Endovascular repair and open repair resulted in similar long-term survival. The perioperative survival advantage with endovascular repair was sustained for several years, but rupture after repair remained a concern. Endovascular repair led to increased long-term survival among younger patients but not among older patients, for whom a greater benefit from the endovascular approach had been expected. (Funded by the Department of Veterans Affairs Office of Research and Development; OVER ClinicalTrials.gov number, NCT00094575.).

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Lederle FA, Freischlag JA, Kyriakides TC, and the OVER Veterans Affairs Cooperative Study Group. N Engl J Med 2012;367:1988-97. Conclusion:Endovascular and open repair of abdominal aortic aneurysm (AAA) have similar long-term survival. In those aged <70 years, survival tends to be better with endovascular repair, whereas in those aged >70 years, survival appears improved with open repair.Summary: With the exception of colectomy, aneurysm repair results in more perioperative deaths than any other general or vascular surgical procedure, w1250 perioperative deaths per year (Ghaferi AA et al, N Engl J Med 2009;1361-8-75). Randomized trials have demonstrated decreased perioperative mortality in patients undergoing endovascular AAA repair. This survival advantage in the United Kingdom EVAR 1 trial and the Dutch DREAM trial was lost #2 years due to excess late deaths in the endovascular repair groups (The United Kingdom EVAR Trial Investigators, N Engl J Med 2010;362:1863-71; De Bruin JL et al, N Engl J Med 2010;362:1881-9). In the Veterans Affair Cooperative Study of Open vs Endovascular Repair (OVER), excess late deaths in the endovascular groups were not noted at 2 years (Lederle FA et al, JAMA 2009;302:1535-42). The authors of this study present the longer-term results of the OVER trial. In the trial, 881 patients with asymptomatic AAAs who were candidates for open or endovascular repair were randomized to endovascular repair (n ¼ 444) or open repair (n ¼ 437). Followup is for up to 9 years (mean, 5.2 years). Forty-two Veteran's Affairs medical centers participated in the trial, and all patients were aged $49 years at entry into the trial. More than 95% of patients underwent the assigned repair. The primary outcome was all-cause mortality, and 146 deaths occurred in each group (hazard risk [HR] with endovascular repair vs open repair, 0.97; 95% confidence interval [CI], 0.77-1.22; P ¼ .81). The previously reported reduction in perioperative mortality with endovascular repair was sustained at 2 years (HR, 0.63; 95% CI, 0.40-0.98; P ¼ .04) and at 3 years (HR, 0.72; 95% CI, 0.51-1.00; P ¼ .05) but not thereafter. In the endovascular repair group there were 10 aneurysm-related deaths (2.3%) vs 16 in the open repair group (3.7%; P ¼ .22). Six aneurysm ruptures were confirmed in the endovascular repair group vs none in the open repair group (P ¼ .03). A significant interaction was observed between age and type of treatment (P ¼ .006). Survival was increased among patients aged <70 years in the endovascular repair group but tended to be better among those aged >70 years in the open repair group. The two groups did not differ significantly with respect to number of secondary therapeutic procedures, number of hospitalizations after repair, quality of life, or erectile dysfunction.Comment: Perhaps the most surprising finding in this study was that endovascular repair appears to result in better outcomes among younger patients and in worse outcomes among older patients. The reasons for this are unclear, but perhaps older ...

We present one of the most comprehensive and longest follow-up analyses of patients treated with aortic endografts. Endoleaks were common and negatively affected aneurysm diameter reduction. Delayed type II endoleaks were associated with late aneurysm diameter enlargement. Endoleaks and aneurysm diameter enlargement were not associated with excess mortality compared with those without these features.

The discovery of reliable and sensitive blood biomarkers is useful for the diagnosis, monitoring and potential future therapy of diseases. Recently, microRNAs (miRNAs) have been identified in blood circulation and might have the potential to be used as biomarkers for several diseases and clinical conditions. Myotonic Dystrophy type 1 (DM1) is the most common form of adult-onset muscular dystrophy primarily characterized by muscle myotonia, weakness and atrophy. Previous studies have shown an association between miRNAs and DM1 in muscle tissue and, recently, in plasma. The aim of this study was to detect and assess muscle-specific miRNAs as potential biomarkers of DM1 muscle wasting, an important parameter in the disease’s natural history. Disease stable or progressive DM1 patients with muscle weakness and wasting were recruited and enrolled in the study. RNA isolated from participants’ serum was used to assess miRNA levels. Results suggest that the levels of muscle-specific miRNAs are correlated with the progression of muscle wasting and weakness observed in the DM1 patients. Specifically, miR-1, miR-133a, miR133b and miR-206 serum levels were found elevated in DM1 patients with progressive muscle wasting compared to disease stable DM1 patients. Based on these results, we propose that muscle-specific miRNAs might be useful molecular biomarkers for monitoring the progress of muscle atrophy in DM1 patients.

