Genicular Artery Embolization for Recurrent Hemarthrosis of the Knee Following Total Knee Arthroplasty: A Single Centre Experience.

PURPOSE: To retrospectively review the safety and efficacy of genicular artery embolization procedures performed at our institution in patients presenting with recurrent knee hemarthrosis following total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 13 consecutive patients (average age: 68; range 51-84, 62% female) were identified who underwent 14 genicular artery embolization procedures after presenting with recurrent hemarthrosis after TKA. Patient charts were retrospectively reviewed for demographic information, pre-embolization investigations, and details of embolization procedure including complications, technical success, and clinical success. Each patient had failed initial conservative therapy and all patients had a diagnostic aspiration performed by the referring physician prior to the procedure. The average time between TKA and embolization in our cohort was 21 months. RESULTS: All procedures performed were technically successful, defined as elimination of periprosthetic hypervascular blush. An average of 3.6 genicular vessels were embolized in each patient; 355 to 500 µm polyvinyl alcohol (PVA) particles were used in each case. There were no cases of transient cutaneous ischemia, skin erythema, or skin necrosis. Clinical success was obtained in 85.7% of cases, defined by elimination of the presenting clinical symptoms (knee pain and swelling) during continued follow-up by the referring clinician. CONCLUSION: Particle embolization is a safe and effective treatment for recurrent hemarthrosis after arthroplasty and our experience suggests that utilizing particle sizes of greater than 300 µm appears to be important in order to avoid cutaneous ischemic complications.

Nonlocal Spin Dynamics in the Crossover from Diffusive to Ballistic Transport.

Improved fabrication techniques have enabled the possibility of ballistic transport and unprecedented spin manipulation in ultraclean graphene devices. Spin transport in graphene is typically probed in a nonlocal spin valve and is analyzed using spin diffusion theory, but this theory is not necessarily applicable when charge transport becomes ballistic or when the spin diffusion length is exceptionally long. Here, we study these regimes by performing quantum simulations of graphene nonlocal spin valves. We find that conventional spin diffusion theory fails to capture the crossover to the ballistic regime as well as the limit of long spin diffusion length. We show that the latter can be described by an extension of the current theoretical framework. Finally, by covering the whole range of spin dynamics, our study opens a new perspective to predict and scrutinize spin transport in graphene and other two-dimensional material-based ultraclean devices.

Graphene Nanobubbles as Valley Filters and Beam Splitters.

The energy band structure of graphene has two inequivalent valleys at the K and K^{'} points of the Brillouin zone. The possibility to manipulate this valley degree of freedom defines the field of valleytronics, the valley analogue of spintronics. A key requirement for valleytronic devices is the ability to break the valley degeneracy by filtering and spatially splitting valleys to generate valley polarized currents. Here, we suggest a way to obtain valley polarization using strain-induced inhomogeneous pseudomagnetic fields (PMFs) that act oppositely on the two valleys. Notably, the suggested method does not involve external magnetic fields, or magnetic materials, unlike previous proposals. In our proposal the strain is due to experimentally feasible nanobubbles, whose associated PMFs lead to different real space trajectories for K and K^{'} electrons, thus allowing the two valleys to be addressed individually. In this way, graphene nanobubbles can be exploited in both valley filtering and valley splitting devices, and our simulations reveal that a number of different functionalities are possible depending on the deformation field.

Electron Interference in Ballistic Graphene Nanoconstrictions.

We realize nanometer size constrictions in ballistic graphene nanoribbons grown on sidewalls of SiC mesa structures. The high quality of our devices allows the observation of a number of electronic quantum interference phenomena. The transmissions of Fabry-Perot-like resonances are probed by in situ transport measurements at various temperatures. The energies of the resonances are determined by the size of the constrictions, which can be controlled precisely using STM lithography. The temperature and size dependence of the measured conductances are in quantitative agreement with tight-binding calculations. The fact that these interference effects are visible even at room temperature makes the reported devices attractive as building blocks for future carbon based electronics.

The pregnant mouse uterus exhibits a functional kisspeptin/KISS1R signaling system on the day of embryo implantation.

