Habib Khan - Academia.edu (original) (raw)
Papers by Habib Khan
Plant and Soil, 2007
Among grain legumes, faba bean is becoming increasingly popular in European agriculture due to re... more Among grain legumes, faba bean is becoming increasingly popular in European agriculture due to recent economic and environmental interests. Faba bean can be a highly productive crop, but it is sensitive to drought stress and yields can vary considerably from season to season. Understanding the physiological basis of drought tolerance would indicate traits that can be used as indirect selection criteria for the development of cultivars adapted to drought conditions. To assess genotypic variation in physiological traits associated with drought tolerance in faba bean and to determine relationships among these attributes, two pot experiments were established in a growth chamber using genetic materials that had previously been screened for drought response in the field. Nine inbred lines of diverse genetic backgrounds were tested under adequate water supply and limited water conditions. The genotypes showed substantial variation in shoot dry matter, water use, stomatal conductance, leaf temperature, transpiration efficiency, carbon isotope discrimination (Δ13C), relative water content (RWC) and osmotic potential, determined at pre-flowering vegetative stage. Moisture deficits decreased water usage and consequently shoot dry matter production. RWC, osmotic potential, stomatal conductance and Δ13C were lower, whereas leaf temperature and transpiration efficiency were higher in stressed plants, probably due to restricted transpirational cooling induced by stomatal closure. Furthermore, differences in stomatal conductance, leaf temperature, Δ13C and transpiration efficiency characterized genotypes that were physiologically more adapted to water deficit conditions. Correlation analysis also showed relatively strong relationships among these variables under well watered conditions. The drought tolerant genotypes, ILB-938/2 and Melodie showed lower stomatal conductance associated with warmer leaves, whereas higher stomatal conductance and cooler leaves were observed in sensitive lines (332/2/91/015/1 and Aurora/1). The lower value of Δ13C coupled with higher transpiration efficiency in ILB-938/2, relative to sensitive lines (Aurora/1 and Condor/3), is indeed a desirable characteristic for water-limited environments. Finally, the results showed that stomatal conductance, leaf temperature and Δ13C are promising physiological indicators for drought tolerance in faba bean. These variables could be measured in pot-grown plants at adequate water supply and may serve as indirect selection criteria to pre-screen genotypes.
RR35. Is There a Role for Duplex Ultrasound Surveillance after Endovascular Therapy for Infrainguinal Arterial Disease
Journal of Vascular Surgery, 2009
RR20. Secondary Endovascular Intervention after Failed Primary Intervention: Is it Warranted
Journal of Vascular Surgery, 2009
Does Renal Transplantation Improve Endovascular Interventional Outcomes for Patients with Chronic Renal Insufficiency
Journal of Vascular Surgery, 2010
European Journal of Cardiovascular Prevention & Rehabilitation, Volume 51, Issue 2, Pages 528... more European Journal of Cardiovascular Prevention & Rehabilitation, Volume 51, Issue 2, Pages 528, February 2010, Authors:Combiz Rezayat; Ashley Graham; Habib Khan; James McKinsey; Nicholas Morrisey; Rajeev Dayal; Harry Bush; John Karwowski; Roman Nowygrod. ...
Transactions of The ... Meeting of The American Surgical Association, 2008
Objectives: Endovascular options for the treatment of lower extremity peripheral arterial disease... more Objectives: Endovascular options for the treatment of lower extremity peripheral arterial disease are typified with diminished patency. A novel alternative to standard angioplasty and stent is the excision of the obstructing arterial plaque using a minimally invasive technique, the Silverhawk Atherectomy device. Methods: A prospective database was maintained of SilverHawk procedures from 2004 to 2007. A total of 579 lesions were treated in 275 patients (claudication 101 patients (36.7%) and critical limb ischemia (CLI) in 174 patients (63.3%). Noninvasive laboratory evaluation was performed at 1, 3, and 6 months, and yearly. Stand-alone atherectomy was attempted, and adjunct therapy was used for residual stenosis. Results: Mean age was 70.0 years (range, 37-102) (62.5% male, 46.2% smokers, 67.6% diabetes mellitus). Lesion characteristics were 199 superficial femoral arteries, 110 popliteal, 218 tibials, and 52 multilevel. Thirty-day perioperative mortality was 1.8%. Mean follow-up was 12.5 months (range, 0.5-48.2). 18-month primary and secondary patency for all lesions was 52.7% Ϯ 2.8 and 75.0% Ϯ 2.4 (P Ͻ 0.0001). Eighteen-month primary and secondary patency for claudicants was 58.0% Ϯ 4.3 and 82.5% Ϯ 3.5 (P Ͻ 0.0001) and for CLI was 49.4% Ϯ 3.7 and 69.9% Ϯ 3.2 (P Ͻ 0.0001), respectively. The reintervention rate was 25.3% in claudicants and 30.1% for CLI. Limb salvage was 100% in claudicants and overall limb salvage was 92.4% per patient at 18 months and only 4.4% required bypass. Conclusion: This is the largest reported series with the longest follow-up showing the SilverHawk device as an effective endovascular therapy for patients with claudication and CLI with a low mortality, low complications rate, low amputation rate, and rare need for conversion to surgical bypass. The majority of reintervention was performed with endovascular techniques.
