bluuebunny/crossref_metadata_2025 huggingface dataset:
Children of Promise: The Bodies of Hadewijch of Brabant
Authors: Dailey Patricia
Published: May 2011

Hadewijch of Brabant's seventh vision of union with the Eucharist has often been cited as exemplifying the embodied nature of medieval women's spirituality. This essay recontextualizes the way embodiment and gender are conceived of through an analysis of the figures and functions of inner and outer bodies in Hadewijch's Visions and her List of the Perfect. Arguing against a Neoplatonic interpretation of Hadewijch's visions that disassociates the ideal inner body from any material and historical manifestation, this essay stresses the importance of werke for Hadewijch, in which the outer body is transformed according to the perfected inner body manifest in the visions. As the visions progress, the way Hadewijch reads and understands the inner body informs the nature and experience of the outer material body. Embodiment is thus inextricable from reading, interpreting, and performing a kind of textuality, recasting how we conceptualize the role of the body in women's mystical texts.
Montaigne's Noble Book: Book History and Biographical Criticism
Authors: Balsamo Jean
Published: May 2011

The editorial process of a book's production—far from a minor material detail in its formation or an anecdotal event of publishing history—constitutes a meaningful aspect of its elaboration as a literary work, as significant as the author's biography. Indeed, book history and descriptive bibliography can lead a biographical approach to a literary work. In this regard, Montaigne's Essais, published in 1580, is a special case in point. The very form of its publication was ingeniously used by Montaigne in a social-climbing strategy, for the ostentatious typographical layout of the title page was intended to demonstrate that it was the book of a gentleman, a “noble book.” This displayed nobility supported Montaigne's moral and pedagogical purpose, it served as the basis of his social authority and literary authorship, and, last but not least, this noble status ensured the success of his book.
Sequential changes at differentiation gene promoters as they become active in a stem cell lineage
Authors: Chen Xin , Lu Chenggang , Prado Jose Rafael Morillo , Eun Suk Ho , Fuller Margaret T.
Published: May 2011

Transcriptional silencing of terminal differentiation genes by the Polycomb group (PcG) machinery is emerging as a key feature of precursor cells in stem cell lineages. How, then, is this epigenetic silencing reversed for proper cellular differentiation? Here, we investigate how the developmental program reverses local PcG action to allow expression of terminal differentiation genes in the Drosophila male germline stem cell (GSC) lineage. We find that the silenced state, set up in precursor cells, is relieved through developmentally regulated sequential events at promoters once cells commit to spermatocyte differentiation. The programmed events include global downregulation of Polycomb repressive complex 2 (PRC2) components, recruitment of hypophosphorylated RNA polymerase II (Pol II) to promoters, as well as the expression and action of testis-specific homologs of TATA-binding protein-associated factors (tTAFs). In addition, action of the testis-specific meiotic arrest complex (tMAC), a tissue-specific version of the MIP/dREAM complex, is required both for recruitment of tTAFs to target differentiation genes and for proper cell type-specific localization of PRC1 components and tTAFs within the spermatocyte nucleolus. Together, the action of the tMAC and tTAF cell type-specific chromatin and transcription machinery leads to loss of Polycomb and release of stalled Pol II from the terminal differentiation gene promoters, allowing robust transcription.
Topoisomerase IIβ is required for lamina-specific targeting of retinal ganglion cell axons and dendrites
Authors: Nevin Linda M. , Xiao Tong , Staub Wendy , Baier Herwig
Published: May 2011

The specific partnering of synaptically connected neurons is central to nervous system function. Proper wiring requires the interchange of signals between a postmitotic neuron and its environment, a distinct pattern of transcription in the nucleus, and deployment of guidance and adhesion cues to the cell surface. To identify genes involved in neurite targeting by retinal ganglion cells (GCs), their presynaptic partners in the retina, and their postsynaptic targets in the optic tectum, we undertook a forward genetic screen for mutations disrupting visual responses in zebrafish. This rapid primary screen was subsequently refined by immunohistochemical labeling of retinal and tectal neurites to detect patterning errors. From this unbiased screen, the notorious (noto) mutant exhibited the most specific phenotypes: intact retinal and tectal differentiation but multiple neurite targeting defects in the retinal inner plexiform layer (IPL) and tectal neuropil. Positional cloning and morpholino phenocopy revealed that the mutation disrupts Topoisomerase IIβ (Top2b), a broadly distributed nuclear protein involved in chromatin modifications during postmitotic differentiation. Top2b-DNA interactions are known to regulate transcription of developmentally important genes, including axon guidance factors and cell adhesion molecules, but a specific role in local synaptic targeting has not been previously described. The neurite targeting defects among GC axons are largely restricted to crossovers between sublaminae of a specific layer, SFGS, and were shown by mosaic analysis to be autonomous to the GC axons. The noto mutant provides the first example of the importance of an epigenetic regulator, Top2b, in the intricate series of events that lead to a properly wired visual system.
ERK signaling controls blastema cell differentiation during planarian regeneration
Authors: Tasaki Junichi , Shibata Norito , Nishimura Osamu , Itomi Kazu , Tabata Yoshimichi , Son Fuyan , Suzuki Nobuko , Araki Ryoko , Abe Masumi , Agata Kiyokazu , Umesono Yoshihiko
Published: May 2011

