Ameliorating the adverse effects of salinity on wheat plants using the bio-wastes (pomegranate peel extract and /or compost).

Climate changes and the related rise in the frequency of excessive weather proceedings have a strong influence on the physical, chemical, and hydrological processes in soils. Recently the investigators confirmed that the use of biological treatments and resources to overcome abiotic stress is fruitful. Thus, pomegranate peel extract (PPE) because of its high efficacy and/or compost application could improve soil characteristics, soil organic matter and nutrient status. This effect may be referred back to the enhancement in the plant antioxidative defense system against stress conditions. This experiment was done to study the influence of spraying wheat plants with pomegranate peel extract (PPE) with and/or without soil compost added under salt stress on some growth parameters and physiological aspects. Wheat plants were grown in the presence or absence of compost in the soil and foliar sprayed with PPE (600 and 1200 mg L-1) under salt irrigation (3000 and 6000 mg L-1). Growth and yield traits were decreased with salinity stress. High levels of PPE (1200 mg L-1) induced the highest values of osmoprotectants (Total soluble sugars, total soluble protein, proline and free amino acids) in both unstressed or salinity-stressed plants presence or absence compost. Using compost in soil for cultivating wheat plants and PPE spraying treatments increased growth traits photosynthetic pigments and yield components. Moreover, these treatments increased the accumulation of minerals content (N, P, K and Ca) in plants. In general, the results of correlation coefficients showed a significant strong positive relationship among measured yield traits and other tested parameters. The correlation between 1000-grain Wt. and grain Wt./spike (r = 0.94**) was the highest. Meanwhile, a strong negative correlation coefficient between Na% and all yield parameters was recorded. Compost adding to soil and spraying pomegranate peel extract is a successful method for increasing wheat growth, yield and improving the nutritional value of the produced grains under salt stress.

Rapid diagnosis of schistosomiasis in Yemen using a simple questionnaire and urine reagent strips.

Schistosomiasis ranks second to malaria in terms of socioeconomic and public health importance in Yemen. This study assessed the validity of a morbidity questionnaire and urine reagent strips as a rapid tool for screening schoolchildren for urinary schistosomiasis as compared with the presence of eggs in urine as the gold-standard parasitological diagnosis. The study examined urine samples and interviewed 696 children (mean age 12.5 years) attending a primary-preparatory school in south Yemen. Urinary schistosomiasis was confirmed in 126 (18.1%) children. Diagnostic performance was poor for 2 items in the morbidity questionnaire (self-reported history of previous infection and self-reported history of antischistosomal treatment). However, self-reported dysuria, self-reported haematuria in the questionnaire and microhaematuria by reagent strips (alone or with macrohaematuria) revealed good diagnostic performance. The results indicated that reagent strips are a valid method for detection of microhaematuria for identifying individuals and communities infected with Schistosoma haematobium.

Rapid diagnosis of schistosomiasis in Yemen using a simple questionnaire and urine reagent strips

Schistosomiasis ranks second to malaria in terms of socioeconomic and public health importance in Yemen.This study assessed the validity of a morbidity questionnaire and urine reagent strips as a rapid tool for screening schoolchildren for urinary schistosomiasis as compared with the presence of eggs in urine as the gold-standard parasitological diagnosis.The study examined urine samples and interviewed 696 children [mean age 12.5 years]attending a primary-preparatory school in south Yemen.Urinary schistosomiasis was confirmed in 126 [18.1%]children.Diagnostic performance was poor for 2 items in the morbidity questionnaire [self-reported history of previous infection and self-reported history of antischistosomal treatment]. However, self-reported dysuria, self-reported haematuria in the questionnaire and microhaematuria by reagent strips [alone or with macrohaematuria]revealed good diagnostic performance.The results indicated that reagent strips are a valid method for detection of microhaematuria for identifying individuals and communities infected with Schistosoma haematobium

