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Mani K, Shah K, Kadom N, Seidenwurm D, Nemeth AJ. Peer Learning in Neuroradiology: Not as Easy as It Sounds. AJNR Am J Neuroradiol 2023; 44:1109-1115. [PMID: 37793783 PMCID: PMC10549937 DOI: 10.3174/ajnr.a7973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/21/2023] [Indexed: 10/06/2023]
Affiliation(s)
- K Mani
- University Radiology GroupRutgers University School of MedicineNewark, New Jersey
| | - K Shah
- MD Anderson Cancer CenterHouston, Texas
| | - N Kadom
- Emory University School of MedicineChildren's Healthcare of AtlantaAtlanta, Georgia
| | | | - A J Nemeth
- Northwestern University, Feinberg School of MedicineNorthwestern Memorial HospitalChicago, Illinois
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2
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Narayanan A, Naidoo M, Kong VY, Pearson L, Mani K, Fisher JP, Khashram M, Clarke DL. Broad responses and attitudes to having music in surgery (the BRAHMS study) - a South African perspective. S AFR J SURG 2023; 61:30-38. [PMID: 37052283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Music is played in operating theatres (OTs) throughout the world, though controversy around its use exists. While some clinicians may find background music favourable to the theatre mood and a way to augment surgical performance, there is concern raised over its distracting and noise-creating properties. METHODS In this prospective observational study, between August and December 2021, 110 surgeons and registrars in South Africa responded to a survey investigating the way they use music, and their perceptions and attitudes towards its effect on the OT environment. RESULTS In this cohort, 66% were male, 29% were consultants and the most common age range was 30-39 years old. Eighty per cent of respondents reported that music was played at least "sometimes", with 74% reporting that they enjoyed it. Easy Listening was the most played and preferred genre followed by Top 40/Billboard hits. Overwhelmingly, respondents reported that background music in the OT improved temperament, focus, mood, and performance, though over a quarter felt it worsened communication. Thirty-one per cent of respondents reported that the choice of music depended on the type of operation, and 70% would turn music down or off during crises. Those who enjoyed music in their spare time were significantly more likely to enjoy music in the OT and perceive it positively. CONCLUSION This study provides a window into the surgeons' use of and attitudes to intraoperative music in South Africa. While overall, music is viewed positively by this cohort, some concerns remain regarding communication and distractedness. Further interventional and qualitative studies would be useful.
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Affiliation(s)
- A Narayanan
- Faculty of Medicine and Health Sciences, University of Auckland, New Zealand and Department of Surgery, University of Auckland, New Zealand and Department of Vascular Surgery, Waikato Hospital, New Zealand
| | - M Naidoo
- Department of Surgery, University of KwaZulu-Natal, South Africa and Department of Surgical Sciences, Uppsala University, Sweden
| | - V Y Kong
- Faculty of Medicine and Health Sciences, University of Auckland, New Zealand and Department of Surgery, University of Auckland, New Zealand and Department of Surgery, University of the Witwatersrand, South Africa and Department of Surgery, University of KwaZulu-Natal, South Africa
| | - L Pearson
- Department of Vascular Surgery, Waikato Hospital, New Zealand
| | - K Mani
- Department of Vascular Surgery, Waikato Hospital, New Zealand and Department of Surgical Sciences, Uppsala University, Sweden
| | - J P Fisher
- Faculty of Medicine and Health Sciences, University of Auckland, New Zealand
| | - M Khashram
- Faculty of Medicine and Health Sciences, University of Auckland, New Zealand and Department of Surgery, University of Auckland, New Zealand and Department of Vascular Surgery, Waikato Hospital, New Zealand
| | - D L Clarke
- Department of Surgery, University of KwaZulu-Natal, South Africa and Department of Surgical Sciences, Uppsala University, Sweden
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3
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Mani K, Luttman J, Nowell J, Carrol A, Jahangiri M. Patients' expectation of postoperative course and satisfaction following cardiac surgery. Ann R Coll Surg Engl 2023; 105:20-27. [PMID: 36546540 PMCID: PMC9773240 DOI: 10.1308/rcsann.2022.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION In patients undergoing cardiac surgery, preoperative concerns, expectations of the impact of surgery, anticipated recovery timelines, and pre- and postoperative education, which impact recovery and quality-of-life, are not well documented. These factors are important with the increase in virtual consultations, the availability of internet-based information and increased use of minimally invasive surgical procedures. METHODS Patients who underwent cardiac surgery between January 2016 and December 2019 took part in an online survey examining preoperative concerns, information provision, use of digital channels, satisfaction with surgery, impact on health and resumption of daily activity. 80 patients completed the survey. RESULTS There was a high rate of overall post-surgical satisfaction (86%); 71% of respondents reported an improvement in physical health, 45% in mental health and 70% in their quality-of-life. The usefulness of information provided by the National Health Service varies across different stages of the patient experience. Although approximately 90% of respondents found the information provided at each stage at least 'somewhat' helpful, the proportion who found the information 'very' helpful was lower (68% for pre-procedure; 55% for post-discharge). The majority (79%) said that they felt prepared for their operation. Survey responses highlighted areas of lower understanding, including survival rate, levels of postoperative pain, duration of hospital stay and when the patient could return to normal physical activity. CONCLUSIONS Levels of satisfaction with the outcomes of heart surgery are high, and the majority of patients report positive health outcomes. However, there is room for improvement in patients' understanding of survival rate and level of pain post-procedure. There is also a clear desire among patients for a more surgical team-based face-to-face consultation.
