Temporary Blockage Research Articles

A Prospective and Observational Study on the Impact of Patient Counselling on Medication Adherence and Quality of Life in Stroke Patients

PURPOSE: The study goals are to improve medication adherence and high-quality lifestyles in stroke patients through effective patient counselling. BACKGROUND: Stroke is one of the most common neurological disorders and the second most common purpose of dying worldwide. Stroke is likewise called cerebral infarction or cerebrovascular twist of fate. It occurs when blood flow to the brain is reduced due to permanent or temporary blockage of an artery that carries blood to the brain, or rupture of an artery in the brain because of high blood pressure The primary danger elements of Stroke encountered are high blood pressure, age, diabetes mellitus, obesity, smoking, and alcohol. the burden of stroke is gigantic and recurrence of stroke is a first-rate risk issue for growing the weight of stroke. medications play an crucial position in stopping stroke recurrence. Adherence can be summarized as ‘The extent to which someone’s behaviour taking medicinal drug, following a diet, and/or executing life-style modifications – corresponds with agreed tips from a health care provider”. current estimates are that only one-sixth of all sufferers come close to perfect adherence to their medicine regimen. the issue is gaining importance because of an increase in the prevalence of chronic diseases and an ageing population. common reasons of medicine nonadherence include complicated remedy regimens and patients’ lack of belief within the treatment. Healthcare specialists play an crucial position in remedy adherence amongst stroke survivors. They should deal with the boundaries and facilitate remedy adherence behaviours. METHODOLOGY: It is a prospective observational study conducted in Lalitha Super specialities Hospital, Guntur over 6 months duration study in the neurology department, a total of 200 patients of age groups between 25-85 of both genders with comorbidities like hypertension, diabetes, and affected with stroke were enrolled in the study. RESULTS & DISCUSSIONS: The outcomes were obtained after 6 months duration observe within the neurology branch of tertiary care hospital a total of 200 patients enrolled in the study. The study of the effect of patient counselling on medication adherence and quality of life in stroke patients is a prospective observational take a look at in which facts is amassed in Lalitha super speciality hospital with a random representative sampling method explaining the qualitative & quantitative evaluation. We accrued 200 instances of these tormented by ischemic, hemorrhagic, and transient ischemic stroke, and affected person counselling was given and followed up after discharge. Out of 2 hundred samples, 67% of patients are suffering from ischemic stroke, 22.5% from hemorrhagic & 10.5% from TIA. males (60.5%) are greater stricken by stroke than females (39.5%) and the age group between 46-55 is more affected by stroke (32%). The patients who are with both hypertension and diabetes were extra affected by stroke (45.5%) than the ones having single co-morbidities, high blood pressure (28%) and DM (13.5%). in the collected samples males are more effecting by hypertension (33.88%) and females with diabetes (15.18%) and both high blood pressure & diabetes (49.36%). medication adherence in stroke patients is the primary goal of the observe, figure no 5 indicates that out of 200 sufferers, 129 (sixty four.5%) have highly adhered to medicine, 61 patients (30.5%) are mild, and, 10 patients (5.0%) low adherence to remedy after counselling to the patients. quality of lifestyles is the main objective of this study. figure no 6 suggests the quality of life of 200 stroke patients earlier than and after patient counselling. The exceptional of lifestyles had been measured using a modified ranking SCALE (mRS). After the 6-month observe up the quality of life had improved in patients. A quantitative analysis was done using the chi-square test the end result of x squared value is 35.1 with Df 6 at a significance level of 0.05, and the P value is <0.05. CONCLUSION: The main aim of this study is to provide better patient counselling to improve medication adherence and the quality of life in stroke patients was achieved successfully. In this study 200 stroke patients were enrolled and patient counseling was provided and followed up through face-to-face interviews and phone calls. Among 200 patients, 129 patients (64.5%) were highly adherence to the medication and 61 patients (30.50%) were moderately. 10 patients (5%) were low adherence to medication. The quality of life of stroke patients increased after the counselling compared to before counselling. The medication adherence and quality of life were measured using MMAS-8 QUESTIONS and a modified ranking scale (mRS) respectively. It is also evident from the study that pharmacist intervention is effective in improving medication adherence and its associated effect on the management of patients receiving stroke therapy.

