Clinical Patterns, Predictors, and Results of Graft Limb Occlusion following Endovascular Aneurysm Repair.

BACKGROUND: To assess the incidence, clinical patterns, and outcomes of graft limb occlusion (GLO) following endovascular aneurysm repair (EVAR). METHODS: A retrospective study of patients undergoing EVAR from 2002 to 2017 at 2 mid-sized suburban teaching hospitals. The ipsilateral and contralateral aorto-common iliac artery (A-CIA) angle and common iliac artery-external iliac artery (CIA-EIA) angle were determined. The diameter of the EIA, graft extension to the EIA, and prior CIA stenting was recorded. RESULTS: Of the 373 patients who underwent EVAR, 319 were analyzed. 22 patients had 23 limbs with GLO (21 unilateral and 1 bilateral) with a mean follow-up of 9.1 ± 2.1 years. There were no statistically significant differences in mean age, gender, size of the abdominal aortic aneurysm, and risk factors of hypertension, coronary artery disease, diabetes mellitus, and chronic obstructive pulmonary disease in patients with and without GLO. There was no statistically significant difference in A-CIA and CIA-EIA angles. A smaller diameter EIA (6 mm or less), graft extension to EIA, and prior CIA stenting were significant predictors of GLO. Four limbs had GLO within 1 month of EVAR, only open thrombectomy was performed in 2 limbs, open thrombectomy with simultaneous axillo-femoral graft in 1 limb, and open thrombectomy with self-expandable stent placement in 1 limb. 12 limbs had GLO within 1-12 months treated with only open thrombectomy in 3 limbs, open thrombectomy with fasciotomy in 1 limb, open thrombectomy with graft extension to EIA in 1 limb, and crossover femoral-femoral graft performed in 3 limbs. Seven limbs had GLO within 1-5 years with a crossover femoral-femoral graft performed in 4 limbs and open thrombectomy with graft extension to EIA was performed in 1 limb. Six limbs with GLO following EVAR did not undergo any intervention. One patient had an above the knee amputation 3 years following occlusion of the axillo-femoral graft and 1 patient returned in 4 years with an increase in size of the excluded aneurysm leading to acute rupture and death. CONCLUSIONS: GLO leads to significant morbidity and mortality following EVAR. Predictors of GLO following EVAR include a small diameter EIA, prior CIA stenting and graft limb extension to the EIA.

Effects of the Implementation of an Intervention Based on Falls Education Programmes on an Older Adult Population Practising Pilates-A Pilot Study.

Age brings consequent physical deterioration of body balance, strength, flexibility and agility. It has been demonstrated that daily physical activity (PA), managed by professionals, is fundamental to ageing with increased quality and to reducing the number of falls, which are a consequence of factors highlighted above. This has been most evident during the COVID-19 pandemic. The aim of this study is to determine and analyse the effects of a multidisciplinary intervention based on the Safe Fall, Safe Schools, adapted utilitarian judo (JUA) and Pilates programmes in a population of older people. After an intervention of 60 min, 2 days a week for 12 weeks, the changes produced in variables such as quality of life, balance, lower body strength, flexibility and agility were analysed. A p-value ≤ 0.05 is accepted. The data show that the intervention can help to improve quality of life, especially two of its dimensions: pain (increases 12 points) and health transition (increases 13 points). It also helped to improve balance, lower body strength, flexibility and agility to a lesser extent. It is concluded that this type of intervention has positive effects for the sample in all the variables mentioned above.

A novel activated-zinc antiseptic solution effective against MRSA and Pseudomonas aeruginosa: a pig model.

OBJECTIVE: The purpose of this study was to investigate the antimicrobial efficacy of a novel activated zinc solution against meticillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa after one hour, and to evaluate any untoward effect of the solution on local wound tissue at 24 hours after solution exposure in a pig wound model. METHOD: A pathogen-free, commercially raised, Yorkshire-cross female pig was acquired 12 days prior to the procedure. Within one week prior to the procedure, a small loopful of test bacteria, Pseudomonas aeruginosa (pig-isolate) and MRSA (ATCC-6538), were streaked and cultured on a non-selective agar. Full-thickness wounds (n=24) were created and evenly divided into three groups: control wounds (exposed to bacteria but untreated, n=8); wounds treated with Compound 1 (n=8), and wounds treated with Compound 2 (n=8). All wounds were dressed and monitored for one hour and 24 hours. RESULTS: After one hour, the wounds treated with Compound 1 and Compound 2 had a mean recoverable total bacteria of 2.8 log colony forming units (CFUs) and 3.5 logCFUs, respectively. After one hour, the wounds treated with Compound 1 and Compound 2 had a mean recoverable MRSA of 2.3 logCFUs and 1.6 logCFUs, respectively (p=0.009). After one hour, the wounds treated with Compound 1 and Compound 2 had a mean recoverable Pseudomonas aeruginosa of 0.3 logCFUs and 0.0 logCFUs, respectively (p=0.000). After 24 hours of exposure to Compound 1 and Compound 2, there was no statistically significant increased necrosis (p=0.12, p=0.31, respectively) or neutrophilic infiltrate (Compound 2, p=0.12) when compared with control wounds. CONCLUSION: The novel activated-zinc compound used in this study demonstrated a 99.5-99.9% reduction in total bacteria, a 99.9-99.98% reduction in MRSA, and 100% eradication of Pseudomonas aeruginosa one hour after exposure. This novel solution may provide another significant tool to treat and/or prevent wound infections.

A Real Welcome Home: Permanent Housing for Homeless Veterans.

Ending homelessness in Washington, DC, involves the collaboration of government and community partners who can identify and address risk factors for homelessness.