Michael D Dake

Stanford University, Palo Alto, California, United States

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Publications (248)1000.04 Total impact

  • M.D. Forrester MD, M.D. Dake MD
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    ABSTRACT: Die Aortendissektion ist eine potenziell tödliche Erkrankung, bei der hohe Aufmerksamkeit in Bezug auf klinische Symptome, eine genaue und prompte Diagnose, ein tief greifendes Verständnis der Anatomie und des natürlichen Verlaufs sowie ein multidisziplinärer Versorgungsansatz dieses hochvariablen Krankheitsprozesses notwendig sind. Die Versorgung einer Aortendissektion ist komplex und hängt von vielen patienten- und krankheitsspezifischen Faktoren ab, die eine komplikationsspezifische Herangehensweise erfordern. Verschiedene Klassifikationssysteme wurden zur Unterstützung derartiger Entscheidungsprozesse entwickelt. Darüber hinaus ist eine adäquate bildgebende Aortendiagnostik für die Diagnosestellung und Therapieplanung entscheidend. Die Messung und Überwachung des initialen Blutdrucks und Pulses auf der Intensivstation sind essenziell. Es ist wahrscheinlich, dass Dissektionen der Aorta descendens (Stanford B, DeBakey III) mit Komplikationen wie Ruptur, schneller Expansion eines falschen Lumens, Gewebeminderdurchblutung, therapieresistenten Schmerzen oder unkontrollierbarer Hypertonie eine akute Intervention erfordern. Dagegen werden unkomplizierte Dissektionen vom Typ B gewöhnlich medikamentös behandelt. Mit der Einführung und Entwicklung endovaskulärer Techniken stehen dem Kliniker zunehmend mehr – oft weniger invasive – Therapieoptionen zur Verfügung. Es gibt bisher jedoch keinen eindeutigen Konsens hinsichtlich offen-chirurgischer Therapie vs. Stentimplantation und anderen adjunktiven Maßnahmen. Dies muss offensichtlich weiter klinisch untersucht werden, was auch geschieht. Letztlich ist es wahrscheinlich, dass die Therapie der Aortendissektion unter Einsatz verschiedener Verfahren sowie mehr patienten- und krankheitsspezifischen Ansätzen erfolgt.
    Gefässchirurgie 12/2011; 16(8). DOI:10.1007/s00772-011-0935-x · 0.24 Impact Factor
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    Journal of the American College of Cardiology 12/2011; 59(3):294-357. DOI:10.1016/j.jacc.2011.10.860 · 15.34 Impact Factor
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    ABSTRACT: To report a prospective, single-arm, multicenter clinical study evaluating the Zilver PTX drug-eluting stent for treating the above-the-knee femoropopliteal segment (NCT01094678; http://www.clinicaltrials.gov ). The Zilver PTX drug-eluting stent is a self-expanding nitinol stent with a polymer-free paclitaxel coating. Patients with symptomatic (Rutherford category 2-6) de novo or restenotic lesions (including in-stent stenosis) of the above-the-knee femoropopliteal segment were eligible for enrollment. Between April 2006 and June 2008, 787 patients (578 men; mean age 66.6±9.5 years) were enrolled at 30 international sites. Nine hundred lesions (24.3% restenotic lesions of which 59.4% were in-stent stenoses) were treated with 1722 Zilver PTX stents; the mean lesion length was 99.5±82.1 mm. The 12-month Kaplan-Meier estimates included an 89.0% event-free survival rate, an 86.2% primary patency rate, and a 90.5% rate of freedom from target lesion revascularization. There were no paclitaxel-related adverse events reported. The 12-month stent fracture rate was 1.5%. The ankle-brachial index, Rutherford score, and walking distance/speed scores significantly improved (p<0.001) from baseline to 12 months. These results indicate that the Zilver PTX drug-eluting stent is safe for treatment of patients with de novo and restenotic lesions of the above-the-knee femoropopliteal segment. At 1 year, the overall anatomical and clinical effectiveness results suggest that this stent is a promising endovascular therapy.
