bluuebunny/crossref_metadata_2025 huggingface dataset:
Toxicity equivalency values for polychlorinated biphenyl mixtures
Authors: Burkhard Lawrence P , Lukasewycz Marta T
Published: February 2008

For aquatic, avian, and mammalian species, dioxin equivalency values (TEQs) were computed for Aroclor, Clophen, Kanechlor, Chlorofen, Sovol, Delor, Phenoclor, and Chinese polychlorinated biphenyl (PCB) mixtures by using World Health Organization toxicity equivalency factors (TEFs) and compound-specific compositional data for PCBs, polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs) for the individual mixtures. The TEQs were similar across the different PCB product lines for mixtures of similar chlorine content. Depending on the PCB mixture, the polychlorinated dibenzo-p-dioxins/dibenzofurans (PCDD/Fs) in the mixture contributed anywhere from 0 to 96% of the total TEQs, and the impact of PCDD/Fs was greatest for the fish TEQs. In comparison to the dioxin-like PCBs, few measurements have been performed for PCDD/Fs in the commercial PCB products.
Distribution of polybrominated diphenyl ethers in fish tissues from the Pearl River Delta, China: Levels, compositions, and potential sources
Authors: Guo Ying , Meng Xiang-Zhou , Tang Hong-Lei , Mai Bi-Xian , Zeng Eddy Y
Published: February 2008

Fish tissues from three different farming types (freshwater farmed, seawater farmed, and seawater wild fish collected from the Pearl River Delta of South China), including skin, gills, gastrointestinal tract (GIT), liver, and muscle, were analyzed for polybrominated diphenyl ethers (PBDEs). In general, the dry weight based concentrations of Σ10PBDE (sum of BDE-28, -47, -66, -85, -99, -100, -138, -153, -154, and -183) in fish tissues followed the sequence of liver > gill > skin > GIT and muscle. The BDE congener profiles varied with fish species. Decabrominated diphenyl ether was detected in 37.4% of the total 187 samples, and this ratio may actually have been underestimated because the reporting limit for BDE-209 was considerably higher than those for other congeners. Decabrominated diphenyl ether was the dominant BDE congener in skin and GIT, and less abundant in gills, muscle, and liver. Except for skin, no significant difference in BDE-209 lipid-normalized concentrations was observed among fish tissues. These results suggest that BDE-209 can occur abundantly in the fish species under investigation, somewhat inconsistent with the results from most previous studies that reported low bioaccumulative potential of BDE-209. Combined with the likelihood that BDE-209 can be debrominated into lower brominated congeners that tend to be more toxic than BDE-209, the abundant occurrence of BDE-209 could continue to pose prolonged health risk to the ecological environment.
Spatial trends of perfluoroalkyl compounds in ringed seals (Phoca hispida) from the Canadian Arctic
Authors: Butt Craig M , Mabury Scott A , Kwan Michael , Wang Xiaowa , Muir Derek C.G
Published: February 2008

The present study examined spatial trends of perfluoroalkyl compounds (PFCs) in liver samples from 11 populations of ringed seals (Phoca hispida) in the Canadian Arctic from 2002 to 2005. Trophic position and relative carbon sources were compared by analyzing stable nitrogen and carbon isotopes in muscle samples. Geometric mean concentrations of total C9–C15 perfluorinated carboxylates (PFCAs) ranged from 8.8 to 84 ng/g wet weight, and C9–C11 PFCAs predominated. Perfluorooctane sulfonate was the dominant PFC measured, with concentrations ranging from 6.5 to 89 ng/g wet weight, contributing between 29 and 56% of the total PFC concentration. Overall, mean PFC concentrations were similar between populations, and differences were attributed largely to elevated levels in the Gjoa Haven (Rae Strait, central Canadian Arctic archipelago) and Inukjuak populations (eastern Hudson Bay) and to lower concentrations at Pangnirtung (Cumberland Sound, Baffin Island). Mean stable nitrogen isotope ratios (±95% confidence intervals) ranged from 14.7‰ (±0.3‰) at Nain (Labrador) to 17.9‰ (±0.7‰) at Gjoa Haven, suggesting that all populations were within the same trophic level. Stable carbon isotope ratios varied widely between the seal populations, ranging from —22.9‰ (±0.2‰) at Gjoa Haven to — 17.7‰ (±0.4‰) at Nain. The δ13C ratios from Gjoa Haven were significantly more depleted than those for other populations and may suggest a terrestrially based carbon source. The depleted stable carbon isotope ratio may explain the elevated PFC concentrations in the Gjoa Haven population. Analysis of covariance indicated that δ13C was a significant covariable for seven of nine seal populations for which δ13C values were available. After adjusting for δ13C values, concentrations of most PFCs generally were statistically greater in the Grise Fiord, Qikiqtarjuaq, Arviat, and Nain populations.
Effect of Pioglitazone Therapy on Myocardial and Hepatic Steatosis in Insulin-Treated Patients with Type 2 Diabetes
Authors: Zib Ivana , Jacob Aris N. , Lingvay Ildiko , Salinas Karin , McGavock Jonathan M. , Raskin Philip , Szczepaniak Lidia S.
Published: February 2008

