO infarcts (5%) bypassing the nearest thrombolysis center. Atypical presentations accounted for the bulk of scale misclassifications, but the majority of these misclassifications were not detrimental, and use of LVO scales would significantly increase timely delivery to endovascular centers, with only a small proportion of non-LVO infarcts bypassing the nearest thrombolysis center. Our findings, however, would require paramedics to score as accurately as doctors, and this translation is made difficult by weaknesses in current scales that need to be addressed before widespread adoption. © 2017 American Heart Association, Inc.

Discussion on the Timing of Balloon Occlusion of the Abdominal Aorta during a Caesarean Section in Patients with Pernicious Placenta Previa Complicated with Placenta Accreta

PubMed Central

Yang, Kaili; Cai, Lina

2017-01-01

Objective This paper is aimed at investigating the role and value of the timing of balloon occlusion of the abdominal aorta during caesarean section in patients with pernicious placenta previa complicated with placenta accreta. Methods 79 cases admitted to the Second Affiliated Hospital of Zhengzhou University from September 2015 to December 2016 were treated with ultrasound mediated abdominal aortic balloon occlusion. Among them, 42 cases, whose balloon occlusion time was selected before the delivery and transverse incision was taken, were group A. The other 37 cases were group B, whose timing of balloon occlusion was selected after the delivery and the uterine incision made trying to avoid the placenta or double incisions. The intraoperative blood loss, utilization of blood, and other indicators were compared between the two groups. Results The intraoperative blood loss in groups A and B was 413.8 ± 105.9 ml and 810.3 ± 180.3 ml, and the utilization of blood products in groups A and B was 30.23% and 89.2%. The total hysterectomy rate was 2.53% (2/79), with no hysterectomies in groups A and 2 cases in group B. Conclusion The balloon occlusion of the abdominal aorta before the delivery combined with a transverse incision is more effective. PMID:29230417

Electronic monitoring of occlusion treatment for amblyopia in patients aged 7 to 16 years.

PubMed

Fronius, Maria; Bachert, Iris; Lüchtenberg, Marc

2009-10-01

Age limits for the prescription of amblyopia treatment have been debated and challenged recently, due to results of studies from ophthalmology and the neurosciences. Lack of knowledge about compliance with prescribed treatment is still a major factor for the uncertainty about the amount of plasticity in the visual system of older children and adolescents. The development of devices for the electronic recording of patching (Occlusion Dose Monitor, ODM) has allowed the collection of objective data about daily occlusion. In a prospective study, occlusion dose rates were recorded continuously during 4 months by means of the ODM developed in the Netherlands [1] in nine amblyopic patients between 7 and 16 years of age who were prescribed between 5 and 7 hours of daily patching. Visual acuity was assessed every 3 to 6 weeks. The electronic monitoring showed objective occlusion between 2 and 6.25 hours/day (mean 4.61 h/d) during the first month and 0 to 6.5 hours/day (mean 3.47 h/d) during the following 3 months of treatment. The total acuity gain in the amblyopic eye amounted to between -0.1 and 0.4 log units (mean 0.19) for crowded optotypes. Differences to initial acuities were statistically significant. The calculated average dose-response relationship (cumulated hours occlusion*0.1/acuity gain) for 4 months of occlusion was 234 hours of occlusion per 0.1 log unit of acuity gain. This study presents for the first time objective treatment and dose response data in amblyopic patients beyond the "classical" treatment age. Electronic monitoring of occlusion and considerable amounts of patching were shown to be feasible. The acuity results indicate that there is a potential for improvement, yet treatment seemed to be less efficient than shown by previous studies in younger patients. Continuation of this research may advance the discussion about age-dependent evidence-based amblyopia treatment, about preschool screening for amblyopia and about plasticity of the visual system.

Occlusal traits of deciduous dentition of preschool children of Indian children

PubMed Central

Bahadure, Rakesh N.; Thosar, Nilima; Gaikwad, Rahul

2012-01-01

Objectives: To assess the occlusal relationship, canine relationship, crowding, primate spaces, and anterior spacing in both maxillary and mandibular arches of primary dentition of Indian children of Wardha District and also to study the age-wise differences in occlusal characteristics. Materials and Methods: A total of 1053 (609 males and 444 females) children of 3-5 year age group with complete primary dentition were examined for occlusal relationship, canine relationship, crowding, primate spaces, and anterior spacing in both maxillary and mandibular arches. Results: The data after evaluation showed significant values for all parameters except mandibular anterior spacing, which was 47.6%. Mild crowding was prevalent at 5 year age group and moderate crowding was common at 3 year-age group. Conclusion: Evaluated parameters such as terminal molar relationship and canine relationship were predominantly progressing toward to normal but contacts and crowding status were contributing almost equal to physiologic anterior spacing. Five-year-age group showed higher values with respect to all the parameters. PMID:23633806

Placement of a Port Catheter Through Collateral Veins in a Patient with Central Venous Occlusion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Teichgraeber, Ulf Karl-Martin, E-mail: ulf.teichgraeber@charite.de; Streitparth, Florian, E-mail: florian.streitparth@charite.d; Gebauer, Bernhard, E-mail: bernhard.gebauer@charite.d

Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central neck and femoral veins due to long-term use of multiple CVCs over more than 20 years. In patients with central venous occlusion and venous transformation, the implantation of a totally implanted port system by accessing collateral veins is an option to continue long-term parenteral nutrition whenmore » required. A 0.014-in. Whisper guidewire (Terumo, Tokyo) with high flexibility and steerability was chosen to maneuver and pass through the collateral veins. We suggest this approach to avoid unfavorable translumbar or transhepatic central venous access and to conserve the anatomically limited number of percutaneous access sites.« less

Initial Experience and Feasibility of the New Low-Profile Stingray Catheter as Part of the Antegrade Dissection and Re-Entry Revascularization Strategy for Coronary Chronic Total Occlusions

PubMed Central

Maeremans, Joren; Palmers, Pieter-Jan; Dens, Joseph

2017-01-01

Case series Patient: Male, 77 • Male, 57 • Male, 73 Final Diagnosis: Coronary chronic total occlusion Symptoms: Angina pectoris Medication: — Clinical Procedure: Percutaneous coronary intervention of coronary chronic total occlusions Specialty: Cardiology Objective: Unusual setting of medical care Background: During antegrade dissection re-entry (ADR) of chronic total occlusions (CTO), the first-generation Stingray catheter requires the use of large-bore guides (sheathless 7.5 Fr or 8 Fr), which increases the risk for access site-related complications and compromises radial approaches. Smaller guiding sizes necessitate long guidewires (e.g., 300 cm) or guidewire extensions for catheter advancement or removal. However, friction between guides and the Stingray catheter can result in unstable guidewire position or unintentional removal. Furthermore, failure to deliver the catheter at the distal re-entry zone is a common problem. To overcome issues of deliverability and reduce the need for pre-dilatations, with its inherent risk of creating subintimal hematomas, the Stingray low-profile (LP) balloon catheter was developed. Case Report: We describe 3 cases of successful application of the novel Stingray LP catheter during ADR. In all cases, 7 Fr guiding catheters were successfully used in combination with the device. The lower profile facilitated a good exchange and delivery of the device, without the need for balloon pre-dilatations in 2 cases. This resulted in a limited subintimal plane, enabling a smooth puncture into the true lumen. One case presented with extreme levels of calcification and tortuosity, resulting in a high degree of friction, despite the lower catheter profile. No in-hospital coronary or access site-related complications occurred. Conclusions: This case report illustrates the feasibility of the Stingray LP catheter for the treatment of CTOs via the ADR technique. The lower profile of the catheter potentially increases the deliverability, safety, and exchangeability of the device. PMID:28138123

Occlusal Support and Temporomandibular Disorders Among Elderly Vietnamese.

PubMed

Nguyen, Minh Son; Jagomägi, Triin; Nguyen, Toai; Saag, Mare; Voog-Oras, Ülle

The aim of this study was to analyze the associations between missing teeth, occlusal support, and temporomandibular disorders (TMD) among elderly Vietnamese. The study consisted of 145 TMD and 112 non-TMD (control group) participants aged 65 to 74 years. TMD was evaluated using Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I. An occlusal unit (OU) was defined as the cusp of a tooth coupled with the fossa of its antagonist tooth. A premolar pair was counted as one OU and a molar pair as two OUs. Dentition was divided into four occlusal support zones (OSZs) based on occluding pairs of posterior teeth by using Eichner classification: Class A had 4 OSZs, Class B had 1 to 3 OSZs or only anterior teeth, and Class C had no OSZ. The TMD group lost significantly more posterior teeth (mean ± SD 5.1 ± 4.7) than the control group (4.0 ± 3.9, P = .033). The mean ± SD OUs of the TMD and control groups were 5.1 ± 4.6 and 6.0 ± 4.3, respectively, which was nonsignificant (NS). The distribution of Class A (40.7%), Class B (40.0%), and Class C (19.3%) among the TMD group was not significantly different from the control group (50.0%, 38.4%, and 11.6%, respectively, NS). The odds of having TMD were positively associated with total unilateral loss of OUs (OR = 3.4, 95% CI = 1.2-9.4, P = .020) and total bilateral loss of OUs (OR = 2.7, 95% CI = 1.2-6.6, P = .027). Total loss of OSZs on one or both sides of the mouth were found to be predictors of TMD among elderly Vietnamese.

The role of robotic surgical system in the management of vascular disease.

PubMed

Lin, Judith C

2013-10-01

The evolution of minimally invasive treatment for aneurysms and occlusive disease has led to the development of endovascular, laparoscopic, and robot-assisted techniques. This article reviews the current literature on the clinical use of robotic surgical systems in the treatment of patients with aneurysms and occlusive disease. A MEDLINE search was performed using the keywords "robotic, vascular, AND surgery." All pertinent articles concerning the use of the robotic surgical system on aneurysms and occlusive disease were reviewed. The author's personal experience consisted of a retrospective review of a prospectively maintained confidential database on all procedures performed with the da Vinci(®) surgical system. Several robot-assisted laparoscopic series on the treatment of aortic disease were identified, including review articles of potential clinical applications in hybrid, laparoscopic vascular, and endovascular treatments for vascular patients using robotic technology. The use of computer-enhanced or robotic technology as a sole modality for bypass of occlusive disease and repair of abdominal aortic, splenic, and renal aneurysms was described in case series with satisfactory patient outcomes. Current robotic endovascular technology was also described. Minimally invasive techniques using endovascular, laparoscopic, or robot-assisted technology have revolutionized the treatment of aortoiliac, splanchnic, and renal aneurysms and occlusive disease. However, robot-assisted techniques for aortic disease may involve a learning curve and increased operating times. Although endovascular therapy is preferred because of faster recovery, this preference for improved short-term outcomes will be balanced with the superiority and durability of robot-assisted endoscopic methods as comparable to open surgery. Copyright © 2013 Elsevier Inc. All rights reserved.

Sinusoidal obstruction syndrome/veno-occlusive disease: current situation and perspectives—a position statement from the European Society for Blood and Marrow Transplantation (EBMT)

PubMed Central

Mohty, M; Malard, F; Abecassis, M; Aerts, E; Alaskar, A S; Aljurf, M; Arat, M; Bader, P; Baron, F; Bazarbachi, A; Blaise, D; Ciceri, F; Corbacioglu, S; Dalle, J-H; Duarte, R F; Fukuda, T; Huynh, A; Masszi, T; Michallet, M; Nagler, A; NiChonghaile, M; Pagluica, T; Peters, C; Petersen, F B; Richardson, P G; Ruutu, T; Savani, B N; Wallhult, E; Yakoub-Agha, I; Carreras, E

2015-01-01

Sinusoidal obstruction syndrome or veno-occlusive disease (SOS/VOD) is a potentially life-threatening complication of hematopoietic SCT (HSCT). This review aims to highlight, on behalf of the European Society for Blood and Marrow Transplantation, the current knowledge on SOS/VOD pathophysiology, risk factors, diagnosis and treatments. Our perspectives on SOS/VOD are (i) to accurately identify its risk factors; (ii) to define new criteria for its diagnosis; (iii) to search for SOS/VOD biomarkers and (iv) to propose prospective studies evaluating SOS/VOD prevention and treatment in adults and children. PMID:25798682

Rehabilitation strategies for partially edentulous-prosthodontic principles and current trends.

PubMed

D'Souza, Dsj; Dua, Parag

2011-07-01

The prosthetic considerations for treatment of partially edentulous patients involve evaluation of important aspects such as presence of certain functional or skeletal deficits, orientation of the occlusal plane, free-way space, size and location of edentulous areas, number, strategic location and quality of the likely abutment teeth, vertical dimension, and the type of occlusion. A comprehensive evaluation, multidisciplinary approach and a sequential treatment plan, worked out in harmony with the patient's perceptions are important factors to ensure a successful outcome. This article discusses the principles, current trends and importance of clinical decisions in designing a treatment strategy when confronted with complex situations of partial edentulism.

Prohibiting consent: what are the costs of denying permanent contraception concurrent with abortion care?

PubMed

Krashin, Jamie W; Edelman, Alison B; Nichols, Mark D; Allen, Allison J; Caughey, Aaron B; Rodriguez, Maria I

2014-07-01

Oregon and federal laws prohibit giving informed consent for permanent contraception when presenting for an abortion. The primary objective of this study was to estimate the number of unintended pregnancies associated with this barrier to obtaining concurrent tubal occlusion and abortion, compared with the current policy, which limits women to obtaining interval tubal occlusion after abortion. The secondary objectives were to compare the financial costs, quality-adjusted life years, and the cost-effectiveness of these policies. We designed a decision-analytic model examining a theoretical population of women who requested tubal occlusion at time of abortion. Model inputs came from the literature. We examined the primary and secondary outcomes stratified by maternal age (>30 and <30 years). A Markov model incorporated the possibility of multiple pregnancies. Sensitivity analyses were performed on all variables and a Monte Carlo simulation was conducted. For every 1000 women age <30 years in Oregon who did not receive requested tubal occlusion at the time of abortion, over 5 years there would be 1274 additional unintended pregnancies and an additional $4,152,373 in direct medical costs. Allowing women to receive tubal occlusion at time of abortion was the dominant strategy. It resulted in both lower costs and greater quality-adjusted life years compared to allowing only interval tubal occlusion after abortion. Prohibiting tubal occlusion at time of abortion resulted in an increased incidence of unintended pregnancy and increased public costs. Copyright © 2014 Mosby, Inc. All rights reserved.

A 57-year follow-up of occlusal changes, oral health, and attitudes toward teeth.

PubMed

Stenvik, Arild; Espeland, Lisen; Berg, Rolf E

2011-04-01

Very few studies have addressed long-term development and risks associated with untreated malocclusion. The purpose of this study was to examine changes in occlusion in a lifelong perspective and to compare oral health and attitudes toward teeth among persons with malocclusion with those having normal occlusion. In 1950 an epidemiologic survey of 2349 8-year-olds was conducted and included 4 intraoral photographs. Three selected samples with different malocclusions (deep bite, crossbite, or irregular teeth) and 1 sample with normal occlusion (a total of 183 subjects) were, 57 years later, invited for examination and an extensive interview about dental experiences and attitudes. Sixty-nine responded (38%) and constitute the subjects studied. Malocclusion remained the same or worsened except in subjects having deep bite in childhood, which in some improved and in others became worse. Crowding generally increased. Sixteen persons reported moderate or severe temporomandular joint (TMJ) problems, and of these 7 belonged to the group with crossbite in childhood. With few exceptions, the subjects in all samples had good oral hygiene, visited the dentist regularly, and had well-preserved dentitions. Mean number of missing teeth was significantly lower among those with normal occlusion compared with the malocclusion groups. Individuals with normal occlusion responded favorably to all questions related to attitudes and experiences about their teeth, while responses in the malocclusion groups varied. Persons with the particular malocclusions examined experienced more problems related to teeth later in life compared with those having normal occlusion in childhood. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

An evaluation of relation between the relative parallelism of occlusal plane to ala-tragal line and variation in the angulation of Po-Na-ANS angle in dentulous subjects: A cephalometric study

PubMed Central

Shetty, Sanath; Shenoy, K. Kamalakanth; Ninan, Justin; Mahaseth, Pranay

2015-01-01

Aims: The aim was to evaluate if any correlation exists between variation in angulation of Po-Na-ANS angle and relative parallelism of the occlusal plane to the different tragal levels of the ear in dentulous subjects. Methodology: A total of 200 subjects were selected for the study. A custom made occlusal plane analyzer was used to determine the posterior point of the ala-tragal line. The lateral cephalogram was shot for each of the subjects. The points Porion, Nasion, and Anterior Nasal Spine were located and the angle formed between these points was measured. Statistical Analysis Used: Fischer's exact test was used to find the correlation between Po-Na-ANS angle and relative parallelism of the occlusal plane to the ala-tragal line at different tragal levels. Results: Statistical analysis showed no significant correlation between Po-Na-ANS angle and relative parallelism of an occlusal plane at different tragal levels, and an inferior point on the tragus was the most common. Conclusion: Irrespective of variations in the Po-Na-ANS angle, no correlation exists between the variation in the angulations of Po-Na-ANS angle and the relative parallelism of occlusal plane to the ala-tragal line at different tragal levels. Furthermore, in a large number of subjects (54%), the occlusal plane was found parallel to a line joining the inferior border of the ala of the nose and the inferior part of the tragus. PMID:26929506

Layperson's preference regarding orientation of the transverse occlusal plane and commissure line from the frontal perspective.

PubMed

Silva, Bruno Pereira; Jiménez-Castellanos, Emilio; Finkel, Sivan; Macias, Inmaculada Redondo; Chu, Stephen J

2017-04-01

Facial asymmetries in features such as lip commissure and interpupillary plane canting have been described as common conditions affecting smile esthetics. When presented with these asymmetries, the clinician must choose the reference line with which to orient the transverse occlusal plane of the planned dental restorations. The purpose of the online survey described in this study was to determine lay preferences regarding the transverse occlusal plane orientation in faces that display a cant of the commissure line viewed from the frontal perspective. From a digitally created symmetrical facial model with the transverse occlusal plane and commissure line parallel to the interpupillary line (horizontal) and a model constructed in a previous study (control), a new facial model was created with 3 degrees of cant of the commissure line. Three digital tooth mountings were designed with different transverse occlusal plane orientations: parallel to the interpupillary line (A), parallel to the commissure line (B), and the mean angulation plane formed between the interpupillary and commissure line (C), resulting in a total of 4 images. All images, including the control, were organized into 6 pairs and evaluated by 247 selected laypersons through an online Web site survey. Each participant was asked to choose the more attractive face from each of the 6 pairs of images. The control image was preferred by 72.9% to 74.5% of the participants compared with the other 3 images, all of which represented a commissure line cant. Among the 3 pairs which represent a commissure line cant, 59.1% to 61.1% preferred a transverse plane of occlusion cant (B and C) compared with a plane of occlusion parallel to the interpupillary, line and 61.1% preferred a plane of occlusion parallel to the commissure line (B) compared with the mean angulation plane (C). Laypeople prefer faces with a commissure line and transverse occlusal plane parallel to the horizontal plane or horizon. When faces present a commissure line cant, laypeople prefer a transverse occlusal plane with a similar and coincident cant. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Voxel-Space Ambient Occlusion

DTIC Science & Technology

2012-02-01

a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. a...represents the BRDF of the surface material, for incoming direction ψ and an outgoing direction. L(y) is the incoming radiance in the direction ψ from a...10-1-0338). Models come from the Stanford repository. References [BS09] L. Bavoil, M.Sainz Multi-layer dual-resolution screen-space ambient occlusion

Haptic simulation framework for determining virtual dental occlusion.

PubMed

Wu, Wen; Chen, Hui; Cen, Yuhai; Hong, Yang; Khambay, Balvinder; Heng, Pheng Ann

2017-04-01

The surgical treatment of many dentofacial deformities is often complex due to its three-dimensional nature. To determine the dental occlusion in the most stable position is essential for the success of the treatment. Computer-aided virtual planning on individualized patient-specific 3D model can help formulate the surgical plan and predict the surgical change. However, in current computer-aided planning systems, it is not possible to determine the dental occlusion of the digital models in the intuitive way during virtual surgical planning because of absence of haptic feedback. In this paper, a physically based haptic simulation framework is proposed, which can provide surgeons with the intuitive haptic feedback to determine the dental occlusion of the digital models in their most stable position. To provide the physically realistic force feedback when the dental models contact each other during the searching process, the contact model is proposed to describe the dynamic and collision properties of the dental models during the alignment. The simulated impulse/contact-based forces are integrated into the unified simulation framework. A validation study has been conducted on fifteen sets of virtual dental models chosen at random and covering a wide range of the dental relationships found clinically. The dental occlusions obtained by an expert were employed as a benchmark to compare the virtual occlusion results. The mean translational and angular deviations of the virtual occlusion results from the benchmark were small. The experimental results show the validity of our method. The simulated forces can provide valuable insights to determine the virtual dental occlusion. The findings of this work and the validation of proposed concept lead the way for full virtual surgical planning on patient-specific virtual models allowing fully customized treatment plans for the surgical correction of dentofacial deformities.

Latest recanalization techniques for complex superficial femoral artery occlusions.

PubMed

Gonzalez, L; Chen, A; Lin, P H; Pisimisis, G; Barshes, N R; Bechara, C F; Kougias, P

2012-08-01

Complex, long segment lesions of the superficial femoral artery (SFA) are common, occurring in 40% of patients with peripheral vascular disease. In particular, chronic total occlusions (CTOs) continue to pose a challenge in the endovascular management of SFA disease. Several conventional wire and catheter based techniques have been described including subintimal recanalization and retrograde techniques. In addition, advances in endovascular technology have led to the development of a series of new devices aimed specifically at facilitating the crossing of long segment SFA occlusions or establishing re-entry of the true lumen. Here we present an overview of the minimally invasive techniques used to recanalize CTOs of the SFA and the latest specialized devices available for both recanalization and re-entry, as well as a summary of the literature supporting their application.

Neuroprotective effect of cathodal transcranial direct current stimulation in a rat stroke model.

PubMed

Notturno, Francesca; Pace, Marta; Zappasodi, Filippo; Cam, Etrugul; Bassetti, Claudio L; Uncini, Antonino

2014-07-15

Experimental focal brain ischemia generates in the penumbra recurrent depolarizations which spread across the injured cortex inducing infarct growth. Transcranial direct current stimulation can induce a lasting, polarity-specific, modulation of cortical excitability. To verify whether cathodal transcranial direct current stimulation could reduce the infarct size and the number of depolarizations, focal ischemia was induced in the rat by the 3 vessels occlusion technique. In the first experiment 12 ischemic rats received cathodal stimulation (alternating 15 min on and 15 min off) starting 45 min after middle cerebral artery occlusion and lasting 4 h. In the second experiment 12 ischemic rats received cathodal transcranial direct current stimulation with the same protocol but starting soon after middle cerebral artery occlusion and lasting 6 h. In both experiments controls were 12 ischemic rats not receiving stimulation. Cathodal stimulation reduced the infarct volume in the first experiment by 20% (p=0.002) and in the second by 30% (p=0.003). The area of cerebral infarction was smaller in animals receiving cathodal stimulation in both experiments (p=0.005). Cathodal stimulation reduced the number of depolarizations (p=0.023) and infarct volume correlated with the number of depolarizations (p=0.048). Our findings indicate that cathodal transcranial direct current stimulation exert a neuroprotective effect in the acute phase of stroke possibly decreasing the number of spreading depolarizations. These findings may have translational relevance and open a new avenue in neuroprotection of stroke in humans. Copyright © 2014. Published by Elsevier B.V.

Laser targeted photo-occlusion of rat choroidal neovascularization without collateral damage.

PubMed

Nishiwaki, Hirokazu; Zeimer, Ran; Goldberg, Morton F; D'Anna, Salvatore A; Vinores, Stanley A; Grebe, Rhonda

2002-02-01

Laser targeted photo-occlusion (LTO) is a novel method being developed to treat choroidal neovascular membranes (CNV) in age-related and other macular degenerations. A photosensitive agent, encapsulated in heat-sensitive liposomes, is administered intravenously. A low power laser warms the targeted tissue and releases a bolus of photosensitizer. The photosensitizer is activated after it clears from the normal choriocapillaris but not from the CNV. Forty-five experimental CNV were induced in seven rats. Five weeks after LTO, complete occlusion was observed by laser targeted angiography (LTA) in 76% of treated CNV, and partial occlusion was found in the remaining 24%. The tissues outside the CNV but within the area treated by LTO showed no flow alteration and no dye leakage. All untreated CNV were patent on LTA at 5 weeks. Light microscopy and electron microscopy confirmed the results in treated and control lesions. Moreover, treated areas next to lesions showed normal photoreceptors, retinal pigment epithelium (RPE), Bruch's membrane and choriocapillaris. These results indicate that LTO may improve current photodynamic therapy by alleviating the need for repeated treatments and by avoiding the long-term risks associated with damage to the RPE and occlusion of normal choriocapillaries.

Use of atropine penalization to treat amblyopia in UK orthoptic practice.

PubMed

Piano, Marianne; O'Connor, Anna R; Newsham, David

2014-01-01

To compare clinical practice patterns regarding atropine penalization use by UK orthoptists to the current evidence base and identify any existing barriers against use of AP as first-line treatment. An online survey was designed to assess current practice patterns of UK orthoptists using atropine penalization. They were asked to identify issues limiting their use of atropine penalization and give opinions on its effectiveness compared to occlusion. Descriptive statistics and content analysis were applied to the results. Responses were obtained from 151 orthoptists throughout the United Kingdom. The main perceived barriers to use of atropine penalization were inability to prescribe atropine and supply difficulties. However, respondents also did not consider atropine penalization as effective as occlusion in treating amblyopia, contrary to recent research findings. Patient selection criteria and treatment administration largely follow current evidence. More orthoptists use atropine penalization as first-line treatment than previously reported. Practitioners tend to closely follow the current evidence base when using atropine penalization, but reluctance in offering it as first-line treatment or providing a choice for parents between occlusion and atropine still remains. This may result from concerns regarding atropine's general efficacy, side effects, and risk of reverse amblyopia. Alternatively, as demonstrated in other areas of medicine, it may reflect the inherent delay of research findings translating to clinical practice changes. Copyright 2014, SLACK Incorporated.

Comparison between Saline Solution Containing Heparin versus Saline Solution in the Lock of Totally Implantable Catheters.

PubMed

Brito, Antonio Rafael de Oliveira; Nishinari, Kenji; Saad, Paulo Fernandes; Saad, Karen Ruggeri; Pereira, Monica Aparecida Tomé; Emídio, Suellen Cristina Dias; Yazbek, Guilherme; Bomfim, Guilherme Andre Zottele; Cavalcante, Rafael Noronha; Krutman, Mariana; Teivelis, Marcelo Passos; Pignataro, Bruno Soriano; Fonseca, Igor Yoshio Imagawa; Centofanti, Guilherme; Soares, Bruno Leonardo Freitas

2018-02-01

There are only 3 studies comparing the efficacy of 2 different types of lock used in totally implantable catheters regarding occlusion or reflux dysfunction. The present study contains the largest published casuistry (862 patients) and is the only one that analyzes 3 parameters: occlusion, reflux dysfunction, and flow dysfunction. This was a retrospective study of patients operated at a large oncology center and followed up in the outpatient clinic between 2007 and 2015. The patients were divided into 2 groups according to the type of lock: the Hep group (heparine), whose lock was composed of saline solution 0.9% with heparin (100 IU/mL) and the SS group (saline solution), whose lock was composed of saline solution 0.9%. The Hep group was composed of 270 patients (31%) and the SS group of 592 patients (69%). Regarding occlusion, there were 8 cases in the Hep group (2.96%) and 8 in the SS group (1.35%; P = 0.11); in relation to reflux dysfunction, there were 8 cases in the Hep group (2.96%) and 8 in the SS group (1.35%; P = 0.11); in relation to flow dysfunction, there was 1 case in the Hep group (0.37%) and 4 cases in the SS group (0.68%; P = 1). There was no statistically significant difference between the groups regarding occlusion, reflux dysfunction, and flow dysfunction. Copyright © 2017 Elsevier Inc. All rights reserved.

Application of a snare technique in retrograde chronic total occlusion percutaneous coronary intervention – a step by step practical approach and an observational study

PubMed Central

Fang, Hsiu-Yu; Lee, Wei-Chieh; Fang, Chih-Yuan; Wu, Chiung-Jen

2016-01-01

Abstract Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has recently become popular among interventional cardiologists. CTO originating from the ostium has been one of the most difficult CTO lesions to treat with PCI for a number of reasons. Our aim was to illustrate a specific technique during retrograde CTO PCI referred to as the “snare technique.” We retrospectively examined the use of “snare technique” among 371 consecutive retrograde CTO PCIs performed at our institution between 2006 and 2015. “Snare technique” was used in 10 patients among the 371 retrograde CTO PCIs. The baseline clinical and angiographic characteristics of patients with or without “snare technique” were similar. The “snare technique” group had significantly fewer side branches at occlusion (30.0% vs 71.2%, P = 0.01) and a higher incidence of externalization (90% vs 25.5%, P < 0.001). The contrast volume was significantly lower in the “snare technique” group (285.0 ± 68.5 vs 379.2 ± 144.0, P = 0.04). The incidence of major complications, retrograde success, or final success did not differ between the groups. The “snare technique” is safe and feasible in retrograde CTO PCI, especially in cases of difficult coronary engagement in cases such as ostial occlusion, challenging coronary anatomy, or retrograde guidewire cannot get in antegrade guiding catheter. PMID:27741138

Angle classification revisited 2: a modified Angle classification.

PubMed

Katz, M I

1992-09-01

Edward Angle, in his classification of malocclusions, appears to have made Class I a range of abnormality, not a point of ideal occlusion. Current goals of orthodontic treatment, however, strive for the designation "Class I occlusion" to be synonymous with the point of ideal intermeshing and not a broad range. If contemporary orthodontists are to continue to use Class I as a goal, then it is appropriate that Dr. Angle's century-old classification, be modified to be more precise.

Conventional occlusion versus pharmacologic penalization for amblyopia.

PubMed

Li, Tianjing; Shotton, Kate

2009-10-07

Amblyopia is defined as defective visual acuity in one or both eyes without demonstrable abnormality of the visual pathway, and is not immediately resolved by wearing glasses. To assess the effectiveness and safety of conventional occlusion versus atropine penalization for amblyopia. We searched CENTRAL, MEDLINE, EMBASE, LILACS, the WHO International Clinical Trials Registry Platform, preference lists, science citation index and ongoing trials up to June 2009. We included randomized/quasi-randomized controlled trials comparing conventional occlusion to atropine penalization for amblyopia. Two authors independently screened abstracts and full text articles, abstracted data, and assessed the risk of bias. Three trials with a total of 525 amblyopic eyes were included. One trial was assessed as having a low risk of bias among these three trials, and one was assessed as having a high risk of bias.Evidence from three trials suggests atropine penalization is as effective as conventional occlusion. One trial found similar improvement in vision at six and 24 months. At six months, visual acuity in the amblyopic eye improved from baseline 3.16 lines in the occlusion and 2.84 lines in the atropine group (mean difference 0.034 logMAR; 95% confidence interval (CI) 0.005 to 0.064 logMAR). At 24 months, additional improvement was seen in both groups; but there continued to be no meaningful difference (mean difference 0.01 logMAR; 95% CI -0.02 to 0.04 logMAR). The second trial reported atropine to be more effective than occlusion. At six months, visual acuity improved 1.8 lines in the patching group and 3.4 lines in the atropine penalization group, and was in favor of atropine (mean difference -0.16 logMAR; 95% CI -0.23 to -0.09 logMAR). Different occlusion modalities were used in these two trials. The third trial had inherent methodological flaws and limited inference could be drawn.No difference in ocular alignment, stereo acuity and sound eye visual acuity between occlusion and atropine penalization was found. Although both treatments were well tolerated, compliance was better in atropine. Atropine penalization costs less than conventional occlusion. The results indicate that atropine penalization is as effective as conventional occlusion. Both conventional occlusion and atropine penalization produce visual acuity improvement in the amblyopic eye. Atropine penalization appears to be as effective as conventional occlusion, although the magnitude of improvement differed among the three trials. Atropine penalization can be used as first line treatment for amblyopia.

Worn is born: The role of the maxillo-mandibular relation in management of worn dentition.

PubMed

Li, Zhongjie; Yang, Zheng; Lan, Tingting; Zhao, Hanchi; Liu, Yang

2017-07-01

Worn dentition, often accompanied by occlusion changes such as reduced vertical dimension, poses a big challenge to both diagnosis and treatment. Current established causes fail to explain the observed tooth wearing patterns, and the treatments based on the documented pathogeneses are often unpredictable and require frequent maintenance. From the perspective of stomatognathic system, we postulate that the role of maxillo-mandibular relation is a crucial part in the tooth wear progression patterns, and should be well addressed in treatment planning. Incompatible occlusion with the inherent tendency of maxillo-mandibular relation has a profound effect on either wearing of natural teeth or failures of restorations. With the aid of cephalometrics and analysis of occlusion it is now possible to reduce this fallacy and achieve a harmony by re-designing the occlusion. According to our treated worn dentition cases, the restoring treatment guided by the tendency of maxillo-mandibular relation showed very promising results. Copyright © 2017 Elsevier Ltd. All rights reserved.

Influence of stains on lesion contrast in the pits and fissures of tooth occlusal surfaces from 800-1600-nm

NASA Astrophysics Data System (ADS)

Almaz, Elias C.; Simon, Jacob C.; Fried, Daniel; Darling, Cynthia L.

2016-02-01

For over one hundred years, x-rays have served as a cornerstone of dentistry. Dental radiographic imaging technologies have constantly improved, however, detecting occlusal lesions remains as one of the greatest challenges due to the low sensitivity of radiographs and the overlap of enamel. Once detected, occlusal lesions have penetrated far into the dentin, necessitating invasive restorative treatment. The adoption of near-infrared (NIR) systems in dentistry introduces the potential for early detection of occlusal lesions. Commercially available NIR systems for intra-oral applications currently operate near 800-nm; however, extrinsic stains may interfere with the detection of demineralization of the underlying enamel surface. Higher wavelengths such as 1300-nm render stains nearly transparent and enhances the contrast of sound enamel to demineralized enamel. This novel finding promotes minimally invasive dentistry and allows oral health professionals the ability to detect, image, track, and monitor early lesions without repeated exposure to ionizing radiation nor invasive treatment.

Clinical significance of sleep bruxism on several occlusal and functional parameters.

PubMed

Ommerborn, Michelle A; Giraki, Maria; Schneider, Christine; Fuck, Lars Michael; Zimmer, Stefan; Franz, Matthias; Raab, Wolfgang Hans-michael; Schaefer, Ralf

2010-10-01

The aim of this study was to evaluate the association between various functional and occlusal parameters and sleep bruxism. Thirty-nine (39) sleep bruxism patients and 30 controls participated in this investigation. The assessment of sleep bruxism was performed using the Bruxcore Bruxism-Monitoring Device (BBMD) combined with a new computer-based analyzing method. Sixteen functional and/or occlusal parameters were recorded. With a mean slide of 0.95 mm in the sleep bruxism group and a mean slide of 0.42 mm in the control group (Mann Whitney U test; p<0.003), results solely demonstrated a significant group difference regarding the length of a slide from centric occlusion to maximum intercuspation. The results suggest that the slightly pronounced slide could be of clinical importance in the development of increased wear facets in patients with current sleep bruxism activity. Following further evaluation including polysomnographic recordings, the BBMD combined with this new analyzing technique seems to be a clinically feasible instrument that allows the practitioner to quantify abrasion over a short period.

Sickle red cell-endothelium interactions.

PubMed

Kaul, Dhananjay K; Finnegan, Eileen; Barabino, Gilda A

2009-01-01

Periodic recurrence of painful vaso-occlusive crisis is the defining feature of sickle cell disease. Among multiple pathologies associated with this disease, sickle red cell-endothelium interaction has been implicated as a potential initiating mechanism in vaso-occlusive events. This review focuses on various interrelated mechanisms involved in human sickle red cell adhesion. We discuss in vitro and microcirculatory findings on sickle red cell adhesion, its potential role in vaso-occlusion, and the current understanding of receptor-ligand interactions involved in this pathological phenomenon. In addition, we discuss the contribution of other cellular interactions (leukocytes recruitment and leukocyte-red cell interaction) to vaso-occlusion, as observed in transgenic sickle mouse models. Emphasis is given to recently discovered adhesion molecules that play a predominant role in mediating human sickle red cell adhesion. Finally, we analyze various therapeutic approaches for inhibiting sickle red cell adhesion by targeting adhesion molecules and also consider therapeutic strategies that target stimuli involved in endothelial activation and initiation of adhesion.

Influence of stains on lesion contrast in the pits and fissures of tooth occlusal surfaces from 800-1600-nm.

PubMed

Almaz, Elias C; Simon, Jacob C; Fried, Daniel; Darling, Cynthia L

2016-02-13

For over one hundred years, x-rays have served as a cornerstone of dentistry. Dental radiographic imaging technologies have constantly improved, however, detecting occlusal lesions remains as one of the greatest challenges due to the low sensitivity of radiographs and the overlap of enamel. Once detected, occlusal lesions have penetrated far into the dentin, necessitating invasive restorative treatment. The adoption of near-infrared (NIR) systems in dentistry introduces the potential for early detection of occlusal lesions. Commercially available NIR systems for intra-oral applications currently operate near 800-nm; however, extrinsic stains may interfere with the detection of demineralization of the underlying enamel surface. Higher wavelengths such as 1300-nm render stains nearly transparent and enhances the contrast of sound enamel to demineralized enamel. This novel finding promotes minimally invasive dentistry and allows oral health professionals the ability to detect, image, track, and monitor early lesions without repeated exposure to ionizing radiation nor invasive treatment.

[Clinical evaluation of preadjusted appliance based on Chinese normal occlusion].

PubMed

Chen, Lin; Gao, Xue-Mei; Zeng, Xiang-Long

2008-02-01

To evaluate the effect of the preadjusted appliance (Z1 appliance) based on Chinese normal occlusion. Thirty non-extraction patients were treated with Z1 appliance. No wire bending was made during treatment. The results of these 30 cases had been evaluated by five senior orthodontists. Models were analysed quantitatively to testify and evaluate the efficiency of the appliance. The average score for post-treatment models was 91.2 (total score was 100). The model measurements indicated that average projective distance on occlusal plane between proximal contact points of adjacent teeth was less than 0.3 mm, which demonstrated good alignment. The prominence of crowns was almost coincident with the data of Chinese normal occlusion. For the average tip of most teeth, there was no statistical difference between the study group and the normal control group. The crown torque variation tendency from anterior to posterior was similar to that in the subjects with normal occlusion. However, the cases treated with Z1 appliance achieved more negative torque in the lower posterior segment. The result of the non-extraction patients treated with Z1 appliance was quite satisfied. Wire bending could be reduced during treatment. It was necessary to adjust the crown torque values for lower posterior teeth.

Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience

DOE Office of Scientific and Technical Information (OSTI.GOV)

Raupach, J., E-mail: janraupach@seznam.cz; Lojik, M., E-mail: miroslav.lojik@fnhk.cz; Chovanec, V., E-mail: chovanec.v@seznam.cz

2016-02-15

PurposeRetrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA).Materials and methodsFrom 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised.ResultsWe achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due tomore » a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %.ConclusionPrimary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.« less

Connexin hemichannel blockade is neuroprotective after asphyxia in preterm fetal sheep.

PubMed

Davidson, Joanne O; Drury, Paul P; Green, Colin R; Nicholson, Louise F; Bennet, Laura; Gunn, Alistair J

2014-01-01

Asphyxia around the time of preterm birth is associated with neurodevelopmental disability. In this study, we tested the hypothesis that blockade of connexin hemichannels would improve recovery of brain activity and reduce cell loss after asphyxia in preterm fetal sheep. Asphyxia was induced by 25 min of complete umbilical cord occlusion in preterm fetal sheep (103-104 d gestational age). Connexin hemichannels were blocked by intracerebroventricular infusion of mimetic peptide starting 90 min after asphyxia at a concentration of 50 µM/h for one hour followed by 50 µM/24 hour for 24 hours (occlusion-peptide group, n = 6) or vehicle infusion for controls (occlusion-vehicle group, n = 7). Peptide infusion was associated with earlier recovery of electroencephalographic power after asphyxia compared to occlusion-vehicle (p<0.05), with reduced neuronal loss in the caudate and putamen (p<0.05), but not in the hippocampus. In the intragyral and periventricular white matter, peptide administration was associated with an increase in total oligodendrocyte numbers (p<0.05) and immature/mature oligodendrocytes compared to occlusion-vehicle (p<0.05), with a significant increase in proliferation (p<0.05). Connexin hemichannel blockade was neuroprotective and reduced oligodendrocyte death and improved recovery of oligodendrocyte maturation in preterm fetuses after asphyxia.

Connexin Hemichannel Blockade Is Neuroprotective after Asphyxia in Preterm Fetal Sheep

PubMed Central

Davidson, Joanne O.; Drury, Paul P.; Green, Colin R.; Nicholson, Louise F.; Bennet, Laura; Gunn, Alistair J.

2014-01-01

Asphyxia around the time of preterm birth is associated with neurodevelopmental disability. In this study, we tested the hypothesis that blockade of connexin hemichannels would improve recovery of brain activity and reduce cell loss after asphyxia in preterm fetal sheep. Asphyxia was induced by 25 min of complete umbilical cord occlusion in preterm fetal sheep (103–104 d gestational age). Connexin hemichannels were blocked by intracerebroventricular infusion of mimetic peptide starting 90 min after asphyxia at a concentration of 50 µM/h for one hour followed by 50 µM/24 hour for 24 hours (occlusion-peptide group, n = 6) or vehicle infusion for controls (occlusion-vehicle group, n = 7). Peptide infusion was associated with earlier recovery of electroencephalographic power after asphyxia compared to occlusion-vehicle (p<0.05), with reduced neuronal loss in the caudate and putamen (p<0.05), but not in the hippocampus. In the intragyral and periventricular white matter, peptide administration was associated with an increase in total oligodendrocyte numbers (p<0.05) and immature/mature oligodendrocytes compared to occlusion-vehicle (p<0.05), with a significant increase in proliferation (p<0.05). Connexin hemichannel blockade was neuroprotective and reduced oligodendrocyte death and improved recovery of oligodendrocyte maturation in preterm fetuses after asphyxia. PMID:24865217

Use of PTFE Stent Grafts for Hemodialysis-related Central Venous Occlusions: Intermediate-Term Results

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kundu, Sanjoy, E-mail: sanjoy_kundu40@hotmail.com; Modabber, Milad; You, John M.

2011-10-15

Purpose: To assess the safety and effectiveness of a polytetrafluoroethylene (PTFE) encapsulated nitinol stents (Bard Peripheral Vascular, Tempe, AZ) for treatment of hemodialysis-related central venous occlusions. Materials and Methods: Study design was a single-center nonrandomized retrospective cohort of patients from May 2004 to August 2009 for a total of 64 months. There were 14 patients (mean age 60 years, range 50-83 years; 13 male, 1 female). All patients had autogenous fistulas. All 14 patients had central venous occlusions and presented with clinical symptoms of the following: extremity swelling (14%, 2 of 14), extremity and face swelling (72%, 10 of 14),more » and face swelling/edema (14%, 2 of 14). There was evidence of access dysfunction with decreased access flow in 36% (5 of 14) patients. There were prior interventions or previous line placement at the site of the central venous lesion in all 14 patients. Results were assessed by recurrence of clinical symptoms and function of the access circuit (National Kidney Foundation recommended criteria). Results: Sixteen consecutive straight stent grafts were implanted in 14 patients. Average treated lesion length was 5.0 cm (range, 0.9-7 cm). All 14 patients had complete central venous occlusion (100% stenosis). The central venous occlusions were located as follows: right subclavian and brachiocephalic vein (21%, 3 of 14), right brachiocephalic vein (36%, 5 of 14), left brachiocephalic vein (36%, 5 of 14), and bilateral brachiocephalic vein (7%, 1 of 14). A total of 16 PTFE stent grafts were placed. Ten- or 12-mm-diameter PTFE stent grafts were placed. The average stent length was 6.1 cm (range, 4-8 cm). Technical (deployment), anatomic (<30% residual stenosis), clinical (resolution of symptoms), and hemodynamic (resolution of access dysfunction) success were 100%. At 3, 6, and 9 months, primary patency of the treated area and access circuit were 100% (14 of 14). Conclusions: This PTFE encapsulated stent graft demonstrates encouraging intermediate-term patency results for central vein occlusions. Further prospective studies with long-term assessment and larger patient populations will be required.« less

A cephalometric study to establish the relationship of the occlusal plane to the three different ala-tragal lines and the Frankfort horizontal plane in different head forms.

PubMed

Subhas, S; Rupesh, P L; Devanna, R; Kumar, D R V; Paliwal, A; Solanki, P

2017-04-01

The aim of the study is to compare the relationship of the occlusal plane to 3 different ala-tragal lines, namely the superior, middle and inferior lines, in individuals having different head forms and its relation to the Frankfort horizontal plane. A total of 75 lateral cephalometric radiographs of subjects with natural dentition, having full complement of teeth, between the age group of 18-25 were screened and selected. Lateral cephalogram were made for each subjects in an open mouth position. Prior to making the lateral cephalogram, radiopaque markers were placed on the superior, middle and inferior tragus points and on the inferior border of the ala of the nose. Cephalometric tracing was done over each cephalogram. In mesiocephalic head form the middle ala-tragal line was most parallel to the occlusal plane having a mean angle of (1.96°). In dolichocephalic headform, the superior ala-tragal line was most parallel to the occlusal plane having a mean angle of (0.48°). In brachycephalic head form, the middle ala-tragal line was most parallel to the occlusal plane having a mean angle of (2.08°). The mean angulations of occlusal plane to FH plane is 11.04°, 10.16° and 10.60° in mesiocephalic, dolichocephalic and brachycephalic head forms, respectively. The study concludes that the middle ala-tragal line can be used as a reference for the mesiocephalic head form and the superior ala-tragal line for the dolichocephalic and brachycephalic head form as a reference to establish the occlusal plane. Copyright © 2016. Published by Elsevier Masson SAS.

Treatment dose-response in amblyopia therapy: the Monitored Occlusion Treatment of Amblyopia Study (MOTAS).

PubMed

Stewart, Catherine E; Moseley, Merrick J; Stephens, David A; Fielder, Alistair R

2004-09-01

Amblyopia is the commonest visual disorder of childhood. Yet the contributions of the two principal treatments (spectacle wear and occlusion) to outcome are unknown. This study was undertaken to investigate the dose-response relationship of amblyopia therapy. The study comprised three distinct phases: baseline, in which repeat measures of visual function were undertaken to confirm the initial visual deficit; refractive adaptation: an 18-week period of spectacle wear with six weekly measurements of logarithm of the minimum angle of resolution (logMAR) visual acuity; occlusion: in which participants were prescribed 6 hours of "patching" per day. In the latter phase, occlusion was objectively monitored and logMAR visual acuity recorded at 2-week intervals until any observed gains had ceased. Data were obtained from 94 participants (mean age, 5.1 +/- 1.4 years) with amblyopia associated with strabismus (n = 34), anisometropia (n = 23), and both anisometropia and strabismus (n = 37). Eighty-six underwent refractive adaptation. Average concordance with patching was 48%. The relationship between logMAR visual acuity gain and total occlusion dose was monotonic and linear. Increasing dose rate beyond 2 h/d hastened the response but did not improve outcome. More than 80% of the improvement during occlusion occurred within 6 weeks. Treatment outcome was significantly better for children younger than 4 years (n = 17) than in those older than 6 years (n = 24; P = 0.0014). Continuous objective monitoring of the amount of patching therapy received has provided insight into the dose-response relationship of occlusion therapy for amblyopia. Patching is most effective within the first few weeks of treatment, even for those in receipt of a relatively small dose. Further studies are needed to elucidate the neural basis for the dose-response functions. Copyright Association for Research in Vision and Ophthalmology

Drug-coated balloon angioplasty for de novo small vessel disease including chronic total occlusion and bifurcation in real-world clinical practice.

PubMed

Onishi, Takayuki; Onishi, Yuko; Kobayashi, Isshi; Umezawa, Shigeo; Niwa, Akihiro

2018-06-18

The aim of this study is to validate the efficacy of drug-coated balloons (DCBs) for real-world de novo small vessel diseases including chronic total occlusion and bifurcation. DCB angioplasty has been reported to be effective in the treatment of de novo small vessel disease. However, the number of reports that have focused on complex lesions is limited. This observational study comprised consecutive patients who underwent DCB angioplasty for de novo small vessel disease with a reference diameter of less than 2.5 mm by visual estimation. Outcome parameters included late lumen loss, restenosis rate, and major adverse cardiac events, such as cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR). Fifty-two patients underwent DCB angioplasty for 59 lesions with a reference vessel diameter of 1.93 ± 0.63 mm. Thirty-eight of the lesions (69%) were classified as type B2/C, including chronic total occlusions (20%) and bifurcations (33%). At the 8-month follow-up, late lumen loss was - 0.01 ± 0.44 mm with a restenosis rate of 20%. No cardiac deaths or myocardial infarctions were reported and only 5 (9%) angiographically driven TLRs were reported. DCB angioplasty offered an acceptable 8-month lumen patency and a stable clinical outcome for real-world complex de novo coronary diseases.

Protocol design and current status of CLIVIT: a randomized controlled multicenter relevance trial comparing clips versus ligatures in thyroid surgery

PubMed Central

Seiler, CM; Fröhlich, BE; Veit, JA; Gazyakan, E; Wente, MN; Wollermann, C; Deckert, A; Witte, S; Victor, N; Buchler, MW; Knaebel, HP

2006-01-01

Background Annually, more than 90000 surgical procedures of the thyroid gland are performed in Germany. Strategies aimed at reducing the duration of the surgical procedure are relevant to patients and the health care system especially in the context of reducing costs. However, new techniques for quick and safe hemostasis have to be tested in clinically relevance randomized controlled trials before a general recommendation can be given. The current standard for occlusion of blood vessels in thyroid surgery is ligatures. Vascular clips may be a safe alternative but have not been investigated in a large RCT. Methods/design CLIVIT (Clips versus Ligatures in Thyroid Surgery) is an investigator initiated, multicenter, patient-blinded, two-group parallel relevance randomized controlled trial designed by the Study Center of the German Surgical Society. Patients scheduled for elective resection of at least two third of the gland for benign thyroid disease are eligible for participation. After surgical exploration patients are randomized intraoperatively into either the conventional ligature group, or into the clip group. The primary objective is to test for a relevant reduction in operating time (at least 15 min) when using the clip technique. Since April 2004, 121 of the totally required 420 patients were randomized in five centers. Discussion As in all trials the different forms of bias have to be considered, and as in this case, a surgical trial, the role of surgical expertise plays a key role, and will be documented and analyzed separately. This is the first randomized controlled multicenter relevance trial to compare different vessel occlusion techniques in thyroid surgery with adequate power and other detailed information about the design as well as framework. If significant, the results might be generalized and may change the current surgical practice. PMID:16948853

Endovascular Therapy of the Superficial Femoral Artery Via a Stand-Alone Transradial Access: A Single-Center Experience.

PubMed

Hanna, Elias B; Ababneh, Bashar A; Amin, Amit N

2018-02-01

We describe our experience in transradial recanalization of the superficial femoral artery (SFA), and we provide a stepwise approach accounting for the patient's height and optimizing the yield of currently available devices. Fifteen patients with simple SFA disease, including 4 patients with total SFA occlusions <15 cm, were selected for stand-alone transradial recanalization. A 6F, 125-cm multipurpose guiding catheter was used to cannulate the limb of interest and support device delivery. The procedure was successful in all patients and consisted of balloon angioplasty (using 0.014″, 200-cm shaft monorail balloons) in all patients, and orbital atherectomy in 6 patients. We illustrate the steps and challenges of the transradial approach, namely the limited support in complex disease and the limited reach of current equipment. In patients with simple SFA disease, transradial recanalization appears feasible and safe but currently limited to balloon angioplasty ± orbital atherectomy. Proximal SFA stenting may be feasible in patients <160 cm in height.

Intercepting a moving target: On-line or model-based control?

PubMed

Zhao, Huaiyong; Warren, William H

2017-05-01

When walking to intercept a moving target, people take an interception path that appears to anticipate the target's trajectory. According to the constant bearing strategy, the observer holds the bearing direction of the target constant based on current visual information, consistent with on-line control. Alternatively, the interception path might be based on an internal model of the target's motion, known as model-based control. To investigate these two accounts, participants walked to intercept a moving target in a virtual environment. We degraded the target's visibility by blurring the target to varying degrees in the midst of a trial, in order to influence its perceived speed and position. Reduced levels of visibility progressively impaired interception accuracy and precision; total occlusion impaired performance most and yielded nonadaptive heading adjustments. Thus, performance strongly depended on current visual information and deteriorated qualitatively when it was withdrawn. The results imply that locomotor interception is normally guided by current information rather than an internal model of target motion, consistent with on-line control.

Comparison of radiographic and clinical diagnosis of approximal and occlusal dental caries in a young adult population.

PubMed

Hopcraft, Matthew S; Morgan, Michael V

2005-06-01

The aims of the study were: (1) to determine if bitewing radiographs provided additional diagnostic yield for occlusal and approximal dental caries in adults aged between 17 and 30 years of age when compared with a clinical examination only, (2) how this translated into the measurement of dental caries experience, and (3) to determine the influence of water fluoridation on the diagnosis of dental caries in occlusal and approximal surfaces by clinical examination alone and by radiographic examination. Between November 2002 and March 2003 a total of 879 subjects aged 17-30 years had a clinical examination using visual and tactile criteria. Subsequent to this examination, bitewing radiographs were taken and viewed separately and blind. Approximal and occlusal surfaces of molars and premolars were examined on the radiographs. Between 22.9-32.9% of approximal caries and 75.9-82.9% of occlusal caries was detected by clinical examination, while 93.1-97.1% of approximal caries and 33.1-42.6% of occlusal caries was detected by radiographic examination. In addition, while only 0.97% of clinically sound approximal surfaces and 0.83% of clinically sound occlusal surfaces were diagnosed with dentine caries on the radiographs, 67.1-77.1% of approximal caries was detected by radiographs alone, an additional diagnostic yield of 204-336%. The DS score increased 45-46% and the DMFS score increased 6-11% from the clinical examination with the addition of the radiographic information (P<0.001). The prevalence of approximal and occlusal caries was underestimated when clinical means only were employed. There was a significant increase in DS and DMFS scores from the clinical examination only when radiographic information was added across all age groups (P<0.001). This study confirms the value of bitewing radiographs in caries diagnosis.

Class II malocclusion with accentuated occlusal plane inclination corrected with miniplate: a case report

PubMed Central

Farret, Marcel Marchiori; Farret, Milton M. Benitez

2016-01-01

ABSTRACT Introduction: A canted occlusal plane presents an unesthetic element of the smile. The correction of this asymmetry has been typically considered difficult by orthodontists, as it requires complex mechanics and may sometimes even require orthognathic surgery. Objective: This paper outlines the case of a 29-year-old woman with Class II malocclusion, pronounced midline deviation and accentuated occlusal plane inclination caused by mandibular deciduous molar ankylosis. Methods: The patient was treated with a miniplate used to provide anchorage in order to intrude maxillary teeth and extrude mandibular teeth on one side, thus eliminating asymmetry. Class II was corrected on the left side by means of distalization, anchored in the miniplate as well. On the right side, maxillary first premolar was extracted and molar relationship was kept in Class II, while canines were moved to Class I relationship. The patient received implant-prosthetic rehabilitation for maxillary left lateral incisor and mandibular left second premolar. Results: At the end of treatment, Class II was corrected, midlines were matched and the canted occlusal plane was totally corrected, thereby improving smile function and esthetics. PMID:27409658

Increases in intramuscular pressure raise arterial blood pressure during dynamic exercise

NASA Technical Reports Server (NTRS)

Gallagher, K. M.; Fadel, P. J.; Smith, S. A.; Norton, K. H.; Querry, R. G.; Olivencia-Yurvati, A.; Raven, P. B.

2001-01-01

This investigation was designed to determine the role of intramuscular pressure-sensitive mechanoreceptors and chemically sensitive metaboreceptors in affecting the blood pressure response to dynamic exercise in humans. Sixteen subjects performed incremental (20 W/min) cycle exercise to fatigue under four conditions: control, exercise with thigh cuff occlusion of 90 Torr (Cuff occlusion), exercise with lower body positive pressure (LBPP) of 45 Torr, and a combination of thigh cuff occlusion and LBPP (combination). Indexes of central command (heart rate, oxygen uptake, ratings of perceived exertion, and electromyographic activity), cardiac output, stroke volume, and total peripheral resistance were not significantly different between the four conditions. Mechanical stimulation during LBPP and combination conditions resulted in significant elevations in intramuscular pressure and mean arterial pressure from control at rest and throughout the incremental exercise protocol (P < 0.05). Conversely, there existed no significant changes in mean arterial pressure when the metaboreflex was stimulated by cuff occlusion. These findings suggest that under normal conditions the mechanoreflex is tonically active and is the primary mediator of exercise pressor reflex-induced alterations in arterial blood pressure during submaximal dynamic exercise in humans.

Veno-occlusive disease in snow leopards (Panthera uncia) from zoological parks.

PubMed

Munson, L; Worley, M B

1991-01-01

Livers from 54 snow leopards, 4 days to 23 years old, that had died in 23 US zoos, were evaluated histopathologically to determine if the hepatic fibrosis, which has been noted to be prevalent in this species, was due to chronic active hepatitis from hepadnaviral infection, Ito cell proliferation, or hemosiderosis. Forty-two of 54 snow leopards had subintimal vascular fibrosis with partial or total occlusion of central and sublobular veins (veno-occlusive disease) of unknown origin. All 21 leopards older than 5 years were affected. Four leopards had chronic active hepatitis, and 12 leopards had cholangiohepatitis; but these lesions were not connected anatomically to central and sublobular venous fibrosis. Hepatocellular and Kupffer cell siderosis and Ito cell proliferation were prevalent and often coexisted with perisinusoidal, central, and sublobular venous fibrosis; but fibrosis was present in leopards without siderosis or Ito cell proliferation. The pattern and prevalence of veno-occlusive disease in these leopards was similar to that reported in captive cheetah (Acinonyx jubatus), suggesting that a common extrinsic factor may cause the majority of hepatic disease in these large felid animals in captivity.

Aspirin Use Is Associated With Reduced Risk of Occlusion of Metallic Biliary Stents.

PubMed

Jang, Sunguk; Stevens, Tyler; Parsi, Mansour A; Lopez, Rocio; Vargo, John J

2017-03-01

Biliary self-expandable metallic stents (SEMSs) are widely used to treat malignant and benign conditions of bile duct. Despite their lower rate of occlusion and longer patency than plastic stents, SEMSs still have significant rates of occlusion. We aimed to identify factors associated with occlusion of biliary SEMS. We performed a retrospective study of consecutive patients who underwent endoscopic retrograde cholangiopancreatography with biliary SEMS placement at the Cleveland Clinic Foundation from March 2011 to April 2016. We collected clinical, endoscopic, radiographic, and surgical data from medical records and performed multivariable analysis to identify factors associated with SEMS patency. Subjects that received minimal daily dose of 81 mg at the time of stent placement until the end of follow-up were assigned to the aspirin exposure group (n = 157) and compared with subjects with no aspirin exposure (n = 436). Patients were followed for a median 81 days. The primary outcome was hazard ratio for SEMS occlusion requiring an interventional maneuver for biliary drainage. We analyzed data from patients receiving a total of 593 biliary SEMS for treatment of malignant and benign conditions of bile duct. Stent occlusion was observed in 126 cases. Multivariable analysis showed that daily use of aspirin (81 mg or more) was associated with 51% lower risk of stent occlusion than in patients without daily use of aspirin (hazard ratio, 0.49; 95% confidence interval, 0.32-0.75). Furthermore, SEMSs had a longer duration of stent patency in patients in the aspirin exposure group (434.4 days) versus the no aspirin exposure group (339.9 days) (P < .001). Stricture location limited to distal bile duct (in comparison with strictures involving proximal extrahepatic duct) was associated with lower risk of stent occlusion (hazard ratio, 0.39; 95% CI, 0.22-0.71). In an analysis of a large cohort of subjects with metallic biliary stent placement for malignant and benign conditions of bile duct, we associated daily use of aspirin (81 mg or more) with lower risk of SEMS occlusion and longer stent patency duration. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

C-reactive protein predicts further ischemic events in first-ever transient ischemic attack or stroke patients with intracranial large-artery occlusive disease.

PubMed

Arenillas, Juan F; Alvarez-Sabín, José; Molina, Carlos A; Chacón, Pilar; Montaner, Joan; Rovira, Alex; Ibarra, Bernardo; Quintana, Manuel

2003-10-01

The role of inflammation in intracranial large-artery occlusive disease is unclear. We sought to investigate the relationship between high-sensitivity C-reactive protein (CRP) levels and the risk of further ischemic events in first-ever transient ischemic attack (TIA) or stroke patients with intracranial large-artery occlusive disease. Of a total of 127 consecutive first-ever TIA or ischemic stroke patients with intracranial stenoses detected by transcranial Doppler ultrasonography, 71 fulfilled all inclusion criteria, which included angiographic confirmation. Serum high-sensitivity CRP level was determined a minimum of 3 months after the qualifying event. Patients were followed up during 1 year after blood sampling. Thirteen patients (18.3%) with intracranial large-artery occlusive disease experienced an end point event: 9 cerebral ischemic events, 7 of which were attributable to intracranial large-artery occlusive disease, and 4 myocardial infarctions. Patients in the highest quintile of high-sensitivity CRP level had a significantly higher adjusted odds ratio for new events compared with those in the first quintile (odds ratio, 8.66; 95% CI, 1.39 to 53.84; P=0.01). A high-sensitivity CRP level above the receiver operating characteristic curve cutoff value of 1.41 mg/dL emerged as an independent predictor of new end point events (hazard ratio, 7.14; 95% CI, 1.77 to 28.73; P=0.005) and of further intracranial large-artery occlusive disease-related ischemic events (hazard ratio, 30.67; 95% CI, 3.6 to 255.5; P=0.0015), after adjustment for age, sex, and risk factors. Kaplan-Meier curves showed that a significantly lower proportion of patients with a high-sensitivity CRP >1.41 mg/dL remained free of a new ischemic event (P<0.0001). High-sensitivity CRP serum level predicts further intracranial large-artery occlusive disease-related and any major ischemic events in patients with first-ever TIA or stroke with intracranial large-artery occlusive disease. These findings are consistent with the hypothesis that inflammation may be involved in the progression and complication of intracranial large-artery occlusive disease.

A Novel, Modified Reverse Controlled Antegrade and Retrograde Subintimal Tracking Technique for Bypassing the Calcified Proximal Cap of Coronary Total Occlusions

PubMed Central

Ochiai, Masahiko; Munehisa, Masato; Ootomo, Tatsushi

2017-01-01

Antegrade crossing is the most common approach to chronic total occlusions (CTOs). However, it is sometimes difficult to penetrate the proximal hard cap with guidewires, especially in the case of CTOs of anomalous coronary arteries because of a lack of support. Herein, we describe a novel, modified reverse controlled antegrade and retrograde subintimal tracking (CART) technique in which the dissection reentry was intentionally created in the proximal segment of the vessel, not within the occluded segment, using retrograde guidewire and the aid of an antegrade balloon. This technique facilitated retrograde crossing of CTOs by avoiding the proximal hard cap and may provide a viable option for patients in which conventional reverse CART is not possible. PMID:28529807

Quantification of muscle oxygenation and flow of healthy volunteers during cuff occlusion of arm and leg flexor muscles and plantar flexion exercise

NASA Astrophysics Data System (ADS)

Durduran, Turgut; Yu, Guoqiang; Zhou, Chao; Lech, Gwen; Chance, Britton; Yodh, Arjun G.

2003-07-01

A hybrid instrument combining near infrared and diffuse correlation spectroscopies was used to measure muscle oxygenation and blood flow dynamics during cuff occlusion and ischemia. Measurements were done on six healthy subjects on their arm and leg flexor muscles. Hemodynamic response was characterized for blood oxygen saturation, total hemoglobin concenration and relative blood flow speed. The characterization allowed us to define the normal response range as well as showing the feasibility of using a hybrid instrument for dynamic measurements.

