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PURPOSE We performed a systematic review on 3 major types of scleral-fixated intraocular lens (SFIOL) implantations and conducted subgroup analyses on pediatric population and subjects with Marfan syndrome. DESIGN Systematic review. METHODS We performed a search in PubMed, Ovid MEDLINE, and Embase for English language articles with keywords "(sutured intraocular lens) OR (SFIOL) OR (sutureless intraocular lens) OR (glued intraocular lens) OR (intrascleral intraocular lens) OR (SFIOL)" through October 16, 2019. Articles reporting individual outcomes after SFIOL were included in this systematic review. Recorded outcome measures included intraoperative and postoperative complications, endothelial cell changes, and intraocular lens-related outcomes. RESULTS Our search yielded 217 papers. After removing duplicated and irrelevant reports, we included 57 articles involving 2624 eyes. The mean age at operation was 51.47 ± 25.62 years. Sutured SFIOL was most commonly reported in all subjects with Marfan syndrome and 92.87% of pediatric patients. The pooled intraoperative complication rate was 6.65%. Minor anterior chamber hemorrhage was the most common intraoperative (1.92%) and postoperative complication (13.93%). Optic capture was the top intraocular lens (IOL)-related complication (4.47%). The overall mean endothelial cell loss was 8.95% at 16.77 ± 11.04 months. Overall 11.99% of SFIOLs were decentred with a mean distance of 0.49 ± 0.40 mm and a mean degree of tilt by 4.11 ± 3.03°. CONCLUSIONS Glued SFIOL had the fewest IOL-related complications and the lowest endothelial cell loss. Sutured SFIOL carried the highest IOL-related complications, whereas sutureless, glueless SFIOL was associated with the greatest endothelial cell loss.

Background Mini-sternotomy has been proven superior to full sternotomy in aortic valve replacement by providing better perioperative outcomes. We investigated whether such technique provides better outcomes in patients undergoing aortic root surgery. Methods A comprehensive electronic literature search was undertaken among the four major databases (PubMed, Ovid, Scopus and EMBASE) to identify all published studies up to June 2018. The search terms used related to mini-sternotomy versus full sternotomy, aortic root, valve sparing, Bentall procedure. Only articles that compared mini against full sternotomy were considered in this analysis. After excluding articles based on title or abstract, the full text articles selected had reference lists searched for any potential further articles to be included in this review. Results A total of 2,765 patients were analysed from across eight comparative studies that were included in the quantitative analysis of the parameters of interest that fulfilled the criteria for meta-analysis. Mini-sternotomy aortic root replacement was associated with significantly shorter cardiopulmonary bypass time (p = 0.009), lower rate of blood transfusion (p = 0.01). additionally, they had lower operative mortality (p = 0.02), and shorter stay at intensive care and at hospital (p = 0.0009, p = 0.03 respectively). However, there was no difference between mini-sternotomy and conventional aortic root replacement in terms of aortic cross-clamp time (p = 0.28), total operation time (p = 0.31), re-exploration rate for bleeding (p = 0.28), stroke rate (p = 0.90), wound infection rate (p = 0.96), and length of mechanical ventilation (p = 0.10). Conclusion Mini-sternotomy is a safe, feasible alternative option to full sternotomy in aortic root repair. However, the significant heterogeneity in data points to the need for a larger, well-designed trial to support the currently limited literature evidences.

Sternal wound infection (SWI) is one of the potential complications post cardiac surgery, and despite refined surgical techniques such as smaller incisions, antibiotic therapy, and optimised glycaemic control, the incidence rate is between

