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Systemic systolic (SAP) and mean (MAP) arterial pressure monitoring is the cornerstone in hemodynamic management of the cardiac surgical patient, and the radial artery is the most common site of catheter placement. The present study compared 3 different arterial line procedures. It is hypothesized that a 20-G 12.7- cm catheter inserted into the radial artery will be equal to a 20-G 12.7- cm angiocath placed in the brachial artery, and superior to a 20-G 5.00 cm angiocath placed in the radial artery. A prospective randomized control study was performed. Single academic university hospital. Adult patients ≥18 years old undergoing nonemergent cardiac surgery using cardiopulmonary bypass (CPB). After approval by the Rhode Island Hospital institutional review board, a randomized prospective control study to evaluate 3 different peripheral intraarterial catheter systems was performed: (1) Radial Short (RS): 20-G 5- cm catheter; (2) Radial Long (RL): 20-G 12- cm catheter; and (3) Brachial Long (BL): 20-G 12- cm catheter. Gradients between central aortic and peripheral catheters (CA-P) were compared and analyzed before CPB and 2 and 10 minutes after separation from CPB. The placement of femoral arterial lines and administration of vasoactive medications were recorded. After exclusions, 67 BL, 61 RL, and 66 RS patients were compared. Before CPB, CA-P SAP and MAP gradients were not significant among the 3 groups. Two minutes after CPB, the CA-P SAP gradient was significant for the RS group (p = 0.005) and insignificant for BL (p = 0.47) and RL (p = 0.39). Two-group analysis revealed that CA-P SAP gradients are similar between BL and RL (p = 0.84), both of which were superior to RS (p = 0.02 and p = 0.04, respectively). At 10 minutes after CPB, the CA-P SAP gradient for RS remained significant (p = 0.004) and similar to the gradient at 2 minutes. The CA-P SAP gradients increased from 2 to 10 minutes for BL (p = 0.13) and RL (p = 0.06). Two minutes after CPB, the CA-P MAP gradients were significant for the BL (p = 0.003), RL (p < 0.0001), and RS (p < 0.0001) groups. Two-group analysis revealed that the CA-P MAP gradients were lower for the BL group compared with the RL (p = 0.054) and RS (p< 0.05) groups. Ten minutes after CPB, the CA-P MAP gradients in the RL and RS groups remained significant (p < 0.0001) and both greater than the BL group (p = 0.002). A femoral arterial line was placed more frequently in the RS group (8/66 = 12.1%) than in the RL group (3/61 = 4.9%) and the BL group (2/67 = 3.0%). Vasopressin was administered significantly more frequently in the RS group. Regarding CA-P SAP gradients, the RL group performed equally to the BL group, both being superior to RS. Regarding CA-P MAP gradients, BL was superior to RL and RS. Clinically, femoral line placement and vasopressin administration were fewer for the BL and RL groups when compared with the RS group. This study demonstrated the benefits of a long (12.7 cm) 20- G angiocath placed in the radial artery. [ABSTRACT FROM AUTHOR]

Injuries to the biceps reflection pulley lead to instability of the long head of the biceps tendon (LHBT). However, conventional magnetic resonance (MR) imaging (MRI) has low diagnostic accuracy for LHBT and pulley lesions. Here, we investigated the usefulness of novel biceps-radial MRI for evaluating LHBT and pulley lesions. Biceps-radial MR images of 84 patients (84 shoulders) were prospectively analyzed. The biceps-radial MRI protocol includes sequences acquired in radial planes perpendicular to the LHBT in the shoulder joint. All patients underwent shoulder arthroscopy, and the intraoperative LHBT and pulley lesion findings were compared to the preoperative evaluations. The diagnostic accuracies of the biceps-radial MR images and conventional MR images were determined. A normal LHBT was observed in 30 (31.6%) patients, partial tears in 43 (52.6%), and complete tears in 11 (15.8%). Normal LHBT stability was present in 54 (61.4%) patients, subluxation in 24 (31.6%), and dislocation in 6 (7.0%). The biceps-radial MR (kappa coefficient: 0.94) and conventional MR (kappa coefficient: 0.68) images accurately identified LHBT tears. The biceps-radial MR images excellently agreed with the arthroscopic findings (kappa coefficient: 0.91), whereas the conventional MR images poorly agreed (kappa coefficient: 0.17) regarding LHBT instability. A normal medial wall of the pulley was observed in 26 (31.0%) patients, partial tears in 30 (35.7%), and complete tears in 28 (33.3%). A normal lateral wall of the pulley was observed in 30 (35.7%) patients, partial tears in 21 (25.0%), and complete tears in 33 (39.3%). The biceps-radial MR images excellently agreed with the arthroscopic findings (kappa coefficient: 0.89), whereas the conventional MR images moderately agreed (kappa coefficient: 0.50) regarding medial pulley lesions. The biceps-radial MR images excellently agreed with the arthroscopic findings (kappa coefficient: 0.95) and the conventional MR images moderately agreed (kappa coefficient: 0.56) regarding lateral pulley lesions. Biceps-radial MRI allows for tracking of the LHBT and pulley from the supraglenoid tuberosity to the bicipital groove in the glenohumeral joint and accurate evaluations of LHBT and pulley lesions. [ABSTRACT FROM AUTHOR]

To develop an arterial spin labeling (ASL) perfusion imaging method with balanced steady-state free precession (bSSFP) readout and radial sampling for improved SNR and robustness to motion and off-resonance effects. An ASL perfusion imaging method was developed with pseudo-continuous arterial spin labeling (pCASL) and bSSFP readout. Three-dimensional (3D) k -space data were collected in segmented acquisitions following a stack-of-stars sampling trajectory. Multiple phase-cycling technique was utilized to improve the robustness to off-resonance effects. Parallel imaging with sparsity-constrained image reconstruction was used to accelerate imaging or increase the spatial coverage. ASL with bSSFP readout showed higher spatial and temporal SNRs of the gray matter perfusion signal compared to those from spoiled gradient-recalled acquisition (SPGR). Cartesian and radial sampling schemes showed similar spatial and temporal SNRs, regardless of the imaging readout. In case of severe B 0 inhomogeneity, single-RF phase incremented bSSFP acquisitions showed banding artifacts. These artifacts were significantly reduced when multiple phase-cycling technique (N = 4) was employed. The perfusion-weighted images obtained by the Cartesian sampling scheme showed respiratory motion-related artifacts when a high segmentation number was used. The perfusion-weighted images obtained by the radial sampling scheme did not show these artifacts. Whole brain perfusion imaging was feasible in 1.15 min or 4.6 min for cases without and with phase-cycling (N = 4), respectively, using the proposed method with parallel imaging. The developed method allows non-invasive perfusion imaging of the whole-brain with relatively high SNR and robustness to motion and off-resonance effects in a practically feasible imaging time. [ABSTRACT FROM AUTHOR]

Background: Fast and accurate T1ρ mapping in myocardium is still a major challenge, particularly in small animal models. The complex sequence design owing to electrocardiogram and respiratory gating leads to quantification errors in in vivo experiments, due to variations of the T1ρ relaxation pathway. In this study, we present an improved quantification method for T1ρ using a newly derived formalism of a T1ρ* relaxation pathway. Methods: The new signal equation was derived by solving a recursion problem for spin-lock prepared fast gradient echo readouts. Based on Bloch simulations, we compared quantification errors using the common monoexponential model and our corrected model. The method was validated in phantom experiments and tested in vivo for myocardial T1ρ mapping in mice. Here, the impact of the breath dependent spin recovery time Trec on the quantification results was examined in detail. Results: Simulations indicate that a correction is necessary, since systematically underestimated values are measured under in vivo conditions. In the phantom study, the mean quantification error could be reduced from − 7.4% to − 0.97%. In vivo, a correlation of uncorrected T1ρ with the respiratory cycle was observed. Using the newly derived correction method, this correlation was significantly reduced from r = 0.708 (p < 0.001) to r = 0.204 and the standard deviation of left ventricular T1ρ values in different animals was reduced by at least 39%. Conclusion: The suggested quantification formalism enables fast and precise myocardial T1ρ quantification for small animals during free breathing and can improve the comparability of study results. Our new technique offers a reasonable tool for assessing myocardial diseases, since pathologies that cause a change in heart or breathing rates do not lead to systematic misinterpretations. Besides, the derived signal equation can be used for sequence optimization or for subsequent correction of prior study results. [ABSTRACT FROM AUTHOR]

