The Outcome of Sac Filling With Fibrin Sealant and Gentamicin After Endovascular Aortic Repair of Brucella-Related Aorto-Iliac Artery Aneurysms: A Retrospective Single-Center Study.

PURPOSE: This study aimed to analyze the experience of our center and assess the efficacy of sac filling with fibrin sealant (FS) and gentamicin after endovascular aortic repair (EVAR) in patients with Brucella-related aorto-iliac artery aneurysms. MATERIALS AND METHODS: All patients who received sac filling with FS and gentamicin after EVAR for Brucella-related aorto-iliac artery aneurysms between March 2019 and September 2022 were reviewed. Before and after sac filling with FS and gentamicin, aneurysm sac thrombosis and endoleak were evaluated using a preloaded catheter to monitor immediate repair outcome. Short- to mid-term outcomes were assessed by the incidence of vascular graft infection (VGI), all-cause mortality, maximum aneurysm diameter, aneurysm sac thrombosis, and other adverse events. RESULTS: There were 14 patients with Brucella-related aorto-iliac artery aneurysms who underwent sac filling with FS and gentamicin after EVAR. Perioperative death due to myocardial infarction in 1 patient resulted in a postoperative all-cause mortality rate of 7.1% (1/14). All patients received anti-Brucella drugs for a median of 6.0 (range: 3-12) months postoperatively. During a median follow-up period of 15.0 (range 0.5-36) months, the absolute and sagittal maximum diameters of the aorto-iliac aneurysm sac were significantly smaller than preoperation (from 46.3 ± 17.0 to 27.2 ± 16.3 mm, P<.001, and from 39.2 ± 13.1 to 24.0 ± 13.8 mm, P<.001). Two of these patients had a postoperative disappearance of the pseudoaneurysm. One patient was reintervened for bilateral femoral artery bypass surgery. Except for sac filling with gentamicin, all patients received anti-brucella medication for a median of 6.0 (range: 3-12) months. There were no allergic reactions, nephrotoxicity, endoleak, recurrence, VGI, aorta-related or infection-related deaths during the perioperative period and follow-up. CONCLUSIONS: Sac filling with FS and gentamicin adjunctive to EVAR, with targeted drug delivery to the sites of Brucella-related aorto-iliac artery aneurysm infection lesions, may be an effective solution to control pseudoaneurysm infection and rupture. CLINICAL IMPACT: Previous Brucella-associated aorto-iliac artery aneurysms have been limited to case reports. This study significantly increased the number of Brucella-associated aorto-iliac aneurysms by 19.7% (14/71) and extended the follow-up to 3 years. In this retrospective study of 14 patients with Brucella-associated aorto-iliac aneurysms treated endovascularly with fibrin sealant and gentamicin for sac filling and targeted administration to infection-related aneurysms, there were no aneurysm-related deaths or infection-related complications and may be an effective solution for controlling aneurysm infection and rupture. And, this approach is an attractive treatment for moving away from long-term dependence on antibiotics but still needs further evaluation.

Aggressive surgical approach with vascular resection and reconstruction for retroperitoneal sarcomas: a systematic review.

BACKGROUND AND AIM: Surgery is the mainstay of treatment and completeness of surgical resection is critical to achieve local control for retroperitoneal sarcoma (RPS). En-bloc resection of adjacent organs, including major abdominal vessels, is often required to achieve negative margins. The aim of this review was to summarise the available evidence to assess the relative benefits and disadvantages of an aggressive surgical approach with vascular resection in patients with retroperitoneal sarcoma (RPS). METHODS: We searched PubMed, the Cochrane Library, and EMBASE for relevant studies published from inception up to August 1, 2022. We performed a systematic review of the available studies to assess the safety and long-term survival results of vascular resection for RPS. RESULTS: We identified a total of 23 studies for our review. Overall postoperative in-hospital or 30-day mortality rate of patients with primary iliocaval leiomyosarcoma was 3% (11/359), and the major complication rate was 13%. The recurrence-free survival (RFS) rates after the follow-up period varied between 15% and 52%, and the 5-year overall survival (OS) rates ranged from 25 to 78%. Overall postoperative in-hospital or 30-day mortality rate of patients with RPSs receiving vascular resection was 3%, and the major complication rate was 27%. The RFS rates after the follow-up period were 18-86%, and the 5-year OS rates varied between 50% and 73%. There were no significant differences in the rates of RFS (HR: 0.97; 95% CI: 0.74-1.19; p = 0.945) and OS (HR: 1.01; 95% CI: 0.66-1.36; p = 0.774) between the extended resection group and tumour resection alone group. CONCLUSIONS: With adequate preparation and proper management, for patients with RPSs involving major vessels, aggressive surgical approach with vascular resection can achieve R0/R1 resection and improve survival.