SIRT3 facilitates mitochondrial structural repair and functional recovery in rats after ischemic stroke by promoting OPA1 expression and activity

BackgroundOptical atrophy 1 (OPA1), a protein accountable for mitochondrial fusion, facilitates the restoration of mitochondrial structure and function following cerebral ischemia/reperfusion (I/R) injury. The OPA1-conferred mitochondrial protection involves its expression and activity, which can be improved by SIRT3 in non-cerebral ischemia. Nevertheless, it remains obscure whether SIRT3 enhances the expression and activity of OPA1 after cerebral I/R injury. MethodsMature male Sprague Dawley rats were intracranially injected with adeno-associated viral-Sirtuin-3(AAV-SIRT3) and AAV-sh_OPA1, followed by a 90-min temporary blockage of the middle cerebral artery and subsequent restoration of blood flow. Cultured cortical neurons of rats were transfected with LV-SIRT3 or LV-sh_OPA1 before a 2-h oxygen-glucose deprivation and reoxygenation. The rats and neurons were subsequently treated with a selective OPA1 activity inhibitor (MYLS22). The interaction between SIRT3 and OPA1 was assessed by molecular dynamics simulation technology and co-immunoprecipitation. The expression, function, and specific protective mechanism of SIRT3 were examined by various analyses. ResultsSIRT3 interacted with OPA1 in the rat cerebral cortex before and after cerebral I/R. After cerebral I/R damage, SIRT3 upregulation increased the OPA1 expression, which enhanced deacetylation and OPA1 activity, thus alleviating cerebral infarct volume, neuronal apoptosis, oxidative pressure, and impairment in mitochondrial energy production; SIRT3 upregulation also improved neuromotor performance, repaired mitochondrial ultrastructure and membrane composition, and promoted the mitochondrial biogenesis. These neuroprotective effects were partly reversed by OPA1 expression interference and OPA1 activity inhibitor MYLS22. ConclusionIn rats, SIRT3 enhances the expression and activity of OPA1, facilitating the repair of mitochondrial structure and functional recovery following cerebral I/R injury. These findings highlight that regulating SIRT3 may be a promising therapeutic strategy for ischemic stroke.

Cooperative Vehicles versus Non-Cooperative Traffic Light: Safe and Efficient Passing

Connected and automated vehicles (CAVs) will be a key component of future cooperative intelligent transportation systems (C-ITS). Since the adoption of C-ITS is not foreseen to happen instantly, not all of its elements are going to be connected at the early deployment stages. We consider a scenario where vehicles approaching a traffic light are connected to each other, but the traffic light itself is not cooperative. Information about indented trajectories such as decisions on how and when to accelerate, decelerate and stop, is communicated among the vehicles involved. We provide an optimization-based procedure for efficient and safe passing of traffic lights (or other temporary road blockage) using vehicle-to-vehicle communication (V2V). We locally optimize objectives that promote efficiency such as less deceleration and larger minimum velocity, while maintaining safety in terms of no collisions. The procedure is computationally efficient as it mainly involves a gradient decent algorithm for one single parameter.

Improved vanishing point reference detection to early detect and track distant oncoming vehicles for adaptive traffic light signaling

Real-time traffic monitoring is essential for the operation of an adaptive traffic lighting system and plays a significant role in decision-making, particularly signaling in roadworks. When only one lane is accessible due to temporary road blockage, early detection of oncoming vehicles is crucial to minimize bottlenecks near the traffic light that could result in congestion and accidents. This research aimed to enhance the detection and tracking of traffic at a distance from the traffic light. We utilized the vanishing point as a reference for detection and calculated the region of interest. We implemented the proposed method on twelve traffic surveillance videos and evaluated the system performance based on how quickly it could detect incoming traffic compared with the R-CNN method. The proposed method detected target vehicles in an average of 17.75 frames, while the R-CNN method required an average of 63.36 frames. Moreover, the proposed method’s precision depends on the number of pixel orientations used to estimate the vanishing point and the definition of the region of interest. Therefore, the proposed method for enhancing the safety and reliability of an adaptive traffic light system is reliable.

Probing the lower ionospheric electron density modulation by the 2019 solar eclipse with VLF phase studies and ion-chemistry model

During a solar eclipse, the temporary blockage of daytime solar illumination resembles a nighttime situation up to a certain degree. This effectively modulates the lower ionosphere by reducing the ionization rate and hence electron–ion density and the VLF signal responds accordingly. This study investigates the lower ionospheric response to the Annular Solar Eclipse of December 26, 2019 (ASE19) by analyzing VLF phase modulation as observed from four different locations in India during the campaign organized by the Indian Centre for Space Physics (ICSP), Kolkata. The eclipse path crossed the four signal paths between NWC (19.8 kHz) transmitter and the receivers from time to time and produced significant deviations in the detected signal amplitudes and phases. We adopt the analysis of the phase delay mechanism to obtain the perturbed electron density fluctuations over the paths and compute changes in VLF reflection heights during the eclipse. The electron density modulation during the eclipse with an in situ theoretical chemical model using the solar obscuration at five different points over all the signal paths are also calculated and compared with the results from VLF. Both the temporal VLF responses at the receiving points and the changes in derived electron densities are found to exactly follow the obscuration profile at the point of maximum obscuration for all the paths. This article, for the first time successfully compares two distinct independent models related to lower ionosphere during a solar eclipse and demonstrates that though we lack the necessary means to directly explore the lower ionospheric dynamics, our theories are more than adequate and roughly reflect the actual scenario.