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Sodium imaging typically employs ultrashort echo time radial, density adapted and cones trajectories to capture the rapidly decaying short T2 signal. The present study considers the parameter choices involved in the use of these trajectories in terms of their impact on the resolution and signal to noise ratio. Many parameters have a strong effect on these image properties, particularly the number of spokes which impacts voxel size. The present article develops an understanding of the trade-offs involved and how to choose optimal (or at least reasonable) parameter values. This has a practical role in designing clinical protocols for imaging sodium. [ABSTRACT FROM AUTHOR]

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Purpose: Wall shear stress (WSS) and pulse wave velocity (PWV) are important parameters to characterize blood flow in the vessel wall. Their quantification with flow-sensitive phase-contrast (PC) cardiovascular magnetic resonance (CMR), however, is time-consuming. Furthermore, the measurement of WSS requires high spatial resolution, whereas high temporal resolution is necessary for PWV measurements. For these reasons, PWV and WSS are challenging to measure in one CMR session, making it difficult to directly compare these parameters. By using a retrospective approach with a flexible reconstruction framework, we here aimed to simultaneously assess both PWV and WSS in the murine aortic arch from the same 4D flow measurement. Methods: Flow was measured in the aortic arch of 18-week-old wildtype (n = 5) and ApoE−/− mice (n = 5) with a self-navigated radial 4D-PC-CMR sequence. Retrospective data analysis was used to reconstruct the same dataset either at low spatial and high temporal resolution (PWV analysis) or high spatial and low temporal resolution (WSS analysis). To assess WSS, the aortic lumen was labeled by semi-automatically segmenting the reconstruction with high spatial resolution. WSS was determined from the spatial velocity gradients at the lumen surface. For calculation of the PWV, segmentation data was interpolated along the temporal dimension. Subsequently, PWV was quantified from the through-plane flow data using the multiple-points transit-time method. Reconstructions with varying frame rates and spatial resolutions were performed to investigate the influence of spatiotemporal resolution on the PWV and WSS quantification. Results: 4D flow measurements were conducted in an acquisition time of only 35 min. Increased peak flow and peak WSS values and lower errors in PWV estimation were observed in the reconstructions with high temporal resolution. Aortic PWV was significantly increased in ApoE−/− mice compared to the control group (1.7 ± 0.2 versus 2.6 ± 0.2 m/s, p < 0.001). Mean WSS magnitude values averaged over the aortic arch were (1.17 ± 0.07) N/m2 in wildtype mice and (1.27 ± 0.10) N/m2 in ApoE−/− mice. Conclusion: The post processing algorithm using the flexible reconstruction framework developed in this study permitted quantification of global PWV and 3D-WSS in a single acquisition. The possibility to assess both parameters in only 35 min will markedly improve the analyses and information content of in vivo measurements. [ABSTRACT FROM AUTHOR]

Background: Young children present frequently to the emergency department with an immobile, painful arm. It is often difficult to discern a point of tenderness in a frightened, injured child. Common approaches included sending the child for x-ray studies of the extremity or empirically attempting reduction of radial head subluxation. We created a step-by-step point-of-care ultrasound screening protocol of the upper extremity to increase or decrease the probability of fracture before x-ray study or reduction.Case Report: We present the cases of 6 children younger than 4 years without a clear history of pulled elbow and without swelling or deformity on examination, for whom this protocol revealed fracture or lowered the probability of fracture, thereby increasing the safety of radial head reduction. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In most cases, identification of a single fracture on ultrasound allows for focused x-ray study on the area of fracture. Children with a normal ultrasound screen can undergo reduction of radial head subluxation safely. [ABSTRACT FROM AUTHOR]

Background: Computed tomography angiography (CTA) or contrast-enhanced (CE) cardiovascular magnetic resonance angiography (CMRA) is often obtained in patients with atrial fibrillation undergoing evaluation prior to pulmonary vein (PV) isolation. Drawbacks of CTA include radiation exposure and potential risks from iodinated contrast agent administration. Free-breathing 3D balanced steady-state free precession (bSSFP) Non-contrast CMRA is a potential imaging option, but vascular detail can be suboptimal due to ghost artifacts and blurring that tend to occur with a Cartesian k-space trajectory or, in some cases, inconsistent respiratory gating. We therefore explored the potential utility of both breath-holding and free-breathing non-contrast CMRA, using radial k-space trajectories that are known to be less sensitive to flow and motion artifacts than Cartesian. Main body: Free-breathing 3D Cartesian and radial stack-of-stars acquisitions were compared in 6 healthy subjects. In addition, 27 patients underwent CTA and non-contrast CMRA for PV mapping. Three radial CMR acquisition strategies were tested: (1) breath-hold (BH) 2D radial bSSFP (BH-2D); (2) breath-hold, multiple thin-slab 3D stack-of-stars bSSFP (BH-SOS); and (3) navigator-gated free-breathing (FB) 3D stack-of-star bSSFP using a spatially non-selective RF excitation (FB-NS-SOS). A non-rigid registration algorithm was used to compensate for variations in breath-hold depth. In healthy subjects, image quality and vessel sharpness using a free-breathing 3D SOS acquisition was significantly better than free-breathing (FB) Cartesian 3D. In patients, diagnostic image quality was obtained using all three radial CMRA techniques, with BH-SOS and FB-NS-SOS outperforming BH-2D. There was overall good correlation for PV maximal diameter between BH-2D and CTA (ICC = 0.87/0.83 for the two readers), excellent correlation between BH-SOS and CTA (ICC = 0.90/0.91), and good to excellent correlation between FB-NS-SOS and CTA (ICC = 0.87/0.94). For PV area, there was overall good correlation between BH-2D and CTA (ICC = 0.79/0.83), good to excellent correlation between BH-SOS and CTA (ICC = 0.88/0.91) and excellent correlation between FB-NS-SOS and CTA (ICC = 0.90/0.95). CNR was significantly higher with BH-SOS (mean = 11.04) by comparison to BH-2D (mean = 6.02; P = 0.007) and FB-NS-SOS (mean = 5.29; P = 0.002). Conclusion: Our results suggest that a free-breathing stack-of-stars bSSFP technique is advantageous in providing accurate depiction of PV anatomy and ostial measurements without significant degradation from off-resonance artifacts, and with better image quality than Cartesian 3D. For patients in whom respiratory gating is unsuccessful, a breath-hold thin-slab stack-of-stars technique with retrospective motion correction may be a useful alternative. [ABSTRACT FROM AUTHOR]

• A radial mesoporous MBG with high P and Ca content is synthesized in this study. • MBG with high P and Ca content has excellent ability of inducing apatite formation. • MBG has excellent biocompatibility at an appropriate concentration. A novel uniform monodispersed radial mesoporous bioactive glass nanosphere (MBG) with high phosphorus and calcium content has been successfully synthesized. The synthesis was first taken place in a cyclohexane-water biphasic stratification reaction system, which fabricated the radial mesoporous SiO 2 -P 2 O 5 nanosphere (SPN) using hexadecyltrimethyl ammonium bromide (CTAB) as a template agent and triethanolamine (TEA) as a hydrolysis catalyst. Solid reactions were then carried out to synthesize SiO 2 -CaO-P 2 O 5 MBG using SPN as both the silicon source and phosphorus source, and Ca(NO 3) 2 as the calcium source. The prepared MBG not only displayed the radial structure and high specific surface area (~321 m2/g), but also had high phosphorus and calcium content. The results of energy dispersive spectrometer (EDS) demonstrated that P 2 O 5 content was enhanced by properly increasing the reaction temperature. The in vitro bioactivity test showed that MBG had an excellent ability of inducing apatite formation. Furthermore, the MBG showed excellent biocompatibility at a low concentration of 50–100 μg/mL in vitro, and it would have a promising prospect as drug delivery system for bone tissue regeneration. [ABSTRACT FROM AUTHOR]

• First line transradial access for posterior circulation stroke intervention was assessed. • Data was prospectively collected for 12-months at a high volume thrombectomy center. • Transradial access was successful in 96% of cases The median arteriotomy-reperfusion time was 24 minutes. • Good angiographic outcome rate was 100%, good clinical outcome rate was 61%. • No radial access site complications occurred. The Neurointerventional Surgery Standards and Guidelines Committee has advocated the use of transradial access in the setting of posterior circulation stroke intervention, however there is a paucity of published data on this approach. The purpose of this study is to present 12-months of prospectively collected data from a high volume thrombectomy center following the adoption of a first line transradial approach for posterior circulation stroke intervention. A range of data on patient characteristics, procedural metrics, complications and outcomes was prospectively collected between August 2018 - August 2019 following the adoption of first line transradial access for posterior circulation stroke intervention at a high volume thrombectomy center. Transradial access was successful in 22/23 cases (96%), median arteriotomy to reperfusion time was 24 min (IQR 18–40), good angiographic outcome (mTICI 2b-3) was achieved in all cases and good clinical outcome (mRs 0–2) was achieved in 61% of cases. No intracranial or radial artery access site complications occurred. The fast procedure times, excellent outcomes and low complication rates achieved in this prospective 12-month study indicate that transradial access is a viable first line strategy in posterior circulation stroke intervention. [ABSTRACT FROM AUTHOR]