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Affiliation(s)
- K Mani
- St George’s University Hospitals NHS Foundation Trust, UK
| | | | - J Nowell
- St George’s University Hospitals NHS Foundation Trust, UK
| | | | - M Jahangiri
- St George’s University Hospitals NHS Foundation Trust, UK
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4
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Bissacco D, Mandigers T, Savaré L, Domanin M, D'Oria M, Ieva F, Van Herwaarden J, Mani K, Wanhainen A, Trimarchi S. Variability and Reproducibility in Ultrasound Abdominal Aortic Diameter Measurements: a Systematic Review and Methods Comparison. EJVES Vasc Forum 2023. [DOI: 10.1016/j.ejvsvf.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
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5
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D’Oria M, Bertoglio L, Bignamini A, Mani K, Kölbel T, Oderich G, Chiesa R, Lepidi S. PRINciples of optimal antithrombotiC therapy and coagulation managEment during elective fenestrated and branched EndovaScular aortic repairS (PRINCE2SS): An International Expert Based Delphi Consensus Study. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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6
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Nganso BT, Mani K, Eliash N, Rafaeli A, Soroker V. Towards disrupting Varroa -honey bee chemosensing: A focus on a Niemann-Pick type C2 transcript. Insect Mol Biol 2021; 30:519-531. [PMID: 34216416 DOI: 10.1111/imb.12722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/30/2021] [Accepted: 05/30/2021] [Indexed: 06/13/2023]
Abstract
We focused our study on the 12 recently identified putative odorant carrier proteins in the ectoparasitic mite, Varroa destructor. Here we show, via an exclusion of the chemosensory appendages (forelegs and gnathosoma) that transcripts of five of the 12 genes were significantly lower, suggesting that they are likely involved in carrying host volatiles. Specifically, three transcripts were found to be foreleg-specific while the other two transcripts were expressed in both the forelegs and gnathosoma. We focused on one of the highly expressed and foreleg-specific transcript Vd40090, which encodes a Niemann-Pick disease protein type C2 (NPC2) protein. Effects of dsRNA-mediated silencing of Vd40090 were first measured by quantifying the transcript levels of genes that encode other putative odorant carrier proteins as well as reproduction related proteins. In addition, the impact of silencing on mites behaviour and survival was tested. Silencing of Vd40090 effectively disrupted Varroa host selection, acceptance and feeding and significantly impaired the expression of genes that regulate its reproduction in brood cells, resulting in reduced reproduction and survival.
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Affiliation(s)
- B T Nganso
- Institute of Plant Protection, Agricultural Research Organization, the Volcani Center, Rishon LeZion, Israel
| | - K Mani
- Institute of Plant Protection, Agricultural Research Organization, the Volcani Center, Rishon LeZion, Israel
| | - N Eliash
- Institute of Plant Protection, Agricultural Research Organization, the Volcani Center, Rishon LeZion, Israel
| | - A Rafaeli
- Institute of Postharvest and Food Sciences, Agricultural Research Organization, the Volcani Centre, Rishon LeZion, Israel
| | - V Soroker
- Institute of Plant Protection, Agricultural Research Organization, the Volcani Center, Rishon LeZion, Israel
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7
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Scali S, Beck A, Sedrakyan A, Mao J, Behrendt CA, Boyle J, Venermo M, Faizer R, Schermerhorn M, Beiles B, Szeberin Z, Eldrup N, Thomson I, Cassar K, Altreuther M, Debus S, Johal A, Bjorck M, Cronenwett J, Mani K. Optimal Threshold for the Volume–Outcome Relationship After Open AAA Repair in the Endovascular Era: Analysis of the International Consortium of Vascular Registries. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Behrendt CA, Sigvant B, Kuchenbecker J, Grima M, Schermerhorn M, Thomson I, Altreuther M, Setacci C, Svetlikov A, Laxdal E, Goncalves F, Secemsky E, Debus E, Cassar K, Beiles B, Beck A, Mani K, Bertges D. International Variations and Sex Disparities in the Treatment of Peripheral Arterial Occlusive Disease: A Report from VASCUNET and the International Consortium of Vascular Registries. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Grip O, Mani K, Altreuther M, Bastos Gonçalves F, Beiles B, Cassar K, Davidovic L, Eldrup N, Lattmann T, Laxdal E, Menyhei G, Setacci C, Settembre N, Thomson I, Venermo M, Björck M. Contemporary Treatment of Popliteal Artery Aneurysms in 14 Countries: A Vascunet Report. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Aktuerk D, Ali J, Badran A, Balmforth D, Bleetman D, Brown C, Suelo-Calanao R, Cartwright J, Casey L, Chiwera L, Fudulu D, Garner M, Gradinariu G, Harky A, Hussain A, Hutton S, Kew E, Loubani M, Mani K, Martin J, Rochon M, Moawad N, Mohamed S, Muretti M, Murphy G, Olivieri G, Paglinawan I, Quijano-Campos J, Rizzo V, Robertson S, Rogers L, Roman M, Salmon K, Sanders J, Talukder S, Tanner J, Vaja R, Zientara A, Green S, Miles R, Lamagni T, Harrington P. National survey of variations in practice in the prevention of surgical site infections in adult cardiac surgery, United Kingdom and Republic of Ireland. J Hosp Infect 2020; 106:812-819. [DOI: 10.1016/j.jhin.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
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11
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Baderkhan H, Wanhainen A, Haller O, Björck M, Mani K. Detection of Late Complications After Endovascular Abdominal Aortic Aneurysm Repair and Implications for Follow up Based on Retrospective Assessment of a Two Centre Cohort. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Dias-Neto M, Castro-Ferreira R, Mani K, Freitas A, Leite-Moreira A, Sampaio S. Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000–2015). J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Grima M, Behrendt CA, Vidal-Diez A, Altreuther M, Björck M, Boyle J, Eldrup N, Karthikesalingam A, Khashram M, Loftus I, Schermerhorn M, Setacci C, Szeberin Z, Debus S, Venermo M, Holt P, Mani K. Assessment of Correlation Between Mean Size of Infrarenal Abdominal Aortic Aneurysm at Time of Intact Repair Against Repair and Rupture Rate in Nine Countries. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Abstract
Abdominal aortic aneurysm (AAA) is a relatively common and potentially fatal disease. The management of AAA has undergone extensive changes in the last two decades. High quality vascular surgical registries were established early and have been found to be instrumental in the evaluation and monitoring of these changes, most notably the wide implementation of minimally invasive endovascular surgical technology. Trends over the years showed the increased use of endovascular aneurysm repair (EVAR) over open repair, the decreasing perioperative adverse outcomes and the early survival advantage of EVAR. Also, data from the early EVAR years changed the views on endoleak management and showed the importance of tracking the implementation of new techniques. Registry data complemented the randomized trials performed in aortic surgery by showing the high rate of laparotomy-related reinterventions after open repair. Also, they are an essential tool for the understanding of outcomes in a broad patient population, evaluating the generalizability of findings from randomized trials and analysing changes over time. By using large-scale data over longer periods of time, the importance of centralization of care to high-volume centres was shown, particularly for open repair. Additionally, large-scale databases can offer an opportunity to assess practice and outcomes in patient subgroups (e.g. treatment of AAA in women and the elderly) as well as in rare aortic pathologies. In this review article, we point out the most important paradigm shifts in AAA management based on vascular registry data.
