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1

Long, Roy. "Technology Tomorrow: Reserves Growth: Torturous and Tortuous." Journal of Petroleum Technology 58, no. 08 (2006): 26–28. http://dx.doi.org/10.2118/0806-0026-jpt.

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2

Rohn, T. T., R. A. Rissman, E. Head, and C. W. Cotman. "Caspase activation in the Alzheimer's disease brain: Tortuous and torturous." Drug News & Perspectives 15, no. 9 (2002): 549. http://dx.doi.org/10.1358/dnp.2002.15.9.740233.

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3

Levin, Michael. "Tortuous Dualism." Journal of Philosophy 92, no. 6 (1995): 314. http://dx.doi.org/10.2307/2941043.

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4

Døsen, K. "Tortuous application." Mathematical Intelligencer 20, no. 1 (1998): 72. http://dx.doi.org/10.1007/bf03024403.

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5

Weiss, Joseph. "Tortuous Time." James Baldwin Review 8, no. 1 (2022): 86–107. http://dx.doi.org/10.7227/jbr.8.5.

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This article compares the works of James Baldwin and Jean Améry, a survivor of the Jewish Holocaust. It attempts to unpack the ethical and political implications of their shared conception of the temporality of trauma. The experiences of the victim of anti-Semitism and the victim of anti-Black racism not only parallel one another, but their mutual incapacity to let go of the injustice of the past also generates a unique ethico-political response. The backward glance of the victim, the avowed incapacity to heal, as well as the phantasmatic desire to reverse time all guide this unique response. Instead of seeking forgiveness for the wrong done and declaring that all forms of resentment are illegitimate, Baldwin and Améry show us that channeling the revenge fantasy that so often attends the temporality of trauma is the material precondition of actually ending that trauma. This ultimately suggests that, for both thinkers, anything less than a new, revolutionary humanism equipped with an internationalist political project would betray the victims’ attempt to win back their dignity.
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6

Sharawat, Indar Kumar, Renu Suthar, Sameer Vyas, Amit Rawat, and Naveen Sankhyan. "Mystery Case: Tortuous hairs and tortuous blood vessels." Neurology 90, no. 13 (2018): e1174-e1176. http://dx.doi.org/10.1212/wnl.0000000000005208.

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7

Li, Yang, Yi Feng, Genshan Ma, Chengxing Shen, and Naifeng Liu. "Coronary tortuosity is negatively correlated with coronary atherosclerosis." Journal of International Medical Research 46, no. 12 (2018): 5205–9. http://dx.doi.org/10.1177/0300060518804723.

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Objective The impact of coronary tortuosity on coronary atherosclerosis remains unclear. This study was performed to determine to the relationship between coronary tortuosity and the presence of coronary atherosclerosis. Methods Tortuosity and the presence of coronary atherosclerosis in the main coronary arteries were evaluated. The coronary artery was divided into non-tortuous and tortuous segments. The incidence of coronary atherosclerosis between the two segments was compared. Results The prevalence of coronary atherosclerotic stenosis was significantly lower in the tortuous than non-tortuous segment. Conclusion The prevalence of coronary atherosclerotic stenosis is lower in the coronary tortuous than non-tortuous segment, indicating that coronary tortuosity might be considered a protective factor for atherosclerosis.
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8

Rueetsky, I. I. "Highlights in Modern Epilepsy Science." Kazan medical journal 29, no. 10 (2022): 826–34. http://dx.doi.org/10.17816/kazmj90141.

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Epileptics, tormented by endless tortures of morbus herculeus, go through a difficult path. Lost in the past and receding into the distance is a long and tortuous history of studying and dealing with this suffering. What is epilepsy? What forms does it have? Does genuinal epilepsy exist? What is the pathogenesis of epilepsy? And a number of other questions arise from the doctor.
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9

Dogra, Mohit, and MangatR Dogra. "Congenital tortuous retinal vessels." Indian Journal of Ophthalmology 67, no. 2 (2019): 277. http://dx.doi.org/10.4103/ijo.ijo_1281_18.

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10

Grundy, Kenneth W. "South Africa’s Tortuous Transition." Current History 92, no. 574 (1993): 229–33. http://dx.doi.org/10.1525/curh.1993.92.574.229.

