Popliteal artery aneurysms: a review

Popliteal artery aneurysms (PAAs) are the most common form of peripheral arterial aneurysms. The popliteal artery is the continuation of the femoral artery and represents the major source of blood to the leg. Thrombus formation as a result of PAA may reduce blood flow, leading to limb-threatening ischemia and potential limb amputation. Popliteal artery aneurysms are predominantly seen in males (95-99% of cases), presumably owing to their predisposition for arteriosclerosis, which is also a major factor for PAA predisposition. Additionally, it is not uncommon to see an abdominal aortic aneurysm associated with a PAA (30-50% of cases) or bilateral presentation of PAA (~50% of cases). A consequence of a PAA and thrombus located in the popliteal fossa is an inflammatory reaction, potentially involving adjacent structures in the fossa. This may present clinically as pain in the leg and/or edema. Treatment of PAA involves either a conservative management protocol or a more aggressive intervention such as surgery. Proponents of conservative management will regulate the diameter of the aneurysm by ultrasound, while those in favor of surgical intervention will repair the aneurysm through a number of open surgical methods or by endovascular stent grafting. This review summarizes the historical points related to PAA and analyzes the pertinent anatomical implications, clinical findings and treatment methods for PAA

Emission of Air Pollutants in the Region of the Central European Initiative - 1988

This paper presents an emission inventory of sulfur dioxide (SO2), nitrogen oxides (NO,), particulate matter (PM) and carbon dioxide (CO2), for the countries cooperating in the Central European Initiative, i.e., Austria, Croatia, Czechoslovakia, Hungary, Italy, Poland, Slovenia. The inventory is based on national and regional statistics as well as on information available from the collaborating institutions, which has not yet been internationally published. National data has been verified and converted into a common format, consistent with the database used by the European Environmental Agency and the European Community (the CORINAIR system). The inventory describes emissions in the year 1988 (before the restructuring process began in former socialist economies). Data has been collected for three levels: National, Administrative, Large Point Sources (LPS). A point source database has been created, in which specific information (e.g., capacity, commissioning year, fuel use, production) about 400 large plants in Central Europe is stored. The result of this work represents the first consistent inventory of the sources of air pollution in Central Europe

Spatio-temporal assessment of beech growth in relation to climate extremes in Slovenia – An integrated approach using remote sensing and tree-ring data

Climate change is predicted to affect tree growth due to increased frequency and intensity of extreme events such as ice storms, droughts and heatwaves. Yet, there is still a lot of uncertainty on how trees respond to an increase in frequency of extreme events. Use of both ground-based wood increment (i.e. ring width) and remotely sensed data (i.e. vegetation indices) can be used to scale-up ground measurements, where there is a link between the two, but this has only been demonstrated in a few studies. We used tree-ring data together with crown features derived from the Moderate Resolution Imaging Spectroradiometer (MODIS) to assess the effect of extreme climate events on the growth of beech (Fagus sylvatica L.) in Slovenia. We found evidence that years with climate extremes during the growing season (drought, high temperatures) had a lower ring width index (RWI) but we could not find such evidence for the remotely sensed EVI (Enhanced Vegetation Index). However, when assessing specific events where leaf burning or wilting has been reported (e.g. August 2011) we did see large EVI anomalies. This implies that the impact of drought or heatwave events cannot be captured by EVI anomalies until physical damage on the canopy is caused. This also means that upscaling the effect of climate extremes on RWI by using EVI anomalies is not straightforward. An exception is the 2014 ice storm that caused a large decline in both RWI and EVI. Extreme climatic parameters explained just a small part of the variation in both RWI and EVI by, which could indicate an effect of other climate variables (e.g. late frost) or biotic stressors such as insect outbreaks. Furthermore, we found that RWI was lower in the year after a climate extreme occurred in the late summer. Most likely due to the gradual increase in temperature and more frequent drought we found negative trends in RWI and EVI. EVI maps could indicate where beech is sensitive to climate changes and could be used for planning mitigation interventions. Logical next steps should focus on a tree-based understanding of the short -and long-term effects of climate extremes on tree growth and survival, taking into account differential carbon allocation to the crown (EVI) and to wood-based variables. This research highlights the value of an integrated approach for upscaling tree-based knowledge to the forest level

A novel amplitude binning strategy to handle irregular breathing during 4DMRI acquisition: improved imaging for radiotherapy purposes.

