Effect of cervical contralateral lateral flexion on the median nerve and fascia at the wrist - Cadaveric study.

BACKGROUND: Neurodynamic tests are an essential aspect of the physical examination of the patient when suspicion of neural involvement exists. A manoeuvre that is hypothesised to move nerves differentially relative to other structures (structural differentiation) has been proposed as a necessary part of neurodynamic testing for differential diagnosis. However, although the specificity of structural differentiation for peripheral nerve over muscle has been demonstrated in some body regions, no study has tested specificity of nerve movement relative to fascia. OBJECTIVES: The aim of this study was to measure the effect of the cervical contralateral lateral flexion (CCLF) as an structural differentiation manoeuvre for the median nerve compared to fascia (superficial and deep) at the wrist during the upper limb neurodynamic test 1 (ULNT1). DESIGN: A cross-sectional study was performed in 5 fresh frozen cadavers. METHODS: Excursion and strain in the fascia (superficial and deep) and the median nerve were measured at the wrist with structural differentiation during the ULNT1. KINOVEA software was used to measure kinematic parameters. RESULTS: CCLF resulted in significant proximal excursion in the median nerve (p < 0.001*) but not in the strain. CCLF neither produced changes in strain nor excursion in the superficial and deep fascia (p > 0.05). CONCLUSION: This study showed that CCLF produced significant differential excursion in the median nerve at the wrist compared to the local superficial and deep fascia during the ULNT1. The data support CCLF in mechanical differentiation between nerve and fascia in this area in diagnosis of local sources of wrist pain.

Comparison of Magnetic Resonance Imaging with Electrodiagnosis in the Evaluation of Clinical Suspicion of Lumbosacral Radiculopathy.

(1) Background: The diagnosis of lumbosacral radiculopathy involves anamnesis, an assessment of sensitivity and strength, diagnostic imaging-usually magnetic resonance imaging (MRI)-and electrodiagnostic testing (EDX), typically electromyography (EMG), and electroneurography (ENG). MRI evaluates the structures supporting the spinal cord, while EDX evaluates root functionality. The present study aimed to analyze the concordance of MRI and EDX findings in patients with clinically suspected radiculopathy. Additionally, we investigated the comparison between these two reference tests and various clinical variables and questionnaires. (2) Methods: We designed a prospective epidemiological study of consecutive cases with an observational, descriptive, cross-sectional, and double-blind nature following the STROBE guidelines, encompassing 142 patients with clinical suspicion of lumbosacral radiculopathy. (3) Results: Of the sample, 58.5% tested positive for radiculopathy using EDX as the reference test, while 45.8% tested positive using MRI. The comparison between MRI and EDX in the diagnosis of radiculopathy in patients with clinical suspicion was not significant; the overall agreement was 40.8%. Only the years with symptoms were comparatively significant between the positive and negative radiculopathy groups as determined by EDX. (4) Conclusion: The comparison between lumbar radiculopathy diagnoses in patients with clinically suspected pathology using MRI and EDX as diagnostic modalities did not yield statistically significant findings. MRI and EDX are complementary tests assessing different aspects in patients with suspected radiculopathy; degeneration of the structures supporting the spinal cord does not necessarily imply root dysfunction.

In Vivo Effects of Joint Movement on Nerve Mechanical Properties Assessed with Shear-Wave Elastography: A Systematic Review and Meta-Analysis.

