bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Hyperlipidemia and Its Risk Factors for the Middle-Aged and Elderly in the Guangxi Hei Yi Zhuang and Han Populations
Authors: Ruixing Yin , Fengping He , Shangling Pan , Dezhai Yang , Weixiong Lin , Tangwei Liu , Yuming Chen , Jinzhen Wu , Limei Yao , Jiandong Huang
Published: August 2007

Background

Han is the largest and Zhuang is the second largest among the 56 nationalities in China. Geographically and linguistically, Zhuang can be classified into 43 ethnic subgroups, among which Hei Yi (which means “black worship” and “black dressing”) Zhuang is the most conservative group, according to its unique culture and customs. Little is known about the lipid profiles and corresponding risk factors of hyperlipidemia in this population. Therefore, the aim of this study was to compare the effects of demographic characteristics, health-related behaviors, and lifestyle factors on the prevalence of hyperlipidemia for the middle-aged and elderly in the Guangxi Hei Yi Zhuang and Han populations.

Methods

A sample of 657 people of Hei Yi Zhuang aged 40 years and over was randomly selected from 7 villages in Napo County, Guangxi, China. Information on demographic characteristics, health-related behaviors, and lifestyle factors was collected by questionnaire. Blood pressure, height, weight, waist circumference, and serum lipid and apolipoprotein (apo) levels were measured, and body mass index (BMI) was calculated as a measure of weight relative to height. The results were compared with those in 520 people of Han living in the same region.

Results

The prevalence of hyperlipidemia in the Hei Yi Zhuang was significantly lower than that in the Han (36.2% vs 42.3%; p < .05). The levels of total cholesterol, triglyceride, low-density lipoprotein cholesterol, and apo B in Hei Yi Zhuang were also significantly lower than those in the Han (p < .05 to .001), but the levels of high-density lipoprotein cholesterol and the ratio of apo A-I to apo B in the Hei Yi Zhuang were significantly higher than those in the Han (p < .01 and < .001, respectively). There were no significant differences in apo A-I levels between the two ethnic groups (p > .05). The prevalence of hyperlipidemia was positively correlated with BMI and blood pressure in the Hei Yi Zhuang. Hyperlipidemia was positively associated with age, BMI, and blood pressure and negatively associated with gender (female higher) in the Han.

Conclusions

In the present study of the middle-aged and elderly population, the Hei Yi Zhuang have a more favorable lipid profile and a lower prevalence of hyperlipidemia than do the Han, and there is also a significant difference in the risk factors for hyperlipidemia between the two ethnic groups, which might result from the effects of different demographic characteristics, health-related behaviors, and lifestyle factors.
Phase I and Phase II Enzyme Polymorphisms and Childhood Cancer
Authors: Swinney Ryan , Hsu Stephanie , Tomlinson Gail
Published: August 2007

Childhood cancers continue to be challenging clinical entities whose etiology, demographic characteristics, clinical progression, treatment efficacy, and outcomes remain incompletely understood. Research suggests that multiple environmental and genetic factors may play crucial roles in the pathophysiology of many of these malignancies. Recent attention has been directed to the role of carcinogen metabolizing enzymes in the etiology and progression of cancer in both adults and children due to their multitude of polymorphic variants and their intimate interaction with environmental factors. In particular, xenobiotic metabolizing enzymes (XME), which are intimately involved in the activation and deactivation of many environmental carcinogens, have become an area of significant interest. Traditionally, these enzymes have been classified into either phase I or phase II enzymes depending on their substrates, activity, and occasionally based on their sequence in the metabolic pathways, and have been demonstrated to have numerous polymorphic variants. Phase I enzymes predominantly consist of cytochrome enzymes responsible for mixed function oxidase activity, whereas phase II enzymes are frequently conjugation reactions necessary for drug metabolism or the further metabolism of phase I enzyme products. Current research has discovered numerous interactions between polymorphisms in these enzymes and changes in cancer susceptibility, treatment efficacy, and clinical outcomes in childhood cancer. Furthermore, studies of polymorphisms in these enzymes have demonstrated to have synergistic/antagonistic interactions with other XME polymorphisms and demonstrate variable influences on disease pathophysiology depending on the patient's ethnic background and environmental milieu. Continuing research on the role of polymorphisms in phase I and phase II enzymes will likely further elucidate the intimate role of these polymorphisms with environmental factors in the etiology of childhood cancer.
Prostate-Specific Antigen ‘Velocity’ as a Diagnostic Test for Prostate Cancer
Authors: Concato John , Wells Carolyn K.
Published: August 2007

Background

Prostate-specific antigen “velocity” (slope) is promoted as a diagnostic test for prostate cancer, but its clinical usefulness is uncertain. Accordingly, we evaluated the sensitivity of prostate-specific antigen (PSA) velocity among men who are diagnosed subsequently with prostate cancer.

Methods

Among 64,545 men receiving primary care at any of nine Veterans Affairs Medical Centers during 1989-1990, 1,313 men at least 50 years old had an incident diagnosis of prostate cancer during 1991-1995. PSA velocity values obtained prior to diagnosis (“test”) were compared with results from prostate biopsies (“truth”).

Results

Among men ( n = 493) with at least two tests before diagnosis, the sensitivity of PSA velocity ≥ 0.75 ng/mL/yr was 75.5% (95% confidence interval [CI] 71.7-79.3) overall and 48.1% (95% CI 34.8-61.5) among men with normal values of PSA (< 4.0 ng/mL). Based on published data for specificity and prevalence, the estimated positive predictive value of PSA velocity ≥ 0.75 ng/mL/yr is as low as 5%.

