The role of thoracodorsal artery perforator flap in oncoplastic breast surgery

Publication date: Available online 6 March 2017
Source:Journal of the Egyptian National Cancer Institute
Author(s): Ayman A. Amin, Mohamed Rifaat, Ahmed Farahat, Tarek Hashem
Background and aimThoracodorsal artery perforator flap (TDAP) is one of the relatively new techniques in breast reconstruction. In this study, we try to evaluate the outcome of this flap in oncoplastic procedures.MethodsThis study included 40 patients of stage II breast cancer who underwent partial mastectomy with skin excision at the National Cancer Institute of Cairo University between 2011 and 2014. The resultant defects were immediately reconstructed using the thoracodorsal artery perforator flap. Operative time and complication rates were recorded. The cosmetic outcome was assessed through a questionnaire.ResultsThe mean operative time was 227min. The total complication rate was 20% with flap congestion being the most common complication. The cosmetic outcome was acceptable with 80% of patients rating their outcome as either good or excellent. The subjectively assessed functional outcome showed a mean time of 10days postoperative for patients to regain their full range of shoulder movements.ConclusionThoracodorsal artery perforator flap can play a significant role in oncoplastic surgery and breast reconstruction with acceptable cosmetic and functional outcome.



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Influence of humidity on the removal of volatile organic compounds using solid surfaces

Publication date: Available online 6 March 2017
Source:Catalysis Today
Author(s): Eun Ji Park, Hyun Ook Seo, Young Dok Kim
In recent years, much attention has been devoted to understand how the humidity affects the volatile organic compound (VOC) removal efficiencies using absorbents, photocatalysts or dark-catalysts and both positive and negative effects of humidity on VOC removal have been reported. We show that sorption capability of VOCs of absorbents with high surface areas can be significantly reduced by the competitive adsorption with water in the air and, by hydrophobically modifying the absorbent surfaces, selective sorption of VOCs to water molecules is achieved. For the TiO2 photocatalysts, humidity was found to have both positive and negative effects on catalytic activity; humidity facilitates the total oxidation of toluene to CO2 allowing the long-term stability of the catalytic activity, on the other hand, reduces the adsorption of VOCs on the catalyst surface. By depositing TiO2 islands on hydrophilic nanodiamond nanoparticles, positive effect of humidity becomes more pronounced. Positive and negative effects of humidity analogous to those on photocatalyst were also observed for the dark-catalysts, NiO nanoparticle decorated mesoporous silica. TiO2 interlayer with a high affinity toward toluene was applied between SiO2 and NiO and, as a result, negative effect of humidity, reduction of toluene adsorption in the presence on water, is suppressed.

Graphical abstract

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Carbon nanodots: mechanisms of photoluminescence and principles of application

Publication date: Available online 6 March 2017
Source:TrAC Trends in Analytical Chemistry
Author(s): Irina Yu. Goryacheva, Andrei V. Sapelkin, Gleb B. Sukhorukov
Carbon nanoparticles are relatively new and promising area of research receiving increasingly growing attention. They are small, cheap to produce, and do not contain potentially toxic components while showing bright and tunable light emission. They can thus potentially replace inorganic quantum dots in applications such as bioimaging, solar cells, photocatalysis and sensor applications. Units of nanometer size carbon dots (CDs) stable in aqueous solutions with photoluminescence in visible range can be obtained in one-step synthesis from variety of available materials. Currently, application of CDs is restricted by the lack of understanding of fundamental relationship between synthesis routes (and ingredients including raw materials), CDs' structure and CDs' properties. This review is focused on evaluating recent trends in CDs research and application, including CDs synthesis, understanding of their photoluminescent properties. We also discuss the principles, perspectives and current limitations in CDs applications.