Background For radiotherapy of abdominal cancer, four-dimensional magnetic resonance imaging (4DMRI) is desirable for tumor definition and the assessment of tumor and organ motion. However, irregular breathing gives rise to image artifacts. We developed a outlier rejection strategy resulting in a 4DMRI with reduced image artifacts in the presence of irregular breathing.Methods We obtained 2D T2-weighted single-shot turbo spin echo images, with an interleaved 1D navigator acquisition to obtain the respiratory signal during free breathing imaging in 2 patients and 12 healthy volunteers. Prior to binning, upper and lower inclusion thresholds were chosen such that 95% of the acquired images were included, while minimizing the distance between the thresholds (inclusion range (IR)). We compared our strategy (Min95) with three commonly applied strategies: phase binning with all images included (Phase), amplitude binning with all images included (MaxIE), and amplitude binning with the thresholds set as the mean end-inhale and mean end-exhale diaphragm positions (MeanIE). We compared 4DMRI quality based on: Data included (DI); percentage of images remaining after outlier rejection. Reconstruction completeness (RC); percentage of bin-slice combinations containing at least one image after binning. Intra-bin variation (IBV); interquartile range of the diaphragm position within the bin-slice combination, averaged over three central slices and ten respiratory bins. IR. Image smoothness (S); quantified by fitting a parabola to the diaphragm profile in a sagittal plane of the reconstructed 4DMRI. A two-sided Wilcoxon's signed-rank test was used to test for significance in differences between the Min95 strategy and the Phase, MaxIE, and MeanIE strategies.Results Based on the fourteen subjects, the Min95 binning strategy outperformed the other strategies with a mean RC of 95.5%, mean IBV of 1.6 mm, mean IR of 15.1 mm and a mean S of 0.90. The Phase strategy showed a poor mean IBV of 6.2 mm and the MaxIE strategy showed a poor mean RC of 85.6%, resulting in image artifacts (mean S of 0.76). The MeanIE strategy demonstrated a mean DI of 85.6%.Conclusions Our Min95 reconstruction strategy resulted in a 4DMRI with less artifacts and more precise diaphragm position reconstruction compared to the other strategies.Trial registration Volunteers: protocol W15_373#16.007; patients: protocol NL47713.018.14

Children’s experiences following a CBT intervention to reduce dental anxiety: one year on

Objective: To investigate children’s ongoing experiences of dental care and use of strategies to manage their dental anxiety following cognitive behavioural therapy (CBT). Design: A child self-completed postal questionnaire. Settings: Hospital, community and general dental practice. Subjects: Questionnaires were sent to 44 children, aged 10-17 years who had been referred to specialist services due to their dental anxiety. Intervention: Children had all previously received a guided CBT self-help intervention to reduce their dental anxiety and, on completion of treatment, had been discharged to their referring dentist. Questionnaires were sent out 12-18 months later to ascertain dental attendance patterns and application of any strategies learnt from the previous CBT intervention. Results: 22 responses (50%) were received from 16 girls and 6 boys. 82% had subsequently accessed follow up care with a general dental practitioner and over half of these had undergone a dental procedure, other than a check-up. 91% reported feeling less worried about dental visits, than previously, and described a change in cognition, behaviours, and feelings that allowed them to manage their anxiety better. Conclusions: CBT has positive immediate and longitudinal effects in reducing children’s dental anxiety. The challenge of adopting this evidence-based approach within primary care settings remains

Riboflavin Supplementation in Patients with Crohn's Disease [the RISE-UP study]

