Duplex ultrasonography (DUS) currently has limited applicability in the diagnosis and surveillance of thoracic aortic pathologies because of associated limitations. This study investigates the ...feasibility of using an optimised DUS protocol to detect descending thoracic aortic pathology.
This was a prospective, case control cohort study. Patients with computed tomography (CT) confirmed thoracic aortic pathology underwent DUS of the thoracic aorta. A control group known to have no thoracic pathology also underwent DUS. The sonographer performing DUS was blinded to the CT findings, and recorded the presence of pathology or any dilated aortic segment where visualised. Diameter cutoff points of 35 mm and 40 mm were compared.
Forty patients were scanned (20 cases and 20 controls). All patients but one had a technically adequate assessment of the thoracic aorta (at least one view of the descending thoracic aorta). Using a size threshold of 40 mm, 16 out of 19 cases and two out of 20 control patients would have been recommended for definitive imaging. Using a cutoff of 35 mm, this became 18 out of 19 cases and six of 20 controls. Sensitivity and specificity were 100% and 70% for a threshold of 35 mm, and 84% and 90% for a threshold of 40 mm.
DUS has the potential to be used as a diagnostic modality for thoracic aortic pathology, and may have a role in surveillance for some patients for whom CT scanning is contraindicated. Further validation and refinements to this technique are required. However, this study provides proof of concept.
Objective
The aim of this study was to determine the association between fluoroquinolones (FQs) use, the risk of
de novo
aortic aneurysm or dissection (AAD), and the prognosis of patients with ...pre-existing AAD.
Materials and methods
We searched PubMed, EMBASE, CENTRAL, Scopus, and Web of Science on 31 March 2022. Observational studies that evaluated the association of FQs with AAD risk in the general population or FQs with the prognosis of patients with preexisting AAD and presented adjusted effect estimates were included. Two reviewers assessed study eligibility, extracted data, and assessed the risk of bias and certainty of evidence using GRADE.
Results
Of the 13 included studies, 11 focused on the association of FQs with
de novo
AAD incidence, and only one study investigated the association of FQs with the patient with AAD prognosis. FQ use was associated with an increased risk of
de novo
AAD within 30 days (RR: 1.42; 95% CI: 1.11–1.81; very low certainty) and 60 days (RR: 1.44; 95% CI: 1.26–1.64; low certainty). Specifically, the association was significant when compared with amoxicillin, azithromycin, doxycycline, or no antibiotic use. Furthermore, patients with preexisting AAD exposure to FQ had an increased risk of all-cause mortality (RR: 1.61; 95% CI: 1.50–1.73; moderate certainty) and aortic-specific mortality (RR: 1.80; 95% CI: 1.50–2.15; moderate certainty), compared to the non-exposed FQ group within a 60-day risk period.
Conclusion
FQs were associated with an increased incidence of AAD in the general population and a higher risk of adverse outcomes in patients with preexisting AAD. Nevertheless, the results may be affected by unmeasured confounding factors. This should be considered by physicians contemplating using FQs in patients with aortic dilation and those at high risk of AAD.
Systematic Review Registration
https://www.crd.york.ac.uk/prospero/
, identifier CRD42021230171.
Background
: Tuberculosis (TB) is predominantly an airborne disease. However, quantitative and qualitative analysis of bio-aerosols containing the aetiological agent,
Mycobacterium tuberculosis (Mtb)
..., has proven very challenging. Our objective is to sample bio-aerosols from newly diagnosed TB patients for detection and enumeration of
Mtb
bacilli.
Methods
: We monitored each of 35 newly diagnosed, GeneXpert sputum-positive, TB patients during 1 hour confinement in a custom-built Respiratory Aerosol Sampling Chamber (RASC). The RASC (a small clean-room of 1.4m
3
) incorporates aerodynamic particle size detection, viable and non-viable sampling devices, real-time CO
2
monitoring, and cough sound-recording. Microbiological culture and droplet digital polymerase chain reaction (ddPCR) were used to detect
Mtb
in each of the bio-aerosol collection devices.
Results
:
Mtb
was detected in 27/35 (77.1%) of aerosol samples; 15/35 (42.8%) samples were positive by mycobacterial culture and 25/27 (92.96%) were positive by ddPCR. Culturability of collected bacilli was not predicted by radiographic evidence of pulmonary cavitation, sputum smear positivity. A correlation was found between cough rate and culturable bioaerosol.
Mtb
was detected on all viable cascade impactor stages with a peak at aerosol sizes 2.0-3.5μm. This suggests a median of 0.09 CFU/litre of exhaled air (IQR: 0.07 to 0.3 CFU/l) for the aerosol culture positives and an estimated median concentration of 4.5x10
7
CFU/ml (IQR: 2.9x10
7
-5.6x10
7
) of exhaled particulate bio-aerosol.
