Here, we studied the effects of tacrolimus and sirolimus on lymphocyte subpopulations in an I/R rat model. The animals were treated with tacrolimus, sirolimus or vehicle, before undergoing a 60-min ischemia event of the right hepatic lobe, followed by excision of the remaining liver. After 2 h, I/R rats showed increased mortality, plasma lactate dehydrogenase (LDH) levels, hepatocyte apoptosis, liver histological STI571 cell line injury and parenchymal infiltration by neutrophils, macrophages, NK cells and T lymphocytes.

Most of the changes were antagonized by both immunosuppressants. Tacrolimus augmented the proportion of cycling cells in I/R rats, whereas sirolimus showed the opposite effect. The increased Th1/Th2 ratio found in I/R livers after 2 h was reverted by immunosuppressants, which also amplified the proportion of CD4(+)CD25(+)Foxp3(+) regulatory T lymphocytes at 24 h. The protective effects of both tacrolimus and sirolimus correlated well with a decreased ratio of proinflammatory to anti-inflammatory T lymphocytes, and with an increase in the Treg proportion. This suggests a new mechanism to explain the known beneficial effect selleck products shown by immunosuppressants early after I/R.”
“OBJECTIVE: We present a case of syringomyelia attributed to a transverse

thoracic arachnoid web at T4. The cerebrospinal fluid pressure caudal to the web was higher than the cerebrospinal fluid pressure rostral to the web, causing a syrinx in the thoracic and cervical spinal cord above the web.

CLINICAL PRESENTATION: A 43-year-old man presented with numbness and a burning pain in his left upper back and extremities. Magnetic resonance imaging showed a cervical-thoracic syrinx that terminated relatively abruptly at T4. Because of the abrupt termination of the syrinx at T4 and the slight ventral displacement of the spinal cord at this level, a dorsal arachnoid web was suspected.

INTERVENTION: A T4 laminectomy was performed. Intraoperative ultrasound before opening of the thecal

sac showed a pulsating transverse dorsal arachnoid web. The dura was 4-Aminobutyrate aminotransferase opened and the web resected, thus widely communicating the dorsal subarachnoid space. The syrinx dramatically decreased in size and the patient’s pain improved but did not resolve completely.

CONCLUSION: In patients with presumed idiopathic syringomyelia, imaging studies should be closely inspected for the presence of a transverse arachnoid web. Surgical resection of a transverse thoracic arachnoid web with syringomyelia can result in resolution of the syringomyelia and improvement in neurological function. Syrinx formation in patients with these webs may occur in the area of the spinal cord where there is lower cerebrospinal fluid pressure, which may be either rostral or caudal to the arachnoid web. We evaluate this hypothesis by comparing our case with other published cases.

Yield was 30 mg of purified protein (94% purity) per liter of culture. The reconstituted HDL particles checked via non-denaturing PAGE showed high homogeneity in their size when reconstituted both GDC-0941 price with wild-type apo A-I and apo A-I Z. An optimized system for the expression and purification of wildtype apo A-I and apo A-I Z with high yield and purity grade has been achieved, in addition to their use in reconstituted HDL particles, as a basis for further studies. (C) 2011 Elsevier Inc. All rights reserved.”
“N-terminal fusion tags

that enhance translation initiation or protein solubility are often used to facilitate protein overexpression. As the optimal tag for a given target protein cannot be predicted a priori, valuable time can be lost in cloning and manipulating the corresponding gene to generate different fusion constructs for expression analysis. We have developed a cell-free strategy that consolidates these steps, enabling the utility of a panel of nine fusion-tags to be determined within one to two days. This approach exploits the fact that PCR-amplified DNA can be used as a template for cell-free protein synthesis. Overlap/extension PCR using the TEV protease site

as the overlap region allows the fusion of different 17 promoter (T7p)-tag-TEV DNA fragments with a TEV-gene-T7 terminator www.selleckchem.com/products/i-bet-762.html (T7ter) fragment. For tag sequences where the TEV site is not compatible, a short C(3)G(3) repeat (CGr) sequence can be used as the overlap region. The resulting T7p-tag-TEV-gene-T7ter

