Serial Inflation Research Articles

Reperfusion Injury: How Can We Reduce It by Pre-, Per-, and Postconditioning.

While early coronary reperfusion via primary percutaneous coronary intervention (pPCI) is established as the most efficacious therapy for minimizing infarct size (IS) in acute ST-elevation myocardial infarction (STEMI), the restoration of blood flow also introduces myocardial ischemia-reperfusion injury (IRI), leading to cardiomyocyte death. Among diverse methods, ischemic conditioning (IC), achieved through repetitive cycles of ischemia and reperfusion, has emerged as the most promising method to mitigate IRI. IC can be performed by applying the protective stimulus directly to the affected myocardium or indirectly to non-affected tissue, which is known as remote ischemic conditioning (RIC). In clinical practice, RIC is often applied by serial inflations and deflations of a blood pressure cuff on a limb. Despite encouraging preclinical studies, as well as clinical studies demonstrating reductions in enzymatic IS and myocardial injury on imaging, the observed impact on clinical outcome has been disappointing so far. Nevertheless, previous studies indicate a potential benefit of IC in high-risk STEMI patients. Additional research is needed to evaluate the impact of IC in such high-risk cohorts. The objective of this review is to summarize the pathophysiological background and preclinical and clinical data of IRI reduction by IC.

Expanded Cheek-Shaped Flap for Aesthetic Cheek Reconstruction in the Cervicoperiauricular Area.

The cervical area is well acknowledged as an ideal donor site for aesthetic reconstruction of the cheek, and tissue expansion may play an important role for maximally achieving such a purpose. However, the conventional design of the expanded cervical flap generally results in unsightly morbidity of the donor site. The aim of this study is to evaluate the results of using an improvised cervical expanded flap in aesthetic reconstruction of the cheek. From July 2004 to October 2012, a total of 23 burn sequelae patients (30 cheeks) underwent cheek reconstruction with an expanded flap that originated from the cervicoperiauricular area. The procedures were initially carried out with the insertion of a round tissue expander in the cervicoperiauricular area, followed by serial inflation of the expander, and finally, transplantation of the expanded flap to the cheek in a rotation advancement fashion. The donor site closure was along the auricular sulcus. The average area of the harvested flaps was 9.7 × 8.1 cm. All the flaps completely survived, only one major complication occur-a dome exposure of the tissue expander after the expansion was completed. The flap was salvaged, and the transfer stage was done without intact. Minor complications after flap transfer include: widened scar at the donor site, a "dog-ear" needing additional minor surgery, distal part of the flap transient congestion. The patients achieved very satisfactory results functionally and aesthetically. Using the expanded cheek-shaped flap technique can provide a safe, thin, and color-matched flap in aesthetic reconstruction of the cheek with minimal donor site morbidity.

Leaving the “Big Deal”: Consequences and Next Steps

Many libraries are facing difficult fiscal climates with serials inflation, budget cutbacks, and reductions in allocations requiring difficult collection management decisions. Libraries may find their flexibility to plan and react unduly restricted due to being contracted to one or more “Big Deals,” in which they are obligated to buy large, inflexible title lists from big publishers for a set price. This presentation discusses the experience of Southern Illinois University–Carbondale and the University of Oregon in leaving “Big Deals,” provides data on impacts on interlibrary loans, community response, and collection budgets, details the steps required before and after the decision, and describes the benefits that other libraries could achieve by following the example of these two members of the Association of Research Libraries.

Biz of Acq -- Predicting Serials Inflation Rates in the Era of Electronic Resources

Biz of Acq -- Predicting Serials Inflation Rates in the Era of Electronic Resources

Enhanced external counterpulsation improves systolic function by echocardiography in patients with coronary artery disease

The clinical benefits of enhanced external counterpulsation (EECP) for patients with refractory angina pectoris have been well established.1–5 the mechanisms by which this clinical benefit occurs, however, has not yet been clearly elucidated. improved systolic and diastolic function by way of recruitment of coronary collateral vasculature is one plausible mechanism. eecp is a noninvasive technique that provides augmentation of diastolic coronary blood flow similar to the intra-aortic balloon pump and uses the serial inflation of 3 sets of cuffs that wrap around the calves, thighs, and buttocks.

The End of an American (Library) Dream

SUMMARY Berkeley's Collection Development Policy Statement (CDPS) dates from 1980 and reflects the spirit of this era, written to facilitate building of comprehensive collections on the national level as well as to assist in regional cooperative efforts. Fiscal constraints (largely the result of serials inflation) have since encouraged greater emphasis on meeting immediate local needs. Despite this, the 1980 CDPS has never been systematically revised, partly due to the effort required, the impact of administrative changes (including the loss of a centralized collections office during a critical period), and uncertainty about the place of electronic resources. As the library learns to cope with inflation and to incorporate electronic resources in collection planning, a CDPS is needed to guide collection development in an age of diminished resources. Such a new CDPS must take a different approach to collection planning, providing great flexibility, allowing for long-range planning, and coordinating approach...

Tragedy of the Commons Revisited: Librarians, Publishers, Faculty and the Demise of a Public Resource

The model of scholarly publishing can be reduced, in economic terms, to a Tragedy of the Commons, whereby the individual interests of publishers, libraries and scholars are in conflict with what is in the best interest of the public good. Serials inflation, price discrimination, and site-license pricing are all manifestations of this dysfunctional economic model. Moral arguments to change human behavior are not effective because they do not provide individual incentives. Technology alone is also not a viable solution since it fails to change the underlying human behavior that is driving the economic model. Abandoning the current system of publishing is both risky and costly. This paper argues for a reintermediation of the library as governor of the public scholarly commons, but illustrates that these solutions are in conflict with the mission of the library profession.

