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Harfouche, Tieme Breternitz, Ana Paula Dalla Corte, Marieli Ruza, and Alexandre Behling. "USO DE APLICATIVOS EM SMARTPHONE PARA MEDIÇÕES DE ÁRVORES." BIOFIX Scientific Journal 4, no. 1 (January 6, 2019): 07. http://dx.doi.org/10.5380/biofix.v4i1.62532.
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Este trabalho visou verificar a precisão de aplicativos de smartphone para medir indiretamente a altura de árvores e a distância entre o operador e a árvore. Como testemunha para medir altura, adotou-se o Hipsômetro Vertex IV (T0a) e, para distância, a variável medida com trena (T0b). Foram selecionadas 30 árvores isoladas do Campus da Universidade Federal do Paraná em Curitiba - PR e 30 árvores pertencentes à um plantio de Eucalyptus sp. na Fazenda Experimental Canguiri em Pinhais – PR. Foram 7 tratamentos testados para altura: Smart Measure (T1a), sMeasure (T2a), Distance meter (T3a), Hypsometer (T4a), 3D-Prumo (T5a), Height and Distance (T6a) e Tree-H (T7a). Foram 8 tratamentos para medir distância: Smart Measure (T1b), sMeasure (T2b), Distance meter (T3b), Hypsometer (T4b), 3D-Prumo (T5b), Height and Distance (T6b), Easy Measure (T7b) e Smart Distance (T8b). Avaliou-se a precisão dos aplicativos com o teste t de Student pareado com 5% de significância em relação às testemunhas e cálculo dos erros. Para altura em árvores isoladas, o tratamento T2a apresentou diferença estatística a probabilidade de 5%. O tratamento T6a obteve menor erro (2,48 m). No plantio de Eucalyptus sp., os tratamentos T1a, T6a e T7a apresentaram diferenças significativas e T3a obteve menor erro (2,99 m). Para a medição de distância em árvores isoladas, os tratamentos T4b e T6b não apresentaram diferença e T4b apresentou menor erro (2,28 m). No plantio, todos apresentaram diferença estatística. A incorporação de aplicativos para smartphones é alternativa para uso em inventários florestais para alturas. Para distâncias, deve-se ter cautela.
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Cao, Chuanwu, So-Yeon Kim, Gun Ha Kim, Ji Hoon Shin, In Chul Nam, Meshari Alali, Hee Ho Chu, and Heung-Kyu Ko. "Comparison of transradial and transfemoral access for transcatheter arterial embolization of iatrogenic renal hemorrhage." PLOS ONE 16, no. 8 (August 20, 2021): e0256130. http://dx.doi.org/10.1371/journal.pone.0256130.
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Background There are few reports of renal artery embolization (RAE) via transradial access (TRA) for renal hemorrhage, and none have compared outcomes of RAE via TRA and transfemoral access (TFA). The objective was to compare technical and clinical outcomes in patients undergoing RAE via TRA or TFA for iatrogenic renal hemorrhage. Materials and methods This study included 45 RAE procedures (16 TRA and 29 TFA) for iatrogenic renal hemorrhage in 43 patients performed at a tertiary referral center between October 2018 and December 2020. Information regarding underlying diseases, coagulation status, angiographic and embolization procedure details, technical and clinical successes, and complications were retrospectively evaluated. Results There were no differences in demographics, underlying diseases, updated Charlson comorbidity scores, angiographic findings, and volume of contrast material between the TRA and TFA groups. By contrast, prothrombin time and international normalized ratio were significantly lower in the TRA than in the TFA group. Embolic materials differed significantly in the two groups. Procedure duration, fluoroscopy time, digital subtraction angiography number, and dose area product were slightly lower in the TRA than in the TFA group, but the differences were not statistically significant. Technical and clinical success rates in the TRA and TFA groups were 100% and 96.6%, and 100% and 96.6%, respectively. No patient in either group experienced procedure-related complications during a 4 week follow-up period. Conclusion RAE via TRA in the management of iatrogenic renal hemorrhage was safe and feasible, with similar procedure duration and radiation exposure to RAE via TFA. TRA may be an acceptable alternative to TFA in these patients.
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Catapano, Joshua S., Vance L. Fredrickson, Tatsuhiro Fujii, Tyler S. Cole, Stefan W. Koester, Jacob F. Baranoski, Daniel D. Cavalcanti, et al. "Complications of femoral versus radial access in neuroendovascular procedures with propensity adjustment." Journal of NeuroInterventional Surgery 12, no. 6 (December 16, 2019): 611–15. http://dx.doi.org/10.1136/neurintsurg-2019-015569.
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BackgroundThe transradial artery (TRA) approach for neuroendovascular procedures continues to gain popularity, but neurointerventionalists still lag behind interventional cardiologists in the adoption of a TRA-first approach. This study compares the complications and efficiency of the TRA approach to the standard transfemoral artery (TFA) approach at our institution during our initial phase of adopting a TRA-first approach.MethodsA retrospective analysis was performed on all consecutive neuroangiographic procedures performed at a large cerebrovascular center from October 1, 2018 to June 30, 2019. The standard TFA approach was compared with TRA access, with the primary outcome of complications analyzed via a propensity-adjusted analysis.ResultsA total of 1050 consecutive procedures were performed on 877 patients during this 9-month period; 206 (20%) procedures were performed via TRA and 844 (80%) via TFA. The overall complication rate was significantly higher with the TFA procedures than with the TRA procedures (7% (60/844) vs 2% (4/206), respectively; p=0.003). A propensity-adjusted analysis showed that the TFA approach was a significant risk factor for a complication (OR 3.6, 95% CI 1.3 to 10.2, p=0.01). However, the propensity analysis showed that fluoroscopy times were on average 4 min less for TFA procedures than for TRA procedures (p=0.003).ConclusionThe TRA approach for neuroendovascular procedures appears to be safer than the TFA approach. Although a steep learning curve is initially encountered when adopting the TRA approach, the transition to a TRA-first practice can be performed safely for neurointerventional procedures and may reduce complications.
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Liu, Yandong, Xingzhu Wen, Jun Bai, Xiangguo Ji, Kangkang Zhi, and Lefeng Qu. "A Single-Center, Randomized, Controlled Comparison of the Transradial vs Transfemoral Approach for Cerebral Angiography: A Learning Curve Analysis." Journal of Endovascular Therapy 26, no. 5 (July 1, 2019): 717–24. http://dx.doi.org/10.1177/1526602819859285.
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Purpose: To compare the characteristics and learning curve of the transfemoral approach (TFA) vs the transradial approach (TRA) for cerebral angiography. Materials and Methods: Between February 2016 and April 2017, 101 patients undergoing cerebral angiography were enrolled. Fifty-one patients (mean age 67 years; 40 men) were randomized to TFA and 50 (mean age 68 years; 41 men) to TRA using a computer-generated random table. The patients’ demographic and angiographic data were recorded and analyzed. The learning curve of a novice interventionist was analyzed for procedure time, puncture time, fluoroscopy time, and contrast volume as markers of technical proficiency with TFA compared with TRA. Median values are given with the interquartile range (IQR). Results: Procedure time [35 (IQR 30, 47.5) vs 31.0 (IQR 25.0, 48.9) minutes, p=0.16), fluoroscopy time [10.3 (IQR 7.6, 13.9) vs 9.4 (IQR 6.1, 17.6) minutes, p=0.70], contrast volume [105 (IQR 92, 120) vs 95.5 (IQR 90, 111.3) mL, p=0.13), radiation exposure [390.2 (IQR 268.2, 617.9) vs 455.8 (IQR 286.8, 602.3) mGy, p=0.74], and the number of catheter exchanges [1 (IQR 1, 3) vs 1 (IQR 1, 1), p=0.06] were not significantly different between the TFA and TRA groups, respectively, but puncture time was shorter with TFA than with TRA [0.6 (IQR 0.5, 1.1) vs 1 (IQR 0.6, 1.9) minutes, p=0.01]. The learning curve was steeper with TRA than with TFA in the beginning stages of training, but with increasing experience, the procedure and fluoroscopy times were better for TRA than for TFA. Training progress was made earlier in TRA. Conclusion: TRA is a reasonable alternative to TFA for cerebral angiography. TRA has a shorter learning curve for novice interventionists.
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Snelling, Brian M., Samir Sur, Sumedh S. Shah, Justin Caplan, Priyank Khandelwal, Dileep R. Yavagal, Robert M. Starke, and Eric C. Peterson. "Transradial Approach for Complex Anterior and Posterior Circulation Interventions: Technical Nuances and Feasibility of Using Current Devices." Operative Neurosurgery 17, no. 3 (November 28, 2018): 293–302. http://dx.doi.org/10.1093/ons/opy352.
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AbstractBACKGROUNDDespite several studies analyzing the safety of transradial access (TRA) for neurointervention compared to transfemoral approach (TFA), neurointerventionalists are apprehensive about implementing TRA. From our positive institutional experience, we now utilize TRA first line for a majority of our cases. Here, we present our single-institution experience.OBJECTIVETo determine safety and feasibility of TRA for neurointervention.METHODSThrough retrospective review of patients receiving TRA for anterior and posterior circulation cerebrovascular interventions at our institution between December 2015 and January 2018, we present our experience regarding this transition, while focusing on technique, complications, feasibility, indications, and limitations.RESULTSOne hundred five procedures were performed on 92 patients (anterior circulation: 77%; posterior circulation: 23%). Radial artery access was achieved in all patients. Twenty-nine cases constituted mechanical thrombectomy, 33 cases represented intracranial aneurysms treatments, and 33 cases included interventions like angioplasty, balloon test occlusion, chemotherapy delivery, and thrombolysis. TRA was used as second-line access to TFA in 5 instances due to aortic arch anomalies and atherosclerotic disease. Minor access-site complications were seen in 2.85% of patients. Ten procedures (9.0%) could not be completed with TRA, with crossover to TFA occurring in 7 cases.CONCLUSIONTRA is safe and feasible for the majority of neurointerventional procedures and provides decreased risk of major access-site complications compared to TFA. Perceived limitations of TRA can likely be eliminated via operator experience and engineering ingenuity; thus, there is a role for TRA for neurointervention, especially in patients with increased risk of access-site complications from TFA.