Peripheral nerves are subjected to mechanical tension during limb movements and body postures. Nerve response to tensile stress can be assessed in vivo with shear-wave elastography (SWE). Greater tensile loads can lead to greater stiffness, which can be quantified using SWE. Therefore, this study aimed to conduct a systematic review and meta-analysis to perform an overview of the effect of joint movements on nerve mechanical properties in healthy nerves. The initial search (July 2023) yielded 501 records from six databases (PubMed, Embase, Scopus, Web of Science, Cochrane, and Science Direct). A total of 16 studies were included and assessed with a modified version of the Downs and Black checklist. Our results suggest an overall tendency for stiffness increase according to a pattern of neural tensioning. The main findings from the meta-analysis showed a significant increase in nerve stiffness for the median nerve with wrist extension (SMD [95%CI]: 3.16 [1.20, 5.12]), the ulnar nerve with elbow flexion (SMD [95%CI]: 2.91 [1.88, 3.95]), the sciatic nerve with ankle dorsiflexion (SMD [95%CI]: 1.13 [0.79, 1.47]), and the tibial nerve with both hip flexion (SMD [95%CI]: 2.14 [1.76, 2.51]) and ankle dorsiflexion (SMD [95%CI]: 1.52 [1.02, 2.02]). The effect of joint movement on nerve stiffness also depends on the nerve segment, the amount of movement of the joint mobilized, and the position of other joints comprised in the entirety of the nerve length. However, due to the limited number of studies, many aspects of nerve behavior together with the effect of using different ultrasound equipment or transducers for nerve stiffness evaluation still need to be fully investigated.

Inferior Vena Cava Filter Long Term Complications and Retrieval Techniques: A Case Series and Literature Review.

INTRODUCTION AND IMPORTANCE: Long-term mechanical complications after inferior vena cava (IVC) filter placement include embedded or tilted filters, erosion of the vena cava, filter thrombosis. In the setting of caval thrombosis, patients may subsequently develop venous hypertension and post-thrombotic syndrome (PTS). Here we present three unique cases of IVC filter complications and surgical management. CASE PRESENTATION: A 30-year-old female presented with acute abdominal pain, revealing a duodenal perforation caused by an IVC filter eroding into her duodenum. A 42-year-old female with an IVC filter in place for 20 years due to a prior pulmonary embolism underwent laser-assisted retrieval of the filter due to concerns of caval adherence. A 48-year-old male with a history of DVT, venous stasis ulcer, and an IVC filter presented for filter retrieval. CLINICAL FINDINGS AND INVESTIGATIONS: The surgical techniques described in this report include complicated IVC filter retrieval, performed in cases of filter complications including migration, fracture, duodenal perforation and IVC thrombosis resulting in PTS. One case, requiring open retrieval, is explained and the surgical technique is provided. There are images and videos of these procedures to enrich the learning experience. INTERVENTION AND OUTCOMES: The surgical techniques described in this report include complicated inferior vena cava filter retrieval, performed in cases of filter complications including migration, fracture, duodenal perforation and IVC thrombosis. One case, requiring open retrieval, is explained and the surgical technique is provided. There are images and videos of these procedures to enrich the learning experience. RELEVANCE AND IMPACT: Endovascular retrieval of long-term complicated IVC filters is challenging, but it can be a safely performed in many patients. However, open surgery may be necessary in selected patients.

The influence of different downstream plate length towards the flow-induced vibration on a square cylinder.

The investigations of flow-induced vibration have been around for decades to solve many engineering problems related to structural element. In a hindsight of advancing technology of microelectronics devices, the implementation of flow-induced vibration for energy harvesting is intrigued. The influence of downstream flat plate to flow-induced vibration experienced by a square cylinder is discussed in this study to surpass the limitation of wind energy due to geographical constraints and climate change. The mechanism of flow-induced vibration experienced by a square cylinder with downstream flat plate is numerically simulated based on the unsteady Reynolds Navier-Stokes (URANS) flow field. The Reynolds number, Re assigned in this study is ranging between [Formula: see text]-[Formula: see text] and the mass damping ratio designated for the square cylinder is [Formula: see text] = 2.48. The influence of three different flat plate lengths [Formula: see text], 1 and 3 is examined. Each case of different flat plate is explored for gap separation between the square cylinder and the plate in the range [Formula: see text]. Based on the numerical findings, the configuration of cylinder-flat plate with length [Formula: see text] has shown the highest potential to harvest high energy at comparatively low reduced velocity.

Race-based outcomes of thoracic aortic aneurysms and dissections in the Global Registry for Endovascular Aortic Treatment.

