bluuebunny/crossref_metadata_2025 huggingface dataset:
Alcohol Abuse and Acute Lung Injury: Epidemiology and Pathophysiology of a Recently Recognized Association
Authors: Guidot David M. , Hart Michael C.
Published: August 2007

Alcohol is the most commonly used and abused drug in the United States. The deleterious health effects of alcohol can be attributed both to its acute intoxicating effects, which result in temporary impairment of judgment and motor skills, and to its more chronic and toxic effects on the liver, pancreas, heart, and brain, all of which may result in irreversible organ damage. Although recognized for more than a century as a major risk factor for pneumonia, alcohol abuse was until recently perceived to have no significant effects on lung structure and/or function. However, within the past decade, epidemiologic studies have revealed that alcohol abuse independently increases the risk of acute respiratory distress syndrome (ARDS) two- to fourfold in patients with sepsis or trauma and may play a role in ARDS pathogenesis in as many as half of all patients with the syndrome. Although alcohol abuse alone does not cause acute lung injury, it renders the lung susceptible to dysfunction in response to the inflammatory stresses of sepsis, trauma, and other clinical conditions recognized to cause ARDS. Recent investigations in both animal models of chronic ethanol ingestion and in human subjects with a history of alcohol abuse have explored this previously unrecognized connection between alcohol and acute lung injury and have uncovered multiple derangements, which we now characterize as the “alcoholic lung.” This review summarizes the epidemiologic association between alcohol abuse and acute lung injury and the recent experimental findings that are unraveling the underlying pathophysiology.
Innate Immune Response to Adenovirus
Authors: Nazir Shoab A. , Metcalf Jordan P.
Published: August 2007

Adenovirus is a common infectious pathogen in both children and adults. It is a significant cause of morbidity in immunocompetent people living in crowded living conditions and of mortality in immunocompromised hosts. It has more recently become a popular vehicle for gene therapy applications. The host response to wild-type infection and gene therapy vector exposure involves both the innate and adaptive immune systems. The initial innate immune response is associated with the severe acute manifestations of adenovirus infection and also plays a significant role in acute toxicity owing to adenovirus vector exposure. This review discusses the innate immune response primarily during wild-type adenovirus infection because this serves as the basis for understanding the response during both natural infection and exposure to adenovirus vectors.
Attitudes toward Hormone Replacement Therapy in the New Millennium: University Physicians’ and Patients’ Perspectives
Authors: Ismail Hassan M. , Aleveritis Ellie , Guha Bhuvana , Olive Kenneth , Sloan Susan
Published: August 2007

Background

Recent studies are changing the way physicians and patients view hormone replacement therapy (HRT). This study was performed at the East Tennessee State University (ETSU) internal medicine clinic to evaluate the current behaviors of university physicians and patients with respect to HRT.

Methods

A retrospective chart review was conducted at the main internal medicine outpatient clinic at ETSU. Two hundred seventy-four postmenopausal female patients were randomly selected using a computerized systematic sampling technique of International Classification of Diseases, Ninth Revision (ICD-9) codes for menopause or postmenopause. The study period was from July 2002 until June 2004. Patients were postmenopausal women age 35 years or over who had been seen by their physicians at least twice a year during the study period. Patients who were noncompliant with HRT or physician's visits or had contraindications or side effects to HRT mandating discontinuation of the treatment were excluded. Data regarding physicians’ patterns in discussion and discontinuation of the therapy and patients’ responses were collected. Epi Info 2002 was used for statistical analysis.

Results

One hundred seventy-seven patients met all of the criteria, of whom 140 were 35 to 75 years of age. Of this age group, 49 patients (35%) had coronary artery disease (CAD), 101 (72.1%) were on HRT prior to July 2002, and 30 (21.4%) had osteoporosis. Seventy-five patients (53.6%) had documented discussions with their physicians about HRT after July 2002. Most patients who were on HRT had no CAD (p = .0008). Of the patients who were on HRT, only 36 (35.6%) continued treatments (23 continued the same dose, and 13 had the dose modified), whereas 65 (64.3%) had treatments discontinued. HRT discussions were carried on mostly when patients had treatments stopped or modified (p = .0032). Of these patients who had discussions, 60 (80%) were advised to stop or modify the dose and agreed, and only 15 (20%) disagreed or received unbiased discussions from their physicians about HRT. Thiry-seven patients were over 75 years of age. This older group had a higher rate of HRT discontinuation (82%) but a lower rate of documented discussion (22%) than the younger group.

Conclusion

Physicians should pay more attention to the importance of providing high-quality and well-balanced patient counseling when addressing uncertain treatments and adequately document discussions with patients in medical records.
Bacterial Penetration of the Mucosal Barrier by Targeting Lipid Rafts
Authors: Abraham Soman N. , Duncan Matthew J. , Li Guojie , Zaas David
Published: August 2007

