bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mechanisms of Focal Calcification in Rabbit Aortas: Role of Calcifying Vesicles
Authors: Hsu Howard H.T. , Tawfik Ossama 
Published: August 2007

Background We previously demonstrated that calcification in rabbit thoracic aortas is initiated in the lower zone of the extensively thickened plaques (LZP) adjacent to the media. Whether osteogenesis or a local increase in calcifying vesicles underlies the focal calcification remains to be established. Methods To determine that focal calcification is related to osteogenesis, an obligatory osteogenic biomarker, alkaline phosphatase (ALP) activity, was evaluated in the unfixed thoracic aorta sections of rabbits fed a supplemental cholesterol diet and of humans with advanced atherosclerosis. To determine whether blood shortage to the smooth muscle cells (SMCs) imposed by intima thickening may increase calcifying vesicles, the effect of serum deprivation on the biogenesis of calcifying vesicles in cultured SMCs was investigated. Results (1) In contrast to positive rabbit kidney cross sections and consistent with the activity in various isolated subcellular fractions of aortas, ALP activity was absent in the media, adventitia, lesions, and LZP of rabbit aortas or in the fibrointima of human aortas. (2) Histologic assessments of the lesions indicate the absence of bone cells or osteoid. (3) Depletion of the serum from culture media caused a twofold increase in the levels of ALP-deficient and adenosine triphosphatase-rich calcifying vesicles, which were released from the cells by treatment with 0.05% trypsin-0.02% ethylenediaminetetraacetic acid for 15 minutes. Conclusions (1) Focal calcification in rabbit aortas and diffuse mineralization in human fibrointima are not associated with osteogenesis, and (2) blockade of the blood supply to SMCs may trigger the cells to produce more calcifying vesicles, thereby leading to site-specific calcification in rabbit aortas.
Effects of Multiple Daily Insulin Injections on Peripheral Glucose Disposal in Latin Americans with Type 2 Diabetes Mellitus
Authors: Avilés-Santa Larissa , Salinas Karin , Adams-Huet Beverley , Raskin Philip 
Published: August 2007

Objective To evaluate the effects of insulin in multiple daily injections (MDI) on peripheral glucose disposal in Latin American patients with type 2 diabetes. Methods and Results Ten Latin American patients (four men and six women) with type 2 diabetes between the ages of 32 and 45 years were evaluated. All women were premenopausal and had regular menstrual periods. A hyperinsulinemic-euglycemic clamp procedure was performed at baseline and was repeated approximately 2 years after insulin monotherapy on MDI was initiated. Both genders had comparable baseline anthropometric and laboratory features, including a mean body mass index > 30 kg/m 2 and percent body fat > 30%. Baseline percent hemoglobin A1c (HbA1c%) was 9.5 ± 1.5%, and post-intervention HbA1c% was 7.0 ± 1.2%. The peripheral glucose disposal rate at baseline was 4.5 ± 2.2 mg/kg/min fat-free mass and at postintervention was 3.6 ± 2.3 mg/kg/min fat-free mass. Conclusions Despite a significant improvement in glycemic control, MDI did not seem to increase the insulin-mediated glucose disposal rate. Underlying obesity and increased percent body fat may have been the most counteracting factors on the potential improvement in insulin sensitivity expected with insulin monotherapy.
Clinical Science Training at the University of Colorado: A Measurement of Trainee Satisfaction
Authors: Hall Deborah A. , Sheeder Jeanelle , Box Tamara , Shroyer Laurie A. 
Published: August 2007