Mitochondrial dynamics, elimination and biogenesis during post-ischemic recovery in ischemia-resistant and ischemia-vulnerable gerbil hippocampal regions

Transient ischemic attacks (TIA) result from a temporary blockage in blood circulation in the brain. As TIAs cause disabilities and often precede full-scale strokes, the effects of TIA are investigated to develop neuroprotective therapies. We analyzed changes in mitochondrial network dynamics, mitophagy and biogenesis in sections of gerbil hippocampus characterized by a different neuronal survival rate after 5-minute ischemia-reperfusion (I/R) insult.Our research revealed a significantly greater mtDNA/nDNA ratio in CA2–3, DG hippocampal regions (5.8 ± 1.4 vs 3.6 ± 0.8 in CA1) that corresponded to a neuronal resistance to I/R. During reperfusion, an increase of pro-fission (phospho-Ser616-Drp1/Drp1) and pro-fusion proteins (1.6 ± 0.5 and 1.4 ± 0.3 for Mfn2 and Opa1, respectively) was observed in CA2–3, DG. Selective autophagy markers, PINK1 and SQSTM1/p62, were elevated 24-96 h after I/R and accompanied by significant elevation of transcription factors proteins PGC-1α and Nrf1 (1.2 ± 0.4, 1.78 ± 0.6, respectively) and increased respiratory chain proteins (e.g., 1.5 ± 0.3 for complex IV at I/R 96 h).Contrastingly, decreased enzymatic activity of citrate synthase, reduced Hsp60 protein level and electron transport chain subunits (0.88 ± 0.03, 0.74 ± 0.1 and 0.71 ± 0.1 for complex IV at I/R 96 h, respectively) were observed in I/R-vulnerable CA1. The phospho-Ser616-Drp1/Drp1 was increased while Mfn2 and total Opa1 reduced to 0.88 ± 0.1 and 0.77 ± 0.17, respectively. General autophagy, measured as LC3-II/I ratio, was activated 3 h after reperfusion reaching 2.37 ± 0.9 of control.This study demonstrated that enhanced mitochondrial fusion, followed by late and selective mitophagy and mitochondrial biogenesis might together contribute to reduced susceptibility to TIA.

RESULTS OF THERMAL VISION EXAMINATION BEFORE AND AFTER ORTHOTOPIC LIVER TRANSPLANTATION IN INBRED RATS

This article describes the using of thermal imaging examination in orthotopic liver transplantation in inbred rats. For the experiment, 40 inbred rats of the Vistar line were selected: 20 females, weighing 400–550 g, 20 males, weighing 600–750 g, about a year old. For comparison, we identified the control group, which underwent only an incision of the skin and muscles of the abdominal wall, and then closed the surgical wound, experimental group No. 1, in which the left lateral lobe of the liver was excluded from the bloodstream to create a model of graft ischemia, and experimental group No. 2 who underwent orthotopic transplantation. All manipulations were performed under anesthesia, in compliance with the rules of asepsis and antisepsis. Thermal imaging examination was carried out with a medical thermal imager model ULIRvision Ti120 before the operation, then on the first, third, fifth, seventh day after. When comparing the thermograms of rats from the experimental group No. 2 and the control group, differences were observed on the 3rd day after the operation, then the temperature in the graft area in the experimental group No. 2 was higher than the temperature of the same skin area in the control group. This may be due to a slight ischemia of the graft during its disconnection from the blood flow, as well as to surgical intervention. After conducting research, we came to the conclusion that on the 3rd day in the transplant area there is a local increase in temperature, which is associated with ischemia of the organ due to temporary blockage of blood vessels, which occurs from the moment of explantation of the liver until its subsequent connection to the bloodstream. Rats in which this process affects 33% of the liver die on the first day from developing fulminant sepsis.

The Occurrence of Hyperactivated Platelets and Fibrinaloid Microclots in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).

