Palliation of Abdominal Aortic Aneurysms in the Endovascular Era

AbstractObjectivesTo establish outcome of patients with abdominal aortic aneurysm (AAA) deemed unfit for repair.DesignRetrospective non-randomised study.Materials and methodsIdentification of males with >5.5 cm or females with >5.0 cm AAA turned down for elective repair between 01/01/2006–24/07/2009 from a prospective database. Comorbidities, reasons for non-intervention, aneurysm size, survival, use of CPEX (cardio-pulmonary exercise) testing and cause of death were analysed. Although well-established at the time, patients unfit for open operation were not considered for endovascular repair.ResultsSeventy two patients were unsuitable for AAA repair. Aneurysm size ranged from 5.3 cm to 12 cm. Functional status, comorbidity and patient preference determined decision to palliate. Sixty percent of patients were alive at study close. Aneurysm rupture was cause of death in 46%. CPEX testing was performed in 54%, whose mortality was 28%, vs. 54% in the non-CPEX group (P < 0.05).Median survival of patients with 5.1–6.0 cm AAA was 44 months and 11% died of rupture. Between 6.1 and 7.0 cm median survival was 26 months and 20% died of rupture. However, with >7 cm aneurysms, survival was 6 months and 43% ruptured.ConclusionUnder half the deaths in our comorbid cohort were due to rupture. However, decision to palliate may be revisited as risk-benefit ratio changes with aneurysm expansion

The Value of Transcranial Doppler in Predicting Cerebral Ischaemia During Carotid Endarterectomy

AbstractObjectives: transcranial Doppler (TCD) measurement of middle cerebral artery velocity (MCAV) is an indirect method of assessing cerebral blood flow and therefore predicting patients at risk of stroke during carotid endarterectomy (CEA), and may be used to determine the need for shunting. This study evaluates the accuracy of three accepted TCD criteria in predicting the need for a shunt. Design: prospective study. Methods: one hundred and twenty consecutive CEA were performed under loco/regional anaesthesia. Patients monitored by TCD and Awake neurological examination were included. Shunts were inserted if there was neurological deterioration. Awake patient monitoring was compared with the three TCD criteria. Results: inadequate TCD recordings were obtained in 16 operations (13%). In the remainder (104 cases), 12 developed symptoms of cerebral ischaemia and required a shunt (12%). Comparisons with the three accepted criteria were as follows: (1) m MCAV <30 cm/s had a sensitivity, specificity, PPV and NPV of 92%, 49%, 19%, and 98%, respectively; (2) clamp/pre-clamp ratio <0.6 had a sensitivity, specificity, PPV and NPV of 92%, 75%, 33% and 99%, respectively; (3) greater than 50% reduction in m MCAV had a sensitivity, specificity, PPV and NPV valves of 83%, 77%, 32% and 97%, respectively. Conclusions: TCD flow velocities are not a reliable method for detecting cerebral ischaemia and therefore determining the need for a shunt in CEA

Minimizing Effective Many-Body Interactions

A simple two-level model is developed and used to test the properties of effective interactions for performing nuclear structure calculations in truncated model spaces. It is shown that the effective many-body interactions sensitively depend on the choice of the single-particle basis and they appear to be minimized when a self- consistent Hartree-Fock basis is used.Comment: (15 pages of text and 1 postscript figure (Figure available upon request), Preprint Number not assigned ye

The Increasing Role of Percutaneous Transluminal Angioplasty in the Primary Management of Critical Limb Ischaemia

AbstractObjective: to review the current role and results of angioplasty in the management of critical limb ischaemia (CLI) in a single institution.Methods: data on 526 patients with 608 ischaemic limbs, treated between January 1994 and December 1999 was collected prospectively and analysed retrospectively. Patients were divided into 3 groups according to the date of presentation: group 1 (1994–95), group 2 (1996–97) and group 3 (1998–99). The groups were comparable in terms of demographics, mode of presentation and level of disease.Results: Revascularisation was attempted in 87%, 81% and 91% for groups 1, 2 and 3 respectively (NS). Primary percutaneous transluminal angioplasty (PTA) rates increased from 44% (1994–95) to 69% (1998–99) (p < 0.001), and surgical revascularisation rates decreased correspondingly (p<0.01). Overall cumulative patient survival and limb salvage rates were 82% and 89% for 1 year and 45% and 87% for 5 years, respectively. No statistically significant difference existed between the three groups regarding patient survival, limb salvage rates and mean hospital stay (19, 12 and 12 days, respectively).Conclusion: PTA is increasingly replacing bypass surgery in the treatment of CLI, without compromising patient survival or limb salvage rates

Analyzing Power Measurements for (p,n) Reactions

This work was supported by the National Science Foundation Grant NSF PHY 78-22774 A02 & A03 and by Indiana Universit

Analyzing-Power Measurements for (p,n) Reactions

This work was supported by the National Science Foundation Grant NSF PHY 81-14339 and by Indiana Universit

A VALUE PLATFORM ANALYSIS PERSPECTIVE ON CUSTOMER ACCESS INFORMATION TECHNOLOGY

Customer access information technologies (CAITs) provide a link between a firm and its customers. Firms invest in CAITs to reduce costs, increase revenues and market share, lock in existing customers and capture new ones. These benefits, however, are notoriously difficult to measure. This paper proposes an evaluative method for CAlT deployment called value platform analysis, that is based on a conceptual model drawn from the theory of retail outlet deployment in marketing science. The model focuses on the impact of CAIT features and environmental features on transactions generated by the CAIT. Specific econometric models are developed for deployment. Hypotheses regarding the likely impact of automated teller machine (ATM) location design choices and environmental features on ATM transactions are evaluated. The results indicate that there are a number of key features influencing ATM performance. Two distinct ATM deployment scenarios emerge: one for servicing a bank's own customers, and another for providing transaction services for customers for a fee.Information Systems Working Papers Serie

Global ubiquitinome profiling identifies NEDD4 as a regulator of Profilin 1 and actin remodelling in neural crest cells

The ubiquitin ligase NEDD4 promotes neural crest cell (NCC) survival and stem-cell like properties to regulate craniofacial and peripheral nervous system development. However, how ubiquitination and NEDD4 control NCC development remains unknown. Here we combine quantitative analysis of the proteome, transcriptome and ubiquitinome to identify key developmental signalling pathways that are regulated by NEDD4. We report 276 NEDD4 targets in NCCs and show that loss of NEDD4 leads to a pronounced global reduction in specific ubiquitin lysine linkages. We further show that NEDD4 contributes to the regulation of the NCC actin cytoskeleton by controlling ubiquitination and turnover of Profilin 1 to modulate filamentous actin polymerization. Taken together, our data provide insights into how NEDD4-mediated ubiquitination coordinates key regulatory processes during NCC development.Iman Lohraseb, Peter McCarthy, Genevieve Secker, Ceilidh Marchant, Jianmin Wu, Naveid Ali, Sharad Kumar, Roger J. Daly, Natasha L. Harvey, Hiroshi Kawabe, Oded Kleifeld, Sophie Wiszniak, Quenten Schwar