Journal of Vascular Surgery, 2009
Objective: Historically, large randomized controlled studies looking at carotid endarterectomy (C... more Objective: Historically, large randomized controlled studies looking at carotid endarterectomy (CEA) have indicated an increased perioperative risk for women when gender subgroup analysis was performed. However, the outcomes of carotid stenting in women as compared to men have not been adequately investigated. We sought to compare the safety and efficacy of carotid angioplasty and stenting (CAS) when performed in women as compared to men. Methods: Procedures, complications, demographics, co-morbidities, and follow-up data from carotid stenting procedures performed in a bi-campus division were entered into a prospective database and then retrospectively supplemented with stored angiographic image data and reviewed. Arterial anatomic characteristics evaluated using angiographic images were: common carotid/internal carotid lesion length ratio, common carotid/internal carotid diameter, index lesion length, common carotid/internal carotid artery tortuosity, and lesion and aortic arch calcification. Outcomes compared included groin complications, postoperative pressor requirements, length of stay, restenosis, stroke, myocardial infarction (MI), and death. Results: Between 2003 and 2008, 228 patients underwent 238 procedures. Cerebral protection devices and selfexpanding stents were placed in all patients. A total of 97 percutaneous interventions performed in 93 women were compared with 141 interventions in 135 men. Mean age in women was 71.8 ؎ 9.2 years, in men was 72.2 ؎ 9.1 years (P > .99); 44.3% of women and 34.7% of men had symptomatic disease (P ؍ .14). Preoperative demographics and co-morbidities did not differ significantly between genders, with the exception of hypertension (83.0% of males vs 96.7% of females, P ؍ .001), and history of coronary artery bypass grafting (31.8% of males vs 16.1% of females, P ؍ .01). There were no significant differences seen in anatomic arterial characteristics, though there was a trend towards women having larger internal carotid to common carotid diameter ratios (0.65 vs 0.62) and more plaques isolated to the common carotid segment (9.5% vs 6.9%). There were no significant differences seen in overall 30-day peri-procedural stroke rate (2.1% in women and 4.2% in men, P ؍ .48), death rate (0 % vs 0.7%, P > .99), or cardiac events (3.2% vs 0.7%, P ؍ .3). The combined 30-day stroke, death, and MI rate was 5.7% for males compared to 5.4% for females (P > .99). There were no differences observed in the long-term survival, stroke-free survival, or restenosis between genders. Conclusion: Despite previous concerns over adverse outcomes in women undergoing carotid endarterectomy, from our data, carotid stenting appears to be a safe modality in women with equivalent outcomes when compared to men. ( J Vasc Surg 2009;49:315-24.)
RR35. Is There a Role for Duplex Ultrasound Surveillance after Endovascular Therapy for Infrainguinal Arterial Disease
Journal of Vascular Surgery, 2009
RR20. Secondary Endovascular Intervention after Failed Primary Intervention: Is it Warranted
Journal of Vascular Surgery, 2009
Does Renal Transplantation Improve Endovascular Interventional Outcomes for Patients with Chronic Renal Insufficiency
Journal of Vascular Surgery, 2010
European Journal of Cardiovascular Prevention & Rehabilitation, Volume 51, Issue 2, Pages 528... more European Journal of Cardiovascular Prevention & Rehabilitation, Volume 51, Issue 2, Pages 528, February 2010, Authors:Combiz Rezayat; Ashley Graham; Habib Khan; James McKinsey; Nicholas Morrisey; Rajeev Dayal; Harry Bush; John Karwowski; Roman Nowygrod. ...
Transactions of The ... Meeting of The American Surgical Association, 2008
Objectives: Endovascular options for the treatment of lower extremity peripheral arterial disease... more Objectives: Endovascular options for the treatment of lower extremity peripheral arterial disease are typified with diminished patency. A novel alternative to standard angioplasty and stent is the excision of the obstructing arterial plaque using a minimally invasive technique, the Silverhawk Atherectomy device. Methods: A prospective database was maintained of SilverHawk procedures from 2004 to 2007. A total of 579 lesions were treated in 275 patients (claudication 101 patients (36.7%) and critical limb ischemia (CLI) in 174 patients (63.3%). Noninvasive laboratory evaluation was performed at 1, 3, and 6 months, and yearly. Stand-alone atherectomy was attempted, and adjunct therapy was used for residual stenosis. Results: Mean age was 70.0 years (range, 37-102) (62.5% male, 46.2% smokers, 67.6% diabetes mellitus). Lesion characteristics were 199 superficial femoral arteries, 110 popliteal, 218 tibials, and 52 multilevel. Thirty-day perioperative mortality was 1.8%. Mean follow-up was 12.5 months (range, 0.5-48.2). 18-month primary and secondary patency for all lesions was 52.7% Ϯ 2.8 and 75.0% Ϯ 2.4 (P Ͻ 0.0001). Eighteen-month primary and secondary patency for claudicants was 58.0% Ϯ 4.3 and 82.5% Ϯ 3.5 (P Ͻ 0.0001) and for CLI was 49.4% Ϯ 3.7 and 69.9% Ϯ 3.2 (P Ͻ 0.0001), respectively. The reintervention rate was 25.3% in claudicants and 30.1% for CLI. Limb salvage was 100% in claudicants and overall limb salvage was 92.4% per patient at 18 months and only 4.4% required bypass. Conclusion: This is the largest reported series with the longest follow-up showing the SilverHawk device as an effective endovascular therapy for patients with claudication and CLI with a low mortality, low complications rate, low amputation rate, and rare need for conversion to surgical bypass. The majority of reintervention was performed with endovascular techniques.
Journal of Vascular Surgery, 2009
Objective: Historically, large randomized controlled studies looking at carotid endarterectomy (C... more Objective: Historically, large randomized controlled studies looking at carotid endarterectomy (CEA) have indicated an increased perioperative risk for women when gender subgroup analysis was performed. However, the outcomes of carotid stenting in women as compared to men have not been adequately investigated. We sought to compare the safety and efficacy of carotid angioplasty and stenting (CAS) when performed in women as compared to men. Methods: Procedures, complications, demographics, co-morbidities, and follow-up data from carotid stenting procedures performed in a bi-campus division were entered into a prospective database and then retrospectively supplemented with stored angiographic image data and reviewed. Arterial anatomic characteristics evaluated using angiographic images were: common carotid/internal carotid lesion length ratio, common carotid/internal carotid diameter, index lesion length, common carotid/internal carotid artery tortuosity, and lesion and aortic arch calcification. Outcomes compared included groin complications, postoperative pressor requirements, length of stay, restenosis, stroke, myocardial infarction (MI), and death. Results: Between 2003 and 2008, 228 patients underwent 238 procedures. Cerebral protection devices and selfexpanding stents were placed in all patients. A total of 97 percutaneous interventions performed in 93 women were compared with 141 interventions in 135 men. Mean age in women was 71.8 ؎ 9.2 years, in men was 72.2 ؎ 9.1 years (P > .99); 44.3% of women and 34.7% of men had symptomatic disease (P ؍ .14). Preoperative demographics and co-morbidities did not differ significantly between genders, with the exception of hypertension (83.0% of males vs 96.7% of females, P ؍ .001), and history of coronary artery bypass grafting (31.8% of males vs 16.1% of females, P ؍ .01). There were no significant differences seen in anatomic arterial characteristics, though there was a trend towards women having larger internal carotid to common carotid diameter ratios (0.65 vs 0.62) and more plaques isolated to the common carotid segment (9.5% vs 6.9%). There were no significant differences seen in overall 30-day peri-procedural stroke rate (2.1% in women and 4.2% in men, P ؍ .48), death rate (0 % vs 0.7%, P > .99), or cardiac events (3.2% vs 0.7%, P ؍ .3). The combined 30-day stroke, death, and MI rate was 5.7% for males compared to 5.4% for females (P > .99). There were no differences observed in the long-term survival, stroke-free survival, or restenosis between genders. Conclusion: Despite previous concerns over adverse outcomes in women undergoing carotid endarterectomy, from our data, carotid stenting appears to be a safe modality in women with equivalent outcomes when compared to men. ( J Vasc Surg 2009;49:315-24.)
