Propensity Score-Matched Analysis of Open Surgical and Endovascular Repair for Type B Aortic Dissection

Objective. To identify national outcomes of thoracic endovascular aortic repair (TEVAR) for type B aortic dissections (TBADs). Methods. The Nationwide Inpatient Sample database was examined from 2005 to 2008 using ICD-9 codes to identify patients with TBAD who underwent TEVAR or open surgical repair. We constructed separate propensity models for emergently and electively admitted patients and calculated mortality and complication rates for propensity score-matched cohorts of TEVAR and open repair patients. Results. In-hospital mortality was significantly higher following open repair than TEVAR (17.5% versus 10.8%, P = .045) in emergently admitted TBAD. There was no in-hospital mortality difference between open repair and TEVAR (5.6% versus 3.3%, P = .464) for elective admissions. Hospitals performing thirty or more TEVAR procedures annually had lower mortality for emergent TBAD than hospitals with fewer than thirty procedures. Conclusions. TEVAR produces better in-hospital outcomes in emergent TBAD than open repair, but further longitudinal analysis is required

Outcomes in Combined Anterior and Posterior Fusion for 3- and 4-Level Degenerative Lumbar Disc Disease

Introduction. This study reported the clinical and functionaloutcomes in a consecutive series of patients with3- or 4-level degenerative disc disease (DDD) betweenvertebral levels L2 to S1, who were treated with combinedanterior lumbar interbody fusion (ALIF) and posteriorspinal fusion at one-year and two-year follow-ups. Methods. A retrospective chart review was performed on allpatients who underwent long segment fusion for DDD by asingle surgeon between August 2002 and January 2012. Fiftyfivepatients were identified and 32 had complete charts for review(14 had one-year follow-up and 18 two-year follow-up).In addition to demographic data, disability (Oswestry DisabilityIndex, ODI), pain level (Visual Analog Scale, VAS), andflexion-extension range-of-motion were measured pre- andpost-operatively. Operative data also were collected, includingoperative time, blood loss, surgical implants used, surgicalapproach, operative levels treated, and complications.Results. Both VAS and ODI improved significantly postoperatively.The average VAS score improved from 6.5 ± 1.5(range: 4 - 9) to 4.4 ± 1.7 (range: 2 - 7) for one-year follow-up,and 7.0 ± 1.8 (range: 4 - 10) to 4.4 ± 2.6 (range: 1 - 9) for twoyearfollow-up. For one-year follow-up, the average ODI scoreimproved from 53 ± 19% (range: 18 - 70%) to 37 ± 17% (range:12 - 64%), and for two-year follow-up, the average improvedfrom 53 ± 18% (range: 18 - 80%) to 31 ± 24% (range: 2 - 92%).The level of improvement in pain and function was similar topreviously published data for 1- and 2-level fusions, but overallpain and function scores were worse in this study group. Conclusions. Arthrodesis for 3- and 4-level DDD is, on average,a successful surgery that shows clinically significantimprovements in function and pain similar to fusionfor 1- and 2-levels with low rates of re-operation. Patientswith involvement of 3- or 4-levels have higher disabilityand pain both pre- and post-operatively compared to shorterfusion level involvement. KS J Med 2016;9(3):50-53