Background Clinical science (CLSC) research education differs from basic science education in that many CLSC programs have an added goal of creating successful academicians. CLSC programs have expanded curricula that include teaching career development techniques, such as manuscript and grant writing, and helping young investigators establish successful mentor-mentee relationships. Methods A group of K30 CLSC training program students coordinated a pilot survey to determine if the CLSC training programs at the University of Colorado were meeting the needs of the participants in both didactic courses and in other aspects of academic medicine, including research. The small group survey was conducted as part of a clinical outcomes assessment course. Opportunities for improvement in the CLSC training programs were explored based on the results. Results Of 117 CLSC training program participants surveyed, 56% responded. Overall, there was a positive improvement found for the didactic CLSC research constructs. Participants also reported success in manuscript publication and grant writing applications. The CLSC program, however, was not successful in coordinating faculty mentor support for student research projects for 78% of respondents. Once a mentoring relationship was established, students were satisfied with the mentoring they received. Conclusion In general, CLSC trainees were satisfied that the K30 clinical research curriculum was meeting their needs. Many of the trainees were successful in developing academic skills during the program. Establishing a mentor relationship was the missing ingredient within the K30 CLSC training program. This may be an important component that should be considered when developing programs to create the next generation of clinician-scientists.
Survival Rate and Causes of Mortality in the Elderly with Depression: A 15-Year Prospective Study of a Japanese Community Sample, the Matsunoyama-Niigata Suicide Prevention Project
Authors: Kawamura Tsuyoshi , Shioiri Toshiki , Takahashi Kuniaki , Ozdemir Vural , Someya Toshiyuki 
Published: August 2007

Objective To compare long-term survival rates and causes of death in community-dwelling elderly with and without depression using the International Research Diagnostic Criteria administered by a psychiatrist. Method From 1985 to 2000, we prospectively examined Japanese persons ( N = 920) aged 65 years or older. Cases with depression ( n = 158) and a control sample without depression ( N = 762) were evaluated. The main outcome variables were survival rates and causes of mortality. Results By 2000, 61% of the subjects with depression had died. By contrast, 48% had died in the control group at the completion of the 15-year follow-up. Using age-adjusted Kaplan-Meier survival analysis, we found a hazard ratio (HR) of 1.49 (95% confidence interval [CI] 1.16-1.89) for mortality in the depressed group compared with controls ( p = .0009). Importantly, in female subjects with depression, the HR was 1.55 (95% CI 1.16-2.07; p = .002). In males with depression, by contrast, the HR (1.34) was not significant (95% CI 0.84-2.13; p = .19). Significantly more subjects died of cerebrovascular disorders, malignant tumors, respiratory disorders, or suicide after the onset of depression compared with controls ( p < .05). Conclusions Depression appears to be associated with a significant increase in the risk of mortality among elderly Japanese subjects, particularly in females. The elderly with a diagnosis of depression may be at an elevated risk of mortality owing to cerebrovascular disorder, malignant tumors, respiratory disorders, or suicide. These prospective data provide a new quantitative insight on gender differences and the long-term public health significance of depression among the community-dwelling elderly.
Relationship between the Soluble F11 Receptor and Markers of Inflammation in Hemodialysis Patients
Authors: Salifu Moro O. , Kolff Quirine , Murty Preethi , Haria Dhiren M. , Zimpa Mahamadu , Shakeel Muhammad , Lee Howon , Kornecki Elizabeth , Babinska Anna 
Published: August 2007

Background The human F11 receptor (F11R) is an important cell adhesion molecule implicated in inflammatory thrombosis. We hypothesize that serum levels of the soluble released form of F11R (sF11R) are elevated in dialysis patients since these patients have higher cardiovascular disease burdens than the general population. In this study, we examined whether sF11R levels were elevated in hemodialysis (HD) patients and correlated with known inflammatory cytokines. Methods We used new and standard enzyme-linked immunosorbent assay techniques to measure levels of sF11R, as well as high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10), in a cross section of 52 HD patients and compared these with 15 healthy controls. Results The mean age of the patients was 56 ± 17.3 years; 60% were female, and 36% had diabetes mellitus. Serum levels of sF11R, hs-CRP, TNF-α, IL-6, and IL-10 were all significantly higher in patients than in control sera ( p < .05). Within the patient group, there was a significant positive correlation between sF11R and TNF-α ( r = .41, p = .003), IL-10 ( r = .32, p = .023), and IL-6 ( r = .32, p = .023), whereas hs-CRP showed no significant correlation ( r = −.27, p = .052). Conclusion We conclude that the sF11R level is elevated in HD patients and correlates with known markers of cardiovascular disease. sF11R may be a novel cardiovascular risk marker, and longitudinal studies are needed to better assess its relationship with cardiovascular disease morbidity and mortality in this population.
The Meaning of Author Order in Medical Research
Authors: Baerlocher Mark Otto , Newton Marshall , Gautam Tina , Tomlinson George , Detsky Allan S. 
Published: August 2007

