Successful endovascular repair of blunt traumatic innominate artery transection with covered stent graft.

We have presented the case of a 20-year-old woman who had been involved in a motor vehicle collision with innominate artery transection. Because of her concomitant possible cerebral injury, she was deemed at extremely high risk of postoperative neurologic dysfunction if undergoing open surgical repair. Using intravascular ultrasound and angiography, the lesion was evaluated, and covered stents were deployed across the lesion. The patient tolerated the procedure well and was discharged without complications. Duplex ultrasound scans at 1 and 6 months showed satisfactory results. Thus, endovascular repair is a feasible alternative approach to open repair for patients with blunt traumatic innominate artery injury.

Racial and Gender Disparity in Achieving Optimal Medical Therapy for Inpatients with Peripheral Artery Disease.

Best medical therapy for peripheral artery disease (PAD) includes statin and anti-platelet agents, a combination shown to decrease rates of major cardiovascular events. Despite these findings, many patients remain undertreated and the objective of this project was to investigate the rate of initiating anti-platelet and statin therapy for inpatients newly diagnosed with PAD with a focus on disparities by race and sex. A retrospective chart review of inpatients with newly diagnosed PAD was performed between January 1, 2016 to December 31, 2016 at a single institution. Demographics and comorbid conditions were collected. Primary outcomes included antiplatelet and statin prescription at discharge. The 44 patients included in this study were predominantly male (59% vs. 41%) and African American (61% vs. 39%). Between admission and discharge, prescriptions rose from 70% to 82% for statin and 82% to 91% for anti-platelet agents. Vascular specialists were more successful than non-vascular specialists at initiating medical therapy, with statin prescriptions increasing 22% and anti-platelet prescriptions climbing 23% for those admitted to a vascular specialist. Interestingly, when the ABI was reported in the normal range, rates of statin initiation were particularly compromised at only 40%. For the total patient sample, those discharged without a statin were more commonly African American (63%) and the majority were female (67%). All patients discharged without an antiplatelet were African American and 50% were females. Despite national guidelines, patients with PAD continue to be discharged without optimal medical therapy. This study suggests that obstacles to initiation may include race, sex, admitting service, or presence of a normal ABI. Further investigation is warranted to determine effective avenues for provider education and system-wide initiatives.

Zebrafish embryos sequester and retain petrochemical combustion products: developmental and transcriptome consequences.

Zebrafish embryos are a model for studying effects of environmental stressors on development. Incomplete combustion of the environmentally relevant volatile petrochemical, 1,3-butadiene (BD) yields butadiene soot (BDS) nanoparticles, to which polynuclear aromatic hydrocarbons (PAHs) are adsorbed. In mammalian cells these PAHs are concentrated in lipid droplets and trigger up-regulation of biotransformation, oxidative stress and inflammatory genes. The present study was designed to determine whether: (a) PAH-rich BDS elicits alterations in zebrafish embryo development; (b) BDS-exposed zebrafish embryos sequester PAHs in select tissues; and (c) developmental abnormalities are correlated with altered gene expression patterns. 1-day old zebrafish embryos were exposed for 48 h to BDS (0, 6, 30 or 60 µg/ml) sprinkled on the water surface. PAH localization was tracked by fluorescence. Developmental responses (pericardial edema, yolk sac swelling, axial malformations) were monitored by microscopy. Gene expression changes were assessed by gene microarray and qRT-PCR. Our results show that PAHs localized with endogenous lipids in the yolk sac and in hatching gland cells. PAHs were retained at least 8 days after exposures ended. Dose-dependent pericardial and yolk sac edema and axial malformations were prominent and accompanied by up-regulation of biotransformation and oxidative stress gene cascades. Thus, zebrafish embryos should be useful for predicting the potential for developmental toxicity following exposure to PAH-rich petrochemical soots, e.g., those arising from attempts at oil spill remediation by combustion.