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BACKGROUND: Management of juxta-renal abdominal aortic aneurysms (JRAAA) remains challenging. Both open surgical and endovascular options are feasible, however, there is lack of level 1 evidence to support one modality over the other. Operative interventions frequently necessitate either open repair with a suprarenal clamp positioning (ORSRC) or complex endovascular repair (EVAR) with fenestrated (fEVAR) or parallel stent grafts (chEVAR). AIM: The aim of this study was to compare the renal function deterioration and mortality between ORSRC and fEVAR in patients who were operated on for unruptured JRAAA at a tertiary centre. DESIGN: This was a retrospective observational study of patients. SETTING: Tertiary vascular unit in the United Kingdom. POPULATION: Patients with unruptured juxta-renal AAA. METHODS: A retrospective review of prospectively collected data was performed on patients who underwent repair for unruptured JRAAA between March 2008 and October 2019. Analysis of short and mid-term outcomes after ORSRC (occlusion of the aorta above at least one of the main renal arteries) and fEVAR was conducted. Patients who underwent open repair of JRAAA with an infrarenal clamp were excluded. Procedural data as well as data regarding complications was noted. Acute kidney injury (AKI) and chronic kidney disease were defined using the KDIGO criteria (Kidney Disease: Improving Global Outcomes). Renal impairment data up to 1 year and mortality up to 5 years was recorded. RESULTS: During the study period, 162 patients who underwent JRAAA repair met the inclusion criteria (60.5% of them having ORSRC). Approximately, 85.8% of the population were males (80.6% in the open group compared to 93.7% in the endovascular group; p=0.019). The mean age for patients in the open group was 74.0 (SD=±5.5) years compared to 76.1 (SD=±7.2) years in the fEVAR group (p=0.035). More patients in the ORSRC group were symptomatic (18.4% versus 6.3% in the fEVAR group; p=0.028) and they also had larger aneurysms compared to the fEVAR group (66.9 (±12.7) mm versus 62.6 (±8.6) mm, respectively; p=0.021). In the ORSRC group, all patients required suprarenal clamping, with clamping above only one of the main renal arteries carried out in 43 patients (44.3%) of cases. At baseline, 37.0% and 44.5% of patients had CKD stage 3 or worse in ORSRC and fEVAR groups, respectively (p=0.759). Approximately 47.6% of patients having ORSRC had evidence of acute renal impairment on post-operative day 3 compared to 12.7% of those in the endovascular group (p

Introduction Endovascular management of aortic occlusive disease is an alternative to open surgery. This case describes the use of a Nellix graft to treat infrarenal aortic stenosis, outwith the graft indication for use. Case report A 71 year old man with multiple comorbidities, presented with bilateral buttock claudication. A computed tomography angiogram (CTA) showed significant infrarenal aortic stenosis. Under local anaesthetic, using a percutaneous approach, Nellix grafts were inserted. The patient was discharged within 24 hours. His claudication improved significantly. A 6 month follow-up CT showed stent patency. Conclusion Although further research is necessary, this case suggests that Nellix is safe and effective for primary stenting of the stenotic infrarenal aorta., Highlights • Aortobifemoral bypass has been considered the gold standard for aortic occlusive disease. • Endovascular treatment of aortic occlusive disease has evolved rapidly in the last 20 years. • Covered stent and bare metal stent are commonly used in management of isolated aortic occlusive disease. • In this case report, the Nellix® endovascular aneurysm sealing (EVAS) system was used as a novel technique for managing aortic occlusive disease.

Aim To determine current practice regarding brain imaging for newly diagnosed lung cancer patients without symptoms of brain metastases. Materials and methods A survey questionnaire was sent by e-mail to all the lung cancer lead clinicians in England currently on the National Cancer Intelligence Network database. The survey asked whether brain imaging was used in new lung cancer patients without symptoms or signs to suggest brain metastases; and if so, which patient subgroups were imaged according to cell type, stage of disease, and intention to treat, and which techniques were used to image these patients. Responses were received between February and May 2014. Results Fifty-nine of 154 centres replied to the survey (38%). Thirty of the 59 centres (51%) did not image the brain in these patients. Twenty-nine of the 59 (49%) centres imaged the brain in at least certain subgroups. Of those centres that did image the brain 21 (72%) used CT as the first-line imaging technique and six (20%) used MRI. Twenty-five of 59 (42%) centres stated that the 2011 NICE guidelines had led to a change in their practice. Conclusion There is wide variation in practice regarding brain imaging in this patient group in England, with no brain imaging at all in approximately half of centres and a spectrum of imaging in the other half. When the brain is imaged, CT is the technique most commonly used. The 2011 NICE guidelines have led to some change in practice but not to national uniformity.

