An updated review of current concepts in the management of carotid stenosis

Several large randomized clinical trials in North America and Europe concluded over a decade ago that carotid endarterectomy plus medical management was significantly better than medical management alone for stroke prevention in either symptomatic or asymptomatic patients with severe carotid stenosis. Percutaneous carotid angioplasty now represents yet another treatment option that currently appears to have a higher risk than endarterectomy in symptomatic patients as well as in those who are 70 years of age or older. For these reasons, there is a consensus that angioplasty should be used cautiously in such patients and probably remains most appropriate either in the context of ongoing randomized trials or for patients who are at a higher-than-average risk for conventional surgical treatment

Why Police Kill: An Investigation into the Causes of and Solutions to Law Enforcement's Excessive Use of Lethal Force

Lethal force, and the debate surrounding its legitimacy, has been an impassioned part of society in the United States for decades. With over 600 civilian lives taken every year by police officers, the issue of police-involved homicides is at the forefront of discussion amongst scholars, politicians, and community members. Analysis into the specific details of each of these cases reveals certain conditions that were common to most of these incidents. The demographics of the suspect, the reason police presence was initially requested, and the behavior at the scene all contributed to the escalation of a standard police-suspect interaction into one that resulted in the use of lethal force. The excessive rate of police-involved homicides in the United States can be attributed to a potent police culture that influences its officers to prioritize force and aggression over communication and de-escalation. These attitudes are reinforced through training curricula, department policies, and police rhetoric. The legal system also condones this behavior, as evidenced by the lack of charges, trials, and guilty verdicts of officers that kill civilians. These causes must be combatted to eliminate unnecessary shootings. Steps need to be taken to reform police culture into one that reserves violence as a last resort. These could include increasing officer training requirements that teach cooperative tactics, diversifying the force to add new perspectives, creating new standards of practice that emphasize police-community relations, and strictly enforcing legal sanctions for misconduct while on duty. Change is necessary to ensure that law enforcement is truly protecting the community they serve.No embargoAcademic Major: Histor

RUS: Heterogene Unix-Server-Plattformen

Seit einigen Wochen steht den Nutzern des Rechenzentrums ein weiterer, leistungsfähiger und universeller Server vom Typ Silicon Graphics Power Challenge L zur Verfügung: sgiserv1. Dieser ergänzt das Server-Angebot um eine zusätzliche Plattform. Neben der breiten Palettean existierenden IBM-Systemen wurden im Frühjahr 1994 ein SUN SPARC-Server 1000(sunserv1) mit 4 CPUs und 256 MBytes Hauptspeicher sowie im Winter 1994 ein DEC2100-Server A500MP (decserv1) mit 2 CPUs und 256 MBytes Hauptspeicher in Betrieb genommen

CXCR2 deficient mice display macrophage-dependent exaggerated acute inflammatory responses

CXCR2 is an essential regulator of neutrophil recruitment to inflamed and damaged sites and plays prominent roles in inflammatory pathologies and cancer. It has therefore been highlighted as an important therapeutic target. However the success of the therapeutic targeting of CXCR2 is threatened by our relative lack of knowledge of its precise in vivo mode of action. Here we demonstrate that CXCR2-deficient mice display a counterintuitive transient exaggerated inflammatory response to cutaneous and peritoneal inflammatory stimuli. In both situations, this is associated with reduced expression of cytokines associated with the resolution of the inflammatory response and an increase in macrophage accumulation at inflamed sites. Analysis using neutrophil depletion strategies indicates that this is a consequence of impaired recruitment of a non-neutrophilic CXCR2 positive leukocyte population. We suggest that these cells may be myeloid derived suppressor cells. Our data therefore reveal novel and previously unanticipated roles for CXCR2 in the orchestration of the inflammatory response

Left ventricular apical puncture: A procedure surviving well into the new millennium