High levels of myocardial and hepatic triglyceride are common in obesity and type 2 diabetes. Monotherapy with thiazolidinedione agents reduces hepatic steatosis by up to 50% in patients with type 2 diabetes. It is not known if treatment with a thiazolidinedione added to insulin has a similar beneficial antisteatotic effect. The aim of our study was to determine whether the addition of pioglitazone to insulin treatment in patients with type 2 diabetes has antisteatotic action in the heart and the liver. Thirty-two patients were randomized to 6 months of treatment with insulin or insulin plus pioglitazone. In addition to blood tests, we evaluated myocardial and hepatic triglyceride content, as well as subcutaneous and visceral fat mass at the L2 level, by magnetic resonance spectroscopy and imaging, respectively. Despite weight and subcutaneous fat mass gain, hemoglobin A1c was significantly reduced by both treatments. Myocardial and hepatic triglyceride contents were reduced by the treatment with pioglitazone plus insulin ( p = .02 and .03, respectively) but not by the treatment with insulin. Systolic and diastolic blood pressure and heart function remained unchanged in both groups. The addition of pioglitazone to insulin therapy reduced myocardial and hepatic steatosis, consistent with the reported ability of the thiazolidinedione agents to redistribute fat from nonadipose to subcutaneous adipose depots.
Catabolism of Glycoconjugates in Chronic Otitis Media with Cholesteatoma
Authors: Olszewska Ewa , Borzym-Kluczyk Malgorzata , Olszewski Slawomir , Zwierz Krzysztof
Published: February 2008

Chronic ear disease with cholesteatoma is characterized by an intrusion of keratinizing stratified squamous epithelium into the middle ear manifesting bone resorption at the interface of the perimatrix. The aim of our study was to investigate the markers of a catabolic process associated with several chronic inflammatory states. We assessed the level of catabolism of glycoconjugates in assays of cholesteatoma extracts, quantifying two lysosomal exoglycosidases: α-mannosidase (α-MAN) and β-galactosidase (β-GAL). Cholesteatomas ( n = 15) and normal adult postauricular skin served as controls ( n = 15) were collected from the patients during surgery owing to chronic otitis media. To assess exoglycosidase activity, release of p-nitrophenol from p-nitrophenol derivatives of α-mannose and β-galactose was used. In 13 of 15 specimens, we observed significantly higher activity of investigated enzymes in cholesteatoma tissue compared with control tissue (postauricular skin). The mean activity of α-MAN from the cholesteatoma cells was 1.76 ± 1.10 nkat/g wet tissue and 0.61 ± 0.21 nkat/g wet tissue in the control probes. The mean activity of β-GAL from the cholesteatoma cells was 1.77 ± 1.07 nkat/g wet tissue and 0.87 ± 0.20 nkat/g wet tissue in the control probes. Catabolic reactions involving glycoproteins, glycolipids, and proteoglycans may play a role in cholesteatoma-related bone resorption. The present data indicating that the lysosomal exoglycosidases α-MAN and β-GAL are significantly and consistently elevated suggest the need to further correlations assessment between levels of α-MAN and β-GAL and cholesteatoma behavior. Further research should also evaluate the relative importance of these particular exoglycosidases in manifesting bone resorption in considering the spectrum of identified inflammatory mediators.
Insertion/Deletion Polymorphism of the Angiotensin I-Converting Enzyme Gene in Patients with Breast Cancer and Effects on Prognostic Factors
Authors: Yaren Arzu , Turgut Sebahat , Kursunluoglu Raziye , Oztop Ilhan , Turgut Gunfer , Degirmencioglu Serkan , Kelten Canan , Erdem Ergun
Published: February 2008

The aims of the present study were to investigate the distribution of the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene in breast cancer patients and the association between ACE genotypes and clinicopathologic features, as well as their effects on prognosis. We assessed the I/D polymophism of the ACE gene by using polymerase chain reaction from peripheral blood in breast cancer and healthy age-matched women. The clinicopathologic parameters of breast cancer patients were obtained from medical records. Of the 57 patients, 31 (54.4%) had DD, 24 (42.1%) had ID, and 2 (3.5%) had II genotypes. In control subjects, 33 (63.5%) had DD, 12 (23.1%) had ID, and 7 (13.4%) had II genotypes. The ID genotype was seen more commonly in breast cancer patients ( p = .03). When the combination of ID and II genotypes was used as a reference group, the DD genotype was associated with negative hormone receptor status ( p = .003), tumor size ( p = .054), and lymph node involvement ( p = .07) but not histologic high grade and c- erb B2 overexpression. These results suggest that the DD genotype may accompany poor prognostic factors and influence the tumor course.
Calcific Aortic Valve Disease: Imaging Studies and Therapeutic Interventions
Authors: Shavelle David M.
Published: February 2008

Echocardiography is the predominant imaging method used for patients with aortic valve disease because of its excellent diagnostic accuracy, high reproducibility and noninvasive nature. Cardiac catheterization is typically reserved for patients in whom the diagnosis remains unclear, those requiring coronary angiography prior to valve replacement, and in the setting of complex valve disease. Cardiac computed tomography (CT) has recently been applied as a research tool to quantify the amount of aortic valve calcium (AVC), which has served as a clinical end point in several medical therapy trials. Medical therapy for aortic valve disease remains an active area of clinical research. Multiple retrospective studies have shown a benefit for 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (HMG-CoA reductase inhibitors or statins) in reducing disease progression. However, two recently completed prospective, randomized trials yielded conflicting results. The data for using angiotensin converting enzyme (ACE) inhibitors are in the preliminary stages. This review will focus on imaging methods that are available for patients with aortic valve disease and summarize the recent trials that have evaluated medical therapy aimed to reduce progression of aortic valve disease.
Epidemiology and Genetics of Calcific Aortic Valve Disease
Authors: O'Brien Kevin D.
Published: February 2008

Calcific aortic valve disease is a common condition in the elderly and is associated with significant morbidity and mortality. Although biologically plausible roles in disease pathogenesis have been proposed for both lipoproteins and the renin-angiotensin system, no properly controlled, randomized trials have demonstrated that any pharmacologic therapy slows development of the disease. This review defines the stages of calcific aortic valve disease; discusses the role of nonechocardiographic techniques, such as cardiac computed tomography, that may allow identification and study of earlier-stage disease; reviews associated epidemiologic factors; and summarizes recent studies of “novel” risk factors, such as metabolic syndrome and inflammatory biomarkers. Finally, the role of genetics in this disease is receiving greater attention, and recent studies are reviewed that examine genetic polymorphisms and identify single-gene defects associated with this disease. Together these latter sets of studies emphasize that unique “nonatherosclerotic” factors can influence calcific aortic valve disease development, suggesting the possibility of novel therapeutic strategies for this condition.
Models of Aortic Valve Calcification
Authors: Guerraty Marie , Mohler Emile R.
Published: February 2008

Aortic valve stenosis is a complex inflammatory process, akin to arterial atherosclerosis, involving lymphocytic infiltrates, macrophages, foam cells, endothelial activation and dysfunction, increased cellularity and extracellular matrix deposition, and lipoprotein accumulation. A clonal population of aortic valve myofibroblasts spontaneously undergoes phenotypic transdifferentiation into osteoblast-like cells and forms calcific nodules in cell culture. Animal models complement these cell culture models by providing in vivo systems in which to study the complex molecular and cellular interactions that cause aortic valve disease in the native hemodynamic and biochemical environment. Whereas some species, such as swine, can develop spontaneous vascular and valvular atherosclerotic lesions, others, such as rabbits and mice, have not been shown to develop lesions naturally and require an inciting factor, such as hypercholesterolemia. In this article, we review the published cell culture and animal models available to study calcific aortic valve disease.
Cosegregation of Gastrointestinal Ulcers and Schizophrenia in a Large National Inpatient Discharge Database Revisiting the “Brain-Gut Axis” Hypothesis in Ulcer Pathogenesis
Authors: Ozdemir Vural , Jamal Mazen M. , Osapay Klara , Jadus Martin R. , Sandor Zsuzsanna , Hashemzadeh Mehrtash , Szabo Sandor
Published: February 2008

The lifetime prevalence of duodenal ulcer in the United States is 8 to 10%, whereas another 1% of the population is affected by gastric ulcer. Both central and peripheral dopamine pathways may influence ulcer pathogenesis. Dopamine agonists prevent whereas antagonists augment stress- and chemically induced gastrointestinal ulcers in preclinical models. The dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,36-tetrahydropyridine (MPTP) depletes central dopamine and induces lesions in the substantia nigra, and, if given in high doses, MPTP induces a Parkinson disease-like syndrome and gastric ulcers. Because schizophrenia is attributed, in part, to an overactive dopaminergic system, persons with schizophrenia may display a reduced susceptibility toward gastrointestinal ulcers. A case-control study was conducted in patients represented in the 2002 National Inpatient Sample, the largest all-payer inpatient care database in the United States, consisting of 5 to 8 million inpatient hospital stays per year, which approximates a 20% sample of community hospitals. A significant association was observed between schizophrenia and diminished risk for duodenal (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.45-0.67) and gastric (OR 0.54; 95% CI 0.46-0.63) ( p < .01) ulcers but not for gastrojejunal ulcers (OR 0.44; 95% CI 0.16-1.20) ( p = .11). Potential confounders such as age, gender, race, tobacco or alcohol dependence, and Helicobacter pylori infection were controlled in multivariate analyses. This observational study in a large sample of patients in community hospitals suggests that schizophrenia and attendant neurobiologic mechanisms (eg, variability in dopamine pathways) may act in concert to modify the composite risk for gastrointestinal ulcers. Dopamine pathways warrant further prospective research as new potential drug targets in ulcer disease.
Biomarkers of Acute Kidney Injury: Early Diagnosis, Pathogenesis, and Recovery
Authors: Parikh Chirag R. , Edelstein Charles L. , Devarajan Prasad , Cantley Lloyd
Published: February 2008

This review article represents the proceedings from the translational research symposium presented at the Federation of American Societies for Experimental Biology/American Federation for Medical Research (FASEB/AFMR) meeting in May 2007 in Washington, DC. This research symposium consisted of four talks, which are individually summarized below. The first talk gave a general overview of the biomarkers in the setting of acute kidney injury (AKI), along with some data from clinical biomarker studies. The second talk discussed the preclinical studies of the emerging biomarkers in the area of AKI. The third talk discussed the biomarkers of AKI after deceased kidney transplantation, which is a unique model of kidney ischemia-reperfusion injury. The final talk discussed the role of circulating stem cells in renal tubule regeneration after ischemic injury and if they have potential for biomarkers of recovery or therapeutic intervention.
Attenuation of Signaling and Nitric Oxide Production following Prolonged Leptin Exposure in Human Aortic Endothelial Cells
Authors: Blanquicett Carmelo , Graves Anitra , Kleinhenz Dean J. , Hart Michael C.
Published: February 2008

