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Hingorani A, Ascher E, Chait J, Hingorani A. Risk factors for low back pain after iliac vein stenting for non-thrombotic iliac vein lesions. J Vasc Surg Venous Lymphat Disord 2024; 12:101822. [PMID: 38237676 DOI: 10.1016/j.jvsv.2024.101822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Iliac vein stenting is an option being explored to treat chronic venous insufficiency. We have noted that our most common postoperative complication is low back pain after stent placement, which is occasionally quite severe. We wanted to investigate risk factors that are involved in this phenomenon and identify potentially modifiable factors. METHODS Patients who failed 3 months of conservative therapy had iliac vein interrogation performed. We limited the scope of this database to non-thrombotic iliac vein lesions treated in the office in which Wallstents were placed. Data were collected from September 2012 to August 2020 for 2308 consecutive outpatients who underwent 3747 procedures. Before August 2016, patients received pre-procedure oral valium (n = 2679) and thereafter, patients received intravenous (IV) sedation (n = 1068). A pain score, on a Likert scale ranging from 0 to 10, was assessed within 1 hour postoperatively. We analyzed the medications administered and correlated them with pain scores. RESULTS The average of all the pain scores was 0.86 (range, 0-10; standard deviation [SD], 2.00). Age had a slight inverse effect on pain scores (r = -0.12; P < .00001). Presenting signs (based upon CEAP) (P = .11) and body mass index (P = .88) did not have a significant effect on pain scores. Average pain score for females (0.96) was slightly higher than for males (0.70), with P < .0001. Average pain score for procedures on the right side (0.67) was lower than for procedures on the left side (1.01), with P < .0001. Average pain score for patients who received IV sedation (mean, 0.68; SD, 1.58) was lower than that for those who did not (mean, 0.93; SD, 2.15), with P = .0004. When using a single agent, propofol was associated with the lowest pain scores (P < .0001). Toradol displayed a dose-dependent effect on pain score (P < .0001). The best combination of agents for pain control was propofol and toradol together. CONCLUSIONS Overall, the vast majority of pain scores were low. Factors that were associated with lower pain scores were older age, male sex, procedures on the right side, and IV sedation, in particular with the use of propofol. These data may help us better target patients anticipated to have high pain scores and suggest the preferential use of propofol and toradol.
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Affiliation(s)
- Amrit Hingorani
- Division of Vascular Surgery, Department of Surgery, NYU Brooklyn and Total Vascular Care, Brooklyn, NY
| | - Enrico Ascher
- Division of Vascular Surgery, Department of Surgery, NYU Brooklyn and Total Vascular Care, Brooklyn, NY
| | - Jesse Chait
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Anil Hingorani
- Division of Vascular Surgery, Department of Surgery, NYU Brooklyn and Total Vascular Care, Brooklyn, NY.
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Hingorani A, Marks N, Ascher E, Hingorani A. Clinical Factors Associated with Acute Iliac Vein Stent Thrombosis. J Vasc Surg Venous Lymphat Disord 2022. [DOI: 10.1016/j.jvsv.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hingorani A, Ascher E, Hingorani A. The Great Masquerader - TB Osteoarthritis. Ann Vasc Surg 2022; 78:377.e1-377.e3. [PMID: 34481885 DOI: 10.1016/j.avsg.2021.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/26/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES TB arthritis is a rarely reported entity in Western literature and its ability to masquerade as many other diseases makes it difficult to diagnose. We report an interesting case of TB arthritis of the ankle. METHODS We present a 44 year-old diabetic Chinese male with a recent history of worsening pain, swelling, and redness in his left foot with an abscess and X-ray findings consistent with Charcot foot. RESULTS At first, the presentation was believed to be Charcot's foot with MSSA osteomyelitis but after the wound culture and bone biopsy were both positive for Mycobacterium tuberculosis as well, the diagnosis of tuberculous arthritis was confirmed. CONCLUSIONS While the prevalence of TB and other diseases is low in the majority of the United States, we still need to be aware of such diseases in populations with increasing migration and be cognizant of the potential impact of a patient's background on a diagnosis is critical to properly diagnosing and treating patients. Vascular surgeons may be seeing patients with abscesses of the lower extremities and may miss the diagnosis if cultures for TB are not sought.
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MESH Headings
- Adult
- Ankle Joint/diagnostic imaging
- Ankle Joint/microbiology
- Ankle Joint/surgery
- Antibiotics, Antitubercular/therapeutic use
- Arthritis, Infectious/diagnosis
- Arthritis, Infectious/microbiology
- Arthritis, Infectious/surgery
- Debridement
- Humans
- Male
- Mycobacterium tuberculosis/isolation & purification
- Osteoarthritis/diagnosis
- Osteoarthritis/microbiology
- Osteoarthritis/surgery
- Treatment Outcome
- Tuberculosis, Miliary/diagnosis
- Tuberculosis, Miliary/microbiology
- Tuberculosis, Miliary/surgery
- Tuberculosis, Osteoarticular/diagnosis
- Tuberculosis, Osteoarticular/microbiology
- Tuberculosis, Osteoarticular/surgery
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Ascher E, Gunduz Y, Hingorani A, Yorkovich W. Posterior Transverse Plication : A Technique for Treatment of Redundant Internal Carotid Artery During Endarterectomy. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- E. Ascher
- Maimonides Medical Center, Brooklyn, NY, USA
| | - Y. Gunduz
- Maimonides Medical Center, Brooklyn, NY, USA
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Hingorani A, Hingorani A, Chait J, Kibrik P, Alsheekh A, Oberoi R, Seitllari E, Ascher E. Value and Limitations of Postoperative Duplex Ultrasound for Iliac Vein Stenting. J Vasc Surg Venous Lymphat Disord 2020. [DOI: 10.1016/j.jvsv.2019.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chait J, Aurshina A, Marks N, Hingorani A, Ascher E. Comparison of Ultrasound-Accelerated Versus Multi-hole Infusion Catheter-Directed Thrombolysis for the Treatment of Acute Limb Ischemia. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hingorani A, Chait J, Kibrik P, Alsheekh A, Marks N, Rajaee S, Hingorani A, Ascher E. Spontaneous hemorrhage from varicose veins: A single-center experience. J Vasc Surg Venous Lymphat Disord 2019; 8:106-109. [PMID: 31843245 DOI: 10.1016/j.jvsv.