Amarjit S. Arneja

Pharmacological basis of different targets for the treatment of atherosclerosis

The development of atherosclerotic plaque is a highly regulated and complex process which occurs as a result of structural and functional alterations in endothelial cells, smooth muscle cells (SMCs), monocytes/macrophages, T‐lymphocytes and platelets. The plaque formation in the coronary arteries or rupture of the plaque in the peripheral vasculature in latter stages of atherosclerosis triggers the onset of acute ischemic events involving myocardium. Although lipid lowering with statins has been established as an important therapy for the treatment of atherosclerosis, partially beneficial effects of statins beyond decreasing lipid levels has shifted the focus to develop newer drugs that can affect directly the process of atherosclerosis. Blockade of renin angiotensin system, augmentation of nitric oxide availability, reduction of Ca2+ influx, prevention of oxidative stress as well as attenuation of inflammation, platelet activation and SMC proliferation have been recognized as targets for drug treatment to control the development, progression and management of atherosclerosis. A major challenge for future drug development is to formulate a combination therapy affecting different targets to improve the treatment of atherosclerosis.

Rheumatoid nodules on amputation stumps: report of three cases.

We describe three patients, all of them lower limb amputees who also had seropositive, nodular rheumatoid arthritis. In each case, rheumatoid nodules developed on the amputation stump, causing difficulties with prosthesis fit and comfort and impairment of ambulation. Nodules were successfully excised in two cases and the prosthesis modified in the third. The patients were able to resume walking or transferring with their prostheses.

Sarpogrelate Inhibits Genes Involved in Vascular Neointimal Hyperplasia and Remodeling

Although basic molecular mechanisms of vascular neointimal hyperplasia leading to vascular remodeling remain unknown, it is generally held that various genes are upregu-lated or inhibited during this process. We have recently discovered that a specific serotonin receptor (5-HT2A) antagonist, sarpogrelate, inhibits vascular remodeling by suppressing the serotonin-induced c-fos and c-jun heterodimerization. By conducting RT-PCR and cell transfection studies, we have shown that over-expression of the 5-HT2A receptor enhanced while sarpogrelate inhibited vascular neoinitmal hyperplasia and remodeling by binding with the ligand binding domain (localized in the third intra-cytoplasmic loop) of the 5-HT2A receptor. These data are interpreted to suggest the therapeutic potential of sarpogrelate in cardiovascular diseases such as atherosclerosis, myocardial ischemia, and coronary artery restenosis.

Modification of Biochemical and Cellular Processes in the Development of Atherosclerosis by Red Wine

Atherosclerosis is commonly associated with unstable angina and acute myocardial infarction. It occurs as a result of a cascade of events caused by various environmental, dietary, genetic, and inflammatory factors. Different epidemiological studies have suggested that moderate amounts of red wine consumption reduce the risk of complications associated with atherosclerosis. This contention is further supported by a variety of experimental investigations demonstrating that both alcoholic and phenolic components are responsible for the apparent protective effects of red wine. The maintenance of endothelial function, augmentation in the levels of high-density lipoproteins (HDLs), prevention of low-density lipoprotein (LDL) oxidation, attenuation of smooth muscle proliferation and migration, inhibition of platelet aggregation and adhesion, as well as reduction in inflammatory mediators are major mechanisms linked with the protective effects of red wine. Despite these beneficial effects, insufficient information is available to recommend red wine as a therapeutic strategy to prevent atherosclerosis. Particularly, in view of high alcoholic content, excessive consumption of red wine can be seen to produce harmful effects. Therefore, a large-scale clinical trial is needed to determine the exact amount of red wine required for the beneficial effects and to categorize it as a future antiatherosclerotic agent.

Deep Vein Thrombosis in Amputee Patients

Discussion: The purpose of developing the templates was to ensure effective care while improving the outcomes. The templates achieved their said objectives of improving FIM scores and decreasing the length of stay. Overall length of stay significantly decreased in the two years that the templates were implemented. Conclusions: Use of templates has improved the Functional Independance Measures and decreased the length of stay while directing complex care in an effective fashion.

Poster 326 Assessment of Electromagnetic Field in the Treatment of Chronic Lower Back Pain in Patients With Osteoarthritis

Disclosures: A. Arneja, none. Objective: To examine the effects of electromagnetic field (EMF) therapy in patients with osteoarthritis and persistent pain. Design: Double-blind randomized placebo controlled study. Setting: Clinical therapy center. Participants: The subjects were randomized into 1 of 2 groups: EMF group (n 14; 60.3 9.7 years of age) and control group (n 8; 59.3 12.4 years of age). Interventions: Subjects assigned to the treatment group were exposed to EMF for 1 hour (0.92 Hz for 15 minutes; 7.7 Hz for 12 minutes; 9.6 Hz for 10 minutes; and 0.92 Hz for 23 minutes) at visits 2-8 by using a medical device resonator, whereas subjects in the placebo group underwent all procedures as the treatment arm, but the device was turned off during the session. Main Outcome Measures: Demographic questionnaire, medical history, the Roland Disability Questionnaire, Short Form 36 Health Survey at baseline. The Roland and Short Form 36 were repeated at the end of the study after visit 8. Mobility (forward and right-left lateral mobility), Visual Analog Pain Scale and McGill Total Pain Scale at visits 2-8. Results: The Roland Disability Questionnaire revealed a larger reduction in the total score in the EMF group compared with controls but did not reach significance. However, significant improvements in overall physical health (P .017), social functioning (P .008), and reduction in bodily pain (P .040) were observed in the EMF group. The pain relief rating scale showed a higher level of pain relief at the target area in the EMF group. Although a decrease in pain intensity was observed in the EMF group, an increase occurred in the control group. An increase in left lateral mobility was only seen in the EMF-treated group. Conclusions: EMF treatment resulted in improved physical functioning, health, and pain reduction compared with the control group.

Poster 37: Cardiovascular Morbidity and Mortality and Reamputation Rates Among Persons with Lower Extremity Amputations Secondary to Peripheral Vascular Occlusive Disease: A Manitoba Perspective

an average of 3.1 treatment visits. Conclusions: This long-term review in the management of BoNT-A in adult patients treated for muscle overactivity resulting from stroke, TBI and ACP summarizes commonly treated limb patterns, trends in dosing, selected muscles and treatment sessions. Our experience can be used to guide others in this useful treatment strategy.