Graphical abstract

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Preface

Publication date: March 2017
Source:Journal of Photochemistry and Photobiology C: Photochemistry Reviews, Volume 30
Author(s): Takashi Hirano, Takehiko Wada




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Electroacupuncture improves gait locomotion, H-reflex and ventral root potentials of spinal compression injured rats

Publication date: Available online 6 March 2017
Source:Brain Research Bulletin
Author(s): Carlos Escobar-Corona, Sergio Torres-Castillo, Erika Elizabeth Rodríguez-Torres, Bertha Segura-Alegría, Ismael Jiménez-Estrada, Salvador Quiroz-González
This study explored the effect of electroacupuncture stimulation (EA) on alterations in the Hoffman reflex (H-reflex) response and gait locomotion provoked by spinal cord injury (SCI) in the rat. A compression lesion of the spinal cord was evoked by insufflating a Fogarty balloon located in the epidural space at the T8–9 spinal level of adult Wistar male rats (200-250 gr; n=60). In different groups of SCI rats, EA (frequencies: 2, 50 and 100Hz) was applied simultaneously to Huantiao (GB30), Yinmen (BL37), Jizhong (GV6) and Zhiyang (GV9) acupoints from the third post-injury day until the experimental session. At 1, 2, 3 and 4 post-injury weeks, the BBB scores of the SCI group of rats treated with EA at 50Hz showed a gradual but greater enhancement of locomotor activity than the other groups of rats. Unrestrained gait kinematic analysis of SCI rats treated with EA–50Hz stimulation showed a significant improvement in stride duration, length and speed (p<0.05), whereas a discrete recovery of gait locomotion was observed in the other groups of animals. After four post-injury weeks, the H-reflex amplitude and H-reflex/M wave amplitude ratio obtained in SCI rats had a noticeable enhancement (217%) compared to sham rats (n=10). Meanwhile, SCI rats treated with EA at 50Hz manifested a decreased facilitation of the H-reflex amplitude and H/M amplitude ratio (154%) and a reduced frequency-dependent amplitude depression of the H-reflex (66%). In addition, 50 Hz-EA treatment induced a recovery of the presynaptic depression of the Gs-VRP evoked by PBSt conditioning stimulation in the SCI rat (63.2±8.1%; n=9). In concordance with the latter, it could be suggested that 50 Hz-EA stimulation reduced the hyper-excitability of motoneurons and provokes a partial improvement of the locomotive performance and H reflex responses by a possible recovery of presynaptic mechanisms in the spinal cord of experimentally injured rats.



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Altered functional efficacy of hippocampal interneuron during epileptogenesis following febrile seizures

Publication date: Available online 7 March 2017
Source:Brain Research Bulletin
Author(s): Yeon Hee Yu, Kahyun Lee, Dal Sik Sin, Kyung-Ho Park, Dae-Kyoon Park, Duk-Soo Kim
Febrile seizure (FS) is the most common seizure type in infants and young children. FS may induce functional changes in the hippocampal circuitries. Abnormality of excitatory and inhibitory neurotransmissions was previously related to wide-spread seizure attack in the hippocampus following recurrent seizure onset. To clarify the involvement of expressional changes and functional alterations of hippocampal interneurons with epileptogenesis following FS, we investigated long-term effects following recurrent seizure in a hyperthermia-induced seizure animal model. At 12 weeks following FS, the recurrent seizure time period, local field potentials (LFP) revealed high amplitude potential and a sharp wave characteristic of epilepsy. Mossy fiber reorganization in the hippocampus was also detected as abnormal synaptic connection at 8 weeks. Calretinin (CR) −positive interneurons were transiently enhanced during epileptogenic period at 7-9 weeks after FS in the CA1 and DG region and it is double labeled with VGLUT-1. However, although GABAA-α1 immunoreactivities were un-changed as similar to control hippocampus at 7-9 weeks after seizure onset, its expression was significantly enhanced at 4 weeks and 12 weeks and it is colocalized with GABA. Furthermore, the field excitatory postsynaptic potential (fEPSP) and the paired-pulse responses including population spike (PS) latency, excitability ratio and PS2/PS1 ratio were markedly altered in the CA1 and DG region at 12 weeks after FS. Therefore, our findings in present study indicate that these time-dependent changes may be based on the persistent alterations of hippocampal neuronal circuits in balance between excitatory and inhibitory responses, and may lead to the epileptogenesis and spread of seizure activity following FS.



