The effectiveness of infrainguinal percutaneous transluminal angioplasty in the treatment of critical limb ischaemia

Critical chronic lower limb ischaemia (CLI) is the most severe form of peripheral arterial disease. Even though the treatment of CLI has evolved during the last decade, CLI is still associated with considerable morbidity, mortality and a decreased quality of life, in addition to a large financial impact on society. ---- Bypass surgery has traditionally been considered the approach of choice to treat CLI patients in order to avoid amputation. However, there are increasing data on the efficacy of endovascular revascularization procedures, such as percutaneous transluminal angioplasty (PTA), to achieve good leg salvage rates as well. Data gathered on all the 2,054 CLI patients revascularized at the Helsinki University Central Hospital between 2000 and 2007 were retrospectively analyzed. This patient cohort was used to compare the results of infrainguinal PTA and bypass surgery as well as to investigate predictors of failure after PTA. This study showed that infrainguinal PTA and bypass surgery yielded rather similar results in terms of survival, amputation-free survival and freedom from any re-intervention. When the femoropoliteal segment was treated, leg salvage was significantly better in the bypass surgery group, whereas no significant difference was observed between the two treatment methods when the revascularization extended to the infrapopliteal segment. PTA resulted in a significantly lower freedom from surgical re-interventions when compared to surgical revascularization. In this study the most important predictors of poor outcome after PTA for CLI were cardiac morbidity, nonambulatory status upon hospital arrival, and gangrene as a manifestation of CLI. Thus, when feasible, PTA seems to be a valid alternative for bypass surgery in the treatment of CLI provided that active redo-surgery is utilized. The optimal revascularization strategy should always be sought for each CLI patient individually considering the clinical state of the leg, the occlusive lesions to be treated, co-morbidities, life-expectancy, and the availability of a suitable vein for bypass.

High-risk patients and high-risk grafts in infrainguinal bypass for critical limb ischaemia

The main purpose of revascularization procedures for critical limb ischaemia (CLI) is to preserve the leg and sustain the patient s ambulatory status. Other goals are ischaemic pain relief and healing of ischaemic ulcers. Patients with CLI are usually old and have several comorbidities affecting the outcome. Revascularization for CLI is meaningless unless both life and limb are preserved. Therefore, the knowledge of both patient- and bypass-related risk factors is of paramount importance in clinical decision-making, patient selection and resource allocation. The aim of this study was to identify patient- and graft-related predictors of impaired outcome after infrainguinal bypass for CLI. The purpose was to assess the outcome of high-risk patients undergoing infrainguinal bypass and to evaluate the usefulness of specific risk scoring methods. The results of bypasses in the absence of optimal vein graft material were also evaluated, and the feasibility of the new method of scaffolding suboptimal vein grafts was assessed. The results of this study showed that renal insufficiency - not only renal failure but also moderate impairment in renal function - seems to be a significant risk factor for both limb loss and death after infrainguinal bypass in patients with CLI. Low estimated GFR (PIENEMPI KUIN 30 ml/min/1.73 m2) is a strong independent marker of poor prognosis. Furthermore, estimated GFR is a more accurate predictor of survival and leg salvage after infrainguinal bypass in CLI patients than serum creatinine level alone. We also found out that the life expectancy of octogenarians with CLI is short. In this patient group endovascular revascularization is associated with a better outcome than bypass in terms of survival, leg salvage and amputation-free survival especially in presence of coronary artery disease. This study was the first one to demonstrate that Finnvasc and modified Prevent III risk scoring methods both predict the long-term outcome of patients undergoing both surgical and endovascular infrainguinal revascularization for CLI. Both risk scoring methods are easy to use and might be helpful in clinical practice as an aid in preoperative patient selection and decision-making. Similarly than in previous studies, we found out that a single-segment great saphenous vein graft is superior to any other autologous vein graft in terms of mid-term patency and leg salvage. However, if optimal vein graft is lacking, arm vein conduits are superior to prosthetic grafts especially in infrapopliteal bypasses for CLI. We studied also the new method of scaffolding suboptimal quality vein grafts and found out that this method may enable the use of vein grafts of compromised quality otherwise unsuitable for bypass grafting. The remarkable finding was that patients with the combination of high operative risk due to severe comorbidities and risk graft have extremely poor survival, suggesting that only relatively fit patients should undergo complex bypasses with risk grafts. The results of this study can be used in clinical practice as an aid in preoperative patient selection and decision-making. In the future, the need of vascular surgery will increase significantly as the elderly and diabetic population increases, which emphasises the importance of focusing on those patients that will gain benefit from infrainguinal bypass. Therefore, the individual risk of the patient, ambulatory status, outcome expectations, the risk of bypass procedure as well as technical factors such as the suitability of outflow anatomy and the available vein material should all be assessed and taken into consideration when deciding on the best revascularization strategy.