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Khan, Muhammad Ijaz, Shireen Shah, Hamza Ashfaq, and Muhammad Kashif Rafiq. "Upper Extremity Function Following Transradial Percutaneous Coronary Intervention: Results of the ARCUS Trail." Pakistan Journal of Medical and Health Sciences 16, no. 12 (December 31, 2022): 769–71. http://dx.doi.org/10.53350/pjmhs20221612769.
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Background: Regardless of the recent rise in the number of articles published on transradial access (TRA) for diagnostic coronary intervention and complications of the upper extremity may be underestimated. The aim of this study to investigate the prevalence of upper extremity disorder by comparing the transradial and transfemoral artery percutaneous coronary intervention (TR-PCI). Study Design: This was cross-sectional study and conducted in the Ayub teaching hospital Abbotabad, for six months July 2022 to December 2022. Materials and Methods: The total participants were 250 which included 200 TRA and 50 TFA participants and involving any type of cerdiointervention, thrombectomies for acute ischemic stroke, and carotid artery stents. The participants were selected by sampling technique were interviewed in the Khyber teaching hospital Peshawar. We analyzed dependent and independent variables. Data analysis statistically by SPSS 22 version. The upper extremity scores were analyzed using Chi-squared test. Results: There were total 250 participants which include 80%TRA and 20% TFA in this research. The majority of the participants in TRA were in the age group (59.2±6.7) years and in TFA group (55.5±7.1) years. The baseline characteristics of the total participants was no significant difference between transradial artery (TRA) and transradial femoral artery (TFA). During follow-up, Cochran's Q-test revealed a significant increase in UED in the intervention extremity of the TRA group p=0.003 and in the TFA group's right upper extremity (p=0.001). During follow-up, 1% TRA participants had RAO, which recanalized over time. Three weeks after the procedure, 10% of participants in the TRA group were referred to a hand specialist then TFA participants. Conclusion: Transradial arterial access (TRA) for percutaneous coronary artery intervention has been linked to lower access site complication rates and higher patient satisfaction when compared to transfemoral access (TFA) after 3 weeks follow up. Keywords: Transradial artery (TRA), Transfemoral artery (TFA), Rotational acetabular osteotomy (RAO).
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Young, Bradley L., Shawna L. Watson, Jorge L. Perez, Gerald McGwin, Jasvinder A. Singh, and Brent A. Ponce. "Trends in Joint Replacement Surgery in Patients with Rheumatoid Arthritis." Journal of Rheumatology 45, no. 2 (December 1, 2017): 158–64. http://dx.doi.org/10.3899/jrheum.170001.
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Objective.This study analyzed trends in large total joint arthroplasties (TJA) and in the proportion of these procedures performed on patients with rheumatoid arthritis (RA).Methods.The US Nationwide Inpatient Sample (2002–2012) was used to identify the incidences of total shoulder (TSA), elbow (TEA), knee (TKA), hip (THA), and ankle (TAA) arthroplasty and the proportion of these performed with coexisting RA.Results.The prevalence of RA among patients with TJA increased 3.0%. The prevalence of RA among cases of TEA and TSA decreased by 50% (p < 0.0001) and 18% (p = 0.0016), respectively; a 38.0% decrease occurred in the prevalence of RA among TAA (p = 0.06); and nonsignificant increases were seen among THA and TKA. The average age difference between RA and non-RA patients undergoing TJA narrowed by 2 years (p < 0.0001). There was a greater reduction in the proportion of TSA, TEA, and TAA groups among women with RA than men with RA. In the TSA and TEA groups, there was a reduction in the proportion of whites with RA, but not blacks. The proportion of privately insured TSA and TAA patients with RA decreased, while patients with RA undergoing TSA, TEA, or TAA who were receiving Medicaid (government medical insurance) remained relatively stable over time.Conclusion.The prevalence of RA has decreased among TSA and TEA patients. A nonsignificant decline occurred among TAA patients. The average age of TJA patients with RA is beginning to mirror those without RA. Sex ratios for TSA, TEA, and TAA patients are following a similar pattern. These results may be evidence of the success of modern RA treatment strategies.
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Li, Yangchun, Stephanie H. Chen, Alejandro M. Spiotta, Pascal Jabbour, Michael R. Levitt, Peter Kan, Christoph J. Griessenauer, et al. "Lower complication rates associated with transradial versus transfemoral flow diverting stent placement." Journal of NeuroInterventional Surgery 13, no. 1 (June 2, 2020): 91–95. http://dx.doi.org/10.1136/neurintsurg-2020-015992.
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BackgroundCurrently, there are no large-scale studies in the neurointerventional literature comparing safety between transradial (TRA) and transfemoral (TFA) approaches for flow diversion procedures. This study aims to assess complication rates in a large multicenter registry for TRA versus TFA flow diversion.MethodsWe retrospectively analyzed flow diversion cases for cerebral aneurysms from 14 institutions from 2010 to 2019. Pooled analysis of proportions was calculated using weighted analysis with 95% CI to account for results from multiple centers. Access site complication rate and overall complication rate were compared between the two approaches.ResultsA total of 2,285 patients who underwent flow diversion were analyzed, with 134 (5.86%) treated with TRA and 2151 (94.14%) via TFA. The two groups shared similar patient and aneurysm characteristics. Crossover from TRA to TFA was documented in 12 (8.63%) patients. There were no access site complications in the TRA group. There was a significantly higher access site complication rate in the TFA cohort as compared with TRA (2.48%, 95% CI 2.40% to 2.57%, vs 0%; p=0.039). One death resulted from a femoral access site complication. The overall complications rate was also higher in the TFA group (9.02%, 95% CI 8.15% to 9.89%) compared with the TRA group (3.73%, 95% CI 3.13% to 4.28%; p=0.035).ConclusionTRA may be a safer approach for flow diversion to treat cerebral aneurysms at a wide range of locations. Both access site complication rate and overall complication rate were lower for TRA flow diversion compared with TFA in this large series.
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Chen, Stephanie H., Brian M. Snelling, Samir Sur, Sumedh Subodh Shah, David J. McCarthy, Evan Luther, Dileep R. Yavagal, Eric C. Peterson, and Robert M. Starke. "Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: comparison of technical and clinical outcomes." Journal of NeuroInterventional Surgery 11, no. 9 (January 22, 2019): 874–78. http://dx.doi.org/10.1136/neurintsurg-2018-014485.
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BackgroundA transradial approach (TRA) is associated with fewer access site complications than a transfemoral technique (TFA).However, there is concern that performing mechanical thrombectomy (MT) via TRA may lead to longer revascularization times and thus worse outcomes. Nonetheless, TRA may confer added benefits in MT since navigation of challenging aortic arch and carotid anatomy is often facilitated by a right radial artery trajectory.ObjectiveTo compare outcomes in patients who underwent MT via TRA versus TFA.MethodsWe performed a retrospective review of our institutional database to identify 51 patients with challenging vascular anatomy who underwent MT for anterior circulation large vessel occlusion between February 2015 and February 2018. Patient characteristics, procedural techniques, and outcomes were recorded. TFA and TRA cohorts were compared.ResultsOf the 51 patients, 18 (35%) underwent MT via TRA. There were no significant cohort differences in patient characteristics, clot location, or aortic arch type and presence of carotid tortuosity. There were no significant differences in outcomes between the two cohorts, including single-pass recanalization rate (54.5% vs 55.6%, p=0.949) and average number of passes (1.9 vs 1.7, p=0.453). Mean access-to-reperfusion time (61.9 vs 61.1 min, p=0.920), successful revascularization rates (Thrombolysis in Cerebral Infarction score ≥2b 87.9% vs 88.9%, p=1.0) and functional outcomes (modified Rankin Scale score≤2, 39.4% vs 33.3%, p=0.669) were similar between TFA and TRA cohorts, respectively.ConclusionsOur results demonstrate equivalence in efficacy and efficiency between TRA and TFA for MT of anterior circulation large vessel occlusion in patients with challenging vascular anatomy. TRA may be better than TFA in well-selected patients undergoing MT.
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Amankwah, Curtis, Lauren Lombardo, John Rutledge, Ahsan Sattar, Bree Chancellor, and Dorothea Altschul. "Comparison of radiation exposure and clinical outcomes between transradial and transfemoral diagnostic cerebral approaches: a retrospective study." BMJ Surgery, Interventions, & Health Technologies 4, no. 1 (January 2022): e000110. http://dx.doi.org/10.1136/bmjsit-2021-000110.
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ObjectiveTo identify and compare patient and procedural variables that are associated with a high radiation dose exposure and worse clinical outcomes between transradial arterial (TRA) and transfemoral arterial (TFA) approaches.DesignThis was a retrospective analysis.SettingA community hospital during the initial phase of adopting a TRA-first approach.ParticipantsA resultant 215 subjects who only underwent diagnostic cerebral angiograms (DCA) after excluding all therapeutic procedures and patients under 18 years.InterventionsOnly DCA from 1 May 2018 to 31 January 2021.Main outcome measuresWe compared radiation exposure parameters (total fluoroscopy time (FT), total radiation dose (TD) and dose area product (DAP), number of vessels injected and Patient-Reported Global Health Physical and Mental Outcome Scores (PROGHS) at 30 days postprocedure between groups.ResultsFT was significantly greater in TRA compared with TFA (p<0.001). In addition, TRA had a significantly higher TD (p=0.002) and DAP (p=0.005) when compared with TFA. Analysis of only 6-vessel DCAs also showed that TRA had a significantly higher FT, DAP and TD in comparison to TFA. Despite observing a longer FT in TRA, results showed fewer vessels injected and a notably lower success rate in acquiring a 6-vessel DCA using the TRA. Further analysis of the effect of vessel number on FT using general linear models showed that with every increase of one vessel, the FT increases by 2.2 min for TRA (p<0.001; 95% CI 1.03 to 3.36) and by 1.3 min for TFA (p<0.001; 95% CI 0.72 to 1.83). There was no significant difference between groups in PROGHS mental and physical t-scores at 30 days postprocedure, even though our cohort showed a significantly greater percentage of TRA procedures done in the outpatient setting.ConclusionsAdopting a TRA first approach for DCAs may be initially associated with a higher radiation dose for the patient. Better strategies and devices are needed to mitigate this effect.
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Snelling, Brian M., Samir Sur, Sumedh S. Shah, Priyank Khandelwal, Justin Caplan, Rianna Haniff, Robert M. Starke, Dileep R. Yavagal, and Eric C. Peterson. "Transradial cerebral angiography: techniques and outcomes." Journal of NeuroInterventional Surgery 10, no. 9 (January 8, 2018): 874–81. http://dx.doi.org/10.1136/neurintsurg-2017-013584.
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BackgroundDespite several retrospective studies analyzing the safety and efficacy of transradial access (TRA) versus transfemoral access (TFA) for cerebral angiography, this transition for neurointerventional procedures has been gradual. Nonetheless, based on our positive initial institutional experience with TRA for mechanical thrombectomy in acute ischemic stroke patients, we have started transitioning more of our cerebral angiography cases to TRA. Here we present our single institution experience.MethodsWe performed a retrospective review of patients receiving TRA cerebral angiography at our institution between January 2016 and February 2017. We present our experience transitioning from TFA to TRA, including our criteria for patient selection, technical nuances, patient experience, complications, and operator learning curve.ResultsWe included 148 angiograms performed in 141 people by one of four operators. No major complications were observed, and the technical success of the procedures was consistent with those of TFA. Marked improvement in operator efficiency was achieved in a short number of cases during this transition when looking at operator proficiency as a function of angiograms performed and days of exposure to TRA (4.3 vs 3.6 min/vessel, P<0.05).ConclusionsSafety and efficiency can be preserved while transitioning to TRA. While further investigation is necessary to support transition to TRA, these findings should call for a re-evaluation of the role of TRA in catheter cerebral angiography.
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Chen, Stephanie H., Brian M. Snelling, Sumedh Subodh Shah, Samir Sur, Marie Christine Brunet, Robert M. Starke, Dileep R. Yavagal, Joshua W. Osbun, and Eric C. Peterson. "Transradial approach for flow diversion treatment of cerebral aneurysms: a multicenter study." Journal of NeuroInterventional Surgery 11, no. 8 (January 22, 2019): 796–800. http://dx.doi.org/10.1136/neurintsurg-2018-014620.
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BackgroundThe transradial approach (TRA) to endovascular procedures decreases access site morbidity and mortality in comparison with the traditional transfemoral technique (TFA). Despite its improved safety profile, there is a concern that TRA is less favorable for neurointerventional procedures that require large coaxial systems to manage the small tortuous cerebral vessels.ObjectiveTo report our experience with TRA for flow diverter placement for treatment of unruptured cerebral aneurysms.MethodsWe performed a retrospective review of prospective institutional databases at two high-volume centers to identify 49 patients who underwent flow diversion for aneurysm treatment via primary TRA between November 2016 and November 2018. Patient demographics, procedural techniques, and clinical data were recorded.ResultsOf the 49 patients, 39 underwent successful flow diversion placement by TRA. Ten patients were converted to TFA after attempted TRA. There were no procedural complications. Reasons for failure included tortuosity in eight patients and severe radial artery spasm in two.ConclusionsIn the largest reported series to date of flow diverter deployment via TRA for aneurysm treatment, we demonstrate the technical feasibility and safety of the method. The most common reason for failure of TRA was an acute angle of left common carotid artery origin or left internal carotid artery tortuosity. Overall, our data suggest that increasing adoption of TRA is merited given its apparent equivalence to the current TFA technique and its documented reduction in access site complications.
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Kalpak, Oliver, Donco Donev, Hristo Pejkov, Slobodan Antov, Gjorgji Kalpak, and Sasko Kedev. "Transition Towards Transradial Approach Improves Outcomes of Acute Myocardial Infarction PCI." PRILOZI 38, no. 2 (September 1, 2017): 69–78. http://dx.doi.org/10.1515/prilozi-2017-0024.
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Abstract Introduction and aim: Transradial (TRA) instead of transfemoral (TFA) approach strategy has been presented in research literature as superior access strategy especially for acute ST elevation myocardial infarction (STEMI) primary percutaneous coronary intervention (PCI). There is a paucity of registry-based data of outcomes from default TRA strategy compared to TFA. Materials and methods: All-comers STEMI PCI institutional Registry identified 1808 consecutive patients in time-frame of 40 months from 2007 to 2010, without making any exclusions. Moreover, we applied Propensity Score Matching (PSM) to replace randomization, address the potential confounding and selection bias. PSM derived 565 congruent pairs of patients from the groups. Results: After 30 days the primary composite endpoint of major adverse cardiovascular events (MACE) was in favor of TRA 6.5% vs. 12.4% in TFA group, simultaneously secondary endpoints of death in TRA with rate of 4.8% and with rate of 10.1% in TFA. Moreover, the rate of major access related bleeding was 1.1% in TRA vs. 8.5% in TFA, in contrast the major non-access related bleeding was 1.8% and 2.4% respectively showed no significant difference. One year Kaplan Meier survival plots were in favor of TRA. Conclusions: Default transradial access strategy is associated with improved STEMI PCI outcomes.
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Catapano, Joshua S., Andrew F. Ducruet, Candice L. Nguyen, Neil Majmundar, D. Andrew Wilkinson, Tyler S. Cole, Jacob F. Baranoski, et al. "Propensity-Adjusted Comparative Analysis of Radial Versus Femoral Access for Neurointerventional Treatments." Neurosurgery 88, no. 6 (February 13, 2021): E505—E509. http://dx.doi.org/10.1093/neuros/nyab036.
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Abstract BACKGROUND Transradial artery (TRA) catheterization for neuroendovascular procedures is associated with a lower risk of complications than transfemoral artery (TFA) procedures. However, the majority of literature on TRA access pertains to diagnostic procedures rather than interventional treatments. OBJECTIVE To compare TRA and TFA approaches for cerebrovascular interventions. METHODS All patients with an endovascular intervention performed at a single center from October 1, 2018 to December 31, 2019 were retrospectively analyzed. Patients were grouped into 2 cohorts on the basis of whether TRA or TFA access was used. Outcomes included complications, fluoroscopy times, and total contrast administered. RESULTS A total 579 interventional treatments were performed during the 15-mo study period. TFA procedures (n = 417) were associated with a significantly higher complication rate than TRA (n = 162) procedures (43 cases [10%] vs 5 cases [3%]; P = .008). After excluding patients who underwent thrombectomy and performing a propensity adjustment (including age, sex, pathology, procedure, sheath size, and catheter size), TRA catheterization was associated with decreased odds of a complication (odds ratio, 0.25; 95% CI 0.085-0.72; P = .01), but no significant difference in the amount of contrast administered (6.7-mL increase; 95% CI, −7.2 to 20.6; P = .34) or duration of fluoroscopy (2.1-min increase; 95% CI, −2.5 to 6.7; P = .37) compared with TFA catheterization. CONCLUSION Neurointerventional procedures and treatments for a variety of pathologies can be performed successfully using the TRA approach, which is associated with a lower risk of complications and no difference in fluoroscopy duration compared with the TFA approach.
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Chen, Stephanie H., Marie-Christine Brunet, Samir Sur, Dileep R. Yavagal, Robert M. Starke, and Eric C. Peterson. "Feasibility of repeat transradial access for neuroendovascular procedures." Journal of NeuroInterventional Surgery 12, no. 4 (October 5, 2019): 431–34. http://dx.doi.org/10.1136/neurintsurg-2019-015438.
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IntroductionTransradial artery access (TRA) for cerebrovascular angiography is increasing due to decreased access site complications and overwhelming patient preference. While interventional cardiologists have reported up to 10 successive TRA procedures via the same radial access site, this is the first study examining successive use of the same artery for repeat procedures in neurointerventional procedures.1 MethodsWe reviewed our prospective institutional database for all patients who underwent a transradial neurointerventional procedure between 2015 and 2019. Index procedures were defined as procedures performed via TRA after which there was a second TRA procedure attempted. Reasons for conversion to a transfemoral approach (TFA) for subsequent procedures were identified.Results104 patients underwent 237 procedures (230 TRA, 7 TFA). 97 patients underwent ≥2 TRA procedures, 20 patients >3, four patients >4, three patients >5, and two patients >6 TRA procedures. The success rate was 94.7% (126/133) with 52% (66/126) of successive procedures performed via the same radial access site (snuffbox vs antebrachial) while the alternate radial artery segment was used for access in 48% (60/126) of subsequent procedures. There were seven (5.3%) cases requiring crossover to TFA, six cases for radial artery occlusion (RAO) and one for radial artery narrowing.ConclusionSuccessive TRA is both technically feasible and safe for neuroendovascular procedures in up to six procedures. The low failure rate (5.3%) was primarily due to RAO. Thus, even without clinical consequences, strategies to minimize RAO should be optimized for patients to continue to benefit from TRA in future procedures.
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Groenland, Frederik T., Jeroen M. Wilschut, Stijn C. van den Oord, Isabella Kardys, Roberto Diletti, Peter P. de Jaegere, Felix Zijlstra, Joost Daemen, Nicolas M. Van Mieghem, and Wijnand K. den Dekker. "Cardiac Catheterizations in Patients With Prior Coronary Bypass Surgery: Impact of Access Strategy on Short-Term Safety and Long-Term Efficacy Outcomes." Angiology 72, no. 5 (January 19, 2021): 465–73. http://dx.doi.org/10.1177/0003319720987351.
