Background and purpose:
 Transfemoral approach has been a common technique in endovascular treatment (ET) of neurovascular diseases. When aortic or peripheral arterial conditions limit transfemoral approach, transbrachial approach is attempted as the alternative. The purpose of our study was to report the utility of novel sheath guide specifically designed for transbrachial approach in ET for carotid or cerebral vascular pathology.

 Methods:
 Included in our analysis were patients who underwent transbrachial ET with the sheath guide for transbrachial approach between 2011 and 2014. The sheath guide has a 6Fr (2.24 mm, 0.088 inch) internal diameter (ID) with 90 cm in length, a soft distal part and a particular distal shape like a modified Simmons catheter. The MSK-guide 7.5 has 7.5 cm of the distal part in length for the common carotid artery and the MSK-guide 15 has 15.0 cm of the distal part in length for the internal carotid artery. Carotid artery stenting and external carotid artery embolization were performed with the MSK-guide 7.5, and ET for intracranial lesions with MSK-guide 15.

 Results:
 Two hundred and seventy patients underwent transbrachial ET with the particular sheath guide. The procedures included treatment of 143 extracranial carotid stenosis, 31 intracranial carotid stenosis, 50 intracranial aneurysms, 25 AVMs/DAVFs and 21 acute ischemic strokes. Transbrachial carotid cannulation was easy and successful in every case except for one case (0.4%) with brachial artery spasm. After transbrachial carotid cannulation of MSK-guide, procedures were performed easily through the sheath guide in every case. On sheath-related periprocedural complications, 2 pseudoaneurysms (0.7%) and brachial artery occlusions (0.7%) occurred after ET or a follow-up period, respectively.

 Conclusion:
 The sheath guide specifically designed for transbrachial approach provided a favorable impact upon ET of neurovascular diseases.


Abstract Vulvar cancer is a rare disease affecting elderly women that is commonly treated with surgery, radiation, and chemotherapy. When tumors compromise the urethra and the anus, or when it is in the groin lymph nodes, radiotherapy, chemotherapy, or both are necessary after surgery. The treatment of locally advanced vulvar cancer has suffered significant changes though the recent decades. So far, the best sequence of treatment is not known: surgery, chemotherapy, or radiotherapy. The radical surgeries usually need a long recovery term both in the region of the vulva and in the area of the groin lymph nodes. When it is performed, convalescence can delay other treatments, such as radiotherapy and chemotherapy. On the other hand, the use of radiotherapy and chemotherapy as a first step treatment can result in a complete elimination of the disease in at least 30% of the cases or substantial reduction of its size, allowing less extensive surgery. Therefore, the historical evolution of locally advanced vulvar cancer is reviewed.


Efficient delivery of cells to target tissues is a major problem in cell therapy. We report that enhancing delivery of mesoangioblasts leads to a complete reconstitution of downstream skeletal muscles in a mouse model of severe muscular dystrophy (α-sarcoglycan ko). Mesoangioblasts, vessel-associated stem cells, were exposed to several cytokines, among which stromal- derived factor (SDF) 1 or tumor necrosis factor (TNF) α were the most potent in enhancing transmigration in vitro and migration into dystrophic muscle in vivo. Transient expression of α4 integrins or L-selectin also increased several fold migration both in vitro and in vivo. Therefore, combined pretreatment with SDF-1 or TNF-α and expression of α4 integrin leads to massive colonization (>50%) followed by reconstitution of >80% of α-sarcoglycan–expressing fibers, with a fivefold increase in efficiency in comparison with control cells. This study defines the requirements for efficient engraftment of mesoangioblasts and offers a new potent tool to optimize future cell therapy protocols for muscular dystrophies.


Airborne infections have been documented as a major source of hospital acquired infection - one of the major concerns in healthcare delivery. An important factor contributing to airborne infection is cross contamination through air particulate dispersion as affected by the ventilation system design. Clean room technology (with membrane ceiling) has been successfully used in technology and pharmaceutical industries to control airborne contamination. This study examined the performance of membrane ceiling technology in controlling air particulate dispersion in a mock-up exam room. It included both performance tests in a mock-up room and a simulation study of six different ventilation system designs using Computational Fluid Dynamics (CFD) analysis. Findings suggest that a membrane diffuser directed airflow ventilation strategy occupying approximately 20% to 30% of the ceiling surface and placed over the patient in a contemporary sized exam room provides a less turbulent airflow pattern and less mixing of the air between the patient and others in the room.