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/01/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Whereas the commonly described manifestations of venous insufficiency include telangiectasia, varicose veins (VVs), edema, skin changes, and ulcers, we have noted some patients who present with external hemorrhage from lower extremity VVs. Because there are few recent data examining this entity, we herein describe our experience. METHODS During 29 months, we had 32 patients present with hemorrhage from lower extremity VVs. There were 15 men and 17 women with a mean age of 60.2 years (range, 38-89 years; standard deviation [SD], ±14.9 years). Interestingly, 16 of these patients presented after coming into contact with warm water; 28 patients, 19 patients, and 1 patient presented with reflux >500 milliseconds in the great, small, and accessory saphenous veins, respectively. Eight patients and six patients had reflux >1 second in the femoral and popliteal veins, respectively. RESULTS All patients were treated with weekly Unna boots. Mean ulcer healing time was 2.12 weeks (range, 1-8 weeks; SD, ± 2.15 weeks). Patients with VV hemorrhage after contact with warm water had a mean healing time of 1.75 weeks, whereas those who bled without such exposure took an average of 3.5 weeks (P = .0426). Twenty patients underwent at least one endovenous thermal ablation procedure, with the average patient in the cohort receiving 2.16 procedures (range, 0-9; SD, ± 2.37). There was no significant difference between laterality, age, or sex between patients who bled after warm water contact and those who bled spontaneously. The ulcers recurred in three of the patients, and Unna boot treatment was reapplied until wounds healed once more. Patients had an average follow up of 7.2 months (range, 26 months; SD, ± 8.9 months), and we noted no recurrent bleeding episodes. CONCLUSIONS Spontaneous hemorrhage of VVs, although relatively under-reported, is not a rare occurrence. Risk factors are unknown; however, half of our patient cohort reported VV hemorrhage during or directly after coming into contact with warm water. Furthermore, these patients demonstrated a significantly shorter wound healing time compared with the rest of the cohort. Basic first aid, wound care, and hemostasis control education should be provided to all patients with VVs. Further investigation surrounding the risk factors associated with VV hemorrhage is warranted.
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Affiliation(s)
| | - Jesse Chait
- Vascular Institute of New York, Brooklyn, NY.
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Latifkar A, Ling L, Hingorani A, Johansen E, Clement A, Zhang X, Hartman J, Fischbach C, Lin H, Cerione RA, Antonyak MA. Loss of Sirtuin 1 Alters the Secretome of Breast Cancer Cells by Impairing Lysosomal Integrity. Dev Cell 2019; 49:393-408.e7. [PMID: 30982660 DOI: 10.1016/j.devcel.2019.03.011] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/09/2019] [Accepted: 03/13/2019] [Indexed: 12/23/2022]
Abstract
The NAD+-dependent deacetylase Sirtuin 1 (SIRT1) is down-regulated in triple-negative breast cancer. To determine the mechanistic basis by which reduced SIRT1 expression influences processes related to certain aggressive cancers, we examined the consequences of depleting breast cancer cells of SIRT1. We discovered that reducing SIRT1 levels decreased the expression of one particular subunit of the vacuolar-type H+ ATPase (V-ATPase), which is responsible for proper lysosomal acidification and protein degradation. This impairment in lysosomal function caused a reduction in the number of multi-vesicular bodies (MVBs) targeted for lysosomal degradation and resulted in larger MVBs prior to their fusing with the plasma membrane to release their contents. Collectively, these findings help explain how reduced SIRT1 expression, by disrupting lysosomal function and generating a secretome comprising exosomes with unique cargo and soluble hydrolases that degrade the extracellular matrix, can promote processes that increase breast-cancer-cell survival and invasion.
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Affiliation(s)
- Arash Latifkar
- Department of Molecular Medicine, Cornell University, Ithaca, NY 14853, USA; Department of Chemistry and Chemical Biology, Cornell University, Ithaca, NY 14853, USA
| | - Lu Ling
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Ithaca, NY 14853, USA; Kavli Institute at Cornell for Nanoscale Science Cornell University, Ithaca, NY 14853, USA
| | - Amrit Hingorani
- Department of Molecular Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Eric Johansen
- Department of Molecular Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Amdiel Clement
- Department of Molecular Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Xiaoyu Zhang
- Department of Chemistry and Chemical Biology, Cornell University, Ithaca, NY 14853, USA
| | - John Hartman
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Claudia Fischbach
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Ithaca, NY 14853, USA; Kavli Institute at Cornell for Nanoscale Science Cornell University, Ithaca, NY 14853, USA
| | - Hening Lin
- Department of Chemistry and Chemical Biology, Cornell University, Ithaca, NY 14853, USA; Howard Hughes Medical Institute, Cornell University, Ithaca, NY 14853, USA
| | - Richard A Cerione
- Department of Molecular Medicine, Cornell University, Ithaca, NY 14853, USA; Department of Chemistry and Chemical Biology, Cornell University, Ithaca, NY 14853, USA.
| | - Marc A Antonyak
- Department of Molecular Medicine, Cornell University, Ithaca, NY 14853, USA
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Aurshina A, Hingorani A, Hingorani A, Marks N, Ascher E. Routine use of ultrasound to avert mechanical complications during placement of tunneled dialysis catheters for hemodialysis. J Vasc Surg Venous Lymphat Disord 2019; 7:543-546. [PMID: 30922984 DOI: 10.1016/j.jvsv.2018.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 12/16/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE While placement of tunneled dialysis catheters for hemodialysis access is considered a routine procedure, it is associated with a small chance of mechanical complications. Because the literature examining these issues is not recent and our impression of the incidence of these postprocedural complications is at variance with the existing literature, we decided to review our experience. METHODS Since 1998, our vascular service has placed 1766 tunneled hemodialysis catheters in 1065 patients for hemodialysis access. All catheters were placed with ultrasound guidance for the puncture, with selective use of a micropuncture set for patients with low-volume status. All patients underwent chest radiography at the end of each procedure. RESULTS The average age of the patients was 61 ± 21 (standard deviation) years. Among the 1065 patients, 44% were female; 93% of catheters were placed in the right internal jugular vein and 7% in the left internal jugular vein. The prevalence of diabetes and hypertension in our population of patients was 52% and 72%, respectively. In this consecutive series, no case of postprocedure hemothorax or pneumothorax was encountered. Two cutdowns had to be performed because of injury to branches of the external carotid artery. Three patients had to have a subsequent revision because of malpositioning of the catheter. CONCLUSIONS Using modern-day techniques, the incidence of mechanical complications during placement of tunneled catheters can be diminished. Hence, routine use of ultrasound guidance for insertion of tunneled dialysis catheters should become the standard of care.