Incidence, risk factors, and outcomes of venous thromboembolism in patients undergoing surgery for retroperitoneal tumors: a propensity-matched retrospective cohort study.

BACKGROUND: Venous thromboembolism (VTE) is a common postoperative complication; however, the incidence and risk stratification of postoperative VTE in patients with retroperitoneal tumor remains unclear. The authors aim to quantify the incidence, identify risk factors, and determine the outcomes of VTE in patients undergoing retroperitoneal tumor surgery. METHODS: The authors retrospectively reviewed the characteristics, perioperative outcomes, and overall survival (OS) of patients (VTE and non-VTE) who underwent retroperitoneal tumor surgery between 2015 and 2020. Perioperative and oncologic outcomes were compared using propensity-matching and Cox analyses. RESULTS: Of 1223 patients with retroperitoneal tumor surgery, 2.1% had VTE. Age [odds ratio (OR) 1.140, 95% CI: 1.053-1.239, P =0.004], recurrence (OR 1.851, 95% CI: 1.241-2.761, P =0.003), and vascular resection (OR 2.036, 95% CI: 1.054-3.934, P =0.034) were independent risk factors, with significant between-group differences regarding age, recurrence, sarcoma, organ resection, vascular resection, and operation time. No between-group differences in 30-day all-cause mortality (8 vs. 4%, OR 0.657, 95% CI: 0.375-1.151, P =0.427) and major complications (12 vs. 8%, OR 0.775, 95% CI: 0.483-1.244, P =0.572) were observed. Mean hospitalization duration (20.1 vs. 22.9 days, OR 1.153, 95% CI: 1.022-1.386, P =0.033) and ICU stay (3.2 vs. 5.5 days, OR 1.193, 95% CI: 1.034-1.347, P =0.012) were shorter in non-VTE versus VTE, respectively, with inferior OS (hazard ratio 2.090, 95% CI: 1.014-4.308, P =0.046) in VTE. CONCLUSIONS: Age, recurrence, and vascular resection are positively associated with VTE, which is associated with inferior OS.

Venous Ulcer in a 5-Year-Old Girl.

BACKGROUND: Agenesis of the inferior vena cava (IVC) is an extremely rare congenital malformation. Although IVC dysplasia can present with symptoms, because of the low prevalence of this disease, it is often omitted from routine examination. Most reports on this topic have described the absence of the IVC; the absence of both a deep venous system and the IVC is even rarer. Chronic venous hypertension and varicosities leading to venous ulcers have been reported in patients with absent IVC that could be surgically bypassed; however, the absence of iliofemoral veins precluded any bypass procedure in the present patient. CASE PRESENTATION: The authors report a case of IVC below renal vein hypoplasia in a 5-year-old girl who presented bilaterally with venous stasis dermatitis and ulcers in the lower extremity limb area. Ultrasonography revealed no clear IVC and iliofemoral venous system under the renal venous plane. Magnetic resonance venography subsequently confirmed the same findings. The patient's ulcers were healed by compression therapy and routine wound care. CONCLUSIONS: This is a rare case of venous ulcer in a pediatric patient stemming from congenital IVC malformation. With this case, the authors demonstrate the etiology of the appearance of venous ulcers in children.

[Single-Center Experience of Treating Chronic Limb-Threatening Ischemia of Lower Limbs Combined with Diabetes].