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Possible role of endothelin receptor against hyperhomocysteinemia and β-amyloid induced AD type of vascular dementia in rats

Publication date: Available online 6 March 2017
Source:Brain Research Bulletin
Author(s): Major Singh, Atish Prakash
Vascular dementia (VaD) is considered as the second commonest form of dementia after Alzheimer's disease (AD). The study was designed to investigate the effect of endothelin receptor against β-amyloid induced AD type of vascular dementia. This disease was induced by combine administration of single ICV (intracerebroventricle) infusion of β-amyloid (Aβ) once and chronic oral administration of L-Methionine for 21 days. Bosentan (dual endothelin receptor antagonist) was administered for 21 days. Behavioral alterations were observed during different time interval of the study. Animals were killed immediately following the last behavior session. Oxidative parameters, acetylcholinesterase activity, neuro-inflammatory markers, amyloid beta levels were determined in hippocampus and cortex while serum homocysteine, serum nitrite carotid artery superoxide anion level were also determined. Endothelial function was measured on isolated carotid artery using myograph instrument. Aβ+L-Methionine showed more significant development of cognitive and vascular endothelial deficits, manifested in terms of increase in serum homocysteine level, endothelial dysfunction, impairment of learning and memory, enhanced brain acetylcholinesterase activity, marked mito-oxidative damage in rats. We have observed that L-Methionine and combination of Aβ+L-Methionine significantly enhanced Aβ level both in cortex as well as hippocampus. Treatment of bosentan attenuated Aβ+L-Methionine induced impairment of learning and memory, enhanced Aβ level, mitochondrial and endothelial dysfunction. The results of present study concluded that bosentan offers protection against β-amyloid-induced vascular dementia in rats. Endothelin receptor may be considered as a potential pharmacological target for the management of AD type of vascular dementia.



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The role of aquaporin-4 in synaptic plasticity, memory and disease

Publication date: Available online 6 March 2017
Source:Brain Research Bulletin
Author(s): Jacqueline A. Hubbard, Jenny I. Szu, Devin K. Binder
Since the discovery of aquaporins, it has become clear that the various mammalian aquaporins play critical physiological roles in water and ion balance in multiple tissues. Aquaporin-4 (AQP4), the principal aquaporin expressed in the central nervous system (CNS, brain and spinal cord), has been shown to mediate CNS water homeostasis. In this review, we summarize new and exciting studies indicating that AQP4 also plays critical and unanticipated roles in synaptic plasticity and memory formation. Next, we consider the role of AQP4 in Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), Parkinson's disease (PD), multiple sclerosis (MS), neuromyelitis optica (NMO), epilepsy, traumatic brain injury (TBI), and stroke. Each of these conditions involves changes in AQP4 expression and/or distribution that may be functionally relevant to disease physiology. Insofar as AQP4 is exclusively expressed on astrocytes, these data provide new evidence of "astrocytopathy" in the etiology of diverse neurological diseases.



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Nutritional Status of Rural Older Adults Is Linked to Physical and Emotional Health