Objective: We sought to compare the transradial and transfemoral approaches for coronary angiography and percutaneous intervention in patients with coronary artery bypass grafts in terms of volume of radiographic contrast administered during cardiac catheterization, fluoroscopy time, and total procedure time.Background: The transradial access has been increasingly used as an alternative to transfemoral. Several studies demonstrated that such access is associated with lower rates of vascular and bleeding complications. Although coronary artery bypass graft patients comprise a significant portion of the coronary artery disease population, this subpopulation was often excluded or underrepresented in transradial access studies.Methods: Single center, retrospective cohort study. In the study period, all patients who had previously undergone coronary artery bypass graft surgery and had received cardiac catheterization at our institution were included in the study population.Results: A total of 2153 patients were included in the study. From these, 1937 were performed by femoral artery and 216 by transradial approach. Compared to the transfemoral approach, transradial access was associated with lower contrast use (136.3 ± 74.4 ml vs. 122.8 ± 59.1 ml, p = 0.035) and longer fluoroscopy time (13.9 ± 25.6 min vs. 15.9 ± 14.3 min, p < 0.001).Conclusion: Diagnostic and interventional catheterization through the transradial approach in patients with previous coronary artery bypass graft surgery was associated with less contrast amount used and longer fluoroscopy time compared to the transfemoral approach. The transradial approach was also associated with lower crossover rates and less vascular complications. [ABSTRACT FROM AUTHOR]

Background: Pre-procedural anemia is associated with increased bleeding and mortality post-percutaneous coronary intervention (PCI). The effect of trans-radial PCI (TR-PCI) in improving outcomes compared to trans-femoral PCI (TF-PCI) in anemic patients is not known.Objective: The aim of this study was to evaluate the association between arterial access site (radial versus femoral) and outcomes in anemic Veterans undergoing PCI.Methods: Patients with baseline anemia, undergoing PCI at Veterans Affairs (VA) facilities between 2009 and 2015, were divided into two groups based on primary radial or femoral access. The association between anemia and access site with in-hospital and one-year adverse outcomes was evaluated using multivariable analysis.Results: 7330 veterans were included in the analysis, with 1712 (23%) treated via radial access. Baseline anemia was independently associated with in-hospital major bleeding (OR 3.8, 95% CI 2.5-5.6 for moderate anemia, OR 18.6, 95% CI 11.6-29.7 for severe anemia), and in-hospital mortality (OR 3.2, 95% CI 1.8-5.8 for moderate anemia, OR 7.9, 95% CI 3.7-16.8 for severe anemia). Anemia was also associated with increased one-year MACE and mortality. PCI performed via radial access was not associated with different outcomes compared with femoral access in the presence of anemia. Comparable results were noted when analysis was restricted to only patients with acute coronary syndrome (ACS).Conclusions: Moderate and severe anemia were strongly associated with increased in-hospital and one-year mortality in a large healthcare system, though there was no interaction between arterial access site for PCI and clinical outcomes among patients with moderate or severe anemia. [ABSTRACT FROM AUTHOR]

Open ulnar and radial shaft fractures refers to the simultaneous rupture and injury of the skin and subcutaneous soft tissue at the fracture, and is easy to cause wound infection, local soft tissue necrosis or osteomyelitis. The purpose of this paper is to observe the efficacy of external locking compression plate in the treatment of open fractures, so as to provide reference for clinical practice. From January 2019 to January 2020, 11 patients with open ulnar or radial shaft fractures underwent surgery by a single surgeon. Physical examination, radiography, and functional scores were performed before surgery and the average follow-up was 14 months (range, 12 to16 months) after surgery. Clinical outcome scores were recorded. Six patients obtained excellent Anderson Scores, four of satisfactory and one of Unsatisfactory. No surgical complications, reoperations, nonunion and implant breakage in this series and the fractures can be healed from 6 to 12 months after the operation. All implant removal was requested for all cases. Open ulnar and radial shaft fractures refers to the simultaneous rupture and injury of the skin and subcutaneous soft tissue at the fracture, which can connect the fracture site with the outside environment, and is easy to cause wound infection, local soft tissue necrosis or osteomyelitis. The open fracture mostly involves adjacent joints. If it is not treated in time, it is easy to lead to complications such as infection and nonunion. The locking plate is named as "internal fixation", which means the internal fixation is placed in the soft tissue, and is similar to the external fixator. However, its biomechanical properties still need to be verified, the appropriate screw position and number need to be further defined, and there is a lack of clinical validation of large number of cases. In this study, locking compression plate externaI fixation for technology for the treatment of open ulnar and radial shaft fractures has the advantages of minimal trauma, simple operation, reliable fixation, fewer postoperative complications, and restored stability and function of forearm joints. Level IV, therapeutic case series. • We adopted external locking plate fixation in the management of open ulnar and radial shaft fractures. • From January 2019 to January 2020, 11 patients with open ulnar or radial shaft fractures underwent surgery by a single surgeon. • Our results suggest that this reconstruction technique is a reliable and useful alternative treatment. [ABSTRACT FROM AUTHOR]

The restoration of shoulder function after brachial plexus injury is a high priority. Shoulder abduction and stabilization can be achieved by nerve transfer procedures including spinal accessory nerve (SAN) to suprascapular nerve (SSN) and radial to axillary nerve transfer. The objective of this study is to compare functional outcomes after SAN to SSN transfer versus the combined radial to axillary and SA to SSN transfer. This retrospective chart review included 14 consecutive patients with brachial plexus injury who underwent SAN to SSN transfer, 4 of whom had both SA to SSN and radial to axillary nerve transfer. SAN to SSN transfer achieved successful shoulder abduction (≥M3) in 64.3% of this cohort (9/14). During the long-term follow-up, patients achieved an average increase of 67.5° in shoulder abduction. There was no association between motor recovery and time from injury to surgery, age, body mass index (BMI), sex, or smoking status. The 4 patients who had SAN to SSN combined with radial to axillary nerve transfer demonstrated a statistically significant increase in the range of abduction (median, 90° vs. 42.5°, respectively; P = 0.022) compared with those who had SAN to SSN transfer alone; however, the difference in Medical Research Council (MRC) grades (MRC > M3) did not reach statistical significance (P = 0.07). Patients with brachial plexus injury and an intact C7 root could benefit from radial to axillary transfer in addition to SAN to SSN transfer. There was no association between recovery of shoulder abduction and time interval from injury to surgery, age, sex, smoking, and BMI. [ABSTRACT FROM AUTHOR]

Background: There is concern about potential detrimental effects of transradial access (TRA) on radial artery structure, endothelial and hand function. This thermography study evaluated TRA impact on hand microvascular perfusion.Methods and Results: We prospectively measured hand thermography, radial and ulnar artery size and blood flow velocities in both catheterization and non-catheterization hands at baseline and 30-days after TRA in 158 patients. There were no differences in radial or ulnar arterial diameters or velocities pre- and post-TRA in catheterization and non-catheterization hands (p = NS). The absolute total hand thermography values post-TRA were increased in both catheterization and non-catheterization hand (pre-TRA 30.4 ± 2.9 vs. post-TRA 31.6 ± 2.6 p < 0.01; pre-TRA 30.2 ± 2.9, post-TRA 31.6 ± 2.6 p < 0.01, respectively). After ulnar artery occlusion, hand temperatures decreased in both catheterization and non-catheterization hands, both pre- and post-TRA and were similar in the catheterization and non-catheterization hands (p = NS). Total hand temperature decreased with ulnar artery occlusion and was significantly attenuated post-TRA (p < 0.001 both catheterization and non-catheterization hands).Conclusions: TRA is associated with temperature changes in both catheterization and non-catheterization hands at one month after the index procedure. These changes likely represent a systemic response to local TRA stimulus. [ABSTRACT FROM AUTHOR]