Conclusions
:
Mtb
was identified in bio-aerosols exhaled by the majority of untreated TB patients using the RASC. Molecular detection was more sensitive than mycobacterial culture on solid media, suggesting that further studies are required to determine whether this reflects a significant proportion of differentially detectable bacilli in these samples.
Variations in pedal circulation in congenital talipes equinovarus (CTEV) are well documented. There is a reported risk of vascular injury to the posterior tibial artery (PTA) during operative ...procedures for CTEV, potentially leading to necrosis and amputation. The aim of this systematic review was to identify the most common anomalies in arterial pedal circulation in CTEV and to determine the relevance of these to clinical practice. The systematic review was registered on PROSPERO and was carried out according to Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines by two independent reviewers. Studies that examined pedal circulation in idiopathic CTEV were included. Articles that studied nonidiopathic CTEV and those not published in English were excluded. Data extracted included patient demographics, imaging modalities, and findings. A total of 14 articles satisfied the inclusion criteria, including 192 patients (279 clubfeet), aged 0–13.5 years, at various stages in their treatment. Imaging modalities included arteriography (n = 5), duplex ultrasound (n = 5), magnetic resonance angiography (n = 2), and direct visualization intraoperatively (n = 2). The dorsalis pedis was most frequently reported as absent (21.5%), and the anterior tibial artery (ATA) was most frequently reported as hypoplastic (18.3%). Where reported (n = 36 feet), 61% of patients were noted to have a dominant supply from the PTA. The most common variation in pedal circulation in CTEV is diminished supply from ATA and dorsalis pedis, although there are documented anomalies in all of the vessels supplying the foot. We therefore recommend routine Doppler ultrasound imaging prior to operative intervention in CTEV.
Background Junctional vascular trauma such as that at the thoracic outlet poses particular challenges in surgical management. The use of endovascular techniques for such injuries is attractive as ...repair may be facilitated without the need for thoracotomy; however, the utility of such techniques is currently based on opinion, small retrospective series, and literature reviews of narrative and not systematic quality. The objective of this study is to provide a complete and systematic analysis of the literature pertaining to open surgery (OS) and endovascular management (EM) of thoracic outlet vascular injuries. Methods An electronic search using the MEDLINE, Embase, Cochrane Library, Science Citation Index, and LILACS databases was performed for articles published from 1947 to November 2011. The review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement standards. Prospective studies and retrospective cohorts of more than 10 patients were included. The primary outcome was all-cause mortality. Results One prospective noncomparative study and 73 retrospective series met the inclusion criteria. There were no randomized studies. All studies were at high risk of bias. Fifteen studies described outcomes for both OS and EM (549 patients). The majority of these studies described EM for traumatic arteriovenous fistulas or false aneurysms in stable patients. Direct comparison between OS and EM was possible in only three studies (comprising 23 OS and 25 EM patients), which showed no difference in all-cause mortality (odds ratio, 0.67; 95% confidence interval CI, 0.11-4.05), but a shorter operating time with EM (mean difference = 58.34 minutes; 95% CI, 17.82-98.85). These three series included successful EM of unstable patients and those with vessel transection. There were 55 studies describing only OS (2057 patients) with a pooled mortality rate of 12.4% (95% CI, 9.9%-15.2%). Four studies described only EM (101 patients) with a pooled mortality rate of 26% (95% CI, 8%-51%), but these represented a distinct subgroup of cases (mainly iatrogenic injuries in older patients). Conclusions The current evidence is weak and fails to show superiority of one modality over the other. EM is currently used primarily in highly selected cases, but there are reports of a broader applicability in trauma. High-quality randomized studies or large-scale registry data are needed to further comment on the relative merits or disadvantages of EM in comparison to OS.
Objective Improving the safety of elective abdominal aortic aneurysm (AAA) repair has become an imperative. Five well-described risk-scoring systems developed on open aneurysm repair (OR) were tested ...on a multicenter contemporary sample of patients undergoing endovascular repair of AAA (EVR) to determine if they predicted 30-day morbidity and mortality. Methods The Glasgow score (GAS), combined prognostic index (CPI), and its modification (M-CPI), the Leiden score and the Vascular Biochemical and Haematological Outctome Model (VBHOM) score were studied using a retrospective database of 846 patients. Thirty-day mortality and serious morbidity were used as end-points. A receiver-operator characteristic curves was plotted and the area under this (known as the c-statistic) was calculated to determine discriminatory ability of each model. Results Incidence of postoperative mortality was 2.2% and serious morbidity was 12.3%. All scores were predictive of mortality except the Leiden score, which had a c-statistic of 0.603 (95% CI, 0.485-0.720; P = .123). The VBHOM score and the M-CPI had a c-statistic of 0.649 (95% CI, 0.514 -0.783; P = .026) and 0.653 (95% CI, 0.544-0.763; P = .026), respectively. The best performing scores were the GAS and CPI, which had a c-statistic of 0.677 (95% CI, 0.559-0.795; P = .008) and 0.679 (95% CI, 0.572-0.787; P = .007), respectively. No score effectively predicted morbidity. Conclusion None of the available scores predicted the outcome of EVR with enough accuracy to be recommended for clinical use. To improve preoperative risk prediction in EVR validation of new systems is required, taking into account morphologic features of the aneurysm to predict medium-term morbidity and re-intervention.