Publication date: Available online 6 March 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Seung Eun Jung, Alex J. Bishop, Minjung Kim, Janice Hermann, Giyeon Kim, Jeannine Lawrence
BackgroundAlthough nutritional status is influenced by multidimensional aspects encompassing physical and emotional well-being, there is limited research on this complex relationship.ObjectiveThe purpose of this study was to examine the interplay between indicators of physical health (perceived health status and self-care capacity) and emotional well-being (depressive affect and loneliness) on rural older adults' nutritional status.DesignThe cross-sectional study was conducted from June 1, 2007, to June 1, 2008.Participants/settingA total of 171 community-dwelling older adults, aged 65 years and older, residing within nonmetro rural communities in the United States participated in this study.Main outcome measuresParticipants completed validated instruments measuring self-care capacity, perceived health status, loneliness, depressive affect, and nutritional status.Statistical analyses performedStructural equation modeling was employed to investigate the complex interplay of physical and emotional health status with nutritional status among rural older adults. The χ² test, comparative fit index, root mean square error of approximation, and standardized root mean square residual were used to assess model fit.ResultsThe χ² test and the other model fit indexes showed the hypothesized structural equation model provided a good fit to the data (χ² (2)=2.15; P=0.34; comparative fit index=1.00; root mean square error of approximation=0.02; and standardized root mean square residual=0.03). Self-care capacity was significantly related with depressive affect (γ=–0.11; P=0.03), whereas self-care capacity was not significantly related with loneliness. Perceived health status had a significant negative relationship with both loneliness (γ=–0.16; P=0.03) and depressive affect (γ=–0.22; P=0.03). Although loneliness showed no significant direct relationship with nutritional status, it showed a significant direct relationship with depressive affect (β=.4; P<0.01). Finally, the results demonstrated that depressive affect had a significant negative relationship with nutritional status (β=–.30; P<0.01). The results indicated physical health and emotional indicators have significant multidimensional associations with nutritional status among rural older adults.ConclusionsThe present study provides insights into the importance of addressing both physical and emotional well-being together to reduce potential effects of poor emotional well-being on nutritional status, particularly among rural older adults with impaired physical health and self-care capacity.



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Exploring the Role of Sugar-Sweetened Beverage Consumption in Obesity among New Yorkers Using Propensity Score Matching

Publication date: Available online 6 March 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Marissa Burgermaster, Hiershenee Bhana, M. Dot Fullwood, Diego A. Luna Bazaldua, Elizabeth Tipton
BackgroundResults from clinical trials have shown that sugar-sweetened beverages (SSBs) lead to increased body mass index (BMI) and obesity. This relationship has yet to be explored in observational data for nonclinical populations of adults.ObjectiveTo compare adults who drank 4+ SSBs daily to those who drank 0 in the population of adults in New York City, and to better understand adult risk factors associated with higher daily SSB consumption and BMI.DesignSecondary analysis of cross-sectional data using propensity score matching.Participants/settingThe 2009 New York City Community Health Survey (N=9,934) was used.Main outcome measureBMI.Statistical analysesFor each participant who consumed 4+ SSBs daily, propensity score matching identified matched comparisons who did not drink any SSBs. BMI in unadjusted and matched pairs was tested using t tests. A post hoc analysis compared features of those likely to drink SSBs and those not likely to drink SSBs.ResultsIn unmatched analyses, participants who consumed 4+ SSBs daily (n=475) had higher BMI than those who consumed 0 SSBs (n=3,818; BMI difference=1.4±0.29; t value=4.81; P<0.001); however, when compared with similar participants using nearest neighbor with replacement matching (n=1,062), the difference between those who consumed 4+ SSBs daily and those who consumed none decreased (BMI difference=0.37±0.36; t value=1.01; P=0.32). Analyses also indicated that those likely to drink SSBs and those unlikely to drink SSBs differed in several important characteristics, including sex, age, race, ethnicity, socioeconomic status, education, diet, and exercise.ConclusionsThe data preclude strong causal conclusions about the role of SSB in obesity. However, our results suggest that there is a subset of participants demographically and behaviorally similar with higher BMI regardless of their self-reported SSB intake. In addition to targeting SSBs, public health policies and programs should identify and address other modifiable aspects of this profile and tailor approaches to the groups identified to be most affected by high BMI.



