The lack of a consistent decrease in gray and white matter density argues against a progressive neurodegenerative process in essential tremor that leads to a substantial decrease in cerebellar gray matter volume. Patients with predominant intention tremor show a relative expansion of gray matter areas involved in higher order visuospatial processing, which might represent a long-term result of adaptive reorganization compensating the higher demands on the visuospatial control of skilled movements in case of trembling.
Conclusions:The 2006 Massachusetts insurance expansion was associated with a decreased probability of patients presenting with severe peripheral arterial disease (PAD) and resolution of measured racial disparities in presentation with severe PAD in Massachusetts.Summary: Lack of insurance coverage with poor access to care and non-white race have been shown to be associated with increased severity of PAD, decreased rates of revascularization and increased rates of amputation (
operative procedures at time of graduation for matriculating general surgery chief residents been impacted (P ¼ .56). Comments: The concern that specialty-specific training programs (vascular surgery from our perspective) would degrade the general surgery training experience has not materialized. This may be particularly true for vascular surgery programs since the shift in general surgery to laparoscopic techniques and ours to endovascular techniques have really taken us down different roads, which continues to evolve and differentiate. It should be noted that these results were potentially impacted by introducing offsite experience that marginally increased volume during this study. The latter is a good example of being a good steward of the opportunities available and could suggest steps open to other institutions facing similar conditions of training.
The Stent-Supported Percutaneous Angioplasty of the Carotid Artery versus Endarterectomy (SPACE) Trial is investigating if both treatment modalities are equivalent in the treatment of severe symptomatic carotid stenoses. Patients with symptomatic (transient ischaemic attack or minor stroke) stenosis (above 50% following the North American Symptomatic Endarterectomy Trial criteria) eligible for both methods can be recruited into this trial. The primary endpoint is the incidence of an ipsilateral stroke or death between randomisation and day 30 after treatment. Surgeons as well as the interventionalists have to demonstrate their expertise prior to participation in the trial. Funding is mostly by public institutions (Federal Ministry of Education and Research and German Research Foundation). An external monitoring is applied. Thirty-two centres are currently taking part in the SPACE Trial that has been running in Germany, Austria and Switzerland for 3 years, and they have been able to recruit a total of around 670 patients. The definitive results of this study cannot be expected before 3–5 years.
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