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11

Rubin, Geoffrey Allan, Lauren Tal Grinspan, and Jonathan Ginns. "Of a Tortuous Nature." Circulation 135, no. 25 (2017): 2567–71. http://dx.doi.org/10.1161/circulationaha.117.027385.

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12

Wolman, Dylan, and Gabriela Gayer. "Achalasia With Tortuous Megaesophagus." Seminars in Ultrasound, CT and MRI 40, no. 3 (2019): 275–77. http://dx.doi.org/10.1053/j.sult.2019.03.005.

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13

Thomas, Raju. "Catheterizing a Tortuous Ureter." Journal of Urology 140, no. 4 (1988): 778–79. http://dx.doi.org/10.1016/s0022-5347(17)41810-6.

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14

Woolston, Chris. "PhDs: the tortuous truth." Nature 575, no. 7782 (2019): 403–6. http://dx.doi.org/10.1038/d41586-019-03459-7.

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15

Lejay, Anne, Salome Kuntz, and Nabil Chakfé. "Born to be tortuous." Journal of Vascular Surgery 70, no. 2 (2019): 606. http://dx.doi.org/10.1016/j.jvs.2019.02.049.

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16

Genc, Selahattin, Baran Acar, and Meliha Gulden Genc. "Tortuous Internal Carotid Artery." Journal of Craniofacial Surgery 21, no. 6 (2010): 2033–34. http://dx.doi.org/10.1097/scs.0b013e3181f53a9d.

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17

Iwanaga, Joe, Koichi Watanabe, Saga Tsuyoshi, Yoko Tabira, and Koh-ichi Yamaki. "Tortuous Common Carotid Artery: A Report of Four Cases Observed in Cadaveric Dissections." Case Reports in Otolaryngology 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/2028402.

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A tortuous common carotid artery poses a high risk of injury during tracheotomy. Preoperative diagnosis is therefore important to avoid serious complications. We found four cases of tortuous common carotid artery during an anatomical dissection course for students. The first case was a 91-year-old woman who had bilateral tortuous common carotid arteries without arteriosclerosis. Case2was a 78-year-old woman who had bilateral tortuous common carotid arteries without arteriosclerosis. Case3was an 86-year-old woman who died from bladder cancer and who also had a right tortuous common carotid artery without arteriosclerosis. Case4was an 89-year-old woman who had bilateral tortuous common carotid arteries and a tortuous brachiocephalic artery with severe arteriosclerosis. Case4was also examined using computed tomography to evaluate the arteriosclerosis. Computed tomography revealed severe calcification of the vascular wall, which was confirmed in the aortic arch and origins of its branches. In all four cases, the tortuosity was located below the level of the thyroid gland. Based on prior study results indicating that fusion between the carotid sheath and visceral fascia was often evident at the level of the thyroid gland, we speculated that the major region in which tortuosity occurs is at the same level or inferior to the level of the thyroid gland.
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18

Matsuda, Megumi, Hideki Endo, Kohei Ishikawa, et al. "Extremely tortuous superior cerebellar artery mimicking an aneurysm." Surgical Neurology International 12 (November 23, 2021): 569. http://dx.doi.org/10.25259/sni_864_2021.

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Background: An extremely tortuous superior cerebellar artery is a rare anomaly. We report a case of an extremely tortuous superior cerebellar artery mimicking an aneurysm. Case Description: A 77-year-old woman was initially diagnosed with unruptured cerebral aneurysm at the right basilar artery-superior cerebellar artery junction by magnetic resonance angiography. Catheter angiogram revealed that there was no apparent aneurysm at the basilar artery-superior cerebellar artery junction and the lesion was actually an extremely tortuous superior cerebellar artery. Conclusion: Although an extremely tortuous superior cerebellar artery is rare, it should be considered when examining other vascular lesions.
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19

BOTHUN, G., Q. NI, and S. ILIAS. "Solvent-dependent permeability in asymmetric ceramic membranes with tortuous or non-tortuous mesopores." Journal of Membrane Science 325, no. 2 (2008): 982–88. http://dx.doi.org/10.1016/j.memsci.2008.09.026.