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Gender Disparities in the Food Insecurity–Overweight and Food Insecurity–Obesity Paradox among Low-Income Older Adults

Publication date: Available online 6 March 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Daphne C. Hernandez, Layton Reesor, Rosenda Murillo
BackgroundObesity and obesity-related comorbidities are increasing among older adults. Food insecurity is a nutrition-related factor that coexists with obesity among low-income individuals. The majority of the research on the food insecurity–obesity paradox has been conducted on low-income mothers and children, with research lacking on large diverse samples of older adults.ObjectiveThe purpose of this study was to assess gender disparities in the association between food insecurity and overweight and obesity among low-income older adults.Study designCross-sectional 2011 and 2012 National Health Interview Survey data were used. Food insecurity status was determined by ≥3 affirmative responses on the 10-item US Department of Agriculture Food Security Scale (FSS). Body mass index (BMI) was calculated as outlined by the Centers for Disease Control and Prevention based on self-reported height and weight.Participants/settingsAdults included were low-income (≤1.99 federal poverty level [FPL]), older (aged ≥60 years), with a normal BMI (18.5) or greater who had complete data on FSS, BMI, and the following covariates: age, race or ethnicity, marital status, income, nativity status, physical activity, poor health status, health insurance coverage, problems paying medical bills or for medicine, and region of residency (N=5,506).Statistical analyses performedMultivariate logistic regression models were stratified by gender to estimate the association between food insecurity and higher weight status. All models included covariates.ResultsIn covariate-adjusted models, compared with low-income, food secure men, low-income, food-insecure men had 42% and 41% lower odds of being overweight and overweight or obese, respectively. Despite the high prevalence rate of obesity among low-income, food-insecure women, food insecurity was not significantly related to overweight, obesity, or overweight or obesity for older adult women in adjusted models.ConclusionsFood insecurity–overweight and –obesity paradox appears not to be present in older men. However, food insecurity and obesity coexist among low-income, older women.



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The addition of silica nanoparticles on the mechanical properties of dental stone

Publication date: Available online 6 March 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Leonardo De Cesero, Elisa Magno Nunes de Oliveira, Luiz Henrique Burnett Junior, Ricardo Meurer Papaléo, Eduardo Gonçalves Mota
Statement of problemThe current application of nanotechnology in dentistry is limited to nanoparticles incorporated into adhesive systems and composite resins. Dental stone is a widely used material, and the incorporation of silica nanoparticles is still unexplored.PurposeThe purpose of this in vitro study was to evaluate the mechanical properties of dental stone after the addition of silica nanoparticles in different concentrations.Material and methodsA total of 180 specimens were prepared, 90 for each dental stone (Durone and Fuji Rock). For the control group (CG), no silica particles were added, while test group TGnI had silica nanoparticles added to 1 wt%, and test group TGnV had silica nanoparticles added to 5 wt%. The roughness, diametral tensile strength (DTS), and compressive strength were measured 24 hours after the start of spatulation.ResultsThe mean roughness values for Durone were 0.55, 0.36, and 0.28 μm for CG, TGnI, and TGnV; for Fuji Rock, the mean roughness values were 0.47 for CG, 0.31 for TGnI, and 0.35 μm for TGnV. The mean DTS values for Durone were 6.0, 5.1, and 5.0 MPa for CG, TGnI, and TGnV, respectively, and for Fuji Rock, the mean DTS values were 6.4, 5.2, and 4.5 MPa for CG, TGnI, and TGnV, respectively. The mean compressive strength values for Durone were 35.4, 32.7, and 32.4 MPa for CG, TGnI, and TGnV, respectively, and for Fuji Rock, the mean compressive strength values were 42.9, 31.2, and 29.8 MPa for CG, TGnI, and TGnV respectively.ConclusionsSurface roughness was statistically lower for the Durone and Fuji Rock stones (P<.001) when silica nanoparticles were added. The addition of silica nanoparticles did not significantly affect the DTS and compressive strength of Durone compared with CG (P>.05) but did affect the DTS of Fuji Rock when 5 wt% was added and the compressive strength in both concentrations (P<.05).



