Direct visualization of postoperative aortobronchial fistula on computed tomography.

BACKGROUND: Postoperative aortobronchial fistula (ABF) is a rare complication that can occur in 0.3%-5.0% of patients over an extended period of time after thoracic aortic surgery. Direct visualization of the fistula via imaging is rare. AIM: To investigate the relationship between computed tomography (CT) findings and the clinical signs/symptoms of ABF after thoracic aortic surgery. METHODS: Six patients (mean age 71 years, including 4 men and 2 women) with suspected ABF on CT (air around the graft) at our hospital were included in this retrospective study between January 2004 and September 2022. Chest CT findings included direct confirmation of ABF, peri-graft fluid, ring enhancement, dirty fat sign, atelectasis, pulmonary hemorrhage, and bronchodilation, and the clinical course were retrospectively reviewed. The proportion of each type of CT finding was calculated. RESULTS: ABF detection after surgery was found to have a mean and median of 14 and 13 years, respectively. Initial signs and symptoms were asymptomatic in 4 patients, bloody sputum was found in 1 patient, and fever was present in 1 patient. The complications of ABF included graft infection in 2 patients and graft infection with hemoptysis in 2 patients. Of the 6 patients, 3 survived, 2 died, and 1 was lost to follow-up. The locations of the ABFs were as follows: 1 in the ascending aorta; 1 in the aortic arch; 2 in the aortic arch leading to the descending aorta; and 2 in the descending aorta. ABFs were directly confirmed by CT in 4/6 (67%) patients. Peri-graft dirty fat (4/6, 67%) and peri-graft ring enhancement (3/6, 50%) were associated with graft infection, endoleaks and pseudoaneurysms were associated with hemoptysis (2/6, 33%). CONCLUSION: Asymptomatic ABF after thoracic aortic surgery can be confirmed on chest CT. CT is useful for the diagnosis of ABF and its complications.

Developing fibrin-based biomaterials/scaffolds in tissue engineering.

Tissue engineering technology has advanced rapidly in recent years, offering opportunities to construct biologically active tissues or organ substitutes to repair or even enhance the functions of diseased tissues and organs. Tissue-engineered scaffolds rebuild the extracellular microenvironment by mimicking the extracellular matrix. Fibrin-based scaffolds possess numerous advantages, including hemostasis, high biocompatibility, and good degradability. Fibrin scaffolds provide an initial matrix that facilitates cell migration, differentiation, proliferation, and adhesion, and also play a critical role in cell-matrix interactions. Fibrin scaffolds are now widely recognized as a key component in tissue engineering, where they can facilitate tissue and organ defect repair. This review introduces the properties of fibrin, including its composition, structure, and biology. In addition, the modification and cross-linking modes of fibrin are discussed, along with various forms commonly used in tissue engineering. We also describe the biofunctionalization of fibrin. This review provides a detailed overview of the use and applications of fibrin in skin, bone, and nervous tissues, and provides novel insights into future research directions for clinical treatment.

Intraoperative cell salvage technique in patients undergoing complex endovascular aortic repair.

Complex endovascular aortic repair (EVAR) requires the use of multiple small sheath cannulation inside a large sheath. Because the large sheath is not designed for multiple small sheath cannulation, large amounts of blood loss can be encountered in complex EVARs. Cell Saver can be used effectively in complex EVARs using a modified draping technique, allowing for increased cell salvage and autogenous transfusions as needed.

Mechanism of Zuogui pill enhancing ovarian function and skin elastic repair in premature aging rats based on artificial intelligence medical image analysis.

BACKGROUND: AI medical image analysis shows potential applications in research on premature aging and skin. The purpose of this study was to explore the mechanism of the Zuogui pill based on artificial intelligence medical image analysis on ovarian function enhancement and skin elasticity repair in rats with premature aging. MATERIALS AND METHODS: The premature aging rat model was established by using an experimental animal model. Then Zuogui pills were injected into the rats with premature aging, and the images were detected by an optical microscope. Then, through the analysis of artificial intelligence medical images, the image data is analyzed to evaluate the indicators of ovarian function. RESULTS: Through optical microscope image detection, we observed that the Zuogui pill played an active role in repairing ovarian tissue structure and increasing the number of follicles in mice, and Zuogui pill also significantly increased the level of progesterone in the blood of mice. CONCLUSION: Most of the ZGP-induced outcomes are significantly dose-dependent.

