A Feasibility Study Comparing Platelet-Rich Plasma Injection With Saline for the Treatment of Plantar Fasciitis Using a Prospective, Randomized Trial Design.

Platelet-rich plasma (PRP) has been advocated for treatment of plantar fasciitis but there are few good-quality clinical trials to support its use. We conducted a feasibility study of PRP versus saline for treatment of plantar fasciitis. Patients with 6 months or more of magnetic resonance imaging-proven plantar fasciitis, who had failed conservative treatment were invited to participate in the study.

Patients With Atrial Fibrillation Who Are Not on Anticoagulant Treatment Due to Increased Bleeding Risk Are Common and Have a High Risk of Stroke.

Objectives: This study sought to determine how many patients with atrial fibrillation (AF) are not treated with oral anticoagulants (OAC) due to a high risk of bleeding and to characterize their risk of ischemic stroke in a real-world setting.

Background: AF is associated with a 5-fold increased risk of ischemic stroke. OAC reduce the risk of stroke in patients with AF who do not have an increased bleeding risk, but no comparably effective treatment exists for patients with contraindications to OAC.

Assessing prevalence of alcohol consumption in early pregnancy: Self-report compared to blood biomarker analysis.

Providing appropriate antenatal and postnatal care for women who drink alcohol in pregnancy is only possible if those at risk can be identified. We aimed to compare the prevalence of alcohol consumption in the first trimester of pregnancy using self-report and blood biomarker analysis. Six-hundred routine blood samples from 2014, taken at the antenatal booking appointment, in the first trimester of pregnancy, were anonymously analysed for the presence of Carbohydrate Deficient Transferrin (CDT), a validated marker of chronic alcohol exposure (normalising 2-3 weeks from abstinence) and Gamma-glutamyltransferase (GGT), a liver enzyme elevated for up to 8 weeks after alcohol exposure.

Delivering value through volume.

Procedural and 30-day outcomes with MitraClip are associated with center volumes. FDA approval of MitraClip led to greater volumes and trends toward improved outcomes. Possible extension of indications for MitraClip may further increase volumes.

Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association.

Intracranial endovascular interventions provide effective and minimally invasive treatment of a broad spectrum of diseases. This area of expertise has continued to gain both wider application and greater depth as new and better techniques are developed and as landmark clinical studies are performed to guide their use. Some of the greatest advances since the last American Heart Association scientific statement on this topic have been made in the treatment of ischemic stroke from large intracranial vessel occlusion, with more effective devices and large randomized clinical trials showing striking therapeutic benefit.

Eluvia drug-eluting vascular stent system for the treatment of symptomatic femoropopliteal lesions.

Endovascular options are increasingly recognized as primary treatments for lower extremity peripheral arterial disease inadequately responsive to noninvasive therapy. Options include balloon angioplasty and stent implantation, and newer technologies incorporate drug coatings to prevent restenosis and reduce the need for reintervention. The Eluvia drug-eluting vascular stent system (Boston Scientific, MA, USA) was designed with a biocompatible fluoropolymer coating to allow for drug elution over time.

Thermodynamically Constrained Averaging Theory: Principles, Model Hierarchies, and Deviation Kinetic Energy Extensions.

The thermodynamically constrained averaging theory (TCAT) is a comprehensive theory used to formulate hierarchies of multiphase, multiscale models that are closed based upon the second law of thermodynamics. The rate of entropy production is posed in terms of the product of fluxes and forces of dissipative processes. The attractive features of TCAT include consistency across disparate length scales; thermodynamic consistency across scales; the inclusion of interfaces and common curves as well as phases; the development of kinematic equations to provide closure relations for geometric extent measures; and a structured approach to model building.

A longitudinal study of cognitive decline in rural Tanzania: rates and potentially modifiable risk factors.

Unlabelled: ABSTRACTBackground:The number of people living with dementia in sub-Saharan Africa (SSA) is expected to increase rapidly in the coming decades. However, our understanding of how best to reduce dementia risk in the population is very limited. As a first step in developing intervention strategies to manage dementia risk in this setting, we investigated rates of cognitive decline in a rural population in Tanzania and attempted to identify associated factors.

Long-term clinical and quality of life outcomes after stenting of femoropopliteal artery stenosis: 3-year results from the STROLL study.