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20

Esenboga, Kerim, Emir Baskovski, Ebru Sahin, et al. "Assessment of Myocardial Perfusion by Angiographic Methods in Tortuous Coronary Arteries." Angiology 71, no. 7 (2020): 616–20. http://dx.doi.org/10.1177/0003319720919325.

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The relationship between coronary tortuosity (CorT) and tissue-level myocardial perfusion is not clear. We investigated tissue perfusion in myocardial territories supplied by tortuous coronary arteries. Among patients who had undergone coronary angiography, patients with reported CorT, those with ≥1 coronary artery were included in the study group (100 patients). The control group included patients with normal coronary arteries (100 patients). Thrombolysis In Myocardial Infarction frame count (TFC) and myocardial blush grade (MBG) were calculated for each coronary artery. Mean TFC was significantly higher in tortuous right coronary artery (RCA), left anterior descending (LAD) artery, and circumflex (Cx) artery compared to their non-tortuous counterparts (28.81 ± 6.463 vs 21.94 ± 3.328, P = .009; 43.28 ± 5.698 vs 36.17 ± 3.875, P = .006; 29.35 ± 4.111 vs 23.821 ± 2.639; P < .001, respectively). Mean MBG was also significantly lower in tortuous RCA, LAD, and Cx, compared to their normal counterparts (2.78 ± 0.417 vs 2.98 ± 0.155, P < .001; 2.74 ± 0.483 vs 2.97 ± 0.164, P < .001; 2.92 ± 0.277 vs 2.99 ± 0.110, P < .001, respectively). For each tortuous coronary artery, TFC was similar for every MBG category. Tortuous coronary arteries have higher TFC and lower MBG, suggesting impaired epicardial and microvascular coronary flow, when compared to normal coronary arteries.
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21

Fumoto, Toshio, Shouhei Kinoshita, Takao Sasaki, Norihito Shimamura, and Hiroki Ohkuma. "Oxidative Stress Mediates Vascular Tortuosity." Antioxidants 10, no. 6 (2021): 926. http://dx.doi.org/10.3390/antiox10060926.

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Vascular tortuosity is associated with various disorders and is being increasingly detected through advances in imaging techniques. The underlying mechanisms for vascular tortuosity, however, remain unclear. Here, we tested the hypothesis that oxidative stress mediates the generation of tortuous vessels. We used the bilateral common carotid artery (CCA) ligation model to induce vascular tortuosity. Both young and adult rats showed basilar artery tortuous morphological changes one month after bilateral CCA ligation. These tortuous changes were permanent but more pronounced in the adult rats. Microarray and real-time PCR analysis revealed that these tortuous changes were accompanied by the induction of oxidative stress-related genes. Moreover, the indicated model in rabbits showed that tortuous morphological changes to the basilar artery were suppressed by antioxidant treatment. These results are highly suggestive of the significance of oxidative stress in the development of vascular tortuosity. Although further studies will be needed to elucidate the possible mechanisms by which oxidative stress enhances vascular tortuosity, our study also points toward possible prophylaxis and treatment for vascular tortuosity.
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22

Velat, G. J., M. F. Lawson, B. L. Hoh, and J. Mocco. "Novel Application of an Intermediate Sized Bridging Catheter as an Adjunct to Aneurysm Coiling in Patients with Tortuous Vasculature." Interventional Neuroradiology 15, no. 4 (2009): 448–52. http://dx.doi.org/10.1177/159101990901500413.

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Selective microcatheterization of intracranial aneurysms during coiling can be limited by tortuous vasculature. Stabilization of the microcatheter via distal placement of the guide catheter in the intracranial vasculature may cause vessel dissection or vasospasm. We describe the application of an intermediate sized bridging catheter in four patients with tortuous vasculature who underwent successful coiling of ruptured aneurysms. No complications occurred. The intermediate sized bridging catheter is a useful adjunct for navigation of tortuous parent artery vasculature.
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23

Miller, Saul. "The tortuous path of progress." British Journal of General Practice 72, no. 720 (2022): 344. http://dx.doi.org/10.3399/bjgp22x720053.