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Affiliation(s)
- L de Guerre
- Division of Vascular Surgery and Endovascular Therapy, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Venermo
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland
| | - K Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - A Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - M Schermerhorn
- Division of Vascular Surgery and Endovascular Therapy, Beth Israel Deaconess Medical Center, Boston, MA, USA
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15
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Abstract
Aortic pathologies such as aneurysm, dissection and trauma are relatively common and potentially fatal diseases. Over the past two decades, we have experienced unprecedented technical and medical developments in the field. Despite this, there is a great need, and great opportunities, to further explore the area. In this review, we have identified important areas that need to be further studied and selected priority aortic disease trials. There is a pressing need to update the AAA natural history and the role for endovascular AAA repair as well as to define biomarkers and genetic risk factors as well as influence of gender for development and progression of aortic disease. A key limitation of contemporary treatment strategies of AAA is the lack of therapy directed at small AAA, to prevent AAA expansion and need for surgical repair, as well as to reduce the risk for aortic rupture. Currently, the most promising potential drug candidate to slow AAA growth is metformin, and RCTs to verify or reject this hypothesis are warranted. In addition, the role of endovascular treatment for ascending pathologies and for uncomplicated type B aortic dissection needs to be clarified.
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Affiliation(s)
- R L Dalman
- From the, Division of Vascular Surgery, Department of Surgery, Stanford Medicine, Stanford, CA, USA
| | - A Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - K Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - B Modarai
- Academic Department of Vascular Surgery, St Thomas' Hospital, King's Health Partners, London, UK
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16
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Wanhainen A, Mani K. The way forward to understand aortic disease. J Intern Med 2020; 288:3-5. [PMID: 32133695 DOI: 10.1111/joim.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- A Wanhainen
- From the, Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - K Mani
- From the, Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
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17
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Golledge J, Singh TP, Moxon JV, Bown M, Mani K, Wanhainen A. Response to letter about 'Lack of an effective drug for abdominal aortic aneurysm'. J Intern Med 2020; 288:152-154. [PMID: 31549438 DOI: 10.1111/joim.12978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J Golledge
- From the, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - T P Singh
- From the, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
| | - J V Moxon
- From the, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - M Bown
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - K Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - A Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
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18
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Abstract
Abdominal aortic aneurysm (AAA) rupture is a common cause of death in adults. Current AAA treatment is by open surgical or endovascular aneurysm repair. Rodent model and human epidemiology, and genetic and observational studies over the last few decades have highlighted the potential of a number of drug therapies, including medications that lower blood pressure, correct dyslipidaemia, or inhibit thrombosis, inflammation or matrix remodelling, as approaches to managing small AAA. This review summarizes prior AAA pathogenesis data from animal and human studies aimed at identifying targets for the development of drug therapies. The review also systematically assesses past randomized placebo-controlled drug trials in patients with small AAAs. Eleven previously published randomized-controlled clinical trials testing different drug therapies aimed at slowing AAA progression were identified. Five of the trials tested antibiotics and three trials assessed medications that lower blood pressure. Meta-analyses of these trials suggested that neither of these approaches limit AAA growth. Allocation to blood pressure-lowering medication was associated with a small reduction in AAA rupture or repair, compared to placebo (relative risk 0.94, 95% confidence intervals 0.89, 1.00, P = 0.047). Three further trials assessed the effect of a mast cell inhibitor, fibrate or platelet aggregation inhibition and reported no effect on AAA growth or clinical events. Past trials were noted to have a number of design issues, particularly small sample sizes and limited follow-up. Much larger trials are needed to properly test potential therapeutic approaches if a convincingly effective medical therapy for AAA is to be identified.
