Tissue-engineered vascular grafts (TEVGs) are currently being developed to overcome the limitations and complications associated with traditional synthetic grafts. This article aims to review the current status of research into the production and use of tissue-engineered grafts. TEVGs have a number of theoretical advantages over synthetic grafts. The results of animal and human studies have been promising, but more work must be done before TEVGs can replace traditional grafts.
INTRODUCTION: Metabolic risk factors have been implicated in the incidence of colorectal cancer (CRC); however, less is known about the relationship between obesity and CRC outcomes. We hypothesized that obesity would be associated with worse outcomes compared to normal weight, but with better outcomes compared to underweight individuals. METHODS: A systematic review of electronic databases was performed through May 2019, including NCBI, Embase, Cochrane, and Web of Science. Screening was performed independently by two authors using Covidence. Inclusion criteria were retrospective and prospective cohort studies reporting CRC outcomes at least 60 months after CRC diagnosis. The primary outcome analyzed was CRC mortality in obese compared to normal body mass index (BMI). Secondary outcomes included overall mortality, disease free survival (DFS) and CRC mortality by BMI category (underweight, normal, overweight, and obese), and high vs. normal waist circumference (WC). Odds ratios (OR) and 95% confidence intervals (95% CI) are reported. Random effects analysis was performed for all outcomes, with heterogeneity assessed by the I2 statistic and meta-regression by area of origin (East vs. West). RESULTS: 484 relevant citations were identified and 17 were included in the final analysis. Fifteen studies analyzed CRC outcome data in terms of BMI, and 2 in terms of WC. These studies comprised 251,347 patients, with a median age range of 61.8-71 years and follow-up time range of 60-192 months. Obesity was associated with significantly increased CRC-specific mortality compared to normal BMI (Figure 1). Interestingly, study origin (East vs. West) explained 53% of the heterogeneity in these results, R2 = 0.53 (Figure 2). Underweight patients had increased CRC mortality compared to both normal and overweight patients, but not significantly different from obese patients. High WC was also associated with increased CRC mortality compared to normal WC (Table 1). Obese and underweight patients both had increased OM compared to normal weight patients; underweight patients had increased OM compared to obese patients. Significant effects of BMI on DFS were only observed in Eastern studies, where underweight patients had worse DFS than normal weight and obese. CONCLUSION: Overweight and obesity as well as underweight are risk factors for CRC-specific mortality. Underweight patients had poorer prognosis than overweight patients, but not significantly different from obese patients.
Background Patients with renal insufficiency have poor short‐term outcomes after transcatheter aortic valve replacement (TAVR). Methods Retrospective chart review identified 575 consecutive patients not on hemodialysis who underwent TAVR between September 2014 and January 2017. Outcomes were defined by VARC‐2 criteria. Primary outcome of all‐cause mortality was evaluated at a median follow‐up of 811 days (interquartile range 125–1,151). Results Preprocedural glomerular filtration rate (GFR) was ≥60 ml/min in 51.7%, 30–60 ml/min in 42.1%, and < 30 ml/min in 6.3%. Use of transfemoral access (98.8%) and achieved device success (91.0%) did not differ among groups, but less contrast was used with lower GFR (23 ml [15–33], 24 ml [14–33], 13 ml [8–20]; p < .001). Peri‐procedural stroke (0.7%, 2.1%, 11.1%; p < .001) was higher with lower GFR. Core lab analysis of preprocedural computed tomography scans of patients who developed a peri‐procedural stroke identified potential anatomic substrate for stroke in three out of four patients with GFR 30–60 ml/min and all three with GFR <30 ml/min (severe atheroma was the most common subtype of anatomical substrate present). Compared to GFR ≥60 ml/min, all‐cause mortality was higher with GFR 30–60 ml/min (HR 1.61 [1.00–2.59]; aHR 1.61 [0.91–2.83]) and GFR <30 ml/min (HR 2.41 [1.06–5.48]; aHR 2.34 [0.90–6.09]) but not significant after multivariable adjustment. Follow‐up echocardiographic data, available in 63%, demonstrated no difference in structural heart valve deterioration over time among groups. Conclusions Patients with baseline renal insufficiency remain a challenging population with poor long‐term outcomes despite procedural optimization with a transfemoral‐first and an extremely low‐contrast approach.
INTRODUCTION: There is a wealth of epidemiologic evidence supporting the association between weight parameters and colorectal cancer incidence. However, how these variables affect colorectal cancer (CRC) recurrence is still a topic of debate. In our study, we hypothesized that there would be increased risk of recurrence of colorectal cancer with obesity and higher visceral fat. METHODS: A systematic review of electronic databases was performed through April 2019, including NCBI, Embase, Cochrane, and Web of Science. Screening was performed using Covidence and each article was screened independently by two authors. Included were retrospective and prospective studies reporting CRC outcomes of at least 2 months after cancer diagnosis. The primary outcome was CRC recurrence in obese compared to normal weight subjects, and high vs. normal visceral fat. Weight parameters tested were body mass index (BMI) categories of underweight, normal, overweight, and obese; visceral fat as measured by CT scan into categories of normal and high visceral fat. Odds ratios (OR), risk ratios (RR), and 95% confidence intervals (95% CI) are reported. Random effects analysis was performed for all outcomes, with heterogeneity assessed by the I2 statistic. RESULTS: 484 citations were reviewed of which 9 were included in the final analysis. In total, 7 studies analyzed CRC recurrence data in terms of BMI, and 2 in terms of visceral adiposity. Most were retrospective cohort studies. These studies comprised 5777 patients, with an average age of 61.4 years and with mean follow-up time of 58.4 months, range (52 months–77 months). Both overweight and obese BMI were associated with significantly increased risk of cancer recurrence compared to normal BMI individuals (Figure 1), OR 1.41 (95% CI 1.18–1.69), P = 0.00, I2 = 0%, N = 4295, and OR 1.47 (95% CI 1.02–2.12), P = 0.04, I2 = 45%, N = 3637, respectively. There was no association between being underweight and colorectal cancer recurrence compared to normal BMI or overweight BMI. High visceral adiposity was also not associated with increased CRC recurrence, although only two studies were included in our meta-analysis (Table 1). CONCLUSION: Obese and overweight BMI are both associated with increased risk of CRC recurrence compared to normal weight. However, being underweight was not associated with CRC recurrence compared to being normal weight. Patients with CRC would likely benefit from active interventions to prevent obesity.
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