يحتل داء البلهارسيات الموقع الثاني بعد الملاريا من حيث الأهمية من وجهة نظر الصحة العمومية في اليمن. وتقيم هذه الدراسة صحة استبيان يتناول المراضة مع استخدام أشرطة وكواشف للبول، باعتبارهما أداتين سريعين لتحري أطفال المدارس بحثا عن داء البلهارسيات البولي، ومقارنة ذلك بوجود البيوض في البول باعتباره المعيار الذهبي للتشخيص بفحص الطفيليات. وقد شملت الدراسة فحص عينات بول مع مقابلة 696 طفلا [وسطي أعمارهم 12.5 عاما]ممن يداومون في مدرسة ابتدائية في جنوب اليمن. وقد تأكد تشخيص داء البلهارسيات البولي لدى 126 طفلا [18.1 %]. واتضح أن الأداء التشخيصي كان سيئا في بندين اثنين من بنود استبيان المراضة [وهما الإبلاغ الذاتي عن سوابق عدوى بولية سابقة، والإبلاغ الذاتي عن سوابق معالجة مضادة للبلهارسيا]. وبالمقابل فقد أثبت كل من الإبلاغ الذاتي عن عسر التبول، والإبلاغ الذاتي عن تبول الدم في الاستبيان، وكشف أو كاشف وجود الدم في البول بكميات زهيدة بالفحص المجهري بالأشرطة ذات الكواشف [لوحده أو مع وجود الدم في البول بالعين المجردة]أنها ذات أداء تشخيصي جيد. وتشير النتائج إلى أن الأشرطة ذات الكواشف تعتبر طريقة صحيحة لكشف وجود البول في الدم بكميات زهيدة، من أجل التعرف على الأفراد والمجتمعات المصابة بعدوى البلهارسيا الدموية

La schistosomiase vient en deuxième place après le paludisme en termes de poids socioéconomique et de problème de santé publique au Yémen.La présente étude a évalué la validité d'un questionnaire sur la morbidité ainsi que des bandelettes urinaires réactives comme outils rapides de dépistage de la schistosomiase urinaire chez des écoliers par rapport à la recherche d'oeufs dans les urines en tant que méthode diagnostique parasitologique de référence.Au cours de l'étude, les échantillons d'urine de 696 enfants fréquentant une école primaire ou préparatoire dans le sud du Yémen ont été examinés, puis les enfants ont été interrogés [âge moyen 12, 5 ans]. Une schistosomiase urinaire a été confirmée chez 126 enfants [18, 1 %]. La performance du diagnostic était médiocre pour deux items du questionnaire sur la morbidité [antécédents auto déclarés d'une infection antérieure et d'un traitement contre la schistosomiase]. Toutefois, une dysurie autodéclarée, une hématurie autodéclarée dans le questionnaire et une microhématurie par bandelettes urinaires réactives [seule ou associée à une macrohématurie]ont fait ressortir une bonne performance diagnostique.Les résultats ont indiqué que les bandelettes urinaires réactives étaient une méthode valable pour le dépistage de la microhématurie permettant d'identifier les personnes et les communautés infestées par Schistosoma haematobiurn

Hybrid laparorobotic debranching and endovascular repair of thoracoabdominal aortic aneurysm.

Surgical debranching and endovascular repair is an attractive hybrid approach in high-risk patients with thoracoabdominal aneurysms unsuitable for conventional open repair. Vascular laparorobotic technology is an evolving field in the treatment of aortoiliac and aneurysmal disease. Herein we present a case in which hybrid laparorobotic debranching and endovascular repair was performed in a patient with a symptomatic 7 cm thoracoabdominal aortic aneurysm extent III. The laparorobotic approach was utilized for iliac artery exposure and suturing of the proximal anastomosis of the debranching graft. The technique was also useful in limiting the extent of the abdominal incision in a patient with severe comorbidities. Advantages of computer-assisted robotic vascular reconstruction include a high-resolution three-dimensional field of view and technical precision for vascular dissection and anastomosis.