Background Manuscript authorship and author placement have important implications for accountability and allocation of credit. The objective of this study was to assess the relationship between an author's place in the author list and the type of contribution reported by that author. This pattern was then used to develop a method by which author responsibility and accountability can be clarified. Methods The published contributions of each author of original research articles with a minimum of four authors published in the Journal of the American MedicalAssociation, the British Medical Journal, TheLancet, and the Canadian Medical Association Journal in a 3-year period after author contribution forms were required were coded into 1 of eleven contribution categories. The contributions were grouped according to first, second, middle, and last author and compared by position. Results For most categories of contribution, the levels of participation were highest for first authors, followed by last and then second authors. Middle authors had lower levels particularly in conception, drafts of the manuscript, supervision, and being a guarantor. Conclusions Current patterns of author order and contribution suggest a consistent theme. Based on the results, a proposal is put forth by which author accountability is clarified. In this proposal, authors are classified as either “primary,” “contributing,” or “senior or supervisory,” each with specified contributions. More than one author may be classified into each author category.
Surgical Treatment of Abdominal Aortic Aneurysms Associated with Horseshoe Kidney
Authors: Göksel Onur , Çınar Bayer , Kömürcü Gürkan , Ahin Sinan , Eren Tunc 
Published: August 2007

Abdominal aortic aneurysm surgery associated with a horseshoe kidney (HSK) is a serious technical challenge for the surgeon. We reviewed our experience with 127 patients electively operated on between 1990 and 2004 for abdominal aortic aneurysm. Pre- and perioperative medical, surgical, and radiologic data were retrospectively reviewed. Preoperative diagnosis was achieved with computed tomography with or without angiography or with additional conventional aortography. Seven patients were recognized to have had a HSK, with a mean age of 67.29 ± 2.43 years. Preoperative serum creatinine levels were similar in patients with or without HSK (1.0 ± 0.08 vs 0.9 ± 0.12 mg/dL; not significant). In five of the patients with HSK, reimplantation of the anomalous renal artery was necessary. In all 127 patients, hospital mortality consisted of 5 patients, none of whom had an HSK. Dealing with HSK seemed to increase aortic clamp times (30.43 ± 3.55 vs 27.04 ± 3.92 minutes; p < .05) slightly. Patients with or without HSK were given similar amounts of intravenous fluid replacement (2,214.2 ± 441.3 vs 1,923.3 ± 433.6 mL/patient; not significant) and allogeneic blood transfusion (0.71 ± 0.49 vs 0.9 ± 0.4 U/patient; not significant) and had a similar intensive care unit stay. Abdominal aortic aneurysms associated with HSK have been managed without division of the isthmic tissue. The left retroperitoneal approach provided adequate exposure for all patients with HSK.
Statin Use Is Associated with Reduced All-Cause Mortality after Endovascular Abdominal Aortic Aneurysm Repair
Authors: Leurs Lina J. , Visser Patrice , Laheij Robert J.F. , Buth Jaap , Harris Peter L.H. , Blankensteijn Jan D. 
Published: August 2007

It has been shown that preoperative statin therapy reduces all-cause and cardiovascular mortality in patients undergoing major noncardiac vascular surgery. In this report, we investigated the influence of statin use on early and late outcome following endovascular abdominal aortic aneurysm repair (EVAR). The study population, consisting of patients collated in the EUROSTAR registry, was stratified in two groups according to statin use. Baseline characteristics between the two groups were compared by chi-square and Wilcoxon rank sum tests for discrete and continuous variables. The effects of statin use on outcomes after EVAR were analyzed by multivariate regression models. Of the 5,892 patients enrolled in the EUROSTAR registry, 731 (12.4%) patients used statins for hyperlipidemia. Statin users were younger, were more obese, and had a higher prevalence of diabetes, cardiovascular disease, and hypertension. After 5 years of follow-up, the cumulative survival rate was 77% for nonusers of statin versus 81% for statin users ( p = .005). After adjustment for age and other risk factors, statin use was still an independent predictor of improved survival ( p = .03). Our results revealed that statin prescription was more frequent in younger patients. However, when adjusted for age and medical risk factors, the use of statin in patients who underwent EVAR was still independently associated with reduced overall mortality.
Impact of Delay on Survival in Patients with Ruptured Abdominal Aortic Aneurysm
Authors: Salhab Mohamed , Farmer Jessica , Osman Isam 
Published: August 2007