    Journal of Endovascular Therapy 10/2011; 18(5):613-23. DOI:10.1583/11-3560.1 · 3.59 Impact Factor
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    ABSTRACT: Sustained benefits of drug-eluting stents in femoropopliteal arteries have not been demonstrated. This prospective, multinational, randomized study was designed to compare the 12-month safety and effectiveness of a polymer-free, paclitaxel-coated nitinol drug-eluting stent (DES) with percutaneous transluminal angioplasty (PTA) and provisional bare metal stent (BMS) placement in patients with femoropopliteal peripheral artery disease. Patients were randomly assigned to primary DES implantation (n=236) or PTA (n=238). Demographics and lesion characteristics were similar between groups (eg, average lesion length, approximately 65±40 mm). One hundred twenty patients had acute PTA failure and underwent secondary random assignment to provisional DES (n=61) or BMS (n=59). Primary end points were the 12-month rates of event-free survival and patency in the primary DES and PTA groups. Compared with the PTA group, the primary DES group exhibited superior 12-month event-free survival (90.4% versus 82.6%; P=0.004) and primary patency (83.1% versus 32.8%; P<0.001), satisfying the primary hypotheses. In the secondary evaluations, (1) the primary DES group exhibited superior clinical benefit compared with the PTA group (88.3% versus 75.8%; P<0.001), (2) the provisional DES group exhibited superior primary patency (89.9% versus 73.0%; P=0.01) and superior clinical benefit (90.5% and 72.3%, P=0.009) compared with the provisional BMS group, and (3) the stent fracture rate (both DES and BMS) was 0.9% (4/457). Femoropopliteal peripheral artery disease treatment with the paclitaxel-eluting stent was associated with superior 12-month outcomes compared with PTA and provisional BMS placement.
    Circulation Cardiovascular Interventions 09/2011; 4(5):495-504. DOI:10.1161/CIRCINTERVENTIONS.111.962324 · 6.98 Impact Factor
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    ABSTRACT: MRV has been proposed as a possible screening method to identify chronic cerebrospinal venous insufficiency, which may play a role in MS. We report our initial experience comparing MRV and CV in MS patients to evaluate venous stenosis and collateral venous drainage. Time-of-flight and time-resolved imaging of contrast kinetics MRV and CV were performed in 39 MS patients. The presence and severity of both IJ vein caliber changes and non-IJ collaterals were graded by using a 4-point scale by 2 radiologists in an independent and blinded manner. Both studies frequently showed venous abnormalities, most commonly IJ flattening at the C1 level and in the lower neck. There was moderate-to-good agreement between the modalities (κ = 0.55; 95% CI, 0.45%-0.65%). For collaterals, agreement was only fair (κ = 0.30; 95% CI, 0.09%-0.50%). The prevalence of IJ segments graded mild or worse on CV was 54%. If CV was considered a standard, the sensitivity and specificity of MRV was 0.79 (0.71-0.86) and 0.76 (0.67-0.83), respectively. Degree of stenosis was related to the severity of collaterals for CV but not for MRV. IJ caliber changes were seen in characteristic locations on both MRV and CV in MS patients. Agreement between modalities was higher for stenosis than for collaterals. If CV is considered a standard, MRV performance is good but may require additional improvement before MRV can be used for screening.
