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Farber A.,Boston Medical Center | Long B.M.,Cedars Sinai Medical Center | Bohannon T.,Scott and White Clinic | Siegal C.L.,New Hill
Journal of Vascular Surgery | Year: 2010

During the past decade, there has been a sharp increase in the number of vascular procedures performed in the United States. Due to the increase in the size of the aging population, this trend is predicted to continue. Despite this, general public knowledge about vascular surgery appears low. This gap may significantly affect the success of vascular surgery as a specialty. To objectively define knowledge about vascular surgery, we administered a questionnaire to both a sample of the general population and medical students. The Vascular Surgery Knowledge Questionnaire (VSQ), a 58-item multiple choice survey, was designed to assess knowledge about the field of vascular surgery, including types of procedures commonly performed, presenting illnesses, training, and financial compensation. VSQ was tested for reliability and validity. It was administered to a sample of the general population (GP) and first year medical students (MS) via a random digit dial telephone survey and a paper-based survey, respectively. VSQ Score was derived by calculating the percent of questions from the 38-item, non-demographic part of the questionnaire answered correctly and expressed in numerical form. The maximum score possible was 100. Statistical analysis was used to assess differences in VSQ scores. Two hundred GP and 160 MS subjects completed the questionnaire. The mean VSQ score for GP and MS groups was 54 and 67 (P < .01), respectively. Forty-one percent of the GP group received a score of less than 50. Only 50% of the GP and 51% of MS cohorts agreed with the statement that vascular surgeons perform procedures on all blood vessels with the exception of the heart and brain. Just 24% of the GP group agreed with the statement that vascular surgeons treat patients with wounds that do not heal. Finally, only half of the GP group agreed that vascular surgeons treat patients with abdominal aortic aneurysms. The GP cohort significantly underestimated the average length of postgraduate training (five years) to become a vascular surgeon. Level of education, income, and residence in the Western states significantly correlated with higher scores. General population subjects who admitted to knowing a vascular surgeon received similar scores to those who did not (58 vs. 53, P >.05). These findings support our hypothesis that there is a significant knowledge deficit among both the general population and medical students about the field of vascular surgery. This has protean implications for the future of our specialty and public health in the United States. © 2010 Society for Vascular Surgery. Source

Zivkovic A.M.,University of California at Davis | Yang J.,University of California at Davis | Georgi K.,University of California at Davis | Hegedus C.,University of California at Davis | And 7 more authors.
Metabolomics | Year: 2012

Immunoglobulin A nephropathy (IgAN) is a leading cause of chronic kidney disease, frequently associated with hypertension and renal inflammation. ω-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in fish oil (FO) improve kidney function in animal models, but have inconsistent metabolic effects in humans. Oxylipin profiles in serum from IgAN patients supplemented with either FO or corn oil (CO) placebo were analyzed by liquid chromatography coupled to tandem mass spectrometry. EPA cyclooxygenase and lipoxygenase metabolites, and EPA and DHA epoxides and diols were increased in response to FO supplementation, as were total epoxides and epoxide/diol ratios. Several of these metabolites were drivers of separation as assessed by multivariate analysis of FO patients pre- versus post-supplementation, including 17,18-dihydroxyeicosatrienoic acid, prostaglandin D 3, prostagalandin E 3, Resolvin E1, 12-hydroxyeicosapentaenoic acid, and 10(11)-epoxydocosapentaenoic acid. In patients whose proteinuria improved, plasma total oxylipins as well as several hydroxyoctadecadienoic acids, hydroxyeicosatetraenoic acids, and leukotriene B 4 metabolites were among the metabolites that were significantly lower than in patients whose proteinuria either did not improve or worsened. These data support the involvement of oxylipins in the inflammatory component of IgAN as well as the potential use of oxylipin profiles as biomarkers and for assessing responsiveness to ω-3 fatty acid supplementation in IgAN patients. © 2012 Springer Science+Business Media, LLC. Source