The robust regenerative ability of planarians depends on a population of somatic stem cells called neoblasts, which are the only mitotic cells in adults and are responsible for blastema formation after amputation. The molecular mechanism underlying neoblast differentiation associated with blastema formation remains unknown. Here, using the planarian Dugesia japonica we found that DjmkpA, a planarian mitogen-activated protein kinase (MAPK) phosphatase-related gene, was specifically expressed in blastema cells in response to increased extracellular signal-related kinase (ERK) activity. Pharmacological and genetic [RNA interference (RNAi)] approaches provided evidence that ERK activity was required for blastema cells to exit the proliferative state and undergo differentiation. By contrast, DjmkpA RNAi induced an increased level of ERK activity and rescued the differentiation defect of blastema cells caused by pharmacological reduction of ERK activity. These observations suggest that ERK signaling plays an instructive role in the cell fate decisions of blastema cells regarding whether to differentiate or not, by inducing DjmkpA as a negative regulator of ERK signaling during planarian regeneration.
Transient expression of Mnb/Dyrk1a couples cell cycle exit and differentiation of neuronal precursors by inducing p27KIP1 expression and suppressing NOTCH signaling
Authors: Hämmerle Barbara , Ulin Edgar , Guimera Jordi , Becker Walter , Guillemot François , Tejedor Francisco J.
Published: May 2011

The decision of a neural precursor to stop dividing and begin its terminal differentiation at the correct place, and at the right time, is a crucial step in the generation of cell diversity in the nervous system. Here, we show that the Down's syndrome candidate gene (Mnb/Dyrk1a) is transiently expressed in prospective neurons of vertebrate CNS neuroepithelia. The gain of function (GoF) of Mnb/Dyrk1a induced proliferation arrest. Conversely, its loss of function (LoF) caused over proliferation and cell death. We found that MNB/DYRK1A is both necessary and sufficient to upregulate, at transcriptional level, the expression of the cyclin-dependent kinase inhibitor p27KIP1 in the embryonic chick spinal cord and mouse telencephalon, supporting a regulatory role for MNB/DYRK1A in cell cycle exit of vertebrate CNS neurons. All these actions required the kinase activity of MNB/DYRK1A. We also observed that MNB/DYRK1A is co-expressed with the NOTCH ligand Delta1 in single neuronal precursors. Furthermore, we found that MNB/DYRK1A suppressed NOTCH signaling, counteracted the pro-proliferative action of the NOTCH intracellular domain (NICD), stimulated Delta1 expression and was required for the neuronal differentiation induced by the decrease in NOTCH signaling. Nevertheless, although Mnb/Dyrk1a GoF led to extensive withdrawal of neuronal precursors from the cell cycle, it was insufficient to elicit their differentiation. Remarkably, a transient (ON/OFF) Mnb/Dyrk1a GoF efficiently induced neuronal differentiation. We propose that the transient expression of MNB/DYRK1A in neuronal precursors acts as a binary switch, coupling the end of proliferation and the initiation of neuronal differentiation by upregulating p27KIP1 expression and suppressing NOTCH signaling.
Improving patient safety: How can the Legal Profession Help?
Authors: Christian Ian , Gibb Lindsay , Rowland Sarah
Published: May 2011

This article explores what role lawyers can play in contributing to learning from those incidents that result in a litigation claim. Specifically the authors consider what role the NHSLA has played and should be playing in improving patient safety.
Full recovery – Just and fair?
Authors: Pittaway David
Published: May 2011

In the case of Ingram v Williams [2010] EWHC 758 (QB) 13/4/2010, (2010) Med LR 255 Walker J rejected the evidence of the claimant's parents that his mother had suffered a significant loss of liquid before she attended her GP on 29 July 1983, when cystitis was diagnosed. The claimant was born prematurely on 3 August 1983 at the home of his parents, when his mother's pregnancy was 24 weeks. The expert evidence was that had the claimant's mother been admitted to hospital on 29 July 1983, the claimant would have been born prematurely with peri-ventricular leukomalacia. The difference would have been that a paediatrician would have been present at birth, with the consequence that he would have avoided a period of hypoxia. The experts were agreed that the claimant would have been born with a material but unquantifiable reduction in his disability. After a fully argued oral hearing, the Court of Appeal refused to grant permission to the claimant for permission to appeal where the trial judge had been able to assess the strength of the oral evidence in reaching his findings of fact. Because permission was not granted, the opportunity of arguing before the Court of Appeal whether a claimant should be entitled to recover in full where severely disabled in any event, will await another case.
State Space Collapse in Many-Server Diffusion Limits of Parallel Server Systems
Authors: Dai J. G. , Tezcan Tolga
Published: May 2011

We consider a class of queueing systems that consist of server pools in parallel and multiple customer classes. Customer service times are assumed to be exponentially distributed. We study the asymptotic behavior of these queueing systems in a heavy traffic regime that is known as the Halfin-Whitt many-server asymptotic regime. Our main contribution is a general framework for establishing state space collapse results in this regime for parallel server systems. In our work, state space collapse refers to a decrease in the dimension of the processes tracking the number of customers in each class waiting for service and the number of customers in each class being served by various server pools. We define and introduce a “state space collapse” function, which governs the exact details of the state space collapse. We show that a state space collapse result holds in many-server heavy traffic if a corresponding deterministic hydrodynamic model satisfies a similar state space collapse condition. Unlike the single-server heavy traffic setting for multiclass queueing network, our hydrodynamic model is different from the standard fluid model for many-server queues. Our methodology is similar in spirit to that in Bramson [Bramson, M. 1998. State space collapse with application to heavy traffic limits for multiclass queueing networks. Queueing Systems 30 89–148.], which focuses on the single-server heavy traffic regime. We illustrate the applications of our results by establishing state space collapse results in many-server diffusion limits for V-model systems under static-buffer-priority policy and the threshold policy proposed in the literature.
International Osteoporosis Foundation and International Federation of Clinical Chemistry and Laboratory Medicine Position on bone marker standards in osteoporosis
Authors: Vasikaran Samuel , Cooper Cyrus , Eastell Richard , Griesmacher Andrea , Morris Howard A. , Trenti Tommaso , Kanis John A.
Published: May 2011

