Tag: nevin manimala

Eur J Vasc Endovasc Surg. 2022 Nov 2:S1078-5884(22)00732-8. doi: 10.1016/j.ejvs.2022.11.005. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare rates of mortality, rupture and secondary intervention following endovascular repair (EVAR) of intact abdominal aortic aneurysms (AAA) using contemporary endograft devices from three major manufacturers.

DESIGN: Retrospective cohort study using linked clinical registry (Australasian Vascular Audit) and all payer administrative data.

METHODS: We identified patients undergoing EVAR for intact AAA between 2010-2019 in New South Wales, Australia. We compared rates of all-cause mortality, secondary rupture and secondary intervention (subsequent aneurysm repair; other secondary aortic intervention) for patients treated with Cook, Medtronic and Gore standard devices. We used inverse probability of treatment weighted proportional hazards and competing risk regression to adjust for patient, clinical and aneurysm characteristics, using Cook as the referent device.

RESULTS: We identified 2,874 eligible EVAR patients, with a median follow-up of 4.1 (maximum 9.5) years. Mortality rates were similar for patients receiving different devices (ranging between 7.0-7.3 per 100 person-years). There was no significant difference between devices in secondary rupture rates, which ranged between 0.4-0.5 per 100 person-years. Patients receiving Medtronic and Gore devices tended to have higher crude rates of subsequent aneurysm repair (1.5 per 100 person-years) than patients receiving Cook devices (0.8 per 100 person-years). This finding remained in the adjusted analysis, but was only statistically significant for Medtronic devices (HR 1.57, 95% CI 1.02-2.47; HR 1.73, 95% CI 0.94-3.18 respectively).

CONCLUSION: Major endograft devices have similar overall long-term safety profiles. However, there may be differences in rates of secondary intervention for some devices. This may reflect endograft durability, or patient selection for different devices based on aneurysm anatomy. Continuous comparative assessments are needed to guide evidence for treatment decisions across the range of available devices.

PMID:36334901 | DOI:10.1016/j.ejvs.2022.11.005

Eur J Vasc Endovasc Surg. 2022 Nov 2:S1078-5884(22)00729-8. doi: 10.1016/j.ejvs.2022.10.045. Online ahead of print.

ABSTRACT

OBJECTIVES AND DESIGN: Plasma extracellular vesicles (EV) are an emerging source of biomarkers for diagnosis and prognosis of cardiovascular disease (CVD). Risk stratification for common adverse events such as Major Adverse Limb Event (MALE) and Major Adverse Cardiovascular Events (MACE) by an EV blood sample could improve healthcare management by individualizing drug therapy or by improving informed decision-making regarding revascularisations in patients with PAD. As such, we investigated the associations of plasma EV proteins with prospectively registered MALE and MACE in consecutive patients undergoing femoral endarterectomy.

METHODS: Using the Athero-Express biobank study, we measured four EV proteins (Cystatin C, CD14, Serpin C1 and Serpin G1) in the HDL subfraction isolated from plasma of 317 PAD patients undergoing arterial revascularization. Multivariable Cox proportional hazard regression was used to investigate the association between plasma EV-protein levels with MACE and MALE, in the three-year postoperative period.

RESULTS: Most patients were treated for claudication (Fontaine II, 52.8%), although rest pain (Fontaine III, 30.1%) and ischemic wounds (Fontaine IV, 17.1%) were common in this cohort. Within three years, 51 patients died of which 25 due to CVD, 39 patients experienced a MACE, and 125 patients experienced a MALE. Multivariable regression models, based on statistically proven covariables and on literature, showed a significant association of Serpin G1 (HR 1.49 (95% CI 1.08 – 2.06) P = .016) and CD14 (HR 1.40 (1.03-1.90) P = .029) with MACE, and of Serpin G1 (HR 1.29 (1.07 – 1.57) P = .009) with MALE.

CONCLUSIONS: Serpin G1 and CD14 plasma EV protein levels are associated with future MACE and MALE in patients with severe PAD.

PMID:36334903 | DOI:10.1016/j.ejvs.2022.10.045

Exp Gerontol. 2022 Nov 2:112006. doi: 10.1016/j.exger.2022.112006. Online ahead of print.