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Aurshina A, Ascher E, Mount L, Hingorani A, Marks N, Hingorani A. Success rate and factors predictive of redo radiofrequency ablation of perforator veins. J Vasc Surg Venous Lymphat Disord 2018; 6:621-625. [DOI: 10.1016/j.jvsv.2018.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/22/2018] [Indexed: 10/17/2022]
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Aurshina A, Hingorani A, Iadagarova E, Ascher E, Marks N, Hingorani A, Blumberg SN. A Trainee Perspective to Issues Needing Redressal in Current Vascular Surgery Training Programs: Survey Results from 2004 to 2015. Ann Vasc Surg 2018. [PMID: 29522874 DOI: 10.1016/j.avsg.2018.01.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vascular surgery training and practice have been constantly evolving in the last 2 decades. The goal of this study is to report the changing trends in perspectives of vascular surgery trainees on current training program and issues that need redressal in vascular training and practice. METHODS Vascular surgery trainees in the United States, who attended the Society of Clinical Vascular Surgery meeting from 2004 to 2015, were surveyed annually with an anonymous questionnaire during the meet. Questions pertaining to their endovascular and open surgical learning experience, independent performance of procedures, challenges of job search, starting an independent practice, and their perception of issues in vascular surgery training were analyzed. Responses from the first half of the decade (2004-2009) were compared with the second half (2010-2015) to identify evolving trends in trainee perception. RESULTS Among the 908 vascular surgery trainees who attended the annual meeting from 2004 to 2015, 670 (74%) trainees responded to the questionnaire. The mean age of vascular trainees was 32.5 years. In the latter half of the decade, there was a 2-fold increase in female trainees, from 12.3% to 23.6% (P = 0.002), and the integrated program trainees also increased from 0% to 12% of respondents (P = 0.0023). Trainee satisfaction with endovascular training improved from 78% to 90% (P = 0.0001), and satisfaction with open surgical experience was unchanged at 83% over the 10-year period (P = 0.16). The perception of vascular laboratory experience improved with only 35% vs. 27% (P = 0.016) of respondents dissatisfied, despite only a third of respondents actually performing the noninvasive tests in both the former and the latter half of the decade, respectively. CONCLUSIONS Although the quality of vascular cases during training has improved, vascular trainees desire shorter training paradigms, and vascular laboratory education is still viewed as deficient. These findings can be used by training programs to re-examine their curricula and implement changes to improve the quality of training the next generation of vascular surgeons.
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Affiliation(s)
| | | | | | | | | | | | - Sheila N Blumberg
- NYU Langone Hospital-Brooklyn, Division of Vascular and Endovascular Surgery, Brooklyn, NY.
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Aurshina A, Hingorani A, Hingorani A, Zainab A, Marks N, Blumberg S, Ascher E. Recent trends in publications of US vascular surgery program directors. Vascular 2017; 26:352-355. [DOI: 10.1177/1708538117740502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective In order to examine the academic productivity of US vascular surgery program directors, the number of vascular publications listed in PubMed from 2001 to 2015 for US vascular surgery program directors was reviewed. We suggest that this can be used as a benchmark for academic productivity. Methods The names of the program directors were taken from the Accreditation Council for Graduate Medical Education (ACGME) website at two time points: December 2009 (Independent Programs) and December 2015 (Independent + Integrated). This was used to query PubMed, which listed 5196 publications: 3284 from 2001 to 2009 and 1912 from 2010 to 2015. Results There were 104 program directors (2001–2009) and 114 program directors (2010–2015) with average number of publications in PubMed per program director as 3.68/year (SD ± 2.31) and 2.80/year (SD ± 2.73), respectively ( P = .01). From 2001 to 2009, 1215 (37%) and in 2010 to 2015, 860 (45%) of the publications were from Journal of vascular surgery. The top third produced 67% and 69% of publications in the two time-points. No statistical difference was ascertained regionally: northeast, southeast, midwest and west ( P = .46). The numbers of publications/year decreased by 17% compared to first 10 years. From 2001 to 2009, there were no programs with no publications which increased to five and three with no Journal of Vascular Surgery publications which increased to 21 in 2010–2015. The independent and integrated program directors published average of 2.85 (SD ± 2.69) and 3.47 (SD ± 3.1) total publications; 1.25 (SD ± 1.4) and 3.47 (SD ± 1.7) Journal of Vascular Surgery papers/year, respectively ( P = .28, P = .23). Changes in the study subject were noted by percentage of total publications: endovascular lower extremity arterial (4.7% to 8.9%), Thoracic Endovascular Aortic Repair (TEVAR) (4.5% to 9.9%), Arterio-Venous (AV) access (0.0% to 3.0%), basic science (14.7% to 6.8%), open thoracic (3.0% to 0.6%). Conclusion There seems to be a significant decline in the number of publications over the last 15 years. Yet, the subject of the publications has progressed from Open to TEVAR with an increase in endovascular publications. However, basic science publications reduced by half.
