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INTRODUCTION Endovascular aortic repair (EVAR) has been extensively study regarding elective and ruptured AAA repair. However, much less is known on EVAR of symptomatic non-ruptured AAA (sAAA), especially concerning the long-term results. The aim of this study is to assess the outcomes of EVAR of sAAA compared to asymptomatic AAAs (aAAA) at a tertiary center using a single graft. METHODS All consecutive patients treated for sAAA and aAAA from 1998 - 2012 at our institution, using the Cook-ZenithTM stentgraft, were included in the study. Ruptured AAA were excluded. Patient charts were reviewed to obtain pre-, intra-, and post-operative data. All available imaging was reviewed. Life-tables were constructed to assess for overall and late-AAA related survival, clinical success and endoleak freedom. RESULTS 680 patients were included (137 sAAA). No difference in technical success rate (96.1 % aAAA vs 94.9 % sAAA) was present (p= 0.477). Thirty-day mortality was more common in sAAA (6.6 % vs aAAA 1.5 %, p= 0.002). . These results suggest the need of improving the identification of the symptomatic patients requiring preoperative medical optimization. However, this is often limited by the acute need of the procedure and more intensive post-operative monitoring may have greater potential. Independently, a strict anatomic selection for infrarenal EVAR is of paramount importance for the long-term outcome. Spreading of the COVID-19 pandemic in Italy forced health facilities to drastically change their organization to face the overwhelming number of infected patients needing hospitalization. The USL (Unità Sanitaria Locale) Toscana Centro adopted a protocol of reorganization of the Vascular Surgery Unit during the first difficult weeks of the epidemic, consisting in the creation of a Vascular Hub for urgent cases with a profound reorganization of activities, wards, surgical operators, operating blocks and ICU beds. The aim of this paper is to share the protocol with all the vascular community, hoping to help other institutions to face the emergency during the hard weeks coming. BACKGROUND The prognostic value of asymptomatic perioperative troponin rise in vascular surgery, is unclear. We conducted this systematic review and meta-analysis to determine the significance of clinical and sub-clinical troponin elevation after vascular surgery. METHODS We searched Medline (Ovid), Embase (Ovid), and the Cochrane Library, without language restriction, from inception to May 2019 and included studies that reported associations between elevated post-operative troponin and short-term mortality, major adverse cardiac events (MACE), or long-term mortality in a vascular surgery cohort. We synthesised study-level data on the maximally-adjusted estimates using mixed-effects modelling to generate summary odds ratios (OR) for fixed-interval outcomes and summary hazards ratios (HR) for long-term mortality. Between-study heterogeneity was assessed with meta-regression. Methodological quality and publication bias were formally assessed. RESULTS We included 24 studies involving 11.657 participants. Post-opncreased risk of worse outcomes, and who may be candidates for personalised preventative interventions. Advances in the understanding and management of bipolar disorder (BD) have been slow to emerge. Despite notable recent developments in neurosciences, our conceptualization of the nature of this mental disorder has not meaningfully progressed. One of the key reasons for this scenario is the continuing lack of a comprehensive disease model. Within the increasing complexity of modern research methods, there is a clear need for an overarching theoretical framework, in which findings are assimilated and predictions are generated. In this review and hypothesis article, we propose such a framework, one in which dysregulated energy expenditure is a primary, sufficient cause for BD. Our proposed model is centered on the disruption of the molecular and cellular network regulating energy production and expenditure, as well its potential secondary adaptations and compensatory mechanisms. We also focus on the putative longitudinal progression of this pathological process, considering its most likely periods for onset, such as critical periods that challenges energy homeostasis (e.g. neurodevelopment, social isolation), and the resulting short and long-term phenotypical manifestations. OBJECTIVES Long-term survival of two highly viscous glass ionomer cements (Fuji IX GP Fast and Equia Fil) over a period of 6 years in vivo. METHODS A total of 85 two- or three-surface class II restorations, comprising 43 Equia Fil / Equia Coat and 42 Fuji IX GP Fast / Fuji Coat LC, were placed in 34 patients. The restorations were re-evaluated after 6 years using the FDI criteria. The statistical analysis was performed with Fisher's exact test, the Wilcoxon signed-rank test, the Mann-Whitney U test and the Kaplan-Meier method. RESULTS Forty-four restorations (22 Equia Fil and 22 Fuji IX GP Fast) could be assessed at the 6-year follow-up. During the whole study period, eight failures, four for each material, were observed. The main reasons for failure were material fractures and retention loss, which were partly combined with poor marginal adaptation or poor proximal anatomical form. Two failures may be attributed to insufficient application of the materials, as suspected according to the radiographs. The Kaplan-Meier survival proportion for Equia Fil restorations at 6 years was 86.5% and that for Fuji IX GP Fast at 6 years was 86.8% (log-rank p = 0.907). During the period from 3 to 6 years, only one filling in each group failed. find more CONCLUSION Both materials showed acceptable and comparable survival rates after 6 years. CLINICAL SIGNIFICANCE Highly viscous glass ionomer cement can be an acceptable restoration material for smaller class