The strategy to eliminate tuberculosis (TB) in low-incidence countries includes the investigation of the contacts of TB cases 1. This recognises that whilst most TB disease in these settings is due ...to reactivation 2, local transmission also occurs 3. In the UK, TB networks (TBN), which support and coordinate local and regional TB services, typically follow the National Institute of Health and Care Excellence guidance which recommends screening close contacts (predominantly household) but not routinely for social or non-household contacts 4. Many studies from low TB burden countries report contact investigation for specific congregate settings including outbreaks in childcare centres 5, homeless facilities 6 and methadone treatment clinics 7. However, the comprehensive application of contact investigation across multiple non-household locations is rarely reported. Therefore, we evaluated a systematic approach to managing people potentially exposed to TB in congregate settings.
A systematic approach to nonhousehold TB contact identified a similar number of LTBI cases to household screening over the same time period
https://bit.ly/2Tq96LN
Purpose: To assess the feasibility and report preliminary results of ruptured abdominal aortic aneurysm (rAAA) repair with endovascular aneurysm sealing (EVAS), a novel therapeutic alternative whose ...feasibility has not been established in rAAAs due to the unknown effects of the rupture site on the ability to achieve sealing. Case Report: Between December 2013 and April 2014, 5 patients (median age 71 years, range 57–90; 3 men) with rAAAs were treated with the Nellix EVAS system at a single institution. Median aneurysm diameter was 70 mm (range 67–91). Aneurysm morphology in 4 of the 5 patients was noncompliant with instructions for use (IFU) for both EVAS and standard stent-grafts; the remaining patient was outside the IFU for standard stent-grafts but treated with EVAS under standard IFU for the Nellix system. Median Hardman index was 2 (range 0–3). Two patients died of multiorgan failure after re-laparotomy and intraoperative cardiac arrest, respectively. Among survivors, all devices were patent with no signs of endoleak or failed aneurysm sac sealing at 6 months (median follow-up 9.2 months). Conclusion: EVAS for the management of infrarenal rAAAs appears feasible. The use of EVAS in emergency repairs may broaden the selection criteria of the current endovascular strategy to include patients with more complex aneurysm morphology.
Dyslexia, also known as reading disability, is defined as difficulty processing written language in individuals with normal intellectual capacity and educational opportunity. The prevalence of ...dyslexia is between 5 and 17%, and the heritability ranges from 44 to 75%. Genetic linkage analysis and association studies have identified several genes and regulatory elements linked to dyslexia and reading ability. However, their functions and molecular mechanisms are not well understood. Prominent among these is
, encoded in the DYX2 locus of human chromosome 6p22. The association of
with reading performance has been replicated in independent studies and different languages. Rodent models suggest that
is involved in neuronal migration, but its role throughout the cortical development is largely unknown. In order to define the function of
in human cortical development, we applied the neural developmental model of a human embryonic stem cell. We knocked down
expression in hESCs and performed the cortical neuroectodermal differentiation. We found that neuroepithelial cell differentiation is one of the first stages of hESC differentiation that are affected by
knocked down could affect radial migration and thus differentiation into diverse neural populations at the cortical layers.
Background Different methods have been used to assess remodeling of the thoracic aorta after endovascular treatment of Stanford type B aortic dissections. Changes in morphology may be described using ...diameter, area, or volume. The aim of this study was to determine if aortic diameter measurements could be used to approximate aortic area in order to refine reporting standards. Methods The study population encompassed 100 patients enrolled in the VIRTUE registry (designed to assess thoracic endografting with the Valiant Stent Graft System Medtronic, Minneapolis, MN for the treatment of type B aortic dissections). Diameter and area measurements of the true lumen, false lumen, and whole aorta were made using three-dimensional computed tomographic (3D CT) workstations, at different anatomic locations. Measurements included preoperative, postoperative, and follow-up scans. The Pearson test was used to determine general correlation between diameter and volume at each location. Scatter plots were drawn and linear regression models were used to draw a line of best fit. Comparison of these with nonlinear models was performed. Results Aortic true and false lumen diameter and area showed good correlation ( p < 0.001) in the majority of anatomic locations. This relationship was present preoperatively and during follow-up ( p < 0.001). The linear regression models fit well with high R2 values. At very large aortic sizes nonlinear models were a slightly better fit, but this was not significant. Conclusions Aortic diameter measurements correlate with luminal areas in patients with type B aortic dissection. This implies area increases proportionately with diameter over time. Therefore, diameter measurements using multiplanar reconstructions based on a central luminal line appear to be adequate when assessing aortic remodeling after endovascular treatment of aortic dissection.
PDF
