Methods: This was a retrospective analysis of all patients who underwent RAS for treatment of renovascular hypertension (RVH) between 2001 and 2007 at Dartmouth-Hitchcock Medical Center. The primary, outcome measure was blood pressure improvement or cure as judged by American Heart Association criteria. Estimated glomerular filtration rate (eGFR), number of antihypertensive medications, and survival were evaluated as secondary outcomes. Univariate and multivariate analyses were performed to identify factors associated with blood pressure improvement at the last follow-up.

Results: During the 6-year period, 129 patients (179 renal arteries) underwent

stent placement for RVH. Procedural complications occurred nine patients (7.0%). Average length follow-up was 1.5 Selleck Bucladesine years. Follow-up data were obtained in 122 patients (95%). At last follow-up, there were significant improvements in systolic blood pressure (161 vs 144 mm Hg, P<.001), diastolic blood pressure (80 vs 73 mm Hg, P<.001), and number of antihypertensive medications (3.1 vs 2.8, P=.034). The eGFR was improved in 16% of patients, stable in 60%, and worse in 24%. By multivariate analysis, a baseline eGFR <40 mL/min/1.73 m(2) (odds ratio, 1.6; 95% confidence interval TPCA-1 [CI], 1.0-2.9; P=.02) and female gender (OR, 1.3; 95% CI, 1.0-2.1; P=.04) were independent predictors of failure to achieve blood

old pressure improvement. By 2 and 4 years of follow-up, sustained blood pressure improvement was present in 67% of patients with a baseline eGFR of >= 40 mL/min/1.73 m(2) and in 31% of patients with a baseline eGFR <40 mL/min/1.73 m(2). During 2 years of follow-up, survival was similar between patients with sustained blood pressure response

and those without.

Conclusion: Patients treated for RVH who have a baseline eGFR of >= 40 mL/min/1.73 m(2) demonstrate a better response to RAS at each follow-up interval, with a significant difference at 2 to 4 years, compared with patients with an eGFR <40 mL/min/1.73 m(2). (J Vasc Surg 2010;51:380-5.)”
“Autism is a heterogeneous disorder involving complex mechanisms and systems occurring at diverse times. Because an individual child with autism may have only a subset of all possible abnormalities at a specific time, it may be challenging to identify beneficial effects of an intervention in double-blind, randomized, controlled trials, which compare the mean responses to treatments. Beneficial effects in a small subset of children may be obscured by the lack of effect in the majority. We review the evidence for several potential model systems of biochemical abnormalities that may contribute to the etiology of autism, we describe potential biomarkers or treatment targets for each of these abnormalities, and we provide illustrative treatment trials using this methodology.