Objective: To systematically compare clinical outcomes between aortic valve repair and replacement in patients with aortic regurgitation. Methods: A comprehensive literature search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all published data comparing clinical outcomes of aortic valve repair vs replacement. Database searched from inception to November 2018. Results: A total of 1071 patients were analyzed in eight articles. Mean age was similar in both groups of patients (47.2 ± 12.8 vs 48.3 ± 12.7 years, P = 0.83, aortic valve repair and replacement, respectively). The preoperative left ventricular ejection fraction was better in the repair group (56.7% ± 4.8 vs 53.3% ± 4.2, P = 0.005). The rate of moderate-to-severe regurgitation and bicuspid aortic valve were similar in both cohorts (81% vs 78%, P = 0.90% and 58% vs 55%, P = 0.46). In-hospital and 1-year mortality was lower in repair cohort, although not reaching statistical significance (1.3% vs 3.6%, P = 0.12; 5.9% vs 9.3%, P = 0.77). Reoperation rate was higher in repair patients at 1 year (8.8% vs 3.7%, P = 0.03). Conclusion: Aortic valve repair offers comparable perioperative outcomes to aortic valve replacement in aortic regurgitation patients at the expense of higher late reintervention rate. Larger trials with long-term follow-up are required to confirm the long-term benefits of aortic valve repair. © 2019 Wiley Periodicals, Inc.

Objective To perform a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, investigating the role of lymph node dissection (LND) during nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC); focussing on survival and complication outcomes. Methods A comprehensive systematic search was completed using a combination of Medical Subject Headings terms and keywords related to UTUC and LND on multiple databases. Meta-analyses were performed when outcomes were reported under the same definition in two or more studies. Where meta-analysis was not possible, outcomes were reviewed in a narrative manner. Results A total of 21 studies were included in the qualitative analysis and 11 cohort studies in the quantitative analysis. Our review did not detect significant improvement in recurrence-free survival (RFS) (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.41–1.92), cancer-specific survival (CSS) (HR 0.89, 95% CI 0.54–1.46) and overall survival (OS) (HR 1.10, 95% CI 0.93–1.30). However, when focussing on studies only including patients with pT2/pT3 UTUC, not performing LND significantly worsened RFS (HR 2.83, 95% CI 1.72–4.66). Reports of removing more than eight lymph nodes may also provide prognostic benefits in pN0 patients. The performance of LND was not associated with a higher rate of postoperative complications (risk ratio 1.06, 95% CI 1.00–1.13). Conclusion Overall, LND did not provide additional benefit in RFS, CSS and OS. However, there was a potential benefit in RFS in patients with muscle-invasive and advanced UTUC. LND was also not associated with increased risks of postoperative complications. Abbreviations: CIS: carcinoma in situ; CSS: cancer-specific survival; HR: hazard ratio; LND: lymph node dissection; NU: nephroureterectomy; OS: overall survival; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RFS: recurrence-free survival; RoB, risk of bias; RR: risk ratio; (UT)UC: (upper tract) urothelial carcinoma

Objective The aim of the study was to compare hemodynamic and perioperative outcomes of stented against stentless aortic valve replacement in patients with small aortic root (21 mm or less). Methods A comprehensive search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing stentless to stented bioprosthetic valves in small aortic root patients. Odds ratios, weighted mean differences, or standardized mean differences and their 95% confidence intervals were analyzed. Results A total of seven studies with a total of 965 patients fulfilled the inclusion criteria. There was no significant difference in preoperative baselines including mean age between both groups ( P = 0.08), peak aortic valve gradient ( P = 0.06), and effective orifice area ( P = 0.28), whereas higher mean aortic valve gradient in the stented group ( P = 0.007). No difference in cardiopulmonary bypass time ( P = 0.74), aortic cross-clamp times ( P = 0.88), intensive care unit stay ( P = 0.13), and stroke rate ( P = 0.56) were noted. However, stented group of patients showed higher rate of patient prosthesis mismatch ( P = 0.0001) and longer total hospital stay ( P = 0.002). Postoperatively, stentless group showed lower peak and mean aortic valve gradient ( P = 0.003 and P = 0.008, respectively) with a better effective orifice area ( P < 0.00001) at 6 months of follow-up. Mortality rates while in-hospital and at 1 year were similar in both groups ( P = 0.94 and P = 0.86, respectively). Conclusions Stentless aortic valves offer superior short-term hemodynamic outcomes in patients with small aortic root when compared with stented aortic valves. Although both groups have similar perioperative complications rates, stentless valves bring about a shorter hospital stay. A further large multicenter randomized controlled trial should address the longer-term benefit of stentless aortic valve over stented valve.

