Objective: Controversy exists about the optimal treatment of acute uncomplicated type B aortic dissection (auTBAD). Optimal medical therapy (OMT) provides excellent short-term outcomes, but long-term results are poor. Ideally, auTBAD patients who will fail to respond to OMT in the chronic phase could be identified and undergo thoracic endovascular aortic repair.The purpose of this study was to identify radiographic predictors of auTBAD patients who will fail to respond to OMT.Methods: A review of the Emory aortic database from 2000 to 2017 identified 320 auTBAD patients initially treated with OMT. From this cohort, 121 patients with two or more contrastenhanced imaging scans were available for analysis. These patients were initially divided into groups based on growth of the thoracic aorta ≥10 mm or intervention due to aneurysmal growth: growth (n = 72) and no growth (n = 49). TeraRecon (Foster City, Calif) imaging software was used to analyze characteristics of the primary intimal tear (PIT), false lumen, and overall aortic size.

The impact of the COVID-19 pandemic on admission patterns and outcomes at a burn center is still largely unknown. The aim for this study was to determine how the COVID-19 pandemic affected the epidemiology of burn admissions at a major metropolitan burn center. This retrospective cohort study examined how the COVID-19 pandemic impacted burn volumes and time to presentation. All burn admissions were included from January 20 th – August 31 st for the years 2020, 2019, & 2018. The COVID-19 pandemic group included admissions from 1/20/2020-8/31/2020 and was compared to the non-pandemic group comprised of admissions from 1/20-8/31 in 2018 and 2019. Subgroup analysis was performed according to meaningful dates during the COVID-19 pandemic including the 1 st US COVID-19 case, shelter in place, and state reopening orders. Admission volumes were 403 patients in the COVID-19 pandemic group compared to a mean of 429 patients in the non-pandemic group, which correlated to a 5.8% decrease in volume during the pandemic. The pandemic group showed an increase in time to presentation of 1 day (p<0.0001). Subgroup analysis demonstrated stable admission volumes and an increase in time to presentation of 1 day (P<0.0001) at each timepoint. During shelter-in-place orders, there were higher rates of second/third degree burns and operative burns (94.7% vs 56.3% and 45.6% vs 27%, p<0.0001, p=0.013). During the pandemic there were stable admission volumes, delayed time to admission, and an increase in operative burns during shelter in place orders. This reinforces the need to maintain appropriate burn center staffing and resources during the COVID-19 pandemic.

Background A debate remains on how long to postpone surgery after testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to determine surgical outcomes at different time points after a positive SARS-CoV-2 test. Methods This cohort study included non-preoperative critically ill adult surgical patients from 5/2020–5/2021 and a subset of SARS-CoV-2 positive patients 15–30 days before surgery from 5/2020–12/2021. Demographics, comorbidities, surgical variables, and outcomes were compared between SARS-CoV-2 positive patients within 50 days before surgery to SARS-CoV-2 negative surgical patients. Cases were stratified based on the timing of SARS-CoV-2 positivity before surgery in days (< 15, 15–30, > 30). Outcomes were compared between strata and against SARS-CoV-2 negative controls. A multivariable model was built to determine the association that the timing of SARS-CoV-2 positivity has on the odds of a major complication. Results The SARS-CoV-2 positive cohort had 262 patients compared to 1,840 SARS-CoV-2 negative patients. Timing strata contained 145 (< 15 days), 53 (15–30 days), and 64 (> 30 days). The SARS-CoV-2 positive group had a higher incidence of comorbidities (87.4% vs. 57.2%) and underwent more emergent surgery (45.7% vs. 9.3%). The odds of major complications in patients positive for SARS-CoV-2 before surgery were 1.88 (1.13–3.15) (< 15 days), 0.43 (0.14–1.30) (15–30 days), and 0.98 (0.44–2.21) (31–50 days) times the odds in SARS-CoV-2 negative surgery patients when controlling for other variables. Conclusion Timing of SARS-CoV-2 positivity before surgery has an impact on major complications. In certain cases, it may be appropriate to postpone surgery 14 days after SARS-CoV-2 positivity.

dissection [CD]). SAI procedures were grouped into open (intended treatment zone or remote aortic site), major endovascular (TEVAR extension or endograft implanted at noncontiguous aortic site), and minor endovascular (side branch or false lumen embolization) categories. Kaplan-Meier methodology was used to estimate freedom from SAI and survival. Cox proportional hazards modeling was used to identify predictors of SAI. Results: A total of 258 patients underwent TEVAR for AD (49% [n ¼ 128]) and CD (51% [n ¼ 130]). Overall, mean follow-up was 17 6 22 months with an SAI rate of 27%

Background The incidence of hyperparathyroidism has increased in the USA. The previous work from our institution detected environmental chemicals (EC) within hyperplastic parathyroid tumors. The National Health and Nutrition Examination Survey (NHANES) is a program designed to assess the health status of people in the USA and includes measurements of EC in serum. Our aim was to determine which EC are associated with elevated parathyroid hormone (PTH) and calcium levels within NHANES. Methods NHANES was queried from 2003–2016 for our analysis with calcium. A separate subgroup was queried from 2003–2006 that included PTH levels. Subjects with elevated calcium, and elevated PTH and normal Vitamin D levels were identified. Wilcoxon rank sum tests were used to analyze levels of EC in those with elevated calcium, and those with elevated PTH in the subgroup. All EC with p < 0.05 were then included in separate multivariate models adjusting for serum vitamin D and creatinine for PTH and albumin for calcium. Results There were 51,395 subjects analyzed, and calcium was elevated in 2.1% (1080) of subjects. Our subgroup analysis analyzed 14,681 subjects, and PTH was elevated without deficient Vitamin D in 9.4% (1,377). Twenty‐nine different polychlorinated biphenyls and the organochlorine pesticides hexachlorobenzene, transnonachlor, oxychlordane, and p,p’‐dichlorodiphenyldichloroethylene (DDE) were found to be associated with elevated calcium and separately with elevated PTH (all p < 0.05). Conclusion In NHANES, 33 ECs were found to be associated with elevated calcium as well as elevated PTH levels on our subgroup analysis. These chemicals may lead us toward a causal link between environmental factors and the development of hyperparathyroidism and should be the focus of future studies looking at chemical levels within specimens.