    American Journal of Neuroradiology 07/2011; 32(8):1482-9. DOI:10.3174/ajnr.A2549 · 3.68 Impact Factor
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    Journal of vascular and interventional radiology: JVIR 05/2011; 22(5):587-93. DOI:10.1016/j.jvir.2011.03.007 · 2.15 Impact Factor
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    ABSTRACT: The Society for Vascular Surgery Outcomes Committee, including ad hoc members from Society of Thoracic Surgeons, American Association of Thoracic Surgery, and Society for Interventional Radiology, collected outcomes of patients with traumatic thoracic aortic transections treated with endovascular grafts. Results through 1 year of follow-up are reported. Data from five physician-sponsored investigational device exemption clinical trials from 2000 to 2008 were entered using standardized forms and definitions. Adverse events were reported early (≤30 days) and late (>30 days) by body system. Major adverse events included one or more of the following: death, stroke, myocardial infarction, renal failure, respiratory failure, paralysis, or bowel ischemia. There were 60 symptomatic patients (68.3% men; mean age, 46 years) with traumatic aortic transections, of which 97% were due to a motor vehicle accident and 3% were related to other blunt trauma. The average total injury severity score was 39, most with involvement of the chest and abdomen. The average surgical time was 125 minutes. The mean hospital length of stay was 17 days. Associated procedures for the management of nonaortic injuries occurred in 51.7%. All-cause mortality was 9.1% at 30 days and 14.4% at 1 year. One or more major adverse events occurred in 23.3% of the patients, major adverse events occurred early in 20.0% and late in 3.6%. Death accounted for 41.7% of the early and all of the late major adverse events. Early adverse events included 16.7% pulmonary, 13.3% neurologic, and 11.7% vascular complications. Late adverse events included one patient (1.8%) with pulmonary failure and one patient (1.8%) who died of an unknown cause. One-year results of endograft placement for the management of patients with traumatic aortic injury are acceptable. Most cases treated were due to motor vehicle accident and associated with multiple coexisting injuries. Approximately three-quarters of the deaths occurred ≤30 days, indicating the acute severity of the condition. Although the relatively low rates of adverse and major adverse events are consistent with what is anticipated in an otherwise healthy population, future device and procedural developments may facilitate improved outcomes in the future.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 04/2011; 53(4):1091-6. DOI:10.1016/j.jvs.2010.11.126 · 2.98 Impact Factor
  • M. D. Dake
    Journal of Vascular and Interventional Radiology 03/2011; 22(3). DOI:10.1016/j.jvir.2011.01.011 · 2.15 Impact Factor
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    ABSTRACT: To evaluate the pharmacokinetics and safety of the Zilver PTX Drug-Eluting Stent (Cook Medical, Bloomington, Indiana) in a normal porcine artery model. Pharmacokinetic analyses were performed using 18 pigs, each implanted with four paclitaxel-coated stents. Paclitaxel remaining on the stents, delivered locally (to artery wall), regionally (to adjacent and downstream muscle), and systemically (to plasma), was determined at various times through 56 days. For safety evaluation, local, regional, and systemic responses were grossly and histologically assessed at 1 month, 3 months, and 6 months in 21 additional pigs and compared with the responses to bare metal stents in 21 separate pigs. Stents delivered approximately 95% of the total paclitaxel within 24 hours after deployment. Nonetheless, there were sustained paclitaxel levels in the artery wall through 56 days, maintained at approximately 20% of the peak level through 14 days. Very little paclitaxel was distributed regionally or systemically, becoming undetectable in plasma at 10 hours. Complete necropsy, hematology, and serum chemistry revealed no adverse effects associated with the paclitaxel-coated stents. Within 3 months, vessels with both paclitaxel-coated and bare metal stents showed comparable, complete healing. The Zilver PTX stent appears to be safe, achieves sustained paclitaxel levels in the artery wall, and shows complete vessel healing comparable to bare metal stents within 3 months.
