Study of carotid disease in patients with peripheral artery disease

Objective: To study the stenosis of the carotid arteries in patients with symptomatic peripheral arterial disease.Methods: we assessed 100 consecutive patients with symptomatic peripheral arterial disease in stages of intermittent claudication, rest pain or ulceration. Carotid stenosis was studied by echo-color-doppler, and considered significant when greater than or equal to 50%. We used univariate analysis to select potential predictors of carotid stenosis, later taken to multivariate analysis.Results: The prevalence of carotid stenosis was 84%, being significant in 40% and severe in 17%. The age range was 43-89 years (mean 69.78). Regarding gender, 61% were male and 39% female. Half of the patients had claudication and half had critical ischemia. Regarding risk factors, 86% of patients had hypertension, 66% exposure to smoke, 47% diabetes, 65% dyslipidemia, 24% coronary artery disease, 16% renal failure and 60% had family history of cardiovascular disease. In seven patients, there was a history of ischemic cerebrovascular symptoms in the carotid territory. The presence of cerebrovascular symptoms was statistically significant in influencing the degree of stenosis in the carotid arteries (p = 0.02 at overall assessment and p = 0.05 in the subgroups of significant and non-significant stenoses).Conclusion: the study of the carotid arteries by duplex scan examination is of paramount importance in the evaluation of patients with symptomatic peripheral arterial disease, and should be systematically conducted in the study of such patients.

Duplex stability of DNA.DNA and DNA.RNA duplexes containing 3 '-S-phosphorothiolate linkages

3′-S-Phosphorothiolate (3′-SP) linkages have been incorporated into the DNA strand of both a DNA·RNA duplex and a DNA·DNA duplex. Thermal melting (Tm) studies established that this modification significantly stabilises the DNA·RNA duplex with an average increase in Tm of about 1.4 °C per modification. For two or three modifications, the increase in Tm was larger for an alternating, as compared to the contiguous, arrangement. For more than three modifications their arrangement had no effect on Tm. In contrast to the DNA·RNA duplex, the 3′-S-phosphorothiolate linkage destabilised the DNA·DNA duplex, irrespective of the arrangement of the 3′-SP linkages. The effect of ionic strength on duplex stability was similar for both the phosphorothiolate-substituted and the unmodified RNA·DNA duplexes. The results are discussed in terms of the influence that the sulfur atom has on the conformation of the furanose ring and comparisons are also drawn between the current study and those previously conducted with other modifications that have a similar conformational effect.

Influence of surface texture on the galling characteristics of lean duplex and austenitic stainless steels

Two simulative test methods were used to study galling in sheet forming of two types of stainlesssteel sheet: austenitic (EN 1.4301) and lean duplex LDX 2101 (EN 1.4162) in different surface conditions. Thepin-on-disc test was used to analyse the galling resistance of different combinations of sheet materials and lubricants. The strip reduction test, a severe sheet forming tribology test was used to simulate the conditionsduring ironing. This investigation shows that the risk of galling is highly dependent on the surface texture of theduplex steel. Trials were also performed in an industrial tool used for high volume production of pumpcomponents, to compare forming of LDX 2101 and austenitic stainless steel with equal thickness. The forming forces, the geometry and the strains in the sheet material were compared for the same component.It was found that LDX steels can be formed to high strain levels in tools normally applied for forming ofaustenitic steels, but tool adaptations are needed to comply with the higher strength and springback of thematerial.

Estudo da viabilidade técnica para obtenção de superfície duplex em aço inoxidável martensítico AISI 410 através do processo de deposição a plasma por gaiola catódica

The technique of plasma nitriding by the cathode cage mainly stands out for its ability to produce uniform layers, even on parts with complex geometries. In this study, it was investigated the efficiency of this technique for obtaining duplex surface, when used, simultaneously, to nitriding treatment and thin film deposition at temperatures below 500°C. For this, were used samples of AISI 41 0 Martensitic Stainless Steel and performed plasma treatment, combining nitriding and deposition of thin films of Ti and/or TiN in a plasma atmosphere containing N2-H2. It was used a cathodic cage of titanium pure grade II, cylindrical with 70 mm diameter and 34 mm height. Samples were treated at temperature 420ºC for 2 and 12 hours in different working pressures. Optical Microscopy (OM), Scanning Electron Microscopy (SEM) with micro-analysis by Energy Dispersive Spectroscopy (EDS), X-Ray Diffraction (XRD), Atomic Force Microscopy (AFM) and analysis of Vickers Microhardness were used to investigate coating properties such as homogeneity and surface topography, chemical composition, layer thickness, crystalline phase, roughness and surface microhardness. The results showed there is a direct proportionality between the presence of H2 in plasma atmosphere and the quantity of titanium in surface chemical composition. It was also observed that the plasma treatment at lowpressure is more effective in formation of TiN thin film

