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Yang HQ, Li ZW, Dong XX, Zhang JX, Shan J, Wang MJ, Yang J, Li MH, Wang J, Zhao HM. Vinpocetine alleviates the abdominal aortic aneurysm progression via VSMCs SIRT1-p21 signaling pathway. Acta Pharmacol Sin 2024:10.1038/s41401-024-01358-w. [PMID: 39179867 DOI: 10.1038/s41401-024-01358-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/10/2024] [Indexed: 08/26/2024] Open
Abstract
Abdominal aortic aneurysm (AAA) is a degenerative disease that caused mortality in people aged >65. Senescence plays a critical role in AAA pathogenesis. Advances in AAA repair techniques have occurred, but a remaining priority is therapies to limit AAA growth and rupture. Our Previous study found cyclic nucleotide phosphodiesterase 1C (PDE1C) exacerbate AAA through aggravate vascular smooth muscle cells (VSMCs) senescence by downregulating Sirtuin1 (SIRT1) expression and activity. Vinpocetine as a selective inhibitor of PDE1 and a clinical medication for cerebral vasodilation, it is unclear whether vinpocetine can rely on SIRT1 to alleviate AAA. This study showed that pre-treatment with vinpocetine remarkably prevented aneurysmal dilation and reduced aortic rupture in elastase-induced AAA mice. In addition, the elastin degradation, MMP (matrix metalloproteinase) activity, macrophage infiltration, ROS production, collagen fibers remodeling, and VSMCs senescence were decreased in AAA treated with vinpocetine. While these effects were unable to exert in VSMCs-specific SIRT1 knockout AAA mice. Accordingly, we revealed that vinpocetine suppressed migration, proliferation, and senescence in VSMCs. Moreover, vinpocetine reduced SIRT1 degradation by inhibiting lysosome-mediated autophagy. In conclusion, this study indicated that vinpocetine may be as a potential drug for therapy AAA through alleviate VSMCs senescence via the SIRT1-dependent pathway.
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Affiliation(s)
- Hong-Qin Yang
- Baotou Medical College, Baotou, 014040, Inner Mongolia Autonomous Region, China
- State Key Laboratory of Complex, Severe, and Rare Diseases, Department of Pathophysiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100005, China
| | - Zhi-Wei Li
- State Key Laboratory of Complex, Severe, and Rare Diseases, Department of Pathophysiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100005, China
| | - Xi-Xi Dong
- State Key Laboratory of Complex, Severe, and Rare Diseases, Department of Pathophysiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100005, China
| | - Jia-Xin Zhang
- State Key Laboratory of Complex, Severe, and Rare Diseases, Department of Pathophysiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100005, China
| | - Jin Shan
- State Key Laboratory of Complex, Severe, and Rare Diseases, Department of Pathophysiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100005, China
| | - Min-Jie Wang
- Medical Experimental Center, School of Basic Medical Sciences, Inner Mongolia Medical University, Chilechuan dairy economic development zone, Hohhot, Inner Mongolia Autonomous Region, Hohhot, 010110, China
| | - Jing Yang
- Baotou Medical College, Baotou, 014040, Inner Mongolia Autonomous Region, China.
| | - Min-Hui Li
- Baotou Medical College, Baotou, 014040, Inner Mongolia Autonomous Region, China.
| | - Jing Wang
- State Key laboratory of Respiratory Health and Multimorbidity, Department of Pathophysiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China.
| | - Hong-Mei Zhao
- State Key Laboratory of Complex, Severe, and Rare Diseases, Department of Pathophysiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100005, China.
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López-Téllez A, Ramírez Torres JM, Pérez Vázquez E, Babiano Fernández MÁ, López-Martí H, Zapata Martínez I, Trillo Fernández C, Frías Vargas M, Domínguez Pinos MD, Peiró Morant JF, González-Fajardo JA, Valdivielso Felices P. Ultrasound screening for abdominal aortic aneurysm in primary care. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024; 36:218-226. [PMID: 38350793 DOI: 10.1016/j.arteri.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) constitutes a pathology with high mortality. There is currently no screening program implemented in primary care in Spain. OBJECTIVES To evaluate the usefulness of ultrasound in the detection of AAA in the at-risk population in primary care. Secondarily, to identify subjects whose vascular risk (VR) should be reclassified and to determine whether AAA is associated with the presence of carotid plaque and other risk factors. MATERIAL AND METHODS Cross-sectional, descriptive, multicenter, national, descriptive study in primary care. SUBJECTS A consecutive selection of hypertensive males aged between 65 and 75 who are either smokers or former smokers, or individuals over the age of 50 of both sexes with a family history of AAA. MEASUREMENTS Diameter of abdominal aorta and iliac arteries; detection of abdominal aortic and carotid atherosclerotic plaque. VR was calculated at the beginning and after testing (SCORE). RESULTS One hundred and fifty patients were analyzed (age: 68.3±5 years; 89.3% male). Baseline RV was high/very high in 55.3%. AAA was detected in 12 patients (8%; 95% CI: 4-12); aortic ectasia in 13 (8.7%); abdominal aortic plaque in 44% and carotid plaque in 62% of the participants. VR was reclassified in 50% of subjects. The detection of AAA or ectasia was associated with the presence of carotid plaque, current smoking and lipoprotein(a), p<0.01. CONCLUSIONS The prevalence of AAA in patients with VR is high. Ultrasound in primary care allows detection of AAA and subclinical atherosclerosis and consequently reclassification of the VR, demonstrating its utility in screening for AAA in the at-risk population.
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Affiliation(s)
| | | | | | | | | | | | | | - Manuel Frías Vargas
- Centro de Salud San Andrés, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Funamizu Y, Goto H, Oda A, Miki T, Saijo Y. Opportunistic Ultrasound Screening for Abdominal Aortic Aneurysm. Ann Vasc Dis 2024; 17:157-163. [PMID: 38919325 PMCID: PMC11196171 DOI: 10.3400/avd.oa.23-00110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/06/2024] [Indexed: 06/27/2024] Open
Abstract
Objective: In patients with abdominal aortic aneurysm (AAA), early detection and optimal elective treatment before rupture are desirable. In the absence of an established public screening system, opportunistic screening during ultrasound examination for another purpose might be efficacious. The aim of this study was to evaluate the efficacy of opportunistic screening for AAA. Methods: This prospective multicenter observational study enrolled patients who were scheduled to undergo ultrasound for reasons other than AAA. After the ultrasound for the original purpose, evaluation of the abdominal aorta was added. If the abdominal aorta was clear enough for measurement, its diameter and shape were recorded. Furthermore, information on comorbidities was collected for each patient. Results: A total of 10325 patients (echocardiography: 6150; abdominal ultrasound: 4162) from 16 institutions were enrolled. The abdominal aorta was well visualized in 92.9% of patients who underwent echocardiography. Among 9791 patients, AAA was diagnosed in 122 (1.3%) (107 fusiform and 15 saccular), with a diameter range of 30-63 mm. The diagnostic rate increased with age. On multivariate analysis, older age, male sex, coronary artery disease, peripheral arterial disease, and smoking habituation were the risk factors for AAA. Conclusion: Opportunistic screening for AAA was efficacious.
