Long-Term Outcomes Following Elective Repair of Intact Abdominal Aortic Aneurysms: A Comparison Between Open Surgical and Endovascular Repair Using Linked Administrative and Clinical Registry Data.

OBJECTIVE: Compare long-term mortality, secondary intervention and secondary rupture following elective endovascular aneurysm repair (EVAR) and open surgical repair (OSR). BACKGROUND: EVAR has surpassed OSR as the most common procedure used to repair abdominal aortic aneurysm (AAA), but evidence regarding long-term outcomes is inconclusive. METHODS: We included patients in linked clinical registry and administrative data undergoing EVAR or OSR for intact AAA between January 2010 and June 2019. We used an inverse probability of treatment-weighted survival analysis to compare all-cause mortality, cause-specific mortality, secondary interventions and secondary rupture, and evaluate the impact of secondary interventions and secondary rupture on all-cause mortality. RESULTS: The study included 3460 EVAR and 427 OSR patients. Compared to OSR, the EVAR all-cause mortality rate was lower in the first 30 days [adjusted hazard ratio (HR) = 0.22, 95% confidence interval (CI) 0.140.33], but higher between 1 and 4 years (HR = 1.29, 95% CI 1.12-1.48) and after 4years (HR = 1.41, 95% CI 1.23-1.63). Secondary intervention rates were higher over the first 30 days (HR = 2.26, 95% CI 1.11-4.59), but lower between 1 and 4years (HR = 0.59, 95% CI 0.48-0.74). Secondary aortic intervention rates were higher across the entire follow-up period (HR = 2.52, 95% CI 2.06-3.07). Secondary rupture rates did not differ significantly (HR = 1.06, 95% CI 0.73-1.55). All-cause mortality beyond 1 year remained significantly higher for EVAR after adjusting for any secondary interventions, or secendary rupture. CONCLUSIONS: EVAR has an early survival benefit compared to OSR. However, elevated long-term mortality and higher rates of secondary aortic interventions and subsequent aneurysm repair suggest that EVAR may be a less durable method of aortic aneurysm exclusion.

Editor's Choice - Comparison of Outcomes for Major Contemporary Endograft Devices Used for Endovascular Repair of Intact Abdominal Aortic Aneurysms.

OBJECTIVE: To compare rates of mortality, rupture, and secondary intervention following endovascular repair (EVAR) of intact abdominal aortic aneurysms (AAA) using contemporary endograft devices from three major manufacturers. METHODS: This was a retrospective cohort study using linked clinical registry (Australasian Vascular Audit) and all payer administrative data. Patients undergoing EVAR for intact AAA between 2010 and 2019 in New South Wales, Australia were identified. Rates of all cause death, secondary rupture, and secondary intervention (subsequent aneurysm repair; other secondary aortic intervention) were compared for patients treated with Cook, Medtronic, and Gore standard devices. Inverse probability of treatment weighted proportional hazards and competing risk regression were used to adjust for patient, clinical, and aneurysm characteristics, using Cook as the referent device. RESULTS: This study identified 2 874 eligible EVAR patients, with a median follow up of 4.1 (maximum 9.5) years. Mortality rates were similar for patients receiving different devices (ranging between 7.0 and 7.3 per 100 person years). There was no statistically significant difference between devices in secondary rupture rates, which ranged between 0.4 and 0.5 per 100 person years. Patients receiving Medtronic and Gore devices tended to have higher crude rates of subsequent aneurysm repair (1.5 per 100 person years) than patients receiving Cook devices (0.8 per 100 person years). This finding remained in the adjusted analysis, but was only statistically significant for Medtronic devices (HR 1.57, 95% CI 1.02 - 2.47; HR 1.73, 95% CI 0.94 - 3.18, respectively). CONCLUSION: Major endograft devices have similar overall long term safety profiles. However, there may be differences in rates of secondary intervention for some devices. This may reflect endograft durability, or patient selection for different devices based on aneurysm anatomy. Continuous comparative assessments are needed to guide evidence for treatment decisions across the range of available devices.

Turning promise into practice: Crop biotechnology for increasing genetic diversity and climate resilience.

