Carotid Artery Stenting and Endarterectomy: a clinical evaluation

Stroke is a major cause of mortality and morbidity in the western world. Atherosclerotic disease of the carotid arteries is in approximately 25% of the cases responsible for the cerebral infarction.1 Since NASCET and ECST, carotid endarterectomy (CEA) is considered the standard treatment for severe atherosclerotic carotid obstructive disease in symptomatic patients.2, 3 Similar landmark studies were performed for asymptomatic carotid artery disease.4, 5 On the basis of these trials the American Heart Association has recommended CEA for symptomatic patients with stenosis of 50% to 99% if the perioperative risk of stroke or death is <6%.6 In asymptomatic patients CEA is recommended for a stenosis of 60% to 99% if the perioperative of stroke or death is < 3%. In an effort to minimise interventions, in the last decade carotid artery stenting (CAS) has been suggested as an alternative to surgical endarterectomy for patients with symptomatic and asymptomatic extra cranial obstructive disease. Initially, percutaneous transluminal balloon angioplasty (PTA) was used. Later stent placement was introduced and has been used with or without initial PTA. Current data on CAS and CEA suggest that CAS is quickly gaining ground on CEA as a first-line treatment The advantages of CAS include avoidance of general anaesthesia, an incision in the neck and the risk of cranial and cutaneous nerve damage from the dissection. Surgically inaccessible lesion can be treated with CAS and both procedure- and admission times are usually shorter than for surgery, therefore reducing some cost. On the other hand, devices used for CAS are more expensive. At this moment many interventionists embrace carotid stenting, in particular for patients with obvious contraindications for surgical endarterectomy like high cardiopulmonary risk, high cervical lesion or “hostile neck”. CAS is relatively new compared to CEA and it should be acknowledged that CAS is an evolving technique and dedicated materials became only available recently

A tillering inhibition gene influences root-shoot carbon partitioning and pattern of water use to improve wheat productivity in rainfed environments

Genetic modification of shoot and root morphology has potential to improve water and nutrient 19 uptake of wheat crops in rainfed environments. Near-isogenic lines (NILs) varying for a tillering 20 inhibition (tin) gene and representing multiple genetic backgrounds were investigated in contrasting 21 controlled environments for shoot and root growth. Leaf area, shoot and root biomass were similar 22 until tillering whereupon reduced tillering in tin-containing NILs produced reductions of up to 60% in 23 total leaf area and biomass, and increases in total root length of up to 120% and root biomass to 24 145%. Together, root-to-shoot ratio increased two-fold with the tin gene. The influence of tin on shoot 25 and root growth was greatest in the cv. Banks genetic background, particularly in the biculm-selected 26 NIL, and was typically strongest in cooler environments. A separate de-tillering study confirmed 27 greater root-to-shoot ratios with regular tiller removal in non-tin containing genotypes. In validating 28 these observations in a rainfed field study, the tin allele had a negligible effect on seedling growth but 29 was associated with significantly (P<0.05) reduced tiller number (-37%), leaf area index (-26%) and 30 spike number (-35%) to reduce plant biomass (-19%) at anthesis. Root biomass, root-to-shoot ratio at 31 early stem elongation and root depth at maturity were increased in tin-containing NILs. Soil water use 32 was slowed in tin-containing NILs resulting in greater water availability, greater stomatal 33 conductance, cooler canopy temperatures and maintenance of green leaf area during grain-filling. 34 Together these effects contributed to increases in harvest index and grain yield. In both the controlled 35 and field environments, the tin gene was commonly associated with increased root length and biomass 36 but the significant influence of genetic background and environment suggests careful assessment of 37 tin-containing progeny in selection for genotypic increases in root growth

Supplementation of lamb diets with vitamin E and rosemary extracts on meat quality parameters

BACKGROUND Supranutritional supplementation of lamb diets with alpha-tocopherol is an effective method to reduce lipid oxidation and colour deterioration in meat products. However, alternative antioxidant sources have been proposed to replace the supranutritional vitamin E applications. RESULTS Indoor concentrate-fed Rasa Aragonesa male lambs (n = 480) were supplemented with increasing levels of all-rac-alpha-tocopheryl acetate (0.25, 0.5, 1.0 g kg(-1) compound feed), rosemary extract (0.20, 0.40, or 0.80 g kg(-1) compound feed), or rosemary extract embedded in a fat matrix (0.20, 0.40, or 0.80 g kg(-1) compound feed) for 14 days before slaughter. The longissimus thoracis et lumborum muscle from three lambs per pen (18 lambs per treatment) were modified-atmosphere packaged (70% O-2 + 30% CO2) and maintained under retail conditions for 14 days. Supranutritional supplementation with antioxidants had no effect (P > 0.05) on average daily weight gain, feed intake, and feed efficiency. Rosemary extract supplementation (with or without fat embedment) had no effect on lipid oxidation, myoglobin forms, or colour stability parameters, regardless of the dose. All vitamin E supplementation levels significantly affected lipid oxidation, colour stability (L*, C*, and h), myoglobin forms, and meat discoloration parameters compared with non-supplemented lambs. CONCLUSIONS This study demonstrates that, unlike vitamin E, neither dose nor protection of the rosemary extract had an effect on lipid oxidation or meat colour stability of lambs during the 14 days of storage under retail conditions

Review of a major epidemic of methicillin-resistant Staphylococcus aureus: The costs of screening and consequences of outbreak management

