Successful left gonadal vein to inferior vena cava bypass for symptomatic May-Thurner syndrome

We report the management of symptomatic May-Thurner syndrome refractory to endovascular techniques with left gonadal vein to inferior vena cava bypass. The patient\u27s presentation was exceptional-a young individual with end-stage renal disease status post four failed kidney transplants, dwindling options for dialysis access, and an unusable left thigh arteriovenous graft owing to severe lower extremity edema secondary to common iliac vein compression. Postoperatively, swelling was markedly alleviated and the thigh graft was functional. Discussed are endovascular and venous bypass techniques for management of May-Thurner-associated lesions, as well as approaches to end-stage hemodialysis access salvage

Physical therapy management, surgical treatment, and patient-reported outcomes measures in a prospective observational cohort of patients with neurogenic thoracic outlet syndrome

OBJECTIVE: To assess the results of physical therapy management and surgical treatment in a prospective observational cohort of patients with neurogenic thoracic outlet syndrome (NTOS) using patient-reported outcomes measures. METHODS: Of 183 new patient referrals from July 1 to December 31, 2015, 150 (82%) met the established clinical diagnostic criteria for NTOS. All patients underwent an initial 6-week physical therapy trial. Those with symptom improvement continued physical therapy, and the remainder underwent surgery (supraclavicular decompression with or without pectoralis minor tenotomy). Pretreatment factors and 7 patient-reported outcomes measures were compared between the physical therapy and surgery groups using t-tests and χ RESULTS: Of the 150 patients, 20 (13%) declined further treatment or follow-up, 40 (27%) obtained satisfactory improvement with physical therapy alone, and 90 (60%) underwent surgery. Slight differences were found between the physical therapy and surgery groups in the mean ± standard error degree of local tenderness to palpation (1.7 ± 0.1 vs 2.0 ± 0.1; P = .032), the number of positive clinical diagnostic criteria (9.0 ± 0.3 vs 10.1 ± 0.1; P = .001), Cervical-Brachial Symptom Questionnaire scores (68.0 ± 4.1 vs 78.0 ± 2.7; P = .045), and Short-Form 12-item physical quality-of-life scores (35.6 ± 1.5 vs 32.0 ± 0.8; P = .019) but not other pretreatment factors. During follow-up (median, 21.1 months for physical therapy and 12.0 months for surgery), the mean change in QuickDASH scores for physical therapy was -15.6 ± 3.0 (-29.5% ± 5.7%) compared with -29.8 ± 2.4 (-47.9% ± 3.6%) for surgery (P = .001). The patient-rated outcomes for surgery were excellent for 27%, good for 36%, fair for 26%, and poor for 11%, with a strong correlation between the percentage of decline in the QuickDASH score and patient-rated outcomes (P \u3c .0001). CONCLUSIONS: The present study has demonstrated contemporary outcomes for physical therapy and surgery in a well-studied cohort of patients with NTOS, reinforcing that surgery can be effective when physical therapy is insufficient, even with substantial pretreatment disability. Substantial symptom improvement can be expected for ∼90% of patients after surgery for NTOS, with treatment outcomes accurately reflected by changes in QuickDASH scores. Within this cohort, it was difficult to identify specific predictive factors for individuals most likely to benefit from physical therapy alone vs surgery

Bone Morphogenetic Protein‐2 Decreases MicroRNA‐30b and MicroRNA‐30c to Promote Vascular Smooth Muscle Cell Calcification

