Diabetes and Abdominal Aortic Aneurysms De Rango, P; Farchioni, L; Fiorucci, B ...
European journal of vascular and endovascular surgery,
03/2014, Letnik:
47, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Epidemiologic evidence suggests that patients with diabetes may have a lower incidence of abdominal aortic aneurysm (AAA); however, the link between diabetes and AAA development and expansion is ...unclear. The aim of this review is to analyze updated evidence to better understand the impact of diabetes on prevalence, incidence, clinical outcome, and expansion rate of AAA. A systematic review of literature published in the last 20 years using the PubMed and Cochrane databases was undertaken. Studies reporting appropriate data were identified and a meta-analysis performed using the generic inverse variance method. Sixty-four studies were identified. Methodological quality was “fair” in 16 and “good” in 44 studies according to a formal assessment checklist (Newcastle–Ottawa). In 17 large population prevalence studies there was a significant inverse association between diabetes and AAA: pooled odds ratio (OR) 0.80; 95% confidence intervals (CI) 0.70–0.90 ( p = .0009). An inverse association was also confirmed by pooled analysis of data from smaller prevalence studies on selected populations (OR 0.59; 95% CI 0.35–0.99; p = .05), while no significant results were provided by case-control studies. A significant lower pooled incidence of new AAA in diabetics was found over six prospective studies: OR 0.54; 95% CI 0.31–0.91; p = .03. Diabetic patients showed increased operative (30-day/in-hospital) mortality after AAA repair: pooled OR 1.26; 95% CI 1.10–1.44; p = .0008. The increased operative risk was more evident in studies with 30-day assessment. In the long-term, diabetics showed lower survival rates at 2–5 years, while there was general evidence of lower growth rates of small AAA in patients with diabetes compared to non-diabetics. There is currently evidence to support an inverse relationship between diabetes and AAA development and enlargement, even though fair methodological quality or unclear risk of bias in many available studies decreases the strength of the finding. At the same time, operative and long-term survival is lower in diabetic patients, suggesting increased cardiovascular burden. The higher mortality in diabetics raises the question as to whether AAA repair should be individualized in selected diabetic populations at higher AAA rupture risk.
Objective/Background Absence of an adequate iliac seal rarely represents an absolute contraindication to endovascular abdominal aortic aneurysm repair. Iliac branch devices (IBD) are increasingly ...used in patients with extensive aorto-iliac aneurysmal disease, but few data are available on the long-term results of these procedures. Methods Between 2006 and 2016, 157 consecutive IBD procedures performed at a single centre were entered into a prospective database. Indications included unilateral or bilateral common iliac artery aneurysms combined or not with abdominal aortic aneurysms. Long-term results were reported according to the Kaplan–Meier method. Results During the study period 149 patients were treated with an iliac branched endograft. Isolated IBD was implanted in 17.8% of the cases; technical success rate was 97.5%. Peri-operative procedure failure occurred in seven patients, four during surgery and three within 30 days of the procedure. Presence of ipsilateral hypogastric aneurysm ( p = .031; Exp B = 6.72) and intervention performed during the initial study period ( p = .006; Exp B = 10.40) were predictive of early failure on multivariate analysis. After a mean follow-up of 44.2 months actuarial freedom from IBD related re-intervention was 97.4%, 95.6%, 94.0%, and 91.8% at 1, 3, 5, and 9 years, respectively. Hypogastric artery patency was 94.7%, 92.6%, and 90.4% at 1, 3, and 10 years, respectively. Presence of a hypogastric aneurysm was an independent predictor of target artery occlusion during follow-up on multivariate analysis ( p = .007; Exp B = 5.93). Conclusion Iliac branched endografting can now be performed with a high technical success rate; long-term freedom from re-intervention is comparable with patients treated with standard aortic endografting. IBD should be considered a first-option treatment in patients with adequate vascular anatomy unsuitable for standard endovascular aortic repair.
