Anatomical feasibility of fenestrated stent graft to treat complex abdominal aortic aneurysms from a Korean single institute database.

Purpose: This study aims to investigate the feasibility of Zenith Fenestrated AAA Endovascular Graft (Z-FEN, Cook Medical) from a single Korean institution database by evaluating the vascular anatomy of Korean abdominal aortic aneurysm (AAA) patients with hostile aortic neck. Methods: This is a retrospective study on patients with AAA who underwent endovascular aortic repair (EVAR) and open surgery repair between January 2012 and December 2021 (n = 211). The anatomic characteristics of the aortic neck were evaluated using 3-dimensional reconstructed computed tomographic scans. For the juxtarenal AAA patients (n = 39), feasibility of fenestrated stent graft was evaluated under the protocol of fenestrated EVAR. For those who were not suitable for the application of Z-FEN, the reasons for unsuitability were analyzed. Results: Among 211 AAA patients, 108 patients (51.2%) had complex aortic neck, and 39 (18.5%) had insufficient aortic neck length (<15 mm) for conventional EVAR. Of the 39 patients with juxtarenal AAAs, 13 (33.3%) were determined feasible for Z-FEN. Twenty-six patients (66.7%) were noncandidate for Z-FEN due to severe neck angulation, short aortic neck length, inadequate iliac artery anatomy, large aortic neck diameter, and severe calcification and thrombosis. Proximal aortic neck length of the non-feasible group was significantly shorter than that of the feasible group (P = 0.002). Conclusion: Z-FEN was applicable to 33.3% of the juxtarenal AAA patients. As recent studies confirm, the effectiveness and safety of fenestrated EVAR, Z-FEN can be an option for AAA patients with short aortic neck.

Effectiveness of auricular acupuncture combined with nicotine replacement therapy for smoking cessation.

INTRODUCTION: The aim of this study was to establish if the auricular acupuncture treatment can play a complementary role in enhancing the smoking cessation rate of the smokers receiving conventional therapy, such as NRT and behavioral counseling. METHODS: This was a retrospective cohort study. Republic of Korea Air Force soldiers who visited the clinic with the intention to quit smoking from September 2016 to March 2017 were reviewed. The smoking cessation program consisted of a 6-weeks treatment period with follow-up at 3 and 6 months from the baseline. Smokers who chose to receive nicotine replacement therapy (NRT) were compared with those who chose to receive auricular acupuncture combined with NRT. Both groups received behavioral counseling. RESULTS: A total of 148 subjects were reviewed in the study. Of the 86 smokers who received combination therapy, 41 achieved continuous abstinence (47.7%), while 19 out of the 62 smokers stayed abstinent from the NRT group (30.6%). There was a significant difference between the two groups (p=0.037). Minnesota Nicotine Withdrawal Scale scores significantly decreased after the treatment in both groups, but there was no significant difference between the two groups (p=0.681). No serious adverse events were reported from both groups. CONCLUSIONS: The results of this study indicate that conventional treatments, such as NRT and behavioral counseling, when combined with auricular acupuncture could be a safer and more effective smoking cessation treatment than conventional treatments alone.

Effect of Herbal Prescriptions in Accordance with Pattern Identification in Acute Cerebral Infarction Patients: Based on Fire-Heat Pattern.

Objectives. This study was conducted to verify the necessity of corresponding prescription to the diagnosed pattern in acute cerebral infarction patients. Methods. We studied cerebral infarction patients hospitalized within 30 days after the ictus. Forty-four clinical indicators, Motricity Index (MI) score, Scandinavian Stroke Scale (SSS) score, and herbal prescriptions were checked twice, two weeks apart. The probability of each pattern was calculated based on the clinical indicators. Changes in MI score, SSS score, and the probability of fire-heat pattern were compared between the pattern-prescription correspondence group and the noncorrespondence group. Results. Increments of MI score and SSS score in the correspondence group were significantly greater than those of the noncorrespondence group (p = 0.003, p = 0.001) while the baseline score of the two groups showed no significant difference. Probability of fire-heat pattern decreased significantly in the correspondence group (p = 0.013) while the noncorrespondence group showed no significant difference after the treatment. Conclusion. Acute cerebral infarction patients who are diagnosed as fire-heat pattern showed better improvement in dysfunctions caused by the disease when they took the pattern corresponding prescriptions. This study provides evidence for the necessity and usefulness of pattern identification in Traditional Korean Medicine.

Can the Neutrophil-to-Lymphocyte Ratio Appropriately Predict Carotid Artery Stenosis in Patients with Ischemic Stroke?-A Retrospective Study.

BACKGROUND: Carotid stenosis is a risk factor in ischemic stroke. Although C-reactive protein, interleukin-6, and tumor necrosis factor-alpha are known to predict carotid atherosclerosis, they are difficult to obtain in clinical practice. By studying the association between neutrophil-to-lymphocyte ratio (NLR) and carotid artery intima-media thickening (IMT) in patients with ischemic stroke, we determined that the NLR can predict carotid stenosis. METHODS: We selected 252 patients with acute to subacute ischemic stroke who underwent carotid ultrasonography and complete and differential blood cell count tests. We collected data on sex, age, body mass index (BMI), alcohol consumption, smoking, hypertension, diabetes mellitus, dyslipidemia, and heart disease. Male and female patients were analyzed separately. We divided the subjects into 2 groups according to carotid IMT, and compared baseline characteristics and NLR between the 2 groups. The regression analysis was adjusted for confounding factors such as age, BMI, NLR, smoking, alcohol consumption, and a medical history of hypertension, diabetes mellitus, dyslipidemia, or heart disease. RESULTS: Carotid IMT tended to significantly increase with NLR and age in men and with age in women. In men, multiple linear regression analyses adjusted for confounding factors showed that NLR (P < 0.001) and age (P = 0.001) had a significant positive association with carotid IMT (adjusted R(2) = 0.185, root mean squared error [MSE] = 0.152). However, no parameters showed significant positive associations in women. CONCLUSION: NLR can be a clinically significant predictor of the degree of carotid stenosis in male patients with ischemic stroke. However, additional studies are required to obtain more concrete results.

Effect of ST36 Acupuncture on Hyperventilation-Induced CO 2 Reactivity of the Basilar and Middle Cerebral Arteries and Heart Rate Variability in Normal Subjects.

This study was conducted to verify the effect of acupuncture on cerebral haemodynamics to provide evidence for the use of acupuncture treatment as a complementary therapy for the high-risk stroke population. The effect of ST36 acupuncture treatment on the hyperventilation-induced CO2 reactivity of the basilar and middle cerebral arteries was studied in 10 healthy male volunteers (mean age, 25.2 ± 1.5 years) using a transcranial Doppler sonography with an interval of 1 week between measurements, and a portable ECG monitoring system was used to obtain ECG data simultaneously. The CO2 reactivity of the basilar and middle cerebral arteries increased significantly after ST36 acupuncture treatment, whereas the mean arterial blood pressure and pulse rate did not change significantly. The high-frequency power significantly increased after ST36 acupuncture treatment, and the percentage increase of high-frequency power correlated significantly with the percentage increase in the CO2 reactivity of the contralateral middle cerebral artery. These data suggest that ST36 acupuncture treatment increases CO2 reactivity, indicating improvement of vasodilatory potential of the cerebral vasculature to compensate for fluctuations caused by changes in external conditions. The increase in parasympathetic tone by ST36 acupuncture treatment is responsible for this therapeutic effect.