In this multicenter randomized trial, endovascular AAA repair resulted in lower cost and better survival than open repair after the initial hospitalization for repair; but after 2 years, survival, quality of life, and costs were not significantly different between the two treatments.

BackgroundHuman immunodeficiency virus (HIV) disproportionately impacts minority youth. Interventions to decrease HIV sexual risk are needed.ObjectiveWe hypothesized that an engaging theory-based digital health intervention in the form of an interactive video game would improve sexual health outcomes in adolescents.MethodsParticipants aged 11 to 14 years from 12 community afterschool, school, and summer programs were randomized 1:1 to play up to 16 hours of an experimental video game or control video games over 6 weeks. Assessments were conducted at 6 weeks and at 3, 6, and 12 months. Primary outcome was delay of initiation of vaginal/anal intercourse. Secondary outcomes included sexual health attitudes, knowledge, and intentions. We examined outcomes by gender and age.ResultsA total of 333 participants were randomized to play the intervention (n=166) or control games (n=167): 295 (88.6%) were racial/ethnic minorities, 177 (53.2%) were boys, and the mean age was 12.9 (1.1) years. At 12 months, for the 258 (84.6%) participants with available data, 94.6% (122/129) in the intervention group versus 95.4% (123/129) in the control group delayed initiation of intercourse (relative risk=0.99, 95% CI 0.94-1.05, P=.77). Over 12 months, the intervention group demonstrated improved sexual health attitudes overall compared to the control group (least squares means [LS means] difference 0.37, 95% CI 0.01-0.72, P=.04). This improvement was observed in boys (LS means difference 0.67, P=.008), but not girls (LS means difference 0.06, P=.81), and in younger (LS means difference 0.71, P=.005), but not older participants (LS means difference 0.03, P=.92). The intervention group also demonstrated increased sexual health knowledge overall (LS means difference 1.13, 95% CI 0.64-1.61, P<.001), in girls (LS means difference 1.16, P=.001), boys (LS means difference 1.10, P=.001), younger (LS means difference 1.18, P=.001), and older (LS means difference=1.08, P=.002) participants. There were no differences in intentions to delay the initiation of intercourse between the two groups (LS means difference 0.10, P=.56).ConclusionsAn interactive video game intervention improves sexual health attitudes and knowledge in minority adolescents for at least 12 months.Trial RegistrationClinicaltrials.gov NCT01666496; https://clinicaltrials.gov/ct2/show/NCT01666496 (Archived by WebCite at http://www.webcitation.org/6syumc9C0).

Myotonic dystrophy type 1 (DM1) is the most common form of adult-onset muscular dystrophy, which is characterised by progressive muscle wasting and the discovery of reliable blood-based biomarkers could be useful for the disease progress monitoring. There have been some reports showing that the presence of specific miRNAs in blood correlates with DM1. In one of these, our group identified four muscle-specific miRNAs, miR-1, miR-133a, miR-133b and miR-206, which correlated with the progression of muscle wasting observed in DM1 patients. The levels of the four muscle-specific miRNAs were elevated in the serum of DM1 patients compared to healthy participants and were also elevated in the serum of progressive muscle wasting DM1 patients compared to disease-stable DM1 patients. The aim of this work was to characterise the ontology of these four muscle-specific miRNAs in the blood circulation of DM1 patients. Here we show that the four muscle-specific miRNAs are encapsulated within exosomes isolated from DM1 patients. Our results show for the first time, the presence of miRNAs encapsulated within exosomes in blood circulation of DM1 patients. More interestingly, the levels of the four exosomal muscle-specific miRNAs are associated with the progression of muscle wasting in DM1 patients. We propose that exosomal muscle-specific miRNAs may be useful molecular biomarkers for monitoring the progress of muscle wasting in DM1 patients. There has been a growing interest regarding the clinical applications of exosomes and their role in prognosis and therapy of various diseases and the above results contribute towards this way.