ABSTRACT

INTRODUCTION: Age-related changes in the immune system are called immunosenescence. Within the T lymphocytes is the subpopulation of double negative (DNT) peripheral lymphocytes that are immunomodulators of the immune response, based on their ability to suppress the functions of simple positive T cells and their cytotoxicity for tumor cells and those infected by viruses.

OBJECTIVE: To determine the frequency of peripheral DNT lymphocytes in older Cuban adults.

METHODS: A cross-sectional study was carried out in 30 older adults, residents in Cuba. DNT lymphocytes in peripheral blood were quantified by flow cytometry. A Beckman Coulter Gallios flow cytometer was used for data reading and analysis. Percentage values mean and standard deviation were used. The Chi-square was used to relate the percentage values of DNT and comorbidities. It was considered statistically significant if p ≤ 0.05.

RESULTS: There was a predominance of women who represented 70 %. No older adult with low values of DNT lymphocytes was reported. Women with high percentage and absolute values of DNT lymphocytes prevailed in relation to men. In the group ≥80 years, high values in % and absolute values of DNT lymphocytes predominated. The high percentage values of DNT cells were mainly related to cardiovascular disease, and predominated in the elderly of ≥80 years old; who presented respiratory and skin infections, fundamentally. The percentage normal value in the group < 80 years was significant (p = 0.0198). The Chi-square value was 0,5995.

CONCLUSIONS: Most older adults who exhibited high percentage and absolute values of DNT lymphocytes, or a tendency to them, had some associated comorbidity, an idea that suggests that DNT cells participate in immune surveillance, defense and homeostasis based on their double identity, that is, its pathogenic or immunosuppressive phenotype according to the specific immunological microenvironment.

PMID:36334893 | DOI:10.1016/j.exger.2022.112006

Arthroscopy. 2022 Nov 2:S0749-8063(22)00694-6. doi: 10.1016/j.arthro.2022.10.036. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the diagnostic performance of hip magnetic resonance (MR) arthrography with a gadolinium-based contrast agent (GBCA) or normal saline (NS) for intra-articular pathologies.

METHODS: This retrospective study was approved by the institutional review board of our hospital, and the requirement for informed consent was waived. The study included 37 consecutive patients (38 hips; 21 right hips; 24 males; mean age, 33 years) who underwent GBCA-hip MR arthrography from July 2011 to January 2020 and 30 consecutive patients (30 hips; 20 right hips; 21 males; mean age, 40 years) who underwent NS-hip MR arthrography from January 2018 to June 2020. All images were evaluated twice independently by two radiologists blinded to the arthroscopic findings for the presence of labral tears, cartilage abnormalities, or ligamentum teres tears. Intra- and inter-reader reliabilities were determined by kappa values (k) using the Chi-squared test, and diagnostic performance was evaluated based on the arthroscopic findings. A p-value less than 0.05 was considered to indicate statistical significance.

RESULTS: Intra-reader reliability in the detection of intra-articular pathologies ranged from moderate to almost perfect (k =0.510-0.840) and inter-reader reliability ranged from moderate to substantial (k =0.441-0.695) for GBCA- and NS-hip MR arthrography. The diagnostic accuracy of GBCA- and NS-hip MR arthrography was as follows: 81.6-92.1% and 66.7-73.3% for labral tears, respectively; 68.4-86.8% and 63.3-70.0% for cartilage abnormality, respectively; and 68.4-76.3% and 50.0-56.7% for ligamentum teres tears, respectively.

CONCLUSION: NS-hip MR arthrography may be less accurate than GBCA-hip MR arthrography.

LEVEL OF EVIDENCE: Level II of Development of diagnostic criteria (consecutive patients with consistently applied reference standard and blinding).

PMID:36334855 | DOI:10.1016/j.arthro.2022.10.036

Paediatr Anaesth. 2022 Nov 5. doi: 10.1111/pan.14597. Online ahead of print.

ABSTRACT

BACKGROUND: Tissue oximetry devices use wavelengths in the 680-870 nm range to separate between oxygenated/deoxygenated hemoglobin (Hb). Conjugated bilirubin has an absorption peak at 730 nm.