We have previously demonstrated that platelet-poor plasma (PPP) obtained from patients with Long COVID/Post-Acute Sequelae of COVID-19 (PASC) is characterized by a hypercoagulable state and contains hyperactivated platelets and considerable numbers of already-formed amyloid fibrin(ogen) or fibrinaloid microclots. Due to the substantial overlap in symptoms and etiology between Long COVID/PASC and ME/CFS, we investigated whether coagulopathies reflected in Long COVID/PASC—hypercoagulability, platelet hyperactivation, and fibrinaloid microclot formation—were present in individuals with ME/CFS and gender- and age-matched healthy controls. ME/CFS samples showed significant hypercoagulability as judged by thromboelastography of both whole blood and platelet-poor plasma. The area of plasma images containing fibrinaloid microclots was commonly more than 10-fold greater in untreated PPP from individuals with ME/CFS than in that of healthy controls. A similar difference was found when the plasma samples were treated with thrombin. Using fluorescently labelled PAC-1, which recognizes glycoprotein IIb/IIIa, and CD62P, which binds P-selectin, we observed hyperactivation of platelets in ME/CFS hematocrit samples. Using a quantitative scoring system, the ME/CFS platelets were found to have a mean spreading score of 2.72 ± 1.24 vs. 1.00 (activation with pseudopodia formation) for healthy controls. We conclude that ME/CFS is accompanied by substantial and measurable changes in coagulability, platelet hyperactivation, and fibrinaloid microclot formation. However, the fibrinaloid microclot load was not as great as was previously noted in Long COVID/PASC. Fibrinaloid microclots, in particular, may contribute to many ME/CFS symptoms, such as fatigue, seen in patients with ME/CFS, via the (temporary) blockage of microcapillaries and hence ischemia. Furthermore, fibrinaloid microclots might damage the endothelium. The discovery of these biomarkers represents an important development in ME/CFS research. It also points to possible uses for treatment strategies using known drugs and/or nutraceuticals that target systemic vascular pathology and endothelial inflammation.

Branch retinal artery occlusion caught in the act by an optical coherence tomography angiography image: case report

BackgroundRetinal artery occlusion is a vascular entity caused by the temporary blockage of retinal arterioles.Case presentationWe present the case of a 57-year-old woman a partial visual loss in the right eye due to a cilioretinal artery occlusion. Ophthalmoscopy revealed a focal area of retinal whitening superior to the optic nerve in the right eye, while the left eye was within the limit.Retinal imaging, in particular optical coherence tomography angiography (OCTA), showed a capillary drop out of the superficial capillary plexus and the corresponding b-scan showed a round hyporeflective grey dot (optical empty) corresponding to the dark grey spot on the enface view at the level of the retinal whitening area.ConclusionAlthough the images did not allow the differentiation between vasospasm or retinal emboli, the OCTA imaging might help to identify and to caught in the act the specific region causing the retinal impairment. Also, the possible formation of small microcavity should be considered in case with branch retinal artery occlusion. The use of this new imaging technology might help to evaluate the efficacy of the therapy in vivo.

Abstract 2964: Chromatin silencing complex EZH2/PRC2 modulates aggressive anaplastic thyroid cancer biology

Abstract Introduction: Anaplastic thyroid cancer (ATC) is a rare and lethal undifferentiated thyroid malignancy, with rapid growth, invasion of adjacent tissues and distant metastasis (>50% of cases), leading to survival of ~ 6 months. Understanding the molecular evolution of ATC is a current challenge in thyroid cancer field that may lead to identification of new targets for treatment. In this extent, deregulation of epigenetic regulators and chromatin modifiers may contribute to ATC aggressiveness by altering chromatin state. High levels of EZH2, a component of Polycomb Repressive Complex 2 (PRC2) lead to deposition of H3K27me3 in histones, heterochromatin formation and repression of target genes expression such as tumor suppressors and differentiation genes. Objective: Investigate the role of PRC2/EZH2 in ATC biology, using strategies to block EZH2 function, either pharmacologically or with CRISPR/Cas9-mediated gene editing. Methods: We analyzed the expression of PRC2/EZH2, thyroid differentiation genes and EMT in human data from ATC microarray repository. In vitro, we analyzed protein levels of EZH2 in a panel of thyroid cancer cell lines using Western Blot. In order to block EZH2 function in ATC cells, we used two strategies: A) temporary blockade of EZH2 in KTC2 cells using GSK126, an allosteric inhibitor of EZH2, at 0.5 uM - 5.0 uM, for 6 days; B) permanent blockage of EZH2 using CRISPR/Cas9-induced gene editing in KTC2 cells with PX459 plasmid that contains sgRNA to target EZH2 start codon region. Gene expression of thyroid differentiation genes was evaluated by qPCR. Cell viability was evaluated by MTT assay. Results: The expression of EZH2/PRC2 components is upregulated in ATC while thyroid differentiation genes, transcription factors and epithelial genes are reduced, and EMT genes are induced. EZH2 function temporary blockage with GSK126 induced thyroid differentiation with dose dependent increase in NIS, TG, TPO (8-fold at 5uM), genes related to iodine metabolism in KTC2 cells. Moreover, thyroid transcription factors NKX2-1 (7-fold at 5uM) and PAX8 (5-fold at 5uM), and the epithelial gene E-cadherin (5-fold at 5uM) are induced by GSK126 treatment. CRISPR/Cas9-mediated EZH2 gene editing efficiently reduced EZH2 protein levels, while induced a more epithelial-like cell morphology and reduced cell viability in KTC2-CRISPR-Cl5. Moreover, disruption of EZH2 gene with CRISPR/Cas9 increased TPO (6-fold), NKX2-1 (1.8-fold) and E-cadherin (4-fold) mRNAs, however did not induce NIS, TG and PAX8 as observed in GSK126 treatment. Conclusion: The over-expression and over-activation of EZH2/PRC2 pathway in ATC may contribute to tumor aggressiveness by reducing thyroid cell differentiation and inducing EMT; These results indicate a potential benefit for EZH2 blockage as a neoadjuvant approach to induce differentiation and radioiodine uptake in aggressive thyroid cancer. Citation Format: Diego C. Mello, Marcella M. Cristovao, Kelly C. Saito, Edna T. Kimura, Cesar Seigi Fuziwara. Chromatin silencing complex EZH2/PRC2 modulates aggressive anaplastic thyroid cancer biology [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2964.