Aortic valve disease is one of the most common valvular heart diseases in the cardiovascular category. Surgical replacement of the diseased aortic valve remains the definitive intervention for most diseases. There is a clear consensus that in young patients who require aortic valve replacement, a mechanical prosthesis is the preferred choice due to its durable prosthesis without fear of wear and tear over time. However, this comes at the expense of increased risk of bleeding and thromboembolic events; in addition, there is a lack of strict evidence in using bioprosthesis in patients younger than 50 years. The objective of this review article is to assess the current evidence behind using bioprosthetic aortic valve in this young cohort.

Objective The innominate artery is considered an alternative site for establishing cardiopulmonary bypass in surgical procedures involving the thoracic aorta. This systematic review examines the use of innominate artery cannulation in aortic surgery. Methods A systematic literature search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all studies that utilized innominate artery cannulation for establishing cardiopulmonary bypass and providing cerebral perfusion in thoracic aortic surgery. The data were reviewed up to September 2018. Results Acute type A aortic dissection contributed to 36% (n = 818) of the total 2,290 patients. 31.5% (n = 719) underwent surgery on the aortic root only; 54.5% (n = 1246) had ascending and hemi-arch replacement, while 11.5% had total aortic arch replacement and 2.5% had a frozen elephant trunk inserted. Postoperative stroke rate was 1.25% (n = 28), temporary neurological deficit was 4.8% (n = 111). All-cause 30-day mortality rate was 2.7% (n = 61). Conclusion Innominate artery cannulation is a safe technique in patients who undergo thoracic aortic surgery. It can be utilized, in selected cases, as a reliable route for establishing cardiopulmonary bypass and maintaining cerebral perfusion.

The purpose of this study was to compare perioperative and mortality outcomes of endovascular aortic repair against open repair in acute type B thoracic aortic dissection.A comprehensive search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all published data comparing open vs endovascular repair in management of acute type B aortic dissection. Databases where evaluated and assessed to July 2017. The 95% confidence intervals were analyzed from the extracted data using relevant statistical methods.Overall, 18,193 patients were found in a combination of nine studies. Patients undergoing open repair were younger (mean, 61.3 ± 9.3 years vs 66.6 ± 12.5 years; P .00001). Postoperative stroke and paraplegia were similar in both groups (P = .71 and P = .81 respectively); however, the rate of all neurologic complications were more common in the traditional open repair group (6.9% vs 4.8%; P = .006). The all-cause operative and 1-year death was reported as higher in the open repair group (18.6% vs 7.4% [P .0001] and 24.3% vs 14.3% [P .0001], respectively); however, at 5 years this rate is almost similar between both groups (46.7% vs 49.7%; P = .21). At 1 year, the rate of reintervention was reported to be higher in endovascular repair group of patients (15.4% vs 5.5%; P = .004).This study concludes that endovascular repair, in the setting of acute type B thoracic aortic dissection, provides an early surgical benefit; however, this finding has not yet been supported by long-term data. There seems to be a benefit with respect to all-neurologic events in favor of endovascular repair. Long-term comparative data and studies are required to give a better understanding of these two approaches.