Malaria in late pregnancy in Al Hodeidah Governorate, Yemen.

To investigate the consequences of maternal malaria during late pregnancy, we conducted a preliminary study in the 2 hospitals in Al Hodeidah on 276 women who had uncomplicated vaginal deliveries. Only 17 women had malaria (Plasmodium falciparum), 6 with peripheral parasitaemia and 11 with both peripheral parasitaemia and placental malaria. Coincident infection carried a 9.44 times higher risk of preterm delivery and a 12.2 times greater risk of low birth weight (< 2500 g). Anaemia was diagnosed in 46.4%, associated with malaria in 11.7% of cases. All risk factors, rural residence (OR 5.18), maternal age < 20 years (OR 4.93) and primigravidae (OR 8.29), were significantly associated with malaria infection.

Malaria in late pregnancy in Al Hodeidah governorate, Yemen

To investigate the consequences of maternal malaria during late pregnancy, we conducted a preliminary study in the 2 hospitals in Al Hodeidah on 276 women who had uncomplicated vaginal deliveries. Only 17 women had malaria Plasmodium falciparum], 6 with peripheral parasitaemia and 11 with both peripheral parasitaemia and placental malaria. Coincident infection carried a 9.44 times higher risk of preterm delivery and a 12.2 times greater risk of low birth weight [< 2500 g]. Anaemia was diagnosed in 46.4%, associated with malaria in 11.7% of cases. All risk factors, rural residence [OR 5.18], maternal age < 20 years [OR 4.93] and primigravidae [OR 8.29], were significantly associated with malaria infection

Long-term results justify autogenous infrainguinal bypass grafting in patients with end-stage renal failure.

INTRODUCTION: Infrainguinal bypass grafting for limb-threatening ischemia in patients with end-stage renal disease is generally thought to be associated with increased operative risk and poor long-term outcome. This retrospective study was undertaken to examine the modern-era, long-term results of infrainguinal bypass grafting in dialysis-dependent patients. METHODS: Over the past 5 years in a single institution, 425 lower extremities (368 consecutive patients) were revascularized for the indication of limb salvage. Sixty-four patients (82 limbs) were dialysis-dependent at the time of revascularization, and this group was analyzed separately. They exhibited statistically significant higher incidences of diabetes (83% vs 56%; P <.001), hypertension (91% vs 74%; P <.001), and more distal vascular disease, which required a greater proportion of proximal anastomoses at the popliteal level (24% vs 11%; P <.01) and distal anastomoses at the infrapopliteal level (75% vs 65%; P <.05). RESULTS: Despite the higher prevalence of comorbid conditions and distal disease in patients with renal failure, their perioperative 30-day mortality rate remained low (4.9%) and was not significantly different from that in patients with functioning kidneys (2.9%; P = not significant). After a median follow-up of 11 months (range, 0-60 months), the 3-year autogenous conduit secondary graft patency in patients with renal failure was no different than in patients with functioning kidneys (67% +/- 9% vs 64% +/- 5%; P = not significant). Nonautogenous conduits in dialysis-dependent patients exhibited a significantly poorer outcome with only 27% +/- 12% remaining secondarily patent at 2 years. As expected, both limb salvage and patient survival were significantly less in patients with renal faiture, although both exceeded 50% at 3 years (limb salvage 59% +/- 8% vs 68% +/- 5%; P <.05; patient survival 60% +/- 8% vs 86% +/- 4%; P <.001). The often-quoted phenomenon of limb loss, despite a patent bypass graft, occurred infrequently in this study (n = 3 of 82 limbs). CONCLUSION: Infrainguinal revascularization can be performed in dialysis-dependent patients with acceptable perioperative and long-term results, especially in patients in whom adequate autologous conduit is available.

Patency and limb salvage after infrainguinal bypass with severely compromised ("blind") outflow.