Conclusion

PSA velocity may have limited usefulness as a diagnostic test for prostate cancer.
Relationship between A2A Adenosine Receptor Expression and Intradialytic Hypotension during Hemodialysis
Authors: Giaime Philippe , Carrega Louis , Fenouillet Emmanuel , Mercier Laurence , Gerolami Victoria , Ruf Jean , Sauze Nicole , Brunet Philippe , Saadjian Alain , Berland Yvon , Dussol Bertrand , Guieu Regis
Published: August 2007

Background

Intradialytic hypotension (IDH) is a common complication of hemodialysis sessions (HDSs). Adenosine may contribute to the drop in blood pressure during IDH events because it has hypotensive effects. As A2Aadenosine receptor expression is essential for blood pressure control, we compared the expression of A2Areceptors (Bmax, KD, and messenger ribonucleic acid [mRNA] levels) in peripheral blood mononuclear cells from IDH and non-IDH patients and from controls. We also evaluated adenosine plasma levels (APLs).

Methods

We included 10 hemodialyzed patients with at least three IDH events per month. We also included 11 hemodialyzed patients with no history of IDH events and 10 healthy subjects as controls.

Results

IDH patients had higher Bmax values than non-IDH patients (mean before HDS, +86%; after HDS, +112%), whereas non-IDH patients had lower Bmax values than controls (mean −72%). KDvalues were not significantly different between patients and controls. The levels of mRNA increased significantly during HDS but without an increase in receptor expression on the cell membranes. APLs were higher in hemodialyzed patients than in controls.

Conclusion

We found that A2Areceptors are more expressed in IDH patients than in non-IDH patients, whereas APL was high in all patients. Both high APL and a relative increase in A2Areceptor expression may favor IDH events.
Search for Microbial Signatures within Human and Microbial Calcifications Using Soft X-Ray Spectromicroscopy
Authors: Benzerara Karim , Miller Virginia M. , Barell Gerard , Kumar Vivek , Miot Jennyfer , Brown Gordon E. , Lieske John C.
Published: August 2007

Background

The origin of advanced arterial and renal calcification remains poorly understood. Self-replicating, calcifying entities have been detected and isolated from calcified human tissues, including blood vessels and kidney stones, and are referred to as nanobacteria. However, the microbiologic nature of putative nanobacteria continues to be debated, in part because of the difficulty in discriminating biomineralized microbes from minerals nucleated on anything else (eg, macromolecules, cell membranes). To address this controversy, the use of techniques capable of characterizing the organic and mineral content of these self-replicated structures at the submicrometer scale would be beneficial.

Methods

Calcifying gram-negative bacteria ( Caulobacter crescentus, Ramlibacter tataouinensis) used as references and self-replicating calcified nanoparticles cultured from human samples of calcified aneurysms were examined using a scanning transmission x-ray microscope (STXM) at the Advanced Light Source at Lawrence Berkeley National Laboratory. This microscope uses a monochromated and focused synchrotron x-ray beam (80-2,200 eV) to yield microscopic and spectroscopic information on both organic compounds and minerals at the 25 nm scale.

Results

High-spatial and energy resolution near-edge x-ray absorption fine structure (NEXAFS) spectra indicative of elemental speciation acquired at the C K-edge, N K-edge, and Ca L2,3-edge on a single-cell scale from calcified C. crescentus and R. tataouinensis displayed unique spectral signatures different from that of nonbiologic hydroxyapatite (Ca10(PO4)6(OH)2). Further, preliminary NEXAFS measurements of calcium, carbon, and nitrogen functional groups of cultured calcified nanoparticles from humans revealed evidence of organics, likely peptides or proteins, specifically associated with hydroxyapatite minerals.

Conclusion

Using NEXAFS at the 25 nm spatial scale, it is possible to define a biochemical signature for cultured calcified bacteria, including proteins, polysaccharides, nucleic acids, and hydroxyapatite. These preliminary studies suggest that nanoparticles isolated from human samples share spectroscopic characteristics with calcified proteins.
Mechanisms of Focal Calcification in Rabbit Aortas: Role of Calcifying Vesicles
Authors: Hsu Howard H.T. , Tawfik Ossama
Published: August 2007

Background

We previously demonstrated that calcification in rabbit thoracic aortas is initiated in the lower zone of the extensively thickened plaques (LZP) adjacent to the media. Whether osteogenesis or a local increase in calcifying vesicles underlies the focal calcification remains to be established.

Methods

To determine that focal calcification is related to osteogenesis, an obligatory osteogenic biomarker, alkaline phosphatase (ALP) activity, was evaluated in the unfixed thoracic aorta sections of rabbits fed a supplemental cholesterol diet and of humans with advanced atherosclerosis. To determine whether blood shortage to the smooth muscle cells (SMCs) imposed by intima thickening may increase calcifying vesicles, the effect of serum deprivation on the biogenesis of calcifying vesicles in cultured SMCs was investigated.

Results

(1) In contrast to positive rabbit kidney cross sections and consistent with the activity in various isolated subcellular fractions of aortas, ALP activity was absent in the media, adventitia, lesions, and LZP of rabbit aortas or in the fibrointima of human aortas. (2) Histologic assessments of the lesions indicate the absence of bone cells or osteoid. (3) Depletion of the serum from culture media caused a twofold increase in the levels of ALP-deficient and adenosine triphosphatase-rich calcifying vesicles, which were released from the cells by treatment with 0.05% trypsin-0.02% ethylenediaminetetraacetic acid for 15 minutes.