constructs are then used as templates Glutamate dehydrogenase for PCR-directed cell-free protein synthesis to identify which tag-TEV-gene fusion protein produces the highest amount of soluble protein. We have successfully applied this approach to the overexpression of the Adiponectin hypervariable domain (AHD). Five of the nine N-terminal fusion tags tested enabled the synthesis of soluble recombinant protein. The best of these was the Peptidyl-prolyl cis-trans isomerise B (PpiB) fusion tag which produces 1 mg/ml amounts of soluble fusion protein. PpiB is an example of a new class of fusion tag known as the “”stress-responsive proteins”". Our results suggest that this cell-free fusion-tag expression screen facilitates the rapid identification of suitable fusion-tags that overcome issues such as poor expression and insolubility, often encountered using conventional approaches. (C) 2011 Elsevier Inc. All rights reserved.”
“In a previous paper, the biological activity of a 216-amino acid recombinant truncated form of the soybean 7S globulin alpha’ subunit, known to control cholesterol and triglyceride homeostasis, was described. In this work, a shorter version of the polypeptide chain, spanning 142 amino acid residues from the N-terminus and thus exclusively including the so-called extension region, was cloned and overexpressed in Pichia pastoris. The yield of the recombinant polypeptide, which was termed alpha’E.

Thus, the hippocampus normally has a critical and long-lasting role enabling recall of fear conditioning to a discrete visual stimulus. In the absence of the hippocampus other memory systems support new learning. (C) 2010 IBRO. Published by Elsevier Ltd. All rights reserved.”
“A

neurotoxic regimen of methamphetamine (MA-40 mg/kg ip) administered at 0 (control-MA vehicle), 0.5 and 72 h prior to determinations of striatal dopamine (DA) and DOPAC (3,4-dihydroxyphenylacetic acid)/DA ratios were compared among juvenile and adult female and male mice. Adult females and males showed similar depletions in striatal DA at 0.5 h post-MA, but males showed greater DA depletions and DOPAC/DA ratios at 72 h post-MA. Juvenile mice showed neither sex differences, SGC-CBP30 nor any MA neurotoxicity upon striatal DA or DOPAC/DA ratios. Following MA, body temperatures increased in all mice, but increases in adult males were greater than adult females; juveniles showed no sex differences and body temperature increases were similar to that of adult males. MA-evoked DA output was greater in adult compared to juvenile males and a biologically effective regimen of testosterone to juvenile males neither increased MA-evoked DA output nor decreased MA-induced striatal DA like that observed in adult males. These results demonstrate: (1) Unlike adults, juvenile mice show neither a sex difference for MA-induced ON-01910 neurotoxicity or body temperature

increases, nor MA neurotoxicity, (2) Initial effects of MA (0.5

h) in adult females and males are similar, but at 72 h post-MA females show no further striatal DA depletion, (3) Increased striatal DA depletion within adult versus juvenile males may be related to initially higher MA-evoked DA responses, and (4) Testosterone fails to convert juvenile males into adults with regard to MA effects. (C) Tolmetin 2010 IBRO. Published by Elsevier Ltd. All rights reserved.”
“Exposure to polychlorinated biphenyls (PCBs) during pregnancy and lactation leads to cognitive impairment and motor disorders in children by mechanisms which remain unknown. It also remains unclear whether different non-dioxin-like PCBs have similar or different mechanisms of neurotoxicity. The main aims of this work were: (1) to assess whether developmental exposure to non-dioxin-like-PCBs 52, 138 or 180 affect cognitive function or motor coordination in 3-4 months-old rats; (2) to shed light on the underlying mechanisms. Female rats were treated with PCBs (1 mg/kg day) in food from gestational-day 7 to postnatal-day 21. The ability to learn a Y maze conditional discrimination task was reduced in rats exposed to PCBs 138 or 180, but not in rats exposed to PCB52. The function of the glutamate nitric oxide-cGMP pathway (NMDA-induced increase in extracellular cGMP) in cerebellum in vivo was reduced by 33-59% in rats exposed to PCBs 138 or 180, but not by PCB52.

