Any nonadherence to instructions for use predicts graft-related adverse events in patients undergoing elective endovascular aneurysm repair

Background

A variety of devices exist for endovascular aneurysm repair (EVAR). Device-specific instructions for use (IFU) detail anatomic constraints to application and deployment of devices and are developed from rigorous bench testing. Nonadherence to IFU occurs frequently to avoid open surgery. The purpose of this study was to determine if IFU violations are associated with increased risk of graft-related adverse events (GRAEs) during follow-up.

Mid-term Outcomes of Endovascular Repair of Ruptured Thoraco-abdominal Aortic Aneurysms with Off the Shelf Branched Stent Grafts

Objective

To assess the mid-term outcomes and feasibility of branched endovascular repair (b-EVAR) of ruptured thoracoabdominal aortic aneurysms (rTAAAs).

Inverse finite-element modeling for tissue parameter identification using a rolling indentation probe

This paper investigates the use of inverse finite-element modeling (IFEM)-based methods for tissue parameter identification using a rolling indentation probe for surgical palpation. An IFEM-based algorithm is proposed for tissue parameter identification through uniaxial indentation. IFEM-based algorithms are also created for locating and identifying the properties of an embedded tumor through rolling indentation of the soft tissue. Two types of parameter identification for the tissue tumor are investigated (1) identifying the stiffness (μ) of a tumor at a known depth and (2) estimating the depth of the tumor (D) with known mechanical properties. The efficiency of proposed methods has been evaluated through silicone and porcine kidney experiments for both uniaxial indentation and rolling indentation. The results show that both of the proposed IFEM methods for uniaxial indentation and rolling indentation have good robustness and can rapidly converge to the correct results. The tissue properties estimated using the developed method are generic and in good agreement with results obtained from standard material tests. The estimation error of μ through uniaxial indentation is below 3 % for both silicone and kidney; the estimation error of μ for the tumor through rolling indentation is 7–9 %. The estimation error of D through rolling indentation is 1–2 mm.     

Comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy: a randomized controlled trial

ObjectiveTo compare intraoperative hemorrhage and other operative parameters after laparoscopically assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH) for benign gynecologic conditions.DesignA prospective, randomized, controlled trial.Materials and MethodsBetween April 2010 and March 2011, 50 Thai patients with strong indications for hysterectomy—with uterine sizes ≤16 weeks of gravid uterus and with no contraindications for open or laparoscopic surgeries—were randomly assigned for LAVH or TAH.Main Outcome MeasuresIntraoperative blood loss, operating time, postoperative analgesic requirements, perioperative complications, and duration of hospitalization.ResultsIntraoperative blood loss was significantly less in the LAVH group (median 120 mL [range 50–300]) than in the TAH group (median 250 mL [105–800]) (median difference 130 mL, p <.001, 95% confidence interval [CI] 55–200). The LAVH group required significantly less postoperative morphine sulfate administration (median 3 mg [range 0–12]) than the TAH group (15 mg [6–24]) (median difference 9 mg, p <.001, 95% CI 9–12). The hospital stay for the LAVH group (median 3 days; range 2–7) was significantly shorter than that of the TAH group (median 4 days; range 4–5) (median difference 2 days, p <.001, 95% CI 1–2). The operating time was comparable between the 2 groups (median 100 minutes; range 50–240) for the LAVH and 115 minutes (range 60–200) for the TAH group (median difference 5 minutes, p =.592, 95% CI ?15–25). There were no conversions from a LAVH to a laparotomy.ConclusionsThe LAVH has advantages over the TAH in that in the former there is less intraoperative blood loss, less postoperative morphine requirement, and a shorter duration of postoperative hospital stays.     

Short cervix detection in pregnant women by transabdominal sonography with post-void technique

Purpose

This study aimed to evaluate the diagnostic properties of transabdominal sonography with the post-void technique for cervical length measurement.

Methods

This study was a prospective cohort study. The inclusion criteria were pregnant women aged 18–40 years with gestational age of 18–23 completed weeks. Transabdominal sonography with vertical bladder depth of less than 5 cm and transvaginal cervical length measurements were carried out by a single experienced sonographer.

Results

There were 307 eligible pregnant women. The mean age of all subjects was 29.0 years. The mean cervical length obtained through transabdominal and transvaginal measurement was 3.33 and 3.47 cm, respectively. Ten patients (3.3 %) were identified as having a short cervix using transvaginal sonography, and 12 patients (3.9 %) were identified using transabdominal sonography.

Conclusion

Transabdominal sonography with vertical bladder depth of less than 5 cm performed better compared with transvaginal sonography. It may not be necessary to perform transvaginal sonography if transabdominal sonography reveals the cervical length to be more than 2.5 cm.

     

Identification of highly potent α-glucosidase inhibitory and antioxidant constituents from Zizyphus rugosa bark: enzyme kinetic and molecular docking studies with active metabolites

Context: Previous studies have shown that extracts of Zizyphus rugosa Lam. (Rhamnaceae) bark contained phytoconstituents with antidiabetic potential to lower blood glucose levels in diabetic rats. However, there has been no report on the active compounds in this plant as potential antidiabetic inhibitors.

Objective: We evaluated the α-glucosidase inhibitory and antioxidant activities of Z. rugosa extract. Moreover, the active phytochemical constituents were isolated and characterized.

Materials and methods: The α-glucosidase inhibition of crude ethanol extract obtained from the bark of Z. rugosa was assayed as well as the antioxidant activity. Active compounds (1–6) were isolated, the structures were determined, and derivatives (2a–2?l) were prepared. All compounds were tested for their α-glucosidase inhibitory (yeast and rat intestine) and antioxidant (DPPH) activities.

Results: The active α-glucosidase inhibitors (1–6) were isolated from Z. rugosa bark and 12 derivatives (2a–2?l) were prepared. Compound 2 showed the most powerful yeast α-glucosidase inhibitory activity (IC₅₀ 16.3?μM), while compounds 3 and 4 display only weak inhibition toward rat intestinal α-glucosidase. Moreover, compound 6 showed the most potent antioxidant activity (IC₅₀ 42.8?μM). The molecular docking results highlighted the role of the carboxyl moiety of 2 for yeast α-glucosidase inhibition through H-bonding.

Discussion and conclusions: These results suggest the potential of Z. rugosa bark for future application in the treatment of diabetes and active compounds 1 and 2 have emerged as promising molecules for therapy.