Rupture of the abdominal aortic aneurysm (RAAA) is a common surgical emergency. Surgical treatment of this condition carries a high morbidity and mortality rate. For successful outcome, an early diagnosis and prompt treatment are essential. However, recently, some centers have reported better results in patients whose surgery had been delayed because of interhospital transfer. Delay in treatment sometimes occurs as patients are transferred from one institution to another where specialized vascular care is available. This retrospective study sought to determine the effect of delay in treatment on the mortality of patients with RAAA repair. The time from arrival at the emergency room to surgery and operative time were obtained from the case notes of 45 consecutive patients with RAAA. Patients' physiology scores on admission were calculated using V-POSSUM for the RAAA model. Thirty-five patients were diagnosed with RAAA in the emergency room and were transferred to surgery. These patients were divided into two groups: patients who had surgery within 1 hour ( n = 23) and those in whom surgery was delayed for up to 4 hours ( n = 12). There was no significant difference in physiology score between the two groups ( p = .12). The time to surgery and operative time with death as the outcome were plotted on a logistic regression model that showed that the delay in surgical treatment increases the mortality rate following RAAA repair ( p = .041). Furthermore, a long operative time was associated with a higher surgical mortality rate ( p = .029). Delay to surgery and a long operation increase the mortality rate following RAAA repair. However, delay to surgery alone did not influence the mortality rate.
Endovascular Therapy as the Primary Approach for Limb Salvage in Patients with Critical Limb Ischemia: Experience with 443 Infrapopliteal Procedures
Authors: Bosiers Marc , Hart Joseph P. , Deloose Koen , Verbist Jurgen , Peeters Patrick 
Published: August 2007

Endovascular strategies for the treatment of critical infrageniculate peripheral arterial occlusive disease exist and are becoming the primary methodology for such lesions at many centers. Although technically feasible for experienced operators, the evidence to support this strategy for below the knee (BTK) interventions is still evolving. We studied the 6-month and 1-year outcomes of percutaneous transluminal angioplasty (PTA) alone, PTA with stenting, and excimer laser recanalization for BTK lesions in patients with critical limb ischemia. Between September 2002 and June 2005, 443 patients (355 Rutherford category 4, 82 category 5, 6 category 6) underwent intervention for 681 BTK lesions. Follow-up was performed at 6-month intervals after index intervention: limb salvage data were recorded and duplex ultrasonography was performed to measure the patency of treated areas. The primary patency and limb salvage rates of the entire population were 85.2% and 97.0% and 74.2% and 96.6% at 6 months and 1 year, respectively. Stratified for the treatment strategy (PTA alone in 79, PTA with stenting in 300 patients, and excimer laser in 64), 1-year primary patency rates were 68.6%, 75.5%, and 75.4%, whereas the limb salvage rates were 96.7%, 98.6%, and 87.9% for each modality, respectively. Endovascular intervention will become the primary treatment for BTK lesions in patients with critical limb ischemia, with 1-year primary patency and limb salvage rates that compare favorably with published surgical data. Prospective, randomized, multicenter trials will be needed to further establish the role of endovascular intervention in this challenging patient group.
Treprostinil Sodium (Remodulin), a Prostacyclin Analog, in the Treatment of Critical Limb Ischemia: Open-Label Study
Authors: Berman Scott , Quick Rhonda , Yoder Pam , Voigt Sonia , Strootman Deborah , Wade Michael 
Published: August 2007