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24

Hori, Yoko, Sho Hashimoto, Yukio Katori, Tetsuo Koiwa, Koji Hozawa, and Toshimitsu Kobayashi. "Iracheostomy in Tortuous Brachiocephalic Artery." Nippon Jibiinkoka Gakkai Kaiho 107, no. 2 (2004): 152–55. http://dx.doi.org/10.3950/jibiinkoka.107.152.

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25

Durães, André Rodrigues, and Lilian Souza Araujo. "Tortuous Varicosities in Chronic Schistosomiasis." New England Journal of Medicine 361, no. 6 (2009): e9. http://dx.doi.org/10.1056/nejmicm0803551.

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26

Andrews, K. "Tortuous arguments evade the issue." BMJ 311, no. 7017 (1995): 1437. http://dx.doi.org/10.1136/bmj.311.7017.1437a.

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27

Koponen, A., M. Kataja, and J. Timonen. "Tortuous flow in porous media." Physical Review E 54, no. 1 (1996): 406–10. http://dx.doi.org/10.1103/physreve.54.406.

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28

Dementyev, Petr, Yang Yang, Maria Rezvova, and Armin Gölzhäuser. "Molecular Jamming in Tortuous Nanochannels." Journal of Physical Chemistry Letters 11, no. 1 (2019): 238–42. http://dx.doi.org/10.1021/acs.jpclett.9b03256.

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29

Uchino, Akira, Masamitsu Abe, Akihiro Sawada, Yukinori Takase, and Sho Kudo. "Extremely tortuous superior cerebellar artery." European Radiology 13, S06 (2003): L237—L238. http://dx.doi.org/10.1007/s00330-002-1817-0.

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30

Cavalaris, Charles P., Shreya Narayanan, and John Jacobs. "S2789 A Tremendously Tortuous Time." American Journal of Gastroenterology 118, no. 10S (2023): S1900—S1901. http://dx.doi.org/10.14309/01.ajg.0000960796.74639.ff.

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31

Holman, P., A. J. Brownstein, I. O. Emeruwa, R. Saggar, and R. N. Channick. "A Tortuous Case of Hemoptysis." American Journal of Respiratory and Critical Care Medicine 211, Abstracts (2025): A2185. https://doi.org/10.1164/ajrccm.2025.211.abstracts.a2185.

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32

Cherian, Mathew, Pankaj Mehta, Poyyamoli Santhosh, Kareparambil Rahul, Gandhi Jenny, and Swamiappan Elango. "Overcoming Tortuous Anatomy in Intracranial Intervention." Journal of Clinical Interventional Radiology ISVIR 02, no. 01 (2018): 038–41. http://dx.doi.org/10.1055/s-0038-1649325.

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AbstractIntracranial interventions comprise a set of procedures, which are complex and challenging. Further, they are extremely risky because complications in the brain are usually associated with significant mortality and morbidity. Thus, a clear understanding is necessary to handle tortuous vessels because improper planning can result in a higher rate of complications. The combination of long sheaths, specialty wires, and preshaped catheters can enable us to access some of the most complex vascular anatomy. There are several conditions that can contribute to a difficult access. There are few techniques described by different authors. The authors have listed the techniques found useful based on their experience. These challenges include tortuous iliac arteries, dilated tortuous aortic arch, acute takeoff of the arch vessels, tortuous neck vessels with prominent loops, crossing a large aneurysm, extensive peripheral vascular disease, etc.
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33

Vo, Minh, Kunal Minhas, Malek Kass, and Amir Ravandi. "Novel Use of the GuideLiner Catheter to Deliver Rotational Atherectomy Burrs in Tortuous Vessels." Case Reports in Cardiology 2014 (2014): 1–5. http://dx.doi.org/10.1155/2014/594396.

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Rotational atherectomy (RA) for heavily calcified lesions is essential for improved stent delivery and stent expansion. In tortuous vessels it is often difficult to advance the burr without rotation and possible injury to the endothelium of healthy vessel. The GuideLiner catheter, a child in mother catheter, has recently been used to allow for increased support for delivery of stents through tortuous vessels. We report a novel use of the GuideLiner for the delivery of an RA burr in tortuous vessels requiring increased guide support.
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34

吴, 钦超. "Clinical Features of Coronary Tortuous and the Correlation Analysis between Coronary Tortuous and Coronary Atherosclerosis." Advances in Clinical Medicine 13, no. 04 (2023): 5694–701. http://dx.doi.org/10.12677/acm.2023.134804.

