Perioperative cardiac events in endovascular repair of complex aortic aneurysms and association with preoperative studies

BackgroundEndovascular repair of complex aortic aneurysms (CAAs) can be performed in high-risk individuals, yet is still associated with significant morbidity, including spinal cord ischemia, cardiac complications, and death. This analysis was undertaken to better define the cardiac risk for CAA.MethodsA prospective database of patients undergoing thoracoabdominal or juxtarenal aortic aneurysm repair with branched and fenestrated endografts was used to retrospectively determine the number of cardiac events, defined as myocardial infarction (MI), atrial fibrillation (AF), and ventricular arrhythmia (VA), that occurred ≤30 days of surgery. Postoperative serial troponin measurements were performed in 266 patients. Any additional available cardiac information, including preoperative echocardiography, physiologic stress tests, and history of cardiac disease, was obtained from medical records. The efficacy of preoperative stress testing and the association of various echo parameters were evaluated in the context of cardiac outcomes using univariable and multivariable logistic regression models.ResultsBetween August 2001 and December 2007, 395 patients underwent endovascular repair of a thoracoabdominal or juxtarenal aortic aneurysm. The incidence of AF, VA, and 30-day cardiac-related death was 9%, 3%, and 2%, respectively. Overall 30-day mortality was 6%. Univariable analysis showed the presence of mitral annulus calcification was associated with MI (odds ratio [OR], 3.5; 95% confidence interval [CI], 0.9-13.8; P = .07). Left atrium cavity area, ejection fraction, left ventricle mass, and left ventricular mass index were univariably associated with the presence of VA. Multivariable analysis showed only the left atrium cavity area was independently associated with VA (OR, 1.2; 95% CI, 1.0-1.5; P = .07). Stress test was done in 179 patients. Negative stress test results occurred in 152 (85%), of whom 9 (6%) sustained an MI during the 30-day perioperative course. MI occurred in 2 of the 27 patients (7%) who had a positive stress test result.ConclusionsEndovascular repair of CAA can be performed in high-risk individuals but is associated with significant cardiac risk. It remains difficult to risk stratify patients using preoperative stress testing. Echo evaluation may help to identify patients who may be more likely to develop ventricular arrhythmias in the postoperative period and thus warrant closer monitoring. Postoperative troponin monitoring of all patients undergoing repair of CAA is warranted given the overall risk of MI

Information is Power? Transparency and fetishism in International Relations

International actors, state and non-state, have embraced transparency as a solution to all manner of political problems. Theoretical analyses of these processes present transparency in a fetishtic manner, in which the social relations that generate transparency are misrecognized as the product of information itself. This paper will outline the theoretical problems that arise when transparency promotion is fetishized in International Relations theory. Examining the fetishism of transparency, we will note problematic conception of politics, the public sphere, and rationality they articulate. Confusing the relationship between data, information and knowledge, fetishized treatments of transparency muddy the historical dynamics responsible for the emergence of transparency as a political practice. This alters our understanding of the relationship between global governance institutions, their constituents, and the nature of knowledge production itself. Realizing the normative promise of transparency requires a reorientation of theoretical practice towards sociologically and historically sensitive approaches to the politics of knowledge

The Nitric Oxide Donor DETA-NONOate Decreases Matrix Metalloproteinase-9 Expression and Activity in Rat Aortic Smooth Muscle and Abdominal Aortic Explants

Our objective was to examine the role of an exogenous nitric oxide (NO) donor, DETA-NONOate (DETA), on matrix metalloproteinase (MMP)-9, MMP-2, and tissue inhibitor of matrix metalloproteinases (TIMP)-1 expression and activity in interleukin (IL)-1β-induced rat aortic smooth muscle cells (RA-SMCs) and rat aortic explants (RAEs). RA-SMCs were incubated with IL-1β (2 ng/ml), an inflammatory cytokine known to induce MMP-9 expression, and increasing concentrations of DETA (0, 1.0, 10, 100 μM; n = 3/group) for 48 hr. RAEs were incubated with IL-1β (2 ng/mL) and increasing concentrations of DETA (0, 5.0, 50, 100, and 500 μM; n = 3/group) for 48 hr. Media were collected and assayed for NO x by the Griess reaction and MMP-9 activity by zymography. Messenger RNA (mRNA) was extracted from cells and analyzed for MMP-9, MMP-2, and TIMP-1 expression levels by quantitative real-time reverse-transcriptase polymerase chain reaction. All statistical analyses were performed by analysis of variance. In RA-SMCs and RAEs, DETA administration resulted in a dose-dependent increase in media NO x concentration (RA-SCM p < 0.01, RAE p < 0.01) and a concurrent decrease in both MMP-9 expression (RASMC p = 0.01, RAE p = 0.01) and activity (RASMC p = 0.04, RAE p = 0.006). There were no significant differences seen in MMP-2 and TIMP-1 expression or activity in response to DETA exposure. DETA decreased IL-1β-induced MMP-9 expression and activity in both RA-SMCs and RAEs in a dose-dependent fashion. In addition, DETA administration had no effect on MMP-2 or TIMP-1 expression or activity in vitro. These data suggest that NO donors may be beneficial in decreasing MMP-9 levels and might serve to inhibit MMP-9-dependent vessel wall remodeling seen during abdominal aortic aneurysm formation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41371/1/10016_2005_Article_9429.pd

The Concept of Governance in the Spirit of Capitalism

Through combining insights from political economy and sociology, this article explains the early genesis of the policy notion of governance in relation to ideological changes in capitalism. Such an approach has tended to be neglected in existing conceptual histories, in the process, undermining a sharper politicization of the term and how it became normalized. The argument dissects how the emergence of governance can be understood in light of a relationship between political crises, social critique and justificatory arguments (centered around security and justice claims) that form part of an ideological ‘spirit of capitalism’. Through a distinctive comparison between the creation of ‘corporate governance’ in the 1970s and the formulation of a ‘governance agenda’ by the World Bank from the 1980s, the article elucidates how the concept, within certain policy uses, but by no means all, can reflect and help constitute a neoliberal spirit of capitalism