High-on-treatment platelet reactivity (HTPR) has been established as a predictor of major adverse cardiovascular events (MACE) in patients undergoing percutaneous coronary interventions on dual ...antiplatelet therapy (DAPT), but no data are available on its predictive value in patients on DAPT after carotid artery stenting (CAS). We aimed to evaluate the possible association between HTPR in patients on aspirin plus clopidogrel therapy after CAS and subsequent MACE.
All consecutive patients treated with CAS in a single institution were enrolled in a prospective clinical study. HTPR was evaluated with 5 different laboratory assays carried out just before CAS. MACE incidence (cerebral ischemia, myocardial infarction, stent thrombosis, acute limb ischemia and vascular death) was evaluated at 30 days and thereafter at yearly visits.
A total of 300 patients were enrolled in the study, and eight were then excluded because blood samples resulted unsuitable for the laboratory testing or CAS aborted for technical problems. Median follow-up was 5.8 years and during this period 47 MACE occurred.
HTPR detected by multiplate electronic aggregometry (MEA) and the VASP phosphorylation assay (VASP) were associated with a significantly enhanced risk of MACE (p = 0.048 and p = 0.038, respectively). However, HTPR to three tests (HTPR3) was more strongly predictive of increased risk of a vascular event at follow up (p = 0.005) at bivariate analysis and also at Cox regression multivariate analysis (p = 0.002).
HTPR to three different assays (mainly to VASP + PFA P2Y+ VerifyNow) in patients on DAPT after CAS has predictive value for subsequent MACE. Prospective studies to assess whether platelet function testing-guided antiplatelet therapy is superior to standard DAPT in patient undergoing CAS should be considered.
•While the predictive value of HTPR for PCI is known no data are available for CAS.•300 patients undergoing CAS were enrolled in a prospective clinical study.•HTPR to DAPT was evaluated with 5 different laboratory assays.•HTPR detected by MEA and VASP test was associated with risk of MACE.•HTPR to three tests was strongly predictive of increased MACE risk.
NA62 RICH performance: measurement and optimization Anzivino, G.; Barbanera, M.; Bizzeti, A. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
02/2020, Letnik:
952
Journal Article
Recenzirano
Odprti dostop
The Ring Imaging Cherenkov detector of the NA62 experiment at CERN SPS was commissioned in 2014, but the optimal performance was achieved in 2016 after the precise mirror alignment with reconstructed ...tracks. The measurement and monitoring of basic performance parameters is discussed: ring radius resolution, ring centre resolution, single hit resolution and mean number of hits per ring. The performance is measured with 2016 data on the positron sample. Different contributions to the resolutions are calculated.
The role of the NA62 RICH in the BR(K+→π+νν̄) measurement Volpe, R.; Anzivino, G.; Aisa, D. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
02/2020, Letnik:
952
Journal Article
Recenzirano
The NA62 experiment aims to measure the BR(K+→π+νν̄) with a 10% precision. One of the main backgrounds comes from the decay K+→μ+ν, therefore a highly powerful pion/muon separation is needed. The ...NA62 RICH, together with the calorimeter system, provides an accurate particle identification which has been essential to obtain the first results of the NA62 K+→π+νν̄ analysis, based on 2016 data. Two different algorithms have been exploited which, used in combination, allowed to get a pion reconstruction and identification efficiency of 75%, with a muon suppression factor of about 500, in the momentum range 15–35 GeV/c.
Background
During the past decade, the concept of complete mesocolic excision (CME) has emerged as a possible strategy to minimize recurrence for right colon cancers. The purpose of this study was to ...compare robotic versus laparoscopic CME in performing right colectomy for cancer.
Methods
Pertinent data of all patients who underwent robotic or laparoscopic right colectomy with CME using a Pfannenstiel incision and intracorporeal anastomosis performed between October 2005 and November 2015 were entered in a prospectively maintained database.