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Aurshina A, Ascher E, Alsheekh A, Hingorani A, Hingorani A, Blumberg S, Marks N. Success Rate and Predictive Factors for Redo Radiofrequency Ablation of Perforator Veins. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.07.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rizvi S, Usoh F, Hingorani A, Iadgarova E, Boniscavage P, Eisenberg J. The Clinical Efficacy of Balloon-Assisted Maturation of Autogenous Arteriovenous Fistulae. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.07.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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George M, Stuckey D, Taylor V, Hingorani A, Gilroy D. P4940Infarct size in a rat model of STEMI is reduced by interleukin-6 trans-signalling blockade using sgp130fc but not an anti-IL6R monoclonal antibody. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p4940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aurshina A, Hingorani A, Ascher E, Marks N, Blumberg S, Hingorani A, Iadagarova E. PC096 Recent Trends in Publications of U.S. Vascular Surgery Program Directors. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Blumberg S, Hingorani A, Hingorani A, Ascher E, Marks N, Iadgarova E. Fellows Assessment of Their Training. Ann Vasc Surg 2017. [DOI: 10.1016/j.avsg.2017.03.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hingorani A, Ascher E, Schutzer R, Tsemkhim B, Kallakuri S, Yorkovich W, Jacob T. Carotid Endarterectomy in Octogenarians and Nonagenarians: Is it Worth the Effort ? Acta Chir Belg 2016. [DOI: 10.1080/00015458.2004.11679578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A. Hingorani
- Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn New York
| | - E. Ascher
- Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn New York
| | - R. Schutzer
- Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn New York
| | - B. Tsemkhim
- Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn New York
| | - S. Kallakuri
- Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn New York
| | - W. Yorkovich
- Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn New York
| | - T. Jacob
- Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn New York
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Hingorani A, Hingorani A, Marks N, Eisenberg J, Rizvi A, Ascher E. Fellows' Assessment of the Future of Vascular Surgery. Ann Vasc Surg 2016. [DOI: 10.1016/j.avsg.2016.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hingorani AP, Ascher E, Marks NA, Jung D, Ignatiev I, Hingorani A. Interposition bypass of the popliteal artery using the popliteal vein in 1943. J Vasc Surg 2016; 63:1400-3. [PMID: 27109802 DOI: 10.1016/j.jvs.2015.12.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/10/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Anil P Hingorani
- Division of Vascular Surgery, NYU Lutheran Medical Center, Brooklyn, NY.
| | - Enrico Ascher
- Division of Vascular Surgery, NYU Lutheran Medical Center, Brooklyn, NY
| | - Natalie A Marks
- Division of Vascular Surgery, NYU Lutheran Medical Center, Brooklyn, NY
| | - Daniel Jung
- Division of Vascular Surgery, NYU Lutheran Medical Center, Brooklyn, NY
| | - Igor Ignatiev
- Department of Vascular Surgery, Interregional Clinical and Diagnostic Centre, Kazan State Medical Academy, Kazan, Russia
| | - Amrit Hingorani
- Division of Vascular Surgery, NYU Lutheran Medical Center, Brooklyn, NY
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Ali Rizvi S, Ascher E, Eisenberg J, Hingorani A, Marks N. Stent Patency in Patients With Advanced Chronic Venous Disease and Nonthrombotic Iliac Vein Lesions. J Vasc Surg Venous Lymphat Disord 2016. [DOI: 10.1016/j.jvsv.2015.10.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kheyson B, Hingorani A, Ascher E, Ganelin A, Marks N, Iadgarova E. Clinical Correlation of Anatomical Location of Nonthrombotic Iliac Vein Lesion. J Vasc Surg Venous Lymphat Disord 2014; 2:116-7. [DOI: 10.1016/j.jvsv.2013.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ballehaninna UK, Hingorani A, Ascher E, Shiferson A, Marks N, Aboian E, Jimenez R, Jacob T, McIntyre T. Acute superior mesenteric artery embolism: reperfusion with AngioJet hydrodynamic suction thrombectomy and pharmacologic thrombolysis with the EKOS catheter. Vascular 2012; 20:166-9. [DOI: 10.1258/vasc.2011.cr0311] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acute mesenteric ischemia is commonly treated by surgical exploration and open thrombectomy. Very few reports describe using newer, minimally invasive methods which utilize catheter-based mechanical and pharmacological thrombolysis. Herein, we report a case of acute superior mesenteric embolism successfully treated with AngioJet hydrodynamic mechanical thrombectomy and EKOS catheter pharmacological thrombolysis. A 76-year-old man with new onset atrial fibrillation presented with abdominal pain of 48 hours duration. Subsequent contrast computed tomography scan of the abdomen revealed a filling defect in the superior mesenteric artery (SMA), suggestive of an acute embolus, which was confirmed by SMA angiogram. The AngioJet aspiration device was used for hydrodynamic suction thrombectomy. The repeat angiogram demonstrated only a partial restoration of blood flow, and thus the EKOS tissue plasminogen activator catheter was left in the SMA for continuous thrombolysis. The patient underwent continuous thrombolysis for two days, with two subsequent sessions of angiography. Thereafter, the patient improved symptomatically and serum lactate was normalized. In conclusion, the AngioJet suction thrombectomy and pharmaco-mechanical thrombolysis using the EKOS catheter is associated with minimal morbidity and can be rapidly performed. It may be used as an alternative to open surgical thrombectomy in selected cases of acute SMA embolism.
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Affiliation(s)
- U K Ballehaninna
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY, USA
| | - A Hingorani
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY, USA
| | - E Ascher
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY, USA
| | - A Shiferson
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY, USA
| | - N Marks
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY, USA
| | - E Aboian
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY, USA
| | - R Jimenez
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY, USA
| | - T Jacob
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY, USA
| | - T McIntyre
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY, USA
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Lawlor DA, Macdonald-Wallis C, Fraser A, Nelson SM, Hingorani A, Smith GD, Sattar N, Deanfield J. O1-2.4 Hypertensive disorders of pregnancy and offspring vascular, inflammatory and lipid outcomes in childhood: findings from the Avon Longitudinal Study of Parents and Children. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976a.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Williams D, Fraser A, Fraser W, Sattar N, Hingorani A, Deanfield J, Smith GD, Lawlor D. P2-330 Associations of 25-hydroxyvitamin D2 and D3 with cardiovascular risk factors in childhood: a cross-sectional analysis in the Avon Longitudinal Study of Parents and Children (ALSPAC). Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976k.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hingorani A, Ascher E. Part two: Against the motion asymptomatic popliteal artery aneurysms (less than 3 cm) should be repaired. Eur J Vasc Endovasc Surg 2011; 41:448-9; discussion 449. [PMID: 21453862 DOI: 10.1016/j.ejvs.2011.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A Hingorani
- Division of Vascular Surgery, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY 11219, USA.