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Little data are available on access strategy outcomes for cardiac catheterizations in patients with prior coronary artery bypass graft surgery (CABG). We investigated the effect of transradial access (TRA) and transfemoral access (TFA) on short-term major vascular complications (MVC) and long-term major adverse cardiovascular events (MACE). In this single-center, retrospective cohort study, 1084 patients met our inclusion criteria (TRA = 469; TFA = 615). The cumulative incidence for the primary safety endpoint MVC at 30 days (a composite of major bleeding, retroperitoneal hematoma, dissection, pseudoaneurysm, and arteriovenous fistula) was lower with TRA (0.7% vs 3.0%, P < .01) and this difference remained significant after propensity score adjustment (odds ratio: 0.24; 95% CI, 0.07-0.83; P = .024). The cumulative incidence for the primary efficacy endpoint MACE at 36 months (a composite of all-cause mortality, myocardial infarction, stroke, and urgent target vessel revascularization) was 28.6% with TRA and 27.6% with TFA, respectively. Kaplan-Meier curves showed no difference for the primary efficacy endpoint ( P = .65). Contrast use (mL) was significantly lower with TRA (130 [100-180] vs 150 [100-213], P < .01). In conclusion, in patients with prior CABG, TRA was associated with significantly fewer short-term MVC and contrast use, but not with a difference in long-term MACE, compared with TFA.
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Piers, Lieuwe H., Maarten A. Vink, and Giovanni Amoroso. "Transradial Approach in Primary Percutaneous Coronary Intervention: Lessons from a High-volume Centre." Interventional Cardiology Review 11, no. 2 (2016): 88. http://dx.doi.org/10.15420/icr.2016:21:3.
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The transradial approach (TRA) is the recommended technique for percutaneous coronary intervention (PCI) in acute coronary syndrome, according to the European Society of Cardiology guidelines. There is a large body of evidence showing reduction in bleeding and mortality when the TRA is used. The TRA is also more convenient for patients, by allowing early mobilisation. Finally, by facilitating patient turnover and fast (re)transfer after the procedure, the TRA enables operators to meet the current recommendations of early invasive therapy in both ST and non-ST-elevation myocardial infarction. On the other hand, the TRA is technically more challenging than the transfemoral approach (TFA) and requires longer learning curve, which hinders its uptake by low-volume operators/centres. Nevertheless, in the hands of experienced high-volume operators, such as at Onze Lieve Vrouwe Gasthuis (OLVG) Amsterdam, the TRA achieves comparable procedural outcomes and favourable clinical results compared with the TFA, as it is in cases of primary PCI.
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Posham, Raghuram, Lindsay Young, Robert Lookstein, Constantino Pena, Rahul Patel, and Aaron Fischman. "Radial Access for Lower Extremity Peripheral Arterial Interventions: Do We Have the Tools?" Seminars in Interventional Radiology 35, no. 05 (December 2018): 427–34. http://dx.doi.org/10.1055/s-0038-1676341.
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AbstractThe benefits of transradial arterial access (TRA) versus transfemoral arterial access (TFA) have been extensively described in the literature; however, TFA remains the predominant access site choice in the management of peripheral arterial disease (PAD). There are still significant unmet needs for operators wishing to provide the same effective interventions for lower extremity PAD via TRA as with TFA. This article provides an up-to-date review of the literature and devices currently available for operators wishing to treat lower extremity PAD via TRA and the limitations they may face.
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Vaidogas, Egidijus R. "TOWARDS THE INTEGRATION OF PROBABILISTIC RISK ANALYSIS WITH STRUCTURAL ANALYSIS/TIKIMYBINĖS RIZIKOS ANALIZĖS IR KONSTRUKCIJŲ ANALIZĖS INTEGRAVIMO KLAUSIMU." JOURNAL OF CIVIL ENGINEERING AND MANAGEMENT 5, no. 3 (June 30, 1999): 183–92. http://dx.doi.org/10.3846/13921525.1999.10531460.
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Nagrinėjamas tikimybinės rizikos analizės (TRA) ir tikimybinės konstrucijų analizės (TKA) integravimas. Logine grandimi, susiejančia TRA su TKA, laikomos apkrovos, kurios veikia konstrukcines sistemas avarijų, galinčių įvykti pramoniniuose objektuose, metu. Siūloma bendrąjų TRA problemą. dalyti į dvi: (1) tikimybinio avarinių apkrovų modelio parinkimą derinant TRA metodus su teoriniu avarinių procesų modeliavimu bei (2) konstrucijų avarijų tikimybių vertinimą TKA metodais, kartu naudojant anksčiau parinktus avarinių apkrovų modelius. Tikimybinis rizikos vertinimas straipsnyje aptariamas remiantis įvykių medžio analize. Nagrinėjamos įvykių medžio šakos, kurios apima avarinių apkrovų pridėjimą ir jų nulemtą. konstrucijų suirimą ar pažeidimą. Nustatyta, kad tradicinės kiekybinės įvykių medžio analizės priemonės gali būti nepakankamos, vertinant konstrukcijų avarijų dažnius net ir tada, kai Šios priemonės yra derinamos su klasikiniais TKA metodais. Tai lemia didelis fizinių procesų, modeliuojamų įvykių medžio šaka, neapibrėžtumas. TRA ir TKA derinimo problema yra ta, kad iš anksto nežinoma, kokio intensyvumo avarinės apkrovos pasireikš konkretaus scenarijaus avarijos eigoje. Kaip tikimybiniai apkrovų modeliai TRA uždaviniuose paprastai yra naudojamos rizikos funkcijos (angl. hazard functions). Pasiūlyta, kaip parinkti rizikos funkcijų šeimą apkrovai, kurios pridėjimą lemia keletas fizinių procesų (įvykių), sukeliančių šią apkrovą. Ši rizikos funkcijų šeima išreiškia stochastinį ir pažintinį (angl. state-of-knowledge) neapibrėžtumą avarinės apkrovos intensyvumo atžvilgiu. Parodyta, kaip panaudoti pasirinktąją rizikos funkcijų šeimą vertinant konstrukcijų avarijos dažnį ir kaip pateikti tokio vertinimo rezultatus. Išnagrinėti trys pavyzdžiai apie avarijas pramoniniuose objektuose ir su jomis susijusias apkrovas. Daugiausia dėmesio skirta apkrovoms, kylančioms avarinių sprogimų metu.
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Majmundar, Neil, Pratit Patel, Vincent Dodson, Ivo Bach, James K. Liu, Luke Tomycz, and Priyank Khandelwal. "First case series of the transradial approach for neurointerventional procedures in pediatric patients." Journal of Neurosurgery: Pediatrics 25, no. 5 (May 2020): 492–96. http://dx.doi.org/10.3171/2019.12.peds19448.
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OBJECTIVEThe transradial approach (TRA) has been widely adopted by interventional cardiologists but is only now being accepted by neurointerventionalists. The benefits of the TRA over the traditional transfemoral approach (TFA) include reduced risk of adverse clinical events and faster recovery. The authors assessed the safety and feasibility of the TRA for neurointerventional cases in the pediatric population.METHODSPediatric patients undergoing cerebrovascular interventions since implementation of the TRA at the authors’ institution were retrospectively reviewed. Pertinent patient information, procedure indications, vessels catheterized, fluoroscopy time, and complications were reviewed.RESULTSThere were 4 patients in this case series, and their ages ranged from 13 to 15 years. Each patient tolerated the procedure performed using the TRA without any postprocedural issues, and only 1 patient experienced radial artery spasm, which resolved with the administration of intraarterial verapamil. None of the patients required conversion to the TFA.CONCLUSIONSThe TRA can be considered a safe alternative to the TFA for neurointerventional procedures in the pediatric population and provides potential advantages. However, as pediatric patients require special consideration due to their smaller-caliber arteries, routine use of ultrasound guidance is advised when attempting the TRA.
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Gjoreski, Aleksandar, Josif Gjoreski, and Andrea Nancheva. "Uterine Fibroid Embolization via Transradial versus Transfemoral Arterial Access: Technical Results." Open Access Macedonian Journal of Medical Sciences 7, no. 4 (February 25, 2019): 579–82. http://dx.doi.org/10.3889/oamjms.2019.163.
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AIM: This study was designed to compare the safety and feasibility of uterine fibroid embolisation (UFE) via transradial access (TRA) and transfemoral access (TFA).
MATERIAL AND METHODS: A retrospective analysis was conducted for 2 cohorts: 13 cases with already established TFA (from February 2016 to September 2018) and the first 11 procedures performed via TRA (from October 2017 to October 2018). Indications for embolization included: heavy menstrual bleedings (n = 18), lower urinary tract symptoms (n = 2), pelvic pain (n = 3) and abdominal pain (n = 1). One interventional radiologist and one fellow performed all procedures at one institution. Technical success, procedural time, access site complications as well as feedback from patients were assessed for analysis.
RESULTS: Technical success was achieved in 24/24 cases (100%). Unilateral uterine artery embolisation was performed in 7 cases (29.1%) and bilateral in 17 cases (70.8%). Mean procedure time was 72.4 minutes in TFA group, and 60.3 minutes in the TRA group. Mean fluoroscopy time was 25.3 minutes in the TFA group and 21.1 minutes in the TRA group. Access site-related and overall adverse events did not vary significantly among the study cohorts.
CONCLUSIONS: TRA represents a safe and feasible approach for UFE with a comparable safety profile to TFA.
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Nguyễn, Văn Cương, Gia Trọng Nguyễn, Thế Hiệp Nguyễn, Viết Hoan Đặng, and Thị Phương Liên Phạm. "Ứng dụng công nghệ thông tin trong công tác đánh giá độ chính xác số liệu đo sâu đơn tia phục vụ thành lập bản đồ địa hình đáy biển." Tạp chí Khoa học Đo đạc và Bản đồ, no. 48 (June 1, 2021): 29–34. http://dx.doi.org/10.54491/jgac.2021.48.246.
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Đặc thù khi đo sâu phục vụ thành lập bản đồ địa hình đáy biển đó là người đi đo không quan sát trực tiếp được địa hình khu đo. Để phản ánh đúng địa hình đáy biển đòi hỏi phải đo các điểm chi tiết với mật độ dày đặc sử dụng công nghệ đo sâu hồi âm hoặc 1 số công nghệ đo dưới nước khác. Tuy nhiên, dù đã đo dày đặc thì bên cạnh các đường đo sâu cần phải đo thêm các đường kiểm tra. Sau khi đã có số liệu đo sâu và số liệu kiểm tra cần phải kiểm tra giá trị độ lệch giữa độ sâu xác định theo đường kiểm tra với độ sâu xác định theo đường đo sâu. Các tác giả đã Trên cơ sở tìm hiểu các quy định kỹ thuật về đánh giá kết quả đo sâu bằng máy đo sâu hồi âm đơn tia, chúng tôi đã để từ đó lựa chọn thuật toán cũng như lựa chọn ngôn ngữ lập trình để xây dựng chương trình kiểm tra số liệu đo sâu. Bài báo giới thiệu kết quả lựa chọn thuật toán và chương trình kiểm tra dữ liệu đo sâu đã được xây dựng. Với kết quả kiểm tra số liệu đo sâu hồi âm đơn tia có so sánh, đối chứng với kết quả của các công trình đã thi công cho thấy chương trình được xây dựng hoàn toàn đáp ứng yêu cầu kiểm tra số liệu đo sâu bằng máy đo sâu hồi âm đơn tia.