Several traditionally extracellular pathogens not known to possess invasive capacity have been shown to invade various mucosal epithelial cells. The mucosal epithelium performs an important barrier function and is not typically amenable to bacterial invasion. Valuable clues to the underlying basis for bacterial invasion have emerged from recent studies examining the invasion of bladder epithelial cells by uropathogenic Escherichia coli and alveolar epithelial cells by Pseudomonas aeruginosa. In both cases, bacterial invasion is achieved through targeting of molecules specifically found within distinct glycosphingolipid- and cholesterol-enriched microdomains called lipid rafts. The importance of lipid rafts in promoting bacterial invasion was shown as disruptors of lipid rafts blocked cellular invasion by both E. coli and P. aeruginosa. In addition, molecular components of lipid rafts were found to be highly enriched in membranes encasing these intracellular bacteria. Furthermore, caveolin proteins, which serve to stabilize and organize lipid raft components, are necessary for bacterial entry. Taken together, targeting of lipid rafts appears to be an effective but poorly recognized mechanism used by pathogenic bacteria to circumvent the mucosal barriers of the host.
Atorvastatin Affects Interleukin-2 Signaling by Altering the Lipid Raft Enrichment of the Interleukin-2 Receptor β Chain
Authors: Goebel Jens , Logan Barbara , Forrest Kathy , Mieczkowski Alexandra , Roszman Thomas L. , Wills-Karp Marsha
Published: August 2007

Although the immunomodulatory properties of statins are in part independent of their lipid-lowering effects, cholesterol is a major component of lipid rafts. We therefore studied the effects of atorvastatin (AS) on the raft enrichment of the interleukin-2 receptor (IL-2R) β chain previously described by us and on early IL-2R signaling events in activated human T cells. We found that concomitant AS exposure during a 3-day stimulation with phytohemagglutinin (PHA) attenuates activation-associated events, such as the enhanced surface expression of the raft marker GM-1 and the induced expression of the activation marker CD25 (the IL-2R α chain). In contrast, brief AS treatment after PHA stimulation increased GM-1 surface expression and virtually abolished the selective raft enrichment of the IL-2R β chain. Although this AS-associated increase in GM-1 expression resembled that seen in the presence of the raft-disrupting cholesterol chelator methyl-β-cyclodextrin (MBCD), the two agents had contrasting effects on the tyrosine phosphorylation of the IL-2R β chain by exogenous IL-2: MBCD essentially abolished this event, whereas AS tended to enhance it and shifted its occurrence out of rafts. We conclude that AS affects IL-2R signaling by altering the raft enrichment of the IL-2R β chain and propose that this effect is one mechanism underlying the immunomodulatory properties of statins.
Natriuretic Peptides: Novel Therapeutic Targets in Heart Failure
Authors: Cataliotti Alessandro , Burnett John C.
Published: August 2007

Since the discovery of the cardiac hormone atrial natriuretic peptide by de Bold and colleagues in 1981, the field of natriuretic peptides has significantly advanced with translation of new knowledge to the clinical practice of heart failure. This new knowledge builds on the importance of cardiorenal mechanisms that contribute to optimal cardiovascular regulation. Recent investigations by our group and others have also established the direct myocardial actions of the natriuretic peptides, broadening their therapeutic potential beyond renal mechanisms. Indeed, a potential therapeutic target is cardiac remodeling and fibrosis based on the unique cardiorenal and humoral protective properties that natriuretic peptides possess. We review new insights into the natriuretic peptide system and specifically focus on the possible role of natriuretic peptides as a new therapeutic strategy to limit cardiac remodeling and fibrosis to delay worsening of cardiac function and the progression of heart failure.
Intestinal Adaptation in Short Bowel Syndrome
Authors: Cisler Jason J. , Buchman Alan L.
Published: August 2007

Short bowel syndrome occurs when there is insufficient length of the small intestine to maintain adequate nutrition and/or hydration status without supplemental support. This syndrome most frequently occurs following extensive surgical resection of the intestine, and the extent of adaptation depends on the anatomy of the resected bowel and the amount of bowel remaining. Following resection, the intestinal tissue undergoes morphologic and functional changes to compensate for the lost function of the resected bowel. These changes are mediated by multiple interactive factors, including intraluminal and parenteral nutrients, gastrointestinal secretions, hormones, cytokines, and growth factors, many of which have been well characterized in animal models. The amount of small bowel remaining is the most important predictor of adaptive potential; neither structural nor functional adaptative changes have been demonstrated in humans or animal models with more extreme resections resulting in an end-jejunostomy. The current understanding of these processes has led to the recent use of supplemental hormones, such as growth hormone and glucagon-like peptide 2, in intestinal rehabilitation programs and may lead to the development of pharmacologic agents designed to augment the innate adaptive response.
Current Status of Integrating Information Technologies into the Clinical Research Enterprise within US Academic Health Centers: Strategic Value and Opportunities for Investment
Authors: Turisco Fran , Keogh Diane , Stubbs Connie , Glaser John , Crowley William F.
Published: August 2007

Little information exists about the incorporation of information technologies (ITs) into clinical research processes within US academic health centers (AHCs). Therefore, we queried a group of 37 leading AHCs regarding their current status and future plans in clinical research IT. The survey specifically inquired about the presence or absence of basic infrastructure and IT support requirements; individual applications needed to support study preparation, study conduct, and its administrative support; and integration of data from basic research, clinical trials, and the clinical information systems increasingly used in health care delivery. Of the 37 AHCs, 78% responded. All strongly agreed that a “state-of-the-art” clinical research IT program would be ideal today and will be essential tomorrow. Nonetheless, no AHC currently has an IT solution that even approached this ideal. No AHC reported having all of the essential management foundations (ie, a coherent vision, an overall strategy, a governance structure, and a dedicated budget) necessary to launch and sustain a truly successful implementation of a cohesive clinical research IT platform. Many had achieved breakthroughs in individual aspects of clinical research IT, for example, adverse event reporting systems or consent form templates. However, overall implementation of IT to support clinical research is uneven and insufficient.