Introduction: Over the recent years, there has been increased interest in the use of transradial (TR) access for percutaneous coronary intervention (PCI), including rotational atherectomy (RA). However, a large proportion of operators seem to be reluctant to use TR access for complex PCI including rotational atherectomy for heavily calcified coronary lesions.Methods: We searched MEDLINE, ClinicalTrials.gov and the Cochrane Library for studies comparing radial versus femoral access in patients undergoing RA. Studies were included if they reported at least one of the following outcomes in each group separately: major adverse cardiac events (MACE), major bleeding, stent thrombosis, myocardial infarction (MI), hospital length of stay, radiation exposure, procedure time, procedure success and all-cause mortality. Odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) were calculated and a p-value of <0.05 was considered as a level of significance.Results: This meta-analysis included 5 retrospective studies with 3315 patients undergoing RA via radial access and 5838 patients via femoral access. Radial access was associated with lower major access site bleeding (OR: 0.45, 95% CI: 0.31-0.67, p < 0.001), and radiation exposure (MD: -16.1, 95%CI: -25.4--6.7 Gy cm2, p = 0.0007). There were no significant differences observed in all-cause in-hospital mortality (OR: 0.92, 95% CI: 0.69-1.23, p = 0.58); MACE (OR: 0.80, CI: 0.63, 1.02, p = 0.08), stent thrombosis (OR: 0.28, 95%CI: 0.06-1.33 p = 0.11); and MI (OR: 0.43, 95%CI: 0.15-1.24, p = 0.12). There were no significant differences in hospital stay, procedure time or procedure success between the two groups (p > 0.05).Conclusion: This meta-analysis of 9153 patients from observational studies demonstrates similar all-cause mortality, MACE, procedural success and procedural time during RA performed using TR access and TF access. However, TR access was associated with decreased access site bleeding and radiation exposure. Given the observational nature of these findings, a randomized controlled trial is warranted for further evidence. [ABSTRACT FROM AUTHOR]

Abstract Few systematic structure–property-processing correlations for directionally freeze-cast biopolymer scaffolds are reported. Such correlations are critical to enable scaffold design with attractive structural and mechanical cues in vivo. This study focuses on freeze-cast collagen scaffolds with three different applied cooling rates (10, 1, and 0.1 °C/min) and two freezing directions (longitudinal and radial). A semi-automated approach for the structural characterization of fully hydrated scaffolds by confocal microscopy is developed to facilitate an objective quantification and comparison of structural features. Additionally, scanning electron microscopy and compression testing are performed longitudinally and transversely. Structural and mechanical properties are determined on dry and fully hydrated scaffolds. Longitudinally frozen scaffolds have aligned and regular pores while those in radially frozen ones exhibit greater variations in pore geometry and alignment. Lamellar spacing, pore area, and cell wall thickness increase with decreasing cooling rate: in longitudinally frozen scaffolds from 25 µm to 83.5 µm, from 814 µm2 to 8452 µm2, and from 4.21 µm to 10.4 µm, and in radially frozen ones, from 69 µm to 116 µm, from 7679 µm2 to 25,670 µm2, and from 6.18 µm to 13.6 µm, respectively. Both longitudinally and radially frozen scaffolds possess higher mechanical property values, when loaded parallel rather than perpendicular to the ice-crystal growth direction. Modulus and yield strength range from 779 kPa to 4700 kPa and from 38 kPa to 137 kPa, respectively, as a function of cooling rate and freezing direction. Collated, the correlations obtained in this study enable the custom-design of freeze-cast collagen scaffolds, which are ideally suited for a large variety of tissue regeneration applications. Graphical abstract fx1 [ABSTRACT FROM AUTHOR]

Graphical abstract Unlabelled Image [ABSTRACT FROM AUTHOR]

Background Radial head arthroplasty is used in the treatment of nonreconstructible radial head fractures. Although traditional implants have been loosely fixed, smooth stemmed implants functioning more as spacers, modern designs have introduced press-fit, tapered implants that articulate at the capitellum with more rigidly maintained congruity. Cemented implants also use rigid initial fixation. This study was conducted to help determine which fixation method results in better functional outcomes: "fixed" or "unfixed." Methods A systematic review and meta-analysis was used. We identified 63 articles via 3 databases. Ten non-English or articles with insufficient text were excluded, and 17 others did not contain sufficient data or follow-up. The remaining 36 articles were qualitatively and quantitatively reviewed. Results We identified 36 populations, with 878 unduplicated patients: 522 fixed and 356 unfixed. Respectively, mean follow-up in months was 46.2 and 37.4. Average Mayo Elbow Performance Scores were 85.9 and 88.2 (P =.08). Average Disabilities of the Arm, Shoulder and Hand scores were 17.1 and 18.7 (P =.47). Average final flexion/extension arcs were 119.1° and 115.8° (P =.08). Revision rates were 7.9% and 3.1%, and complication rates were 25.5% and 13.2%. Relative risks of revision and complications for the fixed cohort were 2.48 (P =.006) and 1.88 (P < 0.0001), respectively. Conclusions Implant fixation type does not appear to affect functional outcomes of radial head arthroplasty. However, rigidly fixing the implant may increase the risks of revision and complications. [ABSTRACT FROM AUTHOR]

Tensile properties of directionally freeze-cast biopolymer scaffolds are rarely reported, even though they are of interest from a fundamental science perspective and critical in applications such as scaffolds for the regeneration of nerves or when used as ureteral stents. The focus of this study is on collagen scaffolds freeze-cast with two different applied cooling rates (10 °C/min and 1 °C/min) in two freezing directions (longitudinal and radial). Reported are the results of a systematic structural characterization of dry scaffolds by scanning electron microscopy and the mechanical characterization in tension of both dry and fully hydrated scaffolds. Systematic structure-property-processing correlations are obtained for a comparison of the tensile performance of longitudinally and radially freeze-cast collagen scaffolds with their performance in compression. Collated, the correlations, obtained both in tension in this study and in compression for collagen and chitosan in two earlier reports, not only enable the custom-design of freeze-cast biopolymer scaffolds for biomedical applications but also provide new insights into similarities and differences of scaffold and cell-wall structure formation during the directional solidification of "smooth" and "fibrillar" biopolymers. [Display omitted] [ABSTRACT FROM AUTHOR]

The radial (penny-shaped) model of hydraulic fracture is considered. The tangential traction on the fracture walls is incorporated, including an updated evaluation of the energy release rate (fracture criterion), system asymptotics and the need to account for stagnant zone formation near the injection point. The impact of incorporating the shear stress on the construction of solvers, and the effectiveness of approximating system parameters using the first term of the crack tip asymptotics, is discussed. A full quantitative investigation of the impact of tangential traction on solution is undertaken, utilising an extremely effective adaptive time-space solver. • Radial model of hydraulic fracture updated with fluid-induced tangential traction. • Impact of the shear stress on the algorithm construction is investigated. • Quantitative analysis of the effect of shear stress is performed. [ABSTRACT FROM AUTHOR]

Background The treatment of radial neck fractures is controversial and typically depends on displacement. Surgical procedures based on open reduction–internal fixation (ORIF) may lead to several complications, such as avascular necrosis of the radial head, nonunion, malunion, and elbow stiffness. Closed reduction with intramedullary pinning of radial neck fractures, which is commonly used in children, is a viable option for these fractures in adults and may allow for a lower complication rate compared with ORIF. The aim of this study was to report the functional outcome of closed reduction and intramedullary stabilization in isolated radial neck fractures. Methods Fourteen cases were retrospectively reviewed between January 2007 and December 2016. The inclusion criteria were isolated radial neck fractures of type I to III according to the Mason classification, absence of previous injuries of the elbow, and a minimum of 1 year of follow-up. The Mason classification was used to classify these injuries. At final follow-up, functional assessment was established based on functional scores: Morrey Elbow Score, Elbow Self-Assessment Score, and QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score. Range of motion was evaluated similarly. Results The mean follow-up period was 86 months. The mean age was 44.2 years. Regarding the functional outcome, 78% of patients claimed satisfaction. Concerning the functional scoring, the mean visual analog scale score was 0.2 (range, 0-4) and the mean Morrey Elbow Score was 95.7 (range, 85-100). The mean QuickDASH score was 6.4 (range, 7-22). The complication rate was 35%. Malunion was observed in 7% of patients. Conclusion Intramedullary pinning of radial neck fractures represents a viable technique in adults because of its safety and simplicity. The complication rates are lower than those in other reports of ORIF. [ABSTRACT FROM AUTHOR]