Conclusions

(1) Focal calcification in rabbit aortas and diffuse mineralization in human fibrointima are not associated with osteogenesis, and (2) blockade of the blood supply to SMCs may trigger the cells to produce more calcifying vesicles, thereby leading to site-specific calcification in rabbit aortas.
Effects of Multiple Daily Insulin Injections on Peripheral Glucose Disposal in Latin Americans with Type 2 Diabetes Mellitus
Authors: Avilés-Santa Larissa , Salinas Karin , Adams-Huet Beverley , Raskin Philip
Published: August 2007

Objective

To evaluate the effects of insulin in multiple daily injections (MDI) on peripheral glucose disposal in Latin American patients with type 2 diabetes.

Methods and Results

Ten Latin American patients (four men and six women) with type 2 diabetes between the ages of 32 and 45 years were evaluated. All women were premenopausal and had regular menstrual periods. A hyperinsulinemic-euglycemic clamp procedure was performed at baseline and was repeated approximately 2 years after insulin monotherapy on MDI was initiated. Both genders had comparable baseline anthropometric and laboratory features, including a mean body mass index > 30 kg/m 2 and percent body fat > 30%. Baseline percent hemoglobin A1c (HbA1c%) was 9.5 ± 1.5%, and post-intervention HbA1c% was 7.0 ± 1.2%. The peripheral glucose disposal rate at baseline was 4.5 ± 2.2 mg/kg/min fat-free mass and at postintervention was 3.6 ± 2.3 mg/kg/min fat-free mass.

Conclusions

Despite a significant improvement in glycemic control, MDI did not seem to increase the insulin-mediated glucose disposal rate. Underlying obesity and increased percent body fat may have been the most counteracting factors on the potential improvement in insulin sensitivity expected with insulin monotherapy.
Clinical Science Training at the University of Colorado: A Measurement of Trainee Satisfaction
Authors: Hall Deborah A. , Sheeder Jeanelle , Box Tamara , Shroyer Laurie A.
Published: August 2007

Background

Clinical science (CLSC) research education differs from basic science education in that many CLSC programs have an added goal of creating successful academicians. CLSC programs have expanded curricula that include teaching career development techniques, such as manuscript and grant writing, and helping young investigators establish successful mentor-mentee relationships.

Methods

A group of K30 CLSC training program students coordinated a pilot survey to determine if the CLSC training programs at the University of Colorado were meeting the needs of the participants in both didactic courses and in other aspects of academic medicine, including research. The small group survey was conducted as part of a clinical outcomes assessment course. Opportunities for improvement in the CLSC training programs were explored based on the results.

Results

Of 117 CLSC training program participants surveyed, 56% responded. Overall, there was a positive improvement found for the didactic CLSC research constructs. Participants also reported success in manuscript publication and grant writing applications. The CLSC program, however, was not successful in coordinating faculty mentor support for student research projects for 78% of respondents. Once a mentoring relationship was established, students were satisfied with the mentoring they received.

Conclusion

In general, CLSC trainees were satisfied that the K30 clinical research curriculum was meeting their needs. Many of the trainees were successful in developing academic skills during the program. Establishing a mentor relationship was the missing ingredient within the K30 CLSC training program. This may be an important component that should be considered when developing programs to create the next generation of clinician-scientists.
Survival Rate and Causes of Mortality in the Elderly with Depression: A 15-Year Prospective Study of a Japanese Community Sample, the Matsunoyama-Niigata Suicide Prevention Project
Authors: Kawamura Tsuyoshi , Shioiri Toshiki , Takahashi Kuniaki , Ozdemir Vural , Someya Toshiyuki
Published: August 2007

Objective

To compare long-term survival rates and causes of death in community-dwelling elderly with and without depression using the International Research Diagnostic Criteria administered by a psychiatrist.

Method

From 1985 to 2000, we prospectively examined Japanese persons ( N = 920) aged 65 years or older. Cases with depression ( n = 158) and a control sample without depression ( N = 762) were evaluated. The main outcome variables were survival rates and causes of mortality.

Results

By 2000, 61% of the subjects with depression had died. By contrast, 48% had died in the control group at the completion of the 15-year follow-up. Using age-adjusted Kaplan-Meier survival analysis, we found a hazard ratio (HR) of 1.49 (95% confidence interval [CI] 1.16-1.89) for mortality in the depressed group compared with controls ( p = .0009). Importantly, in female subjects with depression, the HR was 1.55 (95% CI 1.16-2.07; p = .002). In males with depression, by contrast, the HR (1.34) was not significant (95% CI 0.84-2.13; p = .19). Significantly more subjects died of cerebrovascular disorders, malignant tumors, respiratory disorders, or suicide after the onset of depression compared with controls ( p < .05).

Conclusions

Depression appears to be associated with a significant increase in the risk of mortality among elderly Japanese subjects, particularly in females. The elderly with a diagnosis of depression may be at an elevated risk of mortality owing to cerebrovascular disorder, malignant tumors, respiratory disorders, or suicide. These prospective data provide a new quantitative insight on gender differences and the long-term public health significance of depression among the community-dwelling elderly.
Relationship between the Soluble F11 Receptor and Markers of Inflammation in Hemodialysis Patients
Authors: Salifu Moro O. , Kolff Quirine , Murty Preethi , Haria Dhiren M. , Zimpa Mahamadu , Shakeel Muhammad , Lee Howon , Kornecki Elizabeth , Babinska Anna
Published: August 2007

Background

The human F11 receptor (F11R) is an important cell adhesion molecule implicated in inflammatory thrombosis. We hypothesize that serum levels of the soluble released form of F11R (sF11R) are elevated in dialysis patients since these patients have higher cardiovascular disease burdens than the general population. In this study, we examined whether sF11R levels were elevated in hemodialysis (HD) patients and correlated with known inflammatory cytokines.

