LE KDs in obese patients are becoming increasingly prevalent. These patients are more likely to have nerve and vascular injuries and are more likely to undergo vascular repair than patients with HE trauma. The epidemic of obesity in the United States presents unique challenges in the identification and treatment of patients with LE KD and their associated injuries.

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Objectives Pseudoaneurysms are a well-recognized complication of percutaneous angiographic procedures. Ultrasound-guided thrombin injection is currently the preferred treatment modality. This study was undertaken to evaluate our experience with the management of post-procedure pseudoaneurysms. Methods A retrospective study was undertaken of all patients who developed a post-procedure pseudoaneurysm between March 2004 and January 2013. Data were obtained from our prospectively maintained non-invasive vascular laboratory data base. Results Overall, 167 patients (80 men) with post-procedure pseudoaneurysms were identified. The mean age was 66 years. Post-procedure pseudoaneurysms developed following diagnostic coronary angiography (38%), coronary angioplasty (37%), peripheral vascular interventions (14.7%), or other access procedures (7.6%). Mean post-procedure pseudoaneurysm diameter was 2.8 ± 1.8 cm. One hundred forty-two post-procedure pseudoaneurysms were injected with thrombin under ultrasound guidance. Primary success rate was 93.5%. There were 12 (8.5%) procedural failures of which seven (58%) responded to reinjection, three (25%) required operative management, one was treated with ultrasound-guided compression, and one (8.3%) was simply observed. On multivariate analysis, failures were associated with increased aneurysm diameter ( p = 0.006; odds ratio 2.23, 95% CI 1.25 to 3.96), end-stage renal disease ( p = 0.013; odds ratio 1.15, 95% CI 1.09 to 1.78) and superficial femoral artery aneurysm origin ( p = 0.031; odds ratio 0.20, 95% CI 0.04 to 0.86). There were two episodes of thrombus formation in the femoral artery; one resolved with anticoagulation alone, and the other required thrombectomy. Conclusions Percutaneous ultrasound-guided thrombin injection is an effective and safe method for managing post-procedure pseudoaneurysms. Failure rates are low and associated with large aneurysm size, superficial femoral artery origin and end-stage renal disease.

We have previously shown that patients with abdominal aortic aneurysm (AAA) have decreased number and diminished immune suppressive function of regulatory type 1 T cells (Tr1) and increased numbers of activated effector Th17 cells. The objective of this clinical trial was to assess the efficacy of allogeneic mesenchymal stem cells (MSCs) in inducing Tr1 cells and suppressing AAA inflammation. Methods: The AneuRysm Repression with mEsenchymal STem cells (ARREST) trial is a blinded, placebo-controlled phase 1 study in which patients with small AAA (30-to 50-mm diameter) are randomized to intravenous infusion of placebo (plasmalyte A), 1 million MSCs/kg, and 3 million MSCs/kg (n ¼ 12/group). Blood samples are collected at baseline and at days 3, 7, 14, 28, and 60 and yearly. The primary end point is change in the ratio of Tr1:Th17 cells at 14 days after treatment using flow cytometry. Secondary end points are changes in FoxP3 + T-regulatory cells, myeloid-derived suppressor cells, microRNA profiles, serum cytokine levels, changes in AAA inflammation as measured by 18-fluorodeoxyglucose positron emission tomography/computed tomography, and changes in aneurysm diameter and volume at years 1 to 5. Results: Twenty-one patients have been enrolled to date. There have been no treatment-related adverse events, and one patient withdrew after discovery of an occult pulmonary malignant neoplasm on baseline positron emission tomography/computed tomography. At day 14, the ratio of Tr1:Th17 cells increased by 20.3 6 1.3-fold from baseline for the highdose MSC group (n ¼ 7) compared with 4.3 6-fold for the low-dose group (n ¼ 7; P < .01) and À10 .66 2.3-fold for the placebo group (n ¼ 7; P ¼ .001; Fig). There was a decrease in 18-fluorodeoxyglucose uptake as measured by standard uptake values by 5.6% 61.3% in the combined MSC group (n ¼ 7) compared with an increase in standard uptake values of 4.1% 6 1.0% in the placebo group (n ¼ 4; P < .05). Although the sample size was too small for statistical comparison, the average increase in maximal transverse diameter of AAA at 12 months after treatment was À1.6 6 0.6 mm in the combined MSC group (n ¼ 4) and 4.3 6 0.9 mm in the placebo group. Conclusions: The results of the ARREST trial demonstrate a significant increase in Tr1 cells concurrent with a decrease in cytotoxic effector Th17 cells in an MSC dose-dependent fashion, achieving the primary end point. Preliminary data suggest that aneurysm inflammation and expansion are decreased with MSC treatment.

This research proposes, designs, and implements a new online system for electronic medical records (EMR) for assisting the current processes of labs and hospitals. Specific consideration is given to the records of blood donors. It provides an online automated alternate to the traditional manual processes adopted for various medical labs. The proposed system provides an easy way to communicate with the world. The article presents use case diagrams that model the logics of the system. It also proposes schema for supporting databases in the system. The system is prototyped, and ready to be used. To achieve the targeted system, in addition to investigating the latest studies in this area, the needed data was collected through a questionnaire survey with the community. The system, as a special case, has been oriented for the communities of the state of Kuwait to improve its healthcare sector. However, this design can be easily ported to other countries platforms due to its generic formulation.