Circumferential defects of the hypopharynx are a reconstructive challenge. Various local, regional and free flaps have been described with each having advantages and disadvantages in terms of functional outcomes. The fasciocutaneous radial forearm free flap (RFFF) is one of the most common free flaps used for reconstructing circumferential hypopharyngeal defects. The skin paddle is pliable and reasonably matches the native hypopharyngeal wall. It is easy to raise, has predictable vascular anatomy and a long pedicle. Unlike the anterior lateral thigh (ALT) flap, the RFFF is associated with higher rates of pharyngo-cutaneous fistula. This was thought to be due to the difficulty in achieving two-layer closure. However, in a post treatment neck or in patient with large body habitus, the use of ALT or other free flaps may not be possible leaving the RFFF as the only viable option. To aim to reduce the risk of fistula and wound dehiscence, we describe a novel design of RFFF, which provides two-layer closure. We believe that our design gives the reconstructive surgeon another reconstructive option, which should be considered in challenging circumferential hypopharyngeal defects. [ABSTRACT FROM AUTHOR]

To clarify or interpret the measurement results of double-flank gear measurement (DFGM), the mathematical model of radial and tangential error analysis of double-flank gear measurement is established. Using differential method, the mathematical model of surface-to-surface contact stage is concerned, and also the tip-to-surface interference stage is involved. The error sources including the base radius error (or profile slope deviation) and the tooth space angle error (or single pitch deviation) of the gear to be measured are concerned. A case study of the gear parameter with the gear contact ratio 1.77 is discussed to explain the tooth contact process, in which the critical contact points are listed for determining the rotation angle. The radial and tangential composite deviations are simulated under different sign combination or different value of the error sources to cover as many results as possible. The simulation results are compared with the measurement results on a gear measuring device (GMD) using double flank rack probe (DFRP), whereby the simulation parameters are determined through the gear profile slope deviation and the single pitch deviation of the gear measured on a Gear Measuring Center Klingelnberg P26. The curves of the simulation results and the measurement results on GMD are consistent to each other. For gear grade 6 according to ISO 1328-1:2013, the allowable value of the total profile deviation is 11.5 μm. The simulation results are compared with the measurement results on a gear measuring device (GMD) based on double flank rack probe (DFRP). The difference between the peak to peak value of the simulation results and the mean line of the measurement results within the evaluation range is 1 μm in radial direction and 1.3 μm in tangential direction, which means the simulation results has better consistency with the measurement results. The radial and tangential error analysis of DFGM can not only be used in simulation of the results, but also in interpreting the DFGM measurement results, which is helpful for gear measurement and quality control. [ABSTRACT FROM AUTHOR]

Tornadoes are generally defined as rotating columns of air characterized by small size, axisymmetry and short duration. Thus, the nature of tornadic wind load is basically different from that of synoptic wind. As direct measurements of velocities are very difficult and limited, lots of empirical and theoretical expressions of tornadic wind have been proposed. In the present study, characteristics of several numerical expressions were investigated, and it was found that the characteristics of velocity fields vary widely from model to model, making it difficult to choose one that is generally applicable. [ABSTRACT FROM AUTHOR]

Background Recently, several meta-analyses of randomized controlled trials (RCTs) have shown that transradial access (TRA) reduces mortality compared to transfemoral access (TFA). However, a critical appraisal of these RCTs suggests that the findings could have resulted from a greater incidence of adverse events in the TFA groups rather than a beneficial effect of TRA. Methods Scientific databases and websites were searched for RCTs. Patients were divided into groups based on access type and whether the operator was a radial expert (RE) or non-radial expert (NRE). The groups were TFA-RE, TFA-NRE, TRA-RE, and TRA-NRE. Both a traditional meta-analysis and a network meta-analysis using mixed-treatment comparison models were performed. Results Data from 13 trials including 15,615 patients were analyzed. The mortality rate for TFA-RE (3.54%) was more than double compared to TFA-NRE (1.61%). In pairwise meta-analysis, TFA-RE was associated with increased risk of mortality (RR: 1.72, 95% CI: 1.13–2.62; p = 0.011) compared to TFA-NRE. In subgroup analysis, TFA-RE was associated with increased mortality (RR: 1.70, 95% CI: 1.24–2.34; p = 0.001) compared to TRA, but TRA-NRE was not. Similarly, in mixed comparison models, TFA-RE was associated with increased mortality compared to TRA-NRE, TRA-RE, and TFA-NRE, but TFA-NRE was not, compared to TRA-RE and TRA-NRE. Conclusion Recently-reported survival differences between TRA and TFA may have been driven by adverse events in the TFA groups of the RCTs rather than a beneficial effect of TRA. This issue needs further investigation before labeling radial access a lifesaving procedure in invasively-managed patients with ACS. [ABSTRACT FROM AUTHOR]

We considered the continuous cylindrical grinding wheel of the planetary transmission with the use of highly porous worm grinding wheels (single and multiple). The process of continuous grinding of teeth by the method of generating is characterized by high accurate of relative rotation of tool and workpiece gears. The developed technological model of the interaction of radial, axial and tangential movements of the feed was allowed to produce the grinding with high accuracy and productivity. The application of highly porous circles makes it possible to reduce thermal stress of process and to improve the cutting conditions. The increase in the number of passes of the grinding wheel and the increase of cutting speed reduces the impact of the thermal processes occurring during grinding of teeth by reducing the contact time between the workpiece and the tool. The treatment of the teeth of the satellites of the double grinding wheels improves performance of the process compared to the single pass on 26%. Statistical control of error radial runout of the teeth of the satellites indicates the high accuracy and stability of process of continuous grinding of teeth by the generating. [ABSTRACT FROM AUTHOR]

Background: For evaluation of the pulmonary arteries in patients suspected of pulmonary embolism, CT angiography (CTA) is the first-line imaging test with contrast-enhanced MR angiography (CEMRA) a potential alternative. Disadvantages of CTA include exposure to ionizing radiation and an iodinated contrast agent, while CEMRA is sensitive to respiratory motion and requires a gadolinium-based contrast agent. The primary goal of our technical feasibility study was to evaluate pulmonary arterial conspicuity using breath-hold and free-breathing implementations of a recently-developed nonenhanced approach, single-shot radial quiescent-interval slice-selective (QISS) MRA. Methods: Breath-hold and free-breathing, navigator-gated versions of radial QISS MRA were evaluated at 1.5 Tesla in three healthy subjects and 11 patients without pulmonary embolism or arterial occlusion by CTA. Images were scored by three readers for conspicuity of the pulmonary arteries through the level of the segmental branches. In addition, one patient with pulmonary embolism was imaged. Results: Scan time for a 54-slice acquisition spanning the pulmonary arteries was less than 2 minutes for breath-hold QISS, and less than 3.4 min using free-breathing QISS. Pulmonary artery branches through the segmental level were conspicuous with either approach. Free-breathing scans showed only mild blurring compared with breath-hold scans. For both readers, less than 1% of pulmonary arterial segments were rated as "not seen" for breath-hold and navigator-gated QISS, respectively. In subjects with atrial fibrillation, single-shot radial QISS consistently depicted the pulmonary artery branches, whereas navigator-gated 3D balanced steady-state free precession showed motion artifacts. In one patient with pulmonary embolism, radial QISS demonstrated central pulmonary emboli comparably to CEMRA and CTA. The thrombi were highly conspicuous on radial QISS images, but appeared subtle and were not prospectively identified on scout images acquired using a single-shot bSSFP acquisition. Conclusions: In this technical feasibility study, both breath-hold and free-breathing single-shot radial QISS MRA enabled rapid, consistent demonstration of the pulmonary arteries through the level of the segmental branches, with only minimal artifacts from respiratory motion and cardiac arrhythmias. Based on these promising initial results, further evaluation in patients with suspected pulmonary embolism appears warranted. [ABSTRACT FROM AUTHOR]

Study Objective: To investigate the value of using a new technique for ultrasound-guided radial artery catheterization; oblique approach; vs transverse and longitudinal views are the traditionally used approaches aiming to combine benefits and avoid drawbacks of aforementioned approaches.Design: A prospective randomized nonblinded study.Setting: Gastroenterology Center, Mansoura University, Egypt from February 2015 to August 2015.Patients: One hundred twenty-six surgical and intensive care unit patients indicated for arterial catheterization.Intervention: Patients were randomly allocated into 3 groups according to the US-guided technique used; group T (n=42) using transverse view, group L (n=42) using longitudinal view, group O (n=42) using oblique view.Measurements: Primary objective was overall success rate; secondary objectives were first attempt success, time to cannulate, and operator satisfaction with the used technique.Main Results: Forty-two patients were included for each study group. Overall success rate of radial artery catheterization was significantly higher in group O than in group T and clinically higher than group L (60% for group T, 70% for group L, 90% for group O; P<.02). Likewise, time needed to cannulate the radial artery was significantly lower in group O than in both group T and group L (28±19 s for group T, 66±5 s for group L, 16±7 s for group O; P<.00].Conclusion: These results support the conclusion that the oblique approach for US-guided radial artery catheterization may replace the 2 classic approaches owing to its superior success rate, higher first attempt success and shorter time consumed for catheterization with more operator satisfaction after the procedure. [ABSTRACT FROM AUTHOR]