Photoacoustic removal of occlusions from blood vessels

DOEpatents

Visuri, Steven R.; Da Silva, Luiz B.; Celliers, Peter M.; London, Richard A.; Maitland, IV, Duncan J.; Esch, Victor C.

2002-01-01

Partial or total occlusions of fluid passages within the human body are removed by positioning an array of optical fibers in the passage and directing treatment radiation pulses along the fibers, one at a time, to generate a shock wave and hydrodynamics flows that strike and emulsify the occlusions. A preferred application is the removal of blood clots (thrombin and embolic) from small cerebral vessels to reverse the effects of an ischemic stroke. The operating parameters and techniques are chosen to minimize the amount of heating of the fragile cerebral vessel walls occurring during this photo acoustic treatment. One such technique is the optical monitoring of the existence of hydrodynamics flow generating vapor bubbles when they are expected to occur and stopping the heat generating pulses propagated along an optical fiber that is not generating such bubbles.

Neutrophils, platelets, and inflammatory pathways at the nexus of sickle cell disease pathophysiology

PubMed Central

Zhang, Dachuan; Xu, Chunliang; Manwani, Deepa

2016-01-01

Sickle cell disease (SCD) is a severe genetic blood disorder characterized by hemolytic anemia, episodic vaso-occlusion, and progressive organ damage. Current management of the disease remains symptomatic or preventative. Specific treatment targeting major complications such as vaso-occlusion is still lacking. Recent studies have identified various cellular and molecular factors that contribute to the pathophysiology of SCD. Here, we review the role of these elements and discuss the opportunities for therapeutic intervention. PMID:26758915

Vascular occlusion and infarction in sickle cell crisis and the sickle chest syndrome.

PubMed Central

Athanasou, N A; Hatton, C; McGee, J O; Weatherall, D J

1985-01-01

A young adult with homozygous sickle cell anaemia (Hb SS) suffered a fatal sickle cell crisis complicated by the sickle chest syndrome. At necropsy multiple large infarcts of the lung, bone marrow, and pituitary gland were found. The large majority of pulmonary infarcts were not associated with either gross or microscopic vaso-occlusion. These findings are discussed and correlated with past and current opinions of sickle cell crisis and the sickle chest syndrome. Images PMID:4008666

[Investigation into the actual condition of patients with occlusal disharmony at the Pedodontic Clinic of Kyushu University. Cases of anterior cross-bite in the deciduous dentition].

PubMed

Yamasaki, K; Hirota, K; Yamasaki, Y; Nonaka, K; Nakata, M

1989-01-01

The total number of subjects was 2754 children (1354 boys and 1402 girls), who visited the Pedodontic Clinic of Kyushu University during the 5 year period from April 1st 1981 to March 31st 1986. We investigated the actual conditions of patients who complained of occlusal disharmony and who were ascertained to be associated with occlusal disharmony. The results were as follows: 1. The percentage ratio of patients with chief complaints concerning occlusions was 14.5% and the percentage of patients with various type of complaints as well as the problem of occlusion was 8.1%. The ratio of the sex of the patients who complained of their occlusal disharmony was 43.0% for boys and 57.0% for girls. 2. The age distributions of the patients who had as the chief complaint occlusal disharmony were at the ages of 3 and 6 to 7 at the maximum. 3. The number of patients who were diagnosed with occlusal disharmony at the first examination was 28.5%. These included anterior cross-bite 32.5%, edge to edge bite 14.1%, cross-bite 13.0%, crowding 11.8% and et al. 4. The distribution of anterior cross-bites due to the developmental stage was divided into the deciduous dentition 59.9%, the mixed dentition 39.3% and the permanent dentition 0.8%. 5. The sex ratios of anterior cross-bites in the deciduous dentition were 45.6% for boys and 54.4% for girls. 6. The treatment of occlusal guidance for anterior cross-bite in the deciduous dentition started from ages 3 to 5. 7. The appliances used for the treatment of anterior cross-bite in the deciduous dentition were maxillary protraction 25.0%, the chin cap 20.0%, the FKO 17.5%, and the lingual arch with herical springs 15.0% and et al. 8. The status of the patients with the anterior cross-bite in the deciduous dentition as of August 1986 was that the 36.2% was under the observation, and 24.4% was under the treatment of occlusal guidance or under the observation after the treatment was done.

Outcomes of endovascular interventions for TASC II B and C femoropopliteal lesions.

PubMed

Baril, Donald T; Marone, Luke K; Kim, Justine; Go, Michael R; Chaer, Rabih A; Rhee, Robert Y

2008-09-01

To evaluate outcomes of endovascular interventions on femoropopliteal occlusive disease and determine predictors of restenosis of Trans Atlantic Inter-Societal Consensus (TASC) II B and C lesions. All patients undergoing endovascular interventions for femoropopliteal occlusive disease between May 2003 and July 2007 were reviewed. Patient demographics, pre- and post-procedure ankle-brachial indices (ABI), and anatomic factors (including categorization by TASC II classification, lesion length, and runoff vessel status) were analyzed. Outcomes evaluated included freedom from restenoses, freedom from re-intervention, overall patency, and assisted-patency. A total of 237 total limbs were treated during the period reviewed. The study group included 108 TASC B and 32 TASC C limbs in 125 patients (mean age 73.1 +/- 10.4 years, male sex: 59%). Seventy-one percent of patients were Rutherford classification 2/3 while the remaining 29% were Rutherford classification 4/5. Mean follow-up period was 12.7 months (range, 1-52 m). Forty-one (41) limbs experienced restenosis or occlusion at a mean time of 8 months (range, 1-24 m). Freedom from restenosis/occlusion was 58.9% at 12 months and 47.9% at 24 months. Predictors of restenosis included a preoperative ABI <0.5 (hazard ratio [HR] 3.05, 95% confidence interval [CI] 1.36-6.86, P = .007) and hypercholesterolemia (HR 2.42, 95% CI 1.11-5.25, P = .025). Lesion length as a continuous variable (per centimeter) also correlated with a higher risk of restenosis (HR 1.06, 95% CI 1.00-1.12, P = .057). The overall assisted-primary and secondary-patency rates were 87% and 94% respectively at 3 years with no significant differences between TASC B and TASC C limbs. Endovascular interventions for TASC II B and C lesions are associated with restenosis/occlusion rates that are at least as good as those of open femoropopliteal bypass surgery from historical, previously published series. Furthermore, overall assisted-patency rates are excellent, although low preoperative ABIs continue to be associated with worse outcomes.

A randomised comparison of Conventional versus Intentional straTegy in patients with high Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion: rationale and design of the CIT-RESOLVE trial

PubMed Central

Zhang, Dong; Yin, Dong; Song, Chenxi; Zhu, Chengang; Kirtane, Ajay J; Xu, Bo; Dou, Kefei

2017-01-01

Introduction The intentional strategy (aggressive side branch (SB) protection strategy: elective two-stent strategy or jailed balloon technique) is thought to be associated with lower SB occlusion rate than conventional strategy (provisional two-stent strategy or jailed wire technique). However, most previous studies showed comparable outcomes between the two strategies, probably due to no risk classification of SB occlusion when enrolling patients. There is still no randomised trial compared the intentional and conventional strategy when treating bifurcation lesions with high risk of SB occlusion. We aim to investigate if intentional strategy is associated with significant reduction of SB occlusion rate compared with conventional strategy in high-risk patients. Methods and analysis The Conventional versus Intentional straTegy in patients with high Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion (CIT-RESOLVE) is a prospective, randomised, single-blind, multicentre clinical trial comparing the rate of SB occlusion between the intentional strategy group and the conventional strategy group (positive control group) in a consecutive cohort of patients with high risk of side branch occlusion defined by V-RESOLVE score, which is a validated angiographic scoring system to evaluate the risk of SB occlusion in bifurcation intervention and used as one of the inclusion criteria to select patients with high SB occlusion risk (V-RESOLVE score ≥12). A total of 21 hospitals from 10 provinces in China participated in the present study. 566 patients meeting all inclusion/exclusion criteria are randomised to either intentional strategy group or conventional strategy group. The primary endpoint is SB occlusion (defined as any decrease in thrombolysis in myocardial infarction flow grade or absence of flow in SB after main vessel stenting). All patients are followed up for 12-month postdischarge. Ethics and dissemination The protocol has been approved by all local ethics committee. The ethics committee have approved the study protocol, evaluated the risk to benefit ratio, allowed operators with a minimum annual volume of 200 cases to participate in the percutaneous coronary intervention procedure and permitted them to perform both conventional and intentional strategies. Written informed consent would be acquired from all participants. The findings of the trial will be shared by the participant hospitals and disseminated through peer-reviewed journals. Trial registration number NCT02644434; Pre-results. PMID:28606906

Defining degree of aortic occlusion for partial-REBOA: A computed tomography study on large animals.

PubMed

Reva, Viktor A; Matsumura, Yosuke; Samokhvalov, Igor M; Pochtarnik, Alexander A; Zheleznyak, Igor S; Mikhailovskaya, Ekaterina M; Morrison, Jonathan J

2018-04-20

Partial resuscitative endovascular balloon occlusion of the aorta (P-REBOA) is a modified REBOA technique designed to help ameliorate ischemia-reperfusion injury. The balloon is partially deflated, allowing a proportion of aortic flow distal to the balloon. The aim of this study is to use an ovine model of haemorrhagic shock to correlate the degree of occlusion to several hemodynamic indices. Six sheep weighing 35-46 kg underwent a controlled venous haemorrhage inside a CT scanner until the systolic arterial pressure (AP) dropped to <90 mmHg. A balloon positioned in an aortic zone I was incrementally filled with 1 mL of saline, with serial measurement of the proximal (carotid artery) and distal (femoral artery) mean APs (MAP) and intra-balloon pressure (IBP), along with CT imaging, following each inflation, until full occlusion was achieved. A diameter of the aorta at zone I was 16.0 (15.7-17.2) mm, with a cross-sectional area of 212 (194-233) mm 2 . Median volume of saline injected into the balloon until total occlusion was 7.0 (6.3-8.5) mL. During gradual balloon inflation, proximal MAP increased and distal MAP decreased proportionate to the degree of occlusion, in a linear fashion (proximal: r 2  = 0.85, p < 0.001; distal: r 2  = 0.95, p < 0.001). The femoral/carotid (F/C) pressure gradient also demonstrated a linear trend (r 2  = 0.90, p < 0.001). The relationship between percentage occlusion and IBP was sigmoid. MAP values became significantly different at 40-49% occlusion and more (p < 0.01). Furthermore, a drop in the distal pulse pressure from 7.0 (5.5-16.5) to 2.0 (1.5-5.0) mmHg was observed at 80% occlusion. All animals had femoral pulse pressure <5 mmHg at 80% of occlusion and more, which also coincided with the observed loss of pulsatility of the femoral wave-form. Serial CT angiography at an ovine model of haemorrhagic shock demonstrates a correlation between the femoral MAP, F/C pressure gradient and degree of zone I P-REBOA during the staged partial aortic occlusion. These parameters should be considered potential parameters to define the degree of P-REBOA during animal research and clinical practice. Copyright © 2018 Elsevier Ltd. All rights reserved.

A randomised comparison of Conventional versus Intentional straTegy in patients with high Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion: rationale and design of the CIT-RESOLVE trial.

PubMed

Zhang, Dong; Yin, Dong; Song, Chenxi; Zhu, Chengang; Kirtane, Ajay J; Xu, Bo; Dou, Kefei

2017-06-12

The intentional strategy (aggressive side branch (SB) protection strategy: elective two-stent strategy or jailed balloon technique) is thought to be associated with lower SB occlusion rate than conventional strategy (provisional two-stent strategy or jailed wire technique). However, most previous studies showed comparable outcomes between the two strategies, probably due to no risk classification of SB occlusion when enrolling patients. There is still no randomised trial compared the intentional and conventional strategy when treating bifurcation lesions with high risk of SB occlusion. We aim to investigate if intentional strategy is associated with significant reduction of SB occlusion rate compared with conventional strategy in high-risk patients. The Conventional versus Intentional straTegy in patients with high Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion (CIT-RESOLVE) is a prospective, randomised, single-blind, multicentre clinical trial comparing the rate of SB occlusion between the intentional strategy group and the conventional strategy group (positive control group) in a consecutive cohort of patients with high risk of side branch occlusion defined by V-RESOLVE score, which is a validated angiographic scoring system to evaluate the risk of SB occlusion in bifurcation intervention and used as one of the inclusion criteria to select patients with high SB occlusion risk (V-RESOLVE score ≥12). A total of 21 hospitals from 10 provinces in China participated in the present study. 566 patients meeting all inclusion/exclusion criteria are randomised to either intentional strategy group or conventional strategy group. The primary endpoint is SB occlusion (defined as any decrease in thrombolysis in myocardial infarction flow grade or absence of flow in SB after main vessel stenting). All patients are followed up for 12-month postdischarge. The protocol has been approved by all local ethics committee. The ethics committee have approved the study protocol, evaluated the risk to benefit ratio, allowed operators with a minimum annual volume of 200 cases to participate in the percutaneous coronary intervention procedure and permitted them to perform both conventional and intentional strategies. Written informed consent would be acquired from all participants. The findings of the trial will be shared by the participant hospitals and disseminated through peer-reviewed journals. NCT02644434; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effectiveness of various toothpastes on dentine tubule occlusion.

PubMed

Arnold, W H; Prange, M; Naumova, E A

2015-04-01

Dentine hypersensitivity is an increasing problem in dentistry. Several products are available that claim to occlude open dentine tubules and to reduce dentine hypersensitivity. The aim of this study was to investigate the effectiveness of several different products on dentine tubule occlusion using qualitative and quantitative methods. Dentine discs were prepared from extracted human premolars and molars. The dentine discs were brushed with 6 different experimental toothpastes, 1 positive control toothpaste and 1 negative control without toothpaste; the brushing simulated a total brushing time of 1 year. Half of the discs were etched with lemon juice after toothpaste application. Standardized scanning electron microphotographs were taken and converted into binary black and white images. The black pixels, which represented the open dentine tubules, were counted and statistically evaluated. Then, half of the dentine discs were broken, and the occlusion of the dentine tubules was investigated using energy dispersive X-ray spectroscopy (EDS). The number of open dentine tubules decreased significantly after brushing with 5 of the 6 tested toothpastes. A significant effect was observed after acid erosion for 3 of the 6 tested toothpastes. EDS revealed partly closed dentine tubules after brushing with 3 toothpastes; however, no partly closed dentine tubules were observed after acid erosion. Some toothpastes are capable of partial dentine tubule occlusion. This occlusion is unstable and can be removed with acid erosion. Desensitizing toothpastes are the most common products that are used against dentine hypersensitivity, and these toothpastes affect dentine tubule occlusion. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Routine Use of Surgical Retrograde Transtibial Endovascular Approach for Failed Attempts at Antegrade Recanalization of Chronic Peripheral Artery Total Occlusions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liang, GangZhu; Zhang, FuXian, E-mail: gangzhuliang@126.com; Luo, XiaoYun

PurposeOur aim was to describe the technical aspects and clinical outcomes of an open surgical approach to retrograde transtibial endovascular therapy for recanalization of chronic total occlusions (CTOs) of peripheral arteries because of inability to acquire antegrade intravascular access across the occlusion.Materials and MethodsBetween January 2011 and May 2014, conventional antegrade revascularization failed in 15 limbs of 15 patients (11 males, 4 females) with complex CTOs. The mean age of the patients was 74 years (range 48–83 years). Five patients had severe claudication (Rutherford Category 3), and 10 patients had critical limb-threatening ischemia (Rutherford Categories 4–5). For each of these cases ofmore » antegrade failure, an open surgical exposure of the tibial or dorsalis pedis artery was used to allow a safe retrograde transtibial endovascular approach to recanalize the CTO.ResultsSurgical retrograde access from the tibial artery was achieved successfully in 14 of the 15 patients. In the 14 successful retrograde endovascular approaches, surgical retrograde transtibial access was achieved from the dorsalis pedis artery in 8 patients and from the posterior tibial artery in 6. The average time to obtain retrograde access was 5 min (range 2–11 min). No stenosis or occlusion occurred in the tibial or dorsalis pedis arteries used for the retrograde access sites during follow-up.ConclusionsRoutine surgical exposure can be a safe and an effective method for retrograde transtibial access to the more proximal occluded arterial segments in selected patients with CTO.« less

An Inertial and Optical Sensor Fusion Approach for Six Degree-of-Freedom Pose Estimation

PubMed Central

He, Changyu; Kazanzides, Peter; Sen, Hasan Tutkun; Kim, Sungmin; Liu, Yue

2015-01-01

Optical tracking provides relatively high accuracy over a large workspace but requires line-of-sight between the camera and the markers, which may be difficult to maintain in actual applications. In contrast, inertial sensing does not require line-of-sight but is subject to drift, which may cause large cumulative errors, especially during the measurement of position. To handle cases where some or all of the markers are occluded, this paper proposes an inertial and optical sensor fusion approach in which the bias of the inertial sensors is estimated when the optical tracker provides full six degree-of-freedom (6-DOF) pose information. As long as the position of at least one marker can be tracked by the optical system, the 3-DOF position can be combined with the orientation estimated from the inertial measurements to recover the full 6-DOF pose information. When all the markers are occluded, the position tracking relies on the inertial sensors that are bias-corrected by the optical tracking system. Experiments are performed with an augmented reality head-mounted display (ARHMD) that integrates an optical tracking system (OTS) and inertial measurement unit (IMU). Experimental results show that under partial occlusion conditions, the root mean square errors (RMSE) of orientation and position are 0.04° and 0.134 mm, and under total occlusion conditions for 1 s, the orientation and position RMSE are 0.022° and 0.22 mm, respectively. Thus, the proposed sensor fusion approach can provide reliable 6-DOF pose under long-term partial occlusion and short-term total occlusion conditions. PMID:26184191

Endovascular Treatment of Cerebral Aneurysms in Relation to Their Parent Artery Wall: A Single Center Study

PubMed Central

Mitsos, A.P.; Giannakopoulou, M.D.; Kaklamanos, I.G.; Kapritsou, M.; Konstantinou, M.I.; Fotis, T.; Mamoura, K.V.; Mariolis-Sapsakos, T.; Ntountas, I.T.; Konstantinou, E.A.

2013-01-01

We report our two-year experience in the endovascular treatment of brain aneurysms in relation to their parent artery wall. We prospectively recorded patients with intracranial aneurysms (107 ruptured - 38 unruptured) treated with coiling during a two-year period: 145 patients, 94 females and 51 males - mean age 56 years. The aneurysms were divided into side-wall (A) and bifurcation (B) groups. A total occlusion rate was noted in post-embolization angiograms in 101 aneurysms (70%) with a morbidity of 4%. No angiographic recurrence arose in the six-month follow-up. The two groups had a similar total occlusion rate (68.31% and 71.8% respectively), while the complication rate was 3% in group A and 4.7% in group B. Significant differences between the two groups were noted in the number of assisted coiling cases: 28 out of 60 cases (46.7%) in group A - 14 out of 85 cases (16.5%) in group B. Further statistical analysis showed strong dependencies for the type of endovascular procedure between the ruptured and unruptured aneurysms in both groups (p 0.000<0.05), but no dependencies between the aneurysm occlusion rate and the ruptured or non-ruptured aneurysms, or between the occlusion rate and the type of endovascular procedure (p 0.552 >0.05 and 0.071 >0.05 respectively). In conclusion, the anatomic relation of the aneurysm sac with the wall of the parent artery is important, as significant differences in endovascular practice, devices and techniques were noted between side-wall and bifurcation aneurysms. PMID:23859171

An Inertial and Optical Sensor Fusion Approach for Six Degree-of-Freedom Pose Estimation.

PubMed

He, Changyu; Kazanzides, Peter; Sen, Hasan Tutkun; Kim, Sungmin; Liu, Yue

2015-07-08

Optical tracking provides relatively high accuracy over a large workspace but requires line-of-sight between the camera and the markers, which may be difficult to maintain in actual applications. In contrast, inertial sensing does not require line-of-sight but is subject to drift, which may cause large cumulative errors, especially during the measurement of position. To handle cases where some or all of the markers are occluded, this paper proposes an inertial and optical sensor fusion approach in which the bias of the inertial sensors is estimated when the optical tracker provides full six degree-of-freedom (6-DOF) pose information. As long as the position of at least one marker can be tracked by the optical system, the 3-DOF position can be combined with the orientation estimated from the inertial measurements to recover the full 6-DOF pose information. When all the markers are occluded, the position tracking relies on the inertial sensors that are bias-corrected by the optical tracking system. Experiments are performed with an augmented reality head-mounted display (ARHMD) that integrates an optical tracking system (OTS) and inertial measurement unit (IMU). Experimental results show that under partial occlusion conditions, the root mean square errors (RMSE) of orientation and position are 0.04° and 0.134 mm, and under total occlusion conditions for 1 s, the orientation and position RMSE are 0.022° and 0.22 mm, respectively. Thus, the proposed sensor fusion approach can provide reliable 6-DOF pose under long-term partial occlusion and short-term total occlusion conditions.

[Clinical study on the coronary artery interventions guided by the magnetic navigation system].

PubMed

Li, Chun-jian; Wang, Hui; Wang, Lian-sheng; Zhu, Tie-bing; Yang, Zhi-jian; Cao, Ke-jiang

2010-03-01

To investigate the efficacy and safety of the magnetic navigation system used in the real world percutaneous coronary artery intervention. All lesions detected by the coronary artery angiography in the magnetic-navigation catheter lab indicated for percutaneous coronary artery intervention (PCI) were included and treated under the guidance of the magnetic navigation system. The characteristics of the target lesion, process of the procedure, time and dosage of the X-ray exposure, and procedure-related complication were recorded and analyzed. One hundred and twenty one patients with 138 lesions were recruited and intervened by PCI during the period from April 2006 to June 2008. Thirty lesions were classified as type A, 50 as type B1, 36 as type B2, 22 as type C (including seven total occlusions). The average stenosis of the target lesions was (85.3 +/- 10.0)%, mean length was (21.1 +/- 10.0) mm. Under the guidance of the magnetic navigation system, 134 target lesions were passed by the magnetic guide-wires, the lesion passing ratio was 97.1%. The X-ray exposure time, X-ray dosage and the contrast volume used during the period of the wire placement were (55.9 +/- 35.4) seconds, (98.0 +/- 86.1) mGy/(490.0 +/- 422.2) microGym(2) and (8.0 +/- 5.4) ml, respectively. A total of 164 stents were implanted in the vessels where the target lesions were passed by the magnetic wires. There was no magnetic navigation system associated complication. Magnetic guide-wires failed to pass four target lesions, two of which were chronic total occlusions (CTOs), and the other two were calcified subtotal occlusions. It is feasible and safe to adopt the magnetic navigation system for the real-world coronary artery intervention. The magnetic guide-wire possesses a high lesion-passing ratio. The CTOs and calcified subtotal occlusions are not ideal lesions for use of the magnetic navigation system.

Corkscrew collaterals in atherosclerosis obliterans.

PubMed

Fujii, Yuichi; Ueda, Tomohiro; Uchimura, Yuko; Teragawa, Hiroki

2017-12-01

Marked calcifications in the femoral artery obscured imaging of the artery in computed tomography (CT) and duplex ultrasonography. The presence of corkscrew collateral arteries in patients with Atherosclerosis obliterans (ASO) indicates total artery occlusion.

[Evaluation of visual acuity in a historical cohort of 137 patients treated for amblyopia by occlusion 30-35 years ago].

PubMed

Simonsz-Tóth, B; Loudon, S E; van Kempen-du Saar, H; van de Graaf, E S; Groenewoud, J H; Simonsz, H J

2007-01-01

Opinions differ on the course of the visual acuity in the amblyopic eye after cessation of occlusion therapy. This study evaluated visual acuity in a historical cohort treated for amblyopia with occlusion therapy 30-35 years ago. Between 1968 and 1975, 1250 patients had been treated by the orthoptist in the Waterland Hospital in Purmerend, The Netherlands. Of these, 471 received occlusion treatment for amblyopia (prevalence 5.0%, after comparison with the local birth rate). We were able to contact 203 of these patients, 137 were orthoptically re-examined in 2003. We correlated the current visual acuity with the cause of amblyopia, the age at start and end of treatment, the visual acuity at start and end of treatment, fixation, binocular vision and refractive errors. Mean age at the start of treatment was 5.4 +/- 1.9 years, 7.4 +/- 1.7 years at the end and 37 +/- 2.7 years at follow-up. Current visual acuity in the amblyopic eye was correlated with a low visual acuity at the start (p < 0.0001) and end (p < 0.0001) of occlusion therapy, an eccentric fixation (p < 0.0001), and the cause of amblyopia (p = 0.005). At the end of the treatment, patients with a strabismic amblyopia (n = 98) had a visual acuity in the amblyopic eye of 0.29 logMAR +/- 0.3, and in 2003 0.27 +/- 0.3 logMAR. In patients with an anisometropic amblyopia (> 1 D, n = 16) visual acuity had decreased from 0.17 +/- 0.23 logMAR to 0.21 logMAR +/- 0.23. In patients with both strabismic and anisometropic amblyopia (n = 23), visual acuity had decreased from 0.52 logMAR +/- 0.54 to 0.65 logMAR +/- 0.54. Overall, acuity had decreased in 54 patients (39%) after cessation of treatment. Of these, 18 patients had an acuity decrease to less than 50% of their acuity at the end of treatment. In 15 of these 18 patients anisohypermetropia had increased. A decrease in visual acuity after cessation of occlusion therapy occurred in patients with a combined cause of amblyopia or with an increase in anisohypermetropia.

Percutaneous laser-assisted recanalization of long chronic iliac artery occlusions: primary and mid-term results.

PubMed

Balzer, Jörn O; Gastinger, Verena; Thalhammer, Axel; Ritter, Ralf G; Lindhoff-Last, Edelgard; Schmitz-Rixen, Thomas; Vogl, Thomas J

2006-02-01

We report the primary and mid-term outcome of patients with long chronic iliac artery occlusions after percutaneous excimer-laser-assisted interventional recanalization. Between 2000 and 2001, 43 patients with 46 chronic occlusions of either the common iliac artery (n=27), the external iliac artery ( n=13) or both (n=3) underwent laser-assisted percutaneous transluminal angioplasty and implantation of stents. The average length of the occlusion was 57.1+/-26 mm. After laser-assisted angioplasty and implantation of a total of 60 stents, the patients were followed up for up to 4 years. Patency rates were analyzed by ankle-brachial index (ABI) measurement and duplex ultrasound. The primary technical success rate was 95.3%, with a major complication rate of 6.9%. Clinical improvement as categorized by the Rutherford guidelines could be observed in 97.6% of cases. The ABI of all patients improved from an average of 0.46+/-0.08 before intervention to 0.97+/-0.13 at the end of the follow-up period. The overall primary patency rate was 86.1%. Four reinterventions were successful (secondary patency rate 95.4%). The mid-term results of the percutaneous recanalization of iliac artery occlusions with primary and secondary patency rates of 86.1 and 95.4% are similar to those of the treatment of short stenoses.

Dentists' knowledge of occlusal splint therapy for bruxism and temporomandibular joint disorders.

PubMed

Candirli, C; Korkmaz, Y T; Celikoglu, M; Altintas, S H; Coskun, U; Memis, S

2016-01-01

The aim of this study was to investigate dentist's approaches to the use of splint therapy for myofascial pain, bruxism, and temporomandibular joint (TMJ) disorders and to assessment of treatment modalities. A 12-item questionnaire was developed to determine dentists' knowledge of TMJ disorders and approaches for occlusal splint treatments. The researchers spoke with each dentist included in the study at his/her clinic or by telephone to assess their immediate knowledge and approach to the TMJ disorders. Chi-squared test was performed to analyze the values. The confidence interval was set as 95%. A total of 370 dentists working in Turkey were participated in this study. The most common splint application reason for occlusal splint treatment was bruxism (77.8%) while TMJ pain was very rare (%1.4). The use of hard splint ratios for 0-5 years of professional experience was 57.0%, 42.4.0%, and 26.8% for the experience of 5-15 years and over 15 years groups, respectively (P < 0.001). While the dentists' with sufficient knowledge soft splint application rates were 11.6%, hard splint application rates were 43.4% for the dentists with sufficient knowledge. Occlusion adjustment rate of dentists who practice in all three groups was under 16.0%. The knowledge of the dentists about TMJ disorders and occlusal splint therapy were found to be insufficient. Their knowledge decreased with increasing experience.

Bilateral ophthalmic artery occlusion in rhino-orbito-cerebral mucormycosis.

PubMed

Song, Yoo Mi; Shin, Sun Young

2008-03-01

To report a case of bilateral ophthalmic artery occlusion in rhino-orbito-cerebral mucormycosis. Reviewed clinical charts, photographs, and fluorescein angiography An 89-year-old man with poorly controlled diabetes developed sudden bilateral ptosis, complete ophthalmoplegia of the right eye, and superior rectus palsy of the left eye. Brain and orbit magnetic resonance imaging showed midbrain infarction and mild diffuse sinusitis. On the 2nd day of hospitalization, sudden visual loss and light reflex loss developed. There were retinal whitening, absence of retinal arterial filling, and a total lack of choroidal perfusion on fluorescein angiography of the right eye. The left eye showed a cherry red spot in the retina and the absence of retinal arterial filling and partial choroidal perfusion on fluorescein angiography. On rhinologic examination, mucormyosis was noticed. Despite treatment, visual acuity and light reflex did not recover and he died 4 days after admission. Bilateral ophthalmic artery occlusion can occur in rhino-orbital-cerebral mucormycosis.

Iliac artery angioplasty : technique and results.

PubMed

Brountzos, E N; Kelekis, D A

2004-10-01

Percutaneous angioplasty is widely used for the treatment of iliac artery occlusive disease. Access to the ipsi-lateral, or less commonly contralateral, common femoral artery is obtained under local anaesthesia; the lesion is crossed with a guidewire and dilated with an angioplasty balloon catheter. This technique yields excellent immediate results with very few complications. Stent placement is used in lesions not amenable to balloon angioplasty, in complications, and recurrences. Evidence suggests that balloon angioplasty is the procedure of choice for iliac artery occlusive lesions. Stent placement should be reserved for angioplasty failures. However, primary stent placement is indicated in total occlusions. Lesion morphology is an important determinant of immediate success and long-term patency. TASC lesions type A and B are best treated with angioplasty and stenting, while TASC lesions type C and D show better results with surgical treatment. The development of new stent designs may expand the indications of the percutaneous treatment.

Chronic total coronary occlusion: treatment results.

PubMed

Kirk Christensen, Martin; Freeman, Phillip Fischer; Rasmussen, Jeppe Groendal; Villadsen, Anton Boel; Raungaard, Bent; Eggert Jensen, Svend; Thuesen, Leif

2017-08-01

To describe the clinical and procedural coronary chronic total occlusion (CTO) treatment results in a Nordic PCI centre during the implementation of a CTO treatment program. In a retrospective registry study, we assessed; (1) indication for the procedure, (2) Canadian Cardiovascular Society angina pectoris score (CCS)/New York Heart Association (NYHA) heart failure score, (3) lesion complexity and (4) adverse events during hospital stay and three months following the index procedure. The study cohort included 503 patients (594 lesions). From 2010 to 2013 96% of procedures were performed with antegrade wire-escalation technique and 4% performed using retrograde techniques, from 2013-2016 the corresponding numbers were 83% and 17.0%. The procedural success rate was 69%, increasing from 64% before to 72% (p = .06) after routinely using the retrograde approach. No individual patient characteristic, lesion variable or score was strongly associated with procedural success or failure. There were 4% serious procedure related complications. In patients with PCI of a CTO lesion only, 87% were in CCS or NYHA functional class ≥2 before the index procedure vs. 22% at follow-up. Routine use of retrograde techniques tended to increase the procedural success rate. Clinical results after three months were acceptable, but the complication rate was higher than for non-CTO PCI. Individual patient and lesion characteristics had a low predictability for procedural success. Therefore, clinical symptoms, objective signs of myocardial ischemia and procedural risk should be focus points in coronary chronic total occlusion treatment strategies.

The Performance of ICDAS-II Using Low-Powered Magnification with Light-Emitting Diode Headlight and Alternating Current Impedance Spectroscopy Device for Detection of Occlusal Caries on Primary Molars.

PubMed

Ari, Timucin; Ari, Nilgun

2013-01-01

Early detection of occlusal caries in children is challenging for the dentists, because of the morphology of pit and fissures. The aim of this study was to compare in vitro the diagnostic performance of low-powered magnification with light-emitting diode headlight (LPMLED) using ICDAS-II criteria and AC Impedance Spectroscopy (ACIS) device, on occlusal surfaces of primary molars. The occlusal surfaces of 18 extracted primary molars were examined blindly by two examiners. The teeth were sectioned and examined under light microscopy using Downer's histological criteria as gold standard. Good to excellent inter- and intraexaminer reproducibility, higher sensitivity, specificity, and AUC values were achieved by LPMLED at D1 threshold. Also the relationship between histology and LPMLED was statistically significant. In conclusion visual aids have the potential to improve the performance of early caries detection and clinical diagnostics in children. Despite its potential, ACIS device should be considered as an adjunct method in detecting caries on primary teeth.

Digitizing the Facebow: A Clinician/Technician Communication Tool.

PubMed

Kalman, Les; Chrapka, Julia; Joseph, Yasmin

2016-01-01

Communication between the clinician and the technician has been an ongoing problem in dentistry. To improve the issue, a dental software application has been developed--the Virtual Facebow App. It is an alternative to the traditional analog facebow, used to orient the maxillary cast in mounting. Comparison data of the two methods indicated that the digitized virtual facebow provided increased efficiency in mounting, increased accuracy in occlusion, and lower cost. Occlusal accuracy, lab time, and total time were statistically significant (P<.05). The virtual facebow provides a novel alternative for cast mounting and another tool for clinician-technician communication.

Postprocedural, midterm, and long-term results of cerebral aneurysms treated with flow-diverter devices: 7-year experience at a single center.

PubMed

Briganti, Francesco; Leone, Giuseppe; Cirillo, Luigi; de Divitiis, Oreste; Solari, Domenico; Cappabianca, Paolo

2017-06-01

OBJECTIVE Flow diversion has emerged as a viable treatment option for selected intracranial aneurysms and recently has been gaining traction. The aim of this study was to evaluate the safety and effectiveness of flow-diverter devices (FDDs) over a long-term follow-up period. METHODS The authors retrospectively reviewed all cerebral aneurysm cases that had been admitted to the Division of Neurosurgery of the Università degli Studi di Napoli between November 2008 and November 2015 and treated with an FDD. The records of 60 patients (48 females and 12 males) harboring 69 cerebral aneurysms were analyzed. The study end points were angiographic evidence of complete aneurysm occlusion, recanalization rate, occlusion of the parent artery, and clinical and radiological evidence of brain ischemia. The occlusion rate was evaluated according to the O'Kelly-Marotta (OKM) Scale for flow diversion, based on the degree of filling (A, total filling; B, subtotal filling; C, entry remnant; D, no filling). Postprocedural, midterm, and long-term results were strictly analyzed. RESULTS Complete occlusion (OKM D) was achieved in 63 (91%) of 69 aneurysms, partial occlusion (OKM C) in 4 (6%), occlusion of the parent artery in 2 (3%). Intraprocedural technical complications occurred in 3 patients (5%). Postprocedural complications occurred in 6 patients (10%), without neurological deficits. At the 12-month follow-up, 3 patients (5%) experienced asymptomatic cerebral infarction. No further complications were observed at later follow-up evaluations (> 24 months). There were no reports of any delayed aneurysm rupture, subarachnoid or intraparenchymal hemorrhage, ischemic complications, or procedure- or device-related deaths. CONCLUSIONS Endovascular treatment with an FDD is a safe treatment for unruptured cerebral aneurysms, resulting in a high rate of occlusion. In the present study, the authors observed effective and stable aneurysm occlusion, even at the long-term follow-up. Data in this study also suggest that ischemic complications can occur at a later stage, particularly at 12-18 months. On the other hand, no other ischemic or hemorrhagic complications occurred beyond 24 months.

Relationship Between Occlusal Plane and Three Levels of Ala Tragus line in Dentulous and Partially Dentulous Patients in Different Age Groups: A Pilot Study

PubMed Central

Shaikh, Saquib Ahmed; K, Lekha

2015-01-01

Statement of problem: Correct orientation of the occlusal plane plays a vital role in achieving optimal aesthetics, occlusal balance and function of complete dentures. The use of ala tragus line for determination of occlusal plane has been a topic of debate over past many years. Also, the effect of age on level of ala tragal line has not been investigated in the past. Purpose: To determine the effect of age on location of Ala-Tragus line. Materials and Methods: A total of 180 patients (90 males and 90 females) were selected with complete dentition and were grouped according to their age in three age groups with 60 subjects in each age group (Group A: 20-35 y, Group B: 36-50 y, Group C: 51-65 y). Right lateral profile photographs were taken with subjects having fox plane placed intraorally parallel to occlusal plane. Reference points corresponding to inferior border, middle or superior border of tragus and inferior border of ala of nose were marked on photographs. These were joined to get three different levels of Ala-Tragus line. Images were analysed photometrically and most parallel relationship was determined in between arms of fox plane (that represented the occlusal plane) and three different levels of ala tragus line. Data obtained was subjected to statistical analysis using Pearson chi-square and Likelihood-ratio chi-square test. Results: Significant correlation was found between age and level of Ala-Tragus line. The occlusal plane was found to be more parallel to Ala-tragus line when inferior border of tragus was considered as posterior reference point in young adult age group (20-35 y). In older age groups, occlusal plane was found to be more parallel to Ala-tragus line when middle of tragus was considered as posterior reference point. Conclusion: Within the limitations of this study, it can be concluded that a definite relationship exists in between age and level of ala tragus line. PMID:25859523

Evaluation of the effectiveness of a semi-finished occlusal appliance – a randomized, controlled clinical trial

PubMed Central

2013-01-01

Introduction Painful temporomandibular disorders (TMDs) are usually treated with physiotherapy, self-exercises, medication-based therapy and splint therapy. For splint therapy different types of splints are available. Therefore this randomized controlled study compared the effectiveness of a semi-finished occlusal appliance (SB) with a laboratory-made occlusal appliance (SS) in myofascial pain patients. Method The trial subjects allocated to the experimental groups with the (SB) occlusal appliance and those provided with a laboratory-made occlusal appliance (SS) did, in addition, receive conservative treatment (self-exercises, drug-based and manual therapy). The control group was given conservative therapy (CO) only. Overall, a total of 63 patients participated in the study with each group consisting of 21 subjects. Results When the first follow-up examination took place (14 days after splint insertion) mouth opening within the SB group was significantly enlarged. When the second examination was conducted (2.5 months after splint insertion) mouth opening was significantly enlarged in both splint groups when compared with the initial value. In the control group, no significant enlargement of mouth opening was detected. At no point there was a significant reduction in the number of pressure-sensitive areas of the TMJ. On palpation of the masticatory muscles however, a significant reduction in the number of pressure-sensitive areas could be observed within the CO group and the SS group after 2.5 months. When comparing pain reduction (muscle/joint pain) and mouth opening, no significant differences could be detected between the treatments. Conclusion The results suggest that TMD should be treated conservatively. In cases of restricted mouth opening, the additional use of occlusal appliances can eliminate the patient’s discomfort more quickly. In this context, the tested, semi-finished occlusal appliance appears to offer an immediately available, temporary alternative to laboratory-made splints. PMID:23351923

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rai, Ansaar T., E-mail: ansaar.rai@gmail.com; Jhadhav, Yahodeep; Domico, Jennifer

Purpose: To identify factors impacting outcome in patients undergoing interventions for acute ischemic stroke (AIS). Materials and Methods: This was a retrospective analysis of patients undergoing endovascular therapy for AIS secondary during a 30 month period. Outcome was based on modified Rankin score at 3- to 6-month follow-up. Recanalization was defined as Thrombolysis in myocardial infarction score 2 to 3. Collaterals were graded based on pial circulation from the anterior cerebral artery either from an ipsilateral injection in cases of middle cerebral artery (MCA) occlusion or contralateral injection for internal carotid artery terminus (ICA) occlusion as follows: no collaterals (grademore » 0), some collaterals with retrograde opacification of the distal MCA territory (grade 1), and good collaterals with filling of the proximal MCA (M2) branches or retrograde opacification up to the occlusion site (grade 2). Occlusion site was divided into group 1 (ICA), group 2 (MCA with or without contiguous M2 involvement), and group 3 (isolated M2 or M3 branch occlusion). Results: A total of 89 patients were studied. Median age and National Institutes of health stroke scale (NIHSS) score was 71 and 15 years, respectively. Favorable outcome was seen in 49.4% of patients and mortality in 25.8% of patients. Younger age (P = 0.006), lower baseline NIHSS score (P = 0.001), successful recanalization (P < 0.0001), collateral support (P = 0.0008), distal occlusion (P = 0.001), and shorter procedure duration (P = 0.01) were associated with a favorable outcome. Factors affecting successful recanalization included younger age (P = 0.01), lower baseline NIHSS score (P = 0.05), collateral support (P = 0.01), and shorter procedure duration (P = 0.03). An ICA terminus occlusion (P < 0.0001), lack of collaterals (P = 0.0003), and unsuccessful recanalization (P = 0.005) were significantly associated with mortality. Conclusion: Angiographic findings and preprocedure variables can help prognosticate procedure outcomes in patients undergoing endovascular therapy for AIS.« less

Changing strategies of the retrograde approach for chronic total occlusion during the past 7 years.

PubMed

Muramatsu, Toshiya; Tsukahara, Reiko; Ito, Yoshiaki; Ishimori, Hiroshi; Park, Seung-Jung; de Winter, Robert; Shokry, Khaled; Wang, Lefeng; Chen, Jiyan; Wang, Haichang

2013-03-01

We reviewed the technical changes and results achieved with the retrograde approach since we introduced it 7 years ago. The subjects were 1,268 patients who were treated for CTO between January 2004 and December 2010. They were investigated with respect to the success rate, the frequency of employing the retrograde approach and its outcome, and other factors. The retrograde approach was employed in ∼30% of chronic total occlusion (CTO) patients (n = 281) and the retrograde guidewire success rate was 81.1%. The kissing wire technique was substituted for the retrograde approach in 126 of the 281 patients, with antegrade crossing of a guidewire being successful in 88 of them (70%). The retrograde approach was combined with the CART and reverse controlled antegrade retrograde tracking (CART) techniques in 22 and 21 patients, respectively. Among 83 patients treated with Corsair catheters, crossing of the CTO was achieved in 63. The overall procedural success rate was 79.7% (224 patients). Complications of the retrograde approach included collateral channel dissection (2.1%), channel perforation (1.7%), CTO perforation (1.7%), and donor artery occlusion (1.1%). The success rate and safety of the retrograde approach are both satisfactory if the appropriate devices and techniques are selected. Copyright © 2012 Wiley Periodicals, Inc.

Simultaneous Antegrade-Retrograde Subintimal Revascularization of a Femoropopliteal Chronic Total Occlusion by a Reentry Device-Facilitated Puncture of a Retrogradely Inserted Balloon.

PubMed

Goltz, Jan Peter; Anton, Susanne; Wiedner, Marcus; Barkhausen, Jörg; Stahlberg, Erik

2017-08-01

To report a rendezvous technique for subintimal revascularization of a chronic total occlusion (CTO) of the superficial femoral artery (SFA). This maneuver is appropriate after failure to cross a long SFA CTO via intra- and subintimal approaches from the ipsilateral femoral as well as retrograde posterior tibial artery (PTA) access sites. After predilation of the subintimal space from the femoral access, a reentry device was placed at the level of the first popliteal artery segment. A balloon was delivered via the retrograde PTA access and inflated at the corresponding level of the reentry device. The balloon was punctured with the needle of the reentry device under fluoroscopic control, and a 0.014-inch guidewire was placed within the punctured balloon. The balloon and the antegrade guidewire were retracted from the retrograde access while the guidewire was gently pushed from the femoral site. Conventional balloon angioplasty of the SFA occlusion was performed via the femoral access, followed by overlapping stent-graft implantation. Complete revascularization of the CTO was documented. In selected cases a transfemoral reentry device-assisted puncture of a retrogradely inserted balloon within the subintimal space may facilitate a rendezvous and revascularization if standard techniques to cross long CTOs have failed.

Effects of gum chewing exercises on saliva secretion and occlusal force in community-dwelling elderly individuals: A pilot study.

PubMed

Nakagawa, Kazuharu; Matsuo, Koichiro; Takagi, Daisuke; Morita, Yu; Ooka, Takafumi; Hironaka, Shouji; Mukai, Yoshiharu

2017-01-01

Elderly individuals face the risk of reductions in saliva secretion and occlusal force caused by systemic diseases or medications that can eventually result in malnutrition and systemic complications. We tested the hypothesis that regular gum chewing exercises (GCE) would enhance saliva secretion and occlusal force in an elderly population. A total of 12 community-dwelling elderly individuals (3 men and 9 women) participated in this study after providing informed consent. Participants carried out GCE regimens using a soft gum (GCE-S) or hard gum (GCE-H) for 2 weeks each, with a 2-week rest period between trials. Mucosal moisture on the tongue surface, resting saliva, and occlusal force were measured before and after each test gum, and changes in parameters at relevant time-points were statistically analyzed. Differences in each measurement item were assessed using the Friedman test for before and after the GCE. We used the Holm's correction for multiple comparisons if the Friedman test results were significant. The critical value for rejecting the null hypothesis was set at P < 0.05. Resting saliva secretion significantly increased after GCE-S, returned to baseline levels during the rest period and significantly increased again after GCE-H. Mucosal moisture and occlusal force followed a similar trend, with a significant rise after GCE-H. The results of the present study suggest that GCE can increase resting saliva secretion and occlusal force in elderly individuals. Further investigations are required on the appropriate use of soft and hard gums to address oral frailty in elderly individuals. Geriatr Gerontol Int 2017; 17: 48-53. © 2015 The Authors. Geriatrics & Gerontology International published by Wiley Publishing Asia Pty Ltd on behalf of Japan Geriatrics Society.

Non-carious cervical lesions (NCCLs) in a random sampling community population and the association of NCCLs with occlusive wear.

PubMed

Yang, J; Cai, D; Wang, F; He, D; Ma, L; Jin, Y; Que, K

2016-12-01

This study investigated the prevalence, risk factors and association of occlusive wear with non-carious cervical lesions (NCCLs) in the general Chinese population. A total of 1320 subjects were recruited, and multistage and random sampling methods of survey spots were performed. All age groups comprised similar numbers of participants and equal numbers of males and females. Each subject completed a structured interview, and all teeth of each subject were examined by a practitioner to determine NCCLs and occlusive wear. Binary logistic regression was conducted by analysing the association of risk factors with the occurrence of NCCLs. Bivariate correlation analysis was performed by determining the association of NCCLs dimension or depth with the range of occlusive wear facets. Clinical assessment showed that the overall prevalence of subjects diagnosed with NCCLs was 63%. The proportion of subjects or teeth with NCCLs significantly increased with age. Pre-molars were the most commonly affected teeth. Single variables and interactive effects of variables associated with the occurrence of NCCLs include the following: age group, intensity of toothbrushing, frequency of fresh fruit consumption and interactive effect between intensity of toothbrushing and frequency of fresh fruit consumption. A weak positive correlation of the grading index was found between NCCLs dimension, size or depth and range of occlusive wear facets. This study reported the higher prevalence of NCCLs in the general Chinese population. Implementation of a combined strategy to reduce risk factors of NCCLs could be more effective than individual techniques; meanwhile, the occurrence of NCCL could be related to the wear degree of occlusive defects in the population studied. © 2016 John Wiley & Sons Ltd.

Recanalization of Acute and Subacute Venous and Synthetic Bypass-Graft Occlusions With a Mechanical Rotational Catheter

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wissgott, Christian, E-mail: cwissgott@wkk-hei.de; Kamusella, Peter; Andresen, Reimer

2013-08-01

PurposePercutaneous mechanical thrombectomy (PMT) is now established as an alternative treatment of acute arterial occlusions in addition to fibrinolysis and surgical thrombectomy. The objective of this retrospective study was the investigation of a rotational atherothrombectomy catheter in terms of safety and efficacy in the treatment of acute and subacute femoropopliteal bypass occlusions.Materials and MethodsForty-two patients (average age 65.8 {+-} 9.1 years) with acute (<14 days [n = 31]) and subacute (14-42 days [n = 11]) femoropopliteal bypass occlusions were treated consecutively with a rotational debulking and removal catheter (Straub Rotarex). The average occlusion length was 28.4 {+-} 2.9 (24-34) cm.more » Thirty-four (81 %) patients underwent venous bypass, and 8 (19 %) patients underwent polytetrafluoroethylene bypass.ResultsThe technical success rate was 97.6 % (41 of 42). In 1 patient, blood flow could not be restored despite the use of the atherothrombectomy system. The average catheter intervention time was 6.9 {+-} 2.1 (4-9) min. Ankle-brachial index increased from 0.39 {+-} 0.13 to 0.83 {+-} 0.11 at discharge and to 0.82 {+-} 0.17 after 1 month (p < 0.05). There were a total of 2 (4.8 %) peri-interventional complications: One patient developed a distal embolism, which was successfully treated with local lysis, and another patient had a small perforation at the distal anastomosis, which was successfully treated with a stent.ConclusionPMT with the Rotarex atherothrombectomy catheter represents a safe and effective option in the treatment of acute and subacute femoropopliteal bypass occlusions because it can quickly restore blood flow.« less

Sealing occlusal caries lesions in adults referred for restorative treatment: 2-3 years of follow-up.

PubMed

Bakhshandeh, Azam; Qvist, Vibeke; Ekstrand, Kim R

2012-04-01

The aim of this study was to assess the possibility to arrest occlusal caries lesions in adults by sealant as well as to assess the presence of radiographic progression, arrest, and regression of the sealed lesions. Seventy-two occlusal caries lesions in 52 adult patients referred to restorative treatment by senior lecturers at School of Dentistry, Copenhagen, Denmark were included. In case the patient had more than one occlusal caries lesion, randomization between sealing and restoration was made; otherwise, the lesion was sealed. In total, 60 resin sealants and 12 composite restorations were made. Follow-up period was 25-38 months (mean = 33 months). Data were analyzed using non-parametric statistics including kappa statistics. After 2-3 years, the dropout rate was 15%; two patients did not show up for control and nine previously sealed lesions were restored by the patients' general practitioners. All 12 restorations and 39 of the remaining 49 sealants were well functioning, seven (14%) sealants were repaired/replaced due to failure, and three (6%) sealed lesions were restored due to caries progression (p > 0.05). The radiographic assessment showed caries progression beneath five (10%) sealants, caries regression beneath one (2%) sealant, and unchanged depth beneath 43 (88%) sealants and all restorations (p > 0.05). The majority of the referred lesions were successfully arrested by sealants, indicating the possibility for extending the criteria for sealing occlusal caries lesions in adults. However, a longer observation period is needed for final conclusion. Extending the criteria of therapeutic sealing of occlusal caries lesions in adults will lead to increased dental health.

Trial occlusion to assess the risk of persistent pulmonary arterial hypertension after closure of a large patent ductus arteriosus in adolescents and adults with elevated pulmonary artery pressure.

PubMed

Zhang, Duan-Zhen; Zhu, Xian-Yang; Lv, Bei; Cui, Chun-Sheng; Han, Xiu-Min; Sheng, Xiao-Tang; Wang, Qi-Guang; Zhang, Po

2014-08-01

No method is available to predict whether patients with patent ductus arteriosus (PDA) and severe pulmonary arterial hypertension (PAH) will show persistent postprocedural PAH (PP-PAH) after PDA closure. This study evaluated the usefulness of trial occlusion for predicting PP-PAH after transcatheter PDA closure in patients with severe PAH. Trial occlusion was performed in 137 patients (age ≥12 years) with PDA and severe PAH. All patients undergoing trial occlusion had a mean pulmonary artery pressure ≥45 mm Hg, pulmonary:systemic flow (Qp/Qs) ratio >1.5, and pulmonary:systemic resistance (Rp/Rs) ratio <0.7. A total of 135 patients (98%) showing stable hemodynamics during occlusion trial underwent successful device closure. Linear correlation analysis revealed weak or moderate relationships between the baseline and post-trial pulmonary artery pressures and pulmonary:systemic pressure (Pp/Ps) ratios. Patients were followed up for 1 to 10 years (median: 5 years). PP-PAH (systolic pulmonary artery pressure >50 mm Hg by Doppler echocardiography) was detected in 17 patients (13%), who displayed no significant differences in sex and age compared with patients without PP-PAH. According to discriminant analysis, the strongest discriminators between patients with and without PP-PAH were the baseline left ventricular end-diastolic volume and the baseline and post-trial systolic Pp/Ps ratios. In particular, a post-trial systolic Pp/Ps ratio >0.5 correctly classified 100% of the PP-PAH and non-PAH patients. Trial occlusion is a feasible method to predict PP-PAH in patients with PDA and severe PAH. A post-trial systolic Pp/Ps ratio >0.5 indicates a high risk of PP-PAH occurrence after device closure. © 2014 American Heart Association, Inc.

Can different occlusal positions instantaneously impact spine and body posture? : A pilot study using rasterstereography for a three-dimensional evaluation.

PubMed

März, Karoline; Adler, Werner; Matta, Ragai-Edward; Wolf, Linda; Wichmann, Manfred; Bergauer, Bastian

2017-05-01

Orthodontists influence dental occlusion directly. To suggest any link between dental occlusion and body posture is highly contentious, as evidenced by the literature. Rasterstereography, an optical technique that enables three-dimensional (3D) body measurements to be collected, has not yet been used to impartially examine whether different occlusal positions could instantaneously alter spine and body posture. We therefore set out to use this technique to nonsubjectively evaluate this question under static conditions. Optical body scans were collected for 44 subjects, using the Diers formetric 4D system, for seven different mandible positions. In total, ten spinal and body posture parameters were assessed (trunk inclination, trunk imbalance, pelvic tilt, pelvic torsion, fleche cervicale, fleche lombaire, kyphotic angle, lordotic angle, surface rotation, and lateral deviation) for each mandible position and compared with scans performed with habitual intercuspation (HIC). Significant body posture deviations were found for the fleche cervicale (position of the mandible: right eccentrically), fleche lombaire (positions of the mandible: physiologic rest position, cotton rolls on both sides, bite elevation 1 mm), and the kyphotic angle (positions of the mandible: cotton rolls on both sides, right eccentrically). No other significant differences were detected. Data for the parameters that varied with different dental occlusions generated high standard deviations. Therefore, within the limitations of this pilot study, we could not conclusively associate dental occlusion to an instantaneous impact on the tested parameters. The posture changes that we detected could also have arisen from individual neuromuscular compensation; a possibility that must now be ruled-in, or out, by further research studies with a higher number of subjects.

Contributions to muscle force and EMG by combined neural excitation and electrical stimulation

NASA Astrophysics Data System (ADS)

Crago, Patrick E.; Makowski, Nathaniel S.; Cole, Natalie M.

2014-10-01

Objective. Stimulation of muscle for research or clinical interventions is often superimposed on ongoing physiological activity without a quantitative understanding of the impact of the stimulation on the net muscle activity and the physiological response. Experimental studies show that total force during stimulation is less than the sum of the isolated voluntary and stimulated forces, but the occlusion mechanism is not understood. Approach. We develop a model of efferent motor activity elicited by superimposing stimulation during a physiologically activated contraction. The model combines action potential interactions due to collision block, source resetting, and refractory periods with previously published models of physiological motor unit recruitment, rate modulation, force production, and EMG generation in human first dorsal interosseous muscle to investigate the mechanisms and effectiveness of stimulation on the net muscle force and EMG. Main results. Stimulation during a physiological contraction demonstrates partial occlusion of force and the neural component of the EMG, due to action potential interactions in motor units activated by both sources. Depending on neural and stimulation firing rates as well as on force-frequency properties, individual motor unit forces can be greater, smaller, or unchanged by the stimulation. In contrast, voluntary motor unit EMG potentials in simultaneously stimulated motor units show progressive occlusion with increasing stimulus rate. The simulations predict that occlusion would be decreased by a reverse stimulation recruitment order. Significance. The results are consistent with and provide a mechanistic interpretation of previously published experimental evidence of force occlusion. The models also predict two effects that have not been reported previously—voluntary EMG occlusion and the advantages of a proximal stimulation site. This study provides a basis for the rational design of both future experiments and clinical neuroprosthetic interventions involving either motor or sensory stimulation.

Contributions to muscle force and EMG by combined neural excitation and electrical stimulation

PubMed Central

Crago, Patrick E; Makowski, Nathaniel S; Cole, Natalie M

2014-01-01

Objective Stimulation of muscle for research or clinical interventions is often superimposed on ongoing physiological activity, without a quantitative understanding of the impact of the stimulation on the net muscle activity and the physiological response. Experimental studies show that total force during stimulation is less than the sum of the isolated voluntary and stimulated forces, but the occlusion mechanism is not understood. Approach We develop a model of efferent motor activity elicited by superimposing stimulation during a physiologically activated contraction. The model combines action potential interactions due to collision block, source resetting, and refractory periods with previously published models of physiological motor unit recruitment, rate modulation, force production, and EMG generation in human first dorsal interosseous muscle to investigate the mechanisms and effectiveness of stimulation on the net muscle force and EMG. Main Results Stimulation during a physiological contraction demonstrates partial occlusion of force and the neural component of the EMG, due to action potential interactions in motor units activated by both sources. Depending on neural and stimulation firing rates as well as on force-frequency properties, individual motor unit forces can be greater, smaller, or unchanged by the stimulation. In contrast, voluntary motor unit EMG potentials in simultaneously stimulated motor units show progressive occlusion with increasing stimulus rate. The simulations predict that occlusion would be decreased by a reverse stimulation recruitment order. Significance The results are consistent with and provide a mechanistic interpretation of previously published experimental evidence of force occlusion. The models also predict two effects that have not been reported previously - voluntary EMG occlusion and the advantages of a proximal stimulation site. This study provides a basis for the rational design of both future experiments and clinical neuroprosthetic interventions involving either motor or sensory stimulation. PMID:25242203

Safety and efficacy of defibrotide for the treatment of severe hepatic veno-occlusive disease.

PubMed

Richardson, Paul G; Ho, Vincent T; Giralt, Sergio; Arai, Sally; Mineishi, Shin; Cutler, Corey; Antin, Joseph H; Stavitzski, Nicole; Niederwieser, Dietger; Holler, Ernst; Carreras, Enric; Soiffer, Robert

2012-08-01

Hepatic veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome, is a potentially life-threatening complication of chemotherapeutic conditioning used in preparation for hematopoietic stem-cell transplantation (SCT). VOD may occur in up to 62% of patients undergoing SCT, with onset generally within the first month after SCT. In severe cases, 100-day mortality is in excess of 80%. Current management consists of best supportive care, with no agents to date approved for treatment in the USA or the EU. Defibrotide, a polydisperse oligonucleotide, has been shown in phase II and III trials to improve complete response and survival in patients undergoing SCT with severe VOD. This article reviews our current understanding of VOD, and examines recent clinical findings on defibrotide for the treatment and prophylaxis of VOD.

Influence of various bonding techniques on the fracture strength of thin CAD/CAM-fabricated occlusal glass-ceramic veneers.

PubMed

Yazigi, Christine; Kern, Matthias; Chaar, Mohamed Sad

2017-11-01

To evaluate the efficiency of immediate dentin sealing and the effects of different bonding protocols on the fracture strength of CAD/CAM occlusal veneers bonded to exposed dentin. Ninety-six extracted maxillary premolars were initially divided into three main groups with 32 specimens each: without immediate dentin sealing, immediate dentin sealing/total etching and immediate dentin sealing/selective etching. Teeth were identically prepared in the dentin to receive occlusal veneers of 0.8mm thickness, milled from lithium disilicate ceramic blocks (IPS e.max CAD). Each main group was later subdivided, according to the pre-cementation surface etching protocol (total/selective), into two subgroups with 16 specimens each. All restorations were adhesively bonded using a resin cement (Variolink Esthetic). Half of the specimens of each subgroup were subjected to thermo-dynamic loading in a chewing simulator with 1,200,000 cycles at 10kg load. The other half and the surviving specimens were subjected to quasi-static loading until failure. Statistical analysis was performed using three-way ANOVA and Tukey's post-hoc tests. All specimens except one survived the artificial aging. A significantly higher fracture strength of restorations (p ≤ 0.001) was obtained when immediate dentin sealing was followed regardless of the etching method with values ranging from a minimum of 1122 ± 336N to a maximum of 1853 ± 333N. Neither the pre-cementation treatment nor the artificial aging had a statistical significant effect on the fracture strength. Immediate dentin sealing protocol is recommended whenever dentin is exposed during the preparation for thin glass-ceramic occlusal veneers. Copyright © 2017 Elsevier Ltd. All rights reserved.

Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention: Insights from a Contemporary Multicenter Registry

PubMed Central

Christakopoulos, Georgios E.; Christopoulos, Georgios; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Yeh, Robert W.; Jaffer, Farouc A.; Wyman, Michael R.; Lombardi, William L.; Tarar, Muhammad Nauman J.; Grantham, J. Aaron; Kandzari, David; Lembo, Nicholas; Moses, Jeffrey W.; Kirtane, Ajay; Parikh, Manish; Green, Philip; Finn, Matthew; Garcia, Santiago; Doing, Anthony; Hatem, Raja; Thompson, Craig A.; Banerjee, Subhash; Brilakis, Emmanouil S.

2016-01-01

Background High patient radiation dose during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may lead to procedural failure and radiation skin injury. Methods We examined the association between several clinical and angiographic variables on patient air kerma (AK) radiation dose among 748 consecutive CTO PCIs performed at 9 experienced US centers between May 2012 and May 2015. Results Mean age was 65±10 years, 87% of patients were men, and 35% had prior coronary artery bypass graft surgery (CABG). Technical and procedural success was 92% and 90%, respectively. The median patient AK dose was 3.40 (2.00, 5.40) Gray and 34% of the patients received >4.8 Gray (high radiation exposure). On univariable analysis male gender (p=0.016), high body mass index (p<0.001), history of hyperlipidemia (p=0.023), prior CABG (p<0.001), moderate or severe calcification (p<0.001), tortuosity (p<0.001), proximal cap ambiguity (p=0.001), distal cap at a bifurcation (p=0.006), longer CTO occlusion length (p<0.001), blunt/no blunt stump (p<0.001), and center (<0.001) were associated with higher patient AK dose. On multivariable analysis high body mass index (p<0.001), prior CABG (p=0.005), moderate or severe calcification (p=0.005), longer CTO occlusion length (p<0.001), and center (p<0.001) were independently associated with higher patient AK dose. Conclusions Approximately 1 in 3 patients undergoing CTO PCI receives high AK radiation dose (>4.8 Gray). Several baseline clinical and angiographic characteristics can help predict the likelihood of high radiation dose and assist with intensifying efforts to reduce radiation exposure for the patient and the operator. PMID:28169091

Dissection and re-entry techniques and longer-term outcomes following successful percutaneous coronary intervention of chronic total occlusion.

PubMed

Rinfret, Stéphane; Ribeiro, Henrique Barbosa; Nguyen, Can Manh; Nombela-Franco, Luis; Ureña, Marina; Rodés-Cabau, Josep

2014-11-01

New techniques involving dissection of the subintimal space and re-entry into the true lumen increase success rates in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, their long-term safety and efficacy were unknown. This study included a series of consecutive patients who underwent CTO PCI. All patients who did not present events were contacted 12 to 18 months after their PCI. The combined incidence of cardiac death, myocardial infarction, ischemia-driven target-vessel revascularization (TVR), or reocclusion was assessed as our primary outcome. From January 2010 to January 2013, of 212 CTOs treated in our CTO program, 192 (91%) were successfully opened (in 179 patients). Follow-up data were available for 187 CTOs (97.4%), with 82 (44%) that were opened with dissection re-entry and 105 (56%) with conventional wire escalation techniques. At a median follow-up of 398 days, the primary outcome occurred in 18 of 179 CTOs treated (10.7%), driven by TVR. No patient died from cardiac causes. Eleven CTOs (15.2%) treated with dissection re-entry versus 7 CTOs (7.3%) treated with wire escalation presented with the primary outcome (p = 0.17). With multivariate adjustment, dissection re-entry techniques had no significant impact on outcomes. However, treatment of an in-stent occlusion was independently associated with TVR (hazards ratio >6.0, p <0.001). In conclusion, dissection re-entry techniques have minimal impact on long-term outcomes after CTO PCI, which are favorable in most patients. However, treatment of an in-stent occlusion and use of sirolimus-eluting stent were predictors of subsequent adverse outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Onyx in Brain Arteriovenous Malformation Embolisation.