HYPOTHESIS: Infrainguinal graft patency and limb salvage are adversely affected by severely compromised outflow. DESIGN: Retrospective review of all infrainguinal bypass procedures performed at a single institution during a 5-year period. SETTING: University teaching hospital. PATIENTS: Two hundred seventy-four patients underwent infrainguinal bypass for limb salvage (351 grafts in 307 limbs). INTERVENTIONS: All infrainguinal bypasses originated from a femoral artery. The distal anastomosis in 279 grafts was located in an artery with at least 1 patent outflow vessel with anatomically normal end-artery runoff (Society for Vascular Surgery/International Society for Cardiovascular Surgery ad hoc committee runoff score, 1-9). The distal anastomosis of 72 grafts was located in an artery with only collateral outflow ("blind bypass"; runoff score, 10). MAIN OUTCOME MEASURES: Perioperative morbidity and mortality, primary-assisted and secondary graft patency, limb salvage, and survival. RESULTS: All data are presented as mean +/- SEM. Patients undergoing blind bypass were older (age, 70 +/- 2 vs. 66 +/- 1 years; P <.05) and had a higher incidence of hypertension (90% vs 70%; P <.05) and end-stage renal disease (24% vs. 13%; P <.05). Comparing patients undergoing blind bypass to bypass with at least 1 patent outflow vessel, there were no differences in the use of nonautogenous conduits (50% vs 59%; P =.21) or postoperative warfarin (30% vs 32%; P =.69), or in perioperative mortality rates (2.7% vs 3.2%; P =.79). After a median follow-up of 13 months (range, 0-60 months), 2-year secondary graft patency for the entire group was 63% +/- 4%. The secondary patency rate of blind bypass grafts was no different from that of grafts with at least 1 patent outflow vessel (67% +/- 7% vs. 64% +/- 4%; P was not significant). However, the 2-year limb salvage rate in limbs with blind outflow was significantly worse than in limbs with at least 1 patent outflow vessel (67% +/- 7% vs. 76% +/- 3%; P =.04). CONCLUSION: Acceptable long-term patency rates can be achieved in infrainguinal bypass grafts with blind outflow, although blind outflow remains a marker for subsequent limb loss in the chronically ischemic leg.

Pulsatile flow in an end-to-side vascular graft model: comparison of computations with experimental data.

Various hemodynamic factors have been implicated in vascular graft intimal hyperplasia, the major mechanism contributing to chronic failure of small-diameter grafts. However, a thorough knowledge of the graft flow field is needed in order to determine the role of hemodynamics and how these factors affect the underlying biological processes. Computational fluid dynamics offers much more versatility and resolution than in vitro or in vivo methods, yet computations must be validated by careful comparison with experimental data. Whereas numerous numerical and in vitro simulations of arterial geometries have been reported, direct point-by-point comparisons of the two techniques are rare in the literature. We have conducted finite element computational analyses for a model of an end-to-side vascular graft and compared the results with experimental data obtained using laser-Doppler velocimetry. Agreement for velocity profiles is found to be good, with some clear differences near the recirculation zones during the deceleration and reverse-flow segments of the flow waveform. Wall shear stresses are determined from velocity gradients, whether by computational or experimental methods, and hence the agreement for this quantity, while still good, is less consistent than for velocity itself from the wall shear stress numerical results, we computed four variables that have been cited in the development of intiimal hyperplasia-the time-averaged wall shear stress, an oscillating shear index, and spatial and temporal wall shear stress gradients in order to illustrate the versatility of numerical methods. We conclude that the computational approach is a valid alternative to the experimental approach for quantitative hemodynamic studies. Where differences in velocity were found by the two methods, it was generally attributed to the inability of the numerical method to model the fluid dynamics when flow conditions are destabilizing. Differences in wall shear, in the absence of destabilizing phenomena, were more likely to be caused by difficulties in calculating wall shear from relatively low resolution in vitro data.

Bioenvironmental and meteorological factors related to the persistence of malaria in Fayoum Governorate: a retrospective study.