Coronary venous lipid peroxide concentrations after coronary angioplasty: correlation with biochemical and electrocardiographic evidence of myocardial ischaemia.

Raised lipid peroxide concentrations in coronary venous plasma have been reported after coronary angioplasty in humans. This may reflect increased free radical activity after myocardial ischaemia and reperfusion. If so, it may be possible to correlate lipid peroxide concentrations with the degree of myocardial ischaemia produced during angioplasty. 15 patients (age range 42-70; 12 men) with stable angina pectoris undergoing angioplasty of a proximal left anterior descending coronary artery stenosis were studied. Plasma lipid peroxide and lactate concentrations were measured in sequential blood samples taken from the great cardiac vein before and immediately after one to five serial 60 second balloon inflations. The maximum ST segment shift during each balloon inflation was also measured. Lipid peroxide concentrations in coronary venous plasma were raised from pre-angioplasty values by more than 2 SDs of the relevant measurement error after 27 out of 46 (59%) balloon inflations. Lactate concentrations were raised after 43 out of 46 (93%) balloon inflations. No significant difference was found between the peak percentage change of either lipid peroxide or lactate concentrations after any of the first three serial inflations. The maximum ST segment shift after each of the first three serial inflations was also similar. Coronary venous lactate concentrations after balloon inflation correlated positively with the maximum ST segment shift, but did not correlate with lipid peroxide concentrations. Raised lipid peroxide concentrations in coronary venous plasma can be detected in humans after balloon angioplasty. There is no positive correlation between lipid peroxide concentrations in coronary venous plasma after angioplasty and the degree of preceding myocardial ischaemia as assessed by either ST segment shift or lactate production. These indices showed that one to three serial 60 second balloon inflations each produce a similar degree of myocardial ischaemia. The origin of the raised lipid peroxide concentrations in coronary venous plasma after angioplasty remains unknown.

Explosive ILL Growth at the University of Montana

Abstract This article explores the causes and the consequences of rapid growth in Interlibrary Loan use at the University of Montana between 1984–1990. For many years the state university library had emphasized traditional collection development and ownership. Since 1984, however, slow attrition of the acquisition budget, coupled with serials inflation, and a concomitant development of new electronic information sources, has forced a new emphasis—access, resource sharing, and temporary ownership. The result has been a steady and rapid growth of the Interlibrary Loan service. From 1984–1990 ILL use increased almost 200%. This specific case study from the Mansfield Library can serve as a template or guide for possible solutions, for what has transpired here is not unusual. In fact, our experience is illustrative of widespread problems that confront many libraries.

How to Manage the Serials Budget in Today's Climate

Serials inflation is not a new problem. The situation is now so serious that research and college libraries are reporting materials budgets with serials purchases consuming seventy to eighty percent of the funds, while monographic purchases have been reducd by an estimated twenty percent since 1985.

Post-mastectomy breast reconstruction using the inflatable tissue expander.

Breast reconstruction following mastectomy has previously relied on the insertion of a silicone gel implant or the use of a myocutaneous flap. We report the use of an innovation, the inflatable tissue expander, for both immediate and delayed breast reconstruction in 26 patients where soft tissue cover was inadequate to permit the use of the silicone implant. By serial inflation of the tissue expander with saline, sufficient tissue cover was achieved for a second operative placement of a silicone prosthesis of appropriate volume to match the normal breast. To date, 10 patients undergoing delayed reconstruction and 5 of 16 patients with immediate reconstruction have had their final prosthesis inserted, while 3 women are satisfied with the result of the expandable implant and desire no further surgery. Only two technical complications have arisen with loss of the expander in one patient who had had recent radiotherapy and in another the tissue expander was placed much too high on the chest wall. Mechanical failure occurred in three cases where disruption of the seam led to sudden deflation in two and a slow leak from the injection port developed in one. One patient also attempted self-inflation leading to deflation of the tissue expander. The cosmetic results were subjectively and objectively very good with capsular distortion present in only one case. We feel that the inflatable tissue expander is simple and safe to use, may be used for immediate reconstruction without compromising the ablative surgery and should be a choice available to general surgeons for providing safe and cosmetically acceptable reconstructive surgery.

Effect of interstitial fluid (kerosene) on pressure-volume characteristics of rat lung.

Although pulmonary interstitial edema has been estimated to decrease pulmonary compliance (CL), it has been experimentally difficult to demonstrate whether the observed changes in CL are directly due to the presence of interstitial fluid or if they result instead from concomitant pulmonary vascular engorgement and/or alveolar edema. Since kerosene-inflated lungs do not leak, we were able to use kerosene to measure the effect on CL of the accumulation of interstitial fluid (kerosene) in the postmortem rat lung. Pressure-volume (PV) studies of the lung were done during the progressive increase in interstitial fluid (kerosene). Analysis of the deflation limbs of the quasistatic PV curves obtained following serial inflations with kerosene indicated that the maximal volume of kerosene [MV35, equal to the maximum tissue plus airway volume at a transpulmonary pressure (Ptp) of 35 cmH2O] was 3.8 +/- 1.2 ml (31.0 +/- 11.8%) greater than TLC35 [air volume at Ptp of 35 cmH2O prior to kerosene inflation]. The increases in interstitial kerosene volume had no effect on kerosene PV characteristics, as was demonstrated by superimposing lung PV curves obtained at various states of interstitial filling. We conclude that the interstitial compartment is large and very compliant and that the presence of even great amounts of fluid limited to this compartment does not restrict lung expansion.