Outcomes of endovascular treatment of ruptured abdominal aortic aneurysms

IntroductionThe successful application of endovascular techniques for the elective repair of abdominal aortic aneurysms (AAAs) has stimulated a strong interest in their possible use in dealing with a long-standing surgical challenge: the ruptured abdominal aortic aneurysm (RAAA). The use of a conventional open procedure to repair ruptured aneurysms is associated with a high operative mortality of 45% to 50%. In this study, we evaluated the current frequency of endovascular repair of RAAAs in four large states and the impact of this technique on patient outcome.MethodsWe examined discharge data sets from 2000 through 2003 from the four states of California, Florida, New Jersey, and New York, whose combined population represents almost a third of the United States population. Proportions and trends were analyzed by χ2 analysis and continuous variables by the Student’s t test.ResultsWe found that since the year 2000, endovascular repair has begun to emerge as a viable treatment option for RAAAs, accounting for the repair of 6.2% of cases in 2003. During the same period, the use of open procedures for RAAAs declined. The overall mortality rate for the 4-year period was significantly lower for endovascular vs open repair (39.3% vs. 47.7%, P = .005). Moreover, compared with open repair, endovascular repair resulted in a significantly lower rate of pulmonary, renal, and bleeding complications. Survival after endovascular repair correlated with hospital experience, as assessed by the overall volume of elective and nonelective endovascular procedures. For endovascular repairs, mortality ranged from 45.9% for small volume hospitals to 26% for large volume hospitals (P = .0011). Volume was also a determinant of mortality for open repairs, albeit to a much lesser extent (51.5% for small volume hospitals, 44.3% for large volume hospitals; P < .0001).ConclusionWe observed a benefit to using endovascular procedures for RAAAs in institutions with significant endovascular experience; however, the analysis of administrative data cannot rule out selection bias as an explanation of better outcomes. These data strongly endorse the need for prospective studies to clarify to what extent the improved survival in RAAA patients is to be attributed to the endovascular approach rather than the selection of low-risk patients

Atomic Resonance and Scattering

Contains reports on nine research projects.National Science Foundation (Grant PHY79-09743)National Science Foundation (Grant PHY82-10486)Joint Services Electronics Program (Contract DAAG29-83-K-0003)U.S. Navy - Office of Naval Research (Contract N00014-79-C-0183)National Bureau of Standards (Grant NB83-NAHA-4058)National Science Foundation (Grant CHE79-02967-A04)National Science Foundation (Grant PHY83-07172)Joint Services Electronics Program (Grant DAAG29-83-K-0003

Atomic Resonance and Scattering

Contains reports on eight research projects.National Science Foundation (Grant PHY77-09155)Joint Services Electronics Program (Contract DAAG29-78-C-0020)U. S. Department of Energy (Grant EG-77-S-02-4370)National Science Foundation (Grant DMR 77-10084)National Aeronautics and Space Administration (Grant NSG-1551)U. S. Air Force - Office of Scientific Research (Grant AFOSR-76-2972)National Science Foundation (Grant CHE76-81750

Lung function and microbiota diversity in cystic fibrosis

Abstract: Background: Chronic infection and concomitant airway inflammation is the leading cause of morbidity and mortality for people living with cystic fibrosis (CF). Although chronic infection in CF is undeniably polymicrobial, involving a lung microbiota, infection surveillance and control approaches remain underpinned by classical aerobic culture-based microbiology. How to use microbiomics to direct clinical management of CF airway infections remains a crucial challenge. A pivotal step towards leveraging microbiome approaches in CF clinical care is to understand the ecology of the CF lung microbiome and identify ecological patterns of CF microbiota across a wide spectrum of lung disease. Assessing sputum samples from 299 patients attending 13 CF centres in Europe and the USA, we determined whether the emerging relationship of decreasing microbiota diversity with worsening lung function could be considered a generalised pattern of CF lung microbiota and explored its potential as an informative indicator of lung disease state in CF. Results: We tested and found decreasing microbiota diversity with a reduction in lung function to be a significant ecological pattern. Moreover, the loss of diversity was accompanied by an increase in microbiota dominance. Subsequently, we stratified patients into lung disease categories of increasing disease severity to further investigate relationships between microbiota characteristics and lung function, and the factors contributing to microbiota variance. Core taxa group composition became highly conserved within the severe disease category, while the rarer satellite taxa underpinned the high variability observed in the microbiota diversity. Further, the lung microbiota of individual patient were increasingly dominated by recognised CF pathogens as lung function decreased. Conversely, other bacteria, especially obligate anaerobes, increasingly dominated in those with better lung function. Ordination analyses revealed lung function and antibiotics to be main explanators of compositional variance in the microbiota and the core and satellite taxa. Biogeography was found to influence acquisition of the rarer satellite taxa. Conclusions: Our findings demonstrate that microbiota diversity and dominance, as well as the identity of the dominant bacterial species, in combination with measures of lung function, can be used as informative indicators of disease state in CF. BBFJdPr3cu-jH3LTAhe361Video Abstrac