Objective: To summarize our hospital's single-center experience of and reflections on the treatment of chronic limb-threatening ischemia (CLTI) of lower limbs combined with diabetes in the past 5 years. Methods: We retrospectively analyzed cases of lower limb CLTI combined with diabetes diagnosed at our hospital from March 2017 to June 2021. The baseline data, surgical information, and follow-up results of the patients were collected. The primary outcome indicator was the patency rate of lower limb target artery within 1 year post-op, and the secondary indicators were the reoperation rate within 1 year post-op and the amputation rate within 1 year post-op. Results: A total of 89 patients with lower limb CLTI combined with diabetes were included in the study. A total of 85 patients underwent percutaneous transluminal angioplasty and the operation of 7 patients ended in failure, with the operation success rate reaching 91.76% (78/85). Three patients underwent femoral popliteal artery bypass grafting with artificial blood vessels and one patient underwent iliac femoral artery bypass grafting with artificial blood vessels, with the success rate of the operations reachign 100% (4/4). Among 78 patients who successfully underwent percutaneous transluminal angioplasty, the median follow-up time was 33 months (13, 64). Two patients died within one year after operation, with the post-op one-year survival rate being 97.44% (76/78). The post-op 1-year reoperation rate was 19.23% (15/78), the 1-year target vascular patency rate (deaths not included) was 85.53% (65/76), and the 1-year amputation rate was 3.85% (3/78). Among the patients who underwent bypass surgery, the follow-up period was 13-48 months. No thrombosis in or re-occlusion of the artificial blood vessels were observed during the follow-up period, and the artificial blood vessels remained unoccluded. Conclusion: Transluminal angioplasty has a relatively ideal rate of postoperative vascular patency. In addition, it is a minimally invasive procedure involving low perioperative risks and is performed under local anesthesia. Therefore, it can be used as the preferred treatment for patients with CLTI. On the other hand, bypass surgery has good long-term patency rate, but it involves higher perioperative risks and the procedure is more invasive. Therefore, bypass surgery can be used as an alternative when transluminal angioplasty ends in failure.

Adiponectin gene therapy prevents islet loss after transplantation.

Significant pancreatic islet dysfunction and loss shortly after transplantation to the liver limit the widespread implementation of this procedure in the clinic. Nonimmune factors such as reactive oxygen species and inflammation have been considered as the primary driving force for graft failure. The adipokine adiponectin plays potent roles against inflammation and oxidative stress. Previous studies have demonstrated that systemic administration of adiponectin significantly prevented islet loss and enhanced islet function at post-transplantation period. In vitro studies indicate that adiponectin protects islets from hypoxia/reoxygenation injury, oxidative stress as well as TNF-α-induced injury. By applying adenovirus mediated transfection, we now engineered islet cells to express exogenous adiponectin gene prior to islet transplantation. Adenovirus-mediated adiponectin transfer to a syngeneic suboptimal islet graft transplanted under kidney capsule markedly prevented inflammation, preserved islet graft mass and improved islet transplant outcomes. These results suggest that adenovirus-mediated adiponectin gene therapy would be a beneficial clinical engineering approach for islet preservation in islet transplantation.

Survival outcomes of surgery for retroperitoneal sarcomas: A systematic review and meta-analysis.