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Combination antitumor therapy with targeted dual-nanomedicines

Publication date: Available online 7 March 2017
Source:Advanced Drug Delivery Reviews
Author(s): Wenbing Dai, Xiaoyou Wang, Ge Song, Tongzhou Liu, Bing He, Hua Zhang, Xueqing Wang, Qiang Zhang
Combination therapy is one of important treatment strategies for cancer at present. However, the outcome of current combination therapy based on the co- administration of conventional dosage forms is suboptimal, due to the short half-lives of chemodrugs, their deficient tumor selectivity and so forth. Nanotechnology-based targeted delivery systems show great promise in addressing the associated problems and providing superior therapeutic benefits. In this review, we focus on the combination therapeutic strategies between different nanomedicines or drug-loaded nanocarriers, rather than the co-delivery of different drugs via a single nanocarrier. We introduce the general concept of various targeting strategies of nanomedicines, present the principles of combination antitumor therapy with dual-nanomedicines, analyze their advantages and limitations compared with co-delivery strategies, and overview the recent advances of combination therapy based on targeted nanomedicines. Finally, we reviewed the challenges and future perspectives regarding the selection of therapeutic agents, targeting efficiency and the gap between the preclinical and clinical outcome.

Graphical abstract

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Inhalation of progesterone inhibits chronic airway inflammation of mice exposed to ozone

Publication date: May 2017
Source:Molecular Immunology, Volume 85
Author(s): Xia Fei, Wuping Bao, Pengyu Zhang, Xue Zhang, Guoqing Zhang, Yingying Zhang, Xin Zhou, Min Zhang
Chronic ozone exposure leads to a model of mice with lung inflammation, emphysema and oxidative stress. Progesterone plays an important role in attenuating the neuroinflammation. We assume that progesterone will reduce the chronic airway inflammation exposed to ozone and evaluate whether combination of progesterone with glucocorticoids results in synergistic effects. C57/BL6 mice were exposed to ozone (2.5ppm, 3h) 12 times over 6 weeks, and were administered with progesterone (0.03 or 0.3mg/L; inhaled) alone or combined with budesonide (BUD) (0.2g/L) after each exposure until the tenth week. Mice were studied 24h after final exposure, cells and inflammatory mediators were assessed in bronchoalveolar lavage fluid (BALF) and lungs used for evaluation of glucocorticoids receptors (GR), p38 mitogen-activated protein kinase (MAPK) phosphorylation and nuclear transcription factor κB (NF-κB) activation. Exposure to ozone resulted in a marked lung neutrophilia. Moreover, in ozone-exposed group, the levels of oxidative stress-related interleukin (IL)-1β, IL-6, IL-8, IL-17A, activated NF-κB and p38MAPK, airway inflammatory cells infiltration density, mean linear intercept (Lm) were greatly increased, FEV25 and glucocorticoids receptors (GR) were markedly decreased. Comparable to BUD, progesterone treatment dose-dependently led to a significant reduction of IL-1β, IL-6, IL-8, IL-17A, activated NF-κB and p38MAPK, and an increase of FEV25 and GR. Progesterone combined with BUD resulted in dramatic changes, compared to monotherapy of BUD or progesterone. Therefore, these results demonstrate that chronic ozone exposure has profound airway inflammatory effects counteracted by progesterone and progesterone acts synergistically with glucocorticoids in attenuating the airway inflammation dose-dependently.



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Think of ALL the Arteries in the Thorax!

Publication date: Available online 7 March 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): A. Chaudhuri, R. de Silva




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TEVAR for Adult Coarctation of the Aorta

Publication date: Available online 7 March 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): A. Chaudhuri, R. Dey




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Carotid Stenosis Treatment: Variation in International Practice Patterns

