Fetal cerebrovascular acclimatization responses to high-altitude, long-term hypoxia: a model for prenatal programming of adult disease?

During the past several decades, many risk factors for cerebrovascular and cardiovascular disease have been identified. More recently, it has been appreciated that inadequate nutrition and/or other intrauterine factors during fetal development may play an important role in the genesis of these conditions. An additional stress factor that may "program" the fetus for disease later in life is chronic hypoxia.

Inflammatory markers, D-dimer, pro-thrombotic factors, and physical activity levels in patients with peripheral arterial disease.

Men and women with lower extremity peripheral arterial disease (PAD) have reduced physical activity levels compared with persons without PAD. We describe associations between physical activity levels with D-dimer, pro-coagulant factors, and inflammatory markers in patients with PAD. Participants were 188 patients with PAD identified from non-invasive vascular laboratories.

Inflammatory and thrombotic blood markers and walking-related disability in men and women with and without peripheral arterial disease.

Objectives: To determine whether higher circulating levels of thrombotic and inflammatory markers are associated with greater disability.

Design: Cross-sectional.

Setting: Academic medical center.

Essential role for the p110delta phosphoinositide 3-kinase in the allergic response.

Inflammatory substances released by mast cells induce and maintain the allergic response. Mast cell differentiation and activation are regulated, respectively, by stem cell factor (SCF; also known as Kit ligand) and by allergen in complex with allergen-specific immunoglobulin E (IgE). Activated SCF receptors and high-affinity receptors for IgE (FcvarepsilonRI) engage phosphoinositide 3-kinases (PI(3)Ks) to generate intracellular lipid second messenger signals.

Maturational modulation of endothelium-dependent vasodilatation in ovine cerebral arteries.

To address the hypothesis that maturation enhances endothelial vasodilator function in cerebral arteries, relaxant responses to ADP and A-23187 were determined in ovine carotid and cerebral arteries harvested from 25 newborn lambs (3-7 days) and 23 adult sheep. Maturation significantly increased pD(2) values for A-23187 (newborn range: 4.9 +/- 0.

Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms.

Context: Among individuals with lower-extremity peripheral arterial disease (PAD), specific leg symptoms and the ankle brachial index (ABI) are cross-sectionally related to the degree of functional impairment. However, relations between these clinical characteristics and objectively measured functional decline are unknown.

Objective: To define whether PAD, ABI, and specific leg symptoms predict functional decline at 2-year follow-up.

What's new in vascular ultrasound.

Duplex ultrasound has long been the method of choice in the diagnosis and evaluation of deep venous thrombosis and carotid artery stenosis and in monitoring lower extremity bypasses. In recent years, innovative procedures and technology have fostered new applications for duplex ultrasound, such as detection of in-stent stenosis and endoleaks, intraoperative evaluation of in situ vein bypasses and monitoring of endovenous procedures, and treatment of common femoral pseudoaneurysms. The low cost and noninvasiveness of duplex ultrasound make it ideal for such studies,as well as for screening for asymptomatic vascular disease.

Does carotid stenting measure up to endarterectomy? A vascular surgeon's experience.

Hypothesis: Carotid angioplasty and stenting seems to have equal or better outcomes in high-risk patients than carotid endarterectomy.

Design: Single-center case-control study.

Setting: University hospital tertiary referral center.

A pilot exercise intervention to improve lower extremity functioning in peripheral arterial disease unaccompanied by intermittent claudication.

Purpose: A pilot study was conducted to test the feasibility of supervised treadmill exercise training to improve functioning in study participants with peripheral arterial disease who did not have classical symptoms of intermittent claudication.

Methods: For this study, 32 men and women with peripheral arterial disease but no symptoms of claudication were randomized to exercise training or usual care. The intervention was a 12-week supervised treadmill walking program.

Percutaneous repair of abdominal aortic aneurysm.

Objective: Percutaneous treatment of an abdominal aortic aneurysm (AAA) is feasible, but is associated with a unique set of risks. A comparison of Excluder endograft deployment with femoral artery cutdown (FAC) versus percutaneous femoral access (PFA) for treatment of infrarenal AAA was undertaken.

Methods: A single-institution, controlled, retrospective review was carried out in patients who underwent either bilateral FAC or bilateral PFA for endovascular repair of infrarenal AAA with the Gore bifurcated Excluder endograft between March 1999 and November 2003.

Abdominal wall hernias after open abdominal aortic aneurysm repair: prospective radiographic detection and clinical implications.

The purpose of this study was to evaluate the prevalence of radiographically detected abdominal wall defects (AWD) after open abdominal aortic aneurysm (AAA) repair and to correlate it with prospectively gathered clinical information. Fine collimation, high-resolution, serial follow-up computed tomography (CT) scans for 99 patients in the control group of the Guidant Ancure device trial were reviewed. CT scans were obtained at 12, 24, 36, 48, and 60 months.

Expression of several cytoskeletal proteins in ovine cerebral arteries: developmental and functional considerations.