These data are discussed in relation to the treatment of patients with suspected ureteral dysfunction using Ca entry blockers.”
“To GSK872 in vitro assess cerebral functional asymmetry for accessing the meaning of emotional words, native English speakers were asked to make lexical decisions to emotional words,

neutral words and nonwords briefly flashed in their left or right visual field, that is, perceived by their right or left visual cortex, respectively. Emotionally negative words had an overall probability of occurrence of 12.5% in each visual field and were expected to elicit a P3b event-related potential modulation indexing shifts of attention. Emotionally negative words elicited a P3b when perceived by the left visual cortex but failed to

trigger such attention-related response when perceived click here by the right hemisphere. The results suggest relative insensitivity on the part of the right hemisphere in registering the negative emotional valence of written words.”
“The ketogenic diet, a high-fat diet, is a therapeutic alternative in the treatment of refractory epilepsy, especially in children. However, there are concerns that a high-fat diet may influence the normal development of the central nervous system and cognition. In this study we investigated the influence of ketogenic diet on adult neurogenesis in the dentate gyrus. Rats were provided with either a high-fat diet (80% fat) or a standard rat diet (5% fat) Exoribonuclease ad libitum for 4 weeks. In both female and male rats, the amounts of bromodeoxyuridine immunoreactive cells in the dentate gyrus were the same in the different groups. Our results suggest that the ketogenic diet does not disturb the neurogenesis in the rat dentate gyrus.”
“Axonal outgrowth is a prerequisite

for the development of the most complex organ, the brain. It depends partially on the attachment of sialic acid on glycans of (sialo)-glycoproteins expressed on the plasma membrane. In our study, we showed that nerve growth factor-induced neurite outgrowth of PCl2-cells enhances the expression of UDP-N-acetylglucosamine 2-epimerase/N-acetylmannosamine-kinase (GNE), the key enzyme for the biosynthesis of sialic acid. Furthermore, we could show that overexpression of GNE induces neurite outgrowth in PC12 cells. The neurite-outgrowth promoting activity of overexpressed GNE, however, does not lead to an increased biosynthesis of sialic acid. These data suggest a novel role of GNE during neurite outgrowth, which is independent to its specific enzymatic activity.”
“This study aimed to clarify the effects of inescapable and escapable stressors on behavior and interleukin-2 (IL-2) levels in the brain.

This is consistent with the predicted mobility of the amino terminus that may bring the amino groups within 19 angstrom of one another in solution. These technical improvements allow this method to be used for investigating protein-protein interactions in complex biological samples.”
“Consolidation and reconsolidation are phases of memory stabilization that diverge slightly. Noradrenaline is known to influence both processes, but the relative contribution of alpha

1- and beta-adrenoceptors is unclear. The present study sought to investigate this matter by comparing their recruitment to consolidate and/or reconsolidate a contextual fear memory trace under enhanced noradrenergic activity induced by yohimbine. We report that this alpha 2-adrenoceptor antagonist was able to potentiate fear memory trace consolidation or reconsolidation when administered this website immediately after acquisition https://www.selleckchem.com/products/VX-809.html or retrieval, respectively, resulting in increased freezing expression. In either case,

generalization of this response to an unpaired context was also seen when it achieved a ceiling level in the paired context. These effects endured for over 7 d and relied on action at central rather than peripheral sites, but were prevented when a memory trace was not acquired, when memory reactivation was omitted, or when administration of yohimbine was delayed until 6 h after acquiring or retrieving the memory trace. The beta-adrenoceptor antagonist propranolol was able to prevent the above-mentioned effects of yohimbine, while pretreatment with the alpha 1-adrenoceptor antagonist prazosin blocked only its facilitating effects on memory reconsolidation. These results

highlight a differential participation of alpha 1- and beta-adrenoceptors in fear memory processing. Moreover, it was shown that the alpha 2-adrenoceptor agonist clonidine, as opposed to yohimbine, mitigates fear expression by weakening memory consolidation or reconsolidation.”
“Purpose: The 20S proteasome is a multicatalytic protein complex, which plays a major role in intracellular protein degradation. In mammalian cells, it consists of 28 subunits arranged in four stacked rings (alpha 1-7 beta 1-7 Acetophenone beta 1-7 alpha 1-7). The aim of this study is to characterize and compare subunit composition and heterogeneity (or subtypes) of the 20S proteasome from four human pancreatic cancer cell lines.

Experimental design: To study subunit compositions and heterogeneity of 20S proteasome from human pancreatic cancer cell lines, in the present study, 20S proteasome from four different pancreatic cancer cell lines (SW1990, a human exocrine adenocarcinoma, derived from spleen metastasis; PANC-1, a human ductal carcinoma in situ; BxPC-3, a human ductal carcinoma in situ; and CFPAC-1, a human ductal adenocarcinoma, derived from liver metastasis) were subjected to a gel-based proteomics analysis, respectively.