    Journal of vascular and interventional radiology: JVIR 03/2011; 22(5):603-10. DOI:10.1016/j.jvir.2010.12.027 · 2.15 Impact Factor
  • Journal of Vascular and Interventional Radiology 03/2011; 22(3). DOI:10.1016/j.jvir.2011.01.170 · 2.15 Impact Factor
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    ABSTRACT: This study analyzed 1-year outcome after thoracic endovascular aortic repair (TEVAR) in patients with complicated type B aortic dissection (cTBAoD) who had rupture or malperfusion and symptom onset ≤14 days (acute), 15 to 30 days (subacute), and 31 to 90 days (chronic) until required intervention. The main focus of this report is primarily on the acute cohort. Clinical data were systematically collected from five physician-sponsored investigational device exemption (IDE) clinical trials between 2000 and 2008 using standardized definitions and forms. Adverse events were reported early (≤30 days) and late (>30 days) by body system. Major adverse events included death, stroke, myocardial infarction, renal failure, respiratory failure, paralysis, and bowel ischemia. There were 99 cTBAoD patients: 85 were acute, 11 were subacute, and 3 were chronic. Among the acute patients, 31.8% had rupture and 71.8% had malperfusion, including 55.7% lower extremity, 36.1% renal, 19.7% visceral, 8.2% other, and 3.3% spinal cord (patients may have more than one source). Rupture and malperfusion were both reported for three acute patients. Additional findings for the acute cohort included pain (76.5%), hypertension (43.5%), and bleeding (8.2%); comorbidities included hypertension (83.5%), current/past smoking history (69.8%), and diabetes (12.9%). The main focus of this analysis was the acute cohort (n = 85). Age averaged 59 years (72.9% male). Early adverse events included pulmonary (36.5%), vascular (28.2%), renal (25.9%), and neurologic (23.5%). Early major adverse events occurred in 37.6% of patients, including death (10.6%), stroke (9.4%), renal failure (9.4%), and paralysis (9.4%); late adverse events included vascular (15.8%), cardiac (10.5%), gastrointestinal (6.6%), and hemorrhage (5.3%). The point-estimate mortality rate was 10.8 (95% confidence interval [CI], 4.1-17.5) at 30 days and 29.4 (95% CI, 18.4-40.4) at 1 year, when 34 patients remained at risk. Emergency TEVAR for patients with cTBAoD (malperfusion or rupture) provided acceptable mortality and morbidity results out to 1 year. Manufacturers can use this 30-day mortality point-estimate of 10.8 (95% CI, 4.1-17.5) for the acute cohort to establish a performance goal for use in single-arm commercial IDE trials if the Food and Drug Administration and other regulatory bodies concur.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 02/2011; 53(4):1082-90. DOI:10.1016/j.jvs.2010.11.124 · 2.98 Impact Factor
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    Biomedical Engineering, Trends in Materials Science, 01/2011; , ISBN: 978-953-307-513-6
  • Jacob M Waugh, Jane Lee, Michael D Dake, Dan Browne
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    ABSTRACT: Considerations in rational designs of CPP-based transcutaneous delivery systems are described. Impact of design considerations of nonclinical and clinical results are presented in detail.
    Methods in molecular biology (Clifton, N.J.) 01/2011; 683:553-72. DOI:10.1007/978-1-60761-919-2_39 · 1.29 Impact Factor
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    ABSTRACT: Carotid atherosclerotic plaque rupture is thought to cause transient ischemic attack (TIA) and ischemic stroke (IS). Pathological hallmarks of these plaques have been identified through observational studies. Although generally accepted, the relationship between cerebral thromboembolism and in situ atherosclerotic plaque morphology has never been directly observed noninvasively in the acute setting. Consecutive acutely symptomatic patients referred for stroke protocol magnetic resonance imaging/angiography underwent additional T1- and T2-weighted carotid bifurcation imaging with the use of a 3-dimensional technique with blood signal suppression. Two blinded reviewers performed plaque gradings according to the American Heart Association classification system. Discharge outcomes and brain magnetic resonance imaging results were obtained. Image quality for plaque characterization was adequate in 86 of 106 patients (81%). Eight TIA/IS patients with noncarotid pathogenesis were excluded, yielding 78 study patients (38 men and 40 women with a mean age of 64.3 years, SD 14.7) with 156 paired watershed vessel/cerebral hemisphere observations. Thirty-seven patients had 40 TIA/IS events. There was a significant association between type VI plaque (demonstrating cap rupture, hemorrhage, and/or thrombosis) and ipsilateral TIA/IS (P<0.001). A multiple logistic regression model including standard Framingham risk factors and type VI plaque was constructed. Type VI plaque was the dominant outcome-associated observation achieving significance (P<0.0001; odds ratio, 11.66; 95% confidence interval, 5.31 to 25.60). In situ type VI carotid bifurcation region plaque identified by magnetic resonance imaging is associated with ipsilateral acute TIA/IS as an independent identifier of events, thereby supporting the dominant disease pathophysiology.
