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r the renals. Whenever possible, surgeons should consider this configuration in order to maximize proximal seal length and potentially reduce the risk of proximal endoleak. An additional advantage of this approach is that stenting of the SMA to prevent shuttering is unnecessary or impossible, making the procedure more technically facile. OBJECTIVE Although endovascular repair (EVAR) for abdominal aortic aneurysm (AAA) significantly decreases perioperative mortality compared to open surgical repair (OSR), we have not concluded superiority between EVAR and OSR beyond the perioperative period. Our aim of this study was to compare phase-specific survival after EVAR versus OSR. METHODS The review was conducted according to PRISMA guideline. EMBASE and MEDLINE were searched up to November 2019 to identify randomized control trials (RCTs) and propensity-score matched (PSM) studies that investigated ≥2-year all-cause mortality (primary outcome) after EVAR versus OSR for intact infrarenal AAA. For each study, the hazard ratio (HR) with 95% confidence interval (CI) of mortality for EVAR versus OSR was calculated using survival curves for the following specific phases the early-term (0-2 years after repair), mid-term (2-6 years after repair), long-term (6-10 years after repair), and very long-term (≥10 years after repair) periods. The risk ratio (RR) in = .27) and very long-term (HR, 1.17; 95% CI, 0.93-1.47; P = .19) periods. In sensitivity analyses, the significant benefit of EVAR in the perioperative period and that of OSR in the mid-term period were not changed. No funnel plot asymmetry was identified in all analyses. CONCLUSIONS Compared to OSR, EVAR associated with lower perioperative mortality and higher mortality in the mid-term period for intact infrarenal AAA. The superiority of EVAR was absent in the early-term period, and the inferiority of EVAR in the mid-term period disappeared in the long-term and very long-term periods. OBJECTIVES YouTube videos have become a common resource for trainees to learn about surgical procedures. Carotid endarterectomy (CEA) is one example procedure that may be performed by multiple specialties and with a variety of techniques. Little is known about educational content and the representation of vascular surgeons in these videos. We sought to compare the educational quality of CEA YouTube videos, techniques demonstrated, and prevalence of each specialty. METHODS YouTube was programmatically searched for the terms "carotid endarterectomy," "carotid endarterectomy surgery," "carotid endarterectomy technique," "carotid endarterectomy CEA," and "carotid artery surgery." Videos that met inclusion criteria were analyzed for surgical technique, procedural steps, surgeon specialty, video length, and date. Videos were determined to have high-quality educational content if the video included English language captions or narration and demonstrated key steps of the procedure division of the common facial vein, ideos were older than videos by cardiac surgeons (6.0 ± 1.1 y vs. 3.0 ± 0.5 y, p less then 0.05) and neurosurgeons (6.0 ± 1.1 y vs. 3.1 ± 0.8 y, p less then 0.05). CONCLUSIONS Despite more views, the field of vascular surgery is underrepresented in YouTube videos demonstrating carotid endarterectomy. Vascular surgery videos tend to be older and make up a minority of high-quality videos. As more learners turn to YouTube for information about surgical procedures, vascular surgeons should expand their online presence through the production and collection of high-quality videos for trainees. OBJECTIVE Patients with peripheral arterial occlusive disease (PAOD) have a poor prognosis and a high prevalence of comorbidity. This study investigated whether sarcopenia and/or myosteatosis negatively affect long-term survival in patients with PAOD. METHODS This was a single-center retrospective cohort study of 686 consecutive patients diagnosed and treated for PAOD and who underwent computed tomography scanning. Cross-sectional muscle measurements were obtained at the level of the third lumbar vertebra. Optimal stratification was used to define sex-specific and body mass index (BMI)-specific cutoff values for sarcopenia and myosteatosis, respectively. The Cox proportional hazards model was used to determine the effect of sarcopenia and myosteatosis on overall survival. RESULTS Sarcopenia was associated with age, BMI, myosteatosis, malignancy, congestive heart failure, hemodialysis, and Fontaine 4 classification. Myosteatosis was associated with age, sarcopenia, type 2 diabetes mellitus, hypertension, chronic obstructive pulmonary disease, malignancy, congestive heart failure, ischemic stroke, and Fontaine 4 classification. Sarcopenia (hazard rate [HR], 2.82; 95% confidence interval [CI], 2.05-3.86; p less then 0.001) and myosteatosis (HR, 4.13; 95% CI, 3.03-5.63; p less then 0.001) were both associated with reduced survival in univariable analysis. When adjusted for other prognostic markers, myosteatosis (HR, 2.09; 95% CI, 1.46-2.99; p less then 0.001) was still associated with reduced overall survival in the multivariable model but sarcopenia (HR, 1.40; 95% CI, 0.97-2.01; p = 0.073) was not. CONCLUSIONS Muscle depletion is independently associated with a poorer overall survival in patients with PAOD. Myosteatosis is a stronger predictor than sarcopenia, which indicates that quality is more important than quantity. Results should be interpreted with caution due to missing data on medication usage. OBJECTIVES The U.S. Preventative Services Task Force guidelines for abdominal aortic aneurysm (AAA) screening are based mainly on studies of older Caucasian males from non-U.S. POPULATIONS