In 2017, a high-energy muon neutrino detected by IceCube was found positionally coincident with the direction of a known blazar, TXS 0506 + 056, in a state of enhanced γ-ray emission. Soon after, ...IceCube reported compelling evidence for an earlier neutrino flare from the same direction found in the archival data, this time not accompanied by any observed electromagnetic activity. The IceCube findings suggest searching for flaring neutrino emission from astrophysical sources, not necessarily accompanied by flares detected in γ-rays. The analysis presented in this contribution scans the events collected by the ANTARES neutrino telescope in 13 years of data taking in a search for clustering in space and time. The analysis method is based on an unbinned maximum likelihood approach. Generic Gaussian and Box profiles are assumed for the signal time emission, with both the central time and duration of the flare being free parameters in the likelihood maximization. The time-dependent approach is applied to the catalog of radio-bright blazars for which a promising directional correlation with IceCube muon tracks was recently reported 1, 2. No significant space and time clustering of neutrinos above background expectation is observed after accounting for trials. Seven sources are found to have a pre-trial significance of over 3σ, with the highest excess being the one at the location of the blazar J1500 − 2358, with a pre-trial significance of 3.4σ, corresponding to a post-trial p-value of 40%.
Objectives To evaluate the potential benefit of systematic preoperative coronary-artery angiography followed by selective coronary-artery revascularization on the incidence of myocardial infarction ...(MI) in patients undergoing carotid endarterectomy (CEA) without a previous history of coronary artery disease (CAD). Methods We randomised 426 patients who were candidates for CEA, with no history of CAD, a normal electrocardiogram (ECG), and a normal cardiac ultrasound. In group A (n = 216) all patients underwent coronary angiography before CEA. In group B (n = 210) CEA was performed without coronary angiography. Patients were not blinded for relevant assessments during follow-up. Primary end-point was the occurrence of MI at 3.5 years. The secondary end-point was the overall survival rate. Median length of follow-up was 6.2 years. Results In group A, coronary angiography revealed significant coronary artery stenosis in 68 patients (31.5%). Among them, 66 underwent percutaneous Intervention (PCI) prior to CEA and 2 received combined CEA and coronary-artery bypass grafting (CABG). Postoperatively, no MI was observed in group A, whereas 6 MI occurred in group B, one of which was fatal ( p = .01). During the study period, 3 MI occurred in group A (1.4%) and 33 were observed in group B (15.7%), 6 of which were fatal. The Cox model demonstrated a reduced risk of MI for patients in group A receiving coronary angiography (HR,.078; 95% CI, 0.024-0.256; p < .001). In addition, patients with diabetes and patients <70 years presented with an increased risk of MI. Survival analysis at 6 years by Kaplan-Meier estimates was 95.6 ± 3.2% in Group A and 89.7 ± 3.7% in group B (Log Rank = 6.54, p = .01). Conclusions In asymptomatic coronary-artery patients, systematic coronary angiography prior to CEA followed by selective PCI or CABG significantly reduces the incidence of late MI and increases long-term survival. ( ClinicalTrials.gov number, NCT02260453 ).
Abstract Objective To evaluate the usefulness of systematic coronary angiography followed, if needed, by coronary artery angioplasty (percutaneous coronary intervention (PCI)) on the incidence of ...cardiac ischaemic events after carotid endarterectomy (CEA) in patients without evidence of coronary artery disease (CAD). Materials and methods From January 2005 to December 2008, 426 patients, candidates for CEA, with no history of CAD and with normal cardiac ultrasound and electrocardiography (ECG), were randomised into two groups. In group A ( n = 216) all the patients had coronary angiography performed before CEA. In group B, all the patients had CEA without previous coronary angiography. In group A, 66 patients presenting significant coronary artery lesions at angiography received PCI before CEA. They subsequently underwent surgery under aspirin (100 mg day−1 ) and clopidogrel (75 mg day−1 ). CEA was performed within a median delay of 4 days after PCI (range: 1–8 days). Risk factors, indications for CEA and surgical techniques were comparable in both groups ( p > 0.05). The primary combined endpoint of the study was the incidence of postoperative myocardial ischaemic events combined with the incidence of complications of coronary angiography. Secondary endpoints were death and stroke rates after CEA and incidence of cervical haematoma. Results Postoperative mortality was 0% in group A and 0.9% in group B ( p = 0.24). One postoperative stroke (0.5%) occurred in group A, and two (0.9%) in group B ( p = 0.62). No postoperative myocardial event was observed in group A, whereas nine ischaemic events were observed in group B, including one fatal myocardial infarction ( p = 0.01). Binary logistic regression analysis demonstrated that preoperative coronary angiography was the only independent variable that predicted the occurrence of postoperative coronary ischaemia after CEA. The odds ratio for coronary angiography (group A) indicated that when holding all other variables constant, a patient having preoperative coronary angiography before carotid surgery was 4 times less likely to have a cardiac ischaemic event after carotid surgery. No complications related to coronary angiography were observed and no cervical haematomas occurred in patients undergoing surgery under aspirin and clopidogrel in this study. Conclusions Systematic preoperative coronary angiography, possibly followed by PCI, significantly reduces the incidence of postoperative myocardial events after CEA in patients without clinical evidence of CAD.
The diabetic foot: a review Ricco, J B; Thanh Phong, L; Schneider, F ...
Journal of cardiovascular surgery
54, Številka:
6
Journal Article
Recenzirano
Diabetic foot ulceration (DFU) is among the most frequent complications of diabetes. Neuropathy and ischaemia are the initiating factors and infection is mostly a consequence. We have shown in this ...review that any DFU should be considered to have vascular impairment. DFU will generally heal if the toe pressure is >55 mmHg and a transcutaneous oxygen pressure (TcPO2) <30 mmHg has been considered to predict that a diabetic ulcer may not heal. The decision to intervene is complex and made according to the symptoms and clinical findings. If both an endovascular and a bypass procedure are possible with an equal outcome to be expected, endovascular treatments should be preferred. Primary and secondary mid-term patency rates are better after bypass, but there is no difference in limb salvage. Bedridden patients with poor life expectancy and a non-revascularisable leg are indications for performing a major amputation. A deep infection is the immediate cause of amputation in 25% to 50% of diabetic patients. Patients with uncontrolled abscess, bone or joint involvement, gangrene, or necrotising fasciitis have a "foot-at risk" and need prompt surgical intervention with debridement and revascularisation. As demonstrated in this review, foot ulcer in diabetic is associated with high mortality and morbidity. Early referral, non-invasive vascular testing, imaging and intervention are crucial to improve DFU healing and to prevent amputation. Diabetics are eight to twenty-four times more likely than non-diabetics to have a lower limb amputation and it has been suggested that a large part of those amputations could be avoided by an early diagnosis and a multidisciplinary approach.
The management of patients with recurrent neck cancer invading the carotid artery is controversial. The aim of this study was to evaluate the overall survival and healthy survival years (QALY) as ...well as the patency of carotid revascularization after enbloc tumor resection followed by complementary radiotherapy.
From 2000 to 2016, 42 consecutive patients with recurrent neck cancer invading the carotid artery underwent resection of the tumor associated with reconstruction of the carotid artery with a PTFE prosthesis (n=31) or with a saphenous vein graft (n=11). In 11 cases, resection was associated with musculocutaneous flap coverage. The primary tumor was a squamous cell carcinoma of the larynx (20 patients) or of the pharynx (9 patients), undifferentiated carcinoma of unknown origin (10 patients) and anaplastic thyroid carcinoma (3 patients). All patients had postoperative radiotherapy (50-70Gy) supplemented in 16 of them by chemotherapy. Nine patients had metastatic dissemination at the time of reoperation with a recurrent tumor ulcerated to the skin in 5 of them.
The combined 30-day mortality and stroke rate was nil. Postoperative morbidity included dysphagia (n=8), vocal cord paralysis (n=6), late wound healing delay (n=2), transient mandibular claudication (n=1) and partial necrosis of the musculocutaneous flap (n=1). No infection and no thrombosis of the bypass were observed during follow-up median: 31 months, range: 8-167 months. Twenty-one patients (50%) died from the consequences of the spread of cancer, which had become metastatic, but without local recurrence. The 5-year survival rate was 50.9±8.3%. The median healthy survival year (QALY) was 3.38 95% CI: 1.70-4.54 with a significant difference between patients without metastasis at the time of reoperation n=33; QALY=4.02 and those with metastases n=9; QALY=0.43; P=0.005. Healthy life expectancy was also significantly longer in patients with laryngeal cancer n=20, QALY=4.95 compared to patients with other types of tumors n=22, QALY=1.67; P=0.032.
In the absence of metastases, enbloc resection of recurrent neck cancers invading the carotid artery improves the duration and quality of patient survival.
The aim of this randomized study is to evaluate the real benefits of the FOCUS Harmonic Scalpel in total thyroidectomies compared with conventional ligation, regarding operative time, postoperative ...blood loss, length of stay and complications. Furthermore, as never seen in other studies, we studied the effects of using the FOCUS during thyroidectomy analyzing the vocal production of patients before and after surgery.
We enrolled 361 patients who underwent total thyroidectomy from 2008 to 2014. It was a randomized clinical trial in which all the surgical procedures were performed by the same surgeon. Patients were randomized into two groups according to the haemostatic technique: 187 patients were included in a "conventional" group (C) in whom dissection and haemostasis were performed using conventional materials (Vicryl, stitches, V titanium hemostatic clips and monopolar or bipolar electrocautery); 174 patients were included in a group in which the FOCUS was used (F group).
Our data show that the FOCUS allows a one-third time-saving vs. classic haemostasis. Moreover, the use of the FOCUS would allow reduced traction and reduced manipulation of the thyroid during surgery. Our data demonstrate that the rate of complications in the Focus group might not be significantly reduced. In our series, we noticed that the quantitative acoustic assessment of voice quality show important alterations in several parameters (Shim, Jitt, sPPQ, sAPQ studied with the Multi Dimensional Voice Program evaluation) between the C group and F group.
The FOCUS Harmonic Scalpel reduces the operative time, post-operative blood loss and length of hospital stay in thyroidectomy. Besides, important vocal alterations after thyroidectomy seem more severe using the conventional technique instead of FOCUS.
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