    Circulation 11/2010; 122(20):2031-8. DOI:10.1161/CIRCULATIONAHA.109.866053 · 14.95 Impact Factor
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    ABSTRACT: To review an experience with the Amplatzer vascular plug (AVP) for prevention of type II endoleaks during endovascular aneurysm repair (EVAR) of thoracic and thoracoabdominal aneurysms. Retrospective review was undertaken of 14 patients undergoing transcatheter occlusion of the left subclavian (n = 12) or celiac artery (n = 2) with the AVP as part of EVAR of thoracic and thoracoabdominal aneurysms at a single institution. Procedural criteria evaluated were success at target vessel occlusion, the number of AVPs used, use of adjunctive embolization devices, and embolization-related ischemic end-organ events. Follow-up imaging criteria included evaluation of persistent target vessel occlusion, evidence of device migration, and the presence and characterization of endoleak secondary to AVP failure. Complete target vessel occlusion was documented for all cases. In six cases, more than one AVP was placed, with an average of 1.5 devices per patient. In two cases, adjunctive coils were placed. Computed tomographic or magnetic resonance angiography follow-up was available for all patients (mean follow-up, 419 days; range 28-930 d). No case showed evidence of device migration or type II endoleak resulting from AVP failure. There was a single instance of left subclavian artery recanalization without type II endoleak. There were no embolization-related ischemic end-organ events. Transcatheter arterial occlusion of the subclavian and celiac arteries with the AVP is a valuable adjunct to endografting in cases in which side branch embolization is necessary to extend the landing zone.
    Journal of vascular and interventional radiology: JVIR 10/2010; 21(10):1501-7. DOI:10.1016/j.jvir.2010.05.021 · 2.15 Impact Factor
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    Circulation 06/2010; 121(25):2780-804. DOI:10.1161/CIR.0b013e3181e4d033 · 14.95 Impact Factor
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    ABSTRACT: To determine the feasibility of electromagnetic tracking as a method to augment conventional imaging guidance for the safe delivery, precise positioning, and accurate deployment of thoracic aortic endografts. Custom guide wires were fabricated, and the delivery catheters for thoracic aortic endoprostheses were retrofitted with integrated electromagnetic coil sensors to enable real-time endovascular tracking. Preprocedure thoracic computed tomographic (CT) angiograms were obtained after the placement of fiducial skin patches on the chest wall of three anesthetized swine, enabling automatic registration. The stent-graft deployment location target near the subclavian artery was selected on the preprocedure CT angiogram. Two steps were analyzed: advancing a tracked glidewire to the aortic arch and positioning the tracked stent-graft assembly by using electromagnetic guidance alone. Multiple CT scans were obtained to evaluate the accuracy of the electromagnetic tracking system by measuring the target registration error, which compared the actual position of the tracked devices to the displayed "virtual" electromagnetic-tracked position. Postdeployment CT angiography and necropsy helped confirm stent-graft position and subclavian artery patency. A stent-graft was successfully delivered and deployed in each of the three animals by using real-time electromagnetic tracking alone. The mean fiducial registration error with autoregistration was 1.5 mm. Sixteen comparative scans were obtained to determine the target registration error, which was 4.3 mm +/- 0.97 (range, 3.0-6.0 mm) for the glidewire sensor coil. The mean target registration error for the stent-graft delivery catheter sensor coil was 2.6 mm +/- 0.7 (range, 1.9-3.8 mm). The mean deployment error for the stent-graft, defined as deployment deviation from the target, was 2.6 mm +/- 3.0. Delivery and deployment of customized thoracic stent-grafts with use of electromagnetic tracking alone is feasible and accurate in swine. Combining endovascular electromagnetic tracking with conventional fluoroscopy may further improve accuracy and be a more realistic multimodality approach.
