Outcomes of carotid artery stenting versus historical surgical controls for radiation-induced carotid stenosis

PurposeTo evaluate the outcomes of carotid artery stenting (CAS) and open surgical repair (OR) for treatment of radiation-induced carotid stenosis (RICS).MethodsWe retrospectively reviewed 60 patients treated for 73 RICSs from a group of 5,824 patients who had carotid interventions between 1992 and 2009. Thirty-three patients (37 arteries) were treated with CAS and 27 patients (36 arteries) with OR. CAS was performed using embolic protection as part of a prospective institutional registry since 2003. End-points included mortality, stroke, myocardial infarction (MI), cranial nerve injury (CNI), wound complication, restenosis, and reintervention.ResultsDemographics and cardiovascular risk factors were similar in both groups, with the exception of higher rates (P < .05) of hyperlipidemia (81% vs 56%) and coronary artery disease (63% vs 33%) in OR patients. There were more patients with tracheostomy (31% vs 4%) and time interval from irradiation to intervention was longer in the CAS group. There were no early deaths. At 30 days, OR was associated with one (3%) stroke, two (5.5%) MIs, six (17%) CNIs, and three (8%) wound complications. OR patients with prior radical neck dissections had more wound complications (14% vs 5%) and CNIs (28% vs 9%) compared with those without neck dissections. In the CAS group, there were two (6%) strokes and no MIs, CNIs, or wound complications. Mean length of hospital stay was longer after OR than CAS (4.1 ± 3.7 days vs 2.4 ± 2.1 days; P = .02). Median follow-up was 58 months. At 7 years, OR was associated with higher patient survival (75% ± 15% vs 29% ± 13%, P = .008) and freedom from neurological events (100% vs 57% ± 9.5%, P = .058), but similar freedom from restenosis (80% ± 10% vs 72% ± 9%) and reinterventions (87% ± 10% vs 86% ± 9%) compared with CAS.ConclusionCarotid artery stenting for radiation-induced stenosis has the advantages of no CNI or wound complications with similar early stroke rate compared with open carotid repair. However, the lower freedom from neurological events may offset the early benefits of carotid stenting in patients who are considered good candidates for open surgery

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead