Faculty Bibliography

We report a rare case of a 30-year-old female who had a long-standing history of middle aortic syndrome that was being managed nonsurgically. She presented with hypertension and buttock pain with plans to become pregnant. She underwent an aortoiliac bypass.

There is a clear association between carotid artery stenosis and cognitive impairment. However, there is no consensus as to how to interpret this association, and what, if any, impact this connection should have on the management of carotid stenosis. A review of the relevant literature suggests that although an intervention to relieve carotid stenosis in patients without clinically significant cognitive impairment does not improve cognition, there may be a cognitive benefit with intervention for carotid stenosis in those patients with clinically significant cognitive disorders.

We report the case of a 55-year-old female who presented with symptomatic high-grade stenosis of the right internal carotid artery, years after her diagnosis of moyamoya disease (MMD), which had been treated with extensive carotid and cerebral vascular reconstructions. A percutaneous carotid revascularization was unsuccessful, and a carotid endarterectomy with bovine patch angioplasty was subsequently performed. The presence of symptomatic atherosclerotic carotid disease in combination with MMD, with all the perioperative challenges, has not been previously described.

Background Transfemoral aortic valve replacement (TAVR) is a novel technique for treating aortic stenosis, yet vascular complications are yet to be delineated. Objectives This study aims to study the vascular complications of TAVR with Edwards Sapien valves (Edwards Lifesciences Corp., Irvine, CA). Methods We performed a retrospective evaluation of TAVR patients. Standard demographics, femoral vessel and sheath size, access type (femoral cut-down [FC], percutaneous access [PFA], and iliac conduit [IC]), and treatment method were recorded. Complications were defined by the Valve Academic Research Consortium Criteria. Logistic regression was used for statistical analysis. Results A total of 99 patients underwent TAVR between February 15, 2012 and July 17, 2013 with an Edwards Sapien valve. Out of which, 48 were males with a mean age of 83 ± 7 years. Overall, 33 had FC, 58 had PFA, and 6 had an IC. A total of 17 major (2 aortic and 15 iliac) and 38 minor complications (36 access and 2 emboli) occurred. Aortic complications were managed by open repair (OR, 1) or percutaneous repair (PR, 1). Overall, 12 iliac injuries were managed by PR and 3 by OR. Out of the 33 groin complications in FC patients 8 (24%) were treated by OR, whereas 30 (52%) of the 58 groin complications in PTA patients were treated by PR. There were no differences in transfusion requirements or length of stay. Conclusion Vascular complications of TAVR are common with most being minor, related to access site and causing no immediate sequelae. Iliac injury can be managed by PR or OR. Aortic injury is associated with significant mortality. These findings increase vascular surgeons' awareness of these complications and how to manage them.

MAIN CONCLUSION/CONCLUSIONS:The activation and level of expression of an endogenous, stress-responsive biosensor (bioreporter) can be visualized in real-time and non-destructively using highly accessible equipment (fluorometer). Biosensor output can be linked to computer-controlled systems to enable feedback-based control of a greenhouse environment. Today's agriculture requires an ability to precisely and rapidly assess the physiological stress status of plants in order to optimize crop yield. Here we describe the implementation and utility of a detection system based on a simple fluorometer design for real-time, continuous, and non-destructive monitoring of a genetically engineered biosensor plant. We report the responses to heat stress of Arabidopsis thaliana plants expressing a Yellow Fluorescent Protein bioreporter under the control of the DREB2A temperature-sensing promoter. Use of this bioreporter provides the ability to identify transient and steady-state behavior of gene activation in response to stress, and serves as an interface for novel experimental protocols. Models identified through such experiments inform the development of computer-based feedback control systems for the greenhouse environment, based on in situ monitoring of mature plants. More broadly, the work here provides a basis for informing biologists and engineers about the kinetics of bioreporter constructs, and also about ways in which other fluorescent protein constructs could be integrated into automated control systems.