Significant atheromatous debris following uncomplicated vein graft direct stenting: evidence supporting routine use of distal protection devices.

We present the case of an angiographically uncomplicated direct stent vein graft intervention in which the Percusurge embolization containment device was used. We performed histological examination of the resulting debris and observed massive particulate atheromatous material. This case illustrates the severity of distal embolization that can go clinically unnoticed after direct stenting and also supports the routine use of distal protection devices for vein graft intervention.

A randomized trial using computerized decision support to improve treatment of major depression in primary care.

Objective: To examine whether feedback and treatment advice for depression presented to primary care physicians (PCPs) via an electronic medical record (EMR) system can potentially improve clinical outcomes and care processes for patients with major depression.

Design: Randomized controlled trial.

Setting: Academically affiliated primary care practice in Pittsburgh, PA.

Contactless conductivity detector for microchip capillary electrophoresis.

A microfabricated electrophoresis chip with an integrated contactless conductivity detection system is described. The new contactless conductivity microchip detector is based on placing two planar sensing aluminum film electrodes on the outer side of a poly(methyl methacrylate) (PMMA) microchip (without contacting the solution) and measuring the impedance of the solution in the separation channel. The contactless route obviates problems (e.

Selective automated indexing of findings and diagnoses in radiology reports.

The recent improvements in capabilities of desktop computers and communications networks give impetus for the development of clinical image repositories that can be used for patient care and medical education. A challenge in the use of these systems is the accurate indexing of images for retrieval performance acceptable to users. This paper describes a series of experiments aiming to adapt the SAPHIRE system, which matches text to concepts in the UMLS Metathesaurus, for the automated indexing of image reports.

Alternatives to traditional coronary bypass surgery.

Over 1 million percutaneous coronary interventions (PCI) and a half million surgical coronary artery bypass grafting procedures (CABG) are performed in the United States annually for treatment of coronary artery disease. With recent advances in anti-restenosis strategies, the number of PCIs is expected to increase dramatically. Still, these therapies treat relatively discrete coronary lesions.

Towards disposable lab-on-a-chip: poly(methylmethacrylate) microchip electrophoresis device with electrochemical detection.

A fully disposable microanalytical device based on combination of poly(methylmethacrylate) (PMMA) capillary electrophoresis microchips and thick-film electrochemical detector strips is described. Variables influencing the separation efficiency and amperometric response, including separation voltage or detection potential are assessed and optimized. The versatility, simplicity and low-cost advantages of the new design are coupled to an attractive analytical performance, with good precision (relative standard deviation RSD = 1.

Catalytic antisense DNA molecules targeting Egr-1 inhibit neointima formation following permanent ligation of rat common carotid arteries.

Animal models of neointima (NI) formation have proven useful in gaining insights into the mechanisms of restenosis after coronary angioplasty and stenting, but the events at a molecular level remain incompletely understood. Here, we describe a technically straightforward, rat model of NI formation, involving complete ligation of the common carotid artery and demonstrate the importance of the immediate-early gene and zinc finger transcription factor Egr-1 in this process. Acute cessation of common carotid blood flow by vessel ligation, was followed by the expression of Egr-1 in the arterial media within 3 h and NI formation proximal to the point of ligation at 18 days.

Evaluation of a filmless radiology pilot--a preliminary report.

The development of the Multimedia Electronic Medical Record System (MEMRS) promises new opportunities to significantly reduce the routine use of film as the medium for viewing radiological medical images. The effect of this change to digital media on physician workflow and the perceived value and utility of medical images is an area of ongoing investigation. In this study we examined oncology clinicians use of medical images in a MEMRS.

Coronary in-stent restenosis: current status and future strategies.

In-stent restenosis (ISR) is a novel pathobiologic process, histologically distinct from restenosis after balloon angioplasty and comprised largely of neointima formation. As percutaneous coronary intervention increasingly involves the use of stents, ISR is also becoming correspondingly more frequent. In this review, we examine the available studies of the histology and pathogenesis of ISR, with particular reference to porcine and other animal models.

Catalytic oligodeoxynucleotides define a key regulatory role for early growth response factor-1 in the porcine model of coronary in-stent restenosis.

Early growth response factor-1 (Egr-1) controls the expression of a growing number of genes involved in the pathogenesis of atherosclerosis and postangioplasty restenosis. Egr-1 is activated by diverse proatherogenic stimuli. As such, this transcription factor represents a key molecular target in efforts to control vascular lesion formation in humans.

Induction of the transcriptional repressor Yin Yang-1 by vascular cell injury. Autocrine/paracrine role of endogenous fibroblast growth factor-2.

Yin Yang-1 (YY1) is a multifunctional transcription factor that can repress the expression of many growth factor, hormone, and cytokine genes implicated in atherogenesis. YY1 expression is activated in rat vascular smooth muscle cells shortly after injury. YY1 DNA binding activity paralleled elevated protein levels in the nucleus.

Critical dynamics of gelation.

Shear relaxation and dynamic density fluctuations are studied within a Rouse model, generalized to include the effects of permanent random crosslinks. We derive an exact correspondence between the static shear viscosity and the resistance of a random resistor network. This relation allows us to compute the static shear viscosity exactly for uncorrelated crosslinks.

The electronic medical record. A randomized trial of its impact on primary care physicians' initial management of major depression [corrected].

Background: Inadequate treatments are reported for depressed patients cared for by primary care physicians (PCPs). Providing feedback and evidence-based treatment recommendations for depression to PCPs via electronic medical record improves the quality of interventions.

Methods: Patients presenting to an urban academically affiliated primary care practice were screened for major depression with the Primary Care Evaluation of Mental Disorders (PRIME-MD).

Defining the role of anatomic pathology images in the multimedia electronic medical record--a preliminary report.

The development of the Multimedia Electronic Medical Record System (MEMRS) offers new opportunities for integrating medical imaging data with text-based clinical data. The effective integration of pathology images into the patient's medical record poses some significant technical and organizational challenges. Before these challenges can be met, it is imperative that we investigate the value and utility of providing these images to clinicians.

A novel approach for crossing a virtually occluded vessel using ultra-low-profile balloon backup.

We discuss a case in which a novel ultra-low-profile angioplasty balloon was used to provide wire backup by advancing the uninflated balloon nose into the entry point of a virtually occluded lesion. This enabled crossing of the lesion, and demonstrates how an improved balloon design can directly lead to improved clinical outcomes.

Automated semantic indexing of imaging reports to support retrieval of medical images in the multimedia electronic medical record.

This paper describes preliminary work evaluating automated semantic indexing of radiology imaging reports to represent images stored in the Image Engine multimedia medical record system at the University of Pittsburgh Medical Center. The authors used the SAPHIRE indexing system to automatically identify important biomedical concepts within radiology reports and represent these concepts with terms from the 1998 edition of the U.S.

Use of the multifunction probing catheter as an adjunctive device for occluded vein graft intervention.

We describe the use of the multifunction probing catheter (Schneider, Bulach, Switzerland) as an adjunct to conventional techniques in the treatment of a recent vein graft occlusion by thrombus, in order to highlight a possible further use for this device.

Second generation bifurcation stent: the rapid development of device technology.

A 57-year-old male with unstable angina and an eccentric 88% diameter stenosis of the left anterior descending artery prior to, and involving the first diagonal branch was treated with the 2nd generation Jomed Sidebranch stent (Jomed, Randingengen, Germany). This case outlines the improvements in this novel stent design and demonstrates the rapid advance of device design.