Value of ultrasonographic contrast in duplex scanning of leg arteries - Comparison with conventional duplex scanning and arteriography

Aim. Duplex scanning has been used in the evaluation of the aorta and proximal arteries of the lower extremities, but has limitations in evaluating the arteries of the leg. The utilization of ultrasonographic contrast (USC) may be helpful in improving the quality of the image in these arteries. The objective of the present study was to verify whether the USC increases the diagnostic accuracy of patency of the leg arteries and if it diminishes the time needed to perform duplex scanning.Methods. Twenty patients with critical ischemia (20 lower extremities) were examined by standard duplex scanning, duplex scanning with contrast and digital subtraction arteriography (DSA). The 3 arteries of the leg were divided into 3 segments, for a total of 9 segments per limb. Each segment was evaluated for patency in order to compare the 3 diagnostic methods. Comparison was made between standard duplex scanning and duplex scanning with contrast in terms of quality of the color-coded Doppler signal and of the spectral curve, and also of the time to perform the exams.Results. Duplex scanning with contrast was similar to arteriography in relation to patency diagnosis (p>0.3) and even superior in some of the segments. Standard duplex scanning was inferior to arteriography and to duplex scanning with contrast (p<0.001). There were improvements of 70% in intensity of the color-coded Doppler signal and 76% in the spectral curve after the utilization of contrast. The time necessary to perform the examinations was 23.7 minutes for standard duplex scanning and 16.9 minutes for duplex scanning with contrast (p<0.001).Conclusion. The use of ultrasonographic contrast increased the accuracy of the diagnosis of patency of leg arteries and diminished the time necessary for the execution of duplex scanning.

Correlation between the intensity of venous reflux in the saphenofemoral junction and morphological changes of the great saphenous vein by duplex scanning in patients with primary varicosis

Aim. One of the major causes of chronic venous disease is venous reflux, the identification and quantification of which are important for diagnosis. Duplex scanning allows for the detection and quantification of reflux in individual veins. Evaluation of the great saphenous vein in primary varicosis is necessary for its preservation. Objective of the study is to evaluate a possible correlation between the intensity of reflux at the saphenofemoral junction, diameter alterations of the incompetent great saphenous vein and the practical effect of such correlation. Also to compare the clinical severity of the CEAP classification with such parameters.Methods. Three hundred limbs were submitted to duplex evaluation of their insufficient saphenous veins. Vein diameter was measured on five different points. Velocity and flow at reflux peak and reflux time were determined. The saphenous vein's diameters were correlated with velocity, flow and time. The three latter parameters and diameters were compared with clinical severity according to CEAP.Results. Correlation was found between the saphenous vein's diameters, velocity and flow. No correlation was observed between time and diameter in the thigh's upper and middle thirds. When comparing diameter, velocity and flow with CEAP clinical severity classification, an association was observed. The correlation between reflux time with clinical severity was weak.Conclusion. Reflux time is a good parameter for identifying the presence of reflux, but not for quantifying it. Velocity and peak flow were better parameters for evaluating reflux intensity as they were correlated with great saphenous vein alterations, and were associated with the disease's clinical severity. [Int Angiol 2010;29:323-30]

Prevalence of deep vein thrombosis and pulmonary embolism in superficial thrombophlebitis of the lower limbs: prospective study of 60 cases

Aim. Superficial thrombophlebitis (ST) ascending the lower limbs is a common disease, which may be associated with deep vein thrombosis (DVT) and pulmonary embolism (PE). The aim of this study was to investigate the prevalence of DVT and PE as complications of ascending ST of the lower limbs in the great saphenous vein (GSV) or SSV (SSV) and probable risk factors.Methods. For this study 60 consecutive patients were enrolled with ascending ST of the GSV or SSV, seen between 2000 and 2003 at a public hospital in Botucatu, SP, Brazil. All patients were assessed clinically, by venous Duplex scanning of the lower limbs to confirm ST and test for DVT, and by means of pulmonary scintigraphy to test for PE.Results. In 13 ST cases (21.67%) there was concomitant DVT and 17 ST patients (28.33%) also had PE. Eleven patients had a clinical status suggestive of DVT, but only in eight of these (61.5%), this clinical diagnosis was confirmed. Fourteen patients had a clinical status suggestive of PE, and this diagnosis was confirmed in six cases (35.30%). ST patients who also had DVT and/or PE were given anticoagulant treatment with heparin and warfarin. None of the variables studied was predictive of DVT or PE (P>0.05). However, the presence of varicose veins reduced the risk of patients having DVT (relative risk=9.09; 95%CI:1.75 - 50.00 and P=0.023).Conclusion. The prevalence rates of PE (28.3%) and DVT (21.6%) were elevated in this sample of ascending ST cases, indicating a need for detailed assessment of patients for signs of these complications, including for therapeutic management decision making. [Int Angiol 2009;28:400-8]