The present study was conducted to determine the magnitude of the malaria problem in Fayoum Governorate and to ascertain the determinant factors behind its persistence in this area. Malaria records in Fayoum Governorate for the period 1971-1999 were reviewed retrospectively. The data show that no Plasmodium vivax cases were recorded during 1997-1999 and prediction up till 2004 indicated no positive cases expected. No P. falciparum cases were detected in 1998 and 1999. The prediction trend for this species showed an apparent but not statistically significant decrease in the incidence. The factors responsible for the persistence of malaria in this governorate are discussed.

Bioenvironmental and meteorological factors related to the persistence of malaria in Fayoum Governorate: a retrospective study

The present study was conducted to determine the magnitude of the malaria problem in Fayoum Governorate and to ascertain the determinant factors behind its persistence in this area. Malaria records in Fayoum Governorate for the period 1971-1999 were reviewed retrospectively. The data show that no Plasmodium vivax cases were recorded during 1997-1999 and prediction up till 2004 indicated no positive cases expected. No P. falciparum cases were detected in 1998 and 1999. The prediction trend for this species showed an apparent but not statistically significant decrease in the incidence. The factors responsible for the persistence of malaria in this governorate are discussed

Hypercholesterolemia superimposed by experimental hypertension induces differential distribution of collagen and elastin.

We studied the mural distribution of collagen types I and III and tropoelastin in enhanced experimental atherogenesis induced in rabbits by hyperlipidemia superimposed by hypertension. Animals were fed a high-cholesterol diet for 5 weeks and also subjected to midthoracic aortic coarctation for 4 weeks. Serum cholesterol levels were increased and blood pressure was elevated proximal to the coarctation. Foam cell lesions developed in the aorta proximal to the coarctation. In situ hybridization and immunohistochemistry showed that gene expression of collagen types I and III and tropoelastin was upregulated, with a differential distribution across the arterial wall. New collagen type I was mainly distributed in the intima, the outer media, and the adventitia. New collagen type III was spread more uniformly across the wall, including the adventitia, whereas tropoelastin was mainly localized in intimal foam cell lesions. Morphometric data showed an increase in wall thickness. These results suggest that collagen types I and III play a role in remodeling of the aortic wall in response to hypertension. The remarkable involvement of the adventitia in this response indicates that the adventitia is an important component of the arterial wall. Tropoelastin is closely associated with foam cell lesion formation, suggesting a role for this component in atherogenesis as well.

Angioplasty does not affect subsequent operative renal artery revascularization.

BACKGROUND: Although increased application of percutaneous renal artery angioplasty and stenting has facilitated nonoperative renal revascularization, patient outcomes after failed angioplasty are not established. METHODS: Renal artery revascularization was performed in 31 patients (38 arteries) from 1993 to 1999. Twenty patients underwent primary surgical repair, and 11 patients underwent secondary reconstruction after angioplasty (n = 7) or angioplasty and stenting (n = 4). Before operation, all patients had severe hypertension (blood pressure 166+/-5.2/92 +/- 2.7 mm Hg) that required an average of 3.0 +/- 0.2 medications for control. In addition, 12 patients (primary 45% vs secondary 27%; P = NS) had evidence of renal insufficiency (creatinine > or =1.7 mg/dL). RESULTS: There was no difference between primary and secondary procedures in the length of hospital stay (12+/- 1.4 vs. 12+/-3.2 days; P = NS), major morbidity (10% vs. 18%; P = NS) or perioperative mortality (overall mortality 2 of 31; primary 5% vs secondary 9%; P = NS). The majority of patients demonstrated improvement or cure of hypertension (primary 94% vs secondary 90%; P = NS) and stable or decreased creatinine (primary 74% vs secondary 82%; P = not significant). Overall survival (mean follow-up 22+/-3.5 months) was 89%+/-5.7%. CONCLUSIONS: Although this surgical series does not address the true outcomes of renal artery angioplasty, the results suggest that renal artery angioplasty does not prejudice subsequent surgical outcomes in patients who are carefully followed after angioplasty.