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35

Martin, A. E., D. Jørgensen, and C. C. Gates. "Costs and benefits of straight versus tortuous migration paths for Prairie Rattlesnakes (Crotalus viridis viridis) in seminatural and human-dominated landscapes." Canadian Journal of Zoology 95, no. 12 (2017): 921–28. http://dx.doi.org/10.1139/cjz-2017-0031.

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An individual’s migration path shape should affect its fitness, because patchily distributed features (e.g., prey) are encountered more often on straight than tortuous paths. We hypothesized that Prairie Rattlesnakes (Crotalus viridis viridis (Rafinesque, 1818)) with straighter migration paths should have better body condition, because they encounter prey patches more frequently, and higher migration mortality, because they also encounter predators and hazardous human land uses more frequently, than individuals with tortuous paths. If true, then a straighter path should be favoured when the benefit (resource acquisition) outweighs the cost (mortality risk). Humans pose a significant mortality risk for migrants; thus, the cost of straight-line movement should increase relative to the benefit in more human-dominated landscapes, favouring more tortuous movements. We tested these hypotheses using data on the body condition, mortality, and migration movements of 25 female Prairie Rattlesnakes in one human-dominated and one seminatural landscape. As hypothesized, we found better body condition and higher migration mortality for snakes with straighter migration paths, and that snakes followed more tortuous paths in the human-dominated landscape. Although selection for tortuous movements may reduce rates of migration mortality in human-dominated landscapes, this may ultimately contribute to population declines if poorer body condition reduces overwinter survival or reproductive success.
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36

Chetia, Sanyukta, and SR Nirmala. "Image processing-based model for tortuosity measurement of retinal blood vessels." Modeling and Artificial Intelligence in Ophthalmology 2, no. 3 (2019): 43–67. http://dx.doi.org/10.35119/maio.v2i3.86.

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Purpose: The study of retinal blood vessel morphology is of great importance in retinal image analysis. The retinal blood vessels have a number of distinct features such as width, diameter, tortuosity, etc. In this paper, a method is proposed to measure the tortuosity of retinal blood vessels obtained from retinal fundus images. Tortuosity is a situation in which blood vessels become tortuous, that is, curved or non-smooth. It is one of the earliest changes that occur in blood vessels in some retinal diseases. Hence, its detection at an early stage can prevent the progression of retinal diseases such as diabetic retinopathy, hypertensive retinopathy, retinopathy of prematurity, etc. The present study focuses on the measurement of retinal blood vessel tortuosity for the analysis of hypertensive retinopathy. Hypertensive retinopathy is a condition in which the retinal vessels undergo changes and become tortuous due to long term high blood pressure. Early recognition of hypertensive retinopathy signs remains an important step in determining the target-organ damage and risk assessment of hypertensive patients. Hence, this paper attempts to estimate tortuosity using image-processing techniques that have been tested on artery and vein segments of retinal images.
 Design: Image processing-based model designed to measure blood vessel tortuosity.
 Methods: In this paper, a novel image processing-based model is proposed for tortuosity measurement. This parameter will be helpful for analyzing hypertensive retinopathy. To test the eff ectiveness of the system in determining tortuosity, the method is first applied on a set of synthetically generated blood vessels. Then, the method is repeated on blood vessel (both artery and vein) segments extracted from retinal images collected from publicly available databases and on images collected from a local eye hospital. The blood vessel segment images that are used in the method are binary images where blood vessels are represented by white pixels (foreground), while black pixels represent the background. Vessels are then classified into normal, moderately tortuous, and severely tortuous by following the analysis performed on the images in the Retinal Vessel Tortuosity Data Set (RET-TORT) obtained from BioIm Lab, Laboratory of Biomedical Imaging (Padova, Italy). This database consists of 30 artery segments and 30 vein segments, which were manually ordered on the basis of increasing tortuosity by Dr. S. Piermarocchi, a retinal specialist belonging to the Department of Ophthalmology of the University of Padova (Italy). The artery and vein segments with the fewest number of turns are given a low tortuosity ranking, while those with the greatest number of turns are given a high tortuosity ranking by the expert. Based on this concept, our proposed method defines retinal image segments as normal when they present the fewest number of twists/turns, moderately tortuous when they present more twists/turns than normal but fewer than severely tortuous vessels, and severely tortuous when they present a greater number of twists/turns than moderately tortuous vessels. On implementing our image processing-based method on binary blood vessel segment images that are represented by white pixels, it is found that the vessel pixel (white pixels) count increases with increasing vessel tortuosity. That is, for normal blood vessels, the white pixel count is less compared to moderately tortuous and severely tortuous vessels. It should be noted that the images obtained from the different databases and from the local hospital for this experiment are not hypertensive retinopathy images. Instead, they are mostly normal eye images and very few of them show tortuous blood vessels.
 Results: The results of the synthetically generated vessel segment images from the baseline for the evaluation of retinal blood vessel tortuosity. The proposed method is then applied on the retinal vessel segments that are obtained from the DRIVE and HRF databases, respectively. Finally, to evaluate the capability of the proposed method in determining the tortuosity level of the blood vessels, the method is tested with a standard tortuous database, namely, the RET-TORT database. The results are then compared with the tortuosity level mentioned in the database. It was found that our method is able to classify blood vessel images as normal, moderately tortuous, and severely tortuous, with results closely matching the clinical ordering provided by the expert in the RET-TORT database. Subjective evaluation was also performed by research scholars and postgraduate students to cross-validate the results.
 Conclusion: The close correlation between the tortuosity evaluation using the proposed method and the clinical ordering of retinal vessels as provided by the retinal specialist in the RET-TORT database shows that, although simple, this method can evaluate the tortuosity of vessel segments effectively.
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37

