External Validation of a Rapid Ruptured Abdominal Aortic Aneurysm Score.

BACKGROUND: The Rapid Ruptured Abdominal Aortic Aneurysm Score (RrAAAS) was developed from Vascular Study Group of New England (VSGNE) data (649 ruptured abdominal aortic aneurysm (rAAA) patients, repaired both open and endovascularly), using preoperative age, creatinine, and blood pressure. This study validates that model using the larger National Vascular Quality Initiative (VQI) data set and compares its performance to previous models. METHODS: The VQI registry was queried for patients undergoing rAAA repair from 2006 to 2016. The performance of our original model, RrAAAS, was tested on this data set excluding VSGNE patients (VQI minus VSGNE), and its performance was then compared to the performance of the Glasgow Aneurysm Score (GAS) and Edinburgh Ruptured Aneurysm Score (ERAS). RESULTS: VQI contained 2,704 eligible patients, of which 715 had been contributed by VSGNE. The discrimination of RrAAAS was similar to GAS or ERAS (area under a receiver operator characteristic curve = 0.66). Neither GAS nor ERAS provides a direct prediction of mortality; observed mortality in the VQI minus VSGNE cohort tended to be somewhat lower than predictions of the original RrAAAS. A recalibrated equation predicting the percent mortality was Mortality (%) = 16 + 12*(age > 76) + 8*(creatinine > 1.5) + 20*(systolic blood pressure < 70). CONCLUSIONS: The previously described RrAAAS has similar discrimination as the GAS and ERAS, is easier to obtain in an emergency setting, and has been recalibrated to reflect the experience of a large national sample. The RrAAAS could be useful for clinicians caring for these patients and could be used for risk adjustment when comparing regional differences in mortality associated with rAAA repair.

Predicting Mortality of Ruptured Abdominal Aortic Aneurysms in the Era of Endovascular Repair.

BACKGROUND: Previous risk prediction models of mortality after ruptured abdominal aortic aneurysm (rAAA) repair have been limited by imprecision, complexity, or inclusion of variables not available in the preoperative setting. Most importantly, these prediction models have been derived and validated before the adoption of endovascular aneurysm repair (EVAR) as a treatment for rAAA. We sought to derive and validate a new risk-prediction tool using only easily obtainable preoperative variables in patients with rAAA who are being considered for repair in the endovascular era. METHODS: We used the Vascular Study Group of New England (VSGNE) database to identify all patients who underwent repair of RAAA (2006-2015). Variables were entered into a multivariable logistic regression model to identify independent predictors of 30-day mortality. Linear regression was then used to develop an equation to predict risk of 30-day mortality. RESULTS: During the study period, 649 patients underwent repair of rAAA; of these, 247 (38.1%) underwent EVAR and 402 (61.9%) underwent an open repair. The overall mortality associated with rAAA was 30.7% (open, 33.4% and EVAR, 26.2%). On multivariate modeling, the primary determinants of 30-day mortality were advanced age (>76 vs. ≤76 years, odds ratio [OR] = 2.91 and CI: 2.0-4.24), elevated creatinine (>1.5 mg/dL vs. ≤1.5 mg/dL, OR = 1.57 and CI: 1.05-2.34), and lowest systolic blood pressure (SBP) (BP <70 mm Hg vs. ≥70 mm Hg, OR = 2.65 and CI: 1.79-3.92). The logistic regression model had an area under a c-statistic of 0.69. The corresponding linear model used to provide a point estimate of 30-day mortality (%) was % mortality = 14 + 22 * (age >76) + 9 * (creatinine >1.5) + 20 * (bp <70) Using this model, patients can be stratified into different groups, each with a specific estimated risk of 30-day mortality ranging from a low of 14% to a high of 65%. CONCLUSIONS: In the endovascular era where both open and endovascular treatment are offered for the treatment of rAAA three variables, easily obtained in an emergency setting, accurately predict 30-day mortality for patients operated on for rAAA. This simple risk prediction tool could be used as a point of care decision aid to help the clinician in counseling patients and their families on treatment of those presenting with rAAA.

Early Axonal Area Measurement Predicts Early Nerve Regeneration Outcomes.

BACKGROUND: Study of peripheral nerve injury and regeneration in laboratory animals can be time consuming and expensive. This study determines if it is possible to reduce time and cost for a peripheral nerve regeneration study. PURPOSE: The purpose of this study was to determine if nerve axonal area (NXA) or nerve fiber counting (NFC) correlates with compound muscle action potential (CMAP) recovery which is known to predict functional muscular recovery in the early stage of nerve regeneration. METHODS: In this study, six rats had a crush injury of the sciatic nerve without treatment. These rats were evaluated at 4 weeks of recovery with the following assessments: CMAP readings from the extensor digitorum longus, NXA measurement, and NFC. RESULTS: NXA correlated with CMAP; NFC did not correlate with CMAP. CONCLUSION: NFC is not a reliable method for predicting muscular recovery in the early stages. NXA is a dependable assessment for muscular recovery in the early stages of nerve regeneration. Using NXA measurement can predict later electrophysiological and functional recovery. Using NXA with CMAP measurement for nerve injury, repair, and treatment in the animal study can save cost and time.

Maxillary myxoma: A case report and review.

An odontogenic myxoma is a rare, benign tumor that is found almost exclusively in the facial bones, usually the mandible. The diagnosis poses a challenge because its features overlap with those of other benign and malignant neoplasms. We present an unusual case of odontogenic myxoma that involved the maxilla, and we review the clinical, radiographic, and histologic characteristics of this case. Even though it is benign, odontogenic myxoma can be locally invasive and cause significant morbidity. Complete surgical excision is the treatment of choice, but it can be challenging because of the tumor's indistinct margins.

The value of personalised risk information: a qualitative study of the perceptions of patients with prostate cancer.

OBJECTIVE: To explore the experiences of patients with prostate cancer with risk information and their perceptions of the value of personalised risk information in treatment decisions. DESIGN: A qualitative study was conducted using focus groups. Semistructured interviews explored participants' experiences with using risk information, and their perceptions of the potential value of personalised risk information produced by clinical prediction models. PARTICIPANTS: English-speaking patients, ages 54-82, diagnosed with prostate cancer within the past 3 years, residing in rural and non-rural geographic locations in Maine (USA), and attending prostate cancer patient support groups. SETTING: 6 focus groups were conducted with 27 patients; separate groups were held for patients with low-risk, medium-risk and high-risk disease defined by National Comprehensive Cancer Network guidelines. RESULTS: Several participants reported receiving risk information that was imprecise rather than precise, qualitative rather than quantitative, indirect rather than direct and focused on biomarker values rather than clinical outcomes. Some participants felt that personalised risk information could be useful in helping them make better informed decisions, but expressed scepticism about its value. Many participants favoured decision-making strategies that were heuristic-based and intuitive rather than risk-based and deliberative, and perceived other forms of evidence-emotions, recommendations of trusted physicians, personal narratives-as more reliable and valuable in treatment decisions. CONCLUSIONS: Patients with prostate cancer appear to have little experience using personalised risk information, may favour heuristic-based over risk-based decision-making strategies and may perceive personalised risk information as less valuable than other types of evidence. These decision-making approaches and perceptions represent potential barriers to the clinical use of personalised risk information. Overcoming these barriers will require providing patients with greater exposure to risk information, education about the nature and value of personalised risk information and training in deliberative decision-making strategies. More research is needed to confirm these findings and address these needs.