The International Osteoporosis Foundation (IOF) and the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Working Group on Bone Marker Standards (WG-BMS) has evaluated the clinical potential of bone turnover markers (BTMs) in the prediction of fracture risk and for monitoring treatment. Research evidence suggests that BTMs may provide information on fracture risk independently from BMD, so that fracture risk prediction might be enhanced by their inclusion in assessment algorithms. The potential use of BTMs to predict the response to treatments for osteoporosis in the individual patient is also of great interest. Treatment-induced changes in specific markers account for a substantial proportion of fracture risk reduction. However, there is still a need for stronger evidence on which to base practice in both situations. IOF/IFCC recommends one bone formation marker (serum procollagen type I N propeptide, s-PINP) and one bone resorption marker (serum C-terminal cross-linking telopeptide of type I collagen, s-CTX) to be used as reference markers and measured by standardised assays in observational and intervention studies in order to enlarge the international experience of the application of markers to clinical medicine and to help resolve uncertainties over their clinical use.
c-Jun N-terminal kinases in memory and synaptic plasticity
Authors: Sherrin Tessi , Blank Thomas , Todorovic Cedomir
Published: May 2011

The c-Jun N-terminal kinases (JNK) belong to the subfamily of mitogen-activated protein kinases (MAPK). JNK is an important signaling enzyme that is involved in many facets of cellular regulation including gene expression, cell proliferation and programmed cell death. Activation of JNK isoforms (JNK1, 2, and 3) is regarded as a molecular switch in stress signal transduction. The activation of JNK pathways is also critical for pathological death associated with neurodegenerative diseases. Considering that a variety of stressors activate JNK, it is surprising that the role of hippocampal JNK in memory and synaptic plasticity has not yet been systematically investigated. Here we summarize the emerging evidence for the functions of hippocampal JNK in memory and synaptic plasticity, including our recent demon­stration that JNK isoforms play critical roles in regulation of contextual fear conditioning under stressful and baseline conditions. We postulate that sustained activation of the hippocampal JNK2 and JNK3 pathways is involved in the initial stress response that ultimately leads to deficits in memory and long-term potentiation, whereas transient JNK1 activation regulates baseline contextual fear conditioning. Results obtained within the framework of our recent findings will be used for future work, which will differentiate mechanisms underlying beneficial short-term JNK action from prolonged JNK activation that may lead to memory deficits and neurodegeneration.
A New Round Panel Test for the Characterization of Fiber Reinforced Concrete: A Broad Experimental Study
Authors: Minelli Fausto , Plizzari Giovanni
Published: May 2011

Standard test methods for determining the mechanical properties of Fiber Reinforced Concrete (FRC) are properly defined if they reproduce the actual structural behavior. Among many proposals, a round panel test seems to have all potentials to become an easy-to-use tool and, at the same time, a reliable procedure for the characterization of FRC, in terms of toughness and the post-cracking constitutive cohesive law. A new geometry for the round panel test is herein proposed and discussed in order to make the panel easier to place, handle, and test, therefore avoiding one of the major drawbacks that limit an extensive utilization of the panel test. A comparison between different test typologies for characterizing FRC is reported and discussed in the present paper, with special emphasis on the different scatter that each test produces. Tests are performed on beams as well as on panels. All specimens herein compared have the same concrete mechanical properties and fiber content. The aim of the experimental investigation is to critically discuss the advantages and disadvantages of each testing procedure, focusing on the applicability of the method and on the reliability of results toward a consistent characterization of the structural behavior. Suitable correlations among the different fracture and energy parameters defined in the standards considered are finally reported, and the results are very useful for harmonizing the available standards.
Correlation Analyses for Implementation of Binder Properties for Rut Potential Estimation of Asphalt Mixtures
Authors: Kim Sungun , Park Jiyong , Kim Kwang W.
Published: May 2011

This study examined the relationship of three binder properties with three permanent deformation (rut) test data. The three binder properties include the stiffness (G*/sin δ) measured by dynamic shear rheometer, the large molecular size (LMS) ratio, measured by gel-permeation chromatography, and the absolute viscosity. The three rut tests at 60°C include the wheel tracking (WT), asphalt pavement analyzer (APA), and deformation strength (SD) tests on 28 hot-mix asphalt mixtures (two aggregates, two gradations and seven binders). The regression analyses showed the two binder properties (G*/sin δ and LMS) had very high correlation (R2>0.81) with the rut depth values of WT and APA, and with SD values. This is an indication that G*/sin δ and LMS are reliable properties that provide a reasonable estimation of the rut potential of asphalt mixtures. Prediction models for rut estimation were developed by multiple regression using binder properties and aggregate information. The predicted rut data were well fit (R2>0.92) to the measured rut data. Therefore, it was found that the two binder properties could be reliably used for the estimation of the rut potential of asphalt mixtures.
Coprescription of Antibiotics and Asthma Drugs in Children
Authors: De Boeck Kris , Vermeulen François , Meyts Isabelle , Hutsebaut Luc , Franckaert Danny , Proesmans Marijke
Published: May 2011

BACKGROUND:

In children, antibiotics as well as asthma drugs are frequently prescribed. We investigated the effects of the codispensing of antibiotics and asthma drugs to children.