Methods

We used new and standard enzyme-linked immunosorbent assay techniques to measure levels of sF11R, as well as high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10), in a cross section of 52 HD patients and compared these with 15 healthy controls.

Results

The mean age of the patients was 56 ± 17.3 years; 60% were female, and 36% had diabetes mellitus. Serum levels of sF11R, hs-CRP, TNF-α, IL-6, and IL-10 were all significantly higher in patients than in control sera ( p < .05). Within the patient group, there was a significant positive correlation between sF11R and TNF-α ( r = .41, p = .003), IL-10 ( r = .32, p = .023), and IL-6 ( r = .32, p = .023), whereas hs-CRP showed no significant correlation ( r = −.27, p = .052).

Conclusion

We conclude that the sF11R level is elevated in HD patients and correlates with known markers of cardiovascular disease. sF11R may be a novel cardiovascular risk marker, and longitudinal studies are needed to better assess its relationship with cardiovascular disease morbidity and mortality in this population.
The Meaning of Author Order in Medical Research
Authors: Baerlocher Mark Otto , Newton Marshall , Gautam Tina , Tomlinson George , Detsky Allan S.
Published: August 2007

Background

Manuscript authorship and author placement have important implications for accountability and allocation of credit. The objective of this study was to assess the relationship between an author's place in the author list and the type of contribution reported by that author. This pattern was then used to develop a method by which author responsibility and accountability can be clarified.

Methods

The published contributions of each author of original research articles with a minimum of four authors published in the Journal of the American MedicalAssociation, the British Medical Journal, TheLancet, and the Canadian Medical Association Journal in a 3-year period after author contribution forms were required were coded into 1 of eleven contribution categories. The contributions were grouped according to first, second, middle, and last author and compared by position.

Results

For most categories of contribution, the levels of participation were highest for first authors, followed by last and then second authors. Middle authors had lower levels particularly in conception, drafts of the manuscript, supervision, and being a guarantor.

Conclusions

Current patterns of author order and contribution suggest a consistent theme. Based on the results, a proposal is put forth by which author accountability is clarified. In this proposal, authors are classified as either “primary,” “contributing,” or “senior or supervisory,” each with specified contributions. More than one author may be classified into each author category.
Surgical Treatment of Abdominal Aortic Aneurysms Associated with Horseshoe Kidney
Authors: Göksel Onur , Çınar Bayer , Kömürcü Gürkan , Ahin Sinan , Eren Tunc
Published: August 2007

Abdominal aortic aneurysm surgery associated with a horseshoe kidney (HSK) is a serious technical challenge for the surgeon. We reviewed our experience with 127 patients electively operated on between 1990 and 2004 for abdominal aortic aneurysm. Pre- and perioperative medical, surgical, and radiologic data were retrospectively reviewed. Preoperative diagnosis was achieved with computed tomography with or without angiography or with additional conventional aortography.

Seven patients were recognized to have had a HSK, with a mean age of 67.29 ± 2.43 years. Preoperative serum creatinine levels were similar in patients with or without HSK (1.0 ± 0.08 vs 0.9 ± 0.12 mg/dL; not significant). In five of the patients with HSK, reimplantation of the anomalous renal artery was necessary. In all 127 patients, hospital mortality consisted of 5 patients, none of whom had an HSK. Dealing with HSK seemed to increase aortic clamp times (30.43 ± 3.55 vs 27.04 ± 3.92 minutes; p < .05) slightly. Patients with or without HSK were given similar amounts of intravenous fluid replacement (2,214.2 ± 441.3 vs 1,923.3 ± 433.6 mL/patient; not significant) and allogeneic blood transfusion (0.71 ± 0.49 vs 0.9 ± 0.4 U/patient; not significant) and had a similar intensive care unit stay.

Abdominal aortic aneurysms associated with HSK have been managed without division of the isthmic tissue. The left retroperitoneal approach provided adequate exposure for all patients with HSK.
Aortic Arch Abnormality in a Patient with Klippel-Feil Syndrome
Authors: Abbas Jihad , Nazzal Munier , Serrano Pablo , Elmer Lawrence
Published: August 2007

We present a case of a 43-year-old female with headaches, progressive paresthesias of the upper extremities, and vertigo. Ultrasonography could not visualize the left internal carotid artery (ICA). Magnetic resonance imaging (MRI) showed complete fusion of the C5, C6, and C7 levels, representing Klippel-Feil deformity. Angiography showed a unique abnormality of the aortic arch with complete absence of the left ICA. An embryologic defect associated with this type of abnormality is proposed, with defects of development of the third aortic arch and the aortic sac secondarily.
Reinforced Long Saphenous Vein Bypass Graft for Infrainguinal Reconstruction Procedures: Case Series and Literature Review
Authors: Hynes Niamh , Mahendran Bhasakarapandian , Tawfik Sherif , Sultan Sherif
Published: August 2007

