cardiotoxicity with immune system targeting drugs a meta analysis of anti pd pd l1 immunotherapy randomized clinical trials

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Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery:A Network Meta-Analysis of Clinical Outcomes

Background-There remains uncertainty regarding the second-best conduit after the internal thoracic artery in coronary artery bypass grafting. Few studies directly compared the clinical results of the radial artery (RA), right internal thoracic artery (RITA), and saphenous vein (SV). No network meta-analysis has compared these 3 strategies.Methods and Results-MEDLINE and EMBASE were searched for adjusted observational studies and randomized controlled trials comparing the RA, SV, and/or RITA as the second conduit for coronary artery bypass grafting. The primary end point was all-cause long-term mortality. Secondary end points were operative mortality, perioperative stroke, perioperative myocardial infarction, and deep sternal wound infection (DSWI). Pairwise and network meta-analyses were performed. A total of 149 902 patients (4 randomized, 31 observational studies) were included (RA, 16 201, SV, 112 018, RITA, 21 683). At NMA, the use of SV was associated with higher long-term mortality compared with the RA (incidence rate ratio, 1.23; 95% CI, 1.12-1.34) and RITA (incidence rate ratio, 1.26; 95% CI, 1.17-1.35). The risk of DSWI for SV was similar to RA but lower than RITA (odds ratio, 0.71; 95% CI, 0.55-0.91). There were no differences for any outcome between RITA and RA, although DSWI trended higher with RITA (odds ratio, 1.39; 95% CI, 0.92-2.1). The risk of DSWI in bilateral internal thoracic artery studies was higher when the skeletonization technique was not used.Conclusions-The use of the RA or the RITA is associated with a similar and statistically significant long-term clinical benefit compared with the SV. There are no differences in operative risk or complications between the 2 arterial conduits, but DSWI remains a concern with bilateral ITA when skeletonization is not used.</p

THE SYMBOLISM OF COLORS IN COPTIC ART

Los colores representan un simbolismo variado: la simbología cósmica, la biológica, la fisiológica, la psicológica, o la nacional-estética. Los colores poseen los mismos símbolos y significados en la cultura de los distintos pueblos antiguos, es una coincidencia que lleva una lengua común universal que se relaciona íntimamente con la religión. La coincidencia de los símbolos de los colores sorprendió a los científicos e investigadores, de la cual sacaron una conclusión esencial: la unidad de las religiones en su esencia humana; la gran prueba consiste en el significado y simbología de los colores, que es el mismo para todos los pueblos y épocas. Analizamos el uso de los colores en el Arte Copto y cómo estos transmiten el mensaje religioso cristiano.The colors represent varied symbolism: cosmic symbolism, biological, physiological, psychological, or national-aesthetic. The colors and symbols have the same meanings in the culture of the various ancient peoples, coincidentally carries a universal common language that is closely related to religion. The coincidence of the symbols of the colors surprised scientists and researchers, which removed a key conclusion: the unity of religions in their human essence, the big test is the meaning and symbolism of the colors, which is the same for all peoples and all times. We analyze the use of color in Coptic art and how they transmit the Christian religious message

Embolization of congenital intercostobronchial trunk-pulmonary artery fistula using Amplatzer vascular plugs

We present the case of a 54-year-old male patient diagnosed with a right upper lobe lung cancer and was referred for resection. Positron emission tomography-computed tomography scan showed a prominent vascular structure in the right lung, suspicious for vascular malformation. A computed tomography angiography was done, demonstrating an intercostobronchial trunk-pulmonary artery fistula. There was also non-tapering dilated wandering pulmonary artery coursing through the right lower lung without any abnormal connection with pulmonary veins and were supplying normal lung parenchyma. Amplatzer vascular plugs were used for the treatment of the intercostobronchial trunk-pulmonary artery fistula. Our case highlights these very rare vascular anomalies, and their management

Percutaneous coronary intervention in the elderly: current updates and trends

Ischemic heart disease is the leading cause of death with acute coronary syndrome accounting for more than 30% of causes of mortality in the elderly population. The rate of growth of the older segment of the population has increased exponentially and will become more pronounced in the future. Historically, there has been a paucity of clinical trials investigating the challenges and outcomes of more invasive treatment strategies such as percutaneous coronary intervention (PCI) for that very segment of the population. However, the safety, efficacy, and outcomes of PCI in the older population have started to receive more attention, leading to some changes in their trends. There are several factors that make interventional cardiologists more resistant to direct the elderly to PCI. Most of these challenging factors, such as the complexity of coronary lesions, frailty, hematological and vascular changes, are discussed in this review. In addition. more advanced technologies have been introduced to PCI platform such as second- and third-generations stents, several alternative approaches have been adopted like transradial approach and the usage of bivalirudin instead of heparin and GP IIb/IIIa inhibitor, and several imaging modalities have been optimized to assess patients’ outcome and prognosis more accurately. Several recent studies have shown better results when these strategies are adopted. The most recent recommendations regarding performing PCI in the elderly are also discussed in this review

Open repair of descending and thoracoabdominal aortic aneurysms in octogenarians

Objective: Despite improved outcomes for open repair of descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA), these operations remain challenging in octogenarians. Patients unsuitable for thoracic endovascular aortic repair require open surgery to avoid catastrophic rupture. We analyzed our results for DTA/TAAA repair in these elderly patients. Methods: Our institutional aortic database was queried to identify those ≥80 years old and those <80 years old undergoing open DTA/TAAA repair. Logistic and Cox regression analyses were used to account for confounders and to identify predictors of perioperative and long-term outcomes. Results: From 1997 to 2017, there were 783 patients who underwent open repair of DTA or TAAA; 96 (12.3%) were ≥80 years old. Octogenarians were more likely to be female (P =.018), with chronic pulmonary disease (P =.012), severe peripheral vascular disease (P <.001), and hypertension (P =.025). Degenerative aneurysms were more common among octogenarians (P <.001), whereas chronic and acute dissections were more common among those younger than 80 years (P <.001 for both). Operative mortality was 5.6% and was not negatively affected by advanced age (<80 years, 5.7%; ≥80 years, 5.6%; P =.852). Other than an increased incidence of left recurrent nerve palsy in the younger cohort (<80 years, 6.7%; ≥ 80 years, 1.0%; P =.029), there were no significant differences in the incidence of major postoperative complications. Logistic regression modeling showed that age ≥80 years was not predictive of operative mortality or postoperative complications. A greater percentage of octogenarians had aortic reconstruction with a clamp and sew strategy (85.4% vs 61.6%; P <.001), which led to significantly shorter cross-clamp times in this cohort (26.6 minutes vs 30.7 minutes; P <.004). In octogenarians, the incidence of major postoperative adverse events was associated with extent II aneurysms (odds ratio, 2.6; P <.025). Short- and long-term survival was significantly reduced in octogenarians. Conclusions: In select octogenarians, open repair of DTA/TAAA can be performed with acceptable risk. A simplified surgical approach may provide the best opportunity for a successful outcome