Effect of atherothrombotic aorta on outcomes of total aortic arch replacement

ObjectiveThe effect of an atherothrombotic aorta on the short- and long-term outcomes of total aortic arch replacement, including postoperative neurologic deficits, remains unknown. We evaluated this relationship and also elucidated the synergistic effect of multiple other risk factors, in addition to an atherothrombotic aorta, on the neurologic outcome.MethodsA group of 179 consecutive patients undergoing total aortic arch replacement were studied. An atherothrombotic aorta was present in 34 patients (19%), more than moderate leukoaraiosis in 71 (39.7%), and significant extracranial carotid artery stenosis in 27 (15.1%). In-hospital deaths occurred in 2 patients, 1 (2.9%) of 34 patients with and 1 (0.7%) of 145 patients without an atherothrombotic aorta (P = .26). Permanent neurologic deficits occurred in 4 (2.2%) and transient neurologic deficits in 17 (9.5%) patients. Multivariate analysis demonstrated that the risk factors for transient neurologic deficits were an atherothrombotic aorta (odds ratio, 4.4), extracranial carotid artery stenosis (odds ratio, 5.5), moderate/severe leukoaraiosis (odds ratio, 3.6), and cardiopulmonary bypass time (odds ratio, 1.02). To calculate the probability of transient neurologic deficits, the following equation was derived: probability of transient neurologic deficits = {1 + exp [7.276 − 1.489 (atherothrombotic aorta) − 1.285 (leukoaraiosis) − 1.701 (extracranial carotid artery stenosis) − 0.017 (cardiopulmonary bypass time)]}−1. An exponential increase occurred in the probability of transient neurologic deficits with presence of an atherothrombotic aorta and other risk factors in relation to the cardiopulmonary bypass time. Survival at 3 years after surgery was significantly reduced in patients with vs without an atherothrombotic aorta (75.0% ± 8.8% vs 89.2% ± 3.1%, P = .01).ConclusionsPatients with an atherothrombotic aorta and associated preoperative comorbidities might be predisposed to adverse short- and long-term outcomes, including transient neurologic deficits

Outcome of elective total aortic arch replacement in patients with non–dialysis-dependent renal insufficiency stratified by estimated glomerular filtration rate

ObjectiveLittle is known about the impact of preoperative renal function stratified by estimated glomerular filtration rate (eGFR) on outcomes of total aortic arch replacement (TAR). The current study addressed this issue and identified a cutoff value of eGFR for the requirement of postoperative renal replacement therapy.MethodsFrom January 2000 to May 2011, 229 consecutive patients who did not require preoperative hemodialysis were retrospectively studied after elective TAR. Patients were grouped into the following categories: those with normal renal function (eGFR >90 mL/min/1.73 m2; n = 11) and those with mild (eGFR, 60-90 mL/min/1.73 m2; n = 86), moderate (eGFR, 30-59 mL/min/1.73 m2; n = 111), or severe (eGFR <30 mL/min/1.73 m2; n = 21) renal dysfunction. Linear trend tests demonstrated that the lower categories of eGFR were associated with a higher age, hypertension, coronary artery disease, peripheral arterial disease, and a higher EuroSCORE II.ResultsThe overall hospital mortality was 2.2%. A lower categories of eGFR were an independent risk factor for hospital mortality (odds ratio, 0.91; P = .002) and postoperative renal replacement therapy (odds ratio, 0.94; P < .002). A cutoff value for the requirement of postoperative renal replacement therapy was 26.0 mL/min/1.73 m2. Patients in the lower categories of eGFR had significantly higher hospital mortality (P = .03) and more morbidities, such as renal replacement therapy (P < .01), postoperative permanent neurologic deficits (P = .013), and prolonged mechanical ventilatory support (P < .01). Midterm survival and freedom from major adverse cerebrocardiovascular events were worse across the levels of the lower categories of eGFR.ConclusionsPreoperative eGFR is a strong predictor of short- and midterm outcomes in contemporary TAR

The Asia‐Pacific Biodiversity Observation Network : 10‐year achievements and new strategies to 2030.

The Asia-Pacific Biodiversity Observation Network (APBON) was launched in 2009, in response to the establishment of the Biodiversity Observation Network under the Group on Earth Observations in 2008. APBON's mission is to increase exchange of knowledge and know-how between institutions and researchers concerning biodiversity science research in the Asia-Pacific (AP) region and thereby contribute to evidence-based decision-making and policy-making. Here we summarize APBON activities and achievements in its first 10 years. We review how APBON has developed networks, facilitated communication for sharing knowledge, and built capacity of researchers and stakeholders through workshops and publications as well as discuss the network plan. Key findings by APBON members include descriptions of species new to science, mapping tropical forest cover change, evaluating impacts of hydropower dams and climate change on fish species diversity in the Mekong, and mapping “Ecologically and Biologically Significant Areas” in the oceans. APBON has also contributed to data collection, sharing, analysis, and synthesis for regional and global biodiversity assessment. A highlight was contributing to the “Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services” regional report. New strategic plans target the development of national-level BONs and interdisciplinary research to address the data and knowledge gaps and increase data accessibility for users and for meeting societal demands. Strengthening networks in AP region and capacity building through APBON meetings will continue. By promoting monitoring and scientific research and facilitating the dialogue with scientists and policymakers, APBON will contribute to the implementation of conservation and sustainable use of biodiversity in the entire AP region.publishedVersio

Hepatic sarcoidosis with atypical radiological manifestations: A case report

Sarcoidosis is a multisystemic inflammatory disease of unknown origin characterized by the formation of noncaseating granulomas and accumulation of inflammatory cells. Sarcoidosis most commonly affects the lungs and lymphoid system. However, the liver can also be involved in 50%-65% of cases. On magnetic resonance imaging, sarcoidosis lesions usually present as hypointense lesions on all sequences. However, we present a rare case of nodular liver sarcoidosis presenting with T2 hyperintense lesions. In addition, while most cases of hepatic nodular sarcoidosis present with multiple small hepatic nodules, liver masses of our case are larger than usual. Moreover, this case suggested that when intact vascular structures penetrating liver nodular lesions are observed as in the current case, liver sarcoidosis can be included in a list of differential diagnosis. Keywords: Hepatic sarcoidosis, Atypical manifestations, CT, MR