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On-Table Zenith® CE Fenestrated Stent Graft Modifcation for the Treatment of Delayed Type Ia Endoleak
No full textINTRODUCTION: Delayed type Ia endoleaks are often associated with proximal extension of the aneurysmal
degeneration to the juxtarenal aortic segment. Endovascular treatment of type Ia endoleaks secondary to aortic
neck dilatation can raise many technical challenges related to the previous implanted stent graft.
CASE REPORT: The authors present a clinical case of an 84 year-old man, with a past medical history of atrial
fbrillation, acute ischemic stroke, hypertension and dyslipidemia, that initially underwent an EVAR for a 5.5.cm
infrarenal AAA with a TREO Bolton® endograft. After 3 years of follow-up, the CTA scan showed a delayed type Ia endoleak secondary to aortic neck dilatation with signifcant growth of the aneurysmatic sac.
An endovascular proximal extension was planned, using a Zenith Fenestrated (ZFEN) platform (Cook Medical,
Bloomington, Ind) but the short distance to the previous EVAR bifurcation did not allow the implantation of a
standard 94cm CE fenestrated stent graft. To overcome this challenge, on-table modifcation of the fenestrated
stent graft was performed by cutting the distal aortic stent. The stent graft was partially deployed on-table,
the distal stent was cut with thermocautery, and the device was re-sheathed. The fenestrated cuff was then
implanted in the standard fashion with target vessel catheterization and stenting. Two aortic covered stents
(Aortic Begraft Bentley® 18mm) were implanted inside each iliac limb of the previous EVAR and sealed proximally in a parallel graft confguration on the fenestrated cuff.
The fnal completion angiogram demonstrated perfusion of the visceral arteries, resolution of the Ia endoleak
and without further endoleaks, as well as perfusion of both hypogastric arteries. At two months of follow up, the
patient remains asymptomatic and the CTA scan showed resolution of the type Ia endoleak but the presence of
a late type II endoleak.
DISCUSSION: Delayed type Ia endoleaks associated with proximal extension of the aneurysmal degeneration to the juxtarenal aortic segment, can raise some technical diffculties related to the previous implanted stent graft. Careful evaluation of patient anatomy and previous endografts should be done in planning for these procedures. On table physician modifcation of stent grafts is a valid solution to overcome challenging cases limitations. Further long-term follow-up is needed.info:eu-repo/semantics/publishedVersio
Predicting Function Delay with a Machine Learning Model: Improve the Long-term Survival of Pancreatic Grafts
No full textThe impact of delayed graft function on outcomes following various solid organ transplants is well documented
and addressed in the literature. Delayed graft function following various solid organ transplants is associated with both short- and long-term graft survival issues. In a retrospective cohort study including 106 patients we evaluated whether pancreas graft survival differs according to moment of insulin therapy following simultaneous pancreaskidney transplant. As a result, we aimed to identify possible risk factors and build a machine-learning-based model that predicts the likelihood of dysfunction following SPK transplant patients based on day zero data after transplant, allowing to enhance pancreatic graft survival. Feature selection by Relief algorithm yielded donor features, age, cause of death, hemoglobin, gender, ventilation days, days in ICU, length of cardiac respiratory arrest and recipient features, gender, long-term insulin, dialysis type, time of diabetes mellitus, vPRA pre-Tx, number of HLA-A mismatches and PRDI, all contributed to the models' strength.info:eu-repo/semantics/publishedVersio
A Multinational Study of Acute and Long‐Term Outcomes of Type 1 Galactosemia Patients Who Carry the S135L (c.404C > T) Variant of GALT
No full textPatients with galactosemia who carry the S135L (c.404C > T) variant of galactose-1-P uridylyltransferase (GALT), documented to encode low-level residual GALT activity, have been under-represented in most prior studies of outcomes in Type 1 galactosemia. What is known about the acute and long-term outcomes of these patients, therefore, is based on very limited data. Here, we present a study comparing acute and long-term outcomes of 12 patients homozygous for S135L, 25 patients compound heterozygous for S135L, and 105 patients homozygous for two GALT-null (G) alleles. This is the largest cohort of S135L patients characterized to date. Acute disease following milk exposure in the newborn period was common among patients in all 3 comparison groups in our study, as were long-term complications in the domains of speech, cognition, and motor outcomes. In contrast, while at least 80% of both GALT-null and S135L compound heterozygous girls and women showed evidence of an adverse ovarian outcome, prevalence was only 25% among S135L homozygotes. Further, all young women in this study with even one copy of S135L achieved spontaneous menarche; this is true for only about 33% of women with classic galactosemia. Overall, we observed that while most long-term outcomes trended milder among groups of patients with even one copy of S135L, many individual patients, either homozygous or compound heterozygous for S135L, nonetheless experienced long-term outcomes that were not mild. This was true despite detection by newborn screening and both early and life-long dietary restriction of galactose. This information should empower more evidence-based counseling for galactosemia patients with S135L.info:eu-repo/semantics/publishedVersio
Pathophysiology of Coronary Microvascular Dysfunction
No full textinfo:eu-repo/semantics/publishedVersio
Tumor Necrosis Impacts Prognosis of Patients Undergoing Resection for T1 Intrahepatic Cholangiocarcinoma
No full textBackground: The prognostic impact of tumor necrosis among patients undergoing resection for intrahepatic cholangiocarcinoma (ICC) remains ill-defined.