Results
A total of 202 patients underwent robotic (
n
= 101) or laparoscopic (
n
= 101) right colectomy within the study period. Patient characteristics were equivalent between groups. The robotic group showed a statistically significant reduction in conversion rate (0% vs. 6.9%,
p
= 0.01) but a longer operative time (279 min vs. 236 min,
p
< 0.001) compared with the laparoscopic group. There were no other differences in perioperative clinical or pathological outcomes. Five-years overall survival was 77 versus 73 months for the robotic versus laparoscopic groups (
p
= 0.64). The disease-free survival (DFS) rates were 85% and 83% for the robotic versus laparoscopic groups (
p
= 0.58). Among UICC stage III patients, there was a slight but not significant difference in 5-year DFS for the robotic group (81 vs. 68 months;
p
= 0.122).
Conclusions
Both approaches for right colectomy with CME were safe and feasible and resulted in excellent survival. Robotic assistance was beneficial for performing intracorporeal anastomosis and dissection as evidenced by the lower conversion rates. Further robotic experience may shorten the operative time.
Objective/Background A consistent number of elderly patients with ruptured abdominal aortic aneurysms (rAAAs) are deemed unfit for repair and excluded from any treatment. The objective of this study ...was to examine the impact on survival of endovascular repair and open surgery with restricted turndown in acute AAA repair. Methods A prospective database for patients treated for rAAA was established. None of the patients admitted alive with rAAA were denied treatment. Multivariate regression models, the predictive risk assessment Glasgow Aneurysm Score (GAS), and subgroup analyses in older patients were applied to identify indicators of excessive 30 day mortality risk that could affect the decision for turndown. Results From 2006 to 2015, 113 consecutive patients (93 males; mean age 77.2 years) with rAAAs were treated (69 open surgery; 44 EVAR). Overall peri-operative (30 day) mortality was 38.9% (44/113): 40.6% (28/69), and 36.4% (16/44) after open surgery and EVAR, respectively ( p = .70). Multivariate logistic regression identified old age as an indicator of increased peri-operative mortality (odd ratio OR 1.2, 95% confidence interval CI 1.1–1.3; p = .001), as well as free aneurysm rupture (OR 5.0, 95% CI 1.3–19.9; p = .02). GAS was higher in patients who died (97.75 vs. 86.62), but the score failed to identify increased peri-operative mortality risk in adjusted analyses (OR 1.0; p = .06). Almost two thirds of the patients ( n = 71) were older than 75 at the time of aneurysm rupture (48.6% octogenarians) and EVAR was more commonly applied than open surgery (86.4% vs. 47.8%; p < .0001). Peri-operative mortality in > 75 year old patients was 46.5% compared with 26.2% in younger patients ( p = .05), with rates increased after open surgery (54.5% vs. 27.8%, p = .03) but not after EVAR (39.5% vs. 16.7%; p = .39). According to Kaplan–Meier estimates, mean survival was 39.7 ± 4.8 months. Patients older than 75 years of age survived for a mean of 23.0 ± 4.47 months after rupture. Conclusion In this study aggressive treatment with a very restricted or no turndown strategy for any rAAA, also applied to older patients, allowed for an additional mean 40 months of survival after aneurysm rupture. In the contemporary endovascular era the decision to deny repair arbitrarily to older patients with rAAAs must be revisited.
Status of the NA62 ring imaging Cherenkov detector Cenci, P.; Anzivino, G.; Aisa, D. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
02/2020, Letnik:
952
Journal Article
Recenzirano
The Ring Imaging Cherenkov detector of the NA62 experiment at the CERN SPS is a key element of particle identification in the NA62 experimental strategy. The detector fulfills different conditions: ...to distinguish pions from muons with a muon rejection factor of O(102) in the NA62 momentum range of operation, between 15 and 35 GeV/c; to measure particle arrival time in the decay region with a precision better than 100 ps; to provide fast signals and reference time to the NA62 trigger system. The main design aspects and functional characteristics, as well as the performance of the detector measured with the data taken in the first NA62 physics runs, will be summarized in this paper.
•The NA62 experiment aims to measure the branching ratio of the K+→π+νν¯ decay.•The NA62 RICH performance fulfills the experiment requirements.•Pion–muon identification is performed with a muon rejection factor of O(102).•Time resolution with precision better than 100 ps is achieved.•The RICH is a key element to select charged particles in the trigger system.
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