OBJECTIVE: This study characterizes racial differences in presentation, as well as short- and long-term outcomes after endovascular treatment of thoracic aortic aneurysm (TAA) and type B aortic dissection (TBAD). METHODS: We queried the Gore Global Registry for Endovascular Aortic Treatment for thoracic endovascular aortic repairs (TEVARs) performed between 2010 and 2016 and followed through 2022. Pathologies represented were descending TAA, complicated TBAD, and uncomplicated TBAD. Using standard statistical tests, we compared overall and pathology-specific demographics, procedural factors, and outcomes among Black and White patients undergoing TEVAR. RESULTS: We identified 438 TEVAR cases, including 236 descending TAA, 121 complicated TBAD, and 74 uncomplicated TBAD. Overall, Black patients were younger and had a higher incidence of renal insufficiency (P = .001), whereas White patients had more chronic obstructive pulmonary disease (P = .003) and cardiac arrhythmias (P = .037). In patients treated for descending TAA, Black patients had increased device- and procedure-related complications (34.3% vs 17.4%; P = .014), conversion to open repair (2.9% vs 0%; P = .011) and type II endoleak (5.7% vs 1.0%; P = .040), but no differences in mortality, length of hospital stay, or major adverse cardiovascular events. Whereas outcomes of TEVAR for uncomplicated TBAD were comparable, Black patients more frequently presented with complicated TBAD than White patients (Black, 40.5% vs White, 24.8%; P = .008) and had subsequently greater reintervention rates (28.1% vs 12.4%; P = .012), all-cause mortality (hazard ratio, 4.28; 95% confidence interval, 1.74-10.5; P = .002) and aortic-related mortality (hazard ratio, 16.7; 95% confidence interval, 1.49-186; P = .022). CONCLUSIONS: Despite increased device- and procedure-related complications, similar short- and long-term outcomes are achieved in Black and White patients undergoing TEVAR for descending TAA and uncomplicated TBAD. However, Black patients are more likely to present with, require reintervention for, and suffer mortality from complicated TBAD.

Identification of Electrical Tree Aging State in Epoxy Resin Using Partial Discharge Waveforms Compared to Traditional Analysis.

Electrical treeing is one of the main degradation mechanisms in high-voltage polymeric insulation. Epoxy resin is used as insulating material in power equipment such as rotating machines, power transformers, gas-insulated switchgears, and insulators, among others. Electrical trees grow under the effect of partial discharges (PDs) that progressively degrade the polymer until the tree crosses the bulk insulation, then causing the failure of power equipment and the outage of the energy supply. This work studies electrical trees in epoxy resin through different PD analysis techniques, evaluating and comparing their ability to identify tree bulk-insulation crossing, the precursor of failure. Two PD measurement systems were used simultaneously-one to capture the sequence of PD pulses and another to acquire PD pulse waveforms-and four PD analysis techniques were deployed. Phase-resolved PD (PRPD) and pulse sequence analysis (PSA) identified tree crossing; however, they were more sensible to the AC excitation voltage amplitude and frequency. Nonlinear time series analysis (NLTSA) characteristics were evaluated through the correlation dimension, showing a reduction from pre- to post-crossing, and thus representing a change to a less complex dynamical system. The PD pulse waveform parameters had the best performance; they could identify tree crossing in epoxy resin material independently of the applied AC voltage amplitude and frequency, making them more robust for a broader range of situations, and thus, they can be exploited as a diagnostic tool for the asset management of high-voltage polymeric insulation.

Primary aortoenteric fistula after intravesical instillation of Bacillus Calmette-Guérin for bladder cancer.

OBJECTIVE: Primary aortoenteric fistulas (PAEFs) are a rare entity with high morbidity, and their relationship with Bacillus Instillation of Calmette-Guérin is anecdotal. METHODS/RESULTS: We present a 68-year-old male with a primary aortoenteric fistula after instillation of Bacillus Calmette-Guérin (BCG) for a non-muscle-invasive bladder cancer. Diagnosis was made by CT angiography, subsequently confirmed by intraoperative findings and results of anatomopathological studies of aortic wall samples. We performed an in-situ reconstruction with a silver prosthesis impregnated in rifampicin with satisfactory evolution at one year. CONCLUSIONS: Primary aortoenteric fistula is an extremely rare complication, and although its relationship with intravesical BCG therapy is anecdotal, it should be considered in patients with gastrointestinal bleeding who have previously undergone this treatment. Its diagnosis requires clinical suspicion, and its treatment should be carried out without delay. Long-term targeted anti-biotherapeutic treatment is a fundamental pillar for its management. Reconstruction with an antibiotic-impregnated silver prosthesis is a valid option in cases of controlled infection.

Effect of Body Mass Index on Early Outcomes of Endovascular Abdominal Aortic Aneurysm Repair.

BACKGROUND: This study compares the presentation, management, and outcomes of patients undergoing endovascular abdominal aortic aneurysm repair (EVAR), based on their weight status as defined by their body mass index (BMI). METHODS: Patients with primary EVAR for ruptured and intact abdominal aortic aneurysm (AAA) were identified in the National Surgical Quality Improvement Program database (2016-2019). Patients were categorized by weight status (underweight: BMI < 18.5 kg/m2, normal weight: 18.5-24.9 kg/m2, overweight: 25-29.9 kg/m2, Obese I: 30-34.9 kg/m2, Obese II: 35-39.9 kg/m2, Obese III: > 40 kg/m2). Preoperative characteristics and 30-day outcomes were compared. RESULTS: Of 3,941 patients, 4.8% were underweight, 24.1% normal weight, 37.6% overweight, and 22.5% with Obese I, 7.8% Obese II, and 3.3% Obese III status. Underweight patients presented with larger (6.0 [5.4-7.2] cm) and more frequently ruptured (25.0%) aneurysms than normal weight patients (5.5 [5.1-6.2] cm and 4.3%, P < 0.001 for both). Pooled 30-day mortality was worse for underweight (8.5%) compared to all other weight status (1.1-3.0%, P < 0.001), but risk-adjusted analysis demonstrated that aneurysm rupture (odds ratio [OR] 15.9, 95% confidence interval [CI] 8.98-28.0) and not underweight status (OR 1.75, 95% CI 0.73-4.18) accounted for increased mortality in this population. Obese III status was associated with prolonged operative time and respiratory complications after ruptured AAA, but not 30-day mortality (OR 0.82, 95% CI 0.25-2.62). CONCLUSIONS: Patients at either extreme of the BMI range had the worst outcomes after EVAR. Underweight patients represented only 4.8% of all EVARs, but 21% of mortalities, largely attributed to higher incidence of ruptured AAA at presentation. Severe obesity, on the other hand, was associated with prolonged operative time and respiratory complications after EVAR for ruptured AAA. BMI, as an independent factor, was however not predictive of mortality for EVAR.

Insecticide Resistance Status of Aedes albopictus (Diptera: Culicidae) Populations from Cuba.

Aedes albopictus (Skuse, 1894) is one of the major vectors for arboviruses such as dengue, Zika, and chikungunya. Originally from Southeast Asia, this species has spread to Africa, Europe, and the Americas, including Cuba. This spread has been favored by its great adaptability to variable temperatures and to the resistance of its eggs to desiccation. Chemical control of mosquitoes is an essential alternative to stop arbovirus transmission, but insecticide resistance status of the Cuban Ae. albopictus populations is unknown. For this study, Ae. albopictus larvae and adults were collected from two municipalities in Havana, Cuba in 2019. Adult bioassays for deltamethrin, cypermethrin, lambda-cyhalothrin, chlorpyrifos, propoxur, and bendiocarb susceptibility were conducted according to CDC methodology. Larval bioassays for temephos susceptibility were performed following WHO protocols. Resistance profiles for α and ß-esterases, glutathione S-transferase (GST), and multifunction oxidases (MFO) pathways were constructed and analyzed. Resistance to temephos and deltamethrin was detected in Mulgoba and Plaza field populations, but resistance to lambda-cyhalothrin was only found in the Plaza colony. Plaza colony exhibited a higher expression level to all four metabolic enzymes and α-esterases and GTS were over-expressed in Mulgoba. The development of insecticide resistance in Cuban Ae. albopictus populations makes it imperative that we develop integrated control strategies to minimize the development of resistance and provide effective vector control that prevents the onset of arbovirus epidemics.