PubMed

Hashim, Hilwati; Muda, A Sobri; Abdul Aziz, Aida; Abdul Hamid, Zuhanis

2016-07-01

Embolisation has long been used as an adjunct to surgical resection in the treatment of brain arteriovenous malformation (bAVM). The most commonly used embolic material, n-butylcyanoacrylate glue, requires experience and skill to handle its quick and unpredictable flow and polymerisation. A new liquid embolic agent, ethylene vinyl alcohol copolymer (Onyx), is less adhesive and polymerises slowly, which provides better control for radiologists performing embolisation. To report our experience in embolisation using Onyx alone or in combination with histoacryl for bAVM embolisation in our tertiary referral centre. We retrospectively reviewed the anatomy, technical conditions, complications and clinical outcome of all bAVM patients embolised at our centre using Onyx alone or in combination with n-butylcyanoacrylate glue. Between 2010 and 2013, 13 patients [6 (46.2%) male; 7 (53.8%) female; aged, 14-57 years] were included, and a total of 31 embolisations were performed. Clinical presentation included hemorrhage [9 (69.2%)], seizures [2 (15.4%)], and headache [2 (15.4%)]. Most AVMs were located in the brain hemispheres [12 (92.3%)] and measured <3 cm [7 (53.8%]. Complete occlusion of the AVM was obtained in 2 (15.4%) patients; 11 (84.6%) patients had partial occlusion [6 (54.5%) had <50% nidus occlusion]. Complications occurred in four procedures involving 3 patients (morbidity, 23.1%). This resulted in the death of 1 patient (mortality, 7.7%) and complete recovery with no disability in 2 patients. The total nidal occlusion achieved herein is comparable to other similar studies. Our morbidity and mortality were higher compared to other studies which may be attributed to the small number of patients. More data is being collected which may better reflect on our experience.

A double blind randomized clinical trial comparing lingualized and fully bilateral balanced posterior occlusion for conventional complete dentures.

PubMed

Kawai, Yasuhiko; Ikeguchi, Nobuyuki; Suzuki, Asako; Kuwashima, Azusa; Sakamoto, Ryuji; Matsumaru, Yuichi; Kimoto, Suguru; Iijima, Morio; Feine, Jocelyne Sylvia

2017-04-01

A lingualized occlusion (LO) for complete dentures reduces lateral inferences and occlusal force contacts and direction; thus, LO is theorized to be more suitable for patients with compromised ridges than fully bilateral balanced articulation (FBBA). However, no studies have yet provided evidence to support LO in edentate patients with compromised alveolar ridges. The purpose of this study was to compare LO and FBBA in edentulous individuals with compromised ridges. Sixty edentulous individuals were randomly allocated into groups and received dentures with either LO or FBBA. Following delivery, several denture-related satisfaction variables were measured using 100mm visual analogue scales; oral health-related quality of life (OHRQoL) was also assessed using the Oral Health Impact Profile (OHIP). Sub-group analyses of the effect of moderate and severe mandibular bone loss were also carried out. No significant differences were detected between LO and FBBA with the primary outcome. At 6 months, participants with severely atrophied mandibles and FBBA rated their satisfaction with retention of mandibular dentures significantly lower than those with LO (median LO: 86, FBBA: 58.5, p=0.03). They also had significantly lower OHRQoL for the domain of Pain (median LO: 4, FBBA: 5, p=0.02). General satisfaction and total OHIP scores significantly improved between baseline and 6 months only for the LO subjects with severely atrophied mandibles (satisfaction: p=0.003, OHIP total score: p=0.0007). The results indicate that the LO occlusal scheme with hard resin artificial teeth is more efficient for patients with severely resorbed mandibular ridges. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

The total occlusal convergence of the abutment of a partial fixed dental prosthesis: A definition and a clinical technique for its assessment

PubMed Central

Mamoun, John S.

2013-01-01

The abutment(s) of a partial fixed dental prosthesis (PFDP) should have a minimal total occlusal convergence (TOC), also called a taper, in order to ensure adequate retention of a PFDP that will be made for the abutment(s), given the height of the abutment(s). This article reviews the concept of PFDP abutment TOC and presents an alternative definition of what TOC is, defining it as the extent to which the shape of an abutment differs from an ideal cylinder shape of an abutment. This article also reviews experimental results concerning what is the ideal TOC in degrees and explores clinical techniques of estimating the TOC of a crown abutment. The author suggests that Dentists use high magnification loupes (×6-8 magnification or greater) or a surgical operating microscope when preparing crown abutments, to facilitate creating a minimum abutment TOC. PMID:24932130

Novel antireflux covered metal stent for recurrent occlusion of biliary metal stents: a pilot study.

PubMed

Hamada, Tsuyoshi; Isayama, Hiroyuki; Nakai, Yousuke; Kogure, Hirofumi; Togawa, Osamu; Kawakubo, Kazumichi; Yamamoto, Natsuyo; Ito, Yukiko; Sasaki, Takashi; Tsujino, Takeshi; Sasahira, Naoki; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

2014-03-01

Feasibility of antireflux metal stent (ARMS), designed to prevent duodenobiliary reflux, was reported in patients with distal malignant biliary obstruction. In this prospective pilot study, we aimed to evaluate a newly designed ARMS as a reintervention for self-expandable metallic stent (SEMS) occlusion believed to be caused by duodenobiliary reflux. Patients with non-resectable distal malignant biliary obstruction were included in whom a prior SEMS was occluded as a result of sludge or food impaction between March 2010 and January 2012 at two Japanese tertiary referral centers. The occluded SEMS were endoscopically removed, if possible, and subsequently replaced by a newly designed ARMS. We evaluated the technical success rate and complications of ARMS and compared the time to occlusion of ARMS with that of prior SEMS. A total of 13 patients were included. ARMS was successfully placed in all patients in a single procedure. No procedure-related complications were identified. ARMS occlusion occurred in two patients (15%), the causes of which were sludge in one patient and unknown in the other. ARMS migration occurred in four patients (31%). ARMS patency time was significantly longer than that of prior SEMS (median, not available vs 58 days; P = 0.039). This newly designed ARMS is a technically feasible, safe, and effective reintervention for SEMS occlusion as a result of sludge or food impaction. An anti-migration mechanism to improve the outcomes of ARMS should be considered. © 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

EMBOLIC MIDDLE CEREBRAL ARTERY OCCLUSION MODEL USING THROMBIN AND FIBRINOGEN COMPOSED CLOTS IN RAT

PubMed Central

Ren, Ming; Lin, Zi-Jing; Qian, Hai; Gourav, Choudhury Roy; liu, Ran; Liu, Hanli; Yang, Shao-Hua

2012-01-01

Ischemic stroke accounts for over 80% in total human stroke which mostly affect middle cerebral artery (MCA) territory. Embolic stroke models induced by injection of homologous clots into the internal carotid artery and MCA closely mimic human stroke and have been commonly used in stroke research. Studies indicate that the size and composition of clots are critical for the reproducibility of the stroke model. In the present study, we modified the homologous clots formation by addition of thrombin and fibrinogen which produced even distribution of fibrin with tight cross linkage of red blood cells. We optimized the embolic MCA occlusion model in rats using different size of the mixed clots. A precise lodgment of the clots at the MCA bifurcation and highly reproducible ischemic lesion in the MCA territory were demonstrated in the embolic MCA occlusion model induced by injection of 10 pieces of 1-mm long mixed clots made in PE-60 catheter. We further tested the effect of recombinant tissue plasminogen activator (rtPA) in this embolic MCA occlusion model. rtPA induced thrombolysis, improved neurological outcome, and significantly reduced ischemic lesion volume when administered at 1 hour after embolism as compared with control. In summary, we have established a reproducible embolic MCA occlusion model using clots made of homologous blood, thrombin and fibrinogen. The mixed clots enable precise lodgment at the MCA bifurcation which is responsive to thrombolytic therapy of rtPA. PMID:22985597

Embolic middle cerebral artery occlusion model using thrombin and fibrinogen composed clots in rat.

PubMed

Ren, Ming; Lin, Zi-Jing; Qian, Hai; Choudhury, Gourav Roy; Liu, Ran; Liu, Hanli; Yang, Shao-Hua

2012-11-15

Ischemic stroke accounts for over 80% in total human stroke which mostly affect middle cerebral artery (MCA) territory. Embolic stroke models induced by injection of homologous clots into the internal carotid artery and MCA closely mimic human stroke and have been commonly used in stroke research. Studies indicate that the size and composition of clots are critical for the reproducibility of the stroke model. In the present study, we modified the homologous clots formation by addition of thrombin and fibrinogen which produced even distribution of fibrin with tight cross linkage of red blood cells. We optimized the embolic MCA occlusion model in rats using different size of the mixed clots. A precise lodgment of the clots at the MCA bifurcation and highly reproducible ischemic lesion in the MCA territory were demonstrated in the embolic MCA occlusion model induced by injection of 10 pieces of 1-mm long mixed clots made in PE-60 catheter. We further tested the effect of recombinant tissue plasminogen activator (rtPA) in this embolic MCA occlusion model. rtPA induced thrombolysis, improved neurological outcome, and significantly reduced ischemic lesion volume when administered at 1h after embolism as compared with control. In summary, we have established a reproducible embolic MCA occlusion model using clots made of homologous blood, thrombin and fibrinogen. The mixed clots enable precise lodgment at the MCA bifurcation which is responsive to thrombolytic therapy of rtPA. Copyright © 2012 Elsevier B.V. All rights reserved.

The role of an occlusal template during the placement of preformed metal crowns in children under general anaesthesia: a randomised control trial.

PubMed

Pani, S C; Dimashkieh, M; Mojaleed, F; Al Shammery, F

2015-12-01

This aim was to evaluate preformed metal crowns (PMC) placed under general anaesthesia using an occlusal template in comparison to crowns placed without the use of a template. CONSORT protocols were followed in the design of the study. A total of 60 children between 4-7 years requiring pulpotomy and PMC for all primary molars met the inclusion criteria for this study. The control group comprised patients for whom the PMC were placed without the use of an occlusal template, while in the test group crowns were placed using a polyvinyl siloxane occlusal template. Patients were followed up at 24 h, 7 days, 3 and 6 months. The time taken for the placement of crowns, instances of post-operative discomfort, success or failure of the pulp therapy and loss of any crowns were compared between the groups. The mean time taken for completion of the procedure in the control group was significantly greater than the template group (t = 2.566, p = 0.013). Significantly fewer patients in the template group reported symptoms of discomfort or high points at the 24-h recall; however, these differences were not significant at the 1-week, 3- or 6-month recall. The use of an occlusal template for the placement of multiple PMC under general anaesthesia reduces the time taken for their placement and reduces the incidence of immediate post-operative discomfort.

Rehabilitation with implant-supported overdentures in total edentulous patients: A review.

PubMed

Martínez-Lage-Azorín, Juan F; Segura-Andrés, Gustavo; Faus-López, Joan; Agustín-Panadero, Rubén

2013-12-01

The main aim of this review article is to discuss implant-supported overdentures (ISOs) as treatment in edentulous patients. Besides, we will try to discuss among the different treatment options in such patients and to analyze their validity when ISOs are compared with other clinical modalities. At the same time, we will try to suggest clinical guidelines supported by current clinical studies. We performed a Medline search and review of pertinent articles on the mentioned subject from 1986 to 2011. As a searching strategy, we used the following words: implant-supported overdentures, attachment systems, Locator attachment, cantilever, fixed prosthesis. Implant-supported overdentures constitute an accurate and predictable treatment option and achieve a higher patients' satisfaction. This type of treatment constitutes a cheaper treatment than fixed prostheses and in some patients, with loss of lip support or with an interoclusal space larger than 15 mm, the choice of implant-supported overdentures seems to prevent future aesthetic or phonetic problems. Key words:Overdentures, implant occlusion, implant rehabilitation, total edentulous rehabilitation, fixed prosthesis.

Anti-arrhythmic activities of opioid agonists and antagonists and their stereoisomers.

PubMed Central

Sarne, Y.; Flitstein, A.; Oppenheimer, E.

1991-01-01

1. A series of opioid agonists, antagonists and their (+)-stereoisomers were tested for antiarrhythmic activity in the rat coronary artery occlusion model. 2. Naloxone (0.01-2 mg kg-1) significantly reduced the incidence and severity of cardiac arrhythmias, in accordance with previous published studies. 3. The non-opioid stereoisomer, (+)-naloxone, was equipotent with naloxone against occlusion-induced arrhythmia. 4. Similar non-stereospecific antiarrhythmic effects were induced by another opioid antagonist, Win 44,441-3 and its stereoisomer Win 44,441-2. 5. The opioid agonists, morphine and levorphanol, protected against occlusion-induced arrhythmia as did the opioid antagonists, and the (+)-stereoisomer, dextrorphan, was equipotent to levorphanol. 6. It is concluded that the antiarrhythmic effects of opioid drugs are not mediated by opioid receptors. A direct effect on ionic currents in cardiac muscle is suggested as the mechanism of opioid antiarrhythmic activity. PMID:1364840

[SERV clinical practice guidelines: management of retinal vein occlusion. Sociedad Española de Retina y Vitreo].

PubMed

Gómez-Ulla, F; Abraldes, M J; Basauri, E; Fernández, M; García-Layana, A; Gili, P; Montero, J; Nadal, J; Morales, V; Saravia, M; Cabrera, F; Cervera, E

2010-09-01

A guidelines for the management of retinal vein occlusion is presented. This is necessary because at this moment several therapeutic alternatives have been developed although their role is not yet sufficiently defined. Review of the literature for evidence published up to date. Relevant literature was identified and the level of evidence graded. Evidence was then assessed for consistency, applicability and clinical impact. The information was contrasted with those guides published in other countries. Taking into account the different options of treatment that are currently used, several modes of action are suggested. The role of the various complementary examinations are discussed and it is recommended that criteria for the treatment are based on clinical, angiographic, and tomographic findings. Although there is no overall consensus, these guidelines promote a good standard of clinical practise and provide an update of the management of retinal vein occlusion. Copyright © 2010. Published by Elsevier Espana.

Retinal vein occlusion: current treatment.

PubMed

Lattanzio, Rosangela; Torres Gimeno, Ana; Battaglia Parodi, Maurizio; Bandello, Francesco

2011-01-01

Retinal vein occlusion (RVO) is a pathology noted for more than 150 years. Although a lot has been written on the matter, it is still a frequent condition with multifactorial etiopathogenesis with many unclear aspects. The RVO pathogenesis has varied systemic and local implications that make it difficult to elaborate treatment guidelines. The management of the patient with RVO is very complex and a multidisciplinary approach is required in order to identify and correct the associated risk factors. Laser therapy remains the gold standard in RVO, but only modest functional improvement has been shown in branch retinal occlusion forms. Multicenter studies of intravitreal drugs present them as an option to combine with laser. Anti-vascular endothelial growth factor, corticosteroids and sustained-release implants are the future weapons to stop disease progression and get a better visual outcome. Consequently, it is useful to clarify some aspects of the pathology that allow a better patient management. Copyright © 2010 S. Karger AG, Basel.

Comparative mRNA and MicroRNA Profiling during Acute Myocardial Infarction Induced by Coronary Occlusion and Ablation Radio-Frequency Currents

PubMed Central

Santana, Eduardo T.; Feliciano, Regiane dos Santos; Serra, Andrey J.; Brigidio, Eduardo; Antonio, Ednei L.; Tucci, Paulo J. F.; Nathanson, Lubov; Morris, Mariana; Silva, José A.

2016-01-01

The ligation of the left anterior descending coronary artery is the most commonly used experimental model to induce myocardial infarction (MI) in rodents. A high mortality in the acute phase and the heterogeneity of the size of the MI obtained are drawbacks recognized in this model. In an attempt to solve the problem, our group recently developed a new MI experimental model which is based on application of myocardial ablation radio-frequency currents (AB-RF) that yielded MI with homogeneous sizes and significantly reduce acute mortality. In addition, cardiac structural, and functional changes aroused by AB-RF were similar to those seen in animals with MI induced by coronary artery ligation. Herein, we compared mRNA expression of genes that govern post-MI milieu in occlusion and ablation models. We analyzed 48 mRNAs expressions of nine different signal transduction pathways (cell survival and metabolism signs, matrix extracellular, cell cycle, oxidative stress, apoptosis, calcium signaling, hypertrophy markers, angiogenesis, and inflammation) in rat left ventricle 1 week after MI generated by both coronary occlusion and AB-RF. Furthermore, high-throughput miRNA analysis was also assessed in both MI procedures. Interestingly, mRNA expression levels and miRNA expressions showed strong similarities between both models after MI, with few specificities in each model, activating similar signal transduction pathways. To our knowledge, this is the first comparison of genomic alterations of mRNA and miRNA contents after two different MI procedures and identifies key signaling regulators modulating the pathophysiology of these two models that might culminate in heart failure. Furthermore, these analyses may contribute with the current knowledge concerning transcriptional and post-transcriptional changes of AB-RF protocol, arising as an alternative and effective MI method that reproduces most changes seem in coronary occlusion. PMID:27932994

Chronic idiopathic intestinal pseudo-obstruction treated by near total small bowel resection: a 20-year experience.

PubMed

Lapointe, Roch

2010-12-01

Patients suffering from chronic idiopathic intestinal pseudo-obstruction (CIIPO) clearly benefit from home parenteral nutrition (HPN) to maintain adequate nutritional status and general health. But intestinal dismotility can seriously disturb their quality of life (QOL) to the point of making it intolerable. Report our clinical experience on the management of chronic severe occlusive symptoms in CIIPO by near total small bowel resection. A 20-year retrospective study of eight patients with end-stage CIIPO maintained on HPN and suffering of chronic occlusive symptoms refractory to medical treatment underwent extensive small bowel resection preserving less than 70 cm of total small bowel and less than 20 cm of ileum. The jejunum was anastomosed either to the ileum or to the colon. Six patients were completely relieved from obstructive symptoms. Two patients needed a second operation to remove the residual ileum because of recurrent symptoms. Two were significantly improved. There was no post-operative death. All patients experienced a significant improvement in their QOL. Near total small bowel resection appears to be a safe and effective procedure in end-stage CIIPO patients, refractory to optimal medical treatment.

Biomechanical considerations for distraction of the monobloc, Le Fort III, and Le Fort I segments.

PubMed

Figueroa, Alvaro A; Polley, John W; Figueroa, Aaron D

2010-09-01

Distraction osteogenesis is effective for correction of severe maxillary and midface hypoplasia. The vectors controlling the segment to be moved must be planned. This requires knowledge of the physical characteristics of the osteotomized bone segment, including the location of the center of mass (free body) and the center of resistance (restrained body). The purpose of this study was to determine the center of mass of the osteotomized monobloc, Le Fort III, and Le Fort I bone segments. A dry human skull was used to sequentially isolate three bone segments: monobloc, Le Fort III, and Le Fort I. Each segment was suspended from three different points, and digital photographs were obtained from each suspension. The photographs were digitally superimposed. The center of mass was determined by calculating the intersection of the suspension lines. The center of mass for the monobloc segment was located at a point 43.5 percent of the total height from the occlusal plane to the superior edge of the frontal bone supraorbital osteotomy. For the Le Fort III, it was located 38 percent of the total height from the occlusal plane to the superior edge of the osteotomized base of the nasal bones. For the Le Fort I, it was 53 percent of the total height from the occlusal plane to the superior edge of the osteotomized maxillary bone. Knowledge of the location of the center of mass in the monobloc, Le Fort III, and Le Fort I segments provides a starting point for the clinician when planning vectors for advancement with distraction.

The unique contribution of elements of smile aesthetics to psychosocial well-being.

PubMed

Lukez, A; Pavlic, A; Trinajstic Zrinski, M; Spalj, S

2015-04-01

Pleasant smile aesthetics is an important contributory factor to psychosocial well-being. The aim of this study was to determine the psychosocial influence of smile aesthetics. The study was cross-sectional on a convenient sample that included patients, pupils, students and faculty staff. A total of 155 subjects (36% male) aged 12-39 (mean age 21, interquartile range 19-23) were included. Occlusal characteristics were recorded by the Index of Complexity, Outcome and Need, and smiling frontal view photographs were obtained. Fourteen variables were measured using photogrammetric analysis: smile width, visibility of buccal corridors, maximum teeth exposure, total gingival display, lip thickness, degree of occlusal cant and deviation from golden proportion of the teeth in maxillary intercanine sector. Psychometric instruments included the Psychosocial Impact of Dental Aesthetics Questionnaire and the Rosenberg Self-Esteem Scale. Statistical analysis comprised multiple linear regressions. Malocclusion severity is the most important predictor of psychosocial influence of smile aesthetics and self-esteem, the unique contribution of which accounts for a total of 4-27% of variability. Female gender is associated with higher psychological influence of dental aesthetics while male gender and older age with self-esteem. Malocclusions have higher psychosocial impact than parameters of mini- and micro-aesthetics of smile related to visibility of buccal corridors, amount of teeth exposure, gingival display, lip thickness, presence of occlusal cant and deviation from golden proportion of the teeth. It appears that people are not as focused on details of their smile as they are on distinctive malposition of teeth. © 2014 John Wiley & Sons Ltd.

[Characteristics of lip-mouth region in smiling position from 80 adults with acceptable faces and individual normal occlusions].

PubMed

Zhang, J; Chen, Y; Zhou, X

1997-07-01

The Characteristics of Lip-mouth region including the soft and hard tissues in smiling position with frontal fixed position photographic computered analysis was studied. The examples were 80 adults (40 males and 40 females) with acceptable faces and individual normal occlusions. The age was between 17-25 years of age. The method adopting maximum smiling position to study the lip-mouth region is scientific, and the maximum smile line could be divided into three categories: low smile line-a-counted for 16.25% of the total samples; average smile line--68.75%; high smile line--15%.

Successful penetration and bougie dilatation with Brockenbrough needle for severely calcified occlusion in superficial femoral artery.

PubMed

Makita, Toshio; Suzuki, Kenji; Takizawa, Kaname; Ootomo, Tatsushi; Inoue, Naoto; Meguro, Taiichirou

2014-04-01

A 75-year-old hemodialysis patient with right critical limb ischemia received endovascular therapy for a chronic total occlusion (CTO) in a diffusely calcified superficial femoral artery (SFA). During a retrograde approach, a Brockenbrough needle (BN) was able to penetrate the calcified hard plaque formed in the middle segment of the CTO. Moreover, bougie dilatation with the BN allowed balloon crossing and stent deployment, even after failure to pass a 2.0-mm monorail balloon across the plaque. These results suggest that the BN offers a new therapeutic option in the penetration and modification of severely calcified CTO in SFA.

Endovascular Crossing of Chronic Total Occlusions Using an Impulse: An Explorative Design Study.

PubMed

Sakes, Aimée; van der Wiel, Marleen; Dodou, Dimitra; Breedveld, Paul

2017-06-01

In this study we investigated whether exerting an impulse on a Chronic Total Occlusion (CTO) improves the success rate of CTO crossing as compared to the currently used method of statically pushing the guidewire against the CTO. A prototype (Ø2 mm) was developed that generates translational momentum using a spring-loaded indenter and converts it to an impulse during impact. Mechanical performance was evaluated by measuring the peak force and momentum for different spring compressions and strike distances in air and blood-mimicking fluid. Puncture performance, in terms of number of punctures, number of strikes to puncture, and energy transfer from the indenter to the CTO, was assessed for six tip shapes (stamp, wedge, spherical, pointed, hollow spherical, and ringed) on three CTO models with different weight percentages of gelatin and calcium. As a control, a Ø0.4 mm rigid rod was tested. A maximum indenter momentum of 1.3 mNs (velocity of 3.4 m/s), a peak force of 19.2 N (vs. 1.5 N reported in literature and 2.7 N for the control), and CTO displacement of 1.4 mm (vs. 2.7 mm for the control) were measured. The spherical and ringed tips were most effective, with on average 2.3 strikes to puncture the most calcified CTO model. The prototype generated sufficient peak forces to puncture highly calcified CTO models, which are considered most difficult to cross during PCI. Furthermore, CTO displacement was minimized, resulting in a more effective procedure. In future, a smaller, faster, and flexible clinical prototype will be developed.

Effect of antihypertensive treatment on focal cerebral infarction.

PubMed

Fujii, K; Weno, B L; Baumbach, G L; Heistad, D D

1992-06-01

The goal of the current study was to determine whether treatment of hypertension reduces cerebral infarction after occlusion of the middle cerebral artery in stroke-prone spontaneously hypertensive rats (SHRSPs). Three-month-old SHRSPs received untreated drinking water or drinking water containing cilazapril, an angiotensin converting enzyme inhibitor, or hydralazine and hydrochlorothiazide. After 3 months of treatment, the left middle cerebral artery was occluded and neurological deficit was evaluated. Infarct volume was measured 3 days after occlusion using computer imaging techniques from brain slices. Cilazapril and hydralazine with hydrochlorothiazide were equally effective in reducing systolic blood pressure in SHRSPs. One day after occlusion of the middle cerebral artery, neurological deficit was decreased by both cilazapril and hydralazine with hydrochlorothiazide compared with untreated SHRSPs, and the deficit 3 days after occlusion was decreased significantly only by cilazapril. Infarct volume was 178 +/- 7 mm3 (mean +/- SEM) in untreated SHRSPs, and it was significantly reduced to 117 +/- 15 mm3 by hydralazine with hydrochlorothiazide and to 101 +/- 17 mm3 by cilazapril. Infarct volume in Wistar-Kyoto rats was 27 +/- 16 mm3. Thus, reduction in arterial pressure by hydralazine with hydrochlorothiazide or an angiotensin converting enzyme inhibitor is protective against focal cerebral ischemia in SHRSPs.

A severe case of ipilimumab-induced guillain-barré syndrome revealed by an occlusive enteric neuropathy: a differential diagnosis for ipilimumab-induced colitis.

PubMed

Gaudy-Marqueste, Caroline; Monestier, Sandrine; Franques, Jérome; Cantais, Emmanuel; Richard, Marie-Aleth; Grob, Jean-Jacques

2013-01-01

Ipilimumab is a fully human monoclonal antibody directed against cytotoxic T-lymphocyte antigen-4 recently approved for the treatment of metastatic melanoma and currently under investigation in the adjuvant setting of high-risk stage III melanoma. The blockade of CTLA-4 induces activation of T cells, with an expected increase in the immunological reaction directed to cancer. We report a case of ipilimumab-induced Guillain-Barré syndrome revealed by an occlusive enteric neuropathy. Two weeks after the second dose of ipilimumab, our patient started to complain of abdominal meteorism and nausea. Within a few days, an occlusive syndrome developed. Wall biopsies during colonoscopy revealed a slight edema of the mucosa and a high number of lymphocytic follicles, leading to the diagnosis of ipilimumab-induced immune colitis. A respiratory failure occurred and a neurological deficiency developed rapidly. The diagnosis of polyradiculoneuritis was retained. Despite IV steroids, tacrolimus than plasmatic exchanges, the patient died within a few days because of multivisceral failure. Polyradiculoneuritis is a rare but very severe immune-mediated complication of ipilimumab. Occlusive enteric neuropathy may mimic the digestive symptoms of colitis, which is so frequent under ipilimumab.

Side effects of stabilization occlusal splints: a report of three cases and literature review.

PubMed

Magdaleno, Fernando; Ginestal, Eduardo

2010-04-01

Stabilization splints are frequently used for the treatment of temporomandibular disorders (TMD) and bruxism, despite the fact that little is known about their mechanism of action or the precise conditions under which they can be recommended. Moreover, information about their possible adverse effects, which in the majority of cases include occlusal modifications of little clinical relevance, is scarce. On occasions, these splints can provoke severe occlusal alterations and other complications, which are rarely alluded to in the literature. Here presented in this paper are three case reports in which part-time stabilization splints led to irreversible occlusal alterations and a discussion of the relevant clinical implications. Such splints are reported to negatively affect the condyle-disk relation in patients who exhibit disk displacement with reduction and to modify breathing features in patients with obstructive sleep apnea, although further studies are required to unequivocally demonstrate these findings. Finally, the splint seems to modify peripheral information at the level of the Central Nervous System, leading to modifications in corporal postural tone. The clinical repercussions of such alterations are currently poorly understood. It is our hope that future research will throw fresh light on these important topics.

[Application of lower abdominal aorta balloon occlusion technique by ultrasound guiding during caesarean section in patients with pernicious placenta previa].

PubMed

Wei, L C; Gong, G Y; Chen, J H; Hou, P Y; Li, Q Y; Zheng, Z Y; Su, Y M; Zheng, Y; Luo, C Z; Zhang, K; Xu, T F; Ye, Y H; Lan, Y J; Wei, X M

2018-03-27

Objective: To discuss the feasibility, effect and safety of lower abdominal aorta balloon occlusion technique by ultrasound guiding during caesarean section in patients with pernicious placenta previa. Methods: The clinical data of 40 patients with pernicious placenta previa complicated with placenta accreta from January 2015 to August 2017 in Liuzhou workers hospital were analyzed retrospectively. The study group included 20 cases, which were operated in the way of cesarean section combined lower abdominal aorta balloon occlusion technique by ultrasound guiding, while the control group also included 20 cases, which were operated in the way of the conventional cesarean section without balloon occlusion technique. The bleeding amount, blood transfusion volume, operative total time, hysterectomy and complications of the two groups were compared. Results: The bleeding amount and blood transfusion volume in study group were(850±100)ml and (400±50)ml, which were lower than that of the control group[(2 500±230)ml and (1 500±100)ml], the difference was statistically significant( t =35.624, 16.523, all P <0.05). In addition, the hysterectomy rate in study group was 5%, which was lower than that in the control group(30%), the difference was statistically significant(χ 2 =8.672, P <0.05). And the total time of operation was (2.0±0.5)h in the study group, which was shorter than that in the control group[(3.5±0.4)h]. The difference was statistically significant( t =11.362, P <0.05). No postoperative complications took place in the study group.The blood pressure, heart rate and blood oxygen fluctuated significantly, and the postoperative renal function was significantly reduced in the control group. Conclusions: The lower abdominal aorta balloon occlusion technique by ultrasound guiding during a caesarean section in patients with pernicious placenta previa can effectively control the bleeding during operation, and preserve reproductive function to the utmost degree.Therefore, the technique is safe, feasible, convenient and cheaper, and worthy of being widely applied in clinic.

Coronary Artery Spasm: Review and Update

PubMed Central

Hung, Ming-Jui; Hu, Patrick; Hung, Ming-Yow

2014-01-01

Coronary artery spasm (CAS), an intense vasoconstriction of coronary arteries that causes total or subtotal vessel occlusion, plays an important role in myocardial ischemic syndromes including stable and unstable angina, acute myocardial infarction, and sudden cardiac death. Coronary angiography and provocative testing usually is required to establish a definitive diagnosis. While the mechanisms underlying the development of CAS are still poorly understood, CAS appears to be a multifactorial disease but is not associated with the traditional risk factors for coronary artery disease. The diagnosis of CAS has important therapeutic implications, as calcium antagonists, not β-blockers, are the cornerstone of medical treatment. The prognosis is generally considered benign; however, recurrent episodes of angina are frequently observed. We provide a review of the literature and summarize the current state of knowledge regarding the pathogenesis of CAS. PMID:25249785

Repeated arterial occlusion, delta-opioid receptor (DOR) plasticity and vagal transmission within the sinoatrial node of the anesthetized dog.

PubMed

Deo, Shekhar H; Barlow, Matthew A; Gonzalez, Leticia; Yoshishige, Darice; Caffrey, James L

2009-01-01

Brief interruptions in coronary blood flow precondition the heart, engage delta-opioid receptor (DOR) mechanisms and reduce the damage that typically accompanies subsequent longer coronary occlusions. Repeated short occlusions of the sinoatrial (SA) node artery progressively raised nodal methionine-enkephalin-arginine-phenylalanine (MEAP) and improved vagal transmission during subsequent long occlusions in anesthetized dogs. The DOR type-1 (DOR-1) antagonist, BNTX reversed the vagotonic effect. Higher doses of enkephalin interrupted vagal transmission through a DOR-2 mechanism. The current study tested whether the preconditioning (PC) protocol, the later occlusion or a combination of both was required for the vagotonic effect. The study also tested whether evolving vagotonic effects included withdrawal of competing DOR-2 vagolytic influences. Vagal transmission progressively improved during successive SA nodal artery occlusions. The vagotonic effect was absent in sham animals and after DOR-1 blockade. After completing the PC protocol, exogenously applied vagolytic doses of MEAP reduced vagal transmission under both normal and occluded conditions. The magnitude of these DOR-2 vagolytic effects was small compared to controls and repeated MEAP challenges rapidly eroded vagolytic responses further. Prior DOR-1 blockade did not alter the PC mediated, progressive loss of DOR-2 vagolytic responses. In conclusion, DOR-1 vagotonic responses evolved from signals earlier in the PC protocol and erosion of competing DOR-2 vagolytic responses may have contributed to an unmasking of vagotonic responses. The data support the hypothesis that PC and DOR-2 stimulation promote DOR trafficking, and down regulation of the vagolytic DOR-2 phenotype in favor of the vagotonic DOR-1 phenotype. DOR-1 blockade may accelerate the process by sequestering newly emerging receptors.

Pulmonary Capillary Hemangiomatosis and Pulmonary Veno-occlusive Disease.

PubMed

Chaisson, Neal F; Dodson, Mark W; Elliott, Charles Gregory

2016-09-01

This article provides an overview of pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH), two disorders that challenge clinicians, radiologists, and pathologists because they often mimic pulmonary arterial hypertension (PAH). The article reviews the features that differentiate PVOD and PCH from PAH. The article also describes the overlap of PVOD and PCH, highlighted by recent reports of families diagnosed with PVOD or PCH caused by EIF2AK4 mutations. In addition, the article outlines current approaches to the diagnosis and treatment of PVOD and PCH. Copyright © 2016 Elsevier Inc. All rights reserved.

Current status of clot dissolution therapy.

DOT National Transportation Integrated Search

1962-11-01

Clot dissolution using fibrinolytic agents is a promising approach to the treatment of thromboembolic disease, particularly peripheral venous and arterial occlusion. In their present state of development, these agents are not recommended for general ...

77 FR 36548 - Dermatologic and Ophthalmic Drugs Advisory Committee; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-19

... edema (DME). Ranibizumab injection is currently approved for the treatment of neovascular (wet) age-related macular degeneration (AMD) and macular edema following retinal vein occlusion (RVO). During the...

Safety and efficacy of defibrotide for the treatment of severe hepatic veno-occlusive disease

PubMed Central

Ho, Vincent T.; Giralt, Sergio; Arai, Sally; Mineishi, Shin; Cutler, Corey; Antin, Joseph H.; Stavitzski, Nicole; Niederwieser, Dietger; Holler, Ernst; Carreras, Enric; Soiffer, Robert

2012-01-01

Hepatic veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome, is a potentially life-threatening complication of chemotherapeutic conditioning used in preparation for hematopoietic stem-cell transplantation (SCT). VOD may occur in up to 62% of patients undergoing SCT, with onset generally within the first month after SCT. In severe cases, 100-day mortality is in excess of 80%. Current management consists of best supportive care, with no agents to date approved for treatment in the USA or the EU. Defibrotide, a polydisperse oligonucleotide, has been shown in phase II and III trials to improve complete response and survival in patients undergoing SCT with severe VOD. This article reviews our current understanding of VOD, and examines recent clinical findings on defibrotide for the treatment and prophylaxis of VOD. PMID:23606935

Redefining Onyx HD 500 in the Flow Diversion Era

PubMed Central

Dalyai, Richard Tyler; Randazzo, Ciro; Ghobrial, George; Gonzalez, L. Fernando; Tjoumakaris, Stavropoula I.; Dumont, Aaron S.; Rosenwasser, Robert H.; Jabbour, Pascal

2012-01-01

We report the largest US case series results using Onyx HD-500 (EV3), a new liquid embolic agent, in the successful treatment of 21 patients with wide-neck intracranial aneurysms (mean size 4.5 mm), which are at increased risk of incomplete occlusion or recanalization with standard endovascular intervention utilizing detachable platinum coils. All aneurysms were located in the anterior circulation, and three aneurysms presented as acute subarachnoid hemorrhages. Complete aneurysm occlusion was present in 19 of 21 patients (90%). On six-month followup, one patient with an initially small residual neck progressed to total occlusion. Aneurysm recanalization was not detected in any patients on mean follow up of 8.9 months in 11 patients. Four patients experienced transient neurologic deficits in the immediate postoperative period and one in a delayed fashion. Embolization with the liquid embolic agent Onyx appears to be a safe and effective endovascular modality of treatment for wide-neck aneurysms or recurrent aneurysms that had previously failed treatment with detachable coils. PMID:22121488

DOE Office of Scientific and Technical Information (OSTI.GOV)

Matsuo, Toshihiko, E-mail: matsuot@cc.okayama-u.ac.j; Fujiwara, Hiroyasu; Gobara, Hideo

The aim of this study is to describe vision loss caused by central retinal artery and posterior ciliary artery occlusion as a consequence of sclerotherapy with a polidocanol injection to a glabellar hemangioma. An 18-year-old man underwent direct injection with a 23-gauge needle of 1 mL of a polidocanol-carbon dioxide emulsion into the glabellar subcutaneous hemangioma under ultrasound visualization of the needle tip by radiologists. He developed lid swelling the next day, and 3 days later at referral, the visual acuity in the left eye was no light perception. Funduscopy revealed central retinal artery occlusion and fluorescein angiography disclosed nomore » perfusion at all in the left fundus, indicating concurrent posterior ciliary artery occlusion. The patient also showed mydriasis, blepharoptosis, and total external ophthalmoplegia on the left side. Magnetic resonance imaging demonstrated the swollen medial rectus muscle. In a month, blepharoptosis and ophthalmoplegia resolved but the visual acuity remained no light perception. Sclerosing therapy for facial hemangioma may develop a severe complication such as permanent visual loss.« less

Aortocoronary dissection with acute left main artery occlusion: successful treatment with emergent stenting.

PubMed

Wykrzykowska, Joanna J; Carrozza, Joseph; Laham, Roger J

2006-08-01

Iatrogenic aortocoronary dissection is a rare but devastating complication of percutaneous coronary interventions and cardiac surgery, with a mortality rate up to 35%. Of the type-A dissections in the International Registry of Aortic Dissections (IRAD), 27% were caused by coronary interventions. The mechanism involves an initial dissection in the coronary artery, which then propagates in a retrograde fashion past the sinuses of Valsalva, often several centimeters beyond the aortic valve. With the advent of complex interventions such as left main stent implantation, revascularization of chronic total occlusions and mechanical thrombectomy, this complication may become more prevalent. Here we present a unique case of percutaneous coronary intervention (PCI) of the left circumflex (LCx) artery complicated by a left main coronary dissection that propagated approximately 8 cm into the ascending aorta and caused abrupt left main coronary artery occlusion and hemodynamic collapse. Rescue of the left main artery and sealing of the aortic dissection with stabilization of the patient was possible with rapid ostial left main artery stenting.

Influence of bruxism on survival of porcelain laminate veneers

PubMed Central

Agustín-Panadero, Rubén; Fons-Font, Antonio; Román-Rodríguez, Juan L.; Solá-Ruíz, María F.

2014-01-01

Objectives: This study aims to determine whether bruxism and the use of occlusal splints affect the survival of porcelain laminate veneers in patients treated with this technique. Material and Methods: Restorations were made in 70 patients, including 30 patients with some type of parafunctional habit. A total of 323 veneers were placed, 170 in patients with bruxism activity, and the remaining 153 in patients without it. A clinical examination determined the presence or absence of ceramic failure (cracks, fractures and debonding) of the restorations; these incidents were analyzed for association with bruxism and the use of splints. Results: Analysis of the ceramic failures showed that of the 13 fractures and 29 debonding that were present in our study, 8 fractures and 22 debonding were related to the presence of bruxism. Conclusions: Porcelain laminate veneers are a predictable treatment option that provides excellent results, recognizing a higher risk of failure in patients with bruxism activity. The use of occlusal splints reduces the risk of fractures. Key words:Veneer, fracture, debonding, bruxism, occlusal splint. PMID:23986018

Effect of tracheal occlusion on peripheric pulmonary vessel muscularization in a fetal rabbit model for congenital diaphragmatic hernia.

PubMed

Roubliova, Xenia I; Verbeken, Eric K; Wu, Jun; Vaast, Pascal; Jani, Jacques; Deprest, Jan A

2004-09-01

This study was undertaken to evaluate the effects on peripheric pulmonary vessel muscularization by tracheal occlusion (TO) performed at different gestational ages in fetal rabbits with surgically induced diaphragmatic hernia. In 23 New Zealand white does, both ovarian end fetuses underwent surgical creation of diaphragmatic hernia at 23 days of gestation (pseudoglandular phase). At 26, 27, or 28 days 1 fetus underwent TO, the contralateral one underwent a sham operation for a total of 46 fetuses. At 30 days (alveolar phase), fetuses were harvested together with 1 nonoperated internal control. Lungs were processed for vascular morphometry. Proportionate medial thickness and muscularization of intra-acinar vessels were evaluated. Late TO (day 28; saccular phase) normalizes the lung-to-body weight ratio and causes significant medial thinning in vessels up to 35 microm diameter. Tracheal occlusion decreases muscularization of intra-acinar pulmonary vessels in a gestational age-dependent fashion, with maximal effect when TO is performed at 28 days.

Preoperative partitioning of pulmonary vascular resistance correlates with early outcome after thromboendarterectomy for chronic thromboembolic pulmonary hypertension.

PubMed

Kim, Nick H S; Fesler, Pierre; Channick, Richard N; Knowlton, Kirk U; Ben-Yehuda, Ori; Lee, Stephen H; Naeije, Robert; Rubin, Lewis J

2004-01-06

Pulmonary thromboendarterectomy (PTE) is the preferred treatment for chronic thromboembolic pulmonary hypertension (CTEPH), but persistent pulmonary hypertension after PTE, as a result of either inaccessible distal thrombotic material or coexistent intrinsic small-vessel disease, remains a major determinant of poor outcome. Conventional preoperative evaluation is unreliable in identifying patients at risk for persistent pulmonary hypertension or predicting postoperative hemodynamic outcome. We postulated that pulmonary arterial occlusion pressure waveform analysis, a technique that has been used for partitioning pulmonary vascular resistance, might identify CTEPH patients with significant distal, small-vessel disease. Twenty-six patients underwent preoperative right heart catheterization before PTE. Pulmonary artery occlusion waveform recordings were performed in triplicate. Postoperative hemodynamics after PTE were compared with preoperative partitioning of pulmonary vascular resistance derived from the occlusion data. Preoperative assessment of upstream resistance (Rup) correlated with both postoperative total pulmonary resistance index (R2=0.79, P<0.001) and postoperative mean pulmonary artery pressure (R2=0.75, P<0.001). All 4 postoperative deaths occurred in patients with a preoperative Rup <60%. Pulmonary arterial occlusion pressure waveform analysis may identify CTEPH patients at risk for persistent pulmonary hypertension and poor outcome after PTE. Patients with CTEPH and Rup value <60% appear to be at highest risk.

Pattern of dental caries experience on tooth surfaces in an adult population.

PubMed

Hopcraft, Matthew Scott; Morgan, Michael Vivian

2006-06-01

To determine the pattern of caries experience across teeth and surfaces in an adult population depending on age and exposure to water fluoridation. Between November 2002 and March 2003 a total of 973 subjects aged 17-51 years had a clinical examination using visual and tactile criteria. Subsequent to this examination, bitewing radiographs were taken and viewed separately. Approximal and occlusal surfaces of molars and premolars were examined on the radiographs. Caries experience was relatively low, with mean DMFS scores of 3.21, 5.12, 9.61, 13.04 and 24.35 for subjects aged 17-20, 21-25, 26-30, 31-35 and 36-51 years respectively. The first molar teeth had the greatest caries experience, and occlusal surfaces had more caries experience than approximal surfaces. Subjects with a lifetime exposure to fluoridated drinking water had significantly lower caries experience than those who had no exposure to fluoridated drinking water. This study showed that caries prevalence, although relatively low in the study population, was found predominantly in occlusal surfaces, with an increasing prevalence in approximal surfaces of posterior teeth in older subjects. Subjects with a lifetime exposure to fluoridated drinking water had a lower level of caries experience than those with no exposure to fluoridated drinking water, and this was more noticeable in approximal surfaces than occlusal surfaces.

A morphological study of amblyopic eyes in children failing to achieve normal visual acuity after electronically monitored long-term occlusion treatment.

PubMed

Kuhli-Hattenbach, Claudia; Koss, Michael Janusz; Kohnen, Thomas; Fronius, Maria

2015-11-01

To search for morphological abnormalities in compliant unilaterally amblyopic children with poor occlusion treatment outcomes, for the first time with electronically recorded patching dosage. We included school children with remaining interocular logMAR (logarithm of the minimum angle of resolution) difference ≥ 0.3 after patching time of more than 22 months and 1300 h total in a previous prospective study. Six patients with a mean age of 11.19 years were included. Four patients had anisometropic amblyopia and two patients had a mixed strabismic and anisometropic amblyopia. Best-corrected visual acuity, cycloplegic refraction, dilated fundus examination, optic disc morphology and macular thickness using optical coherence tomography (OCT), retinal visual acuity, color perception, and the presence of a relative afferent pupillary defect (RAPD) were assessed. Paired t tests were performed to compare optic disc values and macular thickness of the amblyopic eyes to those of the fellow eyes. Average (± SD) logMAR VA in the amblyopic eyes was 0.42 (±0.23) with a remaining average interocular difference (IOD) of 0.51 (± 0.23), despite electronically monitored occlusion treatment of more than 1300 h. All patients presented with hyperopia and a significantly different mean spherical equivalent of + 4.73 (± 2.73) D in the amblyopic eye compared with the fellow eye (p = 0.02). A statistically significant difference in macular thickness was found between amblyopic and fellow eyes, with amblyopic eyes having an increased average thickness (p = 0.0062) and total volume (p = 0.0091) of the macula. One patient had familial hereditary primary macrodisc in both eyes. Our results provide evidence that average macular thickness and total macular volume tended to be increased among these compliant amblyopic children with unsatisfactory occlusion treatment outcomes. Further studies are warranted to evaluate whether morphological changes may have an impact on the effectiveness of amblyopia treatment. Moreover, our findings suggest that greater magnitude of hyperopia and anisometropia as well as older age may be risk factors associated with a poor visual acuity outcome among compliant amblyopic children.

Prognosis of untreated strokes due to anterior circulation proximal intracranial arterial occlusions detected by use of computed tomography angiography.

PubMed

Lima, Fabricio O; Furie, Karen L; Silva, Gisele S; Lev, Michael H; Camargo, Erica C S; Singhal, Aneesh B; Harris, Gordon J; Halpern, Elkan F; Koroshetz, Walter J; Smith, Wade S; Nogueira, Raul G

2014-02-01

Limited data exist regarding the natural history of proximal intracranial arterial occlusions. OBJECTIVE To investigate the outcomes of patients who had an acute ischemic stroke attributed to an anterior circulation proximal intracranial arterial occlusion. A prospective cohort study at 2 university-based hospitals from 2003 to 2005 in which nonenhanced computed tomography scans and computed tomography angiograms were obtained at admission of all adult patients suspected of having an ischemic stroke in the first 24 hours of symptom onset. Anterior circulation proximal intracranial arterial occlusion. Frequency of good outcome (defined as a modified Rankin Scale score of ≤ 2) and mortality at 6 months. A total of 126 patients with a unilateral complete occlusion of the intracranial internal carotid artery (ICA; 26 patients: median National Institutes of Health Stroke Scale [NIHSS] score, 11 [interquartile range, 5-17]), of the M1 segment of the middle cerebral artery (MCA; 52 patients: median NIHSS score, 13 [interquartile range, 6-16]), or of the M2 segment of the MCA (48 patients: median NIHSS score, 7 [interquartile range, 4-15]) were included. Of these 3 groups of patients, 10 (38.5%), 20 (38.5%), and 26 (54.2%) with ICA, MCA-M1, and MCA-M2 occlusions, respectively, achieved a modified Rankin Scale score of 2 or less, and 6 (23.1%), 12 (23.1%), and 10 (20.8%) were dead at 6 months. Worse outcomes were seen in patients with a baseline NIHSS score of 10 or higher, with a modified Rankin Scale score of 2 or less achieved in only 7.1% (1 of 14), 23.5% (8 of 34), and 22.7% (5 of 22) of patients and mortality rates of 35.7% (5 of 14), 32.4% (11 of 34), and 40.9% (9 of 22) among patients with ICA, MCA-M1, and MCA-M2 occlusions, respectively. Age (odds ratio, 0.94 [95% CI, 0.91-0.98]), NIHSS score (odds ratio, 0.73 [95% CI, 0.64-0.83]), and strength of leptomeningeal collaterals (odds ratio, 2.37 [95% CI, 1.08-5.20]) were independently associated with outcome, whereas the level of proximal intracranial arterial occlusion (ICA vs MCA-M1 vs MCA-M2) was not. The natural history of proximal intracranial arterial occlusion is variable, with poor outcomes overall. Stroke severity and collateral flow appear to be more important than the level of proximal intracranial arterial occlusion in determining outcomes. Our results provide useful data for proper patient selection and sample size calculations in the design of new clinical trials aimed at recanalization therapies.

Effects of noninvasive facial nerve stimulation in the dog middle cerebral artery occlusion model of ischemic stroke.

PubMed

Borsody, Mark K; Yamada, Chisa; Bielawski, Dawn; Heaton, Tamara; Castro Prado, Fernando; Garcia, Andrea; Azpiroz, Joaquín; Sacristan, Emilio

2014-04-01

Facial nerve stimulation has been proposed as a new treatment of ischemic stroke because autonomic components of the nerve dilate cerebral arteries and increase cerebral blood flow when activated. A noninvasive facial nerve stimulator device based on pulsed magnetic stimulation was tested in a dog middle cerebral artery occlusion model. We used an ischemic stroke dog model involving injection of autologous blood clot into the internal carotid artery that reliably embolizes to the middle cerebral artery. Thirty minutes after middle cerebral artery occlusion, the geniculate ganglion region of the facial nerve was stimulated for 5 minutes. Brain perfusion was measured using gadolinium-enhanced contrast MRI, and ATP and total phosphate levels were measured using 31P spectroscopy. Separately, a dog model of brain hemorrhage involving puncture of the intracranial internal carotid artery served as an initial examination of facial nerve stimulation safety. Facial nerve stimulation caused a significant improvement in perfusion in the hemisphere affected by ischemic stroke and a reduction in ischemic core volume in comparison to sham stimulation control. The ATP/total phosphate ratio showed a large decrease poststroke in the control group versus a normal level in the stimulation group. The same stimulation administered to dogs with brain hemorrhage did not cause hematoma enlargement. These results support the development and evaluation of a noninvasive facial nerve stimulator device as a treatment of ischemic stroke.

New findings on object permanence: A developmental difference between two types of occlusion

PubMed Central

Moore, M. Keith; Meltzoff, Andrew N.

2013-01-01

Manual search for totally occluded objects was investigated in 10-, 12- and 14-month-old infants. Infants responded to two types of total hiding in different ways, supporting the inference that object permanence is not a once-and-for-all attainment. Occlusion of an object by movement of a screen over it was solved at an earlier age than occlusion in which an object was carried under the screen. This dissociation was not explained by motivation, motor skill or means–ends coordination, because for both tasks the same object was hidden in the same place under the same screen and required the same uncovering response. This dissociation generalized across an experimentally manipulated change in recovery means—infants removed cloths while seated at a table in Expt 1 and were required to crawl through 3-D space to displace semi-rigid pillows in Expt 2. Further analysis revealed that emotional response varied as a function of hiding, suggesting an affective correlate of infant cognition. There are four empirical findings to account for: developmental change, task dissociation, generalization of the effects across recovery means, and emotional reactions. An identity-development theory is proposed explaining these findings in terms of infants’ understanding of object identity and the developmental relationship between object identity and object permanence. Object identity is seen as a necessary precursor to the development of object permanence. PMID:25364086

New findings on object permanence: A developmental difference between two types of occlusion.

PubMed

Moore, M Keith; Meltzoff, Andrew N

1999-11-01

Manual search for totally occluded objects was investigated in 10-, 12- and 14-month-old infants. Infants responded to two types of total hiding in different ways, supporting the inference that object permanence is not a once-and-for-all attainment. Occlusion of an object by movement of a screen over it was solved at an earlier age than occlusion in which an object was carried under the screen. This dissociation was not explained by motivation, motor skill or means-ends coordination, because for both tasks the same object was hidden in the same place under the same screen and required the same uncovering response. This dissociation generalized across an experimentally manipulated change in recovery means-infants removed cloths while seated at a table in Expt 1 and were required to crawl through 3-D space to displace semi-rigid pillows in Expt 2. Further analysis revealed that emotional response varied as a function of hiding, suggesting an affective correlate of infant cognition. There are four empirical findings to account for: developmental change, task dissociation, generalization of the effects across recovery means, and emotional reactions. An identity-development theory is proposed explaining these findings in terms of infants' understanding of object identity and the developmental relationship between object identity and object permanence. Object identity is seen as a necessary precursor to the development of object permanence.

Changing Strategies of the Retrograde Approach for Chronic Total Occlusion During the Past 7 Years

PubMed Central

Muramatsu, Toshiya; Tsukahara, Reiko; Ito, Yoshiaki; Ishimori, Hiroshi; Park, Seung-Jung; Winter, Robert; Shokry, Khaled; Wang, Lefeng; Chen, Jiyan; Wang, Haichang

2013-01-01

Objective We reviewed the technical changes and results achieved with the retrograde approach since we introduced it 7 years ago. Subjects and Methods The subjects were 1,268 patients who were treated for CTO between January 2004 and December 2010. They were investigated with respect to the success rate, the frequency of employing the retrograde approach and its outcome, and other factors. Results The retrograde approach was employed in ∼30% of chronic total occlusion (CTO) patients (n = 281) and the retrograde guidewire success rate was 81.1%. The kissing wire technique was substituted for the retrograde approach in 126 of the 281 patients, with antegrade crossing of a guidewire being successful in 88 of them (70%). The retrograde approach was combined with the CART and reverse controlled antegrade retrograde tracking (CART) techniques in 22 and 21 patients, respectively. Among 83 patients treated with Corsair catheters, crossing of the CTO was achieved in 63. The overall procedural success rate was 79.7% (224 patients). Complications of the retrograde approach included collateral channel dissection (2.1%), channel perforation (1.7%), CTO perforation (1.7%), and donor artery occlusion (1.1%). Conclusion The success rate and safety of the retrograde approach are both satisfactory if the appropriate devices and techniques are selected. © 2012 Wiley Periodicals, Inc. PMID:22517670

Differences in Pain Management Between Hematologists and Hospitalists Caring for Patients with Sickle Cell Disease Hospitalized for Vaso-Occlusive Crisis

PubMed Central

Shah, Nirmish; Rollins, Margo; Landi, Daniel; Shah, Radhika; Bae, Jonathan; De Castro, Laura M.

2013-01-01

Sickle cell disease (SCD) is a chronic disease characterized by multiple vaso-occlusive complications and is increasingly cared for by hospitalists. We performed a single-institution, retrospective review of pain management patterns and outcomes in adult SCD patients hospitalized for vaso-occlusive crisis. Over 26 months, we found a total of 298 patients (120 cared for by the hematologists and 178 by hospitalists), with a mean age of 32 (range 19 – 58). Patients cared for by hospitalists had a lower total number of hours on a patient controlled analgesia (PCA) device (171 vs. 212 hours, p=0.11). Hospitalists also were significantly more likely to utilize demand only PCA (42% vs. 23%, p=0.002) and had a significantly lower rate of using both continuous and demand PCA (54% vs. 67%, p=0.04). In addition, patients cared for by hospitalists had a significantly shorter hospitalization (8.4 days) compared to hematologists (10 days, p=0.04) with a non-significant difference in 7 and 30 day readmission rates (7.2% vs. 6.7% and 40% vs. 35% respectively). In conclusion, we found patients cared for by hospitalists more frequently utilized home oral pain medication during admission, had shorter lengths of hospitalization, and did not have a significant increase in readmission rates. PMID:23669451

Optical see-through head-mounted display with occlusion capability

NASA Astrophysics Data System (ADS)

Gao, Chunyu; Lin, Yuxiang; Hua, Hong

2013-05-01

Lack of mutual occlusion capability between computer-rendered and real objects is one of fundamental problems for most existing optical see-through head-mounted displays (OST-HMD). Without the proper occlusion management, the virtual view through an OST-HMD appears "ghost-like", floating in the real world. To address this challenge, we have developed an innovative optical scheme that uniquely combines the eyepiece and see-through relay optics to achieve an occlusion-capable OST-HMD system with a very compelling form factor and high optical performances. The proposed display system was based on emerging freeform optical design technologies and was designed for highly efficient liquid crystal on silicon (LCoS) type spatial light modulator (SLM) and bright Organic LED (OLED) microdisplay. The proposed display technology was capable of working in both indoor and outdoor environments. Our current design offered a 1280x1024 color resolution based on 0.8" microdisplay and SLM. The MTF values for the majority of the fields at the cutoff frequency of 40lps/mm, which is determined by the pixel size of the microdisplay, are better than 15%. The design achieved a diagonal FOV of 40 degrees, 31.7 degrees horizontally and 25.6 degrees vertically, an exit pupil diameter of 8mm (non-vignetted), and an eye clearance of 18mm. The optics weights about 20 grams per eye. Our proposed occlusion capable OST-HMD system can easily find myriads of applications in various military and commercial sectors such as military training, gaming and entertainment.

Contralateral occlusion is not a clinically important reason for choosing carotid artery stenting for patients with significant carotid artery stenosis.

PubMed

Brewster, Luke P; Beaulieu, Robert; Kasirajan, Karthik; Corriere, Matthew A; Ricotta, Joseph J; Patel, Siddharth; Dodson, Thomas F

2012-11-01

Contralateral carotid artery occlusion by itself carries an increased risk of stroke. Carotid endarterectomy (CEA) in the presence of contralateral carotid artery occlusion has high reported rates of perioperative morbidity and mortality. Our objective was to determine if there is a clinical benefit to patients who receive carotid artery stenting (CAS) compared to CEA in the presence of contralateral carotid artery occlusion. We conducted a retrospective medical chart review over a 4.5-year institutional experience of persons with contralateral carotid artery occlusion and ipsilateral carotid artery stenosis who underwent CAS or CEA. The main outcome measures were 30-day cardiac, stroke, and mortality rate, and midterm mortality. Of a total of 713 patients treated for carotid artery stenosis during this time period, 57 had contralateral occlusion (~8%). Thirty-nine of these patients were treated with CAS, and 18 with CEA. The most common indications for CAS were prior neck surgery (18), contralateral internal carotid occlusion (nine), and prior neck radiation (seven). The average age was 70 ± 8.5 for CEA and 66.7 ± 9.3 for CAS (P = .20). Both groups were predominantly men (CEA 12 of 18; CAS 28 of 39; P = .76), with similar prevalence of symptomatic lesions (CEA 8 of 18, CAS 20 of 39; P = .77). Two patients died within 30 days in the CAS group (5%). No deaths occurred within 30 days in the CEA group (P = .50); the mortality rate for CAS and CEA combined was 3.5%. No perioperative strokes or myocardial infarction occurred in either group. Two transient ischemic attacks occurred after CAS. At mean follow-up of 29.4 ± 16 months (CEA) and 28 ± 14.4 months (CAS; range, 1.5-48.5 months), seven deaths occurred in the CAS group and one in the CEA group (17.9% vs 5.5%; P = .40). There were two reinterventions in the CAS group for in-stent restenosis and there were no reoperations in the CEA group. Although CEA and CAS can both be performed with good perioperative results and acceptable midterm mortality, the observed outcomes do not support use of contralateral carotid artery occlusion as a selection criterion for CAS over CEA in the absence of other indications. Copyright © 2012 Society for Vascular Surgery. All rights reserved.

ONYX versus n-BCA for embolization of cranial dural arteriovenous fistulas.

PubMed

Rabinov, James David; Yoo, Albert J; Ogilvy, Christopher S; Carter, Bob S; Hirsch, Joshua A

2013-07-01

To evaluate the efficacy of n-butyl-2-cyanoacrylate (Trufill n-BCA) versus ethylene vinyl alcohol copolymer (ONYX) for the embolization of cranial dural arteriovenous fistulas (DAVF). Fifty-three consecutive patients with cranial dural AVF were treated with liquid embolic agents from November, 2003 to November, 2008. These 53 patients had 56 lesions treated with arterial embolization. Patients embolized to completion underwent follow-up angiography at 3 months to assess for durable occlusion. Twenty-one lesions were treated with n-BCA. Seven patients treated with n-BCA had initial angiographic occlusion of their DAVF, which were durable at 3 months. Six patients had adjunctive treatment with coils and/or polyvinyl alcohol particles, but none of these were occluded by endovascular treatment alone. Eleven patients underwent post-embolization surgery for closure of their DAVF. There was one death related to intractable status epilepticus at presentation. One patient developed a major stroke from venous sinus thrombosis after embolization. Thirty-five lesions were treated with ONYX in 34 patients. Twenty-nine patients treated with ONYX had initial angiographic occlusion of their DAVF by embolization alone. One patient had recurrence at 3 months and was re-treated out of 27 total follow-ups. Four patients underwent post-embolization surgical obliteration of their lesions. No deaths or major strokes occurred in this cohort. Initial angiographic occlusion (p=0.0004) and durable angiographic occlusion (p=0.0018) rates for embolization of cranial DAVF show a statistically significant higher efficacy with ONYX compared with n-BCA. Patients embolized with ONYX underwent surgery less frequently compared with those treated with n-BCA (p=0.0015).

Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, Qinghua, E-mail: qh-wu77@163.com; Liu, Zhuan, E-mail: liuchuan2015ck@163.com; Zhao, Xianlan, E-mail: zxl121292014@163.com

PurposeTo explore the efficacy and safety of prophylactic temporary balloon occlusion of the infrarenal abdominal aorta during caesarean for the management of patients with placenta praevia accreta.MethodsTwo hundred and sixty-eight cases of placenta praevia accreta from January 2012 to June 2015 were retrospectively reviewed. Group A included two hundred and thirty patients who underwent prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section. Group B included thirty-eight patients who underwent caesarean without endovascular intervention. The parameters including operating room time, estimated blood loss, blood transfusion volume, PT (prothrombin time) during operation, days in the intensive care unit,more » and total hospital days were compared between the two groups.ResultsThe operating room time, estimated blood loss, PT, the incidence of hysterectomy, blood transfusion volume, postpartum haemorrhage, and days in intensive care unit were lower in group A than in group B, with statistical significance (P < 0.05). There was no significant difference in the Apgar scores of the neonates and the incidences of thrombosis in lower limbs between the two groups (P > 0.05). No patient in the group with prophylactic temporary balloon occlusion of the infrarenal abdominal aorta was performed hysterectomy, while three patients in group B were performed hysterectomy because of uncontrollable haemorrhage.ConclusionsThe results indicate that prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section is safe and effective to control intraoperative blood loss and greatly decreases the risk of hysterectomy in patients with placenta praevia accreta.« less

Efficacy of treatment of edge stenosis of endografts inserted for superficial femoral artery stenotic disease.

PubMed

Golchehr, Bahar; Holewijn, Suzanne; Kruse, Rombout R; van Walraven, Laurens A; Zeebregts, Clark J; Reijnen, Michel M P J

2015-09-01

The role of endografts in the treatment of extensive superficial femoral artery (SFA) occlusive disease is enlarging. Results are limited by the occurrence of edge stenosis. The aim of the study was to retrospectively evaluate the efficacy of treatment of edge stenosis of endografts inserted for SFA occlusive disease. All patients, treated between November 2001 and December 2011, with a self-expandable polytetrafluoroethylene-endograft were gathered in a prospective database in three hospitals. The incidence of primary edge stenosis and the incidence of re-edge stenosis after treatment were retrospectively noted and a comparison was made between the results of percutaneous transluminal angioplasty (PTA) and extension of the endograft. A total of 88 patients presented with 115 edge stenoses, of which the majority presented within 1 year after insertion of the endograft (mean time to edge stenosis 10.7 ± 8.2 months). Seventy-three stenoses (63%) manifested at the proximal and 42 at the distal edge (37%). The 1-year incidence of restenosis and/or occlusion was 45% after PTA and 43% after endograft extension, with 1-year patency rates of 81% and 92%, respectively. The incidence of restenosis/occlusion after treatment with PTA was 12% higher at two years compared to extension of the endograft (55% vs. 43%, respectively). Edge stenosis may well be treated with either PTA or extension of the endograft. The incidence of restenosis and/or occlusion after both PTA and extension is high, but patency rates are acceptable. Aggressive surveillance is needed during the first year after insertion. © 2015 Wiley Periodicals, Inc.