Gastrointestinal Endoscopy, 2010
Gastrointestinal Endoscopy, 2010
Background and Aim: Carbon dioxide (CO2) insufflation during colonoscopy has been proven to effec... more Background and Aim: Carbon dioxide (CO2) insufflation during colonoscopy has been proven to effectively reduce post-procedure abdominal discomfort. However, CO2 delivery equipment is not yet a standard in endoscopy unit. Moreover, when and how to use CO2 insufflation remains uncertain. Because the inspection for the pathologic changes during colonoscopy takes place during the withdrawal of the scope, the withdrawal time at least over 6 minutes is essential for a qualified colonoscopy. This study is to determine whether CO2 insufflation only at withdrawal of colonoscopy has a comparable effect with full course CO2 usageMethod and Patients: From symptomatic patients subjected to colonoscopy were randomized in three groups: 1. patients given air insufflation (A); patients given CO2 insufflation only at the time of scope withdrawal (CW); and 3. patients given the CO2 insufflation (C) for the whole course of colonoscopy.The criteria for the exclusion from the study were: ageϽ 18 or Ͼ 75; status post right or left hemicolectomy; those scheduled for therapeutic colonoscopy such as polyp removal and lower gastrointestinal bleeding; patients known to have severe cardiopulmonary disease and patients with poor verbal communication. After colonoscopy, patients were requested to answer questionnaires about their pain score during, at the end, and 1 hour after procedure by using pain numerical scale ranging from 0 to 10. And was also asked as to how many hours was needed for the complete resolution of discomfort.Result: Total of 100 patients who completed questionnaires were enrolled. A/CW/C: 33/34/33. There was no statistic difference in age, gender, insertion/withdrawal time, and polyp detection rate among 3 groups. The pain score reveals no difference statistically during the insertion (p ϭ 0.957), but was noted at the end of procedure and 1 hour after procedure (p ϭ 0.026, p Ͻ 0.001). We further analyzed the scores between two of the three groups. Both CW (versus A; p ϭ 0.021, p ϭ 0.003) and C (versus A; p ϭ 0.033, p Ͻ 0.001) showed less post procedure pain when comparing with the A group. Moreover, the pain score between CW and C revealed equity at each time segment (p ϭ 0.725, p ϭ 0.272). More patients in the CW (20/33, 60.6%) and the C (20/34, 58.8%) reported complete resolution of discomfort within one hour when comparing to the A group (6/33, 18.1%) (p ϭ 0.007). No difference was noted between the CW and the C groups (p ϭ 0.767) Conclusion: CO2 insufflation merely at withdrawal of colonoscopy improved post-procedure abdominal discomfort and the effect was not inferior to the full course CO2 insufflation.
Gastrointestinal Endoscopy, 2009
Background: Transnasal esophagogastroduodenoscopy (TN-EGD) is now accepted as a screening tool fo... more Background: Transnasal esophagogastroduodenoscopy (TN-EGD) is now accepted as a screening tool for upper gastrointestinal disease due to its tolerability and safety. However, the diagnostic adequacy of a small gastric biopsied specimen according to the location of the lesion has not been fully evaluated. We tried to explore the quality and quantity of TN-EGD biopsied specimens according to where they were obtained inside the stomach. Method: Two hundred and eighty-nine gastric biopsy specimens obtained from 117 patients who underwent diagnostic TN-EGD. The gastric biopsied specimens were quantified according to their diameter in um, depth in um, and depth in layers (superficial mucosa, deep mucosa, muscularis mucosa, and submucosa). Their quality was measured by the degree of anatomical orientation (good, intermediate, and poor), presence of crush artifact (none to minimal, mild, and moderate), and overall diagnostic adequacy (adequate, suboptimal, and inadequate). Results: Poor orientation, presence of crush, and overall diagnostic inadequacy were present in 33 (11.4%), 26 (9.0%), and 37 (12.8%) of the 289 specimens, respectively. Deep mucosa was present in 211 specimens (73.0%) while muscularis mucosa was present in only 75 specimens (26.0%). Specimens taken from the posterior aspect of the cardia exhibited the shallowest depth (p Z 0.011) ), poorest orientation (p ! 0.001), and poorest adequacy (p ! 0.001). Conclusions: TN-EGD biopsied specimens obtained from the posterior aspect of the cardia exhibit limitations in both quality and quantity. When performing a biopsy using TN-EGD, special attention should be paid to gastric lesions located on the posterior aspect of the cardia.
Group work activities are one of the main point or task in the high education. Switzer and Shrine... more Group work activities are one of the main point or task in the high education. Switzer and Shriner (2000) were of the view that students are the most obvious party who benefit from group work among students, faculty members, and the community. According to them there are four overlapping types of benefits for students. These are: 1) immediate educational benefits, 2) immediate social benefits, 3) critical thinking benefits, and 4) long-term career benefits. Lawrance (1992) , and Yates were of the opinion that face to face communication will not solve the empowerment problems in group work activities. As, through FTF interaction male dominant role can be produced due to identity of speaker, eye contact, nodding, moving the hands , and facial expressions etc. In this situation suitable adoption of technology can be consider as an alternative mode of communication, where there is a chance of discrimination.
