A scoring system based on anatomic criteria has been developed to facilitate patient selection

for CAS. Advancements in simulation science also enable IWP-2 solubility dmso case evaluation through patient-specific virtual reality (VR) rehearsal on an endovascular simulator. This study aimed to validate the anatomic scoring system for CAS using the patient-specific VR technology.

Methods: Three patients were selected and graded according to the CAS scoring system (maximum score, 9): one easy (score, <4.9), one intermediate (score, 5.0-5.9), and one difficult (score, >7.0). The three cases were performed on the simulator in random order by 20 novice interventionalists pretrained in CAS. Technical performances were assessed using simulator-based metrics and expert-based ratings.

Results: The interventionalists took significantly longer to perform the difficult CAS case (median, 31.6 vs 19.7 vs 14.6 minutes; P < .0001) compared with the intermediate and easy cases; similarly, more fluoroscopy time (20.7 vs 12.1 vs 8.2 minutes; P <. 0001), contrast volume (56.5 vs 51.5 vs 50.0 mL; P = .0060), and roadmaps (10 vs 9 vs mTOR inhibitor 9; P = .0040) were used. The quality of performance declined significantly as the cases became more

challenging (score, 24 vs 22 vs 19; P < .0001).

Conclusions: The anatomic scoring system for CAS can predict the difficulty of a CAS procedure as measured by patient-specific VR. This scoring system, with or

without the additional use of patient-specific VR, can guide Docetaxel chemical structure novice interventionalists in selecting appropriate patients for CAS. This may reduce the perioperative stroke risk and enhance patient safety. (J Vasc Surg 2012;56:1763-70.)”
“The intrinsically unfolded protein a-synuclein has an N-terminal domain with seven imperfect KTKEGV sequence repeats and a C-terminal domain with a large proportion of acidic residues. We characterized pK(a) values for all 26 sites in the protein that ionize below pH 7 using 2D H-1-N-15 HSQC and 3D C(CO)NH NMR experiments. The N-terminal domain shows systematically lowered pK(a) values, suggesting weak electrostatic interactions between acidic and basic residues in the KTKEGV repeats. By contrast, the C-terminal domain shows elevated pKa values due to electrostatic repulsion between like charges. The effects are smaller but persist at physiological salt concentrations. For alpha-synuclein in the membrane-like environment of sodium dodecylsulfate (SDS) micelles, we characterized the pK(a) of His50, a residue of particular interest since it is flanked within one turn of the a-helix structure by the Parkinson’s disease-linked mutants E46K and A53T. The pK(a) of His50 is raised by 1.4 pH units in the micelle-bound state.