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Affiliation(s)
- Yasuharu Funamizu
- Clinical Physiology Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hitoshi Goto
- Department of Vascular Surgery, South Miyagi Medical Center, Ogawara, Miyagi, Japan
| | - Ayaka Oda
- Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Takashi Miki
- Clinical Physiology Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Yoshifumi Saijo
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
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Summers KL, Kerut EK, To F, Sheahan CM, Sheahan MG. Machine learning-based prediction of abdominal aortic aneurysms for individualized patient care. J Vasc Surg 2024; 79:1057-1067.e2. [PMID: 38185212 DOI: 10.1016/j.jvs.2023.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The United States Preventative Services Task Force guidelines for screening for abdominal aortic aneurysms (AAA) are broad and exclude many at risk groups. We analyzed a large AAA screening database to examine the utility of a novel machine learning (ML) model for predicting individual risk of AAA. METHODS We created a ML model to predict the presence of AAAs (>3 cm) from the database of a national nonprofit screening organization (AAAneurysm Outreach). Participants self-reported demographics and comorbidities. The model is a two-layered feed-forward shallow network. The ML model then generated AAA probability based on patient characteristics. We evaluated graphs to determine significant factors, and then compared those graphs with a traditional logistic regression model. RESULTS We analyzed a cohort of 10,033 patients with an AAA prevalence of 2.74%. Consistent with logistic regression analysis, the ML model identified the following predictors of AAA: Caucasian race, male gender, advancing age, and recent or past smoker with recent smoker having a more profound affect (P < .05). Interestingly, the ML model showed body mass index (BMI) was associated with likelihood of AAAs, especially for younger females. The ML model also identified a higher than predicted risk of AAA in several groups, including female nonsmokers with cardiac disease, female diabetics, those with a family history of AAA, and those with hypertension or hyperlipidemia at older ages. An elevated BMI conveyed a higher than expected risk in male smokers and all females. The ML model also identified a complex relationship of both diabetes mellitus and hyperlipidemia with gender. Family history of AAA was a more important risk factor in the ML model for both men and women too. CONCLUSIONS We successfully developed an ML model based on an AAA screening database that unveils a complex relationship between AAA prevalence and many risk factors, including BMI. The model also highlights the need to expand AAA screening efforts in women. Using ML models in the clinical setting has the potential to deliver precise, individualized screening recommendations.
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Affiliation(s)
- Kelli L Summers
- Division of Vascular Surgery, Department of Surgery, LSU Health Sciences Center, School of Medicine, New Orleans, LA.
| | - Edmund K Kerut
- Division of Cardiovascular Diseases, Department of Medicine, LSU Health Sciences Center, New Orleans, LA; Heart Clinic of Louisiana, Marrero, LA
| | - Filip To
- Department of Agricultural and Biological Engineering, Bagley College of Engineering, Mississippi State University, Mississippi State, MS
| | - Claudie M Sheahan
- Division of Vascular Surgery, Department of Surgery, LSU Health Sciences Center, School of Medicine, New Orleans, LA
| | - Malachi G Sheahan
- Division of Vascular Surgery, Department of Surgery, LSU Health Sciences Center, School of Medicine, New Orleans, LA
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Ren S, Guidoin R, Xu Z, Deng X, Fan Y, Chen Z, Sun A. Narrative Review of Risk Assessment of Abdominal Aortic Aneurysm Rupture Based on Biomechanics-Related Morphology. J Endovasc Ther 2024; 31:178-190. [PMID: 36052406 DOI: 10.1177/15266028221119309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
CLINICAL IMPACT Studies have shown that the biomechanical indicators based on multi-scale models are more effective in accurately assessing the rupture risk of AAA. To meet the need for clinical monitoring and rapid decision making, the typical morphological parameters associated with AAA rupture and their relationships with the mechanical environment have been summarized, which provide a reference for clinical preoperative risk assessment of AAA.
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Affiliation(s)
- Shuqi Ren
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Robert Guidoin
- Department of Surgery, Faculty of Medicine, Université Laval and CHU de Québec Research Centre, Quebec, QC, Canada
| | - Zaipin Xu
- College of Animal Science, Guizhou University, Guiyang, China
| | - Xiaoyan Deng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Zengsheng Chen
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Anqiang Sun
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Vervoort D, Hirode G, Lindsay TF, Tam DY, Kapila V, de Mestral C. One-time screening for abdominal aortic aneurysm in Ontario, Canada: a model-based cost-utility analysis. CMAJ 2024; 196:E112-E120. [PMID: 38316457 PMCID: PMC10843437 DOI: 10.1503/cmaj.230913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Screening programs for abdominal aortic aneurysm (AAA) are not available in Canada. We sought to determine the effectiveness and costutility of AAA screening in Ontario. METHODS We compared one-time ultrasonography-based AAA screening for people aged 65 years to no screening using a fully probabilistic Markov model with a lifetime horizon. We estimated life-years, quality-adjusted life-years (QALYs), AAA-related deaths, number needed to screen to prevent 1 AAA-related death and costs (in Canadian dollars) from the perspective of the Ontario Ministry of Health. We retrieved model inputs from literature, Statistics Canada, and the Ontario Case Costing Initiative. RESULTS Screening reduced AAA-related deaths by 84.9% among males and 81.0% among females. Compared with no screening, screening resulted in 0.04 (18.96 v. 18.92) additional life-years and 0.04 (14.95 v. 14.91) additional QALYs at an incremental cost of $80 per person among males. Among females, screening resulted in 0.02 (21.25 v. 21.23) additional life-years and 0.01 (16.20 v. 16.19) additional QALYs at an incremental cost of $11 per person. At a willingness-to-pay of $50 000 per year, screening was cost-effective in 84% (males) and 90% (females) of model iterations. Screening was increasingly cost-effective with higher AAA prevalence. INTERPRETATION Screening for AAA among people aged 65 years in Ontario was associated with fewer AAA-related deaths and favourable cost-effectiveness. To maximize QALY gains per dollar spent and AAA-related deaths prevented, AAA screening programs should be designed to ensure that populations with high prevalence of AAA participate.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation (Vervoort, Tam, de Mestral), Division of Cardiac Surgery (Vervoort, Tam) and Institute of Medical Science (Hirode), University of Toronto; Toronto Centre for Liver Disease (Hirode), Toronto General Hospital, University Health Network; Division of Vascular Surgery, Department of Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Kapila), William Osler Health System, Brampton, Ont.; Division of Vascular Surgery, Department of Surgery (de Mestral), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Grishma Hirode
- Institute of Health Policy, Management and Evaluation (Vervoort, Tam, de Mestral), Division of Cardiac Surgery (Vervoort, Tam) and Institute of Medical Science (Hirode), University of Toronto; Toronto Centre for Liver Disease (Hirode), Toronto General Hospital, University Health Network; Division of Vascular Surgery, Department of Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Kapila), William Osler Health System, Brampton, Ont.; Division of Vascular Surgery, Department of Surgery (de Mestral), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Thomas F Lindsay
- Institute of Health Policy, Management and Evaluation (Vervoort, Tam, de Mestral), Division of Cardiac Surgery (Vervoort, Tam) and Institute of Medical Science (Hirode), University of Toronto; Toronto Centre for Liver Disease (Hirode), Toronto General Hospital, University Health Network; Division of Vascular Surgery, Department of Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Kapila), William Osler Health System, Brampton, Ont.; Division of Vascular Surgery, Department of Surgery (de Mestral), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Derrick Y Tam
- Institute of Health Policy, Management and Evaluation (Vervoort, Tam, de Mestral), Division of Cardiac Surgery (Vervoort, Tam) and Institute of Medical Science (Hirode), University of Toronto; Toronto Centre for Liver Disease (Hirode), Toronto General Hospital, University Health Network; Division of Vascular Surgery, Department of Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Kapila), William Osler Health System, Brampton, Ont.; Division of Vascular Surgery, Department of Surgery (de Mestral), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Varun Kapila
- Institute of Health Policy, Management and Evaluation (Vervoort, Tam, de Mestral), Division of Cardiac Surgery (Vervoort, Tam) and Institute of Medical Science (Hirode), University of Toronto; Toronto Centre for Liver Disease (Hirode), Toronto General Hospital, University Health Network; Division of Vascular Surgery, Department of Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Kapila), William Osler Health System, Brampton, Ont.; Division of Vascular Surgery, Department of Surgery (de Mestral), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Charles de Mestral
- Institute of Health Policy, Management and Evaluation (Vervoort, Tam, de Mestral), Division of Cardiac Surgery (Vervoort, Tam) and Institute of Medical Science (Hirode), University of Toronto; Toronto Centre for Liver Disease (Hirode), Toronto General Hospital, University Health Network; Division of Vascular Surgery, Department of Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Kapila), William Osler Health System, Brampton, Ont.; Division of Vascular Surgery, Department of Surgery (de Mestral), St. Michael's Hospital, University of Toronto, Toronto, Ont.