Publication date: Available online 6 March 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): M. Venermo, G. Wang, A. Sedrakyan, J. Mao, N. Eldrup, R. DeMartino, K. Mani, M. Altreuther, B. Beiles, G. Menyhei, G. Danielsson, I. Thomson, G. Heller, C. Setacci, M. Björck, J. Cronenwett
ObjectivesThe aim was to determine current practice for the treatment of carotid stenosis among 12 countries participating in the International Consortium of Vascular Registries (ICVR).MethodsData from the United States Vascular Quality Initiative (VQI) and the Vascunet registry collaboration (including 10 registries in Europe and Australasia) were used. Variation in treatment modality of asymptomatic versus symptomatic patients was analysed between countries and among centres within each country.ResultsAmong 58,607 procedures, octogenarians represented 18% of all patients, ranging from 8% (Hungary) to 22% (New Zealand and Australia). Women represented 36%, ranging from 29% (Switzerland) to 40% (USA). The proportion of carotid artery stenting (CAS) among asymptomatic patients ranged from 0% (Finland) to 26% (Sweden) and among symptomatic patients from 0% (Denmark) to 19% (USA). Variation among centres within countries for CAS was highest in the United States and Australia (from 0% to 80%). The overall proportion of asymptomatic patients was 48%, but varied from 0% (Denmark) to 73% (Italy). There was also substantial centre level variation within each country in the proportion of asymptomatic patients, most pronounced in Australia (0–72%), Hungary (5–55%), and the United States (0–100%). Countries with fee for service reimbursement had higher rates of treatment in asymptomatic patients than countries with population based reimbursement (OR 5.8, 95% CI 4.4–7.7).ConclusionsDespite evidence about treatment options for carotid artery disease, the proportion of asymptomatic patients, treatment modality, and the proportion of women and octogenarians vary considerably among and within countries. There was a significant association of treating more asymptomatic patients in countries with fee for service reimbursement. The findings reflect the inconsistency of the existing guidelines and a need for cooperation among guideline committees all over the world.



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Comparison of Renal Complications between Endografts with Suprarenal and Infrarenal Fixation

Publication date: Available online 6 March 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): S.L. Zettervall, P.A. Soden, S.E. Deery, K. Ultee, K.E. Shean, F. Shuja, R.L. Amdur, M.L. Schermerhorn
ObjectivesSurgeons have multiple grafts options available for the endovascular treatment of abdominal aortic aneurysm (EVAR), and some hypothesize that suprarenal fixation endografts may result in higher rates of renal complications than infrarenal endografts. This study aimed to compare the outcomes of contemporary suprarenal and infrarenal endografts.MethodsThe Targeted Vascular Module of the National Surgical Quality Improvement Project was utilised to identify patients undergoing EVAR for infrarenal aneurysm from 2011 to 2013. Pre-operative and operative variables and 30 day outcomes were compared among suprarenal (Zenith and Endurant) and infrarenal fixation devices (Excluder). Renal complications included creatinine increase > 2 mg/dL or new dialysis, as defined by NSQIP. Multivariate regression was completed to account for patient demographics, comorbidities, and operative characteristics.ResultsA total of 3587 patients were evaluated including 2273 (63%) with suprarenal grafts and 1314 (37%) with infrarenal grafts. Patients with suprarenal grafts were less commonly white (84% vs. 88%, p < .01) and more commonly male (83% vs. 80%, p = .03). There were no differences in age or comorbidities. Renal complications (1.1% vs. 0.1%, p < .01) and length of stay more than 2 days (34% vs. 25%, p < .01) occurred more commonly after suprarenal fixation. After adjustment, suprarenal grafts had significantly higher rates of renal complications (OR, 12.0; 95% CI, 1.6–91) and length of stay more than 2 days (OR, 1.4; 95% CI, 1.2–1.7).ConclusionOverall rates of renal complications following EVAR are low. Patients selected for suprarenal stent grafts are at increased risk of renal complications and prolonged length of stay, which may be due to selection bias, deployment techniques, or the presence of a bare stent overlying the renal arteries. Further studies are necessary to evaluate the mechanism and duration of renal dysfunction and important long-term outcomes of interest.