AIMS: We hypothesized that ForeSight Elite using 5 wavelengths reduces interference from bilirubin and shows higher regional tissue oxygen saturation (rSO₂ ) than INVOS 5100C incorporating 2 wavelengths.

METHODS: Infants and children undergoing living donor liver transplantation were included between March 2019 and September 2020. Cerebral and somatic rSO₂ were measured and real-time simultaneous data were collected. Additionally, measurements were collected at 1) Baseline 2) Beginning of dissection phase 3) Beginning of anhepatic phase 4) Reperfusion phase 5) Skin closure. Bilirubin level was available at baseline and at reperfusion. Hyperbilirubinemia was defined as bilirubin level ≥1.0 mg/dl.

RESULTS: Thirty-three patients with median age of 27 months and median weight of 12 kg were included. Baseline bilirubin levels were higher compared to values at reperfusion (P=0.021). A linear mixed effects model considering bilirubin as fixed and patient as random effect showed that there was a statistically significant difference in cerebral rSO₂ readings in function of time (P=0.031), device (P< 0.001) and bilirubin concentrations (P=0.007) but not for Hb (P=0.347), SpO₂ (P=0.882) and arterial partial pressure of CO₂ (PaCO₂ ) (P=0.146). The model showed that there was a statistically significant difference in somatic rSO₂ readings in function of device (P< 0.001) and bilirubin concentrations (P=0.023) but not for time (P=0.074), Hb (P=0.954), SpO₂ (P=0.108) and PaCO₂ (P=0.775). Bland-Altman plot analyzing cerebral and somatic rSO₂ between both devices showed respectively a mean absolute Bias and 95% limits of agreement of 21.73% (-10.21 to 53.67) and 19.52% (-29.51 to 68.54).

CONCLUSIONS: Oximetry devices emitting light at > 2 wavelengths may overcome interference from hyperbilirubinemia providing higher rSO₂ readings.

PMID:36334305 | DOI:10.1111/pan.14597

J Neurosurg. 2022 Nov 4:1-7. doi: 10.3171/2022.10.JNS221138. Online ahead of print.

ABSTRACT

OBJECTIVE: Woven EndoBridge (WEB) intrasaccular flow disruptors and stent-assisted coiling (SAC) are viable endovascular treatment options for wide-neck bifurcation intracranial aneurysms (WNBAs). Data directly comparing these two treatment options are limited. The authors aimed to compare radiographic occlusion rates and complication profiles between patients who received WEB and those who received SAC for WNBAs.

METHODS: Retrospective review of a prospectively maintained cerebrovascular procedural database was performed at a single academic medical center between 2017 and 2021. Patients were included if they underwent WEB embolization or SAC of an unruptured WNBA. SAC patients were propensity matched to WEB-embolized patients on the basis of aneurysm morphology. Complete and adequate (complete occlusion or residual neck remnant) occlusion rates at last angiographic follow-up, as well as periprocedural complications, were compared between the two groups. A cost comparison was performed for a typical 5-mm WNBA treated with WEB versus SAC by using manufacturer-suggested retail prices.

RESULTS: Thirty-five WEB and 70 SAC patients were included. Aneurysm width, neck size, and dome-to-neck ratio were comparable between groups. Follow-up duration was significantly longer in the SAC group (median [interquartile range] 545 [202-834] days vs 228 [177-494] days, p < 0.001, Mann-Whitney U-test). Complete (66% of WEB patients vs 69% of SAC patients) and adequate (94% WEB vs 91% SAC) occlusion rates were similar between groups at the last available angiographic follow-up (p = 0.744, chi-square test). Complete occlusion rates were comparable on Cox regression analysis after correction for follow-up duration (hazard ratio 1.5, 95% CI 0.8-3.1). Average time to residual aneurysm or neck formation was not statistically different between treatment groups (613 days for SAC patients vs 347 days for WEB patients, p = 0.225, log-rank test). Periprocedural complications trended higher in the SAC group (0% WEB vs 9% SAC, p = 0.175, Fisher exact test), although this finding was not significant. The equipment costs for a typical SAC case were estimated at $18,950, whereas the costs for a typical WEB device case were estimated at $18,630.