This study was designed to analyze the findings of a large, all-inclusive AAA screening program in the U.S. METHODS Screening events were held nationally by a U.S. non-profit organization between 2001 and 2017. AAA screening was offered regardless of risk profile. Participants filled out a demographics form with known co-morbidities. Significant risk factors were determined using logistic regression with backward stepwise variable selection. Odds ratios (OR) reported with 95% confidence intervals. RESULTS A total of 9,457 screened participants (47% male) were analyzed. The mean age was 67 ±9 with 40.8% between 65 and 75 years old. Most participants were Caucasian (83.4%), followed by African American (13.1%). Screened risk factors included hypertension (58.1%), hyperlipidemia (54.9%), smoking (52.0%), cardiac disease (29.2%(OR, 1.69; 1.61-2.46), and current smokers (OR, 6.33; 2.62-15.24 for females and OR, 2.50; 1.70-3.65 for males). CONCLUSIONS This study shows that there remain high-risk groups outside the current guidelines which would likely benefit from AAA screening. Risk factors for AAA include male gender, smoking, cardiac disease, family history of AAA and increasing age. The most significant risk factor is current smoking status. This pilot study examined whether a combined aerobic resistance exercise program reduced fatigue and the potential inflammatory and epigenetic mechanisms in patients with head and neck cancer (HNC) receiving intensity-modulated radiotherapy. The exercise group (N = 12) received a 3-month supervised aerobic resistance exercise intervention that was initiated before a 6-week radiotherapy regimen; the control group (N = 14) received standard care. Fatigue was measured using Multidimensional Fatigue Inventory-20; physical function measures included a 6-minute walk distance (6MWD), chair stands, bicep curls, and hand grip strength. Inflammatory markers and DNA methylation data were acquired using standardized protocol. Patients were mostly white (93%) and male (81%) with a mean age of 57 years. At the end of the intervention, the exercise group had a marginal decrease in fatigue compared with the control (-5.0 vs. 4.9; P = 0.10). The exercise group had a significantly greater improvement in 6MWD (29.8 vs. -55.5 m;performance and reduce fatigue, which could be further linked to decreased inflammation, during active radiotherapy for HNC patients. Larger studies are warranted. OBJECTIVE Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, there are reports on the increased prevalence of physical symptoms observed in the general population. We investigated the association between psychological outcomes and physical symptoms among healthcare workers. METHODS Healthcare workers from 5 major hospitals, involved in the care for COVID-19 patients, in Singapore and India were invited to participate in a study by performing a self-administered questionnaire within the period of February 19 to April 17, 2020. Healthcare workers included doctors, nurses, allied healthcare workers, administrators, clerical staff and maintenance workers. This questionnaire collected information on demographics, medical history, symptom prevalence in the past month, Depression Anxiety Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. The prevalence of physical symptoms displayed by healthcare workers and the associations between physical symptoms and psgnificantly associated with the presence of physical symptoms experienced in the preceding month. Linear regression revealed that the presence of physical symptoms was associated with higher mean scores in the IES-R, DASS Anxiety, Stress and Depression subscales. CONCLUSIONS Our study demonstrates a significant association between the prevalence of physical symptoms and psychological outcomes among healthcare workers during the COVID-19 outbreak. We postulate that this association may be bi-directional, and that timely psychological interventions for healthcare workers with physical symptoms should be considered once an infection has been excluded. IMPORTANCE Schizophrenia and major depressive disorder (MDD) are associated with increased risks of immunologic disease and metabolic syndrome. It is unclear to what extent growth, immune or glucose dysregulations are similarly present in these disorders without the influence of treatment or chronicity. OBJECTIVE To conduct a meta-analysis investigating whether there are altered peripheral growth, immune or glucose metabolism compounds in drug-naïve first-episode patients with schizophrenia or MDD compared with controls. DATA SOURCES AND STUDY SELECTION Case-control studies reporting compound measures in drug-naïve first-episode patients with schizophrenia or MDD compared with controls in the Embase, PubMed and PsycINFO databases. DATA EXTRACTION AND SYNTHESIS Two independent authors extracted data for a random-effects meta-analysis. MAIN OUTCOMES AND MEASURES Peripheral growth, immune or glucose metabolism compounds in schizophrenia or MDD compared with controls. Standardized mean differences were quantified P=.009) and IL-2 (g=4.41, P=.04) were elevated, whereas IL-8 (g=-0.84, P=.01) was decreased. click here The fasting glucose metabolism factors glucose (g=0.24, P=.003) and insulin (g=0.38, P=.003) were elevated in schizophrenia. CONCLUSIONS AND RELEVANCE Both schizophrenia and MDD show alterations in growth and immune factors from disease onset. An altered glucose metabolism seems to be present from onset in schizophrenia. These findings support efforts for further research into transdiagnostic preventive strategies and augmentation therapy for those with immune or metabolic dysfunctions.
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