Cytoskeleton proteins play important roles in regulating vascular smooth muscle (VSM) contraction and relaxation. We tested the hypotheses that the expression levels of several of these proteins change significantly during the course of development, and that these changes contribute to age-related changes in contractile responses. In cerebral arteries from 95-day (d) gestation and 140-d fetus, newborn lambs, and adult sheep, by Western immunoblot (n= 5 for each age) we quantified the relative expression of alpha-actin, alpha-tubulin, cyclophilin A, and proliferating cell nuclear antigen (PCNA).

Peripheral arterial disease in African Americans: clinical characteristics, leg symptoms, and lower extremity functioning.

Objectives: The describe peripheral arterial disease (PAD) in African Americans, and compare findings in African Americans and whites with PAD.

Design: Cross-sectional.

Setting: Three academic medical centers.

The effects of continuing medical education credits on physician response rates to a mailed questionnaire.

This study investigated whether the opportunity to obtain Continuing Medical Education (CME) credit together with a five-dollar bill increased response rates and questionnaire completion rates in a physician survey involving mailed questionnaires. One thousand, three hundred and fourteen cardiologists, family practitioners, general internists (non-surgeons) and 264 vascular surgeons randomly identified from the American Medical Association database participated. After two, of up to four, questionnaire mailings, the opportunity to obtain CME credit and a five-dollar bill were included with questionnaire mailings.

ERK-mediated uterine artery contraction: role of thick and thin filament regulatory pathways.

We have demonstrated that extracellular signal-regulated kinase (ERK) plays an important role in the regulation of uterine artery contraction. The present study tested the hypothesis that ERK regulates thick and thin filament regulatory pathways in the uterine artery. Isometric tension, intracellular free Ca2+ concentration ([Ca2+]i), and 20-kDa myosin light chain (LC20) phosphorylation were measured simultaneously in uterine arteries isolated from near-term (140 days gestation) pregnant sheep.

Leg strength in peripheral arterial disease: associations with disease severity and lower-extremity performance.

Objective: The purpose of this study was to determine relationships between lower-extremity arterial obstruction, leg strength, and lower-extremity functioning.

Design: The study design was cross-sectional. A total of 514 outpatients (269 with ankle-brachial index [ABI] <0.

Carotid artery revascularization.

Stroke is the third leading cause of death in the United States, and up to one third of patients have a stroke secondary to carotid occlusive disease. Surgical management has firmly established itself as an important modality in treating this disease. Several prospective randomized trials have defined the patients that would have the most benefit from carotid endarterectomy (CEA).

Explaining racial variation in lower extremity amputation: a 5-year retrospective claims data and medical record review at an urban teaching hospital.

Hypothesis: Population-based hospital data indicate that African American patients undergo major lower extremity (LE) amputation 2 to 3 times more frequently than white patients. Some have attributed this to a lack of access to LE revascularization procedures by African American patients. To determine the likelihood that racial disparities in amputation rates are related to treatment choice, this study examines rates of primary amputation (major amputation without any previous attempt at revascularization) and repeat amputation.

Exploring the boundaries of SLI: findings from morphosyntactic and story grammar analyses.

The nature of morphosyntactic and story-grammar differences were examined between children with SLI and children with language impairments that fell outside the diagnostic category for SLI solely because of their low non-verbal cognitive abilities (LNVA). Two oral narratives were elicited from 5-year-old children with language impairments and age-matched children with normally developing language. Morphosyntactic difficulties were found to be similar for children with SLI and children with LNVA.

Hematopoietic stem cell transplantation for cardiac and peripheral vascular disease.

Recent studies have suggested that marrow and blood hematopoietic stem cells may contribute to nonhematopoietic tissue repair in multiple organ systems. In animal models and more recently in limited human trials, unpurified marrow mononuclear cells and/or subsets of adult hematopoietic stem cells have been reported to contribute to neoangiogenesis. Since the subset of hematopoietic stem cells (HSCs) that are both CD34+ and AC133+ are endothelial cell precursors, clinical trials using autologous AC133+ HSCs isolated with the Miltenyi CLIMACS cell separator and transplanted into patients with ischemic and refractory peripheral vascular or coronary artery disease are being implemented at Northwestern University.

Relation of levels of hemostatic factors and inflammatory markers to the ankle brachial index.

Associations between hemostatic and inflammatory markers relative to the ankle brachial index (ABI), an indicator of the presence and severity of peripheral arterial disease (PAD), are not fully understood. We studied relations among selected hemostatic factors, inflammatory markers, and the ankle brachial index (ABI) in patients with and without peripheral arterial disease (PAD). Participants were 370 men and women with ABI <0.

Fetal cardiac and cerebrovascular acclimatization responses to high altitude, long-term hypoxia.

In response to high altitude long-term hypoxemia, the heart of fetal sheep shows a decrease in cardiac output that is secondary to a decrease in myocardial cell contractile function. The intracellular mechanisms responsible for these reductions might include reduced myofibrillar Mg(2+)-activated ATPase. There is also a decrease in beta(1)-adrenergic receptor stimulated augmentation of myocardial contraction.

Depressive symptoms and lower extremity functioning in men and women with peripheral arterial disease.

Objective: Factors associated with impaired functioning in patients with lower extremity peripheral arterial disease (PAD) are not fully understood. The purpose of this study was to determine the relationship between depressive symptoms and objective measures of lower extremity functioning in persons with PAD.

Design: Cross-sectional.