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Affiliation(s)
- J Golledge
- From the, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Qld, Australia.,The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Qld, Australia.,Centre for Molecular Therapeutics, The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Qld, Australia
| | - J V Moxon
- From the, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Qld, Australia.,Centre for Molecular Therapeutics, The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Qld, Australia
| | - T P Singh
- From the, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Qld, Australia.,The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Qld, Australia
| | - M J Bown
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - K Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - A Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
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19
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Sutzko DC, Mani K, Behrendt CA, Wanhainen A, Beck AW. Big data in vascular surgery: registries, international collaboration and future directions. J Intern Med 2020; 288:51-61. [PMID: 32303118 DOI: 10.1111/joim.13077] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/21/2020] [Accepted: 04/06/2020] [Indexed: 01/09/2023]
Abstract
Given the increasing availability of large data set, small single-institutional series raise decreasing attention. Rapid expansion of technology from electronic medical records to easily accessible internet access, and widespread use and acceptance of registries in the medical world has allowed for research and quality improvement efforts using 'big data'. Big data, although technically not defined, typically refers to large databases that can be used to investigate common or rare disease processes or outcomes, describe variation in clinical practices across and between different specialties at various practice location, whilst allowing important information about trends over time. Big data have allowed investigators to quickly assimilate cohorts of patients and/or procedures to answer current questions, with more complete population representation and improved generalizability whilst decreasing the likelihood of power problems and type II errors. On the other hand, pitfalls still exist with the growing problem of hypothesis fishing, lack of granularity and the fear by many clinicians that registry transparency may have already gone too far, where surgery groups or individual surgeon outcomes are readily available to patients and referring providers. Within vascular surgery specifically, big data have expanded over the last decade and now includes regional, national and global registries that have major benefits of gathering specific clinical and procedural information within vascular surgery. In this review, we highlight the main vascular surgery registries and recap a few success stories of how the registries have been leveraged to benefit discovery, quality improvement and ultimately patient care. Additionally, we outline future directions that will be imperative for continued expansion, acceptance and adoption of 'big data' utilization inpatients with vascular disease.
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Affiliation(s)
- D C Sutzko
- From the, Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AB, USA
| | - K Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - C-A Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - A W Beck
- From the, Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AB, USA
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20
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Mani K, De Luccia N, Wanhainen A. Rupture EVAR - It's a Kind of Magic! Eur J Vasc Endovasc Surg 2020; 59:701-702. [PMID: 32284218 DOI: 10.1016/j.ejvs.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- K Mani
- Department of Surgical Sciences, Uppsala University, Uppsala Sweden.
| | - N De Luccia
- Department of Surgery, Discipline of Vascular Surgery, University of São Paulo, São Paulo, Brazil
| | - A Wanhainen
- Department of Surgical Sciences, Uppsala University, Uppsala Sweden
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21
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Palaniappan B, Arthur S, Sundaram VL, Butts M, Sundaram S, Mani K, Singh S, Nepal N, Sundaram U. Inhibition of intestinal villus cell Na/K-ATPase mediates altered glucose and NaCl absorption in obesity-associated diabetes and hypertension. FASEB J 2019; 33:9323-9333. [PMID: 31107610 PMCID: PMC6662973 DOI: 10.1096/fj.201802673r] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/23/2019] [Indexed: 01/07/2023]
Abstract
During obesity, diabetes and hypertension inevitably coexist and cause innumerable health disparities. In the obesity, diabetes, and hypertension triad (ODHT), deregulation of glucose and NaCl homeostasis, respectively, causes diabetes and hypertension. In the mammalian intestine, glucose is primarily absorbed by Na-glucose cotransport 1 (SGLT1) and coupled NaCl by the dual operation of Na-H exchange 3 (NHE3) and Cl-HCO3 [down-regulated in adenoma (DRA) or putative anion transporter 1 (PAT1)] exchange in the brush border membrane (BBM) of villus cells. The basolateral membrane (BLM) Na/K-ATPase provides the favorable transcellular Na gradient for BBM SGLT1 and NHE3. How these multiple, distinct transport processes may be affected in ODHT is unclear. Here, we show the novel and broad regulation by Na/K-ATPase of glucose and NaCl absorption in ODHT in multiple species (mice, rats, and humans). In vivo, during obesity inhibition of villus-cell BLM, Na/K-ATPase led to compensatory stimulation of BBM SGLT1 and DRA or PAT1, whereas NHE3 was unaffected. Supporting this new cellular adaptive mechanism, direct silencing of BLM Na/K-ATPase in intestinal epithelial cells resulted in selective stimulation of BBM SGLT1 and DRA or PAT1 but not NHE3. These changes will lead to an increase in glucose absorption, maintenance of traditional coupled NaCl absorption, and a de novo increase in NaCl absorption from the novel coupling of stimulated SGLT1 with DRA or PAT1. Thus, these novel observations provide the pathophysiologic basis for the deregulation of glucose and NaCl homeostasis of diabetes and hypertension, respectively, during obesity. These observations may lead to more efficacious treatment for obesity-associated diabetes and hypertension.-Palaniappan, B., Arthur, S., Sundaram, V. L., Butts, M., Sundaram, S., Mani, K., Singh, S., Nepal, N., Sundaram, U. Inhibition of intestinal villus cell Na/K-ATPase mediates altered glucose and NaCl absorption in obesity-associated diabetes and hypertension.