75 (95% CI 0.69-0.81). Given the prespecified constraint of achieving at least 85% sensitivity, our model led to the clinical CP-690550 solubility dmso decision rule, for children with a first febrile urinary tract infection cystography should be performed in cases with ureteral

dilatation and serum procalcitonin level 0.17 ng/ml or higher, or without ureteral dilatation (ie ureter not visible) when serum procalcitonin level is 0.63 ng/ml or higher. The rule had 86% sensitivity (95% CI 74-93) with 47% specificity (95% CI 42-51). Internal cross-validation produced 86% sensitivity (95% CI 79-93) and 43% specificity (95% CI 39-47).

Conclusions: A clinical decision rule was derived to enable a selective approach to cystography in children with urinary tract infection. The rule predicts high grade vesicoureteral reflux with approximately 85% sensitivity and avoids half of the cystograms that do not find reflux grade III or higher. Further validation is needed before its widespread use.”
“Although established smokers have a very regular pattern of smoking behavior, converging lines of evidence suggest that the escalation of smoking behavior is a critical Selleckchem TH-302 factor in the development of dependence. However, the neurobiological mechanisms that underlie the escalation

of smoking are unknown, because there is no animal model of the escalation of nicotine intake. On the basis of the pattern of smoking behavior in humans and presence of monoamine oxidase inhibitors in tobacco smoke, we hypothesized that the escalation of nicotine intake may only occur when animals are given extended-access (21 h per day) self-administration sessions after repeated periods of abstinence (24-48 h), and after chronic inhibition of monoamine oxidase using phenelzine sulfate. Intermittent access (every Docetaxel chemical structure 24-48 h) to extended nicotine self-administration produced a robust escalation of nicotine intake, associated with increased responding under fixed- and progressive-ratio schedules of reinforcement, and increased somatic signs of withdrawal. The escalation of nicotine intake

was not observed in rats with intermittent access to limited (1 h per day) nicotine self-administration or daily access to extended (21 h per day) nicotine self-administration. Moreover, inhibition of monoamine oxidase with daily administration of phenelzine increased nicotine intake by similar to 50%. These results demonstrate that the escalation of nicotine intake only occurs in animals given intermittent periods of abstinence with extended access to nicotine, and that inhibition of monoamine oxidase may contribute to the escalation of smoking, thus validating both an animal model of the escalation of smoking behavior and the contribution of monoamine oxidase inhibition to compulsive nicotine-seeking. Neuropsychopharmacology (2012) 37, 2153-2160; doi:10.1038/npp.2012.

“
“BACKGROUND AND IMPORTANCE: We describe an unusual presentation of a ruptured aneurysm of the posterior communicating artery with an acute intracranial hematoma between the dural layers associated with an acute spinal epidural hematoma descending to L1.

CLINICAL PRESENTATION: A 35-year-old woman presented 3 hours

after ictus learn more with a postcoital headache, neck stiffness, and bilateral abducens cranial nerve palsy. No other neurological deficits were present. Clinically, she had a subarachnoid hemorrhage World Federation of Neurosurgical Societies grade 1. CT scan demonstrates an acute subdural hematoma, extending from the right parasellar region, around the clivus, tentorium, and falx. Angio-CT showed a posterior communicating artery aneurysm and an anterior communicating artery aneurysm and an extension of the hematoma to the cervical spine. This justified a spinal and cerebral MRI that confirmed an extension of the hematoma to the epidural CFTRinh-172 chemical structure space

at the cervical, thoracic, and lumbar levels. Three-dimensional digital subtraction angiography confirmed aneurysms on the right posterior communicating artery and on the anterior communicating artery. Both aneurysms were completely occluded by coiling. With reference to the concept of the cranial subdural compartment described in studies conducted using an electron microscope, this group of hematomas was classified as interdural.