Acute leptin exposure stimulates endothelial nitric oxide (NO) production in vitro. In contrast, chronic elevations in circulating leptin levels in patients with obesity are associated with endothelial dysfunction and impaired endothelial NO production. Therefore, the goal of the current study was to examine the direct effects of acute and more sustained leptin stimulation on endothelial nitric oxide synthase (eNOS) and NO production in human aortic endothelial cells (HAECs). HAECs were treated with vehicle or with leptin (5 or 60 ng/mL) acutely (30-60 minutes) or for 72 hours. HAEC NO release into culture media was measured with a chemiluminescence technique, and superoxide (O2−.) production was measured with electron spin resonance (ESR) spectroscopy. HAEC eNOS activity was measured as the conversion of 3 H-arginine to 3 H-citrulline, and protein levels of eNOS, phospho-eNOS (serine 1177), Erk, phospho-Erk, suppressor of cytokine signaling (SOCS3), xanthine oxidase (XO), and the reduced nicotinamide adenine dinucleotide (NADPH) oxidase components p22phox, p67phox, Nox-4, and gp91phox were examined by Western blotting or immunoprecipitation. Acute leptin exposure increased eNOS serine 1177 phosphorylation and caused Erk activation. In contrast, prolonged leptin stimulation was not cytotoxic and failed to alter eNOS expression, phosphorylation, or HAEC NO release. Furthermore, prolonged leptin stimulation did not alter O2−. production or NADPH oxidase or XO expression but increased SOCS3 expression. In contrast to acute stimulation, prolonged (72 hours) stimulation does not alter endothelial cell NO or O2−. production. We postulate that chronic leptin stimulation, through increased SOCS3 expression, may attenuate the effects of leptin on vascular endothelial function.
Intracardiac and Intrarenal Renin-Angiotensin Systems: Mechanisms of Cardiovascular and Renal Effects
Authors: Raizada Veena , Skipper Betty , Luo Wentao , Griffith Jeffrey
Published: February 2008

The renin-angiotensin system (RAS) is a hormonal system that controls body fluid volume, blood pressure, and cardiovascular function in both health and disease. Various tissues, including the heart and kidneys, possess individual locally regulated RASs. In each RAS, the substrate protein angiotensinogen is cleaved by the peptidases renin and angiotensin-converting enzyme to form the biologically active product angiotensin II, which acts as an intracrine cardiac and renal hormone. The components of each RAS, including aldosterone (ALDO), may be produced locally and/or may be delivered by or sequestered from the circulation. Overactivity of the cardiac RAS has been associated with cardiac diseases, including cardiac hypertrophy due to volume and/or pressure overload, heart failure, coronary artery disease with myocardial infarction, and hypertension. Overactivity of the renal RAS has been associated with various kidney diseases, including nephropathies and renal artery stenosis. The principal effects of an overactive RAS include the generation of reactive oxygen species, which leads to “oxidative stress,” activation of the nuclear transcription factor κB, and stimulation of pathways and genes that promote vasoconstriction, endothelial dysfunction, cell hypertrophy, fibroblast proliferation, inflammation, excess extracellular matrix deposition, atherosclerosis, and thrombosis. It has been suggested that oxidative stress is the central mechanism underlying the pathogenesis of RAS-related and ALDO-related chronic cardiovascular and renal tissue injury and of cardiac arrhythmias and conduction disturbances.
Integrating International Medical Graduates into the Physician-Scientist Pool: Solution to the Problem of Decreasing Physician-Scientists in the United States
Authors: Vidyasagar Dharmapuri
Published: February 2008

There is an increasing shortage of physician-scientists in the United States, threatening future medical research. There are several factors that dissuade US medical graduates from entering into physician scientists careers. This article proposes that international medical graduates (IMGs) who have contributed to the physician work force in the under serviced rural health system could also be a great source to meet the increasing physician-scientist demand. Mechanisms to allow IMGs to enter into the physician-scientist career track in the United States are suggested.
Anti-Saccharomyces cerevisiae Antibodies in Acute Myocardial Infarction
Authors: Cinemre Hakan , Bilir Cemil , Gokosmanoglu Feyzi , Kadakal Figen
Published: February 2008

Background

Elevated anti- Saccharomyces cerevisiae antibody (ASCA) immunoglobulin (IgG) and IgA levels were first described in the serum of Crohn disease patients and have increasingly been reported in other inflammatory diseases. The role of in situ and remote inflammation in atherosclerosis is a major area of interest. In this study, we compared ASCA IgG and IgA levels in acute myocardial infarction (AMI) and controls to investigate the possible role of ASCA in AMI.

Methods

Serum samples were obtained from 140 consecutive patients who presented to the emergency department with acute chest pain. AMI was diagnosed by electrocardiography and serial enzymes. Patients ruled out for acute coronary event were grouped as controls. ASCA IgA and IgG levels were determined using enzyme-linked immunosorbent assay. Groups were compared for statistically significant difference.