This paper is devoted to the study of semi-stable radial solution u ∈ C 1 ( R N ) of − Δ p u = f ( u ) in R N , where N ≥ 2 , p > 1 , Δ p is the p -Laplace operator and f ∈ C 1 ( R ) is a general function. We establish sharp pointwise estimates for such solutions for p ≥ 2 or 1 < p < 2 and N ≤ 2 p ( 2 − p + 1 ) ( p − 1 ) ( 2 − p ) , which do not depend on f . [ABSTRACT FROM AUTHOR]

Relative rates of early graft failure and conduit selection in coronary artery bypass grafting (CABG) surgery remain controversial. Therefore, we sought to determine the incidence and determinants of graft failure of the left internal mammary artery (LIMA), radial artery, saphenous vein, and right internal mammary artery (RIMA) 1 year after CABG surgery. A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) CABG study, involving patients from 83 centers in 22 countries. We completed an analysis of 3480 grafts from 1068 patients who underwent CABG surgery with complete computed tomography angiography data. The primary outcome was graft failure as diagnosed by computed tomography angiography 1 year after surgery. Graft failure occurred in 6.4% (68/1068) for LIMA, 9.9% (9/91) for radial artery, 10.4% (232/2239) for saphenous vein, and 26.8% (22/82) for RIMA grafts. The RIMA had a greater rate of graft failure (26.8%) than radial artery (9.9%) and veins (10.4%) (adjusted odds ratio, 2.69; 95% confidence interval, 1.30-5.57; P =.008 and adjusted odds ratio, 2.07; 95% confidence interval, 1.33-3.21; P =.001, respectively). In this international trial dataset, LIMA and radial artery performed as expected, whereas vein grafts performed better. However, high rates of RIMA failure are worrisome and highlight the need for a thorough evaluation of the patency and safety of the RIMA in CABG surgery. Shown from top to bottom are the perioperative surgical characteristics (outlined boxes), postoperative CTA at 1 year after surgery (CTA and bypass graft diagrams), graft failure rates of each conduit (LIMA, radial artery, saphenous vein, RIMA), and main conclusions of the study (red font). Surgical characteristics associated with an increased risk of graft failure are represented as checkmarks (green) and those that were not statistically significant are represented by an "X" (red). Graft failure was diagnosed by computed tomography angiography, depicted as a camera (grey) rotated around the bypass graft (red vessel wall). Graft failure was defined as stenosis >75% or occlusion or string sign. CTA and bypass graft diagrams (cross section only) are not drawn to scale. Values are % (numbers of failed grafts/total number of grafts). ∗Rates of graft failure were higher in RIMA than radial arteries (26.8% [22/82] vs 9.9% [9/91]; adjusted odds ratio, 2.77; 95% CI, 1.39-5.54; P =.004) or saphenous veins (26.8% [22/82] vs 10.4% [232/2239]; adjusted odds ratio, 2.52; 95% CI, 1.66-3.83; P <.001). CTA , Computed tomography angiography; LIMA , left internal mammary artery; RIMA , right internal mammary artery; CABG , coronary artery bypass grafting; COMPASS , Cardiovascular Outcomes for People Using Anticoagulation Strategies. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Data regarding radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study aims to evaluate patients enrolled in the FERARI study regarding radiation exposure, fluoroscopy time and contrast agent use.Methods: The Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) study evaluated prospectively 400 patients between February 2014 and May 2015 undergoing PCI either using the radial or femoral access. In these 400 patients, baseline characteristics, procedural data such as procedural duration, fluoroscopy time, dose-area product (DAP) as well as the amount of contrast agent used were documented and analyzed.Results: Median fluoroscopy time was not significantly different in patients undergoing radial versus femoral access (12.2 vs. 9.8min, p=0.507). Furthermore, median DAP (54.5 vs. 52.0 Gycm2, p=0.826), procedural duration (46.0 vs. 45.0min, p=0.363) and contrast agent use (185.5 vs. 199.5ml, p=0.742) were also similar in radial and femoral PCI.Conclusion: There was no difference regarding median fluoroscopy time, procedural duration, radiation dose or contrast agent use between radial versus femoral arterial access in PCI. [ABSTRACT FROM AUTHOR]

Background The transradial route has become the primary approach for coronary angiography with the presence of radial artery anomalies found to be 10–20%. There has been limited study on the influence of these anomalies on procedural pain. Our aims were to determine local prevalence of the high radial origin (HRO) anatomical variant; to investigate factors influencing transradial procedural pain; and to determine if HRO specifically was associated with increased pain. Methods Radial artery anatomy was characterized by arteriography in sequential patients undergoing angiography. Patients were asked to mark their perceived procedural pain on a visual analog scale, which was converted to a pain score. Results 382 patients were enrolled, 5 were excluded. There were 259 males (68.7%) and 118 females (31.3%). HRO was present in 51 patients (13.5%). Overall mean pain score was 2.6 (SD 2.5). HRO was associated with a higher mean pain score than normal anatomy (3.3 (SD 2.9) vs. 2.4 (SD 2.4) p = 0.027). HRO was not associated with increased procedural failure, screening time or procedure time. When pain score was dichotomized into mild pain (< 4.0) and moderate-to-severe pain (≥ 4.0), HRO was associated with almost double the frequency of moderate-to-severe pain (37.2% vs. 21.1%, p = 0.012). Using a logistic regression model, only female gender, younger age and HRO remained significant predictors of moderate-to-severe pain. Conclusions There was significantly increased pain in patients with HRO without increased procedure/screening time or procedural failure. Female gender and younger age were also found to be significant predictors of increased pain. [ABSTRACT FROM AUTHOR]

The pathogenesis of congenital radial head dislocation/subluxation is unknown and has not been previously investigated. In this review, we explore the pathogenesis and define five different primary insults: collagen abnormalities, abnormal endochondral ossification of the developing growth plate, abnormalities of forearm ossification outside the growth plate, disproportionate growth of the radius and ulna, and altered HOX D expression/activity. Finally, the clinical relevance of our review is discussed. [ABSTRACT FROM AUTHOR]

Cell culture in three-dimensional hollow cylindrical porous scaffolds in radial-flow packed-bed bioreactors (rPBBs) has advantages over static culture and axial perfusion bioreactors. Transport models of rPBBs for tissue engineering proposed thus far neglect the effect of the fluid dynamics of the bioreactor void spaces on radial flux maldistribution, although such an effect was proven important for industrial reactors. In this paper, a two-dimensional axisymmetric model is proposed for steady-state momentum transport in the three compartments of rPBBs under conditions and for construct permeability typical of tissue engineering applications. Transport in the inner hollow cavity and outer peripheral annulus is described according to Navier–Stokes equations, while Darcy–Brinkman equation is used for transport across the annular construct. Model predictions were qualitatively validated against literature data. Effects of the performance-determining dimensionless groups on radial flux distribution along the bioreactor length were investigated, and a criterion was proposed to design and operate rPBBs in which radial fluxes are uniformly distributed along the bioreactor length under conditions typical of tissue engineering. Bioreactor designs and operation meeting the criterion will avoid non-uniform development of tissue structure and functional properties. [ABSTRACT FROM AUTHOR]

Objective To ascertain the impact of definition and diagnostic criteria on sural sparing in Guillain–Barré syndrome (GBS). Methods We retrospectively reviewed records of 78 consecutive patients with GBS from Birmingham, UK (2001–2012) studied within 21 days post-onset. Different criteria were initially used for subtype classification. Sural sparing was subsequently ascertained using historical/recent definitions. Results With Hadden et al.’s criteria, “absent median present sural” and “absent median normal sural” patterns offered sensitivities of 21.7% and 15.2% respectively for AIDP, with specificities of 100% versus axonal GBS. Present sural with two abnormal upper limb responses had a sensitivity of 19.1% and 100% specificity. “Abnormal radial present sural” and “abnormal radial normal sural” patterns had sensitivities of 18.9% and 16.2% and specificity of 100%. With newly-proposed criteria ( Rajabally et al., 2015 ), “absent median present sural” and “absent median normal sural” patterns offered sensitivities of 27.8% and 19.4% respectively, with specificity of 100%. Ulnar patterns were unhelpful with both criteria. Other patterns had suboptimal specificity. Conclusion Although of low sensitivity, sural sparing defined by absent median/present sural patterns, is specific of AIDP versus axonal GBS, irrespective of criteria. Significance Sural sparing is definition and criteria-dependent in GBS but is specific of AIDP with historical definitions, regardless of criteria. [ABSTRACT FROM AUTHOR]

