Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for patients with symptomatic severe aortic stenosis who are at high risk of perioperative mortality. Previous studies showed increased risk of postoperative AKI with TAVR, but it is unclear whether differences in patient risk profiles confounded the results. To conduct a propensity-matched study, we identified all adult patients undergoing isolated aortic valve replacement for aortic stenosis at Mayo Clinic Hospital in Rochester, Minnesota from

Introduction Robust wall apposition for flow-diverter stents (FDS) may be important for endothelialization. Using a large series of experimental aneurysms treated with the Pipeline Embolization Device (PED), the objectives of this study were to 1) assess interobserver agreement for the evaluation of wall apposition on post-treatment DSA and evaluate its association with aneurysm occlusion and 2) measure the relationship between wall apposition assessed with histology and aneurysm occlusion rate after PED treatment. Material and methods Saccular aneurysms were created in 41 rabbits and treated with PED. DSA was performed just after the deployment of the device and at follow-up. Three investigators independently graded wall apposition on post-treatment DSA as good or poor. One histopathologist blinded to the angiographic results, graded the wall-apposition on histological samples. We examined the correlation between angiographic occlusion and wall apposition with histology and angiography. Results Wall apposition evaluated on histology was strongly associated with saccular aneurysm occlusion. Sensitivity and specificity of wall apposition to predict complete occlusion at follow-up were, respectively, 76.9% and 84.0% with an overall accuracy 81.6%. In this experimental study, DSA was sub-optimal to assess flow diverter apposition with moderate inter-observer agreement and low accuracy. Conclusion Good wall apposition is strongly associated with complete occlusion following flow-diverter therapy. In this study, DSA is suboptimal for assessing wall apposition of FDS. These findings suggest that improved tools for assessing FDS wall apposition are highly relevant.

Purpose To determine whether gadolinium accumulates within cerebrospinal fluid (CSF) in patients recently exposed to the macrocyclic agent gadobutrol and identify factors that may affect this accumulation. Materials and Methods In this prospective observational cohort study, gadolinium was quantified by using inductively coupled plasma mass spectrometry of CSF samples from patients who underwent gadobutrol-enhanced magnetic resonance (MR) imaging followed by lumbar puncture within 30 days (gadobutrol group) or patients who underwent lumbar puncture without history of gadolinium-enhanced MR imaging (control group). CSF total protein level of 35 mg/dL or lower was used as a surrogate marker of an intact blood-brain barrier (BBB). Associations between gadolinium CSF concentration and patient characteristics were examined by using log (e)-linear regression models. Results A total of 82 patients (68 in gadobutrol group, 14 in control group; 42 male and 40 female patients; median age, 47 years [interquartile range, 25-65 years]) were included in this study. Gadolinium was detected in the CSF of all 68 patients in the gadobutrol group (100% [95% confidence interval: 94.7, 100]; range, 0.2-1494 ng/mL). CSF total protein level higher than 35 mg/dL and patient age of at least 18 years were associated with higher gadolinium concentrations (estimate: 1.1, with standard error [SE] of 0.26 [P < .001] and 0.91, with SE of 0.37 [P = .02], respectively). Conclusion Intravenous administration of the macrocyclic agent gadobutrol results in gadolinium accumulation within the CSF, even in the setting of normal renal function and no BBB dysfunction.

Biomarkers of intravascular monocyte activation in at-risk patients were associated with development of ARDS. The potential clinical benefit of early aspirin for prevention of ARDS remains uncertain. Together, results of the biochemical and immunological analyses provide a window into the early pathogenesis of human ARDS and represent potential vascular biomarkers of ARDS risk. Clinical trial registered with www.clinicaltrials.gov (NCT01504867).

Objective To estimate the prevalence and incidence of multimorbidity in a populationbased cohort of patients with rheumatoid arthritis (RA) compared to subjects without RA. Methods Residents of Olmsted County, Minnesota with incident RA by 1987 ACR criteria in 1999-2013 were compared to age and sex-matched non-RA subjects from the same population. Twenty-five chronic comorbidities from a combination of the Charlson, Elixhauser and Rheumatic Disease Comorbidity Indexes were included, excluding rheumatic comorbidities. Aalen-Johansen methods were used to estimate the cumulative incidence of multimorbidity (2 or more chronic comorbidities) or substantial multimorbidity (5 or more), adjusting for the competing risk of death. Results The study included 597 patients with RA and 594 non-RA subjects (70% female, 90% Caucasian, mean age 55.5 years). At incidence/index date, the prevalence of multimorbidity was higher in RA than non-RA subjects (38% RA vs. 32% non-RA, p=0.021) while prevalence of substantial multimorbidity was similar (5% RA vs. 4% non- RA, p=0.68). During follow-up (median 11.6 years RA, 11.3 years non-RA), more RA patients developed multimorbidity (214 RA vs. 188 non-RA; adjusted hazard ratio (HR): 1.39; 95% confidence interval (CI):1.14–1.69). By 10 years after RA incidence/index, the cumulative incidence of multimorbidity was 56.5% among the RA patients (95%CI: 56.5-62.3%) compared with 47.9% among the non-RA (95%CI:42.8-53.7%). RA patients showed no evidence of increase in incidence of substantial multimorbidity (adjusted HR: 1.17; 95%CI: 0.93-1.47). Conclusion Patients with RA have both a higher prevalence of multimorbidity at the time of RA incidence as well as increased incidence thereafter.