BACKGROUND: Definitive evidence to guide clinical practice on the principles of surgery for retroperitoneal sarcomas (RPSs) is still lacking. This study aims to summarise the available evidence to assess the relative benefits and disadvantages of an aggressive surgical approach with contiguous organ resection in patients with RPS, the association between surgical resection margins and survival outcomes, and the role of surgery in recurrent RPS. METHODS: We searched PubMed, the Cochrane Library, and EMBASE for relevant randomised trials and observational studies published from inception up to May 1, 2021. Prospective or retrospective studies, published in the English language, providing outcome data with surgical treatment in patients with RPS were selected. The primary outcome was overall survival (OS). FINDINGS: In total, 47 articles were analysed. There were no significant differences in the rates of OS (HR: 0.93; 95% CI: 0.83-1.03; P = 0.574) and recurrence-free survival (HR: 1.00; 95% CI: 0.74-1.27; P = 0.945) between the extended resection group and the tumour resection alone group. Organ resection did not increase postoperative mortality (OR: 1.00; 95% CI: 0.55-1.81; P = 0.997) but had a relatively higher complication rate (OR: 2.24, 95% CI: 0.94-5.34; P = 0.068). OS was higher in R0 than in R1 resection (HR: 1.34; 95% CI: 1.23-1.44; P < 0.001) and in R1 resection than in R2 resection (HR: 1.86; 95% CI: 1.35-2.36; P < 0.001). OS was also higher in R2 resection than in no surgery (HR: 1.26; 95% CI: 1.07-1.45; P < 0.001), however, subgroup analysis showed that the pooled HR in the trials reporting primary RPS was similar between the two groups (HR, 1.14; 95% CI, 0.87-1.42; P = 0.42). Surgical treatment achieves a significantly higher OS rate than does conservative treatment (HR: 2.42; 95% CI: 1.21-3.64; P < 0.001) for recurrent RPS. CONCLUSIONS: For primary RPS, curative-intent en bloc resection should be aimed, and adjacent organs with evidence of direct invasion must be resected to avoid R2 resection. For recurrent RPS, surgical resection should be considered as a priority. Incomplete resection remains to have a survival benefit in select patients with unresectable recurrent RPS.

Comparison of BARD®LIFESTREAM™ covered balloon-expandable stent versus GORE® VIABAHN™ covered self-expandable stent in treatment of aortoiliac obstructive disease: study protocol for a prospective randomized controlled trial (NEONATAL trial).

BACKGROUND: Covered stent has become one of the mainstream therapies for aortoiliac obstructive disease (AIOD), with a higher patency rate than bare metal stent. Covered balloon-expandable (CBE) stent can be placed more accurately with higher a radial support force, while covered self-expanding (CSE) stent has greater elasticity and higher trackability. However, there is no level I evidence regarding the comparison safety and efficacy between the CSE stent and CBE stent in AIOD to date. Therefore, this study aims to compare the efficacy and safety of CBE stent (BARD®LIFESTREAM™) and CSE stent (GORE® VIABAHN™) in AIOD. METHODS: This trial is a prospective, single-center, parallel, noninferiority, randomized controlled trial. A total of 106 patients will be enrolled and these patients will be randomized to either the CBE stent group or the CSE stent group. The primary end point of the study is the occurrence of target lesion revascularization (TLR) at 12 months after the intervention. DISCUSSION: To our knowledge, the ballooN sElf cOver steNt AorToiliAc occuLusive (NEONATAL) trial is the first RCT to compare CBE and CSE stent in AIOD patients. The main aim is to compare the TLR of the target lesion between CBE stent and CSE stent at 12 months post-procedure. The results of clinical trials may contribute to establishing a strategic guideline for choosing the optimal type of covered stent in the treatment of AIOD patients. TRIAL REGISTRATION: Chinese Clinical Trials Registry ChiCTR2100046734. Registered on 27 May 2021.

Open Repair of Large Hepatic Artery Pseudoaneurysm Without Collateral Circulation: A Case Report.

Hepatic artery pseudoaneurysm is a rare arterial disease. This case report describes a patient with hepatic artery pseudoaneurysm who presented with recurrent epigastric pain over a 4-month period. Computed tomography angiography (CTA) showed aneurysmal enlargement of the hepatic artery measuring 55 mm × 46 mm. The angiographic information is as follows: (1) the common hepatic artery originated from the superior mesenteric artery; (2) the proper hepatic artery originated from the common hepatic artery; (3) the proper hepatic aneurysmal disease had no collateral circulation. After careful consideration, the patient underwent an open surgical repair (OSR). The patient recovered well without any associated complications. The 1-year follow-up of patients did not reveal any relevant complications. The treatment choice, puzzles, and reflections of this case are all discussed in this article.

Injury Assessment of Individuals Wounded in the Lushan Earthquake and the Emergency Department Workload: A Corresponding Correlation Study.