Intravitreous Bevacizumab in the Treatment of Macuar Edema from Branch Retinal Vein Occlusion and Hemisphere Retinal Vein Occlusion (An AOS Thesis)

PubMed Central

Fish, Gary Edd

2008-01-01

Purpose To compare intravitreous bevacizumab to other current treatments of branch retinal vein occlusion (BRVO) and hemisphere retinal vein occlusion (HRVO) with consideration to visual outcome, cost, convenience, and risk of treatment. Methods This is a retrospective chart review from a large referral retina practice. The data comprise 56 patients with BRVO and HRVO treated by intravitreous bevacizumab, with and without intravitreous triamcinolone acetonide. Initial visual acuities at the time of first bevacizumab injection, best acuities through the follow-up time, final acuity at last visit before review, initial macular thickness, and final macular thickness were measured. Changes in vision and thickness were calculated, as were the percentage of eyes improving, stabilizing, and worsening. Results The data were compared to composite data derived from several current treatments of BRVO. The subgroup of 39 eyes that received only bevacizumab without triamcinolone acetonide had the most improvement in vision. The median change in visual acuity was 1.5 lines (P = .012) over a mean follow-up of 8.8 months. Twenty-three eyes (59%) improved visually, with 20 eyes (51%) improving 2 or more lines. These results are similar to those for eyes that received argon grid laser and chorioretinal anastomosis, but are worse than in eyes that received arteriovenous adventitial sheathotomy, macular decompression surgery, and intravitreous triamcinolone acetonide. Conclusions Visual benefit from intravitreous bevacizumab compares well against laser treatments for BRVO and HRVO but not as well opposed to surgical techniques and intravitreous triamcinolone acetonide. Intravitreous bevacizumab injection has a risk, cost, and convenience profile that is favorable. PMID:19277242

Morphologic characterization of the patent ductus arteriosus in the premature infant and the choice of transcatheter occlusion device.

PubMed

Philip, Ranjit; Waller, B Rush; Agrawal, Vijaykumar; Wright, Dena; Arevalo, Alejandro; Zurakowski, David; Sathanandam, Shyam

2016-02-01

The aim of this study was to describe and differentiate the morphology of patent ductus arteriosus (PDA) seen in children born prematurely from other PDA types. PDAs are currently classified as types A-E using the Krichenko's classification. Children born prematurely with a PDA morphology that did not fit this classification were described as Type F PDA. A review of 100 consecutive children who underwent transcatheter device closure of PDA was performed. The diameter and length (L) of the PDA and the device diameter (D) were indexed to the descending aorta (DA) diameter. Comparison of 26 Type F PDAs was performed against, 29 Type A, 7 Type C and 32 Type E PDAs. Children with Type F PDAs (median 27.5 weeks gestation) were younger during the device occlusion compared with types A, C, and E (median age: 6 vs. 32, 11, and 42 months; P = 0.002). Type F PDAs were longer and larger, requiring a relatively large device for occlusion than types A, C, and E (Mean L/DA: 1.88 vs. 0.9, 1.21, and 0.89, P ≤ 0.01 and Mean D/DA: 1.04 vs. 0.46, 0.87, and 0.34, P ≤0.01). The Amplatzer vascular plug-II (AVP-II) was preferred for occlusion of Type F PDAs (85%; P <0.001). Children born prematurely have relatively larger and longer PDAs. These "fetal type PDAs" are best classified separately. We propose to classify them as Type F PDAs to add to types A-E currently in use. The AVP-II was effective in occluding Type F PDAs. © 2015 Wiley Periodicals, Inc.

Self-Expanding Versus Balloon-Expandable Stents for Iliac Artery Occlusive Disease: The Randomized ICE Trial.

PubMed

Krankenberg, Hans; Zeller, Thomas; Ingwersen, Maja; Schmalstieg, Josefin; Gissler, Hans Martin; Nikol, Sigrid; Baumgartner, Iris; Diehm, Nicolas; Nickling, Estell; Müller-Hülsbeck, Stefan; Schmiedel, Rainer; Torsello, Giovanni; Hochholzer, Willibald; Stelzner, Christian; Brechtel, Klaus; Ito, Wulf; Kickuth, Ralph; Blessing, Erwin; Thieme, Marcus; Nakonieczny, Jaroslaw; Nolte, Thomas; Gareis, Ragnar; Boden, Harald; Sixt, Sebastian

2017-08-28

Atherosclerosis of iliac arteries is widespread. As inflow vessels, they are of great clinical significance and increasingly being treated by endovascular means. Most commonly, stents are implanted. So far, due to a lack of comparative data, no guideline recommendations on the preferable stent type, balloon-expandable stent (BE) or self-expanding stent (SE), have been issued. In this randomized, multicenter study, patients with moderate to severe claudication from common or external iliac artery occlusive disease were assigned 1:1 to either BE or SE. The primary endpoint was binary restenosis at 12 months as determined by duplex ultrasound. Key secondary endpoints were walking impairment, freedom from target lesion revascularization (TLR), hemodynamic success, target limb amputation, and all-cause death. Six hundred sixty patients with 660 lesions were enrolled at 18 German and Swiss sites over a period of 34 months; 24.8% of the patients had diabetes and 57.4% were current smokers. The common iliac artery was affected in 58.9%. One hundred nine (16.5%) lesions were totally occluded and 25.6% heavily calcified. Twelve-month incidence of restenosis was 6.1% after SE implantation and 14.9% after BE implantation (p = 0.006). Kaplan-Meier estimate of freedom from TLR was 97.2% and 93.6%, respectively (p = 0.042). There was no between-group difference in walking impairment, hemodynamic success, amputation rate, all-cause death, or periprocedural complications. The treatment of iliac artery occlusive disease with SE as compared with BE resulted in a lower 12-month restenosis rate and a significantly reduced TLR rate. No safety concerns arose in both groups. (Iliac, Common and External [ICE] Artery Stent Trial; NCT01305174). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Mechanism of potassium ion uptake by the Na+/K+-ATPase

PubMed Central

Castillo, Juan P.; Rui, Huan; Basilio, Daniel; Das, Avisek; Roux, Benoît; Latorre, Ramon; Bezanilla, Francisco; Holmgren, Miguel

2015-01-01

The Na+/K+-ATPase restores sodium (Na+) and potassium (K+) electrochemical gradients dissipated by action potentials and ion-coupled transport processes. As ions are transported, they become transiently trapped between intracellular and extracellular gates. Once the external gate opens, three Na+ ions are released, followed by the binding and occlusion of two K+ ions. While the mechanisms of Na+ release have been well characterized by the study of transient Na+ currents, smaller and faster transient currents mediated by external K+ have been more difficult to study. Here we show that external K+ ions travelling to their binding sites sense only a small fraction of the electric field as they rapidly and simultaneously become occluded. Consistent with these results, molecular dynamics simulations of a pump model show a wide water-filled access channel connecting the binding site to the external solution. These results suggest a mechanism of K+ gating different from that of Na+ occlusion. PMID:26205423

Real-Time MRI-Guided Endovascular Recanalization of Chronic Total Arterial Occlusion in a Swine Model

PubMed Central

Raval, Amish N.; Karmarkar, Parag V.; Guttman, Michael A.; Ozturk, Cengizhan; Sampath, Smita; DeSilva, Ranil; Aviles, Ronnier J.; Xu, Minnan; Wright, Victor J.; Schenke, William H.; Kocaturk, Ozgur; Dick, Alexander J.; Raman, Venkatesh K.; Atalar, Ergin; McVeigh, Elliot R.; Lederman, Robert J.

2006-01-01

Background Endovascular recanalization (guidewire traversal) of peripheral artery chronic total occlusion (CTO) can be challenging. X-Ray angiography resolves CTO poorly. Virtually “blind” device advancement during X-ray-guided interventions can lead to procedure failure, perforation and hemorrhage. Alternatively, magnetic resonance imaging (MRI) may delineate the artery within the occluded segment to enhance procedural safety and success. We hypothesized that real-time MRI (rtMRI) guided CTO recanalization can be accomplished in an animal model. Methods and Results Carotid artery CTO was created by balloon injury in 19 lipid overfed swine. After 6–8 weeks, two underwent direct necropsy analysis for histology, three underwent primary X-ray-guided CTO recanalization attempts, and the remaining 14 underwent rtMRI-guided recanalization attempts in a 1.5T interventional MRI system. rtMRI intervention used custom CTO catheters and guidewires that incorporated MRI receiver antennae to enhance device visibility. The mean length of the occluded segments was 13.3 ± 1.6cm. rtMRI-guided CTO recanalization was successful in 11/14 swine and only 1/3 swine using X-ray alone. After unsuccessful rtMRI (n = 3), X-ray-guided attempts also were all unsuccessful. Conclusions Recanalization of long CTO is feasible entirely using rtMRI guidance. Low profile clinical-grade devices will be required to translate this experience to humans. Endovascular recanalization of chronic total arterial occlusion (CTO) is challenging under conventional X-ray guidance because devices are advanced almost blindly. MRI can image CTO borders and luminal contents, and could potentially guide these procedures. We test the feasibility of real-time MRI guided wire traversal in a swine model of peripheral artery CTO using custom active MRI catheters. PMID:16490819

Onyx Embolization for Isolated Type Dural Arteriovenous Fistula Using a Dual-Lumen Balloon Catheter.

PubMed

Kim, Jin Woo; Kim, Byung Moon; Park, Keun Young; Kim, Dong Joon; Kim, Dong Ik

2016-05-01

Utilization of a dual-lumen balloon may improve Onyx penetration into isolated dural arteriovenous fistulas (i-DAVFs). To compare the results of Onyx embolization using a dual-lumen balloon with those using a non-balloon catheter for i-DAVFs. Twenty-nine patients underwent Onyx embolization for i-DAVFs using a non-balloon (n = 14) or a dual-lumen balloon catheter (n = 15). Since its introduction, a dual-lumen balloon catheter has been preferred. We compared the dual-lumen balloon group with the non-balloon catheter group regarding angiographic outcome, treatment-related complications, total procedural time, Onyx injection time, and the number of feeders requiring embolization. The dual-lumen balloon group showed complete occlusion of i-DAVFs in 13 and near-complete in 2 patients, while the non-balloon group showed complete occlusion in 5, near-complete in 5, and incomplete in 4 patients (P < .05). Treatment-related complications occurred in 2 patients: 1 in the non-balloon group and 1 in the dual-lumen balloon group. The mean total procedural time was 62 ± 32 minutes in the dual-lumen balloon and 171 ± 88 minutes in the non-balloon group (P < .05). The mean Onyx injection time was 10 ± 6 minutes in the dual-lumen balloon and 49 ± 32 minutes in the non-balloon group (P < .05). The median number of feeders requiring embolization was 1 (range, 1-3) in the dual-lumen balloon and 2 (range, 1-4) in the non-balloon group (P < .05). Utilization of a dual-lumen balloon catheter for Onyx embolization of i-DAVF seemed to significantly increase the immediate complete occlusion rate and decrease total procedural time, Onyx injection time, and number of feeders requiring embolization.

Coronary angioplasty with second generation Monorail catheters.

PubMed

Pande, A K; Meier, B; Urban, P; Villavicencio, R; de la Serna, F; Moles, V

1991-07-01

The Monorail system (Schneider) consists of a balloon catheter in which the guidewire passes through the balloon itself, exits the catheter proximal to the balloon, and runs alongside its small shaft (3 French) through the length of the guiding catheter. It offers distinct advantages over conventional systems of coronary angioplasty. It facilitates contrast injections and permits rapid balloon exchanges. This system was used for coronary angioplasty in 273 unselected consecutive patients (age 59 +/- 10, mean 35 to 73 years). There were 216 patients (84%) undergoing single-vessel and 57 patients (16%) with multi-vessel coronary angioplasty. A total of 335 coronary stenoses were dilated, which included 35 total occlusions. The size of balloon used ranged from 2.0 to 4.25 mm (3.0 +/- 0.5 mm) and the severity of stenosis was 85 +/- 11%. Technical success was defined as a residual stenosis of less than 50% as determined angiographically. Clinical success was defined as technical success, and absence of a major inhospital complication defined as absence of myocardial infarction, lack of need for coronary arterial bypass surgery, and survival. The Monorail system was technically successful in 294/300 stenotic lesions (98%). It was clinically successful for 281 lesions (94%). Of the 35 total occlusions, technical success was obtained in 25 (71%). The residual stenosis of successful cases was 26 +/- 21%. The Monorail system was also successful in 5 patients with stenosis of more than 90% in whom conventional systems failed. The complications included acute occlusion causing acute myocardial infarction in 13 cases (5%), emergency coronary arterial bypass surgery in 1 patient (0.4%), and death in 4 patients (1.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Occlusal plane rotation: aesthetic enhancement in mandibular micrognathia.

PubMed

Rosen, H M

1993-06-01

Patients afflicted with extreme degrees of mandibular micrognathia typically have vertically deficient rami as well as sagittally deficient mandibular bodies. This results in deficient posterior facial height, an obtuse gonial angle, excessively steep occlusal and mandibular planes, and a compensatory increase in anterior facial height. The entire maxillomandibular complex is overrotated in a clockwise direction. Standard orthognathic surgical correction fails to address this rotational deformity. As a consequence, the achieved projection of the lower face is inadequate, posterior facial height is further reduced, and occlusal and mandibular planes remain steep. Eleven patients with severe mandibular micrognathia underwent a surgical correction involving occlusal plane rotation to its normal orientation relative to Frankfort horizontal. This was accomplished by Le Fort I osteotomy to shorten the anterior maxilla (creating open bites in seven patients and making preexisting open bites worse in four patients) and sagittal split ramus osteotomies to advance and rotate the mandibular body counterclockwise, thus closing the surgically produced open bite. Counterclockwise rotation of the mandible afforded significantly greater sagittal displacement at the B point (mean 17 mm) than at the first molar (mean 10 mm) and produced adequate degrees of projection of the lower face when accompanied by a modest sliding genioplasty (mean 6.9 mm). Total advancement at the pogonion was a mean of 25.2 mm. In addition, posterior facial height was preserved, and mandibular and occlusal planes were normalized to mean angles of 27 and 10 degrees, respectively. At follow-up, which ranged from 9 to 24 months with a mean of 14.1 months, the mean sagittal relapse at the B point was 1.9 mm. Although heretofore considered unstable and therefore not clinically accepted, maxillomandibular counterclockwise rotation to normalize the occlusal plane rotational deformity provides stable, aesthetically superior results in patients with extreme degrees of mandibular micrognathia. Extended follow-up will be necessary to document long-term stability.

Mechanical thrombectomy for acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery: a meta-analysis.

PubMed

Saber, Hamidreza; Narayanan, Sandra; Palla, Mohan; Saver, Jeffrey L; Nogueira, Raul G; Yoo, Albert J; Sheth, Sunil A

2017-11-10

Endovascular thrombectomy has demonstrated benefit for patients with acute ischemic stroke from proximal large vessel occlusion. However, limited evidence is available from recent randomized trials on the role of thrombectomy for M2 segment occlusions of the middle cerebral artery (MCA). We conducted a systematic review and meta-analysis to investigate clinical and radiographic outcomes, rates of hemorrhagic complications, and mortality after M2 occlusion thrombectomy using modern devices, and compared these outcomes against patients with M1 occlusions. Recanalization was defined as Thrombolysis in Cerebral Infarction (TICI) 2b/3 or modified TICI 2b/3. A total of 12 studies with 1080 patients with M2 thrombectomy were included in our analysis. Functional independence (modified Rankin Scale 0-2) rate was 59% (95% CI 54% to 64%). Mortality and symptomatic intracranial hemorrhage rates were 16% (95% CI 11% to 23%) and 10% (95% CI 6% to 16%), respectively. Recanalization rates were 81% (95% CI 79% to 84%), and were equally comparable for stent-retriever versus aspiration (OR 1.05; 95% CI 0.91 to 1.21). Successful M2 recanalization was associated with greater rates of favorable outcome (OR 4.22; 95% CI 1.96 to 9.1) compared with poor M2 recanalization (TICI 0-2a). There was no significant difference in recanalization rates for M2 versus M1 thrombectomy (OR 1.05; 95% CI 0.77 to 1.42). This meta-analysis suggests that mechanical thrombectomy for M2 occlusions that can be safely accessed is associated with high functional independence and recanalization rates, but may be associated with an increased risk of hemorrhage. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Occlusal characteristics of children with hypertrophied adenoids in Nigeria.

PubMed

Osiatuma, Vivien Ijeoma; Otuyemi, Olayinka Donald; Kolawole, Kikelomo Adebanke; Ogunbanjo, Babatunde Ogunbiyi; Amusa, Yemisi Bola

2015-03-01

Nasorespiratory function and its relation to craniofacial growth are of great interest because of the basic biological relationship between form and function, and the accumulating findings of the relationship between mode of breathing, craniofacial growth and orthodontic treatment. The aim of this study was to evaluate the effect of adenoid hypertrophy and sociodemographic variables on the occlusion of children. A total of 180 subjects aged 3-12 years were selected at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Ninety subjects had hypertrophied adenoids while 90 normal children served as the control group. Orthodontic examinations were carried out and impressions for study models taken. Occlusion was assessed in the anterior-posterior, transverse and vertical planes. Class I relationship was the most prevalent occlusion in both adenoid and control subjects (55.6% and 72.2%, respectively). The occurrence of class II division 1 was significantly higher among adenoid than control subjects (P=0.003). Posterior crossbites occurred significantly more in adenoid subjects in the 9-12 years category. In the vertical plane, the occurrence of deep bite was significantly greater in male than female adenoid subjects. Age had a statistically significant but weak correlation with anterior open bite (r=0.37). Age and BMI also had significant though weak correlations with posterior crossbite in female adenoid subjects (r=0.39 and r=0.36, respectively). Regression analysis also showed that age had a significant effect on the occurrence of anterior open bite, while BMI had a significant effect on the occurrence of class II occlusion in adenoid subjects (P<0.05). The presence of hypertrophied adenoids affects the occlusion in the three planes. Age and BMI have significant effects on the occurrence of anterior open bite and class II division 1 malocclusion respectively in adenoid subjects. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Endovascular ischemic stroke models of adult rhesus monkeys: a comparison of two endovascular methods.

PubMed

Wu, Di; Chen, Jian; Wang, Bincheng; Zhang, Mo; Shi, Jingfei; Ma, Yanhui; Zhu, Zixin; Yan, Feng; He, Xiaoduo; Li, Shengli; Dornbos Iii, David; Ding, Yuchuan; Ji, Xunming

2016-08-18

To further investigate and improve upon current stroke models in nonhuman primates, infarct size, neurologic function and survival were evaluated in two endovascular ischemic models in sixteen rhesus monkeys. The first method utilized a micro-catheter or an inflatable balloon to occlude the M1 segment in six monkeys. In the second model, an autologous clot was injected via a micro-catheter into the M1 segment in ten monkeys. MRI scanning was performed on all monkeys both at baseline and 3 hours after the onset of ischemia. Spetzler neurologic functions were assessed post-operatively, and selective perfusion deficits were confirmed by DSA and MRI in all monkeys. Animals undergoing micro-catheter or balloon occlusion demonstrated more profound hemiparesis, larger infarct sizes, lower Spetzler neurologic scores and increased mortality compared to the thrombus occlusion group. In animals injected with the clot, there was no evidence of dissolution, and the thrombus was either near the injection site (M1) or flushed into the superior division of the MCA (M2). All animals survived the M2 occlusion. M1 occlusion with thrombus generated 50% mortality. This study highlighted clinically important differences in these two models, providing a platform for further study of a translational thromboembolic model of acute ischemic stroke.

RETINAL VEIN OCCLUSIONS, FROM BASICS TO THE LATEST TREATMENT.

PubMed

Ho, Mary; Liu, David T L; Lam, Dennis S C; Jonas, Jost B

2016-03-01

To review the pathophysiology, diagnosis, and updated treatments of retinal vein occlusions (RVOs). A review of the literature was performed, focusing on the epidemiology, pathophysiology, diagnosis, and treatments (including both medical and surgical treatments) of RVO. Based on this review, a comprehensive overview was provided regarding the topic of RVO and focused on recent treatment updates. Retinal vein occlusions have an age- and sex-standardized prevalence of 5.20 per 1,000 for any RVO, 4.42 per 1,000 for branch RVO, 0.80 per 1,000 for central RVO. Worldwide, an estimated 16.4 million adults are affected by RVOs, with 2.5 million affected by central RVO and 13.9 million affected by branch RVO. Retinal vein occlusion is recognized as an important cause of blindness and the diagnostic approaches and treatment options for RVO are reviewed and reported. The current treatment options including medical treatments (bevacizumab, ranibizumab, aflibercept, triamcinolone, and dexamethasone implants) and surgical alternatives were reviewed and reported with summaries on the corresponding strength of evidence. Despite the understanding of this disease entity, challenges persist in the long-term treatment of RVO-related complications and visual loss. This review provided a detailed summary on the rationality and efficacy of recently developed treatment regimes and evaluated the potential benefit of combination therapy.

Use of an optical clearing agent to enhance the visibility of subsurface structures and lesions from tooth occlusal surfaces

NASA Astrophysics Data System (ADS)

Kang, Hobin; Darling, Cynthia L.; Fried, Daniel

2016-08-01

The purpose of this study is to show that optical clearing agents can be used to increase the visibility of deeply penetrating occlusal lesions that have reached the underlying dentin and spread laterally under the enamel. Previous studies have shown that high refractive index fluids can increase the contrast of caries lesions. Extracted teeth with natural occlusal lesions were imaged with optical coherence tomography (OCT) with and without the addition of a transparent vinyl polysiloxane impression material (VPS) currently used in vivo. The relative intensity of the reflectivity from the underlying lesion area for each sample was measured before and after application of the VPS. Lesion presence was confirmed with polarized light microscopy and microradiography. Application of VPS significantly increased (P<0.0001) the integrated reflectivity of subsurface dentinal lesions. This study shows that optical clearing agents can be used to increase the optical penetration and the visibility of subsurface lesions and the dentinal-enamel junction under sound and demineralized enamel in OCT images.

Lateral line pore diameters correlate with the development of gas bubble trauma signs in several Columbia River fishes

USGS Publications Warehouse

Morris, R.G.; Beeman, J.W.; VanderKooi, S.P.; Maule, A.G.

2003-01-01

Gas bubble trauma (GBT) caused by gas supersaturation of river water continues to be a problem in the Columbia River Basin. A common indicator of GBT is the percent of the lateral line occluded with gas bubbles; however, this effect has never been examined in relation to lateral line morphology. The effects of 115, 125 and 130% total dissolved gas levels were evaluated on five fish species common to the upper Columbia River. Trunk lateral line pore diameters differed significantly (P<0.0001) among species (longnose sucker>largescale sucker>northern pikeminnow≥chinook salmon≥redside shiner). At all supersaturation levels evaluated, percent of lateral line occlusion exhibited an inverse correlation to pore size but was not generally related to total dissolved gas level or time of exposure. This study suggests that the differences in lateral line pore diameters between species should be considered when using lateral line occlusion as an indicator of gas bubble trauma.

Four cases of vertebrobasilar insufficiency.

PubMed

Inui, H; Yoneyama, K; Kitaoku, Y; Nakane, M; Ohue, S; Yamanaka, T; Ueda, T; Fujita, N; Miyahara, H; Matsunaga, T

1998-01-01

Four cases of vertebrobasilar insufficiency are reported. Case 1 was a 38-year-old man who felt a sudden onset of dizziness when he turned his head to the back. An abnormal positional nystagmus was observed when he rotated his head to the left. A magnetic resonance angiogram (MRA) demonstrated total occlusion of the left vertebral artery (VA). Case 2 was a 31-year-old woman who had a total occlusion of her left VA as observed in the MRA. Case 3 was a 68-year-old man who noted dizziness. The systolic blood pressure change on his Schellong test was 28 mmHg. On his MRA, severe displacement of the basilar and the vertebral arteries was visible. Case 4 was a 76-year-old woman who noted a blackout-like sensation. Optokinetic nystagmus was noted with a hyponystagmus pattern, and an eye tracking test showed a saccadic pattern. On her MRA, the vertebrobasilar system was narrowed. The arterial architecture and any stenosis of the blood vessels could be detected non-invasively by MRA.

The role of atherectomy in the treatment of lower extremity peripheral artery disease

PubMed Central

2012-01-01

Background The incidence of lower extremity peripheral artery disease (LE-PAD) continues to increase and associated morbidity remains high. Despite the significant development of percutaneous revascularization strategies, over the past decade, LE-PAD still represents a unique challenge for interventional cardiologists and vascular surgeons. Method Typical features of atherosclerosis that affects peripheral vascular bed (diffuse nature, poor distal runoff, critical limb ischemia, chronic total occlusion) contribute to the disappointing results of traditional percutaneous transluminal angioplasty (PTA). New technologies have been developed in attempt to improve the safety and effectiveness of percutaneous revascularization. Among these, atherectomy, debulking and removing atherosclerotic plaque, offers the potential advantage of eliminating stretch on arterial walls and reducing rates of restenosis. Conclusions This review summarizes the features and the current applications of new debulking devices. PMID:23173800

Secondary Alveolar Bone Grafting in Patients Born With Unilateral Cleft Lip and Palate: A 20-Year Follow-up.

PubMed

Jabbari, Fatemeh; Wiklander, Laila; Reiser, Erika; Thor, Andreas; Hakelius, Malin; Nowinski, Daniel

2018-02-01

To identify factors of oral health important for the final outcome, after secondary alveolar bone grafting in patients born with unilateral cleft lip and palate and compare occlusal radiographs with cone beam computed tomography (CBCT) in assessment of alveolar bone height. Observational follow-up study. Cleft Lip and Palate Team, Craniofacial Center, Uppsala University Hospital, Sweden. 40 nonsyndromic, Caucasian patients with unilateral complete cleft lip and palate. Clinical examination, CBCT, and occlusal radiographs. Alveolar bone height was evaluated according to Bergland index at a 20-year follow-up. The alveolar bone height in the cleft area was significantly reduced compared to a previously reported 10-year follow-up in the same cohort by total ( P = .045) and by subgroup with dental restoration ( P = .0078). This was positively correlated with the gingival bleeding index (GBI) ( r = 0.51, P = .0008) and presence of dental restorations in the cleft area ( r = 0.45, P = .0170). There was no difference in the Bergland index generated from scoring the alveolar bone height on occlusal radiographs as with the equivalent index on CBCT. Patients rehabilitated with complex dental restoration seems to be at higher risk for progression of bone loss in the cleft area. Supportive periodontal therapy should be implemented after complex dental restorations in cleft patients. Conventional occlusal radiographs provide an adequate image for evaluating postoperative bone height in clinical follow-up.

Systematic and detailed analysis of behavioural tests in the rat middle cerebral artery occlusion model of stroke: Tests for long-term assessment

PubMed Central

Diaz, Claris; Farr, Tracy D; Harrison, David J; Fuller, Anna; Tokarczuk, Paweł F; Stewart, Andrew J; Paisey, Stephen J; Dunnett, Stephen B

2016-01-01

In order to test therapeutics, functional assessments are required. In pre-clinical stroke research, there is little consensus regarding the most appropriate behavioural tasks to assess deficits, especially when testing over extended times in milder models with short occlusion times and small lesion volumes. In this study, we comprehensively assessed 16 different behavioural tests, with the aim of identifying those that show robust, reliable and stable deficits for up to two months. These tasks are regularly used in stroke research, as well as being useful for examining striatal dysfunction in models of Huntington’s and Parkinson’s disease. Two cohorts of male Wistar rats underwent the intraluminal filament model of middle cerebral artery occlusion (30 min) and were imaged 24 h later. This resulted in primarily subcortical infarcts, with a small amount of cortical damage. Animals were tested, along with sham and naïve groups at 24 h, seven days, and one and two months. Following behavioural testing, brains were processed and striatal neuronal counts were performed alongside measurements of total brain and white matter atrophy. The staircase, adjusting steps, rotarod and apomorphine-induced rotations were the most reliable for assessing long-term deficits in the 30 min transient middle cerebral artery occlusion model of stroke. PMID:27317655

Clinical Evaluation of Different Pre-impression Preparation Procedures of Dental Arch

PubMed Central

Arora, Nitin; Arora, Monika; Gupta, Naveen; Agarwal, Manisha; Verma, Rohit; Rathod, Pankaj

2015-01-01

Background: Bubbles and voids on the occlusal surface impede the actual intercuspation and pre-impression preparation aims to reduce the incidence of air bubbles and voids as well as influences the quality of occlusal reproduction and actual clinical intercuspation in the articulator. The study was undertaken to determine the influence of different pre-impression preparation procedures of antagonistic dental arch on the quality of the occlusal reproduction of the teeth in irreversible hydrocolloid impressions and to determine most reliable pre-impression preparation method to reduce the incidence of air bubbles. Materials and Methods: A total of 20 subjects were selected having full complement of mandibular teeth from second molar to second molar with well demarcated cusp height. 200 impressions were made with irreversible hydrocolloid material. The impressions were divided into five groups of 40 impressions each and each group had one specific type of pre-impression preparation. All the impressions were poured in die stone. A stereomicroscope with graduated eyepiece was used to count the number of bubbles on the occlusal surface of premolars and molars. The mean and standard deviations were calculated for each group. Mann–Whitney U-test was applied to find the significant difference between different groups. Results: Least bubbles were found in the group in which oral cavity was dried by saliva ejector and fluid hydrocolloid was finger painted onto the occlusal surfaces immediately before the placement of impression tray in the mouth. Conclusion: It was found that finger painting the tooth surfaces with fluid hydrocolloid immediately before the placement of loaded impression tray in the mouth was the most reliable method. The oral cavity can be cleared more easily of excess saliva by vacuum suction rather than by use of an astringent solution. PMID:26229376

Clinical Evaluation of Different Pre-impression Preparation Procedures of Dental Arch.

PubMed

Arora, Nitin; Arora, Monika; Gupta, Naveen; Agarwal, Manisha; Verma, Rohit; Rathod, Pankaj

2015-07-01

Bubbles and voids on the occlusal surface impede the actual intercuspation and pre-impression preparation aims to reduce the incidence of air bubbles and voids as well as influences the quality of occlusal reproduction and actual clinical intercuspation in the articulator. The study was undertaken to determine the influence of different pre-impression preparation procedures of antagonistic dental arch on the quality of the occlusal reproduction of the teeth in irreversible hydrocolloid impressions and to determine most reliable pre-impression preparation method to reduce the incidence of air bubbles. A total of 20 subjects were selected having full complement of mandibular teeth from second molar to second molar with well demarcated cusp height. 200 impressions were made with irreversible hydrocolloid material. The impressions were divided into five groups of 40 impressions each and each group had one specific type of pre-impression preparation. All the impressions were poured in die stone. A stereomicroscope with graduated eyepiece was used to count the number of bubbles on the occlusal surface of premolars and molars. The mean and standard deviations were calculated for each group. Mann-Whitney U-test was applied to find the significant difference between different groups. Least bubbles were found in the group in which oral cavity was dried by saliva ejector and fluid hydrocolloid was finger painted onto the occlusal surfaces immediately before the placement of impression tray in the mouth. It was found that finger painting the tooth surfaces with fluid hydrocolloid immediately before the placement of loaded impression tray in the mouth was the most reliable method. The oral cavity can be cleared more easily of excess saliva by vacuum suction rather than by use of an astringent solution.

Thromboembolic Complications after Zenith{sup ®} Low Profile Endovascular Graft for Infrarenal Abdominal Aneurysms

DOE Office of Scientific and Technical Information (OSTI.GOV)

Urlings, T. A. J., E-mail: t-urlings@hotmail.com; Vries, A. C. de, E-mail: a.de.vries@mchaaglanden.nl; Mol van Otterloo, J. C. A. de, E-mail: a.de.molvanotterloo@mchaaglanden.nl

2015-06-15

PurposeThe purpose of this study was to objectify and evaluate risk factors for thromboembolic complications after treatment with a Zenith{sup ®} Low Profile Endovascular Graft (Zenith LP). Results were compared with those in the recent literature on endovascular aortic repair (EVAR) and with the thromboembolic complications in the patient group treated with a Zenith Flex Endovascular Graft in our institute in the period before the use of the Zenith LP.Materials and MethodsAll consecutive patients who were suitable for treatment with a Zenith LP endograft between October 2010 and December 2011 were included. The preprocedural computed tomography scan (CT), procedural angiographicmore » images, and the postprocedural CT scans were evaluated for risk factors for and signs of thromboembolic complications. All patients treated between December 2007 and November 2012 with a Zenith Flex endograft were retrospectively evaluated for thromboembolic complications.ResultsIn the study period 17 patients were treated with a LP Zenith endograft. Limb occlusion occurred in 35 % of the patients. Limb occlusions occurred in 24 % of the limbs at risk (one limb occluded twice). In one patient two risk factors for limb occlusion were identified. Between December 2007 and November 2012, a total of 43 patients were treated with a Zenith Flex endograft. No limb occlusion or distal embolization occurred.ConclusionDespite that this was a small retrospective study, the Zenith LP endograft seems to be associated with more frequent thromboembolic complications compared with the known limb occlusion rates in the literature and those of the patients treated with a Zenith Flex endograft in our institute.« less

Retinal oximetry in patients with ischaemic retinal diseases.

PubMed

Rilvén, Sandra; Torp, Thomas Lee; Grauslund, Jakob

2017-03-01

The retinal oximeter is a new tool for non-invasive measurement of retinal oxygen saturation in humans. Several studies have investigated the associations between retinal oxygen saturation and retinal diseases. In the present systematic review, we examine whether there are associations between retinal oxygen saturation and retinal ischaemic diseases. We used PubMed and Embase to search for retinal oxygen saturation and retinal ischaemic diseases. Three separate searches identified a total of 79 publications. After two levels of manual screening, 10 studies were included: six about diabetic retinopathy (DR) and four about retinal vein occlusion. No studies about retinal artery occlusion were included. In diabetes, all studies found that increases in retinal venous oxygen saturation (rvSatO 2 ) were associated with present as well as increasing levels of DR. Four of six studies also found increased retinal arterial oxygen saturation (raSatO 2 ) in patients with DR. In patients with central retinal vein occlusion (CRVO), all studies found that rvSatO 2 was reduced, but raSatO 2 remained unchanged. Branch retinal vein occlusion was not associated with changes in retinal oxygen saturation, but this was based on a single study. In conclusion, DR is associated with increased rvSatO 2 and might also be related to increased raSatO 2 . Central retinal vein occlusion (CRVO) is correlated with increased rvSatO 2 but unrelated to raSatO 2 . Prospective studies are needed to expand these findings. These would tell whether retinal oximetry could be a potential tool for screening or a biomarker of treatment outcome in patients with ischaemic retinal diseases. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Shunt occlusion for portosystemic shunt syndrome related refractory hepatic encephalopathy-A single-center experience in 21 patients from Kerala.

PubMed

Philips, Cyriac Abby; Kumar, Lijesh; Augustine, Philip

2017-09-01

Large spontaneous portosystemic shunts (SPSS) are seen in a subset of patients with liver disease and medically refractory recurrent/persistent hepatic encephalopathy (MRHE). Shunt occlusion has been shown to improve clinical outcomes. We retrospectively analyzed patient characteristics, SPSS attributes, procedural features, baseline clinical and investigational parameters, neurological outcomes, adverse effects (procedure and portal hypertension related), and risk factors predicting outcomes in liver disease patients undergoing shunt occlusion procedure for MRHE. Between October 2016 and July 2017, 21 patients (Child-Pugh score, CTP 6 to 13) with mean model of end-stage liver disease (MELD) and MELD-sodium scores 15.7 and 19.3 respectively with MRHE [3-cirrhotic Parkinsonism (CP)] were diagnosed to have single or multiple large SPSSs. A total of 29 shunts were occluded (1 surgical, 20 non-surgical). Recurrent and persistent HE and CP markedly improved in the short (n=20, 1 to 3 months), intermediate (n=12, 3 to 6 months), and long (n=7, 6 to 9 months) follow up. None had spontaneous or persistent HE at a median follow up 105 (30 to 329) days (p<0.05). Motor, speech, sleep abnormalities, daily activities of living, and liver disease severity scores improved significantly on follow up. Baseline arterial ammonia showed a statistically significant reduction in all time periods of follow up after shunt occlusion (p<0.05). CTP >11 predicted mortality post shunt occlusion (p=0.04). Embolization of large SPSS in liver disease patients with MRHE and modestly preserved liver function is safe and efficacious and associated with improved quality of life and can function as a bridge to liver transplantation in accurately selected patients.

Assessment of occlusion after placement of stainless steel crowns in children - a pilot study.

PubMed

Gallagher, S; O'Connell, B C; O'Connell, A C

2014-10-01

Many stainless steel crowns (SSCs) disrupt the occlusion in children, but stabilisation appears to occur within a short period post-placement. The extent and mechanism of these short-term occlusal changes in children are unknown. This study sought to determine whether placement of a SSC changes the maximum intercuspation position (MIP) in children, whether the MIP returns to normal within 4 weeks and whether local anaesthesia had an effect on the child's ability to achieve MIP. The T-Scan(®) III was used for the measurement of occlusal contacts. Reliability and reproducibility of the system was determined using a calibration exercise where MIP recordings were taken of eleven children not undergoing any dental treatment. For the main study, the percentage of total occlusal force on each tooth was recorded in 20 children preoperatively, after local anaesthesia, after SSC placement and 4 weeks postoperatively. There was no significant difference in MIP (P = 0·435) preoperatively and post-administration of local anaesthesia. There was a significant difference between the preoperative force on a tooth and the reading after crown placement (P = 0·0013, Wilcoxon test). By 4 weeks, there was no significant difference overall between post-SSC placement and the preoperative value for the tooth (P = 0·3). Administration of local anaesthesia did not affect the ability of a child to attain MIP. Maximum intercuspation position was disturbed by the placement of a SSC in seven of 20 cases. When MIP was disturbed, in most cases, it returned to preoperative status within 4 weeks of crown placement. © 2014 John Wiley & Sons Ltd.

Endoscopic management of occluded metal biliary stents: Metal versus 10F plastic stents

PubMed Central

Yoon, Won Jae; Ryu, Ji Kon; Lee, Jung Won; Ahn, Dong-Won; Kim, Yong-Tae; Yoon, Yong Bum; Woo, Sang Myung; Lee, Woo Jin

2010-01-01

AIM: To compare the efficacy of self-expandable metal stents (SEMSs) with 10F plastic stents (PSs) in the endoscopic management of occluded SEMSs. METHODS: We retrospectively reviewed the medical records of 56 patients who underwent SEMS insertion for palliation of unresectable malignant biliary obstruction between 2000 and 2007 and subsequent endoscopic retrograde biliary drainage (ERBD) with SEMS or PS for initial SEMS occlusion between 2000 and 2008. RESULTS: Subsequent ERBD with SEMS was performed in 29 patients and with PS in 27. The median time to stent occlusion after subsequent ERBD was 186 d in the SEMS group and 101 d in the PS group (P = 0.118). Overall median stent patency was 79 d for the SEMS group and 66 d for the PS group (P = 0.379). The mean number of additional biliary drainage procedures after subsequent ERBD in patients that died (n = 50) during the study period was 2.54 ± 4.12 for the SEMS group and 1.85 ± 1.95 for the PS group (P = 0.457). The mean total cost of additional biliary drainage procedures after the occlusion of subsequent SEMS or PS was $410.04 ± 692.60 for the SEMS group and $630.16 ± 671.63 for the PS group (P = 0.260). Tumor ingrowth as the cause of initial SEMS occlusion was the only factor associated with a shorter time to subsequent stent occlusion (101 d for patients with tumor ingrowth vs 268 d for patients without tumor ingrowth, P = 0.008). CONCLUSION: Subsequent ERBD with PSs offered similar patency and number of additional biliary drainage procedures compared to SEMSs in the management of occluded SEMS. PMID:21072899

Endoscopic management of occluded metal biliary stents: metal versus 10F plastic stents.

PubMed

Yoon, Won Jae; Ryu, Ji Kon; Lee, Jung Won; Ahn, Dong-Won; Kim, Yong-Tae; Yoon, Yong Bum; Woo, Sang Myung; Lee, Woo Jin

2010-11-14

To compare the efficacy of self-expandable metal stents (SEMSs) with 10F plastic stents (PSs) in the endoscopic management of occluded SEMSs. We retrospectively reviewed the medical records of 56 patients who underwent SEMS insertion for palliation of unresectable malignant biliary obstruction between 2000 and 2007 and subsequent endoscopic retrograde biliary drainage (ERBD) with SEMS or PS for initial SEMS occlusion between 2000 and 2008. Subsequent ERBD with SEMS was performed in 29 patients and with PS in 27. The median time to stent occlusion after subsequent ERBD was 186 d in the SEMS group and 101 d in the PS group (P = 0.118). Overall median stent patency was 79 d for the SEMS group and 66 d for the PS group (P = 0.379). The mean number of additional biliary drainage procedures after subsequent ERBD in patients that died (n = 50) during the study period was 2.54 ± 4.12 for the SEMS group and 1.85 ± 1.95 for the PS group (P = 0.457). The mean total cost of additional biliary drainage procedures after the occlusion of subsequent SEMS or PS was $410.04 ± 692.60 for the SEMS group and $630.16 ± 671.63 for the PS group (P = 0.260). Tumor ingrowth as the cause of initial SEMS occlusion was the only factor associated with a shorter time to subsequent stent occlusion (101 d for patients with tumor ingrowth vs 268 d for patients without tumor ingrowth, P = 0.008). Subsequent ERBD with PSs offered similar patency and number of additional biliary drainage procedures compared to SEMSs in the management of occluded SEMS.

A New Flow-Diverter (the FloWise): In-Vivo Evaluation in an Elastase-Induced Rabbit Aneurysm Model.

PubMed

Kim, Byung Moon; Kim, Dong Joon; Kim, Dong Ik

2016-01-01

We aimed to evaluate the efficacy and safety of a newly developed, partially retrievable flow-diverter (the FloWise) in an elastase-induced rabbit aneurysm model. We developed a partially retrievable flow diverter composed of 48 strands of Nitinol and platinum wire. The FloWise is compatible with any microcatheter of 0.027-inch inner diameter, and is retrievable up to 70% deployment. The efficacy and safety of the FloWise were evaluated in the elastase-induced rabbit aneurysm model. The rate of technical success (full coverage of aneurysm neck) and assessment of aneurysm occlusion and stent patency was conducted by angiograms and histologic examinations at the 1-month, 3-month, and 6-month follow-up. The patency of small arterial branches (intercostal or lumbar arteries) covered by the FloWise were also assessed in the 5 subjects. We attempted FloWise insertion in a total of 32 aneurysm models. FloWise placement was successful in 31 subjects (96.9%). Two stents (6.2%) were occluded at the 3-month follow-up, but there was no evidence of in-stent stenosis in other subjects. All stented aneurysms showed progressive occlusion: grade I (complete aneurysm occlusion) in 44.4% and grade II (aneurysm occlusion > 90%) in 55.6% at 1 month; grade I in 90% and II in 10% at 3 months; and grade I in 90% and II in 10% at 6 months. All small arterial branches covered by the FloWise remained patent. A newly developed, partially retrievable flow-diverter seems to be a safe and effective tool of aneurysm occlusion, as evaluated in the rabbit aneurysm model.

Initial experience with hysteroscopic tubal occlusion (Essure®)

PubMed Central

Depes, Daniella De Batista; Pereira, Ana Maria Gomes; Lippi, Umberto Gazi; Martins, João Alfredo; Lopes, Reginaldo Guedes Coelho

2016-01-01

ABSTRACT Objective To evaluate results of early tubal occlusions performed by hysteroscopy (Essure®). Methods This prospective study included 38 patients, 73.7% of them were white, mean age 34.5 years, they have had on average 3 pregnancies and 2.7 of deliveries. A total of 86.8% of patients previously prepared the endometrium. All procedures were carried out at outpatient unit without anesthesia. Results Insertion rate of the device was 100% at a mean time of 4 minutes and 50 seconds. Based on the analogical visual scale, average pain reported was three, and 55.3% of women did not report pain after the procedure. After 3 months, 89.5% of patients were very satisfied with the method. Simple radiographs of the pelvis showed 92.1% of topical devices, and one case of unilateral expulsion had occurred. A four years follow-up did not show failure in the method. Conclusions Tubal occlusion through hysteroscopy at outpatient unit and without anesthesia was a quickly and well-tolerated procedure. No serious complications were seen, the success rate was high, and patients were satisfied. PMID:27462885

[Surgical prevention of ischaemic strokes by means of an extraintracranial microanastomosis (EICMA) in the carotid basin].

PubMed

Krylov, V V; Luk'yanchikov, V A; Tokarev, A S; Nakhabin, O Yu; Polunina, N A; Sen'ko, I V; Dalibaldyan, V A; Grigor'eva, E V; Kudryashova, N E; Guseinova, G K; Udodov, E V; Fedulova, T A

Not less than 50% of all ischaemic strokes appear to occur resulting from pathology of extracranial arteries. Occlusions and stenoses are more commonly encountered in carotid arteries, with the incidence of occlusion of the internal carotid artery (ICA) ranging from 5 to 10% within the structure of all lesions of brachiocephalic arteries (BCA). The study was aimed at assessing the results of a surgical procedure of extra-intracranial microanastomosis (EICMA) performed in patients presenting with occlusive and stenotic lesions of BCA at the Neurosurgical Department. During the period between January 1st 2009 to September 30th 2015, specialists of the Neurosurgery Department of the Research Institute of Emergency Medical Care named after N.V. Sklifosovsky treated a total of 1,101 patients presenting with atherosclerotic lesions of BCA, with a total of 1,038 surgical interventions performed. Of these, there were 837 operations of carotid endarterectomy and 180 operations of EICMA in the carotid basin. The indications for performing EICMA in patients from the group with occlusive-stenosing lesions of the major arteries of the head and neck were as follows: the presence of occlusion of the internal carotid artery or M1 segment of the middle cerebral artery, verified by the findings of angiographic examinations; previously endured ischaemic-type cerebral circulation impairment in the basin on the side of occlusion; a decrease in the perfusion reserve of the brain on the side of occlusion by the findings of positron emission tomography (PET), single-photon emission computed tomography (SPECT) or CT-perfusion with loading tests. After performing EICMA, the neurological status in patients averagely improved by 1.2 points according to the NIH Stroke Scale; by 0.5 point according to the Rankin scale, and by 3.5 points according to the Rivermead Mobility Index (Table 1). The dynamics of functional outcomes of EICMA turned out to depend on the terms of the operation (R=2143, p<0.05) and the degree of neurological deficit prior to surgery (R=3422, p<0.05): the deeper the neurological deficiency was and the sooner after acute cerebral ischaemia (ACI) the operation was performed, the more significant restoration of the functions was at the moment of discharge from hospital. Major complications of EICMA in patients operated on at various terms of ischaemic stroke were as follows: recurrent cerebral circulatory impairments - in 6 (3.3%) patients, subdural and intracranial haemorrhage - in 2 (1.1%), temporal deepening of the neurological deficit on the background of reperfusion, confirmed by the findings of SPECT - in 2 (1.1%), pneumonia with a lethal outcome - in 1 (0.6%), fatal ischaemic stroke of the opposite hemisphere - in 1 (0.6%) subject. The lethality rate amounted to 1.1% (2 cases). The risk for the development of complications was higher in elderly and aged patients (75 years and over), in patients with pronounced neurological deficit and significant somatic disorders. The indications for surgical prevention of recurrent ischaemic stroke by means of EICMA should be based on the following factors: the presence of confirmed occlusion of the ICA, a history of endured acute cerebral ischaemia, and decreased cerebrovascular reserve. Performing a surgical intervention is not appropriate for patients presenting with pronounced neurological deficit and significant somatic pathology. Careful selection of patients, the use of modern methods of neuroimaging, and intraoperative control make it possible to achieve favourable functional outcomes and to decrease the postoperative complications rate.

Multi-scale Visualization of Molecular Architecture Using Real-Time Ambient Occlusion in Sculptor.

PubMed

Wahle, Manuel; Wriggers, Willy

2015-10-01

The modeling of large biomolecular assemblies relies on an efficient rendering of their hierarchical architecture across a wide range of spatial level of detail. We describe a paradigm shift currently under way in computer graphics towards the use of more realistic global illumination models, and we apply the so-called ambient occlusion approach to our open-source multi-scale modeling program, Sculptor. While there are many other higher quality global illumination approaches going all the way up to full GPU-accelerated ray tracing, they do not provide size-specificity of the features they shade. Ambient occlusion is an aspect of global lighting that offers great visual benefits and powerful user customization. By estimating how other molecular shape features affect the reception of light at some surface point, it effectively simulates indirect shadowing. This effect occurs between molecular surfaces that are close to each other, or in pockets such as protein or ligand binding sites. By adding ambient occlusion, large macromolecular systems look much more natural, and the perception of characteristic surface features is strongly enhanced. In this work, we present a real-time implementation of screen space ambient occlusion that delivers realistic cues about tunable spatial scale characteristics of macromolecular architecture. Heretofore, the visualization of large biomolecular systems, comprising e.g. hundreds of thousands of atoms or Mega-Dalton size electron microscopy maps, did not take into account the length scales of interest or the spatial resolution of the data. Our approach has been uniquely customized with shading that is tuned for pockets and cavities of a user-defined size, making it useful for visualizing molecular features at multiple scales of interest. This is a feature that none of the conventional ambient occlusion approaches provide. Actual Sculptor screen shots illustrate how our implementation supports the size-dependent rendering of molecular surface features.

[Effect of 2 methods of occlusion adjustment on occlusal balance and muscles of mastication in patient with implant restoration].

PubMed

Wang, Rong; Xu, Xin

2015-12-01

To compare the effect of 2 methods of occlusion adjustment on occlusal balance and muscles of mastication in patients with dental implant restoration. Twenty patients, each with a single edentulous posterior dentition with no distal dentition were selected, and divided into 2 groups. Patients in group A underwent original occlusion adjustment method and patients in group B underwent occlusal plane reduction technique. Ankylos implants were implanted in the edentulous space in each patient and restored with fixed prosthodontics single unit crown. Occlusion was adjusted in each restoration accordingly. Electromyograms were conducted to determine the effect of adjustment methods on occlusion and muscles of mastication 3 months and 6 months after initial restoration and adjustment. Data was collected and measurements for balanced occlusal measuring standards were obtained, including central occlusion force (COF), asymmetry index of molar occlusal force(AMOF). Balanced muscles of mastication measuring standards were also obtained including measurements from electromyogram for the muscles of mastication and the anterior bundle of the temporalis muscle at the mandibular rest position, average electromyogram measurements of the anterior bundle of the temporalis muscle at the intercuspal position(ICP), Astot, masseter muscle asymmetry index, and anterior temporalis asymmetry index (ASTA). Statistical analysis was performed using Student 's t test with SPSS 18.0 software package. Three months after occlusion adjustment, parameters of the original occlusion adjustment method were significantly different between group A and group B in balanced occlusal measuring standards and balanced muscles of mastication measuring standards. Six months after occlusion adjustment, parameters of the original occlusion adjustment methods were significantly different between group A and group B in balanced muscles of mastication measuring standards, but was no significant difference in balanced occlusal measuring standards. Using occlusion plane reduction adjustment technique, it is possible to obtain occlusion index and muscles of mastication's electromyogram index similar to the opposite side's natural dentition in patients with single unit fix prosthodontics crown and single posterior edentulous dentition without distal dentitions.

Rehabilitation with implant-supported overdentures in total edentulous patients: A review

PubMed Central

Segura-Andrés, Gustavo; Faus-López, Joan; Agustín-Panadero, Rubén

2013-01-01

Objectives: The main aim of this review article is to discuss implant-supported overdentures (ISOs) as treatment in edentulous patients. Besides, we will try to discuss among the different treatment options in such patients and to analyze their validity when ISOs are compared with other clinical modalities. At the same time, we will try to suggest clinical guidelines supported by current clinical studies. Material and methods: We performed a Medline search and review of pertinent articles on the mentioned subject from 1986 to 2011. As a searching strategy, we used the following words: implant-supported overdentures, attachment systems, Locator attachment, cantilever, fixed prosthesis. Results and conclusions: Implant-supported overdentures constitute an accurate and predictable treatment option and achieve a higher patients’ satisfaction. This type of treatment constitutes a cheaper treatment than fixed prostheses and in some patients, with loss of lip support or with an interoclusal space larger than 15 mm, the choice of implant-supported overdentures seems to prevent future aesthetic or phonetic problems. Key words:Overdentures, implant occlusion, implant rehabilitation, total edentulous rehabilitation, fixed prosthesis. PMID:24455093

Occlusion in the primary and early mixed dentitions in a group of Tanzanian and Finnish children.

PubMed

Kerosuo, H

1990-01-01

Two high and two low socioeconomic areas were selected for the Tanzanian portion of this study, with all nursery schools located in those areas included, for a subtotal of 580 children. The Finnish group was comprised of a total of 575 Caucasian children examined. The Tanzanian children (83 percent Black African, 10 percent Asian, 7 percent Arab) had fewer occlusal anomalies than the Finnish children did. Finnish children had a 13-percent incidence rate of lateral cross-bite; among African children, 8 percent showed anterior crossbite; and among the combined Asian/Arab group of children, 10 percent had an anterior open bite. African children had significantly fewer prevalences of distal bite, lateral crossbite and crowding than Finnish children did.

Surgical treatment of unilateral condylar hyperplasia with piezosurgery.

PubMed

Chiarini, Luigi; Albanese, Massimo; Anesi, Alexandre; Galzignato, Pier-Francesco; Mortellaro, Carmen; Nocini, Pierfrancesco; Bertossi, Dario

2014-05-01

Unilateral condylar hyperplasia (UCH) is a disorder of unknown etiology mainly seen in growing patients, which results in facial asymmetry. High condylectomy alone or in association with orthognathic surgery can improve the occlusion and the facial aesthetics. Between 2005 and 2012, a total of 5 patients underwent high condylectomy for UCH using a piezoelectric cutting device. All patients were treated postoperatively with functional rehabilitation. The long-term follow-up showed that all patients had a satisfactory temporomandibular joint articular function associated with stable occlusion without any recurrence of further condylar growth. High condylectomy in the surgical treatment of unilateral UCH seems to be the procedure of choice in growing patients. The use of a piezoelectric cutting device allows a safe and less invasive high condylectomy.

Evaluation of the occlusal contact of crowns fabricated with the bite impression method.

PubMed

Makino, Sachi; Okada, Daizo; Shin, Chiharu; Ogura, Reiko; Ikeda, Masaomi; Miura, Hiroyuki

2013-09-30

In prosthodontic treatment, reconstruction of a proper occlusal contact relationship is very important as well as reconstruction of a proper interproximal relationship and marginal fitness. Unfortunately, occlusal relationships are sometimes lost in the process of occlusal adjustment of crowns. The purpose of this study was to compare the occlusal contacts of single crown fabricated by two different types of impression techniques. Nine subjects, whose molars required treatment with crown restoration, were enrolled in this study. Full cast crowns were fabricated using two types of impression techniques: the conventional impression method (CIM) and the bite impression method (BIM). The occlusal contacts of crowns were precisely evaluated at the following stages: after occlusal adjustment on the articulator (Step 0), before occlusal adjustment in the mouth (Step 1), after occlusal adjustment at the intercuspal position (Step 2), and after occlusal adjustment during lateral and protrusive excursions (Step 3). The number of occlusal contacts of the crowns on the functional cusps fabricated with BIM was significantly greater than that with CIM after occlusal adjustment. For this reason, the crowns fabricated with BIM might have a more functionally desirable occlusal surface compared to the crowns fabricated with CIM.

History of materials used for recording static and dynamic occlusal contact marks: a literature review

PubMed Central

Rahul, G R.; Poduval, Soorya T.; Shetty, Karunakar; Gupta, Bhawna; Rajora, Varun

2013-01-01

In the discipline of prosthetic dentistry it is important not only to examine the occlusion, but to be able to record, store, and transfer the information. Over the years many occlusion testing materials have been used. It has been suggested the clinical recording and transfer of information using waxes and other occlusion recording materials have disadvantages relating to inaccuracy and problems of manipulation. Therefore, there has been introduction of many new systems for recording occlusion contacts to overcome such problems. The correct physiological recovery of occlusion posses as much a challenge as ever for every dentist and technician. Even the smallest high spots measuring just a few microns can cause dysfunctions like temporo-mandibular pain. Occlusal proportions are being constantly changed with every procedure. Therefore, an understanding of the synergy of the teeth in static and dynamic occlusion forms the basis of good dentistry. The purpose of this review article is to give and overview of the various materials and methods that have been used to record occlusal contact marks. Key words:Occlusal contact marks, Occlusion indicators, Occlusion test materials, Occlusion recording materials. PMID:24455051

Percutaneous protective coil occlusion of the proximal inferior mesenteric artery before N-butyl cyanoacrylate embolization of type II endoleaks after endovascular repair of abdominal aortic aneurysms.

PubMed

Chao, Christine P; Paz-Fumagalli, Ricardo; Walser, Eric M; McKinney, J Mark; Stockland, Andrew H; Falkensammer, Jürgen; Hakaim, Albert G; Oldenburg, W Andrew

2006-11-01

Bowel ischemia can complicate treatment of type II endoleak with liquid or semiliquid agents such as n-butyl cyanoacrylate (NBCA) if nontarget embolization of the inferior mesenteric artery (IMA) occurs. The current report describes four cases of type II endoleak in which the IMA was the main outflow vessel and was prophylactically occluded with embolization coils before NBCA injection into the endoleak nidus. The purpose was to prevent unintentional embolization of the NBCA into IMA branches. If feasible, protective IMA coil occlusion should be considered in type II endoleaks with IMA outflow in cases of NBCA embolization.

In vitro and in vivo Evaluation of a Shape Memory Polymer Foam-over-Wire Embolization Device Delivered in Saccular Aneurysm Models

PubMed Central

Boyle, Anthony J.; Landsman, Todd L.; Wierzbicki, Mark A.; Nash, Landon D.; Hwang, Wonjun; Miller, Matthew W.; Tuzun, Egemen; Hasan, Sayyeda M.; Maitland, Duncan J.

2015-01-01

Current endovascular therapies for intracranial saccular aneurysms result in high recurrence rates due to poor tissue healing, coil compaction, and aneurysm growth. We propose treatment of saccular aneurysms using shape memory polymer (SMP) foam to improve clinical outcomes. SMP foam-over-wire (FOW) embolization devices were delivered to in vitro and in vivo porcine saccular aneurysm models to evaluate device efficacy, aneurysm occlusion, and acute clotting. FOW devices demonstrated effective delivery and stable implantation in vitro. In vivo porcine aneurysms were successfully occluded using FOW devices with theoretical volume occlusion values greater than 72% and rapid, stable thrombus formation. PMID:26227115

Woven Endobridge (WEB) device for endovascular treatment of complex unruptured aneurysms-a single center experience.

PubMed

Lescher, Stephanie; du Mesnil de Rochemont, Richard; Berkefeld, Joachim

2016-04-01

The introduction of the Woven Endobridge (WEB) device increases the feasibility of endovascular treatment of wide-neck bifurcation aneurysms with limitations given by currently available sizes and shapes of the device. Parallel to other studies, we used the new device for selected patients who were no optimal candidates for established techniques like neurosurgical clipping or endovascular coiling. We aimed to report the angiographic and clinical results of WEB implantations or combinations between WEB and coiling or intracranial stents. We reviewed the records of n = 23 interventions in 22 patients with unruptured wide-neck aneurysms (UIA) who were assigned for aneurysm treatment with the use of the WEB or adjunctive techniques. Interventional procedures and clinical and angiographic outcomes are reported for the periprocedural phase and in mid-term FU. Of the included 22 patients, six patients needed additional coiling, intracranial stenting, or implantation of a flow diverter. WEB implantation was technically feasible in 22 out of the 23 interventions. Follow-up angiographic imaging proved total or subtotal occlusion of the aneurysm in 19 of 22 cases. Two minor recurrences remained stable during a period of 15 months. One patient with a partially thrombosed giant MCA aneurysm had a major recurrence and was retreated with a second WEB in combination with coiling. Despite of unfavorable anatomic conditions, broad-based and large UIA endovascular treatment with the WEB and adjunctive techniques was feasible with a low risk of complications and promising occlusion rates in mid-term follow-up.

Ischemia-induced spreading depolarization in the retina

PubMed Central

Srienc, Anja I; Biesecker, Kyle R; Shimoda, Angela M; Kur, Joanna

2016-01-01

Cortical spreading depolarization is a metabolically costly phenomenon that affects the brain in both health and disease. Following severe stroke, subarachnoid hemorrhage, or traumatic brain injury, cortical spreading depolarization exacerbates tissue damage and enlarges infarct volumes. It is not known, however, whether spreading depolarization also occurs in the retina in vivo. We report now that spreading depolarization episodes are generated in the in vivo rat retina following retinal vessel occlusion produced by photothrombosis. The properties of retinal spreading depolarization are similar to those of cortical spreading depolarization. Retinal spreading depolarization waves propagate at a velocity of 3.0 ± 0.1 mm/min and are associated with a negative shift in direct current potential, a transient cessation of neuronal spiking, arteriole constriction, and a decrease in tissue O2 tension. The frequency of retinal spreading depolarization generation in vivo is reduced by administration of the NMDA antagonist MK-801 and the 5-HT(1D) agonist sumatriptan. Branch retinal vein occlusion is a leading cause of vision loss from vascular disease. Our results suggest that retinal spreading depolarization could contribute to retinal damage in acute retinal ischemia and demonstrate that pharmacological agents can reduce retinal spreading depolarization frequency after retinal vessel occlusion. Blocking retinal spreading depolarization generation may represent a therapeutic strategy for preserving vision in branch retinal vein occlusion patients. PMID:27389181

Biomechanical factors related to occlusal load transfer in removable complete dentures.

PubMed

Żmudzki, Jarosław; Chladek, Grzegorz; Kasperski, Jacek

2015-08-01

Owing to economic conditions, removable dentures remain popular despite the discomfort and reduced chewing efficiency experienced by most denture wearers. However, there is little evidence to confirm that the level of mucosal load exceeds the pressure pain threshold. This discrepancy stimulated us to review the current state of knowledge on the biomechanics of mastication with complete removable dentures. The loading beneath dentures was analyzed in the context of denture foundation characteristics, salivary lubrication, occlusal forces, and the biomechanics of mastication. The analysis revealed that the interpretation of data collected in vivo is hindered due to the simultaneous overlapping effects of many variables. In turn, problems with determining the pressure beneath a denture and analyzing frictional processes constitute principal limitations of in vitro model studies. Predefined conditions of finite element method simulations should include the effects of oblique mastication forces, simultaneous detachment and sliding of the denture on its foundation, and the stabilizing role of balancing contacts. This review establishes that previous investigations may have failed because of their unsubstantiated assumption that, in a well-working balanced occlusion, force is only exerted perpendicular to the occlusal plane, allowing the denture to sit firmly on its foundation. Recent improvements in the simulation of realistic biomechanical denture behavior raise the possibility of assessing the effects of denture design on the pressures and slides beneath the denture.

Iatrogenic occlusion of the ophthalmic artery after cosmetic facial filler injections: a national survey by the Korean Retina Society.