Background: A major outbreak of methicillin-resistant Staphylococcus aureus (MRSA) occurred in locations C and Z of our hospital and lasted for several years. It affected 1,230 patients and 153 personnel. Methods: Outbreak management was installed according to the Dutch "search and destroy" policy. A rapid, high-throughput method for molecular screening of potential MRSA carriers was implemented. Outbreak isolates were retrospectively genotyped by pulsed field gel electrophoresis. Costs of molecular screening were compared with screening by culture. Results: Genotyping results revealed 4 distinct epidemic MRSA clones. Three were present in hospital C. Because of a merger of hospitals, these clones spread to hospital Z. Another clone of MRSA affected other health care-related institutions in the region. Because of the implementation of strict containment measures of the "search and destroy" policy, the annual number of tests decreased from 100,000 to 18,000. The disposables and reagents used in polymerase chain reaction technology are more expensive than those of conventional methods. However, the clinical and economic benefits of fast results in regard to expenses of the hospital clearly outweigh the higher costs of screening. Conclusion: The implementation of a rapid, high-throughput molecular screening system greatly contributed to the effectiveness of strict containment measures of the "search and destroy" policy. The major epidemic clones of MRSA in the outbreak were eradicated by this strategy

Toward complete oral cavity cancer resection using a handheld diffuse reflectance spectroscopy probe

This ex-vivo study evaluates the feasibility of diffuse reflectance spectroscopy (DRS) for discriminating tumor from healthy tissue, with the aim to develop a technology that can assess resection margins for the presence of tumor cells during oral cavity cancer surgery. Diffuse reflectance spectra were acquired on fresh surgical specimens from 28 patients with oral cavity squamous cell carcinoma. The spectra (400 to 1600 nm) were detected after illuminating tissue with a source fiber at 0.3-, 0.7-, 1.0-, and 2.0-mm distances from a detection fiber, obtaining spectral information from different sampling depths. The spectra were correlated with histopathology. A total of 76 spectra were obtained from tumor tissue and 110 spectra from healthy muscle tissue. The first- A nd second-order derivatives of the spectra were calculated and a classification algorithm was developed using fivefold cross validation with a linear support vector machine. The best results were obtained by the reflectance measured with a 1-mm source-detector distance (sensitivity, specificity, and accuracy are 89%, 82%, and 86%, respectively). DRS can accurately discriminate tumor from healthy tissue in an ex-vivo setting using a 1-mm source-detector distance. Accurate validation methods are warranted for larger sampling depths to allow for guidance during oral cavity cancer excision.</p

Эффективность комбинированных криоконсервантов, содержащих глицерин или 1,2-пропандиол, при замораживании эритроцитов

Исследовали осмотические свойства эритроцитов, замороженных в комбинированных криоконсервантах, содержащих полимерные непроникающие (декстран, полиэтиленгликоль) и проникающие (глицерин, 1,2-пропандиол) криопротекторы. Установлено, что в эритроцитах, замороженных-отогретых в среде с полимерами, отмечается повышение скорости потока ионов Н+ и осмотической хрупкости в среде, содержащей 0,45–0,9% NaCl. Для сохранения осмотических свойств замороженных- отогретых клеток достаточно включить в среду глицерин или 1,2-пропандиол (1,2-ПД) в концентрации 5%. Полученные результаты позволяют предположить, что криопротекторная эффективность комбинированных криоконсервантов, содержащих непроникающие и проникающие криопротекторы, определяется вкладом различных по механизму действия криозащитных компонентов в суммарную защитную эффективность при замораживании и ослаблением постгипертонического стресса на клетки при размораживании.Досліджували осмотичні властивості еритроцитів, заморожених-відігрітих у комбінованих кріоконсервантах, які містять полімерні непроникаючі (декстран, поліетиленгліколь) і проникаючі (гліцерин, 1,2-пропандіол) кріопротектори. Встановлено, що в еритроцитах, заморожених-відігрітих у середовищі з полімерами, визначається зростання швидкості потоку іонів Н+ і осмотичної крихкості в середовищі, яке містить 0,45–0,9% NaCl. Для збереження осмотичних властивостей заморожених- відігрітих клітин достатньо включити в середовище гліцерин або 1,2-пропандіол в концентрації 5%. Отримані результати дозволяють припустити, що кріопротекторна ефективність комбінованих кріоконсервантів, які містять непроникаючі і проникаючі кріопротектори, визначається внеском різноманітних за механізмом дії кріозахисних компонентів у сумарну захисну ефективність при заморожуванні та послабленням постгіпертонічного стресу на клітини при розморожуванні.The osmotic properties of erythrocytes frozen-thawed in combined cryopreservatives, containing polymeric non-penetrating (dextran, polyethylene glycol) and penetrating (glycerol, 1,2-propane diol) cryoprotectants were studied. It was established that in erythrocytes frozen-thawed in the presence of polymers the increasing of H+ ion flow rate and osmotic fragility in the environment with 0.45–0.9% NaCl was observed. It is sufficient to add 5% glycerol or 1,2-propane diol (1,2-PD) to the medium to preserve osmotic properties of frozen-thawed cells. The obtained results enable to suggest that cryoprotective efficiency of combined cryopreservatives, containing non-penetrating and penetrating cryoprotectants is determined both by the contribution of cryoprotective components differing by action mechanism into th