Background Chronic oral anticoagulation is currently used to avoid thrombosis and the malfunction of tunneled cuffed catheters (TCCs) for hemodialysis (HD). The aim of the study was to assess the efficacy of early warfarin administration, after TCC placement, in comparison to its administration after the first thrombosis or malfunction event of the TCC. Patients and methods One hundred and forty-four chronic dialysis patients, who underwent TCC placement between June 2001 and June 2005, were randomized into two groups: 81 patients, group A, started oral anticoagulation 12 hr after the TCC placement (target international normalized ratio (INR) 1.8–2.5), in association with ticlopidine 250 mg/die; 63 patients, group B, started warfarin after the first thrombosis/malfunction episode (target INR 1.8–2.5) in association with ticlopidine 250 mg/die. The efficacy of oral anticoagulation therapy in preventing TCC thrombotic complications was evaluated in a 12-month follow-up period, after TCC placement, in terms of: a) the number of patients with thrombotic-malfunction events; b) the number of thrombotic-malfunction events with urokinase infusion (events/patient/year); c) intradialytic blood flow rate (BFR, ml/min); d) negative blood pressure (BP) from the arterial line of the TCC (AP, mmHg); e) positive BP, in the extracorporeal circuit from the venous line (VP, mmHg); and f) bleeding complications. Results Ten patients (12%) in group A showed TCC thrombosis/malfunction vs. 33 patients (52%) in group B (p<0.01). In group A, 0.16 events of thrombosis/malfunction per patient/year vs. 1.65 in group B (p<0.001) were observed. BFR was respectively 305 ± 34 vs. 246 ± 42 ml/min (p<0.001). AP was –124 ± 13 in group A vs. –174 ± 21 mmHg in group B (p<0.05). VP was 112 ± 28 in group A vs. 168 ± 41 mmHg in group B (p<0.05). No patient showed any bleeding events. Conclusions Early warfarin therapy allows a significant reduction in TCC thrombotic complications and an improvement in both arterial and venous fluxes in comparison with the same therapy administered after the first TCC thrombotic/malfunction event. This therapy did not induce any bleeding complications in the patients included in the study.


Objective: To study the effect of magnetic resonance neurography on 3 Tesla (MRN-3T) on the outcome of brachial plexus injury management.
Study Design: Prospective comparative study.Place and Duration of Study: Department of Plastic Surgery, Combined Military Hospital Rawalpindi Pakistan, from Apr 2017 to Mar 2019.
Methodology: Two groups of brachial plexus injury (BPI) were studied over two years. Group-A (n=29) cases whose operative intervention was decided based on history, examination, NCS/EMG and CT scan. Second group-B included (n=33) patients in which MRN-3T (magnetic resonance neurography on 3 Tesla) was the critical diagnostic tool. The comparison of preoperative diagnosis with intraoperative findings and outcome of surgery were made.
Results: Out of 29 cases in group-A, 11 (37.93%) were explored. In these 11, neurolysis was done in one case, direct repair in one case, nerve grafting in 4 patients, nerve transfers with bridging grafts in 2 cases, whereas three patients had negative exploration. Of 33 cases in group-B, 21(63.64%) were explored. From these 21 cases, neurolysis was done in four patients; the direct repair was possible in 7 and in 10 cases bridging nerve grafts were used along with primary nerve transfers.
Conclusion: MRN-3T brachial plexus has significantly improved the diagnosis, preoperative planning and surgical outcome of patients with brachial plexus injury.


The research reported is a theoretical investigation of the interaction of land-use and transport in relation to the use of energy. Of particular interest is the relationship between the spatial arrangement of settlements and the use of energy within them for both transport and building services.

The literature of scenarios of energy futures is reviewed, and three scenarios of future constraints on regional planning are adopted. The adopted scenarios emphasise constraints imposed by energy policy and the availability of fuels; they form the background to the comparison of a number of theoretical regional settlement patterns, in terms of their implications for land-use and their potential for fuel-conservation.

A study of an existing regional settlement pattern is used in combination with published land-use data as the basis of a configurational model. This model is intended to characterise the real pattern spatially, quantitatively and in a manner suitable for experimental manipulation. The model encompasses the pattern of developed land (disaggregated by uses), the shape of the transport network, and the intensity of development (in terms of population and floorspace).

A review is then made of published proposals for energy-efficient settlements, which are found to include concentrated, dispersed, nucleated and linear patterns. Five modified versions of the regional configurational model are then constructed in order to characterise the range of realistic possibilities for future regional form which might result from the fuel-conservation policies inherent in the proposals reviewed.

The five regional configurations and the original pattern are then compared by means of a specially-developed land-use transport and energy-evaluation model. The comparison is made in terms of the accessibility of the population in each pattern to employment and services (measured 'biy the model as "benefits"), and. in terms of the use of fuel in both transport and domestic space heating. Fuel use in transport is related to modal split and vehicle speed; fuel use in homes is related to dwelling size and location. Parametric calibration of the land-use and transport models allows the comparison of the patterns to be repeated in the context of each of the three adopted energy scenarios, taking into account changes in travelling behaviour, vehicle efficiencies, and building services technologies.

The results of the comparison are discussed and assessed in terms of their implications for long-term strategic planning policy.


