bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insulin as Initial Therapy in Type 2 Diabetes: Effective, Safe, and Well Accepted
Authors: Lingvay Ildiko , Kaloyanova Polina F. , Adams-Huet Beverley , Salinas Karin , Raskin Philip 
Published: August 2007

Background To achieve glycemic control in type 2 diabetes mellitus (T2DM), multiple oral agents are used in a stepwise approach, but long-term maintenance of normoglycemia is difficult to achieve, and, eventually, most patients require insulin. The aim of this study was to evaluate the feasibility, acceptability, and efficacy of insulin with metformin for newly diagnosed, treatment-naive patients with T2DM. Methods Eligible patients were started on insulin NovoLog 70/30 and metformin 1,000 mg twice daily. Biochemical evaluation was performed at baseline and at the end of the 3-month study. Patients were seen monthly to assess side effects and compliance and make insulin dose adjustments. Patient treatment satisfaction was evaluated at the end of the study. Results Of 63 patients, 92% completed the study. The hemoglobin A1c (HbA1c) decreased from 10.8 to 5.9% ( p < .0001), and 100% of subjects achieved an HbA1c < 7%. Weight increased from 100.0 to 101.6 kg ( p = .004) but was less than expected given that patients lost an average of 7.2 kg prior to diagnosis and achieved a reduction in HbA1c of 5%. The rate of hypoglycemia was low (1.5 episodes/patient-month). Ninety-seven percent of the patients were satisfied with their insulin treatment, and 88% were willing to continue insulin. Compliance was 96.5% with insulin and 95.1% with metformin. Conclusion Outpatient initiation of insulin therapy at the time of diagnosis of T2DM is an effective, safe, and feasible strategy for rapidly lowering HbA1c levels to targets. Insulin was very well accepted by the patients, refuting the misconception of low satisfaction and acceptance of such treatment.
Elevated Lipid Peroxidation Biomarkers and Low Antioxidant Status in Atherosclerotic Patients with Increased Carotid or Iliofemoral Intima Media Thickness
Authors: Polidori M. Cristina , Praticó Domenico , Parente Basso , Mariani Elena , Cecchetti Roberta , Yao Yuemang , Sies Helmut , Cao Piergiorgio , Mecocci Patrizia , Stahl Wilhelm 
Published: August 2007

Objectives Lipid peroxidation plays an important role in the development of atherosclerosis, a chronic, age-related disease process of the arterial wall with onset decades prior to its clinical manifestations. The aim of the study was to assess the association between the intima media thickness (IMT) of the major arteries as a clinical marker of atherosclerosis and markers of lipid peroxidation along with the antioxidant status in humans. Design Case-control study. Setting A university-affiliated outpatient clinic. Subjects Thirty patients (22 males, 8 females; 70.4 ± 7.3 years) with atherosclerosis of the carotid or iliofemoral arteries and 62 healthy controls (30 males, 32 females; 68.3 ± 4.3 years). Methods Plasma levels of 8,12-isoprostane F2α-VI (8,12-IPF2α-VI) were measured by gas chromatography/mass spectrometry, whereas levels of malondialdehyde (MDA), vitamins A (retinol) and E (α- and γ-tocopherol), and carotenoids were determined by high-performance liquid chromatography. The IMT was measured by B-mode ultrasonography. Results Patients showed, independent of fruit and vegetable intake, significantly lower plasma levels of retinol, α-tocopherol, and all carotenoids excluding β-cryptoxanthin compared with controls. On the contrary, plasma 8,12-IPF2α-VI levels were almost doubled ( p < .001) and MDA levels increased by one-third ( p < .01) in atherosclerotic patients compared with controls. Conclusions The analyses of isoprostanes and antioxidant nutrients in plasma as markers of oxidative stress and the parallel evaluation of IMT as a structural marker of atherosclerosis are suitable tools for investigating the role of antioxidants and oxidative stress in atherosclerosis.
Comparison of Testosterone, Alendronate, and a Combination of Both Therapies in Men with Low Bone Mineral Density
Authors: Welch Brian J. , Denke Margo A. , Kermani Asra , Adams-Huet Beverley , Gazmen Nina M. , Gruntmanis Ugis 
Published: August 2007