METHODS:

Using a health insurance database, we examined dispensing and codispensing of antibiotics and asthma drugs for the period of a 1 year in 892 841 Belgian children aged <18 years.

RESULTS:

For a 1-year period, an antibiotic was dispensed to 44.21% of children: 73.05% aged <3 years; 49.62% aged 3 to 7 years; and 34.21% aged 8 to <18 years. An asthma drug was dispensed to 16.04% of children: 44.81% aged <3 years; 17.90% aged 3 to 7 years; and 7.64% aged 8 to <18 years. Overall, an antibiotic was dispensed without an asthma drug to 38.62% of children versus with an asthma drug to 73.50% of children (P < .0001). More frequent dispensing of antibiotics to children who received an asthma drug (odds ratio: 1.90; 95% confidence interval: 1.89–1.91) occurred in all age categories (P < .0001). In 35.64% of children with an asthma drug dispensed, an antibiotic was dispensed on the same day.

CONCLUSIONS:

In all age groups, dispensing of antibiotics is more likely in children who have an asthma drug dispensed in the same year. In all age groups, codispensing of antibiotics and asthma drugs is a common practice. Efforts to decrease antibiotic use in children could be improved by focusing on children who are being treated with asthma drugs.
Prospective Evaluation of Residents On Call: Before and After Duty-Hour Reduction
Authors: Bismilla Zia , Breakey Vicky R. , Swales Jennifer , Kulik Dina M. , Pai Nikhil , Singh Nikate , Parshuram Christopher S.
Published: May 2011

BACKGROUND:

On July 1, 2009, in Ontario the maximum period of continuous duty that residents were permitted to work was reduced from 28 to 24 hours. We evaluated the effect of regulation on residents in 3 eras: 2 before (2005 and early 2009) and 1 after (late 2009) the duty-hour reduction.

METHODS:

On-call pediatric residents on pediatric medicine rotations prospectively recorded the numbers of patients (assigned and admitted) and the durations of direct patient care, documentation, staff supervision, and education attended. Sleep was measured with actigraphy.

RESULTS:

The 51 residents worked 180 duty periods, were assigned a median of 6 (interquartile range: 4 –12) daytime patients and 24 (interquartile range: 19–30) overnight patients. Residents reported spending means of 239 minutes providing direct patient care, 235 minutes documenting, and 243 minutes sleeping and receiving 73 minutes of staff supervision and 52 minutes of education. From early 2009 to after duty-hour reduction, residents provided 47 fewer (19.6%) minutes of direct patient care (P = .056) and received 44 fewer minutes (60.3%) of supervision (P = .0005) but spent similar times documenting, receiving education, and sleeping. In early 2009, residents provided 73 more minutes (30.5%) of direct patient care (P = .0016), spent 63 more minutes (26.8%) documenting, and slept 105 fewer minutes (43.0%) (P = .0062) than in 2005.

DISCUSSION:

After duty-hour reduction in 2009, we found reduced supervision and direct patient care. Comparison of the 2 periods before duty-hour reduction showed less sleep and longer patient contact in early 2009, which suggests that changes occurred without regulation.
Disparities in Child Access to Emergency Care for Acute Oral Injury
Authors: Bisgaier Joanna , Cutts Diana B. , Edelstein Burton L. , Rhodes Karin V.
Published: May 2011

OBJECTIVE:

We examined the impact of insurance status on dental practices' willingness to schedule an appointment for a child with a symptomatic fractured permanent front tooth.

PATIENTS AND METHODS:

Between February and May 2010, 6 research assistants posed as mothers of a 10-year-old boy seeking an urgent dental appointment. Two calls 4 weeks apart, with the same clinical scenario, were made by the same caller to a stratified random sample of dental practices, one-half of which were enrolled in the state's combined Medicaid and Children's Health Insurance Program (CHIP) dental program. The only difference in the calls was the child's insurance coverage (Medicaid/CHIP versus private Blue Cross dental coverage). We estimated differences in the log-odds probability of scheduling an appointment for a child with public versus private insurance by using exact conditional (fixed-effects) logistic regression, which accounts for paired data.

RESULTS:

Of 170 paired calls to 85 dental practices (41 participating in the Medicaid program), only 36.5% of Medicaid beneficiaries obtained any appointment compared with 95.4% of Blue Cross–insured children with the same oral injury. Among dental providers enrolled in the Medicaid program, children with Medicaid were still 18.2 times more likely to be denied an appointment than privately insured counterparts (95% confidence interval: 3.1 to ∞; P < .001).