    Journal of vascular and interventional radiology: JVIR 06/2010; 21(6):888-95. DOI:10.1016/j.jvir.2009.12.402 · 2.15 Impact Factor
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    ABSTRACT: To determine the clinical importance of the bird-beak configuration after thoracic endovascular aortic repair (TEVAR). The institutional review board approved this retrospective study and waived the requirement to obtain informed consent from patients. Sixty-four patients (40 men, 24 women; mean age, 64 years) who underwent TEVAR were evaluated. The treated diseases included dissection (n = 29), degenerative aneurysm (n = 13), acute traumatic transection (n = 8), pseudoaneurysm (n = 4), penetrating aortic ulcer (n = 6), intramural hematoma (n = 2), and mycotic aneurysm (n = 2). Bird-beak configuration, defined as the incomplete apposition of the proximal endograft with a wedge-shaped gap between the device and the aortic wall, was assessed with postprocedural CT angiography. The presence and length of the bird-beak configuration were compared with the formation of endoleaks and adverse clinical events. Endoleaks were detected in 26 (40%) of the 64 patients, including 14 with type Ia endoleak formation, one with type Ib endoleak formation, six with type II endoleak formation (from the left subclavian artery), two with type IIo endoleak formation (from other arteries), and three with type III endoleak formation. Bird-beak configuration was observed in 28 (44%) of 64 patients and correlated significantly with the risk of developing a type Ia or IIa endoleak (P < .01). Mean bird-beak length was significantly longer (P < .01) in patients with a type Ia or II endoleak (mean length, 14.3 and 13.9 mm, respectively) than in patients without endoleaks (mean length, 8.4 mm). Adverse events included early aortic-related death in three patients, additional treatment for endoleak in eight patients, and stent-graft collapse or infolding in six patients. Detection of bird-beak configuration is helpful in the prediction of adverse clinical events after TEVAR.
    Radiology 05/2010; 255(2):645-52. DOI:10.1148/radiol.10091468 · 6.21 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 03/2010; 182. DOI:10.1055/s-0030-1252600 · 1.96 Impact Factor
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    Carlos H Timaran, Michael D Dake
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 10/2009; 50(3):705; author reply 705. DOI:10.1016/j.jvs.2009.04.070 · 2.98 Impact Factor

Publication Stats

10k Citations
1,000.04 Total Impact Points


  • 1995–2014
    • Stanford University
      • • Department of Cardiothoracic Surgery
      • • Division of Interventional Radiology
      • • Department of Radiology
      Palo Alto, California, United States
  • 2007–2013
    • University of Virginia
      • • Department of Radiology and Medical Imaging
      • • Division of Angiography and Interventional Radiology
      Charlottesville, Virginia, United States
  • 1992–2012
    • Stanford Medicine
      • • Falk Cardiovascular Research Center
      • • Division of Interventional Radiology
      • • Program in Human Gene Therapy
      • • Department of Cardiothoracic Surgery
      • • Department of Radiology
      • • Stanford Advanced Medicine Center
      Stanford, California, United States
  • 2003
    • Sapienza University of Rome
      • Department of Radiological, Oncological and Pathological Sciences
      Roma, Latium, Italy
  • 2001
    • Savannah Vascular & Cardiac Institute
      Savannah, Georgia, United States
  • 1997
    • Santa Clara Valley Medical Center
      San Jose, California, United States
  • 1993–1997
    • University of Minnesota Medical Center, Fairview
      Minneapolis, Minnesota, United States
    • University of Michigan
      • Department of Radiology
      Ann Arbor, Michigan, United States