Background Both bisphosphonates and testosterone are known to improve bone mineral density (BMD) in men with low bone mass, but whether combination therapy is superior to these agents used alone is not clear. We compared the changes in lumbar spine BMD when men with low bone mass were treated with each agent alone or as combination therapy. Methods In a retrospective study, we analyzed serum and BMD data from 149 men who had been evaluated in the Endocrinology Clinic at the Dallas Veterans Affairs Medical Center, Dallas, Texas. The subjects were divided into three cohorts: 59 men receiving testosterone therapy alone, 68 men receiving alendronate therapy alone, and 22 receiving combination therapy. Results Compared with the baseline values, the lumbar spine and BMD increased significantly in each of the testosterone, alendronate, and combination therapy cohorts (median annualized rate of change: 2.1% [ p < .001], 2.6% [ p < .001], and 2.5% [ p = .04], respectively). The combination therapy group did not demonstrate any additional increase in BMD at the lumbar spine or total hip compared with either agent alone. The results did not change after adjusting for differences in baseline weight, age, BMD, or baseline testosterone level. Conclusion The results suggest that the combination of testosterone and alendronate does not appear to be superior to single-drug therapy in our patient population.
Critical Bleeding in Vascular Surgery: Expanding the Indication of Recombinant Activated Factor VII
Authors: Tawfick Wael A. , Tawfik Sherif , Hynes Niamh , Mahendran Bhaskarapandian , Sultan Sherif 
Published: August 2007

Recombinant activated factor VII (rFVIIa) is considered a universal hemostatic agent. We present our experience with rFVIIa in vascular surgery patients who developed major hemorrhagic complications with no obvious major vessel bleeding as an expansion of the indications of rFVIIa. Of 973 major complex vascular procedures, 18 patients with intractable bleeding were administered 40 to 80 μg/kg rFVIIa. Blood and by-products transfused, pH, coagulation profile, platelet count, and preoperative antiplatelets and anticoagulants were recorded. Twelve patients (67%) showed clinical improvement. Six remained unstable despite further hemostatic measures and died perioperatively. Thirty-three percent ( n = 6) received over 20 U of blood before rFVIIa administration. All but one died within the first 24 hours ( p = .0175). Seven patients had acidosis with a pH of 7.3 or less. Five of them died within 24 hours ( p = .05). Six patients had a platelet count below 100,000/cm3, five of whom died perioperatively ( p = .0175). Patients with an international normalized ratio above 1.2 had a better survival rate because rFVIIa was used early. There were no signs of systemic or local thrombotic events. The amount of blood and plasma transfused was significantly reduced after rFVIIa administration. rFVIIa is a safe adjunct for patients with significant hemorrhagic complications, with a low risk of thrombotic complications. We found it effective if administered early with measures to achieve hemodynamic stability and correction of acidosis.
Regional Anesthesia: Preferred Technique for Venodilatation in the Creation of Upper Extremity Arteriovenous Fistulae
Authors: Hingorani Anil P. , Ascher Enrico , Gupta P. , Alam S. , Marks Natalie , Schutzer Richard W. , Multyala Manykiam , Shiferson Alex , Yorkovich William , Jacob Theresa , Salles-Cunha Sergio 
Published: August 2007

Owing to the overall poor medical health of patients with end-stage renal disease, we have sought alternatives to the use of general anesthesia for access procedures. Furthermore, since local anesthesia (1) does not offer the motor block that is sometimes desired and (2) can be difficult to maintain when a large amount of vein needs to be transposed, we examined whether regional blocks can be useful for the creation of new arteriovenous fistulae (AVF). From August 2002 to January 2005, 41 patients scheduled for AVF placement underwent a regional block with the use of a lidocaine and ropivacaine mixture using a nerve stimulator. Either axillary, interscalene, or infraclavicular blocks or a combination was used. Intraoperative duplex ultrasonography was used to assess the degree of venodilatation of the basilic and cephalic veins before and after the block. The site of each measurement was marked on the skin and selected by a clearly identifiable branch point. Each measurement was recorded three times and was made in the (1) native state, (2) after application of a tourniquet with opening and closing of the hand for 15 seconds, and (3) after placement of the block. The average age of the patients was 65 ± 14 years (SD), with ages ranging from 33 to 91 years, and the prevalence of diabetes mellitus was 50%. Complete brachial plexus block was achieved in 34 patients (83%). Sensory block was accomplished within 10 to 15 minutes and usually lasted 4 to 6 hours. Motor block was accomplished in 10 to 25 minutes. Venodilatation was not noted in patients whose blocks did not work ( n = 7) or whose vein was found to be phlebitic on exploration ( n = 3). The degree of venodilatation noted as a percentage increase after application of the tourniquet compared with the native state for these 34 patients (in whom the block worked) was 37% for the distal cephalic, 31% for the midcephalic, and 32% for the midbasilic vein. The degree of venodilatation noted as a percentage increase after placement of the block compared with after tourniquet application for these 34 patients was 42% for the distal cephalic, 19% for the midcephalic, and 26% for the midbasilic vein. No instances of systemic toxicity, hematomas, or nerve injury from the block were noted. Accesses placed included 20 radiocephalic AVF, 8 brachiobasilic AVF, 8 brachiocephalic AVF, 2 arteriovenous grafts, 2 radiobasilic AVF, and 1 brachial vein AVF. Regional block is a safe and, in our opinion, preferred technique for providing anesthesia for upper extremity vascular surgery. The venodilatation observed is augmented compared with that using a tourniquet and may allow more options for access placements.
Paravertebral Blockade with Propofol Sedation versus General Anesthesia for Elective Endovascular Abdominal Aortic Aneurysm Repair
Authors: Falkensammer Juergen , Hakaim Albert G. , Klocker Josef , Biebl Matthias , Lau Louis L. , Neuhauser Beate , Mordecai Monica , Crawford Claudia , Greengrass Roy 
Published: August 2007

The objective of this study was to evaluate the applicability of paravertebral blockade (PVB) for endovascular abdominal aortic aneurysm repair compared with general anesthesia (GA). Data from patients who underwent elective infrarenal endovascular abdominal aortic aneurysm repair between August 2001 and July 2002 using PVB or GA were retrospectively reviewed and compared with respect to risk factors, intraoperative hemodynamic characteristics, operative outcome, and complications. Ten patients underwent elective infrarenal endovascular abdominal aortic aneurysm repair under PVB, whereas 15 patients were operated on under GA. One conversion from PVB to GA was necessary for block failure. The perioperative (< 30 days) cardiovascular morbidity and overall mortality were zero in both groups. The PVB group benefited significantly with respect to the incidence of intraoperative hypotension ( p < .05) and blood pressure lability ( p < .01), as well as postoperative nausea ( p < .01). Our preliminary results indicate that PVB is feasible and can be performed safely in a patient population with significant comorbidities.
Comparison of the Results of Percutaneous Transluminal Angioplasty and Stenting with Medical Treatment for Claudicants Who Have Superficial Femoral Artery Occlusive Disease
Authors: Wilson Samuel , Gelfand Dmitri , Jimenez Juan , Gordon Ian 
Published: August 2007

The outcomes of medical management of peripheral vascular disease localized to the superficial femoral artery (SFA) were compared with those obtained by percutaneous transluminal angioplasty (PTA) with or without stenting in a review of selected studies. The natural history of localized SFA disease is favorable, with major amputation rates less than 10% and revascularization in only 18% of patients over a 10-year interval. Conservative treatment of claudicants shows increases (150%) in walking distance if the ankle brachial index (ABI) is over 0.6 and patients stop smoking. Analysis of 10 trials (882 patients) of PTA with or without stenting found that the overall primary patency rates at 12 months were 71.1% for PTA plus stenting and 58.3% for PTA alone. Technical success with PTA with or without stenting is over 90%, and early results at 6 months are superior to those with exercise. In three randomized controlled trials, however, the difference between PTA and medical treatment at 2 years, whether measured by walking distance or ABI, was not significant, nor was the quality of life. For long-term improvement in walking distance (> 1 year) in the claudicant, intervention is not superior to medical treatment and a monitored exercise program. Consideration should be given to including a nonintervention control group and 2-year outcomes in the evaluation of new SFA stents.
Prospective Evaluation of Factors Associated with Early Failure of Arteriovenous Fistulae in Hemodialysis Patients
Authors: Elsharawy Mohamed A. 
Published: August 2007