II cavities. Sensorimotor consolidation occurs during sleep. However, the benefit of sleep-based consolidation decreases with age due to decreased sleep quality and quantity. This study aimed to enhance sensorimotor performance through repetitive delivery of task-based auditory cues during sleep, known as targeted memory reactivation (TMR). Healthy older adults performed a non-dominant arm throwing task before and after a 1 -h nap. While napping, half of participants received TMR throughout the hour. Participants who received TMR during sleep demonstrated a greater overall change in throwing accuracy from the start of the first to the end of the second throwing task session. However, there was no generalization of throwing accuracy to variants of the task or to a novel dart throwing task. Findings support the use of TMR during sleep to enhance task-specific sensorimotor performance in healthy older adults despite age-related decreases in sleep quality and quantity. Future research is needed to evaluate the effects of TMR on rehabilitation protocols. V.PURPOSE Endovascular interventions have become standard procedures for the therapy of abdominal aortic aneurysms. Therefore, endovascular surgeons need special skills which have to be learned and trained. Additionally, authentic simulators are needed for further development of new endovascular devices and procedures. The aim of this project was to develop an authentic and modular endovascular simulation environment with patient-specific vascular anatomy for training and research purposes. MATERIAL AND METHODS We first designed a prototype with exchangeable 3D-printed patient-specific vascular anatomy. Then, the feasibility of the prototype was validated by a simulation of an EVAR procedure in a clinical setting. RESULTS We developed an authentic endovascular simulator with an exchangeable patient-specific vascular anatomy and performed an EVAR procedure under realistic conditions. The evaluation of the accuracy of the vascular models showed little deviation when compared with the original CT data. CONCLUSION Endovascular simulators based on patient-specific 3D-printed vascular models can realistically mimic endovascular procedures and have the potential to be used for further development of new devices and grafts as well as for training purposes. Furthermore, in our opinion they can reduce the use of animals during developmental processes. PURPOSE The periorbital area undergoes a series of postoperative sequelae after rhinoplasty. PATIENTS AND METHODS Between January 2015 and January 2016, 50 patients aged between 19 and 46 years who underwent rhinoplasty qualified for the study. Of these patients, 25 were chosen for each group One group underwent a low-to-low lateral nasal osteotomy, and the other group underwent a low-to-high lateral nasal osteotomy. Six specific periocular findings were designated and recorded to measure differences in the outcomes of the 2 osteotomy techniques. Specific periocular findings included the amount of scleral show as measured through the marginal reflex distance; lateral and medial scleral surface area; and palpebral fissure height, width, and inclination. RESULTS There were no significant differences in any of the outcome variables at different intervals between the 2 groups (P > .05) except for palpebral fissure inclination after 3 months (P = .02). CONCLUSIONS According to the results and considering the inherent limitations of the study, it can be concluded that both low-to-low and low-to-high techniques are similar and have no considerable permanent effects on the periorbital region. PURPOSE The aim of this study was to test the hypothesis that the dose of estrogen replacement therapy may have an influence on the clinical, radiographic, and histopathologic changes within the temporomandibular joint (TMJ). MATERIALS AND METHODS A prospective experimental study was conducted in 12 mature ovariectomized dogs. Dogs were randomly allocated into 1 of 4 groups (OVX-E0, dogs that did not receive any estrogen replacement therapy; OVX-E0.5, dogs that received 0.15 mg/kg of estradiol; OVX-E1, dogs that received 0.3 mg/kg of estradiol; and OVX-E2, dogs that received 0.6 mg/kg of estradiol); dogs were evaluated clinically for 12 weeks; and contact radiographic and histopathologic examinations of the TMJ were performed just after euthanasia. RESULTS Radiographic examination of the TMJ in the OVX-E0 group showed narrowing of the joint space with marginal osteophyte formation along the mandibular condyle. The OVX-E0.5 group showed mild widening of the joint space with no remarkable changes within the mancal, radiographic, and histopathologic changes within the TMJ. Estrogen replacement therapy should be prescribed at the optimum dose when indicated as hormonal replacement therapy. PURPOSE Insight into the causes and outcomes of malpractice claims against surgeons will help inform practitioners and may support better patient care. The purpose of this study was to characterize national malpractice claims against oral and maxillofacial surgeons (OMSs). MATERIALS AND METHODS A comprehensive review of all claims against OMSs from 2000 to August 2018 in the National Practitioner Data Bank was performed. Primary outcomes were claims against OMSs, payment amount, claim duration, and percentage of anesthesia-related claims. Other variables of interest included demographic characteristics, nature of allegations, clinical outcome of injury, outcome of claim, and number of payments of $1 million or greater ("catastrophic payments"). Student t tests and Wilcoxon rank-sum test were performed, and P less then .05 was considered significant. RESULTS This was a retrospective cohort study of malpractice claims against OMSs. There were 2,643 claims against OMSs during the study period. The average age of the claimant was 35.
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