Culture Media Supplemented With 10% Equine Serum Provided Chondroprotection in an In Vitro Co-Culture of Cartilage and Synovial Membrane.

No studies have evaluated the effect of culture in serum-free media (SF) vs. media supplemented with equine serum (ES) on co-culture of synovial membrane and cartilage tissue explants. The study objective was to evaluate the effects of equine serum supplementation on induced production of inflammatory and catabolic mediators from articular cartilage and synovial explants while in co-culture. Articular cartilage and synovial membrane explants were harvested from femoropatellar joints of five adult horses. Cartilage and synovial explants were harvested from the stifle of five horses, placed in co-culture, stimulated with IL-1ß (10 ng/ml) and maintained in culture for 3, 6 and 9 days in 10% ES or SF. At each time point, media was harvested for analysis of cellular viability (Lactate dehydrogenase) and elution of glycosaminoglycans (Dimethylene Blue Binding Assay). Tissue explants were harvested for histopathologic and gene expression analyses. No differences in cell viability were observed between SF and ES groups. SF culture produced an upregulation of TNF-α in synovial membrane and ADAMTS-4 and five in articular cartilage at 9 days of culture. ES produced an upregulation of aggrecan expression in cartilage at 9 days of culture. No differences in tissue viability were found between culture media, but SF media produced a higher glycosaminoglycan concentration in media at 3 days of culture. The addition of 10% ES produced a slight chondroprotective effect in an inflamed co-culture system. This effect should be considered when designing studies evaluating treatment of serum or plasma-based orthobiologic studies in vitro.

Determining Follow-Up Imaging Study Using Radiology Reports.

Radiology reports often contain follow-up imaging recommendations. Failure to comply with these recommendations in a timely manner can lead to delayed treatment, poor patient outcomes, complications, unnecessary testing, lost revenue, and legal liability. The objective of this study was to develop a scalable approach to automatically identify the completion of a follow-up imaging study recommended by a radiologist in a preceding report. We selected imaging-reports containing 559 follow-up imaging recommendations and all subsequent reports from a multi-hospital academic practice. Three radiologists identified appropriate follow-up examinations among the subsequent reports for the same patient, if any, to establish a ground-truth dataset. We then trained an Extremely Randomized Trees that uses recommendation attributes, study meta-data and text similarity of the radiology reports to determine the most likely follow-up examination for a preceding recommendation. Pairwise inter-annotator F-score ranged from 0.853 to 0.868; the corresponding F-score of the classifier in identifying follow-up exams was 0.807. Our study describes a methodology to automatically determine the most likely follow-up exam after a follow-up imaging recommendation. The accuracy of the algorithm suggests that automated methods can be integrated into a follow-up management application to improve adherence to follow-up imaging recommendations. Radiology administrators could use such a system to monitor follow-up compliance rates and proactively send reminders to primary care providers and/or patients to improve adherence.

Cross-Sectional Imaging Techniques and Normal Anatomy of the Salivary Glands.

The salivary glands play an important role in digestion and oral hygiene, and give rise to a variety of benign and malignant pathologies. In suspected pathology, the goal of imaging is to confirm a lesion as being of salivary gland origin, narrow the list of differential considerations, define the extent of disease, and guide further management decisions. This review outlines the function, embryologic development, anatomy, and normal imaging features of the major salivary glands. The article also discusses imaging indications, the general approach to imaging the salivary glands, and the commonly used cross-sectional techniques used for evaluating the salivary gland.

Early cannulation prosthetic graft (Flixene™) for arteriovenous access.

PURPOSE: Preferred hemodialysis (HD) access is an autologous fistula. Vascular grafts are used in patients with vessels unsuitable to accomplish an arteriovenous fistula (AVF). It is recommended that most current grafts mature in situ for 2-3 weeks before being accessed. Graft complications occur because the structure was not designed for the trauma of repeated cannulation. This study graft has a different structure that enables early use. Its design minimizes weeping through the graft walls and is meant to endure repeated access, thus minimizing the use of HD catheters. The purpose of this study was to show that the Flixene™ graft can be safely placed in patients where fistulas have failed and can be cannulated in 24-72 hr, while maintaining patency rates similar to other polytetrafluoroethylene (PTFE) grafts on the market. Flixene™ configuration should also reduce the incidence of pseudoaneurysms and seromas. METHODS: A prospective two-center study placed 33 grafts in 33 patients; graft efficacy, post-operative complications, and patency were evaluated. Ease of cannulation and dialysis center complications related to early cannulation were documented. Six month follow-up data was analyzed. RESULTS: Successful access was achieved in all 33 patients within 72 hr (29 patients within 24 hr). Overall primary patency at 6 months was 49%; primary-assisted patency at 6 months was 80%. No pseudoaneurysms or seromas were documented at 6 months. Complications were typical of graft access. CONCLUSION: Early cannulation was successful in all patients. Primary and secondary patency rates at 6-months were equivalent to other data reported on PTFE grafts. Flixene™ successfully prevented pseudoaneurysm and seroma formation at 6 months of prospective follow-up. This graft is a better last-resort option for patients who cannot receive a fistula, compared to double-lumen cuffed catheters.