Indications and Evolution of the Butterfly Graft in Nasal Valve Repair.

Persistent nasal airway obstruction from inadequately addressed nasal valve compromise is common. Many techniques exist to perform nasal valve repair. Historically, spreader grafts are the most commonly used, despite a relative lack of evidence demonstrating its superiority over other methods. The butterfly graft is an alternative method of nasal valve repair and detailed surgical description from over 20 years of innovation follows in this section. There is growing evidence to suggest that the butterfly graft may be superior to spreader grafts with similar acceptability of the esthetic outcomes.

Advanced glycation end products impair the repair of injured tendon: a study in rats.

BACKGROUND: The AGEs levels in tissues of diabetics and elderly tend to be higher than in normal individuals. This study aims to determine the effects of AGEs on Achilles tendon repair. MATERIALS AND METHODS: Thirty-six male eight-week-old Sprague Dawley rats were selected in this study. The rats were randomly divided into two experimental groups and a control group after the transection of the Achilles tendon. During the tendon repair, the experimental groups were injected around the Achilles tendon with 350mmol/L (low dose group) and 1000mmol/L (high dose group) D-ribose 0.2 ml respectively to increase the AGEs level, while in the control group were given the same amount of PBS. The injections were given twice a week for six weeks. Collagen-I, TNF-α, and IL-6 expression in the healed Achilles tendon was assessed. Additionally, macroscopic, pathological, and biomechanical evaluations of Achilles tendon repair were conducted. RESULTS: The repaired Achilles tendons in the high dose group showed severe swelling and distinctive adhesions. The histological score went up with the increase of the AGEs in the Achilles tendon (p<0.001). TNF- α and IL-6 in the Achilles tendon increased (p<0.001, p<0.001), and the production of collagen-I decreased with the accumulation of AGEs in the repaired Achilles tendon (p<0.001). The tensile strength of Achilles tendon in the high dose group was impaired significantly. CONCLUSION: In current study, the compromised tendon repair model induced by AGEs was successfully established in rat. The study demonstrated that AGEs significantly impair Achilles tendon repair.

Tyrosyl-DNA phosphodiesterase 2 (Tdp2) repairs DNA-protein crosslinks and protects against double strand breaks in vivo.

DNA-protein crosslinks pose a significant challenge to genome stability and cell viability. Efficient repair of DPCs is crucial for preserving genomic integrity and preventing the accumulation of DNA damage. Despite recent advances in our understanding of DPC repair, many aspects of this process, especially at the organismal level, remain elusive. In this study, we used zebrafish as a model organism to investigate the role of TDP2 (Tyrosyl-DNA phosphodiesterase 2) in DPC repair. We characterized the two tdp2 orthologs in zebrafish using phylogenetic, syntenic and expression analysis and investigated the phenotypic consequences of tdp2 silencing in zebrafish embryos. We then quantified the effects of tdp2a and tdp2b silencing on cellular DPC levels and DSB accumulation in zebrafish embryos. Our findings revealed that tdp2b is the main ortholog during embryonic development, while both orthologs are ubiquitously present in adult tissues. Notably, the tdp2b ortholog is phylogenetically closer to human TDP2. Silencing of tdp2b, but not tdp2a, resulted in the loss of Tdp2 activity in zebrafish embryos, accompanied by the accumulation of DPCs and DSBs. Our findings contribute to a more comprehensive understanding of DPC repair at the organismal level and underscore the significance of TDP2 in maintaining genome stability.

Bicuspid Aortic Valve, from the Unknown till the Perfection of the Species.

The bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality. Though most often isolated, BAV may be associated with other cardiovascular malformations. BAV-related aortopathy is the most common, sharing genetic alterations and phenotypic heterogeneity characteristics. Sometimes silent for a lifetime, BAV may manifest as aortic valve dysfunction, aortic aneurysm, or more emergent situations, such as endocarditis or aortic dissection. Its embryological origin and the characterization of the genes involved, as well as the histopathological and hemodynamic aspects of its natural history, are becoming increasingly clear. In addition, emerging evidence of rhythm disorders associated with BAV has been identified. A new international nomenclature and classification has been introduced to interpret all the advances made in recent years for the comprehension of this condition. In the guidelines, more attention has been paid to the diagnosis of BAV and related aortopathy, together with surveillance, and family screening. Surgical treatment remains the gold standard, especially in young low-risk patients, and valve repair techniques have been shown to be effective and durable. Finally, the new era of transcatheter techniques is also being applied to dysfunctional BAV, allowing the treatment of patients at high surgical risk, with increasingly promising results, and the possibility of expanding indications through the introduction of more advanced devices. This review aims to comprehensively describe the BAV conundrum, focusing on anatomy, pathophysiology, genetics, diagnosis of BAV-related disorders, and the different treatment options available in the transcatheter era.

Papillary Muscle Maneuvers: Pathophysiology-based Approach in Secondary Mitral Regurgitation.

The treatment of secondary mitral regurgitation (SMR) remains challenging despite the implementation of modern heart failure medication and established catheter-based techniques. Only a subgroup of SMR patients benefit from mitral valve (MV) intervention, and the long-term prognostic benefit of different therapeutic approaches in SMR remains controversial. A literature search was conducted through PubMed and Embase databases to identify relevant studies addressing the pathophysiological background for papillary muscle maneuvers in SMR and currently available surgical techniques. Furthermore, the studies evaluating patients' selection criteria for papillary muscle maneuvers were specifically considered. Articles were selected based on quality and relevance. Over the last two decades, papillary muscle maneuvers have evolved as a pathophysiology-based treatment strategy to address left ventricular (LV) remodeling in SMR. In particular, patients with severe leaflet tenting and moderate heart failure phenotype seem to benefit most from papillary muscle maneuvers that improve LV geometry and thereby the durability of MV repair. We conclude that papillary muscle maneuvers are an evolving pathophysiology-based treatment strategy of ventricular SMR which target papillary muscle displacement due to LV remodeling.

C286, an orally available retinoic acid receptor ß agonist drug, regulates multiple pathways to achieve spinal cord injury repair.

Retinoic acid receptor ß2 (RARß2) is an emerging therapeutic target for spinal cord injuries (SCIs) with a unique multimodal regenerative effect. We have developed a first-in-class RARß agonist drug, C286, that modulates neuron-glial pathways to induce functional recovery in a rodent model of sensory root avulsion. Here, using genome-wide and pathway enrichment analysis of avulsed rats' spinal cords, we show that C286 also influences the extracellular milieu (ECM). Protein expression studies showed that C286 upregulates tenascin-C, integrin-α9, and osteopontin in the injured cord. Similarly, C286 remodulates these ECM molecules, hampers inflammation and prevents tissue loss in a rodent model of spinal cord contusion C286. We further demonstrate C286's efficacy in human iPSC-derived neurons, with treatment resulting in a significant increase in neurite outgrowth. Additionally, we identify a putative efficacy biomarker, S100B, which plasma levels correlated with axonal regeneration in nerve-injured rats. We also found that other clinically available retinoids, that are not RARß specific agonists, did not lead to functional recovery in avulsed rats, demonstrating the requirement for RARß specific pathways in regeneration. In a Phase 1 trial, the single ascending dose (SAD) cohorts showed increases in expression of RARß2 in white blood cells correlative to increased doses and at the highest dose administered, the pharmacokinetics were similar to the rat proof of concept (POC) studies. Collectively, our data suggests that C286 signalling in neurite/axonal outgrowth is conserved between species and across nerve injuries. This warrants further clinical testing of C286 to ascertain POC in a broad spectrum of neurodegenerative conditions.

First-in-Man Use of Intraoperative Electrophysiological Mapping to Evaluate the Efficacy of the EnCompass Clamp During a Cox-IV Maze Procedure.