Résumé L’observation d’une patiente obèse, admise pour la prise en charge d’un syndrome coronaire aigu ST+ en angioplastie primaire, nous permet, à partir des résultats des publications récentes, études randomisées et registres, de rappeler les avantages de la voie radiale dans ce type d’indication en termes de réduction d’évènements majeurs, y compris de réduction de la mortalité. Nous discutons les éléments de réticence à l’utilisation de cette voie d’abord dont seule l’expérience et l’utilisation quotidienne permettront de placer cette voie d’abord comme celle devant s’imposer par défaut dans les SCA ST+. This overweight woman's case, who underwent a primary coronary intervention for STEMI, reminds us how much the trans-radial angioplasty is interesting in this particular case leaning on the recent literature, randomized trials and registries, in terms of major adverse events reduction including mortality. We are going to debate about hesitation of using radial approach whose only everyday's practising could make this approach a STEMI one. [ABSTRACT FROM AUTHOR]

Purpose Targeted muscle reinnervation (TMR) offers enhanced prosthetic use by harnessing additional neural control from unused nerves in the amputated limb. The purpose of this study was to document the location and number of motor end plates to each muscle commonly used in TMR in the brachium relative to proximally based bony landmarks. Methods We dissected 18 matched upper limbs (9 fresh-frozen cadavers). The locations of each of the nerves’ muscular insertions into the medial biceps and brachialis were measured relative to the anterolateral tip of the acromion. The terminal branches to the lateral triceps were measured relative to the posterolateral tip of the acromion. Both the number of branches and the location of the muscular insertions were documented. Common descriptive statistics were used to describe the data. Results There was a median of 2 branches to the medial biceps located 19.6 cm from the anterolateral tip of the acromion (range, 15–25 cm). There was a median of 3.5 branches to the brachialis located 24.2 cm from the anterolateral tip of the acromion (range, 19–27.5 cm). There was a median of 2.5 branches to the lateral triceps located 21.6 cm from the posterolateral tip of the acromion (range, 11–29 cm). The mean distances to the primary branch muscle and the number of smaller branches were not significantly different when compared by sex or side. Conclusions Motor points for the medial biceps, brachialis, and lateral triceps can be identified reliably using proximal landmarks in targeted muscle reinnervation. Clinical relevance The data obtained from this study may assist the surgeon in localizing the nerve branches and muscular insertions for the commonly used muscles for TMR of the brachium. [ABSTRACT FROM AUTHOR]

Transradial access is becoming the default strategy for routine coronary procedures, but there is still room for improvement. For instance, left radial access is known to offer some advantages for graft cases, less tortuosity, amongst other potential benefits. The downside has been the applicability of this access point on patients with a larger body mass index both from the viewpoint of the patient and the operator. The patient must lay with their arm in a supine position and the operator as a result must stand in a flexed position for an unknown period of time. Additionally, patients with various orthopedic injuries, including frozen shoulders, on may be unable to supinate their wrist for optimal access. One solution to this dilemma is to approach the radial artery from the dorsal aspect of the hand so the wrist can pronate naturally if body habitus requires the arm to be shifted towards the operator. This report outlines the steps and background behind this approach and an educational opportunity for those interested in expanding their access skills. [ABSTRACT FROM AUTHOR]

Compressive peripheral nerve lesions commonly present for surgical consultation and research continually points to an optimal window of opportunity to better functional outcome. Here we provide a review of the anatomy, aetiology, clinical presentation, examination techniques and management of peripheral nerve pathology concentrating in the upper and lower limbs. We provide table summaries of peripheral nerve lesions and examination of all muscle groups in the upper and lower limbs, for your clinical revision aid. [ABSTRACT FROM AUTHOR]

Background Radial artery occlusion (RAO) remains the Achilles' heel of transradial coronary procedures. Standard over lower systemic anticoagulation levels are believed to reduce RAO rates but this is ill-supported by scientific evidence. We compared whether standard in comparison with less intensive anticoagulation was superior in preventing vessel closure. Methods and results The two arms of this analysis included 731 pooled patients with the same inclusion and exclusion criteria. We assessed forearm arterial access site occlusion rate by unfractionated heparin (UFH) dose in an individual participant data meta-analysis of this randomized study and of consecutive eligible patients from our previous trial. We randomized 308 consecutive patients undergoing transradial coronary angiography with 5 French (5Fr) catheters without need to crossover to receive 2500 or 5000 UFH units. The primary end-point was the ultrasonographically determined vessel occlusion rate. Incident RAOs in the randomized arm were 15.9% vs. 14%, in the low and standard UFH dose, respectively (p = 0.7). Corresponding figures for forearm arterial occlusion rates in the pooled population were 13.0% vs. 9.9% (relative risk: 1.3, 95% confidence interval -- CI: 0.88-1.98; p = 0.2). Procedural and fluoroscopy duration was less than 15 and 3 min, respectively. The mean UFH dose difference was 3.52 (95% CI: - 0.45 to 7.49) units per kilo body weight between occluded (n = 84) and patent forearm arteries (n = 647); (p = 0.053). Conclusions Incident forearm arterial occlusions were high despite using 5Fr catheters for a short-lasting procedure. Systemic anticoagulation with standard over lower UFH dose did not reduce the frequency of RAOs after coronary angiography. [ABSTRACT FROM AUTHOR]

Objective The aim of this study is to evaluate the efficacy and safety of two doses of heparin, a low dose (2500 IU) and a standard dose (5000 IU) in patients who underwent transradial coronary angiography (TRCAG). Methods A total of 459 consecutive patients were included in the present study, 217 in the 2500-IU heparin group and 242 in the 5000-IU heparin group. Radial artery patency was evaluated one month after the TRCAG with Doppler ultrasonography. Results The RAO was observed in 15 (3.3%) patients. The RAO was significantly higher in 2500 IU heparin group than 5000 IU heparin group (5.5% vs 1.2% p = 0.010, respectively). Female gender (Odds ratio (OR) = 66.135, p = 0.002, 95% confidence interval (CI) = 4.584-954.131), sheath removal time (OR = 1.496, p < 0.001, 95% CI = 1.254-1.784) and administration of 2500 IU heparin (OR = 9.758, p = 0.034, 95% CI = 1.195-79.695) were the independent predictors of RAO in multivariate regression analysis. While the presence of hypertension was independently associated with radial artery patency in multivariate regression analysis (OR = 0.022, p = 0.005, 95% CI = 0.002-0.307). Conclusion The patients in the standard dose heparin group had lower RAO rates compared to low dose group in this study. This suggests that using the current technique, standard dose of heparin is still required for transradial diagnostic angiography. [ABSTRACT FROM AUTHOR]

Development of internal flesh browning (IB) of ‘Cripp’s Pink’ (Pink Lady™) apples was studied over 6 years (2004–2011), on stored fruit coming from different orchards. The aim was to determine the effect of geographical location, climatic condition and fruit maturity on incidence of IB in the most important production regions of Chile. Geographical and climatic conditions were based on latitude, longitude, altitude, growing-degree-days (GDD), growing-degree-hours (GDH) and days after full bloom (DAFB). Maturity indexes included flesh firmness, starch index, soluble solids, background and red skin color. Fruits were stored at 0–1 °C for 5 months and IB incidence evaluated after removal plus 7–10 days at 18 °C. The disorder was classified as radial, diffuse or mixed IB. Data were analyzed through ANOVA, principal components analysis (PCA) and logistic regression analysis. Results showed that radial and diffuse IB can appear within the same orchard, and both symptoms may be combined within a fruit (mixed IB), which has not been reported. The different ranges of diffuse, radial and mixed IB found after storage were highly influenced by preharvest conditions (geographic/climatic and maturity variables). Although the three types of IB were found to increase with extended harvests, which were associated with advanced maturity, relative strength of the models to predict IB were higher for radial and mixed IB (Max-rescaled R 2 = 0.466 and 0.404, respectively), but less effective for diffuse IB (Max-rescaled R 2 = 0.117). Data from 6 years suggest that radial IB could best be explained by GDH and firmness at harvest; diffuse IB could be accounted for by GDH and background color at harvest, whereas for mixed IB the most meaningful variables would be DAFB and background color. [ABSTRACT FROM AUTHOR]