Influência da potência de laser Nd: YAG na soldagem do aço inoxidável duplex UNS S32205

Pós-graduação em Engenharia Mecânica - FEIS

Diagnosis of gastric cryptosporidiosis in birds using a duplex real-time PCR assay

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

High-throughput procedure for tick surveys of tick-borne encephalitis virus and its application in a national surveillance study in Switzerland

Tick-borne encephalitis (TBE), a viral infection of the central nervous system, is endemic in many Eurasian countries. In Switzerland, TBE risk areas have been characterized by geographic mapping of clinical cases. Since mass vaccination should significantly decrease the number of TBE cases, alternative methods for exposure risk assessment are required. We established a new PCR-based test for the detection of TBE virus (TBEV) in ticks. The protocol involves an automated, high-throughput nucleic acid extraction method (QIAsymphony SP system) and a one-step duplex real-time reverse transcription-PCR (RT-PCR) assay for the detection of European subtype TBEV, including an internal process control. High usability, reproducibility, and equivalent performance for virus concentrations down to 5 x 10(3) viral genome equivalents/microl favor the automated protocol compared to the modified guanidinium thiocyanate-phenol-chloroform extraction procedure. The real-time RT-PCR allows fast, sensitive (limit of detection, 10 RNA copies/microl), and specific (no false-positive test results for other TBEV subtypes, other flaviviruses, or other tick-transmitted pathogens) detection of European subtype TBEV. The new detection method was applied in a national surveillance study, in which 62,343 Ixodes ricinus ticks were screened for the presence of TBE virus. A total of 38 foci of endemicity could be identified, with a mean virus prevalence of 0.46%. The foci do not fully agree with those defined by disease mapping. Therefore, the proposed molecular test procedure constitutes a prerequisite for an appropriate TBE surveillance. Our data are a unique complement of human TBE disease case mapping in Switzerland.

Clinical validation of an automated vessel-segmentation software of the extracranial-carotid arteries based on 3D-MRA: A prospective study

OBJECTIVES: To determine the accuracy of automated vessel-segmentation software for vessel-diameter measurements based on three-dimensional contrast-enhanced magnetic resonance angiography (3D-MRA). METHOD: In 10 patients with high-grade carotid stenosis, automated measurements of both carotid arteries were obtained with 3D-MRA by two independent investigators and compared with manual measurements obtained by digital subtraction angiography (DSA) and 2D maximum-intensity projection (2D-MIP) based on MRA and duplex ultrasonography (US). In 42 patients undergoing carotid endarterectomy (CEA), intraoperative measurements (IOP) were compared with postoperative 3D-MRA and US. RESULTS: Mean interoperator variability was 8% for measurements by DSA and 11% by 2D-MIP, but there was no interoperator variability with the automated 3D-MRA analysis. Good correlations were found between DSA (standard of reference), manual 2D-MIP (rP=0.6) and automated 3D-MRA (rP=0.8). Excellent correlations were found between IOP, 3D-MRA (rP=0.93) and US (rP=0.83). CONCLUSION: Automated 3D-MRA-based vessel segmentation and quantification result in accurate measurements of extracerebral-vessel dimensions.

Duplex sonographic criteria for measuring carotid stenoses

PURPOSE: The aim of this retrospective study was to determine optimal duplex sonographic criteria for use in our institution for diagnosing severe carotid stenoses and to correlate those findings with angiographic measurements obtained by the European Carotid Surgery Trial (ECST), North American Symptomatic Carotid Endarterectomy Trial (NASCET), and Common Carotid (CC) methods of grading carotid stenoses. METHODS: We analyzed the angiographic data using the ECST, NASCET, and CC methods and compared the results with the duplex sonographic findings. We then calculated the sensitivity, specificity, positive and negative predictive values, and accuracy of the duplex sonographic method. Taking these parameters into account, the optimal intrastenotic peak systolic velocity (PSV) and end diastolic velocity (EDV) were derived for diagnosing severe stenoses according to the 3 angiographic methods. RESULTS: Optimal PSV and EDV values for diagnosing a 70% or greater stenosis in our laboratory were as follows: with the NASCET method of angiographic grading of stenoses, PSV 220 cm/second or greater and EDV 80 cm/second or greater, and with the ECST and CC methods, PSV 190 cm/second or greater, and EDV 65 cm/second or greater. The optimal PSV and EDV for diagnosing a stenosis of 80% or greater with the ECST grading method were 215 cm/second or greater and 90 cm/second or greater, respectively. CONCLUSIONS: Duplex sonography is a sensitive and accurate tool for evaluating severe carotid stenoses. Optimal PSVs and EDVs vary according to the angiographic method used to grade the stenosis. They are similar for stenoses 70% or greater with the NASCET method and for stenoses 80% or greater with the ECST method.

