This master thesis describes a journaling system for compression ultrasonography and a clinical assessment system for deep vein thrombosis (DVT). We evaluate Support Vector Machines (SVM) models with linear- and radial basis function-kernels for predicting deep vein thrombosis, and for facilitating creation of new clinical DVT assessment. Data from 159 patients where analysed, with our dataset, Wells Score with a high clinical probability have an accuracy of 58%, sensitivity 60% and specificity of 57% these figured should be compared to those of our base models accuracy of 81%, sensitivity 66% and specificity 84%. A 23 percentage point increase in accuracy.The diagnostic odds ratio went from 2.12 to 11.26. However a larger dataset is required to report anything conclusive. As our system is both a journaling and prediction system, every patient examined helps the accuracy of the assessment. / I denna rapport beskrivs ett journalsystem samt ett system för klinisk bedömning av djupvenstromboser.Vår modell baserar sig på en stödvektormaskin (eng. Support Vector Machine) med linjär och radial basfunktion för att fastställa förekomsten av djupa ventromboser samt att hjälpa till i skapandet av nya modeller för bedömning. 159 patientjournaler användes för att fastställa att Wells Score har en klinisk precision på 58%, 60% sensitivitet och specificitet på 57% somkan jämföras med våran modell som har en precision på 81%, 66% sensitivitet och specificitet på 84%. En 23 procentenheters ökning i precision.Den diagnostiska oddskvoten gick från 2.12 till 11.26. Det behövs dock en större datamängd för att rapportera något avgörande. Då vårt system både är för journalskapande och klinisk bedömning så kommer varje undersökt patient att bidra till högre precision i modellen.

The expression of the α1C-adrenoceptor subtype in human and rabbit blood vessels has been analyzed using the reverse transcriptase/polymerase chain reaction technique (RT/PCR). The 20 bp primers employed were designed from the bovine α1C-adrenoceptor and flank a least conserved region - the putative third cytoplasmic loop. RT/PCR products generated from rabbit and human brain mRNA both had 93% homology to the bovine α1C-adrenoceptor and were used as species and subtype specific probes in Southern blot analysis of vascular RT/PCR products. Poly A+ RNA was purified from the human saphenous vein and rabbit aorta, renal, pulmonary and central ear arteries and amplified by RT/PCR. Size analysis by agarose gel electrophoresis, together with Southern hybridization of the resulting cDNA products confirm the expression of the α1C-adrenoceptor in these vessels.

Traumatic arteriovenous fistulas of the neck are a relatively uncommon injury, whose ramifications can include immediate or delayed neurological insults, massive bleeding, or death. Angiography and embolization have been increasingly used to manage this complex injury pattern. In this particular case, the patient underwent management of bilateral communicating arteriovenous fistulae using a commercially available plug occlusion device. Epidemiology, with an emphasis on patient management and outcomes, is discussed.

Patients with inflammatory bowel disease (IBD) are known to have an increased propensity for thromboembolic events. Like any patient with a high risk of event recurrence, most of these patients can be managed successfully with long-term warfarin therapy. We present the case of a 66-year-old woman with Crohn's disease who, despite careful attention to the management of her international normalized ratio, developed a new deep vein thrombosis and required inferior vena cava filter placement in addition to ongoing warfarin therapy to prevent recurrent pulmonary emboli. This report serves as a reminder to physicians to have a low threshold for diagnosing thromboembolic events in patients with IBD, even if they are presumed to be adequately anticoagulated. Known and theoretical contributing factors to this increased clotting tendency are also reviewed.

Background: Recent studies have suggested that patients with idiopathic pulmonary fibrosis (IPF) may have a higher risk of venous thromboembolism (VTE) compared to general population even though the results were inconsistent. Objective: To investigate the risk of VTE among patients with IPF. Methods: Comprehensive literature review using MEDLINE and EMBASE database were performed to identify studies that compared the risk of VTE among patients with IPF to general population. Effect estimates from each study were combined together using random effect model, generic inverse variance method of DerSimonian and Laird. Results: Out of 510 retrieved articles, 5 studies met the inclusion criteria and were included in the meta-analysis. A significant risk of VTE in patients with IPF was observed with the pooled risk ratio of 2.11 (95% confidence interval, 1.28-3.48). The heterogeneity was moderate with I2 of 64%. Conclusion: An approximately 2-fold increased risk of VTE among patients with IPF was observed in this meta-analysis.