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Thériault G. Réfutation des mythes entourant le dépistage. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:e216-e220. [PMID: 37963800 PMCID: PMC10645457 DOI: 10.46747/cfp.6911e216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Guylène Thériault
- Directrice du volet Rôle du médecin et directrice du Centre de pédagogie au Campus Outaouais de la Faculté de médecine de l’Université McGill à Montréal (Québec)
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8
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Thériault G. Debunking myths about screening: How to screen more judiciously. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:767-771. [PMID: 37963786 PMCID: PMC10645442 DOI: 10.46747/cfp.6911767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Guylène Thériault
- Academic Lead for the Physicianship Component and Director of Pedagogy at the Outaouais Medical Campus in the Faculty of Medicine at McGill University in Montréal, Que
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Cote CL, Jessula S, Kim Y, Cooper M, McDougall G, Casey P, Dua A, Lee MS, Smith M, Herman C. Trends in Incidence of Abdominal Aortic Aneurysm Rupture, Repair, and Mortality in Nova Scotia. Ann Vasc Surg 2023; 95:62-73. [PMID: 36509371 DOI: 10.1016/j.avsg.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The purpose of this study was to examine sex-based trends in incidence of elective abdominal aortic aneurysm (AAA), ruptured AAA, ruptured AAA repair, and AAA-related mortality. METHODS A retrospective analysis of patients presenting with AAA from 2005 to 2015 was conducted. Rates of elective AAA repair, ruptured AAA, ruptured AAA repair, and mortality were obtained from linking provincial administrative data using medical services insurance billing number. The age-adjusted incidence of elective AAA repair, overall rate of ruptured AAA, ruptured AAA repair, and AAA-related mortality was calculated for each sex based on Canadian census estimates, adjusted to the Canadian standard population. Weighted linear regression was performed to analyze trends in incidence over time. RESULTS One thousand nine hundred eighty-six elective AAA repairs were identified, of which 1,098 were repaired open and 898 underwent endovascular abdominal aneurysm repair (EVAR). Five hundred and seventy ruptured AAAs were identified, of which 295 (52%) were repaired: 259 open and 36 EVAR. The proportion of ruptured AAA that was repaired did not change over time (P = 0.54). The proportion repairs performed using EVAR increased significantly in both elective (P < 0.001) and rupture repairs (P < 0.001). During the study period, 662 patients died of AAA-associated mortality. The average incidence of elective AAA repair in men was 29.3 (95% confidence interval (CI): 27.8 to 30.8) per 100,000 and decreased over time (P = 0.04), whereas the average incidence in women was 9.2 [8.3 to 10.0] and stable (P = 0.07). The incidence of open elective AAA repair was 10.5 [9.9-11.1] with a decreasing trend over time (P < 0.001) and EVAR was 9.0 (8.5-9.6) with an increasing trend over time (P < 0.001). A decreasing trend of overall ruptured AAA (5.4 [5.0-5.9], P < 0.001), ruptured AAA repair (2.9 [2.5-3.2], P = 0.02), and of AAA-related mortality (6.2 [5.8-6.8], P < 0.001) was found, with consistent trends in both sexes. The incidence of open ruptured AAA repair decreased over time (P = 0.001) whereas the incidence of ruptured EVAR remained stable (P = 0.23). CONCLUSIONS The incidence of elective AAA repair is decreasing in males but not females, whereas the incidence of rupture has decreased in both sexes. This has translated into reduced incidence of AAA-related mortality. Increased adoption of EVAR for ruptured AAA should continue these trends.
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Affiliation(s)
- Claudia L Cote
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Canada.
| | - Samuel Jessula
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Young Kim
- Division of Vascular and Endovascular Surgery, Duke University, Durham, NC
| | - Matthew Cooper
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Garrett McDougall
- Department of Emergency Medicine, McMaster University, Hamilton, Canada
| | - Patrick Casey
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Min S Lee
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - Matthew Smith
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - Christine Herman
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Canada; Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
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11
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Lin YC, Chen QY, Xiao J, Shen LC, Li XT, Yang YZ, Guo PF, Lin MJ, Lin DC. Mouse Abdominal Aortic Aneurysm Model Induced by Periarterial Incubation of Papain. J Transl Med 2023; 103:100035. [PMID: 36925203 DOI: 10.1016/j.labinv.2022.100035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 01/11/2023] Open
Abstract
For decades, numerous experimental animal models have been developed to examine the pathophysiologic mechanisms and potential treatments for abdominal aortic aneurysms (AAAs) in diverse species with varying chemical or surgical approaches. This study aimed to create an AAA mouse model by the periarterial incubation with papain, which can mimic human AAA with advantages such as simplicity, convenience, and high efficiency. Eighty C57BL/6J male mice were randomly assigned to 1 of the 4 groups: papain (1.0 or 2.0 mg), porcine pancreatic elastase, and phosphate-buffered solution. The aortic segment was wrapped for 20 minutes, and the diameter was measured using ultrasound preoperatively and postoperative days 7 and 14. Then, the mice were killed for histomorphometric and immunohistochemical analyses. According to ultrasound measurements and histomorphometric analyses, on postoperative day 7, 65% of mice in the 1.0-mg papain group and 60% of mice in the 2.0-mg papain group developed AAA. In both papain groups, 100% of mice developed AAA, and 65% of mice in the porcine pancreatic elastase group developed AAA on postoperative day 14. Furthermore, hematoxylin/eosin, elastin van Gieson, and Masson staining of tissues from the papain group revealed thickened media and intimal hyperplasia, collagen sediments, and elastin destruction, indicating that AAA histochemical alteration was similar to that of humans. In addition, the immunohistochemical analysis was conducted to detect infiltrated inflammatory cells, such as macrophages and leukocytes, in the aortic wall and hyperplasic adventitia. The expression of matrix metalloproteinase 2 and 9 was significantly upregulated in papain and human AAA tissues. Periarterial incubation with 1.0 mg of papain for 20 minutes can successfully create an experimental AAA model in mice for 14 days, which can be used to explore the mechanism and treatment of human AAA.