Recent guidelines have recommended performing native arteriovenous fistulae (AVF) in hemodialysis patients rather than synthetic grafts whenever possible. However, early failure of AVF may reach up to 50%. The purpose of this study was to assess the factors associated with early failure of such procedures in hemodialysis patients. A prospective study was performed on all patients with end-stage renal disease who had an AVF between June 2003 and March 2005. Data including patient characteristics and the type of AVF were recorded. The internal diameter of the vein and artery and intraoperative blood flow were measured. Patients were followed up for 3 months. One hundred twenty-six AVF were included in this study. Early failure was in 14 (9%) patients. The internal diameter of the vein and artery and intraoperative blood flow were significantly lower in the failure group than in the patent group. The failure rate was not significantly related to other parameters. Our data showed that intraoperative blood flow is a reliable parameter that determines the early failure of an AVF. Careful selection of the vein and the artery may reduce the rate of failure.
Atherosclerotic Aneurysm Formation in a Lower Extremity Saphenous Vein Graft
Authors: Bikk Andras , Rosenthal Martin D. , Wellons Eric D. , Hancock Susan M. , Rosenthal David 
Published: August 2007

Saphenous vein is the most widely used conduit for arterial bypass procedures and aneurysms of the vein graft are rare. We report a true aneurysm of a reversed femoropopliteal saphenous vein graft implanted nine years earlier. Duplex ultrasonography identified an aneurysm of the saphenous vein graft and arteriography confirmed this finding. A consideration for endovascular coiling of the aneurysm was entertained, but no proximal “neck” on the aneurysm was present. The patient, therefore, underwent an uneventful resection of the aneurysm with end-to-end anastomosis. Histopathologic examination of the aneurysm demonstrated atherosclerotic degeneration with endothelial disruption, medial necrosis, and fibrous proliferation. The cause of a saphenous vein graft aneurysm is rare and unknown. The management of vein graft aneurysms, however, should be subject to the same criteria that apply to other aneurysms because once vein graft dilation occurs, it is followed by a rapid increase in size, which may lead to possible rupture.
Long-term Outcome Of Operated Inflammatory Aortic Aneurysms
Authors: Ockert Stefan , Schumacher Hardy , Böckler Dittmar , Ganten Marika , Seelos Robert , Allenberg Jens 
Published: August 2007

Inflammatory aortic aneurysms (IAAs) represent a rare form of aortic aneurysms. Compared with atherosclerotic aneurysms, patients with IAA have an increased risk of perioperative and long-term morbidity. This retrospective clinical study analyzed the outcome after conventional and endovascular repair of IAAs. Patients treated for an abdominal IAA between January 1995 and November 2004 were included. Imaging (computed tomographic angiography or magnetic resonance angiography) was performed preoperatively and at the time of follow-up (mean 2.7 years). Transperitoneal open repair and endovascular aortic repair were the operative procedures used. Over 10 years, 40 patients were treated with conventional and 5 patients with endovascular repair. The in-hospital morbidity rate was 11.1% (five patients; four conventional, one endovascular). On 10 patients (47.6%), the retroperitoneal fibrosis was no longer detectable. After operative repair, the majority of cases presented with a distinct regression of inflammation. Endovascular treatment of IAA represents a feasible alternative procedure to open aortic repair.
False Anastomotic Aneurysms
Authors: Marković Dragan M. , Davidović Lazar B. , Kostić Dušan M. , Maksimović Živan L. , Kuzmanovic Ilija B. , Koncar Igor B. , Cvetkovic Dragan M. 
Published: August 2007