Objectives Radial approach invasive coronary angiography has been shown to be superior to the femoral approach in terms of reducing vascular access complications and improving patient comfort. However, one major limitation has been the perception of higher patient radiation exposure, with guidelines recommending 7mSv as an appropriate average effective dose (E) for routine coronary angiography. Therefore, we sought here to assess differences in radiation exposure between the femoral and radial access routes in patients undergoing diagnostic coronary angiography with or without angioplasty (CA +/- PCI), as performed by two operators, experienced in both techniques. Methods Consecutive patients (n = 870) from July 2011-December 2012, undergoing routine CA +/- PCI at Royal Prince Alfred Hospital, Sydney by two experienced interventional cardiologists were identified. Radiation doses were automatically recorded as dose area products (DAPs) at procedure time and converted into E using a conversion factor of 0.18 mSv/(Gycm2), as validated by the National Radiological Protection Board (NRPB). Results Of the 870 patients, 598 underwent diagnostic CA (347 femoral, 251 radial); and 272 underwent CA+ PCI (179 femoral, 93 radial). The mean age of the patients was 65 ± 12 years and the majority (n = 617, 71%) were male. Both groups were well matched with respect to baseline demographics, clinical presentation and angiographic characteristics, though there was an excess of patients with a history of coronary grafts in the femoral group, due to operator preference. In the patients who underwent diagnostic CA, there was no significant difference in the average effective radiation dose for femoral versus radial arterial access ( E = 7.9 ± 8.2 vs. 8.3 ± 10.6mSv; p = 0.66). Similarly, there was also no difference in average effective radiation dose for femoral versus radial arterial access in patients undergoing CA + PCI ( E = 13.2 ± 8.1 vs E = 14.4 ± 8.3 mSv; p = 0.26). Conclusion In our high volume cardiac catheterisation laboratory, radiation doses for routine angiography were near UNSC targets. Patient radiation exposure was comparable between femoral and radial approaches, for both CA and CA +/- PCI. Thus, our results allay concerns that radial cardiac catheterisation might be associated with greater radiation exposure. [ABSTRACT FROM AUTHOR]

Non-planar solar cell devices have been promoted as a means to enhance current collection in absorber materials with charge-transport limitations. This work presents an analytical framework for assessing the ultimate performance of non-planar solar cells based on materials and geometry. Herein, the physics of the p-n junction is analyzed for low-injection conditions, when the junction can be considered spatially separable into quasi-neutral and space-charge regions. For the conventional planar solar cell architecture, previously established one-dimensional expressions governing charge carrier transport are recovered from the framework established herein. Space-charge region recombination statistics are compared for planar and non-planar geometries, showing variations in recombination current produced from the space-charge region. In addition, planar and non-planar solar cell performances are simulated, based on a semi-empirical expression for short-circuit current, detailing variations in charge carrier transport and efficiency as a function of geometry, thereby yielding insights into design criteria for solar cell architectures. For the conditions considered here, the expressions for generation rate and total current are shown to universally govern any solar cell geometry, while recombination within the space-charge region is shown to be directly dependent on the geometrical orientation of the p-n junction. [ABSTRACT FROM AUTHOR]

Background: The abnormal signal intensity in cardiac T2-weighted images is associated with various pathologies including myocardial edema. However, the assessment of pathologies based on signal intensity is affected by the acquisition parameters and the sensitivities of the receiver coils. T2 mapping has been proposed to overcome limitations of T2-weighted imaging, but most methods are limited in spatial and/or temporal resolution. Here we present and evaluate a double inversion recovery radial fast spin-echo (DIR-RADFSE) technique that yields data with high spatiotemporal resolution for cardiac T2 mapping. Methods: DIR-RADFSE data were collected at 1.5 T on phantoms and subjects with echo train length (ETL) = 16, receiver bandwidth (BW) = ±32 kHz, TR = 1RR, matrix size = 256 x 256. Since only 16 views per echo time (TE) are collected, two algorithms designed to reconstruct highly undersampled radial data were used to generate images for 16 time points: the Echo-Sharing (ES) and the CUrve Reconstruction via pca-based Linearization with Indirect Echo compensation (CURLIE) algorithm. T2 maps were generated via least-squares fitting or the Slice-resolved Extended Phase Graph (SEPG) model fitting. The CURLIE-SEPG algorithm accounts for the effect of indirect echoes. The algorithms were compared based on reproducibility, using Bland-Altman analysis on data from 7 healthy volunteers, and T2 accuracy (against a single-echo spin-echo technique) using phantoms. Results: Both reconstruction algorithms generated in vivo images with high spatiotemporal resolution and showed good reproducibility. Mean T2 difference between repeated measures and the coefficient of repeatability were 0.58 ms and 2.97 for ES and 0.09 ms and 4.85 for CURLIE-SEPG. In vivo T2 estimates from ES were higher than those from CURLIE-SEPG. In phantoms, CURLIE-SEPG yielded more accurate T2s compared to reference values (error was 7.5-13.9% for ES and 0.6-2.1% for CURLIE-SEPG), consistent with the fact that CURLIE-SEPG compensates for the effects of indirect echoes. The potential of T2 mapping with CURLIE-SEPG is demonstrated in two subjects with known heart disease. Elevated T2 values were observed in areas of suspected pathology. Conclusions: DIR-RADFSE yielded TE images with high spatiotemporal resolution. Two algorithms for generating T2 maps from highly undersampled data were evaluated in terms of accuracy and reproducibility. Results showed that CURLIE-SEPG yields T2 estimates that are reproducible and more accurate than ES. [ABSTRACT FROM AUTHOR]

Objectives This study sought to determine the relationships among access site practice, clinical presentation, and procedural outcomes in a large patient population. Background Transradial access (TRA) has been associated with improved patient outcomes in selected populations in randomized trials. It is unclear whether these outcomes are achievable in clinical practice. Methods Using the BCIS (British Cardiovascular Intervention Society) database, we investigated outcomes for percutaneous coronary intervention procedures undertaken between 2007 and 2012 according to access site practice. Patients were categorized as stable, non-ST-segment elevation acute coronary syndrome (NSTEACS) and ST-elevation acute coronary syndrome (STEACS). The impact of access site on 30-day mortality, major adverse cardiac events, bleeding, and arterial access site complications was studied. Results Data from 210,260 TRA and 229,687 transfemoral access procedures were analyzed. Following multivariate analysis, TRA was independently associated with a reduction in bleeding in all presenting syndromes (stable odds ratio [OR]: 0.24, p < 0.001; NSTEACS OR: 0.35, p < 0.001; STEACS OR: 0.47, p < 0.001) as well as access site complications (stable OR: 0.21, p < 0.001; NSTEACS OR: 0.19; STEACS OR: 0.16, p < 0.001). TRA was associated with reduced major adverse cardiac events only in patients with unstable syndromes (stable OR: 1.08, p = 0.25; NSTEACS OR: 0.72, p < 0.001; STEACS OR: 0.70, p < 0.001). TRA was associated with improved outcomes compared with a transfemoral access (TFA) with a vascular closure device in a propensity matched cohort. Conclusions In this large study, TRA is associated with reduced percutaneous coronary intervention–related complications in all patient groups and may reduce major adverse cardiac events and mortality in ACS patients. TRA is superior to transfemoral access with closure devices. Use of TRA may lead to important patient benefits in routine practice. TRA should be considered the preferred access site for percutaneous coronary intervention. [ABSTRACT FROM AUTHOR]

Three reformers with different designs (multi-channel, radial and tubular) were developed for thermal integration with a high temperature polymeric electrolyte membrane fuel cell (HT-PEMFC). They were characterized experimentally at temperatures between 443 K and 473 K, using the commercial catalyst G66 MR from Süd-Chemie (CuO/ZnO/Al 2 O 3 ). The reactors were modeled and simulated using a computational fluid dynamics (CFD) analysis. The models were validated using experimental data. The results showed that the multi-channel design is the best solution for thermal integration with a HT-PEMFC, presenting high methanol conversion and low pressure drop. Regarding the heat transfer ability, the multi-channel showed also the best performance, presenting the lowest temperature sink among the studied reformers. The low flow velocities and the absence of metallic surfaces in the radial reformer had detrimental effect on the heat transfer. Concerning the flow distribution a coefficient of variation of 0.6% was observed in the multichannel reformer. A quasi plug flow behavior was found in the tubular and a multichannel (channels region only) reformer, while in the radial a not fully developed laminar flow was found. At temperatures lower than 473 K was found that the reformate stream did not require further purification to be fed to a HT-PEMFC due to the low CO concentration (<1600 ppm). The advantages and limitations of each design is discussed based on experimental data and CFD modeling. [ABSTRACT FROM AUTHOR]