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Affiliation(s)
- Yi-Chen Lin
- Department of Vascular Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China; Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China; The First School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Qin-Ye Chen
- Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Jie Xiao
- Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Li-Chuan Shen
- Department of Vascular Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China; The First School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Xian-Tao Li
- Department of Vascular Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China; The First School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Yu-Ze Yang
- The First School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Ping-Fan Guo
- Department of Vascular Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China; The First School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Mo-Jun Lin
- Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China.
| | - Da-Cen Lin
- Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China; Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China.
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12
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Sex and Gender Bias as a Mechanistic Determinant of Cardiovascular Disease Outcomes. Can J Cardiol 2022; 38:1865-1880. [PMID: 36116747 DOI: 10.1016/j.cjca.2022.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/21/2022] [Accepted: 09/11/2022] [Indexed: 12/14/2022] Open
Abstract
Defined as a prejudice either for or against something, biases at the provider, patient, and societal level all contribute to differences in cardiovascular disease recognition and treatment, resulting in outcome disparities between sexes and genders. Provider bias in the under-recognition of female-predominant cardiovascular disease and risks might result in underscreened and undertreated patients. Furthermore, therapies for female-predominant phenotypes including nonobstructive coronary artery disease and heart failure with preserved ejection fraction are less well researched, contributing to undertreated female patients. Conversely, women are less likely to seek urgent medical attention, potentially related to societal bias to put others first, which contributes to diagnostic delays. Furthermore, women are less likely to have discussions around risk factors for coronary artery disease compared with men, partially because they are less likely to consider themselves at risk for heart disease. Provider bias in interpreting a greater number of presenting symptoms, some of which have been labelled as "atypical," can lead to mislabelling presentations as noncardiovascular. Furthermore, providers might avoid discussions around certain therapies including thrombolysis for stroke, and cardiac resynchronization therapy in heart failure, because it is incorrectly assumed that women are not interested in pursuing options deemed more invasive. To mitigate bias, organizations should aim to increase the visibility and involvement of women in research, health promotion, and clinical and leadership endeavours. More research needs to be done to identify effective interventions to mitigate sex and gender bias and the resultant cardiovascular outcome discrepancies.
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13
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Olmstead C, Wakabayashi AT, Freeman TR, Cejic SS. Abdominal aortic aneurysm screening in an academic family practice: Short-term impact of guideline changes. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:899-904. [PMID: 36515055 PMCID: PMC9796976 DOI: 10.46747/cfp.6812899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate abdominal aortic aneurysm (AAA) screening rates in the 6 months before and after the introduction of updated Canadian Task Force on Preventive Health Care (CTFPHC) guidelines to determine effects on practice patterns, as well as to determine whether certain patient characteristics impact AAA screening rates. DESIGN Retrospective chart review. SETTING Academic family health centre in London, Ont. PARTICIPANTS Male patients between the ages of 65 and 80. MAIN OUTCOME MEASURES Screening rates for AAA before and after the guideline update were compared using the normal approximation of the binomial distribution. Analysis of demographic characteristic effects on screening rates was completed with the Fisher exact test. Number of visits to the clinic with a primary care provider within the study period and imaging type were collected. RESULTS Of the 266 patients included in the study, 160 patients were eligible for screening at the start of the study period, 6 months before publication of the CTFPHC AAA guideline. Individuals eligible for screening visited the clinic an average (SD) of 2.44 (1.82) times in the 6 months before and 2.66 (1.99) times in the 6 months after. Overall, 69 individuals had AAA screening completed and 9 had a discussion of AAA screening without any imaging, for a total uptake rate of 88.5% for those who had screening recommended. The overall imaging rate was 48.9%. There was no statistically significant difference in screening rates between the time periods (P=.337) among those eligible for screening. For demographic characteristics for risk stratification, 7 individuals had a documented family history, of whom 5 had imaging of their abdominal aorta performed, plus 1 additional individual who had screening recommended but not completed. This was not statistically significant relative to the total population (P=.0598). Positive smoking status (active or ex-smoker) was more common, with 135 individuals having a relevant smoking history. Approximately half of these current and former smokers (68 individuals [50.4%]) had any sort of abdominal aortic imaging performed or recommended, which was not statistically significantly different compared with non-smokers (62 of 126 imaging performed or recommended, 49.2%; P=.9016). CONCLUSION Screening practices did not change appreciably with the introduction of the CTFPHC AAA screening guidelines. Further research is needed to improve AAA screening rates. It is worth exploring electronic medical record-based reminders, nursing staff involvement in screening, screening programs via public health, and point-of-care ultrasound screening in a primary care setting.
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Affiliation(s)
- Craig Olmstead
- Adjunct Professor in the Department of Family Medicine at Western University in London, Ont.
| | | | - Thomas R Freeman
- Professor Emeritus in the Centre for Studies in Family Medicine in the Department of Family Medicine at Western University
| | - Sonny S Cejic
- Associate Professor in the Department of Family Medicine at Western University
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Abstract
ABSTRACT Point-of-care ultrasound (PoCUS) is a cost-effective diagnostic technology that, with training, is accessible, portable, and a convenient diagnostic modality to complement physical assessments. PoCUS is beneficial in that it can reduce the number of imaging tests required, while also mitigating barriers to healthcare for rural and remote communities.