Results

ASCA IgG titers ranged between 0.1 and 31.0 RIU/mL (mean 4.92) in the AMI group and 0.1 and 6.0 (mean 0.84) in the controls. The groups were found to differ very significantly ( p = .001). ASCA IgA titers ranged between 2.0 and 200.0 RIU/mL (mean 13.73) in the AMI group and 2.0 and 11.5 RIU/mL, (mean 4.25) in controls. The groups differed significantly ( p = .32). AMI and controls were also analyzed for ASCA IgA and IgG positivity. Both groups differed significantly from controls ( p = .013).

Conclusion

Elevated ASCA IgA and IgG levels as well as ASCA positivity in the AMI might suggest use of ASCA as a marker for atherosclerotic plaque instability. It might also provide a link between inflammatory processes and increased cardiovascular risk. Further studies are needed on a Saccharomyces cerevisiae-based diet, related intestinal colonization, and associated inflammation, autoimmune disorders, and cardiovascular events.
Contributions of International Medical Graduates to US Biomedical Research: The Experience of US Medical Schools
Authors: Alexander Hershel , Heinig Stephen J. , Fang Di , Dickler Howard , Korn David
Published: February 2008

International medical graduates (IMGs) constitute an appreciable fraction of full-time faculty at US medical schools and of principal investigators (PIs) on National Institutes of Health (NIH) research project grants. Information from the Faculty Roster of the Association of American Medical Colleges (AAMC) and from the NIH Consolidated Grant Applicant File (CGAF) was examined to assess IMGs’ contribution to US medical school faculty and research. The study found that the number of IMG full-time faculty more than doubled over two decades-from 7,866 individuals in 1984 to 17,085 individuals in 2004, but that IMGs remained relatively stable as a share of physician full-time faculty (from 18.8 to 19.4%); the share is somewhat higher (20.0% of full-time physician faculty in 1984 to 23.7% in 2004) if faculty with degrees of unknown provenance are included. From 1984 to 2004, IMGs increased as a share of full-time physician faculty who are principal investigators on NIH research grants from 16.5% (540) to 21.3% (1,143). Including faculty with incomplete data on degree provenance, the corresponding IMG share increases to 18.0 and 24.0% respectively. Thus, IMGs comprise at least one-fifth and more likely one-fourth of all full-time faculty physicians who are PIs on NIH research project grants. The proportion of IMG full-time physician faculty who are in basic science departments is about twice that of their US/Canadian counterparts, as is the proportion of IMG physician PIs. Slightly fewer than half (48%) of full-time IMG faculty PIs pursue human subjects research (as coded by the NIH), while the majority of US/Canadian counterparts pursue human subjects research.
Toward Early Identification of Acute Lung Injury in the Emergency Department
Authors: Freishtat Robert J. , Mojgani Bahar , Mathison David J. , Chamberlain James M.
Published: February 2008

Background

There are no studies evaluating the epidemiology of pediatric acute lung injury (ALI) in the emergency department (ED), where early identification and interventions are most likely to be helpful. The purpose of this study was to describe the epidemiology of the ALI precursor acute hypoxemic respiratory failure (AHRF) in the ED.

Methods

We analyzed 11,664 pediatric patient records from 16 EDs. Records were selected if oxygen saturation (SpO2) was recorded during the visit. Virtual partial pressure of oxygen (pO2) was calculated from SpO2, thus allowing calculation of ratios of pO2 to fraction of inspired oxygen (FiO2) (PFRs). Patients with a PFR < 300 were classified as having AHRF. Univariate analyses and logistic regression were used to test the association of clinical factors with the presence of AHRF and intubation.

Results

AHRF criteria (ie, PFR < 300) were met in 121 (2.9%) of the 4,184 patients with an oxygenation measurement. The following variables were independently associated with ALI: higher Pediatric Risk of Admission II score (adjusted odds ratio [95% confidence interval (CI)] = 1.12 [1.08-1.16]; p < .001), higher heart rate (1.02 [1.01-1.03]; p = .009), a positive chest radiograph (2.35 [1.02-5.43]; p = .045), and lower temperature (0.49 [0.36-0.68]; p < .001). The final model had an R2= .20.

Conclusion

We found nonintubated AHRF to be prevalent in the ED. The low R2for the regression model for AHRF underscores the lack of criteria for early identification of patients with respiratory compromise. Our findings represent an important first step toward establishing the true incidence of ALI in the pediatric ED.
Mutation Analysis of WASF2 and GALE Genes in One Chinese Family with Benign Familial Infantile Convulsions with a Novel Locus
Authors: Xiaohong Zi , Abuhamed Mutasem , Ya-qin Wang
Published: February 2008

Benign familial infantile convulsions (BFIC) are an autosomal dominant form of idiopathic epilepsy in which partial and generalized seizures commence in the first 3 months of life and spontaneously remit by age 1 year. As it is still unknown whether WASF2 and GALE genes are responsible for pure BFIC syndromes, in this article, mutations of the WASF2 and GALE genes in the proband of one Chinese family with pure BFICs were studied. Mutation analysis was carried out by polymerse chain reaction and deoxyribonucleic acid direct sequencing. One exonic variant (1047A→G) and one intronic variant (IVS10+13A→G), neither causing a modification of the physiologic messenger ribonucleic acid maturation, were found. The WASF2 and GALE genes do not appear to be involved in the ethiopathogenesis of pure BFIC syndromes, at least in the Chinese family we studied.
Open Surgical Treatment of Aneurysmal Sac Expansion following Endovascular Abdominal Aneurysm Repair: Solution for an Unresolved Clinical Dilemma
Authors: Halak Moshe , McDonnell Ciaran O. , Muhlmann Mark D. , Baker Stephen R.
Published: February 2008

