Biomechanical Investigation of Disturbed Hemodynamics-Induced Tissue Degeneration in Abdominal Aortic Aneurysms Using Computational and Experimental Techniques.

Abdominal aortic aneurysm (AAA) is the dilatation of the aorta beyond 50% of the normal vessel diameter. It is reported that 4-8% of men and 0.5-1% of women above 50 years of age bear an AAA and it accounts for ~15,000 deaths per year in the United States alone. If left untreated, AAA might gradually expand until rupture; the most catastrophic complication of the aneurysmal disease that is accompanied by a striking overall mortality of 80%. The precise mechanisms leading to AAA rupture remains unclear. Therefore, characterization of disturbed hemodynamics within AAAs will help to understand the mechanobiological development of the condition which will contribute to novel therapies for the condition. Due to geometrical complexities, it is challenging to directly quantify disturbed flows for AAAs clinically. Two other approaches for this investigation are computational modeling and experimental flow measurement. In computational modeling, the problem is first defined mathematically, and the solution is approximated with numerical techniques to get characteristics of flow. In experimental flow measurement, once the setup providing physiological flow pattern in a phantom geometry is constructed, velocity measurement system such as particle image velocimetry (PIV) enables characterization of the flow. We witness increasing number of applications of these complimentary approaches for AAA investigations in recent years. In this paper, we outline the details of computational modeling procedures and experimental settings and summarize important findings from recent studies, which will help researchers for AAA investigations and rupture mechanics

Coronary arteriovenous fistulas in the adults: natural history and management strategies

<p>Abstract</p> <p>Objective</p> <p>To describe aspects of the natural history and pathophysiology of coronary arteriovenous fistula and to propose potential treatment strategies.</p> <p>Methods</p> <p>Eleven adult patients were treated surgically for coronary arteriovenous fistulas (8 male, 3 female) during the last three years. Mean age was 48,7 ± 9,5 years (range 32-65 years). Diagnosis was made by coronary angiography and transesophageal echocardiography</p> <p>Results</p> <p>All patients were symptomatic due to the associating cardiac disorder or fistula. Presenting symptoms were chest pain, exertional dyspnea and palpitation. All patients were diagnosed by selective angiography. Transthoracic and transoesophageal echocardiography was performed to identify the Qp/Qs ratio in one patient. One patient who had an LAD to pulmonary artery coronary arteriovenous fistula with a vascular malformation needed early reoperation due to recurrence of the fistula. Echocardiographic evaluation at the postoperative third month revealed no residual shunts in all patients.</p> <p>Conclusion</p> <p>Because of the severe complications that may develop due to coronary arteriovenous fistula, we believe that every coronary artery fistula should be treated invasively by surgery or transcatheter closure. But both treatment modalities still need to be evaluated with randomized multicenter studies for long term survival and effectiveness.</p

Nieinwazyjny pomiar ilości tkanki tłuszczowej trzewnej metodą ultrasonograficzną — potencjalne zastosowanie w ocenie zaawansowania subklinicznej miażdżycy u mężczyzn z niedoczynnością przysadki i niedoborem hormonu wzrostu