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Affiliation(s)
- Balasubramanian Palaniappan
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Subha Arthur
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Vijaya Lakshmi Sundaram
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Molly Butts
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Shanmuga Sundaram
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Kathiresh Mani
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Soudamani Singh
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Niraj Nepal
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Uma Sundaram
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
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Högberg D, Björck M, Mani K, Svensjö S, Wanhainen A. Five Year Outcomes in Men Screened for Carotid Artery Stenosis at 65 Years of Age: A Population Based Cohort Study. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Burdess A, Wanhainen A, Tegler G, Mani K. AAN 3. Fenestrated and Branched Endovascular Repair of Aortic Arch Pathology. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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24
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Verhoeven EL, Mani K. New Technology Failures: Who to Blame or Time to be Cautious? Eur J Vasc Endovasc Surg 2018; 56:318-319. [DOI: 10.1016/j.ejvs.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
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25
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Högberg D, Mani K, Wanhainen A, Svensjö S. Clinical Effect and Cost-Effectiveness of Screening for Asymptomatic Carotid Stenosis: A Markov Model. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Baderkhan H, Haller O, Wanhainen A, Björck M, Mani K. Follow-up after endovascular aortic aneurysm repair can be stratified based on first postoperative imaging. Br J Surg 2018; 105:709-718. [DOI: 10.1002/bjs.10766] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/13/2017] [Accepted: 10/22/2017] [Indexed: 02/01/2023]
Abstract
Abstract
Background
Lifelong postoperative surveillance is recommended following endovascular aneurysm repair (EVAR). Although the purpose is to prevent and/or identify complications early, it also results in increased cost and workload. This study was designed to examine whether it may be possible to identify patients at low risk of complications based on their first postoperative CT angiogram (CTA).
Methods
All patients undergoing EVAR in two Swedish centres between 2001 and 2012 were identified retrospectively and categorized based on the first postoperative CTA as at low risk (proximal and distal sealing zone at least 10 mm and no endoleak) or high risk (sealing zone less than 10 mm and/or presence of any endoleak) of complications.
Results
Some 326 patients (273 men) with a CTA performed less than 1 year after EVAR were included (low risk 212, 65·0 per cent; high risk 114, 35·0 per cent). There was no difference between the groups in terms of sex, age, co-morbidities, abdominal aortic aneurysm (AAA) diameter, preoperative AAA neck anatomy, stent-graft type or duration of follow-up (mean(s.d.) 4·8(3·2) years). Five-year freedom from AAA-related adverse events was 97·1 and 47·7 per cent in the low- and high-risk groups respectively (P < 0·001). The corresponding freedom from AAA-related reintervention was 96·2 and 54·1 per cent (P < 0·001). The method had a sensitivity of 88·3 per cent, specificity of 77·0 per cent and negative predictive value of 96·6 per cent to detect AAA-related adverse events. The number of surveillance imaging per AAA-related adverse event was 168 versus 11 for the low-risk versus high-risk group.
Conclusion
Two-thirds of patients undergoing EVAR have an adequate seal and no endoleak on the first postoperative CTA, and a very low risk of AAA-related events up to 5 years. Less vigilant follow-up after EVAR may be considered for these patients.
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Affiliation(s)
- H Baderkhan
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - O Haller
- Department of Radiology, Gävle Hospital, Gävle, Sweden
| | - A Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - M Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - K Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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27
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Karthikesalingam A, Grima MJ, Holt PJ, Vidal-Diez A, Thompson MM, Wanhainen A, Bjorck M, Mani K. Comparative analysis of the outcomes of elective abdominal aortic aneurysm repair in England and Sweden. Br J Surg 2018; 105:520-528. [PMID: 29468657 PMCID: PMC5900926 DOI: 10.1002/bjs.10749] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/21/2017] [Accepted: 10/09/2017] [Indexed: 12/04/2022]
Abstract
Background There is substantial international variation in mortality after abdominal aortic aneurysm (AAA) repair; many non‐operative factors influence risk‐adjusted outcomes. This study compared 90‐day and 5‐year mortality for patients undergoing elective AAA repair in England and Sweden. Methods Patients were identified from English Hospital Episode Statistics and the Swedish Vascular Registry between 2003 and 2012. Ninety‐day mortality and 5‐year survival were compared after adjustment for age and sex. Separate within‐country analyses were performed to examine the impact of co‐morbidity, hospital teaching status and hospital annual caseload. Results The study included 36 249 patients who had AAA treatment in England, with a median age of 74 (i.q.r. 69–79) years, of whom 87·2 per cent were men. There were 7806 patients treated for AAA in Sweden, with a median of age 73 (68–78) years, of whom 82·9 per cent were men. Ninety‐day mortality rates were poorer in England than in Sweden (5·0 versus 3·9 per cent respectively; P < 0·001), but were not significantly different after 2007. Five‐year survival was poorer in England (70·5 versus 72·8 per cent; P < 0·001). Use of EVAR was initially lower in England, but surpassed that in Sweden after 2010. In both countries, poor outcome was associated with increased age. In England, institutions with higher operative annual volume had lower mortality rates. Conclusion Mortality for elective AAA repair was initially poorer in England than Sweden, but improved over time alongside greater uptake of EVAR, and now there is no difference. Centres performing a greater proportion of EVAR procedures achieved better results in England. Improving in England
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Affiliation(s)
