Endovascular Versus Open Repair For Chronic Type B Dissection Treatment: A meta-analysis.

BACKGROUND: The respective place of endovascular versus open surgery in thoracic dissecting aneurysm treatment remains debatable. This comprehensive review seeks to analyse the outcomes of endovascular repair (ER) compared to open surgery (OS) in chronic type B aortic dissection treatment. METHODS: Embase and Medline searches (2000 - 2017)were performed following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Outcomes data extracted comprised firstly early mortality and major complications: stroke, spinal cord ischemia (SCI), dialysis, respiratory complications; secondly, late survival and reinterventions. Reintervention causes were divided into proximal, adjacent, distal. Comparative studies provided comparative meta-analyses. Non-comparative studies were analysed in pooled proportion meta-analyses for each group. RESULTS: 39 studies were identified: 10 OS, 25 ER, 4 comparative. Comparative studies meta-analyses revealed lower early mortality for ER (OR: 4.13, 95% CI: 1.10 - 15.4), stroke (OR: 4.33, 95% CI: 1.02-18.35), SCI (OR: 3.3, 95% CI: 0.97 - 11.25) and respiratory complications (OR: 6.88, 95% CI:1.52- 31.02), but higher reintervention rate (OR: 0.34, 95% CI: 0.16 - 0.69). Mid-term survival was similar (OR: 1.19, 95% CI:0.42 - 3.32). Non-comparative studies analyses showed distal causes as the principal reintervention indication in both groups: OS 73%; ER 59%. Reintervention procedures were mainly surgical for OS (85%), mainly endovascular for ER (75%). Rupture rates were: OS 1.2% , ER 3%. CONCLUSIONS: This recent non -randomised data shows early ER benefit, unsustained at mid-term. Reintervention is higher after ER, necessitating improved technique. However, OS is exempt neither from reintervention nor rupture. Both techniques have their place, but patient selection is key

Risk Factor Analysis of Bird Beak Occurrence after Thoracic Endovascular Aortic Repair

ObjectivesThe aim was to analyze the role played by anatomy and stent graft in the incidence of incomplete apposition to aortic arch.MethodsBetween 2007 and 2014 data including available and suitable computed tomographic angiography (CTA) imaging of patients who had undergone thoracic endovascular aortic repair were reviewed. The study included 80 patients (65 men, 54 ± 21 years) treated for traumatic aortic rupture (n = 27), thoracic aortic aneurysm (n = 15), type B aortic dissection (n = 24), penetrating aortic ulcer (n = 5), intramural hematoma (n = 2), aorto-oesophageal fistula (n = 2), and aortic mural thrombus (n = 5). Pre- and post-operative CTA images were analyzed to characterize bird beak in terms of length and angle, and to calculate aortic angulation within a 30 mm range at the proximal deployment zone.ResultsBird beak configuration was detected in 46 patients (57%): mean stent protrusion length was 16 mm (range: 8–29 mm) and mean bird beak angle was 20° (range: 7–40°). The bird beak effect was significantly more frequent after traumatic aortic rupture treatment (p = .05) and in landing zone 2 (p = .01). No influence of either stent graft type or generation, or degree of oversizing was observed (p = .29, p = .28, p = .81 respectively). However, the mean aortic angle of patients with bird beak was higher in the Pro-form group than that in the Zenith TX2 group (62° vs. 48°, p = .13). Multivariate analysis identified the aortic angle of the deployment zone as the unique independent risk factor of malapposition (HR = 1.05, 95% CI 1–1.10, p = .005). The cutoff value of 51° was found to be predictive of bird beak occurrence with a sensitivity of 58% and a specificity of 85%.ConclusionsAssessment of proximal landing zone morphology to avoid deployment zones generating an aortic angle of over 50° can be recommended to improve aortic curvature apposition with the current available devices

TiO 2

Nanocomposites TiO2-CdS with different relative contents of CdS (molar ratios Cd/Ti = 0.02, 0.03, 0.05, 0.1, 0.2, and 0.5) were studied. The structural, photophysical, and chemical properties were investigated using XRD, Raman spectroscopy, XPS, GSDR, and LIL. XRD and Raman results confirmed the presence of TiO2 and CdS with intensities dependent on the ratio Cd/Ti. The presence of CdSO4 was detected by XPS at the surface of all TiO2-CdS composites. The relative amount of sulphate was dependent on the CdS loading. Luminescence time-resolved spectra clearly proved the existence of an excitation transfer process from CdS to TiO2 through the luminescence emission from TiO2 after excitation of CdS at λexc=410 nm, where no direct excitation of TiO2 occurs. Photodegradation of a series of aromatic carboxylic acids—benzoic, salicylic, 4-bromobenzoic, 3-phenylpropionic, and veratric acids—showed a great enhancement in the photocatalytic efficiency of the TiO2-CdS composites, which is due, mainly, to the effect of the charge carriers’ increased lifetime. In addition, it was shown that the oxidation of CdS to CdSO4 did not result in the deactivation of the photocatalytic properties and even contributed to enhance the degradation efficiency

Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study

Aims/hypothesis Outcome data on individuals with diabetic foot ulcers are scarce, especially in those with peripheral arterial disease (PAD). We therefore examined the clinical characteristics that best predict poor outcome in a large population of diabetic foot ulcer patients and examined whether such predictors differ between patients with and without PAD. Methods Analyses were conducted within the EURODIALE Study, a prospective cohort study of 1,088 diabetic foot ulcer patients across 14 centres in Europe. Multiple logistic regression modelling was used to identify independent predictors of outcome (i.e. non-healing of the foot ulcer). Results After 1 year of follow-up, 23% of the patients had not healed. Independent baseline predictors of non-healing in the whole study population were older age, male sex, heart failure, the inability to stand or walk without help, end-stage renal disease, larger ulcer size, peripheral neuropathy and PAD. When analyses were performed according to PAD status, infection emerged as a specific predictor of non-healing in PAD patients only. Conclusions/Interpretation Predictors of healing differ between patients with and without PAD, suggesting that diabetic foot ulcers with or without concomitant PAD should be defined as two separate disease states. The observed negative impact of infection on healing that was confined to patients with PAD needs further investigation

Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm

Background: The aim of this study was to develop a 48-h mortality risk score, which included morphology data, for patients with ruptured abdominal aortic aneurysm presenting to an emergency department, and to assess its predictive accuracy and clinical effectiveness in triaging patients to immediate aneurysm repair, transfer or palliative care. Methods: Data from patients in the IMPROVE (Immediate Management of the Patient With Ruptured Aneurysm: Open Versus Endovascular Repair) randomized trial were used to develop the risk score. Variables considered included age, sex, haemodynamic markers and aortic morphology. Backwards selection was used to identify relevant predictors. Predictive performance was assessed using calibration plots and the C-statistic. Validation of the newly developed and other previously published scores was conducted in four external populations. The net benefit of treating patients based on a risk threshold compared with treating none was quantified. Results: Data from 536 patients in the IMPROVE trial were included. The final variables retained were age, sex, haemoglobin level, serum creatinine level, systolic BP, aortic neck length and angle, and acute myocardial ischaemia. The discrimination of the score for 48-h mortality in the IMPROVE data was reasonable (C-statistic 0·710, 95 per cent c.i. 0·659 to 0·760), but varied in external populations (from 0·652 to 0·761). The new score outperformed other published risk scores in some, but not all, populations. An 8 (95 per cent c.i. 5 to 11) per cent improvement in the C-statistic was estimated compared with using age alone. Conclusion: The assessed risk scores did not have sufficient accuracy to enable potentially life-saving decisions to be made regarding intervention. Focus should therefore shift to offering repair to more patients and reducing non-intervention rates, while respecting the wishes of the patient and family

Paper functionalized with nanostructured TiO2/AgBr: Photocatalytic degradation of 2–propanol under solar light irradiation and antibacterial activity

A facile method to produce paper–TiO2 decorated with AgBr nanoparticles by a mild hydrothermal process at 140◦C was reported. The synthesis method was based on the immersion of the paper in a ready-made suspension of TiO2/AgBr, comprising TiO2 sol solution prepared in acidic conditions and AgBr solution (10−4 M). A paper–TiO2 sample was prepared and used as reference. The formation of crystalline phases of titanium oxide (TiO2) and silver bromide (AgBr) was demonstrated by XRD, Raman and EDX analyses. The surface morphology of the TiO2–AgBr was investigated by Field Effect Scanning Electronic Microscopy (FE–SEM). The photocatalytic performances of the prepared material were evaluated in the degradation of 2-propanol in the gas phase, under simulated sunlight illumination. Its antibacterial properties against Escherichia coli (E. coli) were also assessed. The efficiency of photodegradation and the anti-bacterial properties of paper–TiO2–AgBr were attributed to an improvement in the absorption of visible light, the increased production of reactive oxygen species (ROS) and the low recombination of photogenerated charge carriers due to the synergistic effect between TiO2 and AgBr/Ag nanoparticles