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American relief aid and the Spanish Civil War
\" The Spanish Civil War created a conflict for Americans who preferred that the United States remain uninvolved in foreign affairs. Despite the country's isolationist tendencies, opposition to the rise of fascism across Europe convinced many Americans that they had to act in support of the Spanish Republic. While much has been written about the war itself and its international volunteers, little attention has been paid to those who coordinated these relief efforts at home. American Relief Aid and the Spanish Civil War tells the story of the political campaigns to raise aid for the Spanish Republic as activists pushed the limits of isolationist thinking. Those concerned with Spain's fate held a range of political convictions (including anarchists, socialists, liberals, and communists) with very different understandings of what fascism was. Yet they all agreed that fascism's advance must be halted. With labor strikes, fund-raising parties, and ambulance tours, defenders of Spain in the United States sought to shift the political discussion away from isolation of Spain's elected government and toward active assistance for the faltering Republic. Examining the American political organizations affiliated with this relief effort and the political repression that resulted as many of Spain's supporters faced the early incarnations of McCarthyism's trials, Smith provides new understanding of American politics during the crucial years leading up to World War II. By also focusing on the impact the Spanish Civil War had on those of Spanish ethnicity in the United States, Smith shows how close to home the seemingly distant war really hit. \"-- Provided by publisher.
Book
American Relief Aid and the Spanish Civil War
The Spanish Civil War created a conflict for Americans who preferred that the United States remain uninvolved in foreign affairs. Despite the country's isolationist tendencies, opposition to the rise of fascism across Europe convinced many Americans that they had to act in support of the Spanish Republic. While much has been written about the war itself and its international volunteers, little attention has been paid to those who coordinated these relief efforts at home.
American Relief Aid and the Spanish Civil War tells the story of the political campaigns to raise aid for the Spanish Republic as activists pushed the limits of isolationist thinking. Those concerned with Spain's fate held a range of political convictions (including anarchists, socialists, liberals, and communists) with very different understandings of what fascism was. Yet they all agreed that fascism's advance must be halted. With labor strikes, fund-raising parties, and ambulance tours, defenders of Spain in the United States sought to shift the political discussion away from isolation of Spain's elected government and toward active assistance for the faltering Republic.
Examining the American political organizations affiliated with this relief effort and the political repression that resulted as many of Spain's supporters faced the early incarnations of McCarthyism's trials, Smith provides new understanding of American politics during the crucial years leading up to World War II. By also focusing on the impact the Spanish Civil War had on those of Spanish ethnicity in the United States, Smith shows how close to home the seemingly distant war really hit.
eBook
Epidemiology and Socioeconomic Impact of Pancreatic Cancer: An Analysis of the Global Burden of Disease Study 1990–2019
IntroductionThe aim of this study is to estimate the global burden of pancreatic cancer from 1990 to 2019.MethodsWe reconstructed the Global Burden of Diseases (GBD) study results for pancreatic cancer across 204 countries and territories. Our study generated estimates for key disease burden indicators, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs), and cost. Linear regression analysis of the natural logarithm of age-standardized outcomes was used to calculate annual percent change.ResultsIn 2019, there were a total of 530,296 incident and 442,101 prevalent cases of pancreatic cancer, resulting in 531,107 deaths and 11.5 million DALYs lost. The age-standardized incidence and prevalence of pancreatic cancer has increased from 5.22 (95% CI 4.97–5.40) to 6.57 (CI 6.00–7.09) per 100,000 people per year, and 4.1 (95% CI 3.95–4.26) to 5.4 (CI 4.96–5.87), respectively. This equated to 10 million (95% CI 9.5 to 10.4 million) incident cases of pancreatic cancer. The number of DALYs lost as a result of pancreatic cancer was 225 million years (95% CI 216–234 million years). Mortality from pancreatic cancer increased over the study period from 3.7 (95% CI 3.54–3.83) to 6.9 (95% CI 6.36–7.32). Incidence, prevalence, DALYs, and mortality were higher in countries with a higher socio-demographic index.ConclusionsPancreatic cancer is rising around the world and is associated with a high economic burden. Programs aimed at reducing modifiable risk factors are needed.
Journal Article
Applications of Artificial Intelligence in Gastrointestinal Endoscopic Ultrasound: Current Developments, Limitations and Future Directions
Endoscopic ultrasound (EUS) effectively diagnoses malignant and pre-malignant gastrointestinal lesions. In the past few years, artificial intelligence (AI) has shown promising results in enhancing EUS sensitivity and accuracy, particularly for subepithelial lesions (SELs) like gastrointestinal stromal tumors (GISTs). Furthermore, AI models have shown high accuracy in predicting malignancy in gastric GISTs and distinguishing between benign and malignant intraductal papillary mucinous neoplasms (IPMNs). The utility of AI has also been applied to existing and emerging technologies involved in the performance and evaluation of EUS-guided biopsies. These advancements may improve training in EUS, allowing trainees to focus on technical skills and image interpretation. This review evaluates the current state of AI in EUS, covering imaging diagnosis, EUS-guided biopsies, and training advancements. It discusses early feasibility studies and recent developments, while also addressing the limitations and challenges. This article aims to review AI applications to EUS and its applications in clinical practice while addressing pitfalls and challenges.
Journal Article
Stent retriever versus direct aspiration thrombectomy for acute large vessel occlusion: A meta-analysis including 17,556 patients, from MR CLEAN to present
Stent retriever (SR) and direct aspiration (DA) mechanical thrombectomy (MT) improve clinical outcomes for stroke secondary to large vessel occlusion. The purpose is to perform an updated meta-analysis comparing the two techniques.
PubMed database was searched for studies between January 1, 2015, and July 5th, 2021 with mechanical thrombectomy to treat acute ischemic stroke.
We identified 136 studies including 17,556 patients, with 11,258 (64.1%) patients treated by SR or a combined approach and 6298 (35.9%) patients with DA. The DA group had less posterior cerebral artery strokes, was significantly older, and had lower National Institutes of Health Stroke Scale scores (p = .05,.02,.04) There was no difference between groups in percentage of middle cerebral artery or internal carotid artery occlusions or intravenous tissue plasminogen activator administered (p = .62,.19,.06). A regression model showed no difference between SR and DA in mortality, symptomatic intracranial hemorrhage, and disability (mRS > 2) at 90 days (p = .13,.75,.84). Successful reperfusion (mTICI 2b/3 rates) were higher in the DA group (DA 87.6% vs SR 82.3%, p < .01), but after accounting for covariates was not significant (p = .17).
Our updated meta-analysis shows that DA has similar safety, reperfusion and 90-day clinical outcomes compared to SR. These results should serve to increase confidence in DA thrombectomy for acute ischemic stroke secondary to LVO.
•Stent retriever (SR) and direct aspiration (DA) are the two most common methods of mechanical thrombectomy•Debate remains on the best first-line strategy•In our updated meta-analysis, we found similar outcomes comparing SR and DA•Both SR and DA are reasonable up front treatment options during mechanical thrombectomy
Journal Article
Brain herniation (encephalocele) into arachnoid granulations: prevalence and association with pulsatile tinnitus and idiopathic intracranial hypertension
Purpose
Brain herniation into arachnoid granulations (BHAG) of the dural venous sinuses is a recently described finding of uncertain etiology. The purpose of this study was to investigate the prevalence of BHAG in a cohort of patients with pulsatile tinnitus (PT) and to clarify the physiologic and clinical implications of these lesions.
Methods
The imaging and charts of consecutive PT patients were retrospectively reviewed. All patients were examined with MRI including pre- and post-contrast T1- and T2-weighted sequences. Images were reviewed separately by three blinded neuroradiologists to identify the presence of BHAG. Their location, signal intensity, size, presence of arachnoid granulation, and associated dural venous sinus stenosis were documented. Clinical records were further reviewed for idiopathic intracranial hypertension, history of prior lumbar puncture, and opening pressure.
Results
Two hundred sixty-two consecutive PT patients over a 4-year period met inclusion criteria. PT patients with BHAG were significantly more likely to have idiopathic intracranial hypertension than PT patients without BHAG (OR 4.2, CI 1.5–12,
p
= 0.006). Sixteen out of 262 (6%) patients were found to have 18 BHAG. Eleven out of 16 (69%) patients had unilateral temporal or occipital lobe herniations located in the transverse sinus or the transverse-sigmoid junction. Three out of 16 (19%) patients had unilateral cerebellar herniations and 2/16 (13%) patients had bilateral BHAG.
Conclusion
In patients with PT, BHAG is a prevalent MRI finding that is strongly associated with the clinical diagnosis of IIH. The pathogenesis of BHAG remains uncertain, but recognition should prompt comprehensive evaluation for IIH.