PubMed

Park, Kyu Hyung; Kim, Yong-Kyu; Woo, Se Joon; Kang, Se Woong; Lee, Won Ki; Choi, Kyung Seek; Kwak, Hyung Woo; Yoon, Ill Han; Huh, Kuhl; Kim, Jong Woo

2014-06-01

Iatrogenic occlusion of the ophthalmic artery and its branches is a rare but devastating complication of cosmetic facial filler injections. To investigate clinical and angiographic features of iatrogenic occlusion of the ophthalmic artery and its branches caused by cosmetic facial filler injections. Data from 44 patients with occlusion of the ophthalmic artery and its branches after cosmetic facial filler injections were obtained retrospectively from a national survey completed by members of the Korean Retina Society from 27 retinal centers. Clinical features were compared between patients grouped by angiographic findings and injected filler material. Visual prognosis and its relationship to angiographic findings and injected filler material. Ophthalmic artery occlusion was classified into 6 types according to angiographic findings. Twenty-eight patients had diffuse retinal and choroidal artery occlusions (ophthalmic artery occlusion, generalized posterior ciliary artery occlusion, and central retinal artery occlusion). Sixteen patients had localized occlusions (localized posterior ciliary artery occlusion, branch retinal artery occlusion, and posterior ischemic optic neuropathy). Patients with diffuse occlusions showed worse initial and final visual acuity and less visual gain compared with those having localized occlusions. Patients receiving autologous fat injections (n = 22) had diffuse ophthalmic artery occlusions, worse visual prognosis, and a higher incidence of combined brain infarction compared with patients having hyaluronic acid injections (n = 13). Clinical features of iatrogenic occlusion of the ophthalmic artery and its branches following cosmetic facial filler injections were diverse according to the location and extent of obstruction and the injected filler material. Autologous fat injections were associated with a worse visual prognosis and a higher incidence of combined cerebral infarction. Extreme caution and care should be taken during these injections, and physicians should be aware of a diverse spectrum of complications following cosmetic facial filler injections.

The role of "rescue saccades" in tracking objects through occlusions.

PubMed

Zelinsky, Gregory J; Todor, Andrei

2010-12-29

We hypothesize that our ability to track objects through occlusions is mediated by timely assistance from gaze in the form of "rescue saccades"-eye movements to tracked objects that are in danger of being lost due to impending occlusion. Observers tracked 2-4 target sharks (out of 9) for 20 s as they swam through a rendered 3D underwater scene. Targets were either allowed to enter into occlusions (occlusion trials) or not (no occlusion trials). Tracking accuracy with 2-3 targets was ≥ 92% regardless of target occlusion but dropped to 74% on occlusion trials with four targets (no occlusion trials remained accurate; 83%). This pattern was mirrored in the frequency of rescue saccades. Rescue saccades accompanied approximatlely 50% of the Track 2-3 target occlusions, but only 34% of the Track 4 occlusions. Their frequency also decreased with increasing distance between a target and the nearest other object, suggesting that it is the potential for target confusion that summons a rescue saccade, not occlusion itself. These findings provide evidence for a tracking system that monitors for events that might cause track loss (e.g., occlusions) and requests help from the oculomotor system to resolve these momentary crises. As the number of crises increase with the number of targets, some requests for help go unsatisfied, resulting in degraded tracking.

Challenges and Recent Developments in Hearing Aids: Part II. Feedback and Occlusion Effect Reduction Strategies, Laser Shell Manufacturing Processes, and Other Signal Processing Technologies

PubMed Central

Chung, King

2004-01-01

This is the second part of a review on the challenges and recent developments in hearing aids. Feedback and the occlusion effect pose great challenges in hearing aid design and usage. Yet, conventional solutions to feedback and the occlusion effect often create a dilemma: the solution to one often leads to the other. This review discusses the advanced signal processing strategies to reduce feedback and some new approaches to reduce the occlusion effect. Specifically, the causes of three types of feedback (acoustic, mechanical, and electromagnetic) are discussed. The strategies currently used to reduce acoustic feedback (i.e., adaptive feedback reduction algorithms using adaptive gain reduction, notch filtering, and phase cancellation strategies) and the design of new receivers that are built to reduce mechanical and electromagnetic feedback are explained. In addition, various new strategies (i.e., redesigned sound delivery devices and receiver-in-the-ear-canal hearing aid configuration) to reduce the occlusion effect are reviewed. Many manufacturers have recently adopted laser shell-manufacturing technologies to overcome problems associated with manufacturing custom hearing aid shells. The mechanisms of selected laser sintering and stereo lithographic apparatus and the properties of custom shells produced by these two processes are reviewed. Further, various new developments in hearing aid transducers, telecoils, channel-free amplification, open-platform programming options, rechargeable hearing aids, ear-level frequency modulated (FM) receivers, wireless Bluetooth FM systems, and wireless programming options are briefly explained and discussed. Finally, the applications of advanced hearing aid technologies to enhance other devices such as cochlear implants, hearing protectors, and cellular phones are discussed. PMID:15735871

Does temproray bilateral balloon occlusion of the common iliac arteries reduce the need for intra-operative blood transfusion in cases of placenta accretism?

PubMed

Al-Hadethi, Sinan; Fernando, Shane; Hughes, Simon; Thakorlal, Ajay; Seruga, Adam; Scurry, Bonnie

2017-06-01

Bilateral balloon occlusion has been employed as a prophylactic measure in cases of placenta accretism prior to caesarean section with the aim of reducing blood loss and its associated morbidity/mortality. There is however no clear consensus on its efficacy in the current literature. The objective of this study was to assess the efficacy of bilateral balloon occlusion of the common iliac arteries (CIA) in reducing intra-operative morbidity in cases of placenta accretism. The databases of the pathology department and radiology interventional suite were reviewed over a nine year period. Fifty-two cases of confirmed placental accretism who underwent caesarean section with or without hysterectomy were identified and divided into two groups. Twenty-five cases had temporary occlusion of the common iliac arteries (CIA) during delivery and these were considered the study group. The reminder 27 cases did not have temporary occlusion of the CIA and were considered the control group. The two groups were compared based on gravidity, age group, post-operative haemoglobin, drop in haemoglobin, estimated blood loss (EBL), transfusion requirement and the histopathological sub-types of placenta accretism. There was no statistically difference between the study and the control groups regarding EBL, post-operative haemoglobin drop, transfusion requirement or in the placenta accretism histopathological subtype. Two cases in the study group had acute thromboembolic complications. Both groups had a single patient requiring a massive intra-operative transfusion. Our study was not able to detect a significant difference in blood loss or blood product requirement between patients who underwent CIA balloon in the setting of caesarean section for placenta accreta. This remains a challenging scenario requiring a multidisciplinary approach. © 2016 The Royal Australian and New Zealand College of Radiologists.

Endoscopic management of malignant biliary obstruction by means of covered metallic stents: primary stent placement vs. re-intervention.

PubMed

Kida, M; Miyazawa, S; Iwai, T; Ikeda, H; Takezawa, M; Kikuchi, H; Watanabe, M; Imaizumi, H; Koizumi, W

2011-12-01

Recent progress in chemotherapy has prolonged the survival of patients with malignant biliary strictures, leading to increased rates of stent occlusion. Occlusion of covered metallic stents now occurs in about half of all patients with malignant biliary strictures. The removal of metallic stents followed by placement of a second stent has been attempted, but outcomes remain controversial. The aim of the current study was to evaluate the effectiveness and safety of the primary placement and secondary placement (re-intervention) of covered metallic stents and to assess the feasibility and safety of stent removal. The study included 186 patients with unresectable malignant biliary strictures who underwent primary stent placement between October 2001 and March 2010.  Covered biliary self-expandable metal stents (SEMSs) were removed in 39 of these patients, and 36 underwent re-intervention. The patency times, occlusion rates of the first stent and re-intervention, success rates of stent removal, and complications were investigated. Covered SEMSs were placed in 186 patients. The median patency time of the first stent was 352 days. Stent occlusion occurred in 48.9 % of the patients and was mainly caused by debris or food residue (37 %), dislocation (19 %), and migration with hyperplasia (19 %). Stent removal was attempted in 50 patients and was successful without complication in 39 (78 %). Most of the patients in whom stent removal was unsuccessful had migration with hyperplasia. The median patency time of the second stent was 263 days. The stent patency time did not significantly differ between the first and the second stent. Covered SEMSs could be safely removed at the time of stent occlusion. Patency rates were similar for initial stent placement and re-intervention. © Georg Thieme Verlag KG Stuttgart · New York.

The effect of lateral eccentricity on failure loads, kinematics, and canal occlusions of the cervical spine in axial loading.

PubMed

Van Toen, C; Melnyk, A D; Street, J; Oxland, T R; Cripton, P A

2014-03-21

Current neck injury criteria do not include limits for lateral bending combined with axial compression and this has been observed as a clinically relevant mechanism, particularly for rollover motor vehicle crashes. The primary objectives of this study were to evaluate the effects of lateral eccentricity (the perpendicular distance from the axial force to the centre of the spine) on peak loads, kinematics, and spinal canal occlusions of subaxial cervical spine specimens tested in dynamic axial compression (0.5 m/s). Twelve 3-vertebra human cadaver cervical spine specimens were tested in two groups: low and high eccentricity with initial eccentricities of 1 and 150% of the lateral diameter of the vertebral body. Six-axis loads inferior to the specimen, kinematics of the superior-most vertebra, and spinal canal occlusions were measured. High speed video was collected and acoustic emission (AE) sensors were used to define the time of injury. The effects of eccentricity on peak loads, kinematics, and canal occlusions were evaluated using unpaired Student t-tests. The high eccentricity group had lower peak axial forces (1544 ± 629 vs. 4296 ± 1693 N), inferior displacements (0.2 ± 1.0 vs. 6.6 ± 2.0 mm), and canal occlusions (27 ± 5 vs. 53 ± 15%) and higher peak ipsilateral bending moments (53 ± 17 vs. 3 ± 18 Nm), ipsilateral bending rotations (22 ± 3 vs. 1 ± 2°), and ipsilateral displacements (4.5 ± 1.4 vs. -1.0 ± 1.3 mm, p<0.05 for all comparisons). These results provide new insights to develop prevention, recognition, and treatment strategies for compressive cervical spine injuries with lateral eccentricities. © 2013 Published by Elsevier Ltd.

The sensorimotor and cognitive deficits in rats following 90- and 120-min transient occlusion of the middle cerebral artery.

PubMed

Zvejniece, Liga; Svalbe, Baiba; Liepinsh, Edgars; Pulks, Eduards; Dambrova, Maija

2012-07-15

Middle cerebral artery occlusion (MCAO) is the most commonly used method to study the neurological and histological outcomes and the pathological mechanisms of ischaemic stroke. The current work compares sensorimotor and cognitive deficits and the infarct volume in rats following a transient 90- or 120-min MCAO, which allows the appropriate behavioural tests to be chosen based on the goal and design of the experiment. In the beam-walking test, we found significant differences between the 90- and 120-min MCAO groups in the number of foot faults made with the impaired hindlimb on post-stroke days 3, 7 and 14. In the cylinder test, a difference between the 90- and 120-min groups was observed on post-operation day 14. The responses to tactile and proprioceptive stimulation were impaired to a similar extent after 90- and 120-min MCAO in the vibrissae-evoked forelimb-placing and limb-placing tests. Moreover, we found significant memory impairment in the 120-min MCAO group 6 days after the acquisition trial. The brain tissue damage was significantly higher after 120-min occlusion of the MCA compared with 90-min occlusion; the infarct volumes were 13% and 25% of the contralateral hemispheres, respectively. In conclusion, both the 90- and 120-min occlusion models result in a significant impairment of sensorimotor, tactile and proprioceptive function, but memory impairment is only observed in the 120-min MCAO group. The beam-walking and cylinder tests detected neurological dysfunction after the 120-min MCAO, whereas the limb-placing and vibrissae-evoked forelimb-placing tests were able to evaluate the neurological dysfunction in rats after 90- and 120-min MCAO. Copyright © 2012 Elsevier B.V. All rights reserved.

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

PubMed

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.

Impact of revascularization of coronary chronic total occlusion on left ventricular function and electrical stability: analysis by speckle tracking echocardiography and signal-averaged electrocardiogram.

PubMed

Sotomi, Yohei; Okamura, Atsunori; Iwakura, Katsuomi; Date, Motoo; Nagai, Hiroyuki; Yamasaki, Tomohiro; Koyama, Yasushi; Inoue, Koichi; Sakata, Yasushi; Fujii, Kenshi

2017-06-01

The present study aimed to assess the mechanisms of effects of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) from two different aspects: left ventricular (LV) systolic function assessed by two-dimensional speckle tracking echocardiography (2D-STE) and electrical stability evaluated by late potential on signal-averaged electrocardiogram (SAECG). We conducted a prospective observational study with consecutive CTO-PCI patients. 2D-STE and SAECG were performed before PCI, and after 1-day and 3-months of procedure. 2D-STE computed global longitudinal strain (GLS) and regional longitudinal strain (RLS) in CTO area, collateral blood-supplying donor artery area, and non-CTO/non-donor area. A total of 37 patients (66 ± 11 years, 78% male) were analyzed. RLS in CTO and donor areas and GLS were significantly improved 1-day after the procedure, but these improvements diminished during 3 months. The improvement of RLS in donor area remained significant after 3-months the index procedure (pre-PCI -13.4 ± 4.8% vs. post-3M -15.1 ± 4.5%, P = 0.034). RLS in non-CTO/non-donor area and LV ejection fraction were not influenced. Mitral annulus velocity was improved at 3-month follow-up (5.0 ± 1.4 vs. 5.6 ± 1.7 cm/s, P = 0.049). Before the procedure, 12 patients (35%) had a late potential. All components of the late potential (filtered QRS duration, root-mean-square voltage in the terminal 40 ms, and duration of the low amplitude signal <40 μV) were not improved. CTO-PCI improved RLS in the donor area at 3-month follow-up without changes of LV ejection fraction. Although higher prevalence of late potential in the current population compared to healthy population was observed, late potential as a surrogate of arrhythmogenic substrate was not influenced by CTO-PCI.

Haemodynamic changes in hepatocellular carcinoma and liver parenchyma under balloon occlusion of the hepatic artery.

PubMed

Sugihara, Fumie; Murata, Satoru; Ueda, Tatsuo; Yasui, Daisuke; Yamaguchi, Hidenori; Miki, Izumi; Kawamoto, Chiaki; Uchida, Eiji; Kumita, Shin-Ichiro

2017-06-01

To investigate haemodynamic changes in hepatocellular carcinoma (HCC) and liver under hepatic artery occlusion. Thirty-eight HCC nodules in 25 patients were included. Computed tomography (CT) during hepatic arteriography (CTHA) with and without balloon occlusion of the hepatic artery was performed. CT attenuation and enhancement volume of HCC and liver with and without balloon occlusion were measured on CTHA. Influence of balloon position (segmental or subsegmental branch) was evaluated based on differences in HCC-to-liver attenuation ratio (H/L ratio) and enhancement volume of HCC and liver. In the segmental group (n = 20), H/L ratio and enhancement volume of HCC and liver were significantly lower with balloon occlusion than without balloon occlusion. However, in the subsegmental group (n = 18), H/L ratio was significantly higher and liver enhancement volume was significantly lower with balloon occlusion; HCC enhancement volume was similar with and without balloon occlusion. Rate of change in H/L ratio and enhancement volume of HCC and liver were lower in the segmental group than in the subsegmental group. There were significantly more perfusion defects in HCC in the segmental group. Hepatic artery occlusion causes haemodynamic changes in HCC and liver, especially with segmental occlusion. • Hepatic artery occlusion causes haemodynamic changes in hepatocellular carcinoma and liver. • Segmental occlusion decreased rate of change in hepatocellular carcinoma-to-liver attenuation ratio. • Subsegmental occlusion increased rate of change in hepatocellular carcinoma-to-liver attenuation ratio. • Hepatic artery occlusion decreased enhancement volume of hepatocellular carcinoma and liver. • Hepatic artery occlusion causes perfusion defects in hepatocellular carcinoma.

Percutaneous management of urolithiasis during pregnancy.

PubMed

Kavoussi, L R; Albala, D M; Basler, J W; Apte, S; Clayman, R V

1992-09-01

A total of 6 pregnant women with obstructing urinary calculi was managed by percutaneous nephrostomy drainage placed under ultrasound guidance with the patient under local anesthesia. All patients initially had relief of acute obstruction. However, occlusion of the percutaneous nephrostomy tubes with debris necessitated tube changes in 5 of 6 patients. In 2 patients recurrent nephrostomy tube obstruction, fever and pain led to percutaneous stone removal during pregnancy. In the remaining 4 patients the nephrostomy tubes were left indwelling through delivery. During the postpartum period 3 patients successfully underwent ureteroscopic stone extraction and 1 passed the stone spontaneously. Bacteriuria developed in each patient despite the use of preventive antibiotics. All 6 women had uncomplicated vaginal deliveries of healthy newborns and are currently asymptomatic with no evidence of obstruction. Percutaneous drainage of an acutely obstructed kidney in a pregnant woman is an effective temporizing alternative to ureteral stent placement until definitive treatment can be performed.

Modeling the impact of novel male contraceptive methods on reductions in unintended pregnancies in Nigeria, South Africa, and the United States.

PubMed

Dorman, Emily; Perry, Brian; Polis, Chelsea B; Campo-Engelstein, Lisa; Shattuck, Dominick; Hamlin, Aaron; Aiken, Abigail; Trussell, James; Sokal, David

2018-01-01

We modeled the potential impact of novel male contraceptive methods on averting unintended pregnancies in the United States, South Africa, and Nigeria. We used an established methodology for calculating the number of couple-years of protection provided by a given contraceptive method mix. We compared a "current scenario" (reflecting current use of existing methods in each country) against "future scenarios," (reflecting whether a male oral pill or a reversible vas occlusion was introduced) in order to estimate the impact on unintended pregnancies averted. Where possible, we based our assumptions on acceptability data from studies on uptake of novel male contraceptive methods. Assuming that only 10% of interested men would take up a novel male method and that users would comprise both switchers (from existing methods) and brand-new users of contraception, the model estimated that introducing the male pill or reversible vas occlusion would decrease unintended pregnancies by 3.5% to 5.2% in the United States, by 3.2% to 5% in South Africa, and by 30.4% to 38% in Nigeria. Alternative model scenarios are presented assuming uptake as high as 15% and as low as 5% in each location. Model results were sensitive to assumptions regarding novel method uptake and proportion of switchers vs. new users. Even under conservative assumptions, the introduction of a male pill or temporary vas occlusion could meaningfully contribute to averting unintended pregnancies in a variety of contexts, especially in settings where current use of contraception is low. Novel male contraceptives could play a meaningful role in averting unintended pregnancies in a variety of contexts. The potential impact is especially great in settings where current use of contraception is low and if novel methods can attract new contraceptive users. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

Optimizing logistics for balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices by doing away with the indwelling balloon: concept and techniques.

PubMed

Saad, Wael E; Nicholson, David B

2013-06-01

Since the conception of balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices 25 years ago, the placement of an indwelling balloon for hours has been central to the BRTO procedure. Numerous variables and variations of the BRTO procedure have been described, including methods to reduce sclerosant, combining percutaneous transhepatic obliteration, varying sclerosant, and using multiple sclerosants within the same procedure. However, the consistent feature of BRTO has always remained the indwelling balloon. Placing an indwelling balloon over hours for the BRTO procedure is a logistical burden that taxes the interventional radiology team and hospital resources. Substituting the balloon with hardware (coils or Amplatzer vascular plugs [AVPs] or both) is technically feasible and its risks most likely correlate with gastrorenal shunt (GRS) size. The current authors use packed 0.018- or 0.035-in coils or both for small gastric variceal systems (GRS size A and B) and AVPs for GRS sizes up to size E (from size A-E). The current authors recommend an indwelling balloon (no hardware substitute) for very large gastric variceal system (GRS size F). Substituting the indwelling balloon for hardware in size F and potentially size E GRS can also be risky. The current article describes the techniques of placing up to 16-mm AVPs through balloon occlusion guide catheters and then deflating the balloon once it has been substituted with the AVPs. In addition, 22-mm AVPs can be placed through sheaths once the balloon occlusion catheters are removed to further augment the 16-mm Amplatzer occlusion. To date, there are no studies describing, let alone evaluating, the clinical feasibility of performing BRTO without indwelling balloons. The described techniques have been successfully performed by the current authors. However, the long-term safety and effectiveness of these techniques is yet to be determined. Copyright © 2013 Elsevier Inc. All rights reserved.

Promotion of artery occlusion in dogs by percutaneous rotational atherectomy.

PubMed

Hou, Chuan-Ju; Zhang, Duan-Zhen; Wang, Qi-Guang; Cui, Chun-Sheng; Kuang, Li; Chen, Bing; Wang, Yang

2014-07-01

This study aims to offer experimental data and indirect evidences for the application of percutaneous rotational atherectomy to treat patent ductus arteriosus (PDA). Eleven dogs (6 male dogs and 5 female dogs; aged 14-20 months, with an average of 16.7±3.2 months; weight 20-25 kg, with an average of 22.7±2.5 kg) were enrolled in this study. The diameters of the left and right arteries ranged from 3.2 to 4.8 mm (average 3.9±0.6 mm) on percutaneous angiography. Percutaneous rotational atherectomy with proper rotablator (the size was 1-1.5 mm larger than the artery diameter) was performed in the arterial intima. After 4 weeks from percutaneous rotational atherectomy, arteriography was conducted to observe the changes in artery diameter. Then all dogs were sacrificed and the pathologic examination was conducted on the left and right axillary arteries. There were obvious changes with different degrees in 22 arteries, including 8 arteries with complete occlusion and 12 arteries with stenosis (≥2/3, 1/2, and 1/3 stenosis in 4, 4, and 4 arteries, respectively). The occlusion rate was 36.4% and the total effective rate was 90.9%. It was considered failure in other 2 arteries with <1/3 of stenosis. Percutaneous rotational atherectomy of arterial intima can promote the occlusion of arteries. This has provided a new choice for the treatment of PDA. Copyright © 2014 Elsevier Inc. All rights reserved.

Submorphotypes of the maxillary first molar and their effects on alignment and rotation.

PubMed

Kim, Hong-Kyun; Kwon, Ho Beom; Hyun, Hong-Keun; Jung, Min-Ho; Han, Seong Ho; Park, Young-Seok

2014-09-01

The aim of this study was to explore the shape differences in maxillary first molars with orthographic measurements using 3-dimensional virtual models to assess whether there is variability in morphology that could affect the alignment results when treated by straight-wire appliance systems. A total of 175 maxillary first molars with 4 cusps were selected for classification. With 3-dimensional laser scanning and reconstruction software, virtual casts were constructed. After performing several linear and angular measurements on the virtual occlusal plane, the teeth were clustered into 2 groups by the method of partitioning around medoids. To visualize the 2 groups, occlusal polygons were constructed using the average data of these groups. The resultant 2 clusters showed statistically significant differences in the measurements describing the cusp locations and the buccal and lingual outlines. The rotation along the centers made the 2 cluster polygons look similar, but there was a difference in the direction of the midsagittal lines. There was considerable variability in morphology according to 2 clusters in the population of this study. The occlusal polygons showed that the outlines of the 2 clusters were similar, but the midsagittal line directions and inner geometries were different. The difference between the morphologies of the 2 clusters could result in occlusal contact differences, which might be considered for better alignment of the maxillary posterior segment. Copyright © 2014 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

A comparison of the efficacy of heparinized and nonheparinized solutions for maintenance of perioperative radial arterial catheter patency and subsequent occlusion.

PubMed

Tuncali, Binnur E; Kuvaki, Buhar; Tuncali, Bahattin; Capar, Emine

2005-04-01

In a randomized, double-blind, controlled study, we compared heparinized and nonheparinized infusions for the maintenance of perioperative arterial catheter patency and the incidence of subsequent radial arterial occlusion. Two-hundred patients were randomized into 2 groups to receive heparinized (group H, n = 100) or nonheparinized (group S, n = 100) flush solutions. Radial and ulnar blood flows were assessed using Doppler probe and pulse oximetry before, just after, and 24 h after decannulation by the same investigator. The cannulation site was examined for complications such as hematoma, nerve injury, and infection. The mean duration of cannulations was 378 +/- 159.0 min in group H and 332 +/- 154.6 min in group S. The mean number of corrective interventions caused by dampening of the pressure wave (mean number of positional changes [group S, 1.5 +/- 2.0; group H, 1.4 +/- 3.8] and mean number of manual flushes [group S, 1.3 +/- 1.7; group H, 1.2 +/- 1.2]) was not significantly different in both groups. After decannulation, partial or total occlusion developed in 20 group H patients and 16 group S patients (not significant). The incidence of occlusion was correlated to the presence of hematoma at the puncture site after decannulation (P = 0.013), long duration of cannulation (P = 0.04), and age <65 yr (P = 0.009). In conclusion, there is no significant difference between heparinized and nonheparinized flush solutions for the maintenance of perioperative radial artery catheter patency.

Transarterial venous sinus occlusion of dural arteriovenous fistulas using ONYX.

PubMed

Torok, Collin M; Nogueira, Raul G; Yoo, Albert J; Leslie-Mazwi, Thabele M; Hirsch, Joshua A; Stapleton, Christopher J; Patel, Aman B; Rabinov, James D

2016-12-01

The purpose of this article is to present a case series of transarterial venous sinus occlusion for dural arteriovenous fistulas (DAVFs) of the transverse and sigmoid sinuses. From 2006 to 2012, 11 patients with DAVF of the transverse and sigmoid sinuses were treated with transarterial closure of the affected venous sinus using ethylene vinyl alcohol copolymer (ONYX). The consecutive retrospective cohort included six female and five male patients with an age range of 30-79. Patients presented with stroke, intracranial hemorrhage, seizure, headache, focal neurologic deficit or cognitive change. Lesions were categorized as Cognard II a + b (n = 5) or Cognard II b (n = 6). Four of this latter group consisted of isolated sinus segments. Selection criteria for dural sinus occlusion included direct multi-hole fistulas involving a broad surface in length or circumference of the sinus wall. External carotid artery (ECA) branches were directly embolized when considered safe. High-risk arterial supply from ICA, PICA, AICA or ECA cranial nerve branches were closed via retrograde approach during sinus occlusion. DAVF closure was accomplished in all 11 patients with a total of 17 embolization procedures using ONYX. High-risk arterial collaterals were closed via artery-artery or artery-sinus-artery embolization. The vein of Labbe was spared in the four cases with initial antegrade flow. No neurologic complications occurred, and DAVF closures were durable on three-month angiography. Transarterial closure of the transverse and sigmoid sinuses. © The Author(s) 2016.

In vivo Sonothrombolysis of Ear Marginal Vein of Rabbits Monitored with High-frequency Ultrasound Needle Transducer.

PubMed

Chen, Ruimin; Paeng, Dong-Guk; Lam, Kwok Ho; Zhou, Qifa; Shung, K Kirk; Matsuoka, Naoki; Humayun, Mark S

2013-01-01

Ultrasound (US) is known to enhance thrombolysis when thrombolytic agents and/or microbubbles are injected into the targeted vessels. In this research, high-intensity US (1 MHz, 7 W/cm 2 , 30 % duty cycle) was applied in vivo to the ear marginal vein of three rabbits which was occluded by either laser photothrombosis or thrombin, right after the injection of 0.3~0.6 cc of microbubbles (13 × 10 8 bubbles/ml of concentration) through the other ear vein without using any thrombolytic agent. To determine the effect of the sonothrombolysis, the blood flow velocity near the occlusion site in the vein was measured by a custom-made 40-MHz US needle transducer and its corresponding Doppler US system. The Doppler spectra show that the blood flow velocity recovered from total occlusion after three 10-minute high-intensity US treatments. Fluorescein angiography was employed to confirm the opening of the vessel occlusion. A control study of three rabbits with only the microbubble injection showed no recovery on the occlusion in 3 hours. The results show that the sonothrombolysis in the rabbit ear marginal vein can be achieved with microbubbles only. The results of cavitation measurements indicate that the mechanism of sonothrombolysis is probably due to the cavitation induced by the microbubbles. Without the need of applying any thrombolytic agent, high-intensity US has high potential for therapies targeting on small blood vessels.

Occlusal status in Asian male adults: prevalence and ethnic variation.

PubMed

Soh, Jen; Sandham, Andrew; Chan, Yiong Huak

2005-09-01

The purpose of this study was to determine the occlusal status in young Asian male adults of three ethnic groups. Study models of a sample of male army recruits (N = 339, age 17-22 years) with no history of orthodontic treatment were assessed. The ethnic proportions of the sample were Chinese 76.1% (n = 258), Malay 17.7% (n = 60), and Indian 6.2% (n = 21). British Standard Institute (BSI) and Angle's classification were used to determine incisor and molar relationships, respectively. Chi-square test or Fisher's Exact test was performed to compare the occlusal traits between ethnic groups. The distribution of incisor relationships of the total sample consisted of Class I = 48.1%, Class II/1 = 26.3%, Class II/2 = 3.2%, and Class III = 22.4%. Right Angle's molar relationships were 49.9%, 24.5%, and 24.2% whereas left Angle's molar relationships were 53.1%, 25.1%, and 21.2% for Class I, II, and III, respectively. Comparison between ethnic groups found that Indian subjects were more likely to have Class II/1 malocclusions and clinically missing permanent teeth (P < .05). The study found that the overall prevalence of malocclusion (BSI) was Class I, Class II/1, Class III, and Class II/2 in descending order of proportions. Angle's Class I molar was most prevalent followed by Class II and Class III relations. A significant difference in occlusal status between the ethnic groups was found regarding incisor relationship and missing permanent teeth (P < .05).

Outcomes of 3 hours part-time occlusion treatment combined with near activities among children with unilateral amblyopia.

PubMed

Alotaibi, Abdullah G; Fawazi, Samah M; Alenazy, Badriah R; Abu-Amero, Khaled K

2012-04-01

To evaluate the outcome of part-time occlusion therapy with or without near activities in monocular amblyopic patients. One hundred and thirty patients who prescribed daily occlusion therapy (part-time occlusion) were followed-up for a 12-week period. The study was carried out in the Pediatric Ophthalmology and Orthoptics Clinics of King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia for the period from January to November 2010. Sixty-five patients were recommended to undertake the 3 hours of near visual activities (such as reading a book during patching) while the other 65 patients were not advised to do any near activity. Main outcome measures were best corrected visual acuity (VA) for both groups and line improvement. The total line of VA improved from baseline by an average of 6.7+/-2.37 line log MAR (logarithm of the minimum angle of resolution) units in the group of patching with near activities and by an average of 5.3+/- 2.04 line log MAR units in the group of patching without near activities. All type of amblyopia (strabismic, anisometropic, and mixed types of amblyopia) improved significantly after patching with near activities. Both moderate and severe amblyopia improved significantly in the group of near activities compared with the group without near activities. Performing near activities while patching in the treatment of anisometropic, stabismic, or combined amblyopia improves the VA outcome more than patching alone.

Intraoral conversion of occlusal force to electricity and magnetism by biting of piezoelectric elements.

PubMed

Kameda, Takashi; Ohkuma, Kazuo; Sano, Natsuki; Ogura, Hideo; Terada, Kazuto

2012-01-01

Very weak electrical, magnetic and ultrasound signal stimulations are known to promote the formation, metabolism, restoration and stability of bone and surrounding tissues after treatment and operations. We have therefore investigated the possibility of intraoral generation of electricity and magnetism by occlusal force in an in vitro study. Biting bimorph piezoelectric elements with lead zirconate titanate (PZT) using dental models generated appropriate magnetism for bone formation, i. e. 0.5-0.6 gauss, and lower electric currents and higher voltages, i. e. 2.0-6.0 μA at 10-22 V (appropriate levels are 30 μA and 1.25 V), as observed by a universal testing machine. The electric currents and voltages could be changed using amplifier circuits. These results show that intraoral generation of electricity and magnetism is possible and could provide post-operative stabilization and activation of treated areas of bone and the surrounding tissues directly and/or indirectly by electrical, magnetic and ultrasound stimulation, which could accelerate healing.

Hepatic veno-occlusive disease after hematopoietic stem cell transplantation: update on defibrotide and other current investigational therapies.

PubMed

Ho, V T; Revta, C; Richardson, P G

2008-02-01

Hepatic veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS), remains one of the most serious and common complications after myeloablative hematopoietic stem cell transplantation (HSCT). Clinical diagnosis of hepatic VOD is based on the clinical triad of (1) painful hepatomegaly, (2) hyperbilirubinemia and (3) unexplained fluid retention. While milder cases usually resolve spontaneously, severe VOD is associated with a grim prognosis. Defibrotide (DF), a polydisperse mixture of single-stranded oligonucleotide with antithrombotic and fibrinolytic effects on microvascular endothelium, has emerged as an effective and safe therapy for patients with severe VOD. Multiple studies, including a recent large international multicenter phase II clinical trial, have demonstrated 30-60% complete remission rates with DF, even among patients with severe VOD and multiorgan failure. This article will review our current understanding of hepatic VOD, and update the clinical trial experience with DF and other potential therapies for this feared transplant complication.

A Review of Developments in Computer-Based Systems to Image Teeth and Produce Dental Restorations

PubMed Central

Rekow, E. Dianne; Erdman, Arthur G.; Speidel, T. Michael

1987-01-01

Computer-aided design and manufacturing (CAD/CAM) make it possible to automate the creation of dental restorations. Currently practiced techniques are described. Three automated systems currently under development are described and compared. Advances in computer-aided design and computer-aided manufacturing (CAD/CAM) provide a new option for dentistry, creating an alternative technique for producing dental restorations. It is possible to create dental restorations that are automatically produced and meet or exceed current requirements for fit and occlusion.

Usefulness of MRI to Differentiate Between Temporary and Long-Term Coronary Artery Occlusion in a Minimally Invasive Model of Experimental Myocardial Infarction

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abegunewardene, Nico, E-mail: nico@uni-mainz.de; Vosseler, Markus; Gori, Tommaso

The surgical technique employed to determine an experimental ischemic damage is a major factor in the subsequent process of myocardial scar development. We set out to establish a minimally invasive porcine model of myocardial infarction using cardiac contrast-enhanced magnetic resonance imaging (ce-MRI) as the basic diagnostic tool. Twenty-seven domestic pigs were randomized to either temporary or permanent occlusion of the left anterior descending artery (LAD). Temporary occlusion was achieved by inflation of a percutaneous balloon in the left anterior descending artery directly beyond the second diagonal branch. Occlusion was maintained for 30 or 45 min, followed by reperfusion. Permanent occlusionmore » was achieved via thrombin injection. Thirteen animals died peri- or postinterventionally due to arrhythmias. Fourteen animals survived the 30-min ischemia (four animals; group 1), the 45-min ischemia (six animals; group 2), or the permanent occlusion (4 animals; group 3). Coronary angiography and ce-MRI were performed 8 weeks after coronary occlusion to document the coronary flow grade and the size of myocardial scar tissue. The LAD was patent in all animals in groups 1 and 2, with normal TIMI flow; in group 3 animals, the LAD was totally occluded. Fibrosis of the left ventricle in group 1 (4.9 {+-} 4.4%; p = 0.008) and group 2 (9.4 {+-} 2.9%; p = 0.05) was significantly lower than in group 3 (14.5 {+-} 3.9%). Wall thickness of the ischemic area was significantly lower in group 3 versus group 1 and group 2 (2.9 {+-} 0.3, 5.9 {+-} 0.7, and 6.1 {+-} 0.7 mm; p = 0.005). The extent of late enhancement of the left ventricle was also significantly higher in group 3 (16.9 {+-} 2.1%) compared to group 1 (5.3 {+-} 5.4%; p = 0.003) and group 2 (9.7 {+-} 3.4%, p = 0.013). In conclusion, the present model of minimally invasive infarction coupled with ce-MRI may represent a useful alternative to the open chest model for studies of myocardial infarction and scar development.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gandini, Roberto; Pipitone, Vincenzo; Stefanini, Matteo

The purpose of this study was to describe the efficacy of planned combined subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) to obtain the precise recanalization of the patent portion of a distal runoff vessel in critical limb ischemia (CLI) patients presenting long occlusions involving the popliteal trifurcation. Four patients at risk of limb loss due to long occlusions involving the leg vessel tree and not suitable for a surgical bypass were treated by the subintimal antegrade and retrograde (posterior tibial or anterior tibial artery) approach. The patent portion of the runoff vessel was previously assessed by magnetic resonance angiography (MRA)more » and directly punctured under Doppler ultrasound (US) guidance. A subintimal channel rendezvous was performed to allow snaring of the guidewires. Subsequently, a balloon dilatation was performed without stent deployment. All patients were successfully recanalized and had complete healing of the limb lesions. At the 12-month follow-up all patients showed clinical improvement with no major complications related to the procedure. This combined antegrade and retrograde subintimal approach is currently an excellent endovascular option in patients with long occlusions extending onto the leg vessels trifurcation and at risk of limb loss.« less

Use of an optical clearing agent to enhance the visibility of subsurface structures and lesions from tooth occlusal surfaces

PubMed Central

Kang, Hobin; Darling, Cynthia L.; Fried, Daniel

2016-01-01

Abstract. The purpose of this study is to show that optical clearing agents can be used to increase the visibility of deeply penetrating occlusal lesions that have reached the underlying dentin and spread laterally under the enamel. Previous studies have shown that high refractive index fluids can increase the contrast of caries lesions. Extracted teeth with natural occlusal lesions were imaged with optical coherence tomography (OCT) with and without the addition of a transparent vinyl polysiloxane impression material (VPS) currently used in vivo. The relative intensity of the reflectivity from the underlying lesion area for each sample was measured before and after application of the VPS. Lesion presence was confirmed with polarized light microscopy and microradiography. Application of VPS significantly increased (P<0.0001) the integrated reflectivity of subsurface dentinal lesions. This study shows that optical clearing agents can be used to increase the optical penetration and the visibility of subsurface lesions and the dentinal–enamel junction under sound and demineralized enamel in OCT images. PMID:27071709

Reevaluation of the Dentary Structures of Caenagnathid Oviraptorosaurs (Dinosauria, Theropoda).

PubMed

Wang, Shuo; Zhang, Qiyue; Yang, Rui

2018-01-10

Among the characters of caenagnathid oviraptorosaurians, the lateral occlusal grooves and ridges on the occlusal surface of the jaw bones often receive special attention. Recent studies demonstrated that ontogenetic edentulism is present in caenagnathids, and therefore the lateral occlusal grooves and ridges are vestigial alveoli and interdental septa, respectively. In the present paper, the dentary structures of caenagnathids were reevaluated based on CT images of Caenagnathiasia sp. IVPP V20377. Several previously unknown features including crateriform vestigial alveoli, the morphology of the dentary interior hollow space, and the paired blind tubes beneath the dentary symphyseal shelf are recognized. Current lines of evidence suggest different jaw bone morphologies are likely produced by various tooth reduction patterns, which indicates ontogenetic dietary shift, if once presented in caenagnathids and Sapeornis, may have been different from the condition seen in Limusaurus. The 3D images of dentary interior spaces suggest that while tooth reduction progresses, the empty alveoli are partially modified into structures accommodating blood vessels that nourish the rhamphotheca, probably representing a functional compensation for the insufficient blood supply in toothed jaw bones.

Initial experience with a dedicated coronary re-entry device for revascularization of chronic total occlusions.

PubMed

Whitlow, Patrick L; Lombardi, William L; Araya, Mario; Michael Wyman, R; Torres, Humberto; Dauvergne, Christian; Tsuchikane, Etsuo; Lansky, Alexandra; Thompson, Craig A

2012-11-01

The aim of this registry was to evaluate a new device designed to facilitate antegrade guidewire re-entry into the true lumen of a chronic total coronary occlusion (CTO) from the adjacent subintimal space. Successful recanalization of CTOs results in clinical improvement in appropriately selected patients. CTO intervention is time- and resource-consuming, and a simplified approach enabling antegrade guidewire re-entry into the distal true lumen might improve success. Patients with CTO and ischemia were entered into a prospective registry regardless of lesion characteristics. If wire manipulation resulted in subintimal wire entrapment, a new re-entry tool (a 2.5-mm flat subintimal balloon with two exit ports offset by 180°) was used as a platform to attempt guidewire penetration into the distal true lumen. The primary endpoint assessed was successful device-guided re-entry. Standard techniques were then utilized to open the CTO. In 40 consecutive CTO lesions attempted, 19 resulted in subintimal wire entrapment (mean occlusion length 44 mm). Sixteen of these 19 were successfully crossed with an antegrade guidewire into the distal true lumen using the new device (84%). One patient with unsuccessful re-entry was subsequently recanalized with a retrograde technique. All crossed lesions were stented (17/17), resulting in TIMI 3 flow without major complications. Two cases were unsuccessful. One patient had a grade I coronary perforation requiring no treatment. A new device to recanalize CTOs complicated by subintimal wire entrapment can be used successfully by experienced operators. Further study of this coronary re-entry device is ongoing. Copyright © 2011 Wiley Periodicals, Inc.

Impact of the Intracoronary Rendezvous technique on coronary angioplasty for chronic total occlusion.

PubMed

Nihei, Taro; Yamamoto, Yoshito; Kudo, Shun; Hanawa, Kenichiro; Hasebe, Yuhi; Takagi, Yusuke; Minatoya, Yutaka; Sugi, Masafumi; Shimokawa, Hiroaki

2017-10-01

The Rendezvous technique, which requires bidirectional wiring, is one of the useful methods for improving the success rate of recanalization for chronic total occlusion (CTO) in the field of peripheral intervention. Recently, advanced new devices for percutaneous coronary intervention have enabled us to perform the Rendezvous technique for peripheral as well as for coronary CTO lesions. We used the Intracoronary Rendezvous technique to perform angioplasty for coronary CTO. "Intracoronary Rendezvous" means that Rendezvous was achieved within the CTO lesion. From March 2009 to November 2015, 189 patients underwent CTO angioplasty at our institute, and we treated 10 patients with the Intracoronary Rendezvous technique. This technique involves crossing the Gaia series guidewire to the contralateral Corsair microcatheter located inside the plaque of CTO lesions. The majority of the CTO sites examined were in the proximal RCA (60 %). Lesion length of the occlusion was relatively long (64.4 ± 12.2 mm). Using the biplane imaging system, we were able to control the Gaia guidewires in a specific direction. Furthermore, if the antegrade and retrograde wires can be advanced into contiguous space inside the CTO lesion, we intentionally entered either wire into the contralateral Corsair microcatheter, followed by successful CTO crossing. CTO recanalization was completed for all patients without controlled antegrade retrograde subintimal tracking (CART) or reverse CART. No major complications occurred during hospitalization. These results indicate that the Rendezvous technique, assisted by new devices and a biplane imaging system, represents one of the primary options to achieve successful coronary CTO recanalization.

Imaging cortical absorption, scattering, and hemodynamic response during ischemic stroke using spatially modulated near-infrared illumination

NASA Astrophysics Data System (ADS)

Abookasis, David; Lay, Christopher C.; Mathews, Marlon S.; Linskey, Mark E.; Frostig, Ron D.; Tromberg, Bruce J.

2009-03-01

We describe a technique that uses spatially modulated near-infrared (NIR) illumination to detect and map changes in both optical properties (absorption and reduced scattering parameters) and tissue composition (oxy- and deoxyhemoglobin, total hemoglobin, and oxygen saturation) during acute ischemic injury in the rat barrel cortex. Cerebral ischemia is induced using an open vascular occlusion technique of the middle cerebral artery (MCA). Diffuse reflected NIR light (680 to 980 nm) from the left parietal somatosensory cortex is detected by a CCD camera before and after MCA occlusion. Monte Carlo simulations are used to analyze the spatial frequency dependence of the reflected light to predict spatiotemporal changes in the distribution of tissue absorption and scattering properties in the brain. Experimental results from seven rats show a 17+/-4.7% increase in tissue concentration of deoxyhemoglobin and a 45+/-3.1, 23+/-5.4, and 21+/-2.2% decrease in oxyhemoglobin, total hemoglobin concentration and cerebral tissue oxygen saturation levels, respectively, 45 min following induction of cerebral ischemia. An ischemic index (Iisch=ctHHb/ctO2Hb) reveals an average of more then twofold contrast after MCAo. The wavelength-dependence of the reduced scattering (i.e., scatter power) decreased by 35+/-10.3% after MCA occlusion. Compared to conventional CCD-based intrinsic signal optical imaging (ISOI), the use of structured illumination and model-based analysis allows for generation of separate maps of light absorption and scattering properties as well as tissue hemoglobin concentration. This potentially provides a powerful approach for quantitative monitoring and imaging of neurophysiology and metabolism with high spatiotemporal resolution.

Validation of the Spanish version of the "Questionnaire on the treatment of approximal and occlusal caries".

PubMed

Ruiz, Begoña; Urzúa, Iván; Cabello, Rodrigo; Rodríguez, Gonzalo; Espelid, Ivar

2013-01-01

To translate and validate a Spanish version of the "Questionnaire on the treatment of approximal and occlusal caries" as a method of collecting information about treatment decisions on caries management in Chilean primary health care services. The original questionnaire proposed by Espelid et al. was translated into Spanish using the forward-backward translation technique. Subsequently, validation of the Spanish version was undertaken. Data were collected from two separate samples; first, from 132 Spanish-speaking dentists recruited from primary health care services and second, from 21 individuals characterised as cariologists. Internal consistency was evaluated by the generation of Cronbach's alpha, test-retest reliability was evaluated by Cohen's kappa, convergent validity was evaluated by comparing the total scale scores to a global evaluation of treatment trends and discriminant validity was evaluated by investigating the differences in total scale scores between the Spanish-speaking dentist and cariologist samples. Cronbach's alpha indicated an internal consistency of 0.63 for the entire scale. Cohen's kappa correlation coefficient expressed a test-retest reliability of 0.83. Convergent validity determined a Pearson's correlation coefficient of 0.24 (p < 0.01). The comparison of proportions (chi-squared) indicated that discriminant validity was statistically significant (p < 0.01), using a one-tailed test. The Spanish version of the "Questionnaire on the treatment of approximal and occlusal caries" is a valid and reliable instrument for collecting information regarding treatment decisions in cariology. The clinical relevance of this study is to acquire a reliable instrument that allows for the determination of treatment decisions in Spanish-speaking dentists.

Plasma Omentin-1 Level as a Predictor of Good Coronary Collateral Circulation.

PubMed

Zhou, Ji-Peng; Tong, Xiao-Yu; Zhu, Ling-Ping; Luo, Jing-Min; Luo, Ying; Bai, Yong-Ping; Li, Chuan-Chang; Zhang, Guo-Gang

2017-09-01

Coronary collateral circulation (CCC) is crucial during an acute ischemic attack. Evidences showed that omentin-1 exhibited remarkable antiatherogenic effects and ischemia-induced revascularization. The aim of this study was to investigate the relationship between plasma omentin-1 levels and CCC in patients with ≥90% angiography-proven coronary occlusion. 142 patients with ≥90% luminal diameter stenosis in at least one major epicardial coronary artery were recruited. Among them, 79 patients with Rentrop 0-1 grade were classified into the poor CCC group and 63 patients with Rentrop 2-3 grade were included into the good CCC group. The association between plasma omentin-1 levels and CCC status was assessed. Plasma omentin-1 level was significantly higher in patients with good CCC than those with poor CCC (566.57±26.90 vs. 492.38±19.70 ng/mL, p=0.024). Besides, omentin-1 was positively correlated with total cholesterol (TC), high-density lipoprotein, and gensini score but inversely with hyperlipidemia and body mass index (all p values＜0.05). Multivariate regression analysis indicated that omentin-1 [odds ratio (OR)=1.002, 95% confidence interval (CI): 1.000-1.004, p=0.041)], TC, the number of the diseased vessels, a higher frequency of left circumflex artery and right coronary artery, chronic total occlusion, and gensini score remained as the independent predictors of good CCC. Higher plasma omentin-1 level was associated with better CCC development. Our findings suggest that omentin-1 may be an alternative marker for adequate CCC in patients with ≥90% coronary occlusion.

The feasibility of transradial laser atherectomy for chronic total occlusion using the 5 Fr sheath system.

PubMed

Sherif, Khaled; Yaqub, Yasir; Suarez, Jose A

2016-05-01

We present a case of chronic total occlusion (CTO) approached with LASER endovascular intervention by radial artery approach using a 5 French sheath. A 57-year-old man presented to our hospital having had retrosternal chest pain for two days. Physical examination was normal at the time of presentation. The laboratory tests were within normal limits, including cardiac enzymes except the lipid panel which showed hypertriglyceridemia. The patient underwent a myocardial perfusion scintigraphy stress test that revealed inferior wall ischemia, with normal left ventricular ejection fraction. A 5-French vascular sheath was placed in the right radial artery. Selective coronary artery angiography was performed, which showed right coronary artery (RCA) CTO. A 5-French JR4 guide catheter successfully engaged the RCA and Laser angioplasty was performed across the CTO into the RCA. A marked improvement of flow was evident thereafter. To best of our knowledge this is the first case report showing the feasibility of laser atherectomy using the 5 French sheath system in a coronary arterial CTO. Copyright © 2016 by Academy of Sciences and Arts of Bosnia and Herzegovina.

Noninvasive imaging of human skin hemodynamics using a digital red-green-blue camera

NASA Astrophysics Data System (ADS)

Nishidate, Izumi; Tanaka, Noriyuki; Kawase, Tatsuya; Maeda, Takaaki; Yuasa, Tomonori; Aizu, Yoshihisa; Yuasa, Tetsuya; Niizeki, Kyuichi

2011-08-01

In order to visualize human skin hemodynamics, we investigated a method that is specifically developed for the visualization of concentrations of oxygenated blood, deoxygenated blood, and melanin in skin tissue from digital RGB color images. Images of total blood concentration and oxygen saturation can also be reconstructed from the results of oxygenated and deoxygenated blood. Experiments using tissue-like agar gel phantoms demonstrated the ability of the developed method to quantitatively visualize the transition from an oxygenated blood to a deoxygenated blood in dermis. In vivo imaging of the chromophore concentrations and tissue oxygen saturation in the skin of the human hand are performed for 14 subjects during upper limb occlusion at 50 and 250 mm Hg. The response of the total blood concentration in the skin acquired by this method and forearm volume changes obtained from the conventional strain-gauge plethysmograph were comparable during the upper arm occlusion at pressures of both 50 and 250 mm Hg. The results presented in the present paper indicate the possibility of visualizing the hemodynamics of subsurface skin tissue.

Interventional Management of “Balloon-Uncrossable” Coronary Chronic Total Occlusion: Is There Any Way Out?

PubMed Central

2018-01-01

It has been estimated that coronary chronic total occlusion (CTO) is encountered in 15 to 20% patients referred for coronary angiography (CAG). The success of percutaneous coronary intervention (PCI) of CTO can be attributed to the vast array of hardware that has now become available and also to the vastly enhanced operator expertise. It is however realistic to state that despite the tremendous increase in the rate of success, there then comes a subset of CTO where PCI attempts fail. The reason for such failures given that other variables remain constant is the inability to cross the CTO lesion. This can be due to a failure to cross the lesion with a guide wire (despite guide wire escalation). The second cause of failure is the inability to cross the lesion with a balloon (balloon-uncrossable [BU] CTO). This can occur despite the successful placement of a guidewire in the distal true lumen. The BU lesions contribute 2% to 10% of CTO PCI failure cases. The author attempts to present a creative solution to assist crossing such lesions. PMID:29625510

New Advances in Chronic Total Occlusions

PubMed Central

Konstantinidis, Nikolaos; Pighi, Michele; Dogu Kilic, Ismail; Serdoz, Roberta; Sianos, Georgios

2014-01-01

Coronary chronic total occlusions (CTOs) still represent the greatest technical challenge that interventional cardiologists face. CTOs remain seriously undertreated with percutaneous techniques, far below their prevalence. One reason for the low uptake was the suboptimal CTO percutaneous coronary intervention (PCI) success rates over a long period of time. During the last years, dedicated groups of experts in Japan, Europe and United States fostered the development and standardisation of modern CTO recanalisation techniques, along with providing focused training and proctorship worldwide. As a result, dedicated operators achieved success rates far beyond 90 %, while coping with lesions of increasing complexity. A series of studies, mainly retrospective and observational in nature, explored the prognostic impact of CTO PCI, revealing that successful lesion recanalisation is related to improved patient outcome and anginal status; further evidence from randomised trials is on the way. The following review reports on the most recent advances in the field of CTO recanalisation, in an attempt to promote a more balanced approach in patients with chronically occluded coronary arteries and encourage more operators to cope with these inherently complex lesions. PMID:29588804

Threshold of microvascular occlusion: injury size defines the thrombosis scenario.

PubMed

Belyaev, Aleksey V; Panteleev, Mikhail A; Ataullakhanov, Fazly I

2015-07-21

Damage to the blood vessel triggers formation of a hemostatic plug, which is meant to prevent bleeding, yet the same phenomenon may result in a total blockade of a blood vessel by a thrombus, causing severe medical conditions. Here, we show that the physical interplay between platelet adhesion and hemodynamics in a microchannel manifests in a critical threshold behavior of a growing thrombus. Depending on the size of injury, two distinct dynamic pathways of thrombosis were found: the formation of a nonocclusive plug, if injury length does not exceed the critical value, and the total occlusion of the vessel by the thrombus otherwise. We develop a mathematical model that demonstrates that switching between these regimes occurs as a result of a saddle-node bifurcation. Our study reveals the mechanism of self-regulation of thrombosis in blood microvessels and explains experimentally observed distinctions between thrombi of different physical etiology. This also can be useful for the design of platelet-aggregation-inspired engineering solutions. Copyright © 2015 Biophysical Society. Published by Elsevier Inc. All rights reserved.

In vivo evaluation of DIAGNOdent for the quantification of occlusal dental caries.

PubMed

Khalife, Moufida A; Boynton, James R; Dennison, Joseph B; Yaman, Peter; Hamilton, James C

2009-01-01

The accurate diagnosis of non-cavitated occlusal caries is generally considered problematic. Induced fluorescence quantified by the DIAGNOdent device (KaVo) gives a reading from 0-99, which may help in the caries diagnostic process. There is some controversy around the implication of increased severity of decay with increased DIAGNOdent readings. This in vivo study assessed the correlation of depth and volume of decay as it was removed by traditional rotary handpieces with DIAGNOdent readings and determined sensitivities/specificities of the device at different cut-off points. Included in the current study were 31 patients providing 60 permanent molar and premolar occlusal surfaces suspected of dentinal decay. DIAGNOdent readings were recorded, along with lesion depth (as measured by periodontal probe) and volume measurements (as calculated from measuring the mass of a polyvinyl siloxane impression of the cavity, divided by the material's calculated density). Clinical detection of decay at the DEJ was used as the gold-standard to calculate an appropriate cut-off. Pearson correlation coefficients indicated that DIAGNOdent readings were weakly correlated with lesion depth (r = 0.47) and lesion volume (also r = 0.47). An appropriate cut-off point for the sample in the current study was calculated between 35 and 40; a more specific cut-off point could not be determined due to the sample size distribution. It was concluded that the DIAGNOdent device should be used as an adjunct in the caries diagnosis and treatment planning process.

Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: The RECHARGE score.

PubMed

Maeremans, Joren; Spratt, James C; Knaapen, Paul; Walsh, Simon; Agostoni, Pierfrancesco; Wilson, William; Avran, Alexandre; Faurie, Benjamin; Bressollette, Erwan; Kayaert, Peter; Bagnall, Alan J; Smith, Dave; McEntegart, Margaret B; Smith, William H T; Kelly, Paul; Irving, John; Smith, Elliot J; Strange, Julian W; Dens, Jo

2018-02-01

This study sought to create a contemporary scoring tool to predict technical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) from patients treated by hybrid operators with differing experience levels. Current scoring systems need regular updating to cope with the positive evolutions regarding materials, techniques, and outcomes, while at the same time being applicable for a broad range of operators. Clinical and angiographic characteristics from 880 CTO-PCIs included in the REgistry of CrossBoss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE) were analyzed by using a derivation and validation set (2:1 ratio). Variables significantly associated with technical failure in the multivariable analysis were incorporated in the score. Subsequently, the discriminatory capacity was assessed and the validation set was used to compare with the J-CTO score and PROGRESS scores. Technical success in the derivation and validation sets was 83% and 85%, respectively. Multivariate analysis identified six parameters associated with technical failure: blunt stump (beta coefficient (b) = 1.014); calcification (b = 0.908); tortuosity ≥45° (b = 0.964); lesion length 20 mm (b = 0.556); diseased distal landing zone (b = 0.794), and previous bypass graft on CTO vessel (b = 0.833). Score variables remained significant after bootstrapping. The RECHARGE score showed better discriminatory capacity in both sets (area-under-the-curve (AUC) = 0.783 and 0.711), compared to the J-CTO (AUC = 0.676) and PROGRESS (AUC = 0.608) scores. The RECHARGE score is a novel, easy-to-use tool for assessing the risk for technical failure in hybrid CTO-PCI and has the potential to perform well for a broad community of operators. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Impact of a Disposable Sterile Radiation Shield on Operator Radiation Exposure During Percutaneous Coronary Intervention of Chronic Total Occlusions.

PubMed

Shorrock, Deborah; Christopoulos, Georgios; Wosik, Jedrek; Kotsia, Anna; Rangan, Bavana; Abdullah, Shuaib; Cipher, Daisha; Banerjee, Subhash; Brilakis, Emmanouil S

2015-07-01

Daily radiation exposure over many years can adversely impact the health of medical professionals. Operator radiation exposure was recorded for 124 percutaneous coronary interventions (PCIs) performed at our institution between August 2011 and May 2013: 69 were chronic total occlusion (CTO)-PCIs and 55 were non-CTO PCIs. A disposable radiation protection sterile drape (Radpad; Worldwide Innovations & Technologies, Inc) was used in all CTO-PCI cases vs none of the non-CTO PCI cases. Operator radiation exposure was compared between CTO and non-CTO PCIs. Mean age was 64.6 ± 6.2 years and 99.2% of the patients were men. Compared with non-CTO PCI, patients undergoing CTO-PCI were more likely to have congestive heart failure, to be current smokers, and to have longer lesions, and less likely to have prior PCI and a saphenous vein graft target lesion. CTO-PCI cases had longer procedural time (median: 123 minutes [IQR, 85-192 minutes] vs 27 minutes [IQR, 20-44 minutes]; P<.001), fluoroscopy time (35 minutes [IQR, 19-54 minutes] vs 8 minutes [IQR, 5-16 minutes]; P<.001), number of stents placed (2.4 ± 1.5 vs 1.7 ± 0.9; P<.001), and patient air kerma radiation exposure (3.92 Gray [IQR, 2.48-5.86 Gray] vs 1.22 Gray [IQR, 0.74-1.90 Gray]; P<.001), as well as dose area product (267 Gray•cm² [IQR, 163-4.25 Gray•cm²] vs 84 Gray•cm² [IQR, 48-138 Gray•cm²]; P<.001). In spite of higher patient radiation exposure, operator radiation exposure was similar between the two groups (20 μSv [IQR, 9.5-31 μSv] vs 15 μSv [IQR, 7-23 μSv]; P=.07). Operator radiation exposure during CTO-PCI can be reduced to levels similar to less complicated cases with the use of a disposable sterile radiation protection shield.

Chronic total occlusion in non-infarct-related artery is associated with increased short-and long-term mortality in patients with ST-segment elevation acute myocardial infarction complicated by cardiogenic shock (from the CREDO-Kyoto AMI registry).

PubMed

Watanabe, Hiroki; Morimoto, Takeshi; Shiomi, Hiroki; Kawaji, Tetsuma; Furukawa, Yutaka; Nakagawa, Yoshihisa; Ando, Kenji; Kadota, Kazushige; Kimura, Takeshi

2017-09-30

We aimed to investigate the effect of chronic total occlusion (CTO) in non-infarct-related artery (IRA) on short- and long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients complicated by cardiogenic shock (CS). Previous studies show contradictory results about the clinical effect of CTO in non-IRA on short-term mortality in STEMI patients with CS. From the CREDO-Kyoto AMI registry enrolling 5429 patients, the current study population consisted of 313 STEMI patients with multivessel disease complicated by CS who underwent primary PCI for the nonleft main coronary artery culprit lesion within 24 hr after onset. They were divided according to the presence of CTO (CTO group: N = 100 and non-CTO group: N = 213). Hemodynamic compromise was more profound in the CTO group as suggested by the more frequent use of intra-aortic balloon pumping and/or extracorporeal membrane oxygenation. Infarct size estimated by the peak creatine phosphokinase level was larger in the CTO group than in the non-CTO group. The cumulative 30-day and 5-year incidences of all-cause death were significantly higher in the CTO group than in the non-CTO group (34.0% vs 18.0%, P = 0.001, and 64.5% vs 46.0%, P = 0.0001). After adjusting for confounders, the excess risk of the CTO group relative to the non-CTO group for all-cause death remained significant both at 30 days and at 5 years (hazard ratio [HR]: 2.05, 95% confidence interval [CI]: 1.27-3.29, P = 0.003, and HR: 1.90, 95% CI: 1.34-2.69, P = 0.0004). In STEMI patients complicated by CS, CTO in non-IRA was associated with increased 30-day and 5-year mortality. © 2017 Wiley Periodicals, Inc.

Use of drug-eluting stents in Victorian public hospitals.

PubMed

Yan, Bryan P; Ajani, Andrew E; Duffy, Stephen J; New, Gishel; Horrigan, Mark; Szto, Gregory; Walton, Antony; Eccleston, David; Lefkovits, Jeffery; Black, Alexander; Sebastian, Martin; Brennan, Angela L; Reid, Christopher M; Clark, David J

2006-10-02

We aimed to assess the pattern of use of drug-eluting stents (DESs) in patients undergoing percutaneous coronary interventions (PCIs) in Victorian public hospitals. Prospective study comparing the use of one or more DESs versus bare-metal stents (BMSs) only, in consecutive patients undergoing 2428 PCIs with stent implantation from 1 April 2004 to 31 December 2005 at seven Victorian public hospitals. Adherence to current Victorian Department of Human Services guidelines which recommend DES use in patients with high-risk features for restenosis (diabetes, small vessels, long lesions, in-stent restenotic lesions, chronic total occlusions and bifurcation lesions). Of the 2428 PCIs performed, at least one DES was implanted in 1101 (45.3%) and BMSs only were implanted in 1327 (54.7%). In 87.7% (966/1101) of PCI with DESs, there was at least one criterion for high risk of restenosis. DESs were more likely to be used in patients with diabetes (risk ratio [RR], 2.45; 95% CI, 2.02-2.97), small vessels (RR, 3.35; 95%CI, 2.35-4.76), long lesions (RR, 3.87; 95% CI, 3.23-4.65), in-stent restenotic lesions (RR, 3.98; 95%CI, 2.67-6.06), chronic total occlusions (RR, 1.30; 95% CI, 0.51-2.88) and bifurcation lesions (RR, 2.23; 95%CI, 1.57-3.17). However, 66.2% (1608/2428) of all PCIs were in patients eligible for DESs according to Victorian guidelines, and in 39.9% (642/1608) of these PCIs, a BMS was used. In Victorian public hospitals, DESs have been largely reserved for patients at high risk of restenosis in accordance with Department of Human Services guidelines. However, many patients with high-risk criteria for restenosis did not receive DESs. Greater use of DESs in these patients may improve outcomes by reducing the need for repeat revascularisation.

Effect of occlusion amblyopia after prescribed full-time occlusion on long-term visual acuity outcomes.

PubMed

Longmuir, Susannah; Pfeifer, Wanda; Scott, William; Olson, Richard

2013-01-01

To investigate the incidence and characteristics of occlusion amblyopia with prescribed full-time patching and determine its effect on long-term visual acuity outcomes. The records of patients younger than 10 years diagnosed as having amblyopia between 1970 and 2000 were retrospectively reviewed. Patients were prescribed full-time occlusion and observed until completion of therapy. Of 597 patients treated for amblyopia by full-time patching, 115 were diagnosed as having occlusion amblyopia (19.3%). Seventy-five percent (86 of 115) developed occlusion amblyopia during the first episode of full-time patching. Occlusion amblyopia occurred more frequently in children prescribed full-time patching at an earlier age (P = .0002), with an odds ratio of 8.56 (95% confidence interval: 2.73, 26.84) in children younger than 36 months and 2.66 (95% confidence interval: 0.96, 7.37) in children between 36 and 59 months old. Seven of the patients with occlusion amblyopia did not reverse fixation and continued to fixate with the initially amblyopic eye after treatment. Final visual acuity in these eyes with occlusion amblyopia was 20/30 or better. After cessation of treatment, the final interocular difference in visual acuity was less in patients with a history of occlusion amblyopia (P = .003). Occlusion amblyopia occurred at all ages, but the incidence decreased with increasing age. Patients who developed occlusion amblyopia with prescribed full-time occlusion had less interocular visual acuity difference than patients who did not, suggesting that development of occlusion amblyopia can indicate the potential for the development of better vision in the originally amblyopic eye. Copyright 2013, SLACK Incorporated.