This case report describes the first-in-man use of intraoperative electrophysiological (EP) mapping to evaluate the efficacy of the EnCompass clamp (AtriCure, Inc., Mason, OH) during a Cox-IV Maze procedure. A 53-year-old male with paroxysmal atrial fibrillation and severe mitral valve regurgitation underwent mitral valve repair with concomitant surgical ablation for atrial fibrillation. Intraoperative 3D EP mapping was performed using the Abbott EnSite Precision system (Abbott Inc., Chicago, IL) before ablation, after initial radiofrequency ablation with the AtriCure EnCompass clamp, and after the full Cox-IV Maze procedure was completed. The pre-ablation map showed approximately 80-85% high voltage areas in the posterior left atrial wall. Initial ablation with the EnCompass clamp reduced high voltage areas to 30-35%. The final map following the Cox-IV Maze procedure demonstrated near-complete electrical silence, with only 5-10% of the atrial surface retaining high voltage activity. This represents an estimated 88% reduction in high-voltage areas from baseline. The patient had an uncomplicated postoperative course apart from one episode of postoperative atrial fibrillation requiring direct current (DC) cardioversion. This case demonstrates the utility of intraoperative EP mapping in guiding and confirming the efficacy of surgical ablation procedures, as well as the effectiveness of combining the EnCompass clamp with a full Cox-IV Maze in achieving comprehensive atrial electrical isolation. The EnCompass clamp can be used for ablations with a beating heart, thus reducing the aortic cross-clamp time and therefore minimizing the total myocardial ischemia time.

Glioma oncogenesis in the Constitutional mismatch repair deficiency (CMMRD) syndrome.

Background: Constitutional mismatch repair deficiency (CMMRD) is a cancer predisposition due to biallelic mutations in one of the mismatch repair (MMR) genes associated with early onset of cancers, especially high-grade gliomas. Our aim was to decipher the molecular specificities of these gliomas. Methods: Clinical, histopathological, and whole exome sequencing data were analyzed in 12 children with genetically proven CMMRD and a high-grade glioma. Results: PDL1 expression was present in immunohistochemistry in 50% of the samples. In 9 patients, the glioma harbored an ultra-hypermutated phenotype (104-635 coding single nucleotide variants (SNV) per Mb, median 204). Driver mutations in POLE and POLD1 exonuclease domains were described for 8 and 1 patients respectively and were always present in the mutation burst with the highest variant allele frequency (VAF). The mutational signatures were dominated by MMR-related ones and similar in the different mutation bursts of a same patient without subsequent enrichment of the mutation signatures with POL-driven ones. Median number of coding SNV with VAF above one of the driving polymerase mutation per Mb was 57 (17-191). Our findings suggest that somatic polymerase alterations does not entirely explain the ultra-hypermutant phenotype. SETD2, TP53, NF1, EPHB2, PRKDC, and DICER1 genes were frequently mutated with higher VAF than the deleterious somatic polymerase mutation. Conclusions: CMMRD-associated gliomas have a specific oncogenesis that does not involve usual pathways and mutations seen in sporadic pediatric or adult glioblastomas. Frequent alterations in other pathways such as MAPK may suggest the use of other targeted therapies along with PD1 inhibitors.

ATR inhibition radiosensitizes cells through augmented DNA Damage and G2 cell cycle arrest abrogation.

Ataxia telangiectasia and Rad3-related protein (ATR) is a key DNA damage response protein that facilitates DNA damage repair and regulates cell cycle progression. As such, ATR is an important component of the cellular response to radiation, particularly in cancer cells which show altered DNA damage response and aberrant cell cycle checkpoints. Therefore, ATR's pharmacological inhibition could be an effective radiosensitization strategy to improve radiotherapy. We assessed the ability of an ATR inhibitor, AZD6738, to sensitize cancer cell lines of various histologic types to photon and proton radiotherapy. We found that radiosensitization took place through persistent DNA damage and abrogated G2 cell cycle arrest. We also found that AZD6738 increased the number of micronuclei after exposure to radiotherapy. We found that combining radiation with AZD6738 led to tumor growth delay and prolonged survival relative to radiation alone in a breast cancer model. Combining AZD6738 with photons or protons also led to increased macrophage infiltration at the tumor microenvironment. These results provide a rationale for further investigation of ATR inhibition in combination with radiotherapy and with other agents such as immune checkpoint blockade.

Structure, function and evolution of the HerA subfamily proteins.

HerA is an ATP-dependent translocase that is widely distributed in archaea and some bacteria. It belongs to the HerA/FtsK translocase bacterial family, which is a subdivision of the RecA family. Currently, it is identified that HerA participates in the repair of DNA double-strand breaks (DSBs) or confers anti-phage defense by assembling other proteins into large complexes. In recent years, there has been a growing understanding of the bioinformatics, biochemistry, structure, and function of HerA subfamily members in both archaea and bacteria. This comprehensive review compares the structural disparities among diverse HerAs and elucidates their respective roles in specific life processes.