- A Karthikesalingam
- St George's Vascular Institute, St George's University of London, London, UK.,Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - M J Grima
- St George's Vascular Institute, St George's University of London, London, UK.,Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - P J Holt
- St George's Vascular Institute, St George's University of London, London, UK.,Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Vidal-Diez
- St George's Vascular Institute, St George's University of London, London, UK.,Population Health Research Institute, St George's University of London, London, UK
| | - M M Thompson
- St George's Vascular Institute, St George's University of London, London, UK
| | - A Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - M Bjorck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - K Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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Chakraborty S, Chopra M, Mani K, Giri AK, Banerjee P, Sahni NS, Siddhu A, Tandon N, Bharadwaj D. Prevalence of vitamin B12
deficiency in healthy Indian school-going adolescents from rural and urban localities and its relationship with various anthropometric indices: a cross-sectional study. J Hum Nutr Diet 2018; 31:513-522. [DOI: 10.1111/jhn.12541] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- S. Chakraborty
- Genomics and Molecular Medicine Unit; CSIR-Institute of Genomics and Integrative Biology; New Delhi India
- Academy of Scientific and Innovative Research; CSIR-Institute of Genomics and Integrative Biology; New Delhi India
| | - M. Chopra
- Department of Food and Nutrition; Lady Irwin College; University of Delhi; New Delhi India
| | - K. Mani
- Department of Biostatistics; All India Institute of Medical Sciences; New Delhi India
| | - A. K. Giri
- Genomics and Molecular Medicine Unit; CSIR-Institute of Genomics and Integrative Biology; New Delhi India
- Academy of Scientific and Innovative Research; CSIR-Institute of Genomics and Integrative Biology; New Delhi India
| | - P. Banerjee
- Genomics and Molecular Medicine Unit; CSIR-Institute of Genomics and Integrative Biology; New Delhi India
| | - N. S. Sahni
- School of Computational and Integrative Sciences; Jawaharlal Nehru University; New Delhi India
| | - A. Siddhu
- Department of Home Science; Lady Irwin College; University of Delhi; New Delhi India
| | - N. Tandon
- Department of Endocrinology and Metabolism; All India Institute of Medical Sciences; New Delhi India
| | - D. Bharadwaj
- Genomics and Molecular Medicine Unit; CSIR-Institute of Genomics and Integrative Biology; New Delhi India
- Academy of Scientific and Innovative Research; CSIR-Institute of Genomics and Integrative Biology; New Delhi India
- Systems Genomics Laboratory; School of Biotechnology; Jawaharlal Nehru University; New Delhi India
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29
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Grima M, Karthikesalingam A, Holt P, Vidal-Diez A, Thompson M, Wanhainen A, Bjorck M, Mani K. Comparative Analysis of the Outcomes of Elective Abdominal Aortic Aneurysm Repair in England and Sweden: Context for Contemporary Practice. Eur J Vasc Endovasc Surg 2017. [DOI: 10.1016/j.ejvs.2017.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Gavali H, Mani K, Tegler G, Kawati R, Covaciu L, Wanhainen A. Prolonged ICU Length of Stay after AAA Repair: Analysis of Time Trends and Long-term Outcome. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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31
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Budtz-Lilly J, Venermo M, Debus S, Behrendt CA, Altreuther M, Beiles B, Szeberin Z, Eldrup N, Danielsson G, Thomson I, Wigger P, Björck M, Loftus I, Mani K. Assessment of International Outcomes of Intact Abdominal Aortic Aneurysm Repair over 9 Years. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Budtz-Lilly J, Venermo M, Debus S, Behrendt CA, Altreuther M, Beiles B, Szeberin Z, Eldrup N, Danielsson G, Thomson I, Wigger P, Björck M, Loftus I, Mani K. Editor's Choice – Assessment of International Outcomes of Intact Abdominal Aortic Aneurysm Repair over 9 Years. Eur J Vasc Endovasc Surg 2017; 54:13-20. [DOI: 10.1016/j.ejvs.2017.03.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/02/2017] [Indexed: 01/01/2023]
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33
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Lilja F, Mani K, Wanhainen A. Trend-break in Abdominal Aortic Aneurysm Repair With Decreasing Surgical Workload. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Gavali H, Mani K, Tegler G, Kawati R, Covaciu L, Wanhainen A. Editor's Choice - Prolonged ICU Length of Stay after AAA Repair: Analysis of Time Trends and Long-term Outcome. Eur J Vasc Endovasc Surg 2017. [PMID: 28648757 DOI: 10.1016/j.ejvs.2017.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the frequency and outcome of prolonged intensive care unit (ICU) length of stay (LOS) after abdominal aortic aneurysm (AAA) repair in the endovascular era. METHODS All patients operated on for AAA between 1999 and 2013 at Uppsala University hospital were identified. Data were retrieved from the Swedish Vascular registry, the Swedish Intensive Care registry, the National Population registry, and case records. Prolonged ICU LOS was defined as ≥ 48 h during the primary hospital stay. Patients surviving ≥ 48 h after AAA surgery were included in the analysis. RESULTS A total of 725 patients were identified, of whom 707 (97.5%) survived ≥ 48 h; 563 (79.6%) underwent intact AAA repair and 144 (20.4%) ruptured AAA repair. A total of 548 patients (77.5%) required < 48 h of intensive care, 115 (16.3%) 2-6 days and 44 (6.2%) ≥ 7 days. The rate of prolonged ICU LOS declined considerably over time, from 41.4% of all AAA repairs in 1999 to 7.3% in 2013 (p < .001) whereas the use of endovascular aortic repair (EVAR) increased from 6.9% in 1999 to 78.0% in 2013 (p < .001). The 30 day survival rate was 98.2% for those with < 48 h ICU stay versus 93.0% for 2-6 days versus 81.8% for ≥ 7 days (p < .001); the corresponding 90 day survival was 97.1% versus 86.1% versus 63.6% (p < .001) respectively. For patients surviving 90 days after repair, there was no difference in long-term survival between the groups. CONCLUSION During the period of progressively increasing use of EVAR, a simultaneous significant reduction in frequency of prolonged ICU LOS occurred. Although prolonged ICU LOS was associated with a high short-term mortality, long-term outcome among those surviving the initial 90 days was less affected.
