Outcome after endovascular stent graft treatment for mycotic aortic aneurysm: A systematic review

BackgroundSurgical treatment for mycotic aortic aneurysms is not optimal. Even with a large excision, extensive debridement, in situ or extra-anatomical reconstruction, and with or without lifelong antibiotic treatment, mycotic aneurysms still carry very high mortality and morbidity. The use of endovascular aneurysm repair (EVAR) for mycotic aortic aneurysms simplifies the procedure and provides a good alternative for this critical condition. However, the question remains: if EVAR is placed in an infected bed, what is the outcome of the infection? Does it heal, become aggravated, or even cause a disastrous aortic rupture? In this study, we tried to clarify the risk factors for such an adverse response.MethodsA literature review was undertaken by using MEDLINE. All relevant reports on endoluminal management of mycotic aortic aneurysms were included. Logistic regressions were applied to identify predictors of persistent infection.ResultsA total of 48 cases from 22 reports were included. The life-table analysis showed that the 30-day survival rate was 89.6% ± 4.4%, and the 2-year survival rate was 82.2% ± 5.8%. By univariate analysis, age 65 years or older, rupture of the aneurysm (including those with aortoenteric fistula and aortobronchial fistula), and fever at the time of operation were identified as significant predictors of persistent infection, and preoperative use of antibiotics for longer than 1 week and an adjunct procedure combined with EVAR were identified as significant protective factors for persistent infection. However, by multivariate logistic regression analysis, the only significant independent predictors identified were rupture of aneurysm and fever.ConclusionsEVAR seems a possible alternative method for treating mycotic aortic aneurysms. Identification of the risk factors for persistent infection may help to decrease surgical morbidity and mortality. EVAR could be used as a temporary measure; however, a definite surgical treatment should be considered for patients present with aneurysm rupture or fever

Bacteroides fragilis aortic arch pseudoaneurysm: case report with review

We present a case of 58-year-old woman with underlying diabetes mellitus, hepatitis C virus-related liver cirrhosis, and total hysterectomy for uterine myoma 11 moths ago, who was diagnosed ruptured aortic arch mycotic pseudoaneurysm after a certain period of survey for her unknown fever cause. After emergent surgery with prosthetic graft interposition, all her blood cultures and tissue cultures revealed pathogen with Bacteroides fragilis. Although mycotic aneurysms have been well described in literatures, an aneurysm infected solely with Bacteroides fragilis is unusual, with only eight similar cases in the literature. Here we reported the only female case with her specific clinical and management course and summarized all reported cases of mycotic aneurysm caused by Bacteroides fragilis to clarify their conditions and treatments, alert the difficulty in diagnosis, and importance of highly suspicious

PHYSIOLOGICAL AND ELECTROMYOGRAPHIC RESPONSES AT THREE LEVELS OF BICYCLE SEAT HEIGHT

Recently, bicycle riding has become one of the most popular exercises. As the use time increased, the risk of pedalling injury raised. Holmes (1994) indicated that inappropriate bicycle saddle height could result in lower limbs injuries. The motivation of this study was to find out the best riding position that could effectively use energy from the physiology and electromyography measures. The oxygen consumption (VO2), heart rate (HR), respiratory exchange ratio (RER) and the muscle activity (electromyography, EMG) from rectus femoris (RF) and biceps femoris (BF) of lower limb were collected during a 6 min cycling trail in three different heights of bicycle saddle. The purpose of this study was to compare the effects of three different types of bicycle seat heights and different perspectives of muscle activity and physiology’s parameters

The Influences of Personality and Motivation on Exercise Participation and Quality of Life

[[abstract]]The major purpose of this study was to identify the effects of personality on individual exercise motivation and exercise participation, which then influences quality of life. A comprehensive model was developed, based on an extensive literature review, and empirically tested using members of fitness centers from Taiwan, Europe and the United States as respondents. The results indicate that individuals with a positive personality tend to have higher levels of exercise motivation and exercise participation. Personality and exercise participation then impacted on individuals’ quality of life, in terms of physical health improvement, psychological health improvement, and sexual satisfaction. The study results offer valuable suggestions not only to marketing managers of fitness centers but also to government officers to promote health and quality of life through stimulating exercise motivation and exercise participation

Effect on Spasticity After Performance of Dynamic-Repeated-Passive Ankle Joint Motion Exercise in Chronic Stroke Patients

Spasticity associated with abnormal muscle tone is a common motor disorder following stroke, and the spastic ankle may affect ambulatory function. The purpose of this study was to investigate the short-term effect of dynamic-repeated-passive ankle movements with weight loading on ambulatory function and spastic hypertonia of chronic stroke patients. In this study, 12 chronic stroke patients with ankle spasticity and inefficient ambulatory ability were enrolled. Stretching of the plantar-flexors of the ankle in the standing position for 15 minutes was performed passively by a constant-speed and electrically powered device. The following evaluations were done before and immediately after the dynamic-repeated-passive ankle movements. Spastic hypertonia was assessed by the Modified Ashworth Scale (MAS; range, 0–4), Achilles tendon reflexes test (DTR; range, 0–4), and ankle clonus (range, 0–5). Improvement in ambulatory ability was determined by the timed up-and-go test (TUG), the 10-minute walking test, and cadence (steps/minute). In addition, subjective experience of the influence of ankle spasticity on ambulation was scored by visual analog scale (VAS). Subjective satisfaction with the therapeutic effect of spasticity reduction was evaluated by a five-point questionnaire (1 = very poor, 2 = poor, 3 = acceptable, 4 = good, 5 = very good). By comparison of the results before and after intervention, these 12 chronic stroke patients presented significant reduction in MAS and VAS for ankle spasticity, the time for TUG and 10-minute walking speed (p < 0.01). The cadence also increased significantly (p < 0.05). In addition, subjective satisfaction with the short-term therapeutic effect was mainly good (ranging from acceptable to very good). In conclusion, 15 minutes of dynamic-repeated-passive ankle joint motion exercise with weight loading in the standing position by this simple constant-speed machine is effective in reducing ankle spasticity and improving ambulatory ability