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15
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Kapila V, Jetty P, Wooster D, Vucemilo V, Dubois L. Screening for abdominal aortic aneurysms in Canada: 2020 review and position statement of the Canadian Society for Vascular Surgery. Can J Surg 2021; 64:E461-E466. [PMID: 34467750 PMCID: PMC8526155 DOI: 10.1503/cjs.009120] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Abdominal aortic aneurysms (AAAs) remain a major risk to patients, despite level 1 evidence for screening to prevent rupture events and decrease mortality. In 2007, the Canadian Society for Vascular Surgery (CSVS) published a review and position statement for AAA screening in Canada. Since that publication, there have been a number of updates in the published literature affecting screening recommendations. In this paper, we present a review of some of the controversies in the AAA screening literature to help elucidate differences in the various published screening guidelines. This article represents a review of the data and updated recommendations for AAA screening in the Canadian population on behalf of the CSVS. Les anévrismes de l’aorte abdominale (AAA) continuent de poser un risque majeur pour les patients, malgré des données probantes de niveau 1 à l’appui du dépistage pour prévenir les ruptures et réduire la mortalité. En 2007, la Société canadienne de chirurgie vasculaire (SCCV) a publié une revue et un énoncé de position sur le dépistage de l’AAA au Canada. Depuis lors, plusieurs mises à jour ont paru dans la littérature et elles ont un impact sur les recommandations relatives au dépistage. Dans le présent article, nous présentons une synthèse de quelques controverses soulevées dans la littérature sur le dépistage de l’AAA afin d’expliquer les différences entre les diverses lignes directrices publiées à ce sujet. Cet article propose au nom de la SCCV une revue des données probantes et des recommandations à jour sur le dépistage de l’AAA dans la population canadienne.
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Affiliation(s)
- Varun Kapila
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Prasad Jetty
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Doug Wooster
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Vic Vucemilo
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Luc Dubois
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
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16
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Celebi OO, Celebi S, Berkalp B. Appraisal of transthoracic echocardiography for opportunistic screening of abdominal aortic aneurysm. Medicine (Baltimore) 2021; 100:e26171. [PMID: 34087879 PMCID: PMC8183806 DOI: 10.1097/md.0000000000026171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/04/2021] [Accepted: 05/13/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Abdominal aortic aneurysm is a life threatening disease. Most of the patients diagnosed incidentally because of the asymptomatic nature of this disease. This study aimed to determine the frequency of abdominal aortic aneurysm and evaluate the value of opportunistic screening during transthoracic echocardiography.A total of 5138 patients referred for echocardiographic evaluation for any reason were screened for abdominal aortic aneurysm between November 2014 to July 2019. The aneurysm was defined as an abdominal aorta with a diameter greater than 30 mm, or segmental dilatation of more than 50% of its size in non-dilated parts.The overall frequency of abdominal aortic aneurysm was 2.2% (n = 109) in the study population. Male sex (P < .001), older age (P < .001), presence of diastolic dysfunction (P = .036), hypertension (P < .001), coronary artery disease (P < .001), and hyperlipidemia (P < .001) were associated with abdominal aortic aneurysm. Patients with aneurysm had significantly increased diameters of the aortic trunk (P < .001) and ascending aorta (P < .001), significantly thicker interventricular septum (P < .001) and posterior wall (P < .001), significantly increased end-diastolic diameter (P < .001) and enlarged left atrium (P < .001), and significantly decreased ejection fraction (P < .001). The mostly met criteria for screening abdominal aortic aneurysm in international guidelines was the age of the patients.Based on the results of this study, screening patients over 60 years of age who undergo a transthoracic echocardiography for any reason would be beneficial to detect an asymptomatic abdominal aortic aneurysm in Turkish population.
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Affiliation(s)
- Ozlem Ozcan Celebi
- Department of Cardiology, University of Health Sciences, Ankara City Hospital
| | - Savas Celebi
- Department of Cardiology, TOBB Economics and Technology University Medical School, Ankara, Turkey
| | - Berkten Berkalp
- Department of Cardiology, TOBB Economics and Technology University Medical School, Ankara, Turkey
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17
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Abstract
Background To date, our understanding of the global aortic aneurysm (AA) burden distribution is very limited. Objective To assess a full view of global AA burden distribution and attributable risk factors from 1990 to 2017. Methods We extracted data of AA deaths, disability-adjusted life years (DALYs), and their corresponding age-standardized rates (ASRs), in general and by age/sex from the 2017 Global Burden of Disease (GBD) study. The current AA burden distribution in 2017 and its changing trend from 1990 to 2017 were separately showed. The spatial divergence was discussed from four levels: global, five social-demographic index regions, 21 GBD regions, and 195 countries and territories. We also estimated the risk factors attributable to AA related deaths. Results Globally, the AA deaths were 167,249 with an age-standardized death rate (ASDR) of 2.19/100,000 persons in 2017, among which the elderly and the males accounted for the majority. Although reductions in ASRs were observed in developed areas, AA remained an important health issue in those relatively underdeveloped areas and might be much more important in the near future. AA may increasingly affect the elderly and the female population. Similar patterns of AA DALYs burden were noted during the study period. AA burden attributable to high blood pressure and smoking decreased globally and there were many heterogeneities in their distribution. Discussion AA maintained an incremental public health issue worldwide. The change pattern of AA burden was heterogeneous across locations, ages, and sexes and it is paramount to improve resource allocation for more effective and targeted prevention strategies. Also, prevention of tobacco consumption and blood pressure control should be emphasized.
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18
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Bains P, Oliffe JL, Mackay MH, Kelly MT. Screening Older Adult Men for Abdominal Aortic Aneurysm: A Scoping Review. Am J Mens Health 2021; 15:15579883211001204. [PMID: 33724072 PMCID: PMC7970195 DOI: 10.1177/15579883211001204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a potentially fatal condition predominantly affecting older adult men (60 years or over). Based on evidence, preventative health-care guidelines recommend screening older males for AAA using ultrasound. In attempts to reduce AAA mortality among men, screening has been utilized for early detection in some Western countries including the UK and Sweden. The current scoping review includes 19 empirical studies focusing on AAA screening in men. The findings from these studies highlight benefits and potential harms of male AAA screening. The benefits of AAA screening for men include decreased incidence of AAA rupture, decreased AAA mortality, increased effectiveness of elective AAA repair surgery, and cost-effectiveness. The potential harms of AAA screening included lack of AAA mortality reduction, negative impacts on quality of life, and inconsistent screening eligibility criteria being applied by primary care practitioners. The current scoping review findings are discussed to suggest changes to AAA screening guidelines and improve policy and practice.
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Affiliation(s)
- Priya Bains
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
| | - John L. Oliffe
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
- Department of Nursing, University
of Melbourne, Melbourne, VIC, Australia
| | - Martha H. Mackay
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and
Outcomes Sciences, Vancouver, BC, Canada
| | - Mary T. Kelly
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
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19
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Dickinson JA, Thériault G, Singh H, Grad R, Bell NR, Szafran O. Too soon or too late? Choosing the right screening test intervals. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:100-106. [PMID: 33608359 DOI: 10.46747/cfp.6702100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- James A Dickinson
- Professor in the Department of Family Medicine and the Department of Community Health Sciences at the University of Calgary in Alberta.
| | - Guylène Thériault
- Academic Lead for the Physicianship Component and Director of Pedagogy at Outaouais Medical Campus in the Faculty of Medicine at McGill University in Montreal, Que
| | - Harminder Singh
- Associate Professor in the Department of Internal Medicine and the Department of Community Health Sciences at the University of Manitoba in Winnipeg and in the Department of Hematology and Oncology at CancerCare Manitoba
| | - Roland Grad
- Associate Professor in the Department of Family Medicine at McGill University
| | - Neil R Bell
- Professor and Associate Director of Research, Department of Family Medicine at the University of Alberta in Edmonton
| | - Olga Szafran
- Professor and Associate Director of Research, Department of Family Medicine at the University of Alberta in Edmonton
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20
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Dickinson JA, Thériault G, Singh H, Grad R, Bell NR, Szafran O. Trop tôt ou trop tard? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:e48-e55. [PMID: 33608370 PMCID: PMC8324119 DOI: 10.46747/cfp.6702e48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- James A Dickinson
- Professeur au département de médecine familiale et au département des sciences de santé communautaire de l'Université de Calgary en Alberta.