OBJECTIVE: In this study, we aimed to evaluate the correlation between the trauma score of individuals wounded in the Lushan earthquake and emergency workload for treatment. We further created a trauma score-emergency workload calculation model. METHODS: We included data from patients wounded in the Lushan earthquake and treated at West China Hospital, Sichuan University. We calculated scores per the following models separately: Revised Trauma Score (RTS), Prehospital Index (PHI), Circulation Respiration Abdominal Movement Speech (CRAMS), Therapeutic Intervention Scoring System (TISS-28), and Nursing Activities Score (NAS). We assessed the association between values for CRAMS, PHI, and RTS and those for TISS-28 and NAS. Subsequently, we built a trauma score-emergency workload calculation model to quantitative workload estimation. RESULTS: Significant correlations were observed for all pairs of trauma scoring models with emergency workload scoring models. TISS-28 score was significantly associated with PHI score and RTS; however, no significant correlation was observed between the TISS-28 score and CRAMS score. CONCLUSIONS: CRAMS, PHI, and RTS were consistent in evaluating the injury condition of wounded individuals; TISS-28 and NAS scores were consistent in evaluating the required treatment workload. Dynamic changes in emergency workload in unit time were closely associated with wounded patient visits.

Surgical clinical trials with non-inferiority design: a cross-sectional bibliometric analysis.

BACKGROUND: Wide-spread concerns have been raised about possible bias in published surgical non-inferiority trials. Therefore, we performed a comprehensive bibliometric analysis to identify the existence of bias, and provided recommendations for future non-inferiority trials. METHODS: Databases including MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched (last update on 27 April 2020) to include published phase II and phase III non-inferiority surgical trials. We collected general information and parameters associated with trial design. The association between extracted factors and establishment of non-inferiority was then analyzed. RESULTS: A total of 347 trials were included in this study. Only 13 (3.7%) trials reported the pre-specified non-inferiority margin in registration, and 99 (28.5%) trials justified margin selection in ultimate trial publications. A significant association was found between industry funding and increased odds of achieving non-inferiority [odds ratio (OR): 1.17, 95% confidence interval (CI): 1.06 to 1.30, P=0.001]. Moreover, trials which had been presented in conferences were less likely to claim non-inferiority (OR: 0.83, 95% CI: 0.69 to 0.99, P=0.035). CONCLUSIONS: Our study was the first quantitative analysis revealing the presence of biases in findings of existing surgical non-inferiority trials, which could possibly mislead surgeons' clinical decision making. We suggest improving reporting of detailed study design especially funding sources as well as margin justification for future trials. We also encourage conference presentation of ongoing trials prior to the ultimate publication.

Systematic review and meta-analysis of sex differences in outcomes after endovascular aneurysm repair for infrarenal abdominal aortic aneurysm.

OBJECTIVE: Women face distinctive challenges when they receive endovascular aneurysm repair (EVAR) treatment, and according to the previous studies, sex differences in outcomes after EVAR for infrarenal abdominal aortic aneurysm (AAA) remains controversial. This study aimed to compare the short-term and long-term outcomes between women and men after EVAR for infrarenal AAA. METHODS: We conducted a comprehensive systematic review and meta-analysis of all available studies reporting sex differences after EVAR for infrarenal AAA, which were retrieved from the MEDICINE, Embase, and Cochrane Database. The pooled results were presented as odds ratios (ORs) for dichotomous data and hazard ratios for time-to-event data using a random effect model. RESULTS: Thirty-six cohorts were included in this meta-analysis. The pooled results showed that women were associated with a significantly increased risk of 30-day mortality (crude OR, 1.67; 95% confidence interval [CI], 1.50-1.87; P < .001; adjusted OR, 1.73; 95% CI, 1.32-2.26; P < .001), in-hospital mortality (OR, 1.90; 95% CI, 1.43-2.53; P < .001), limb ischemia (OR, 2.44; 95% CI, 1.73-2.43; P < .001), renal complications (OR, 1.73; 95% CI, 1.12-2.67; P = .028), cardiac complications (OR, 1.68; 95% CI, 1.01-2.80; P = .046), and long-term all-cause mortality (hazard ratio, 1.23; 95% CI, 1.09-1.38; P = .001) compared with men; however, no significant sex difference was observed for visceral/mesenteric ischemia (OR, 1.62; 95% CI, 0.91-2.88; P = .098), 30-day reinterventions (OR, 1.37; 95% CI, 0.95-1.98; P = .095), late endoleaks (OR, 1.18; 95% CI, 0.88-1.56; P = .264), and late reinterventions (OR, 1.05; 95% CI, 0.78-1.41; P = .741). In the intact AAA subgroup, women had a significantly increased risk of visceral/mesenteric ischemia (OR, 1.85; 95% CI, 1.01-3.39; P = .046) and an equivalent risk of cardiac complications (OR, 1.64; 95% CI, 0.85-3.17; P = .138) compared with men. CONCLUSIONS: Compared with male sex, female sex is associated with an increased risk of 30-day mortality, in-hospital mortality, limb ischemia, renal complications, cardiac complications, and long-term all-cause mortality after EVAR for infrarenal AAA. Women should be enrolled in a strict and regular long-term surveillance after EVAR.

