Explantation of an ALTO abdominal stent graft.

Explantation of traditional infrarenal aortic endografts has been previously described, and explanation of aortic endografts with standard suprarenal fixation at our center has been well defined. However, to the best of our knowledge, no cases have been reported on explantation of endografts with polymer rings present to facilitate the proximal seal. By obtaining full thoracoabdominal exposure with supraceliac clamping and opening the entire aorta along the graft, we were able to successfully explant the ALTO stent graft with polymer rings.

Left-sided inferior vena cava implications for cardiopulmonary bypass cannulation in open thoracoabdominal aortic aneurysm repair.

A left-sided inferior vena cava poses a unique challenge when cannulating for cardiopulmonary bypass during thoracoabdominal aortic aneurysm repair, and how to effectively and safely do so has not been previously described. A 51-year-old woman with a history of Loeys-Dietz syndrome and a left-sided inferior vena cava underwent open Crawford extent II thoracoabdominal aortic aneurysm repair. Cardiopulmonary bypass cannulation was performed using the right axillary artery, left common femoral artery, and right internal jugular vein.

Impact of Glycemic Control on Risk of Mortality and Complications in Trauma Patients.

The impact of diabetes mellitus on outcomes in trauma patients continues to attract interest, but data regarding the impact of longer term glycemic control are still lacking. This study evaluated the effect of long-term glycemic control on outcomes. Trauma patients presenting to the University of Alabama at Birmingham Hospital, between 2011 and 2018, were stratified into 4 groups, based on admission Hemoglobin A1c (HbA1c) level.

Bioremediation of storage tank bottom sludge by using a two-stage composting system: Effect of mixing ratio and nutrients addition.

The effect of mixing ratio and nutrients addition on the efficiency of a two-stage composting system in removal of total petroleum hydrocarbons (TPH) from storage tank bottom sludge (STBS) was investigated. The system consisted of ten windrow piles as primary composting (PC) followed by four in-vessel reactors as secondary composting (SC). Various initial C/N/P and mixing ratios of STBS to immature compost (IC) were examined in the PC and SC for 12 and 6weeks, respectively.

Should We Perform Carotid Doppler Screening Before Surgical or Transcatheter Aortic Valve Replacement?

Background: Screening for internal carotid artery stenosis (ICAS) with Doppler ultrasound is commonly used before cardiovascular surgery. Nevertheless, the relationship between ICAS and procedure-related stroke in isolated aortic valve replacement is unclear.

Methods: We retrospectively reviewed patients with artery stenosis who underwent ICAS screening before surgical (SAVR) or transcatheter aortic valve replacement (TAVR) between January 2007 and August 2014.

Transcatheter Aortic Valve Replacement: Current Technology and Future Directions.

Transcatheter aortic valve replacement as an alternative to open surgical repair is rapidly becoming more used in high-risk patients with aortic stenosis. Transcatheter aortic valve replacement offers the benefit of being much less invasive than traditional surgical repair and has evolved as a therapeutic option for patients with prohibitive surgical risk or those deemed surgically inoperable. Nevertheless, despite its potential to mitigate risk in this frail population, it comes with its own unique set of complications.

Does a Higher Society of Thoracic Surgeons Score Predict Outcomes in Transfemoral and Alternative Access Transcatheter Aortic Valve Replacement?

Background: Nontransfemoral (non-TF) transcatheter aortic valve replacement (TAVR) is often associated with worse outcomes than TF TAVR. We investigated the relationship between increasing Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) score and observed mortality and morbidity in TF and non-TF TAVR groups.

Methods: We reviewed 595 patients undergoing TAVR at Emory Healthcare between 2007 and 2014.

Antiplatelet and Anticoagulant Medications Significantly Increase the Risk of Postoperative Hematoma: Review of over 4500 Thyroid and Parathyroid Procedures.

Purpose: Antiplatelet and/or anticoagulant medication use is common. Abstinence a week before surgery may still result in altered hemostasis. The study aim was to report on perioperative antiplatelet and anticoagulant use in thyroidectomy and parathyroidectomy patients, and to determine the association with postoperative hematoma (POH) rates.

Use of the gamma probe to identify multigland disease in primary hyperparathyroidism.

Aim: The purpose of this study was to determine threshold gamma probe counts to distinguish single adenoma (SA) from multigland disease (MGD) during radioguided parathyroidectomy.

Methods: A retrospective analysis of 1656 patients was performed. counts of the first excised gland were taken and recorded as a percentage of background counts.

Balloon Versus Computed Tomography Sizing of the Aortic Annulus for Transcatheter Aortic Valve Replacement and the Impact of Left Ventricular Outflow Tract Calcification and Morphology on Sizing.

Objectives: To evaluate the role of balloon annular sizing in transcatheter aortic valve replacement (TAVR).

Background: Multidetector cardiac computed tomography (MDCT) is the gold standard for aortic annular sizing in TAVR. Balloon sizing is increasingly used in patients with borderline annular size and severe calcification.