Trends of Anti-Vascular Endothelial Growth Factor Use in Ophthalmology Among Privately Insured and Medicare Advantage Patients.

PubMed

Parikh, Ravi; Ross, Joseph S; Sangaralingham, Lindsey R; Adelman, Ron A; Shah, Nilay D; Barkmeier, Andrew J

2017-03-01

To characterize the first 10 years of intravitreal anti-vascular endothelial growth factor (VEGF) medication use for ophthalmic disease, including bevacizumab, ranibizumab, and aflibercept. A retrospective cohort study using administrative claims data from January 1, 2006 to December 31, 2015. Total of 124 835 patients 18 years of age or over in the United States. OptumLabs Data Warehouse, which includes administrative claims data for over 100 million commercially insured and Medicare Advantage individuals, was used to identify patients receiving intravitreal anti-VEGF injections based on Current Procedural Terminology codes. Total and annual numbers of intravitreal anti-VEGF injections, as well as injections per 1000 enrolled patients per general category of ophthalmic disease, overall and for each available medication. There were 959 945 anti-VEGF injections among 124 835 patients from 2006 to 2015. Among all injections, 64.6% were of bevacizumab, 22.0% ranibizumab, and 13.4% aflibercept; 62.7% were performed to treat age-related macular degeneration (AMD), 16.1% to treat diabetic retinal diseases (including 0.9% of all injections that were for proliferative diabetic retinopathy), 8.3% to treat retinal vein occlusions, and 12.9% for all other uses. Use of bevacizumab and ranibizumab for AMD plateaued as of 2011/2012 and decreased thereafter (in 2006, 58.8 and 35.3 injections/1000 AMD patients, respectively; in 2015, 294.4 and 100.7 injections/1000), whereas use of aflibercept increased (1.1 injections/1000 AMD patients in 2011 to 183.0 injections/1000 in 2015). Bevacizumab use increased each year for diabetic retinal disease (2.4 injections/1000 patients with diabetic retinal disease in 2009 to 13.6 per 1000 in 2015) while that of ranibizumab initially increased significantly and then declined after 2014 (0.1 in 2009 to 4.0 in 2015). Aflibercept use increased each year in patients with diabetic retinal diseases and retinal vein occlusions (both <0.1 per 1000 retinal vein occlusion patients in 2011, 5.6 and 140.2 in 2015). Intravitreal injections of anti-VEGF medications increased annually from 2006 to 2015. Bevacizumab was the most common medication used, despite its lacking U.S. Food and Drug Administration approval to treat ophthalmic disease, and AMD was the most common condition treated. Ranibizumab use declined after 2014 while both the absolute and relative use of bevacizumab and aflibercept increased. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Computer modeling of occlusal surfaces of posterior teeth with the CICERO CAD/CAM system.

PubMed

Olthoff, L W; Van Der Zel, J M; De Ruiter, W J; Vlaar, S T; Bosman, F

2000-08-01

Static and dynamic occlusal interference frequently needs to be corrected by selective grinding of the occlusal surface of conventional cast and ceramic-fused-to-metal restorations. CAD/CAM techniques allow control of the dimensional contours of these restorations. However, parameters responsible for the occlusal form need to be determined. In most articulators, these parameters are set as default values. Which technique is best for minimizing the introduction of occlusal interference in restorations has not been determined. This study investigated differences in crown structure of a crown designed in static occlusion (STA) with designs adapted for dynamic occlusal interferences. Therefore, values from an optoelectronic registration system (String-Condylocomp, KAVO), an occlusal generated path (OGP) technique and default settings (DEF) were used in the CICERO CAD/CAM system. Morphology of CON, DEF, and OGP crowns was compared with that of the STA crown with respect to differences in a buccolingual section and frequency of occlusal distances in an interocclusal range of 1 mm, measured from the occlusal surface of the crown. All crown types fulfilled the esthetic and morphologic criteria for restorations in clinical dentistry. Difference in the morphology of the OGP crown, compared with that of the STA crown, was greater than that for the CON and DEF crowns. These differences were seen especially in the distobuccal part of the occlusal surface; however, the number of occlusal contacts was considered sufficient to stabilize occlusion. Functional occlusion, adapted to dynamic occlusion in a CICERO crown for the first mandibular molar, can be obtained using data acquired with the String-Condylocomp registration system. The OGP technique was preferred to other techniques because of the simplicity of the technique for eliminating potential problems with opposing teeth during motion. However, this is achieved at the cost of fewer points of contact during occlusion than with the CON crown.

Robust information encryption diffractive-imaging-based scheme with special phase retrieval algorithm for a customized data container

NASA Astrophysics Data System (ADS)

Qin, Yi; Wang, Zhipeng; Wang, Hongjuan; Gong, Qiong; Zhou, Nanrun

2018-06-01

The diffractive-imaging-based encryption (DIBE) scheme has aroused wide interesting due to its compact architecture and low requirement of conditions. Nevertheless, the primary information can hardly be recovered exactly in the real applications when considering the speckle noise and potential occlusion imposed on the ciphertext. To deal with this issue, the customized data container (CDC) into DIBE is introduced and a new phase retrieval algorithm (PRA) for plaintext retrieval is proposed. The PRA, designed according to the peculiarity of the CDC, combines two key techniques from previous approaches, i.e., input-support-constraint and median-filtering. The proposed scheme can guarantee totally the reconstruction of the primary information despite heavy noise or occlusion and its effectiveness and feasibility have been demonstrated with simulation results.

Improved methods for venous access: the Port-A-Cath, a totally implanted catheter system.

PubMed

Strum, S; McDermed, J; Korn, A; Joseph, C

1986-04-01

We prospectively evaluated the performance and rate of long-term complications with the Port-A-Cath (PAC), a totally implanted vascular access system. Two catheter styles were evaluated, a small-bore (SB) catheter (0.51-mm diameter) and a large-bore (LB) catheter (1.02-mm diameter), in conjunction with the use of a strict catheter care protocol. The PAC performed well, and with both SB and LB systems, no significant extravasation, skin necrosis, hematoma, septum damage or leakage, or subcutaneous portal infections occurred after 7,240 days of implantation and 1,435 days of use. Complications with the PAC system consisted of catheter occlusion (seven patients, 21.5%) and one instance of possible catheter infection (3.1%). Occlusions were limited to patients implanted with the SB catheter (seven of 16, 43.8%), and five of the seven (71.4%) occurred in patients receiving continuous infusion chemotherapy and/or total parenteral nutrition. Patency of the PAC system was maintained using a regular flushing schedule once every 30 days, a significant advantage compared with the daily maintenance schedule required with externally placed venous catheters. The results of this study suggest that the PAC system can provide a safe and reliable method for venous access in patients requiring intermittent or prolonged intravenous therapy.

Combined Central Retinal Vein and Branch Retinal Artery Occlusion Post Intense Physical Activity.

PubMed

Coca, Mircea; Tecle, Nahom; Amde, Wendewessen; Mehta, Ankur

2017-08-23

We report a case of combined central retinal vein occlusion and branch retinal artery occlusion. A previously healthy 47-year-old male presented with decreased vision in the right eye after completing a half marathon. A fundus exam and retinal imaging revealed a combined central retinal vein and branch retinal artery occlusion. In the present report, we review the literature and discuss the possible mechanisms behind combined retinal vessel occlusions. To our knowledge, this is the first reported case of combined central retinal vein occlusion and branch retinal artery occlusion following intense exercise.

Combined Central Retinal Vein and Branch Retinal Artery Occlusion Post Intense Physical Activity

PubMed Central

Tecle, Nahom; Amde, Wendewessen; Mehta, Ankur

2017-01-01

We report a case of combined central retinal vein occlusion and branch retinal artery occlusion. A previously healthy 47-year-old male presented with decreased vision in the right eye after completing a half marathon. A fundus exam and retinal imaging revealed a combined central retinal vein and branch retinal artery occlusion. In the present report, we review the literature and discuss the possible mechanisms behind combined retinal vessel occlusions. To our knowledge, this is the first reported case of combined central retinal vein occlusion and branch retinal artery occlusion following intense exercise. PMID:29067224

Evaluation of recovery in lip closing pressure and occlusal force and contact area after orthognathic surgery.

PubMed

Ueki, Koichiro; Moroi, Akinori; Sotobori, Megumi; Ishihara, Yuri; Marukawa, Kohei; Iguchi, Ran; Kosaka, Akihiko; Ikawa, Hiroumi; Nakazawa, Ryuichi; Higuchi, Masatoshi

2014-10-01

The purpose of this study was to evaluate the relationship between lip closing force, occlusal contact area and occlusal force after orthognathic surgery in skeletal Class III patients. The subjects consisted of 54 patients (28 female and 26 male) diagnosed with mandibular prognathism who underwent sagittal split ramus osteotomy with and without Le Fort I osteotomy. Maximum and minimum lip closing forces, occlusal contact area and occlusal force were measured pre-operatively, 6 months and 1 year post-operative. Maximum and minimum lip closing forces, occlusal contact area and occlusal force increased with time after surgery, however a significant increase was not found in the occlusal contact area in women. In increased ratio (6 months/pre-operative and 1 year/pre-operative), the maximum lip closing force was significantly correlated with the occlusal contact area (P < 0.0001). This study suggested that orthognathic surgery could improve the occlusal force, contact area and lip closing force, and an increase ratio in maximum lip closing force was associated with an increased ratio in occlusal contact area. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Use of the TriSpan Coil to Facilitate the Transcatheter Occlusion of Pulmonary Arteriovenous Malformation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cil, Barbaros E., E-mail: barbaroscil@hotmail.com, E-mail: barbaros@hacettepe.edu.tr; Erdogan, Cueneyt; Akmangit, Ilkay

Pulmonary arteriovenous malformation (PAVM) is a rare vascular malformation of the lung which may occur as an isolated entity or in association with hereditary hemorrhagic telangiectasia (HHT). Because of considerable risk of serious complications such as cerebral embolism, brain abscess and pulmonary hemorrhage, definitive treatment should be considered in most patients. Embolization with coils or detachable balloons is currently the preferred treatment. Paradoxical embolization of coils and balloons may happen, especially in patients with PAVMs with large feeding arteries. In this report we present our initial experience with the use of the TriSpan coil to lower the risk of coilmore » migration during the transcatheter occlusion of PAVMs.« less

Temporomandibular Disorders and Headache: A Retrospective Analysis of 1198 Patients

PubMed Central

Di Paolo, Carlo; D'Urso, Anna; Di Sabato, Francesco; Pompa, Giorgio

2017-01-01

Aim. Headache is one of the most common diseases associated with Temporomandibular Disorders (TMDs). The aim of this study was to evaluate, retrospectively, if headache influences TMD's symptoms. Material and Methods. A total sample of 1198 consecutive TMD patients was selected. After a neurological examination, a diagnosis of headache, according to the latest edition of the International Classification of Headache Disorders, was performed in 625 subjects. Patients were divided into two groups based on presence/absence of headache: Group with Headache (GwH) and Group without Headache (GwoH). Descriptive statistics and Chi-square index were performed. Results. Sociodemographic (gender, marital status, and occupation) and functional factors, occlusion (occlusal and skeletal classes, dental formula, and occlusal abnormalities), and familiar pain did not show a statistically significant correlation in either group. Intensity and frequency of neck pain, arthralgia of TMJ, and myalgia showed higher correlation values in GwH. Conclusion. This study is consistent with previous literature in showing a close relationship between headache and TMD. All data underlines that headache makes pain parameters more intense and frequent. Therefore, an early and multidisciplinary treatment of TMDs should be performed in order to avoid the overlay of painful events that could result in pain chronicity. PMID:28420942

Onyx 18 embolisation of dural arteriovenous fistula via arterial and venous pathways: preliminary experience and evaluation of the short-term outcomes

PubMed Central

Long, X-A; Karuna, T; Zhang, X; Luo, B; Duan, C-Z

2012-01-01

Objective This paper mainly focuses on our preliminary experience and short-term outcome evaluation of embolisation of non-cavernous dural arteriovenous fistulas (ncsDAVFs) and cavernous sinus dural arteriovenous fistulas (csDAVFs) using Onyx 18 (ev3, Plymouth, MN), and in combination with coils, via arterial and venous approaches, respectively. Methods Between August 2008 and March 2010, 21 DAVFs (11 ncsDAVFs and 10 csDAVFs; age range: 28–68 years; 12 females and 9 males) were undertaken. Borden classification showed Type III in 1 and Type II in 10 ncsDAVFs, and Type II in 4 and Type I in 6 csDAVFs. Onyx 18 was used in 11 ncsDAVFs (10 via single feeder and 1 via 2 feeders). Onyx 18 or in combination with coils was used in 10 csDAVFs (9 via the inferior petrosal sinus and 1 via the superior ophthalmic vein). Results Total occlusion in immediate angiography was achieved in 18 cases (85.7%; 10 ncsDAVFs and 8 csDAVFs), and near-total occlusion in 1 ncsDAVF and 2 csDAVFs. Onyx 18 was migrated into normal vasculature in two ncsDAVFs without any sequelae. One csDAVF had VI cranial nerve palsy post-operatively, which completely recovered 2 weeks post-embolisation. Follow-up angiography at 3–12 months showed complete occlusion in 20 cases (95.2%; 10 ncsDAVFs and 10 csDAVFs). One ncsDAVF (4.8%) recurred after 3 months and was successfully re-embolised. Conclusion Preliminary results achieved after embolising 11 ncsDAVFs and 10 csDAVFs using Onyx 18 and in combination with coils via arterial and venous pathways, respectively, appeared to be safe, feasible and effective, as 95.2% of cases were totally occluded without any clinical sequelae. PMID:22374275

Association of Stress Test Risk Classification With Health Status After Chronic Total Occlusion Angioplasty (from the Outcomes, Patient Health Status and Efficiency in Chronic Total Occlusion Hybrid Procedures [OPEN-CTO] Study).

PubMed

Salisbury, Adam C; Sapontis, James; Saxon, John T; Gosch, Kensey L; Lombardi, William L; Karmpaliotis, Dimitri; Moses, Jeffery W; Qintar, Mohammed; Kirtane, Ajay J; Spertus, John A; Cohen, David J; Grantham, J Aaron

2018-03-01

Stress testing is endorsed by the American College of Cardiology/American Heart Association Appropriate Use Criteria to identify appropriate candidates for Chronic Total Occlusion (CTO) Percutaneous Coronary Intervention (PCI). However, the relation between stress test risk classification and health status after CTO PCI is not known. We studied 449 patients in the 12-center OPEN CTO registry who underwent stress testing before successful CTO PCI, comparing outcomes of patients with low-risk (LR) versus intermediate to high-risk (IHR) findings. Health status was assessed using the Seattle Angina Questionnaire Angina Frequency (SAQ AF), Quality of Life (SAQ QoL), and Summary Scores (SAQ SS). Stress tests were LR in 40 (8.9%) and IHR in 409 (91.1%) patients. There were greater improvements on the SAQ AF (LR vs IHR 14.2 ± 2.7 vs 23.3 ± 1.3 points, p <0.001) and SAQ SS (LR vs IHR 20.8 ± 2.3 vs 25.4 ± 1.1 points, p = 0.03) in patients with IHR findings, but there was no difference between groups on the SAQ QoL domain (LR vs IHR 24.8 ± 3.4 vs 27.3 ± 1.6 points, p = 0.42). We observed large health status improvements after CTO PCI in both the LR and IHR groups, with the greatest reduction in angina among those with IHR stress tests. Although patients with higher risk studies may experience greater reduction in angina symptoms, on average, patients with LR stress tests also experienced large improvements in symptoms after CTO PCI, suggesting patients with refractory symptoms should be considered appropriate candidates for CTO PCI regardless of stress test findings. Copyright © 2017 Elsevier Inc. All rights reserved.

Percutaneous Coronary Revascularization for Chronic Total Occlusions: A Novel Predictive Score of Technical Failure Using Advanced Technologies.

PubMed

Galassi, Alfredo R; Boukhris, Marouane; Azzarelli, Salvatore; Castaing, Marine; Marzà, Francesco; Tomasello, Salvatore D

2016-05-09

The aims of this study were to describe the 10-year experience of a single operator dedicated to chronic total occlusion (CTO) and to establish a model for predicting technical failure. During the last decade, the interest in percutaneous coronary interventions (PCIs) of chronic total occlusions (CTOs) has increased, allowing the improvement of success rate. One thousand nineteen patients with CTO underwent 1,073 CTO procedures performed by a single CTO-dedicated operator. The study population was subdivided into 2 groups by time period: period 1 (January 2005 to December 2009, n = 378) and period 2 (January 2010 to December 2014, n = 641). Observations were randomly assigned to a derivation set and a validation set (in a 2:1 ratio). A prediction score was established by assigning points for each independent predictor of technical failure in the derivation set according to the beta coefficient and summing all points accrued. Lesions attempted in period 2 were more complex in comparison with those in period 1. Compared with period 1, both technical and clinical success rates significantly improved (from 87.8% to 94.4% [p = 0.001] and from 77.6% to 89.9% [p < 0.001], respectively). A prediction score for technical failure including age ≥75 years (1 point), ostial location (1 point), and collateral filling Rentrop grade <2 (2 points) was established, stratifying procedures into 4 difficulty groups: easy (0), intermediate (1), difficult (2), and very difficult (3 or 4), with decreasing technical success rates. In derivation and validation sets, areas under the curve were comparable (0.728 and 0.772, respectively). With growing expertise, the success rate has increased despite increasing complexity of attempted lesions. The established model predicted the probability of technical failure and thus might be applied to grading the difficulty of CTO procedures. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Technique Refinement and Validation of Variable Aortic Occlusion via Extracorporeal Flow Circuit in a Pig Model (Sus scrofa) of Uncontrolled Hemorrhage with Subsequent Resuscitation and Critical Care

DTIC Science & Technology

2016-07-24

60th Medical Group (AMC), Travis AFB, CA INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC) FINAL REPORT SUMMARY (Please type all information. Use...TRIENNIAL REVISION DATE: N/A FUNDING SOURCE: HQ USAF SG 1. RECORD OF ANIMAL USAGE: Animal Species: Total # Approved # Used this FY Total # Used to...Restraint Training: non-Live Animal Health Promotion Research: Survival (chronic) Prevention x_ Research: non-Survival (acute) Utilization Mgt. Other

Application of photogrammetry for analysis of occlusal contacts.

PubMed

Shigeta, Yuko; Hirabayashi, Rio; Ikawa, Tomoko; Kihara, Takuya; Ando, Eriko; Hirai, Shinya; Fukushima, Shunji; Ogawa, Takumi

2013-04-01

The conventional 2D-analysis methods for occlusal contacts provided limited information on tooth morphology. This present study aims to detect 3D positional information of occlusal contacts from 2D-photos via photogrammetry. We propose an image processing solution for analysis of occlusal contacts and facets via the black silicone method and a photogrammetric technique. The occlusal facets were reconstructed from a 2D-photograph data-set of inter-occlusal records into a 3D image via photogrammetry. The configuration of the occlusal surface was reproduced with polygons. In addition, the textures of the occlusal contacts were mapped to each polygon. DIFFERENCE FROM CONVENTIONAL METHODS: Constructing occlusal facets with 3D polygons from 2D-photos with photogrammetry was a defining characteristic of this image processing technique. It allowed us to better observe findings of the black silicone method. Compared with conventional 3D analysis using a 3D scanner, our 3D models did not reproduce the detail of the anatomical configuration. However, by merging the findings of the inter-occlusal record, the deformation of mandible and the displacement of periodontal ligaments under occlusal force were reflected in our model. EFFECT OR PERFORMANCE: Through the use of polygons in the conversion of 2D images to 3D images, we were able to define the relation between the location and direction of the occlusal contacts and facets, which was difficult to detect via conventional methods. Through our method of making a 3D polygon model, the findings of inter-occlusal records which reflected the jaw/teeth behavior under occlusal force could be observed 3-dimensionally. Copyright © 2012 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

The Attentional Demand of Automobile Driving Revisited: Occlusion Distance as a Function of Task-Relevant Event Density in Realistic Driving Scenarios.

PubMed

Kujala, Tuomo; Mäkelä, Jakke; Kotilainen, Ilkka; Tokkonen, Timo

2016-02-01

We studied the utility of occlusion distance as a function of task-relevant event density in realistic traffic scenarios with self-controlled speed. The visual occlusion technique is an established method for assessing visual demands of driving. However, occlusion time is not a highly informative measure of environmental task-relevant event density in self-paced driving scenarios because it partials out the effects of changes in driving speed. Self-determined occlusion times and distances of 97 drivers with varying backgrounds were analyzed in driving scenarios simulating real Finnish suburban and highway traffic environments with self-determined vehicle speed. Occlusion distances varied systematically with the expected environmental demands of the manipulated driving scenarios whereas the distributions of occlusion times remained more static across the scenarios. Systematic individual differences in the preferred occlusion distances were observed. More experienced drivers achieved better lane-keeping accuracy than inexperienced drivers with similar occlusion distances; however, driving experience was unexpectedly not a major factor for the preferred occlusion distances. Occlusion distance seems to be an informative measure for assessing task-relevant event density in realistic traffic scenarios with self-controlled speed. Occlusion time measures the visual demand of driving as the task-relevant event rate in time intervals, whereas occlusion distance measures the experienced task-relevant event density in distance intervals. The findings can be utilized in context-aware distraction mitigation systems, human-automated vehicle interaction, road speed prediction and design, as well as in the testing of visual in-vehicle tasks for inappropriate in-vehicle glancing behaviors in any dynamic traffic scenario for which appropriate individual occlusion distances can be defined. © 2015, Human Factors and Ergonomics Society.

Clinical Sequelae of Thrombus in an Inferior Vena Cava Filter

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ahmad, Iftikhar; Yeddula, Kalpana; Wicky, Stephan

The purpose of this study was to assess the long-term clinical sequelae of inferior vena cava (IVC) filter thrombus and the effect of anticoagulation on filter thrombus. Of 1,718 patients who had IVC filters placed during 2001-2008, 598 (34.8%) had follow-up abdominal CT. Filter thrombus was seen in 111 of the 598 (18.6%). There were 44 men (39.6%). The mean age at filter placement was 64 years. The medical diseases included cancer in 64, trauma in 15, stroke in 12, and others in 20. The frequency of filter thrombus on CT and asymptomatic filter thrombus on CT was calculated. Themore » frequency of pulmonary embolism (PE) in patients with filter thrombus was calculated. The frequency of thrombus progression or regression (on CT, available in 56) was calculated. The effect of anticoagulation on filter thrombus regression/progression was evaluated using the Fisher exact test by comparing the group of patients who received anticoagulants versus those who did not. A P-value of <0.05 was considered significant. The overall frequency of filter thrombus was 18.6%. Total occlusion of the IVC filter was seen in 12 of 598 (2%). The filter thrombus was asymptomatic in 110 (18.3%). Filter thrombus was detected after a median of 35 days (range, 0-2082) following filter placement. Thrombus extended above the filter in 4 (3.6%); IVC thrombus below the filter was seen in 35(31.5%). Thrombus in the filter occluded <25% of the filter volume in 58 (52.3%), 25-50% in 21 (18.9%), and 50-75% in 20 (18%). Total IVC occlusion was seen in 12 (10.8%). Eighty-three patients received anticoagulation. Sixteen patients developed symptoms of PE. PE was confirmed on CT in 3 of 15 (2.7%). On follow-up, filter thrombus regressed completely in 19 (33.9%) after a median of 6 months. Filter thrombus decreased in size in 13 (23.2%) and it progressed without IVC occlusion in 7 (12.6%). In one (1.7%), filter thrombus progressed to IVC occlusion. Filter thrombus remained stable in 16 (28.6%). There was no significant difference in thrombus regression or progression rates whether or not the patients received anticoagulation for filter thrombus. In conclusion, asymptomatic thrombus in the filter is common and it rarely progresses to complete caval occlusion. Anticoagulation has little effect on the resolution of filter thrombosis and future occurrence of PE.« less

Addressing challenges of clinical trials in acute pain: The Pain Management of Vaso-occlusive Crisis in Children and Young Adults with Sickle Cell Disease Study.

PubMed

Nottage, Kerri A; Hankins, Jane S; Faughnan, Lane G; James, Dustin M; Richardson, Julie; Christensen, Robbin; Kang, Guolian; Smeltzer, Matthew; Cancio, Maria I; Wang, Winfred C; Anghelescu, Doralina L

2016-08-01

Neuropathic pain is a known component of vaso-occlusive pain in sickle cell disease; however, drugs targeting neuropathic pain have not been studied in this population. Trials of acute pain are complicated by the need to obtain consent, to randomize participants expeditiously while optimally treating pain. We describe the challenges in designing and implementing the Pain Management of Vaso-occlusive Crisis in Children and Young Adults with Sickle Cell Disease Study (NCT01954927), a phase II, randomized, double-blind, placebo-controlled trial to determine the effect of gabapentin for vaso-occlusive crisis. In the Pain Management of Vaso-occlusive Crisis in Children and Young Adults with Sickle Cell Disease Study, we aim to assess the analgesic effect of gabapentin during vaso-occlusive crisis. Difficulties we identified included avoiding delay of notification of study staff of potential participants which we resolved by automated notification. Concern for rapid randomization and drug dispensation was addressed through careful planning with an investigational pharmacy and a single liquid formulation. We considered obtaining consent during well-visits to avoid the time constraints with acute presentations, but the large number of patients and limited duration that consent is valid made this impractical. In all, 79% of caregivers/children approached have agreed to participate. The trial is currently active, and enrollment is at 45.8% of that targeted (76 of 166) and expected to continue for two more years. Maintaining staff availability after-hours remains problematic, with 8% of screened patients missed for lack of available staff. Lessons learned in designing a trial to expedite procedures in the acute pain setting include (1) building study evaluations upon a standard-of-care backbone; (2) implementing a simple study design to facilitate consent and data capture; (3) assuring ample, well-trained study staff; and (4) utilizing technology to automate procedures whenever possible. This study design has circumvented many of the logistical barriers usually associated with acute pain trials and may serve as a prototype for future studies. © The Author(s) 2016.

Study of the occlusion effect induced by an earplug: Numerical modelling and experimental validation

NASA Astrophysics Data System (ADS)

Brummund, Martin

Despite existing limits for occupational noise exposure, professional hearing loss remains a high priority problem both in Quebec and worldwide. Several approaches exist to protect workers from harmful noise levels. The most frequently employed short term solution includes the distribution of hearing protection devices (HPD) such as earplugs and ear muffs. While HPDs offer an inexpensive (e.g. direct cost) and efficient means of protection workers often only tend to wear HPDs for limited amounts of time and, thus, remain at risk of developing professional hearing loss. Discomfort while using HPDs contributes to HPD underutilization and non-use. Two more general categories of discomfort can be distinguished. The category physical discomfort includes, for instance, problems such as heating of the ear and irritation of the ear canal that that occur upon earplug insertion. The category auditory discomfort refers to alterations in the auditory perception of sounds and one's own voice as well as hindered workplace communications. One important auditory discomfort that promotes HPD non-use is the occlusion effect. The occlusion effect occurs upon earplug insertion and describes sound amplification phenomena in the occluded ear canal at the low frequencies. The sound amplification is both perceivable and measurable (e.g., open and occluded sound pressure levels, hearing threshold shift). Additionally, the occlusion effect causes the HPD wearer to perceive his/her own voice as being distorted (e.g. hollow sounding) and physiological noises (e.g. respiration, blood circulation) are amplified also subsequent to earplug insertion. Reducing the occlusion effect has the potential to increase the auditory comfort of HPDs and could help preventing occupational hearing loss in the future. In order to improve this and other shortcomings observed with currently existing HPDs a large research collaboration between the Robert-Sauve research institute in occupational health and safety (IRSST) and the Ecole de technologie superieure (ETS) has been launched. The present study represents a part of this collaboration and aims at studying the occlusion effect of the system earplug - ear canal through the development of novel numerical models and experimental methods. (Abstract shortened by UMI.).

[Relationship between Occlusal Discomfort Syndrome and Occlusal Threshold].

PubMed

Munakata, Motohiro; Ono, Yumie; Hayama, Rika; Kataoka, Kanako; Ikuta, Ryuhei; Tamaki, Katsushi

2016-03-01

Occlusal dysesthesia has been defined as persistent uncomfortable feelings of intercuspal position continuing for more than 6 months without evidence of physical occlusal discrepancy. The problem often occurs after occlusal intervention by dental care. Although various dental treatments (e. g. occlusal adjustment, orthodontic treatment and prosthetic reconstruction) are attempted to solve occlusal dysesthesia, they rarely reach a satisfactory result, neither for patients nor dentists. In Japan, these symptoms are defined by the term "Occlusal discomfort syndrome" (ODS). The aim of this study was to investigate the characteristics of ODS with the simple occlusal sensory perceptive and discriminative test. Twenty-one female dental patients with ODS (mean age 55.8 ± 19.2 years) and 21 age- and gender-matched dental patients without ODS (mean age 53.1 ± 16.8 years) participated in the study. Upon grinding occlusal registration foils that were stacked to different thicknesses, participants reported the thicknesses at which they recognized the foils (recognition threshold) and felt discomfort (discomfort threshold). Although there was no significant difference in occlusal recognition thresholds between the two patient groups, the discomfort threshold was significantly smaller in the patients with ODS than in those without ODS. Moreover, the recognition threshold showed an age-dependent increase in patients without ODS, whereas it remained comparable between the younger (< 60 years old) and elderly (60 years old or more) patient subgroups with ODS. These results suggest that occlusal discomfort threshold rather than recognition threshold is an issue in ODS. The foil grinding procedure is a simple and useful method to evaluate occlusal perceptive and discriminative abilities in patients with ODS.

Contrast-Enhanced and Time-of-Flight MRA at 3T Compared with DSA for the Follow-Up of Intracranial Aneurysms Treated with the WEB Device.

PubMed

Timsit, C; Soize, S; Benaissa, A; Portefaix, C; Gauvrit, J-Y; Pierot, L

2016-09-01

Imaging follow-up at 3T of intracranial aneurysms treated with the WEB Device has not been evaluated yet. Our aim was to assess the diagnostic accuracy of 3D-time-of-flight MRA and contrast-enhanced MRA at 3T against DSA, as the criterion standard, for the follow-up of aneurysms treated with the Woven EndoBridge (WEB) system. From June 2011 to December 2014, patients treated with the WEB in our institution, then followed for ≥6 months after treatment by MRA at 3T (3D-TOF-MRA and contrast-enhanced MRA) and DSA within 48 hours were included. Aneurysm occlusion was assessed with a simplified 2-grade scale (adequate occlusion [total occlusion + neck remnant] versus aneurysm remnant). Interobserver and intermodality agreement was evaluated by calculating the linear weighted κ. MRA test characteristics and predictive values were calculated from a 2 × 2 contingency table, by using DSA data as the standard of reference. Twenty-six patients with 26 WEB-treated aneurysms were included. The interobserver reproducibility was good with DSA (κ = 0.71) and contrast-enhanced-MRA (κ = 0.65) compared with moderate with 3D-TOF-MRA (κ = 0.47). Intermodality agreement with DSA was fair with both contrast-enhanced MRA (κ = 0.36) and 3D-TOF-MRA (κ = 0.36) for the evaluation of total occlusion. For aneurysm remnant detection, the prevalence was low (15%), on the basis of DSA, and both MRA techniques showed low sensitivity (25%), high specificity (100%), very good positive predictive value (100%), and very good negative predictive value (88%). Despite acceptable interobserver reproducibility and predictive values, the low sensitivity of contrast-enhanced MRA and 3D-TOF-MRA for aneurysm remnant detection suggests that MRA is a useful screening procedure for WEB-treated aneurysms, but similar to stents and flow diverters, DSA remains the criterion standard for follow-up. © 2016 by American Journal of Neuroradiology.

Field and en route resuscitative endovascular occlusion of the aorta: A feasible military reality?

PubMed

Reva, Viktor A; Hörer, Tal M; Makhnovskiy, Andrey I; Sokhranov, Mikhail V; Samokhvalov, Igor M; DuBose, Joseph J

2017-07-01

Severe noncompressible torso hemorrhage remains a leading cause of potentially preventable death in modern military conflicts. Resuscitative endovascular occlusion of the aorta (REBOA) has demonstrated potential as an effective adjunct to the treatment of noncompressible torso hemorrhage in the civilian early hospital and even prehospital settings-but the application of this technology for military prehospital use has not been well described. We aimed to assess the feasibility of both field and en route prehospital REBOA in the military exercise setting, simulating a modern armed conflict. Two adult male Sus Scrofa underwent simulated junctional combat injury in the context of a planned military training exercise. Both underwent zone I REBOA in conjunction with standard tactical combat casualty care interventions-one during point of injury care and the other during en route flight care. Animals were sequentially evacuated to two separate forward surgical teams by rotary wing platform where the balloon position was confirmed by chest x-ray. Animals then underwent different damage control thoracic and abdominal procedures before euthanasia. The first swine underwent immediate successful REBOA at the point of injury 7 minutes and 30 seconds after the injury. It required 6 minutes total from initiation of procedure to effective aortic occlusion. Total occlusion time was 60 minutes. In the second animal, the REBOA placement procedure was initiated immediately after take off (17 minutes and 40 seconds after the injury). Although the movements and vibration of flight were not significant impediments, we only succeeded to put a 6-French (Fr) sheath into a femoral artery during the 14 minutes flight due to lighting and visualization challenges. After the sheath had been upsized in the forward surgical team, the REBOA catheter was primarily placed in zone I followed by its replacement to zone III. Both animals survived to study completion and the termination of training. No complications were observed in either animal. Our study demonstrates the potential feasibility of REBOA for use during tactical field and en route (flight) care of combat casualties. Further study is needed to determine the optimal training and utilization protocols required to facilitate the effective incorporation of REBOA into military prehospital care capabilities.

Experimental Evaluation of Early and Long-Term Effects of Microparticle Embolization in Two Different Mini-Pig Models. Part I: Kidney

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stampfl, S.; Stampfl, U.; Rehnitz, C.

Purpose. Using a pig model: (1) to evaluate the vascular distribution pattern, including the homogeneity and completeness of the intra-arterial microsphere distribution, of 40-120-{mu}m trisacryl-gelatin microspheres (Embospheres) in acute whole-kidney embolization; (2) to evaluate the durability and biocompatibility of 40-120-{mu}m trisacryl-gelatin microspheres (Embospheres) in chronic partial kidney embolization. Methods. Twenty-two animals were divided into four groups: group 1 (n = 4) underwent total arterial renal occlusion with immediate euthanasia. Groups 2-4 had chronic superselective and partial renal embolization with increasing follow-up times: group 2 (n = 2), 1 week; group 3 (n = 7), 4 weeks; and group 4 (nmore » = 9), 14 weeks. Key endpoints in group 1 were homogeneity and completeness of acute embolizations. In groups 2-4 the key endpoints were durability of embolization and particle-related inflammation in chronic partial embolizations as assessed by quantitative angiography or histomorphometry. A numerical angiographic occlusion score (0.0 to 4.0, where 3.0 is optimal) was developed to assess and quantify the angiographic durability of superselective embolizations (groups 2-4). Results. In group 1, a relatively homogeneous distribution of the particles from segmental arteries to the precapillary level was shown by histomorphometry. Some particles reached the glomerular vas afferens (10 {mu}m diameter). In groups 2-4, a mild recanalization appeared during follow-up. The immediate average postembolization occlusion score of 3.18 {+-} 0.73 was reduced to 1.44 {+-} 0.73 (statistically significant). Microscopy revealed subtotal necrosis but no foreign body granuloma formation. The intra-arterial appearance of giant cells closely attaching to the surface of the embolic spheres inside the vessel lumen was noted. Vessel walls showed major ischemic reactions. Conclusion. Microspheres 40-120 {mu}m in diameter might achieve total occlusion of the arterial kidney vasculature when injected centrally as a result of their fairly homogeneous distribution. Segmental renal infarction occurs after chronic partial embolization despite recanalizations during follow-up. Only mild specific intra-arterial foreign body reactions were found.« less

Extravasal occlusion of large vessels with titanic clips: efficiency, indications, and contraindications.

PubMed

Vasilenko, Yu V; Kim, A I; Kotov, S A

2002-11-01

The mechanism of extravasal occlusion of blood vessels with titanic clips "Atrauclip" and "Ligaclip extra" was studied in order to reveal indications and contraindications to their use. Occlusion with the clips of both types was ineffective in vessels with a diameter of >7.0 mm. Arteritis or the presence of an intravascular occlusion facility in the vessel were also the contraindications for clip occlusion. In overcases the procedure of occlusion with titanic clips was efficient and atraumatic.

Interventions for unilateral and bilateral refractive amblyopia.

PubMed

Taylor, Kate; Powell, Christine; Hatt, Sarah R; Stewart, Catherine

2012-04-18

Refractive amblyopia is a common cause of reduced visual acuity in childhood, but optimal treatment is not well defined. This review examined the treatment effect from spectacles and conventional occlusion. Evaluation of the evidence of the effectiveness of spectacles, occlusion or both in the treatment of unilateral and bilateral refractive amblyopia. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 1), MEDLINE (January 1950 to January 2012), EMBASE (January 1980 to January 2012), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to January 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 24 January 2012. We manually searched relevant conference proceedings. Randomised controlled trials of treatment for unilateral and bilateral refractive amblyopia by spectacles, with or without occlusion, were eligible. We included studies with participants of any age. Two authors independently assessed abstracts identified by the searches. We obtained full-text copies and contacted study authors where necessary. Eleven trials were eligible for inclusion. We extracted data from eight. Insufficient data were present for the remaining three trials so data extraction was not possible. We identified no trials as containing participants with bilateral amblyopia. We performed no meta-analysis as there were insufficient trials for each outcome. For all studies mean acuity (standard deviation (SD)) in the amblyopic eye post-treatment was reported. All included trials reported treatment for unilateral refractive amblyopia.One study randomised participants to spectacles only compared to no treatment, spectacles plus occlusion compared to no treatment and spectacles plus occlusion versus spectacles only. For spectacles only versus no treatment, mean (SD) visual acuity was: spectacles group 0.31 (0.17); no treatment group 0.42 (0.19) and mean difference (MD) between groups was -0.11 (borderline statistical significance: 95% confidence interval (CI) -0.22 to 0.00). For spectacles plus occlusion versus no treatment, mean (SD) visual acuity was: full treatment 0.22 (0.13); no treatment 0.42 (0.19). Mean difference (MD) between the groups -0.20 (statistically significant: 95% CI -0.30 to -0.10). For spectacles plus occlusion versus spectacles only, MD was -0.09 (borderline statistical significance 95% CI -0.18 to 0.00). For two other trials that also looked at this comparison MD was -0.15 (not statistically significant 95% CI -0.32 to 0.02) for one trial and MD 0.01 (not statistically significant 95% CI -0.08 to 0.10) for the second trial.Three trials reviewed occlusion regimes.One trial looked at two hours versus six hours for moderate amblyopia: MD 0.01 (not statistically significant: 95% CI -0.06 to 0.08); a second trial 2003b reviewed six hours versus full-time for severe amblyopia: MD 0.03 (not statistically significant: 95% CI -0.08 to 0.14) and a third trial looked at six hours versus full-time occlusion: MD -0.12 (not statistically significant: 95% CI -0.27 to 0.03). One trial looked at occlusion supplemented with near or distance activities: MD-0.03 (not statistically significant 95% CI -0.09 to 0.03). One trial looked at partial occlusion and glasses versus glasses only: MD -0.01 (not statistically significant: 95% CI -0.05 to 0.03). In some cases of unilateral refractive amblyopia it appears that there is a treatment benefit from refractive correction alone. Where amblyopia persists there is evidence that adding occlusion further improves vision. Despite advances in the understanding of the treatment of amblyopia it is currently still not possible to tailor individual treatment plans for amblyopia. The nature of any dose/response effect from occlusion still needs to be clarified. Partial occlusion appears to have the same treatment effect as glasses alone when started simultaneously for the treatment of unilateral refractive amblyopia. Treatment regimes for bilateral and unilateral refractive amblyopia need to be investigated further.

The use of a Colapinto TIPS Needle under cone-beam computed tomography guidance for true lumen re-entry in subintimal recanalization of chronic iliac artery occlusion.

PubMed

Liang, Huei-Lung; Li, Ming-Feng; Chiang, Chia-Ling; Chen, Matt Chiung-Yu; Wu, Chieh-Jen; Pan, Huay-Ben

2017-06-01

To report the technique and clinical outcome of subintimal re-entry in chronic iliac artery occlusion by using a Colapinto transjugular intrahepatic portosystemic shunt (TIPS) needle under rotational angiography (cone-beam computed tomography; CT) imaging guidance. Patients with chronic iliac artery occlusion with earlier failed attempts at conventional percutaneous recanalization during the past 5 years were enrolled in our study. In these patients, an ipsilateral femoral access route was routinely utilized in a retrograde fashion. A Colapinto TIPS Needle was used to aid the true lumen re-entry after failed conventional intraluminal or subintimal guidewire and catheter-based techniques. The puncture was directed under rotational angiography cone-beam CT guidance to re-enter the abdominal aorta. Bare metallic stents 8-10 mm in diameter were deployed in the common iliac artery, and followed by balloon dilation. Ten patients (9 male; median age, 75 years) were included in our investigation. The average occlusion length was 10.2 cm (range, 4-15 cm). According to the Trans-Atlantic Inter-Society Consensus (TASC) II classification, there were five patients each with Class B and D lesions. Successful re-entry was achieved in all patients without procedure-related complications. The ankle-brachial index (ABI) values increased from 0.38-0.79 to 0.75-1.28 after the procedure. Imaging follow-up (> 6 months) was available in six patients with patency of all stented iliac artery. Thereafter, no complaints of recurrent clinical symptoms occurred during the follow-up period. The use of Colapinto TIPS needle, especially under cone-beam CT image guidance, appears to be safe and effective to re-enter the true lumen in a subintimal angioplasty for a difficult chronic total iliac occlusion. Copyright © 2017. Published by Elsevier Taiwan LLC.

nNOS inhibition during profound asphyxia reduces seizure burden and improves survival of striatal phenotypic neurons in preterm fetal sheep.

PubMed

Drury, Paul P; Davidson, Joanne O; Mathai, Sam; van den Heuij, Lotte G; Ji, Haitao; Bennet, Laura; Tan, Sidhartha; Silverman, Richard B; Gunn, Alistair J

2014-08-01

Basal ganglia injury after hypoxia-ischemia remains common in preterm infants, and is closely associated with later cerebral palsy. In the present study we tested the hypothesis that a highly selective neuronal nitric oxide synthase (nNOS) inhibitor, JI-10, would improve survival of striatal phenotypic neurons after profound asphyxia, and that the subsequent seizure burden and recovery of EEG are associated with neural outcome. 24 chronically instrumented preterm fetal sheep were randomized to either JI-10 (3 ml of 0.022 mg/ml, n = 8) or saline (n = 8) infusion 15 min before 25 min complete umbilical cord occlusion, or saline plus sham-occlusion (n = 8). Umbilical cord occlusion was associated with reduced numbers of calbindin-28k-, GAD-, NPY-, PV-, Calretinin- and nNOS-positive striatal neurons (p < 0.05 vs. sham occlusion) but not ChAT-positive neurons. JI-10 was associated with increased numbers of calbindin-28k-, GAD-, nNOS-, NPY-, PV-, Calretinin- and ChAT-positive striatal neurons (p < 0.05 vs. saline + occlusion). Seizure burden was strongly associated with loss of calbindin-positive cells (p < 0.05), greater seizure amplitude was associated with loss of GAD-positive cells (p < 0.05), and with more activated microglia in the white matter tracts (p < 0.05). There was no relationship between EEG power after 7 days recovery and total striatal cell loss, but better survival of NPY-positive neurons was associated with lower EEG power. In summary, these findings suggest that selective nNOS inhibition during asphyxia is associated with protection of phenotypic striatal projection neurons and has potential to help reduce basal ganglia injury in some premature babies. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Field Assessment Stroke Triage for Emergency Destination (FAST-ED): a Simple and Accurate Pre-Hospital Scale to Detect Large Vessel Occlusion Strokes

PubMed Central

Lima, Fabricio O.; Silva, Gisele S.; Furie, Karen L.; Frankel, Michael R.; Lev, Michael H.; Camargo, Érica CS; Haussen, Diogo C.; Singhal, Aneesh B.; Koroshetz, Walter J.; Smith, Wade S.; Nogueira, Raul G.

2016-01-01

Background and Purpose Patients with large vessel occlusion strokes (LVOS) may be better served by direct transfer to endovascular capable centers avoiding hazardous delays between primary and comprehensive stroke centers. However, accurate stroke field triage remains challenging. We aimed to develop a simple field scale to identify LVOS. Methods The FAST-ED scale was based on items of the NIHSS with higher predictive value for LVOS and tested in the STOPStroke cohort, in which patients underwent CT angiography within the first 24 hours of stroke onset. LVOS were defined by total occlusions involving the intracranial-ICA, MCA-M1, MCA-2, or basilar arteries. Patients with partial, bi-hemispheric, and/or anterior + posterior circulation occlusions were excluded. Receiver operating characteristic (ROC) curve, sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of FAST-ED were compared with the NIHSS, Rapid Arterial oCclusion Evaluation (RACE) scale and Cincinnati Prehospital Stroke Severity Scale (CPSSS). Results LVO was detected in 240 of the 727 qualifying patients (33%). FAST-ED had comparable accuracy to predict LVO to the NIHSS and higher accuracy than RACE and CPSS (area under the ROC curve: FAST-ED=0.81 as reference; NIHSS=0.80, p=0.28; RACE=0.77, p=0.02; and CPSS=0.75, p=0.002). A FAST-ED ≥4 had sensitivity of 0.60, specificity 0.89, PPV 0.72, and NPV 0.82 versus RACE ≥5 of 0.55, 0.87, 0.68, 0.79 and CPSS ≥2 of 0.56, 0.85, 0.65, 0.78, respectively. Conclusions FAST-ED is a simple scale that if successfully validated in the field may be used by medical emergency professionals to identify LVOS in the pre-hospital setting enabling rapid triage of patients. PMID:27364531

[Treatment of amblyopia].

PubMed

von Noorden, G K

1990-01-01

Animal experiments have explored the structural and functional alterations of the afferent visual pathways in amblyopia and have emphasized the extraordinary sensitivity of the immature visual system to abnormal visual stimulation. The practical consequences of these experiments are obvious: early diagnosis of amblyopia and energetic occlusion therapy as early in life as possible. At the same time, measures must be taken to prevent visual deprivation amblyopia in the occluded eye. After successful treatment, alternating penalization with two pairs of spectacles is recommended. Pleoptics involves an enormous commitment in terms of time, personnel and costs. In view of the fact that the superiority of this treatment over occlusion therapy has yet to be proven, the current value of pleoptics appears dubious. Moreover, overtreated patients may end up with intractable diplopia. Diverging opinions exist with regard to the use of penalization as a primary treatment of amblyopia. We employ it only in special cases as an alternative to occlusion therapy. Visual deprivation in infancy caused by opacities of the ocular media, especially when they occur unilaterally, must be eliminated, and deprivation amblyopia must be treated without delay to regain useful vision. Brief periods of bilateral occlusion are recommended to avoid the highly amblyopiogenic imbalance between binocular afferent visual input. Future developments will hopefully include new objective methods to diagnose amblyopia in preverbal children and infants. The application of positron emission tomography is perhaps the first step in the direction of searching for new approaches to this problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Stent Graft in Managing Juxta-Renal Aortoiliac Occlusion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Prabhudesai, V., E-mail: v_prabhudesai@hotmail.com; Mitra, K.; West, D. J.

2003-09-15

Endovascular procedures are frequently used as an alternative to surgical bypass in aortic and iliac occlusion. Stents have revolutionized the scope of such endovascular procedures, but there are few reports of stents or stent grafts in occlusive juxta-renal aortic occlusion. We present a case where such occlusion was managed by use of a stent graft with successful outcome.

Occlusal contact of fixed implant prostheses using functional bite impression technique.

PubMed

Suzuki, Yasunori; Shimpo, Hidemasa; Ohkubo, Chikahiro

2015-02-01

Functional bite impression (FBI) has been described as a definitive impression made under occlusal force after functional generated path (FGP) recording. This study compared the accuracy of occlusal contact of implant-fixed prostheses using the FBI technique and the conventional impression technique. Twelve subjects, each missing a single premolar or molar, were selected for this study. The conditions of the occlusal contacts were identified by the modified transillumination method. The occlusal contact condition was determined by comparing the rate of change in the occlusal contact area of the implant-fixed prostheses and both adjacent teeth before and after occlusal adjustment. The rate of change in the occlusal contact area using the FBI technique was 96%, and the rate using the conventional technique was 54%. The occlusal contact of implant prostheses using the FBI technique revealed better accuracy than that of the conventional technique. Regarding the FBI technique, a precise and functional prosthesis could be produced by completing the maxillomandibular registration, impression, and FGP at the same time.

Reduction of deviation angle during occlusion therapy: in partially accommodative esotropia with moderate amblyopia.

PubMed

Chun, Bo Young; Kwon, Soon Jae; Chae, Sun Hwa; Kwon, Jung Yoon

2007-09-01

To evaluate changes in ocular alignment in partially accommodative esotropic children age ranged from 3 to 8 years during occlusion therapy for amblyopia. Angle measurements of twenty-two partially accommodative esotropic patients with moderate amblyopia were evaluated before and at 2 years after occlusion therapy. Mean deviation angle with glasses at the start of occlusion treatment was 19.45+/-5.97 PD and decreased to 12.14+/-12.96 PD at 2 years after occlusion therapy (p<0.01). After occlusion therapy, 9 (41%) cases were indications of surgery for residual deviation but if we had planned surgery before occlusion treatment, 18 (82%) of patients would have had surgery. There was a statistical relationship between increase of visual acuity ratio and decrease of deviation angle (r=-0.479, p=0.024). There was a significant reduction of deviation angle of partially accommodative esotropic patients at 2 years after occlusion therapy. Our results suggest that occlusion therapy has an influence on ocular alignment in partially accommodative esotropic patients with amblyopia.

Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study

ClinicalTrials.gov

2017-05-02

Glaucoma; Glaucoma Suspect; Diabetic Retinopathy; Ocular Hypertension; Cataract; Branch Retinal Vein Occlusion; Branch Retinal Arterial Occlusion; Central Retinal Vein Occlusion; Central Retinal Artery Occlusion; Epi-retinal Membrane; Macular Degeneration; Drusen; Loss of Vision

Liver size, bodyweight, and tolerance to acute complete occlusion of congenital extrahepatic portosystemic shunts in dogs.

PubMed

Doran, Ivan P; Barr, Frances J; Hotston Moore, Alasdair; Knowles, Toby G; Holt, Peter E

2008-10-01

To investigate the relationship between preoperative liver size, bodyweight, and tolerance to shunt occlusion in dogs with congenital extrahepatic portosystemic shunt(s) (CPSS). Longitudinal cohort study. Dogs with CPSS (n=35). Ultrasonography was used to measure preoperative maximum transverse dimension of the liver (TS) of each dog. Intraoperative portal pressures were measured, before and after CPSS occlusion, via a jejunal vein catheter. Tolerance to shunt occlusion was judged on gross visceral observations, and on changes in portal pressure, central venous and mean arterial pressures. TS was significantly related to bodyweight (P<.05). Mean ratios for TS/bodyweight were calculated for dogs tolerant and intolerant of acute complete shunt occlusion. Dogs tolerant to occlusion had significantly higher TS/bodyweight ratios than dogs intolerant to occlusion (P=.025). Dogs with a TS/bodyweight ratio of >7 were more likely to tolerate CPSS occlusion than dogs with a TS/bodyweight ratio of <5 (P=.036). A model was generated to predict portal pressure rise after shunt occlusion, based on liver dimensions and bodyweight (R=0.668). Intestinal oxygenation did not correlate significantly with tolerance to CPSS occlusion (P=.29). In dogs with CPSS, liver size (relative to bodyweight) is significantly greater (P=.025) in dogs that are tolerant of full ligation than intolerant of occlusion. Preoperative measurement of bodyweight and liver size help indicate the likelihood of tolerance to acute complete occlusion of CPSS in dogs.

Efficacy of Selective Grinding Guided by an Occlusal Splint in Management of Myofascial Pain: A Prospective Clinical Trial

PubMed Central

Fernández-González, Felipe J.; Cabero-López, Jorge; Brizuela, Aritza; Suazo, Ivan; Pérez-Pevida, Esteban; Cobo, Teresa; Montalban, Oier; Diéguez-Pereira, Markel; Chávarri-Prado, David; de la Pinta, Iker Bellanco; Jiménez-Garrudo, Antonio

2017-01-01

Background: For patients whose centric relation (CR) has not been considered at the start and during treatment, the task of achieving an occlusal scheme that works together with the temporomandibular joint, the muscles, and the structures of the stomatognathic apparatus becomes a major concern. Objective: This study aims to describe a reproducible, predictable and to date unreported procedure of selective grinding guided by an occlusal splint and to analyze condylar position (CP) based on the skeletal pattern. Methods: A total of 72 symptomatic patients (38 females and 34 males) were classified into three groups: hyperdivergent, intermediate and hypodivergent. CP was quantified by mounted casts on a measures condyle displacement (MCD) device. Helkimo index was also performed in order to assess the severity of the temporomandibular joint (TMJ) disorders attending to clinical dysfunction, occlusal state and anamnestic dysfunction. Once the stability had been obtained, the splint was progressively reduced until the maximum intercuspation (MIC) was achieved. Results: The vertical displacement was found to be significantly different between the hyperdivergent and other two groups (p<0.01). Comparisons of MCD analysis before and after the selective grinding procedure identified a statistically significant difference in the horizontal and vertical CP (p<0.01) between the different groups whereas the Helkimo Index showed a clear improvement of TMJ disorders. Conclusion: All facial types, specially the hyperdivergent face type, showed a reduction in condylar displacement (CD) and less craniomandibular symptoms using this procedure, making it an excellent technique for clinicians. PMID:28839479

The Fucosylation Inhibitor, 2-Fluorofucose, Inhibits Vaso-Occlusion, Leukocyte-Endothelium Interactions and NF-ĸB Activation in Transgenic Sickle Mice

PubMed Central

Belcher, John D.; Chen, Chunsheng; Nguyen, Julia; Abdulla, Fuad; Nguyen, Phong; Nguyen, Minh; Okeley, Nicole M.; Benjamin, Dennis R.; Senter, Peter D.; Vercellotti, Gregory M.

2015-01-01

2-Fluorofucose (2FF) blocks the fucosylation and the tethering of sialyl-Lewisx tetrasaccharide and structural variants on leukocytes and red blood cells to P- and E-selectins on activated endothelial cell surfaces. Because P- and E-selectin are required for vaso-occlusion in murine sickle cell disease (SCD), we investigated whether 2FF would inhibit vaso-occlusion in SCD mice. Microvascular stasis was measured in subcutaneous venules in NY1DD and HbSS-Townes SCD mice with dorsal skin-fold chambers after infusion of hemoglobin or exposure to hypoxia/reoxygenation. 2FF in drinking water or administered by gavage inhibited stasis in sickle mice in a dose-responsive manner. Significant inhibitory effects on stasis were seen 1 day post-treatment. 2FF treatment of SCD mice also significantly reduced leukocyte rolling and adhesion along the vessel walls of SCD mice and the static adhesion of neutrophils and sickle red blood cells isolated from 2FF-treated SCD mice to resting and activated endothelial cells. Total white blood cell counts increased in response to 2FF. NF-ĸB activation and VCAM-1 and E-selectin expression were inhibited in the livers of SCD mice consistent with an overall decrease in vascular inflammation and ischemia-reperfusion physiology. Pretreatment with 2FF completely eliminated heme-induced lethality in HbSS-Townes mice, consistent with the observed anti-inflammatory and anti-adhesive properties of 2FF in SCD mice. These data suggest that 2FF may be beneficial for preventing or treating vaso-occlusive crises in SCD patients. PMID:25706118

Intracranial aneurysms: optimized diagnostic tools call for thorough interdisciplinary treatment strategies.

PubMed

Mueller, Oliver M; Schlamann, Marc; Mueller, Daniela; Sandalcioglu, I Erol; Forsting, Michael; Sure, Ulrich

2011-09-01

Intracranial aneurysms (IAs) require deliberately selected treatment strategies as they are incrementally found prior to rupture and deleterious subarachnoid haemorrhage (SAH). Multiple and recurrent aneurysms necessitate both neurointerventionalists and neurosurgeons to optimize aneurysmal occlusion in an interdisciplinary effort. The present study was conducted to condense essential strategies from a single neurovascular centre with regard to the lessons learned. Medical charts of 321 consecutive patients treated for IAs at our centre from September 2008 until December 2010 were retrospectively analysed for clinical presentation of the aneurysms, multiplicity and treatment pathways. In addition, a selective Medline search was performed. A total of 321 patients with 492 aneurysms underwent occlusion of their symptomatic aneurysm: 132 (41.1%) individuals were treated surgically, 189 (58.2%) interventionally; 138 patients presented with a SAH, of these 44.2% were clipped and 55.8% were coiled. Aneurysms of the middle cerebral artery were primarily occluded surgically (88), whereas most of the aneurysms of the internal carotid artery and anterior communicating artery (114) were treated endovascularly. Multiple aneurysms (range 2-5 aneurysms/individual) were diagnosed in 98 patients (30.2%). During the study period 12 patients with recurrent aneurysms were allocated to another treatment modality (previously clip to coil and vice versa). Our data show that successful interdisciplinary occlusion of IAs is based on both neurosurgical and neurointerventional therapy. In particular, multiple and recurrent aneurysms require tailored individual approaches to aneurysmal occlusion. This is achieved by a consequent interdisciplinary pondering of the optimal strategy to occlude IAs in order to prevent SAH.

Curative embolization of pediatric intracranial arteriovenous malformations using Onyx: the role of new embolization techniques on patient outcomes.

PubMed

de Castro-Afonso, L H; Nakiri, G S; Oliveira, R S; Santos, M V; Santos, A C Dos; Machado, H R; Abud, D G

2016-06-01

Intracranial arteriovenous malformations (AVMs) are the most frequent cause of hemorrhagic strokes in the pediatric population. The study aim was to retrospectively assess the safety and efficacy of Onyx embolization with the intention to cure AVMs in a pediatric population. A retrospective analysis of all patients (<18 years) who underwent endovascular embolization using Onyx at our institution was conducted. The primary endpoint was the composite complete angiographic occlusion of AVM immediately after the last embolization session that had no procedure-related complication requiring emergency surgery. Secondary endpoints were angiographic occlusion rates, procedure-related complications, and clinical outcomes after treatment and at the 6-month follow-up Twenty-three patients (mean age, 11.7 years) underwent a total of 45 embolization sessions. The median Spetzler-Martin grade was 3 (range 1 to 4). The primary endpoint was achieved in 19 patients (82.6 %). Complete angiographic occlusion of the AVM was obtained in 21 patients (91.3 %) immediately after embolization and at the 6-month follow-up. Embolization-related complications were observed in three patients (13 %). None of the complications resulted in permanent functional disability or death. In two patients (8.7 %), the AVM could not be completely occluded by embolization alone and the patients were referred to radiosurgery and microsurgery, respectively. Onyx embolization of AVM in pediatric patients with the intention to cure resulted in high occlusion rates without increasing neurological disability or death. The development of new embolization techniques and devices seems to improve the safety of Onyx embolization.

Central retinal artery occlusion - rethinking retinal survival time.

PubMed

Tobalem, Stephan; Schutz, James S; Chronopoulos, Argyrios

2018-04-18

The critical time from onset of complete occlusion of the central retinal artery (CRA) to functionally significant inner retinal infarction represents a window of opportunity for treatment and also has medical-legal implications, particularly when central retinal artery occlusion (CRAO) complicates therapeutic interventions. Here, we review the evidence for time to infarction from complete CRAO and discuss the implications of our findings. A Medline search was performed using each of the terms "central retinal artery occlusion", "retinal infarction", "retinal ischemia", and "cherry red spot" from 1970 to the present including articles in French and German. All retrieved references as well as their reference lists were screened for relevance. An Internet search using these terms was also performed to look for additional references. We find that the experimental evidence showing that inner retinal infarction occurs after 90-240 min of total CRAO, which is the interval generally accepted in the medical literature and practice guidelines, is flawed in important ways. Moreover, the retinal ganglion cells, supplied by the CRA, are part of the central nervous system which undergoes infarction after non-perfusion of 12-15 min or less. Retinal infarction is most likely to occur after only 12-15 min of complete CRAO. This helps to explain why therapeutic maneuvers for CRAO are often ineffective. Nevertheless, many CRAOs are incomplete and may benefit from therapy after longer intervals. To try to avoid retinal infarcton from inadvertent ocular compression by a headrest during prone anesthesia, the eyes should be checked at intervals of less than 15'.

Immediate Flow Disruption as a Prognostic Factor After Flow Diverter Treatment: Long-Term Experience with the Pipeline Embolization Device.

PubMed

Dodier, Philippe; Frischer, Josa M; Wang, Wei-Te; Auzinger, Thomas; Mallouhi, Ammar; Serles, Wolfgang; Gruber, Andreas; Knosp, Engelbert; Bavinzski, Gerhard

2018-05-01

To report long-term results after Pipeline Embolization Device (PED) implantation, characterize complex and standard aneurysms comprehensively, and introduce a modified flow disruption scale. We retrospectively reviewed a consecutive series of 40 patients harboring 59 aneurysms treated with 54 PEDs. Aneurysm complexity was assessed using our proposed classification. Immediate angiographic results were analyzed using previously published grading scales and our novel flow disruption scale. According to our new definition, 46 (78%) aneurysms were classified as complex. Most PED interventions were performed in the paraophthalmic and cavernous internal carotid artery segments. Excellent neurologic outcome (modified Rankin Scale 0 and 1) was observed in 94% of patients. Our data showed low permanent procedure-related mortality (0%) and morbidity (3%) rates. Long-term angiographic follow-up showed complete occlusion in 81% and near-total obliteration in a further 14%. Complete obliteration after deployment of a single PED was achieved in all standard aneurysms with 1-year follow-up. Our new scale was an independent predictor of aneurysm occlusion in a multivariable analysis. All aneurysms with a high flow disruption grade showed complete occlusion at follow-up regardless of PED number or aneurysm complexity. Treatment with the PED should be recognized as a primary management strategy for a highly selected cohort with predominantly complex intracranial aneurysms. We further show that a priori assessment of aneurysm complexity and our new postinterventional angiographic flow disruption scale predict occlusion probability and may help to determine the adequate number of per-aneurysm devices. Copyright © 2018 Elsevier Inc. All rights reserved.

Accuracy of contacts calculated from 3D images of occlusal surfaces.

PubMed

DeLong, R; Knorr, S; Anderson, G C; Hodges, J; Pintado, M R

2007-06-01

Compare occlusal contacts calculated from 3D virtual models created from clinical records to contacts identified clinically using shimstock and transillumination. Upper and lower full arch alginate impressions and vinyl polysiloxane centric interocclusal records were made of 12 subjects. Stone casts made from the alginate impressions and the interocclusal records were optically scanned. Three-dimensional virtual models of the dental arches and interocclusal records were constructed using the Virtual Dental Patient Software. Contacts calculated from the virtual interocclusal records and from the aligned upper and lower virtual arch models were compared to those identified clinically using 0.01mm shimstock and transillumination of the interocclusal record. Virtual contacts and transillumination contacts were compared by anatomical region and by contacting tooth pairs to shimstock contacts. Because there is no accepted standard for identifying occlusal contacts, methods were compared in pairs with one labeled "standard" and the second labeled "test". Accuracy was defined as the number of contacts and non-contacts of the "test" that were in agreement with the "standard" divided by the total number of contacts and non-contacts of the "standard". Accuracy of occlusal contacts calculated from virtual interocclusal records and aligned virtual casts compared to transillumination were: 0.87+/-0.05 and 0.84+/-0.06 by region and 0.95+/-0.07 and 0.95+/-0.05 by tooth, respectively. Comparisons with shimstock were: 0.85+/-0.15 (record), 0.84+/-0.14 (casts), and 81+/-17 (transillumination). The virtual record, aligned virtual arches, and transillumination methods of identifying contacts are equivalent, and show better agreement with each other than with the shimstock method.