Poor rehabilitation rates and the high-cost of managing postamputation patients justify an aggressive revascularization policy in critical lower limb ischemia. Endovascular therapy is our first choice for limb salvage in these patients. However there are patients for whom endovascular therapy is not feasible. When bypass is necessary, autologous vein is a superior conduit to synthetic material. However, varicosities usually contraindicate autologous vein bypass because of the risk of aneurysm formation, rupture and increased intimal hyperplasia compared with nonvaricose venous grafts. We report the use of varicosed long saphenous vein (LSV) with external Dacron support in infrainguinal bypass procedures for limb salvage, where endovascular therapy was not feasible. The external Dacron tube was not brought close to the distal anastomotic area itself. With a mean follow-up of 18 months, duplex ultrasonography and computed tomography angiography showed no evidence of stenosis of the reinforced vein segments or aneurysmal degeneration of the residual vein. External reinforcement with Dacron prosthesis allows the use of autogenous greater saphenous veins with varicose dilatation without compromising graft patency and limb salvage.
Repeated Arterial Thrombosis as a Complication of Carboplatin-Based Chemotherapy
Authors: Yeung Kakkhee K. , Coster Erwin , Floris Vos A.W. , Van der Vijgh Roger K. , Linsen Mattheus A.M. , Wisselink Willem
Published: August 2007

We describe a case of a 57-year-old woman with repeated acute arterial thrombosis of the femoral arteries following intravenous carboplatin-based combination chemotherapy for metastatic ovarian carcinoma. By extensive workup, no other known causes of arterial thrombosis were found. To our knowledge, this is the first case describing arterial thrombosis occurring as a complication of carboplatin therapy.
Intraluminal Thrombus Enhances Proteolysis in Abdominal Aortic Aneurysms
Authors: Carrell Tom W.G. , Burnand Kevin G. , Booth Nuala A. , Humphries Julia , Smith Alberto
Published: August 2007

This study examined whether intraluminal thrombus in abdominal aortic aneurysms (AAAs) is a source of fibrinolytic activity and proteolysis that could weaken the aneurysm wall. Plasmin, tissue plasminogen activator (tPA), and urokinase plasminogen activator (uPA) activity, plasminogen activator inhibitor 1 (PAI-1), and α2-antiplasmin (α2AP) antigen were measured in the AAA wall and juxtamural and luminal aspects of intraluminal thrombus in 18 patients. The aneurysm wall contained 100-fold higher tPA activity (1.06 ± 0.34 [standard error of measurement] U/mg soluble protein) compared with juxtamural thrombus (JMT) (0.011 ± 0.001 ) and luminal thrombus (LT) (0.01 ± 0.001) ( p < .00001) and over 6-fold higher uPA activity (29.3 ± 3.4 IU/mg compared with the JMT (4.3 ± 2.4, p = .00024) and LT (7.9 ± 1.76, p = .0005). The LT had significantly lower levels of PAI-1 (1.26 ± 0.34 ng/mg) than the AAA wall (2.08 ± 0.51, p = .04) and the JMT (3.94 ± 0.85, p = .007). The levels of α2AP in the wall (19.4 ± 3.1 ng/mg) were lower than in the JMT or LT (43.0 ± 7.9 ng/mg, p = .013, and 47.6 ± 6.0 ng/mg, p = .002, respectively). There was no significant difference, however, in plasmin activity among the AAA wall, JMT, and LT. There were significant amounts of latent gelatinase B (matrix metalloproteinase [MMP]-9) in the AAA, JMT, and LT. Mean levels of activated MMP-9 activity were similar in the AAA, JMT, and LT. Plasmin activation of MMPs at the interface between intraluminal thrombus and the aneurysm wall may enhance proteolysis and accelerate aneurysm expansion.
Statin Use Is Associated with Reduced All-Cause Mortality after Endovascular Abdominal Aortic Aneurysm Repair
Authors: Leurs Lina J. , Visser Patrice , Laheij Robert J.F. , Buth Jaap , Harris Peter L.H. , Blankensteijn Jan D.
Published: August 2007

It has been shown that preoperative statin therapy reduces all-cause and cardiovascular mortality in patients undergoing major noncardiac vascular surgery. In this report, we investigated the influence of statin use on early and late outcome following endovascular abdominal aortic aneurysm repair (EVAR).

The study population, consisting of patients collated in the EUROSTAR registry, was stratified in two groups according to statin use. Baseline characteristics between the two groups were compared by chi-square and Wilcoxon rank sum tests for discrete and continuous variables. The effects of statin use on outcomes after EVAR were analyzed by multivariate regression models.

Of the 5,892 patients enrolled in the EUROSTAR registry, 731 (12.4%) patients used statins for hyperlipidemia. Statin users were younger, were more obese, and had a higher prevalence of diabetes, cardiovascular disease, and hypertension. After 5 years of follow-up, the cumulative survival rate was 77% for nonusers of statin versus 81% for statin users ( p = .005). After adjustment for age and other risk factors, statin use was still an independent predictor of improved survival ( p = .03).

Our results revealed that statin prescription was more frequent in younger patients. However, when adjusted for age and medical risk factors, the use of statin in patients who underwent EVAR was still independently associated with reduced overall mortality.
Impact of Delay on Survival in Patients with Ruptured Abdominal Aortic Aneurysm
Authors: Salhab Mohamed , Farmer Jessica , Osman Isam
Published: August 2007

Rupture of the abdominal aortic aneurysm (RAAA) is a common surgical emergency. Surgical treatment of this condition carries a high morbidity and mortality rate. For successful outcome, an early diagnosis and prompt treatment are essential. However, recently, some centers have reported better results in patients whose surgery had been delayed because of interhospital transfer. Delay in treatment sometimes occurs as patients are transferred from one institution to another where specialized vascular care is available. This retrospective study sought to determine the effect of delay in treatment on the mortality of patients with RAAA repair.

