The main aim of this study was to identify the changes in nerve conduction parameters in cases of lumbar radiculopathy due to lumbar spondylosis and intervertebral disc pathology with no clinical ...neurologic deficit and to identify the potential of nerve conduction studies in the early diagnosis of these cases. Eleven patients aged between 41 and 78 years (mean age 58 ± 13.1 years; 4 males, 36.36%) met the inclusion criteria and agreed to participate in this study. Nerve conduction studies were performed with Neuro‐MEP‐Micro (Figure 1), a digital system designed to record electrical activity of muscles and nerves at 1 or 2‐channel stimulation, and to measure and analyze their parameters. Conduction velocity was reduced in 29.41% of the examined tibial nerves, and in none of the examined peroneal nerves. The registered amplitudes, for none of the tibial or peroneal nerve, have not been lower than the reference values. Patients with reduced tibial conduction velocity had a Grade 2 nerve root involvement on MRI. Nerve conduction studies should be used to complete the physical and imagistic assessment of patients with lumbar radiculopathy, to detect functional abnormalities not only structural ones provided by the MRI.
Sarcopenia may be an indicator of frailty. We used the total psoas area index (TPAI) to identify sarcopenia and evaluated the effect of preoperative TPAI on outcomes after descending thoracic aortic ...aneurysm (DTAA) repair.
Patients with DTAA between 2007 and 2015 who were undergoing thoracic endovascular aortic repair (TEVAR) and open surgical repair (OSR) with available preoperative imaging were analyzed. Sarcopenia was defined as TPAI <6.5cm
/m
. An adverse event was defined as the composite endpoint of three or more multisystem complications, discharge to other than home, or death within 30 days.
A total of 282 of 386 DTAA repairs had imaging available for TPAI measurements; 71 of 282 (25%) patients underwent TEVAR, and 211 of 282 (75%) underwent OSR. Preoperative sarcopenia was similar in the two groups (OSR, 57% vs TEVAR, 48%, p = 0.188). Risk factors for sarcopenia were age >70 years, female sex, and large body surface area, whereas heritable thoracic aortic disease was a protective factor. OSR-treated patients with sarcopenia were older compared with patients without sarcopenia (p < 0.001), whereas TEVAR-treated patients had a similar age category distribution (p = 0.187). Patients with sarcopenia had significantly increased adverse events compared with patients who did not have sarcopenia in both groups (sarcopenia-TEVAR, 41% vs nonsarcopenia-TEVAR, 16%, p = 0.020; sarcopenia-OSR, 49% vs nonsarcopenia-OSR, 32%, p = 0.012). Determinants of long-term mortality were increasing age (parameter estimate PE, 0.06, p < 0.001), TPAI as a decreasing linear function (PE, 0.36, p = 0.003), OSR (PE, 2.92, p = 0.003), and interaction between OSR and TPAI (PE, -0.34, p = 0.010). The interaction term showed that OSR increases long-term mortality risk in more sarcopenic patients.
Preoperative sarcopenia significantly correlated with postoperative adverse events and long-term mortality after DTAA repair. If anatomically feasible, TEVAR should be considered in sarcopenic patients.
A single-institutional study comparing early and long-term outcomes of thoracic endovascular aortic repair (TEVAR) and open surgical repair (OSR) was performed to determine the appropriate treatment ...option for descending thoracic aortic aneurysm (DTAA).
Between 2005 and 2014, 438 DTAA patients were treated (TEVAR, 88; OSR, 350). Acute dissection and traumatic injury were excluded. Perioperative and follow-up data were reviewed. Stratified analyses were conducted to identify patients most likely to benefit from TEVAR. A propensity score for TEVAR was developed by logistic regression, and predictive logistic and Cox regression models for death were adjusted for propensity score.
TEVAR patients were frequently older women with emergent status, chronic obstructive pulmonary disease, or coronary artery disease. TEVAR had similar immediate (0% vs 1%; p = 0.588) and delayed (5% vs 6%, p = 1.000) motor deficits and early mortality (6% vs 12%, p = 0.121) but lower dialysis (3% vs 18%, p < 0.001), respiratory failure (10% vs 34%, p < 0.001), and intensive care unit stay (2.0 vs 5.0 days, p < 0.001). Early mortality after TEVAR was lower in septuagenarians (3% vs 16%, p < 0.02), glomerular filtration rate of less than 60 mL/min (8% vs 32%, p < 0.049), chronic obstructive pulmonary disease (6% vs 21%, p < 0.02), defined as target population that had fourfold mortality reduction (p < 0.006) attributable to TEVAR. Propensity-adjusted predictors of early mortality predictors included OSR (odds ratio OR, 4.3; p < 0.024), target population (OR, 7.7; p < 0.001), diabetes (OR, 3; p < 0.009), peripheral vascular disease (OR, 4.7; p < 0.001), and emergent status (OR, 4.6; p < 0.001). Propensity-adjusted determinants of survival were age, glomerular filtration rate of less than 60 mL/min, peripheral vascular disease, chronic obstructive pulmonary disease, and emergent status.
In older patients with significant comorbidities, TEVAR demonstrated superior results compared with OSR and may be preferable in this target population.
The leather industry is one of the most polluting industries in the world due to the large amounts of waste following raw hide processing but also due to the high content of chemical substances ...present in leather waste. The main problem with chromium-tanned leather solid waste is related to the storage, due to the ability of chromium to leach into soil or water, and also owing to the high ability of trivalent chromium to oxidize to its toxic form, hexavalent chromium. The purpose of this article is to present the most current methods of chromium extraction from solid tanned leather waste in order to obtain non-polluting leather, which can constitute secondary raw material in new industrial processes. The extraction methods identified in the present study are based on acid/basic/enzymatic hydrolysis and substitution with the help of organic chelators (organic acids and organic acid salts). In addition, this study includes a comparative analysis of the advantages and disadvantages of each identified extraction method. At the same time, this study also presents alternative chromium extraction methods based on the combination of conventional extraction methods and ultrasound-assisted extraction.
Background We report on our experience with treatment of adults requiring de novo or redo open aortic coarctation repair mostly by a resection and interposition graft technique. Methods We ...retrospectively reviewed all patients older than 16 years requiring open repair of aortic coarctation. Indications for repair, operative details, and outcomes were analyzed. Results Between 1996 and 2011, we treated 29 adult aortic coarctation patients with open repair. The mean age was 42 years (range, 17-69 years), and there were 15 men. Nine patients had previous repair with recurrence; the remaining 20 had native coarctation. Thoracic aortic aneurysms were present in 22 patients (76%), ranging in size from 3.0 to 9.6 cm (mean, 4.8 cm). Four patients had intercostal artery aneurysms (range, 1.0-2.5 cm), four had left subclavian artery aneurysms, and four had ascending/arch aneurysms. The most common repair was resection of aortic coarctation with interposition graft replacement (93%). Two patients without aneurysm had bypasses from the proximal descending thoracic aorta to the infrarenal aorta without aortic resection. There was no in-hospital mortality, stroke, or paraplegia. Long-term survival was 89% during a median follow-up of 81 months (interquartile range, 47-118 months), with no patient requiring reoperation on the repaired segment. Conclusions Open repair of native and recurrent adult aortic coarctation has acceptable morbidity and low mortality. Especially in patients with concomitant aneurysm, resection with interposition graft replacement provides a safe and durable repair option.
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