Minimalist transcatheter aortic valve replacement: The new standard for surgeons and cardiologists using transfemoral access?

Background: A minimalist approach for transcatheter aortic valve replacement (MA-TAVR) utilizing transfemoral access under conscious sedation and transthoracic echocardiography is increasing in popularity. This relatively novel technique may necessitate a learning period to achieve proficiency in performing a successful and safe procedure. This report evaluates our MA-TAVR cohort with specific characterization between our early, midterm, and recent experience.

Transcatheter Aortic Valve Replacement Results in Improvement of Pulmonary Function in Patients With Severe Aortic Stenosis.

Background: Chronic obstructive pulmonary disease (COPD) has been identified as a risk factor for morbidity and mortality after transcatheter aortic valve replacement (TAVR). We hypothesized that a portion of pulmonary dysfunction in patients with severe aortic stenosis may be of cardiac origin, and has potential to improve after TAVR.

Methods: A retrospective analysis was made of consecutive TAVR patients from April 2008 to October 2014.

Epstein-Barr virus transcription factor Zta acts through distal regulatory elements to directly control cellular gene expression.

Lytic replication of the human gamma herpes virus Epstein-Barr virus (EBV) is an essential prerequisite for the spread of the virus. Differential regulation of a limited number of cellular genes has been reported in B-cells during the viral lytic replication cycle. We asked whether a viral bZIP transcription factor, Zta (BZLF1, ZEBRA, EB1), drives some of these changes.

Outcomes after subtotal parathyroidectomy for primary hyperparathyroidism due to hyperplasia: significance of whole vs. partial gland remnant.

Introduction: Primary hyperparathyroidism (PHPT) due to multigland hyperplasia is managed by subtotal parathyroidectomy (sPTX), with a partial gland left in situ. However, smaller, hyperplastic glands may be encountered intraoperatively, and it is unclear if leaving an intact gland is an equivalent alternative. This study evaluates the rates of permanent hypoparathyroidism and cure of PHPT patients with four-gland hyperplasia that were left with either a whole gland remnant (WGR) or a partial gland remnant (PGR) after sPTX.

Is intraoperative parathyroid hormone monitoring necessary with ipsilateral parathyroid gland visualization during anticipated unilateral exploration for primary hyperparathyroidism: a two-institution analysis of more than 2,000 patients.

Introduction: Intraoperative parathyroid hormone (ioPTH) monitoring during focused parathyroidectomy for primary hyperparathyroidism (PHPT) is used commonly, but some argue that ioPTH adds little if a normal ipsilateral parathyroid gland (IPG) is visualized. This hypothesis was tested for validity.

Methods: The prospective databases of consecutive patients with PHPT undergoing initial parathyroidectomy with ioPTH at two academic institutions were queried.

Justified follow-up: a final intraoperative parathyroid hormone (ioPTH) Over 40 pg/mL is associated with an increased risk of persistence and recurrence in primary hyperparathyroidism.

Introduction: After parathyroidectomy for sporadic primary hyperparathyroidism (PHPT), overall rates of persistence/recurrence are extremely low. A marker of increased risk for persistence/recurrence is needed. We hypothesized that final intraoperative parathyroid hormone (FioPTH) ≥40 pg/mL is indicative of increased risk for disease persistence/recurrence, and can be used to selectively determine the degree of follow-up.

Primary hyperparathyroidism across the ages: presentation and outcomes.

Background: Primary hyperparathyroidism (PHPT) is a disease process traditionally thought to present during middle age, but can occur at any age. The purpose of this study was to compare PHPT patient characteristics based on patient age at the time of surgical referral.

Methods: A retrospective review of a prospectively managed database of adult patients undergoing parathyroid surgery for PHPT was conducted.

Effect of ejaculation on serum prostate specific antigen level in screening and non-screening population.

Background: The serum prostate specific antigen (PSA) levels are used for prostate cancer screening. Some conditions such as prostatitis, manipulation, and prostate cancer could influence on serum PSA. The impact of ejaculation on serum PSA is controversial.

2012-2025 Roadmap of I.R.Iran's Disaster Health Management.

Objective: In line with Iran's Comprehensive Health Sector Road Map, the National Institute of Health Research at the Tehran University of Medical Sciences developed the 2012-2025 road map of Disaster Health Management (DHM), including goals and objectives, strategies, activities and related prerequisites. This article presents the process and results of this road mapping project.

Methods: The project started with an expanded literature review followed by stakeholder analysis to assess level of interest and impact of related organizations to DHM; STEEP.

Comparing immune response of intradermal low dose versus intramuscular high dose of hepatitis B vaccination in hemodialysis patients.

Background: Hepatitis B is the most important cause of cirrhosis in developing countries. Hemodialysis patients are susceptible to infection due to repeated contact with dialysis machines and blood products. The aim of this study was to compare the efficacy of intradermal low dose with intramuscular high dose hepatitis B vaccination in hemodialysis patients.