Understanding the mechanisms governing the switch between hypoxia-induced adaptive and pathological transcription may reveal novel therapeutic targets for stroke. Using an in vitro hypoxia model that temporally separates these divergent responses, we found apoptotic signaling was preceded by a decline in c/EBP-β activity and was associated with markers of ER-stress including transient eIF2α phosphorylation, and the delayed induction of the bZIP proteins ATF4 and CHOP-10. Pretreatment with the eIF2α phosphatase inhibitor salubrinal blocked the activation of caspase-3, indicating that ER-related stress responses are integral to this transition. Delivery of either full-length, or a transcriptionally inactive form of c/EBP-β protected cultures from hypoxic challenge, in part by inducing levels of the anti-apoptotic protein Bcl-2. These data indicate that the pathologic response in cortical neurons induced by hypoxia involves both the loss of c/EBP-β-mediated survival signals and activation of pro-death pathways originating from the endoplasmic reticulum.
We report the first case of a purely isolated axillary artery dissection because of focal blunt trauma to the axilla. A 42-year-old man presented to our outpatient orthopedic clinic 7 days after a fall during a hockey game whereby another player's skate blade struck the patient directly in the axilla without disrupting the skin. The patient denied having any symptoms of shoulder dislocation but experienced some pain and numbness, which subsided rapidly. Then he developed a cool hand with exertional claudication. Physical examination revealed absent radial and brachial pulses. Computed tomographic angiography demonstrated dissection of the distal axillary artery extending to the middle two-thirds of the brachial artery. Following urgent consultation with vascular surgery, the patient was treated operatively with reverse saphenous interpositional grafting and embolectomy. This case illustrates the need to have a heightened index of suspicion to all injuries to the axilla and the importance of performing careful soft tissue and neurovascular examinations in hockey players presenting with shoulder complaints, even when bony injury is not present.
malnutrition (2.77; 1.79-4.31). Smokers had a lower rate of MACE (0.61; 0.49-0.75). History of MI, prior percutaneous coronary intervention, coronary artery bypass graft, or stroke did not have a significant effect on rate of MACE. Hospital characteristics, such as size, teaching status, and location, also were not significant. Patients who experienced MACE had a higher rate of complications including (Table IV): wound (7.25% vs 1.88%; P < .0001), infection (2.25% vs 0.24%; P < .0001), urinary (2.5% vs 1.14%; P ¼ .0109), pulmonary (10.75% vs 1.35%; P < .0001), gastrointestinal (1.25% vs 0.48%; P ¼ .0467), shock (2.25% vs 0.13%; P < .0001), intraoperative puncture (5% vs 0.7%; P < .0001), hemorrhage (5.5% vs 1.02%; P < .0001), and phlebitis (2.75% vs 0.55%; P < .0001). The average LOS was 9.54 days for patients with MACE compared to 2.53 days (P < .0001; Table V). Patients who experienced MACE incurred $53,630 per hospitalization compared with $26,915 (P < .0001). MACE was associated with a higher rate of nonroutine discharge (63% vs 16.49%; P < .0001) and mortality (22.5% vs 0.42%; P < .0001).Conclusions: The top predictors for MACE are fluid and electrolyte disorders, malnutrition, Asian race, and CAD. Although less than 1% of patients undergoing EVAR experience major cardiac complications, it is associated with a $26,715 increase in cost and a 22.5% mortality rate.
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