A meta-analysis of translumbar embolization versus transarterial embolization for type II endoleak after endovascular repair of abdominal aortic aneurysm.

OBJECTIVE: This systematic review and meta-analysis aimed to compare the clinical outcomes between transarterial and translumbar (direct aneurysm sac puncture) approaches for persistent type II endoleak after endovascular repair of abdominal aortic aneurysm. METHODS: We searched multiple electronic databases (up to October 31, 2018) for eligible trials in patients with type II endoleaks after endovascular abdominal aortic aneurysm repairs that evaluated the outcomes of translumbar embolization vs transarterial embolization. The primary outcome was clinical success (absence of the endoleak on the last examination); the secondary outcomes were technical success and complication rate. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. RESULTS: Among the 904 studies screened, 9 studies with 354 participants were included in this review. None of the studies reported rupture or mortality. The translumbar group had a relatively higher clinical success rate than the transarterial group, but this difference was not statistically significant (OR, 2.29; 95% CI, 1.00-5.25; P = .05; I2 = 52%). The technical success rate was significantly higher in the translumbar group than in the transarterial group (OR, 13.32; 95% CI, 3.41-52.07; P = .0002; I2 = 0%). No significant difference was found in the complication rate of the two groups (OR, 1.15; 95% CI, 0.26-4.96; P = .85; I2 = 0%). We also included five studies that reported the clinical outcomes of open repair. All patients were technically treated by open repair, and 58 of 60 patients owned clinical success during the follow-up period. CONCLUSIONS: The translumbar route was more successful in obliterating the endoleak on follow-up imaging. When repeated endovascular embolizations fail, a laparotomy should follow.

MSCs protect endothelial cells from inflammatory injury partially by secreting STC1.

Inflammatory factors play an important role in the pathogenesis of diabetic vascular complications. Considerable interest in the therapeutic potential of mesenchymal stem cells (MSCs) has recently arisen. The purposes of this study were to investigate the effects of MSCs on endothelial cells under inflammatory conditions and to determine the relevant mechanism underlying these effects. In vitro, after TNF-α stimulation, MSCs-CM treatment significantly restored cell viability, reduced THP-1 cell adhesion and enhanced tube formation capacity via inhibiting ROS overproduction and NF-κB activation, subsequently down-regulating adhesion molecules and chemokines. These effects may be partially due to the up-regulation of uncoupling protein 2 (UCP2) in HUVECs that was induced by the secretion of stanniocalcin 1 (STC1) from MSCs. In vivo, MSCs transplantation ameliorated the progression of diabetes-associated vascular dysfunction by reducing ROS production and down-regulating the expression of adhesion molecules. These results suggest that MSCs protect HUVECs from inflammatory injury partially by secreting STC1. MSCs may be a potential therapeutic approach for the treatment of diabetic vascular complications.

MSCs promote the development and improve the function of neonatal porcine islet grafts.

