Objective: To analyse the early and mid-term outcome of patients undergoing conventional aortic valve replacement (AVR) versus minimally invasive via hemi-sternotomy aortic valve replacement (MIAVR). Methods: A single centre retrospective study involving 653 patients who underwent isolated aortic valve replacement (AVR) either via conventional AVR ( n = 516) or MIAVR ( n = 137) between August 2015 and March 2020. Using pre-operative characteristics, patients were propensity matched (PM) to produce 114 matched pairs. Assessment of peri-operative outcomes, early and mid-term survival and echocardiographic parameters was performed. Results: The mean age of the PM conventional AVR group was 71.5 (±8.9) years and the number of male ( n = 57) and female ( n = 57) patients were equal. PM MIAVR group mean age was 71.1 (±9.5) years, and 47% of patients were female ( n = 54) and 53% male ( n = 60). Median follow-up for PM conventional AVR and MIAVR patients was 3.4 years (minimum 0, maximum 4.8 years) and 3.4 years (minimum 0, maximum 4.8 years), respectively. Larger sized aortic valve prostheses were inserted in the MIAVR group (median 23, IQR = 4) versus conventional AVR group (median 21, IQR = 2; p = 0.02, SMD = 0.34). Cardiopulmonary bypass (CPB) time was longer with MIAVR (94.4 ± 19.5 minutes) compared to conventional AVR (83.1 ± 33.3; p = 0.0001, SMD = 0.41). Aortic cross-clamp (AoX) time was also longer in MIAVR (71.6 ± 16.5 minutes) compared to conventional AVR (65.0 ± 52.8; p = 0.0001, SMD = 0.17). There were no differences in the early post-operative complications and mortality between the two groups. Follow-up echocardiographic data showed significant difference in mean aortic valve gradients between conventional AVR and MIAVR groups (17.3 ± 8.2 mmHg vs 13.0 ± 5.1 mmHg, respectively; p = 0.01, SMD = −0.65). There was no significant difference between conventional AVR and MIAVR in mid-term survival at 3 years (88.6% vs 92.1%; log-rank test p = 0.31). Conclusion: Despite the longer CPB and AoX times in the MIAVR group, there was no significant difference in early complications, mortality and mid-term survival between MIAVR and conventional AVR.
Fifteen prepubertal male rats (age 30 days) were divided into three groups of five each: Group 1, hypothyroid (Tx)--rats were thyroidectomized at day 30; Group 2, T4 (L-thyroxine) replacement therapy (Tx+T4)--rats were thyroidectomized at day 30 and treated daily i.m. with T4 (6 micrograms/100 g body weight/day) for 30 days from day 31 to day 60 post-thyroidectomy (age 90 days); Group 3, control--rats were sham-operated and treated with vehicle. The rats from all groups were killed on day 61 post-thyroidectomy or post-sham operation (age 91 days). The serum levels of testosterone, T4 and T3 decreased in the Tx group (p < 0.001). In the Tx+T4 group the levels of T4 and T3 were restored to control values, whereas testosterone levels remained lower than in the control group. Hypothyroidism caused various changes in the levels of epididymal phospholipids and neutral lipids. These were restored differentially or were altered further in the Tx+T4 group. The number and forward motility of spermatozoa, recovered from the cauda epididymis, were decreased significantly (p < 0.01) in the Tx group and were not restored in the Tx+T4 group. This study shows that chronic hypothyroidism, induced at prepuberty and continued for 60 days, causes various changes in the lipid composition of the caput and cauda epididymis and lowers the quality and quantity of spermatozoa in the cauda epididymis. T4 therapy for 30 days, especially during the postpubertal period, did not restore the quality or quantity of spermatozoa and caused differential changes in the levels of epididymal lipids, depending upon the region.(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUND: Treatments not considered a part of conventional cancer care are known as Complementary and Alternative Medicine (CAM) and are becoming increasingly popular. These CAM therapies, divided into Alternative Medical Systems (AMS), Mind-Body Interventions (MBI), Biological Based Therapies (BBT), Manipulative Therapies (MT) and Energy Therapies (ET), may or may not benefit patients (pts). Socioeconomic factors which may be associated with CAM use have not been well defined. AIM: To further define socioeconomic factors associated with the use of specific CAMs in pts with early stage breast cancer. METHODS: 513 early stage breast cancer pts were interviewed between 4/2012 and 6/2014 using an IRB approved survey. The pts were interviewed after completion of all adjuvant chemotherapy, radiation and at least 6 months of adjuvant hormone therapy. Data collected included pt demographics, age, race, employment, insurance, marital status, income, education, religion and residence. All pts had literacy testing using a validated reading test. Pts were questioned on the use of 36 specific CAMs within the 5 CAM divisions, why they chose to use CAMs, and their opinion relative to benefits. Chi square test was used to evaluate the data. RESULTS: CAM use was common with 100% of pts using or participating in at least 1 CAM class. CAMS within the MBI division were used by most patients with statistically increased use seen in non-protestant religion and employed pts (p=0.02 and 0.04). BBT division use was associated with age (p=0.001) and marginal for being insured (p=0.06). AMS use appeared to be more common in unemployed pts but was not statistically significant (p= 0.07). The most common specific CAMs used were prayer (95%), exercise (65%), deep breathing (39%), and music therapy (38%). Statistically significant socioeconomic associations with specific CAM subclass utilizations included: Advancing age was associated with herbal supplement use. White pts used PET, music and art therapy as compared to black pts who used dance therapy and progressive relaxation. Insured pts used herbal, yoga and pilates. Pts with high income participated in yoga while low income used deep breathing, progressive relaxation, music and dance therapy. Pts with higher reading level (education) used deep breathing, music, dance and pet therapy. CONCLUSION: All pts, with early stage breast cancer, utilize CAMs and see their use as an important part of their cancer therapy. Specific CAM subgroups use was associated with advancing age, employment, income, race and reading levels. Although all pts use CAM therapy, the vast majority of CAMs pose no risk and could benefit the individual pt. Utilization of various herbal supplements, which could pose a risk, is seen in all socioeconomic groups, however, a statistically significant increased use was seen with advancing age and having insurance. This study, however, did not obtain information from the 2% of pts seen at our institution who abandoned all conventional therapy and were lost to follow-up. Citation Format: Swetha Panati, Kamran Shahid, Kaylin S Watson, Lauren Adair, Sanjay Juneja, Kimberly Nguyen, Runhua Shi, Gary V Burton. Socioeconomic factors and the use of complimentary and alternative therapies in patients with early stage breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-12-11.
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