| | - Guylène Thériault
- Responsable universitaire du volet Rôle du médecin et directrice de la pédagogie au Campus médical Outaouais de la Faculté de médecine de l'Université McGill à Montréal, Québec
| | - Harminder Singh
- Professeur agrégé au département de médecine interne et au département des sciences de santé communautaire de l'Université du Manitoba à Winnipeg, et au département d'hématologie et d'oncologie à ActionCancer Manitoba
| | - Roland Grad
- Professeur agrégé au département de médecine de famille de l'Université McGill
| | - Neil R Bell
- Professeur et directrice adjointe de recherche au Département de médecine familiale de l'Université de l'Alberta à Edmonton
| | - Olga Szafran
- Professeur et directrice adjointe de recherche au Département de médecine familiale de l'Université de l'Alberta à Edmonton
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21
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Pottie K, Magwood O, Rahman P, Concannon T, Alonso-Coello P, Jaramillo Garcia A, Santesso N, Thombs B, Welch V, Wells GA, Saad A, Archibald D, Grad R, Moore A, Ximena Rojas M, Iorio A, Pinto N, Doull M, Morton R, Santesso N, Akl EA, Schünemann HJ, Tugwell P. GRADE Concept Paper 1: Validating the "F.A.C.E" instrument using stakeholder perceptions of feasibility, acceptability, cost, and equity in guideline implement. J Clin Epidemiol 2020; 131:133-140. [PMID: 33276054 DOI: 10.1016/j.jclinepi.2020.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE To present a structured approach for assessing stakeholder perceptions and implementing the approach in guideline development. METHODS This work was carried out by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Equity and Stakeholder Engagement Project Groups through brainstorming and iterative frameworks, stakeholder engagement, pilot testing, refinement of ideas, using input from workshops, and discussions at GRADE Working Group meetings to produce this document, which constitutes a GRADE conceptual article on implementation. RESULTS We introduce the FACE implementation criteria, feasibility, acceptability, cost, and equity; priority; and "intent to implement" criterion. We outline the implementation importance of networks and approaches to patient and other stakeholder engagement. Implementation is often highly contextual and can benefit from stakeholder engagement and other assessments. Our FACE approach provides stakeholder questions and language to inform guideline implementation and tools. CONCLUSION The FACE criteria propose a series of knowledge translation questions to guide the assessment of implementation for evidence-based guidelines. It is desirable for guideline developers to use a conceptual approach, such as FACE, to tailor implementation and inform end of guideline dissemination and knowledge translation activities.
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Affiliation(s)
- Kevin Pottie
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - Olivia Magwood
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Prinon Rahman
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | | | - Nancy Santesso
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Brett Thombs
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Vivian Welch
- Centre for Global Health, Bruyère Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - George A Wells
- Ottawa Heart Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ammar Saad
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas Archibald
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Ainsley Moore
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Maria Ximena Rojas
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá,Colombia
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Pinto
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Marion Doull
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Rachael Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nancy Santesso
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Peter Tugwell
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
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22
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Lodewyks CL, Prior HJ, Hiebert BM, Nickel NC, Yamashita MH, Ouzounian M, Kumar KK, Arora RC, Tangri N. A Province-Wide Analysis of the Epidemiology of Thoracic Aortic Disease: Incidence Is Increasing in a Sex-Specific Way. Can J Cardiol 2020; 36:1729-1738. [DOI: 10.1016/j.cjca.2019.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 12/01/2022] Open
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23
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de Boer AR, Vaartjes I, van Dis I, van Herwaarden JA, Nathoe HM, Ruigrok YM, Bots ML, Visseren FLJ. Screening for abdominal aortic aneurysm in patients with clinically manifest vascular disease. Eur J Prev Cardiol 2020; 29:1170-1176. [PMID: 33624031 DOI: 10.1093/eurjpc/zwaa014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/13/2020] [Accepted: 07/28/2020] [Indexed: 11/12/2022]
Abstract
AIMS Declining prevalence of abdominal aortic aneurysm (AAA) might force a more targeted screening approach (high-risk populations only) in order to maintain (cost-)effectiveness. We aimed to determine temporal changes in the prevalence of screening-detected AAA, to assess AAA-related surgery, and evaluate all-cause mortality in patients with manifest vascular disease. METHODS AND RESULTS We included patients with manifest vascular disease but without a history of AAA enrolled in the ongoing single-centre prospective UCC-SMART cohort study. Patients were screened at baseline for AAA by abdominal ultrasonography. We calculated sex- and age-specific prevalence of AAA, probability of survival in relation to the presence of AAA, and the proportion of patients undergoing AAA-related surgery. Prevalence of screening-detected AAA in 5440 screened men was 2.5% [95% confidence interval (CI) 2.1-2.9%] and in 1983 screened women 0.7% (95% CI 0.4-1.1%). Prevalence declined from 1997 until 2017 in men aged 70-79 years from 8.1% to 3.2% and in men aged 60-69 years from 5.7% to 1.0%. 36% of patients with screening-detected AAA received elective AAA-related surgery during follow-up (median time until surgery = 5.3 years, interquartile range 2.5-9.1). Patients with screening-detected AAA had a lower probability of survival (sex and age adjusted) compared to patients without screening-detected AAA (51%, 95% CI 41-64% vs. 69%, 95% CI 68-71%) after 15 years of follow-up. CONCLUSION The prevalence of screening-detected AAA has declined over the period 1997-2017 in men with vascular disease but exceeds prevalence in already established screening programs targeting 65-year-old men. Screening for AAA in patients with vascular disease may be cost-effective, but this remains to be determined.