Apolipoprotein (a) fragments in relation to human carotid plaque instability.

PURPOSE: An elevated plasma level of lipoprotein (a) is an independent risk factor for atherothrombotic cardiovascular disease by yet undefined mechanisms. We have previously reported that matrix metalloproteinases cleave apolipoprotein (a) into 2 main fragments, F1 and F2, the latter (the C-terminal domain) exhibiting in vitro a high-affinity binding to extracellular matrix components, including fibrin(ogen). We therefore tested the hypothesis that the lipoprotein (a) matrix metalloproteinase-derived F2 is localized in potentially or morphologically unstable human carotid plaque at regions of increased matrix metalloproteinase activity. METHODS: Carotid plaques removed after endarterectomy (n = 18) were evaluated for structural features indicative of instability (thin fibrous cap, inflammation, and proximity of the necrotic core to the lumen); each plaque was classified as unstable (n = 10) or stable (n = 8). Western blot analysis was performed to quantitate apolipoprotein (a) and its fragments F1 and F2 in plaque extracts. Immunohistochemical staining was used to localize apolipoprotein (a) and its fragments within the atherosclerotic plaque. In situ zymography was used to determine regions of gelatinase (matrix metalloproteinase 2 and matrix metalloproteinase 9) activity. RESULTS: Western blot analyses demonstrated a 2.5-fold higher density of F2 in unstable plaques than in stable plaques (3.07 +/- 1.9 vs 1.18 +/- 0.8; P <.05). In morphologically unstable plaques, there was preferential distribution of F2 within regions of fibrous cap inflammation and/or foam cell accumulation and within abluminal necrotic cores. In morphologically stable plaques, however, localization was predominantly found in the medial smooth muscle cells. Regions of enhanced matrix metalloproteinase 2 and matrix metalloproteinase 9 activity co-localized with the transmural distribution of F2 within the plaque. CONCLUSIONS: These findings suggest that F2 in regions of increased matrix metalloproteinase activity is a potential mechanism for superimposed thrombotic events in morphologically unstable human carotid plaques. The relationship between plasma lipoprotein (a) levels and accumulation of F2 and the potential correlation of F2 to human plaque disruption and thrombosis warrant further study.

Differential transmural distribution of gene expression for collagen types I and III proximal to aortic coarctation in the rabbit.

To assess the effects on the biosynthesis of collagen types I and III associated with an acute increase in blood pressure, we established a mid-thoracic aortic coarctation in the rabbit and studied gene expression and protein accumulation of these collagen types proximal to the stenosis 1, 3 and 7 days and 2, 4 and 8 weeks after coarctation. The mRNA level of type I collagen pro-alpha2(I) was maximal at 3 days and returned to normal at 4 weeks. mRNA of pro-alpha2(I) was localized mainly in the outer media, adventitia and intima. Accumulation of type I collagen and its precursors was increased by 3 days, peaked at 4 weeks, and decreased toward normal by 8 weeks, corresponding to the distribution of pro-alpha2(I) mRNA. Gene expression for pro-alpha1(III) was similar to that of pro-alpha2(I) but was distributed throughout the media. We conclude that the mechanical stresses associated with an acutely induced alteration in pressure initiate rapid gene expression for collagen types I and III in the aortic wall. The response for collagen type I, predominantly in the outer media and adventitia, suggests that these regions play an immediate role in the resistance to excessive dilatation of the aorta. The diffuse response for collagen type III in the media suggests participation in a more extensive remodeling response associated with the reinforcement and reorganization of the musculo-elastic fascicles.

Effective hemodynamic diameter: an intrinsic property of vein grafts with predictive value for patency.