CONCLUSIONS: Midterm complete and adequate occlusion rates were similar between patients treated with WEB and those treated with SAC. Given these comparable outcomes, there may be equipoise in treatment options for WNBAs.

PMID:36334292 | DOI:10.3171/2022.10.JNS221138

Cranio. 2022 Nov 5:1-8. doi: 10.1080/08869634.2022.2140245. Online ahead of print.

ABSTRACT

OBJECTIVE: To study postural changes, taking into account different mandibular positions and the cephalic and plantar body segments.

METHODS: A cross-sectional, descriptive, clinical, and observational study was carried out on 76 patients, (mean age 28.79 years), in whom body posture and plantar support were evaluated in the maximum mandibular intercuspal position and the mandibular rest position without dental contact.

RESULTS: When the mandibular position was altered, 71.01% of the patients showed changes in the bipupillary line (p = 0.008), while those who did not show such changes did, however, show changes in plantar support. More than 85% of the sample experienced alterations in the plantar plane when the mandibular position was changed, with statistically significant results (p < 0.001).

CONCLUSION: There is a positive relationship between the different segments in body posture. In the sample, changes in plantar support with respect to the different mandibular positions were noticeable.

PMID:36334277 | DOI:10.1080/08869634.2022.2140245

Nicotine Tob Res. 2022 Nov 5:ntac256. doi: 10.1093/ntr/ntac256. Online ahead of print.

ABSTRACT

INTRODUCTION: Tobacco is the leading preventable cause of morbidity and mortality for Aboriginal and Torres Strait Islander people. Accordingly, the provision of culturally safe and effective smoking cessation strategies are crucial. While previous research has suggested Aboriginal Health Workers/Practitioners are well placed to provide smoking cessation care, no research to date has explored the workforce knowledge, attitudes and practices in offering best practice cessation care.

METHODS: A cross-sectional study was conducted among Aboriginal Health Workers/Practitioners from June to September 2021. Descriptive and inferential statistics were conducted to examine participant characteristics, provision of smoking cessation care, and explore the factors associated with smoking cessation care.

RESULTS: Out of 1052 registered Aboriginal Health Workers/Practitioners, 256 participants completed the full survey (24.3%). Smoking cessation counselling was always provided by 41.9%; provided some of the time by 42.4%, and never provided by 12.9%. Combination NRT and Quitline referral were always offered by 23.1% and 44.9% of participants respectively. Those that received training, felt smoking cessation care was part of their role, and were based in Aboriginal Community Controlled Health Organisation were significantly more likely to offer best practice smoking cessation care.

CONCLUSION: Aboriginal Health Workers/Practitioners and Aboriginal Community Controlled Health Organisations play a critical role in delivering high quality, evidence based and culturally safe care to Aboriginal and Torres Strait Islander people. Aboriginal Health Workers/Practitioners are well placed to offer smoking cessation care. Ongoing funding and implementation of a targeted smoking cessation workforce with appropriate training and resources are urgently required.

IMPLICATIONS: Aboriginal Health Workers/Practitioners are well placed to offer culturally safe, best practice smoking cessation care. However, due to the magnitude and complexity of Aboriginal Health Workers/Practitioners roles, it is challenging for smoking cessation care to be consistently and feasibly integrated into usual care. Acknowledging Australia’s National Preventative Health Strategy target of 27% or less Aboriginal and Torres Strait Islander people smoking by 2030, urgent investment and resourcing must be directed to building a skilled workforce to support quitting and maintaining smokefree behaviours, ensuring equitable access to smoking cessation care for Aboriginal and Torres Strait Islander peoples.

PMID:36334273 | DOI:10.1093/ntr/ntac256

Circulation. 2022 Nov 5. doi: 10.1161/CIRCULATIONAHA.122.061991. Online ahead of print.

