Lesion characteristics of patients with chronic critical limb ischemia that determine choice of treatment modality

This paper will review the literature in order to define lesion characteristics that determine decision for surgical or endovascular therapy in patients with chronic critical limb ischemia (CLI). The typical pattern of disease is multilevel, infrainguinal disease. The great majority of patients with CLI can be treated by endovascular means, and the pathoanatomical pattern of disease dictates the choice of treatment modality. Long iliac artery occlusions, in particular, if associated with common femoral artery pathology and long superficial femoral artery occlusions crossing the knee joint so far remain a domain of surgery. However, there is an ongoing shift from surgery to endovascular treatment.

Sleep-disordered breathing in acute ischemic stroke and transient ischemic attack: effects on short- and long-term outcome and efficacy of treatment with continuous positive airways pressure - rationale and design of the SAS CARE study

Sleep-disordered breathing represents a risk factor for cardiovascular morbidity and mortality and negatively affects short-term and long-term outcome after an ischemic stroke or transient ischemic attack. The effect of continuous positive airways pressure in patients with sleep-disordered breathing and acute cerebrovascular event is poorly known. The SAS CARE 1 study assesses the effects of sleep-disordered breathing on clinical evolution, vascular functions, and markers within the first three-months after an acute cerebrovascular event. The SAS CARE 2 assesses the effect of continuous positive airways pressure on clinical evolution, cardiovascular events, and mortality as well as vascular functions and markers at 12 and 24 months after acute cerebrovascular event.

Effect of treatment delay on disease severity and need for resuscitation in porcine fecal peritonitis.

Early treatment in sepsis may improve outcome. The aim of this study was to evaluate how the delay in starting resuscitation influences the severity of sepsis and the treatment needed to achieve hemodynamic stability.

Methods to convert continuous outcomes into odds ratios of treatment response and numbers needed to treat: meta-epidemiological study

Clinicians find standardized mean differences (SMDs) calculated from continuous outcomes difficult to interpret. Our objective was to determine the performance of methods in converting SMDs or means to odds ratios of treatment response and numbers needed to treat (NNTs) as more intuitive measures of treatment effect.

Government Influence and the Failure of Fannie Mae and Freddie Mac

In 2008 two government-sponsored enterprises, Fannie Mae and Freddie Mac, were placed into conservatorship due to insolvency. The financial bailout of the two publically traded corporations came at the expense of the American tax payer. This study investigates the relationship between direct and indirect government influence and the increasing risk taking of Fannie Mae and Freddie Mac from the late 1990’s through their conservatorship in 2008. As government-sponsored enterprises Fannie Mae and Freddie Mac have many special advantages that other publically traded companies did not possess. These advantages allowed Fannie Mae and Freddie Mac to increase their profitability. Theoretical literature regarding Congress and the bureaucracy suggests that the actions of bureaucrats can be linked to the preferences of Congressional members because bureaucrats are responsive to potential threats or perceived threats from the legislature. This theory is applicable to Fannie Mae and Freddie Mac, and is used to explain why the government was able to directly and indirectly influence the government-sponsored enterprises. Overall this investigation has determined that the United States government pursued a clear mission that determined to increase the availability of housing to all Americans, specifically to low-income and under-served individuals, through the use of the government-sponsored enterprises. Despite this link there is no conclusive data to show that the pursuit of this housing mission led Fannie Mae and Freddie Mac to operate in riskier business segments. This study has also found that motivation regarding profit-seeking and compensation structure provide a more plausible explanation for why the government-sponsored enterprises began to engage in riskier business practices that led to their insolvency.

[Modalities of acupuncture treatments in assisted reproductive technology--a comparison of treatment practice in Swiss, German, and Austrian fertility centers with findings from randomized controlled trials]

One in 5 couples is affected by infertility. To increase the effectiveness of assisted reproductive technology (ART) adjuvant acupuncture treatments are frequently administered. However, little is known about acupuncture treatment modalities employed in fertility centers. The aim of our study was to assess modalities of acupuncture treatments in fertility centers and compare them with investigated acupuncture treatments in randomized controlled trials (RCTs) related to ART.

Long-term outcome after structural failure of rotator cuff repairs

BACKGROUND: In a previous study, twenty consecutive patients with a rerupture of the rotator cuff, as documented with magnetic resonance imaging, were found to have significantly less pain and better function and strength, compared with the preoperative state, at 3.2 years postoperatively. It was the purpose of this study to determine the clinical and structural outcomes of these reruptures in the same twenty patients after a longer period of follow-up. METHODS: At a mean of 7.6 years postoperatively, the twenty patients were reexamined clinically and with standard radiographs and magnetic resonance imaging with use of the same clinical, radiographic, and magnetic resonance imaging criteria as were utilized in the review at 3.2 years. The mean age at the time of final follow-up was sixty-six years. RESULTS: Nineteen of the twenty patients continued to be either very satisfied or satisfied with the outcome. The relative Constant score averaged 88% and was not significantly different from the score at 3.2 years, which averaged 83%. The mean scores for pain, function, and strength also had not changed significantly. Overall, the twenty reruptures had not increased in size, and eight of them had healed structurally at the time of the 7.6-year follow-up. Seven of these eight reruptures had been of the supraspinatus tendon only, and seven had been smaller than 400 mm(2) at 3.2 years. Twelve reruptures persisted, and five were larger than the preoperative tear. Fatty infiltration of the infraspinatus muscle progressed significantly (p = 0.015) and the acromiohumeral distance decreased significantly (p = 0.006) between the two follow-up periods. Neither fatty infiltration of the supraspinatus and subscapularis muscles nor glenohumeral osteoarthritis progressed significantly. CONCLUSIONS: At an average of 7.6 years, the clinical outcomes after structural failure of rotator cuff repairs remained significantly improved over the preoperative state in terms of pain, function, strength, and patient satisfaction. Overall, the reruptures that had been present at 3.2 years did not increase in size. We also found that reruptures of the supraspinatus that had been smaller than 400 mm(2) had the potential to heal.