Tolerating DNA damage by repriming: Gap filling in the spotlight.

Timely and accurate DNA replication is critical for safeguarding genome integrity and ensuring cell viability. Yet, this process is challenged by DNA damage blocking the progression of the replication machinery. To counteract replication fork stalling, evolutionary conserved DNA damage tolerance (DDT) mechanisms promote DNA damage bypass and fork movement. One of these mechanisms involves "skipping" DNA damage through repriming downstream of the lesion, leaving single-stranded DNA (ssDNA) gaps behind the advancing forks (also known as post-replicative gaps). In vertebrates, repriming in damaged leading templates is proposed to be mainly promoted by the primase and polymerase PRIMPOL. In this review, we discuss recent advances towards our understanding of the physiological and pathological conditions leading to repriming activation in human models, revealing a regulatory network of PRIMPOL activity. Upon repriming by PRIMPOL, post-replicative gaps formed can be filled-in by the DDT mechanisms translesion synthesis and template switching. We discuss novel findings on how these mechanisms are regulated and coordinated in time to promote gap filling. Finally, we discuss how defective gap filling and aberrant gap expansion by nucleases underlie the cytotoxicity associated with post-replicative gap accumulation. Our increasing knowledge of this repriming mechanism - from gap formation to gap filling - is revealing that targeting the last step of this pathway is a promising approach to exploit post-replicative gaps in anti-cancer therapeutic strategies.

Biomechanical evaluation of the effect of arthroscopic suture passing instruments on the posterior meniscal root.

BACKGROUND: The study aimed to biomechanically evaluate the effect of arthroscopic suture passing instruments used in the treatment of meniscal root tears on the meniscal suture interface in the root region. METHODS: A total of 40 intact lateral menisci, obtained during total knee arthroplasty, were procured for the purpose of conducting a biomechanical study. The menisci were randomly assigned to one of two distinct test groups: Group 1 using the Accu-Pass Suture Shuttle (cannulated) and Group 2 using the First-pass Mini Suture Passer (non-cannulated), with each group consisting of n = 20 samples. Maximum failure load, stiffness, and displacement values were obtained using a uniaxial universal tensile testing machine. RESULTS: When the groups were compared in terms of average maximum failure load (Group 1: 152.5N ± 50.7, Group 2: 162.5N ± 54.4), no statistically significant difference was observed (P = 0.549). At the moment of maximum failure load, the displacement values of both groups were similar (P = 0.502). In the comparison conducted for both groups in terms of preconditioning and postconditioning stiffness, no significant difference was detected between groups (P-values were 0.252 and 0.210, respectively). CONCLUSION: In our study, the tissue laceration size created by suture passers at the meniscus-suture interface within the root region was indirectly tested based on the influence of tensile forces. Both suture passers (cannulated and non-cannulated) are similar in terms of maximum failure load, stiffness, and displacement amounts. This study indicates that there is no difference between suture passers for root tears and supports the usability of both methods during surgery.

Volume Measurements for Surveillance after Endovascular Aneurysm Repair using Artificial Intelligence.