ABSTRACT

Background: Social and psychosocial factors are associated with cardiovascular health (CVH). Our objective was to examine the contributions of individual-level social and psychosocial factors to racial and ethnic differences in population CVH in the National Health and Nutrition Examination Surveys (NHANES) 2011-2018, to inform strategies to mitigate CVH inequities. Methods: In NHANES participants aged ≥20 years, Kitagawa-Blinder-Oaxaca decomposition estimated the statistical contribution of individual-level factors (education, income, food security, marital status, health insurance, place of birth, depression) to racial and ethnic differences in population mean CVH score (range 0-14, accounting for diet, smoking, physical activity, body mass index, blood pressure, cholesterol, blood glucose) among Hispanic, non-Hispanic Asian, or non-Hispanic Black adults compared with non-Hispanic White adults. Results: Among 16,172 participants (representing 255 million US adults), 24% were Hispanic, 12% non-Hispanic Asian, 23% non-Hispanic Black, and 41% non-Hispanic White. Among males, mean (standard error [SE]) CVH score was 7.45 (2.3) in Hispanic, 8.71 (2.2) in non-Hispanic Asian, 7.48 (2.4) in non-Hispanic Black, and 7.58 (2.3) in non-Hispanic White adults. In Kitagawa-Blinder-Oaxaca decomposition, education explained the largest component of CVH differences among males (if distribution of education were similar to Non-Hispanic White, CVH score would be 0.36 [0.04] points higher in Hispanic, 0.24 [0.04] points lower in Non-Hispanic Asian, and 0.23 [0.03] points higher in Non-Hispanic Black, p<0.05). Among females, mean (SE) CVH score was 8.03 (2.4) in Hispanic, 9.34 (2.1) in non-Hispanic Asian, 7.43 (2.3) in non-Hispanic Black, and 8.00 (2.5) in non-Hispanic White adults. Education explained the largest component of CVH difference in Non-Hispanic Black females (if distribution of education were similar to NH White, CVH score would be 0.17 [0.03] points higher in NH Black, p<0.05). Place of birth (US-born versus born outside the US) explained the largest component of CVH difference in Hispanic and Non-Hispanic Asian females (if distribution of place of birth were similar to Non-Hispanic White, CVH score would be 0.36 [0.07] points lower and 0.49 [0.16] points lower, respectively, p<0.05). Conclusions: Education and place of birth confer the largest statistical contributions to the racial and ethnic differences in mean CVH score among US adults.

PMID:36334260 | DOI:10.1161/CIRCULATIONAHA.122.061991

Obes Surg. 2022 Nov 5. doi: 10.1007/s11695-022-06336-x. Online ahead of print.

ABSTRACT

PURPOSE: Subclinical cardiac dysfunction is common in patients with obesity. Bariatric surgery is associated with normalization of subclinical cardiac function in 50% of the patients with obesity. The aim of this study was to identify predictors for a lack of improvement of subclinical cardiac dysfunction 1-year post-bariatric surgery.

METHODS: Patients who were referred for bariatric surgery were enrolled in a longitudinal study. Inclusion criteria were age 35-65 years and BMI ≥ 35 kg/m². Patients with a suspicion of or known cardiovascular disease were excluded. Conventional and advanced echocardiography, Holter monitoring, and blood tests were performed pre- and 1-year post-bariatric surgery. Subclinical cardiac dysfunction was defined as either a reduced left ventricular ejection fraction, decreased global longitudinal strain (GLS), diastolic dysfunction, arrhythmia, or an increased BNP or hs Troponin I.

RESULTS: A total of 99 patients were included of whom 59 patients had cardiac dysfunction at baseline. Seventy-two patients completed the 1-year follow-up after bariatric surgery. There was a significant reduction in weight and cardiovascular risk factors. Parameters of cardiac function, such as GLS, improved. However, in 20 patients cardiac dysfunction persisted. Multivariate analysis identified a decreased heart rate variability (which is a measure of autonomic function), and a decreased vitamin D pre-surgery as predictors for subclinical cardiac dysfunction after bariatric surgery.

CONCLUSION: Although there was an overall improvement of cardiac function 1-year post-bariatric surgery, autonomic dysfunction and a decreased vitamin D pre-bariatric surgery were predictors for a lack of improvement of subclinical cardiac dysfunction.

PMID:36334252 | DOI:10.1007/s11695-022-06336-x