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The actual Anguish involving Choice-Where to position the actual Trend involving BCMA-Targeted Therapies inside the Multiple Myeloma Therapy Bigger picture within 2022 and Beyond.
Objective Three out of four patients with infrarenal abdominal aortic aneurysm (AAA) are now treated with endovascular aneurysm repair (EVAR). The incidence of secondary procedures and surgical conversions is increasing for a population theoretically unfit for open surgery. The indications and outcomes of late open surgical conversions (LOC) after EVAR in a high volume tertiary vascular unit are reported. Methods This retrospective single-center study includes all patients who underwent a late open conversion between January 1996 and July 2018. Data were collected from records on patient demographics, operative indications, surgical strategy, peri-operative outcomes and medium term survival. Results Sixty-two consecutive patients (88.7% male), with a mean age of 77.5 years are included. The median duration since index EVAR was 38.5 months. 65% of stent grafts requiring LOC had suprarenal fixation. Indications included 22.6% type IA, 16.1% type IB and 45.2% type II endoleaks, 12.9% graft thrombosis and 14.5% ek when performed in a high-volume aortic surgical center. Elective open conversion is associated with excellent early and late outcomes. Endograft preservation strategies decrease perioperative morbidity.Objective The objective of this study is to compare the performance between Viabahn balloon-expandable stents (VBX) and self-expandable covered stents (SES) (Viabahn and Fluency) used as bridging stents for directional branches during F-BEVAR of complex aortic aneurysms (CAA). Methods Patients with thoracoabdominal aortic aneurysms (TAAA)(Type I-IV) or pararenal aortic aneurysms either high risk for open repair or unsuitable for endovascular repair with commercially available devices were prospectively enrolled into a physician-sponsored investigational device exempt trial. Descriptive statistics of the cohort included demographics, risk factors, as well as anatomic and device characteristics. FumaratehydrataseIN1 Individual branches were grouped as either VBX or SES and had data analyzed for primary patency, branched-related type I/III endoleaks, branch-instability, branch-related secondary intervention, and branch-related aortic rupture or death. Categorical variables were expressed as total and percentage, and continuous varia LRA received VBX as bridging stents in 40%, 46.7%, 33.8% and 32.2% respectively. The overall cohort survival rate at was 78.5% at 24 months. There was no branch-related rupture or mortality. Primary patency at 24 months (VBX 98.1%, SES 98.6%, log-rank=0.95), freedom from endoleak (VBX 95.6%, SES 98.6%, log-rank 0.66), freedom from secondary intervention (VBX 94.7%, SES 98.1%, log-rank 0.33) and freedom from branch-instability (VBX 95.6%, SES 97.2%, log-rank 0.77) were all similar between groups. Conclusion This initial experience with VBX stents demonstrated excellent primary patency and similarly low rates of branches-related complications and endoleaks with no branch-related aortic rupture or death. Our results demonstrate that, in a high volume, experienced aortic center, the VBX stent is a safe and effective bridging stent option during the branched endovascular aortic repair. Multicenter studies with a larger cohort and longer follow-up are necessary to validate these findings.Objectives Contemporary data on outcomes in open thoracoabdominal aortic aneurysm (TAAA) repair is limited to reports from major aortic referral centers showing excellent outcomes. This study aims to characterize the national experience of open TAAA repair using national outcomes data, with a primary focus to examine the association of hospital volume with mortality and morbidity. Methods The Nationwide Inpatient Sample was queried from 1998-2011 and all patients with a diagnosis of TAAA who underwent open operative repair were included. These patients were further stratified into tertiles based on the operative volume of the institution that performed their operation low volume (LV, less then 3 cases/year), medium volume (MV, 3-11 cases/year), high volume (HV, ≥12 cases/year). Baseline demographics as well as perioperative outcomes were compared between these groups. Multivariable logistic regression was performed to determine predictors of operative mortality and morbidity. Subgroup analyses were performed3, 95% CI 1.02 - 1.03, p less then 0.001). Conclusions Patients with TAAA in the United States operated on at HV centers have significantly lower mortality and morbidity compared to lower volume centers. Consideration of referral to HV centers may be warranted, but further research is required to justify this conclusion.Objective Fenestrated/branched endovascular aneurysm repair (F-BEVAR) is a complex procedure that generates high radiation doses. Magnification aids in vessel cannulation but increases radiation. The aim of the study was to compare radiation doses to patients and operating room staff from two fluoroscopic techniques, standard magnification vs. dual fluoroscopy with live-image digital zooming during F-BEVAR. Methods An observational, prospective, single center study of F-BEVAR procedures using Philips Allura XperFD20 equipment was performed over a 42-month period. Intravascular ultrasound, 3D-fusion and extreme collimation were used in all procedures. Intraoperative live imaging processing was performed using two imaging systems standard magnification in 123 (81%) and dual fluoroscopy with live-image digital zooming in 28 patients (18%). In the latter, the live 'processed' zoomed images are displayed on examination displays and live images are displayed on reference displays. The reference air kerma was collecIQR, 116.5-572] vs 171[IQR, 