Utility of Closed Suction Drains in Groin Incisions after Femoral Artery Exposure.

BACKGROUND: Surgical groin wounds are at risk of delayed healing and infection, leading to costly and prolonged postoperative recoveries. This study assesses the use of closed suction drains (CSDs) as a wound care adjunct in groin incisions to prevent surgical site infections (SSI). METHODS: A single-center retrospective review was performed on 210 consecutive patients after vascular surgery with common femoral artery exposure from 2016 to 2021. The cohort was divided into 2 groups, groins with and without CSD, looking for surgical site complications. A subgroup analysis comparing postoperative outcomes between complicated and uncomplicated groin incisions within both groups was also performed. RESULTS: Of 293 surgical groins, 20% (n = 59) had drains. Overall, the CSD group had higher SSI rates (14% vs. 5.6%), but also had higher proportion of smokers (92% vs. 83%; P = 0.019), diabetes (56% vs. 36%; P = 0.005), coronary artery disease (69% vs. 46%; P = 0.001), hyperlipidemia (69% vs. 51%; P = 0.01), and previous groin surgery (54% vs. 17%; P < 0.001). The higher risk of SSI was not significant after adjustment of these confounders. A separate analysis within each group showed SSI groins with CSD had lower reintervention rates (37.5%) than those without CSD (69%), as well as shorter length of hospital stay (7 [5-11] vs. 22 [7-25] days). CONCLUSIONS: Our study suggests that CSDs can be a beneficial adjunct for groin wounds after common femoral artery exposure in patients with comorbidities cited above. CSDs decrease the risk of reintervention and length of hospital stay.

Racial disparities in presentation and outcomes for endovascular abdominal aortic aneurysm repair.

OBJECTIVE: In the present study, we used a national database to identify racial differences in the presentation and outcomes for patients undergoing endovascular abdominal aortic aneurysm (AAA) repair (EVAR) and identified areas for improving their care. METHODS: We queried the EVAR-targeted National Surgical Quality Improvement Program database (2016-2019) to identify patients who had undergone EVAR for both ruptured and nonruptured AAAs. The patients were categorized according to race (White, Black, and Asian). Patients with a history of abdominal aortic surgery or an indication other than AAAs were excluded. The data was analyzed using the χ2 and Kruskal-Wallis tests, presented as frequencies and percentages or median and interquartile range (IQR) for categorical and continuous variables, respectively. RESULTS: We identified 3629 patients (16.6% female), including 3312 White (91.3%), 248 Black (6.8%), and 69 Asian (1.9%) patients. Black patients were more frequently women (27.0%) compared with White patients (15.9%) and were younger (median age, 71 years; IQR, 64-77 years) than White (median age, 73 years; IQR, 67-79 years) and Asian (median age, 76 years; IQR, 67-81 years) patients (P < .001 for both). The incidence of smoking, congestive heart failure, and dialysis dependency was highest for Black patients, and the incidence of obesity was lowest for Asian patients. The AAAs in Black patients extended more frequently beyond the aortic bifurcation (P = .047). In Asian patients, the internal iliac arteries were more involved (P = .040). For Black patients, 29.8% of the EVARs were performed in a nonelective setting compared with 20.2% for the White and 15.9% for the Asian patients (P < .001). The aneurysm diameter, nonruptured symptomatic rate, and rupture rate were similar across the groups (P = .807). The operative time was prolonged for Black (median, 128 minutes; IQR, 96-177 minutes) compared with White (median, 114 minutes; IQR, 84-162 minutes) patients (P < .001). Postoperatively, Black patients were more likely to require blood transfusion (16.5%) and had prolonged length of hospital stay (median, 2 days; IQR, 1-4 days) compared with White (10.0%; median, 1 day; IQR, 1-3 days) and Asian (4.3%; median, 1 day; IQR, 1-3 days) patients (P = .001 and P < .001, respectively). Black patients also had a higher 30-day readmission rate (P = .038). On multivariate analysis, Black race was an independent factor for length of stay >1 day after both elective and nonelective EVAR and 30-day readmission for elective EVAR, but not 30-day mortality after elective and nonelective EVAR. CONCLUSIONS: In the present nationwide sample of EVAR cases, Black patients were more often women and younger. Despite similar rates of symptomatic and ruptured AAAs at presentation and 30-day mortality, Black patients more often presented and were treated during the same nonelective admission; they also had associated increased length of hospital stay and readmission. These findings signal a missed opportunity to diagnose, optimize, and treat this particular group of patients in an elective setting.