CONCLUSIONS:

Illinois dentists, including those participating in Medicaid, are less likely to see a child for an urgent dental complaint if the child has public versus private dental coverage. These results have implications for developing policies that improve access to oral health care.
Imagens cerebrais e o caso da síndrome da fadiga crônica
Authors: Ortega Francisco , Zorzanelli Rafaela
Published: May 2011

Este artigo analisa o uso de neuroimageamento nas pesquisas da síndrome da fadiga crônica. Revisam-se alguns dos estudos publicados sobre o assunto na década de 1990 e analisa-se um ponto específico desses estudo, que é a busca de alterações na ativação cerebral ou outros tipos de anormalidade que possam fornecer um padrão para diagnóstico e tratamento da doença. Analisa-se o entendimento da síndrome da fadiga crônica como uma doença reduzida aos achados cerebrais, argumentando em favor de uma visão mais ampliada da doença, que leve em conta os elementos psicossociais da vida do paciente em detrimento de explicações reduzidas ao somático.
Aortitis and Bacterial Endocarditis
Authors: Leon Luis R. , Rodriguez Heron E. , Labropoulos Nicos , Littooy Fred N. , Psalms Shemuel B.
Published: May 2011

Aortitis is an inflammatory condition that can be due to numerous causes. It is a diagnostic quandary because it commonly shows similar clinical, pathologic, and aortographic features independently of the etiology. A case of aortitis, possibly secondary to bacterial endocarditis, initially misdiagnosed as an atherosclerotic aortic ulcer and managed with an endoprosthesis is presented. On the fourth postoperative day, the patient presented with fever and worsening abdominal pain, which was later diagnosed as infectious aortitis. It required débridement and replacement of the infrarenal aorta with a cadaveric cryopreserved allograft. This case emphasizes the need for early diagnosis and aggressive therapy to avoid life-threatening sequelae.
Regulation of Vascular Smooth Muscle Cell Growth by Survivin
Authors: Hoel Andrew W. , Wang Grace J. , Simosa Hector F. , Conte Michael S.
Published: May 2011

The inhibitor of apoptosis protein survivin has long been of interest in the cancer literature for its role in both the regulation of cell proliferation and the inhibition of apoptosis. A growing body of literature has implicated survivin in the maladaptive pathways following vascular injury and, in particular, in the growth of vascular smooth muscle cells that comprise the hyperplastic neointimal lesions that characterize midterm vein bypass graft failure and restenosis following angioplasty and stenting. This review focuses on the emerging role of survivin in the regulation of smooth muscle cell growth and its implications for the prevention of restenosis following revascularization procedures. The expression, regulation, and function of survivin are addressed, as well as the current state of understanding regarding the effects of survivin inhibition in vitro and in vivo.
Theory, Technique, and Practice of Magnetic Resonance Angiography
Authors: Muhs Bart E. , Verhagen Hence J.M. , Huddle Matthew G. , Pai Vinay M. , Hecht Elizabeth M. , Dardik Alan
Published: May 2011

Magnetic resonance angiography (MRA) is now a widely accepted technique used to characterize vascular pathology such as stenosis, dissection, fistula, and aneurysms. Magnetic resonance techniques are increasingly driving clinical decision making by vascular physicians. The physics behind MRA can contribute to the general understanding and interpretation of the anatomic images. We seek to provide a window into how magnetic resonance images are generated, which techniques may be employed, and the potential advantages and limitations of various techniques and to discuss the future role MRA may have for the vascular physician.
Direct Thrombin Inhibitors: Alternatives to Heparin
Authors: Mureebe Leila
Published: May 2011

After more than 70 years of effective clinical use, heparin remains the most common anticoagulant in use and one of the most commonly prescribed drugs to hospitalized patients. However, the biologic variability and immunogenicity limit its utility. With increasing volumes of vascular intervention and an aging population, an increase in the need for anticoagulation can be anticipated. This article reviews current viable options and barriers to the use of heparin.
Endothelial Progenitor Cells: A Primer for Vascular Surgeons
Authors: Magri Dania , Fancher Tiffany T. , Fitzgerald Tamara N. , Muto Akihito , Dardik Alan
Published: May 2011

Endothelial progenitor cells (EPCs) participate in vascular healing during both acute injury and chronic disease. The quantity and quality of circulating EPCs correlate inversely with the severity of vascular disease, such that reduced number and/or function of EPCs are significant independent risk factors for impaired healing capacity, dysfunctional endothelium, and progression of atherosclerosis and vascular disease. EPC therapy assists healing of cardiac and limb ischemia and has great potential for improving the quality of life and longevity of patients with severe cardiovascular and peripheral vascular disease who are not candidates for conventional revascularization procedures. In addition, EPCs can be used to promote vascular graft patency. This review focuses on the characterization of EPCs, positive and negative regulators of EPCs, the role of EPCs in vascular disease, and the potential for EPC therapy to ameliorate the sequelae of severe peripheral vascular disease.
Endovascular Common Iliac Aneurysm Exclusion with Antegrade Hypogastric Artery Flow Preservation: A Novel Approach
Authors: Leon Luis R. , Psalms Shemuel B. , Ihnat Daniel M. , Becker Gary J. , Mills Joseph L.
Published: May 2011

Open surgical repair of iliac aneurysms has been usually associated with significant morbidity and mortality. The introduction of novel endovascular techniques has expanded the currently available options to treat these aneurysms. However, the use of endoluminal stent grafts to treat common iliac artery aneurysms by landing their distal end into the hypogastric artery in patients where flow into the latter artery is crucial to avoid end-organ ischemia has only been rarely reported in the past. A case report of a common iliac aneurysm case treated with a novel therapeutic approach, not previously reported is herein presented. Three telescopically-overlapping Hemobahn/Viabahn polytetrafluoroethylene (PTFE)-covered endoprosthesis (W.L. Gore & Associates, Flagstaff, AZ) were used with success.
Inelastic Compression Legging Produces Gradient Compression and Significantly Higher Skin Surface Pressures Compared with an Elastic Compression Stocking
Authors: Kline Cassie N. , Macias Brandon R. , Kraus Emily , Neuschwander Timothy B. , Angle Niren , Bergan John , Hargens Alan R.
Published: May 2011