These data document a substantial gap in clinical research IT investments in leading US AHCs. Linking the clinical research IT enterprise with its clinical operations in a meaningful fashion remains a crucial strategic goal of AHCs. If they are to continue to serve as the “translational research engines” that our society expects, AHCs must recognize this gap and allocate substantial resource deployment to remedying this situation.
Osborn (J) Wave Appearance on the Electrocardiogram in Relation to Potassium Transfer and Myocardial Metabolism during Hypothermia
Authors: Brunson Charlie E. , Abbud Eliyya , Osman Khidir , Skelton Thomas N. , Markov Angel K.
Published: August 2007

The genesis of the J wave during hypothermia has been attributed to injury current, delayed ventricular depolarization and early repolarization, tissue anoxia, and acidosis. To our knowledge, no studies have addressed the appearance of the J wave in relation to the myocardial K+ transfer and metabolism during hypothermia. Dogs (n = 9) were progressively cooled, blood samples were taken from the aorta and coronary sinus, and myocardial tissue samples were obtained for adenosine triphosphate (ATP), creatine phosphate (CP), and glycolytic intermediate determination. In every instance, the appearance of the J wave was preceded by a net loss of K+ from the myocardium. In one dog, there was no myocardial K+ loss and the J wave was absent. The J wave appeared when the esophageal temperature was between 27° and 24°C (26.6 ± 0.73°C). At that temperature, the animals were hypotensive and bradycardic, but arterial oxygen partial pressure, carbon dioxide partial pressure, and pH were within the physiologic range at that temperature. The myocardial ATP and CP from the hypothermic dogs was lower compared with the value obtained from dogs at 37°C (p < .025 and p < .005, respectively). The levels of the glycolytic intermediates, fructose-1,6-diphosphate, dihydroxyacetone phosphate, and pyruvate, were lower and the level of lactate was higher compared with those from the normothermic dogs (not significant; p < .007, p < .02, p < .001, respectively). These findings suggest that the appearance of the J wave on electrocardiography during cooling is a result of depression of the metabolic process concerned with maintenance of the partition of ions across the cell membrane, as evidenced by decreased myocardial energy content and K+ loss during the hypothermic state.
Osteoporosis: How Should it be Treated?
Authors: Odvina Clarita V.
Published: August 2007

Osteoporosis develops as a result of imbalance between bone resorption and bone formation. A number of effective and safe therapies for osteoporosis are currently available, most of which are inhibitors of bone resorption. However, because osteoporosis is a complex and heterogeneous disease with different pathogenetic factors, defining the role of the different factors in its development is important in formulating a more selective approach to therapy. This review discusses the advantages and disadvantages of the currently available agents used in the management of osteoporosis.
Significance of Hepatitis C Virus Core Protein in the Diagnosis of Hepatitis C Virus Infection in Different Liver Diseases
Authors: Irshad Mohammad , Dhar Indranil , Joshi Yogesh Kumar
Published: August 2007

The present article describes the presence of hepatitis C virus (HCV) core protein in relation to HCV antibody in different types of liver diseases caused by hepatitis viral infections. One hundred thirty patients with various types of liver diseases, including those with acute viral hepatitis ( n = 50), chronic viral hepatitis ( n = 30), cirrhosis of the liver ( n = 30), and fulminant hepatic failure ( n = 20), were analyzed for HCV core protein, HCV-ribonucleic acid (RNA) and anti-HCV antibodies using enzyme immunoassays and reverse transcriptase-polymerase chain reaction. All patients were also simultaneously analyzed for other hepatitis markers to diagnose hepatitis A to E in all cases. Patients with HCV infection were additionally tested for HCV core protein and HCV-RNA. The results of analysis demonstrated the presence of hepatitis B, C, and E in different proportions of patients with these liver diseases. Hepatitis A and D infections were absent in all cases. Analysis of sera from acute viral hepatitis demonstrated the presence of HCV core protein, HCV-RNA, anti-HCV antibodies, and both core protein and anti-HCV together in 18%, 16%, 6%, and 2% of cases, respectively. In fulminant hepatic failure patients, these markers were recorded in 20%, 10%, 10%, and 5% of cases, respectively. In the chronic viral hepatitis group, the pattern was reversed, and their presence was recorded in 13.3%, 13.3%, 46.6%, and 10% of cases, respectively. Similarly, in cirrhosis patients, these markers were noted in 23.3%, 23.3%, 23.3%, and 13.3% of cases, respectively. None of the control sera were positive for any hepatitis marker. The significance of HCV core protein in relation to HCV-RNA and anti-HCV for the diagnosis of HCV infection in different liver diseases has been discussed.
Does Diabetes Mellitus Explain the Higher Hospital Mortality of Women with Acute Myocardial Infarction? Results from the Berlin Myocardial Infarction Registry
Authors: Maier Birga , Thimme Walter , Kallischnigg Gerd , Graf-Bothe Claudia , Röhnisch Jens-Uwe , Hegenbarth Claire , Theres Heinz
Published: August 2007

Background

Women with acute myocardial infarction (AMI) exhibit greater hospital mortality than do men. In general, diabetes mellitus is one of the major factors influencing the outcome of patients with AMI. The aim of this study was to analyze the interaction between diabetes and gender, specifically with regard to the higher hospital mortality of female AMI patients aged ≤ 75 years.

Methods

We prospectively collected data from 3,715 patients aged ≤ 75 (2,794 men, 921 women) with acute myocardial infarction who were treated in 25 hospitals in Berlin, Germany, from 1999 to 2002. In a multivariate analysis, we specifically studied the interaction between the factors diabetes mellitus and gender in their effects on hospital mortality.