Brachial artery thrombosis secondary to fixation screw pullout: Case report.

The vascular supply of the shoulder and forearm are principal derivates of the ipsilateral subclavian artery. The trajectory of this arterial supply predisposes it to concomitant injuries in the shoulder and clavicular fractures proximally and elbow dislocation distally. Distal bicep tendon tears often occur most commonly in middle-aged men due to trauma to the elbow, typically in weight-bearing situations [1]. To our knowledge, this is the first case of distal biceps tendon tear repair resulting in distal brachial artery injury from displaced hardware due to postoperative re-injury. We present a case of a 41-year-old male who developed a vaso-occluding hematoma at the distal biceps secondary to a displaced fixation screw. The patient required emergency vascular surgery with embolectomy and arterial bypass. Although this patient fully recovered, the clinical course the patient experienced could have been minimized with appropriate postoperative care. This report aims to alert clinicians to the relevant local anatomy and relate it to the proposed mechanism of injury, thereby bringing attention to the importance of postoperative limb protection in at-risk patients. The timing of the injury, and the protracted rate of thrombus formation suggest that the brachial artery's thrombosis was associated with the screw pullout during reinjury of the area. Screw pullout in orthopedics is a rare phenomenon that can lead to significant complications. The risk of reinjury, screw pullout, and other complications such as thrombosis is evidence to support the careful treatment of the area postoperatively.

Characterization of Insecticide Resistance in Aedes aegypti from the Zoological Garden of Havana, Cuba.

Chemical control of Aedes aegypti continues to be an indispensable alternative to preventing dengue, Zika, and chikungunya outbreaks. The Havana Zoological Garden requires constant vigilance because its special characteristics help in the spread of the causal agents of diseases transmitted by mosquitoes, which put the health of visitors at risk. The goals of this study were to determine the level of susceptibility and insecticide resistance mechanisms in the Ae. aegypti population. Temephos susceptibility in larvae was evaluated with bioassays using the World Health Organization's methodology, and susceptibility of adult mosquitoes was determined by the impregnated bottle bioassay, recommended by the Centers for Disease Control and Prevention. Resistance mechanisms were determined with biochemical assays. Mosquito larvae from the Havana Zoo were found resistant to temephos, which was associated with the activity of the enzymes α- and ß-esterases and mixed function oxidases but not glutathione-S-transferase. Adult mosquitoes were susceptible to pyrethroid (lambda-cyhalothrin, deltamethrin, and cypermethrin), organophosphate (chlorpyrifos), and carbamate (bendiocarb). Temephos resistance detected in the mosquito population from the Havana Zoo is an alert for the Vector Control Program, which must take measures to manage their resistance, relying on the surveillance carried out by Cuba's medical entomology laboratories.

Outcomes and role of shunting during carotid endarterectomy for symptomatic patients.