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Jacob T, Hemavathy K, Jacob J, Hingorani A, Marks N, Ascher E. A nanotechnology-based delivery system: Nanobots. Novel vehicles for molecular medicine. J Cardiovasc Surg (Torino) 2011; 52:159-167. [PMID: 21460765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM We previously demonstrated that adenovirus-mediated p53 gene transfer following balloon angioplasty, decreased neointimal hyperplasia. However, safety concerns arise because viral promoters can cause unrestricted transgene expression. The paucity of safe and efficient vehicles for gene transfer thus limits the potential for clinical utilization of gene therapy. Our objective was to design and clone a virus-free p53 construct, targeted to express specifically in vascular smooth muscle cells (SMCs), via a nanoparticle-based delivery system for therapeutic modulation in vascular wall. METHODS Biodegradable poly(lactide-co-glycolide) (PLGA), an FDA approved polymer, was used to formulate the nanoparticles. Cloned constructs consisting of SMC promoter, SM22, and p53 cDNA sequences along with enhanced green fluorescent protein (EGFP) gene, were loaded into PLGA nanoparticles. The affect of these nanobots on cell growth was examined. RESULTS The gene sequences carried by the nanobot are expressed in target cells. The p53/EGFP construct under the constitutive promoter was found to express in 293T human embryonic kidney cells, whereas the p53/EGFP with SMC promoter expressed only in human aortic SMCs. SMCs internalize these nanobots without compromising cell viability or growth kinetics. CONCLUSION A novel genetic sequence that targets a specific cell population has been successfully designed, cloned and encapsulated in a nanoparticle. This experiment is a significant step towards the development of a nanoparticle-based delivery system for therapeutic delivery of targeted gene-therapy towards attenuation of restenosis. Further work is necessary to expand the repertoire of this delivery system and determine whether it could become a versatile vehicle in molecular medicine.
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Affiliation(s)
- T Jacob
- Clinical Trials Unit and Translational Research, Maimonides Medical Center, Brooklyn, New York, NY, USA.
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Burgess S, Thompson SG, Burgess S, Thompson SG, Andrews G, Samani NJ, Hall A, Whincup P, Morris R, Lawlor DA, Davey Smith G, Timpson N, Ebrahim S, Ben-Shlomo Y, Davey Smith G, Timpson N, Brown M, Ricketts S, Sandhu M, Reiner A, Psaty B, Lange L, Cushman M, Hung J, Thompson P, Beilby J, Warrington N, Palmer LJ, Nordestgaard BG, Tybjaerg-Hansen A, Zacho J, Wu C, Lowe G, Tzoulaki I, Kumari M, Sandhu M, Yamamoto JF, Chiodini B, Franzosi M, Hankey GJ, Jamrozik K, Palmer L, Rimm E, Pai J, Psaty B, Heckbert S, Bis J, Anand S, Engert J, Collins R, Clarke R, Melander O, Berglund G, Ladenvall P, Johansson L, Jansson JH, Hallmans G, Hingorani A, Humphries S, Rimm E, Manson J, Pai J, Watkins H, Clarke R, Hopewell J, Saleheen D, Frossard R, Danesh J, Sattar N, Robertson M, Shepherd J, Schaefer E, Hofman A, Witteman JCM, Kardys I, Ben-Shlomo Y, Davey Smith G, Timpson N, de Faire U, Bennet A, Sattar N, Ford I, Packard C, Kumari M, Manson J, Lawlor DA, Davey Smith G, Anand S, Collins R, Casas JP, Danesh J, Davey Smith G, Franzosi M, Hingorani A, Lawlor DA, Manson J, Nordestgaard BG, Samani NJ, Sandhu M, Smeeth L, Wensley F, Anand S, Bowden J, Burgess S, Casas JP, Di Angelantonio E, Engert J, Gao P, Shah T, Smeeth L, Thompson SG, Verzilli C, Walker M, Whittaker J, Hingorani A, Danesh J. Bayesian methods for meta-analysis of causal relationships estimated using genetic instrumental variables. Stat Med 2010; 29:1298-311. [PMID: 20209660 DOI: 10.1002/sim.3843] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Genetic markers can be used as instrumental variables, in an analogous way to randomization in a clinical trial, to estimate the causal relationship between a phenotype and an outcome variable. Our purpose is to extend the existing methods for such Mendelian randomization studies to the context of multiple genetic markers measured in multiple studies, based on the analysis of individual participant data. First, for a single genetic marker in one study, we show that the usual ratio of coefficients approach can be reformulated as a regression with heterogeneous error in the explanatory variable. This can be implemented using a Bayesian approach, which is next extended to include multiple genetic markers. We then propose a hierarchical model for undertaking a meta-analysis of multiple studies, in which it is not necessary that the same genetic markers are measured in each study. This provides an overall estimate of the causal relationship between the phenotype and the outcome, and an assessment of its heterogeneity across studies. As an example, we estimate the causal relationship of blood concentrations of C-reactive protein on fibrinogen levels using data from 11 studies. These methods provide a flexible framework for efficient estimation of causal relationships derived from multiple studies. Issues discussed include weak instrument bias, analysis of binary outcome data such as disease risk, missing genetic data, and the use of haplotypes.
