Highlights d T-bet + B cells are a separate and durable memory subset in mice and humans d T-bet hi memory B cells are absent from the lymphatic circulation d Influenza-specific T-bet hi memory B cells are spleen-resident in mice d B cell-intrinsic T-bet is required for >90% of flu-and HA stalkspecific antibodies
The first in vivo evaluation of ECR demonstrated that this technology has objectively reduced KAP and operator irradiation by approximately 75% without interfering with the performance of fluoroscopically guided interventional procedures. In addition, reduced scatter production subjectively improved device visualization. These findings indicate the practicability of achieving better radiation optimization.
Objective: Investigation of lymph fluid dynamics in thoracic duct during central venous pressure elevation.Background: Lymphatic flow is affected by elevated central venous pressure (CVP) in congestive heart failure. The changes of thoracic duct (TD) lymph flow have not been studied chronically in the setting of elevated CVP. This study is to investigate fluid dynamics and remodeling of the TD in the elevated CVP animal model.Methods: A flow probe was implanted on the swine TD (n = 6) and tricuspid regurgitation (TR) was created by cutting tricuspid chordae percutaneously. Six swine were used as control group animals. The TD flow was measured for 2 weeks (baseline) before TR and 4 weeks postop-TR surgery. Arterial pressure and CVP were measured. The pressure and flow in the TD were measured percutaneously. Histological and morphological analyses were performed.Results: TR resulted in an increase in CVP from 4.2 ± 2.6 to 10.1 ± 4.3 mmHg (p < 0.05). The lymph flow in the TD increased from 0.78 ± 1.06 before TR to 8.8 ± 4.8 ml/min (p < 0.05) 2 days post-TR and remained plateau for 4 weeks, i.e., the TD flow remained approximately 8–11 fold its baseline. Compared to the 8.1 ± 3.2 mmHg control group, the TD average pressures at the lymphovenous junction increased to 14.6 ± 5.7 mmHg in the TR group (p < 0.05). The TD diameter and wall thickness increased from 3.35 ± 0.37 mm and 0.06 ± 0.01 mm in control to 4.32 ± 0.57 mm and 0.26 ± 0.02 mm (p < 0.05) in the TR group, respectively.Conclusion: The elevated CVP results in a significant increase in TD flow and pressure which causes the TD’s outward remodeling and thickening. Our study implicates that the outward remodeling may result in the TD valve incompetence due to failure coaptation of leaflets.
Arteriovenous fistulas (AVFs) are considered superior to arteriovenous grafts and catheters. Never-theless, AVF prevalence in the United States remains under the established target. The complication rates and financial cost of vascular access continue to rise and disproportionately contribute to the burgeoning health care costs. The relationship between financial incentives for a type of vascular access and rate of access placement is unclear. All chronic hemodialysis patients (n=99) receiving care at Philadelphia Veterans Affairs Medical Center as of August 1, 2008 were participants. Demographic characteristics, vascular access type, and nonrelative value unit compensation were assessed as predictors, and the vascular access prevalence rate, operative times, and frequency of access interventions were analyzed. A 73.7% AVF rate was achieved in this cohort of patients with 51.5% diabetes mellitus. The number of access procedures per patient per year remained constant over time. The Philadelphia Veterans Affairs Medical Center, a single payer system, achieved superior AVF prevalence and exceeded the national AVF target. Financial incentives for arteriovenous graft placement currently exist in the United States, as there is similar Medicare reimbursement for arterio-venous graft and basilic vein transposition, despite longer operative times for basilic vein transpositions. The high AVF prevalence at the Philadelphia Veterans Affairs Medical Center may be due to the VA nonrelative value unit-driven system that allows for interdisciplinary care, priority of AVFs, and frequent use of basilic vein transposition surgery, when appropriate. We have identified an important, hypothesis-generating example of a nonrelative value unit-based approach to vascular access yielding superior results with respect to patient care and cost.
chemoembolization (n ¼ 3), trauma embolization (n ¼ 2), upper arm revascularization/embolization (n ¼ 29) and uterine artery embolization (n ¼ 6). Clinical hemostasis success was correlated with artery accessed, sheath size and heparin dose. Results: Puncture site clinical hemostasis was 100% using the device. Mean fluoroscopic time was 26 min. Left radial access was the most common (46%) with median sheath size of 4 F (range 4-7 F). Access sites grouped into upper limb (radial/ brachial/ulnar, n ¼ 48) and lower limb (pedal, n ¼ 24) showed a mean time to hemostasis in the upper limb group of 22 min, significantly shorter than the lower limb group at 41 min (P ¼ 0.007). Mean heparin dose in the upper limb group was 4023 units compared to 7952 units in the lower limb group (Po0.001). Three patients (4.3%) had mild upper limb ecchymosis at initial follow-up that resolved without event. One patient developed radial artery occlusion (1.4%) 3 days after device placement. Conclusions: Use of a novel device for upper limb and pedal arterial access hemostasis was safe and effective. Shorter time to hemostasis was observed in the upper limb group of patients which may be attributable to lower mean heparin dose. A low rate of arterial access occlusion was observed compared to other reported radial compression devices.
Purpose: To assess the outcome of lymphatic approach for patients with postoperative lymphoceles that are refractory to sclerotherapy. Materials: During a period of one year, five patients with lymphoceles that had developed after gynecologic surgery were treated by percutaneous embolization of the leaking lymphatic channels using N-butyl cyanoacrylate. We assessed the outcome of these patients after the procedure. Results: All five patients had a history of gynecologic surgery involving extensive dissection of lymph nodes in the pelvic cavity. Two patients had developed lymphoceles that failed to regress despite multiple attempts of sclerotherapy using absolute ethanol. Two other patients had lymphoceles that were leaking into the peritoneal cavity and therefore contraindicated for sclerotherapy. A fifth patient had a recurrent lymphocele that had previously been treated by lymphangiography without embolization. After intranodal lymphangiography followed by percutaneous embolization of the leaking lymphatic channels, the lymphoceles successfully regressed and drainage catheters were uneventfully removed. No procedure-related complications were seen. Conclusions: Percutaneous lymphatic embolization offers a potential bail-out option for the treatment of lymphoceles that are either refractory to sclerotherapy or are contraindicated for sclerotherapy due to rupture.
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