CONCLUSION: Ruptured aneurysm of the posterior communicating artery may cause cranial acute interdural hematoma with a typical subarachnoid hemorrhage clinical presentation, and it rarely can extend to spinal epidural space.”
“The genetic elements of herpesvirus origins of lytic replication have been characterized in detail; however, much remains to be elucidated concerning their functional role in replication Methocarbamol initiation. In the case of the Epstein-Barr virus (EBV), we have found that in addition to the two well-defined critical elements required for lytic replication (the upstream and downstream essential

elements, UEE and DEE), the origin of lytic replication (OriLyt) also requires the presence of a GC-rich RNA in cis. The BHLF1 transcript is similar to the essential K5 transcript identified at the Kaposi’s sarcoma-associated herpesvirus OriLyt. We have found that truncation of the BHLF1 transcript or deletion of the TATA box, but not the putative ATG initiation codon, reduce OriLyt function to background levels. By using an antibody specific for RNA-DNA hybrid molecules, we found the BHLF1 RNA stably annealed to its DNA template during the early steps of lytic reactivation. Furthermore, expression of human RNase H1, which degrades RNA in RNA-DNA hybrids, drastically reduces OriLyt-dependent DNA replication as well as recruitment of the viral single-stranded DNA binding protein BALF2 to OriLyt.

Conclusion: LA intake of 4 en% appears to be a recommendable intake, without signs of stimulated eicosanoid biosynthesis or oxidation. (c) 2008 Elsevier Ltd. Idasanutlin research buy All rights reserved.”
“It is well established that patients with hemispatial neglect present with severe visuospatial impairments, but studies that have investigated visuomotor control directly have revealed diverging results, with some investigations finding impairments mirroring the perceptual difficulties of these patients, while others have shown that

such neglect patients perform relatively better in action tasks.

In this review we attempt to reconcile these diverging findings, addressing differences in the type of visuomotor tasks studied but also highlighting the diverging neuroanatomy that seems to be driving the differences in performance.

We argue that there are different types of actions and that these in turn depend on different cortical networks (Goodale, Westwood, & Milner, 2004; Milner & Goodale, 2006). Patients with visuospatial neglect, in contrast to patients with optic ataxia, are relatively unimpaired at performing target-directed tasks even towards stimuli located in their ‘neglected’ field. We relate these findings to the view that for the on-line guidance of action, spatial information is coded in egocentric coordinates

and depends on the visuomotor networks of the visual dorsal stream. Furthermore, based on recent lesion-symptom LY2228820 datasheet mapping studies, we postulate that deficits in on-line actions that are observed after right-brain damage are associated with damage

to the visuomotor Chlormezanone control network, in particular with damage to the basal ganglia, frontal and parieto-occipital regions. On the other hand, clear neglect-specific deficits emerge when the action is off-line and not directly target-driven, thus requiring relational metrics or scene-based coordinates (as is the case for example in delayed and mirrored (anti-pointing) reaches). We review recent studies that support our argument that such deficits in off-line actions are associated with damage to occipito-temporal and parahippocampal cortex, perhaps as part of the ventral visual stream or areas where information from the two visual streams is combined. Crown Copyright (C) 2011 Published by Elsevier Ltd. All rights reserved.”
“Venezuelan equine encephalitis (VEE) virus is a mosquito-borne alphavirus associated with sporadic outbreaks in human and equid populations in the Western Hemisphere. After the bite of an infected mosquito, the virus initiates a biphasic disease: a peripheral phase with viral replication in lymphoid and myeloid tissues, followed by a neurotropic phase with infection of central nervous system (CNS) neurons, causing neuropathology and in some cases fatal encephalitis.

Finite element models were constructed from in vivo magnetic resonance imaging-based cardiac geometry and postmortem measurement of myofiber helix angles using diffusion tensor magnetic resonance imaging. Material properties were iteratively determined by comparing the finite

element model output with systolic tagged magnetic resonance imaging strain measurements.

Results: At the mid-wall, fiber stress in the border zone decreased by 39% (sham = 32.5 +/- 2.5 kPa, repair = 19.7 +/- 3.6 kPa, P = .001) to the level of remote regions after repair. In the septum, however, border zone fiber stress remained high (sham = 31.3 +/- 5.4 kPa, repair = 23.8 +/- 5.8 kPa, P = .29). Cross-fiber stress at the mid-wall decreased LXH254 ic50 by 41% (sham = 13.0 +/- 1.5 kPa, repair = 7.7 +/- 2.1 kPa, P = .01), but cross-fiber stress in the un-excluded septal infarct was 75% higher in the border zone than RAD001 mouse remote regions (remote = 5.9 +/- 1.9 kPa, border zone = 10.3 +/- 3.6 kPa, P < .01). However, end-diastolic fiber and cross-fiber stress were not reduced in the remote myocardium after plication.

