Comorbidities Associated with Large Abdominal Aortic Aneurysms

BACKGROUND: Abdominal aortic aneurysm has become increasingly important owing to demographic changes. Some other diseases, for example, cholecystolithiasis, chronic obstructive pulmonary disease, and hernias, seem to co-occur with abdominal aortic aneurysm. The aim of this retrospective analysis was to identify new comorbidities associated with abdominal aortic aneurysm. METHODS: We compared 100 patients with abdominal aortic aneurysms and 100 control patients. Their preoperative computed tomographic scans were examined by two investigators independently, for the presence of hernias, diverticulosis, and cholecystolithiasis. Medical records were also reviewed. Statistical analysis was performed using univariate analysis and multiple logistic regression analysis. RESULTS: The aneurysm group had a higher frequency of diverticulosis (p = 0.008). There was no significant difference in the occurrence of hernia (p = 0.073) or cholecystolithiasis (p = 1.00). Aneurysm patients had a significantly higher American Society of Anesthesiology score (2.84 vs. 2.63; p = 0.015) and were more likely to have coronary artery disease (p < 0.001), congestive heart failure (p < 0.001), or chronic obstructive pulmonary disease (p < 0.001). Aneurysm patients were more likely to be former (p = 0.034) or current (p = 0.006) smokers and had a significantly higher number of pack years (p < 0.001). Aneurysm patients also had a significantly poorer lung function. In multivariate analysis, the following factors were associated with aneurysms: chronic obstructive pulmonary disease (odds ratio, OR = 12.24; p = 0.002), current smoking (OR = 4.14; p = 0.002), and coronary artery disease (OR = 2.60; p = 0.020). CONCLUSIONS: Our comprehensive analysis identified several comorbidities associated with abdominal aortic aneurysms. These results could help to recognize aneurysms earlier by targeting individuals with these comorbidities for screening

Heritage, History and Design Between East and West:

This book comprises a collection of essays on traditional machiya in Kyoto from various viewpoints and at different scales, including the urban fabric, the construction, the layout of the space plan, and building materials and details. By discussing the topic further from the various perspectives of the Dutch and Japanese scholars, we aim not only to cultivate a better understanding of machiya, but also to clarify the difference between the Netherlands and Japan in terms of ideas and approaches to preservation and regeneration of historical&nbsp;buildings. Concepts and approaches with respect to traditional architecture differ greatly between the Netherlands and Japan. The differences lie not only in the construction methods, respectively brick and timber construction, but also in the ways of living, as well as miscellaneous systems and regulations regarding architectural materials. Efforts to clarify such differences will promote a better understanding of each other’s culture, history and context, as well as comparative studies and a re-evaluation of ideas and approaches to preservation, regeneration and adaptive reuse of historic buildings in both&nbsp;countries. This book was conceived as a record of the outcomes of exchanges between students and scholars of architectural history, preservation and adaptive reuse at Delft University of Technology (TU Delft) and Kyoto Institute of Technology (KIT). The exchange started when Kazuto Kasahara from KIT joined TU Delft’s RMIT (which later became the Heritage &amp; Architecture section) as a visiting scholar from 2010 to 2011, and conducted surveys and research on preservation and adaptive reuse of historical buildings. Since then, both universities have been engaged in ongoing research and educational exchanges through KIT’s invitations to scholars from TU Delft. In February 2012, KIT hosted the international symposium The Present and Future of Preservation of Modern Architecture and invited Marie-Thérèse van Thoor and Hielkje Zijlstra to lecture. On the occasion of other symposia on preservation and adaptive reuse of historical buildings, Wessel de Jonge (November 2016) and Paul Meurs (February 2018) were invited to speak. In March 2015, Paul Meurs and Hielkje Zijlstra visited Japan to investigate possibilities for further collaboration in research and education within the KYOTO&nbsp;Design Lab, an institution launched by KIT and dedicated to practice-based research and innovation in, amongst others, the field of urban revitalization and architectural design. As a first joint project, KIT and TU Delft organized the design project Heritage &amp; Machiya, involving a group of ten students from each university, from November 2015 to February 2016. Sara Stroux and Alexander de Ridder from the Netherlands and Kazuto Kasahara and Kazue Akamatsu from Japan participated in the project as instructors. The students’ works were exhibited at TU Delft in November 2016. Five TU Delft scholars spent a month in Kyoto conducting research into machiya: Hielkje Zijlstra (Nov.-Dec. 2015), Lidwine Spoormans (Jan.-Feb. 2016), Carola Hein (July-Aug. 2016), Marie-Thérèse van Thoor (Feb.-Mar. 2017), and Barbara Lubelli (July-Aug. 2017). Most of the contributions in this book present the outcomes of these study trips. Thus, TU Delft and KIT have been cultivating research and educational exchanges especially in the field of preservation and adaptive reuse of historical buildings, which are the challenges of the immediate future in the Netherlands and in Japan. The exchanges between both universities will hopefully contribute to finding solutions