Microbiological characterisation of soils : Evaluation of some critical steps in data collection and experimental design

The study of soil microbiota and their activities is central to the understanding of many ecosystem processes such as decomposition and nutrient cycling. The collection of microbiological data from soils generally involves several sequential steps of sampling, pretreatment and laboratory measurements. The reliability of results is dependent on reliable methods in every step. The aim of this thesis was to critically evaluate some central methods and procedures used in soil microbiological studies in order to increase our understanding of the factors that affect the measurement results and to provide guidance and new approaches for the design of experiments. The thesis focuses on four major themes: 1) soil microbiological heterogeneity and sampling, 2) storage of soil samples, 3) DNA extraction from soil, and 4) quantification of specific microbial groups by the most-probable-number (MPN) procedure. Soil heterogeneity and sampling are discussed as a single theme because knowledge on spatial (horizontal and vertical) and temporal variation is crucial when designing sampling procedures. Comparison of adjacent forest, meadow and cropped field plots showed that land use has a strong impact on the degree of horizontal variation of soil enzyme activities and bacterial community structure. However, regardless of the land use, the variation of microbiological characteristics appeared not to have predictable spatial structure at 0.5-10 m. Temporal and soil depth-related patterns were studied in relation to plant growth in cropped soil. The results showed that most enzyme activities and microbial biomass have a clear decreasing trend in the top 40 cm soil profile and a temporal pattern during the growing season. A new procedure for sampling of soil microbiological characteristics based on stratified sampling and pre-characterisation of samples was developed. A practical example demonstrated the potential of the new procedure to reduce the analysis efforts involved in laborious microbiological measurements without loss of precision. The investigation of storage of soil samples revealed that freezing (-20 °C) of small sample aliquots retains the activity of hydrolytic enzymes and the structure of the bacterial community in different soil matrices relatively well whereas air-drying cannot be recommended as a storage method for soil microbiological properties due to large reductions in activity. Freezing below -70 °C was the preferred method of storage for samples with high organic matter content. Comparison of different direct DNA extraction methods showed that the cell lysis treatment has a strong impact on the molecular size of DNA obtained and on the bacterial community structure detected. An improved MPN method for the enumeration of soil naphthalene degraders was introduced as an alternative to more complex MPN protocols or the DNA-based quantification approach. The main advantage of the new method is the simple protocol and the possibility to analyse a large number of samples and replicates simultaneously.

Impurity effects on the critical behaviour of the electrical resistance of binary liquid mixtures

The electrical resistance of the binary liquid system cyclohexane + acetic anhydride is measured, in the critical region, both in the pure mixture and when the mixture is doped with small amounts (≈ 100 ppm) of H2O/D2O impurities.T c was approached to aboutt=3×10−6 wheret=(T −T c )/T c . The critical exponentb ≈ 0.35 in the fit of the resistance data to the equationdR/dT ∼t −b does not seem to be affected appreciably by the impurities. There is a sign reversal ofdR/dt in the non-critical region. Binary liquid systems seem to violate the universality of the critical resistivity.

Critical resistivity in impurity doped binary liquid mixtures

The electrical resistance of the critical binary liquid system C6H12+(CH3CO)2O is measured both in the pure form and when the system is doped with small amounts (≈ 100 ppm) of H2O impurities. Near Tc, the resistance varies as dR/dT = A1+A2 (T-Tc)-b with b ≈ 0.35. Neither the critical exponent b nor the amplitude ratio A1/A2 are affected by the impurities. A sign reversal of dR/dT is noticed at high temperatures T much greater-than Tc.

Critical phenomena in electrical resistance of binary liquids: A study of the frequency dependence

The electrical resistance is measured in two binary liquid systems CS2 + CH3NO2 and n-C7H16 + CH3OH in the critical region as a function of frequency from 10 Hz to 100 kHz. The critical exponent b ≈ 0.35 in the singularity of dR/dT α (T - Tc)−b near Tc has no appreciable dependence upon the frequency. Thus any contribution from dielectric dispersion to the critical resistivity is not appreciable. The universal behaviour of the dR/dT anomaly does not seem to be followed in binary liquid systems.

A critical re-examination and a revised phase diagram of La1-xSrxCoO3

We report the results of a comprehensive study on dc magnetization, ac susceptibility, and the magnetotransport properties of the La1-xSrxCoO3(0 <= x <= 0.5) system. At higher Sr doping (x >= 0.18), the system exhibits Brillouin-like field cooled magnetization (M-FC). However, for x < 0.18, the system exhibits a kink in the M-FC, a peak at the intermediate field in the thermoremnant magnetization and a non-saturating tendency in the M-H plot that all point towards the characteristic of spin glass behavior. More interestingly, dc magnetization studies for x < 0.18 do not suggest the existence of ferromagnetic correlation that can give rise to an irreversible line in the spin glass regime. The ac susceptibility study for x > 0.2 exhibits apparently no frequency dependent peak shift around the ferromagnetic transition region. However, a feeble signature of glassiness is verified by studying the frequency dependent shoulder position in chi `' (T) and the memory effect below the Curie temperature. But, for x < 0.18, the ac susceptibility study exhibits a considerable frequency dependent peak shift, time dependent memory effect, and the characteristic spin relaxation time scale tau(0) similar to 10(-13) s. The reciprocal susceptibility versus temperature plot adheres to Curie-Weiss behavior and does not provide any signature of preformed ferromagnetic clusters well above the Curie temperature. The magnetotransport study reveals a cross over from metallic to semiconducting-like behavior for x <= 0.18. On the semiconducting side, the system exhibits a large value of magnetoresistance (upto 75%) towards low temperature and it is strongly connected to the spin dependent part of the random potential distribution in the spin glass phase. Based on the above observations, we have reconstructed a new magnetic phase diagram and characterized each phase with associated properties.

Professional Driving : An Emphasis on Organizational Safety Climate

According to the literature and statistical figures, professional drivers constitute a high-risk group in traffic and should be investigated in connection with the factors related to safe driving. However, safety-related behaviours and outcomes among professional drivers have attracted very little attention from safety researchers. In addition, comparing different professional and non-professional driver groups in terms of critical on-the-road characteristics and outcomes has been indicated in the literature as being necessary for a more comprehensive understanding of driver groups and the nature of driving itself. The aim of the present study was to investigate professional driving from a safety climate stand point in relation to predominant driving-related factors and by considering the differences between driver groups. Hence, four Sub-studies were conducted according to a framework emphasizing the relationships between safety climate, driver groups, driver stress, human factors (i.e., driver behaviour and performance) and accidents. Demographic information, as well as data for driver behaviour, performance, and driver stress was collected by questionnaire. The data was analysed using factor analysis, analysis of covariance as well as hierarchical and logistic regression analysis. The results revealed multi-dimensional factor structures for the safety climate measures. Considering the relationships between variables, differences were evidenced regarding on-the-road stress reactions, risky driver behaviours and penalties, between the various professional and non-professional driver groups. Driver stress was found to be related to accidents. The results also indicated that the safety climate has positive relationships with both driver behaviour and performance, and as well as involvement in accidents. The present study has a number of critical implications resulting from the fact that the way in which the effects of safety climate on professional driving were investigated, as well as the differences between professional and non-professional driver groups, was unique. Additionally, for the first time, a safety climate scale was developed specifically for professional drivers. According to the results of the study and to previous literature, a tentative model was proposed representing a possible route for the relationships between safety climate, human factors, driver stress, driver groups and accidents, by emphasizing the effects of safety climate.

