British Hospital

About: British Hospital is a healthcare organization based out in Montevideo, Uruguay. It is known for research contribution in the topics: Population & Hazard ratio. The organization has 445 authors who have published 358 publications receiving 7878 citations. The organization is also known as: British Hospital.

Commentary: The sandwich technique to preserve the hypogastric artery during EVAR.

Abstract: Compromise of the distal common iliac artery (CIA) represents a problem to the operator performing endovascular aneurysm repair (EVAR) of the abdominal aorta or/and the iliac arteries. Distal CIA landing zones need to be long enough to secure fixation and sealing. Among the most common techniques to prevent retrograde flow from the internal iliac artery (IIA) when an aortic endograft needs to be extended to the external iliac artery (EIA), coverage of the ostium or proximal embolization using coils or occluders is better tolerated than more extensive coil embolization with occlusion of the branches. The latter is accompanied by more frequent buttock claudication and other complications. Occlusion of one IIA is generally well tolerated, although some patients complain of temporary or permanent hip claudication. Bilateral IIA occlusion, however, is accompanied by higher incidences of buttock claudication and erectile dysfunction and sometimes life-threatening complications, such as colon ischemia. In a review of 634 patients in whom unilateral or bilateral hypogastric artery occlusions were performed, buttock claudication occurred in 28% of the patients and new erectile dysfunction in 17%. Differences in the incidence of complications were not statistically significant between unilateral or bilateral occlusions in this series. Every interventionist would agree that preservation of the IIAs when possible and affordable is desirable. Other methods of preserving the IIA are (1) surgical bypass or reimplantation of the IIA onto the EIA, (2) retrograde endograft implantation in the IIA from the EIA, or (3) antegrade implantation in the IIA from the proximal endograft; the latter 2 techniques need a femorofemoral bypass to restore flow to the ipsilateral common femoral artery. Placement of a side branch off the endograft in the IIA is a useful procedure but entails a somewhat complicated technique that cannot be performed in tortuous anatomy or when the CIA is ,18 mm in diameter. In addition, the device is expensive and not readily available. The technique presented by Dr. Lobato in this issue of JEVT represents a potential step forward in the preservation of IIA flow using readily available devices and a relatively simple procedure. Cost is also an issue, and the sandwich technique is less costly than a bifurcated iliac device. Cannulating the IIA from above, as needed for the sandwich technique, is relatively simple, and advancing an endograft from the upper extremity is not complicated. Sealing the commissural angles is apparently achievable using the sandwich technique as oversizing of the limbs and endografts in relation to the diameter of the main graft will produce tight apposition of the components. The 6-cm overlap of the covered stent with the limb of the aortic endograft in addition to the oversizing of the components could be enough to seal both the endograft and the covered stent. Obviously, long-term followup is needed to verify this assumption.

Re-Evaluating Disease-Free Survival as an Endpoint vs Overall Survival in Stage III Adjuvant Colon Cancer Trials

Abstract: Background Disease-free survival with a 3-year median follow-up (3-year DFS) was validated as a surrogate for overall survival with a 5-year median follow-up (5-year OS) in adjuvant chemotherapy colon cancer (CC) trials. Recent data show further improvements in OS and survival after recurrence, in patients who received adjuvant FOLFOX. Hence, re-evaluation of the association between DFS and OS and determination of the optimal follow-up duration of OS to aid its utility in future adjuvant trials are needed. Methods Individual patient data from nine randomized studies conducted between 1998 and 2009 were included; three trials tested biologics. Trial-level surrogacy examining the correlation of treatment effect estimates of 3-year DFS with 5 to 6.5-year OS was evaluated using both linear regression (R2WLS) and Copula bivariate (R2Copula) models and reported with 95% confidence intervals (CIs). For R2, a value closer to 1 indicates a stronger correlation. Results Data from a total of 18,396 patients were analyzed (median age = 59 years; 54.0% male), with 54.1% having low-risk tumors (pT1-3 & pN1), 31.6% KRAS mutated, 12.3% BRAF mutated, and 12.4% microsatellite instability high/deficient mismatch repair tumors. Trial level correlation between 3-year DFS and 5-year OS remained strong (R2 =0.82, 95% CI = 0.67 to 0.98; R2 =0.92, 95% CI = 0.83 to 1.00) and increased as the median follow-up of OS extended. Analyses limited to trials that tested biologics showed consistent results. Conclusion Three-year DFS remains a validated surrogate endpoint for 5-year OS in adjuvant CC trials. The correlation was likely strengthened with 6 years of follow-up for OS.

Clinical and biological clusters of sepsis patients using hierarchical clustering.

Abstract: BACKGROUND Heterogeneity in sepsis expression is multidimensional, including highly disparate data such as the underlying disorders, infection source, causative micro-organismsand organ failures. The aim of the study is to identify clusters of patients based on clinical and biological characteristic available at patients' admission. METHODS All patients included in a national prospective multicenter ICU cohort OUTCOMEREA and admitted for sepsis or septic shock (Sepsis 3.0 definition) were retrospectively analyzed. A hierarchical clustering was performed in a training set of patients to build clusters based on a comprehensive set of clinical and biological characteristics available at ICU admission. Clusters were described, and the 28-day, 90-day, and one-year mortality were compared with log-rank rates. Risks of mortality were also compared after adjustment on SOFA score and year of ICU admission. RESULTS Of the 6,046 patients with sepsis in the cohort, 4,050 (67%) were randomly allocated to the training set. Six distinct clusters were identified: young patients without any comorbidities, admitted in ICU for community-acquired pneumonia (n = 1,603 (40%)); young patients without any comorbidities, admitted in ICU for meningitis or encephalitis (n = 149 (4%)); elderly patients with COPD, admitted in ICU for bronchial infection with few organ failures (n = 243 (6%)); elderly patients, with several comorbidities and organ failures (n = 1,094 (27%)); patients admitted after surgery, with a nosocomial infection (n = 623 (15%)); young patients with immunosuppressive conditions (e.g., AIDS, chronic steroid therapy or hematological malignancy) (n = 338 (8%)). Clusters differed significantly in early or late mortality (p < .001), even after adjustment on severity of organ dysfunctions (SOFA) and year of ICU admission. CONCLUSIONS Clinical and biological features commonly available at ICU admission of patients with sepsis or septic shock enabled to set up six clusters of patients, with very distinct outcomes. Considering these clusters may improve the care management and the homogeneity of patients in future studies.

The Development of Palliative Care in Argentina: A Mapping Study Using Latin American Association for Palliative Care Indicators.

Abstract: Background: The Latin American Association for Palliative Care (ALCP) developed 10 indicators to monitor the development of palliative care. The indicators have been applied across Latin A...