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Himiniuc, Loredana Maria, Mara Murarasu, Bogdan Toma, Razvan Popovici, Ana-Maria Grigore, Ioana-Sadiye Scripcariu, Mihaela Oancea, and Mihaela Grigore. "Transradial Embolization, an Underused Type of Uterine Artery Embolization Approach: A Systematic Review." Medicina 57, no. 2 (January 20, 2021): 83. http://dx.doi.org/10.3390/medicina57020083.
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Background and Objectives: The most utilized approach for the embolization of uterine arteries is the transfemoral path. However, the transradial approach (TRA) has been gaining popularity among cardiologic interventions in the last years but only few studies have shown its applicability in uterine myoma treatment. The objective of this paper is to assess the feasibility, safety and efficacy of TRA when compared with the transbrachial, transulnar or transfemoral approach (TFA) for uterine arteries embolization (UAE). Materials and methods: A systematic review of the literature that analyzes the TRA for UAE it was carried out, in order to assess its safety and effectiveness. It was systematically searched the literature (Google Scholar, PubMed/MEDLINE, Cochrane Library and Embase) using the words “uterine artery embolization”/“uterine embolization” and “transradial”/“radial”. All the relevant papers published until March 2020 were retrieved and analyzed. Results: Ten studies were considered eligible for this topic. TRA is a comparable method with TFA for uterine artery embolization. Conclusions: These studies allowed us to conclude that TRA is as safe and efficient as TFA. Its advantages include few complications, shorter hospitalization period, and rapid mobilization but a steeper learning curve has the disadvantage of a longer learning curve compared to TFA. Yet, these findings are built on few reports and more research is needed.
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Ocsan, Ryan James, Ata Doost, Paul Marley, and Ahmad Farshid. "The Rise of Transradial Artery Access for Percutaneous Coronary Intervention in Patients with Acute Coronary Syndromes in Australia." Journal of Interventional Cardiology 2020 (November 27, 2020): 1–8. http://dx.doi.org/10.1155/2020/4397697.
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Objectives. The aim of this study was to evaluate the outcomes of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) via transradial artery access (TRA) or transfemoral artery access (TFA). Background. Over the last decade, evidence for the benefit of TRA for PCI has grown, leading to a steady uptake of TRA around the world. Despite this, the topic remains controversial with contrary evidence to suggest no significant benefit over TFA. Methods. A retrospective study of consecutive ACS patients from 2011 to 2017 who underwent PCI via TRA or TFA. The primary outcome was Major Adverse Cardiovascular Events (MACE), a composite of death, myocardial infarction (MI), target lesion revascularisation (TLR), or coronary artery bypass graft surgery (CABG) at 12 months. Secondary outcomes included Bleeding Academic Research Consortium (BARC) bleeding events scored 2 or higher, haematoma formation, and stent thrombosis, in addition to all individual components of MACE. Results. We treated 3624 patients (77% male), with PCI via TFA (n = 2391) or TRA (n = 1233). Transradial artery access was associated with a reduction in mortality (3% vs 6.3%; p < 0.0001 ), MI (1.8% vs 3.9%; p = 0.0004 ), CABG (0.6% vs 1.5%; p = 0.0205 ), TLR (1% vs 2.9%; p < 0.0001 ), large haematoma (0.4% vs 1.8%; p = 0.0003 ), BARC 2 (0.2% vs 1.1%; p = 0.0029 ), and BARC 3 events (0.4% vs 1.0%; p = 0.0426 ). On multivariate Cox regression analysis, TFA, age ≥ 75, prior PCI, use of bare metal stents, cardiogenic shock, cardiac arrest, and multivessel coronary artery disease were associated with an increased risk of MACE. Conclusion. Despite the limitations secondary to the observational nature of our study and multiple confounders, our results are in line with results of major trials and, as such, we feel that our results support the use of TRA as the preferred access site in patients undergoing PCI for ACS to improve patient outcomes.
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Siddiqui, Adnan H., Muhammad Waqas, Jenna Neumaier, Jeff F. Zhang, Rimal H. Dossani, Justin M. Cappuzzo, Russell J. Van Coevering III, et al. "Radial first or patient first: a case series and meta-analysis of transradial versus transfemoral access for acute ischemic stroke intervention." Journal of NeuroInterventional Surgery 13, no. 8 (February 25, 2021): 687–92. http://dx.doi.org/10.1136/neurintsurg-2020-017225.
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BackgroundFew studies have compared technical success and effectiveness of transradial access (TRA) versus transfemoral access (TFA) for mechanical thrombectomy (MT) for acute ischemic stroke (AIS). We compared the two approaches for technical success, effectiveness, and outcomes.MethodsWe retrospectively compared TRA with TFA for AIS MT at our institute. We additionally performed a systematic review and meta-analysis of studies describing the use of TRA alone or in comparison with TFA for MT. Primary outcomes included rate of successful reperfusion (thrombolysis in cerebral infarction (TICI) >2b), number of passes, access-site complications, and 3- month mortality and favorable functional outcomes (modified Rankin Scale (mRS) score 0–2).ResultsA total of 222 consecutive patients (TRA=93, TFA=129) were included in our case series. The rate of successful reperfusion was significantly higher for the TFA cohort (91.4% vs 79.6%, P=0.01) with lower mean number of passes (1.8±1.2 vs 2.4±1.6, P=0.014). Three-month mortality in the TFA group was lower (22.1% vs 40.9% for the TRA cohort (P=0.004), with a higher rate of favorable functional outcomes (51.3% vs 34.1%, P=0.015). A meta-analysis of 10 studies showed significant heterogeneity in rates of successful reperfusion (57.1% to 95.6%, heterogeneity=67.55%, P=0.001). None of the previous comparative studies reported 3-month mortality and functional outcomes.ConclusionsThis case series demonstrate a higher successful reperfusion rate, fewer passes, lower 3-month mortality, and improved 3-month functional outcomes with TFA. The systematic review highlights the inadequacy of existing evidence. Prospective comparative studies are needed before a ‘radial-first’ approach can be adopted for stroke intervention.
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GÖKMEN KAVAK, Demet, İsmail AĞIRBAŞ, Yücel BALBAY, and Keziban AVCI. "COST ANALYSIS OF CORONARY INTERVENTIONS: TRANSRADIAL OR TRANSFEMORAL?" Business & Management Studies: An International Journal 5, no. 3 (December 19, 2017): 640–53. http://dx.doi.org/10.15295/bmij.v5i3.148.
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The purpose of this research is to conduct cost minimisation analysis of coronary angiography interventions with Transradial (TRA) and Transfemoral (TFA) approach. Thus, operators will be guided in relation with intervention selection and cardiovascular area on the subject matter will be enriched which is quite inadequate with a cost analysis sample. The research has been conducted by evaluating and examining of data of the patients who had coronary angiography. Population of the research consists of angiography interventions in the scope of the research carried out within the year of 2013 in a Cardiology Clinic of a tertiary hospital. Patient records were randomly selected. At the end of the research, the findings have revealed that the costs of TRA and TFA have been respectively Turkish Liras (TRY)746,214 and TRY 710,040. The cost of TRA approach is higher than TFA approach. On the other hand, experts’ opinion is that TRA approach is a more reliable alternative compared to TFA approach. In the selection process of the approach to be used by the operators, it would be beneficial for the patients when both the cost and results of the intervention are considered simultaneously.
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Al Saiegh, Fadi, Ahmad Sweid, Nohra Chalouhi, Lucas Philipp, Nikolaos Mouchtouris, Omaditya Khanna, Michael B. Avery, et al. "Comparison of Transradial vs Transfemoral Access in Neurovascular Fellowship Training: Overcoming the Learning Curve." Operative Neurosurgery 21, no. 1 (February 11, 2021): E3—E7. http://dx.doi.org/10.1093/ons/opab018.
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Abstract BACKGROUND The transradial access (TRA) is rapidly gaining popularity for neuroendovascular procedures as there is strong evidence for its benefits compared to the traditional transfemoral access (TFA). However, the transition to TRA bears some challenges including optimization of the interventional suite set-up and workflow as well as its impact on fellowship training. OBJECTIVE To compare the learning curves of TFA and TRA for diagnostic cerebral angiograms in neuroendovascular fellowship training. METHODS We prospectively collected diagnostic angiogram procedural data on the performance of 2 neuroendovascular fellows with no prior endovascular experience who trained at our institution from July 2018 until June 2019. Metrics for operator proficiency were minutes of fluoroscopy time, procedure time, and volume of contrast used. RESULTS A total of 293 diagnostic angiograms were included in the analysis. Of those, 57.7% were TRA and 42.3% were TFA. The median contrast dose was 60 cc, and the median radiation dose was 14 000 μGy. The overall complication rate was 1.4% consisting of 2 groin hematomas, 1 wrist hematoma, and 1 access-site infection using TFA. The crossover rate to TFA was 2.1%. Proficiency was achieved after 60 femoral and 95 radial cases based on fluoroscopy time, 52 femoral and 77 radial cases based on procedure time, and 53 femoral and 64 radial cases based on contrast volume. CONCLUSION Our study demonstrates that the use of TRA can be safely incorporated into neuroendovascular training without causing an increase in complications or significantly prolonging procedure time or contrast use.
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Haussen, Diogo C., Raul G. Nogueira, Keith G. DeSousa, Ryan N. Pafford, Nazli Janjua, Kevin N. Ramdas, Eric C. Peterson, Mohamed Samy Elhammady, and Dileep R. Yavagal. "Transradial access in acute ischemic stroke intervention." Journal of NeuroInterventional Surgery 8, no. 3 (January 5, 2015): 247–50. http://dx.doi.org/10.1136/neurintsurg-2014-011519.