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Affiliation(s)
- Annemarijn R de Boer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Dutch Heart Foundation, The Hague, the Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Dutch Heart Foundation, The Hague, the Netherlands
| | | | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Hendrik M Nathoe
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ynte M Ruigrok
- Department of Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
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Rockley M, Radonjic A, LeBlanc D, Jetty P. The futility of surveillance for old and small aneurysms. J Vasc Surg 2020; 72:162-170.e1. [DOI: 10.1016/j.jvs.2019.09.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/27/2019] [Indexed: 12/30/2022]
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Saw ST, Leong BDK, Abdul Aziz DA. Early Detection of Undiagnosed Abdominal Aortic Aneurysm and Sub-Aneurysmal Aortic Dilatations in Patients with High-Risk Coronary Artery Disease: The Value of Targetted Screening Programme. Vasc Health Risk Manag 2020; 16:215-229. [PMID: 32606718 PMCID: PMC7293413 DOI: 10.2147/vhrm.s250735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) and coronary artery disease (CAD) share common risk factors. The objective of this study was to determine the prevalence of undiagnosed AAA in patients with angiographically diagnosed significant CAD. PATIENTS AND METHODS Male patients aged 50 years and above (including indigenous people) with angiographically diagnosed significant CAD in the recent one year were screened for AAA. Standard definition of abdominal aortic aneurysm and CAD was used. All new patients were followed up for six months for AAA events (ruptured AAA and AAA-related mortality). RESULTS A total of 277 male patients were recruited into this study. The total prevalence of undiagnosed AAA in this study population was 1.1% (95% CI 0.2-3.1). In patients with high-risk CAD, the prevalence of undiagnosed AAA was 1.7% (95% CI 0.3-4.8). The detected aneurysms ranged in size from 35.0mm to 63.8mm. Obesity was a common factor in these patients. There were no AAA-related mortality or morbidity during the follow-up. Although the total prevalence of undiagnosed AAA is low in the studied population, the prevalence of sub-aneurysmal aortic dilatation in patients with significant CAD was high at 6.6% (95% CI 3.9-10.2), in which majority were within the younger age group than 65 years old. CONCLUSION This was the first study on the prevalence of undiagnosed AAA in a significant CAD population involving indigenous people in the island of Borneo. Targeted screening of patients with high-risk CAD even though they are younger than 65 years old effectively discover potentially harmful asymptomatic AAA and sub-aneurysmal aortic dilatations.
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Affiliation(s)
- Siong Teng Saw
- Faculty of Medicine, Universiti Kebangsaan Malaysia; Hospital Queen Elizabeth II, Kota Kinabalu, Sabah88300, Malaysia
| | | | - Dayang Anita Abdul Aziz
- Faculty of Medicine, Universiti Kebangsaan Malaysia, UKM Medical Center, Kuala Lumpur56000, Malaysia
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Khural M, Gullipalli R, Dubrowski A. Evaluating the Use of a Generic Three-Dimensionally (3D) Printed Abdominal Aortic Aneurysm Model as an Adjunct Patient Education Tool. Cureus 2020; 12:e8533. [PMID: 32665880 PMCID: PMC7352734 DOI: 10.7759/cureus.8533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
An abdominal aortic aneurysm (AAA) is a serious medical condition that requires invasive surgery or endovascular treatment with stent grafts. This procedure is primarily carried out by vascular surgeons and interventional radiologists. Current methods of educating patients about their procedure have been inadequate, causing unnecessary stress in patients who have this condition and seek treatment. In this study, we evaluate a three-dimensionally (3D) printed AAA model to use as an adjunct patient education tool, thus allowing patients to make a more knowledgeable decision when providing informed consent. The physical attributes and realism of the model are evaluated through the use of a quantitative and qualitative survey completed by physicians at St. Clare’s Mercy Hospital in St. John’s, Newfoundland. These physicians are referred to as “Experts” in our study and also rate and comment on the necessity of having patient-specific versus generic 3D AAA models for patient education purposes. The aim of this study is to determine whether our 3D printed AAA model is ready to be used as an adjunct patient education tool and to seek suggestions for improvements that can be made in the model. Furthermore, having generic 3D AAA models would significantly decrease healthcare costs as compared to patient-specific models. Thus, we also investigate if generic models would suffice from the perspective of the physicians.
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Affiliation(s)
- Manveer Khural
- Medicine, Memorial University of Newfoundland, St. John's, CAN
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Murray M, Costa AF. Appropriateness of Abdominal Aortic Aneurysm Screening With Ultrasound: Potential Cost Savings With Guideline Adherence and Review of Prior Imaging. Can Assoc Radiol J 2020; 72:398-403. [PMID: 32364410 DOI: 10.1177/0846537120920866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess the appropriateness of abdominal aortic aneurysm (AAA) screening with ultrasound (US) and potential cost savings by adhering to guidelines and reviewing prior imaging. METHODS Screening aortic US performed in Nova Scotia from January 1 to April 30, 2019, were reviewed. Patient sex, age, risk factors, and study result (negative, <2.5 cm; ectatic, 2.5-2.9 cm; positive for AAA, ≥3 cm) were recorded. Previous imaging tests were reviewed for the presence/absence of aortic ectasia or aneurysm. Appropriateness was based on the Canadian Task Force on Preventive Health Care (CTFPHC) and the Canadian Society of Vascular Surgery (CSVS) guidelines. The number of potentially averted US, subsequent missed positive findings, and cost savings (over the 4-month period) were calculated according to: 1) each guideline; and 2) each guideline combined with review of imaging done 0 to 5 years and 0 to 10 years previously. RESULTS There were 17 (4.6%) of 369 ectatic aortas and 18 (4.9%) of 369 AAAs. The number of potentially averted examinations, missed ectatic aortas, missed AAAs, and cost savings were as follows, respectively: CTFPHC, 222 (60.2%) of 369, 8, 7, and CAD$20 501.70; CSVS, 117 (31.7%) of 369, 4, 2, and CAD$10 804.95. The model that would yield the greatest cost savings and fewest missed positive findings was the combination of CSVS guidelines with review of prior imaging within 5 years; this would avert 189 (51.2%) of 369 examinations, save CAD$17 454.15 over 4 months, and miss only 2 AAAs and 2 ectatic aortas. CONCLUSION Over half of aortic US screening tests can be safely averted by adhering to CSVS guidelines and reviewing imaging performed within 5 years.
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Affiliation(s)
- Matthew Murray
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and 12361Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and 12361Dalhousie University, Halifax, Nova Scotia, Canada
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Zaltzman A, Dubey V, Iglar K. Update to the Preventive Care Checklist Form ©. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:270-272. [PMID: 32273415 PMCID: PMC7145119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Alina Zaltzman
- Family physician in the Department of Family and Community Medicine at St Michael's Hospital in Toronto, Ont
| | - Vinita Dubey
- Associate Medical Officer of Health with Toronto Public Health and Adjunct Professor in the Dalla Lana School of Public Health at the University of Toronto
| | - Karl Iglar
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto and a staff physician at St Michael's Hospital
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Biskup E, Martinkova J, Ferretti MT. Gender medicine: Towards a gender-specific treatment of neuropsychiatric disorders. HANDBOOK OF CLINICAL NEUROLOGY 2020; 175:437-448. [PMID: 33008542 DOI: 10.1016/b978-0-444-64123-6.00029-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sex and gender are increasingly recognized as major influencing factors in disorders across all medical specialties. Even though there is ample evidence of sex and gender differences in neuropsychiatric disorders, a sex and gender-differentiated approach has not yet been sufficiently applied to diagnostics and management. Therefore, there is an urgent need to establish general recommendations and guidelines toward precision and sex/gender medicine, with regard to dosage, tolerability, interactions and side effects, sensitivity of diagnostic tests, and distinct treatment strategies. This chapter illustrates the current knowledge about sex and gender aspects in neuropsychiatric disorders, providing a base not only to assist the clinician in the handling of specific pathologic entities, but also to sensitize medical practitioners to consider sex and gender in clinical decision-making. As such, the chapter is a call to action to physicians and researchers to produce more sex- and gender-stratified evidence, leading to an acceleration of guideline development. Such novel guidelines will provide a base for medical education, of both medical students and specialists, as well as a reference point for practitioners, toward precision medicine.