The purposes of this study were to (1) investigate compression levels beneath an inelastic legging equipped with a new pressure-adjustment system, (2) compare the inelastic compression levels with those provided by a well-known elastic stocking, and (3) evaluate each support's gradient compression production. Eighteen subjects without venous reflux and 12 patients with previously documented venous reflux received elastic and inelastic compression supports sized for the individual. Skin surface pressures under the elastic (Sigvaris 500, 30–40 mm Hg range, Sigvaris, Inc., Peachtree City, GA) and inelastic (CircAid C3 with Built-in-Pressure System [BPS], CircAid Medical Products, San Diego, CA) supports were measured using a calibrated Tekscan I-Scan device (Tekscan, Inc., Boston, MA). The elastic stocking produced significantly lower skin surface pressures than the inelastic legging. Mean pressures (± standard error) beneath the elastic stocking were 26 ± 2 and 23 ± 1 mm Hg at the ankle and below-knee regions, respectively. Mean pressures (± standard error) beneath the inelastic legging with the BPS were 50 ± 3 and 38 ± 2 mm Hg at the ankle and below-knee regions, respectively. Importantly, our study indicates that only the inelastic legging with the BPS produces significant ankle to knee gradient compression ( p = .001).
Elective Shunt Use for Easy Resection of a Carotid Body Tumor
Authors: Sunar Hasan , Keles Cüneyt , Besirli Kazim
Published: May 2011

Carotid body tumor resection has the potential hazards of hemorrhage, cranial nerve palsy, and cerebrovascular accident. The control of intraoperative bleeding during manipulation of the tumor is a critical issue for safe resection. In the presented case with a carotid body tumor, the Shamblin II, a carotid shunt with a dual balloon was used electively. The aim of shunt use was partial isolation of the tumor from carotid arterial circulation in a short time only. Shunt use may facilitate safe and easy resection.
Occlusive Arterial Disease after Radiotherapy for Testicular Cancer: Case Report and Review of the Literature
Authors: Tetik Ömer , Yetkin Ufuk , Calli Aylin Orgen , Ilhan Gokhan , Gurbuz Ali
Published: May 2011

Radiation injury to arterial occlusion is a rare and late complication of radiotherapy. Numerous adverse reactions may occur secondary to radiation therapy. A well-known side effect is radiation-induced occlusive lesions and the enhancement of normally occurring atherosclerosis. We report a case of symptomatic right iliac and femoral artery occlusion after radiation therapy for carcinoma of the testis.
Nonoperative Active Management of Critical Limb Ischemia: Initial Experience Using a Sequential Compression Biomechanical Device for Limb Salvage
Authors: Sultan Sherif , Esan Olubunmi , Fahy Anne
Published: May 2011

Critical limb ischemia (CLI) patients are at high risk of primary amputation. Using a sequential compression biomechanical device (SCBD) represents a nonoperative option in threatened limbs. We aimed to determine the outcome of using SCBD in amputation-bound nonreconstructable CLI patients regarding limb salvage and 90-day mortality.

Thirty-five patients with 39 critically ischemic limbs (rest pain = 12, tissue loss = 27) presented over 24 months. Thirty patients had nonreconstructable arterial outflow vessels, and five were inoperable owing to severe comorbidity scores. All were Rutherford classification 4 or 5 with multilevel disease. All underwent a 12-week treatment protocol and received the best medical treatment.

The mean follow-up was 10 months (SD ± 6 months). There were four amputations, with an 18-month cumulative limb salvage rate of 88% (standard error [SE] ± 7.62%). Ninety-day mortality was zero. Mean toe pressures increased from 38.2 to 67 mm Hg (SD ± 33.7, 95% confidence interval [CI] 55–79). Popliteal artery flow velocity increased from 45 to 47.9 cm/s (95% CI 35.9–59.7). Cumulative survival at 12 months was 81.2% (SE ± 11.1) for SCBD, compared with 69.2% in the control group (SE ± 12.8%) ( p = .4, hazards ratio = 0.58, 95% CI 0.15–2.32). The mean total cost of primary amputation per patient is €29,815 ($44,000) in comparison with €13,900 ($20,515) for SCBD patients.

SCBD enhances limb salvage and reduces length of hospital stay, nonoperatively, in patients with nonreconstructable vessels.
Jugular Vein Aneurysm
Authors: Ilijevski Nenad S. , Radak Sandra , Vučurević Goran , Sagić Dragan , Otašević Petar , Tasić Nebojša , Nenezić Dragoslav , Popov Petar , Radak Đorđe
Published: May 2011

Jugular vein aneurysm is a rare morphologic entity. This report describes a case of an asymptomatic internal jugular vein aneurysm that presented as an enlarging mass in the neck. Diagnosis was established with duplex ultrasonography and venography. No thrombus was diagnosed in the aneurysm, but since the patient was uncomfortable with having a tumor in his neck, surgery was performed with resection of the aneurysm and lateral venorrhaphy of the jugular vein.
Importance of Gender-Specific Role Models in Vascular Surgery
Authors: Shortell Cynthia K. , Cook Chad
Published: May 2011

The percentage of female physicians selecting vascular surgery for residency and/or fellowship lags behind percentages in general surgery selections. A number of factors, such as mentorship, gender biases, lifestyle, and job characteristics, have been proposed as explanations for the lower percentage of applicants. The purpose of this study was to investigate whether selective lifestyle, mentorship, and associated job considerations were more commonly identified by female vascular surgeons during their decision-making process for their specialty. The study used a survey sent to vascular surgery residents and fellows. Questions were related to mentorship, lifestyle, and job characteristics and were analyzed using a series of bivariate comparisons. The findings suggest that both men and women rarely report a female mentor in medical school, and that female vascular surgeons were less likely than others to have children. As in other studies, we found that females lack female role models during medical school. With respect to career choice, no lifestyle or job characteristics were statistically different between female vascular surgeons and male counterparts. This finding contrasts with previous reports. This study confirms the lack of female mentorship in vascular surgery and questions the importance of job and lifestyle characteristics in relation to career selection.
Chyloperitoneum Following Abdominal Aortic Surgery
Authors: Olthof Emilie , Blankensteijn Jan D. , Akkersdijk George J.M.
Published: May 2011

Chyloperitoneum is an uncommon but serious complication following abdominal aortic surgery. As there seems to be no uniformity concerning the treatment, we performed a literature search to evaluate the best treatment results. All Medline-cited articles on chyloperitoneum after abdominal aortic surgery were assessed and analyzed. Thirty-eight cases of chyloperitoneum following abdominal aortic surgery were found. Patients developed symptoms after a median of 16 days (range 2–120 days) and were asymptomatic after 68 days (mean, range 27–93 years). All patients underwent diagnostic paracentesis, which confirmed the diagnosis. In 26 cases (68%), paracentesis was part of the treatment. The use of diuretics (24%) as therapeutic value was abandoned. Total parenteral nutrition, used in 21 patients (55%), provides the possibility of an extended period of oral starvation that reduces the lymphatic flow from the leaking duct. Medium-chain triglyceride, used in 28 cases (76%), is generally accepted as reducing lymphatic flow. When all conservative measures fail, surgical exploration is indicated. Two surgical interventions were mentioned: placing a peritoneovenous shunt or transfixing the damaged lymph vessel; both were described with different outcomes. This review supports conservative treatment of chyloperitoneum following abdominal aortic surgery.
Genomic Modeling of Atherosclerosis in Peripheral Arterial Disease and Its Variant Phenotype in Patients with Diabetes
Authors: Evans David C. , Sileshi Bantayehu , Zakaria Aamir M. , Giangiacomo Dana , Manson Roberto J. , Lawson Jeffrey H.
Published: May 2011

Microarrays can be used to discover candidate genes associated with peripheral arterial disease (PAD) and develop models that predict patient clinical status. We hypothesize that multiple phenotypes of PAD with distinct patterns of gene expression exist. We histologically characterized and extracted ribonucleic acid from 31 arterial samples collected from the lower extremities of patients undergoing amputation or free fibular grafting. Analysis using the Affymetrix U133A microarray identified 335 genes with twofold or greater differences in expression between normal and diseased arteries ( p < .01) and 104 genes with twofold or greater differences between diabetic and nondiabetic atherosclerotic arteries ( p < .1). Many genes identified have known roles in inflammatory and lipid uptake pathways. Predictive models were developed that could predict PAD and the associated diabetic phenotype with an accuracy of 71 to 90%. Developing distinct genomic models of PAD will serve as the first step toward understanding the molecular and genetic basis of PAD and subsequent application of novel therapeutics to this condition.
Role of Negative Pressure Wound Therapy in Treating Peripheral Vascular Graft Infections
Authors: Sumpio Bauer E. , Allie David E. , Horvath Keith A. , Marston William A. , Meites Herbert L. , Mills Joseph L.R. , Orgill Dennis P. , Salazar Jorge D. , Song David H. , Toursarkissian Boulos
Published: May 2011

Wound complications involving large subcutaneous vessels can cause significant challenges for surgeons. Negative pressure wound therapy (NPWT) has been increasingly used for treating complex wounds in vascular surgery, including groin infections, either as a bridge to surgical closure or as a primary wound treatment modality. Although a growing body of evidence exists for managing various problematic wounds, such as diabetic foot ulcers and open abdominal wounds, the role of NPWT in wounds involving large blood vessels or wounds complicating infected vascular grafts has not been well defined. A multidisciplinary advisory panel reviewed the literature relevant to wounds related to vascular surgical procedures and complications, focusing on large subcutaneous or infected vascular conduits. The results supported by the literature and the clinical practice of the consensus panel suggested that NPWT can be a useful adjunct to the management of vascular groin infections and dehiscences but must be used with caution.
Plasma Matrix Metalloproteinase Levels Do Not Predict Tissue Levels in Abdominal Aortic Aneurysms Suitable for Elective Repair
Authors: Wilson W. Richard W. , Choke Edward C. , Dawson Joseph , Loftus Ian M. , Thompson Matthew M.
Published: May 2011