‘Kein ästhetisches Heil, außer im Alterswert?’: Over het actuele Duitse reconstructiedebat

The cultural heritage institutions in the Netherlands have traditionally taken a dim view of the reconstruction of heritage buildings when most or all of the material substance has been lost. Recent discussions about, for example, the listed status of the reconstructed mill at Burum (destroyed by fire in 2012) or the possible reconstruction of the nineteenth-century attic of Artis’s Ledenlokalen (damaged during World War II) illustrate that the guiding principles of the institutional heritage sector do not seem to meet the actual challenges arising from the quest for reconstruction. There is a need for in-depth investigations and theoretical reflections on this topic, yet these are rare at present in the Netherlands. Hence this article takes a closer look at Germany where – in reaction to an increasing number of reconstruction initiatives, such as the Berlin Palace or the Neumarkt/Frauenkirche in Dresden – some noteworthy research projects have been conducted in recent years. First and foremost is Geschichte der Rekonstruktion – Konstruktion der Geschichte, an extensive study by a group of scholars led by Winfried Nerdinger and Uta Hassler. Based on a large corpus of reconstruction cases from different time periods dating back to the classical age, they concluded that the act of restoring a structure to an earlier, lost state using new materials has a long cultural history. The case-study analysis also revealed that while the motives for reconstruction are quite stable over the centuries, the paradigms and techniques for the preservation of ancient monuments are historically determined.The publication and exhibition of the research results provoked fierce protests from German heritage professionals who feared that these conclusions might pressurize them to abandon their reserved attitude towards reconstruction. Their line of argumentation mainly followed the guiding principles of the founding fathers of the modern heritage preservation movement, including Alois Riegl and Georg Dehio. The dispute generated an anthology of interesting key texts, but it also demonstrated that clinging to a theoretical framework established over a hundred years ago can blind one to relevant topics for in-depth research within the field of heritage preservation, such as the question of how and to what extent different target groups should be informed about the reconstruction of (parts of) a building. Another promising line of investigation concerns the various heritage values related to the topic of reconstruction – think of traditional values like the beeldwaarde (image) or recently established ones like the belevingswaarde (experience) and nostalgiewaarde (nostalgia) – and their shift in meaning over time

„Meine fotografische Arbeit ist Spiegelbild meines politischen Engagements.“: Interview mit der Fotografin Marily Stroux

Das Gespräch mit der Fotografin Marily Stroux führten Stefan Höhne und Verena Schreiber

Wahlen im Kongo: das Ende einer langen Transition?

Der vorliegende Beitrag analysiert die Wahlen im Kongo am 30. Juli 2006, die keinen eindeutigen Sieger hervorgebracht haben. Dem offiziellen Wahlergebnis zufolge liegt Präsident Joseph Kabila mit 44,8% deutlich vor Vizepräsident Jean-Pierre Bemba (20%). Die Stichwahl ist für den 29. Oktober vorgesehen. Die Ergebnisse der Wahlen zur Nationalversammlung weisen den gleichen Trend auf: Die Kabila-Allianz AMP (Alliance de la Majorité Présidentielle) bleibt mit etwa 44% unter der absoluten Mehrheit und braucht für eine Regierungsbildung einen Koalitionspartner. Bembas Wahlbündnis RENACO (Rassemblement des Nationalistes du Congo) kommt auf rund 23%. Während die Wahlen mit einigen Ausnahmen reibungslos verliefen, löste die Bekanntgabe der Ergebnisse der Präsidentschaftswahl am 20. August in der Hauptstadt Kinshasa schwere Kämpfe zwischen der Präsidialgarde Kabilas und Bembas Milizen aus. Der Autor kommt zu dem Schluss, dass die Wahl ein entscheidender Schritt zur Umsetzung der Verfassung und des neuen politischen Systems war. (ICD2

Impact of Adjuvant Ocular Interventions on the Quality of Life of Patients with Uveal Melanoma after Proton Beam Therapy