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Ascher E, Gopal K, Marks N, Boniscavage P, Shiferson A, Hingorani A. Duplex-Guided Endovascular Repair of Popliteal Artery Aneurysms (PAAs): A New Approach to Avert the Use of Contrast Material and Radiation Exposure. Eur J Vasc Endovasc Surg 2010; 39:769-73. [DOI: 10.1016/j.ejvs.2010.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 02/16/2010] [Indexed: 10/19/2022]
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Hemingway H, Henriksson M, Chen R, Damant J, Fitzpatrick N, Abrams K, Hingorani A, Janzon M, Shipley M, Feder G, Keogh B, Stenestrand U, McAllister K, Kaski JC, Timmis A, Palmer S, Sculpher M. The effectiveness and cost-effectiveness of biomarkers for the prioritisation of patients awaiting coronary revascularisation: a systematic review and decision model. Health Technol Assess 2010; 14:1-151, iii-iv. [PMID: 20184812 DOI: 10.3310/hta14090] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the effectiveness and cost-effectiveness of a range of strategies based on conventional clinical information and novel circulating biomarkers for prioritising patients with stable angina awaiting coronary artery bypass grafting (CABG). DATA SOURCES MEDLINE and EMBASE were searched from 1966 until 30 November 2008. REVIEW METHODS We carried out systematic reviews and meta-analyses of literature-based estimates of the prognostic effects of circulating biomarkers in stable coronary disease. We assessed five routinely measured biomarkers and the eight emerging (i.e. not currently routinely measured) biomarkers recommended by the European Society of Cardiology Angina guidelines. The cost-effectiveness of prioritising patients on the waiting list for CABG using circulating biomarkers was compared against a range of alternative formal approaches to prioritisation as well as no formal prioritisation. A decision-analytic model was developed to synthesise data on a range of effectiveness, resource use and value parameters necessary to determine cost-effectiveness. A total of seven strategies was evaluated in the final model. RESULTS We included 390 reports of biomarker effects in our review. The quality of individual study reports was variable, with evidence of small study (publication) bias and incomplete adjustment for simple clinical information such as age, sex, smoking, diabetes and obesity. The risk of cardiovascular events while on the waiting list for CABG was 3 per 10,000 patients per day within the first 90 days (184 events in 9935 patients with a mean of 59 days at risk). Risk factors associated with an increased risk, and included in the basic risk equation, were age, diabetes, heart failure, previous myocardial infarction and involvement of the left main coronary artery or three-vessel disease. The optimal strategy in terms of cost-effectiveness considerations was a prioritisation strategy employing biomarker information. Evaluating shorter maximum waiting times did not alter the conclusion that a prioritisation strategy with a risk score using estimated glomerular filtration rate (eGFR) was cost-effective. These results were robust to most alternative scenarios investigating other sources of uncertainty. However, the cost-effectiveness of the strategy using a risk score with both eGFR and C-reactive protein (CRP) was potentially sensitive to the cost of the CRP test itself (assumed to be 6 pounds in the base-case scenario). CONCLUSIONS Formally employing more information in the prioritisation of patients awaiting CABG appears to be a cost-effective approach and may result in improved health outcomes. The most robust results relate to a strategy employing a risk score using conventional clinical information together with a single biomarker (eGFR). The additional prognostic information conferred by collecting the more costly novel circulating biomarker CRP, singly or in combination with other biomarkers, in terms of waiting list prioritisation is unlikely to be cost-effective.
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Affiliation(s)
- H Hemingway
- Department of Epidemiology and Public Health, University College London, UK
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Swerdlow D, Sofat R, Shah T, Kuchenbaecker K, Mindell J, Kumari M, Kivimaki M, Casas J, Brunner E, Hingorani A. P93 OPTIMISING THE SELECTION OF GENETIC MARKERS FOR MENDELIAN RANDOMISATION EXPERIMENTS. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70160-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shah S, Drenos F, Shah T, Palmen J, Sofat R, Kumari M, Pallas J, MacFarlane P, Whittaker J, Talmud P, Humphries S, Hingorani A. MS215 IDENTIFICATION OF GENES ASSOCIATED WITH QT INTERVAL USING THE 50K CARDIO-METABOLIC SNP CHIP: RESULTS FROM THE WHITEHALL II STUDY. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hingorani A, Ascher E, Marks N, Usoh F, Shiferson A, Gopal K, Jung D, Reddy S, Jacob T. Prospective Randomized Study Comparing the Clinical Outcomes Between Inferior Vena Cava Greenfield and TrapEase Filters. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2009.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Humphries S, Talmud P, Drenos F, Shah S, Palmen S, Shah T, Kumari M, Kivimaki M, Pallas J, Casas J, Whittaker J, Hingorani A. EXPLORING THE GENETIC ARCHITECTURE OF LIPID TRAITS IN WHITEHALL II HEALTHY MEN AND WOMEN USING THE 50K-SNP CARDIO-METABOLIC CHIP. Atherosclerosis 2009. [DOI: 10.1016/j.atherosclerosis.2009.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jacob T, Clouden N, Hingorani A, Ascher E. The effect of cotinine on telomerase activity in human vascular smooth muscle cells. J Cardiovasc Surg (Torino) 2009; 50:345-349. [PMID: 19339962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM Cotinine, the main stable metabolite of nicotine, has been shown to have a biological half-life approximately 10 times longer than nicotine. It has also been demonstrated to have a powerful effect on vascular smooth muscle cell (VSMC) proliferation. Telomerase activation is known to play an important role in cell viability and proliferation. The purpose of our experiment was to evaluate the effect of cotinine on proliferative potential of vascular smooth muscle cells via its effects on telomerase activity. METHODS Primary cultures of human VSMC obtained from greater saphenous veins were used in this experiment from 3(rd) to 5(th) passage. Cotinine was added in doses equivalent to plasma levels of cotinine in an active smoker by dissolving, 0.0, 2.88x10(-6), 5.76x10(-6), and 1.44x10(-5) mol/L of cotinine in the media. The number of viable cells was assessed by trypan blue exclusion. The Telomeric Repeat Amplification Protocol (TRAP) was used to detect telomerase activity. TRAP products were detected by ELISA. RESULTS The mitogenic effect of cotinine in VSMC was observed at 48 hours after treatment. The viable cell numbers were significantly increased (4.0x10(7)) at lower doses of cotinine exposure as compared to untreated cultures (2.5x10(5)). At the concentration of 1.44x10(-5) mol/L, cotinine was cytotoxic to VSMCs. Telomerase activity was detected in all sets of VSMC cultures treated with cotinine (P<0.01). CONCLUSIONS Cotinine causes abnormal cell proliferation as demonstrated by increased cell numbers and reactivation of telomerase in a dose dependent manner. This study demonstrated cotinine's stimulatory effect on human SMC proliferation in vitro at low doses while high doses of cotinine had a toxic effect. These data correlate with the results of other studies concerning the mitogenic effect of cotinine and telomerase activation during cellular proliferative response.
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MESH Headings
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Cells, Cultured
- Cotinine/pharmacology
- Cotinine/toxicity
- Dose-Response Relationship, Drug
- Enzyme Activation
- Enzyme Activators/pharmacology
- Enzyme Activators/toxicity
- Humans
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/enzymology
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/enzymology
- Myocytes, Smooth Muscle/pathology
- Saphenous Vein/drug effects
- Saphenous Vein/enzymology
- Telomerase/metabolism
- Time Factors
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Affiliation(s)
- T Jacob
- Department of Surgery, Division of Vascular Surgery, Maimonides Medical Center, Brooklyn New York, New York, NY, USA.