As climate change increasingly threatens agricultural production, expanding genetic diversity in crops is an important strategy for climate resilience in many agricultural contexts. In this Essay, we explore the potential of crop biotechnology to contribute to this diversification, especially in industrialized systems, by using historical perspectives to frame the current dialogue surrounding recent innovations in gene editing. We unearth comments about the possibility of enhancing crop diversity made by ambitious scientists in the early days of recombinant DNA and follow the implementation of this technology, which has not generated the diversification some anticipated. We then turn to recent claims about the promise of gene editing tools with respect to this same goal. We encourage researchers and other stakeholders to engage in activities beyond the laboratory if they hope to see what is technologically possible translated into practice at this critical point in agricultural transformation.

Measures used to assess the burden of ESBL-producing Escherichia coli infections in humans: a scoping review.

BACKGROUND: ESBL-producing bacteria pose a serious challenge to both clinical care and public health. There is no standard measure of the burden of illness (BOI) of ESBL-producing Escherichia coli (ESBL-EC) in the published literature, indicating a need to synthesize available BOI data to provide an overall understanding of the impact of ESBL-EC infections on human health. OBJECTIVES: To summarize the characteristics of BOI reporting in the ESBL-EC literature to (i) describe how BOI associated with antimicrobial resistance (AMR) is measured and reported; (ii) summarize differences in other aspects of reporting between studies; and (iii) highlight the common themes in research objectives and their relation to ESBL-EC BOI. METHODS AND RESULTS: Two literature searches, run in 2013 and 2018, were conducted to capture published studies evaluating the BOI associated with ESBL-EC infections in humans. These searches identified 1723 potentially relevant titles and abstracts. After relevance screening of titles and abstracts and review of full texts, 27 studies were included for qualitative data synthesis. This review identified variability in the reporting and use of BOI measures, study characteristics, definitions and laboratory methods for identifying ESBL-EC infections. CONCLUSIONS: Decision makers often require BOI data to make science-based decisions for the implementation of surveillance activities or risk reduction policies. Similarly, AMR BOI measures are important components of risk analyses and economic evaluations of AMR. This review highlights many limitations to current ESBL-EC BOI reporting, which, if improved upon, will ensure data accessibility and usefulness for ESBL-EC BOI researchers, decision makers and clinicians.

Postmortem Vitreous Humor Magnesium Does Not Elevate in Salt Water Drowning When the Immersion Time Is Less Than an Hour.

BACKGROUND: Elevation in postmortem vitreous humor sodium and chloride (PMVSC) in salt water drowning (SWD) when the immersion time is less than 1 hour (SWD1) is hypothesized to result from electrolyte changes in blood from salt water inhalation/ingestion during drowning. After approximately 1 hour after death, electrolytes may diffuse into the vitreous humor via the eye coverings. Another abundant element in salt water is magnesium, which is approximately 50 times higher in concentration than the blood and vitreous humor magnesium levels. Magnesium is able to diffuse across the eye coverings but not as easily through the blood-ocular barrier. With these properties, we hypothesize that postmortem vitreous magnesium (PMVM) would not be elevated in SWD1 but become elevated in SWD with immersion times greater than 1 hour (SWD>1). AIM: The aim of this article was to investigate the differences in PMVM and PMVSC between nonimmersion deaths, SWD1, and SWD>1. METHODS: This is a 1-year retrospective study comparing PMVM and PMVSC in nonimmersion deaths, SWD1, and SWD>1. RESULTS: Postmortem vitreous magnesium is significantly higher in SWD>1 than SWD1 and nonimmersion deaths, with no significant difference between SWD1 and nonimmersion deaths. Postmortem vitreous humor sodium chloride is statistically higher in SWD1 and SWD>1 than nonimmersion deaths. CONCLUSIONS: As a conclusion, PMVSC elevates and PMVM does not elevate in SWD1.

Pregnancy and neurodevelopmental outcomes with in-utero antiepileptic agent exposure. A pilot study.