Social inequalities between women and men, found throughout the globe, have recently
started to narrow, yet critical gaps remain. These persistent, multi-dimensional gender
disparitieslie at the heart of global inequalities and poverty, directly limiting development
interventions due to income, opportunity, access, and agency inconsistencies. The lack of
progress on dealing with structural issues that underpin gender inequality are noted as a
primary obstacle in achieving the fifth Sustainable Development Goal. This is particularly
evident in developing nations undergoing multiple structural challenges that perpetuate
poverty such as in the focus country of this study: Zimbabwe. Zimbabwe is a highly
patriarchal society, struggling to develop for a myriad of systemic issues including political,
economic, and societal problems. Widespread gender inequality hinders overcoming the
extensive poverty levels throughout the country, particularly in the highly gendered
agricultural sector of which 70% of the population rely on.
One of the main reasons that gender inequalities persist is that norms or expectations
based on gender (commonly referred to as the dominant gender norms) are continually
circulated through and reinforced by social structures and institutions implying a need to
examine them in a holistic manner. To sustainably alter the course of gender disparities
and improve the effectiveness of development interventions, there is a need to be able
to identify dominant gender narratives across society. An integrated examination of the
role that communication plays in enabling and sustaining gender norms is essential to
successfully examine this phenomenon.
Rooted in the conceptual understandings behind the phenomenon of the circulation of
dominant gender discourses, this study presents a novel framework called the Dominant
Gender Discourse Deconstruction Framework (DGDDF) which embraces conceptual
understanding and transforms it into an applied methodology. The DGDDF has been
designed to enable contextually positioned institutional analysis that systematically
identifies and evaluates the interconnected nature of gender and communication
approaches being implemented, and the effect that these approaches have on their target
audiences. By engaging in the structural context, the institutional functionality and the
effects of this on institutional target audiences, the DGDDF exposes how and why
dominant gender discourse is being reinforced throughout society.
Given this, the application of the DGDDF on the Zimbabwean agricultural extension
institutions supports vital research to improve gender equality in the agricultural arena,
and generates findings that add to development theory, practice and policy in rural
iv
communication and wider agricultural development – a fundamental pathway to
sustainable development.
Working alongside research participants affiliated with three case study institutions,
primary qualitative data was collected via a mixed methodological approach and analyzed
using discourse analysis. The findings from this show that the DGDDF successfully
identifies the gender and communication approaches used by agricultural extension
institutions enabling a systematic evaluation of these on gendered access and
engagement. This evaluation presents nuances between different intervention
approaches, illustrating how dominant gender discourses remain largely unchallenged by
current development institutional arrangements, thereby directly affecting information
access and experience for male and female farmers. It also demonstrates that the
framework exposes the complex, interconnected cycles of dominant gender discourse
throughout different levels of societal structures and that these directly dictate
institutional gender and communication structures. Finally, the study shows that
agricultural extension institutions are in a primary position to alter the course of dominant
gender discourses by incorporating a more complex understanding of gender structures
and actively challenging dominant gender discourses which are hindering effective
development.
The findings presented in this study add to national Zimbabwean policy
recommendations, but also to wider discussions about the effectiveness of development
interventions which provide a starting point for opening discussions about how to make
meaningful changes to deal with the persistent gender inequalities found throughout the
globe.


By means of ab initio calculations, including spin-restricted Born–Oppenheimer molecular dynamics at finite vibrational temperature, we investigate the magnetic behaviour of Al, AlNi and AlPt nanoparticles of 19 atoms. Starting from a poly-icosahedron, we observe that the 5-fold symmetry axis is usually preserved at 100 K, but a few dynamical structural transformations take place towards three new architectures characterized by a different piling of the pentagon rings around the 5-fold axis. Other shapes, such as the interplay of an octahedron to an icosahedron, could be detected although less frequently. Notwithstanding a ferromagnetic behaviour is observed independently of shapes and chemical compositions, a depletion of the total magnetisation occurs when the surface is delimited by (100) facets, or by distorted (100) facets, associated with the appearance of an antiferromagnetic ordering.


The demands placed on Higher Education Institutions (HEIs) to deliver sustainability initiatives alongside their long-standing social responsibility commitments has been recognised in literature. However, how these interrelate in practice continues to be relatively unexplored. The extant literature suggests that the integration of the two connected agendas can be problematic due to a range of factors, including a general lack of awareness or even misconceptions of the respective agendas. This paper explores the attitudes and practices related to the integration of social responsibility and sustainability initiatives at HEIs. Theoretically, this study highlights the ongoing relative positioning and importance of economic factors – as it relates to differentiation rather than integration – over others such as social responsibility and sustainability. The main implication of this study is that provide useful insights into how HEIs can closer integrate two contemporary but potentially competing agendas.


In this paper, we explore modifying the field of a permanent magnet through the use of the Meissner effect, motivated by application to a helicon plasma source. The use of a high-temperature superconducting material is more practical for maintaining a system-wide critical temperature, and it is therefore the focus of our investigation. The field supplied by a permanent magnet is confined to the inside of the tube to obtain a uniform field solution analogous to that of an inviscid incompressible fluid. Discussed are both the theoretical results, which neglect flux pinning and experimental results that show its effect. The experiment to assess the approach uses a tube of Bi-2223 cooled with liquid nitrogen inside of a vacuum chamber. Further analysis shows that the experimental and theoretical results agree and that shaping of the magnetic fields is in fact possible.