The purpose of this study was to determine whether thoracic endovascular aortic repair reduces death and morbidity compared with open surgical repair for descending thoracic aortic disease.A comprehensive search was undertaken among the 4 major databases (PubMed, Embase, Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing open versus endovascular repair in thoracic aortic aneurysm. Databases where evaluated and assessed to July 2017. Odds ratios, weighted mean differences, or standardized mean differences and their 95% confidence intervals were analyzed.A total of 14,580 patients were analyzed in total of 13 articles, which were included in the synthesis of the meta-analysis. A total of 10,672 patients had open repair, and 3,908 patients had endovascular repair. Patients undergoing open repair were younger (mean of 65.1 years vs. 70.0 years, P = 0.0009), and there was higher elective rate in open repair patient (83.4% vs. 81%, P = 0.36). Duration of intensive care and total hospital stay was much shorter in endovascular patients (4.5 vs. 8.5 days, P = 0.002 and 5.7 vs. 9.5 days, P = 0.0004). Postoperative stroke was similar in both groups (P = 0.58); however, higher rate of paraplegia noted in open repair group (P = 0.007). The rate of renal failure (P = 0.01) and cardiac complications (P 0.0001) was higher in the open repair group. The rate of vascular complications was much higher in the endovascular group of patients (5.29% vs. 1.17%, P = 0.002). Operative mortality was higher in endovascular procedures (4.4% vs. 3.2%, P = 0.005); however, 1- and 5-year mortality showed no statistical difference between the endovascular and open repair groups (22.19%, vs. 24.04%, P = 0.59, and 44.26% vs. 37.37%, P = 0.49).The present meta-analysis shows that endovascular repair of thoracic aortic aneurysm gives better perioperative outcomes during inhospital stay although the 1- and 5-year mortality remains the same in both groups; but the long-term outcome is yet to be established. A long-term data and studies are required to give a better understanding of comparing these 2 techniques beyond 5 years of follow-up.

A ruptured thoracic aortic aneurysm is considered a surgical emergency; it is often fatal if it is not identified and managed immediately. Since the recognition of this clinical entity, open surgical repair has been the "gold standard" method of management. However, open surgical repair is associated with high morbidity and mortality rates. Among high-risk patients and as an alternative, thoracic endovascular repairs have since transpired, aiming to reduce the morbidity and mortality rates associated with open repair in a number of patients. The results of both treatment options are debatable, yet there is not a full concurrence on the advantages of endovascular repair in comparison to open repair as the gold standard method of managing such emergency cases, particularly ruptures involving the ascending and aortic arch. This literature review aimed to examine current literature evidence for the use of open or endovascular repair in the emergency setting of a ruptured thoracic aortic aneurysm.

Ruptured abdominal aortic aneurysm is a surgical emergency, invariably leading to death without urgent intervention. The emergence of endovascular repair has challenged open repair as the treatment of choice and has featured as the focus of numerous observational and randomised trials across the globe. At present, there is no formal consensus upon the gold standard approach in managing patients with ruptured abdominal aortic aneurysms in the emergency environment, despite the formation of protocols and evidence-based guidance within the elective setting. This literature review examines the current evidence underpinning the use of endovascular repair, and evaluates its efficacy compared to open repair. In summary of the literature, there is no conclusive body of evidence to support the claim that endovascular repair is superior to open repair, particularly from a mortality, complication and cost-utility viewpoint. There are significant conflictions within the evidence-base, often between observational studies, but also between the randomised trials, which themselves are limited in number. It would be appropriate to conclude that endovascular repair is as efficacious as open repair but would be invalid in light of the scientific literature to claim it superior.

Pinacidil is a clinically effective antihypertensive drug that directly relaxes vascular smooth muscle. Pinacidil activates both ATP-sensitive and Ca2+-activated K+ channels in vascular myocytes. However, it remains controversial whether activation of K+ channels and subsequent hyperpolarization mediates pinacidil-induced vasorelaxation, particularly when the concentration is higher than that reported for pinacidil-induced opening of KATP channels. In the present study, attempt was made to investigate the possible KATP channel-independent relaxant effect of pinacidil in isolated rat mesenteric arteries without endothelium. In phenylephrine-contracted rings, glibenclamide at 10 μM attenuated pinacidil-induced relaxation without an effect on the maximum relaxation. Pinacidil relaxed arteries contracted by U46619 and 60 mM K+ with respective IC50 of 0.19 and 16.7 μM. Some rings were first contracted by 60 mM K+ and then relaxed totally by 1 μM nifedipine in order to minimize the influence of both K+ channels and voltage-sensitive Ca2+ channels. Under this condition, U46619-induced tone was reduced by pinacidil (IC50 of 20.6 μM) and maximum relaxation can be achieved. Following inhibition of K+ and Ca2+ channels pinacidil-induced relaxation remained unchanged by pretreatment with 10 μM cyclopiazonic acid, the endoplasmic reticulum Ca2+-ATPase inhibitor or with 100 μM ouabain, the Na+-K+-ATPase inhibitor. Pretreatment with 30 μM Ni2+ caused parallel rightward shift of concentration-relaxation curve for pinacidil without affecting maximal relaxation. Besides, pinacidil also concentration-dependently relaxed rings preconstricted by active phorbol ester, phorbol 12,13-diacetate (1 μM). The present results indicate that the mechanisms by which pinacidil mediates vasorelaxation are multifactorial when its concentration is higher than 1 μM (supported by UPGC Direct Grant)