This retrospective study covers the period from 1991 to 2002, during which 3,623 patients were operated on because of aneurysmal or occlusive disease of aortoiliac and femoropopliteal segments. Among them, 87 patients (2.4%) developed a false anastomotic aneurysm in the 12-year follow-up period and were treated operatively. Most frequently, in 53 patients (6.9%), a false anastomotic aneurysm developed after aortobifemoral bypass performed owing to aortoiliac occlusive disease. The cause of false anastomotic aneurysm was infection in 21 cases (24.7%); resection and revascularization were performed with a Dacron graft in 46 cases (52.9%), with a polytetrafluoroethylene graft in 10 cases (11.5%), and with the great saphenous vein in 16 cases (18.4%). Homograft implantation in 4 patients (4.6%) or extra-anatomic bypasses in 11 cases (12.6%) were performed when graft infection was suspected. Of 87 patients who underwent surgery, 74 (85.5%) had good early results without infection, reintervention, limb loss, and mortality. The presence of infection as a cause of false anastomotic aneurysm and comorbidity increased the mortality rate significantly after the reoperation, whereas the type of graft used in treatment had no influence on early results.
Fault Tolerant Control Design For Polytopic LPV Systems
Authors: Rodrigues Mickael , Theilliol Didier , Aberkane Samir , Sauter Dominique 
Published: August 2007

Fault Tolerant Control Design For Polytopic LPV SystemsThis paper deals with a Fault Tolerant Control (FTC) strategy for polytopic Linear Parameter Varying (LPV) systems. The main contribution consists in the design of a Static Output Feedback (SOF) dedicated to such systems in the presence of multiple actuator faults/failures. The controllers are synthesized through Linear Matrix Inequalities (LMIs) in both fault-free and faulty cases in order to preserve the system closed-loop stability. Hence, this paper provides a new sufficient (but not necessary) condition for the solvability of the stabilizing output feedback control problem. An example illustrates the effectiveness and performances of the proposed FTC method.
Influence of Mold Temperature on the Internal Structure and Creep Variation in the Thickness Direction of sPS Injection Moldings
Authors: Banik K. , Mennig G. 
Published: August 2007

Abstract
In this work, an effort was made to study the effect of mold temperature variation on the creep behavior of syndiotatctic polystyrene (sPS) injection moldings. The resulting molecular orientation, crystallinity and molecular packing density in the moldings due to processing were characterized to understand the creep variation in the thickness direction. The moldings were sliced off in definite layers by milling from both the surfaces and the creep behavior was characterized. The results indicated that the development of internal structures and the resulting creep behavior is strongly interdependent with creep strain decreasing as the core of the molding is reached. A higher mold temperature generally freezes-in more crystalline regions and enhances the molecular packing density inside the part that affects the tendency to creep. The frozen-in molecular orientation on the other hand showed only a negligible effect.
Effects of Zinc Salts of Sulfonated Natural Rubber on Mechanical Properties, Morphology and Compatibility of Natural Rubber/Chlorosulfonated Polyethylene Blends
Authors: Lopattananon N. , Boonsong K. , Seadan M. 
Published: August 2007

Abstract
Rubbery ionomer based on zinc salt of sulfonated natural rubber (Zn-SNR) was employed as a new compatibilizer to prepare blends of natural rubber (NR) and chlorosulfonated polyethylene (CSM) with different compositions by melt mixing process. Epoxidized natural rubber (ENR), known as an effective compatibilizer for such blends, was also incorporated into the blends. The role of ionomer and ENR on NR/CSM blend properties and morphology was evaluated by mean of tensile measurement, oil resistance testing, DMTA and SEM. The tensile properties and oil resistance of the blends were found to increase with respect to CSM content, and increased further on compatibilization with Zn-SNR and ENR. The blends compatibilized with Zn-SNR showed a similar or higher level of improvement in tensile strength and elongation at break as compared to those of ENR. The tensile strength for all of the compatibilized blends was greater than that of corresponding neat blends by 23 to 113%. The mechanism for enhancing in tensile properties of the blends using the Zn-SNR compatibilizing agent has been proposed. The observation of DMTA and SEM showed that the blends were two-separated phase morphology. However, the addition of Zn-SNR to NR/CSM blends resulted in promoted compatibility as indicated by a shift in the tan peak of CSM to lower temperature, a reduction in dispersed phase size and better adhesion between NR and CSM. These results demonstrated that the Zn-SNR is a new reactive compatibilizer for NR and CSM blends.