Journal Article
Dual-agent percutaneous sclerotherapy technique for macrocystic lymphatic malformations
Percutaneous sclerotherapy is an effective technique for treating lymphatic malformations of the head and neck, with clinical success rates exceeding 84%.1 Sodium tetradecyl, which damages lipid membranes and stimulates free radical-induced local damage, and doxycycline, which inhibits angiogenesis, have emerged as the safest and most effective of several available sclerosants.2–4 Although severe periprocedural morbidity is rare, temporary local complications are reported in 14% and skin necrosis or scarring in up to 0.8–5.8% of sclerotherapy procedures.5 As these lesions are frequently located in the face and/or neck, even minor complications can be disfiguring and must be avoided. This technical video describes a ‘dual-agent’ approach for percutaneous sclerotherapy of macrocystic lymphatic malformations using sodium tetradecyl as a ‘primer’ followed by doxycycline as a definitive sclerosant (video 1). This technique emphasizes meticulous backtable preparation and effective use of ultrasound and fluoroscopy to minimize complications. Video 1
Journal Article
Percutaneous sclerotherapy for head and neck lymphatic malformations in neonates and infants ≤12 months of age
BackgroundPercutaneous sclerotherapy is an effective treatment for lymphatic malformations (LM) of the head and neck in adults. The purpose of this study was to examine the indications and efficacy of sclerotherapy for head/neck LM in the neonate and infant population.MethodsWe retrospectively reviewed patients treated with percutaneous sclerotherapy for LM of the head/neck at age ≤12 months at a single vascular anomalies clinic. The clinical, anatomic, and technical aspects of each treatment, complications, and post-treatment clinical and imaging outcomes were analyzed.Results22 patients underwent 36 treatments during the first year of life. Median age at first treatment was 6.2 months (range 2–320 days). Severe airway compromise was the most frequent indication for treatment (31.8%). Sclerosants included doxycycline (80.5%), sodium tetradecyl sulfate (55.5%), bleomycin (11.1%) and ethanol (2.8%). There were no immediate procedure-related complications; sclerosant-related laboratory complications included transient metabolic acidosis (8.3%) and hemolytic anemia (5.5%). Median follow-up was 3.7 years (IQR 0.6–4.8). 47.6% of patients showed >75% lesion size reduction and 19.0% showed minimal response (<25% improvement). At last follow-up, 71.4% of children were developmentally normal and asymptomatic, 23.8% had recurring symptoms, and 4.8% required permanent tracheostomy. Patients with ongoing symptoms or limited response to percutaneous sclerotherapy (33.3%) were treated with long-term sirolimus.ConclusionsPercutaneous sclerotherapy is a safe and effective treatment for symptomatic LM of the head and neck in neonates and infants. Treatment strategy and management of recurrent symptoms requires consensus from an experienced, multidisciplinary team.
Journal Article
Robotic Diagnostic Cerebral Angiography: A Multicenter Experience of 113 Patients
BackgroundNeurointerventional robotic systems have potential to reduce occupational radiation, improve procedural precision, and allow for future remote teleoperation. A limited number of single institution case reports and series have been published outlining the safety and feasibility of robot-assisted diagnostic cerebral angiography.MethodsThis is a multicenter, retrospective case series of patients undergoing diagnostic cerebral angiography at three separate institutions – University of California, Davis (UCD); University of California, Los Angeles (UCLA); and University of California, San Francisco (UCSF). The equipment used was the CorPath GRX Robotic System (Corindus, Waltham, MA).ResultsA total of 113 cases were analyzed who underwent robot-assisted diagnostic cerebral angiography from September 28, 2020 to October 27, 2022. There were no significant complications related to use of the robotic system including stroke, arterial dissection, bleeding, or pseudoaneurysm formation at the access site. Using the robotic system, 88 of 113 (77.9%) cases were completed successfully without unplanned manual conversion. The principal causes for unplanned manual conversion included challenging anatomy, technical difficulty with the bedside robotic cassette, and hubbing out of the robotic system due to limited working length. For robotic operation, average fluoroscopy time was 13.2 min (interquartile range (IQR), 9.3 to 16.8 min) and average cumulative air kerma was 975.8 mGY (IQR, 350.8 to 1073.5 mGy).ConclusionsRobotic cerebral angiography with the CorPath GRX Robotic System is safe and easily learned by novice users without much prior manual experience. However, there are technical limitations such as a short working length and an inability to support 0.035” wires which may limit its widespread adoption in clinical practice.
Journal Article