Tissue engineering is an emerging field that offers novel and unmatched potential medical therapies and treatments. While the vast aim of tissue engineering endeavors is to provide clinically implantable constructs, secondary applications have been developed to utilize tissue-engineered constructs for in-vitro evaluation of devices and therapies. Specifically, in-vitro blood vessel mimics (BVM) have been developed to create a bench-top blood vessel model using human cells that can be used to test and evaluate vascular disease treatments and intravascular devices. Previous BVM work has used fat derived human microvascular endothelial cells (EC) sodded on an ePTFE scaffold. To create a more physiologically accurate model, a dual layer of large vessel endothelial and smooth muscle cells (SMC) on an ePTFE tube is investigated throughout this thesis. Human umbilical vein endothelial cells (HUVEC) and human umbilical vein smooth muscle cells (HUVSMC) were chosen as the large vessel cell types and cultivated according to standard procedures. Before dual sodding, sodding density experiments with HUVSMC were performed to determine the number of cells required to create a confluent cell layer. HUVSMC sodded by trans-luminal pressure at densities ranging from 3.5x10^5 cells/cm^2 to 1.0x10^6 cells/cm^2 were run for one day to observe luminal coverage. After determining the desirable range for HUVSMC sodding, HUVSMC experiments with 5.0x10^5 cells/cm^2 and 7.5x10^5 cells/cm^2 were run over seven days to evaluate progression of the graft over time. Histology and SEM methods were used for analysis. A HUVEC study was next conducted over 7 days to confirm that the large vessel endothelial cell could be sodded and sustained on ePTFE in-vitro. Next, dual sodding was performed by pressure sodding HUVSMC at 7.5x10^5 cells/cm^2 followed by trans-luminal flow for 30 minutes. HUVECs were subsequently trans-luminally pressure sodded at 5.0x10^5 cells/cm^2 followed by an additional 30 minutes of trans-luminal flow; perfusion flow began following the final 30 minutes of trans-luminal flow. Experiments for the dual layered grafts were run for both one and seven days to evaluate and develop the dual sodding protocol as well as observe the co-culture over time. Analysis of the dual layered grafts was performed by SEM, histology, and fluorescence microscopy. HUVECs were incubated with Cell Tracker™ prior to dual sodding and both cell types with bisbenzimide after graft harvest to attempt to distinguish between cell types. Results from the thesis illustrate that large vessel smooth muscle and endothelial cells can be sodded onto ePTFE scaffolds and sustained within the in-vitro BVM system for up to 7 days. Furthermore, cost analysis demonstrates that the addition of a smooth muscle cell layer adds minimal costs to the BVM system. In conclusion, the studies contained within this thesis culminate in a protocol for the dual sodding of smooth muscle and endothelial cells with the aim of creating a physiologically representative co-culture blood vessel mimic.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12917号 / 論医博第2092号 / 新制||医||1009(附属図書館) / 32127 / 京都大学大学院医学研究科医学専攻 / (主査)教授 河野 憲二, 教授 大森 治紀, 教授 渡邉 大 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21638号 / 医博第4444号 / 新制||医||1034(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 木村 剛, 教授 浅野 雅秀, 教授 山下 潤 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Introduction: The reason for the inability of performing the liver resection for colorectal carcinoma metastasis is usually insufficient remnant liver parenchyma after liver resection (future liver remnant volume - FLRV). The current standard method of increasing FLRV is the embolization of the branch of portal vein (portal vein embolization - PVE) on the side of the tumor, and then suspended after hypertrophy of the non-embolised lobe liver resection. Unfortunately, there are some patients who do not increase liver volume despite perfectly executed PVE. Besides that, FLRV occurs during the time necessary for hypertrophy progression of metastatic disease. Therefore, we are trying to find the appropriate way to encourage the growth of remaining liver parenchyma and accelerate hypertrophy of the contralateral liver lobe. From our previous experience (IGA MZ NS 10240), it is possible to be optimistic that there hope is the way of hematopoietic progenitor cells (HPC - adult stem cells) after previous PVE to non-embolised branches of the portal vein. These cells do not only accelerate liver regeneration, but are also able to improve its function (function of the liver) which is especially important for patients after neoadjuvant chemotherapy (steatohepatitis or steatofibrosis), and for patients with...

Kidney and inferior vena cava (IVC) abnormalities with extensive deep vein thrombosis (DVT) is a very rare cause of DVT and has a diverse clinical presentation. Computed tomography (CT) angiography is the gold standard for diagnosis and treatment including thrombectomy, thrombolysis and systemic anticoagulation. We present a rare case of active young healthy male admitted with acute onset of right lower extremity pain and swelling who was found to have extensive DVT on doppler ultrasound. CT abdomen showed extensive clot burden involving right common femoral vein extending into internal and external iliac veins associated with IVC hypoplasia and hypoplastic left kidney. Patient underwent urgent thrombectomy, catheter directed thrombolysis and was discharged home in stable condition on oral anticoagulation.