OBJECTIVE: Surveillance after endovascular aneurysm repair (EVAR) is suboptimal due to limited compliance and relatively large variability in measurement methods of abdominal aortic aneurysm (AAA) sac size after treatment. Measuring volume offers a more sensitive early indicator of aneurysm sac growth or regression/stability, but is more time consuming and thus less practical than measuring maximum diameter. This study evaluated the accuracy and consistency of the artificial intelligence (AI) driven software PRAEVAorta 2 and compared it with an established semi-automated segmentation method. METHODS: Post-EVAR aneurysm sac volumes measured by AI were compared with a semi-automated segmentation method (3mensio software) in patients with infrarenal AAA, focusing on absolute aneurysm volume and volume evolution over time. The clinical impact of both methods was evaluated by categorising patients as showing either AAA sac regression, stabilisation, or growth comparing the 30 day and one year post-EVAR computed tomography angiography (CTA) images. Intermethod and intramethod agreement were assessed using Bland-Altman analysis, the intraclass correlation coefficient (ICC) and Cohen's κ statistic. RESULTS: Forty nine patients (98 CTA images) were analysed, after excluding 15 patients due to segmentation errors by AI owing to low quality CT scans. Aneurysm sac volume measurements showed excellent correlation (ICC = 0.94, 95% confidence interval [CI] 0.88 - 0.99) with good to excellent correlation for volume evolution over time (ICC = 0.85, 95% CI 0.75 - 0.91). Categorisation of AAA sac evolution showed fair correlation (Cohen's κ = 0.33), with 12 discrepancies (24%) between methods. The intramethod agreement for the AI software demonstrated perfect consistency (bias = -0.01 cc), indicating that it is more reliable compared with the semi-automated method. CONCLUSION: Despite some differences in AAA sac volume measurements, the highly consistent AI driven software accurately measured AAA sac volume evolution. AAA sac evolution classification appears to be more reliable than existing methods and may therefore improve risk stratification post-EVAR. It could facilitate AI driven personalised surveillance programmes. While high quality CTA images are crucial, considering radiation exposure is important, validating the software with non-contrast CT scans might reduce the radiation burden.

Factors Associated with and Outcomes of Respiratory Adverse Events Following Thoracic Endovascular Aortic Repair.

OBJECTIVE: Respiratory adverse events (RAEs) after thoracic endovascular aortic repair (TEVAR) remain poorly characterized due to the lack of comprehensive studies that identify individuals prone to these complications. This study aims to determine the incidence, factors associated with, and outcomes of RAEs after TEVAR. METHODS: We identified Vascular Quality Initiative patients undergoing TEVAR isolated to zones 0-5 from 2010 to 2023 for non-traumatic pathologies. After determining the incidence of post-operative RAEs, we assessed baseline characteristics, pathology, procedural details, and postoperative complications stratified by respiratory complication status: none, pneumonia only, reintubation only, or both. We then examined pre- and intra-operative variables independently associated with the development of postoperative RAEs using multivariable modified Poisson regression. Kaplan-Meier analysis and Cox proportional hazards regression model were used to determine associations between postoperative RAEs and 5-year survival adjusting for preoperative variables and other non-respiratory post-operative complications in a separate model. RESULTS: Of 10,708 patients, 8.3% had any RAE (pneumonia only: 2.1%, reintubation only: 4.8%, both: 1.4%). Patients with any RAE were more likely to present with aortic dissection (any respiratory complication: 46% vs no respiratory complication: 35%; p<.001), and be symptomatic (58% vs 48%;p<.001). Developing RAEs post-TEVAR was associated with male sex (aRR: 1.19 [95% CI: 1.01-1.41]; p=0.037), obesity (1.31[1.07-1.61]; p=0.009), morbid obesity (1.68[1.20-2.32]; p=0.002), renal dysfunction (eGFR 30-45: 1.45[1.15-1.82]; p=0.002; eGFR <30/hemodialysis: 1.7[1.37-2.11]; p<0.001), anemia (1.31[1.09-1.58]; p=0.003), aortic diameter >65mm (1.54[1.25-1.89]; p<0.001), proximal disease in the aortic arch (1.23[1.03-1.48]; p=0.025) or ascending aorta (1.61[1.19-2.14]; p=0.002), acute aortic dissection (2.13[1.72-2.63]; p<0.001), ruptured presentation (3.07[2.43-3.87]; p<0.001), same-day surgical thoracic branch treatment (1.51[1.25-1.82]; p<0.001), COPD on home oxygen (1.58[1.08-2.25]; p=0.014), limited self-care or bed-bound status (2.12[1.45-3.03]; p<0.001), and intraoperative transfusion (1.88[1.47-2.40]; p<0.001). Patients who developed post-operative RAEs had higher 30-day mortality (27% vs 4%; p<.001) and 5-year mortality than patients without respiratory complications (46% vs 20%; p<0.001). After adjusting for pre-operative and post-operative variables, 5-year mortality was higher in patients who developed any post-operative RAE (aHR: 1.8[1.6, 2.1]; p<.001), post-operative pneumonia only (1.4[1.0, 1.8];p=.046), reintubation only (2.2[1.8, 2.6]; p<.001) or both (1.5[1.1, 2.0]; p=.008). CONCLUSIONS: RAEs after TEVAR are common, more likely to occur in male patients with obesity, renal dysfunction, anemia, COPD on home oxygen, acute aortic dissection, ruptured presentation, same-day surgical thoracic branch treatment, who received intra-operative transfusion, and are associated with a two-fold increase in 5-year mortality regardless of the development of other post-operative complications. Considering these factors in assessing risks and benefits of TEVAR procedures, along with implementing customized post-operative care, can potentially improve clinical outcomes.