BACKGROUND: Expression of kisspeptin (protein) and Kiss1r (mRNA) was recently documented in the mouse uterus on D4 of pregnancy (the day of embryo implantation) suggesting that the uterine-based kisspeptin (KP)/kisspeptin receptor (KISS1R) signaling system regulates embryo implantation. Despite this important suggestion, it was never demonstrated that the uterus actually exhibits a functional KP/KISS1R signaling system on D4 of pregnancy. Thus, the goal of this study was to determine whether a functional KP/KISS1R signaling system exists in the mouse uterus on D4 of pregnancy. FINDINGS: Since kisspeptin/KISS1R signaling triggers the phosphorylation of the mitogen-activated protein kinases p38 and ERK1/2, through immunohistochemical analyses, we determined whether exogenously administered kisspeptin could trigger p38 and ERK1/2 phosphorylation in the uterus on D4 of pregnancy. The results clearly demonstrated that kisspeptin could and that its effects were mediated via KISS1R. Additionally, the robust kisspeptin-triggered response was observed in the pregnant uterus only. Finally, it was demonstrated that on D4 of pregnancy the Kiss1 null uterus expresses functional KISS1R molecules capable of mediating the effects of kisspeptin. CONCLUSIONS: These results lead us to conclude that on D4 of pregnancy, the mouse uterus expresses a functional KP/KISS1R signaling system strengthening the possibility that this signaling system regulates embryo implantation. These findings strengthen the rationale for determining whether such a functional system exists in the uterus of the human female and if so, what role it might play in human pregnancy.

Theoretical analysis of a dual-probe scanning tunneling microscope setup on graphene.

Experimental advances allow for the inclusion of multiple probes to measure the transport properties of a sample surface. We develop a theory of dual-probe scanning tunneling microscopy using a Green's function formalism, and apply it to graphene. Sampling the local conduction properties at finite length scales yields real space conductance maps which show anisotropy for pristine graphene systems and quantum interference effects in the presence of isolated impurities. Spectral signatures in the Fourier transforms of real space conductance maps include characteristics that can be related to different scattering processes. We compute the conductance maps of graphene systems with different edge geometries or height fluctuations to determine the effects of nonideal graphene samples on dual-probe measurements.

Attitudes towards professionalism in graduate and non-graduate entrants to medical school.

BACKGROUND: The number of places available in Ireland and the United Kingdom (UK) for graduate entry to medical school has increased in the past decade. Research has primarily focused on academic and career outcomes in this cohort, but attitudes towards professionalism in medicine have not been systematically assessed. The purpose of this study was to compare the importance of items related to professional behaviour among graduate entrants and their 'school-leaver' counterparts. METHODS: This was a quantitative cross-sectional study, conducted in University College Cork (UCC), Ireland. A validated questionnaire was distributed to undergraduate-entry (UG) and graduate-entry (GE) students with items addressing the following areas: Demographic and academic characteristics and attitudes towards several classes of professional behaviours in medicine. RESULTS: GE students ascribed greater importance, relative to UG students, to various aspects of professionalism across the personal characteristics, interaction with patients and social responsibility categories. Additionally, in UG students, a significant decrease in perceived importance of the following professionalism items was evident across the course of the degree programme: Respect for patients as individuals, treating the underprivileged and reporting dishonesty of others. Among both groups of students, individual mentoring was rated the most important method for teaching professionalism in medicine. DISCUSSION: This study is the first comparison of attitudes to professionalism in UG and GE students. This study highlighted important group differences between GE and UG students in attitudes towards professional behaviours, together with different perspectives regarding how professionalism might be incorporated within the curriculum.

Renal artery stenosis stenting with unmasking and embolisation of a renal arteriovenous fistula.

A man in his 70s was presented to the emergency department with uncontrollable hypertension and worsening renal function on a background of atherosclerosis-related bilateral renal artery stenosis. Following progressive deterioration in renal function and refractory hypertension, the patient was referred to interventional radiology for consideration of renal artery stenting. Following stenting of the right renal artery, a large renal arteriovenous fistula became apparent, which required emergent embolisation. Both procedures were successful, with excellent clinical and radiological responses.

Quantum Confinement in Epitaxial Armchair Graphene Nanoribbons on SiC Sidewalls.