The advantages of endovascular aneurysm repair (EVAR) are probably related to the avoidance of the three major physiological insults associated with open abdominal aortic aneurysm (AAA) repair: laparotomy, aortic cross-clamping and ischemia reperfusion injury. Continuing aneurysm expansion indicates a failure to exclude the AAA from the circulation. We describe our experience with open surgery of post-EVAR sac expansion. A consecutive series of 68 EVAR patients was followed up. Endovascular and minimally invasive procedures were the initial treatment option. Failure of these attempts to curtail AAA sac expansion or type 2 large endoleaks (EL) resulted in opening of the aneurysm sac. The procedure includes positioning of a deflated occlusion balloon proximal to the stent graft (SG). Laparotomy with opening of the eneurysm sac was then performed. The thrombus was removed and backbleeding vessels oversewn. The aneurysm sac was then plicated over the SG. Four patients (5.9%) were diagnosed as having either persistent large type 2 EL or sac enlargement. In all patients the procedure was accomplished successfully. One patient died from acute myocardial infarction perioperatively. Three patients recovered uneventfully and follow-up computed tomography confirmed the absence of endoleak and a disappearance of the AAA. We believe that whenever EVAR fails to exclude the aneurysm from the circulation, open exploration without graft replacement should be considered.
Recurrent Aortoenteric Fistula: Two Different Bridge Solutions
Authors: Chisci Emiliano , de Donato Gianmarco , Setacci Francesco , Stella Andrea , Setacci Carlo
Published: February 2008

A “recurrent” aortoenteric fistula (AEF) is very rare and in literature anecdotic. Currently, graft excision and extra-anatomic bypass are considered the treatments of choice, but are associated with significant mortality and morbidity. Herein, we describe the case of a “recurrent” AEF treated before definitive extra-anatomic bypass, by two different, staged bridge solutions: allograft in situ replacement and endovascular grafting. At 1, 3 and 6-month follow-up, the patient was asymptomatic and normally active.
Endovascular Repair of Thoracic Aortic Disease: Overview of Current Devices and Clinical Results
Authors: Lin Peter H. , El Sayed Hosam F. , Kougias Panagiotis , Zhou Wei , LeMaire Scott A. , Coselli Joseph S.
Published: February 2008

Endovascular repair of thoracic aortic aneurysm has become an important treatment modality in patients who are at increased risk for open surgical repair. Since the US Food and Drug Administration (FDA) approved the clinical application of this technology in the thoracic aorta in 2005, there has been a rapid growth in this treatment modality as numerous endovascular devices have been introduced in the application of thoracic aortic pathology. Although thoracic aortic aneurysm is the only FDA-approved treatment indication for endovascular repair, this technology may lead to a broader clinical applicability in other thoracic pathologies. This article reviews the current endovascular devices designed for the treatment of thoracic aortic pathology. These devices are described, and the current clinical results are discussed.
Mycotic Aneurysm of the Internal Carotid Artery Presenting with Multiple Cerebral Septic Emboli
Authors: Papadoulas Spyros , Zampakis Petros , Liamis Alexandros , Dimopoulos Panagiotis A. , Tsolakis Ioannis A.
Published: February 2008

Mycotic aneurysms of the extracranial carotid artery are uncommon and always warrant surgical treatment to prevent eventual rupture and death. Septic embolization to the brain is an even rarer complication of these aneurysms. We present a case of a 79-year-old male with an extracranial internal carotid artery mycotic aneurysm during Staphylococcus aureus bacteremia. He presented with hemiparesis owing to brain embolism from multiple septic emboli originating from the aneurysm. Multidetector computed tomographic angiography contributed to the diagnosis. Resection of the aneurysm and restoration of arterial supply to the brain by vein graft interpositioning was the therapeutic procedure along with long-term antibiotic treatment. A high index of suspicion is required for the diagnosis of a mycotic carotid aneurysm and aggressive treatment is always needed to prevent lethal complications.
Ruptured Abdominal Aortic Aneurysm: Endovascular Repair Does Not Confer Any Long-term Survival Advantage Over Open Repair
Authors: Hinchliffe Robert J. , Braithwaite Bruce D.
Published: February 2008

Recent studies have suggested that endovascular aneurysm repair (EVAR) may reduce the perioperative mortality of ruptured abdominal aortic aneurysm (AAA). Whether EVAR confers any long-term survival advantage over published results for open repair of ruptured AAA has not been established. We conducted a single-center retrospective study over a 10-year period (1994–2004) examining the long-term outcome of patients who have undergone endovascular repair of ruptured AAA. Fifty-four patients underwent endovascular repair of a ruptured AAA. The median age was 75 years (interquartile range 69.5–79.5 years); 42 (78%) patients were male. The perioperative mortality rate was 37%. During a median follow-up of 32 months (range 14–48 months), there were 5 aneurysm-related and 13 non-aneurysm-related deaths. Overall, the 3- and 5-year survival rates were 36% and 26%, respectively. EVAR does not appear to confer any overall survival advantage in the mid- to long term compared with the published results for open repair. The reasons for this remain unclear. Further, larger studies are required to confirm these results.
Modified Distal Revascularization with Interval Ligation Procedure for Steal Syndrome after Arteriovenous Fistula Creation for Hemodialysis Access
Authors: van der Meer Saskia , Zeebregts Clark , Tielliu Ignace , Verhoeven Eric , van den Dungen Jan
Published: February 2008