OBJECTIVE: Shunt placement during carotid endarterectomy (CEA) has often been advocated to protect the ischemic penumbra in patients with symptomatic carotid stenosis. In the present study, we assessed the effect of shunt placement during CEA on postoperative stroke risk in symptomatic patients. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program database (2016-2019) for CEA cases with complete CEA procedure-targeted data available. Symptomatic patients were identified as those with a preoperative diagnosis of stroke on presentation (DS), transient ischemic attack, amaurosis fugax, or temporary monocular blindness. The DS patients were further analyzed according to the severity of their stroke using the modified Rankin scale scores. To better assess the effect of shunt placement on the stroke rate, we compared cases of CEA with the patch angioplasty technique stratified by the use of an intraoperative shunt. Patients who had undergone carotid eversion or primary closure were excluded. The baseline demographics and perioperative outcomes were compared using the χ2 and Mann-Whitney U tests. Multivariate analysis was performed to identify the independent risk factors for postoperative stroke and cranial nerve injury. RESULTS: We identified 4652 cases of CEA with patch angioplasty in symptomatic patients, including 1889 with (40.6%) and 2763 without (59.4%) shunt placement. The distribution of age, race, and sex was similar for both procedures. Compared with patients without a shunt, those with a shunt had significantly higher rates of emergency surgery (9.1% vs 7.0%; P = .010), nonelective surgery (40.3% vs 37.2%; P = .035), general anesthesia (97.0% vs 86.3%; P < .001), and bleeding disorders (27.2% vs 22.7%; P < .001). The 30-day incidence of postoperative stroke was similar between the patients with (3.2%) and without (2.6%) shunt placement (P = .219). Additionally, a subgroup analysis failed to show any benefit from shunt placement on the incidence of postoperative stroke, regardless of the preoperative symptoms or neurologic disability. In contrast, shunt placement was associated with an increased rate of cranial nerve injury (4.1% vs 2.4%; P = .001). Multivariate analysis revealed that nonelective surgery (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.36-2.91; P < .001) and DS (vs transient ischemic attack, amaurosis fugax, or temporary monocular blindness; OR, 1.64; 95% CI, 1.12-2.41; P = .012) were predictive of 30-day postoperative stroke. After adjusting for confounders, shunt placement had no effect on stroke risk at 30 days but remained an independent risk factor for cranial nerve injury (adjusted OR, 1.87; 95% CI, 1.32-2.64; P < .001). CONCLUSIONS: For symptomatic patients undergoing CEA with patch angioplasty, shunt placement was associated with an increased risk of cranial nerve injury without a reduction in postoperative stroke risk.

COVID-19-related thrombotic complications experience before and during delta wave.

OBJECTIVE: Hypercoagulability and thrombotic complications seen in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as well as the associated pathophysiology, have been reported extensively. However, there is limited information regarding the factors related to this phenomenon and its association with the Coronavirus disease 2019 (COVID-19) Delta variant. METHODS: A retrospective review including patients admitted to a tertiary center with a COVID-19 positive test and at least one acute thrombotic event confirmed by imaging between June 2020 and August 2021 was performed. We compared the rates of thrombotic events in patients with COVID-19 before and during the Delta peak. We also analyzed the association of the thrombotic complications with demographic characteristics, comorbidities, anticoagulation strategies, and prothrombotic markers while describing other complications secondary to COVID-19 infection. RESULTS: Of 964 patients admitted with COVID-19 diagnosis, 26.5% (n = 256) had a thrombotic event evidenced by ultrasound or computed tomography scan. Venous thromboembolism was found in 60% (n = 153), arterial thrombosis in 23% (n = 60), and both venous and arterial thromboses in 17% (n = 17) of the study cohort. Of all patients, 94% were not vaccinated. Delta variant wave (DW) patients had thrombotic episodes in 34.7% (n = 50/144) of cases compared with 25% (n = 206/820) of non-Delta wave (NDW) patients, posing an estimated risk 1.36 times higher in patients infected with COVID-19 during the DW than NDW. Overall, DW subjects were significantly younger (P < .001) with lower body mass index (P = .021) compared with NDW patients. Statistical analyses showed African American patients were more likely to have arterial thrombosis compared with the other groups when testing positive for COVID-19 (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.04-3.05; P = .035, whereas immunosuppressed patients had less risk of arterial thrombosis (OR, 0.38; 95% CI, 0.15-0.96; P = .042). Female gender (OR, 2.15; 95% CI, 1.20-3.85; P = .009) and patients with active malignancy (OR, 5.99; 95% CI, 2.14-16.78; P = .001) had an increased risk of having multiple thrombotic events at different locations secondary to COVID-19. CONCLUSIONS: COVID-19 infection is associated with elevated rates of thrombotic complications and an especially higher risk in patients infected during the Delta variant peak. We highlight the importance of vaccination and the development of new anticoagulation strategies for patients with COVID-19 with additional hypercoagulable risk factors to prevent thrombotic complications caused by this disease.