Factors Associated with Nonhome Discharge After Endovascular Aneurysm Repair.

OBJECTIVE: This study aims to identify preoperative factors associated with non-home discharge (NHD) after endovascular aneurysm repair (EVAR). NHD has implications for patient care, readmission, and long-term mortality; nevertheless, existing literature lacks information regarding factors associated with NHD for patients undergoing EVAR. In contrast, our study assesses preoperative factors associated with NHD for this population by utilizing national data from the Vascular Quality Initiative (VQI). METHODS: We identified adult patients who underwent elective EVAR in the VQI (2003-2022) and excluded those who were not living at home preoperatively. Multivariable logistic regression was used to identify preoperative factors associated with NHD. Kaplan-Meier methods and Cox-regression analyses were used to assess the impact of NHD on 5-year survival as a secondary outcome. RESULTS: 61,792 patients were included, of which 3,155 (5.1%) had NHD. NHD patients were more likely to be older (79 [73-18] years vs. 73[67-79] years), female (33.7% vs. 18.2%; P<.001), non-white (16.0% vs. 11.7%; P<.001) and have more comorbidities. NHD patients had higher rates of postoperative complications (acute kidney injury: 11.9% vs. 2.0%; P<.001, myocardial infarction: 3.8% vs. 0.5%; P<.001, and in-hospital reintervention: 4.7% vs. 0.5%; P=.033). Multivariable analysis revealed many preoperative characteristics were associated with higher odds of NHD: most notably, age (per additional decade: OR=2.15, 95% CI:2.03-2.28; P<.001), female sex (OR=1.79, 95% CI:1.63-1.95; P<.001) and aneurysm diameter >65mm (OR=2.18, 95% CI:1.98-2.39; P<.001), along with potentially modifiable factors including: anemia, COPD, CHF, weight, and diabetes. In contrast, aspirin, statin, and ACE-inhibitor/ARB usage were associated with lower odds of NHD. NHD was associated with higher hazards of 5-year mortality, even after adjusting for confounders (40% vs. 14%, aHR=2.13, 95% CI:1.86-2.44; P<.001). CONCLUSIONS: Several factors were associated with higher odds of NHD following elective EVAR, including non-modifiable factors such as female sex and larger aortic diameter, and potentially modifiable factors such as anemia, COPD, CHF, BMI, and diabetes. Special attention should be given to populations with non-modifiable factors, and efforts at optimizing medical conditions with higher NHD likelihood seems appropriate to improve patient outcomes and quality of life after EVAR.

Advances in Mussel Adhesion Proteins and Mussel-Inspired Material Electrospun Nanofibers for Their Application in Wound Repair.

Mussel refers to a marine organism with strong adhesive properties, and it secretes mussel adhesion protein (MAP). The most vital feature of MAP is the abundance of the 3,4-dihydroxyphenylalanine (DOPA) group and lysine, which have antimicrobial, anti-inflammatory, antioxidant, and cell adhesion-promoting properties and can accelerate wound healing. Polydopamine (PDA) is currently the most widely used mussel-inspired material characterized by good adhesion, biocompatibility, and biodegradability. It can mediate various interactions to form functional coatings on cell-material surfaces. Nanofibers based on MAP and mussel-inspired materials have been exerting a vital role in wound repair, while there is no comprehensive review presenting them. This Review introduces the structure of MAPs and their adhesion mechanisms and mussel-inspired materials. Second, it introduces the functionalized modification of MAPs and their inspired materials in electrospun nanofibers and application in wound repair. Finally, the future development direction and coping strategies of MAP and mussel-inspired materials are discussed. Moreover, this Review can offer novel strategies for the application of nanofibers in wound repair and bring about new breakthroughs and innovations in tissue engineering and regenerative medicine.