Patients diagnosed with steal syndrome after hemodialysis access surgery have a few options for symptom relief while maintaining vascular access. These include fistula lengthening, banding, distal revascularization with interval ligation (DRIL), revision using distal inflow (RUDI) or proximalization of the arterial inflow (PAI). Two cases are described in which a modified DRIL procedure without interval ligation was used to relieve steal syndrome, leaving the arterial supply of an ischemic hand not entirely dependent upon a bypass. Furthermore, a review of the literature is presented in order to elucidate this relatively new treatment option as a viable means to improve hand perfusion while maintaining a functional fistula.
Thoracic Endograft Positioning and Carotid-Subclavian Bypass Grafting in a Patient with a Saccular Aneurysm at the Aortic Arch
Authors: Valerio Nicolas , Bucci Federico , Redler Adriano , Salvati Bruno , Ferdani Michel
Published: February 2008

A 75-year-old man was referred to our hospital because of sudden thoracic pain. A saccular aneurysm of the aortic arch extending on the anterior surface of the aortic arch was found on computed tomographic arteriography. The patient was hemodynamically stable and he was programmed for a staged surgical and endovascular approach (hybrid approach). As a first stage and in order to prevent major cardiac complications due to the overstenting of the left subclavian artery (LSA) with the occlusion of the aortocoronary bypass, the patient underwent a polytetrafluoroethylene bypass graft (GORE-TEX, W.L. Gore & Associates, Flagstaff, AZ) between the LSA and the left carotid artery. Intraoperative arteriography revealed a good patency of the left carotid-subclavian bypass and of the left internal mammary bypass on the left anterior descending artery. As a second stage the endovascular procedure was accomplished 5 days later in the operating room. A Gore TAG stent graft (W.L. Gore & Associates) was deployed in the aortic arch 20 mm proximally to the aneurysmatic segment covering the ostium of the LSA. The postoperative course was uneventful and the patient was discharged on the fifth postoperative day in good general conditions. Hybrid procedures for treatment of aneurysms of the aortic arch or of the descending thoracic aorta are a promising alternative to open surgery especially in high-risk patients, with lower early morbidity and mortality rates. Long-term effectiveness remains to be fully elucidated.
Optional Vena Cava Filters: What, Why, and When
Authors: Kaufman John A.
Published: February 2008

Optional vena cava filters can used to provide either short-term or permanent protection from pulmonary embolism. These devices have recently become available for clinical use in the United States. However, there remains a paucity of data about these devices and their outcomes. This article reviews current and future devices, the rationale behind non-permanent caval filtration, and the generally accepted guidelines for their clinical application.
Endovenous Radiofrequency Ablation for the Treatment of Varicose Veins
Authors: Dietzek Alan M.
Published: February 2008

Chronic venous insufficiency (CVI) is the most common vascular disease and represents a significant health care problem in the United States. Reflux of the great saphenous vein is the most common cause of this condition, whose symptoms include varicose veins, leg swelling, skin discoloration, and ulceration. The traditional treatment of this condition is saphenofemoral ligation with stripping of the saphenous vein followed by varicose vein removal, if necessary. Recent advances in minimally invasive endovenous therapy have led to the development of catheter-based radiofrequency ablation (RFA) of the saphenous vein, which has gained an increasing acceptance in clinical practice. Endovenous RFA was introduced into clinical practice in Europe in 1998 and in the United States in 1999. Since then, over 250,000 procedures have been performed worldwide. Procedure safety and efficacy are well understood, with over 60 publications on the subject in the peer review literature, including four randomized trials comparing this technology with traditional vein stripping surgery. With the advent of tumescent anesthesia, the majority of RFA procedures are now performed in an office setting. This article examines the current technology using RFA in saphenous vein ablation with the Closure catheter system. Procedural techniques and clinical outcome using RFA in saphenous vein ablation are discussed. Clinical data comparing RFA versus saphenous vein stripping are also examined. Lastly, the clinical utility of a new RFA catheter, ClosureFAST, is discussed. ClosureFAST is a new generation of RFA catheter and has exhibited significant improvement in the ease of use and the procedure speed over the previous generation catheters while maintaining the favorable patient recovery profile seen with the RFA technology.
Endovenous Laser Ablation of Varicose Veins: Review of Current Technologies and Clinical Outcome
Authors: Johnson Colleen M. , McLafferty Robert B.
Published: February 2008