The role of matrix metalloproteinases (MMPs) in abdominal aortic aneurysm (AAA) pathogenesis is well described. However, a clear role for the MMPs in disease prediction has not been established. The aim of this study was to determine if circulating levels of MMPs correlated with AAA diameter and with MMP concentrations within the aneurysm wall. Preoperative plasma samples and intraoperative infrarenal AAA sac biopsies were taken in a standard fashion from 31 patients undergoing elective repair. The concentrations of MMP-1, MMP-2, MMP-3, MMP-9, tissue inhibitor of matrix metalloproteinase (TIMP)-1, and TIMP-2 were quantified in plasma and aneurysm wall homogenates using enzyme-linked immunosorbent assay. Comparison used the Spearman correlation. There were no correlations between the paired plasma and aneurysm wall concentrations for any MMP or TIMP. Correlation between MMP-9 levels in the aneurysm wall and aneurysm diameter was negative ( r = −.42, p = .019). Other correlations between plasma and tissue levels with aneurysm diameter were nonsignificant.
Femoral Vascular Closure Device: The Surgical View
Authors: Germing Alfried , Lindstaedt Michael , Reber Delawer
Published: May 2011

This case report describes the surgical findings of a percutaneous closure device, which was used after diagnostic coronary angiography. The features of the device are described. Surgeons should be familiar with the existence of these devices to avoid complications during vascular access procedures at the level of the common femoral artery.
Diagnosis and Management of Traumatic Pseudoaneurysm of the Carotid Artery: Case Report and Review of the Literature
Authors: Magge Deepa , Farber Alik , Vladimir Felix , Woodson Jonathan , Collins Kathryn , Shaw Palma , Gibbons Gary
Published: May 2011

Injury to the carotid artery can occur in the setting of blunt and penetrating trauma. Such injury can result in pseudoaneurysm formation. We present a case of posttraumatic common carotid pseudoaneurysm (PTCP) that was diagnosed and treated 2 months after a motor vehicle accident and review the literature on the presentation, diagnosis, and management of PTCP.
Hybrid Open and Endovascular Therapy for a Proximal Subclavian Artery Aneurysm
Authors: Harding Gregory E.J. , Kribs Stewart W. , Forbes Thomas L.
Published: May 2011

A 57-year-old male presented with a large proximal right subclavian artery aneurysm that had been the source of upper extremity emboli on two occasions. A combined open and endovascular approach was undertaken involving a common carotid to vertebral artery autogenous bypass via a supraclavicular incision and endovascular repair of the aneurysm from a transbrachial approach. The patient did well postoperatively and recovered fully following a short hospitalization.
Impact of the Type of Anesthesia on Outcome after Elective Endovascular Aortic Aneurysm Repair: Literature Review
Authors: Sadat Umar , Cooper David G. , Gillard Jonathan H. , Walsh Stewart R. , Hayes Paul D.
Published: May 2011

The type of anesthesia used during aneurysm repair affects postoperative outcomes for the patient. Although endovascular aneurysm repair (EVAR) appears to improve surgical outcomes, by convention, general anesthesia remains predominantly used. The aim of this study was to compare the impact of the type of anesthesia (ie, locoregional versus general anesthesia) on the outcomes following EVAR. A literature search was carried out using the PubMed search engine to find relevant published articles that compared locoregional and general anesthesia in patients undergoing EVAR. The review of the selected studies showed that although patients in the locoregional group were less medically fit compared with those in the general anesthesia group, there was a reduction in the cardiovascular support required during and after the surgery, postoperative hospital stay, intensive care unit (ICU) stay, and postoperative mortality and morbidity. Although there is no level 1 evidence for or against locoregional anesthesia in EVAR, conventionally, EVAR has been performed under general anesthesia. But this is rooted in tradition rather than evidence. This review suggests that locoregional anesthesia can improve postoperative outcomes following EVAR by reducing hospital stay, ICU stay, mortality, and morbidity, although other factors may also have some influence.
Another Late Complication after Endovascular Aneurysm Repair: Aneurysmal Degeneration at the Iliac Artery Landing Site
Authors: Agu Obekieze , Boardley Dee , Adiseshiah Mohan
Published: May 2011

The purpose of this article is to describe a hitherto underreported late complication of infrarenal endovascular aneurysm repair (EVAR), namely type Ib endoleakage resulting from aneurysmal degeneration at the iliac artery landing site. In a prospectively recorded audit, between 1994 and 2007, 297 patients underwent EVAR. All cases that developed iliac artery aneurysm (IAA) were studied. Ten cases of IAA in seven patients (2.4% of the cohort) developed 5 to 9 years after EVAR. Eight of the 10 involved the lower landing site of the stent graft. Landing site diameter before EVAR was 12 mm (range 10–15 mm). Three IAAs presented as emergencies with rapidly expanding sacs and impending rupture. All cases underwent further endovascular intervention with no < 30-day mortality. Iliac artery landing site aneurysm formation after EVAR occurs uncommonly after 5 or more years. It should be regarded as an indication for intervention prior to type Ib endoleakage development. The need for lifelong surveillance is highlighted.
Upper Gastrointestinal Obstruction Secondary to Aortoduodenal Syndrome Owing to a Noninflammatory Abdominal Aortic Aneurysm
Authors: Cahill Kevin , Roche-Nagle Graham , MacEneaney Peter , McGreal Gerald
Published: May 2011

Aortoduodenal syndrome is a rare complication of an abdominal aortic aneurysm wherein the aneurysm sac obstructs the patient's duodenum. It presents with the symptoms of an upper gastrointestinal tract obstruction and requires surgical intervention to relieve it. Previously, gastric bypass surgery was advocated, but now aortic replacement is the mainstay of treatment. We report a case of a 67-year-old woman whose aortoduodenal syndrome was successfully managed and review the literature on this topic.