Methods: Patients who underwent curative-intent resection for ICC between 2000 and 2017 were identified using a multi-institutional database. The association of pathologic tumor necrosis with overall survival (OS) and recurrence-free survival (RFS) was examined.
Results: Among 757 patients who underwent resection for ICC, tumor necrosis was present in 384 (50.7%) patients (no necrosis: n = 373, 49.3%; <50% necrosis: n = 291, 38.4%; ≥50% necrosis: n = 93, 12.3%). Tumor necrosis was associated with worse OS (5-year OS: no necrosis 39.3% vs. <50% necrosis 34.7% and ≥50% necrosis 24.0%; p = 0.03) and RFS (5-year RFS: no necrosis 25.7% vs. <50% necrosis 13.9% and ≥50% necrosis 18.8%; p < 0.001). After stratifying by T stage, tumor necrosis was able to further stratify prognosis among patients with T1a ICC (5-year RFS: T1a and no necrosis 46.7% vs. T1a and necrosis 36.1%; p = 0.02), and T1b ICC (5-year RFS: T1b and no necrosis 31.1% vs. T1b and necrosis 11.2%; p = 0.006), but was not associated with outcomes among patients with more advanced T2-T3 disease. Patients with T1a ICC and tumor necrosis had similar 5-year RFS as individuals with T1b ICC and no tumor necrosis (36.1% vs. 31.1%; p = 0.66).
Conclusion: Tumor necrosis was associated with worse prognosis among patients with T1 ICC. Tumor necrosis for T1 ICC should be considered as an important factor to further stratify outcomes of patients with early T-stage ICC.info:eu-repo/semantics/publishedVersio
Management of Asymptomatic Sporadic Non-Functioning Pancreatic Neuroendocrine Neoplasms No Larger Than 2 Cm: Interim Analysis of Prospective ASPEN Trial
No full textinfo:eu-repo/semantics/publishedVersio
A Multinational Study of The Impact of Covid-19 On Urologic Surgery Residency and Wellbeing
No full textObjective: To assess changes to the experiences and wellbeing of urology trainees in the United States (US) and European Union (EU) during the COVID-19 pandemic.
Methods: A 72-item anonymous online survey was distributed September 2020 to urology residents of Italy, France, Portugal, and the US. The survey assessed burnout, professional fulfillment, loneliness, depression and anxiety as well as 38 COVID specific questions.
Results: Two hundred twenty-three urology residents responded to the survey. Surgical exposure was the main educational concern for 81% of US and 48% of EU residents. E-learning was utilized by 100% of US and 57% of EU residents with two-thirds finding it equally or more useful than traditional didactics. No significant differences were seen comparing burnout, professional fulfillment, depression, anxiety, or loneliness among US or EU residents, 73% of US and 71% of EU residents reported good to excellent quality of life during the pandemic. In the US and EU, significantly less time was spent in the hospital, clinic, and operating room (P <.001) and residents spent more time using telehealth and working from home during the pandemic and on research projects, didactic lectures, non-medical hobbies and reading. The majority of residents reported benefit from more schedule flexibility, improved work life balance, and increased time for family, hobbies, education, and research.
Conclusion: The COVID-19 pandemic has resulted in significant restructuring of residents' educational experience around the globe. Preservation of beneficial changes such as reduction of work hours and online learning should be pursued within this pandemic and beyond it.info:eu-repo/semantics/publishedVersio