HUTTON, K. A. R., and D. F. M. THOMAS. "Catheterisation of the Tortuous Neo-urethra." British Journal of Urology 68, no. 6 (1991): 662. http://dx.doi.org/10.1111/j.1464-410x.1991.tb15440.x.

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38

Sheoran, Yogendra Y. "Tortuous path quiet exhaust eductor system." Journal of the Acoustical Society of America 117, no. 4 (2005): 1702. http://dx.doi.org/10.1121/1.1920008.

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39

Thompson, Philip D. "Unravelling the tortuous tale of dystonia." Lancet Neurology 7, no. 6 (2008): 480. http://dx.doi.org/10.1016/s1474-4422(08)70105-4.

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40

Nagarajan, Karthik, and Shing Bor Chen. "Polyelectrolyte Translocation through a Tortuous Nanopore." Journal of Physical Chemistry B 123, no. 42 (2019): 9031–37. http://dx.doi.org/10.1021/acs.jpcb.9b07698.

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41

Berridge, Virginia. "A tortuous history of the NHS." Lancet 349, no. 9049 (1997): 440–41. http://dx.doi.org/10.1016/s0140-6736(97)80072-4.

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42

HILLEL, DANIEL. "ON THE TORTUOUS PATH OF RESEARCH." Soil Science 143, no. 4 (1987): 304–5. http://dx.doi.org/10.1097/00010694-198704000-00008.

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43

Schwalb, David M., and Majid Eshghi. "Techniques to Negotiate the Tortuous Ureter." Journal of Urology 151, no. 4 (1994): 939–42. http://dx.doi.org/10.1016/s0022-5347(17)35128-5.

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44

Fraser, Kenneth S. "A Technique For Stenting Tortuous Ureters." Journal of Urology 138, no. 4 Part 1 (1987): 831. http://dx.doi.org/10.1016/s0022-5347(17)43387-8.

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45

Riolo, Giovanna, Bader Al Ghamdi, and Christine L. D'Arsigny. "Pulmonary hypertension: Tortuous route to diagnosis." Respirology Case Reports 1, no. 1 (2013): 8–9. http://dx.doi.org/10.1002/rcr2.5.

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46

Xiong, Nanqing, Wentao Gu, Jian Li, and Melvin M. Scheinman. "A tortuous tale of tachycardia termination." Heart Rhythm 20, no. 10 (2023): 1457–58. http://dx.doi.org/10.1016/j.hrthm.2022.11.021.

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47

Miyake, Takahito, Riko Takayoshi, Ai Sakamoto, et al. "Fetal Hairpin Curve Tortuous Ascending Aorta." Donald School Journal of Ultrasound in Obstetrics and Gynecology 18, no. 2 (2024): 100–103. http://dx.doi.org/10.5005/jp-journals-10009-2015.

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48

Kodaira, Masaki, and Yohei Numasawa. "Successful percutaneous coil embolization of a severely tortuous coronary artery fistula using the mother-child-grandchild technique via a GuideLiner catheter." SAGE Open Medical Case Reports 5 (January 1, 2017): 2050313X1667238. http://dx.doi.org/10.1177/2050313x16672382.

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Coronary artery fistula is an uncommon congenital disease that requires invasive treatment for symptomatic patients. Although percutaneous intervention has become the popular treatment option, surgical treatment is preferred for severely tortuous coronary artery fistulas. We report a case of an extremely tortuous coronary artery fistula successfully treated with the support of the GuideLiner catheter and the mother-grandchild technique.
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49

Wang, Qiannan, Guoshuai Zhang, Yunyun Tong, and Chunping Gu. "A Numerical Study on Chloride Diffusion in Cracked Concrete." Crystals 11, no. 7 (2021): 742. http://dx.doi.org/10.3390/cryst11070742.

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The cracks in concrete are a fast transport path for chlorides and influence the service life of concrete structures in chloride environments. This study aimed to reveal the effect of crack geometry on chloride diffusion in cracked concrete. The chloride diffusion process in cracked concrete was simulated with the finite difference method by solving Fick’s law. The results showed that the apparent chloride diffusivity was lower in more tortuous cracks, and the cracks with more narrow points also showed lower apparent chloride diffusivity. For tortuous cracks, a higher crack width meant relatively more straight cracks, and consequently, higher apparent chloride diffusivity, while a lower crack width resulted in more tortuous cracks and lower apparent chloride diffusivity. The crack depth showed a more significant influence on the chloride penetration depth in cracked concrete than crack geometry did. Compared with rectangular and V-shaped cracks, the chloride diffusion process in cracked concrete with a tortuous crack was slower at the early immersion age. At the same crack depth, the crack geometry showed a marginal influence on the chloride penetration depth in cracked concrete during long-term immersion.
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Koketsu, Kenta, Kyongsong Kim, Minoru Ideguchi, Rinko Kokubo, Takayuki Mizunari, and Akio Morita. "High-flow bypass surgery using a radial artery graft for an extracranial internal carotid artery aneurysm: Case reports and literature review." Surgical Neurology International 12 (July 6, 2021): 333. http://dx.doi.org/10.25259/sni_408_2021.

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Abstract:
Background: Extracranial carotid artery aneurysms are rare. Surgery may be difficult when vessels are tortuous and on a high cervical level. We report two patients whose tortuous extracranial internal carotid artery (ICA) aneurysm located on a high cervical level was successfully treated by ICA ligation and a high-flow bypass using a radial artery (RA) graft between the external carotid- and the middle cerebral artery. Case Description: (Case 1) A 47-year-old man suffered a recurrent cerebral infarct despite medical treatment. His right extracranial ICA aneurysm measured 33 mm; it was tortuous and located at a high cervical level. We ligated the ICA after placing a high-flow bypass using an RA graft. The aneurysm was not repaired. (Case 2) A 59-year-old woman noticed pulsatile swelling on her left neck. It was due to an extracranial ICA aneurysm that was large (36 mm), tortuous, and located at a high cervical level. We performed ICA ligation after placing a high-flow bypass using an RA graft without direct aneurysmal repair. Six months after the operation she noted a pulsatile bulge on the left oropharynx. We confirmed recurrence of an aneurysm from retrograde blood flow and performed internal trapping by occluding the distal portion of the ICA aneurysm using an intravascular procedure. Conclusion: ICA ligation after placing a high-flow bypass with an RA-graft is a technically demanding, but safe procedure to address extracranial ICA aneurysms that are tortuous and located at a high cervical level.
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