Comparison of Outcomes and Cost of Endovascular Management Versus Surgical Bypass for the Management of Lower Extremities Peripheral Arterial Disease.

The management of lower extremities peripheral arterial disease (LE-PAD) has always been debatable. We sought to explore in-hospital outcomes in hospitalizations that underwent endovascular or bypass surgery for LE-PAD from nation's largest, publicly available database. The National Inpatient Sample from 2012 to 2014 was queried to identify adult hospitalizations underwent endovascular management and bypass surgery for LE-PAD. Appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes were utilized to identify hospitalizations. A total of 89,256 hospitalizations were identified having endovascular management or bypass surgery for LE-PAD. More hospitalizations underwent endovascular intervention as compared with bypass surgery. Overall, hospitalizations for endovascular management had higher baseline co-morbidities and older age. A propensity score matched analysis was performed to compare in-hospital outcomes. After matching, 28,791 hospitalizations were included in each group. In-hospital mortality was significantly lower with endovascular intervention procedure as compared with surgical bypass group (1.5% vs 2.5%, p ≤0.001). All other secondary outcomes were noted lower with endovascular management except stroke and postprocedural infection. Taken together, these may account for higher discharges to home, lower length of stay, and less cost of hospitalizations associated with endovascular management. In conclusion, endovascular management is associated with lower in-hospital morbidity, mortality, length of stay, and cost when compared with bypass surgery in this study.

Morphology dependent nonlinear optical and photocatalytic activity of anisotropic plasmonic silver.

Anisotropic nanoparticles are ideal building blocks for a number of functional materials due to their exceptional and anisotropic optical, electronic, magnetic and mechanical properties. In this work we present systematic studies on morphology dependent ultra-sensitive thermal diffusivity and photodegradation capability of anisotropic plasmonic silver for the first time. Hydrogen peroxide centered synthesis was performed to prepare anisotropic silver nanosystems spherical (14 nm), quasi-spherical (17 nm), elliptical (18 m), rods (aspect ratio 2.1), hexagonal (22 nm) and prisms (19 nm). The synthesized nanosystems were characterized using UV-VIS spectroscopy, high resolution transmission electron microscopy (HRTEM) and band gap analysis. A dual beam mode matched thermal lensing method was adopted for evaluating the thermal diffusivity of the anisotropic system. The present anisotropic nanoparticle system exhibited strong morphology based thermal diffusivity. An increase of 140% in the thermal diffusivity value points to the nonlinear optical application potential of the anisotropic systems. Sunlight mediated photodegradation of methylene blue showed a promising increase in the degradation rate for anisotropic systems compared to other similar systems reported in the literature.