Results

After adjustment in multivariate analysis, the interaction between gender and diabetes was statistically significant, and the estimated odds ratios were as follows: female diabetic patients compared with male diabetic patients, odds ratio (OR) = 2.28 (95% confidence interval [CI] 1.42-3.68); female diabetic patients compared with male nondiabetic patients, OR = 2.90 (95% CI 1.90-4.42); and female diabetic patients compared with female nondiabetic patients, OR = 2.92 (95% CI 1.75-4.87). There was no statistically significant difference between the risk of dying for female nondiabetic patients or for male diabetic patients when compared with male nondiabetic patients.

Conclusions

In AMI patients aged ≤ 75 years, female gender alone is not an independent predictor of hospital mortality. Detailed, multivariate analysis reveals that specifically diabetic women demonstrate higher hospital mortality than do men. Special attention should be provided to these female diabetic patients.
Why is Orthostatic Tolerance Lower in Women than in Men? Renal and Cardiovascular Responses to Simulated Microgravity and the Role of Midodrine
Authors: Grenon Marlene S. , Xiao Xinshu , Hurwitz Shelley , Sheynberg Natalie , Kim Christine , Seely Ellen W. , Cohen Richard J. , Williams Gordon H.
Published: August 2007

Background

Exposure to microgravity induces cardiovascular deconditioning, manifested by orthostatic intolerance (OI). We assessed the renal, cardioendocrine, and cardiovascular responses of women and men to simulated microgravity to examine the impact of gender on OI.

Methods

Fifteen healthy female and 14 healthy male subjects were given a constant diet for 3 to 5 days, after which they underwent a tilt-stand test (pre-TST) and began 14 to 16 days of head-down tilt bed rest (HDTB), followed by a repeat tilt-stand test (post-TST). Female subjects began HDTB so that the post-TST was at the same time in their menstrual cycle as their pre-TST. Twenty-four-hour urine collections (daily), hormonal measurements, plethysmography, and cardiovascular system identification were performed.

Results

The times to presyncope were significantly different for men and women before ( p = .005) and after HDTB ( p = .001), with all of the women but only 50% of the men experiencing presyncope during the pre-TST ( p = .002) and all of the women but only 64% of the men experiencing presyncope during the post-TST. At baseline, the following differences between women and men were observed: women had higher serum aldosterone levels ( p = .02), higher parasympathetic responsiveness ( p = .01), lower sympathetic responsiveness ( p = .05), and lower venous compliance ( p = .05). Several parameters changed with HDTB in both men and women. In a double-blinded randomized trial, midodrine (5 mg orally) or placebo given to female subjects 1 hour before post-TST was ineffective in preventing OI.

Conclusion

In conclusion, the frequency of OI is higher in women than in men and is not modified by midodrine at the dose used. This increased susceptibility is likely secondary to intrinsic basal differences in the activity of volume-mediated parasympathetic and adrenergic systems and in venous tone. Thus, approaches to reduce OI in women are likely to differ from those effective in men.
Focal Segmental Glomerulosclerosis in Patients with Mandibuloacral Dysplasia Owing to ZMPSTE24 Deficiency
Authors: Agarwal Anil K. , Zhou Xin J. , Hall Roger K. , Nicholls Kathy , Bankier Agnes , Van Esch Hilde , Fryns Jean-Pierre , Garg Abhimanyu
Published: August 2007

Background

Mandibuloacral dysplasia (MAD) is a rare autosomal recessive disorder characterized by skeletal abnormalities such as hypoplasia of the mandible and clavicles and acro-osteolysis. Other features include cutaneous atrophy and lipodystrophy. Two genetic loci are known for MAD: lamin A/C ( LMNA), encoding structural nuclear lamina proteins, and zinc metalloproteinase ( ZMPSTE24), a membrane-bound endoprotease involved in post-translational proteolytic cleavage of carboxy terminal residues of prelamin A to form mature lamin A.

Methods

Mutational analysis of ZMPSTE24 in an additional patient with MAD and determination of functional activity of mutant ZMPSTE24 in a yeast growth arrest pheromone diffusion (halo) assay.

Results

We previously reported a Belgian woman with MAD who had ZMPSTE24 mutations and died of complications of chronic renal failure at the age of 27.5 years. We now report a 37-year-old Australian man with MAD who also had compound heterozygous mutations in the ZMPSTE24 gene, a null mutation, Phe361fsX379, and a missense mutation, Asn265Ser, which is partially active in the yeast complementation assay. He also developed end-stage renal disease and, despite receiving a cadaveric renal transplantation, died prematurely at the age of 37 years. Renal biopsies of both patients revealed focal segmental glomerulosclerosis, and the female patient had the collapsing variant.