Desai R.R.,University of Louisville | Malkani A.L.,University of Louisville | Hitt K.D.,Scott and White Clinic | Jaffe F.F.,New York University | And 2 more authors.
Journal of Arthroplasty | Year: 2012

The purpose of this study was to compare results of patients with Paprosky type I and II femoral defects vs type IIIA, IIIB, and IV defects in patients undergoing revision hip arthroplasty. There were 64 patients in the group with type I and II defects with an average age of 68 years. There were 52 patients with Paprosky type IIIA, IIIB, and IV defects with an average age of 67 years. There were 8 intraoperative fractures in the type III and IV group, whereas there were 9 in the type I and II group. There were no differences between the 2 groups with respect to subsidence, loosening, dislocation, infection, and medical complications. Survivorship for the whole group was 96.9% at 5 years. Modular femoral implants provide several intraoperative options to restore leg length, offset, and stability despite femoral defects. We did not realize a higher failure rate in patients with type III or IV defects. © 2012 Elsevier Inc.. Source

Swanson G.P.,University of Texas Health Science Center at San Antonio | Du F.,University of Texas Health Science Center at San Antonio | Michalek J.E.,University of Texas Health Science Center at San Antonio | Hermans M.,Scott and White Clinic
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: The results of salvage radiation therapy for rising prostate-specific antigen (PSA) levels after radical prostatectomy appear favorable, but the ultimate outcome is uncertain, given the relatively short follow-up in most studies. We report on a group of patients at a median follow-up of 13.9 years after salvage radiation therapy. Methods and Materials: From 1990 to 1995, 92 patients were referred postoperatively for radiation for a rising PSA level. PSA level at the time of referral ranged from 0.1 to 30.5 ng/ml (median, 1.5 ng/ml). The median time from surgery to radiation was 2.1 years (range, 0.3-7.4 years). Radiation was directed to the prostatic fossa only with a median dose of 6,500 cGy (range, 6,000-7,000 cGy). Results: Eighty-five patients experienced a PSA drop after radiation, as predicted by Gleason score and PSA level at the start of radiation. Five- and 10-year biochemical failure free survival (BFFS) was 35% and 26%, respectively, and overall survival was 86% and 67%, respectively. Median survival was 12.0 years, and median BFF was 2.3 years. The presurgery PSA level was not predictive, but the PSA level at the start of radiation predicted a response. Patients with Gleason 8 to 9 cancers had a significantly higher progression rate than those with lower Gleason scores. There were no significant differences in outcomes based on pathology findings (none vs. positive margins vs. positive seminal vesicles). Overall, 22 (24%) patients died directly from prostate cancer, resulting in a 10-year cancer-specific survival rate of 82%. Multivariate analysis risk factors for dying of cancer were Gleason's score (8 to 9) and PSA at the start of radiation therapy (>1.0 ng/ml). Conclusions: Patients have a good response to salvage radiation therapy. A small but durable subgroup appears to have permanent control. In those for whom therapy fails, radiation delays the need for other salvage therapy, indicating at least a transient benefit to most patients. © 2011 Elsevier Inc. Source

Holmes Jr. D.R.,Mayo Medical School | Kereiakes D.J.,Vascular Center | Garg S.,Erasmus Medical Center | Serruys P.W.,Erasmus Medical Center | And 5 more authors.
Journal of the American College of Cardiology | Year: 2010

Intense investigation continues on the pathobiology of stent thrombosis (ST) because of its morbidity and mortality. Because little advance has been made in outcomes following ST, ongoing research is focused on further understanding predictive factors as well as ST frequency and timing in various patient subsets, depending upon whether a drug-eluting stent or bare-metal stent has been implanted. Although the preventive role of antiplatelet therapies remains unchallenged, new data on genomics and variability in response to antiplatelet therapy, as well as the effects of novel therapeutic agents and duration of therapy, have become available. The goal remains identification of patients at particularly increased risk of ST so that optimal prevention strategies can be developed and employed. © 2010 American College of Cardiology Foundation. Source

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