Objectives: To evaluate the clinical and health status outcomes of patients undergoing superficial femoral artery (SFA) revascularization using the Shape Memory Alloy Recoverable Technology (S.M.A.

Hypertension in a resource-limited setting: Is it associated with end organ damage in older adults in rural Tanzania?

Few data from sub-Saharan Africa exist on the effects of hypertension on the organs of the human body. We aimed to establish the prevalence of hypertensive end organ damage (EOD) in an elderly cohort of Tanzanians. The population aged 70 years and over of 2 villages in northern Tanzania (n = 246), had blood pressure (BP) data available from 2010 and 2013, and underwent in-depth follow-up for markers of hypertensive EOD in 2016.

Adoption of the transradial approach for percutaneous coronary intervention and rates of vascular complications following transfemoral procedures: Insights from NCDR.

Objectives: This study was designed to examine the association between adopting the transradial approach for percutaneous coronary intervention (PCI) and rates of vascular complications following transfemoral PCI.

Background: Recent studies raised concerns that operators adopting the transradial approach may lose their transfemoral access skills and experience increased rates of vascular complications.

Methods: Retrospective analysis of data from the NCDR CathPCI Registry to examine the rates of vascular complications among physicians who were femoral operators (>90% of cases) in 2010-2011 and later adopted the transradial approach to PCI among low-, intermediate-, or high-level adopters (≤33%, 34-66%, and >66%, respectively) in 2014-2015.

Jetstream Atherectomy System treatment of femoropopliteal arteries: Results of the post-market JET Registry.

Objectives: To report on procedural, safety, and effectiveness outcomes of real-world practice with the Jetstream rotational atherectomy system for treatment of femoropopliteal artery lesions.

Background: Safety and effectiveness of treatment with the Jetstream device has been demonstrated in clinical trials, but outcomes during real-world clinical practice have yet to be examined.

Methods: 241 patients (66% male, mean age 67years, 41% diabetes; Rutherford 1-3) with de novo or restenotic (non-stent) femoropopliteal lesions ≥4cm in length were recruited.

Use of a novel embolic filter in carotid artery stenting: 30-Day results from the EMBOLDEN Clinical Study.

Objectives: The EMBOLDEN study was conducted to test the safety and efficacy of a novel emboli protection filter design for use in carotid artery stenting (CAS) in patients with severe carotid stenosis who were at high risk of operative complications from carotid endarterectomy (CEA).

Background: General considerations for filter design usually involve trade-offs between trackability/profile and wall apposition/capture efficiency. The GORE Embolic Filter (GEF) is intended to address these design goals via a hybrid construction.

Good enough…isn't.

Mild PVR has been shown to increase all-cause and cardiovascular mortality after TAVR, especially in high surgical risk patients. Mechanistic and associative causes, as well imprecise ascertainment have been suggested as underlying etiologies of this association. Ongoing trials with newer valve technologies, broader patient inclusion and more systematic assessment of PVR may provide further insight into the prevalence, causality, and outcome of PVR.

The role and profile of the informal carer in meeting the needs of people with advancing Parkinson's disease.

Background: Many people with Parkinson's disease (PD) (PwP) require care from either informal or formal carers, due to worsening symptoms. Carer strain is a recognised consequence of caring. However there are few data on the role and profile of informal carers and if this impacts on carer strain.

Stigma and functional disability in relation to marriage and employment in young people with epilepsy in rural Tanzania.

Purpose: To assess the impact of childhood epilepsy on social transitioning outcomes for young people with epilepsy (YPWE) living in Tanzania, and to explore influences on these outcomes.

Methods: At six years from baseline, we followed up 84 YPWE and 79 age- sex- and village- matched controls recruited into a case-control study of childhood epilepsy in rural northern Tanzania. Data were collected from interviews with young people and their carers using a structured questionnaire.

Thoracic endovascular repair versus medical management for acute uncomplicated type B aortic dissection.

Background: Current treatment options and outcomes for acute uncomplicated thoracic Type-B aortic dissection (TBAD) remain unclear between medical management (MED) and thoracic endovascular aortic repair (TEVAR). In this study we aim to compare both strategies in terms of all-cause mortality, aortic dilation, and aortic rupture.

Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were queried from January 1990 through March 2017.

Frailty in nonagenarians: A bridge too far?

