Impact of connective tissue disease on the surgical outcomes of aortic dissection in patients with cystic medial necrosis

Abstract Background A retrospective analysis was performed to determine the impact of genetically diagnosed connective tissue disease (CTD) on the early and late outcomes of surgical treatment for aortic dissection in patients having aortic pathology associated with cystic medial necrosis (CMN). Methods Between 2003 and 2013, a total of 43 patients (37 ± 12.8 years old, 23 men, 20 women) who had undergone surgery for aortic dissection associated with CMN in the aortic wall underwent genetic examinations. Subsequently, there were 30 patients with CTD (CTD group) and 13 without CTD (non-CTD group). Results There were no early or late deaths (the follow-up rate was 100% for 57.1 ± 43.0 months). The median age was significantly lower in the CTD group (p = 0.030). The rate of elastic fiber loss was significantly higher in the CTD group (p = 0.014). In the long-term follow-up, there were no significant differences in the incidences of re-dissection (p = 0.332). However, re-operations were required more frequently in the CTD group (p = 0.037). Conclusions In patients with CTD as well as CMN, the onset of aortic dissection tends to be earlier, which would result in higher rates of re-operation, compared with the non-CTD group. Closer and stricter follow-up with medication and adequate surgical treatments with appropriate timing are mandatory for such high-risk patients

Effect of cardiac rehabilitation on cognitive function in elderly patients with cardiovascular diseases.

BACKGROUND:Cognitive function is an important factor for secondary prevention in elderly patients with cardiovascular diseases. The objective of this study was to evaluate the impact of cardiac rehabilitation (CR) on the improvement of cognitive function. METHODS:A total of 66 consecutive elderly patients (≥70 years old) with cardiovascular diseases were prospectively enrolled. The change in cognitive function during 6 months was compared between the patients with monthly CR (at least once per month; n = 27) and those without monthly CR (n = 39). Cognitive function was evaluated using the Mini-mental State Examination (MMSE) and Frontal Assessment Battery (FAB). RESULTS:There was no significant difference in baseline characteristics between the 2 groups. The change in the MMSE score was significantly greater in patients with monthly CR than in those without monthly CR (2.3 ± 0.4 vs. -0.1 ± 0.3 points; p <0.001). Among the MMSE items, the change in temporal orientation and attention and calculation was significantly greater in the monthly CR group than in the non-monthly CR group (0.8 ± 0.7 vs. -0.1 ± 0.8 points [p <0.001] and 1.0 ± 1.5 vs. -0.1 ± 0.1 points [p <0.001], respectively). The general linear model revealed that monthly CR (effect estimate, 1.455; 95% confidence interval, 0.747-2.163; p <0.001) was independently associated with the change in the MMSE score. CONCLUSIONS:Cognitive function may improve with regular CR. These results might partly explain the efficacy of CR for secondary prevention

Effects of Bone Cross-Link Bridging on Fracture Mechanism and Surgical Outcomes in Elderly Patients with Spine Fractures

Study Design This study adopted a cross-sectional study design. Purpose This study was designed to investigate the effects of bone cross-link bridging on fracture mechanism and surgical outcomes in vertebral fractures using the maximum number of vertebral bodies with bony bridges between adjacent vertebrae without interruption (maxVB). Overview of Literature The complex interplay of bone density and bone bridging in the elderly can complicate vertebral fractures, necessitating a better understanding of fracture mechanics. Methods We examined 242 patients (age >60 years) who underwent surgery for thoracic to lumbar spine fractures from 2010 to 2020. Subsequently, the maxVB was classified into three groups: maxVB (0), maxVB (2–8), and maxVB (9–18), and parameters, including fracture morphology (new Association of Osteosynthesis classification), fracture level, and neurological deficits were compared. In a sub-analysis, 146 patients with thoracolumbar spine fractures were classified into the three aforementioned groups based on the maxVB and compared to determine the optimal operative technique and evaluate surgical outcomes. Results Regarding the fracture morphology, the maxVB (0) group had more A3 and A4 fractures, whereas the maxVB (2–8) group had less A4 and more B1 and B2 fractures. The maxVB (9–18) group exhibited an increased frequency of B3 and C fractures. Regarding the fracture level, the maxVB (0) group tended to have more fractures in the thoracolumbar transition region. Furthermore, the maxVB (2–8) group had a higher fracture frequency in the lumbar spine area, whereas the maxVB (9–18) group had a higher fracture frequency in the thoracic spine area than the maxVB (0) group. The maxVB (9–18) group had fewer preoperative neurological deficits but a higher reoperation rate and postoperative mortality than the other groups. Conclusions The maxVB was identified as a factor influencing fracture level, fracture type, and preoperative neurological deficits. Thus, understanding the maxVB could help elucidate fracture mechanics and assist in perioperative patient management