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ObjectiveTo describe the feasibility and safety of transradial access (TRA) in the interventional management of acute ischemic stroke (AIS).MethodsA retrospective review of the local institutional AIS interventional databases of three tertiary academic centers was performed and the use of TRA identified.ResultsTRA was attempted in 15 (1.5%) of 1001 patients; it was used in 12 cases due to transfemoral access (TFA) failure and in 3 as the primary strategy. The mean age was 72.3±8.6 and 46% were male. Baseline National Institutes of Health Stroke Scale score was 19.5±8.7, two patients (14%) received intravenous tissue plasminogen activator, and mean time from last known normal to intra-arterial therapy was 17.0±20.1 h. Five patients had anterior circulation occlusive disease and 10 had vertebrobasilar occlusions. TRA was effective in allowing clot engagement in 13 of 15 cases: one patient had a hypoplastic radial artery that precluded sheath advancement and one had chronic innominate artery occlusion that could not be crossed. Mean time to switch from TFA to TRA was 1.9±1.3 h and the mean time from radial puncture to reperfusion was 2.2±1.0 h. Modified Thrombolysis In Cerebral Infarction 2b–3 reperfusion via TRA was achieved in 9 of 15 patients (60%). No radial puncture site complications were noted. At 90 days, two patients (13%) had a good clinical outcome and seven (50%) had died.ConclusionsFailure of TFA in the endovascular treatment of AIS is uncommon but leads to unacceptable delays in reperfusion and poor outcomes. Standardization of benchmarks for access switch could serve as a guide for neurointerventionalists. TRA is a valid approach for the endovascular treatment of AIS.
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Kedev, Sasko. "The Role of the Transradial Approach for Complex Coronary Interventions in Patients with Acute Coronary Syndrome." Interventional Cardiology Review 8, no. 2 (2013): 81. http://dx.doi.org/10.15420/icr.2013.8.2.81.
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Despite advances in antithrombotic and antiplatelet therapy, bleeding complications remain an important cause of morbidity and mortality in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). A significant proportion of such bleedings are related to the access site, and adoption of transradial access (TRA) may reduce these complications. In patients with ST-segment elevation myocardial infarction (STEMI), TRA reduced cardiac mortality in comparison with the femoral approach (TFA). High-risk patients such as women, obese patients and elderly subjects who are at increased risk for vascular complications and bleeding, might particularly benefit from the TRA. However, specific radial expertise providing procedural time and a success rate comparable to those with the TFA are strongly recommended before using this technique in the emergency setting.
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O'Leary, M. E., and R. Horn. "Internal block of human heart sodium channels by symmetrical tetra-alkylammoniums." Journal of General Physiology 104, no. 3 (September 1, 1994): 507–22. http://dx.doi.org/10.1085/jgp.104.3.507.
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The human heart Na channel (hH1) was expressed by transient transfection in tsA201 cells, and we examined the block of Na current by a series of symmetrical tetra-alkylammonium cations: tetramethylammonium (TMA), tetraethylammonium (TEA), tetrapropylammonium (TPrA), tetrabutylammonium (TBA), and tetrapentylammonium (TPeA). Internal TEA and TBA reduce single-channel current amplitudes while having little effect on single channel open times. The reduction in current amplitude is greater at more depolarized membrane potentials. Analysis of the voltage-dependence of single-channel current block indicates that TEA, TPrA and TBA traverse a fraction of 0.39, 0.52, and 0.46 of the membrane electric field to reach their binding sites. Rank potency determined from single-channel experiments indicates that block increases with the lengths of the alkyl side chains (TBA > TPrA > TEA > TMA). Internal TMA, TEA, TPrA, and TBA also reduce whole-cell Na currents in a voltage-dependent fashion with increasing block at more depolarized voltages, consistent with each compound binding to a site at a fractional distance of 0.43 within the membrane electric field. The correspondence between the voltage dependence of the block of single-channel and macroscopic currents indicates that the blockers do not distinguish open from closed channels. In support of this idea TPrA has no effect on deactivation kinetics, and therefore does not interfere with the closing of the activation gates. At concentrations that substantially reduce Na channel currents, TMA, TEA, and TPrA do not alter the rate of macroscopic current inactivation over a wide range of voltages (-50 to +80 mV). Our data suggest that TMA, TEA, and TPrA bind to a common site deep within the pore and block ion transport by a fast-block mechanism without affecting either activation or inactivation. By contrast, internal TBA and TPeA increase the apparent rate of inactivation of macroscopic currents, suggestive of a block with slower kinetics.
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Firouzi, Ata, Mohammad Javad Alemzadeh-Ansari, Naser Mohammadhadi, Mohammad Mehdi Peighambari, Ali Zahedmehr, Bahram Mohebbi, Reza Kiani, et al. "Association between the risks of contrast-induced nephropathy after diagnostic or interventional coronary management and the transradial and transfemoral access approaches." Journal of Cardiovascular and Thoracic Research 12, no. 1 (February 12, 2020): 51–55. http://dx.doi.org/10.34172/jcvtr.2020.08.
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Introduction: The risk of contrast-induced nephropathy (CIN) as a common and important complication of coronary procedures may be influenced by the vascular access site. We compared the risks of CIN in diagnostic or interventional coronary management between patients treated via the transradial access (TRA) and those treated via the transfemoral access (TFA).<br /> Methods: Patients undergoing invasive coronary catheterization or percutaneous coronary intervention (PCI) were enrolled. We excluded patients with congenital or structural heart disease and those with end-stage renal disease on dialysis. Based on the vascular access site used for invasive coronary catheterization, the patients were divided into 2 study groups: the TFA and the TRA. CIN was defined as an absolute (≥0.5 mg/dL) or relative (>25%) increase in the baseline serum creatinine level within 48 hours following cardiac catheterization or PCI.<br /> Results: Overall, 410 patients (mean age = 61.3 ± 10.8 years) underwent diagnostic or interventional coronary management: 258 were treated via the TFA approach and 152 via the TRA approach. The patients treated via the TFA had a significantly higher incidence of postprocedural CIN (15.1% vs 6.6%; P = 0.01). The multivariate analysis showed that the TFA was the independent predictor of CIN (OR: 2.37, 95% CI: 1.11 to 5.10, and P = 0.027). Moreover, the BARC (Bleeding Academic Research Consortium) and Mehran scores were the other independent predictors of CIN in our study.<br /> Conclusion: The risk of CIN was lower with the TRA, and the TFA was the independent predictor of CIN after the diagnostic or interventional coronary management.
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Indirli, Danila. "La rete indispensabile: tra istituzioni, tra servizi, tra pubblico e privato." MINORIGIUSTIZIA, no. 1 (March 2012): 73–81. http://dx.doi.org/10.3280/mg2012-001005.
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Patel, Aesha, Antony Sare, Muhammad U. Shahid, Abhishek Kumar, and Pratik A. Shukla. "Safety and Feasibility of Transradial Access in Patients Presenting With Traumatic Injuries: A Single Urban Center Experience." Vascular and Endovascular Surgery 54, no. 8 (July 28, 2020): 665–69. http://dx.doi.org/10.1177/1538574420940088.
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Purpose: To evaluate the efficacy, safety, and feasibility of transradial approach (TRA) for endovascular management of traumatic bleeding. Materials and Methods: A retrospective review was performed at a single level 1 trauma institution from August 2018 to July 2019. Patients presented to the interventional radiology department who were intended to be treating using TRA for the management of trauma-induced bleeding were selected. Demographics, indication for embolization, embolization site, preprocedural labs, hemodynamic stability, technical success, and complications were recorded. Results: Transradial approach was attempted in 29 (74.4%) of the 39 patients identified by operators who prefer TRA. Four patients received treatment using TRA on 2 separate occasions, for a total of 33 procedures completed with a technical success of 97% (32/33). Transradial approach was safely completed in 9 patients (27.3%) with preprocedural hemodynamically unstable status. For the 10 patients who received treatment via a transfemoral approach (TFA), traumatic disfiguration of the left upper extremity, preexisting arterial lines placed by the trauma team, and external iliac artery injuries requiring covered stent placement were the most common indications for TFA over TRA. There were no procedural or access site–related complications. Conclusion: Transradial approach for the endovascular management of bleeding in a trauma setting is safe and effective with a high technical success rate and no complications.
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Del Rio-Pertuz, Gaspar, Michel Juarez, Poemlarp Mekraksakit, Kanak Parmar, and Mohammad M. Ansari. "Transradial versus Transfemoral Access and the Risk of Acute Kidney Injury following Primary Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Propensity-Score-Matched Studies." Journal of Interventional Cardiology 2022 (March 10, 2022): 1–8. http://dx.doi.org/10.1155/2022/6774439.
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Objectives. The aim of this study is to examine the association between vascular access sites and the incidence of AKI in patients with STEMI undergoing primary PCI. Background. Emerging evidence has suggested that transradial access (TRA) may be associated with lower rates of acute kidney injury (AKI) as compared with transfemoral access (TFA). However, most of these studies have included a nonselected study population undergoing diagnostic cardiac catheterization or percutaneous coronary intervention (PCI). Data on the association between TRA and AKI in this setting of STEMI are limited and with conflicting results. Methods. We systematically searched PubMed, Embase, and Scopus for abstracts and full-text articles from inception to July 13th of 2021. Studies included were randomized controlled trials (RCTs) and propensity-score-matched (PSM) studies evaluating the association of TRA versus TFA access with AKI in patients undergoing primary PCI for STEMI. Data were integrated using the random effects model and generic inverse‐variance method of DerSimonian and Laird. Results. A total of 10,093 studies were found. After applying our inclusion criteria, 5 studies from 2014 to 2021 with a total of 8,536 STEMI patients were included. TRA was not significantly associated with a reduced risk for AKI compared with TFA (odds ratio 0.85, 95% CI 0.71–1.01, p 0.07, I2 = 40%). Conclusions. Transradial access was not significantly associated with lower risk of AKI in patients undergoing primary PCI for STEMI compared with TFA. Larger studies are needed to clarify this outcome.