Introduction: Growth hormone (GH) deficiency, either isolated or combined with other pituitary hormone deficiencies, is associated with increased mortality and abnormal body composition, particularly visceral adiposity. We aimed to investigate the effects of GH deficiency with or without sex steroid deficiencies on ultrasonographic visceral fat (VF) and cardiovascular risk markers in patients with hypopituitarism on conventional hormone replacement therapy.Material and methods: Forty hypopituitarism patients (24 women, 16 men; mean age 48 ± 16.1 years) with GH deficiency and 15 age- and sex-matched healthy controls were included in this cross-sectional study. The patients were stable on conventional hormone replacement but they were not on GH therapy. Patients who had sex steroid replacement were classified as Group 1 (n = 19), and patients who did not use sex steroids were classified as Group 2 (n = 21). Anthropometric measurements were performed. VF in three regions, subcutaneous fat, and carotid intima-media thickness (CIMT) were measured. VF volume was calculated by using a formula.Results: Visceral fat volume and mean CIMT were significantly higher in patients than healthy controls (p = 0.001 and 0.019 respectively). Homocysteine and hs-CRP were higher in patients (p &lt; 0.05). In males, VF volume and VF thickness measured between abdominal muscle and splenic vein were significantly correlated with CIMT (r = 0.54, p = 0.047 and r = 0.66, p = 0.010 respectively). Furthermore, there was a strong positive correlation between VF thickness in pararenal region and homocysteine (r = 0.74, p = 0.001) in males.Conclusions: VF volume evaluated by ultrasound can be accepted as a cause of subclinical atherosclerosis in GH deficient hypopituitary patients, particularly males.Wstęp: Niedobór hormonu wzrostu (GH, growth hormone) może występować jako zaburzenie izolowane lub współistnieć z niedoborami innych hormonów przysadki. Wszyscy pacjenci z niedoborem GH są jednak obarczeni większym ryzykiem zgonu i mają nieprawidłowy skład tkanek ciała, z tendencją do otyłości brzusznej. Celem pracy była ocena zależności pomiędzy niedoborem GH, niezależnie od ewentualnego współistnienia niedoborów hormonów płciowych a grubością tkanki tłuszczowej trzewnej (VF, visceral fat) mierzoną metodą ultrasonograficzną oraz czynnikami ryzyka sercowo-naczyniowego u pacjentów z niedoczynnością przysadki, leczonych konwencjonalnymi preparatami hormonalnymi.Materiał i metody: Badanie miało charakter przekrojowy i zakwalifikowano do niego 40 pacjentów z niedoczynnością przysadki i niedoborem GH, w tym 24 kobiety, 16 mężczyzn; średni wiek badanych wynosił 48 ± 16,1 lat. Do badania włączono też 15 osób w grupie kontrolnej, dobranych pod względem płci i wieku do osób z grupy badanej. Pacjenci w grupie badanej leczeni byli konwencjonalnie preparatami hormonalnymi, ale nie otrzymywali hormonu wzrostu. Pacjenci leczeni hormonami płciowymi zostali włączeni do grupy 1 (n = 19), a pacjenci nie otrzymujący takich preparatów do grupy 2 (n = 21). U wszystkich wykonano badania antropometryczne. Wykonywano pomiar grubości VF w trzech miejscach, badano grubość podskórnej tkanki tłuszczowej oraz grubość warstwy wewnętrznej i środkowej ściany tętnicy szyjnej (CIMT, carotid intima-media thickness). Objętość VF wyliczano według wzoru.Wyniki: U pacjentów w grupie badanej stwierdzono znamiennie większą objętość trzewnej tkanki tłuszczowej i średnią wartość CIMT w porównaniu z osobami zdrowymi (odpowiednio p = 0,001 i p = 0,019). Stężenie homocysteiny i hs-CRP były również większe w grupie badanej (p &lt; 0,05). U mężczyzn stwierdzono istotną korelację pomiędzy objętością VF i grubością VF mierzoną pomiędzy mięśniami brzucha a żyłą śledzionową a wartością CIMT (odpowiednio r = 0,54 i p = 0,047 oraz r = 0,66 i p = 0,010). Ponadto, u mężczyzn stwierdzono wyraźną zależność pomiędzy grubością VF w okolicy nerek a stężeniem homocysteiny (r = 0,74 i p = 0,001).Wnioski: Objętość VF mierzona ultrasonograficznie może być wykładnikiem subklinicznie toczącej się miażdżycy u pacjentów z niedoborem hormonu wzrostu na skutek niedoczynności przysadki, w szczególności u mężczyzn

Clinical Study Comparison of Efficiencies of Michigan Neuropathy Screening Instrument, Neurothesiometer, and Electromyography for Diagnosis of Diabetic Neuropathy

Aim. This study compares the effectiveness of Michigan Neuropathy Screening Instrument (MNSI), neurothesiometer, and electromyography (EMG) in detecting diabetic peripheral neuropathy in patients with diabetes type 2. Materials and Methods. 106 patients with diabetes type 2 treated at the outpatient clinic of Ankara Numune Education and Research Hospital Department of Endocrinology between September 2008 and May 2009 were included in this study. Patients were evaluated by glycemic regulation tests, MNSI (questionnaire and physical examination), EMG (for detecting sensorial and motor defects in right median, ulnar, posterior tibial, and bilateral sural nerves), and neurothesiometer (for detecting alterations in cold and warm sensations as well as vibratory sensations). Results. According to the MNSI score, there was diabetic peripheral neuropathy in 34 (32.1%) patients (score ≥2.5). However, when the patients were evaluated by EMG and neurothesiometer, neurological impairments were detected in 49 (46.2%) and 79 (74.5%) patients, respectively. Conclusion. According to our findings, questionnaires and physical examination often present lower diabetic peripheral neuropathy prevalence. Hence, we recommend that in the evaluation of diabetic patients neurological tests should be used for more accurate results and thus early treatment options to prevent neuropathic complications

Relation of maternal vitamin D status with gestational diabetes mellitus and perinatal outcome

Objective: To investigate the relationship between maternal vitamin D status and glucose intolerance, and its impact on pregnant women and their newborns. Methods: A cohort of pregnant women were divided into three groups: women with gestational diabetes mellitus, ones with normal results both after the 50 gr and 100 gr OGTT (CG-1) and ones having a positive result after the 50 gr OGTT screening but negative results for gestational diabetes mellitus (GDM) after the 100 gr OGTT (CG-2) Results: The newborn length in CG-1 was greater than in GDM and CG-2 (p= 0.002 and p= 0.02). Fasting blood glucose and insulin resistance (IR) were negatively correlated with length of the newborns (r=-0.3, p=0.03 and r=-0.3, p=0.01). The newborns of women with GDM had lower APGAR-1 and 5 scores than those of CG-1 and CG-2 (APGAR-1 p= 0.001 and p= 0.004, APGAR-5 p=0.005 and p=0.007, respectively). APGAR scores were correlated negatively with IR (APGAR-1 r=- 0.32, p=0.01, APGAR-5 r=-0.3, p=0.03) and positively with 25OHD levels (APGAR-1 r=0.3, p=0.01, APGAR-5 r=0.3, p=0.02). Conclusion: Vitamin D deficiency, gestational diabetes and insulin resistance are interrelated. Severe vitamin D deficiency during pregnancy is associated with poor pregnancy and neonatal outcome

30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data

Background: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Materials and methods: This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien–Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Results: In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). Conclusions: This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts

30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic – The GENEVA study

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients