Irfan I. Galaria

CCL11 (Eotaxin) Induces CCR3-Dependent Smooth Muscle Cell Migration

Objective—CCL11 (Eotaxin) is a potent eosinophil chemoattractant that is abundant in atheromatous plaques. The major receptor for CCL11 is CCR3, which is found on leukocytes and on some nonleukocytic cells. We sought to determine whether vascular smooth muscle cells (SMCs) possessed functional CCR3. Methods and Results—CCR3 mRNA (by RT-PCR) and protein (by Western blot analysis and flow cytometry) were present in mouse aortic SMCs. CCL11 induced concentration-dependent SMC chemotaxis in a modified Boyden chamber, with maximum effect seen at 100 ng/mL. SMC migration was markedly inhibited by antibody to CCR3, but not to CCR2. CCL11 also induced CCR3-dependent SMC migration in a scrape-wound assay. CCL11 had no effect on SMC proliferation. CCR3 and CCL11 staining were minimal in the normal arterial wall, but were abundant in medial SMC and intimal SMC 5 days and 28 days after mouse femoral arterial injury, respectively, times at which SMCs possess a more migratory phenotype. Conclusion—These data demonstrate that SMCs possess CCR3 under conditions associated with migration and that CCL11 is a potent chemotactic factor for SMCs. Because CCL11 is expressed abundantly in SMC-rich areas of the atherosclerotic plaque and in injured arteries, it may play an important role in regulating SMC migration.

Popliteal-to-Distal Bypass: Identifying Risk Factors Associated with Limb Loss and Graft Failure

Modern therapy, including endoluminal procedures and improved medical management, still yield less than desired results for tibial vessel occlusive disease. Despite the recent focus on these newer interventions, few modern series have evaluated the efficacy of popliteal-to-distal bypass procedures. The authors aimed to determine the efficacy of popliteal-distal bypass and to identify adverse prognostic factors for ultimate limb salvage. Eighty-seven patients (54 men; average age: 63 years) underwent 92 popliteal-distal bypasses. Duplex ultrasound was utilized to assess patency of all grafts. Data were analyzed by life-table analysis to determine patency rates at postoperative intervals. Median patient follow-up was 2.4 years. Major indications for bypass included chronic limb ischemia (86%) and disabling claudication (8%); 62% of the limbs were considered threatened, and 74% of the proximal anastomoses were above-knee. All procedures were technically successful. There were no perioperative (<30 days) deaths, and 86% of patients were alive at 5 years. Cumulative patency rates were 74% at 6 months, 70% at 2 years, and 63% at 5 years. Limb salvage rates closely paralleled patency rates. At 5 years, 62% of the affected limbs were intact; 72% of the limbs lost were associated with early (<180 days) bypass failures. Predictors of limb loss included early graft failure (84 days vs 1,288 days, p <0.0001), younger age (57 years vs 64 years, p = 0.039), history of previous ipsilateral vascular procedures (50% vs 21%, p = 0.03), heavy (>1 ppd) tobacco use (p = 0.001), and a thrombosed femoral-popliteal bypass at presentation (p = 0.002). When successful, popliteal-distal bypass is associated with excellent long-term patency and limb salvage rates. Early failures are often associated with limb loss. Heavy tobacco use, younger age, early graft failures, repeat revascularization, and presentation with a thrombosed femoral-popliteal graft are associated with limb loss.

Profile of GERD in the adult population of a north east urban community

Study An observational, cross-sectional, epidemiology study of the characteristics of GERD in a large northeast urban population was performed using a self-responding 84-question survey. Four-hundred and ten surveys were completed from a population sample with demographics comparable to those of the 1990 US Census data. Results No differences in heartburn frequency (monthly) were found between white or black, male or female respondents. Heartburn was significantly (P = 0.01) less common in those over age 60 (36.9%) than in young (47.7%) or middle-age (57.3%) respondents. Impact of heartburn on social activities was less (P = 0.002) in the over 60 group (4.9%) compared with the young (19.3%) or middle-age (20.0%) groups. Although 49.8% of respondents were familiar to the term GERD, few were aware that swallowing difficulty (17.3%), asthma (9.3%) or hoarseness (11.5%) were possible symptoms and similar numbers considered stroke (33.2%) and cancer (31.7%) to be complications of GERD. Conclusions Frequency of GERD symptoms in the United States is unaffected by gender or race but is lower in the elderly.