A Comparative Analysis Applied to the Partial Discharges Identification in Dry-Type Transformers by Hall and Acoustic Emission Sensors.

Dry-type insulated transformers stand out for their higher applicability in substations, high-voltage instrumentation systems, and electrical installations. In this machine, the insulation system is constituted of dielectric materials such as epoxy resin and Nomex paper. Some critical issues in the operation of this equipment, such as overload, moisture, or heat, can induce a slow degradation of the physical-chemical properties of the dielectric materials, which can culminate in the total failure of the transformer. However, before the transformer's shutdown, it is common to detect discharge activity in the insulation system. Based on this issue, this work proposes an experimental and comparative analysis between acoustic emission and Hall-effect sensors, aiming at differentiating discharges in epoxy resin and Nomex paper, materials that constitute the insulation of the dry-type insulated transformers. Two signal processing techniques were studied: traditional frequency analysis and discrete wavelet transform. The objective is to develop signal processing techniques to differentiate each type of discharge since different discharges require different maintenance actions. The results obtained indicate that acoustic emission sensors and Hall sensors are promising in differentiating discharge in epoxy resin and Nomex paper. Furthermore, the pattern recognition tools presented by this work, which associated the wavelet levels energies and the energy of the full signals with the average band and the equivalent bandwidth, were effective to perform feature extraction of power transformer condition.

Utilidad de las prostaglandinas intravenosas en el espasmo vascular neonatal / Use of intravenous prostaglandins in neonatal vasospasm

No disponible

Percutaneous endovascular abdominal aortic aneurysm repair with monitored anesthesia care decreases operative time but not pulmonary complications.

OBJECTIVES: To report our experience and compare the results of percutaneous endovascular aortic aneurysm repair (PEVAR) performed under monitored anesthesia care (MAC) to PEVAR under general anesthesia (GA). METHODS: A retrospective review of patients who underwent non-emergency endovascular abdominal aortic aneurysm repair (EVAR) was completed. Patients were excluded if they had a complex repair, including fenestrated, branched, or parallel endografting. Demographics, operative data, 30-day mortality/morbidity and postoperative outcomes were analyzed. RESULTS: A total of 159 patients were identified with a median age of 69. 115 patients had PEVAR, 45 (39.1%) PEVAR MAC and 70 (60.9%) PEVAR GA. PEVAR MAC compared to PEVAR GA had decreased operative time (106 vs. 134 min, P < 0.001), time in the operating room (163 vs. 245 min, P = 0.016), and estimated blood loss (EBL) (115 vs. 176 mL P = 0.012). There was no statistically significant difference in the hospital length of stay (LOS) (1.9 vs. 2.7 days, P = 0.133), and post-operative complications including pulmonary (2.2 vs. 2.9%, P = 0.835). Forty-four patients had EVAR with a femoral cutdown (FC), including 14 PEVAR conversions. PEVAR conversion was associated with higher EBL (543 vs. 323 mL, P = 0.03), operative time (230 vs. 178 min, P = 0.01), and operating room time (307 vs. 275 min, P = 0.01) compared to planned EVAR with FC. CONCLUSIONS: PEVAR under MAC is associated with shorter time in the operating room compared to PEVAR under GA. PEVAR under MAC does however not decrease overall morbidities, including postoperative pulmonary complications.