44-325]) (P less then .01) compared to procedures with 3 or less fenestration/branches. Among the most complex design (4-vessel), operator radiation dose was significantly lower with digital zooming compared to standard magnification (128.5 μSv [IQR, 70.5-296] vs 309 μSv [IQR, 150-611]) (P = .01). Conclusion Current radiation doses to patients and operating personnel are within acceptable limits; however, dual fluoroscopy with live-image digital zooming results in dramatically lower radiation dosages compared to the standard image processing with dose-dependent magnification.. Operator radiation doses were reduced in half during procedures performed using more complex device designs when digital zooming was used.Objective In the treatment of pararenal abdominal aortic aneurysms and aortic pathological processes (PAAs), the chimney EVAR (CHEVAR) represents an alternative technique for the urgent cases. Aim of the study was the evaluation of the outcomes of CHEVAR in the elective setting. Methods We performed a retrospective analysis of the prospectively collected records of 165 consecutive asymptomatic CHEVAR patients, which were treated between March 2009 and January 2018 with the Endurant stent-graft (Medtronic, Santa-Rosa, CA, USA). A total of 244 chimney-grafts (CGs) were implanted. Primary endpoint was the clinical success defined as freedom from procedure-related mortality, persistent type Ia endoleak, occlusion or high-grade stenosis (>70%) of CGs and from any chimney technique related secondary procedure for the entire follow-up period. Secondary clinical success included patients with a successful treatment of a primary endpoint with a secondary endovascular procedure. Results All 244 targeted chimney vesselsresults, which are similar with the published results of other total endovascular modalities. A prospective randomized trial of elective PAA's treatment with the current endovascular options is needed to assess the value of CHEVAR technique in the elective setting.Objective The objective of this study was to evaluate the outcome of a short interposition using a small-diameter prosthetic graft as a flow-limiting procedure to manage symptomatic high-flow arteriovenous fistula. Methods A retrospective review of medical records on a case series was conducted. From June 2004 to April 2017, 25 patients with clinical symptoms of high output cardiac failure and progressive dilatation of aneurysmal fistula vein due to high-flow arteriovenous fistula (≥1.5 L/min) underwent short interposition with a 5-mm prosthetic graft at Saitama Medical Center. The primary outcome was the relief of clinical symptoms; other outcome measures included technical success, surgical complications, patency of vascular access, and postoperative changes in local and systemic hemodynamics as assessed by Doppler ultrasonography. Results Twenty-five patients underwent short interposition for the following indications cardiac (n=16) and aneurysmal dilatation (n=9). The technical success rate was 100%. The clinical symptoms were relieved in 24 patients (96.0%). Mean reduction in access blood flow was 52.4%. Cumulative primary unassisted patency rates (± standard error) at 1, 2, and 3 years were 76.2 ± 9.3%, 70.4 ± 10.3%, and 58.1 ± 11.6%, respectively. Secondary patency rates (± standard error) at 1, 2, and 3 years were 81.8 ± 8.2%, 71.5 ± 9.9%, and 71.5 ± 9.9%, respectively. Complications included access occlusion due to late thrombosis (n=5, 21.7%) and graft infection (n=1, 4.3%) in the median follow-up period of 3.9 years. Conclusion Short interposition with a prosthetic graft is a simple, effective, and durable treatment option for ESRD patients with cardiac symptoms and progressive dilatation of the fistula vein due to high-flow arteriovenous fistula, offering clinical symptom resolution while preserving the autologous behavior of the initial access.Species in the fungal genus Sticta form symbiotic associations primarily with either green algae or cyanobacteria, but tripartite associations or photosymbiodemes involving both types of photobionts occur in some species. Sticta is known to associate with green algae in the genus Symbiochloris. However, previous studies have shown that algae from other genera, such as Heveochlorella, may also be suitable partners for Sticta. We examined the diversity of green algal partners in the genus Sticta and assessed the patterns of association between the host fungus and its algal symbiont. We used multi-locus sequence data from multiple individuals collected in Australia, Cuba, Madagascar, Mauritius, New Zealand, Reunion and South America to infer phylogenies for fungal and algal partners and performed tests of congruence to assess coevolution between the partners. In addition, event-based methods were implemented to examine which cophylogenetic processes have led to the observed association patterns in Sticta and its green algal symbionts. Our results show that in addition to Symbiochloris, Sticta associates with green algae from the genera Chloroidium, Coccomyxa, Elliptochloris and Heveochlorella, the latter being the most common algal symbiont associated with Sticta in this study. Geography plays a strong role in shaping fungal-algal association patterns in Sticta as mycobionts associate with different algal lineages in different geographic locations. While fungal and algal phylogenies were mostly congruent, event-based methods did not find any evidence for cospeciation between the partners. Instead, the association patterns observed in Sticta and associated algae, were largely explained by other cophylogenetic events such as host-switches, losses of symbiont and failure of the symbiont to diverge with its host. Our results also show that tripartite associations with green algae evolved multiple times in Sticta.
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