Plant and Soil, 2007
Among grain legumes, faba bean is becoming increasingly popular in European agriculture due to re... more Among grain legumes, faba bean is becoming increasingly popular in European agriculture due to recent economic and environmental interests. Faba bean can be a highly productive crop, but it is sensitive to drought stress and yields can vary considerably from season to season. Understanding the physiological basis of drought tolerance would indicate traits that can be used as indirect selection criteria for the development of cultivars adapted to drought conditions. To assess genotypic variation in physiological traits associated with drought tolerance in faba bean and to determine relationships among these attributes, two pot experiments were established in a growth chamber using genetic materials that had previously been screened for drought response in the field. Nine inbred lines of diverse genetic backgrounds were tested under adequate water supply and limited water conditions. The genotypes showed substantial variation in shoot dry matter, water use, stomatal conductance, leaf temperature, transpiration efficiency, carbon isotope discrimination (Δ13C), relative water content (RWC) and osmotic potential, determined at pre-flowering vegetative stage. Moisture deficits decreased water usage and consequently shoot dry matter production. RWC, osmotic potential, stomatal conductance and Δ13C were lower, whereas leaf temperature and transpiration efficiency were higher in stressed plants, probably due to restricted transpirational cooling induced by stomatal closure. Furthermore, differences in stomatal conductance, leaf temperature, Δ13C and transpiration efficiency characterized genotypes that were physiologically more adapted to water deficit conditions. Correlation analysis also showed relatively strong relationships among these variables under well watered conditions. The drought tolerant genotypes, ILB-938/2 and Melodie showed lower stomatal conductance associated with warmer leaves, whereas higher stomatal conductance and cooler leaves were observed in sensitive lines (332/2/91/015/1 and Aurora/1). The lower value of Δ13C coupled with higher transpiration efficiency in ILB-938/2, relative to sensitive lines (Aurora/1 and Condor/3), is indeed a desirable characteristic for water-limited environments. Finally, the results showed that stomatal conductance, leaf temperature and Δ13C are promising physiological indicators for drought tolerance in faba bean. These variables could be measured in pot-grown plants at adequate water supply and may serve as indirect selection criteria to pre-screen genotypes.
RR35. Is There a Role for Duplex Ultrasound Surveillance after Endovascular Therapy for Infrainguinal Arterial Disease
Journal of Vascular Surgery, 2009
RR20. Secondary Endovascular Intervention after Failed Primary Intervention: Is it Warranted
Journal of Vascular Surgery, 2009
Does Renal Transplantation Improve Endovascular Interventional Outcomes for Patients with Chronic Renal Insufficiency
Journal of Vascular Surgery, 2010
European Journal of Cardiovascular Prevention & Rehabilitation, Volume 51, Issue 2, Pages 528... more European Journal of Cardiovascular Prevention & Rehabilitation, Volume 51, Issue 2, Pages 528, February 2010, Authors:Combiz Rezayat; Ashley Graham; Habib Khan; James McKinsey; Nicholas Morrisey; Rajeev Dayal; Harry Bush; John Karwowski; Roman Nowygrod. ...
Transactions of The ... Meeting of The American Surgical Association, 2008
Objectives: Endovascular options for the treatment of lower extremity peripheral arterial disease... more Objectives: Endovascular options for the treatment of lower extremity peripheral arterial disease are typified with diminished patency. A novel alternative to standard angioplasty and stent is the excision of the obstructing arterial plaque using a minimally invasive technique, the Silverhawk Atherectomy device. Methods: A prospective database was maintained of SilverHawk procedures from 2004 to 2007. A total of 579 lesions were treated in 275 patients (claudication 101 patients (36.7%) and critical limb ischemia (CLI) in 174 patients (63.3%). Noninvasive laboratory evaluation was performed at 1, 3, and 6 months, and yearly. Stand-alone atherectomy was attempted, and adjunct therapy was used for residual stenosis. Results: Mean age was 70.0 years (range, 37-102) (62.5% male, 46.2% smokers, 67.6% diabetes mellitus). Lesion characteristics were 199 superficial femoral arteries, 110 popliteal, 218 tibials, and 52 multilevel. Thirty-day perioperative mortality was 1.8%. Mean follow-up was 12.5 months (range, 0.5-48.2). 18-month primary and secondary patency for all lesions was 52.7% Ϯ 2.8 and 75.0% Ϯ 2.4 (P Ͻ 0.0001). Eighteen-month primary and secondary patency for claudicants was 58.0% Ϯ 4.3 and 82.5% Ϯ 3.5 (P Ͻ 0.0001) and for CLI was 49.4% Ϯ 3.7 and 69.9% Ϯ 3.2 (P Ͻ 0.0001), respectively. The reintervention rate was 25.3% in claudicants and 30.1% for CLI. Limb salvage was 100% in claudicants and overall limb salvage was 92.4% per patient at 18 months and only 4.4% required bypass. Conclusion: This is the largest reported series with the longest follow-up showing the SilverHawk device as an effective endovascular therapy for patients with claudication and CLI with a low mortality, low complications rate, low amputation rate, and rare need for conversion to surgical bypass. The majority of reintervention was performed with endovascular techniques.