Background: Vascular calcification resembles bone formation and involves vascular smooth muscle cell (SMC) transition to an osteoblast‐like phenotype to express Runx2, a master osteoblast transcription factor. One possible mechanism by which Runx2 protein expression is induced is downregulation of inhibitory microRNAs (miR). Methods and Results: Human coronary artery SMCs (CASMCs) treated with bone morphogenetic protein‐2 (BMP‐2; 100 ng/mL) demonstrated a 1.7‐fold (P<0.02) increase in Runx2 protein expression at 24 hours. A miR microarray and target prediction database analysis independently identified miR‐30b and miR‐30c (miR‐30b‐c) as miRs that regulate Runx2 expression. Real‐time–polymerase chain reaction confirmed that BMP‐2 decreased miR‐30b and miR‐30c expression. A luciferase reporter assay verified that both miR‐30b and miR‐30c bind to the 3′‐untranslated region of Runx2 mRNA to regulate its expression. CASMCs transfected with antagomirs to downregulate miR‐30b‐c demonstrated significantly increased Runx2, intracellular calcium deposition, and mineralization. Conversely, forced expression of miR‐30b‐c by transfection with pre–miR‐30b‐c prevented the increase in Runx2 expression and mineralization of SMCs. Calcified human coronary arteries demonstrated higher levels of BMP‐2 and lower levels of miR‐30b than did noncalcified donor coronary arteries. Conclusions: BMP‐2 downregulates miR‐30b and miR‐30c to increase Runx2 expression in CASMCs and promote mineralization. Strategies that modulate expression of miR‐30b and miR‐30c may influence vascular calcification

Effect of water on the dislocation creep microstructure and flow stress of quartz and implications for the recrystallized grain size piezometer

Deformation experiments on Black Hills quartzite with three different initial water contents (as-is, water-added, and vacuum-dried) were carried out in the dislocation creep regime in order to evaluate the effect of water on the recrystallized grain size/flow stress piezometer. Samples were deformed in axial compression at temperatures of 750°–1100°C, strain rates between 2 × 10−7 s−1 and 2 × 10−4 s−1 and strains up to 46% using a molten salt assembly in a Griggs apparatus. An increase of the initial water content at otherwise constant deformation conditions caused a decrease in flow stress, an effect known as hydrolytic weakening. The total water content of the starting material was analyzed by Karl Fischer titration (KFT) and Fourier transform infrared (IR) spectroscopy, and quenched samples were analyzed microstructurally and by IR. Changes in the dynamic recrystallization microstructure correlate with changes in flow stress, but there is no independent effect of temperature, strain rate or water content. IR absorption spectra of the deformed spectra indicate that different water contents were maintained in the three sample sets throughout the experiments. However, the amounts of water measured within the vacuum-dried (∼260 ± 40 ppm H2O), the as-is (∼340 ± 50 ppm H2O), and the water-added (∼430 ± 110 ppm H2O) samples are significantly smaller than the initial content of the quartzite (∼640 ± 50 ppm H2O). Water from the inclusions in the starting material adds to the free fluid phase along the grain boundaries, which probably controls the water fugacity and the flow strength, but this water is largely lost during IR sample preparation. Vacuum-dried as well as water-added samples have the same recrystallized grain size/flow stress relationship as the piezometer determined for as-is samples. No independent effect of water on the piezometric relationship has been detected

The Microbiome and Hematopoietic Cell Transplantation: Past, Present, and Future

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Аrtistic аctivities orgаnizing in а dаy cаre centre, аs welfаre Fаctor for people with mentаl disаbilities.

Darbo teorinėje dalyje analizuojami šaltiniai tokių autorių, kaip Ruškus, Leliūgienė, Šinkūnienė, Kvieskienė, Aleksienė, Bagdonas, Bitinas, Gaižutis, Elijošienė, Survilienė, TIdikis ir kt. Nagrinėjama problema - meno taikymas dienos centruose, dirbant su protinę negalią turinčiais žmonėmis. Tyrime atskleidžiama, kaip Vilniaus dienos centro socialiniai darbuotojai, dirbantys su proto negalios asmenimis, taiko meną centro veiklos programų organizavimui ir vykdymui, kokius metodus naudoja bei kaip tai paliečia kliento ir jo šeimą.In this pаper, the Lithuаniаn аnd foreign literаture аnаlysis of sociаl work with mentаlly disаbled people point of Lithuаniа. This pаper deаls with аspects such аs humаn heаlth аnd well-being of persons with disаbilities, intellectuаl disаbilities, аrtistic аctivities, аrt therаpy.Švietimo akademijaVytauto Didžiojo universiteta