Conclusion

These observations suggest focal segmental glomerulosclerosis as a phenotypic manifestation in patients with ZMPSTE24 deficiency.
Reengineering Clinical Research with Informatics
Authors: Chung Thomas K. , Kukafka Rita , Johnson Stephen B.
Published: August 2007

The future success of the translational research spectrum depends on the clinical research enterprise's ability to break through the barriers that constrain its productivity. As more basic science discoveries emerge, our ability to effectively translate this knowledge into improved patient care rests squarely on the manner in which we answer clinical questions. Informatics—the science of effective information use—is poised to help advance the conduct of science. However, incorporating informatics into the enterprise comes with its own set of challenges. To harness the benefits of improved information use, it is important to first establish how information flows within research. A thoughtful implementation of informatics—one that factors in social and organizational nuances—will undoubtedly lead to a more efficient and effective clinical research enterprise.
Role of Osteoprotegerin and Its Ligands and Competing Receptors in Atherosclerotic Calcification
Authors: Tintut Yin , Demer Linda
Published: August 2007

Vascular calcification significantly impairs cardiovascular physiology, and its mechanism is under investigation. Many of the same factors that modulate bone osteogenesis, including cytokines, hormones, and lipids, also modulate vascular calcification, acting through many of the same transcription factors. In some cases, such as for lipids and cytokines, the net effect on calcification is positive in the artery wall and negative in bone. The mechanism for this reciprocal relation is not established. A recent series of reports points to the possibility that two bone regulatory factors, receptor activator of NF-κB ligand (RANKL) and its soluble decoy receptor, osteoprotegerin (OPG), govern vascular calcification and may explain the phenomenon. Both RANKL and OPG are widely accepted as the final common pathway for most factors and processes affecting bone resorption. Binding of RANKL to its cognate receptor RANK induces NF-κB signaling, which stimulates osteoclastic differentiation in preosteoclasts and induces bone morphogenetic protein (BMP-2) expression in chondrocytes. A role for RANKL and its receptors in vascular calcification is spported by several findings: a vascular calcification phenotype in mice genetically deficient in OPG; an increase in expression of RANKL, and a decrease in expression of OPG, in calcified arteries; clinical associations between coronary disease and serum OPG and RANKL levels; and RANKL induction of calcification and osteoblastic differentiation in valvular myofibroblasts.
Uric Acid Homeostasis in the Evaluation of Diuretic-Induced Hyponatremia
Authors: Liamis George , Christidis Dimitrios , Alexandridis George , Bairaktari Eleni , Madias Nicolaos E. , Elisaf Moses
Published: August 2007

Background

Diuretics are one of the most common causes of severe hyponatremia. The responsible pathogenetic mechanisms remain unclear. Serum uric acid concentration has been proposed as an index of differentiating between two pathophysiologic constructs of diuretic-induced hyponatremia-extracellular volume depletion and syndrome of inappropriate antidiuretic hormone secretion (SIADH)-like state-but its discriminating value has not been verified in large series of patients. Here we attempt to illuminate the pathophysiology of diuretic-induced hyponatremia by focusing on uric acid homeostasis. Additionally, we analyze the epidemiology and clinical characteristics of the disorder.

Methods

We studied prospectively 158 adult patients with hyponatremia on admission to our internal medicine clinic. Here we report on those with diuretic-induced hyponatremia.

Results

Forty patients (13 male and 27 female) had diuretic-induced hyponatremia, rendering it the most common cause of the disorder (25.3%). These patients had lower mean ([Na+]) (121.2 ± 7.2 vs 126.4 ± 4.1 mEq/L, p = .0001) than the remaining hyponatremic patients. Patients with serum uric acid levels < 4 mg/dL ( n = 14) exhibited a biochemical profile consistent with a SIADH-like state, whereas patients with serum uric acid levels ≥ 4 mg/d ( n = 26) were consistent with extracellular volume depletion.

Conclusions

Diuretics are the most common cause of community-developed hyponatremia. The serum uric acid level effectively discriminates between two biochemical profiles of diuretic-induced hyponatremia, one consistent with extracellular volume depletion and another that simulates SIADH.
Cellular Immunity and Inflammatory Mediator Responses to Intense Exercise in Overweight Children and Adolescents
Authors: McMurray Robert G. , Zaldivar Frank , Galassetti Pietro , Larson Jennifer , Eliakim Alon , Nemet Dan , Cooper Dan M.
Published: August 2007

Background

Obesity modifies inflammatory mediators, but little is known about how obesity modifies the inflammatory responses of exercising children. This study assessed the acute effect of exercise on inflammatory mediators in overweight children.

Methods

Twenty-eight overweight (OW) youth (body mass index > 85%) and 30 normal-weight (NW) controls of the same proportions of age and gender performed 10 2-minute bouts of cycle ergometry exercise above the anaerobic threshold, with 1-minute rest intervals between bouts. Pre- and postexercise blood samples were collected for white blood cell subpopulation and inflammatory cytokines.

Results

Baseline leukocyte populations were higher in OW youth ( p < .05). Exercise increased most leukocyte subtypes for both groups ( p < .05). Granulocytes remained elevated 2 hours postexercise ( p < .05) for both groups, whereas monocytes remained elevated 2 hours postexercise for the OW children. Natural killer (NK) cells dropped below baseline 2 hours postexercise. Exercise significantly decreased CD4 and CD8 cells, which remained depressed 2 hours postexercise in the OW children. Baseline levels of interleukin (IL)-6 were ≈64% higher in OW children ( p < .001). Exercise increased IL-6 in both groups ( p < .001), which further increased 2 hours postexercise ( p < .05). Tumor necrosis factor α, IL-1β, and IL-1 receptor antagonist did not change with exercise.