Symptomatic lower extremity varicose veins represent one of the most common vascular conditions in the adult population. Associated symptoms ranged from mild conditions such as fatigue, heaviness, and itching to more serious conditions such as skin discoloration and leg ulceration. The predominant causative factor of this condition is reflux of the great saphenous vein (GSV), which is traditionally treated with surgical saphenofemoral ligation and stripping of the incompetent saphenous vein. In recent years, there have been significant advances in saphenous vein ablation using percutaneous techniques, including the endovenous laser therapy (EVLT). In this article, the authors discuss the therapeutic evolution of this technology, theoretical basis of laser energy in GSV ablation, and procedural techniques of EVLT using duplex ultrasonography. Additional discussion of procedural-related complications, such as deep vein thrombosis, skin burn, saphenous nerve injury, and phletibis, and ecchymosis, are provided. Lastly, clinical results of EVLT in GSV ablation are discussed. Current literatures support EVLT as a safe and effective treatment option for varicosities caused by GSV incompetence.
Percutaneous Stenting of Superior Vena Cava Syndrome: Treatment Outcome in Patients with Benign and Malignant Etiology
Authors: Barshes Neal R. , Annambhotla Suman , El Sayed Hosam F. , Huynh Tam T. , Kougias Panagiotis , Dardik Alan , Lin Peter H.
Published: February 2008

Symptomatic obstruction of the superior vena cava (SVC) can be caused by either intrathoracic malignancy or nonmalignant etiology resulting in superior vena cava syndrome (SVCS). The objective of this study was to evaluate the clinical outcome of percutaneous stenting of SVCS in patients with malignant and benign disease. During a 9-year period, 56 patients with SVCS underwent percutaneous stenting placement. Among them, malignant and benign disease was responsible for 40 patients (71%) and 16 patients (29%), respectively. The Wallstent was the most commonly used stent and was used in 45 patients (80%), whereas the Palmaz stent was used in 6 patients (11%). In 38 patients (68%), a single stent was deployed to treat an SVC lesion. In contrast, bilateral kissing stents were deployed in 9 patients (16%), which extended from bilateral brachiocephalic veins to the proximal SVC. Technical success was achieved in all patients while symptomatic improvement was noted in 54 patients (96%). No procedural complications occurred in this series. Primary patency in malignant and benign cases at 1 year was 64% and 76%, respectively. Overall symptom-free survival ranged from 1 to 34 months. Our study showed that endovascular treatment with percutaneous stenting provides an effective treatment strategy in patients with SVCS caused by either malignant or benign disease.
Ultrasound-Guided Percutaneous Ablation for the Treatment of Perforating Vein Incompetence
Authors: Elias Steve , Peden Eric
Published: February 2008

Recent advances in catheter-based endovenous interventions have broadened our understanding in the pathophysiology and therapeutic strategies of chronic venous insufficiency, a condition that can be caused by abnormality of various lower extremity venous structures, including superficial or deep vein reflux or incompetent perforating veins. This article reviews the history and therapeutic principles of percutaneous ablation of perforators (PAPs). Discussions related to treatment strategies and procedural techniques of PAPs using radiofrequency ablation, laser energy, and sclerosant injection are provided. Current clinical results of PAPs with radiofrequency and laser energy ablation as a treatment modality of chronic venous insufficiency are also discussed.
Treatment of Symptomatic Lower Extremity Acute Deep Venous Thrombosis: Role of Mechanical Thrombectomy
Authors: Biuckians Andre , Meier George H.
Published: February 2008

Systemic anticoagulation with heparin or its unfractionated derivatives followed by warfarin therapy has been the mainstay of treatment in patients with lower extremity deep venous thrombosis (DVT). Although heparin is an effective treatment modality in preventing thrombus propagation, it provides minimal therapeutic effect in dissolving preexisting venous thrombus. The clinical consequence of DVT, owing in part to loss of venous endothelial and valvular function, is postphlebitic syndrome or chronic venous insufficiency. Current advances in endovascular therapy have resulted in various endovascular thrombectomy systems that can effectively remove a large venous thrombus burden, which may represent a potential advantage of preserving venous valvular function and thereby reduce the likelihood of postphlebitic syndrome. In this article, we review a variety of surgical and interventional methods in venous thrombus removal. Current treatment modalities using mechanical thrombectomy devices and pharmacomechancial thrombectomy strategy are also discussed.
Chronic Venous Obstruction: Diagnostic Considerations and Therapeutic Role of Percutaneous Iliac Stenting
Authors: Neglén Peter
Published: February 2008

Iliac venous outflow obstruction has an important role in the expression of symptomatic chronic venous insufficiency. This anatomic obstruction is frequently overlooked, owing in part to diagnostic difficulty. The combination of venous obstruction and reflux leads to more severe clinical disease. Current diagnostic modalities do not allow an definitive assessment of hemodynamically critical venous obstruction. No single invasive or noninvasive study can accurately detect borderline obstruction of potential hemodynamic significance. A high index of suspicion is critical in the initial recognition of chronic venous obstruction. The diagnosis relies on clinical signs and symptoms and radiologic assessment of morphologic venous outflow obstruction. Treatment strategy should be based on the results of morphologic investigations such as transfemoral phlebography or, preferably, intravascular ultrasonography. Percutaneous iliac venous stenting offers a safe and efficient method to correct pelvic venous obstruction. Percutaneous iliac stenting does not preclude subsequent venous bypass or corrective superficial and deep reflux surgery. This article reviews the etiologic factors and diagnostic modalities of iliac venous obstruction. The therapeutic role of percutaneous iliac stenting in the management of venous obstruction is also discussed.