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Snelling, Brian M., Samir Sur, Sumedh Subodh Shah, Megan M. Marlow, Mauricio G. Cohen, and Eric C. Peterson. "Transradial access: lessons learned from cardiology." Journal of NeuroInterventional Surgery 10, no. 5 (September 29, 2017): 487–92. http://dx.doi.org/10.1136/neurintsurg-2017-013295.
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Innovations in interventional cardiology historically predate those in neuro-intervention. As such, studying trends in interventional cardiology can be useful in exploring avenues to optimise neuro-interventional techniques. One such cardiology innovation has been the steady conversion of arterial puncture sites from transfemoral access (TFA) to transradial access (TRA), a paradigm shift supported by safety benefits for patients. While neuro-intervention has unique anatomical challenges, the access itself is identical. As such, examining the extensive cardiology literature on the radial approach has the potential to offer valuable lessons for the neuro-interventionalist audience who may be unfamiliar with this body of work. Therefore, we present here a report, particularly for neuro-interventionalists, regarding the best practices for TRA by reviewing the relevant cardiology literature. We focused our review on the data most relevant to our audience, namely that surrounding the access itself. By reviewing the cardiology literature on metrics such as safety profiles, cost and patient satisfaction differences between TFA and TRA, as well as examining the technical nuances of the procedure and post-procedural care, we hope to give physicians treating complex cerebrovascular disease a broader data-driven understanding of TRA.
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Voudris, Konstantinos V., and Mladen I. Vidovich. "Medicolegal implications of radial and femoral access for coronary angiography and intervention in 2016: Focus on retroperitoneal hemorrhage." Journal of Translational Internal Medicine 4, no. 1 (April 1, 2016): 29–34. http://dx.doi.org/10.1515/jtim-2016-0007.
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Abstract Background and Objectives Retroperitoneal hemorrhage is a rare but serious complication of transfemoral approach (TFA) and TFA percutaneous coronary intervention (PCI). Radial approach for coronary angiography and intervention (transradial approach, TRA) is associated with lower access site complications and reduced blood transfusion rates. Retroperitoneal bleeding has not been described with TRA. This study sought to evaluate the relationship between femoral access for coronary angiography (TFA) and PCI-induced retroperitoneal hemorrhage and the resulting medical litigation in the United States. Methods From 342 lawsuit claim records identified in LexisNexis database search, 17 cases of TFA and TFAPCI-related retroperitoneal hemorrhage decided between 1995 and 2015 were included in the study. Claims were thoroughly reviewed and information about the date the case was decided, patient outcome, the plaintiff, the defendant, the claim, and the trial outcome were extracted. Results The most common filled claim was medical malpractice (53% of the cases), followed by wrongful death (18%) and review of the Commissioner's decision to deny the application for supplemental security income (12%). Forty-seven percent of the cases were won by the defense, 29% by the plaintiff, and 24% were remanded for a new trial. In 82% of the cases, physicians were sued, but only 14% of the cases were won by the plaintiff. In 59% of the claims, the patient died; however, 70% of those cases were decided in favor of the defending physician and hospital. Conclusion Retroperitoneal hemorrhage is an uncommon complication of TFA and TFA PCI and is associated with high mortality rates. Physicians should able to identify this complication early and address it in a timely manner based on the applicable standard of care. TRA and TRA PCI is a reliable alternative and may potentially reduce medicolegal liability related to access site choice.
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Minh, Phạm Thành, Dương Văn Đông, Nguyễn Thanh Nhàn, Đặng Hồ Hồng Quang, Mai Phước Minh Thành, Ngô Thị Thu Thủy, Lê Văn Thuận, and Trương Minh Trí. "NGHIÊN CỨU ĐIỀU CHẾ HẠT VI CẦU Y-90 DẠNG HẠT THỦY TINH VÀ DẠNG GEL ỨNG DỤNG TRONG ĐIỀU TRỊ UNG THƯ GAN TẠI VIỆT NAM." Tạp chí Khoa học 17, no. 12 (December 30, 2020): 2110. http://dx.doi.org/10.54607/hcmue.js.17.12.2798(2020).
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Trong bài báo này, chúng tôi tổng hợp hạt vi cầu Y-90 dạng hạt thủy tinh và hạt gel trên Lò phản ứng Hạt nhân Đà Lạt ứng dụng trong điều trị ung thư gan tại Việt Nam. Kích thước và hình thái học của hạt vi cầu Y-90 được kiểm tra bằng phương pháp kính hiển vi điện tử quét phân giải cao (FE-SEM), độ tinh khiết hóa học được kiểm tra bằng phổ tán sắc năng lượng tia X (EDX), độ tinh khiết hạt nhân phóng xạ kiểm tra bằng phổ kế gamma Canberra-GC-3019-7500SL, độ tinh khiết hóa phóng xạ kiểm tra bằng sắc kí lớp mỏng, độc tố kim loại nặng kiểm tra bằng phương pháp ICP-MS, độ vô khuẩn, nội độc tố vi khuẩn, và độ ổn định của sản phẩm theo thời gian kiểm tra theo Dược điển Anh 2016. Kết quả cho thấy hạt vi cầu phóng xạ Y-90 dạng hạt thủy tinh và hạt gel có kích thước hạt từ 20-30 µm, có hoạt độ riêng cao đáp ứng các chỉ tiêu chất lượng của thuốc phóng xạ theo Dược điển Anh 2016. Đây là sản phẩm thuốc phóng xạ đầy hứa hẹn trong điều trị ung thư gan nguyên phát và thứ phát bằng phương pháp tắc mạch phóng xạ tại Việt Nam.
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Dũng, Nguyễn Văn, Chu Vũ Sơn, and Trần Viết Hòa. "Khảo sát nhận thức, thái độ và xác định một số yếu tố liên quan ở bệnh nhân người dân tộc thiểu số bị tăng huyết áp." Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam 35 (December 31, 2021): 12–18. http://dx.doi.org/10.47972/vjcts.v35i.671.
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Mục tiêu: khảo sát nhận thức, thái độ và xác định một số yếu tố liên quan ở bệnh nhân người dân tộc thiểu số bị Tăng huyết áp tới khám và điều trị tại Bệnh viện Quân y 6.
Phương pháp: Nghiên cứu mô tả, cắt ngang 97 bệnh nhân người dân tộc thiểu số được chẩn đoán Tăng huyết áp bằng phỏng vấn, đo đạc các chỉ số nhân trắc theo bộ câu hỏi điều tra soạn sẵn.
Kết quả: nhận thức, thái độ của bệnh nhân về THA: 19.59% chưa nghe về bệnh THA; kiểm tra HA định kỳ 7.21%, khi có triệu chứng 24.74%, không kiểm tra 68.04%; đối tượng biết về tai biến do THA nhưng không đầy đủ chiếm 26.81%; HA tăng tỷ lệ thuận với BMI, p<0.01; Vòng bụng trung bình nữ cao hơn nam (89.83 ± 5.50 cm so với 87.27 ± 5.59 cm), p<0.05, có mối tương quan thuận, mức độ vừa với HA (rHATTr = 0.44, rHATT = 0.56).
Kết luận: Nhận thức, thái độ của người dân tộc thiểu số về THA còn rất hạn chế so với vùng đồng bằng, thành phố. Vòng bụng của người dân tộc có xu hướng cao hơn người kinh. THA có mối tương quan thuận với vòng bụng và chỉ số BMI.
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Resta, Eligio. "Tra generazioni." Revista do Direito 1, no. 54 (January 8, 2018): 2. http://dx.doi.org/10.17058/rdunisc.v1i54.12148.
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Giochi sottili quelli che si instaurano tra tempo della vita, di “una”, di “ogni” vita, e tempo del mondo, di quel “mondo” che astrae, sovrasta, trascende, comprende dentro di sé la vita. Rimandano a una sorta di complicità rivale tra le biografie e la storia, nella quale si annodano i complessi intrecci del plurale del multiversum e del singolare dell’universum. Si separano e si ricongiungono, si allontanano avvicinandosi, scelgono campi diversi condividendo lo stesso spazio. Così, inaspettatamente, disegnano percorsi sempre diversi e sempre uguali. Potremo leggerli nell’ottica della “giustizia”, così come potremo parlarne attraverso l’ottica della “tradizione” o della rappresentazione del “tempo”. Scopriremo così, sempre, che il “nostro tempo”, come ha scritto Derrida, è il tempo del quale non potremo tanto facilmente parlare del nostro tempo
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Kuwabara, Patricia E. "Interspecies Comparison Reveals Evolution of Control Regions in the Nematode Sex-Determining Gene tra-2." Genetics 144, no. 2 (October 1, 1996): 597–607. http://dx.doi.org/10.1093/genetics/144.2.597.
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Abstract The Caenmhabditis elegans sexdetermining gene tra-2 promotes female development and expresses 4.7-, 1.9- and 1.8-kb mRNAs. The 4.7-kb mRNA encodes the major feminizing activity of the locus, a predicted membrane receptor that mediates cell-to-cell communication, named TRA-2A. The tra-2 gene was characterized from a close relative, C. briggsae. The Cb-tra-2 gene expresses only a 4.7-kb mRNA and alternatively spliced variants, which encode TRA-2A homologues. The Cb-TRA-2A and Ce-TRA-2A sequences are highly diverged, sharing only 43% identity, although their hydropathy profiles remain remarkably similar. Three potential regulatory sites of Ce-tra-2 activity were previously identified by analyzing tra-2(eg), tra-2(gf), and tra-2(mx) mutations. Two of these sites, the EG site and MX region, are consewed in Cb-tra-2. By contrast, the two direct repeat elements in the Ce-tra-2 3′ untranslated region, which are disrupted in tra-2(gf) mutants, are absent. Injection of Cb-tra-2 antisense RNA into C. briggsae mimics the Ce-tra-2 loss-of-function phenotype. Thus, antisense RNA permits studies of gene activity in nematodes that lack extensive genetics.
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Novello, Giorgio. "L'interlinguistica tra creativitŕ individuale ed incomprensione tra alloglotti." FUTURIBILI, no. 2 (September 2009): 23–48. http://dx.doi.org/10.3280/fu2008-002005.