We report two patients with a history of prior mitral valve and aortic valve replacement with St. Jude prosthetic valves, who were referred for repeat valve replacement after noninvasive assessment was suggestive of prosthetic valve malfunction. Both patients were managed medically after evaluation with direct left ventricular apical puncture revealed normal hemodynamics in the first and mild aortic stenosis in the second patient. These two cases illustrate that, despite the advancements in the noninvasive evaluation of prosthetic heart valves, left ventricular direct puncture continues to have an important value in the evaluation of patients referred for repeat valve replacement, and it can prevent unnecessary surgeries associated with a high risk of morbidity and mortality. Cathet. Cardiovasc. Intervent. 49:68–73, 2000. © 2000 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/35246/1/15_ftp.pd

Motor domain phosphorylation and regulation of the Drosophila kinesin 13, KLP10A

Microtubule (MT)-destabilizing kinesin 13s perform fundamental roles throughout the cell cycle. In this study, we show that the Drosophila melanogaster kinesin 13, KLP10A, is phosphorylated in vivo at a conserved serine (S573) positioned within the α-helix 5 of the motor domain. In vitro, a phosphomimic KLP10A S573E mutant displays a reduced capacity to depolymerize MTs but normal affinity for the MT lattice. In cells, replacement of endogenous KLP10A with KLP10A S573E dampens MT plus end dynamics throughout the cell cycle, whereas a nonphosphorylatable S573A mutant apparently enhances activity during mitosis. Electron microscopy suggests that KLP10A S573 phosphorylation alters its association with the MT lattice, whereas molecular dynamics simulations reveal how KLP10A phosphorylation can alter the kinesin–MT interface without changing important structural features within the motor’s core. Finally, we identify casein kinase 1α as a possible candidate for KLP10A phosphorylation. We propose a model in which phosphorylation of the KLP10A motor domain provides a regulatory switch controlling the time and place of MT depolymerization

Clinical follow-up rather than duplex surveillance after carotid endarterectomy

AbstractPurpose: The value of duplex surveillance and the significance of contralateral carotid disease after endarterectomy have been assessed.Methods: Three hundred five patients were observed prospectively after carotid endarterectomy for a median time of 36 months (range, 6 to 96 months), with duplex surveillance performed at 1 day; 1 week; 3, 6, 9, and 12 months; and then each year after endarterectomy.Results: Thirty patients (10%) had ipsilateral symptoms (13 strokes, 17 transient ischemic attacks [TIAs]) at a median time of 6 months (range, 0 to 60 months). Life table analysis demonstrated that ipsilateral stroke was equally common for patients who had ≥50% restenosis (3% at 36 months) and those who did not (6% at 36 months, p > 0.5). Twenty-three patients (8%) developed symptoms (stroke 5, TIA 14) attributable to the contralateral carotid artery at a median time of 9 months (range, 0 to 36 months) after endarterectomy. By life table analysis, 40% of patients with 70% to 99%, 6% with 50% to 69%, 1% with <50% contralateral internal carotid stenosis, and 5% with contralateral carotid occlusion at the time of endarterectomy had a contralateral TIA in the 36 months after endarterectomy ( p < 0.01). However, contralateral stroke was not significantly more common for patients with severe contralateral internal carotid stenosis demonstrated at the time of endarterectomy (<50% stenosis, 0%; 50% to 69%, 3%; 70% to 99%, 7%; occlusion, 6% stroke rate at 36 months). Seven of the 32 patients who developed progression of contralateral disease had a TIA, compared with 11 of 227 patients who did not develop progression of contralateral disease ( p < 0.01). None of the 12 patients who progressed from a <70% to a 70% to 99% contralateral stenosis had a stroke.Conclusions: After carotid endarterectomy restenosis is rarely associated with symptoms; contralateral stroke is rare and is not associated with progressive internal carotid artery disease suitable for endarterectomy. This study has shown no benefit from long-term duplex surveillance after carotid endarterectomy. Selective clinical follow-up of patients who have high-grade contralateral stenoses would appear more appropriate. (J Vasc Surg 1997;25:55-63.