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Humphries S, Talmud P, Drenos F, Shah S, Palmen J, Shah T, Kumari M, Pallas J, Casas J, Whittaker J, Hingorani A. Abstract: 527 GENETIC DETERMINANTS OF LDL-C LEVELS: USING THE 50K CARDIO-METABOLIC CHIP TO EXPLORE THE GENETIC ARCHITECTURE OF LIPID TRAITS IN WHITEHALL II. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70076-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shah T, Addo J, Newcombe P, Casas J, Smeeth L, Hingorani A. Abstract: P813 THE CONSIDERATION OF ETHNICITY IN CORONARY RISK PREDICTION USING CRP. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)71167-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hingorani A, Ascher E, Marks N, Shiferson A, Patel N, Gopal K, Jacob T. QS252. Iatrogenic Injuries of the Common Femoral Artery (CFA) and External Iliac Artery (EIA) During Endograft Placement: An Underdiagnosed Entity. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hingorani A, Ascher E, Marks N, Shiferson A, Patel N, Gopal K, Jacob T. QS255. Balloon Angioplasty of Venous Lesions to Facilitate Placement of Tunneled Cuffed Catheters for Hemodialysis. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jacob T, Hingorani A, Ascher E. Carotid Artery Stump Pressure (CASP) in 1135 consecutive endarterectomies under general anesthesia: an old method that survived the test of times. J Cardiovasc Surg (Torino) 2007; 48:677-681. [PMID: 17947923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM Intraoperative electroencephalography, somato-sensory evoked potentials and transcranial Doppler have been proposed to replace carotid artery stump pressure measurement (CASP) as the test of choice in the evaluation of cerebral tolerance during temporary carotid occlusion. CASP is a simple, inexpensive test that does not require an additional specialist in the operating room. Herein, we attempt to demonstrate that CASP is a reliable test that does not need to be replaced by more sophisticated and expensive techniques. METHODS Over the last 6 years, 1 135 consecutive carotid endarterectomies (CEA) were performed under general anesthesia at our institution. There were 592 males and 429 female patients with an age range of 39 to 95 years (mean 72 +/- 9 years). Hypertension, diabetes, smoking, coronary artery disease and chronic renal insufficiency were present in 71%, 39%, 36%, 32% and 26%, respectively. Internal carotid artery (ICA) stenosis ? 70% was confirmed by duplex scanning in 92% of the cases. The remaining 8% of cases had 50% to 69% ICA stenosis in neurologically symptomatic patients. Asymptomatic patients accounted for 75% of the cases. Contralateral ICA occlusion was observed in 57 cases (5%). Indwelling shunts were used when CASP was < 45 mmHg. Carotid patches were used in 233 cases. Completion duplex scanning was performed in all cases. CASP was measured by inserting a 23-gauge needle into the common carotid artery (CCA) after clamping the ICA to avert possible embolization during needle insertion. Once the tip of the needle was confirmed intraluminally by pressure measurement and triphasic waveform tracing, the CCA and the external carotid artery were clamped. After a flat line tracing was depicted on the monitor, ICA clamp was released and CASP was recorded. RESULTS CASP was < 45 mmHg in 233 cases (21%) (Group I) and > or = 45 mmHg in 902 cases (79%) (Group II). The mean CASP in presence of contralateral ICA occlusions was 40 +/- 15 mmHg while it was 65 +/- 27 mmHg for patent contralateral ICAs (P < 0.0001). The overall 30-day stroke rate was 1% (1 135 cases). It was 3% (7/233) for group I and 0.5% (4/902) for group II (P < 0.01). In patients with postoperative strokes CASP ranged from 23 to 44 mmHg (mean 33 +/- 8) in group I (shunted) and it varied from 59 to 116 mmHg (mean 99 +/- 28) in group II (non-shunted) with P < 0.001. The causes of stroke in group I were hyperperfusion (2), partial ICA thrombosis (2), embolization (2) and worsening of acute stroke (1). In group II there were 2 cases of embolization and 2 of ICA thrombosis. No patient had a stroke caused by decreased intraoperative global cerebral perfusion. The overall 30-day mortality rate was 0.5%. The overall combined stroke/death rate was 1.5%. CONCLUSION CASP > or = 45 mmHg was a reliable predictor of adequate cerebral perfusion during 1,135 consecutive CEAs performed under general anesthesia. The percentage of indwelling shunts utilized in this series was not significantly different from the ones using more expensive and sophisticated techniques.
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Affiliation(s)
- T Jacob
- Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA
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Hingorani A. Hyperglycemia independently increases the risk of perioperative stroke, myocardial infarction, and death after carotid endarterectomy. McGirt MJ, Woodworth GF, Brooke BS, et al. Neurosurgery. 2006;58:1066-1073. ACTA ACUST UNITED AC 2007; 19:415. [DOI: 10.1177/1531003507308793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ascher E, Hingorani A. Subintimal angioplasty. J Cardiovasc Surg (Torino) 2007; 48:45-8. [PMID: 17308521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
While the technique of subintimal dissection was described almost 2 decades ago, initial adoption of the technique was quite slow. Recently, a growing number of centers have embraced the technique as a valuable adjunct to standard endovascular and open revascularizations. During our experience with over 100 duplex guidance subintimal angioplasties (SIA) and over 100 flouroscopically guided SIA, we have encountered that persistence can be greatest ally. Fortunately, this is a trait that is common among vascular surgeons. Herein, we will describe the technique with focus on its limitations and advantages.
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Affiliation(s)
- E Ascher
- Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA.