Conclusions

Elevated baseline leukocyte subtypes and IL-6 levels in OW children suggest that childhood obesity is associated with a chronic low-grade inflammatory state. The acute inflammatory response to intense exercise appears to be similar between NW and OW children for most markers, but the depression of NK, CD4, and CD8 cells 2 hours postexercise suggests that an acute risk of mitogen-induced inflammation may exist in OW children after high-intensity exercise.
Future Research in Sex Differences in Obesity and Cardiovascular Disease: Report by the Society for Women's Health Research
Authors: Resnick Eileen M. , Simon Viviana R. , Iskikian Sara O. , Marts Sherry A.
Published: August 2007

Obesity has become an international public health concern. In the United States, the rates of overweight and obesity have escalated dramatically in the last several decades. The health implications of obesity stem from its relationship with the development and progression of several health complications and diseases. Cardiovascular disease, which is the number one killer of women and men, is strongly influenced by obesity. The exact biological relationship between these two conditions is difficult to understand because several overlapping physiological systems and processes influence their development. One important component that affects obesity and cardiovascular disease is the sex of the individual. Although this basic biological variable is an obvious area for scientific study, research analyzing the influence of sex on obesity and cardiovascular disease is gravely lacking. The Society for Women's Health Research convened a workshop of obesity and cardiovascular disease experts in November 2005 to identify the gaps in scientific knowledge and crucial next steps in research related to sex differences in obesity and cardiovascular disease. This meeting report describes the workshop attendees’ recommendations in detail.
Variability in Postheparin Hepatic Lipase Activity is Associated with Plasma Adiponectin Levels in African Americans
Authors: Clarenbach Jacob J. , Vega Gloria Lena , Adams-Huet Beverley , Considine Robert V. , Ricks Madia , Sumner Anne E.
Published: August 2007

Background

African Americans commonly have normal high-density lipoprotein cholesterol (HDL-C) and low triglyceride levels despite having insulin resistance and obesity. The higher than expected HDL-C levels are usually attributed to low levels of hepatic triglyceride lipase (HTGL) activity. Factors that regulate HTGL in African Americans are not well delineated.

Methods

In the current study, HTGL activity was examined in relation to indices of body fat (body mass index [BMI] and waist circumference [WC]), insulin resistance (fasting plasma insulin and homeostasis model assessment of insulin resistance [HOMA-IR] index), and adipokines (adiponectin and leptin). Sixty-three African Americans (33 men, 30 women; median age 31 years, range 20-50 years; median BMI 28.6 kg/m2, range 19.7-54.7 kg/m2) had anthropometry and measurement of postheparin lipase activities (HTGL), plasma HDL-C, triglycerides, and plasma adiponectin.

Results

HTGL correlated strongly with HDL-C ( r = −.52, p < .0001) and adiponectin ( r = −.49, p < .001). HTGL increased with BMI and WC ( r = .297, p = .018 and r = .301, p = .016, respectively). Adiponectin correlated strongly with HDL-C ( r = .50, p < .0001) and triglycerides ( r = −.493, p < .001). From multiple regression models, 28% of HTGL variability among African Americans can be explained by adiponectin levels in combination with gender and 35% of HTGL is explained with HDL-C included in the model.

Conclusion

The data suggest that adiponectin is a significant metabolic concomitant of HTGL activity in African Americans.
Pain Associated with Carotid Artery Surgery Performed under Carotid Plexus Block: Preemptive Analgesic Effect of Ketorolac
Authors: Sindjelic Radomir , Davidovic Lazar , Vlajkovic Gordana , Markovic Miroslav , Kuzmanović Ilija
Published: August 2007

Carotid artery surgery (CAS) performed under cervical plexus block is frequently associated with significant intra- and postoperative pain. To evaluate whether preoperative administration of ketorolac may improve analgesia in this type of surgery, 80 patients scheduled for CAS under cervical plexus block were randomly allocated to receive intravenously either 30 mg of ketorolac or placebo 30 minutes before surgery. Verbal rating scale pain scores during surgery and 3 and 6 hours after surgery, the number of patients requiring additional analgesia, and the total analgesic consumption both during and within 6 hours after surgery were significantly lower, whereas the time to first postoperative analgesia was significantly shorter in the ketorolac group than in the control group.

The results of this prospective, randomized, double-blind study show that a single 30 mg dose of ketorolac administered intravenously 30 minutes before surgery reduces intraoperative pain and preempts postoperative pain in patients undergoing CAS under carotid plexus block.
Do Carotid Surface Irregularities Correlate with the Development of Cerebrovascular Symptoms? An Analysis of the Supporting Studies, the Opposing Studies, and the Possible Pathomechanism
Authors: Liapis Christos D. , Paraskevas Kosmas I.
Published: August 2007

Carotid plaque surface morphology appears to play a controversial role in the occurrence of cerebrovascular symptoms, that is, amaurosis fugax, transient ischemic attacks, and episodes of stroke. A number of researchers favor a strong association between the morphologic abnormalities of the carotid plaque surface and the development of cerebrovascular symptoms. The supporters of this theory have demonstrated that surface contour irregularities not only are important potential sources of flow abnormalities but also contribute significantly to the development of ischemic neurologic symptoms through plaque fragmentation, microthrombi formation, and atheroembolism. However, opposers of this theory also exist. The main arguments for and against this theory, as well as the possible underlying pathomechanism linking the morphology of the carotid plaque surface with the development of cerebrovascular symptoms, are outlined. Detection of carotid surface abnormalities with the aid of angiography or color-flow duplex ultrasonography should play a major role in the early identification of patients at increased risk, this way aiding prompt correction of these usually clinically silent but potentially hazardous lesions.
Long-Term Results of Endovascular Aneurysm Repair with Aortouni-iliac Custom-Made Stent Grafts
Authors: Hakaim Albert G. , Oldenburg W. Andrew , Paz-Fumagalli Ricardo , McKinney J. Mark , Lau Louis , Biebl Matthias , Klocker Josef , Neuhauser Beate , Hugl Beate , Falkensammer Jergen
Published: August 2007