Deficient insulin secretion caused by immaturity is the predominant disadvantage of neonatal porcine islets (NPIs) when they serve as a source for islet xenotransplantation. We hypothesize that the transplantation of NPIs with a combination of mesenchymal stem cells (MSCs) can accelerate NPI maturation and improve the engraftment and function of NPIs. After indirect coculturing with monkey MSCs over 21 d, insulin secretion and the expression of regulatory genes relevant to development were assessed in NPIs. NPIs alone or in combination with allogeneic MSCs were intraportally transplanted into diabetic monkeys. Glycemic control was monitored, and graft function was evaluated. Our results suggest that MSCs benefit both the development and proliferation of NPIs in the coexisting systems in vitro and in vivo. These effects are dependent on platelet-derived growth factor receptor-α and are relevant to the inhibition of downstream target Notch1 signaling and the activation of PI3K/protein kinase B signaling.-He, S., Wang, C., Du, X., Chen, Y., Zhao, J., Tian, B., Lu, H., Zhang, Y., Liu, J., Yang, G., Li, L., Li, H., Cheng, J., Lu, Y. MSCs promote the development and improve the function of neonatal porcine islet grafts.

A preclinical evaluation of alternative site for islet allotransplantation.

The bone marrow cavity (BMC) has recently been identified as an alternative site to the liver for islet transplantation. This study aimed to compare the BMC with the liver as an islet allotransplantation site in diabetic monkeys. Diabetes was induced in Rhesus monkeys using streptozocin, and the monkeys were then divided into the following three groups: Group1 (islets transplanted in the liver with immunosuppressant), Group 2 (islets transplanted in the tibial BMC), and Group 3 (islets transplanted in the tibial BMC with immunosuppressant). The C-peptide and blood glucose levels were preoperatively measured. An intravenous glucose tolerance test (IVGTT) was conducted to assess graft function, and complete blood cell counts were performed to assess cell population changes. Cytokine expression was measured using an enzyme-linked immune sorbent assay (ELISA) and MILLIPLEX. Five monkeys in Group 3 exhibited a significantly increased insulin-independent time compared with the other groups (Group 1: 78.2 ± 19.0 days; Group 2: 58.8 ± 17.0 days; Group 3: 189.6 ± 26.2 days) and demonstrated increases in plasma C-peptide 4 months after transplantation. The infusion procedure was not associated with adverse effects. Functional islets in the BMC were observed 225 days after transplantation using the dithizone (DTZ) and insulin/glucagon stains. Our results showed that allogeneic islets transplanted in the BMC of diabetic Rhesus monkeys remained alive and functional for a longer time than those transplanted in the liver. This study was the first successful demonstration of allogeneic islet engraftment in the BMC of non-human primates (NHPs).

Prevalence and risk factors of type II endoleaks after endovascular aneurysm repair: A meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aims to determine the current evidence on risk factors for type II endoleaks after endovascular aneurysm repair (EVAR). MATERIALS AND METHODS: A systematic literature search was carried out for studies that evaluated the association of demographic, co-morbidity, and other patient-determined factors with the onset of type II endoleaks. Pooled prevalence of type II endoleaks after EVAR was updated. RESULTS: Among the 504 studies screened, 45 studies with a total of 36,588 participants were included in this review. The pooled prevalence of type II endoleaks after EVAR was 22% [95% confidence interval (CI), 19%-25%]. The main factors consistently associated with type II endoleaks included age [pooled odds ratio (OR), 0.37; 95% CI, 0.31-0.43; P<0.001], smoking (pooled OR, 0.71; 95% CI, 0.55-0.92; P<0.001), patent inferior mesenteric artery (pooled OR, 1.98; 95% CI, 1.06-3.71; P = 0.012), maximum aneurysm diameter (pooled OR, 0.23; 95% CI, 0.17-0.30; P<0.001), and number of patent lumbar arteries (pooled OR, 3.07; 95% CI, 2.81-3.33; P<0.001). Sex, diabetes, hypertension, anticoagulants, antiplatelet, hyperlipidemia, chronic renal insufficiency, types of graft material, and chronic obstructive pulmonary diseases (COPD) did not show any association with the onset of type II endoleaks. CONCLUSIONS: Clinicians can use the identified risk factors to detect and manage patients at risk of developing type II endoleaks after EVAR. However, further studies are needed to analyze a number of potential risk factors.

Perioperative Pharmacological Thromboprophylaxis in Patients With Cancer: A Systematic Review and Meta-analysis.