Considerable evidence suggests that s-adrenoceptors are subject to regulation by sex steroid hormones. It was reported that estrogen replacement potentiated the vascular responses mediated by s-adrenoceptor activation by an endothelium-independent mechanism. s-Adrenoceptor is present on both vascular smooth-muscle and endothelial cells. However, no experiment has examined the effect of acute exposure to physiological concentrations of estrogen on s-adrenoceptor–mediated vasorelaxation in mammalian arteries. The major observation in this study is that the relaxant response to s2-adrenoceptor activation with fenoterol was significantly enhanced by short-term incubation (1 hr) with 0.3 nM 17s-estradiol in the isolated porcine coronary circumflex arteries. This effect was abolished by pretreatment with 10-μM tamoxifen. Preincubation with 17s-estradiol (0.3 nM) reduced the relaxant response to dobutamine, a s1-adrenoceptor agonist. The concentration of 0.3 nM falls into the reported circulating level of estrogen ranging between 0.1 and 1 nM in the body. Low concentrations of estrogen appeared to slightly enhance the relaxation induced by isoproterenol, a non-selective s- (s1 and s2) adrenoceptor agonist, following 1-hr incubation. Physiological level of estrogen did not influence the relaxation induced by IBMX, an inhibitor of phosphodiesterase. In contrast, 20-min exposure to 17s-estradiol (0.1–1 nM) was without effect on s1- or s2-adrenoceptor-mediated vascular responses. Our data indicate that acute exposure to physiological concentration of estrogen has differential effect on s-adrenoceptor-mediated relaxation in porcine coronary arteries, increasing s2-adrenergic response but decreasing s1-adrenergic response. It would therefore be not surprising to observe a marginal effect of estrogen on relaxation induced by isoproterenol, an agonist that activates both s1 and s2-adrenoceptors in blood vessels. (supported by UPGC Direct Grant)

Potassium channel plays an active role in the regulation of membrane potential in vascular smooth muscle and vascular tone. These channels not only participate in the physiological responses to endogenously occurring substances, but also become the therapeutic targets for many synthetic drugs. Information regarding the role of K+ channels in vascular effects of female sex steroid hormones is scarce. We previously showed that K+ channel activation contributed in part to the estrogen-mediated vasorelaxation. In order to examine further whether steroid hormones may have direct interaction with K+ channels, we have recently expressed two types of K+ channels, KCa and KV channels in Xenopus oocytes. It was found that 17s-estradiol increased the large-conductance KCa currents in a concentration-related manner. Tetraethylammonium ions or iberiotoxin inhibited the effect of 17s-estradiol. KCa current was increased by NS 1619 and inhibited by progesterone. BSA-conjugated estrogen also increased KCa currents. Progesterone reduced the estrogen-stimulated KCa currents. KV1.5 channels were also expressed in Xenopus oocytes and inhibited by 4-aminopyridine. Progesterone reduced the KV1.5 current, while estrogen had little effect. These results showed that estrogen could stimulate KCa channels without an effect on KV1.5 channels. Progesterone inhibited the activity of both KCa and KV1.5 channels expressed in Xenopus oocytes. Progesterone was described to antagonize the vascular action of estrogen. Inhibition of K+ channels may be involved in the reported antagonistic effect of progesterone against the estrogen-induced vasorelaxation. (supported by UPGC Direct Grant)