The purpose of this study was to review the outcome of endovascular abdominal aortic aneurysm repair (EVAR) using custom-made aortouni-iliac (AUI) devices with femorofemoral bypass. Between June 1999 and March 2001, 23 consecutive patients (1 female, 22 male) at high risk of open aortic aneurysm repair underwent EVAR with custom devices in an AUI configuration. The mean follow-up was 37 months (range 2–72 months), and the mean age was 76.8 years (range 67.5–88.7 years). Increased surgical risk was evidenced by 92% and 69% of patients with significant pulmonary or cardiac disease, respectively. The preoperative mean aneurysm diameter ( n = 23) 62 ± 8.2 mm was significantly greater than the postoperative diameter, ( n = 23) 54 ± 16.4 mm. Ten endoleaks occurred. Migration of the stent graft occurred in 9% ( n = 2). Secondary interventions were necessary in 23%, whereas tertiary interventions were required in 9%. Patients at high risk of open aneurysm repair received sufficient protection from aneurysm rupture with custom-made AUI devices.
Color-Flow Duplex Hemodynamic Assessment of Runoff in Ischemic Lower Limb Revascularization
Authors: Henrique Rossi Fabio , Puech-Leão Pedro , Mitsuro Izukawa Nilo , Pontes Junior Sergio Cunha , Massamitsu Kambara Antonio , Mattos Barreto Rodrigo Bellio , Hassan Saleh Mohamed , Gomes Ferreira Petisco Ana Cláudia , Vasconcelos Oliveira Llanes Alberto
Published: August 2007

The objective of this study was to evaluate the existence of hemodynamic arterial flow correlation between preoperative duplex scanning (DS) and intraoperative direct outflow resistance (IDOR) measurements in ischemic lower limb revascularization.

Sixty-eight ischemic lower limbs were submitted to preoperative DS. Anatomic and hemodynamic arterial characteristics of the outflow system were recorded, and the results were considered in the distal anastomosis placement site decision making. IDOR measurements were obtained at the same arterial segment, and Pearson's correlation coefficient test was performed to study the preoperative DS power in predicting the intraoperative outflow resistance.

DS was technically satisfactory and helped define the distal anastomosis site in 93.2% of the cases (supragenicular popliteal artery, 19 [27.9%]; infragenicular popliteal artery, 10 [14.7%]; crural artery, 31 [57.4%]). A positive correlation could be found between preoperative DS and IDOR (0.450; p < .001). This correlation was particularly powerful in the crural artery (0.715; p < .001) when compared with the popliteal arterial segment (0.237; p = .192).

Preoperative DS may help define the best distal arterial and outflow segment to be revascularized based on anatomic and hemodynamic parameters. There is a positive flow correlation between preoperative DS and IDOR that seems to be stronger in crural revascularization surgery.
Endovascular Repair For Thoracic Aortic Disease: Tertiary Single-center Experience In Northwestern Greece
Authors: Matsagas Miltiadis I. , Papakostas John C. , Katsouras Christos S. , Arnaoutoglou Elena , Lagos Nicolaos , Xanthopoulos Dimitrios , Drossos George E. , Michalis Lampros K.
Published: August 2007

The purpose of this article is to report the initial experience with endovascular repair of thoracic aortic disease in a single tertiary vascular unit in northwestern Greece.

Between 2003 and 2005, 16 patients were treated with endovascular techniques for various pathologies of the descending thoracic aorta. Twelve patients were treated electively and four emergently. Operative and follow-up data for a mean time of 18.4 months were retrospectively collected and analyzed.

Primary technical success was obtained in 14 (87.5%) cases. No early or late deaths occurred, and there was no major operation-related complication. No paraplegia was observed in our patients. Stent graft–related complications occurred in 18.75% (one type 2 and two type 3 endoleaks), but they all had a favorable outcome. No further problems have been reported in any of our patients.

Endovascular stent graft repair for diseases of the thoracic aorta seems to be a promising alternative to open surgery, especially for high-risk patients. Long-term results are needed to confirm the early benefit of this treatment option with regard to morbidity and mortality rates. The potential of this technique to be applicable even in relatively small, tertiary vascular centers might be of great benefit to patients.
Endovascular Exclusion Of Subclavian Artery Pseudoaneurysm
Authors: Sivamurthy Nayan , Eichler Charles , Schneider Darren B.
Published: August 2007

Subclavian artery pseudoaneurysms are typically a rare occurrence commonly caused by iatrogenic injury and trauma. We describe an endovascular approach employing a brachiofemoral through-wire technique for the treatment of a left subclavian artery pseudoaneurysm in the presence of a hostile aortic arch and great vessel anatomy.
Importance Of The Arteriographic Anatomy Of The Descending Genicular Artery And Sural Arteries In Patients With Atherosclerotic Occlusion Of The Popliteal Artery
Authors: Romiti Marcello , Miranda Fausto , Cardoso Brochado-Neto Francisco , Kikuchi Marise , Albers Maximiano
Published: August 2007