Evaluation of viscoelastic surfactant‐based diverting agent during the chemical treatment of sandstone reservoirs

AbstractThe challenges of diversion during the stimulations of carbonate formations have been widely studied for decades. It has been shown that viscoelastic surfactants (VES) are among the effective diverting solutions which can be used during the stimulation of carbonate formations. These chemicals benefit from the reaction products between the acid and the calcite to increase the viscosity of the acid, therefore reducing, temporarily, the permeability of the first invaded rock layer, which holds the highest permeability. This temporary blockage steers the remaining acid to the layers with lower permeability that need treatment. This is usually called self‐diverting acidizing treatment. However, the same approach may not necessarily be applied for sandstone formations that are not calcite rich. In such cases, combining acid stages with batches of diverting agents is still feasible. For this approach, VES is also a suitable, non‐damaging solution that is often overlooked. In this study, the application of VES as a diverting agent was investigated during the chemical treatment operations in sandstone formations. Several dual core‐flooding experiments were performed at high pressure and high temperature (HPHT) conditions using sandstone core samples with high permeability contrast.

Temporary Internal Iliac Artery Blockage versus Uterine Artery Embolization in Patients After Laparoscopic Pregnancy Tissue Removal Due to Cesarean Scar Pregnancy.

ObjectiveThis study aims to evaluate the clinical value of laparoscopic temporary internal iliac artery blockage (TIIAB) compared with uterine artery embolization (UAE) in type III cesarean scar pregnancy (CSP).MethodsA total of 76 patients with type III CSP admitted to the Department of Gynecology the First Affiliated Hospital of Zhengzhou University between September 2017 and June 2019 were selected for this retrospective study. Thirty-six of them in the study group received TIIAB, and the rest in control group received UAE. Laparoscopic pregnancy tissue was removed from all patients, and the uterine defects were repaired. The absence of remnants was then confirmed using ultrasonography. Follow-ups were performed in the two groups for six months, and the factors of intraoperative blood loss, operation and menelipsis time, 24-h human chorionic gonadotropin decline rate, postoperative complications, hospitalization days, hospitalization costs, peri-operative hormone levels, and ovarian function indicators were compared between the two groups and within each group.ResultsThere were statistically significant differences in the hospitalization cost, menelipsis time, and postoperative complication incidence between the two groups (p < 0.05). There were statistically significant differences between ovarian function at one month and three months after surgery (p < 0.05) as well as among the follicle-stimulating hormone, luteinizing hormone, and estradiol levels at one, three, and six months after surgery in the control group (p < 0.05).ConclusionCompared with uterine artery embolization, laparoscopic TIIAB has the advantages of a low hospitalization cost, lower postoperative complication rate, and shorter menelipsis time. Moreover, it avoids ovarian function damage. It is a safe method worthy of clinical popularization.