The integration of graphene into devices necessitates large-scale growth and precise nanostructuring. Epitaxial growth of graphene on SiC surfaces offers a solution by enabling both simultaneous and targeted realization of quantum structures. We investigated the impact of local variations in the width and edge termination of armchair graphene nanoribbons (AGNRs) on quantum confinement effects using scanning tunneling microscopy and spectroscopy (STM, STS), along with density-functional tight-binding (DFTB) calculations. AGNRs were grown as an ensemble on refaceted sidewalls of SiC mesas with adjacent AGNRs separated by SiC(0001) terraces hosting a buffer layer seamlessly connected to the AGNRs. Energy band gaps measured by STS at the centers of ribbons of different widths align with theoretical expectations, indicating that hybridization of π-electrons with the SiC substrate mimics sharp electronic edges. However, regardless of the ribbon width, band gaps near the edges of AGNRs are significantly reduced. DFTB calculations successfully replicate this effect by considering the role of edge passivation, while strain or electric fields do not account for the observed effect. Unlike idealized nanoribbons with uniform hydrogen passivation, AGNRs on SiC sidewalls generate additional energy bands with non-pz character and nonuniform distribution across the nanoribbon. In AGNRs terminated with Si, these additional states occur at the conduction band edge and rapidly decay into the bulk of the ribbon. This agrees with our experimental findings, demonstrating that edge passivation is crucial in determining the local electronic properties of epitaxial nanoribbons.

Rapid, automated, and experimenter-free touchscreen testing reveals reciprocal interactions between cognitive flexibility and activity-based anorexia in female rats.

Anorexia nervosa has among the highest mortality rates of any psychiatric disorder and is characterized by cognitive inflexibility that persists after weight recovery and contributes to the chronic nature of the condition. What remains unknown is whether cognitive inflexibility predisposes individuals to anorexia nervosa, a question that is difficult to address in human studies. Our previous work using the most well-established animal model of anorexia nervosa, known as activity-based anorexia (ABA) identified a neurobiological link between cognitive inflexibility and susceptibility to pathological weight loss in female rats. However, testing flexible learning prior to exposure to ABA in the same animals has been thus far impossible due to the length of training required and the necessity of daily handling, which can itself influence the development of ABA. Here, we describe experiments that validate and optimize the first fully-automated and experimenter-free touchscreen cognitive testing system for rats and use this novel system to examine the reciprocal links between reversal learning (an assay of cognitive flexibility) and weight loss in the ABA model. First, we show substantially reduced testing time and increased throughput compared to conventional touchscreen testing methods because animals engage in test sessions at their own direction and can complete multiple sessions per day without experimenter involvement. We also show that, contrary to expectations, cognitive inflexibility measured by this reversal learning task does not predispose rats to pathological weight loss in ABA. Instead, rats that were predisposed to weight loss in ABA were more quickly able to learn this reversal task prior to ABA exposure. Intriguingly, we show reciprocal links between ABA exposure and cognitive flexibility, with ABA-exposed (but weight-recovered) rats performing much worse than ABA naïve rats on the reversal learning task, an impairment that did not occur to the same extent in rats exposed to food restriction conditions alone. On the other hand, animals that had been trained on reversal learning were better able to resist weight loss upon subsequent exposure to the ABA model. We also uncovered some stable behavioral differences between ABA susceptible versus resistant rats during touchscreen test sessions using machine learning tools that highlight possible predictors of anorectic phenotypes. These findings shed new light on the relationship between cognitive inflexibility and pathological weight loss and provide targets for future studies using the ABA model to investigate potential novel pharmacotherapies for anorexia nervosa.

Strain-induced stacking transition in bilayer graphene.

Strain, both naturally occurring and deliberately engineered, can have a considerable effect on the structural and electronic properties of 2D and layered materials. Uniaxial or biaxial heterostrain modifies the stacking arrangement of bilayer graphene (BLG) which subsequently influences the electronic structure of the bilayer. Here, we use density functional theory (DFT) calculations to investigate the interplay between an external applied heterostrain and the resulting stacking in BLG. We determine how a strain applied to one layer is transferred to a second, 'free' layer and at what critical strain the ground-state AB-stacking is disrupted. To overcome limitations introduced by periodic boundary conditions, we consider an approximate system consisting of an infinite graphene sheet and an armchair graphene nanoribbon. We find that above a critical strain of∼1%, it is energetically favourable for the free layer to be unstrained, indicating a transition between uniform AB-stacking and non-uniform mixed stacking. This is in agreement with a simple model estimate based on the individual energy contributions of strain and stacking effects. Our findings suggest that small levels of strain provide a platform to reversibly engineer stacking order and Moiré features in bilayers, providing a viable alternative to twistronics to engineer topological and exotic physical phenomena in such systems.

Uterine Artery Embolisation of Fibroids and the Phenomenon of Post-Embolisation Syndrome: A Systematic Review.