Introduction: Proton beam therapy is an established primary treatment for patients with nonmetastasized uveal melanoma. Adjuvant local interventions, like intravitreal injections or surgery, were shown to improve long-term eye preservation; however, their impact on the patient's quality of life (QOL) remains unknown. Methods: In a post-radiotherapeutic follow-up, we prospectively collected data on QOL, visual acuity, and interventional adjuvant procedures. QOL was measured with QOL-C30 questionnaire and quality of life questionnaire OPT30 at baseline, and at 3 and 12 months after proton therapy. Patients were grouped by the type of adjuvant treatment. The impact on QOL was analyzed by comparing changes in the mean score values and visual acuity for different interventional subgroups, with generalized linear mixed models and Wilcoxon signed-rank tests. Results: We received 108 (100%) and 95 (88.0%) questionnaires at 3 and 12 months post-therapy, respectively. Adjuvant interventions included observation (n = 61, 56.5%), intravitreal injections (n = 17, 15.7%), and an intraocular surgical procedure (n = 30, 27.8%). In the latter group, several QOL items significantly declined after the 3-month adjuvant interval, but they partially recovered at the 12-month follow-up. In all adjuvant-intervention groups, global QOL scores returned to baseline levels at 12 months. Conclusion: Posttreatment adjuvant interventions had no long-lasting effects on QOL in patients with uveal melanoma

Operative outcome of hernia repair with synthetic mesh in immunocompromised patients

Background: The safety of synthetic mesh in elective hernia repair in the setting of immunosuppression lacks national and international consensus. The aim of our analysis was to explore the effects of immunosuppression on the rates of wound complications. Methods: Comparative analysis of immunocompetent and immunocompromised patients with elective mesh repair of inguinal, femoral, primary ventral, incisional or parastomal hernia between January 2001 and December 2013. Immunosuppression included glucocorticoids, biologicals, chemotherapy and chemoradiotherapy. Primary outcome parameter was mesh infection rate. Follow-up questionnaires were completed in written form or by telephone interview. Results: Questionnaire response rate was 59.5% (n= 194) with a median follow-up of 33 (interquartile range: 28-41) months. There were no differences between immunocompromised (n= 40, 20.6%) and immunocompetent patients (n= 154, 79.4%) based on hernia and patient characteristics. Immunosuppression was not associated with the rates of mesh infection (P= 1.000), surgical site infection (SSI,P= 0.330) or re-operation for SSI (P= 0.365), but with higher rates (P= 0.007) and larger odds for hernia recurrence (odds ratio 3.264, 95% confidence interval 1.304-8.172;P= 0.012). Mesh infection also increased the odds for hernia recurrence (odds ratio 11.625; 95% confidence interval 1.754-77.057;P= 0.011). Only in the subset of ventral/incisional hernias, immunocompromised (n= 8, 40%) patients had higher recurrence rates than immunocompetent patients (n= 5, 11.6%;P= 0.017). Patients with SSI reported more frequently moderate to severe dysesthesia at the surgical site (P= 0.013) and would less frequently re-consent to surgery (P= 0.006). Conclusion Immunosuppression does not increase the rate of wound infections after elective hernia repair with synthetic mesh. However, immunosuppression and mesh infection are risk factors for hernia recurrence

Association of simple renal cysts and chronic kidney disease with large abdominal aortic aneurysm

Background: Abdominal aortic aneurysms (AAA) primarily affect men over 65 years old who often have many other diseases, with similar risk factors and pathobiological mechanisms to AAA. The aim of this study was to assess the prevalence of simple renal cysts (SRC), chronic kidney disease (CKD), and other kidney diseases (e.g. nephrolithiasis) among patients presenting with AAA. Methods: Two groups of patients (97 AAA and 100 controls), with and without AAA, from the Surgical Clinic Charité, Berlin, Germany, were selected for the study. The control group consisted of patients who were evaluated for a kidney donation (n = 14) and patients who were evaluated for an early detection of a melanoma recurrence (n = 86). The AAA and control groups were matched for age and sex. Medical records were analyzed and computed tomography scans were reviewed for the presence of SRC and nephrolithiasis. Results: SRC (74% vs. 57%; p<0.016) and CKD (30% vs. 8%; p<0.001) were both more common among AAA than control group patients. On multivariate analysis, CKD, but not SRC, showed a strong association with AAA. Conclusions: Knowledge about pathobiological mechanisms and association between CKD and AAA could provide better diagnostic and therapeutic approaches for these patients