The time from arrival at the emergency room to surgery and operative time were obtained from the case notes of 45 consecutive patients with RAAA. Patients' physiology scores on admission were calculated using V-POSSUM for the RAAA model.

Thirty-five patients were diagnosed with RAAA in the emergency room and were transferred to surgery. These patients were divided into two groups: patients who had surgery within 1 hour ( n = 23) and those in whom surgery was delayed for up to 4 hours ( n = 12).

There was no significant difference in physiology score between the two groups ( p = .12). The time to surgery and operative time with death as the outcome were plotted on a logistic regression model that showed that the delay in surgical treatment increases the mortality rate following RAAA repair ( p = .041). Furthermore, a long operative time was associated with a higher surgical mortality rate ( p = .029).

Delay to surgery and a long operation increase the mortality rate following RAAA repair. However, delay to surgery alone did not influence the mortality rate.
Endovascular Therapy as the Primary Approach for Limb Salvage in Patients with Critical Limb Ischemia: Experience with 443 Infrapopliteal Procedures
Authors: Bosiers Marc , Hart Joseph P. , Deloose Koen , Verbist Jurgen , Peeters Patrick
Published: August 2007

Endovascular strategies for the treatment of critical infrageniculate peripheral arterial occlusive disease exist and are becoming the primary methodology for such lesions at many centers. Although technically feasible for experienced operators, the evidence to support this strategy for below the knee (BTK) interventions is still evolving. We studied the 6-month and 1-year outcomes of percutaneous transluminal angioplasty (PTA) alone, PTA with stenting, and excimer laser recanalization for BTK lesions in patients with critical limb ischemia.

Between September 2002 and June 2005, 443 patients (355 Rutherford category 4, 82 category 5, 6 category 6) underwent intervention for 681 BTK lesions. Follow-up was performed at 6-month intervals after index intervention: limb salvage data were recorded and duplex ultrasonography was performed to measure the patency of treated areas.

The primary patency and limb salvage rates of the entire population were 85.2% and 97.0% and 74.2% and 96.6% at 6 months and 1 year, respectively. Stratified for the treatment strategy (PTA alone in 79, PTA with stenting in 300 patients, and excimer laser in 64), 1-year primary patency rates were 68.6%, 75.5%, and 75.4%, whereas the limb salvage rates were 96.7%, 98.6%, and 87.9% for each modality, respectively.

Endovascular intervention will become the primary treatment for BTK lesions in patients with critical limb ischemia, with 1-year primary patency and limb salvage rates that compare favorably with published surgical data. Prospective, randomized, multicenter trials will be needed to further establish the role of endovascular intervention in this challenging patient group.
Cystic Adventitial Disease of the Iliofemoral Artery: Case Reports and a Short Review
Authors: Jindal Ravul , Majed Addie , Hamady Mohamad , Wolfe John H.
Published: August 2007

Cystic adventitial disease is a rare disease affecting mainly young males. We describe two patients with this disease affecting the iliofemoral artery. These reports reemphasize the importance of keeping cystic adventitial disease as a differential diagnosis in young patients who present with leg ischemia.
Nocardia asteroides–Infected Aneurysm of the Aorta: Case Report and Review of the Literature
Authors: Gates Jonathan D. , Warth James A. , McGowan Katherine
Published: August 2007

Infected aneurysms of the aorta were first described as a result of septic emboli or contiguous spread from bacterial endocarditis and are usually caused by Staphylococcus or Salmonella species. We report a case of Nocardia-associated infected aneurysm of the native suprarenal aorta in an immunocompromised host. Surgical management consisted of placement of an interposition cryopreserved aortic homograft. Nocardia asteroides was identified on a microbiology specimen of the aorta and both microbiology and pathology specimens of the splenic tissue. To the best of our knowledge, this represents the first carefully documented, unique case of a Nocardia-infected aneurysm treated with homograft interposition. In addition, pathologic and microbiologic data are included from the postmortem examination 10 months later.
Amsterdam Acute Aneurysm Trial: Background, Design, and Methods
Authors:   Amsterdam Acute Aneurysm Trial Collaborators
Published: August 2007

The objective of the Amsterdam Acute Aneurysm Trial is to study the combined outcome of conventional emergency surgery versus endovascular treatment for ruptured abdominal aortic aneurysms. The design used was a multicenter randomized clinical trial conducted in two university hospitals and one teaching hospital in the Amsterdam region. The study included all patients with a ruptured abdominal aneurysm who were eligible for endovascular and conventional surgery. The primary end points were combined mortality and severe morbidity. The secondary end points were quality of life and cost-effectiveness. The background, design, and methods of this trial are presented, and the ethical and legal issues of this type of research are discussed.
Treprostinil Sodium (Remodulin), a Prostacyclin Analog, in the Treatment of Critical Limb Ischemia: Open-Label Study
Authors: Berman Scott , Quick Rhonda , Yoder Pam , Voigt Sonia , Strootman Deborah , Wade Michael
Published: August 2007

The purpose of this study was to assess the safety of continuous subcutaneous therapy with treprostinil sodium (Remodulin), a prostacyclin analog, and its effect on ischemic rest pain and ischemic wound healing in subjects with critical limb ischemia (CLI) and no planned revascularization procedure.