OBJECTIVE: To compare the relative effects between pharmacological thromboprophylaxis and no anticoagulation. BACKGROUND: The efficacy and safety of pharmacological thromboprophylaxis in cancer patients undergoing surgery need to be quantified to guide management. METHODS: We searched multiple electronic databases (up to March 31, 2016) for trials of cancer patients undergoing surgery that assessed the relative benefits and harms of perioperative pharmacological thromboprophylaxis. Relative risks (RRs) with 95% confidence intervals (CI) were estimated. RESULTS: A total of 39 studies were enrolled in this review. Patients with pharmacological thromboprophylaxis had a relatively reduced incidence of deep venous thrombosis (DVT) compared with those without (0.5% vs 1.2%, RR 0.51, 95% CI 0.27-0.94; P = 0.03) but a significantly increased incidence of bleeding events (RR 2.51, 95% CI 1.79-3.51; P < 0.0001). The incidence of pulmonary embolism (PE) (RR 1.77, 95% CI 0.76-4.14; P = 0.19) and mortality related to venous thromboembolism (VTE) (1/2,811 vs 2/3,380) were similar between the pharmacological thromboprophylaxis group and the no pharmacological thromboprophylaxis group. Low-molecular-weight heparin (LMWH) reduced the incidence of DVT compared with unfractionated heparin (UFH) (RR 0.81, 95% CI 0.66-1.00; P = 0.05), and standard extended thromboprophylaxis after cancer surgery significant decreased the incidence of DVT as compared with conventional thromboprophylaxis (RR 0.57, 95% CI 0.39-0.83; P = 0.003). CONCLUSIONS: Routine pharmacological thromboprophylaxis for cancer patients undergoing surgery needs to be carefully considered, because although thromboprophylaxis is associated with lower VTE events, there is a higher incidence of clinically significant bleeding events. If pharmacological thromboprophylaxis is to be used, extended thromboprophylaxis started preoperatively with LWMH might be the most effective strategy.

A Systematic Review of Ultrasound or Magnetic Resonance Imaging Compared With Computed Tomography for Endoleak Detection and Aneurysm Diameter Measurement After Endovascular Aneurysm Repair.

PURPOSE: To analyze the literature comparing ultrasound [duplex (DUS) or contrast-enhanced (CEUS)] or magnetic resonance imaging (MRI) with computed tomography angiography (CTA) for endoleak detection and aneurysm diameter measurement after endovascular aneurysm repair (EVAR). METHODS: A systematic review identified 31 studies that included 3853 EVAR patients who had paired scans (DUS or CEUS vs CTA or MRI vs CTA) within a 1-month interval for identification of endoleaks during EVAR surveillance. The primary outcome was the number of patients with an endoleak detected by one test but undetected by another test. Results are presented for all endoleaks and for types I and III endoleaks only. Aneurysm diameter measurements between CTA and ultrasound were examined using meta-analysis. RESULTS: Endoleaks were seen in 25.6% (985/3853) of patients after EVAR. Fifteen studies compared DUS with CTA for the detection of all endoleak types. CTA had a significantly higher proportion of additional endoleaks detected (214/2346 vs 77/2346 for DUS). Of 19 studies comparing CEUS with CTA for the detection of all endoleak types, CEUS was more sensitive (138/1694) vs CTA (51/1694). MRI detected 42 additional endoleaks that were undetected by CTA during the paired scans, whereas CTA detected 2 additional endoleaks that MRI did not show. CTA had a similar proportion of additional types I and III endoleaks undetected by CEUS or MRI. Of 9 studies comparing ultrasound vs CTA for post-EVAR aneurysm diameter measurement, the aneurysm diameter measured by CTA was greater than ultrasound (mean difference -1.70 mm, 95% confidence interval -2.45 to -0.96, p<0.001). CONCLUSION: This study demonstrated that CEUS and MRI are more accurate than CTA for the detection of post-EVAR endoleaks, but they are no better than CTA for detecting types I and III endoleaks specifically. Aneurysm diameter differences between CTA and ultrasound should be considered when evaluating the change in aneurysm diameter postoperatively.