There is no clear consensus about the definition of frailty and how to accurately measure it. There is accumulating evidence that frail old patients have worse outcomes after TAVR compared to non-frail patients. Further randomized research is needed to confirm those concerns and to standardize the role of frailty assessment in patient selection for TAVR.

Preoperative screening and intervention for mild anemia with low iron stores in elective hip and knee arthroplasty.

Background: Preoperative anemia in patients undergoing elective hip and knee arthroplasty is associated with increased postoperative morbidity and mortality, red blood cell (RBC) transfusion, and length of stay (LOS). The aim of this study was to assess the effect of optimizing hemoglobin (Hb) levels before elective primary hip and knee arthroplasty.

Study Design And Methods: This is a prospective comparative cohort study of patients who underwent elective hip and knee arthroplasty before (control) and after (intervention) the launch of a Hb optimization program.

VASO (Vitamin D and Arthroplasty Surgery Outcomes) study - supplementation of vitamin D deficiency to improve outcomes after total hip or knee replacement: study protocol for a randomised controlled feasibility trial.

Background: Vitamin D deficiency has been linked to poor outcomes after total hip replacement (THR) or total knee replacement (TKR), including lower patient-reported outcome measures (PROMs), peri-prosthetic infection and longer hospital stay. We present a randomised feasibility trial protocol designed to prospectively investigate the influence of vitamin D testing, and subsequent supplementation for deficiency, prior to THR/TKR.

Methods/design: One hundred adult patients undergoing primary THR/TKR for osteoarthritis at two NHS hospital trusts in North East England will be recruited.

Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland.

Objectives: External ventricular drain (EVD) insertion is a common neurosurgical procedure. EVD-related infection (ERI) is a major complication that can lead to morbidity and mortality. In this study, we aimed to establish a national ERI rate in the UK and Ireland and determine key factors influencing the infection risk.

New Innovations in Drug-Eluting Stents for Peripheral Arterial Disease.

Purpose Of Review: The purpose of this paper was to provide a review of the burden of peripheral arterial disease; to examine older therapies and their limitations; and especially to highlight new treatment innovations as well as the data supporting their use.

Recent Findings: Building on the success of paclitaxel in the prevention of restenosis in the peripheral circulation, the newest generation drug-eluting stent is presented, which combines paclitaxel with a polymer-allowing the drug to be eluted slowly over 12 months. The positive results of the pilot MAJESTIC study led to the ongoing IMPERIAL trial.

Carotid Stent Fractures Are Not Associated With Adverse Events: Results From the ACT-1 Multicenter Randomized Trial (Carotid Angioplasty and Stenting Versus Endarterectomy in Asymptomatic Subjects Who Are at Standard Risk for Carotid Endarterectomy With Significant Extracranial Carotid Stenotic Disease).

Background: The impact of carotid artery stent fractures on the incidence of adverse clinical events remains unclear. The objective of this study is to report the stent fracture rate and its association with in-stent restenosis and adverse outcomes in the ACT-1 trial (Carotid Angioplasty and Stenting Versus Endarterectomy in Asymptomatic Subjects Who Are at Standard Risk for Carotid Endarterectomy With Significant Extracranial Carotid Stenotic Disease).

Methods: ACT-1 is a prospective multicenter trial of patients who have standard surgical risk with severe asymptomatic carotid artery stenosis randomly assigned to carotid artery stenting or carotid endarterectomy (Abbott Vascular).

Risk Factors for Delirium in Older Medical Inpatients in Tanzania.

Background: The risk factors for prevalent delirium in older hospitalised adults in Sub-Saharan Africa (SSA) remain poorly characterised.

Methods: A total of 510 consecutive admissions of adults aged ≥60 years to acute medical wards of Kilimanjaro Christian Medical Centre in northern Tanzania were recruited. Patients were assessed within 24 h of admission with a risk factor questionnaire, physiological observations, neurocognitive assessment, and informant interview.

Beliefs, knowledge and attitudes towards Parkinson's disease among a Xhosa speaking black population in South Africa: A cross-sectional study.

Introduction: Many patients with Parkinson's disease (PD) in sub-Saharan Africa (SSA) are thought to be undiagnosed and untreated, leading to poor health outcomes. Increasing rates of diagnosis and treatment, with consequent improvements in the quality of life of people with PD in SSA requires an understanding of how PD is perceived and conceptualized within communities.

Methods: A cross-sectional survey was conducted among a group of Xhosa speaking black South Africans.