Background and Aims: Crohn's disease [CD] is characterised by chronic intestinal inflammation and dysbiosis in the gut. Riboflavin [vitamin B2] has anti-inflammatory, antioxidant and microbiome-modulatory properties. Here, we analysed the effect of riboflavin on oxidative stress, markers of inflammation, clinical symptoms, and faecal microbiome in patients with CD. Methods: In this prospective clinical intervention study, patients received 100 mg riboflavin [DSM, Nutritional Products Ltd] daily for 3 weeks. Clinical disease activity [Harvey-Bradshaw Index: HBI], serum biomarkers of inflammation and redox status [plasma free thiols], and faecal microbiome taxonomical composition and functionality [fluorescent in situ hybridisation: FISH; and metagenomic shotgun sequencing: MGS], were analysed before and after riboflavin intervention. Results: In total, 70 patients with CD with varying disease activity were included. Riboflavin supplementation significantly decreased serum levels of inflammatory markers. In patients with low faecal calprotectin [FC] levels, IL-2 decreased, and in patients with high FC levels, C-reactive protein [CRP] was reduced and free thiols significantly increased after supplementation. Moreover, HBI was significantly decreased by riboflavin supplementation. Riboflavin supplementation led to decreased Enterobacteriaceae in patients with low FC levels as determined by FISH; however, MGS analysis showed no effects on diversity, taxonomy, or metabolic pathways of the faecal microbiome. Conclusions: Three weeks of riboflavin supplementation resulted in a reduction in systemic oxidative stress, mixed anti-inflammatory effects, and a reduction in clinical symptoms [HBI]. FISH analysis showed decreased Enterobacteriaceae in patients with CD with low FC levels, though this was not observed in MGS analysis. Our data demonstrate that riboflavin supplementation has a number of anti-inflammatory and anti-oxidant effects in CD

Consensus Paper—ICIS Expert Meeting Basel 2009 treatment milestones in immune thrombocytopenia

The rarity of severe complications of this disease in children makes randomized clinical trials in immune thrombocytopenia (ITP) unfeasible. Therefore, the current management recommendations for ITP are largely dependent on clinical expertise and observations. As part of its discussions during the Intercontinental Cooperative ITP Study Group Expert Meeting in Basel, the Management working group recommended that the decision to treat an ITP patient be individualized and based mainly on bleeding symptoms and not on the actual platelet count number and should be supported by bleeding scores using a validated assessment tool. The group stressed the need to develop a uniform validated bleeding score system and to explore new measures to evaluate bleeding risk in thrombocytopenic patients—the role of rituximab as a splenectomy-sparing agent in resistant disease was also discussed. Given the apparently high recurrence rate to rituximab therapy in children and the drug's possible toxicity, the group felt that until more data are available, a conservative approach may be considered, reserving rituximab for patients who failed splenectomy. More studies of the effectiveness and side effects of drugs to treat refractory patients, such as TPO mimetics, cyclosporine, mycophenolate mofetil, and cytotoxic agents are required, as are long-term data on post-splenectomy complications. In the patient with either acute or chronic ITP, using a more personalized approach to treatment based on bleeding symptoms rather than platelet count should result in less toxicity and empower both physicians and families to focus on quality-of-life

Updated Systematic Review and Meta-Analysis of the Performance of Risk Prediction Rules in Children and Young People with Febrile Neutropenia

Introduction: Febrile neutropenia is a common and potentially life-threatening complication of treatment for childhood cancer, which has increasingly been subject to targeted treatment based on clinical risk stratification. Our previous meta-analysis demonstrated 16 rules had been described and 2 of them subject to validation in more than one study. We aimed to advance our knowledge of evidence on the discriminatory ability and predictive accuracy of such risk stratification clinical decision rules (CDR) for children and young people with cancer by updating our systematic review. Methods: The review was conducted in accordance with Centre for Reviews and Dissemination methods, searching multiple electronic databases, using two independent reviewers, formal critical appraisal with QUADAS and meta-analysis with random effects models where appropriate. It was registered with PROSPERO: CRD42011001685. Results: We found 9 new publications describing a further 7 new CDR, and validations of 7 rules. Six CDR have now been subject to testing across more than two data sets. Most validations demonstrated the rule to be less efficient than when initially proposed; geographical differences appeared to be one explanation for this. Conclusion: The use of clinical decision rules will require local validation before widespread use. Considerable uncertainty remains over the most effective rule to use in each population, and an ongoing individual-patient-data meta-analysis should develop and test a more reliable CDR to improve stratification and optimise therapy. Despite current challenges, we believe it will be possible to define an internationally effective CDR to harmonise the treatment of children with febrile neutropenia