Objectives: We sought to describe the caliber and vascular health of the subclavian and axillary arteries as related to their potential utilization in complex cardiovascular procedures.Background: Patients referred for advanced catheter-based therapies frequently have lower

Background Patient selection and outcomes for percutaneous coronary intervention ( PCI ) and coronary artery bypass grafting ( CABG ) have changed over the past decade. However, there is limited information on outcomes for both revascularization strategies in the same population. The study evaluated temporal changes in risk profile, procedural characteristics, and clinical outcomes for PCI‐ and CABG ‐treated patients. Methods and Results We analyzed all PCI and isolated CABG between 2005 and 2017 in nonfederal hospitals in Washington State. Descriptive analysis was performed to evaluate temporal changes in risk profile and, risk‐adjusted in‐hospital mortality. Over the study period, 178 474 PCI and 36 592 CABG procedures were performed. PCI and CABG volume decreased by 2.9% and 22.6%, respectively. Compared with 2005–2009, patients receiving either form of revascularization between 2014 and 2017 had a higher prevalence of comorbidities including diabetes mellitus and hypertension and dialysis. Presentation with ST‐segment–elevation myocardial infarction (17% versus 20%) and cardiogenic shock (2.4% versus 3.4%) increased for patients with PCI compared with CABG. Conversely, clinical acuity decreased for patients receiving CABG over the study period. From 2005 to 2017, mean National Cardiovascular Data Registry Cath PCI mortality score increased for patients treated with PCI (20.1 versus 22.4, P <0.0001) and decreased for patients treated with CABG (18.8 versus 17.8, P <0.0001). Adjusted observed/expected in‐hospital mortality ratio increased for PCI (0.98 versus 1.19, P <0.0001) but decreased for CABG (1.21 versus 0.74, P <0.0001) over the study period. Conclusions Clinical acuity increased for patients treated with PCI rather than CABG . This resulted in an increase in adjusted observed/expected mortality ratio for patients undergoing PCI and a decrease for CABG . These shifts may reflect an increased use of PCI instead of CABG for patients considered to be at high surgical risk.

Aberrant crypt foci (ACF), the earliest identified monoclonal lesions in the colon, provide insights into changes that promote and/or accompany the transformation of normal colonic epithelial cells to colorectal cancer. Fatty acid synthase (FAS), the primary enzyme involved in de novo lipogenesis from carbohydrates, is expressed at low levels in most normal human tissues but is elevated in several human neoplasms including colorectal adenomas and carcinomas. To determine if this pathway is altered even earlier in colorectal tumorigenesis, 35 human ACF from 21 patients were evaluated for the immunohistochemical expression of FAS. Sections of colon cancer served as positive controls, and normal colonic mucosa distant from cancer or ACF served as negative controls. FAS expression was increased in 30 (86%) ACF compared with that in adjacent normal colonic mucosa. The expression of FAS in ACF was not related to the degree of dysplasia or to the number of crypts in the ACF. The over expression of FAS in a high proportion of ACF suggests that this enzyme plays an important role very early in colorectal tumorigenesis and may be a target for chemoprevention. ' UICCKey words: human aberrant crypt foci; colon cancer precursors; biomarkers; chemoprevention; colorectal cancer Fatty acid synthase (FAS) is the only mammalian enzyme capable of de novo long-chain fatty acid synthesis from smaller carbohydrate substrates. 1 In adults, it is expressed primarily in hormone-sensitive tissues and those with high lipid metabolism. 2 The expression and activity of FAS in normal tissues is highly regulated by diet, hormones and growth factors: carbohydrates, insulin, and transforming growth factor-beta all upregulate the expression and activity of FAS (reviewed in Ref. 3). In humans on a normal diet in industrialized countries, the expression and activity of FAS is low, even in lipogenic organs like liver and adipose tissue, because of its suppression by small amounts of dietary fatty acids. 3,4 Consequently, FAS plays only a minor role in human lipogenesis. 4 In contrast, FAS is highly expressed by many human cancers including prostate, breast, ovarian, endometrial, thyroid, colorectal (reviewed in Ref. 5); bladder, 6 lung, 7 oral mucosa, 8 tongue, 9 esophageal, 10 and stomach 11 carcinomas as well as melanoma, 12 retinoblastoma, 13 and nephroblastoma. 14 Increased expression of FAS has also been reported in some benign or preinvasive lesions of the prostate, colon, breast (reviewed in Refs. 5,15); lung, 7 cutaneous nevi, 12 and stomach. 11 We evaluated the expression of FAS in aberrant crypt foci (ACF), the earliest microscopically identified monoclonal lesions in the colon. 16 Increased expression of FAS was seen in 30 of 35 (86%) of ACF from 21 patients with sporadic colorectal cancer or familial adenomatous polyposis (FAP). Material and methodsParaffin-embedded sections of ACF with adjacent normal colonic mucosa or samples of human colorectal cancers were stored at 4°C for several months prior to immunohistochemical analysis as d...

Complications of percutaneous coronary intervention (PCI) may have significant impact on patient survival and healthcare costs. PCI procedural complexity and patient risk are increasing, and operators must be prepared to recognize and treat complications, such as perforations, dissections, hemodynamic collapse, no-reflow, and entrapped equipment. Unfortunately, few resources exist to train operators in PCI complication management. Uncertainty regarding complication management could contribute to the undertreatment of patients with high-complexity coronary disease. We, therefore, coordinated the Learning From Complications: How to Be a Better Interventionalist courses to disseminate the collective experience of high-volume PCI operators with extensive experience in chronic total occlusion and high-risk PCI. From these conferences in 2018 and 2019, we developed algorithms that emphasize early recognition, effective treatment, and team-based care of PCI complications. We think that an algorithmic approach will result in a logical and systematic response to life-threatening complications. This construct may be useful for operators who plan to perform complex PCI procedures.

Velocity of capillary flow in closed or open channels decreases as the flow proceeds down the length of the channel, varying as the inverse of the square root of time or as the inverse of travel distance. In order to increase the flow rate-and extend the duration of the flow-capillary pumps have been designed by mimicking the pumping principle of paper or cotton fibers. These designs provide a larger volume available for the wicking of the liquids.In microsystems for biotechnology, different designs have been developed based on experimental observation. In the present manuscript, the mechanisms at the basis of capillary pumping are investigated using a theoretical model for the flow in an open-channel "capillary tree" (i.e., an ensemble of channels with bifurcations mimicking the shape of a tree). The model is checked against experiments. Rules for obtaining better designs of capillary pumps are proposedspecifically we find: (1) when using a capillary tree with identical channel cross-sectional areas throughout, it is possible to maintain nearly constant flow rates throughout the channel network, (2) flow rate can be increased at each branch point of a capillary tree by slightly decreasing the areas of the channel cross-section and decreasing the channel lengths at each level of ramification within the tree, and (3) higher order branching (trifurcations vs. bifurcations) amplify the flow rate effect. This work lays the foundation for increasing the flow rate in open microfluidic channels driven by capillary flow; we expect this to have broad impact across open microfluidics for biological and chemical applications such as cell culture, sample preparation, separations, and onchip reactions.