INTRODUCTION: Conduit size and quality are major determinants of the long-term success of infrainguinal autologous vein grafting. However, accurate measurement of the internal diameter of vein grafts is difficult given their variable wall thickness and taper. The purpose of this study was to define the "effective" internal diameter of a vein graft according to its hemodynamic properties and to determine its significance for graft patency. METHODS: Sixty infrainguinal bypass grafts performed on 57 patients were evaluated intraoperatively. Proximal and distal graft pressure and blood flow (Q(meas)) were measured with fluid-filled catheter transduction and ultrasonic transit-time flowimetry, respectively, after unclamping. Waveforms were recorded digitally at 200 Hz under baseline conditions and after stimulation with 60 mg of papaverine. According to Fourier transformation of the measured pressure gradient (DeltaP), the Womersley solution for fluid flow in a straight rigid tube was used to calculate theoretical flow waveforms (Q(calc)) for a range of graft diameters. The theoretical waveforms were then compared with the measured flow waveforms and the best-fit diameter chosen as the "effective hemodynamic diameter" (EHD). Only grafts in which the correlation coefficient of Q(calc) versus Q(meas) was more than 0.90 were accepted (n = 47) to assure validity of the hemodynamic model. After a mean follow-up of 12.5 months (range, 0.1-43.9 months), patency was determined by the life table method. Hemodynamic and clinical variables were tabulated, and their effect on patency determined the use of univariate and multivariate Cox regression. RESULTS: Mean EHD was 4.1 +/- 0.1 mm with a range of 2.5 to 5.7 mm. Administration of papaverine caused profound changes in DeltaP (+78% +/- 17%) and Q(meas) (+71% +/- 12%) as expected, but had no effect on EHD (+0.05% +/- 0.1%). Univariate regression identified five variables associated with decreased secondary patency (P <.10): low EHD, conduit source other than the greater saphenous vein, high baseline DeltaP(mean), female sex, and redo operation. Of these, only low EHD was significant after multivariate analysis (P =.03). Patency of small diameter grafts (EHD < 3.6 mm; n = 11) was compared with patency of larger grafts (EHD > 3.6 mm; n = 36) to test a frequently espoused clinical guideline. Grafts with an EHD less than 3.6 mm exhibited significantly lower secondary patency compared with larger grafts (P =.0001). The positive and negative predictive values for an EHD less than 3.6 mm for secondary graft failure for grafts with at least 1 year follow-up were 86% and 88%, respectively. CONCLUSION: An EHD is a unique parameter that quantifies conduit size and has a significant impact on vein graft patency. An EHD less than 3.6 mm portends graft failure.

Estimating the contemporary in-hospital costs of carotid endarterectomy.

Carotid endarterectomy (CEA) is the treatment of choice for symptomatic carotid stenosis and selective asymptomatic lesions. Alternative approaches have recently been championed under the guise of increased efficacy and decreased cost. The purpose of this study was to determine the results and in-hospital costs of CEA in a university hospital in the modern era. A retrospective chart review was undertaken for all patients undergoing CEA between January 1995 and December 1997. This corresponded to the implementation of a clinical path and extended efforts toward cost reduction. Patients undergoing combined CEA and cardiopulmonary bypass were excluded (n = 3). Cost was analyzed by the hospital Office of Program Planning using TSI (Transition Systems, Inc.) software. Direct costs are related to the utilization of clinical resources and are therefore manageable by clinicians (bed, room, supplies, nursing staff, OR staff, radiology, pharmacy, etc.). Total costs additionally include administration and overhead costs not directly chargeable to patient accounts. The results of this study showed that CEA can be safely performed with brief hospital stays and reasonable hospital costs. Results of alternative interventions for the treatment of carotid stenosis should be compared to these contemporary data.

Increased flow and shear stress enhance in vivo transforming growth factor-beta1 after experimental arterial injury.