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Affiliation(s)
- Ewelina Biskup
- Women's Brain Project, Guntershausen (TG), Switzerland; Shanghai University of Medicine and Health Sciences, College of Clinical Medicine, Shanghai, China.
| | - Julie Martinkova
- Women's Brain Project, Guntershausen (TG), Switzerland; Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
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Rohailla S, Kitchlu A, Wheatcroft M, Razak F. Mycotic aneurysm formation after bacillus Calmette-Guérin instillation for recurrent bladder cancer. CMAJ 2019; 190:E467-E471. [PMID: 29661816 DOI: 10.1503/cmaj.171214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Sagar Rohailla
- Postgraduate Medical Education, Department of Medicine (Rohailla), University of Toronto; Division of Nephrology, Department of Medicine (Kitchlu); Division of Vacsular Surgery, Department of Surgery (Wheatcroft); and Division of General Internal Medicine, Department of Medicine (Razak), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Abhijat Kitchlu
- Postgraduate Medical Education, Department of Medicine (Rohailla), University of Toronto; Division of Nephrology, Department of Medicine (Kitchlu); Division of Vacsular Surgery, Department of Surgery (Wheatcroft); and Division of General Internal Medicine, Department of Medicine (Razak), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Mark Wheatcroft
- Postgraduate Medical Education, Department of Medicine (Rohailla), University of Toronto; Division of Nephrology, Department of Medicine (Kitchlu); Division of Vacsular Surgery, Department of Surgery (Wheatcroft); and Division of General Internal Medicine, Department of Medicine (Razak), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Fahad Razak
- Postgraduate Medical Education, Department of Medicine (Rohailla), University of Toronto; Division of Nephrology, Department of Medicine (Kitchlu); Division of Vacsular Surgery, Department of Surgery (Wheatcroft); and Division of General Internal Medicine, Department of Medicine (Razak), St. Michael's Hospital, University of Toronto, Toronto, Ont.
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Chan WC, Papaconstantinou D, Winnard D, Jackson G. Retrospective review of abdominal aortic aneurysm deaths in New Zealand: what proportion of deaths is potentially preventable by a screening programme in the contemporary setting? BMJ Open 2019; 9:e027291. [PMID: 31366645 PMCID: PMC6677995 DOI: 10.1136/bmjopen-2018-027291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To describe the proportions of people dying from abdominal aortic aneurysm (AAA) who might have benefited from a formal screening programme for AAA. DESIGN Retrospective cross-sectional review of deaths. SETTING AND STUDY POPULATIONS All AAA deaths registered in New Zealand from 2010 to 2014 in the absence of a national AAA screening programme. MAIN OUTCOME MEASURES Known history of AAA prior to the acute event leading to AAA death, prognosis limiting comorbidities, history of prior abdominal imaging and a validated multimorbidity measure (M3-index scores). RESULTS 1094 AAA deaths were registered in the 5 years between 2010 and 2014 in New Zealand. Prior to the acute AAA event resulting in death, 31.3% of the cohort had a known AAA diagnosis, and 10.9% had a previous AAA procedure. On average, the AAA diagnosis was known 3.7 years prior to death. At least 77% of the people dying from AAA also had one or more other prognosis limiting diagnosis. The hazard of 1-year mortality associated with the non-AAA related comorbidities for the AAA cohort aged 65 or above were 1.5-2.6 times higher than to the age matched general population based on M3-index scores. In 2014, overall AAA deaths accounted for only 0.7% of total deaths, and 1.0% of deaths among men aged 65 or above in New Zealand. At most, 20% of people dying from AAA in New Zealand between 2010 and 2014 might have had the potential to derive full benefit from a screening programme. About 51% of cases would have derived no or very limited benefit from a screening programme. CONCLUSION Falling AAA mortality, and high prevalence of competing comorbidities and/or prior AAA diagnosis and procedure raises the question about the likely value of a national AAA screening programme in a country such as New Zealand.
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Affiliation(s)
- Wing Cheuk Chan
- Population Health, Counties Manukau District Health Board, Auckland, New Zealand
| | | | - Doone Winnard
- Population Health, Counties Manukau District Health Board, Auckland, New Zealand
| | - Gary Jackson
- Population Health, Counties Manukau District Health Board, Auckland, New Zealand
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Cornejo Saucedo M, García-Gil D, Brun Romero F, Torres do Rego A, Beltrán Romero L, Rodilla Sala E, Acosta Guerra G, Villanueva Martínez J, Casas Rojo J, Torres Macho J, García de Casasola-Sánchez G. Prevalence of abdominal aortic aneurysm in patients with high cardiovascular risk. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cornejo Saucedo M, García-Gil D, Brun Romero F, Torres do Rego A, Beltrán Romero L, Rodilla Sala E, Acosta Guerra G, Villanueva Martínez J, Casas Rojo J, Torres Macho J, García de Casasola-Sánchez G. Prevalencia de aneurisma de aorta abdominal en pacientes con alto riesgo cardiovascular. Rev Clin Esp 2018; 218:461-467. [DOI: 10.1016/j.rce.2018.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/17/2018] [Accepted: 08/10/2018] [Indexed: 01/27/2023]
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Sex-Specific Considerations in Guidelines Generation and Application. Can J Cardiol 2018; 35:598-605. [PMID: 30910247 DOI: 10.1016/j.cjca.2018.11.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 12/14/2022] Open
Abstract
New knowledge about male-female differences in pathophysiology, diagnosis, and treatment is shifting the practice of medicine from a one-size-fits all approach to a more individualized process that considers sex-specific interventions at the point of care. In this article, we review how clinical practice guideline committees can incorporate a structured framework to determine whether sex-specific assessments of the quality of the evidence or the particular recommendations should be made. The process can be operationalized by societies who author clinical practice guidelines by developing formal policies to approach biological sex in a systematic way, and by ensuring that writing committees include an individual who will champion the formal appraisal of the literature for associations between sex and the outcomes of interest. Ongoing challenges are discussed, and solutions are provided for how to disaggregate the evidence, how to assess bias, how to improve search strategies, and what to do when the data are insufficient to make sex-specific recommendations. Application of sex-specific recommendations will involve routinely asking whether the presentation, diagnostic workup, or management might change for each patient if they were the opposite sex.
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Point-of-Care Ultrasound Performed by a Medical Student Compared to Physical Examination by Vascular Surgeons in the Detection of Abdominal Aortic Aneurysms. Ann Vasc Surg 2018; 52:15-21. [DOI: 10.1016/j.avsg.2018.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 01/23/2023]
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Boczar KE, Coutinho T. Sex Considerations in Aneurysm Formation, Progression, and Outcomes. Can J Cardiol 2018; 34:362-370. [DOI: 10.1016/j.cjca.2017.12.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/20/2017] [Accepted: 12/24/2017] [Indexed: 01/11/2023] Open
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