Endovascular treatment of stenotic and occluded visceral arteries for chronic mesenteric ischemia

PURPOSE: Percutaneous angioplasty and stenting (PTAS) is emerging as a therapeutic option for patients with chronic mesenteric ischemia. This study evaluated patency and mortality, and their relationship between degree of vessel occlusion (stenotic or totally occluded), stent characteristics, and comorbidities in patients who were treated with PTAS of the visceral vessels for chronic mesenteric ischemia. METHODS: A retrospective review was performed of the records of all patients who underwent PTAS of the celiac, superior mesenteric, or inferior mesenteric arteries, or both, for symptomatic chronic mesenteric ischemia between January 2001 and December 2005. Patient demographics, lesion characteristics (stenosis or occlusion), interventional details, and early and late mortality rates were recorded. Cumulative mortality and patency rates and factors associated with outcomes were determined using Kaplan-Meier method and Cox proportional hazards modeling. RESULTS: Eighty-seven mesenteric vessels (57 superior mesenteric, 23 celiac, and 7 inferior mesenteric arteries) were treated in 65 patients (29 men and 36 women). Completely occluded vessels were treated in 18 patients (28%), and >60% stenosis was treated in 47 patients (72%). Mesenteric angina was the most common symptom (97%). For the entire series, the cumulative 1-year results were primary patency, 65% (95% confidence interval [CI], 50%-80%); primary assisted patency, 97% (95% CI, 92%-100%); secondary patency, 99% (95% CI, 96%-100%); and survival, 89% (95% CI, 80%-98%). All deaths occurred 相似文献   

Le reconditionnement à l’effort au cours des coronaropathies (sans insuffisance cardiaque)

Cardiac rehabilitation (CR) is recommended as a class 1 of the non pharmacological therapy of cardiovascular diseases. Improvements in exercise tolerance, coronary risk factors and psychosocial well-being were already demonstrated. Programs are focused both on exercise therapy and on comprehensive secondary prevention (therapeutic education). Despite the numerous proofs of morbidity and mortality benefits, CR is underused. Validation of several functional measures (as walking tests) will provide adapted means to enrolment and tailor-made organisation of CR programs.     

Imaging mycorrhizal fungal transformants that express EGFP during ericoid endosymbiosis

Ericoid endomycorrhizal fungi form intracellular associations with the epidermal root cells of plants belonging to Ericales. In natural environments, these fungi increase the ability of their host plants to colonise soils polluted with toxic metals, although the underlying mechanisms are not clearly understood. Genetic transformation is a powerful tool to study the function of specific genes involved in the interaction of symbiotic fungi with the host plants and with the environment. Here, we investigated the possibility to genetically transform an ericoid endomycorrhizal strain. A metal tolerant mycorrhizal Oidiodendron maius strain isolated from a contaminated area was chosen to develop the transformation system. Two different protocols were used: protoplasts and Agrobacterium-mediated transformation. Stable transformants were obtained with both techniques. They remained competent for mycorrhizal formation and GFP-transformed fungi were visualised in planta. This is the first report of stable transformation of an ericoid endomycorrhizal fungus. The protocol set up could represent a good starting point for the identification of genes important in the ericoid mycorrhiza formation and in the understanding of how this symbiosis is established and functions. The success in the genetic transformation of this strain will allow us to better define its potential use in bioremediation strategies.     

Value of the magnetic resonance imaging in patients with painful lumbar spinal stenosis (LSS) undergoing lumbar epidural steroid injections

OBJECTIVES: Purpose of this study is to examine the relationship between the magnetic resonance imaging (MRI) findings, pain scores, and opiates use in patients with lumbar spinal stenosis (LSS) undergoing lumbar epidural steroid (LES) injections by retrospective review of 719 patients' electronic medical records. METHODS: Reviewed were Visual Analog Scale (VAS) pain scores and opioid use before and 8 to 12 weeks after series of LES injections. The stenosis pain index (SPI) was produced by adding an assigned numerical value of severity (1=mild, 2=moderate, 3=severe) to the number of lumbar vertebral levels affected by LSS on MRI (lateral or central). RESULTS: The average age of patients was 68.4 years. There was no relationship between the pretreatment age, sex, or number of vertebral levels affected on MRI with pretreatment VAS pain scores or opioid use. The degree of LSS present on MRI, categorized as a mild, moderate, or severe, correlated clearly with initial VAS pain scores (P=0.017). The improvement in VAS pain scores after LES injections correlated well with number of levels affected (P=0.003) and the severity of stenosis (P=0.12). Positive correlation was observed between change in VAS pain score 8 to 12 weeks after the series of LES injections and the SPI (P=0.001). There were no differences found in opioid use. DISCUSSION: The improvement in VAS pain scores after LES injections correlated well with the changes in the SPI except in those patients classified on MRI as severe LSS and more than 3 lumbar levels affected. That patient group is unlikely to benefit from LES injections.