A High Pressure Study of the Phase Diagram and the Critical Exponent β of Binary Liquid Systems

The pressure dependence of critical parameters xc, Tc, and β have been analysed in four systems namely cyclohexane + acetic anhydride, n-heptane + acetic anhydride, methanol + n-heptane, and carbon disulphide + acetonitrile. The separation temperature was found to increase linearly with pressure the value of dTc/dP being 28 mK, 11 mK, 22 mK, and 25 mK respectively. These are in fair agreement with earlier measurements available for two systems. For the methanol + n-heptane system dTc/dP is apparently not consistent with the value predicted from the specific heat and thermal expansion data.Die Druckabhängigkeit der kritischen Parameter xc, Tc und β ist in den vier Systemen Cyclohexan + Essigsäureanhydrid, n-Heptan + Essigsäureanhydrid, Methanol + n-Heptan und Schwefelkohlenstoff + Acetonitril analysiert worden. Es wurde gefunden, daß die kritische Temperatur linear mit dem Druck ansteigt. Die Werte für dTc/dP betragen 28 mK, 11 mK, 22 mK und 25 mK. Sie sind in guter überein-stimmung mit früheren Messungen an zweien dieser Systeme. Für Methanol + n-Heptan stimmt der Wert für dT/dP offensichtlich nicht mit Werten, die mit Hilfe von Daten für die spezifische Wärme und die thermische Ausdehnung vorhergesagt wurden, überein.

Observation of the doubling of critical exponents in reentrant phase transitions

Electrical resistance (R) measurements are reported for ternary mixtures of 3-methylpyridine, water and heavy water as a function of temperature (T) and heavy water content in total water. These mixtures exhibit a limited two-phase region marked by a loop size (ΔT) that goes to zero as the double critical point (DCP) is approached. The measurements scanned the ΔT range 1.010°C less-than-or-equals, slant ΔT less-than-or-equals, slant 77.5°C. The critical exponent (θ), which signifies the divergence of ∂R/∂T, doubles within our experimental uncertainties as the DCP is reached very closely.

Continuous ordering below the tricritical point: A critical test for the kinetic pathway in Fe-12at.% Si alloy

A critical test has been presented to establish the nature of the kinetic pathways for the decomposition of Fe-12 at.% Si alloy below the metastable tricritical point. The results, based on the measurements of saturation magnetization, establish that a congruent ordering from B2 --> D0(3) precedes the development of a B2 + D0(3) two-phase field, consistent with the predictions in 1976 of Allen and Cahn.

Critical Reappraisal of Colloidal Activity of Clays

Soil properties and their behavior, apart from stress history, are influenced markedly by physicochemical characteristics of the constituent clay and nonclay minerals and their relative proportions. Atterberg limits and Skempton’s colloidal activity, which are simple quantitative parameters, reflect the composite effects of the soil constituents and their interactions with pore fluid. Micromechanistic interpretations of these parameters have been provided in this paper. It has been shown that, in general, the liquid limit of fine-grained soils reflects the physicochemical potential and that each of the factors of Skempton’s colloidal activity are interdependent. It has been illustrated that property correlations with colloidal activity, as well as with Atterberg limits, result in involved interrelationships due to the interdependence of the parameters.

Critical Reappraisal of Colloidal Activity of Clays

Soil properties and their behavior, apart from stress history, are influence markedly by physicochemical characteristics of the constituent clay and nonclay minerals and their relative proportions. Atterberg limits and Skempton's colloidal activity, which are simple quantitative parameters, reflect the composite effects of the soil constituents and their interactions with pore fluid. Micromechanistic interpretations of these parameters have been provided in this paper. It has been shown that, in general, the liquid limit of fine-grained soils reflects the physicochemical potential and that each of the factors of Skempton's colloidal activity are interdependent. It has been illustrated that property correlations with colloidal activity, as well as with Atterberg limits, result in involved interrelationships due to the interdependence of the parameters.

Energy efficiencies of end-use devices in an electro-metallurgical industry: A critical study

The inefficient use of energy in a large number of industries is slowly developing into a major energy crisis in the already power-starved Karnataka State, India. This study attempts to bring out the present inefficient pattern of energy use in an electro-metallurgical industry. It also brings out the considerable scope for energy conservation, especially by increasing the efficiency of the end-use devices used. This concept, when extended to other industries, wherein increasing efficiency of the end-use devices would provide the desired end results with small energy input. This, in turn, would result in a slower rate of energy growth as well as saving in energy use.