Percutaneous suture-mediated closure versus surgical arteriotomy in endovascular aortic aneurysm repair.

PURPOSE: To compare percutaneous suture-mediated closure (PSMC) with surgical closure in endovascular aortic aneurysm repair and examine the influence of obesity, sheath size, and vessel calcification on the effectiveness of percutaneous closure. MATERIALS AND METHODS: A total of 445 patients (mean age, 75.9 ± 7.6 years) undergoing aortic aneurysm repair from 2003 to 2010 were retrospectively reviewed. A total of 100 PSMC and 557 surgical closures for arteriotomies with sheath sizes between 12 F and 18 F were compared in terms of failure, complications, and operating room time. Additionally, effects of arterial calcification, body mass index, and sheath size on PSMC were evaluated. RESULTS: Eighty-five percent of PSMCs were successful. Failure was attributed to lack of hemostasis in 11 and difficulty in device positioning in four cases. Complication rate after successful PSMC (9.4%) was significantly less than surgery (19.4%) (P = .02).When failed PSMC cases were considered as complication, the complication rate was not different between the two groups (P = .4). Seroma occurred more after surgical closures (11.4% vs 1.2%; P = .001). Pseudoaneurysm occurred more after PSMC (3.5% vs 0.18%; P = .008).Average PSMC procedure time was less than that of surgical closure (P = .0001). PSMC success rate was 89.7% for < 16-F sheaths and 80.4% for ≥ 16-F sheaths (P = .15). PSMC success was not different between obese and nonobese patients (P = .22). PSMC success in calcified and noncalcified arteries was not different (P = .37). CONCLUSIONS: PSMC is an effective arterial closure method. It is faster and associated with less postprocedure morbidity than surgery. Appropriate technique and meticulous vascular exposure affect PSMC success. Obesity, vascular calcification, and sheath size did not change PSMC outcome in this study.

Skiing and intermittant claudication: an aberrant presentation.

Lower extremity peripheral arterial disease frequently presents with intermittent claudication, typically manifest in lower extremity pain or cramping associated with exercise, generally walking. Occasionally early onset of disease can be associated with running. This report describes the unusual presentation of leg pain associated with skiing and relieved by cessation of skiing immediately caused by focal iliac artery stenosis.

Endovascular treatment of popliteal artery aneurysms: a single-center experience.

PURPOSE: To evaluate the use of covered stent-grafts in the endovascular treatment (ET) of popliteal artery aneurysms (PAAs). MATERIALS AND METHODS: A retrospective analysis was conducted over a period of 52 months in 18 consecutive patients (17 men; mean age +/- SD, 70 years +/- 11) undergoing ET of PAAs with the Viabahn endograft in a single center. Patient symptoms, aneurysm characteristics, technical outcomes, complications, and follow-up were assessed. RESULTS: Aneurysm diameters ranged from 12 to 51 mm with a mean of 30 mm (+/-11). Thirteen aneurysms (72.2%) were partially thrombosed and 12 patients (66.6%) had symptoms of lower limb ischemia at presentation (11 chronic and one acute). The technical success rate was 94%. Intraprocedural emboli and endoleak occurred in one and two patients, respectively. Fourteen patients were available for follow-up after successful treatment, with a mean follow-up time of 15 months (range, 7-37 months). All stent-grafts were patent after 1 month, with no mortality or limb loss. The primary patency rate with complete exclusion of the aneurysm at 6 months was 86%. Pre- and postprocedural noninvasive arterial studies were available in 10 patients, demonstrating improvement of the ankle-brachial index from 0.96 +/- 0.41 to 1.17 +/- 0.18, respectively (P = .06). CONCLUSIONS: Endovascular stent-graft repair of PAAs is a feasible treatment option. However, further follow-up studies regarding the durability of results are required.

A letter to the chief executive.

Beyond the recent accounting scandals, something is wrong with the way most companies are managed today. That's the message of this fictional letter from a board member to a CEO, written by Joseph Fuller, CEO of strategy consulting firm the Monitor Group. The letter highlights the challenges and complexities of running a business in today's uncertain environment. And while it avoids the facile bashing of U.S. executives so common these days, the missive nonetheless casts a harsh light on the flaws that have recently been exposed in the American management model. The letter addresses a single CEO and company, yet it is intended to speak to executives and boards everywhere: "It wasn't the recession that caused us to make three acquisitions in two years at very, very high prices; the need to fuel [unreasonable] growth did. Nor was it the recession that caused us to expand our capacity in anticipation of gaining market share; rather, it was our own overly optimistic sales forecasts that led us to that decision. Where did those forecasts originate? From line managers trying to fulfill profit goals that we created after meeting with the analysts. "The root cause of many of the problems that became apparent in the last 24 months lies not with the economy, not with September 11, and not with the dot-com bubble. Rather, it lies with that willingness to be led by outside forces-indeed, our own lack of conviction about setting a course." Restoring sound, strategic decision making--thinking that looks beyond tomorrow's analyst reports--will go a long way toward keeping those outside forces at bay, according to Fuller.