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Affiliation(s)
- H Gavali
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
| | - K Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - G Tegler
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - R Kawati
- Department of Surgical Sciences, Section of Anesthesiology, Uppsala University, Uppsala, Sweden
| | - L Covaciu
- Department of Surgical Sciences, Section of Anesthesiology, Uppsala University, Uppsala, Sweden
| | - A Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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35
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Sonesson B, Björses K, Dias N, Rylance R, Mani K, Wanhainen A, Resch T. Outcome After Ruptured AAA Repair in Octo- and Nonagenarians in Sweden 1994–2014. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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36
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Lilja F, Mani K, Wanhainen A. Editor's Choice - Trend-break in Abdominal Aortic Aneurysm Repair With Decreasing Surgical Workload. Eur J Vasc Endovasc Surg 2017; 53:811-819. [PMID: 28392057 DOI: 10.1016/j.ejvs.2017.02.031] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/28/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The epidemiology and management of abdominal aortic aneurysms (AAAs) has changed drastically in the past decades, with implementation of nationwide screening programs, introduction of endovascular repair (EVAR), and reduced prevalence of the disease. This report aims to assess recent trends in AAA repair epidemiology in Sweden in this context. METHODS Primary AAA repairs registered in the nationwide Swedish Vascular Registry (Swedvasc) 1994-2014 were analyzed regarding patient characteristics, repair incidence, technique, and outcome. Four time periods were compared: 1994-1999, 2000-2004, 2005-2009, and 2010-2014. RESULT The incidence of intact AAA repair increased (18.4/100,000 1994-1999, 27.3/100,000 2010-2014, p < .001) predominantly among octogenarians (12.7/100,000 1994-1999, 36.0/100,000 2010-2014, p < .001). The utilization of EVAR increased (58% of all intact AAA repairs 2010-2014), especially among octogenarians (80% 2010-2014). During the last time period, however, the incidence of intact AAA repair stabilized, despite an increasing number of screening-detected AAAs operated on (19% in 2010-2014). Short- and long-term outcome after intact AAA repair continued to improve, most pronounced among octogenarians (30-day mortality 9% 1994-1999, 2% 2010-2014, p < .001). The incidence of ruptured AAA repair steadily decreased (9.2/100,000 1994-1999, 6.9/100,000 2010-2014, p < .001) and the use of EVAR for ruptures increased (30% in 2010-2014). The previously observed improvement of short- and long-term outcome after ruptured AAA repair (30-day mortality 38% 1994-1999, 28% 2010-2014, p < .001) stalled during the last time period. The overall 30-day mortality after ruptured AAA repair was 22% after EVAR versus 31% after open repair in 2010-2014. The corresponding mortality for octogenarians was 28% versus 42%. CONCLUSIONS For the first time, a halt in intact AAA repair workload could be identified. This trend-break occurred despite continued increase in treatment of octogenarians and screening-detected aneurysms. Additionally, the ruptured AAA repair incidence continued to decrease. These findings, together with the sustained improvement in survival after AAA repair, may have important impact on planning of vascular surgical services.
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Affiliation(s)
- F Lilja
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - K Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - A Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
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Venermo M, Wang G, Sedrakyan A, Mao J, Eldrup N, DeMartino R, Mani K, Altreuther M, Beiles B, Menyhei G, Danielsson G, Thomson I, Heller G, Setacci C, Björck M, Cronenwett J. Editor's Choice – Carotid Stenosis Treatment: Variation in International Practice Patterns. Eur J Vasc Endovasc Surg 2017; 53:511-519. [DOI: 10.1016/j.ejvs.2017.01.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/24/2017] [Indexed: 12/30/2022]
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38
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Sorelius K, Wanhainen A, Furebring M, Bjork M, Gillgren P, Mani K. Nationwide Study of the Treatment of Mycotic Abdominal Aortic Aneurysms Comparing Open and Endovascular Repair. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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39
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Bruce S, Mani K, Lindskog K, Jangland L, Wanhainen A. Eye Dose Reduction with Various X-ray Protection Shields during Endovascular Procedures. Eur J Vasc Endovasc Surg 2016. [DOI: 10.1016/j.ejvs.2016.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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40
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Goddard L, Brodin P, Lee A, Mani K, Bodner W, Garg M, Tomé W. EP-1906: Importance of true cord delineation in spine SBRT and rigid vs. deformable MRI-to-CT registration. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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41
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Gunnarsson K, Wanhainen A, Djavani Gidlund K, Björck M, Mani K. Endovascular Versus Open Repair as Primary Strategy for Ruptured Abdominal Aortic Aneurysm: A National Population-based Study. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2015.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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42
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Karthikesalingam A, Wanhainen A, Holt PJ, Vidal-Diez A, Brownrigg JRW, Shpitser I, Björck M, Thompson MM, Mani K. Comparison of long-term mortality after ruptured abdominal aortic aneurysm in England and Sweden. Br J Surg 2015; 103:199-206. [PMID: 26620854 DOI: 10.1002/bjs.10049] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/20/2015] [Accepted: 10/07/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Concern has been raised regarding international discrepancies in perioperative mortality after repair of ruptured abdominal aortic aneurysm (rAAA). The variation in in-hospital mortality is difficult to interpret, owing to international differences in discharge strategies. This study compared 90-day and 5-year mortality in patients who had a rAAA in England and Sweden. METHODS Patients undergoing rAAA repair were identified from English Hospital Episode Statistics and the Swedish Vascular Registry (Swedvasc) between 2003 and 2012. Ninety-day and 5-year mortality were compared after matching for age and sex. Within-country analyses examined the impact of co-morbidity, teaching hospital status or hospital annual caseload, adjusted with causal inference techniques. RESULTS Some 12 467 patients underwent rAAA repair in England, of whom 83.2 per cent were men; the median (i.q.r.) age was 75 (70-80) years. A total of 2829 Swedish patients underwent rAAA repair, of whom 81.3 per cent were men; their median (i.q.r.) age was 75 (69-80) years. The 90-day mortality rate was worse in England (44.0 per cent versus 33.4 per cent in Sweden; P < 0.001), as was 5-year mortality (freedom from mortality 38.6 versus 46.3 per cent respectively; P < 0.001). In England, lower mortality was seen in teaching hospitals with larger bed capacity, higher annual caseloads and greater use of endovascular aneurysm repair (EVAR). In Sweden, lower mortality was associated with EVAR, high annual caseload, or surgery on weekdays compared with weekends. CONCLUSION Short- and long-term mortality after rAAA repair was higher in England. In both countries, mortality was lowest in centres performing greater numbers of AAA repairs per annum, and more EVAR procedures.