This was a 12-week, open-label, single-center pilot study enrolling 10 subjects (mean age 82.4 years) with Fontaine stage III to IV (Rutherford class 4–6) peripheral arterial disease and ankle brachial indices less than 0.55. The primary end point was safety, and the secondary end points were the effects of treatment on ischemic rest pain, limb salvage, and wound healing.

There was a 62% reduction in mean worst rest pain and a 57% reduction in mean average rest pain at week 12, with most subjects using less pain medication. Three subjects experienced complete healing of their wounds. No subject developed a new wound during the trial. Treprostinil was generally well tolerated. Subcutaneous infusion-site pain was the most frequently reported side effect, with one subject withdrawing from the study as a result. Jaw pain was reported by two subjects. One subject experienced two serious adverse events considered unrelated to treprostinil (cholecystitis and congestive heart failure).

This study demonstrates that chronic, continuous subcutaneous treprostinil is safe and can be useful in the treatment of ischemic pain and wounds in subjects with CLI. Future controlled studies are needed to evaluate these effects and determine appropriate patient selection.
Occluded Infrainguinal Bypass Graft: Potential Source of Limb-Threatening Emboli
Authors: Chandra Ankur , Angle Niren
Published: August 2007

Surgical bypass represents one of the chief treatment modalities for peripheral arterial occlusive disease. Despite improving techniques, graft occlusion accounts for the majority of these bypass failures. Once occluded, however, these grafts are thought to rarely pose a threat for future ischemic events. This report describes two patients with previously thrombosed grafts who subsequently presented with limb-threatening ischemia owing to peripheral embolization from the graft.

Two patients with occluded grafts presented with ipsilateral limb-threatening acute ischemia. Both of these patients developed severe acute limb-threatening ischemia weeks to months after known graft thrombosis. Arteriography revealed peripheral embolization in each case. Both patients were operated on for disconnection of the thrombosed graft from the native circulation and have been free of recurrent symptoms.

The occluded graft, although generally innocuous, can be a source of peripheral emboli, resulting in peripheral embolization and acute limb ischemia. Both patients in this report developed limb-threatening ischemia owing to embolization from the cul-de-sac of occluded prosthetic grafts. Due to the rarity of the condition and its associated morbidity and mortality, awareness and recognition of this phenomenon are critical. Operative disconnection is recommended if the embolism occurs downstream of the graft and no other embolic source can be identified.
Postendarterectomy Common Carotid Artery Pseudoaneurysm
Authors: Ilijevski Nenad S. , Gajin Predrag , Neskovic Vojislava , Kolar Jovo , Radak Djordje
Published: August 2007

Pseudoaneurysm (PSA) formation is an uncommon complication in carotid surgery. PSA of the carotid artery requires surgical or endovascular treatment to prevent PSA thrombosis, embolization from the thrombotic material within the PSA, hemorrhage after rupture, or compression on the adjacent structures. We present a case of a symptomatic common carotid PSA that occurred 14 months after routinely performed eversion carotid endarterectomy.
Stent-Graft Treatment of Pseudoaneurysms and Arteriovenous Fistulae in the Carotid Artery
Authors: Schönholz Claudio , Krajcer Zvonimir , Carlos Parodi Juan , Mendaro Esteban , Hannegan Christopher , D'Agostino Horacio , Selby Bayne , Guimaraes Marcelo , Uflacker Renan
Published: August 2007

The purpose of this study was to assess the safety and efficacy of stent-graft placement in the management of arteriovenous fistulae (AVF) and pseudoaneurysms (PAs) involving the carotid artery (CA).

Twenty-two patients (16 men, 6 women) with a CA AVF ( n = 5) or PA ( n = 17) owing to a gunshot or stab wound, carotid endarterectomy, blunt trauma, a tumor, spontaneous dissection, or a central venous catheter were treated with percutaneous placement of stent grafts. The patients presented with tumor, bruit, headache, mouth and tracheostomy bleeding, transitory hemiparesis, seizure, or stroke. Diagnoses were made by using computed tomographic angiography (CTA) and digital subtraction angiography. Fourteen lesions were in the common CA; eight were in the internal CA. Homemade devices and stent grafts from a variety of manufacturers were employed. Follow-up evaluations included clinical, CTA, and Doppler ultrasound assessments.

All patients had resolution of the PA or AVF. In one patient with a large petrous PA, acute occlusion of the CA developed after placement of three balloon-expandable stent grafts, but there were no neurologic complications because the circle of Willis was functional. During follow-up ranging from 2 months to 13 years, asymptomatic 90% stenosis owing to stent compression was observed on Doppler ultrasound and angiographic examinations in a patient with an autologous vein–covered stent graft in the internal CA. Three other patients died of causes unrelated to stent-graft placement. In all other patients, the stent graft remained patent.