OBJECTIVE: To assess pregnancy outcomes on women exposed to monotherapy with antiepileptic agents. METHODS: Questionnaires were sent to women with epilepsy in our practice who were pregnant between 2006 and 2011. 62/86 patients (72%) who responded were on monotherapy. 24 fetuses (63%) were exposed to lamotrigine, 11 (28%) to levetiracetam, 2 (5.2%) to topiramate, 1 (2.6%) to gabapentin, 17 (27%) to carbamazepine, 5 to phenytoin and 2 to valproate. RESULTS: There were 55 (88%) live births and 7 unsuccessful pregnancies (miscarriages/stillbirths). Unsuccessful pregnancies were reported in 2/24 gestations exposed to lamotrigine, 2/11 to levetiracetam and 3/17 to carbamazepine. Delayed motor development or speech delay requiring therapy and special programming was noted in 2/24 children prenatally exposed to lamotrigine, 3/17 exposed to carbamazepine and 1/2 children exposed to valproate. CONCLUSION: Our pilot study of children exposed to antiepileptic drug monotherapy in-utero demonstrated a favorable trend for successful pregnancy outcomes and developmental trajectory.

The impact of immersion protection requirements on hair dryer electrocutions in the USA.

OBJECTIVE: To evaluate the effectiveness of the immersion protection requirements of a voluntary safety standard for portable handheld hair dryers in preventing electrocution deaths in the USA. METHODS: The present work was an interrupted time series study design. Data on annual hair dryer-related electrocution deaths resulting from water contact were developed for the 1980-2007 study period. A multivariate Poisson regression model for rate data was used to evaluate the impact of the immersion protection requirements during the post-intervention period. The analysis controlled for the estimated number of hair dryers in use and the estimated number of US homes equipped with ground fault circuit interrupters, safety devices that would address hair dryer electrocutions even in the absence of the immersion protection requirements of the voluntary standard. The implementation of the 1987 and 1991 immersion protection requirements of the voluntary standard for portable handheld hair dryers was the intervention studied. The main outcome measure was the estimated reduction in the hair dryer electrocution rate associated with the immersion protection requirements of the voluntary standard. RESULTS: After controlling for covariates, the immersion protection requirements were estimated to reduce the rate of hair dryer immersion electrocution deaths by 96.6% (95% CI, 90.8% to 98.8%). This suggests the prevention of about 280 immersion electrocution deaths involving hair dryers during the post-intervention period (1987-2007). CONCLUSIONS: The immersion protection requirements of the voluntary safety standard for hair dryers have been highly effective in reducing hair dryer electrocutions.

Nutritional intake of long-term survivors of childhood acute lymphoblastic leukemia: evidence for bone health interventional opportunities.

BACKGROUND: Survivors of childhood acute lymphoblastic leukemia (ALL) are vulnerable to exaggeration of the aging process including decreased bone mineral density (BMD). As little is known about their dietary or nutrient intake that may affect their long-term bone health, we examined nutrient intake in long-term survivors of childhood ALL. PROCEDURE: Survivors (n = 164) of childhood ALL who had completed treatment for at least 5 years and were in continuous remission, completed a 110-item food questionnaire that reflected dietary intake over the previous year. The analyzed cohort comprised 34 females and 38 males younger than 19 years and 45 females and 47 males at least 19 years. Reported nutrient intake and food selection were compared with age-specific Recommended Dietary Allowance and USDA Pyramid Food Guide. Body mass index was compared to the general US population, adjusted for age, gender, Tanner stage and race. RESULTS: Less than 30% of participants met recommended dietary intakes for vitamin D, calcium, potassium, or magnesium regardless of age. Mean daily caloric intake was 2,204 kcal (51% from carbohydrates) for younger and 2,160 kcal (49% from carbohydrates) for older participants. Energy intake from sweets was 70% higher than recommended. Participants < 19 years were less likely to have a healthy weight (odds ratio 0.48, 95% CI 0.30-0.79); > 19 years more likely to be overweight (odds ratio 1.95, 95% CI 1.11-3.32, P < 0.002). CONCLUSIONS: Survivors of childhood ALL need careful dietary intervention to optimize long-term health.