The purpose of this study was to assess the safety of continuous subcutaneous therapy with treprostinil sodium (Remodulin), a prostacyclin analog, and its effect on ischemic rest pain and ischemic wound healing in subjects with critical limb ischemia (CLI) and no planned revascularization procedure. This was a 12-week, open-label, single-center pilot study enrolling 10 subjects (mean age 82.4 years) with Fontaine stage III to IV (Rutherford class 4–6) peripheral arterial disease and ankle brachial indices less than 0.55. The primary end point was safety, and the secondary end points were the effects of treatment on ischemic rest pain, limb salvage, and wound healing. There was a 62% reduction in mean worst rest pain and a 57% reduction in mean average rest pain at week 12, with most subjects using less pain medication. Three subjects experienced complete healing of their wounds. No subject developed a new wound during the trial. Treprostinil was generally well tolerated. Subcutaneous infusion-site pain was the most frequently reported side effect, with one subject withdrawing from the study as a result. Jaw pain was reported by two subjects. One subject experienced two serious adverse events considered unrelated to treprostinil (cholecystitis and congestive heart failure). This study demonstrates that chronic, continuous subcutaneous treprostinil is safe and can be useful in the treatment of ischemic pain and wounds in subjects with CLI. Future controlled studies are needed to evaluate these effects and determine appropriate patient selection.
Occluded Infrainguinal Bypass Graft: Potential Source of Limb-Threatening Emboli
Authors: Chandra Ankur , Angle Niren 
Published: August 2007

Surgical bypass represents one of the chief treatment modalities for peripheral arterial occlusive disease. Despite improving techniques, graft occlusion accounts for the majority of these bypass failures. Once occluded, however, these grafts are thought to rarely pose a threat for future ischemic events. This report describes two patients with previously thrombosed grafts who subsequently presented with limb-threatening ischemia owing to peripheral embolization from the graft. Two patients with occluded grafts presented with ipsilateral limb-threatening acute ischemia. Both of these patients developed severe acute limb-threatening ischemia weeks to months after known graft thrombosis. Arteriography revealed peripheral embolization in each case. Both patients were operated on for disconnection of the thrombosed graft from the native circulation and have been free of recurrent symptoms. The occluded graft, although generally innocuous, can be a source of peripheral emboli, resulting in peripheral embolization and acute limb ischemia. Both patients in this report developed limb-threatening ischemia owing to embolization from the cul-de-sac of occluded prosthetic grafts. Due to the rarity of the condition and its associated morbidity and mortality, awareness and recognition of this phenomenon are critical. Operative disconnection is recommended if the embolism occurs downstream of the graft and no other embolic source can be identified.
Stent-Graft Treatment of Pseudoaneurysms and Arteriovenous Fistulae in the Carotid Artery
Authors: Schönholz Claudio , Krajcer Zvonimir , Carlos Parodi Juan , Mendaro Esteban , Hannegan Christopher , D'Agostino Horacio , Selby Bayne , Guimaraes Marcelo , Uflacker Renan 
Published: August 2007

The purpose of this study was to assess the safety and efficacy of stent-graft placement in the management of arteriovenous fistulae (AVF) and pseudoaneurysms (PAs) involving the carotid artery (CA). Twenty-two patients (16 men, 6 women) with a CA AVF ( n = 5) or PA ( n = 17) owing to a gunshot or stab wound, carotid endarterectomy, blunt trauma, a tumor, spontaneous dissection, or a central venous catheter were treated with percutaneous placement of stent grafts. The patients presented with tumor, bruit, headache, mouth and tracheostomy bleeding, transitory hemiparesis, seizure, or stroke. Diagnoses were made by using computed tomographic angiography (CTA) and digital subtraction angiography. Fourteen lesions were in the common CA; eight were in the internal CA. Homemade devices and stent grafts from a variety of manufacturers were employed. Follow-up evaluations included clinical, CTA, and Doppler ultrasound assessments. All patients had resolution of the PA or AVF. In one patient with a large petrous PA, acute occlusion of the CA developed after placement of three balloon-expandable stent grafts, but there were no neurologic complications because the circle of Willis was functional. During follow-up ranging from 2 months to 13 years, asymptomatic 90% stenosis owing to stent compression was observed on Doppler ultrasound and angiographic examinations in a patient with an autologous vein–covered stent graft in the internal CA. Three other patients died of causes unrelated to stent-graft placement. In all other patients, the stent graft remained patent. Our results indicate that stent grafting is an acceptable alternative to surgery in the treatment of AVF and PAs in the CA.