We have previously demonstrated that high-flow (HF) conditions inhibit experimental intimal hyperplasia. We hypothesized that such flow conditions may alter transforming growth factor-beta1 (TGF-beta1) after mural injury. The right common carotid artery (CCA) was balloon-injured in 54 New Zealand White male rabbits. Flow was thereafter preserved (normal flow [NF]), reduced by partial outflow occlusion (low flow [LF]), or increased by ligation of the left CCA (HF). Four sham-operated animals served as uninjured controls. Mean blood flow and pressure in the right CCA were measured before and after flow modulation and before euthanasia (3, 7, and 14 days). TGF-beta1 mRNA and protein levels in the right CCA were determined by Northern and ELISA analyses at each time point. At 7 and 14 days, intimal hyperplasia was quantified, and the transmural localization of TGF-beta1 was determined by immunohistochemical analysis. Mean flow was reduced from 22+/-1 to 10+/-3 mL/min in the LF group and increased to 34+/-2 mL/min in the HF group (P<0.001). Blood pressure was not different among the flow groups for all time points. Wall shear stress was markedly decreased in the LF group to 14+/-4 dyne/cm(2) and increased in the HF group to 63+/-6 dyne/cm(2) at 7 days compared with values in uninjured controls (39+/-2 dyne/cm(2), P<0.001) and the NF group (44+/-7 dyne/cm(2), P<0.001). At 14 days, wall shear stress was similar among the flow groups. The intima-to-media ratio was 5- and 2-fold greater in the LF group than in the HF and NF groups at 14 days. mRNA levels for TGF-beta1 and its active ligand were increased in the HF group by at least 2- and 3-fold, respectively, at 3 and 7 days compared with levels in uninjured controls and the LF group (P<0.05) but were not different among the flow groups at 14 days. TGF-beta1 preferentially localized in the abluminal vascular smooth muscle cells of the HF arterial segments. Flow- and shear-mediated release of TGF-beta1 may therefore play a role in abrogating the proliferative and migratory response of vascular smooth muscle cells in the early stages after mural injury.

Gene therapy enhances the antiproliferative effect of radiation in intimal hyperplasia.

BACKGROUND: Although ionizing radiation (IR) has been demonstrated to attenuate vessel wall restenosis and intimal hyperplasia (IH), dose-related mural injury and atrophy are possible deleterious side effects. We tested the hypothesis that a radiosensitizing strategy may improve IR-induced inhibition of in vivo vascular smooth muscle cells (VSMCs) without influencing apoptotic cell death. METHODS: In 28 New Zealand White rabbits, the right common carotid artery (CCA) was injured and subjected to low-flow conditions to promote IH. The CCA was transfected with an adenoviral vector incorporating the cytosine deaminase (CD) gene (1 x 10(9) PFU/ml). 5-Fluorocytosine (5-FC), a prodrug that is converted to the radiosensitizing agent 5-fluorouracil (5-FU) by CD, was thereafter administered intravenously. The CCA was exposed to 5 Gy IR at 24 h. Intimal/medial (I/M) area and thickness ratios were determined in the harvested CCAs at 14 days. VSMC proliferative and apoptotic indices were assessed with immunohistochemistry. RESULTS: A 50% reduction in I/M area was found in rabbits treated with IR and IR + CD/5-FC (0.19 +/- 0.03 and 0.18 +/- 0.02) when compared with untreated controls (UC) (0.37 +/- 0.06) (P = 0.005). This finding was substantiated by attenuation of I/M thickness in the IR groups [0.47 +/- 0.13 (IR), 0.41 +/- 0.11 (IR + CD/5-FC), 0.61 +/- 0.17 (UC)] (P = 0.007). The number of proliferating VSMCs was notably smaller when IR was combined with CD/5-FC (4.17 +/- 1.16 vs 2.97 +/- 1.09 log transformed cells/mm(2), P < 0.07). Apoptosis was similar in all groups. CONCLUSIONS: Both IR alone and IR combined with a radiosensitizing agent are effective in attenuating experimental IH. However, combination therapy is synergistic and achieves greater inhibition of VSMC proliferation and may involve selective killing of radioresistant S-phase VSMCs. IR + CD/5-FC represents a novel therapeutic strategy that offers potential for long-term control of IH.