Journal of Vascular Surgery, 2009
Objective: Historically, large randomized controlled studies looking at carotid endarterectomy (C... more Objective: Historically, large randomized controlled studies looking at carotid endarterectomy (CEA) have indicated an increased perioperative risk for women when gender subgroup analysis was performed. However, the outcomes of carotid stenting in women as compared to men have not been adequately investigated. We sought to compare the safety and efficacy of carotid angioplasty and stenting (CAS) when performed in women as compared to men. Methods: Procedures, complications, demographics, co-morbidities, and follow-up data from carotid stenting procedures performed in a bi-campus division were entered into a prospective database and then retrospectively supplemented with stored angiographic image data and reviewed. Arterial anatomic characteristics evaluated using angiographic images were: common carotid/internal carotid lesion length ratio, common carotid/internal carotid diameter, index lesion length, common carotid/internal carotid artery tortuosity, and lesion and aortic arch calcification. Outcomes compared included groin complications, postoperative pressor requirements, length of stay, restenosis, stroke, myocardial infarction (MI), and death. Results: Between 2003 and 2008, 228 patients underwent 238 procedures. Cerebral protection devices and selfexpanding stents were placed in all patients. A total of 97 percutaneous interventions performed in 93 women were compared with 141 interventions in 135 men. Mean age in women was 71.8 ؎ 9.2 years, in men was 72.2 ؎ 9.1 years (P > .99); 44.3% of women and 34.7% of men had symptomatic disease (P ؍ .14). Preoperative demographics and co-morbidities did not differ significantly between genders, with the exception of hypertension (83.0% of males vs 96.7% of females, P ؍ .001), and history of coronary artery bypass grafting (31.8% of males vs 16.1% of females, P ؍ .01). There were no significant differences seen in anatomic arterial characteristics, though there was a trend towards women having larger internal carotid to common carotid diameter ratios (0.65 vs 0.62) and more plaques isolated to the common carotid segment (9.5% vs 6.9%). There were no significant differences seen in overall 30-day peri-procedural stroke rate (2.1% in women and 4.2% in men, P ؍ .48), death rate (0 % vs 0.7%, P > .99), or cardiac events (3.2% vs 0.7%, P ؍ .3). The combined 30-day stroke, death, and MI rate was 5.7% for males compared to 5.4% for females (P > .99). There were no differences observed in the long-term survival, stroke-free survival, or restenosis between genders. Conclusion: Despite previous concerns over adverse outcomes in women undergoing carotid endarterectomy, from our data, carotid stenting appears to be a safe modality in women with equivalent outcomes when compared to men. ( J Vasc Surg 2009;49:315-24.)
RR35. Is There a Role for Duplex Ultrasound Surveillance after Endovascular Therapy for Infrainguinal Arterial Disease
Journal of Vascular Surgery, 2009
RR20. Secondary Endovascular Intervention after Failed Primary Intervention: Is it Warranted
Journal of Vascular Surgery, 2009
Does Renal Transplantation Improve Endovascular Interventional Outcomes for Patients with Chronic Renal Insufficiency
Journal of Vascular Surgery, 2010
European Journal of Cardiovascular Prevention & Rehabilitation, Volume 51, Issue 2, Pages 528... more European Journal of Cardiovascular Prevention & Rehabilitation, Volume 51, Issue 2, Pages 528, February 2010, Authors:Combiz Rezayat; Ashley Graham; Habib Khan; James McKinsey; Nicholas Morrisey; Rajeev Dayal; Harry Bush; John Karwowski; Roman Nowygrod. ...
Transactions of The ... Meeting of The American Surgical Association, 2008
Objectives: Endovascular options for the treatment of lower extremity peripheral arterial disease... more Objectives: Endovascular options for the treatment of lower extremity peripheral arterial disease are typified with diminished patency. A novel alternative to standard angioplasty and stent is the excision of the obstructing arterial plaque using a minimally invasive technique, the Silverhawk Atherectomy device. Methods: A prospective database was maintained of SilverHawk procedures from 2004 to 2007. A total of 579 lesions were treated in 275 patients (claudication 101 patients (36.7%) and critical limb ischemia (CLI) in 174 patients (63.3%). Noninvasive laboratory evaluation was performed at 1, 3, and 6 months, and yearly. Stand-alone atherectomy was attempted, and adjunct therapy was used for residual stenosis. Results: Mean age was 70.0 years (range, 37-102) (62.5% male, 46.2% smokers, 67.6% diabetes mellitus). Lesion characteristics were 199 superficial femoral arteries, 110 popliteal, 218 tibials, and 52 multilevel. Thirty-day perioperative mortality was 1.8%. Mean follow-up was 12.5 months (range, 0.5-48.2). 18-month primary and secondary patency for all lesions was 52.7% Ϯ 2.8 and 75.0% Ϯ 2.4 (P Ͻ 0.0001). Eighteen-month primary and secondary patency for claudicants was 58.0% Ϯ 4.3 and 82.5% Ϯ 3.5 (P Ͻ 0.0001) and for CLI was 49.4% Ϯ 3.7 and 69.9% Ϯ 3.2 (P Ͻ 0.0001), respectively. The reintervention rate was 25.3% in claudicants and 30.1% for CLI. Limb salvage was 100% in claudicants and overall limb salvage was 92.4% per patient at 18 months and only 4.4% required bypass. Conclusion: This is the largest reported series with the longest follow-up showing the SilverHawk device as an effective endovascular therapy for patients with claudication and CLI with a low mortality, low complications rate, low amputation rate, and rare need for conversion to surgical bypass. The majority of reintervention was performed with endovascular techniques.
Journal of Vascular Surgery, 2009
Objective: Historically, large randomized controlled studies looking at carotid endarterectomy (C... more Objective: Historically, large randomized controlled studies looking at carotid endarterectomy (CEA) have indicated an increased perioperative risk for women when gender subgroup analysis was performed. However, the outcomes of carotid stenting in women as compared to men have not been adequately investigated. We sought to compare the safety and efficacy of carotid angioplasty and stenting (CAS) when performed in women as compared to men. Methods: Procedures, complications, demographics, co-morbidities, and follow-up data from carotid stenting procedures performed in a bi-campus division were entered into a prospective database and then retrospectively supplemented with stored angiographic image data and reviewed. Arterial anatomic characteristics evaluated using angiographic images were: common carotid/internal carotid lesion length ratio, common carotid/internal carotid diameter, index lesion length, common carotid/internal carotid artery tortuosity, and lesion and aortic arch calcification. Outcomes compared included groin complications, postoperative pressor requirements, length of stay, restenosis, stroke, myocardial infarction (MI), and death. Results: Between 2003 and 2008, 228 patients underwent 238 procedures. Cerebral protection devices and selfexpanding stents were placed in all patients. A total of 97 percutaneous interventions performed in 93 women were compared with 141 interventions in 135 men. Mean age in women was 71.8 ؎ 9.2 years, in men was 72.2 ؎ 9.1 years (P > .99); 44.3% of women and 34.7% of men had symptomatic disease (P ؍ .14). Preoperative demographics and co-morbidities did not differ significantly between genders, with the exception of hypertension (83.0% of males vs 96.7% of females, P ؍ .001), and history of coronary artery bypass grafting (31.8% of males vs 16.1% of females, P ؍ .01). There were no significant differences seen in anatomic arterial characteristics, though there was a trend towards women having larger internal carotid to common carotid diameter ratios (0.65 vs 0.62) and more plaques isolated to the common carotid segment (9.5% vs 6.9%). There were no significant differences seen in overall 30-day peri-procedural stroke rate (2.1% in women and 4.2% in men, P ؍ .48), death rate (0 % vs 0.7%, P > .99), or cardiac events (3.2% vs 0.7%, P ؍ .3). The combined 30-day stroke, death, and MI rate was 5.7% for males compared to 5.4% for females (P > .99). There were no differences observed in the long-term survival, stroke-free survival, or restenosis between genders. Conclusion: Despite previous concerns over adverse outcomes in women undergoing carotid endarterectomy, from our data, carotid stenting appears to be a safe modality in women with equivalent outcomes when compared to men. ( J Vasc Surg 2009;49:315-24.)