Post-embolisation syndrome (PES) is a prevalent complication that occurs in patients following uterine artery embolisation (UAE) for the treatment of uterine fibroids. The aetiology of PES remains incompletely understood, although postulated to result secondary to tissue infarction resulting in release of inflammatory mediators. We followed PRISMA guidelines and performed a systematic review of studies of PES following UAE from inception to October 2022. Our published protocol was prospectively registered. Our search yielded 54 results. We reviewed 22 full texts, and nine articles were included. Observational studies comprised 6/9 relevant studies, with 5/9 retrospective design. The rate of PES was documented in 5/8 studies (excluding case report) with a reported incidence ranging from 4-34.6%. Five of the nine studies studies postulated that the aetiological basis of PES is inflammatory related. Further research is necessary to advance our understanding of PES to define the biological basis of the syndrome with more certainty and gain a consensus on peri-procedure management to reduce incidence and improve patient outcomes.

Isotopy classes for 3-periodic net embeddings.

Entangled embedded periodic nets and crystal frameworks are defined, along with their dimension type, homogeneity type, adjacency depth and periodic isotopy type. Periodic isotopy classifications are obtained for various families of embedded nets with small quotient graphs. The 25 periodic isotopy classes of depth-1 embedded nets with a single-vertex quotient graph are enumerated. Additionally, a classification is given of embeddings of n-fold copies of pcu with all connected components in a parallel orientation and n vertices in a repeat unit, as well as demonstrations of their maximal symmetry periodic isotopes. The methodology of linear graph knots on the flat 3-torus [0,1)3 is introduced. These graph knots, with linear edges, are spatial embeddings of the labelled quotient graphs of an embedded net which are associated with its periodicity bases.

Portopulmonary venous anastomosis as a rare cause of embolic stroke following endoscopic cyanoacrylate injection for gastric variceal hemorrhage: A case report and review of the literature.

We report the case of a non-cirrhotic 25-year-old female patient with cryptogenic portal hypertension who underwent cyanoacrylate injection for acute gastroesophageal variceal bleeding with a subsequent embolic stroke via a previously unrecognised portopulmonary venous anastomosis.

One-dimensional confinement and width-dependent bandgap formation in epitaxial graphene nanoribbons.

The ability to define an off state in logic electronics is the key ingredient that is impossible to fulfill using a conventional pristine graphene layer, due to the absence of an electronic bandgap. For years, this property has been the missing element for incorporating graphene into next-generation field effect transistors. In this work, we grow high-quality armchair graphene nanoribbons on the sidewalls of 6H-SiC mesa structures. Angle-resolved photoelectron spectroscopy (ARPES) and scanning tunneling spectroscopy measurements reveal the development of a width-dependent semiconducting gap driven by quantum confinement effects. Furthermore, ARPES demonstrates an ideal one-dimensional electronic behavior that is realized in a graphene-based environment, consisting of well-resolved subbands, dispersing and non-dispersing along and across the ribbons respectively. Our experimental findings, coupled with theoretical tight-binding calculations, set the grounds for a deeper exploration of quantum confinement phenomena and may open intriguing avenues for new low-power electronics.

Fast acquisition abdominal MRI study for the investigation of suspected acute appendicitis in paediatric patients.

OBJECTIVES: To assess the diagnostic accuracy of fast acquisition MRI in suspected cases of paediatric appendicitis presenting to a tertiary referral hospital. MATERIALS AND METHODS: A prospective study was undertaken between May and October 2017 of 52 children who presented with suspected appendicitis and were referred for an abdominal ultrasound. All patients included in this study received both an abdominal ultrasound and five-sequence MRI consisting of axial and coronal gradient echo T2 scans, fat-saturated SSFSE and a diffusion-weighted scan. Participants were randomised into groups of MRI with breath-holds or MRI with free breathing. A patient satisfaction survey was also carried out. Histopathology findings, where available, were used as a gold standard for the purposes of data analysis. Statistical analysis was performed, and p values < 0.05 were considered statistically significant. RESULTS: Ultrasound had a sensitivity and specificity of 25% and 92.9%, respectively. MRI with breath-hold had a sensitivity and specificity of 81.8% and 66.7%, respectively, whilst MRI with free breathing was superior with sensitivity and specificity of 92.3% and 84.2%, respectively. MRI with free breathing was also more time efficient (p < 0.0001). Group statistics were comparable (p < 0.05). CONCLUSIONS: The use of fast acquisition MRI protocols, particularly free breathing sequences, for patients admitted with suspected appendicitis can result in faster diagnosis, treatment and discharge. It also has a statistically significant diagnostic advantage over ultrasound. Additionally, the higher specificity of MR can reduce the number of negative appendectomies performed in tertiary centres.