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Post-Carotid Endarterectomy Hypertension. Part 1: Association with Pre-operative Clinical, Imaging, and Physiological Parameters

Publication date: Available online 6 March 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): J.E. Newman, M.J. Bown, R.D. Sayers, J.P. Thompson, T.G. Robinson, B. Williams, R. Panerai, P. Lacy, A.R. Naylor
Objective/BackgroundPost-endarterectomy hypertension (PEH) is a well recognised, but poorly understood, phenomenon after carotid endarterectomy (CEA) that is associated with post-operative intracranial haemorrhage, hyperperfusion syndrome, and cardiac complications. The aim of the current study was to identify pre-operative clinical, imaging, and physiological parameters associated with PEH.MethodsIn total, 106 CEA patients undergoing CEA under general anaesthesia underwent pre-operative evaluation of 24 hour ambulatory arterial blood pressure (BP), baroreceptor sensitivity, cerebral autoregulation, and transcranial Doppler measurement of cerebral blood flow velocity (CBFv) and pulsatility index. Patients who met pre-existing criteria for treating PEH after CEA (systolic BP [SBP] > 170 mmHg without symptoms or SBP > 160 mmHg with headache/seizure/neurological deficit) were treated according to a previously established protocol.ResultsIn total, 40/106 patients (38%) required treatment for PEH at some stage following CEA (26 in theatre recovery [25%], 27 while on the vascular surgical ward [25%]), while seven (7%) had SBP surges > 200 mmHg back on the ward. Patients requiring treatment for PEH had a significantly higher pre-operative SBP (144 ± 11 mmHg vs. 135 ± 13 mmHg; p < .001) and evidence of pre-existing impairment of baroreceptor sensitivity (3.4 ± 1.7 ms/mmHg vs. 5.3 ± 2.8 ms/mmHg; p = .02). However, PEH was not associated with any other pre-operative clinical features, CBFv, or impaired cerebral haemodynamics. Paradoxically, autoregulation was better preserved in patients with PEH. All four cases of hyperperfusion associated symptoms were preceded by PEH. Length of hospital stay was significantly increased in patients with PEH (p < .001).ConclusionIn this study, where all patients underwent CEA under general anaesthesia, PEH was associated with poorly controlled pre-operative BP and impaired baroreceptor sensitivity, but not with other peripheral or central haemodynamic parameters, including impaired cerebral autoregulation.



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Absolute Ethanol Embolisation of Mandibular Arteriovenous Malformations Following Direct Percutaneous Puncture and Release of Coils via a Microcatheter

Publication date: Available online 7 March 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): D. Wang, L. Su, Y. Han, Z. Wang, L. Zheng, X. Fan
Objective/BackgroundTo evaluate the safety, efficacy, and medium-term outcome of a modified technique of ethanol embolisation of mandibular arteriovenous malformations (AVMs) following a direct percutaneous transvenous approach to the release of coils via a microcatheter.MethodsFrom January 2012 to July 2014, 18 consecutive patients (mean age 20.9 years [range 10–35 years]) with symptomatic AVMs of the mandible were enrolled. A microcatheter was inserted into the lesion via a direct percutaneous puncture needle. Electrolytically detachable coils and 0.018 mm coils were super-selectively placed to decrease the flow and volume of the arteriovenous fistulas via a microcatheter. Absolute ethanol was injected to obliterate the fistulas. Clinical follow-up was performed in all patients. Therapeutic outcomes were determined by evaluating the degree of devascularisation at follow-up angiography and symptoms and signs.ResultsTransvenous release of coils combined with absolute ethanol embolisation were used in all cases. The amount of ethanol used ranged from 5 to 50 mL (mean 25.7 mL) in a single session. Sixteen of 18 patients were cured, and two had partial remission. Follow-up times ranged from 8 to 26 months (medium 15.7 months), and there was no angiographic recurrence of the lesions. Minor complication occurred in five of the 18 patients. There were no major complications.ConclusionAbsolute ethanol embolisation following a direct percutaneous transvenous approach to release coils via a microcatheter is a feasible, safe, and highly effective method for the management of mandibular AVMs.



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