The prevalence of carotid artery stenosis in patients undergoing aortic reconstruction.

PubMed

Cahan, M A; Killewich, L A; Kolodner, L; Powell, C C; Metz, M; Sawyer, R; Lilly, M P; Benjamin, M E; Flinn, W R

1999-09-01

Coronary artery disease occurs frequently in patients undergoing aortic reconstruction, and it has been presumed that internal carotid artery occlusive disease is also common. This has led to the practice of screening for and repairing significant carotid lesions in asymptomatic patients prior to aortic reconstruction. The purpose of this study was to determine the true prevalence of internal carotid artery disease in these patients. The records of 240 patients who underwent duplex ultrasound screening for carotid artery disease prior to aortic reconstruction were reviewed. Surgery was performed for aortic aneurysm (AA) or aorto-iliac occlusive disease (AO). The prevalence of hyperlipidemia and coronary artery disease was similar between the two groups, but tobacco use, hypertension, and diabetes mellitus differed. Internal carotid artery stenosis > or = 50% occurred in 26.7% of the total group (64 of 240 cases). Stenosis > or = 50% was more common in the AO group (40 of 101 cases, 39.6%) than the AA group (24 of 139 cases, 17.3%, P = 0.0001). Severe disease (70% to 99%) was also more common in the AO group than the AA group (9.9% versus 3.6%, P = 0.0464). Internal carotid artery disease occurs commonly in patients undergoing aortic reconstruction, and screening is worthwhile. Significant disease is more common in patients with aorto-iliac occlusive disease than in those with aortic aneurysm, although atherosclerotic risk factors occur with varying frequency in the two groups. These findings suggest that additional factors may contribute to the higher prevalence of internal carotid artery stenosis in aorto-iliac occlusive disease.

Efficacy of biofeedback therapy via a mini wireless device on sleep bruxism contrasted with occlusal splint: a pilot study

PubMed Central

Gu, WeiPing; Yang, Jie; Zhang, FeiMin; Yin, XinMin; Wei, XiaoLong; Wang, Chen

2015-01-01

Abstract The putative causes of bruxism are multifactorial and there are no definite measures for bruxism management. The aim of this study was to evaluate the efficacy of biofeedback therapy on sleep bruxism, compared with occlusal splint. Twenty-four volunteers with sleep bruxism were divided into two groups: the GTB group that were treated with biofeedback therapy (n  = 12) and the GTO group that were treated with occlusal splint (n  = 12). A mini pressure sensor integrated with a monitoring circuit by use of a maxillary biofeedback splint was fabricated. To foster the relaxation of the masticatory muscles and the nervous system, the wireless device received signals from bruxism events and vibrations alerted the bruxer when the threshold was exceeded. Total episodes and average duration of bruxism events during 8 hours of sleep were analyzed with the monitoring program (TRMY1.0). After 6 and 12 weeks, the episodes (P  =  0.001) and duration (P < 0.05) in the GTB group declined dramatically. In contrast, there were no significant differences in the GTO group after the treatment (P > 0.05). Furthermore, the episodes had significant differences between the GTB group and the GTO group after the same period of treatment (P  =  0.000). The results suggest that biofeedback therapy may be an effective and convenient measure for mild bruxers, when compared with occlusal splint therapy. The mini wireless biofeedback method may be of value for the diagnosis and management of bruxism in the future. PMID:25859272

Controlled assessment of the efficacy of occlusal stabilization splints on sleep bruxism.

PubMed

van der Zaag, Jacques; Lobbezoo, Frank; Wicks, Darrel J; Visscher, Corine M; Hamburger, Hans L; Naeije, Machiel

2005-01-01

To assess the efficacy of occlusal stabilization splints in the management of sleep bruxism (SB) in a double-blind, parallel, controlled, randomized clinical trial. Twenty-one participants were randomly assigned to an occlusal splint group (n = 11; mean age = 34.2 +/- 13.1 years) or a palatal splint (ie, an acrylic palatal coverage) group (n = 10; mean age = 34.9 +/- 11.2 years). Two polysomnographic recordings that included bilateral masseter electromyographic activity were made: one prior to treatment, the other after a treatment period of 4 weeks. The number of bruxism episodes per hour of sleep (Epi/h), the number of bursts per hour (Bur/h), and the bruxism time index (ie, the percentage of total sleep time spent bruxing) were established as outcome variables at a 10% maximum voluntary contraction threshold level. A general linear model was used to test both the effects between splint groups and within the treatment phase as well as their interaction for each outcome variable. Neither occlusal stabilization splints nor palatal splints had an influence on the SB outcome variables or on the sleep variables measured on a group level. In individual cases, variable outcomes were found: Some patients had an increase (33% to 48% of the cases), while others showed no change (33% to 48%) or a decrease (19% to 29%) in SB outcome variables. The absence of significant group effects of splints in the management of SB indicates that caution is required when splints are indicated, apart from their role in the protection against dental wear. The application of splints should therefore be considered at the individual patient level.

[Evaluation of agreement and correlation of three occlusal indices in an assessment of orthodontic treatment need].

PubMed

Djordjević, Jelena; Sćepan, Ivana; Glisić, Branislav

2011-02-01

Occlusal indices are quantitative diagnostic indicators of malocclusion severity, orthodontic treatment need, complexity and outcome. The aim of this study was to determine correlations and agreement among three occlusal indices: the Index of Orthodontic Treatment Need (IOTN), the Peer Assessment Rating Index (PAR) and the Index of Complexity, Outcome and Need (ICON) in evaluating orthodontic treatment need. A total eighty study models of patients referred to the Department of Orthodontics, School of Dentistry, Belgrade, were assessed in this retrospective study. Malocclusions of various types and severity in the permanent dentition were included. The Aesthetic and the Dental Health Component of IOTN determined orthodontic treatment need in 25% and 51% of the patients, respectively. PAR determined orthodontic treatment need in 59% and ICON in 53% of patients. The Aesthetic Component of IOTN and ICON had the highest correlation (Spearman's correlation coefficient 0.95, p < 0.01). Correlations between indices were 0.44 to 0.61 with statistical significance (p < 0.01). The agreement between indices, calculated using Kappa statistics, was 0.22 to 0.63. The most critical in malocclusion assessment was PAR. The Aesthetic Component of IOTN and ICON correlated highly (p < 0.01). Correlations between other pairs of indices were moderate (p < 0.01). The Aesthetic Component of IOTN and ICON had substantial agreement, whereas agreement between other indices was fair or moderate. ICON could replace PAR and IOTN. Application of occlusal indices enables objective evaluation of orthodontic treatment need and easier determination of the treatment priorities.

Occlusion-amblyopia following high dose oral levodopa combined with part time patching

PubMed Central

Kothari, Mihir

2014-01-01

Part time occlusion therapy is not reported to cause occlusion (reverse) amblyopia. However, when combined with high dose oral levodopa, an increase in the plasticity of the visual cortex can lead to occlusion amblyopia. In this case report, we describe a six year old child who developed occlusion amblyopia following part time patching combined with oral levodopa. PMID:23571255

Occlusion-amblyopia following high dose oral levodopa combined with part time patching.

PubMed

Kothari, Mihir

2014-12-01

Part time occlusion therapy is not reported to cause occlusion (reverse) amblyopia. However, when combined with high dose oral levodopa, an increase in the plasticity of the visual cortex can lead to occlusion amblyopia. In this case report, we describe a six year old child who developed occlusion amblyopia following part time patching combined with oral levodopa.

Acute stroke with major intracranial vessel occlusion: Characteristics of cardioembolism and atherosclerosis-related in situ stenosis/occlusion.

PubMed

Horie, Nobutaka; Tateishi, Yohei; Morikawa, Minoru; Morofuji, Yoichi; Hayashi, Kentaro; Izumo, Tsuyoshi; Tsujino, Akira; Nagata, Izumi; Matsuo, Takayuki

2016-10-01

Acute ischemic stroke with major intracranial vessel occlusion is commonly due to cardioembolic or atherosclerosis-related in situ stenosis/occlusion, and immediate identification of these subtypes is important to establish the optimal treatment strategy. The aim of this study was to clarify the differences in clinical presentation, radiological findings, neurological temporal courses, and outcomes between these etiologies, which have not been fully evaluated. Consecutive emergency patients with acute ischemic stroke were retrospectively reviewed. Among them, patients with stroke with major intracranial vessel occlusion were analyzed with a focus on clinical and radiological findings, and a comparison was performed for those with cardioembolic or atherosclerosis-related in situ stenosis/occlusion. Of 1053 patients, 80 had stroke with acute major intracranial vessel occlusion (45 with cardioembolic and 35 with atherosclerosis-related in situ stenosis/occlusion). Interestingly, the susceptibility vessel sign (SVS) on T2-weighted MR angiography was more frequently detected in cardioembolic stroke (80.0%) than in atherosclerosis (in situ stenosis: 5.9%, chronic occlusion: 14.3%). Moreover, the proximal intra-arterial signal (IAS) on arterial spin labeling MRI and the distal IAS on fluid attenuated inversion recovery MRI was less frequently detected in chronic occlusion (27.3% and 50.0%, respectively) than in acute occlusion due to cardioembolic or in situ stenosis. Multivariate regression analysis showed that the SVS was significantly related to cardioembolism (adjusted odds ratio (OR): 21.68, P=0.004). Clinical characteristics of acute stroke with major intracranial vessel occlusion differ depending on the etiology. The SVS and proximal/distal IAS on MRI are useful to distinguish between cardioembolic and atherosclerotic-related in situ stenosis/occlusion. Copyright © 2016 Elsevier Ltd. All rights reserved.

Influence of the fast-processing technique on the number of the occlusal contacts and occlusal vertical dimension of complete dentures.

PubMed

Atashrazm, Parsa; Alavijeh, Leila Zamani; Afshar, Maryam Sadat Sadrzadeh

2011-03-01

Occlusal errors during acryl processing affect the retention and stability of complete dentures. The aim of the present study was to assess the influence of a short curing technique on the number of occlusal contacts and the occlusal vertical dimension (OVD) of complete dentures. Complete dentures were prepared. The number of occlusal contacts was recorded in centric relation (CR) using 60 µ articulation paper. The OVD was recorded with the waxed trial denture in place. Dentures were then invested and processed with compression molding and short cure water bath technique. The number of occlusal contacts was recorded again. The amount of pin opening was measured for all of the complete dentures on the articulator. Data were analyzed with paired t-test to determine the alterations. The mean number of occlusal contacts before and after processing was 10.9 ± 2.4 and 6.3 ± 3.1 respectively (4.7 ± 1.9 decrease; p < 0.001). A 2 mm mean increase in OVD was observed in 47.7% of the dentures with < 6 occlusal contact changes and 88.9% of the dentures with ≥ 6 occlusal contact changes (p < 0.003). A significant change in the number of occlusal contacts was associated with an OVD increased up to two times. The short curing technique seems to be related to the decreased occlusal contacts and increased OVD. CLINICAL SIGNIFICANCES: More time is needed to adjust the occlusal errors of this method, because it has a negative effect on the morphologic pattern of artificial teeth of complete dentures and thus should be used carefully.

Risk Factors for Vascular Occlusive Events and Death Due to Bleeding in Trauma Patients; an Analysis of the CRASH-2 Cohort

PubMed Central

Pealing, Louise; Perel, Pablo; Prieto-Merino, David; Roberts, Ian

2012-01-01

Background Vascular occlusive events can complicate recovery following trauma. We examined risk factors for venous and arterial vascular occlusive events in trauma patients and the extent to which the risk of vascular occlusive events varies with the severity of bleeding. Methods and Findings We conducted a cohort analysis using data from a large international, double-blind, randomised, placebo-controlled trial (The CRASH-2 trial) [1]. We studied the association between patient demographic and physiological parameters at hospital admission and the risk of vascular occlusive events. To assess the extent to which risk of vascular occlusive events varies with severity of bleeding, we constructed a prognostic model for the risk of death due to bleeding and assessed the relationship between risk of death due to bleeding and risk of vascular occlusive events. There were 20,127 trauma patients with outcome data including 204 (1.01%) patients with a venous event (pulmonary embolism or deep vein thrombosis) and 200 (0.99%) with an arterial event (myocardial infarction or stroke). There were 81 deaths due to vascular occlusive events. Increasing age, decreasing systolic blood pressure, increased respiratory rates, longer central capillary refill times, higher heart rates and lower Glasgow Coma Scores (all p<0.02) were strong risk factors for venous and arterial vascular occlusive events. Patients with more severe bleeding as assessed by predicted risk of haemorrhage death had a greatly increased risk for all types of vascular occlusive event (all p<0.001). Conclusions Patients with severe traumatic bleeding are at greatly increased risk of venous and arterial vascular occlusive events. Older age and blunt trauma are also risk factors for vascular occlusive events. Effective treatment of bleeding may reduce venous and arterial vascular occlusive complications in trauma patients. PMID:23251374

On the relevance of "ideal" occlusion concepts for incisor inclination target definition.

PubMed

Knösel, Michael; Jung, Klaus

2011-11-01

The concept of "ideal" occlusion in harmony with craniofacial structures is often proposed as an ultimate goal of orthodontic treatment. The aim of this study was to assess the impact of slight variations in posterior occlusion and the history of straight-wire orthodontic treatment on the predictability of incisor inclination and third-order angles. Axial incisor inclinations, third-order angles, and craniofacial relationships were assessed on lateral headfilms and corresponding dental casts of 75 healthy white subjects, 16 to 26 years old, selected by the general inclusion criterion of a good interincisal relationship. Four groups were formed: group A (n = 17), Angle Class I occlusion subjects with no orthodontic treatment; group B (n = 20), Angle Class I occlusion subjects treated with standardized straight-wire orthodontics; group C (n = 20), up to a half-cusp distal occlusion after straight-wire treatment; and group D (n = 18), up to a half-cusp distal occlusion and no orthodontic treatment. Regression analysis was used to insert predictor angles into selected regression equations of the subjects with "ideal" occlusion, and the absolute differences between predicted and observed response angles were determined. Small differences in incisor inclination were found between subjects with "ideal" occlusion and those who slightly deviated from "ideal" with a mild occlusion of the Angle Class II category. Posterior occlusion was not relevant to the validity of the vast majority of predictor-response pairs. Straight-wire treatment produced incisor inclination that was slightly protruded compared with subjects who had good natural occlusion. The "ideal" posterior occlusion concepts as a general orthodontic treatment goal should be reconsidered. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Central venous recanalization in patients with short gut syndrome: restoration of candidacy for intestinal and multivisceral transplantation.

PubMed

Lang, Elvira V; Reyes, Jorge; Faintuch, Salomao; Smith, Amy; Abu-Elmagd, Kareem

2005-09-01

To assess feasibility and success of venous recanalization in patients with short gut syndrome who have lost their traditional central venous access and required intestinal or multivisceral transplantation. Twelve patients between the ages of 7 and 55 years with short gut syndrome and long-standing total parenteral nutrition (TPN) dependency and/or hypercoagulability were treated. All had extensive chronic central venous occlusions and survival was dependent on restoration of access and planned transplantation. Central venous recanalizations were obtained via sharp needle recanalization techniques, venous reconstructions with stents, and/or extraanatomic access to the central venous system for placement of central venous tunneled catheters. Central venous access was restored in all patients without operative-related mortality. Three major hemodynamic perioperative technical complications were recorded and successfully treated. There were three self-limited early infectious complications. With a mean follow-up of 22 months, eight of the 12 patients were alive with successful small bowel or multivisceral transplantation; six of those became independent of TPN. The remaining four patients died of complications related to TPN (n = 3) or transplantation (n = 1). With a mean follow-up of 20 months, all but two of the recanalized venous accesses were maintained, for a success rate of 83%. Recanalizations of extensive chronic vein occlusions are feasible but associated with high risk. The technique is life-saving for TPN-dependent patients and can restore candidacy for intestinal and multivisceral transplantation. This approach is likely to be increasingly requested because of the current clinical availability of the transplant procedure.

Clinical outcomes in middle cerebral artery trunk occlusions versus secondary division occlusions after mechanical thrombectomy: pooled analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI trials.

PubMed

Shi, Zhong-Song; Loh, Yince; Walker, Gary; Duckwiler, Gary R

2010-05-01

The benefit of endovascular revascularization of patients with acute ischemic stroke with middle cerebral artery (MCA) secondary division (M2) occlusions as compared with MCA trunk (M1) occlusions is not known. In this analysis, we compared revascularization status and clinical outcomes in patients with angiographically confirmed MCA M1 versus isolated M2 occlusions treated with mechanical thrombectomy using the Merci Retriever devices. We retrospectively analyzed the pooled data of patients with MCA strokes from the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI trials. Patient data were dichotomized into 2 groups: MCA M1 occlusions and isolated M2 occlusions. Baseline characteristics, revascularization rates, hemorrhage rates, complications, outcomes, and mortality were evaluated for both groups. Of 178 patients with MCA occlusion treated in the MERCI and Multi MERCI trials, 84.3% had M1 lesions and 15.7% had isolated M2 lesions. Patients with isolated M2 occlusions were revascularized at a higher rate, required a lower mean number of passes, and were associated with a trend toward shorter mean procedure time than patients with M1 occlusions. No statistically significant differences were found between M2 and M1 groups for symptomatic hemorrhage, clinically significant procedural adverse events, favorable 90-day outcome, or 90-day mortality, although in all instances, the M2 outcomes were numerically better than those in M1 subjects. In multivariate analysis, final revascularization was the strongest independent predictor of good outcome at 90 days. Patients with both MCA M1 occlusions and isolated M2 occlusions can achieve a relatively high rate of revascularization and favorable clinical outcomes after mechanical thrombectomy. In fact, patients with isolated M2 occlusions had a higher rate of revascularization, required fewer passes, and had no increased complications compared with patients with M1 occlusions.

Long-term follow-up of aneurysms treated electively with woven stent-assisted coiling.

PubMed

Cheung, Nicholas K; Chiu, Albert Hy; Cheung, Andrew K; Wenderoth, Jason D

2017-12-15

Preliminary short-term results for stent-assisted coil embolization (SACE) using woven/braided stents have been promising. However, evidence supporting mid- to long-term efficacy and durability is lacking. To report the long-term results for the durability of elective intracranial aneurysms treated with woven stents. Between May 2012 and May 2015, 98 consecutive patients with 103 aneurysms underwent elective woven SACE across three Australian neurovascular centres. All patients had immediate, 6- and 18-month clinical and radiological follow-up. Radiological assessment was performed with modified Raymond-Roy occlusion scores based on angiography results, while clinical assessment was based on the modified Rankin Scale. Six-month follow-up was available in 100 aneurysms, and an 18-month follow-up in 97 aneurysms. Total occlusion rates of 82% were achieved at inception, 82% at 6 months, and 90% at 18 months. Satisfactory occlusion with small neck remnants was present in 17% at inception, 16% at 6 months, and 9% at 18 months. Good neurological outcomes were achieved in 95% at 18 months. Intraprocedural thromboembolic events were recorded in 3% and delayed events in 1% (all in patients taking clopidogrel). Aneurysm recurrence occurred in one patient (1%). Technical complications occurred in 5%. The total complication rate was 10%. Woven SACE is safe, efficacious, and durable at long-term 18-month follow-up, with very low recurrence and re-treatment rates. Preliminary results appear better than those for traditional laser-cut stents. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Maximum occlusal force and physical performance in the oldest old: the Tokyo oldest old survey on total health.

PubMed

Iinuma, Toshimitsu; Arai, Yasumichi; Fukumoto, Motoko; Takayama, Michiyo; Abe, Yukiko; Asakura, Keiko; Nishiwaki, Yuji; Takebayashi, Toru; Iwase, Takashi; Komiyama, Kazuo; Gionhaku, Nobuhito; Hirose, Nobuyoshi

2012-01-01

To elucidate the independent relationship between masticatory and physical performance in community-living oldest old people (mean age ± standard deviation 87.8 ± 2.2, range 85-102). Cross-sectional analysis. University research center or home-based examination. Four hundred eighty-nine community-living individuals (219 men, 270 women) aged 85 and older. Maximum occlusal force (MOF) was measured using an occlusal force measuring device. Sociodemographic and functional factors, oral health, comorbidities, blood chemistry, lower extremity performance, and handgrip strength were assessed. Blood chemistry analyses included serum albumin, C-reactive protein, interleukin (IL)-6, and total and free testosterone. MOF was significantly associated with age, body mass index, and cognitive impairment in men but not in women. Comorbidities and blood chemistry were not associated with MOF except for a significant association with IL-6 concentration in women. In a multivariate model adjusted for various confounders, lower MOF was associated with greater risk for poor performance on the timed up and go (TUG) test in men and women (men: odds ratio (OR)=2.34, 95% confidence interval (CI)=1.02-5.38; women: OR=2.44, 95% CI=1.12-5.33). MOF was similarly associated with performance in chair standing, one-leg standing, and handgrip strength only in men. These associations remained after adjustment for number of natural teeth. MOF was strongly and independently associated with all measures of physical performance in men and with the TUG test in women after adjustment for various confounders, suggesting that age-related declines in masticatory and skeletal muscle functions share common mechanistic pathways in older age, particularly in men. © 2011, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.

Validation of On-Orbit Methodology for the Assessment of Cardiac Function and Changes in the Circulating Volume Using "Braslet-M" Occlusion Cuffs

NASA Technical Reports Server (NTRS)

Hamilton, D. R.; Sargsyan, A. E.; Garcia, K. M.; Ebert, D.; Feiveson, A. H.; Alferova, I. V.; Dulchavsky, S. A.; Matveev, V. P.; Bogomolov, V. V.; Duncan, J. M.

2011-01-01

BACKGROUND: The transition to microgravity eliminates the hydrostatic gradients in the vascular system. The resulting fluid redistribution commonly manifests as facial edema, engorgement of the external neck veins, nasal congestion, and headache. This experiment examined the responses to modified Valsalva and Mueller maneuvers as measured by cardiac and vascular ultrasound in a baseline microgravity steady state, and under the influence of thigh occlusion cuffs (Braslet cuffs). METHODS: Nine International Space Station crewmember subjects (Expeditions 16 - 20) were examined in 15 experiment sessions 101 46 days after launch (mean SD; 33 - 185). 27 cardiac and vascular parameters were obtained under three respiratory conditions (baseline, Valsalva, and Mueller) before and after tightening of the Braslet cuffs for a total of 162 data points per session. The quality of cardiac and vascular ultrasound examinations was assured through remote monitoring and guidance by Investigators from the NASA Telescience Center in Houston, TX, USA. RESULTS: Fourteen of the 81 measured conditions were significantly different with Braslet application and were apparently related to cardiac preload reduction or increase in the venous volume sequestered in the lower extremity. These changes represented 10 of the 27 parameters measured. In secondary analysis, 7 of the 27 parameters were found to respond differently to respiratory maneuvers depending on the presence or absence of thigh compression, with a total of 11 differences. CONCLUSIONS: Acute application of Braslet occlusion cuffs causes lower extremity fluid sequestration and exerts proportionate measurable effects on cardiac performance in microgravity. Ultrasound techniques measuring the hemodynamic effects of thigh cuffs in combination with respiratory maneuvers may serve as an effective tool in determining the volume status of a cardiac or hemodynamically compromised patient in microgravity.

Morphometric analysis of molars in a Middle Pleistocene population shows a mosaic of 'modern' and Neanderthal features.

PubMed

Martinón-Torres, María; Spěváčková, Petra; Gracia-Téllez, Ana; Martínez, Ignacio; Bruner, Emiliano; Arsuaga, Juan Luis; Bermúdez de Castro, José María

2013-10-01

Previous studies of upper first molar (M1) crown shape have shown significant differences between Homo sapiens and Homo neanderthalensis that were already present in the European Middle Pleistocene populations, including the large dental sample from Atapuerca-Sima de los Huesos (SH). Analysis of other M1 features such as the total crown base area, cusp proportions, cusp angles and occlusal polygon have confirmed the differences between both lineages, becoming a useful tool for the taxonomic assignment of isolated teeth from Late Pleistocene sites. However, until now the pattern of expression of these variables has not been known for the SH sample. This fossil sample, the largest collection from the European Middle Pleistocene, is generally interpreted as being from the direct ancestors of Neanderthals, and thus is a reference sample for assessing the origin of the Neanderthal morphologies. Surprisingly, our study reveals that SH M(1) s present a unique mosaic of H. neanderthalensis and H. sapiens features. Regarding the cusp angles and the relative occlusal polygon area, SH matches the H. neanderthalensis pattern. However, regarding the total crown base area and relative cusps size, SH M(1) s are similar to H. sapiens, with a small crown area, a strong hypocone reduction and a protocone enlargement, although the protocone expansion in SH is significantly larger than in any other group studied. The SH dental sample calls into question the uniqueness of some so-called modern traits. Our study also sounds a note of caution on the use of M(1) occlusal morphology for the alpha taxonomy of isolated M(1) s. © 2013 Anatomical Society.

Long-term outcomes after re-entry device use for recanalization of common iliac artery chronic total occlusions.

PubMed

Kokkinidis, Damianos G; Alvandi, Bejan; Cotter, Ryan; Hossain, Prio; Foley, T Raymond; Singh, Gagan D; Waldo, Stephen W; Laird, John R; Armstrong, Ehrin J

2018-03-09

To examine the impact of re-entry device (RED) use on 1- and 5-year outcomes after endovascular treatment of common iliac artery (CIA) chronic total Occlusions (CTOs). There are not enough data regarding the long-term safety and efficacy of RED. We performed a two-center retrospective study of 115 patients (140 lesions) undergoing CIA CTO endovascular intervention between 2006 and 2016. Baseline characteristics and long-term outcomes were described. A Cox proportional hazard model was developed to determine if REDs were associated with target lesion revascularization (TLR) or major adverse limb events (MALE) after 1 and 5 years. Among 140 lesions, 43 (31%) required use of a RED. The mean age was 63.9 years and the majority (n = 80) of patients were male. An antegrade crossing approach and treatment of restenotic lesions were less common in the RED group (10% vs. 29%, P < .05 and 0% vs. 21%, P < .05, respectively). There were no significant differences in Rutherford class, pre-procedure ABI, or patient presentation. The procedural complication rates were similar between the two groups. The 1- and 5-year TLR rates for lesions treated with re-entry device vs. standard approaches were 11% vs. 9%; P = 0.8 and 29% vs. 29%; P = 0.9 respectively. The 1 and 5-year MALE rates for lesions treated with re-entry device were 5% vs. 6%; P = 0.8 and 11% vs. 11%; P = 0.9 respectively. This retrospective analysis found that recanalization of CIA occlusions using a RED is safe and is associated with long-term clinical outcomes similar to that of standard crossing techniques. © 2018 Wiley Periodicals, Inc.

Comparison of Recanalization and In-Stent Stenosis Between the Low-Profile Visualized Intraluminal Support Stent and Enterprise Stent-Assisted Coiling for 254 Intracranial Aneurysms.

PubMed

Feng, Xin; Qian, Zenghui; Liu, Peng; Zhang, Baorui; Wang, Luyao; Guo, Erkang; Wen, Xiaolong; Xu, Wenjuan; Jiang, Chuhan; Wu, Zhongxue; Li, Youxiang; Liu, Aihua

2018-01-01

To compare the rates of recanalization and in-stent stenosis between the Enterprise (EP) and low-profile visualized intraluminal support (LVIS) stent deployments for intracranial aneurysms (IAs), and the factors associated therein. Between June 2014 and July 2016, 142 patients with a total of 161 IAs were treated by LVIS stent-assisted coiling and 111 patients with a total of 142 IAs were treated by EP stent-assisted coiling at our institution. Procedure-related complications, angiographic follow-up results, and clinical outcomes were analyzed statistically. The rates of initially complete and near-complete IA occlusion immediately after the procedure were similar in the LVIS and EP groups (94.3% vs. 89.9%; P = 0.275). On follow-up, complete and near-complete occlusion rates and recanalization rates were also similar in the 2 groups (96.6% vs. 92.1%; P =0.330 and 8.0% vs. 13.5%; P = 0.245, respectively). On logistic regression analysis, a higher size ratio (SR) was significantly associated with the recanalization of aneurysms in the EP group, but not in the LVIS group. The rate of moderate to severe in-stent stenosis was lower in the LVIS group (10.2%) than in the EP group (16.8%), but the difference was not statistically significant (P = 0.198). Our data show acceptable rates of complete and near-complete occlusion with both the LVIS and EP stents. LVIS stents were associated with lower rates of recanalization and in-stent stenosis, but the difference was not significant. Higher SR (≥2) was a significant predictor of recanalization in IAs treated with EP stents, but not in those treated with LVIS stents. Copyright © 2017. Published by Elsevier Inc.

Risk factors for central venous catheter thrombotic complications in children and adolescents with cancer.

PubMed

Revel-Vilk, S; Yacobovich, J; Tamary, H; Goldstein, G; Nemet, S; Weintraub, M; Paltiel, O; Kenet, G

2010-09-01

The use of central venous catheters (CVCs) has greatly improved the quality of care in children with cancer, yet these catheters may cause serious infectious and thrombotic complications. The aim of this prospective registry study was to assess the host and CVC-related risk factors for CVC-created thrombotic complications. Patients undergoing CVC insertion for chemotherapy were followed prospectively for CVC complications. At the time of enrollment, demographic, clinical, and CVC-related data, and family history of thrombosis were collected. Survival and Cox regression analyses were performed. A total of 423 CVCs were inserted into 262 patients for a total of 76,540 catheter days. The incidence of CVC-related deep-vein thrombosis (DVT) was 0.13 per 1000 catheter-days (95% confidence interval [CI], 0.06-0.24). Insertion of peripherally inserted central catheters (PICCs) and insertion in an angiography suite significantly increased the risk of symptomatic CVC-related DVT. The incidence of CVC occlusion was 1.35 per 1000 catheter-days (95% CI, 1.1-1.63). Positive family history of thrombosis significantly increased the risk of CVC occlusion (hazard ratio [HR], 2.16; 95% CI, 1.2-3.8). The CVC-related risk factors were insertion of Hickman catheters, insertion in angiography suite, and proximal-tip location. Patients developing at least 1 episode of both CVC occlusion and infection had an increased risk for developing symptomatic CVC-related DVT (HR, 4.15; 95% CI, 1.2-14.4). Both patient-related and CVC-related factors are associated with higher risk of symptomatic thrombotic complications. These risk factors could be used in the clinical setting and in developing future studies for CVC thromboprophylaxis.

Post-thrombotic syndrome after central venous catheter removal in childhood cancer survivors: A prospective cohort study.

PubMed

Polen, E; Weintraub, M; Stoffer, C; Jaffe, D H; Burger, A; Revel-Vilk, S

2015-02-01

Although the use of central venous catheters (CVCs) has greatly improved the quality of care of children with cancer, these catheters increase the risk of deep vein thrombosis (DVT) and the potential long-term complication of post-thrombotic syndrome (PTS). We aimed to study PTS post-CVC removal using physical, functional and health related quality of life (HRQoL) domains in childhood cancer and bone marrow transplantation (BMT) survivors. We conducted a prospective study in a cohort of childhood cancer and BMT survivors post-CVC use. Participants were evaluated for PTS with the Modified Villalta Score (MVS) and the Manco-Johnson Instrument (MJI). HRQoL was assessed using the PedsQL™ questionnaire. A total of 158 children were enrolled at a median of 41 (4-149) months from CVC removal. Signs and symptoms of PTS were present in 34% (95% confidence interval [CI] 27-43%) (MVS criteria) and 30.5% (95% CI 23.1-37.8%) (MJI criteria). Diagnosis of PTS was associated with history of CVC occlusion, history of CVC-related DVT and the use of ≥2 CVCs. The presence of signs and symptoms of PTS was a predictor for low HRQoL tested by the PedsQL™ Total Scale scores and Physical Health Summary scores. PTS post-CVC removal in pediatric cancer survivors is not a rare event. The association between PTS and the history of CVC occlusion confirms earlier findings, and suggests that CVC occlusion may indicate asymptomatic DVT. PTS is also associated with lower HRQoL scores highlighting the need to study preventive measures, especially for high risk groups. Pediatr Blood Cancer 2015;62:285-290. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

Guidewire and microcatheter utilization patterns during antegrade wire escalation in chronic total occlusion percutaneous coronary intervention: Insights from a contemporary multicenter registry.

PubMed

Karatasakis, Aris; Tarar, Muhammad Nauman J; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Yeh, Robert W; Jaffer, Farouc A; Wyman, R Michael; Lombardi, William L; Grantham, J Aaron; Kandzari, David E; Lembo, Nicholas J; Moses, Jeffrey W; Kirtane, Ajay J; Parikh, Manish; Garcia, Santiago; Doing, Anthony; Pershad, Ashish; Shah, Alpesh; Patel, Mitul; Bahadorani, John; Shoultz, Charles A; Danek, Barbara A; Thompson, Craig A; Banerjee, Subhash; Brilakis, Emmanouil S

2017-03-01

We sought to describe contemporary guidewire and microcatheter utilization for antegrade wire escalation (AWE) during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Equipment utilization for AWE has been variable and evolving over time. We examined device utilization during 694 AWE attempts in 679 patients performed at 15 experienced US centers between May 2012 and April 2015. Mean age was 65.6 ± 9.7 years, and 85% of the patients were men. Successful wiring occurred in 436 AWE attempts (63%). Final technical and procedural success was 91% and 89%, respectively. The mean number of guidewire types used for AWE was 2.2 ± 1.4. The most frequently used guidewire types were the Pilot 200 (Abbott Vascular, 56% of AWE procedures), Fielder XT (Asahi Intecc, 45%), and the Confianza Pro 12 (Asahi Intecc, 28%). The same guidewires were the ones that most commonly crossed the occlusion: Pilot 200 (36% of successful AWE crossings), Fielder XT (20%), and Confianza Pro 12 (11%). A microcatheter or over-the-wire balloon was used for 81% of AWE attempts; the Corsair microcatheter (Asahi Intecc) was the most commonly used (44%). No significant association was found between guidewire type and incidence of major adverse cardiac events (MACE). Our contemporary, multicenter CTO PCI registry demonstrates that the most commonly used wires for AWE are polymer-jacketed guidewires. "Stiff" and polymer-jacketed guidewires appear to provide high crossing rates without an increase in MACE or perforation, and may thus be considered for upfront use. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions.

PubMed

Werner, Gerald S; Martin-Yuste, Victoria; Hildick-Smith, David; Boudou, Nicolas; Sianos, Georgios; Gelev, Valery; Rumoroso, Jose Ramon; Erglis, Andrejs; Christiansen, Evald Høj; Escaned, Javier; di Mario, Carlo; Hovasse, Thomas; Teruel, Luis; Bufe, Alexander; Lauer, Bernward; Bogaerts, Kris; Goicolea, Javier; Spratt, James C; Gershlick, Anthony H; Galassi, Alfredo R; Louvard, Yves

2018-05-02

The clinical value of percutaneous coronary intervention (PCI) for chronic coronary total occlusions (CTOs) is not established by randomized trials. This study should compare the benefit of PCI vs. optimal medical therapy (OMT) on the health status in patients with at least one CTO. Three hundred and ninety-six patients were enrolled in a prospective randomized, multicentre, open-label, and controlled clinical trial to compare the treatment by PCI with OMT with a 2:1 randomization ratio. The primary endpoint was the change in health status assessed by the Seattle angina questionnaire (SAQ) between baseline and 12 months follow-up. Fifty-two percent of patients have multi-vessel disease in whom all significant non-occlusive lesions were treated before randomization. An intention-to-treat analysis was performed including 13.4% failed procedures in the PCI group and 7.3% cross-overs in the OMT group. At 12 months, a greater improvement of SAQ subscales was observed with PCI as compared with OMT for angina frequency [5.23, 95% confidence interval (CI) 1.75; 8.71; P = 0.003], and quality of life (6.62, 95% CI 1.78-11.46; P = 0.007), reaching the prespecified significance level of 0.01 for the primary endpoint. Physical limitation (P = 0.02) was also improved in the PCI group. Complete freedom from angina was more frequent with PCI 71.6% than OMT 57.8% (P = 0.008). There was no periprocedural death or myocardial infarction. At 12 months, major adverse cardiac events were comparable between the two groups. Percutaneous coronary intervention leads to a significant improvement of the health status in patients with stable angina and a CTO as compared with OMT alone. NCT01760083.

Blood flow vs. venous pressure effects on filtration coefficient in oleic acid-injured lung.

PubMed

Anglade, D; Corboz, M; Menaouar, A; Parker, J C; Sanou, S; Bayat, S; Benchetrit, G; Grimbert, F A

1998-03-01

On the basis of changes in capillary filtration coefficient (Kfc) in 24 rabbit lungs, we determined whether elevations in pulmonary venous pressure (Ppv) or blood flow (BF) produced differences in filtration surface area in oleic acid-injured (OA) or control (Con) lungs. Lungs were cyclically ventilated and perfused under zone 3 conditions by using blood and 5% albumin with no pharmacological modulation of vascular tone. Pulmonary arterial, venous, and capillary pressures were measured by using arterial, venous, and double occlusion. Before and during each Kfc-measurement maneuver, microvascular/total vascular compliance was measured by using venous occlusion. Kfc was measured before and 30 min after injury, by using a Ppv elevation of 7 cmH2O or a BF elevation from 1 to 2 l . min-1 . 100 g-1 to obtain a similar double occlusion pressure. Pulmonary arterial pressure increased more with BF than with Ppv in both Con and OA lungs [29 +/- 2 vs. 19 +/- 0.7 (means +/- SE) cmH2O; P < 0. 001]. In OA lungs compared with Con lungs, values of Kfc (200 +/- 40 vs. 83 +/- 14%, respectively; P < 0.01) and microvascular/total vascular compliance ratio (86 +/- 4 vs. 68 +/- 5%, respectively; P < 0.01) increased more with BF than with Ppv. In conclusion, for a given OA-induced increase in hydraulic conductivity, BF elevation increased filtration surface area more than did Ppv elevation. The steep pulmonary pressure profile induced by increased BF could result in the recruitment of injured capillaries and could also shift downstream the compression point of blind (zone 1) and open injured vessels (zone 2).

Usefulness of a collateral channel dilator for antegrade treatment of chronic total occlusion of a coronary artery.

PubMed

Obata, Jyun-Ei; Nakamura, Takamitsu; Kitta, Yoshinobu; Saito, Yukio; Sano, Keita; Fujioka, Daisuke; Kawabata, Ken-Ichi; Kugiyama, Kiyotaka

2012-12-01

 The aim of this study was to clarify the effectiveness of a collateral channel dilator microcatheter in antegrade percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of a coronary artery.  The Corsair microcatheter, which was originally developed as a collateral channel dilator, has been reported to be useful for retrograde CTO-PCI.  We compared the success rate of the Corsair microcatheter collateral channel dilator for antegrade CTO-PCI with a previously available microcatheter. We analyzed the data from 27 patients (32 CTOs) using the FinecrossMG (Finecross group) and the data from 31 patients (34 CTOs) using the Corsair (Corsair group).  There were no significant differences in the clinical or lesion characteristics between the 2 groups. The success rate for crossing the CTO by the microcatheter was 62.5% in the Finecross group and 85.3% in the Corsair group (P < 0.05). After the Corsair crossed the CTO, a 2-mm diameter balloon catheter crossed the lesion in all the cases, but it crossed the lesion in only 17 of 20 cases in the Finecross group (85.0%, P < 0.05). The number of balloon catheters used for predilation was significantly less in the Corsair group compared with the Finecross group (P < 0.05).  The success rate for crossing of the microcatheters and the balloon catheters through the occlusion in antegrade CTO-PCI was better with the Corsair than with the FinecrossMG. In addition, the use of the Corsair reduced the number of balloon catheters used for predilation in antegrade CTO-PCI. ©2012, Wiley Periodicals, Inc.

Morphometric analysis of molars in a Middle Pleistocene population shows a mosaic of ‘modern’ and Neanderthal features

PubMed Central

Martinón-Torres, María; Spěváčková, Petra; Gracia-Téllez, Ana; Martínez, Ignacio; Bruner, Emiliano; Arsuaga, Juan Luis; Bermúdez de Castro, José María

2013-01-01

Previous studies of upper first molar (M1) crown shape have shown significant differences between Homo sapiens and Homo neanderthalensis that were already present in the European Middle Pleistocene populations, including the large dental sample from Atapuerca-Sima de los Huesos (SH). Analysis of other M1 features such as the total crown base area, cusp proportions, cusp angles and occlusal polygon have confirmed the differences between both lineages, becoming a useful tool for the taxonomic assignment of isolated teeth from Late Pleistocene sites. However, until now the pattern of expression of these variables has not been known for the SH sample. This fossil sample, the largest collection from the European Middle Pleistocene, is generally interpreted as being from the direct ancestors of Neanderthals, and thus is a reference sample for assessing the origin of the Neanderthal morphologies. Surprisingly, our study reveals that SH M1s present a unique mosaic of H. neanderthalensis and H. sapiens features. Regarding the cusp angles and the relative occlusal polygon area, SH matches the H. neanderthalensis pattern. However, regarding the total crown base area and relative cusps size, SH M1s are similar to H. sapiens, with a small crown area, a strong hypocone reduction and a protocone enlargement, although the protocone expansion in SH is significantly larger than in any other group studied. The SH dental sample calls into question the uniqueness of some so-called modern traits. Our study also sounds a note of caution on the use of M1 occlusal morphology for the alpha taxonomy of isolated M1s. PMID:23914934

Plasma Omentin-1 Level as a Predictor of Good Coronary Collateral Circulation

PubMed Central

Zhou, Ji-Peng; Tong, Xiao-Yu; Zhu, Ling-Ping; Luo, Jing-Min; Luo, Ying; Bai, Yong-Ping

2017-01-01

Aims: Coronary collateral circulation (CCC) is crucial during an acute ischemic attack. Evidences showed that omentin-1 exhibited remarkable antiatherogenic effects and ischemia-induced revascularization. The aim of this study was to investigate the relationship between plasma omentin-1 levels and CCC in patients with ≥ 90% angiography-proven coronary occlusion. Methods: 142 patients with ≥ 90% luminal diameter stenosis in at least one major epicardial coronary artery were recruited. Among them, 79 patients with Rentrop 0–1 grade were classified into the poor CCC group and 63 patients with Rentrop 2–3 grade were included into the good CCC group. The association between plasma omentin-1 levels and CCC status was assessed. Results: Plasma omentin-1 level was significantly higher in patients with good CCC than those with poor CCC (566.57 ± 26.90 vs. 492.38 ± 19.70 ng/mL, p = 0.024). Besides, omentin-1 was positively correlated with total cholesterol (TC), high-density lipoprotein, and gensini score but inversely with hyperlipidemia and body mass index (all p values < 0.05). Multivariate regression analysis indicated that omentin-1 [odds ratio (OR) = 1.002, 95% confidence interval (CI): 1.000 – 1.004, p = 0.041)], TC, the number of the diseased vessels, a higher frequency of left circumflex artery and right coronary artery, chronic total occlusion, and gensini score remained as the independent predictors of good CCC. Conclusion: Higher plasma omentin-1 level was associated with better CCC development. Our findings suggest that omentin-1 may be an alternative marker for adequate CCC in patients with ≥ 90% coronary occlusion. PMID:28123148

There's an app for that: A handheld smartphone-based infrared imaging device to assess adequacy and level of aortic occlusion during REBOA.

PubMed

Sokol, Kyle K; Black, George E; Willey, Sandra B; Kniery, Kevin; Marko, Shannon T; Eckert, Matthew J; Martin, Matthew J

2017-01-01

Advances in thermal imaging devices have made them an appealing noninvasive point-of-care imaging adjunct in the trauma setting. We sought to assess whether a smartphone-based infrared imaging device (SBIR) could determine presence and location of aortic occlusion in a swine model. We hypothesized that various levels of aortic occlusion would transmit significantly different heat signatures at various anatomical points. Six swine (35-50 kg) underwent sequential zone 1 (Z1) aortic cross clamping as well as zone 3 (Z3) aortic balloon occlusion (resuscitative endovascular balloon occlusion of the aorta [REBOA]). SBIR images and readings (FLIR One) were taken at five anatomic points (axilla [A], subcostal [S], umbilical [U], inguinal [I], medial malleolar [M]) and were used to determine significant thermal trends 5 minutes to 10 minutes after Z1 and Z3 occlusion. Significant (p ≤ 0.05) thermal ratio patterns were identified and compared among groups, and images were reviewed for obvious qualitative differences at the various levels of occlusion. Body temperatures were similar during control (CON), Z1 occlusion, and Z3 occlusion, ranging from 94.0 °F to 100.9 °F (p = 0.126). No significant temperature differences were found among A, S, U, I, M points prior to and after aortic occlusions. Among the anatomical 2-point ratios evaluated, A/M and S/M ratios were the best predictors of aortic occlusion, whether at Z1 (8.2 °F, p < 0.01; 10.9 °F, p < 0.01) or Z3 (7.3 °F, p < 0.01; 8.4 °F, p < 0.01), respectively. The best predictor of Z1 versus Z3 level of occlusion was the S/I ratio (5.2 °F, p < 0.05 vs. 3.4 °F, p = 0.27). SBIR generated qualitatively different thermal signatures among groups. SBIR was capable of detecting thermal trends during Z1 and Z3 aortic occlusion by using an anatomical 2-point thermal ratio. There were also easily recognized qualitative differences between control and occlusion images that would allow immediate determination of adequate occlusion of the aorta. SBIR represents a potential inexpensive and accurate tool for assessing perfusion, adequate REBOA placement, and even the aortic level of occlusion.

Varying face occlusion detection and iterative recovery for face recognition

NASA Astrophysics Data System (ADS)

Wang, Meng; Hu, Zhengping; Sun, Zhe; Zhao, Shuhuan; Sun, Mei

2017-05-01

In most sparse representation methods for face recognition (FR), occlusion problems were usually solved via removing the occlusion part of both query samples and training samples to perform the recognition process. This practice ignores the global feature of facial image and may lead to unsatisfactory results due to the limitation of local features. Considering the aforementioned drawback, we propose a method called varying occlusion detection and iterative recovery for FR. The main contributions of our method are as follows: (1) to detect an accurate occlusion area of facial images, an image processing and intersection-based clustering combination method is used for occlusion FR; (2) according to an accurate occlusion map, the new integrated facial images are recovered iteratively and put into a recognition process; and (3) the effectiveness on recognition accuracy of our method is verified by comparing it with three typical occlusion map detection methods. Experiments show that the proposed method has a highly accurate detection and recovery performance and that it outperforms several similar state-of-the-art methods against partial contiguous occlusion.

Intravitreal triamcinolone acetonide injections in the treatment of retinal vein occlusions.

PubMed

Roth, Daniel B; Cukras, Catherine; Radhakrishnan, Ravi; Feuer, William J; Yarian, David L; Green, Stuart N; Wheatley, Harold M; Prenner, Jonathan

2008-01-01

To report the visual acuity response after intravitreal triamcinolone injection in patients with macular edema due to retinal vein occlusions. Retrospective nonrandomized interventional series of 172 consecutive patients with macular edema due to retinal vein occlusions who were treated with intravitreal triamcinolone acetonide injection. Patients underwent Snellen visual acuity testing and ophthalmoscopic examination at baseline and 1, 3, 6, and 12 months after intravitreal triamcinolone acetonide injection. All subtypes of retinal vein occlusions showed significant improvements in mean visual acuity 1 month after injection. This improvement in visual acuity was maintained over the 12-month period for all but the central retinal vein occlusion group. Seventy-one (41.3%) of the 172 patients received more than one intravitreal triamcinolone injection for unresolved or recurrent macular edema. This study demonstrates a benefit associated with intravitreal triamcinolone acetonide injection for retinal vein occlusions that was maintained by patients with branch retinal vein occlusions and hemiretinal vein occlusions over a 12-month period. Visual acuity improvement was not maintained in patients with central retinal vein occlusions with this course of treatment.

Reduction of Deviation Angle During Occlusion Therapy: In Partially Accommodative Esotropia with Moderate Amblyopia

PubMed Central

Chun, Bo Young; Kwon, Soon Jae; Chae, Sun Hwa

2007-01-01

Purpose To evaluate changes in ocular alignment in partially accommodative esotropic children age ranged from 3 to 8 years during occlusion therapy for amblyopia. Methods Angle measurements of twenty-two partially accommodative esotropic patients with moderate amblyopia were evaluated before and at 2 years after occlusion therapy. Results Mean deviation angle with glasses at the start of occlusion treatment was 19.45±5.97 PD and decreased to 12.14±12.96 PD at 2 years after occlusion therapy (p<0.01). After occlusion therapy, 9 (41%) cases were indications of surgery for residual deviation but if we had planned surgery before occlusion treatment, 18 (82%) of patients would have had surgery. There was a statistical relationship between increase of visual acuity ratio and decrease of deviation angle (r=-0.479, p=0.024). Conclusions There was a significant reduction of deviation angle of partially accommodative esotropic patients at 2 years after occlusion therapy. Our results suggest that occlusion therapy has an influence on ocular alignment in partially accommodative esotropic patients with amblyopia. PMID:17804922

Rigid bronchoscopic management of acute respiratory failure in a 30-year-old woman

PubMed Central

Madan, Karan; Dhungana, Ashesh; Madan, Neha Kawatra; Mohan, Anant; Hadda, Vijay; Garg, Rakesh; Jain, Deepali; Guleria, Randeep

2016-01-01

A 30-year-old woman presented with a history of progressive shortness of breath, cough, and hoarseness. Stridor was audible on examination. Chest X-ray showed normal lung fields and contrast-enhanced computed tomography thorax showed lower tracheal occlusion with endoluminal growth. Diagnostic flexible bronchoscopy demonstrated multiple whitish glistening nodules over both vocal cords and lower tracheal occlusion by whitish nodular growth. In view of critical central airway obstruction, rigid bronchoscopy and excision of the lower tracheal growth were performed. Histopathological examination of the excised specimen demonstrated features of squamous papillomas. A diagnosis of respiratory papillomatosis was established. On follow-up surveillance bronchoscopy, there was a gradual spontaneous regression of the residual lesions, and the patient remains currently asymptomatic 1 year since the procedure. PMID:27891001

Screen Space Ambient Occlusion Based Multiple Importance Sampling for Real-Time Rendering

NASA Astrophysics Data System (ADS)

Zerari, Abd El Mouméne; Babahenini, Mohamed Chaouki

2018-03-01

We propose a new approximation technique for accelerating the Global Illumination algorithm for real-time rendering. The proposed approach is based on the Screen-Space Ambient Occlusion (SSAO) method, which approximates the global illumination for large, fully dynamic scenes at interactive frame rates. Current algorithms that are based on the SSAO method suffer from difficulties due to the large number of samples that are required. In this paper, we propose an improvement to the SSAO technique by integrating it with a Multiple Importance Sampling technique that combines a stratified sampling method with an importance sampling method, with the objective of reducing the number of samples. Experimental evaluation demonstrates that our technique can produce high-quality images in real time and is significantly faster than traditional techniques.

Delayed resolution of eyelid swelling in preseptal cellulitis in a child: beware of causing occlusion amblyopia.

PubMed

Upendran, Muralidharan R; McLoone, Eibhlin

2013-03-08

A 7-month-old child presented with a 6-day history of right eyelid swelling and redness. She was being treated with chloramphenicol ointment and oral flucloxacillin by the general practitioner. Clinical examination revealed features of preseptal cellulitis. There was no evidence of orbital involvement and the child was generally well otherwise. Her oral antibiotics were changed and she was adviced to attend for a review in 2 days time. However, the child did not return for a review. Three weeks later following resolution of the eyelid swelling, the child represented with a divergent squint in the right eye. Clinical and orthoptic investigations suggested occlusion amblyopia. The child is currently receiving patching treatment for the amblyopia and is awaiting surgery for squint eye.

Tracking Algorithm of Multiple Pedestrians Based on Particle Filters in Video Sequences

PubMed Central

Liu, Yun; Wang, Chuanxu; Zhang, Shujun; Cui, Xuehong

2016-01-01

Pedestrian tracking is a critical problem in the field of computer vision. Particle filters have been proven to be very useful in pedestrian tracking for nonlinear and non-Gaussian estimation problems. However, pedestrian tracking in complex environment is still facing many problems due to changes of pedestrian postures and scale, moving background, mutual occlusion, and presence of pedestrian. To surmount these difficulties, this paper presents tracking algorithm of multiple pedestrians based on particle filters in video sequences. The algorithm acquires confidence value of the object and the background through extracting a priori knowledge thus to achieve multipedestrian detection; it adopts color and texture features into particle filter to get better observation results and then automatically adjusts weight value of each feature according to current tracking environment. During the process of tracking, the algorithm processes severe occlusion condition to prevent drift and loss phenomena caused by object occlusion and associates detection results with particle state to propose discriminated method for object disappearance and emergence thus to achieve robust tracking of multiple pedestrians. Experimental verification and analysis in video sequences demonstrate that proposed algorithm improves the tracking performance and has better tracking results. PMID:27847514

Automated Planar Tracking the Waving Bodies of Multiple Zebrafish Swimming in Shallow Water.

PubMed

Wang, Shuo Hong; Cheng, Xi En; Qian, Zhi-Ming; Liu, Ye; Chen, Yan Qiu

2016-01-01

Zebrafish (Danio rerio) is one of the most widely used model organisms in collective behavior research. Multi-object tracking with high speed camera is currently the most feasible way to accurately measure their motion states for quantitative study of their collective behavior. However, due to difficulties such as their similar appearance, complex body deformation and frequent occlusions, it is a big challenge for an automated system to be able to reliably track the body geometry of each individual fish. To accomplish this task, we propose a novel fish body model that uses a chain of rectangles to represent fish body. Then in detection stage, the point of maximum curvature along fish boundary is detected and set as fish nose point. Afterwards, in tracking stage, we firstly apply Kalman filter to track fish head, then use rectangle chain fitting to fit fish body, which at the same time further judge the head tracking results and remove the incorrect ones. At last, a tracklets relinking stage further solves trajectory fragmentation due to occlusion. Experiment results show that the proposed tracking system can track a group of zebrafish with their body geometry accurately even when occlusion occurs from time to time.

Normal saline is associated with increased sickle red cell stiffness and prolonged transit times in a microfluidic model of the capillary system.

PubMed

Carden, Marcus A; Fay, Meredith; Sakurai, Yumiko; McFarland, Brynn; Blanche, Sydney; DiPrete, Caleb; Joiner, Clinton H; Sulchek, Todd; Lam, Wilbur A

2017-07-01

Vaso-occlusive crisis (VOC) is a complex process that occurs in patients with sickle cell disease (SCD) and is often associated with pain and urgent hospitalization. A major instigator of VOC is microvascular obstruction by pathologically stiffened sickle red blood cells (RBCs), and thus, therapy relies heavily on optimizing intravenous fluid (IVF) hydration to increase RBC deformability. However, no evidence-based guidelines regarding the choice of IVF currently exist. We therefore analyzed alterations in biomechanical properties of sickle RBCs isolated from patients with homozygous SCD (hemoglobin SS) after exposure to different osmolarities of clinical IVF formulations. Atomic force microscopy (AFM) was used to assess stiffness of RBCs after exposure to different IVFs. A microfluidic model of the human capillary system was used to assess transit time (TT) and propensity to occlusion after exposure to the different IVF formulations. Sickle RBCs exposed to normal saline (NS) had increased stiffness, TTs, and propensity to microchannel occlusion compared to other osmolarities. NS, an IVF formulation often used to treat patients with SCD during VOC, may induce localized microvascular obstruction due to alterations of sickle RBC biomechanical properties. © 2017 John Wiley & Sons Ltd.

Automated Planar Tracking the Waving Bodies of Multiple Zebrafish Swimming in Shallow Water

PubMed Central

Wang, Shuo Hong; Cheng, Xi En; Qian, Zhi-Ming; Liu, Ye; Chen, Yan Qiu

2016-01-01

Zebrafish (Danio rerio) is one of the most widely used model organisms in collective behavior research. Multi-object tracking with high speed camera is currently the most feasible way to accurately measure their motion states for quantitative study of their collective behavior. However, due to difficulties such as their similar appearance, complex body deformation and frequent occlusions, it is a big challenge for an automated system to be able to reliably track the body geometry of each individual fish. To accomplish this task, we propose a novel fish body model that uses a chain of rectangles to represent fish body. Then in detection stage, the point of maximum curvature along fish boundary is detected and set as fish nose point. Afterwards, in tracking stage, we firstly apply Kalman filter to track fish head, then use rectangle chain fitting to fit fish body, which at the same time further judge the head tracking results and remove the incorrect ones. At last, a tracklets relinking stage further solves trajectory fragmentation due to occlusion. Experiment results show that the proposed tracking system can track a group of zebrafish with their body geometry accurately even when occlusion occurs from time to time. PMID:27128096

Randomised comparison of three tools for improving compliance with occlusion therapy: an educational cartoon story, a reward calendar, and an information leaflet for parents.

PubMed

Tjiam, A M; Holtslag, G; Van Minderhout, H M; Simonsz-Tóth, B; Vermeulen-Jong, M H L; Borsboom, G J J M; Loudon, S E; Simonsz, H J

2013-01-01

We previously demonstrated that compliance with occlusion therapy for amblyopia was improved by the use of an educational programme, especially in children of parents of foreign origin and who spoke Dutch poorly. The programme consisted of: (i) a cartoon story for amblyopic children that explained without words why they should patch, (ii) a calendar with reward stickers, and (iii) an information leaflet for parents. In the current study, we assessed the individual effect of each component on compliance. We recruited 120 3- to 6-year-old children who lived in a low socio-economic status (SES) area in The Hague and were starting occlusion therapy for the first time. They were randomised to receive one of the components (three intervention groups), or a picture to colour (control group). The randomisation was blinded for treating orthoptist and researcher. Compliance was measured electronically using the Occlusion Dose Monitor (ODM). Primary outcome was percentage of compliance (actual/prescribed occlusion time). Secondary outcome was absolute occlusion hours per day. Parental fluency in Dutch was rated on a five-point scale. Compliance could be measured electronically in 88 of the 120 children; in 32 others, it failed for various reasons. Parental fluency in Dutch was moderate or worse in 36.4 % (p = 0.327). Average compliance was 55 % standard deviation (SD) 40 (n = 18) in the control group, 89 % SD 25 in the group receiving the educational cartoon (n = 25, P = 0.002 compared with control group), 67 % SD 33 (n = 24, P = 0.301) in the reward-calendar group and 73 % SD 40 (n = 21, P = 0.119) in the parent-information-leaflet group. On average, children in the control group occluded 1:46 SD1:19 hours/day, 2:33 SD 1:18 hours/day in the group receiving the educational cartoon, 1:59 SD 1:13 hours/day in the reward-calendar group and 2:18 SD 1:13 hours/day in the parent-information-leaflet group. No child who received the cartoon story occluded less than 1 hour per day, against seven in the reward-calendar group, five in the parent-information-leaflet group and five in the control group. Although all three components of the programme improved compliance with occlusion therapy in children in low-SES areas, the educational cartoon had the strongest effect, as it explained without words to a 4- to 5-year-old child why it should wear the eye patch.

Improved single- and multi-contact life-time testing of dental restorative materials using key characteristics of the human masticatory system and a force/position-controlled robotic dental wear simulator.

PubMed

Raabe, D; Harrison, A; Ireland, A; Alemzadeh, K; Sandy, J; Dogramadzi, S; Melhuish, C; Burgess, S

2012-03-01

This paper presents a new in vitro wear simulator based on spatial parallel kinematics and a biologically inspired implicit force/position hybrid controller to replicate chewing movements and dental wear formations on dental components, such as crowns, bridges or a full set of teeth. The human mandible, guided by passive structures such as posterior teeth and the two temporomandibular joints, moves with up to 6 degrees of freedom (DOF) in Cartesian space. The currently available wear simulators lack the ability to perform these chewing movements. In many cases, their lack of sufficient DOF enables them only to replicate the sliding motion of a single occlusal contact point by neglecting rotational movements and the motion along one Cartesian axis. The motion and forces of more than one occlusal contact points cannot accurately be replicated by these instruments. Furthermore, the majority of wear simulators are unable to control simultaneously the main wear-affecting parameters, considering abrasive mechanical wear, which are the occlusal sliding motion and bite forces in the constraint contact phase of the human chewing cycle. It has been shown that such discrepancies between the true in vivo and the simulated in vitro condition influence the outcome and the quality of wear studies. This can be improved by implementing biological features of the human masticatory system such as tooth compliance realized through the passive action of the periodontal ligament and active bite force control realized though the central nervous system using feedback from periodontal preceptors. The simulator described in this paper can be used for single- and multi-occlusal contact testing due to its kinematics and ability to exactly replicate human translational and rotational mandibular movements with up to 6 DOF without neglecting movements along or around the three Cartesian axes. Recorded human mandibular motion and occlusal force data are the reference inputs of the simulator. Experimental studies of wear using this simulator demonstrate that integrating the biological feature of combined force/position hybrid control in dental material testing improves the linearity and reduces the variability of results. In addition, it has been shown that present biaxially operated dental wear simulators are likely to provide misleading results in comparative in vitro/in vivo one-contact studies due to neglecting the occlusal sliding motion in one plane which could introduce an error of up to 49% since occlusal sliding motion D and volumetric wear loss V(loss) are proportional.

The Value of 3D Printing Models of Left Atrial Appendage Using Real-Time 3D Transesophageal Echocardiographic Data in Left Atrial Appendage Occlusion: Applications toward an Era of Truly Personalized Medicine.

PubMed

Liu, Peng; Liu, Rijing; Zhang, Yan; Liu, Yingfeng; Tang, Xiaoming; Cheng, Yanzhen

The objective of this study was to assess the clinical feasibility of generating 3D printing models of left atrial appendage (LAA) using real-time 3D transesophageal echocardiogram (TEE) data for preoperative reference of LAA occlusion. Percutaneous LAA occlusion can effectively prevent patients with atrial fibrillation from stroke. However, the anatomical structure of LAA is so complicated that adequate information of its structure is essential for successful LAA occlusion. Emerging 3D printing technology has the demonstrated potential to structure more accurately than conventional imaging modalities by creating tangible patient-specific models. Typically, 3D printing data sets are acquired from CT and MRI, which may involve intravenous contrast, sedation, and ionizing radiation. It has been reported that 3D models of LAA were successfully created by the data acquired from CT. However, 3D printing of the LAA using real-time 3D TEE data has not yet been explored. Acquisition of 3D transesophageal echocardiographic data from 8 patients with atrial fibrillation was performed using the Philips EPIQ7 ultrasound system. Raw echocardiographic image data were opened in Philips QLAB and converted to 'Cartesian DICOM' format and imported into Mimics® software to create 3D models of LAA, which were printed using a rubber-like material. The printed 3D models were then used for preoperative reference and procedural simulation in LAA occlusion. We successfully printed LAAs of 8 patients. Each LAA costs approximately CNY 800-1,000 and the total process takes 16-17 h. Seven of the 8 Watchman devices predicted by preprocedural 2D TEE images were of the same sizes as those placed in the real operation. Interestingly, 3D printing models were highly reflective of the shape and size of LAAs, and all device sizes predicted by the 3D printing model were fully consistent with those placed in the real operation. Also, the 3D printed model could predict operating difficulty and the presence of a peridevice leak. 3D printing of the LAA using real-time 3D transesophageal echocardiographic data has a perfect and rapid application in LAA occlusion to assist with physician planning and decision making. © 2016 S. Karger AG, Basel.

Cost-effectiveness and clinical efficacy of biliary stents in patients undergoing neoadjuvant therapy for pancreatic adenocarcinoma in a randomized controlled trial.