Cleavage-free human genome editing

Most gene editing technologies introduce breaks or nicks into DNA, leading to the generation of mutagenic insertions and deletions by non-homologous end-joining repair. Here, we report a new, cleavage-free gene editing approach based on replication interrupted template-driven DNA modification (RITDM). The RITDM system makes use of sequence-specific DLR fusion molecules that are specifically designed to enable localized, temporary blockage of DNA replication fork progression, thereby exposing single-stranded DNA that can be bound by DNA sequence modification templates for precise editing.We evaluate the use of zinc-finger arrays for sequence recognition. We demonstrate that RITDM can be used for gene editing at endogenous genomic loci in human cells and highlight its safety profile of low indel frequencies and undetectable off-target side effects in RITDM-edited clones and pools of cells.

Carotid Endarterectomy for Symptomatic Carotid Stenosis.

What are the benefits of carotid endarterectomy for people with symptomatic carotid stenosis?Carotid stenosis is a narrowing of the carotid arteries caused by atherosclerosis, the formation of plaque or fatty deposits on the artery walls.1 The buildup of plaque reduces blood flow to the brain and can lead to an embolus and potentially to an ischemic stroke.2Most patients with carotid stenosis are asymptomatic until the artery becomes severely narrowed or a clot forms. Common first symptoms are related to a transient ischemic attack resulting from a temporary blockage of blood flow to the brain, which subsequently returns to normal. The symptoms are similar to those of stroke and include weakness or numbness on one side of the body, aphasia, facial droop, and diplopia and other vision impairments.3The risk of a stroke resulting from severe carotid stenosis warrants evaluation of all treatment options, with a goal to prevent a stroke from occurring. The World Health Organization lists stroke as the second leading cause of death globally4; more than 13 million people have a stroke each year, and more than 5 million die because of it.5Treatment options for carotid stenosis combine lifestyle changes, medication, and surgical procedures. The most common surgical procedure is carotid endarterectomy, which removes the plaque from the carotid artery with a goal to restore blood flow and prevent a cerebral embolism.1The carotid endarterectomy procedure was first introduced in the 1950s as a stroke-preventing measure; by the early 1980s, more than 100 000 procedures were performed annually. In 1985, a study was published in which investigators stated that the procedure provided no benefit, leading researchers to conduct further studies to assess the efficacy of the procedure.6 As a result, the number of carotid endarterectomies varied each year. The randomized controlled studies that followed regarding the benefit of carotid endarterectomy found different outcomes and used different methods, making it challenging to determine which practices should be recommended.Among these studies was a risk-benefit analysis of carotid endarterectomy related to factors such as the percentage of stenosis (eg, &gt; 60%) and symptoms of transient ischemic attack at presentation. The purpose of this systematic review was to determine the risks and benefits of carotid endarterectomy with appropriate medical management, compared with those of only appropriate medical management, in patients who recently experienced symptomatic carotid stenosis.This summary is an update to a previously published systematic review that was conducted in 2017.7 As new evidence on a topic becomes available, updates are necessary to account for the results that the new evidence presents. This update, conducted by Rerkasem et al,8 included 3 randomized controlled trials comprising 6092 adult participants.The primary outcome was the 5-year cumulative risk for any type of stroke or operative death. The indicator was defined as any stroke or death that occurred within 30 days after carotid endarterectomy.Rerkasem et al8 independently assessed the risk of bias for each study, including selection, performance, detection, attrition, reporting, and publication biases. They resolved any disagreements by reviewing the data together and through discussion.The authors used risk ratios (RRs) with 95% CIs for dichotomous outcomes as measures of treatment effect between the comparisons and outcomes. They used the internationally approved Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to determine the certainty of evidence— high, moderate, low, or very low— for each outcome9: The outcome varied depending on the percentage of carotid stenosis: This systematic review provides guidance related to the risks of carotid endarterectomy that can help inform nurses and other clinicians when they are advocating for the best available care and helping patients understand their options. As always, several factors can determine the outcome of a procedure. With carotid endarterectomy, however, the degree of carotid stenosis is the most important factor to consider. For patients with at least 30% stenosis, the evidence indicates that the procedure would provide benefit. That benefit increased for patients with 70% to 99% stenosis.One of the limitations of this review by Rerkasem et al8 is that the included studies are dated— they had been conducted in the 1990s—as no more recent studies were available that met the inclusion criteria. That being the case, we must consider that during the past 20 years medical treatments have advanced and now help both control atherosclerosis and prevent strokes. As a result, a comparison between the groups studied in this review (only medical treatment vs medical treatment and endarterectomy) would likely not be as significant. Studies are currently underway to explore such a comparison.As nurses caring for critically ill patients, we must advocate for the best evidence-based treatment remaining an important piece of our role. We must always consider the best available evidence and understand the feasibility, appropriateness, meaningfulness, and effectiveness of any intervention to determine whether it is most appropriate to implement in our individual context.