Specificity, duplex degradation and subcellular localization of antagomirs

MicroRNAs (miRNAs) are an abundant class of 20-23-nt long regulators of gene expression. The study of miRNA function in mice and potential therapeutic approaches largely depend on modified oligonucleotides. We recently demonstrated silencing miRNA function in mice using chemically modified and cholesterol-conjugated RNAs termed 'antagomirs'. Here, we further characterize the properties and function of antagomirs in mice. We demonstrate that antagomirs harbor optimized phosphorothioate modifications, require >19-nt length for highest efficiency and can discriminate between single nucleotide mismatches of the targeted miRNA. Degradation of different chemically protected miRNA/antagomir duplexes in mouse livers and localization of antagomirs in a cytosolic compartment that is distinct from processing (P)-bodies indicates a degradation mechanism independent of the RNA interference (RNAi) pathway. Finally, we show that antagomirs, although incapable of silencing miRNAs in the central nervous system (CNS) when injected systemically, efficiently target miRNAs when injected locally into the mouse cortex. Our data further validate the effectiveness of antagomirs in vivo and should facilitate future studies to silence miRNAs for functional analysis and in clinically relevant settings.

Conformational diversity versus nucleic acid triplex stability, a combinatorial study

The stability of a triple helix formed between a DNA duplex and an incoming oligonucleotide strand strongly depends on the solvent conditions and on intrinsic chemical and conformational factors. Attempts to increase triple helix stability in the past included chemical modification of the backbone, sugar ring, and bases in the third strand. However, the predictive power of such modifications is still rather poor. We therefore developed a method that allows for rapid screening of conformationally diverse third strand oligonucleotides for triplex stability in the parallel pairing motif to a given DNA double helix sequence. Combinatorial libraries of oligonucleotides of the requisite (fixed) base composition and length that vary in their sugar unit (ribose or deoxyribose) at each position were generated. After affinity chromatography against their corresponding immobilized DNA target duplex, utilizing a temperature gradient as the selection criterion, the oligonucleotides forming the most stable triple helices were selected and characterized by physicochemical methods. Thus, a series of oligonucleotides were identified that allowed us to define basic rules for triple helix stability in this conformationally diverse system. It was found that ribocytidines in the third strand increase triplex stability relative to deoxyribocytidines independently of the neighboring bases and position along the strand. However, remarkable sequence-dependent differences in stability were found for (deoxy)thymidines and uridines

A numerical discrete element study on the influence of an embedded viscoelastic-plastic layer at different viscosity values

The major aim of this study was to examine the influence of an embedded viscoelastic-plastic layer at different viscosity values on accretionary wedges at subduction zones. To quantify the effects of the layer viscosity, we analysed the wedge geometry, accretion mode, thrust systems and mass transport pattern. Therefore, we developed a numerical 2D 'sandbox' model utilising the Discrete Element Method. Starting with a simple pure Mohr Coulomb sequence, we added an embedded viscoelastic-plastic layer within the brittle, undeformed 'sediment' package. This layer followed Burger's rheology, which simulates the creep behaviour of natural rocks, such as evaporites. This layer got thrusted and folded during the subduction process. The testing of different bulk viscosity values, from 1 × 10**13 to 1 × 10**14 (Pa s), revealed a certain range where an active detachment evolved within the viscoelastic-plastic layer that decoupled the over- and the underlying brittle strata. This mid-level detachment caused the evolution of a frontally accreted wedge above it and a long underthrusted and subsequently basally accreted sequence beneath it. Both sequences were characterised by specific mass transport patterns depending on the used viscosity value. With decreasing bulk viscosities, thrust systems above this weak mid-level detachment became increasingly symmetrical and the particle uplift was reduced, as would be expected for a salt controlled forearc in nature. Simultaneously, antiformal stacking was favoured over hinterland dipping in the lower brittle layer and overturning of the uplifted material increased. Hence, we validated that the viscosity of an embedded detachment strongly influences the whole wedge mechanics, both the respective lower slope and the upper slope duplex, shown by e.g. the mass transport pattern.