Gastrointestinal Endoscopy, 2010
Gastrointestinal Endoscopy, 2010
Background and Aim: Carbon dioxide (CO2) insufflation during colonoscopy has been proven to effec... more Background and Aim: Carbon dioxide (CO2) insufflation during colonoscopy has been proven to effectively reduce post-procedure abdominal discomfort. However, CO2 delivery equipment is not yet a standard in endoscopy unit. Moreover, when and how to use CO2 insufflation remains uncertain. Because the inspection for the pathologic changes during colonoscopy takes place during the withdrawal of the scope, the withdrawal time at least over 6 minutes is essential for a qualified colonoscopy. This study is to determine whether CO2 insufflation only at withdrawal of colonoscopy has a comparable effect with full course CO2 usageMethod and Patients: From symptomatic patients subjected to colonoscopy were randomized in three groups: 1. patients given air insufflation (A); patients given CO2 insufflation only at the time of scope withdrawal (CW); and 3. patients given the CO2 insufflation (C) for the whole course of colonoscopy.The criteria for the exclusion from the study were: ageϽ 18 or Ͼ 75; status post right or left hemicolectomy; those scheduled for therapeutic colonoscopy such as polyp removal and lower gastrointestinal bleeding; patients known to have severe cardiopulmonary disease and patients with poor verbal communication. After colonoscopy, patients were requested to answer questionnaires about their pain score during, at the end, and 1 hour after procedure by using pain numerical scale ranging from 0 to 10. And was also asked as to how many hours was needed for the complete resolution of discomfort.Result: Total of 100 patients who completed questionnaires were enrolled. A/CW/C: 33/34/33. There was no statistic difference in age, gender, insertion/withdrawal time, and polyp detection rate among 3 groups. The pain score reveals no difference statistically during the insertion (p ϭ 0.957), but was noted at the end of procedure and 1 hour after procedure (p ϭ 0.026, p Ͻ 0.001). We further analyzed the scores between two of the three groups. Both CW (versus A; p ϭ 0.021, p ϭ 0.003) and C (versus A; p ϭ 0.033, p Ͻ 0.001) showed less post procedure pain when comparing with the A group. Moreover, the pain score between CW and C revealed equity at each time segment (p ϭ 0.725, p ϭ 0.272). More patients in the CW (20/33, 60.6%) and the C (20/34, 58.8%) reported complete resolution of discomfort within one hour when comparing to the A group (6/33, 18.1%) (p ϭ 0.007). No difference was noted between the CW and the C groups (p ϭ 0.767) Conclusion: CO2 insufflation merely at withdrawal of colonoscopy improved post-procedure abdominal discomfort and the effect was not inferior to the full course CO2 insufflation.
Gastrointestinal Endoscopy, 2009
Background: Transnasal esophagogastroduodenoscopy (TN-EGD) is now accepted as a screening tool fo... more Background: Transnasal esophagogastroduodenoscopy (TN-EGD) is now accepted as a screening tool for upper gastrointestinal disease due to its tolerability and safety. However, the diagnostic adequacy of a small gastric biopsied specimen according to the location of the lesion has not been fully evaluated. We tried to explore the quality and quantity of TN-EGD biopsied specimens according to where they were obtained inside the stomach. Method: Two hundred and eighty-nine gastric biopsy specimens obtained from 117 patients who underwent diagnostic TN-EGD. The gastric biopsied specimens were quantified according to their diameter in um, depth in um, and depth in layers (superficial mucosa, deep mucosa, muscularis mucosa, and submucosa). Their quality was measured by the degree of anatomical orientation (good, intermediate, and poor), presence of crush artifact (none to minimal, mild, and moderate), and overall diagnostic adequacy (adequate, suboptimal, and inadequate). Results: Poor orientation, presence of crush, and overall diagnostic inadequacy were present in 33 (11.4%), 26 (9.0%), and 37 (12.8%) of the 289 specimens, respectively. Deep mucosa was present in 211 specimens (73.0%) while muscularis mucosa was present in only 75 specimens (26.0%). Specimens taken from the posterior aspect of the cardia exhibited the shallowest depth (p Z 0.011) ), poorest orientation (p ! 0.001), and poorest adequacy (p ! 0.001). Conclusions: TN-EGD biopsied specimens obtained from the posterior aspect of the cardia exhibit limitations in both quality and quantity. When performing a biopsy using TN-EGD, special attention should be paid to gastric lesions located on the posterior aspect of the cardia.
Group work activities are one of the main point or task in the high education. Switzer and Shrine... more Group work activities are one of the main point or task in the high education. Switzer and Shriner (2000) were of the view that students are the most obvious party who benefit from group work among students, faculty members, and the community. According to them there are four overlapping types of benefits for students. These are: 1) immediate educational benefits, 2) immediate social benefits, 3) critical thinking benefits, and 4) long-term career benefits. Lawrance (1992) , and Yates were of the opinion that face to face communication will not solve the empowerment problems in group work activities. As, through FTF interaction male dominant role can be produced due to identity of speaker, eye contact, nodding, moving the hands , and facial expressions etc. In this situation suitable adoption of technology can be consider as an alternative mode of communication, where there is a chance of discrimination.