Analysis of factors influencing the large wood transport and block-outburst in debris flow based on physical model experiment

Large wood carried by debris flow is easy to block the slit-check dam and form unstable temporary blockage. When the blockage suddenly bursts, a larger debris flow will form, resulting in a more serious disaster. To better understand the disaster-caused characteristics of large wood, the chain reaction characteristics of large wood transportation, blockage, blocking and block-outburst in debris flow were investigated through a field investigation and a series of physical model experiments by taking the Keze gully in Sichuan Province of China as the prototype. In addition, some fundamental dimensionless parameters such as “blocking ratio”, “clogging coefficient”, and “discharge magnification ratio” were defined to determine a rational criterion for evaluating the characteristics of large wood transport and block-outburst. The results showed that four transport regimes of large wood passing through the slit-check dam were observed: uncongested, semi-congested, congested and block-outburst. The increase in the blocking ratio of large wood became more pronounced with the number of large wood N = 180 and the relative length of large wood L/B = 0.75, indicating that N = 180 and L/B = 0.75 are the inflection points. The blocking ratio of large wood increased with an increase in debris-flow density. The results demonstrated that the clogging coefficient was closely associated with the relative length of large wood, the number of large wood and the density of debris flow. The maximum clogging coefficient was 3.09 in the experiment, with the relative length of large wood, the quantity of large wood and the density of debris flow of 1.0, 180 and 1500 kg/m3, respectively. In essence, the clogging coefficient correlations were developed as a power function of the discharge magnification ratio based on comparative analysis.

Flush Flow Behaviour Affected by the Morphology of Intravascular Endoscope: A Numerical Simulation and Experimental Study.

Background: Whilst intravascular endoscopy can be used to identify lesions and assess the deployment of endovascular devices, it requires temporary blockage of the local blood flow during observation, posing a serious risk of ischaemia.Objective: To aid the design of a novel flow-blockage-free intravascular endoscope, we explored changes in the haemodynamic behaviour of the flush flow with respect to the flow injection speed and the system design.Methods: We first constructed the computational models for three candidate endoscope designs (i.e., Model A, B, and C). Using each of the three endoscopes, flow patterns in the target vessels (straight, bent, and twisted) under three different sets of boundary conditions (i.e., injection speed of the flush flow and the background blood flowrate) were then resolved through use of computational fluid dynamics and in vitro flow experiments. The design of endoscope and its optimal operating condition were evaluated in terms of the volume fraction within the vascular segment of interest, as well as the percentage of high-volume-fraction area (PHVFA) corresponding to three cross-sectional planes distal to the microcatheter tip.Results: With a mild narrowing at the endoscope neck, Model B exhibited the highest PHVFA, irrespective of location of the cross-sectional plane, compared with Models A and C which, respectively, had no narrowing and a moderate narrowing. The greatest difference in the PHVFA between the three models was observed on the cross-sectional plane 2 mm distal to the tip of the microcatheter (Model B: 33% vs. Model A: 18%). The background blood flowrate was found to have a strong impact on the resulting volume fraction of the flush flow close to the vascular wall, with the greatest difference being 44% (Model A).Conclusion: We found that the haemodynamic performance of endoscope Model B outperformed that of Models A and C, as it generated a flush flow that occupied the largest volume within the vascular segment of interest, suggesting that the endoscope design with a diameter narrowing of 30% at the endoscope neck might yield images of a better quality.

Exploration of the Influences of Temporary Velum Paralysis on Auditory-Perceptual, Acoustic, and Tomographical Markers.

Purpose To better understand hypernasality (HN), we explored the relations between velopharyngeal orifice, auditory perception of HN, and acoustic-spectral measures in an in vivo within-subject design: (a) with a normally functioning velum as the control condition and (b) with a temporarily paralyzed velum as the experimental condition. Method The velum of eight volunteers was injected with ropivacaine hydrochloride (Naropin) in the area of the levator veli palatini and tensor veli palatini muscles to induce temporary velopharyngeal inadequacy (VPI) and HN. Sustained [a] and [i] and oronasal text readings were recorded, and 3D cone-beam computed tomography images of the vocal tract were built before and during velar anesthesia. Differences between conditions and correlations in normal-to-numb differences between velopharyngeal cross-sectional area (VParea), mean ratings of HN severity, and nine acoustic-spectral measures were determined. Results Three subjects already had some incomplete velopharyngeal closure in the control condition. Temporary motor nerve blockage of the velum (increased VParea) was accomplished in seven subjects, leading to increased HN and changes in three acoustic-spectral measures. Furthermore, significant correlations only emerged between VParea, HN, and ModelKataoka. Conclusions In most of the participants, it was possible to temporarily increase the velopharyngeal orifice to investigate HN while controlling other speech variables and cephalic morphology. Although this study was exploratory and its are findings preliminary, it provided additional evidence for the possible clinical value of ModelKataoka, A 3-P 0, and B F1 for the objective measurement of VPI or HN.

