The usage of fibre optic technologies presents the possibility of high volume manufacturing at low costs when used with novel diagnostic assays. In this thesis, the technologies of hotwire fibre optic devices are combined with in-fibre Bragg gratings to produce a platform compatible with the developing field of Solid Phase PCR (SP-PCR). Here we demonstrate that the DNA coating of such devices can be performed with economical UV-cross-linking. In the process of validating the platform for SP-PCR usage we have also created a novel assay for monitoring real-time polymerase enzyme activity on solidsurface-attached DNA sequences. The device can function with SP-PCR in real-time through its usage of Total Internal Reflection Fluorescence (TIRF). Our device demonstrates the ability to spatially separate several reactions on a single fibre, representing a novel fibre application, and has the potential to reliably increase the speed and multiplexability of the SP-PCR reactions.
Conclusions: Gore Viabahn VBX and Atrium iCast show high short-term patency and low endoleak rates as bridging stents during fenestrated endovascular repair of complex abdominal and thoracoabdominal aneurysms. Longer follow-up is needed to assess late device-related complications.Objective: Current guidelines to repair abdominal aortic aneurysm (AAA) are determined by AAA size or growth rate. However, many studies suggest that aneurysm diameter alone is not sufficient to predict risk of rupture. Several investigators attempted to relate AAA diameter to body surface area in predicting rupture, but these calculations are cumbersome and difficult to adapt in clinical practice. We aimed to investigate the utility of a novel diameter to height index (DHI) in predicting AAA rupture presentation and 30-day and 5-year mortality.Methods: The Vascular Quality Initiative database (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) was used to identify patients undergoing open or endovascular abdominal aortic aneurysm repair. DHI was defined as AAA diameter in centimeters/height in meters, which yielded a score of 1 to 10. Multivariable logistic regression analysis and receiver operating curves were created to assess the association of DHI with risk of rupture and 30-day mortality. Survival analysis techniques were used to report hazard of 5-year all-cause mortality.Results: A total of 38,798 patients undergoing operative AAA repair were identified, 6.9% of whom presented with rupture. Endovascular aneurysm repair was performed in 56.7% of ruptures compared with 82.1% of intact AAA (P < .001). Patients in the ruptured group were of similar age to those with intact AAA but more likely to be female (22.4% vs 20.5%; P ¼ .017) and black (6.1% vs 4.6%; P < .001). Mean DHI was higher in the ruptured group (mean DHI [6 standard deviation], 4.3 [61.1] vs 3.3 [60.7]; P < .001]. Adjusted odds of rupture increased with 1-point increase of DHI (adjusted odds ratio [aOR], 3.36; 95% confidence interval [CI], 3.15-3.58; P < .001) and chronic kidney disease (aOR, 2.98; 95% CI, 2.66-3.34; P < .001). In contrast, antiplatelet, statin, and beta-blocker use were associated with a significantly reduced odds of rupture (0.52 [0.47-0.59], 0.45 [0.40-0.50], 0.87 [0.84-0.90]; all P < .001). e216Abstracts
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