Conclusions: Thoracic endovascular aortic repair (TEVAR) is a safe and effective treatment for thoracic aortic aneurysms. TEVAR provides improved perioperative results and similar long-term results as open thoracic aortic repair. TEVAR-treated aneurysms initially decrease in diameter and then stabilize over time.Summary: Early clinical results with TEVAR have generally shown a trend toward better perioperative survival and less major perioperative complications than open thoracic aortic aneurysm repair. The early results of the pivotal trials used to gain approval of the Gore TAG, Medtronic Talent, and Cook Zenith TX2 stent grafts provided highly favorable midterm data for stent grafts. Longer-term data are still desirable, however. The authors investigated long-term survival and freedom from aortic complications in patients enrolled in five U.S. Food and Drug Administration investigational device exemption studies of TEVAR grafts from a single center and compared them with a group of open control patients with similar anatomic features. Demographic, clinical, and radiographic parameters were collected prospectively from patients enrolled in trials assessing the Gore TAG ( 55), Medtronic Talent (36), and Cook TX2 (15) devices. Outcomes in patients treated with these stent grafts were compared with 45 contemporaneous open controls. From 1995 to 2007, there were 106 patients enrolled in TEVAR trials at the hospital of the University of Pennsylvania and 45 open controls. TEVAR patients were older and had more comorbidities, including diabetes and renal failure. TEVAR patients had 2.3 Ϯ 1.3 devices implanted. Mortality (2.6% TEVAR, 6.7% open; P ϭ .1) and paralysis/ paraparesis (3.9% TEAVR, 7.1% open; P ϭ .2) did not differ in the open vs TEVAR patients. Prolonged intubation Ͼ24 hours was more common in the open controls (9% TEVAR, 24% open; P ϭ .002). Overall survival at 8 to 10 years was ϳ40% and was similar between groups (log-rank P ϭ .5). Predictors of late mortality included age, diabetes, chronic renal failure, and chronic obstructive coronary disease. Use of TEVAR vs open surgery did not influence mortality (hazard ratio, 0.9; 95% confidence interval, 0.4-1.6). At 5 years in the TEVAR group, mean aortic diameter decreased from 61 to 55 mm. Freedom from reintervention of the treated segment was 85% in TEVAR patients at 10 years.Comment: The article highlights the fact that compared with the number of patients in whom TEVAR has been performed, the number of patients with long term follow-up is still relatively small. (The University of Pennsylvania group has reported Ͼ500 TEVAR procedures in other articles.) In the discussion after the article, Dr Craig Miller from Stanford indicates that he is concerned that "the entire thoracic field is being 'dumbed down' as the TEVAR era evolved." One can easily extrapolate Dr Miller's concerned to all endovascular techniques "dumbing down" all of vascular surgery. In the long run, however, outcomes rather than nostalgia will drive practice patterns in the treatment of vascu...

BackgroundA previous systematic review and meta-analysis reported that omega-3 fatty acids nutrition may reduce mortality in septic patients. As new randomized controlled trials began to accumulate, we conducted an update.MethodsA PubMed database was searched through Feb 2016, and randomized controlled trials comparing omega-3 fatty acids with control were selected by two reviewers independently.ResultsEleven trials randomly assigning 808 patients were included in the present study. Using a fixed effects model, we found no significant effect of omega-3 fatty acids on overall mortality (risk ratio 0.84; 95 % confidence interval (CI): 0.67 to 1.05, P = 0.12), or infectious complications (risk ratio 0.95; 95 % CI: 0.72 to 1.25, P = 0.70). However, the duration of mechanical ventilation was markedly reduced by omega-3 fatty acids (weighted mean differences (WMD) = −3.82; 95 % CI: −4.61 to −3.04; P < 0.00001). A significant heterogeneity was found when the duration of hospital (I 2 = 93 %; WMD = −2.82; 95 % CI: −9.88 to 4.23, P = 0.43), or intensive care stay (I 2 = 87 %; WMD = −2.70; 95 % CI: −6.40 to 1.00, P = 0.15) were investigated.ConclusionsOmega-3 fatty acids confer no mortality benefit but are associated with a reduction in mechanical ventilation duration in septic patients. However, low sample size and heterogeneity of the cohorts included in this analysis limits the generalizability of our findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0200-7) contains supplementary material, which is available to authorized users.

The aim of the present work was to investigate the response and safety of whole-brain radiotherapy (WBRT) plus temozolomide (TMZ) for patients with brain metastases of non-small-cell lung cancer (NSCLC). Methods: The electronic databases of Pubmed, EMbase, Cochrane, Wangfang, china national knowledge infrastructure (CNKI), and Google scholar were systematically searched to identify the prospective randomized trials relevant to WBRT plus TMZ for patients with brain metastases of NSCLC. The data associated with treatment response and toxicity were extracted from original included studies. The relative risk (RR) for treatment response and toxicity between WBRT+TMZ and WBRT alone was pooled by fixed or random effect model. Publication bias was investigated by Begg's funnel plot and Egger's line regression test. Results: Twenty-five clinical trials fulfilled the inclusion criteria and were included in the meta-analysis. The pooled results showed WBRT+TMZ can significant improve the objective response rate (ORR) compared with WBRT alone (RR = 1.43, 95% confidence interval [CI] 1.32-1.55, p < 0.05) under a fixed effect model. WBRT+TMZ significantly increased the III-IV hematological toxicity compared to WBRT alone (RR = 1.66, 95% CI 1.12-2.54, p < 0.05) in the fixed effect model. Grade III-IV gastrointestinal toxicity was increased in WBRT+TMZ compared to WBRT alone (RR = 1.72, 95% CI 1.29-2.30, p < 0.05). Begg's funnel plot and Egger's line regression test indicated publication bias. Conclusion: Based on the present work, WBRT+TMZ can improve the ORR for brain metastases of NSCLC, but the risk of treatment-associated grade III/IV hematological toxicity and gastrointestinal toxicity were also increased compared to WBRT alone.

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