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Careful processing can preserve important biological activities of blueberries despite changing the blueberry (poly)phenol composition and plasma metabolite profile.

BACKGROUND Thresholds for repair of abdominal aortic aneurysms vary considerably among countries. METHODS We examined differences between England and the United States in the frequency of aneurysm repair, the mean aneurysm diameter at the time of the procedure, and rates of aneurysm rupture and aneurysm-related death. Data on the frequency of repair of intact (nonruptured) abdominal aortic aneurysms, in-hospital mortality among patients who had undergone aneurysm repair, and rates of aneurysm rupture during the period from 2005 through 2012 were extracted from the Hospital Episode Statistics database in England and the U.S. Nationwide Inpatient Sample. Data on the aneurysm diameter at the time of repair were extracted from the U.K. National Vascular Registry (2014 data) and from the U.S. National Surgical Quality Improvement Program (2013 data). Aneurysm-related mortality during the period from 2005 through 2012 was determined from data obtained from the Centers for Disease Control and Prevention and the U.K. Office of National Statistics. Data were adjusted with the use of direct standardization or conditional logistic regression for differences between England and the United States with respect to population age and sex. RESULTS During the period from 2005 through 2012, a total of 29,300 patients in England and 278,921 patients in the United States underwent repair of intact abdominal aortic aneurysms. Aneurysm repair was less common in England than in the United States (odds ratio, 0.49; 95% confidence interval [CI], 0.48 to 0.49; P<0.001), and aneurysm-related death was more common in England than in the United States (odds ratio, 3.60; 95% CI, 3.55 to 3.64; P<0.001). Hospitalization due to an aneurysm rupture occurred more frequently in England than in the United States (odds ratio, 2.23; 95% CI, 2.19 to 2.27; P<0.001), and the mean aneurysm diameter at the time of repair was larger in England (63.7 mm vs. 58.3 mm, P<0.001). CONCLUSIONS We found a lower rate of repair of abdominal aortic aneurysms and a larger mean aneurysm diameter at the time of repair in England than in the United States and lower rates of aneurysm rupture and aneurysm-related death in the United States than in England. (Funded by the Circulation Foundation and others.)

Conclusions: T4 endothoracic sympathetic clip application is effective and safe for treatment of patients with upper limb hyperhidrosis, particularly for those with isolated palmar hyperhidrosis but also to a lesser extent for those with combined palmoaxillary hyperhidrosis.Summary: Endothoracic sympathectomy has been established as an effective and safe therapeutic option for patients with primary upper extremity hyperhidrosis. The major drawback, however, is compensatory sweating. Limited intervention at the fourth thoracic ganglion (T4) should result in lower levels of compensatory sweating in patients treated for upper limb hyperhidrosis. Preservation of inhibitory reflex mechanisms above T4 inhibits increased sweating from other body regions (Lin CC et al, Ann Chir Gynaecol 2001;90:161-6). In this study, the authors sought to evaluate long-term outcomes of endothoracic sympathetic block at T4 (EST4). Special emphasis was placed on evaluation of disease-specific quality of life (QoL) through review of a prospectively accumulated database. This was a prospective study conducted at a university hospital where patients treated with EST4 for palmar or palmoaxillary hyperhidrosis between 2001 and 2008 were evaluated. Questionnaires were developed by Keller and Milanez de Campos to evaluate disease-specific QoL. There were 374 EST4 procedures performed in 189 patients. Of 174 evaluated patients, 54 (31.0%) had palmar and 120 (69.0%) had palmoaxillary hyperhidrosis. Median follow-up was 92 months. EST4 successfully reduced hyperhidrosis in both groups (P < .001) and improved QoL (P < .001). Improvement remained stable after 5 years. However, the overall satisfaction rate did decrease secondary to the development of compensatory sweating and recurrence during follow-up. Compensatory sweating affected 41 patients (23.6%) and was severe in 11 of the 163 patients (6.7%) with 5-year follow-up. Severity of compensatory sweating did not further worsen with time, but occurrence of severe hyperhidrosis increased to 11% at the end of follow-up. Severe compensatory sweating was twice as common in patients treated for palmoaxillary sweating than those treated for palmar sweating (13.2% vs 6.1%).Comment: The most irritating side effect after upper extremity sympathectomy is compensatory sweating. In such cases, sweating is activated by stressors such as physical examination, heat, and psychologic stress. However, no patient in this study apparently considered the compensatory sweating, even when "severe" to be intolerable. Although there are other therapies for severe hyperhidrosis, such as botulinum toxin injections and axillary sweat gland aspiration, overall endoscopic sympathectomy at T4 seems to result in both favorable and durable clinical outcomes, particularly for patients with palmar hyperhidrosis, but to a lesser extent, for those with combined palmoaxillary hyperhidrosis as well.

Long-term survival remains poor after aneurysm repair and adverse cardiovascular events are common relative to the wider population. Further research is required to characterise and optimise cardiovascular risk prevention in patients with aortic aneurysms.