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Affiliation(s)
- A Karthikesalingam
- St George's Vascular Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK
| | - A Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - P J Holt
- St George's Vascular Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK
| | - A Vidal-Diez
- St George's Vascular Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK
| | - J R W Brownrigg
- St George's Vascular Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK
| | - I Shpitser
- Department of Mathematical Sciences, University of Southampton, Southampton, UK
| | - M Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - M M Thompson
- St George's Vascular Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK
| | - K Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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Mani K. Open repair for chronic type B dissection. Eur J Vasc Endovasc Surg 2015; 50:744. [PMID: 26409703 DOI: 10.1016/j.ejvs.2015.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/18/2015] [Indexed: 11/17/2022]
Affiliation(s)
- K Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
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Hellgren T, Wanhainen A, Björck M, Mani K. Long-term Survival after TEVAR depends on Indication for Surgery, and is Shorter than Expected after Ruptured Thoracic Aneurysm. Eur J Vasc Endovasc Surg 2015. [DOI: 10.1016/j.ejvs.2015.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Laine M, Björck M, Beiles B, Altreuter M, Szeberin Z, Thompson I, Debus S, Mani K, Menyhei G, Venermo M. Internal Iliac Aneurysms have a Low Risk of Rupture under 4 cm: A Multicentre Study. Eur J Vasc Endovasc Surg 2015. [DOI: 10.1016/j.ejvs.2015.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Eriksson J, Wanhainen A, Mani K. Cost and Health Care Resource Utilization in Fenestrated and Branched Endovascular Aortic Repair of Complex Aortic Aneurysms. Eur J Vasc Endovasc Surg 2015. [DOI: 10.1016/j.ejvs.2015.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Monsen C, Acosta S, Mani K, Wann-Hansson C. A randomised study of NPWT closure versus alginate dressings in peri-vascular groin infections: quality of life, pain and cost. J Wound Care 2015; 24:252, 254-6, 258-0. [PMID: 26075373 DOI: 10.12968/jowc.2015.24.6.252] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to compare the vacuum assisted wound closure (VAC) system (negative pressure wound therapy; NPWT) and alginate wound dressings in terms of quality of life (QoL), pain resource use and cost in patients with deep peri-vascular groin infection after vascular surgery. METHOD Patients with deep peri-vascular groin infection (Szilagyi grade III) were included and randomised to NPWT or alginate therapy. EuroQol 5D (EQ-5D) and brief pain inventory (BPI) were used to evaluate QoL and pain, respectively. RESULTS Wound healing time until complete skin epithelialisation was shorter in the NPWT (n=9) compared to the alginate group (n=7), median 57 and 104 days, respectively (p=0.026). No difference was recorded in QoL and pain between the groups at study start and the second assessment. QoL analysis within groups between time points, showed that patients in NPWT groups improved in EQ-5D domains, 'self-care' (p= 0.034), 'usual activities' (p=0.046); EQ-5D index value (p=0.046) and EQ-VAS (p=0.028). Patients in the NPWT group reported significantly less pain 'affecting their relations with other people' and 'sleep' between time points. The NPWT group had significantly fewer dressing changes compared to the alginate group (p<0.001). The median frequency of wound dressing changes outside hospital was 20 (IQR 6-29) in the NPWT group (n=9), compared to 48 (IQR 42-77) in the alginate group (n=8; p=0.004). The saved personnel time for wound care in the first week for the NPWT group, compared with the alginate group, was 4.5 hours per week per nurse. The total hospitalised care cost was 83-87% of the total cost in both groups. CONCLUSION NPWT therapy in patients with deep peri-vascular groin infection can be regarded as the dominant strategy due to improved clinical outcome with equal cost and quality of life measures.
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Affiliation(s)
- C Monsen
- Vascular Center, Malmö-Lund, Skåne University Hospital
| | - S Acosta
- Vascular Center, Malmö-Lund, Skåne University Hospital
| | - K Mani
- Institution for Surgical Sciences, Uppsala University Hospital
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Mani K, Venermo M, Beiles B, Menyhei G, Altreuther M, Loftus I, Björck M. Regional Differences in Case Mix and Peri-operative Outcome After Elective Abdominal Aortic Aneurysm Repair in the Vascunet Database. Eur J Vasc Endovasc Surg 2015; 49:646-652. [DOI: 10.1016/j.ejvs.2015.01.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 01/28/2015] [Indexed: 01/21/2023]
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Goddard L, Brodin P, Mani K, Lee A, Garg M, Tome W, Kalnicki S. SU-E-J-85: The Effect of Different Imaging Modalities On the Delineation of the True Spinal Cord for Spinal Stereotactic Body Radiation Therapy. Med Phys 2015. [DOI: 10.1118/1.4924172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Mani K. The Importance of Re-interventions After Ruptured EVAR. Eur J Vasc Endovasc Surg 2015; 49:669. [PMID: 25842989 DOI: 10.1016/j.ejvs.2015.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 11/19/2022]
Affiliation(s)
- K Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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