Correction of hip joint instability in children with cerebral palsy — current state of the problem and prospects for its solution (literature REVIEW)

Hip instability in children with cerebral palsy (CP) is a serious unresolved problem in modern orthopedics. Objective. To analyze the state of the problem of the hip joint instability in children with cerebral palsy and determine the prospects for its solution. Me­thods. A thematic review of 68 studies was made. Results. The basis for the prevention of instability of the hip joint should be a systema­tic X-ray screening at least once a year. The instability of the hip joint is based on neurological disorders, if the index of migration of the femoral head (MP) is less than 30 %, the application of selective dorsal rhizotomy or baclofen pump is promising and justified. If MP &gt; 30–100 % dorsal rhizotomy can be used after surgical correction of abnormalities in the hip joint to reduce the recurrence rate. The existing surgeries on the pelvic and femur is sufficient to restore the stability of this joint, even in the most severe cases, but the result is not always possible to maintain due to the recurrence of the deformity. The requirement for hip intervention in a patient with cerebral palsy is a preventive focus, by which we mean not only the achievement of joint stability, but also the creation of conditions for its preservation. Temporary blockage of the medial portion of the femoral head growth area is a minimally invasive procedure and may be recommended for use alone or as an adjunct to hip soft tissue release or for hip and bone surgery. However, it is still unclear at what age it is better to block the growth plate of the femoral head, whether and how often to change the clamps and so on. A prerequisite for the treatment of patients with this pathology is an individual approach, taking into account the degree of displacement of the femoral head, the presence of pathology of adjacent joints, the age of the child and the severity of the disease. Correction of existing deviations should be performed in one step at many levels.

Evolution of laparoscopic myomectomy and description of two hemostatic techniques in a large teaching gynecological center

ObjectiveTo provide a description of laparoscopic myomectomy and the two hemostatic techniques performed over the last 11 years in a single reference center for gynecology and obstetrics and to evaluate the factors associated with favorable surgical outcomes. Study DesignWe retrospectively analyzed 625 who underwent laparoscopic myomectomy from January 2009 to December 2019. ResultsOf 625 patients, 437 (69.8%) were symptomatic. The most common symptoms were heavy uterine bleeding (33.2%). 188 patients (30.1%) were asymptomatic but were operated in 77 cases (12.3%) for rapid fibroid growth, 32 (5.1%) for uterine cavity distortion and, in 45 cases (8.6%), the myomectomy was indicated during a surgery for other medical reason due to its accessibility. In 173 cases (27.9%) intramyometrial adrenaline was injected and in 246 cases (39.7%) a temporary blockage of the uterus blood supply was performed.Only 35 (5.6%) patients presented complications, of which, 14 (40%) were hemorrhagic. These hemorrhagic complications were more frequent when intramyometrial adrenaline was used (5,8%) than after the temporary clipping of the uterine arteries and infundibulopelvic ligaments (0,8%; p < 0,001).In the multivariate logistic regression model, the only factor statistically associated with favorable surgical outcome was the use of temporary clipping of the uterine arteries at their origin and infundibulopelvic ligaments as hemostatic technique during the surgery. ConclusionLaparoscopic myomectomy was generally safe with a high level of favorable outcomes. The temporary clipping of uterine arteries and infundibulopelvic ligaments presented fewer intraoperative bleedings compared with injecting intramyometrial adrenaline.

Carrier Doppler-based initial alignment for MEMS IMU/GNSS integrated system under low satellite visibility

Micro-electro-mechanical system (MEMS)-based inertial measurement unit (IMU) together with single-frequency Global Navigation Satellite System (GNSS) receiver provides a cost-efficient solution for outdoor navigation. An accurate initial alignment is necessary to the GNSS/IMU integrated navigation system to guarantee a good performance. Existing in-motion alignment methods mostly rely on the velocity derived from the GNSS receiver, which is hard to acquire when the receiver suffers from temporary signal blockage or deliberate interference. To mitigate the problem, we propose a carrier Doppler-based initial alignment method, which extends the availability of attitude estimation to cases where only three satellites are available. The proposed method is composed of two steps: the first step estimates a coarse initial attitude without any prior knowledge, and the second step dynamically refines the attitude estimation. Field experiment results show that the proposed method can provide attitude estimation with enough accuracy when only three satellites are available and has equivalent performance compared with the traditional optimization-based-alignment (OBA) method under general cases. The implementation of the proposed method is available on https://github.com/Wiggrim/D2R .