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Hingorani A. Th-W58:1 Life time and variable cardiovascular risk - links to endothelial function. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81929-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hingorani A. OP19. ENDOTHELIAL CELL PATHOBIOLOGY. Rheumatology (Oxford) 2005. [DOI: 10.1093/rheumatology/keh744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jacob T, Ascher E, Alapat D, Olevskaia Y, Hingorani A. Activation of P38MAPK Signaling Cascade in a VSMC Injury Model: Role of P38MAPK Inhibitors in Limiting VSMC Proliferation. Eur J Vasc Endovasc Surg 2005; 29:470-8. [PMID: 15966085 DOI: 10.1016/j.ejvs.2005.01.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION P38 mitogen-activated protein kinase (MAPK) has a crucial role in regulating signaling pathways implicated in the cellular events leading to restenosis. We examine p38MAPK activation in response to vascular cell injury, its biological effects and determine whether selective p38MAPK inhibitors, SB220025/SB203580, decrease vascular smooth muscle cell (VSMC) proliferation. METHODS Human aortic VSMCs were cultured and wounds made on the monolayers to elicit mitogenic responses and induce p38MAPK activation. P38MAPK inhibitor pretreatment, at varying doses (1-100 microM) and treatment duration was used to block p38MAPK phosphorylation. Cytotoxicity, viability, proliferation and apoptosis were determined and expression of p38MAPK/phospho-p38MAPK was obtained by chemiluminiscent immunoblot analysis. RESULTS Phosphorylation of p38MAPK depended on injury severity and was inhibited by both p38MAPK inhibitors, but not by SB202474, a specific antagonist of p38MAPK inhibitors. VSMCs treated with p38MAPK inhibitors showed a dose-dependent decrease in viable cell number, apoptosis and proliferation, reversing the deleterious effects of p38MAPK activation comparable to controls (p < 0.05). CONCLUSIONS This wound injury model activates the p38MAPK-signaling cascade in VSMC and causes cell proliferation that can be abrogated by pre-incubation with p38MAPK selective synthetic inhibitors in a time and dose-dependent manner. SB220025 used here for the first time in VSMC reveals itself to be a stronger p38MAPK inhibitor than SB203580 and being a second generation inhibitor may be the preferred drug for novel therapeutic maneuvers.
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Affiliation(s)
- T Jacob
- Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA
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Shah T, Casas J, Cooper J, Hawe E, Stephens J, Yudkin J, Colhoun H, Bautista L, Meade T, Gaffney D, McMahon A, Hamsten A, Sattar N, Humphries S, Hingorani A. W12-P-066 Insight into the nature of the CRP-coronary event association using mendelian randomisation. ATHEROSCLEROSIS SUPP 2005. [DOI: 10.1016/s1567-5688(05)80309-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ascher E, Depippo PS, Hingorani A, Yorkovich W, Salles-Cunha S. Does repeat duplex ultrasound for lower extremity deep vein thrombosis influence patient management? Vasc Endovascular Surg 2005; 38:525-31. [PMID: 15592633 DOI: 10.1177/153857440403800606] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The clinical significance of lower extremity deep vein thrombus (DVT) propagation in the setting of anticoagulation therapy remains unclear. The purpose of this study is to compare results of thrombus outcome found with repeat duplex ultrasonography to the incidence of pulmonary embolism and mortality. During a recent 18-month period, 457 patients were diagnosed with lower extremity DVT with duplex ultrasonography and their data were retrospectively analyzed. Repeat examinations were available for review in 118 patients (51 men, 67 women). Results of repeat duplex exams were divided into 4 groups: resolved, improved, unchanged, or extended proximally. All patients received heparin and warfarin therapy. Ventilation-perfusion (V/ Q) scans were obtained only for signs and symptoms of pulmonary embolism (n=30). Mortality, the prevalence of high-probability V/ Q scans, frequency of intracaval filter insertion, gender, mean age, mean prothrombin time (PT), mean partial thromboplastin time (PTT), mean number of repeat ultrasounds per patient, and mean time over which the repeat ultrasounds took place were compared among the 4 groups. Patients who had proximal extension of DVT (19%) on repeat duplex ultrasound had an increased prevalence of pulmonary embolism (p<0.05). Also, patients whose DVT resolved were younger (p<0.05). There was no difference among the 4 groups in mortality, placement of Greenfield filters, mean PT, mean PTT, mean number of ultrasound exams per patient, or mean follow-up time over which the exams took place. Proximal extension of DVT documented by repeat duplex ultrasound is a significant risk factor for pulmonary embolism. Repeat duplex ultrasound can identify a group of patients who may benefit from insertion of an intracaval filter device.
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Affiliation(s)
- Enrico Ascher
- Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA.
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Hingorani A, Ascher E, Markevich N, Yorkovich W, Schutzer R, Hou A, Nahata S, Kallakuri S, Jacob T. The role of the endovascular surgeon for lower extremity ischemia. Acta Chir Belg 2004; 104:527-31. [PMID: 15571018 DOI: 10.1080/00015458.2004.11679609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
UNLABELLED Since the data investigating endovascular therapy performed by surgeons is scarce, we retrospectively reviewed our experience of endovascular procedures performed by vascular surgeons in the operating room for lower extremity ischemia due to stenotic lesions. METHODS A total of 14,424 procedures were performed by our division between January 1990--October 2003. Of these, 500 involved a balloon angioplasty. These made up 3.5% of the total caseload. The median age of the patients who underwent these 500 balloon angioplasty was 72+/-0.5 years old; 65% were male; 50% had a history of diabetes mellitus, and 6% had ESRD. Indications for the procedures included acute ischemia (47 cases), critical ischemia (rest pain, gangrene, or ischemic ulcers in 254 cases), failing bypass (64 cases), severe claudication (134 cases), and preoperative for a popliteal artery aneurysm repair. RESULTS 244 of the procedures were percutaneous, and the remaining 256 were combined with some type of open procedure. Those performed as an open technique were in combination with a bypass (135 cases) and in combination with a patch angioplasty (31cases). Balloon angioplasties were performed of the aorta (5 cases), iliac arteries (281 cases), the superficial femoral artery (SFA) (101 cases), the popliteal artery (44 cases), the tibial vessels (77 cases), the subclavian/axillary artery (5 cases) and failing grafts (26 cases). Balloon angioplasty was attempted in eight cases and failed due to inability to cross the lesion with a guidewire. Intraoperative complications included 4 dissections, inability to dilate the lesion adequately (2 cases), and rupture of two iliac lesions that underwent open repair (1 case) or repair with a stent graft (1 case). Stents were initially used highly selectively but recently are now being deployed more liberally in the iliac arteries (total 251 cases with stents). CONCLUSIONS Based on these data, we suggest that balloon angioplasty is a useful tool that can be performed by vascular surgeons safely. The advantages to the patients include one combined procedure to treat lower extremity ischemia.
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Affiliation(s)
- A Hingorani
- Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn, New York 11219, USA
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