PubMed

Gardner, Timothy B; Spangler, Chad C; Byanova, Katerina L; Ripple, Gregory H; Rockacy, Matthew J; Levenick, John M; Smith, Kerrington D; Colacchio, Thomas A; Barth, Richard J; Zaki, Bassem I; Tsapakos, Michael J; Gordon, Stuart R

2016-09-01

The optimal type of stent for the palliation of malignant biliary obstruction in patients with pancreatic adenocarcinoma undergoing neoadjuvant chemoradiotherapy with curative intent is unknown. We performed a prospective trial comparing 3 types of biliary stents-fully covered self-expandable metal (fcSEMS), uncovered self-expandable metal (uSEMS), and plastic-to determine which best optimized cost-effectiveness and important clinical outcomes. In this prospective randomized trial, consecutive patients with malignant biliary obstruction from newly diagnosed pancreatic adenocarcinoma who were to start neoadjuvant chemoradiotherapy were randomized to receive fcSEMSs, uSEMSs, or plastic stents during the index ERCP. The primary outcomes were time to stent occlusion, attempted surgical resection, or death after the initiation of neoadjuvant therapy, and the secondary outcomes were total patient costs associated with the stent, including the index ERCP cost, downstream hospitalization cost due to stent occlusion, and the cost associated with procedural adverse event. Fifty-four patients were randomized and reached the primary end point: 16 in the fcSEMS group, 17 in the uSEMS group, and 21 in the plastic stent group. No baseline demographic or tumor characteristic differences were noted among the groups. The fcSEMSs had a longer time to stent occlusion compared with uSEMSs and plastic stents (220 vs 74 and 76 days, P < .01), although the groups had equivalent rates of stent occlusion, attempted surgical resection, and death. Although SEMS placement cost more during the index ERCP (uSEMS = $24,874 and fcSEMS = $22,729 vs plastic = $18,701; P < .01), they resulted in higher procedural AE costs per patient (uSEMS = $5522 and fcSEMS = $12,701 vs plastic = $0; P < .01). Conversely, plastic stents resulted in an $11,458 hospitalization cost per patient due to stent occlusion compared with $2301 for uSEMSs and $0 for fcSEMSs (P < .01). In a prospective trial comparing fcSEMSs, uSEMSs, and plastic stents for malignant biliary obstruction in patients undergoing neoadjuvant therapy with curative intent for pancreatic adenocarcinoma, no stent type was superior in optimizing cost-effectiveness, although fcSEMSs resulted in fewer days of neoadjuvant treatment delay and a longer time to stent occlusion. (Clincial trial registration number: NCT01038713.). Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Time Sequence Evaluation of Biliary Stent Occlusion by Dissection Analysis of Retrieved Stents.

PubMed

Kwon, Chang-Il; Gromski, Mark A; Sherman, Stuart; Easler, Jeffrey J; El Hajj, Ihab I; Watkins, James; Fogel, Evan L; McHenry, Lee; Lehman, Glen A

2016-08-01

Multiple factors can affect the occlusion of plastic stents. Previous data demonstrate that side holes may induce more biofilm formation probably via microturbulence and bile flow disturbances that could lead to occlusion. These results, however, have not been replicated in subsequent clinical studies with different methods. The objective of this study is to evaluate the physical characteristics of plastic stent occlusion over time. This is a plastic stent sequential analysis study. Biliary stents removed via ERCP from February 24, 2015, to June 2, 2015, were included. One hundred and forty-eight retrieved straight-type plastic stents were longitudinally cut by a custom-made cutting device. These dissected stents were then evaluated in detail with regard to the location of stent occlusion and the stent patency period. Location of stent occlusive debris was the primary outcome in this study. Biofilm formations and occlusions by debris were sequentially but separately tallied. Biofilm formations were initially seen around the side hole areas within 30 days and spread to the entire stent by 60 days. Then, occlusion process by debris was mainly initiated by 80 days and progressed to full occlusion by median of 90 days. Although some occlusions were also observed around the side hole areas within 30 days, affected areas were more widely observed after biofilm formation. This study is the first to attempt to describe the distribution of stent occlusions over time. These observations may help guide future stent development.

Guidance of aortic ablation using optical coherence tomography.

PubMed

Patel, Nirlep A; Li, Xingde; Stamper, Debra L; Fujimoto, James G; Brezinski, Mark E

2003-04-01

There is a significant need for an imaging modality that is capable of providing guidance for intravascular procedures, as current technologies suffer from significant limitations. In particular, laser ablation of in-stent restenosis, revascularization of chronic total occlusions, and pulmonary vein ablation could benefit from guidance. Optical coherence tomography (OCT), a recently introduced technology, is similar to ultrasound except that it measures the back-reflection of infrared light instead of sound. This study examines the ability of OCT to guide vascular laser ablation. Aorta samples underwent laser ablation using an argon laser at varying power outputs and were monitored with OCT collecting images at 4 frames. Samples were compared to the corresponding histopathology. Arterial layers could be differentiated in the images sequences. This allowed correlation of changes in the OCT image with power and duration in addition to histopathology. OCT provides real-time guidance of arterial ablation. At 4 frames, OCT was successfully able to show the microstructural changes in the vessel wall during laser ablation. Since current ablation procedures often injure surrounding tissue, the ability to minimize collateral damage to the adjoining tissue represents a useful advantage of this system. This study suggests a possible role for OCT in the guidance of intravascular procedures.

Influence of denture adhesives on occlusion and disocclusion times.

PubMed

Abdelnabi, Mohamed Hussein; Swelem, Amal Ali; Al-Dharrab, Ayman A

2016-03-01

The effectiveness of adhesives in enhancing several functional aspects of complete denture performance has been well established. The direct influence of adhesives on occlusal contact simultaneity has not yet been investigated. The purpose of this crossover clinical trial was to evaluate quantitatively the influence of adhesives on occlusal balance by recording timed occlusal contacts; namely occlusion time (OT) and disocclusion time during right (DT-right) and left (DT-left) excursions by using computerized occlusal analysis. A crossover clinical trial was adopted. Assessments were carried out while participants (n=49) wore their dentures first without then with adhesives. Computerized occlusal analysis using the T-Scan III system was conducted to perform baseline computer-guided occlusal adjustment for conventionally fabricated dentures. Retention and stability assessment using the modified Kapur index and recording of OT and DT-right and DT-left values using the T-Scan III were subsequently carried out for all dentures, first without adhesives and then after application of adhesive. All T-Scan procedures were carried out by the same clinician. Wilcoxon signed-rank test was used to analyze the Kapur index scores and occlusal parameters (α=.05). Stability and retention of conventional dentures ranged initially from good to very good. However, adhesive application resulted in significant improvement (P<.001) in stability and retention and a significant decrease in duration of all occlusal parameters (OT [P=.003], DT-right [P=.003], and DT-left [P=.008]). Adhesives significantly decreased OT and DT durations in initially well-fitting complete dentures with fairly well balanced occlusion, and further enhanced denture stability and occlusal contact simultaneity. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Recurrence of amblyopia after occlusion therapy.

PubMed

Bhola, Rahul; Keech, Ronald V; Kutschke, Pamela; Pfeifer, Wanda; Scott, William E

2006-11-01

To determine the stability of visual acuity (VA) after a standardized occlusion regimen in children with strabismic and/or anisometropic amblyopia. Retrospective, population-based, consecutive observational case series. Four hundred forty-nine patients younger than 10 years who underwent an occlusion trial for amblyopia and were observed until there was a recurrence of amblyopia or for a maximum of 1 year after decrease or cessation of occlusion therapy. We performed a retrospective chart review of all patients treated by occlusion therapy for strabismic and/or anisometropic amblyopia at our institution over a 34-year period. Of the 1621 patients identified in our database, 449 met the eligibility criteria and were included in this study. Patients having at least a 2 logarithm of the minimum angle of resolution (logMAR)-level improvement in VA by optotypes or a change from unmaintained to maintained fixation preference during the course of occlusion therapy were included. A recurrence of amblyopia was defined as > or =2 logMAR levels of VA reduction or reversal of fixation preference within 1 year after a decrease or cessation of occlusion therapy. Recurrence of amblyopia after a decrease or cessation of occlusion therapy and its relationship with patient age and VA of the amblyopic eye at the time of decrease or cessation of occlusion therapy. Of 653 occlusion trials, 179 (27%) resulted in recurrence of amblyopia. The recurrence was found to be inversely correlated with patient age. There was no statistically significant association between the recurrence of amblyopia and VA of the amblyopic eye at the end of maximal occlusion therapy. There is a clinically important risk of amblyopia recurrence when occlusion therapy is decreased before the age of 10 years. The risk of recurrence is inversely correlated with age (P<0.0001).

The use of indium-111 labeled platelet scanning for the detection of asymptomatic deep venous thrombosis in a high risk population

DOE Office of Scientific and Technical Information (OSTI.GOV)

Siegel, R.S.; Rae, J.L.; Ryan, N.L.

Five hundred indium-111 labeled platelet imaging studies (387 donor and 113 autologous) were performed postoperatively in 473 patients who had undergone total hip replacement, total knee replacement, or internal fixation of a hip fracture to detect occult deep venous thrombosis. All patients had been anticoagulated prophylactically with aspirin, warfarin sodium (Coumadin), or dextran. Thirty-four possible cases of proximal deep venous thrombosis were identified in 28 asymptomatic patients. To verify the scan results, 31 venograms were performed in 25 patients (three refused). In 21 of 31 cases, totally occlusive thrombi were detected; in 5 cases, partially occlusive thrombi were detected; inmore » 5 cases, no thrombus was seen. No patient who had a negative scan nor any patient who had a verified positive scan (and received appropriate heparin therapy) subsequently developed symptoms or signs of pulmonary embolism. One hundred forty-one indium study patients also underwent Doppler ultrasonography/impedance plethysmography (Doppler/IPG) as a comparative non-invasive technique. In 137 cases, the results of the indium study and Doppler/IPG studies were congruent. The indium study had no false negative results that were detected by Doppler/IPG. No patient had any clinically evident toxicity. These results suggest that indium-111 labeled platelet scanning is a safe, noninvasive means for identifying DVT in high risk patients.« less

Management of Chronic Total Coronary Occlusion in Stable Ischemic Heart Disease by Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Versus Medical Therapy.

PubMed

Shuvy, Mony; Qiu, Feng; Chee-A-Tow, Alyssandra; Graham, John J; Abuzeid, Wael; Buller, Christopher; Strauss, Bradley H; Wijeysundera, Harindra C

2017-09-01

Coronary chronic total occlusions (CTOs) are found in approximately 20% of angiograms. We sought to assess the variation in the management of patients with CTOs and to compare the clinical outcomes of CTO lesions with those of non-CTO lesions. We conducted a population-based cohort study and included all patients with stable angina who underwent cardiac catheterization from October 1, 2012, to June 30, 2013, in Ontario, Canada. The primary outcome was a composite of mortality and hospitalization for myocardial infarction. A total of 7,864 patients were included, of whom 2,279 (29%) had a CTO. There were substantial differences in revascularization rates for patients with CTOs across hospitals in Ontario (44.9% to 94.1%). Revascularization was associated with improved outcomes in the overall cohort. Although the advantage of coronary artery bypass grafting over medical therapy was consistent in both patients with CTOs and patients without CTOs, the benefit of percutaneous coronary intervention (PCI) was limited to patients without CTOs (hazard ratio 0.56, 95% confidence interval 0.40- to 0.78), with no difference in patients with CTOs. The CTO lesion, however, was revascularized in few of the PCI cases (41.1%), with PCI limited to the non-CTO lesion in most patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Visuospatial ability correlates with performance in simulated gynecological laparoscopy.

PubMed

Ahlborg, Liv; Hedman, Leif; Murkes, Daniel; Westman, Bo; Kjellin, Ann; Felländer-Tsai, Li; Enochsson, Lars

2011-07-01

To analyze the relationship between visuospatial ability and simulated laparoscopy performed by consultants in obstetrics and gynecology (OBGYN). This was a prospective cohort study carried out at two community hospitals in Sweden. Thirteen consultants in obstetrics and gynecology were included. They had previously independently performed 10-100 advanced laparoscopies. Participants were tested for visuospatial ability by the Mental Rotations Test version A (MRT-A). After a familiarization session and standardized instruction, all participants subsequently conducted three consecutive virtual tubal occlusions followed by three virtual salpingectomies. Performance in the simulator was measured by Total Time, Score and Ovarian Diathermy Damage. Linear regression was used to analyze the relationship between visuospatial ability and simulated laparoscopic performance. The learning curves in the simulator were assessed in order to interpret the relationship with the visuospatial ability. Visuospatial ability correlated with Total Time (r=-0.62; p=0.03) and Score (r=0.57; p=0.05) in the medium level of the virtual tubal occlusion. In the technically more advanced virtual salpingectomy the visuospatial ability correlated with Total Time (r=-0.64; p=0.02), Ovarian Diathermy Damage (r=-0.65; p=0.02) and with overall Score (r=0.64; p=0.02). Visuospatial ability appears to be related to the performance of gynecological laparoscopic procedures in a simulator. Testing visuospatial ability might be helpful when designing individual training programs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Complex Recanalization of Chronic Total Occluison Supported by Minimal Extracorporeal Circulation in a Patient with an Aortic Valve Bioprothesis in Extraanatomic Position

PubMed Central

Jansen, Ruben; Bathgate, Brigitte; Bufe, Alexander

2018-01-01

Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) still remains a major challenge in interventional cardiology. This case describes a complex PCI of the left main coronary artery and of a CTO of the right coronary artery using a minimal extracorporeal circulation system (MECC) in a patient with an aortic valve bioprothesis in extraanatomic position. It illustrates that complex recanalization strategies can be solved combining it with mechanical circulatory support technologies. PMID:29850264

Knowledge of chronic total occlusion among Polish interventional cardiologists.

PubMed

Bryniarski, Krzysztof L; Zabojszcz, Michał; Dębski, Grzegorz; Marchewka, Jakub; Legutko, Jacek; Surowiec, Sławomir; Siudak, Zbigniew; Żmudka, Krzysztof; Dudek, Dariusz; Bryniarski, Leszek

2015-01-01

Chronic total occlusion (CTO) recanalization is indicated in patients with symptoms and evidence of ischemia, but in most cases those types of lesions are still treated medically. In the last few years CTO angioplasty technique has changed dramatically due to considerable advances in techniques and dedicated equipment. An attempt to assess the state of knowledge of technical aspects of CTO angioplasty of coronary arteries among Polish interventional cardiologists. Questionnaire survey performed during two major Polish invasive cardiology workshops. In the study there participated 113 physicians with an average length of work experience of 13 years, most of them cardiologists certified as independent primary operators. The majority of respondents recognized the need of prevention of thrombotic complications through control of activated coagulation time during the CTO procedures. Prevention of renal complications and X-ray protection are also recognized as a significant part of the procedures. The benefits from the use of over-the-wire microcatheters and balloons, the proper choice of dedicated guidewires, contralateral injections and retrograde technique are underestimated. Despite satisfactory knowledge about indications and qualification for the CTO procedure, the awareness of procedural aspects (particularly the retrograde technique) as well as the dedicated CTO equipment among Polish interventional cardiologists is still insufficient.

Influence of occlusal contact area on cusp defection and stress distribution.

PubMed

Costa, Anna Karina Figueiredo; Xavier, Thaty Aparecida; Paes-Junior, Tarcisio José Arruda; Andreatta-Filho, Oswaldo Daniel; Borges, Alexandre Luiz Souto

2014-11-01

The purpose of this study was to evaluate the effect of occlusal contact area for loading on the cuspal defection and stress distribution in a first premolar restored with a high elastic modulus restorative material. The Rhinoceros 4.0 software was used for modeling the three-dimensional geometries of dental and periodontal structures and the inlay restoration. Thus, two different models, intact and restored teeth with three occlusal contact areas, 0.1, 0.5 and 0.75 mm(2), on enamel at the occlusal surface of buccal and lingual cusps. Finite element analysis (FEA) was performed with the program ANSYS (Workbench 13.0), which generated a mesh with tetrahedral elements with greater refinement in the regions of interest, and was constrained at the bases of cortical and trabecular bone in all axis and loaded with 100 N normal to each contact area. To analysis of maximum principal stress, the smaller occlusal contact area showed greater compressive stress in region of load application for both the intact and inlay restored tooth. However, tensile stresses at the occlusal isthmus were similar for all three tested occlusal contact areas (60 MPa). To displacement of the cusps was higher for teeth with inlay (0.46-0.48 mm). For intact teeth, the smaller contact area showed greater displacement (0.10 mm). For teeth with inlays, the displacement of the cusps were similar in all types of occlusal area. Cuspal displacement was higher in the restored tooth when compared to the intact tooth, but there were no significant variations even with changes in the occlusal contact area. RELEVANCE CLINICAL: Occlusal contacts have a great influence on the positioning of teeth being able to maintain the position and stability of the mandible. Axial loads would be able to generate more uniform stress at the root presenting a greater concentration of load application in the point and the occlusal surface. Thus, is necessary to analyze the relationship between these occlusal contacts as dental wear and subsequent occlusal interferences.

Occlusal enamel complexity in middle miocene to holocene equids (Equidae: Perissodactyla) of North America.

PubMed

Famoso, Nicholas A; Davis, Edward Byrd

2014-01-01

Four groups of equids, "Anchitheriinae," Merychippine-grade Equinae, Hipparionini, and Equini, coexisted in the middle Miocene, but only the Equini remains after 16 Myr of evolution and extinction. Each group is distinct in its occlusal enamel pattern. These patterns have been compared qualitatively but rarely quantitatively. The processes influencing the evolution of these occlusal patterns have not been thoroughly investigated with respect to phylogeny, tooth position, and climate through geologic time. We investigated Occlusal Enamel Index, a quantitative method for the analysis of the complexity of occlusal patterns. We used analyses of variance and an analysis of co-variance to test whether equid teeth increase resistive cutting area for food processing during mastication, as expressed in occlusal enamel complexity, in response to increased abrasion in their diet. Results suggest that occlusal enamel complexity was influenced by climate, phylogeny, and tooth position through time. Occlusal enamel complexity in middle Miocene to Modern horses increased as the animals experienced increased tooth abrasion and a cooling climate.

Occlusal Enamel Complexity in Middle Miocene to Holocene Equids (Equidae: Perissodactyla) of North America

PubMed Central

Famoso, Nicholas A.; Davis, Edward Byrd

2014-01-01

Four groups of equids, “Anchitheriinae,” Merychippine-grade Equinae, Hipparionini, and Equini, coexisted in the middle Miocene, but only the Equini remains after 16 Myr of evolution and extinction. Each group is distinct in its occlusal enamel pattern. These patterns have been compared qualitatively but rarely quantitatively. The processes influencing the evolution of these occlusal patterns have not been thoroughly investigated with respect to phylogeny, tooth position, and climate through geologic time. We investigated Occlusal Enamel Index, a quantitative method for the analysis of the complexity of occlusal patterns. We used analyses of variance and an analysis of co-variance to test whether equid teeth increase resistive cutting area for food processing during mastication, as expressed in occlusal enamel complexity, in response to increased abrasion in their diet. Results suggest that occlusal enamel complexity was influenced by climate, phylogeny, and tooth position through time. Occlusal enamel complexity in middle Miocene to Modern horses increased as the animals experienced increased tooth abrasion and a cooling climate. PMID:24587267

Two-year Clinical Outcomes Post Implantation of Epic™ Self-Expanding Nitinol Stents for the Aortoiliac Occlusive Disease in Patients with Peripheral Arterial Disease

PubMed Central

Tsujimura, Takuya; Iida, Osamu; Fujita, Masashi; Masuda, Masaharu; Okamoto, Shin; Ishihara, Takayuki; Nanto, Kiyonori; Kanda, Takashi; Okuno, Shota; Matsuda, Yasuhiro; Fujihara, Masahiko; Yokoi, Yoshiaki; Mano, Toshiaki

2018-01-01

Aim: We investigated 2-year clinical outcomes after implantaton of Epic™ self-expanding nitinol stents for patients with peripheral artery disease (PAD) due to the aortoiliac occlusive disease (AIOD). Methods: This study was a multicenter and retrospective study. From February 2013 through October 2014, 292 lesions (chronic total occlusion, 21%; TASC II C/D, 35%) in 217 consecutive patients (74 ± 8 years; male, 81%; diabetes mellitus, 47%; dialysis, 21%; critical limb ischemia, 29%) who had undergone endovascular therapy (EVT) with Epic™ self-expanding nitinol stents for PAD with AIOD were analyzed. The primary endpoints were 2-year primary patency and target lesion revascularization (TLR)-free rate. The primary patency and freedom from TLR were determined by Kaplan–Meier analysis. Additionally, predictors for loss of patency were estimated by Cox proportional hazard model. Results: The mean follow-up duration was 19.1 ± 8.5 months. Primary patency was 87.3% at 2 years. Freedom from TLR rate was 94.1% at 2 years. Multivariate analysis revealed that the presence of diabetes mellitus was associated with a loss of patency. Conclusion: The Epic™ self-expanding nitinol stent was demonstrated to be safe and effectivene for AIOD when tested for two years in patients with PAD. PMID:28978866

Two-year Clinical Outcomes Post Implantation of EpicTM Self-Expanding Nitinol Stents for the Aortoiliac Occlusive Disease in Patients with Peripheral Arterial Disease.

PubMed

Tsujimura, Takuya; Iida, Osamu; Fujita, Masashi; Masuda, Masaharu; Okamoto, Shin; Ishihara, Takayuki; Nanto, Kiyonori; Kanda, Takashi; Okuno, Shota; Matsuda, Yasuhiro; Fujihara, Masahiko; Yokoi, Yoshiaki; Mano, Toshiaki

2018-04-01

We investigated 2-year clinical outcomes after implantaton of Epic TM self-expanding nitinol stents for patients with peripheral artery disease (PAD) due to the aortoiliac occlusive disease (AIOD). This study was a multicenter and retrospective study. From February 2013 through October 2014, 292 lesions (chronic total occlusion, 21%; TASC Ⅱ C/D, 35%) in 217 consecutive patients (74±8 years; male, 81%; diabetes mellitus, 47%; dialysis, 21%; critical limb ischemia, 29%) who had undergone endovascular therapy (EVT) with Epic TM self-expanding nitinol stents for PAD with AIOD were analyzed. The primary endpoints were 2-year primary patency and target lesion revascularization (TLR)-free rate. The primary patency and freedom from TLR were determined by Kaplan-Meier analysis. Additionally, predictors for loss of patency were estimated by Cox proportional hazard model. The mean follow-up duration was 19.1±8.5 months. Primary patency was 87.3% at 2 years. Freedom from TLR rate was 94.1% at 2 years. Multivariate analysis revealed that the presence of diabetes mellitus was associated with a loss of patency. The Epic TM self-expanding nitinol stent was demonstrated to be safe and effectivene for AIOD when tested for two years in patients with PAD.

Reasons for Placement of Restorations on Previously Unrestored Tooth Surfaces by Dental PBRN Dentists

PubMed Central

Nascimento, Marcelle M.; Gordan, Valeria V.; Qvist, Vibeke; Litaker, Mark S.; Rindal, D. Brad; Williams, O.D.; Fellows, Jeffrey L.; Ritchie, Lloyd K.; Mjör, Ivar A.; McClelland, Jocelyn; Gilbert, Gregg H.

2010-01-01

Objective To identify and quantify the reasons for placing restorations on unrestored permanent tooth surfaces and the dental materials used by Dental Practice-Based Research Network (DPBRN; www.DentalPBRN.org) dentists. Methods A total of 229 DPBRN practitioner-investigators collected data on 9,890 consecutive restorations from 5,810 patients. Information included: (1) reasons for restoring; (2) tooth and surfaces restored; and (3) restorative materials employed. Results Primary caries (85%) and non-carious defects (15%), which included abrasion/ abfraction/ erosion lesions and tooth fracture, were the main reasons for placement of restorations. Restorations due to caries were frequently placed on occlusal surfaces (49%), followed by distal, mesial, buccal/facial, lingual/palatal, and incisal surfaces. Amalgam was used for 46% of the molar and 45% of the premolar restorations. Directly placed resin-based composite (RBC) was used for 48% of the molar, 49% of the premolar, and 92% of the anterior restorations. Conclusion Dental caries on occlusal and proximal surfaces of molar teeth are the main reasons for placing restorations on previously unrestored tooth surfaces by DPBRN practitioner-investigators. RBC is the material most commonly used for occlusal and anterior restorations. Amalgam remains the material of choice to restore proximal caries in posterior teeth, although there are significant differences by DPBRN region. PMID:20354094

Relative contributions of occlusion, maximum bite force, and chewing cycle kinematics to masticatory performance.

PubMed

Lepley, Casey R; Throckmorton, Gaylord S; Ceen, Richard F; Buschang, Peter H

2011-05-01

The purpose of this study was to explore the contributions of occlusion, maximum bite force, and chewing cycle kinematics to masticatory performance. A prospective cross-sectional study was performed on 30 subjects with Class I occlusion. Masticatory performance was measured with the test food Cuttersil (Heraeus Kulzer, South Bend, Ind) and the fractional-sieve technique. Blu-Mousse (Parkell Biomaterials, Farmingdale, NY) bite registrations were used to measure occlusal contact areas. The American Board of Orthodontics occlusal discrepancies were measured on the subjects' dental models. Maximum bite forces were recorded with a custom transducer, and 3-dimensional chewing cycle kinematics were tracked with an opto-electric computer system and Optotrak software (Northern Digital, Waterloo, Ontario, Canada). Masticatory performance was most closely correlated with occlusal contact area, indicating larger contact areas in subjects with better performance. Occlusal contact area and occlusal discrepancies were also related to bite force and chewing cycle kinematics. Maximum bite force was positively related with masticatory performance. Although masticatory performance is related, both directly and indirectly, to a number of morphologic and functional factors, it is most closely related to occlusal factors. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

21 CFR 878.4020 - Occlusive wound dressing.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Occlusive wound dressing. 878.4020 Section 878...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4020 Occlusive wound dressing. (a) Identification. An occlusive wound dressing is a nonresorbable, sterile or non-sterile device...

21 CFR 878.4020 - Occlusive wound dressing.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Occlusive wound dressing. 878.4020 Section 878...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4020 Occlusive wound dressing. (a) Identification. An occlusive wound dressing is a nonresorbable, sterile or non-sterile device...

Contributions of anesthesiology to the surgical treatment of cerebrovascular disease: the role of Arthur S. Keats, M.D.

PubMed

Collard, Charles D; Anton, James M; Cooper, John R; Giesecke, N Martin

2008-04-01

Increased tolerance to cerebral ischemia produced by general anesthesia during temporary carotid occlusion. By B. A. Wells, A. S. Keats, and D. A. Cooley. Surgery 1963; 54:216-23. Local anesthesia with little or no preoperative sedation is currently recommended as the anesthetic of choice for temporary carotid occlusion during carotid endarterectomy. Purported advantages include minimal circulatory and respiratory changes from the local anesthetic, and constant verbal contact can be maintained with the patient so that neurologic changes are promptly recognized. However, local anesthesia may not be satisfactory in uncooperative or semiconscious patients. We therefore undertook a trial of general anesthesia in 56 consecutive patients undergoing carotid endarterectomy. Patients were induced in standardized fashion using intravenous thiopental (100-400 mg), atropine (0.2 mg), and succinylcholine (40-80 mg). Cyclopropane, along with deliberate hypercapnia and hypertension, was used for anesthesia maintenance. All patients tolerated carotid occlusion for periods of up to 30 min during general anesthesia without shunt, bypass, or hypothermia. Except for one patient, electroencephalogram evidence of cerebral ischemia was not apparent during occlusion, and no patient suffered postoperative neurologic sequela. Twenty percent of patients who had their carotid arteries occluded preoperatively for 30-60 s without general anesthesia suffered convulsions. These data suggest that general anesthesia increased the tolerance to cerebral ischemia. Potential mechanisms involved might include: 1) decreased cerebral metabolic rate for oxygen; 2) increased cerebral blood flow from hypercapnia; 3) increased arterial oxygen tension; and 4) recruitment of new routes of collateral circulation.

Dentist and practice characteristics associated with restorative treatment of enamel caries in permanent teeth: multiple-regression modeling of observational clinical data from The National Dental PBRN

PubMed Central

Fellows, Jeffrey L; Gordan, Valeria V.; Gilbert, Gregg H.; Rindal, D. Brad; Qvist, Vibeke; Litaker, Mark S.; Benjamin, Paul; Flink, Håkan; Pihlstrom, Daniel J.; Johnson, Neil

2014-01-01

Purpose Current evidence in dentistry recommends non-surgical treatment to manage enamel caries lesions. However, surveyed practitioners report they would restore enamel lesions that are confined to the enamel. We used actual clinical data to evaluate patient, dentist, and practice characteristics associated with restoration of enamel caries, while accounting for other factors. Methods We combined data from a National Dental Practice-Based Research Network observational study of consecutive restorations placed in previously unrestored permanent tooth surfaces and practice/demographic data from 229 participating network dentists. Analysis of variance and logistic regression, using generalized estimating equations (GEE) and variable selection within blocks, were used to test the hypothesis that patient, dentist, and practice characteristics were associated with variations in enamel restorations of occlusal and proximal caries compared to dentin lesions, accounting for dentist and patient clustering. Results Network dentists from 5 regions placed 6,891 restorations involving occlusal and/or proximal caries lesions. Enamel restorations accounted for 16% of enrolled occlusal caries lesions and 6% of enrolled proximal caries lesions. Enamel occlusal restorations varied significantly (p<0.05) by patient age and race/ethnicity, dentist use of caries risk assessment, network region, and practice type. Enamel proximal restorations varied significantly (p<0.05) by dentist race/ethnicity, network region, and practice type. CLINICAL SIGNIFICANCE Identifying patient, dentist, and practice characteristics associated with enamel caries restorations can guide strategies to improve provider adherence to evidence-based clinical recommendations. PMID:25000667

Central retinal vein occlusion with cilioretinal infarction from branch flow exclusion and choroidal arterial steal.

PubMed

McLeod, David

2009-01-01

The first definitive study of retinal vein occlusion complicated by infarction within the territory of one or more cilioretinal arteries was published in 1976. Many individual cases and further case series have been reported in the interim, but the nature of the interrelationship is still under debate. A review was undertaken of the relevant clinical and fundus fluorescein angiographic characteristics of this combined retinal vascular disorder together with the pathophysiological mechanisms currently presented in the literature to explain their association. Scientific publications up to 2008 were evaluated by one of the authors of the original report. There are broad similarities between publications in their descriptions of the clinical features, but significant differences of detail and interpretation are also evident. Most of the mechanisms so far proposed to account for cilioretinal infarction after central or hemisphere retinal vein occlusion do not withstand critical scrutiny. Two related hypotheses are expounded that appear to satisfactorily elucidate this interrelationship -- branch flow exclusion and branch flow diversion (otherwise termed "choroidal arterial steal"). In eyes with a cilioretinal supply, the probability that cilioretinal infarction will complicate retinal vein occlusion increases with increasing severity of venous obstruction and the more distally the cilioretinal artery arises from the posterior ciliary arterial tree. A distal branch point also facilitates observation of dye front reciprocation within the artery. Indicators of the degree of venous obstruction that may be necessary to instigate cilioretinal infarction include very prolonged dye transit times in the central retinal circulation, exaggerated venous cyanosis and tortuosity, perivenous cotton-wool sentinels, and macular perivenular whitening.

Occlusal Classification in Relation to Original Cleft Width in Patients With Unilateral Cleft Lip and Palate.

PubMed

Huang, Andrew H; Patel, Kamlesh B; Maschhoff, Clayton W; Huebener, Donald V; Skolnick, Gary B; Naidoo, Sybill D; Woo, Albert S

2015-09-01

To determine a correlation between the width of the cleft palate measured at the time of lip adhesion, definitive lip repair, and palatoplasty and the subsequent occlusal classification of patients born with unilateral cleft lip and palate. Retrospective, observational study. Referral, urban, children's hospital Participants : Dental models and records of 270 patients were analyzed. None. Angle occlusion classification. The mean age at which occlusal classification was determined was 11 ± 0.3 years. Of the children studies, 84 were diagnosed with Class I or II occlusion, 67 were diagnosed with Class III occlusion, and 119 were lost to follow up or transferred care. Mean cleft widths were significantly larger in subjects with Class III occlusion for all measures at time of lip adhesion and definitive lip repair (P < .02). At time of palatoplasty, cleft widths were significantly greater at the alveolus (P = .025) but not at the midportion of the hard palate (P = .35) or posterior hard palate (P = .10). Cleft widths from the lip through to the posterior hard palate are generally greater in children who are diagnosed with Class III occlusion later in life. Notably, the alveolar cleft width is significantly greater at each time point for patients who went on to develop Class III occlusion. There were no significant differences in cleft widths between patients diagnosed later with Class I and Class II occlusions.

Morpho-histological assessment of the periodontal support structures under the action of excessive occlusal forces and under the influence of nicotine.

PubMed

Ispas, Ana; Mihu, Carmen Mihaela; Crăciun, Antarinia Maria; Constantiniuc, Mariana

2018-01-01

Smoking and occlusal trauma are two factors that can interfere with bone homeostasis. The aim of this study was to evaluate the histocellular changes occurring in the periodontal ligament and alveolar bone during the action of excessive occlusal forces, and to assess the influence of nicotine on the alveolar bone loss in teeth subjected to occlusal trauma. Fifty-six Wistar rats were randomized into seven groups (n=8). Animals were exposed to nicotine and occlusal trauma for 7, 14 and 30 days. Three groups were exposed to occlusal trauma alone, another three groups were exposed to occlusal trauma and nicotine, and one group was not exposed to any treatment. Periodontal lesions induced in the first stage (7-14 days) manifested by a moderate increase of the periodontal space, a multiplication, thickening and elongation of periodontal fibers, as well as their condensation in the middle area of the periradicular space. Regarding bone changes induced by occlusal trauma, groups 5 and 7 (occlusal trauma and nicotine administration) had higher bone losses compared to groups 1, 2, 3, 4 and 6. This study demonstrated that nicotine significantly affected the alveolar bone. The induced occlusal trauma caused obvious tissue damage. At the same time, it was found that nicotine enhanced alveolar bone resorption, increased tooth mobility and induced an exacerbation of inflammatory processes.

Effect of occlusal trauma on healing of periapical pathoses: report of two cases.

PubMed

Harn, W M; Chen, M C; Chen, Y H; Liu, J W; Chung, C H

2001-10-01

To present two clinical cases and demonstrate that occlusal trauma may affect healing of periapical pathoses. Two teeth with periradicular disease did not respond successfully to conventional root canal treatment or endodontic surgery. Occlusal adjustment was finally performed on both cases. After occlusal adjustment, uncomplicated healing and periapical repair occurred in both cases. The findings in these two cases suggest that occlusal trauma may play a role in the healing of periapical pathoses. Occlusal trauma is positively correlated with changes in periodontal tissues. Although experiments in animals have shown that application of forces to teeth will not induce further periodontal destruction, we believe that some failures of root canal treatment may be due to the presence of occlusal trauma modulating the responses of inflamed periapical tissues or apical pathoses with persistent infection.

Does compliance with amblyopia management improve following supervised occlusion treatment?

PubMed

El-Ghrably, I A; Longville, D; Gnanaraj, L

2007-01-01

To demonstrate improvement in compliance following supervised occlusion therapy for amblyopia in children who had failed to respond to outpatient treatment. Retrospective review of the visual outcome of 30 children who were admitted to an ophthalmology ward for 1-day intensive supervised occlusion. These children had documented poor compliance and previously failed to respond to the outpatient occlusion treatment. During their stay a trained ophthalmology nurse educated parents regarding amblyopia and the benefits of occlusion therapy. Visual acuity (VA) of the amblyopic and fellow eyes was recorded on admission, discharge, and at each subsequent visit. The compliance was recorded from parent's history and also indirectly by noticing improvement in vision. The mean supervised occlusion was 7.4 hours (range 4-12 hours). The compliance with occlusion therapy improved in 23 children (77%) after discharge. The mean duration of occlusion after discharge improved to 4 hours (range 1-12 hours). The mean follow-up was 18 months (range 4-24 months). Though there was no dramatic improvement in VA at discharge there was a statistically significant improvement in VA between admission and last recorded VA (p<0.0001). Of the 23 children who were compliant with occlusion following discharge, 21 (91%) gained at least one line of acuity in their amblyopic eye on the last assessment of their VA and five of them achieved 6/12. Of the seven children who did not comply with occlusion following discharge, only one patient gained one line improvement in his amblyopic eye. This study shows that supervised occlusion treatment and parental education was effective in children who had initially failed traditional outpatient treatment.

21 CFR 884.5380 - Contraceptive tubal occlusion device (TOD) and introducer.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Contraceptive tubal occlusion device (TOD) and... Gynecological Therapeutic Devices § 884.5380 Contraceptive tubal occlusion device (TOD) and introducer. (a) Identification. A contraceptive tubal occlusion device (TOD) and introducer is a device designed to close a...

21 CFR 884.5380 - Contraceptive tubal occlusion device (TOD) and introducer.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Contraceptive tubal occlusion device (TOD) and... Gynecological Therapeutic Devices § 884.5380 Contraceptive tubal occlusion device (TOD) and introducer. (a) Identification. A contraceptive tubal occlusion device (TOD) and introducer is a device designed to close a...

21 CFR 884.5380 - Contraceptive tubal occlusion device (TOD) and introducer.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Contraceptive tubal occlusion device (TOD) and... Gynecological Therapeutic Devices § 884.5380 Contraceptive tubal occlusion device (TOD) and introducer. (a) Identification. A contraceptive tubal occlusion device (TOD) and introducer is a device designed to close a...

21 CFR 884.5380 - Contraceptive tubal occlusion device (TOD) and introducer.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Contraceptive tubal occlusion device (TOD) and... Gynecological Therapeutic Devices § 884.5380 Contraceptive tubal occlusion device (TOD) and introducer. (a) Identification. A contraceptive tubal occlusion device (TOD) and introducer is a device designed to close a...

21 CFR 884.5380 - Contraceptive tubal occlusion device (TOD) and introducer.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Contraceptive tubal occlusion device (TOD) and... Gynecological Therapeutic Devices § 884.5380 Contraceptive tubal occlusion device (TOD) and introducer. (a) Identification. A contraceptive tubal occlusion device (TOD) and introducer is a device designed to close a...

Laser Atherectomy for Treatment of Femoropopliteal In-Stent Restenosis.

PubMed

Armstrong, Ehrin J; Thiruvoipati, Thejasvi; Tanganyika, Kundai; Singh, Gagan D; Laird, John R

2015-08-01

To investigate if laser atherectomy with adjunctive balloon angioplasty can improve endovascular treatment outcomes for femoropopliteal in-stent restenosis (ISR). A dual center study included 135 symptomatic patients (mean age 71 years; 76 men) who underwent endovascular treatment of femoropopliteal ISR between 2006 and 2013. Of these, 54 (40%) were treated with laser atherectomy and the remaining 81 patients with balloon angioplasty alone. Angiographic images were reviewed for lesion morphology and characteristics, TransAtlantic InterSociety Consensus (TASC) II classification, and distal runoff. Class I ISR was defined as focal lesions ≤50 mm, class II ISR as lesions >50 mm, and class III ISR as stent total occlusion. Recurrent ISR was determined by a peak systolic velocity ratio >2.4 by duplex ultrasound. Patients treated with laser atherectomy had longer mean ISR lesion length (222 vs 114 mm, p<0.001) and more class III ISR (69% vs 20%, p=0.001). There was no association between laser atherectomy and rates of recurrent restenosis or occlusion for patients with class I/II ISR, but there was a significantly lower rate of target lesion revascularization at 2 years among patients treated with laser atherectomy (14% vs 44%, p=0.05). In comparison, patients with class III ISR treated with laser atherectomy had lower rates of recurrent restenosis at 1 year (54% vs 91%, p=0.05) and 2 years (69% vs 100%, p=0.05). Patients with class III ISR treated with laser atherectomy also had lower rates of recurrent in-stent occlusion at 2-year follow-up (33% vs 71%, p=0.04). When used to treat complex ISR, including in-stent occlusions, laser atherectomy with adjunctive balloon angioplasty may be associated with improved patency. © The Author(s) 2015.

The Woven EndoBridge (WEB) for endovascular therapy of intracranial aneurysms: Update of a systematic review with meta-analysis.

PubMed

Tau, Noam; Sadeh-Gonik, Udi; Aulagner, Gilles; Turjman, Francis; Gory, Benjamin; Armoiry, Xavier

2018-03-01

Endovascular treatment of wide-neck intracranial aneurysms (IAs) is challenging, especially in bifurcation location. The intra-saccular flow-disruptor Woven EndoBridge (WEB) offers a new concept of endovascular therapy for wide-neck IAs. We performed an update of a systematic review aimed to report the feasibility, effectiveness and safety of WEB device therapy. A systematic review was conducted using several electronic databases (including PUBMED and EMBASE), searching for studies published between October 2015 and December 2017 (those published between January 2010 and September 2015 were included in our initial systematic review). Outcomes were: success of implantation, peri-procedural complications, mortality, and adequate occlusion (complete occlusion or neck remnant). In total (initial review + update), 12 uncontrolled case-series studies were included, reporting outcomes for 940 patients (68.6% female; mean age, 57 years) harboring 962 IAs. Most IAs were wide-neck bifurcation aneurysms (75%-100%), mainly at middle cerebral artery (37%) and anterior communicating artery (24.6%). Feasibility was 97% (95% confidence interval [CI], 95%-99%), and 9% (95%CI, 5%-14%) of cases required additional treatment. There were 14% (95%CI, 9%-19%) peri-procedural complications. After a median clinical follow-up of 7 months, mortality was 5% (95%CI, 1%-10%) and was higher in series with larger proportions of ruptured IAs. At last angiographic follow-up (median, 7 months; range, 3-27.9 months), adequate occlusion rate was 81% (95%CI, 73%-88%). Although WEB showed high rates of adequate aneurysm occlusion at mid-term, procedure-related complications and mortality rates were not negligible. Future studies should compare the WEB device with other treatment options. Copyright © 2018 Elsevier B.V. All rights reserved.

Three-dimensional anatomy of equine incisors: tooth length, enamel cover and age related changes

PubMed Central

2013-01-01

Background Equine incisors are subjected to continuous occlusal wear causing multiple, age related changes of the extragingival crown. It is assumed that the occlusal wear is compensated by continued tooth elongation at the apical ends of the teeth. In this study, μCT-datasets offered the opportunity to analyze the three-dimensional appearance of the extra- and intraalveolar parts of the enamel containing dental crown as well as of the enamel-free dental root. Multiple morphometric measurements elucidated age related, morphological changes within the intraalveolar part of the incisors. Results Equine incisors possess a unique enamel cover displaying large indentations on the mesial and distal sides. After eruption tooth elongation at the apical end outbalances occlusal wear for two to four years resulting in increasing incisor length in this period of time. Remarkably, this maximum length is maintained for about ten years, up to a tooth age of 13 to 15 years post eruption. Variances in the total length of individual teeth are related to different Triadan positions (central-, middle- and corner incisors) as well as to the upper and lower arcades. Conclusion Equine incisors are able to fully compensate occlusal wear for a limited period of time. However, after this ability ceases, it is expected that a diminished intraalveolar tooth length will cause massive changes in periodontal biomechanics. The time point of these morphodynamic and biomechanical changes (13 to 15 years post eruption) occurs in coincidence with the onset of a recently described destructive disease of equine incisor (equine odontoclastic tooth resorption and hypercementosis) in aged horses. However, further biomechanical, cell biological and microbiological investigations are needed to elucidate a correlation between age related changes of incisor morphology and this disease. PMID:24321365

Three-dimensional anatomy of equine incisors: tooth length, enamel cover and age related changes.

PubMed

Schrock, Patricia; Lüpke, Matthias; Seifert, Hermann; Staszyk, Carsten

2013-12-09

Equine incisors are subjected to continuous occlusal wear causing multiple, age related changes of the extragingival crown. It is assumed that the occlusal wear is compensated by continued tooth elongation at the apical ends of the teeth. In this study, μCT-datasets offered the opportunity to analyze the three-dimensional appearance of the extra- and intraalveolar parts of the enamel containing dental crown as well as of the enamel-free dental root. Multiple morphometric measurements elucidated age related, morphological changes within the intraalveolar part of the incisors. Equine incisors possess a unique enamel cover displaying large indentations on the mesial and distal sides. After eruption tooth elongation at the apical end outbalances occlusal wear for two to four years resulting in increasing incisor length in this period of time. Remarkably, this maximum length is maintained for about ten years, up to a tooth age of 13 to 15 years post eruption. Variances in the total length of individual teeth are related to different Triadan positions (central-, middle- and corner incisors) as well as to the upper and lower arcades. Equine incisors are able to fully compensate occlusal wear for a limited period of time. However, after this ability ceases, it is expected that a diminished intraalveolar tooth length will cause massive changes in periodontal biomechanics. The time point of these morphodynamic and biomechanical changes (13 to 15 years post eruption) occurs in coincidence with the onset of a recently described destructive disease of equine incisor (equine odontoclastic tooth resorption and hypercementosis) in aged horses. However, further biomechanical, cell biological and microbiological investigations are needed to elucidate a correlation between age related changes of incisor morphology and this disease.

Percutaneous unilateral biliary metallic stent placement in patients with malignant obstruction of the biliary hila and contralateral portal vein steno-occlusion.

PubMed

Son, Rak Chae; Gwon, Dong Il; Ko, Heung Kyu; Kim, Jong Woo; Ko, Gi-Young

2015-01-01

To investigate the outcomes of percutaneous unilateral metallic stent placement in patients with a malignant obstruction of the biliary hila and a contralateral portal vein steno-occlusion. Sixty patients with a malignant hilar obstruction and unilobar portal vein steno-occlusion caused by tumor invasion or preoperative portal vein embolization were enrolled in this retrospective study from October 2010 to October 2013. All patients were treated with percutaneous placement of a biliary metallic stent, including expanded polytetrafluoroethylene (ePTFE)-covered stents in 27 patients and uncovered stents in 33 patients. A total of 70 stents were successfully placed in 60 patients. Procedural-related minor complications, including self-limiting hemobilia (n = 2) and cholangitis (n = 4) occurred in six (10%) patients. Acute cholecystitis occurred in two patients. Successful internal drainage was achieved in 54 (90%) of the 60 patients. According to a Kaplan-Meier analysis, median survival time was 210 days (95% confidence interval [CI], 135-284 days), and median stent patency time was 133 days (95% CI, 94-171 days). No significant difference in stent patency was observed between covered and uncovered stents (p = 0.646). Stent dysfunction occurred in 16 (29.6%) of 54 patients after a mean of 159 days (range, 65-321 days). Unilateral placement of ePTFE-covered and uncovered stents in the hepatic lobe with a patent portal vein is a safe and effective method for palliative treatment of patients with a contralateral portal vein steno-occlusion caused by an advanced hilar malignancy or portal vein embolization. No significant difference in stent patency was detected between covered and uncovered metallic stents.

Percutaneous Unilateral Biliary Metallic Stent Placement in Patients with Malignant Obstruction of the Biliary Hila and Contralateral Portal Vein Steno-Occlusion

PubMed Central

Son, Rak Chae; Ko, Heung Kyu; Kim, Jong Woo; Ko, Gi-Young

2015-01-01

Objective To investigate the outcomes of percutaneous unilateral metallic stent placement in patients with a malignant obstruction of the biliary hila and a contralateral portal vein steno-occlusion. Materials and Methods Sixty patients with a malignant hilar obstruction and unilobar portal vein steno-occlusion caused by tumor invasion or preoperative portal vein embolization were enrolled in this retrospective study from October 2010 to October 2013. All patients were treated with percutaneous placement of a biliary metallic stent, including expanded polytetrafluoroethylene (ePTFE)-covered stents in 27 patients and uncovered stents in 33 patients. Results A total of 70 stents were successfully placed in 60 patients. Procedural-related minor complications, including self-limiting hemobilia (n = 2) and cholangitis (n = 4) occurred in six (10%) patients. Acute cholecystitis occurred in two patients. Successful internal drainage was achieved in 54 (90%) of the 60 patients. According to a Kaplan-Meier analysis, median survival time was 210 days (95% confidence interval [CI], 135-284 days), and median stent patency time was 133 days (95% CI, 94-171 days). No significant difference in stent patency was observed between covered and uncovered stents (p = 0.646). Stent dysfunction occurred in 16 (29.6%) of 54 patients after a mean of 159 days (range, 65-321 days). Conclusion Unilateral placement of ePTFE-covered and uncovered stents in the hepatic lobe with a patent portal vein is a safe and effective method for palliative treatment of patients with a contralateral portal vein steno-occlusion caused by an advanced hilar malignancy or portal vein embolization. No significant difference in stent patency was detected between covered and uncovered metallic stents. PMID:25995688

A clinical study to evaluate the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics cream for pain reduction of venipuncture in children.

PubMed

Eichenfield, Lawrence F; Funk, Ann; Fallon-Friedlander, Sheila; Cunningham, Bari B

2002-06-01

A double-randomized, blinded crossover trial was performed to assess the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics (EMLA) for pain relief during pediatric venipuncture procedures. Safety was assessed by evaluation for topical or systemic effects and measurement of serum lidocaine concentrations. A total of 120 children who were scheduled for repeat venipuncture for non-study-related reasons at 2 sites participated in the study. Patients were doubly randomized to treatment regimen (study medication application time of either 30 or 60 minutes) and to the order of application of the topical anesthetics for each venipuncture. The primary outcome measures were the child's rating of pain immediately after the venipuncture procedures using a 100-mm visual analog scale (VAS) tool and the parent's and blinded research observer's Observed Behavioral Distress scores. Both ELA-Max and EMLA seemed to alleviate venipuncture pain. There was no clinically or statistically significant difference in the patient VAS scores within the 30-minute or 60-minute treatment groups, and there was no clinical or statistical difference in VAS scores between the 30-minute ELA-Max treatment without occlusion and the 60-minute EMLA treatment with occlusion. There were no clinically or statistically significant differences between treatment with ELA-Max and EMLA in parental or blinded researcher Observed Behavioral Distress scores, the most frequent response at any observation time being "no distress." This study demonstrates that a 30-minute application of ELA-Max without occlusion is as safe and as effective for ameliorating pain associated with venipuncture as a 60-minute application of the prescription product EMLA requiring occlusion.

Limb suction evoked during arterial occlusion causes systemic sympathetic activity in humans

PubMed Central

Cui, Jian; Blaha, Cheryl; Herr, Michael D.; Drew, Rachel C.; Muller, Matthew D.

2015-01-01

Venous saline infusions in an arterially occluded forearm evokes reflex increases in muscle sympathetic nerve activity (MSNA) and blood pressure (BP). We hypothesized that the application of suction to the human limbs would activate this venous distension reflex and raise sympathetic outflow. We placed airtight pressure tanks and applied 100 mmHg negative pressure to an arterially occluded limb (occlusion and suction, O&S) to induce tissue deformation without fluid translocation. BP, heart rate (HR), and MSNA were assessed in 19 healthy subjects during 2 min of arm or leg O&S. Occlusion without suction served as a control. During a separate visit, saline (5% forearm volume) was infused into veins of the arterially occluded arm (n = 13). The O&S increased limb circumference, MSNA burst rate (arm: Δ6.7 ± 0.7; leg: Δ6.8 ± 0.7 bursts/min), and total activity (arm: Δ199 ± 14; leg: Δ172 ± 22 units/min) and BP (arm: Δ4.3 ± 0.3; leg: Δ9.4 ± 1.4 mmHg) from the baseline. The MSNA and BP responses during arm O&S correlated with those during leg O&S. Occlusion alone had no effect on MSNA and BP. MSNA (r = 0.607) responses during arm O&S correlated with those evoked by the saline infusion into the arm. These correlations suggest that sympathetic activation during limb O&S is likely, at least partially, to be evoked via the venous distension reflex. These data suggest that suction of an occluded limb evokes sympathetic activation and that the limb venous distension reflex exists in arms and legs of normal humans. PMID:26136530

Epicardial clip occlusion of the left atrial appendage during cardiac surgery provides optimal surgical results and long-term stability.

PubMed

Kurfirst, Vojtech; Mokrácek, Aleš; Canádyová, Júlia; Frána, Radim; Zeman, Petr

2017-07-01

Occlusion of the left atrial appendage (LAA) has become an integral and important part of the surgical treatment of atrial fibrillation. Different methods of surgical occlusion of the LAA have been associated with varying levels of short- and long-term success for closure. The purpose of this study was to evaluate long-term results of epicardial placement and endocardial occlusion in patients undergoing cardiac operative procedures. A total of 101 patients (average age 65.7 years) undergoing cardiac operative procedures with the epicardial AtriClip Exclusion System of the LAA were enrolled in the study. The AtriClip was placed via a sternotomy or a thoracotomy or from a thoracoscopic approach. Postoperative variables, such as thromboembolic events, clip stability and endocardial leakage around the device, were examined by transoesophageal echocardiography (TEE) and/or computed tomography. Perioperative clip implantation was achieved in 98% of patients. TEE and/or computed tomography conducted during the follow-up period, comprising 1873 patient-months with a mean duration of 18 ± 11 months, revealed no clip migration, no leakage around the device and no clot formation near the remnant cul-de-sac. During the follow-up period, 4 of the cardiac patients experienced transitory ischaemic attacks, whereas no patient experienced a cerebrovascular attack. The Epicardial AtriClip Exclusion System of the LAA appears to be a feasable and safe operative method with a high success rate. Long-term follow-up confirmed clip stability, complete occlussion of the LAA and absence of any atrial fibrilation-related thromboembolic events. These results need to be confirmed by a larger, multicentre study. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Thermal effect of microburst and hyperpulse settings during sleeveless bimanual phacoemulsification with advanced power modulations.

PubMed

Braga-Mele, Rosa

2006-04-01

To assess wound temperature during bimanual sleeveless phacoemulsification using customizable power modulations such as hyperpulse and microburst technology. In vitro laboratory. The Millennium Microsurgical System (Bausch & Lomb) with custom control software (CCS) was used to perform phacoemulsification in 5 porcine eyes with MicroFlow needles (Bausch & Lomb) and with power varied from 20% to 80% in 10% increments. Pulse modes were set for fixed microburst (4 ms on, 4 ms off; and 6 ms on, 12 or 24 ms off) and for hyperpulse (30% duty cycle with 8 or 75 pulses per second [pps]), with and without aspiration-line occlusion. Wound temperatures were measured 3 times per second. Using 80% total power, the wound temperature during 3 minutes of occlusion did not exceed 39.0 degrees C. The maximum temperature with fixed microbursts of 4 ms on, 4 ms off was 29.0 degrees C without occlusion and 37.8 degrees C with occlusion (duration 3 minutes). At 6 ms on, 12 ms off, the maximum temperatures were 28.1 degrees C and 38.7 degrees C, respectively. At 6 ms on, 24 ms off, peak temperatures were 24 degrees C and 23.6 degrees C, respectively. The hyperpulse mode of 30% duty cycle and 8 pps produced maximum temperatures of 25.5 degrees C nonoccluded and 33.4 degrees C occluded. With 30% duty cycle, 75 pps, temperatures were 28 degrees C and 38.0 degrees C, respectively. For all power below 80%, temperatures were lower. Customizable power modulation with microburst and hyperpulse technology further reduced wound temperatures during bimanual sleeveless phacoemulsification. This enhances the safety and effectiveness of phacoemulsification through a sleeveless needle and a small stab incision.

Myocardial Blood Flow Distribution during Ischemia-Induced Coronary Vasodilation in the Unanesthetized Dog

PubMed Central

Bache, Robert J.; Cobb, Frederick R.; Greenfield, Joseph C.

1974-01-01

This study was designed to determine whether coronary vasodilation distal to a flow-limiting coronary artery stenosis could result in redistribution of myocardial blood flow to produce subendocardial underperfusion. Studies were performed in 10 awake dogs chronically prepared with electromagnetic flow-meters and hydraulic occluders on the left circumflex coronary artery. Regional myocardial blood flow was measured using radionuclide-labeled microspheres, 7-10 μm in diameter, injected into the left atrium. A 5-s coronary artery occlusion was followed by reactive hyperemia with excess inflow of arterial blood effecting 375±20% repayment of the blood flow debt incurred during occlusion. When, after a 5-s occlusion, the occluder was only partially released to hold arterial inflow to the preocclusion level for 20 s before complete release, the delayed reactive hyperemia was augmented (mean blood flow repayment = 610±45%, P < 0.01). This augmentation of the reactive hyperemia suggested that ischemia was continuing during the interval of coronary vasodilation when coronary inflow was at the preocclusion level. Measurements of regional myocardial blood flow demonstrated that endocardial flow slightly exceeded epicardial flow during control conditions. When arterial inflow was limited to the preocclusion rate during vasodilation after a 5-s total coronary artery occlusion, however, flow to the subepicardial myocardium was increased at the expense of underperfusion of the subendocardial myocardium. Thus, in the presence of a flow-limiting proximal coronary artery stenosis, ischemia-induced coronary vasodilation resulted in redistribution of myocardial blood flow with production of subendocardial ischemia in the presence of a net volume of arterial inflow which, if properly distributed, would have been adequate to prevent myocardial ischemia. Images PMID:4279928

A preliminary study to find a possible association between occlusal wear and maximum bite force in humans.

PubMed

Jain, Veena; Mathur, Vijay Prakash; Kumar, Abhishek

2013-01-01

The objective of the study was to investigate whether moderate-to-severe attrition is associated with maximum bite force in the first molar region. Maximum bite force in the first molar region was measured for a total of 60 subjects having moderate-to-severe attrition of occlusal surface (experimental group) using a specially-designed piezoelectric sensor based bite force measuring device. An equal number of age, gender, height and weight matched controls (control group) were also subjected to bite force measurement for comparison. The maximum bite force was found to be significantly lower (p < 0.05) in the experimental group [480.32 (153.40)] as compared to the controls [640.63 (148.90)]. While analyzing the possible etiology for occlusal wear mainly two reasons were elicited, i.e. history of parafunctional habits like use of known abrasive tooth powder (sub-group A) and Bruxism (sub-group B). However, there were many subjects in which no known definite etiological factors be attributed to occlusal wear (sub-group C). On analysing further with respect to the possibly correlated etiological factors with maximum bite force, no significant difference was found within the experimental sub-group. However, all three experimental sub-groups had significantly lower maximum bite force as compared to age, gender and BMI matched controls. A significantly lower maximum bite force was found to be associated with moderate-to-severe attrition as compared to subjects without attrition. However, no specific relation could be found between bite force and possible etiological factors like history of parafunctional habits, history of use of known abrasive tooth powder, etc.

Reliability of multiple-degree incisal/occlusal tooth wear assessment on dental casts: findings from a fiveexaminer investigation and related clinical implications.

PubMed

Paesani, Daniel A; Guarda-Nardini, Luca; Gelos, Carlota; Salmaso, Luigi; Manfredini, Daniele

2014-03-01

The aim was to answer the clinical research question: is incisal/occlusal tooth wear assessment on dental casts performed by five professionals with expertise in different fields of dentistry reliable? Five examiners with different fields of expertise in the dental profession assessed tooth wear on dental casts of 45 subjects, based on a six-degree rating of incisal/occlusal wear. After a calibration meeting, the examiners evaluated the casts individually and various issues concerning interexaminer agreement and reliability were assessed. A total of 872 teeth were evaluated. The five examiners agreed only for the rating of 6.6% of the teeth. The teeth with the highest percentage of agreement were the premolars. Pairwise comparison of the assessments of the examiners #1 (bruxism expert), #2 (orthodontist), #3 (temporomandibular disorders [TMD] and occlusion expert), #4 (dental nurse) showed fair to moderate agreement, with κ-values ranging from 0.306 to 0.577, whilst the examiner #5 (lab technician) achieved low interexaminer reliability values with all the other four examiners. The interexaminer reliability of tooth wear assessment on dental casts performed by five professionals with expertise in different fields of dentistry is highly variable. General practitioners should keep in mind that consensus decisions by the examiners and assessment by raters belonging to the same dental discipline are recommended strategies to increase the reliability of tooth wear evaluation in the clinical setting. This investigation adds to the literature suggesting that, in a clinical setting, a single examiner's assessment of tooth wear on dental casts does not have optimal reliability and that it may be source of internal validity problems in the research setting.

ROLE OF PARENTERAL NUTRITION IN ONCOLOGIC PATIENTS WITH INTESTINAL OCCLUSION AND PERITONEAL CARCINOMATOSIS.

PubMed

Aría Guerra, Eva; Cortés-Salgado, Alfonso; Mateo-Lobo, Raquel; Nattero, Lía; Riveiro, Javier; Vega-Piñero, Belén; Valbuena, Beatriz; Carabaña, Fátima; Carrero, Carmen; Grande, Enrique; Carrato, Alfredo; Botella-Carretero, José Ignacio

2015-09-01

the precise role of parenteral nutrition in the management of oncologic patients with intestinal occlusion is not well defined yet. We aimed to identify the effects of parenteral nutrition in these patients regarding prognosis. 55 patients with intestinal occlusion and peritoneal carcinomatosis were included. Parenteral nutrition aimed at 20-35 kcal/Kg/day, and 1.0 g/kg/day of amino-acids. Weight, body mass index, type of tumor, type of chemotherapy, and ECOG among others were recorded and analyzed. 69.1% of the patients had gastrointestinal tumors, 18.2% gynecologic and 12.7% others. Age was 60 ± 13y, baseline ECOG 1.5 ± 0.5 and body mass index 21.6 ± 4.3. Malnutrition was present in 85%. Survival from the start of parenteral nutrition was not significant when considering baseline ECOG (log rank = 0.593, p = 0.743), previous lines of chemotherapy (log rank = 2.117, p = 0.548), baseline BMI (log rank = 2.686, p = 0.261), or type of tumor (log rank = 2.066, p = 0.356). Survival in patients who received home parenteral nutrition after hospital discharge was higher than those who stayed in-hospital (log rank = 7.090, p = 0.008). Survival in patients who started chemotherapy during or after parenteral nutrition was higher than those who did not so (log rank = 17.316, p < 0.001). A total of 3.6% of patients presented catheter related infection without affecting survival (log rank = 0.061, p = 0.804). Parenteral nutrition in patients with advanced cancer and intestinal occlusion is safe, and in tho se who respond to chemotherapy, further administration of home parenteral nutrition together with chemotherapy may enhance prolonged survival. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Influence of bruxism on survival of porcelain laminate veneers.

PubMed

Granell-Ruíz, Maria; Agustín-Panadero, Rubén; Fons-Font, Antonio; Román-Rodríguez, Juan-Luis; Solá-Ruíz, María-Fernanda

2014-09-01

This study aims to determine whether bruxism and the use of occlusal splints affect the survival of porcelain laminate veneers in patients treated with this technique. Restorations were made in 70 patients, including 30 patients with some type of parafunctional habit. A total of 323 veneers were placed, 170 in patients with bruxism activity, and the remaining 153 in patients without it. A clinical examination determined the presence or absence of ceramic failure (cracks, fractures and debonding) of the restorations; these incidents were analyzed for association with bruxism and the use of splints. Analysis of the ceramic failures showed that of the 13 fractures and 29 debonding that were present in our study, 8 fractures and 22 debonding were related to the presence of bruxism. Porcelain laminate veneers are a predictable treatment option that provides excellent results, recognizing a higher risk of failure in patients with bruxism activity. The use of occlusal splints reduces the risk of fractures.

Double-lumen balloon for Onyx® embolization via extracranial arteries in transverse sigmoid dural arteriovenous fistulas: initial experience.

PubMed

Clarençon, Frédéric; Di Maria, Federico; Gabrieli, Joseph; Carpentier, Alexandre; Pistochi, Silvia; Bartolini, Bruno; Zeghal, Chiheb; Chiras, Jacques; Sourour, Nader-Antoine

2016-10-01

Transverse-sigmoid dural arteriovenous fistulas (TS DAVFs) can be challenging to treat by endovascular means. Indeed, a total cure of the fistula can only be achieved when complete occlusion of the fistulous point(s) is obtained by penetration of the embolic agent. However, in some cases, especially for transosseous branches from extracranial arteries like the occipital artery (OcA) or the superficial temporal artery (STA), such penetration is usually poor, leading to major proximal reflux and incomplete fistula obliteration. We present three cases of embolization in two patients with TS DAVF through the OcA and/or the STA with Onyx® using a double-lumen balloon (Microvention, Tustin, CA, USA). This technique allows the penetration of the embolic agent in the transosseous branches by forming a counter-pressure with the inflated balloon. This technique may be useful to achieve complete occlusion of TS DAVFs by endovascular means.

Role of occlusion in endodontic management: report of two cases.

PubMed

Yu, Christine Y

2004-12-01

The two clinical cases reported demonstrate that traumatic occlusion can play a role in the initiation and progression of pulp and periradicular inflammation. The symptom of persistent pain did not subside after the commencement of endodontic treatment. Traumatic occlusion was identified in both cases to be the main cause and hence occlusal adjustment was performed. This resulted in the gradual resolution of the symptoms. The findings suggest that occlusal trauma is often overlooked in the diagnosis and management of endodontic diseases.