Unexpected intraoperative need for vascular surgical expertise occurs often enough that vascular surgeons should be regarded as an essential operating room resource to the general operating room, nonvascular surgeons, and their patients. Intraoperative vascular surgical consultation in support of other surgeons requires a high level of open technical operative skills and is time and labor intensive.

No abstract

Background:Blood glucose level (BGL) is routinely assessed by paramedics in the out-of-hospital setting. Most commonly, BGL is measured using a blood sample of capillary origin analyzed by a hand-held, point-of-care glucometer. In some clinical circumstances, the capillary sample may be replaced by blood of venous origin. Given most point-of-care glucometers are engineered to analyze capillary blood samples, the use of venous blood instead of capillary may lead to inaccurate or misleading measurements.Hypothesis/Problem:The aim of this prospective study was to compare mean difference in BGL between venous and capillary blood from healthy volunteers when measured using a capillary-based, hand-held, point-of-care glucometer.Methods:Using a prospective observational comparison design, 36 healthy participants provided paired samples of blood, one venous and the other capillary, taken near simultaneously. The BGL values were similar between the two groups. The capillary group had a range of 4.3mmol/l, with the lowest value being 4.4mmol/l and 8.7mmol/l the highest. The venous group had a range of 2.7mmol/l, with the lowest value being 4.1mmol/l and 7.0mmol/l the highest.For the primary research question, the mean BGL for the venous sample group was 5.3mmol/l (SD = 0.6), compared to 5.6mmol/l (SD = 0.8) for the capillary group. This represented a statistically significant difference of 0.3mmol/l (P = .04), but it did not reach the a priori established point of clinical significance (1.0mmol/l). Pearson’s correlation coefficient for capillary versus venous indicated moderate correlation (r = 0.42).Conclusion:In healthy, non-fasted people in a non-clinical setting, a statistically significant, but not clinically significant, difference was found between venous- and capillary-derived BGL when measured using a point-of-care, capillary-based glucometer. Correlation between the two was moderate. In this context, using venous samples in a capillary-based glucometer is reasonable providing the venous sample can be gathered without exposure of the clinician to risk of needle-stick injury. In clinical settings where physiological derangement or acute illness is present, capillary sampling would remain the optimal approach.

No abstract

Introduction: Stroke is a sexually dimorphic disease that affects men more severely than women. Transient receptor potential (TRP) channels have been implicated in ischemia-induced neuronal damage. We recently demonstrated that pharmacological and genetic inhibition of TRPM2, a member of the TRP channel superfamily, protects against cerebral ischemia in male mice, while having no effect in females. In addition, TRPM2 channels are activated by adenine dinucleotide phosphate ribose (ADPr) generated by poly(ADPr) polymerase (PARP). In this study, we examined the role of male sex steroids in TRPM2 engagement following experimental stroke. Methods: Focal ischemia was induced by 60 min of middle cerebral artery occlusion in male C57Bl/6 mice. To assess the efficacy of post-insult administration of TRPM2 inhibitor clotrimazole (CTZ), intact mice were treated with either CTZ (30 mg/kg) or vehicle 1 h after reperfusion. Mice were castrated (CAST) in order to remove sex steroids and either dihydrotestosterone (DHT) or vehicle was implanted. Then, animals were treated with either CTZ or vehicle 1 hr after reperfusion. The infarct sizes were evaluated in TRPM2 -/- mice to confirm TRPM2 engagement. We further compared the PARP activity in intact male and female brain to that in ischemic brain. Results: Animals treated with CTZ had significantly smaller infarcts compared to vehicle treated animals (46.2±3.1% (n=8) in vehicle vs. 32.5±3.6% (n=8; P<0.05) in CTZ). Removal of sex steroids resulted in loss of protection by CTZ (44.6±3.1% (n=9) in vehicle treated CAST vs. 35.8±3.6% (n=11) in CTZ treated CAST). Androgen replacement with DHT (CAST+DHT) resulted in recovery of CTZ protection (40.4±2.3% (n=12) in vehicle vs. 31.5±2.8% (n=11; P<0.05) in CTZ). TRPM2 -/- mice had smaller infarcts compared to wild type (28.4±7.0 (n=5) vs. 49.0±1.2 (n=5); P<0.05). We found higher PARP activity in male penumbral tissues compared to male normal tissues (P<0.05), while having no difference in females. Conclusions: These data indicate that TRPM2 inhibition provides protection from ischemic stroke in male animals in an androgen-dependent manner. Therefore, androgen status must be considered when considering inhibition of TRPM2 channels as a potential therapeutic strategy in men.