Our results indicate that stent grafting is an acceptable alternative to surgery in the treatment of AVF and PAs in the CA.
Novel Access Technique Facilitating Carotid Artery Stenting
Authors: Ivancev Krassi , Resch Timothy , Malina Martin
Published: August 2007

Carotid artery stenting (CAS) may be impossible, or associated with a high risk, in patients with severe vessel tortuosity. A novel method of catheterization of the carotid artery intended to facilitate CAS is described. It involves the placement of a microcatheter and a coronary wire through a dissected superficial temporal artery (STA), and then advanced to the ascending aorta. The wire is then snared and brought out through a sheath already placed from the common femoral artery (CFA). Thus through-and-through access from the STA to the CFA is established. The sheath is then brought over the coronary artery into the common carotid artery. Using the coronary artery as "buddy wire" the carotid artery stenting is carried out in a standard fashion. The potential benefit of this new technique is the decrease of risk of the procedures in patients with prohibiting vessel tortuosity.
The Endovascular Explosion: An Interview With Dr. Edward B. Diethrich
Authors: Gregory Roger T.
Published: August 2007

Dr. Edward B. Diethrich, a pioneer in endovascular surgery, discusses the evolution, maturation, and future of endovascular surgery from a personal perspective.
Statins And Biomarkers In Claudicants With Peripheral Arterial Disease: Cross-sectional Study
Authors: DePalma Ralph G. , Hayes Virginia W. , May Patricia E. , Treat Cafferata H. , Mohammadpour Hamid A. , Brigg Laura A. , Chow‡ Bruce K. , Shamayeva Galina , Zacharski Leo R.
Published: August 2007

This exploratory substudy of The Iron (Fe) and Atherosclerosis Study (FeAST) compared baseline inflammatory markers, including cytokines, C-reactive protein (CRP), and ferritin, in subjects with peripheral arterial disease (PAD) taking statins with subjects with PAD who were not taking statins. Inflammatory markers in the serum of 47 subjects with PAD not taking statins and a healthy cohort of 21 medication-free men were compared with 53 PAD subjects taking statins at entry to the FeAST.

Healthy subjects demonstrated lower levels of tumor necrosis factor (TNF)-R1, interleukin-6 (IL-6), and CRP. TNF-α R1 averaged 2.28 ng/mL versus 3.52 ng/mL, p  =  .0025; IL-6 averaged 4.24 pg/mL versus16.61 pg/mL, p  =  .0008; and CRP averaged 0.58 mg/dL versus 0.92 mg/dL, p  =  .0192. A higher level of IL-6 was observed in PAD statin takers versus PAD subjects not taking statins: 19.47 pg/mL versus 13.24 pg/mL, p  =  .0455. As expected, total cholesterol and low-density lipoprotein levels were lower in the statin-treated group, p  =  .0006 and p  =  .0001, respectively. No significant differences in inflammatory cytokines were detected for varying doses of simvastatin. Additionally, no significant differences in inflammatory biomedical markers were found in subjects with PAD alone compared with those with concomitant coronary artery disease (CAD).

Unexpectedly, serum inflammatory cytokine IL-6 levels were significantly higher in PAD subjects receiving statins. There was no difference in measured inflammatory markers in PAD subjects with concomitant CAD.
Total Laparoscopic Aortic Surgery Versus Minimal Access Techniques: Review Of More Than 600 Patients
Authors: Kolvenbach Ralf , Puerschel Ariane , Fajer Simone , Lin Judith , Wassiljew Sergej , Schwierz Elizabeth , Pinter Laslo
Published: August 2007

In the following paper we describe our experience with a large number of patients in which either a laparoscopic assisted procedure or a total laparoscopic operation was performed.

From 1996 until 2005 a total number of 638 aortic patients were operated on using a total laparoscopic or a laparoscopic assisted approach. A total laparoscopic operation was accomplished in 236 cases. A laparoscopic assisted aortic operation was performed in 402 patients. In aneurysm patients a tube graft was more frequently implanted.

Thirty-day mortality was significantly higher in patients with a total laparoscopic abdominal aortic aneurysm repair (3.0%) compared to a laparoscopic assisted procedure (1.8%). There was no significant difference in mortality in patients with occlusive disease and a total laparoscopic aortofemoral bypass versus a laparoscopically assisted operation.

The same tendency could be observed when analyzing the incidence of major perioperative complications. Again we found no significant difference in patients with occlusive disease yet more severe complications directly related to the operation in patients with a total laparoscopic aneurysm repair.

There was a significantly increased complication rate in total laparoscopic aortoiliac repair with a bifurcated prosthesis compared to a tube graft repair: a tendency we could not observe in aneurysm patients with a laparoscopic assisted operation.

Our data also show that there is a lot of room for technical improvements such as stapling devices or special grafts to reduce total operating times as well as the period of aortic crossclamping. The routine use of a minilaparotomy can hardly be a solution considering the technical drawbacks such as impaired vision and long term complications like ventral hernias. Compared to open surgery the midterm results of laparoscopic aortic procedures are promising. The time has come to prove that good results can be obtained in more than a few specialized centers.
Training in Carotid Artery Stenting: Do Carotid Simulation Systems Really Help?
Authors: Dawson David L.
Published: August 2007

Virtual reality (VR) simulations have long been used for training in aviation and other professions. High-fidelity endovascular procedure simulators are now available, providing procedure simulations with real-time interactions; two-dimensional graphic displays of angiographic anatomy; mechanical interfaces with guidewires, sheaths, and catheters that provide some degree of haptic feedback; modeling of physiologic and pharmacology responses; and other features. Simulators have been incorporated into training programs for physicians learning carotid artery stenting (CAS). For the first time, US Food and Drug Administration approval of a new device (CAS systems) has included a requirement for physician training that incorporates the use of VR simulators. Early experience has shown that simulation is well accepted by trainees, performance on simulators improves with training and practice, and simulation prior to first performing endovascular procedures can improve clinical performance. Specific to CAS, the value of education programs using simulators appears to be tangible as trained but inexperienced CAS operators have clinical results comparable to those of physicians with extensive CAS experience.