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- A language may be seen on one hand as the free product of a collectivity of speakers, but on the other as an imposed factor not susceptible to modification by its speakers. There is space, however, for individual creativity (which is the subject of interlinguistics) expressed not only through the language but on it. The more radical deliberate interventions include the "official" modifications carried out on Standard Chinese (Putonghua), Nynorsk (New Norwegian), Kathareuousa ("high" New Greek) and Bahasa Indonesia. The most extreme cases are the planned resuscitation of a dead language (Hebrew) and the creation of a new one (Esperanto).
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Joshi, Krishna C., André Beer-Furlan, R. Webster Crowley, Michael Chen, and Stephan A. Munich. "Transradial approach for neurointerventions: a systematic review of the literature." Journal of NeuroInterventional Surgery 12, no. 9 (March 9, 2020): 886–92. http://dx.doi.org/10.1136/neurintsurg-2019-015764.
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BackgroundDespite the recent increase in the number of publications on diagnostic cerebral angiograms using transradial access (TRA), there have been relatively few regarding TRA for neurointerventional cases. Questions of feasibility and safety may still exist among physicians considering TRA for neurointerventional procedures.MethodsA systematic literature review was performed following PRISMA guidelines. Three online databases (MedLine via PubMed, Scopus and Embase) were searched for articles published between January 2000 and December 2019. Search terms included “Transradial access”, “Radial Access”, “Radial artery” AND “Neurointerventions". The reference lists of selected articles and pertinent available non-systematic analysis were reviewed for other potential citations. Primary outcomes measured were access site complications and crossover rates.ResultsTwenty-one studies (n=1342 patients) were included in this review. Two of the studies were prospective while the remaining 19 were retrospective. Six studies (n=616 patients) included TRA carotid stenting only. The rest of the studies included treatment for cerebral aneurysms (n=423), mechanical thrombectomy (n=127), tumor embolization (n=22), and other indications (n=154) such as angioplasty and stenting for vertebrobasilar stenosis, balloon test occlusion, embolization of dural arteriovenous fistula and arteriovenous malformation, chemotherapeutic drug delivery, intra-arterial thrombolysis, and arterial access during a venous stenting procedure. Two (0.15%) major complications and 37 (2.75%) minor complications were reported. Sixty-four (4.77%) patients crossed over to transfemoral access for completion of the procedure. Seven (0.52%) patients crossed over due to access failure and 57 (4.24%) patients crossed over to TFA due to inability to cannulate the target vessel.ConclusionThis systematic review demonstrates that TRA has a relatively low rate of access site complications and crossovers. With increasing familiarity, development of TRA-specific neuroendovascular devices, and the continued reports of its success in the literature, TRA is expected to become more widely used by neurointerventionalists.
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Zalocar, Luis Alberto Domitrovic, Gustavo Doroszuk, and Javier Goland. "Transradial approach and its variations for neurointerventional procedures: Literature review." Surgical Neurology International 11 (August 15, 2020): 248. http://dx.doi.org/10.25259/sni_366_2020.
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Background: The transfemoral approach (TFA) has been the standard in neuroradiology over the years. However, the transradial approach (TRA) and its variants offer several benefits over the TFA. Methods: Review of the literature about TRA and its variations. We present our results for different neurointerventional procedures at our institution between January 2018 and December 2019. Results: We wrote an educational review describing anatomical and technical aspects, advantages, and complications of this approach. In the past year we increased the percentage of neurointerventional procedures performed through radial or ulnar arteries. Conclusion: There are clearly proven benefits of employing a wrist approach in patients for neurointerventional procedures and its utilization should especially be considered on a daily basis.
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de Bono, Mario, and Jonathan Hodgkin. "Evolution of Sex Determination in Caenorhabditis: Unusually High Divergence of tra-1 and Its Functional Consequences." Genetics 144, no. 2 (October 1, 1996): 587–95. http://dx.doi.org/10.1093/genetics/144.2.587.
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Abstract The tra-1 gene is a terminal regulator of somatic sex in Caenorhabditis elegans: high tra-1 activity elicits female development, low tra-1 activity elicits male development. To investigate the function and evolution of tra-1, we examined the tra-1 gene from the closely related nematode C. briggsae. Ce-tra-1 and Cb-tra-1 are unusually divergent. Each gene generates two transcripts, but only one of these is present in both species. This common transcript encodes TRA-1A, which shows only 44% amino acid identity between the species, a figure much lower than that for previously compared genes. A Cb-tra-1 transgene rescues many tissues of tra-1(nul1) mutants of C. elegans but not the somatic gonad or germ line. This transgene also causes nongonadal feminization of XO animals, indicating incorrect sexual regulation. Alignment of Ce-TRA-1A and Cb-TRA-1A defines several conserved regions likely to be important for tra-1 function. The phenotypic differences between Ce-tra-1(null) mutants rescued by Cb-tra-1 transgenes and wild-type C. elegans indicate significant divergence of regulatory regions. These molecular and functional studies suggest that evolution of sex determination in nematodes is rapid and genetically complex.
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Inoue, Hiroaki, and Toshiki Hiroyoshi. "A MATERNAL-EFFECT SEX-TRANSFORMATION MUTANT OF THE HOUSEFLY, MUSCA DOMESTICA L." Genetics 112, no. 3 (March 1, 1986): 469–82. http://dx.doi.org/10.1093/genetics/112.3.469.
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ABSTRACT A maternal-effect sex-transformation mutant, transformer(tra), of the housefly is described. It is located on autosome 4 in close linkage with the Ba locus. Normally, the sex of Musca domestica is determined by the presence or absence of an epistatic factor, M. When produced by tra/tra mothers, a large fraction of the tra/tra genotypic female progeny carrying no M factors are transformed to develop into intersexes or fertile phenotypic males. The tra/+ progeny are also transformed, but less frequently. Aging of the mothers increases the frequency of sex-transformed flies. When produced by tra/+ mothers, tra/tra progeny (but not +/tra) occasionally undergo sex transformation. Thus, tra + is active both maternally and zygotically. Genotypic males carrying the M factor are not affected by the tra mutant. It is concluded that the tra + gene product is required for female determination and/or differentiation. A model is proposed to explain actions of all the known sex-determination genes in M. domestica, and it is discussed in relation to sex-determination mechanisms in several other insect species.
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Tran, Son Doan, and Hung Tuan Nguyen. ". EFFECT OF POSTMORTEM CHANGES TO FILLET QUALITY AND PERFORMANCE OF TRA FISH (Pangasius Hypophthalmus)." Science and Technology Development Journal 12, no. 6 (March 28, 2009): 5–14. http://dx.doi.org/10.32508/stdj.v12i6.2250.
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Nowadays, Tra fish is one of the main export products of Viet Nam. There are many kinds of products from Tra fish such as whole Tra fish, Tra fish slice, Tra knead, Tra fillet...Among them, Tra fillet gets the largest part in export volume and value of Tra fish. In filleting process nowaday, problems related to quality assurance and filleting performance play important rolls. Filleting quality and performance depend on many factors, among them, the filleting in different post-mortem changes of raw material is the major factor effects to quality and performance of filleting process [1]. So, the aim of present study is to experiment on filleting of Tra/Tra fish in different post-mortem changes for evaluating general quality and performance respectively.
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Усенко, И. А., А. Ю. Князев, Л. Н. Бердников, and В. В. Кравцов. "Спектральные исследования цефеид в созвездиях Циркуля (AV CIR, BP CIR) и Южного треугольника (R TrA, S TrA, U TrA, LR TrA)." Письма в астрономический журнал: Астрономия и космическая астрофизика 40, no. 12 (2014): 857–77. http://dx.doi.org/10.7868/s0320010814110060.
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Usenko, I. A., A. Yu Kniazev, L. N. Berdnikov, and V. V. Kravtsov. "Spectroscopic studies of Cepheids in Circinus (AV Cir, BP Cir) and Triangulum Australe (R TrA, S TrA, U TrA, LR TrA)." Astronomy Letters 40, no. 12 (December 2014): 800–820. http://dx.doi.org/10.1134/s1063773714110061.
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Kuwabara, P. E., and J. Kimble. "A predicted membrane protein, TRA-2A, directs hermaphrodite development in Caenorhabditis elegans." Development 121, no. 9 (September 1, 1995): 2995–3004. http://dx.doi.org/10.1242/dev.121.9.2995.
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The nematode C. elegans naturally develops as either an XO male or XX hermaphrodite. The sex-determining gene, tra-2, promotes hermaphrodite development in XX animals. This gene encodes a predicted membrane protein, named TRA-2A, which has been proposed to provide the primary feminising activity of the tra-2 locus. Here, we show that transgenic TRA-2A driven from a heat shock promoter can fully feminise the somatic tissues of XX tra-2 loss-of-function mutants, which would otherwise develop as male. TRA-2A is thus likely to provide a component of the tra-2 locus that is both necessary and sufficient to promote female somatic development. Transgenic TRA-2A driven by the heat shock promoter can also transform XO animals from male to self-fertile hermaphrodite. This result establishes the role of tra-2 as a developmental switch that controls somatic sexual cell fate. We show that a carboxy-terminal region of TRA-2A, predicted to be intra-cellular, can partially feminise XX tra-2 loss-of-function mutants and XO tra-2(+) males. We suggest that this intra-cellular domain of TRA-2A promotes hermaphrodite development by negatively regulating the FEM proteins.
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Cirlŕ, Mario. "La cittŕ interiore." COSTRUZIONI PSICOANALITICHE, no. 22 (December 2011): 77–86. http://dx.doi.org/10.3280/cost2011-022007.
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La relazione tra cittŕ e periferia dispone la riflessione tra interno/esterno, tra finito/ infinito, tra contenitore/contenuto. Il rapporto tra mondo-cittŕ e cittŕ mondo pone il dilemma inclusione/esclusione. Il dibattito tra stato-nazione e mercato globale interroga la questione di sicurezza/insicurezza. Informato alla riflessione di G. Deleuze, l'intervento cerca nella teoria e nella pratica psicoanalitica prospettive non solo analogiche ma auspicabilmente operative.