Bypasses to the descending genicular artery (DGA) or the medial sural artery (MSA) have been performed with acceptable rates of midterm success. The arteriographic appearance of the DGA, the MSA, and the lateral sural artery (LSA) was described and the applicability of bypass to these vessels was investigated. The arteriograms of 45 patients who had occlusion of the below-knee popliteal artery were analyzed to determine the presence, dominance, and extension of collaterals for each perigeniculate branch, which were used to assess the applicability of a perigeniculate bypass. A dominant perigeniculate artery was found in 26 arteriograms and corresponded to 13 DGAs, 9 MSAs, and 4 LSAs. Of 14 applicable perigeniculate bypasses, 2 would be an obligatory bypass and 12 would be an alternative to a conventional infrapopliteal bypass. Although rarely an obligatory solution, a bypass to a perigeniculate branch artery represents a valuable alternative.
Utility of Retrievable Vena Cava Filters and Mechanical Thrombectomy in the Endovascular Management of Acute Deep Venous Thrombosis
Authors: El Sayed Hosam F. , Kougias Panos , Zhou Wei , Lin Peter H.
Published: August 2007

Endovascular interventions of symptomatic deep venous thrombosis (DVT) using various therapeutic modalities, such as thrombolysis, mechanical thrombectomy, and inferior vena cava (IVC) filter placement, have received increased focus owing in part to advances in catheter-based interventional technologies. Although systemic anticoagulation remains the primary treatment modality in DVT, catheter-based interventions can provide rapid removal of large thrombus burden and possibly preserve venous valvular function in patients with symptomatic DVT. This article reviews current endovascular treatment strategies for acute DVT. Specifically, the utility of mechanical thrombectomy along with various temporary IVC filters in the setting of DVT is examined. Lastly, an illustrative case of acute DVT that was treated with endovascular intervention with IVC filter placement is presented.
Carotid Artery Stenting with Distal Protection Using the Carotid Wallstent and Filterwire Neuroprotection: Single-Center Experience of 380 Cases with Midterm Outcomes
Authors: Lin Peter H. , Zhou Wei , Guerrero Marlon A. , McCoy Sally A. , Felkai Deborah , Kougias Panos , El Sayed Hosam F.
Published: August 2007

Emerging data have supported the clinical efficacy of carotid artery stenting (CAS) in stroke prevention in high-risk surgical patients. This study was performed to evaluate the midterm clinical outcome of CAS using the Carotid Wallstent and FilterWire distal protection (both Boston Scientific, Natick, MA) at an academic institution. Risk factors for in-stent restenosis (ISR) were also analyzed. Clinical variables and treatment outcome of high-risk patients who underwent Carotid Wallstent placement with FilterWire EX/EZ neuroprotection were analyzed during a recent 54-month period. Three hundred eighty CAS procedures were performed in 354 patients. Technical success was achieved in 372 cases (98%), and symptomatic lesions existed in 85 (24%) patients. No patient experienced periprocedural mortality or neuroprotective device–related complication. The 30-day stroke and death rate was 2.7%, and the overall complication rate was 6.9%. The overall major or fatal stroke rates in symptomatic and asymptomatic patients were 4.6% and 1.3%, respectively (not significant). The overall stroke and death rates between the symptomatic and asymptomatic groups were 5.8% and 2.4%, respectively (not significant). The median follow-up period was 29 months (range 1–53 months). With Kaplan-Meier analysis, the rates of freedom from 60% or greater ISR after CAS procedures at 12, 24, 36, and 48 months were 97%, 94%, 92%, and 90%, respectively. The rates of freedom from all fatal and nonfatal strokes at 12, 24, 36, and 48 months were 97%, 91%, 89%, and 85%, respectively. Multivariable analysis of significant univariate predictors identified that postendarterectomy stenosis (odds ratio [OR] 3.98, p = .02) and multiple stent placement (OR 3.68, p = .03) were independent predictors of ISR. Our study yielded favorable short-term and midterm clinical results using Carotid Wallstent with FilterWire neuroprotection. Late follow-up results showed low rates of fatal and nonfatal stroke and favorable ISR rates compared with other carotid stent trials. Postendarterectomy and multiple stent placement were associated with subsequent ISR.
Development of a Tissue-Engineered Bypass Graft Seeded with Stem Cells
Authors: DiMuzio Paul , Fischer Lauren , McIlhenny Stephen , DiMatteo Christopher , Golesorhki Negar , Grabo Daniel , Tarola Nicholas , Mericli Alexander , Shapiro Irving , Tulenko Thomas
Published: August 2007

The gold standard conduit for bypass of diseased small-diameter arteries remains autologous vascular tissue. In the absence of such tissue, patients are offered bypass with prosthetic material, with far less durable results. Vascular tissue engineering, the creation of a vascular conduit by seeding a tubular scaffold with various cells, may offer an alternative approach to this difficult situation. Herein we review some of the significant challenges that remain in designing an ideal vascular conduit and outline potential solutions offered by a graft created by seeding natural vascular tissue (decellularized vein allograft) with readily available autologous cells (adipose-derived stem cells).
Models of Abdominal Aortic Aneurysm: Characterization and Clinical Applications
Authors: Chaer Rabih A. , DeRubertis Brian G. , Hynecek Robert , Kent K. Craig , Faries Peter L.
Published: August 2007

Abdominal aortic aneurysms (AAAs) are responsible for considerable morbidity, mortality, and cost to society. The pathogenesis of AAA formation, however, remains poorly understood. Animal models have been used in a range of experiments designed to provide further objective scientific assessment of the pathogenesis as well as the treatment of AAA. The purpose of this manuscript is to review the current models of AAA and their potential clinical implications.