Conclusion: With the exception of the retained septal infarct, end-systolic stress is reduced in all areas of the left ventricle after infarct plication. Consequently, we expect the primary positive effect of infarct plication to be

in the infarct border zone. However, the amount of stress reduction necessary to halt or reverse nonischemic infarct extension in the infarct border zone and eccentric hypertrophy in the remote myocardium is unknown.”
“Background: Epidemiologic studies have shown a relationship between glycated hemoglobin levels and Astemizole cardiovascular events in patients with type 2 diabetes. We investigated whether intensive therapy to target

normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who had either established cardiovascular disease or additional cardiovascular risk factors.

Methods: In this randomized study, 10,251 patients (mean age, 62.2 years) with a median glycated hemoglobin level of 8.1% were assigned to receive intensive therapy (targeting a glycated hemoglobin level below 6.0%) or standard therapy (targeting a level from 7.0 to 7.9%). Of these patients, 38% were women, and 35% had had a previous cardiovascular event. The primary outcome was a composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The finding of higher mortality in the intensive-therapy group led to a discontinuation of intensive therapy after a mean of 3.5 years of follow-up.

Results: At 1 year, stable median glycated hemoglobin levels of 6.4% and 7.5% were achieved in the intensive-therapy group and the standard-therapy group, respectively. During follow-up, the primary outcome occurred in 352 patients in the intensive-therapy group, as compared with 371 in the standard-therapy group (hazard ratio, 0.90; 95% confidence interval [CI], 0.78 to 1.04; P=0.16).

In this study, SILAC quantitative proteomics

was used to identify differentially externalized proteins in the conditioned media from the mammary fibroblasts Stattic cost with or without intact T beta RII. Over 1000 proteins were identified and their relative differential levels were quantified. Immunoassays were used to further validate identification and quantification of the proteomic results. Differential expression was detected for various extracellular proteins, including proteases and their inhibitors, growth factors, cytokines, and extracellular matrix proteins. CXCL10, a cytokine found to be up-regulated in the T beta RII knockout mammary fibroblasts, is shown to directly stimulate breast tumor cell proliferation and migration Overall, this

study revealed hundreds of specific extracellular protein changes modulated by deletion of T beta RII in mammary fibroblasts, which may play important roles in the tumor microenvironment. These results warrant further investigation into the effects of inhibiting the TGF-beta signaling pathway in fibroblasts because systemic inhibition of TGF-beta signaling pathways is being considered as a potential cancer therapy.”
“Background: Current Canadian and international guidelines suggest patients with transient ischemic attack (TIA) or nondisabling stroke and ipsilateral internal carotid artery stenosis of 50% to 99% should be offered carotid endarterectomy (CEA) <= 2 weeks of the incident TIA or stroke. The objective of the study was to identify whether these goals are being met and the factors that SHP099 manufacturer most influence wait times.

Methods:

Patients who underwent CEA at the Ottawa Hospital for symptomatic carotid artery stenosis from 2008 to 2010 were identified. Time intervals based on the dates of initial symptoms, referral to and visit with a vascular surgeon, the decision to operate, and the date of surgery were recorded for each patient. The influence of various factors on wait times was explored, including age, sex, type of index event, referring physician, PIK-5 distance from the surgical center, degree of stenosis, and surgeon assigned.

Results: Of the 117 patients who underwent CEA, 92 (78.6%) were symptomatic. The median time from onset of symptoms to surgery for all patients was 79 days (interquartile range [IQR], 34-161). The shortest wait times were observed in stroke patients (49 [IQR, 27-81] days) and inpatient referrals (66 [IQR, 25-103] days). Only 7 of the 92 symptomatic patients (8%) received care within the recommended 2 weeks. The median surgical wait time for all patients was 14 days (IQR, 8-25 days). In the multivariable analysis, significant predictors of longer wait times included retinal TIA (P = .003), outpatient referrals (P = .004), and distance from the center (P = .008). Patients who presented to the emergency department had the shortest delays in seeing a vascular surgeon and subsequently undergoing CEA (P < .0001).