In recent years, there has been a significant loss in the number of honeybee hives due to several natural phenomena that are referred to as the Colony Collapse Disorder (CCD). Several research programs have been established to monitor honeybee hives and to understand the behavior of the bees. A reliable monitoring system is important as it provides the beekeepers an opportunity to remotely observe the progress of their hives without the need to actually open them. This paper will present the results of several years of study and investigation for creating a reliable and inexpensive hive monitoring system. Our goal has been to create an inexpensive and modular system which sends sensor data acquired from beehives to a server for further analysis. Our initial efforts utilized video surveillance system but evolved to a more reliable system that utilizes Raspberry Pis and ATmega328Ps as its framework. This paper will provide details on the initial system and how it evolved to a new system that we are calling Beemon with its data acquisition capabilities. The early video and audio recordings obtained by the system are used in some image and signal processing analysis which are not presented on this paper.

Background Idiopathic pulmonary fibrosis (IPF) is a fatal condition with limited treatment options. However, in a previous small study, co-trimoxazole was found to be beneficial. Methods In a double-blind multicentre study, 181 patients with fibrotic idiopathic interstitial pneumonia (89% diagnosed as definite/probable IPF) were randomised to receive co-trimoxazole 960 mg twice daily or placebo for 12 months in addition to usual care. Measurements were made of forced vital capacity (FVC) (primary endpoint), diffusing capacity of carbon monoxide (Dlco) and EuroQol (EQ5D)-based utility, 6-minute walk test (6MWT) and Medical Research Council (MRC) dyspnoea score (secondary endpoints). All-cause mortality and adverse events were recorded (tertiary endpoints). Results Co-trimoxazole had no effect on FVC (mean difference 15.5 ml (95% CI −93.6 to 124.6)), Dlco (mean difference −0.12 mmol/min/kPa (95% CI 0.41 to 0.17)), 6MWT or MRC dyspnoea score (intention-to-treat analysis). The findings of the per-protocol analysis were the same except that co-trimoxazole treatment resulted in a significant improvement in EQ5D-based utility (mean difference 0.12 (95% CI 0.01 to 0.22)), a reduction in the percentage of patients requiring an increase in oxygen therapy (OR 0.05 (95% CI 0.00 to 0.61)) and a significant reduction in all-cause mortality (co-trimoxazole 3/53, placebo 14/65, HR 0.21 (95% CI 0.06 to 0.78), p=0.02)) compared with placebo. The use of co-trimoxazole reduced respiratory tract infections but increased the incidence of nausea and rash. Conclusions The addition of co-trimoxazole therapy to standard treatment for fibrotic idiopathic interstitial pneumonia had no effect on lung function but resulted in improved quality of life and a reduction in mortality in those adhering to treatment. ISRCTN22201583

We thank Neto et al 1 for their comments on our paper2 and for reiterating the points contained within it. ‘The survival benefit conferred by co-trimoxazole, if real, could be due to its antimicrobial activity as there was a significant reduction in the number of infections in the group receiving active treatment’, and this is likely to occur more frequently in patients receiving immunosuppressive treatment. The proportion of deaths in the intention-to-treat group on immunosuppression was 29 of 37. As stated, ‘this study was not designed to collect microbiological information’ however, the results were adjusted for baseline azathioprine or mycophenylate …

Purpose: To present a case of aortic sac occlusion using an Amplatzer vascular plug II (AVP). Case report: A patient with sigmoid malignancy and an infrarenal aortic aneurysm ultimately required an axillobifemoral graft for acute limb ischemia. The sac was ligated at subsequent laparotomy. Persistent filling of the sac was seen post surgery, and the sac was successfully occluded with placement of an AVP in the neck of the sac in conjunction with coil embolization of lumbar arteries. Sac occlusion was confirmed at follow-up CT. Conclusion: The AVP was successfully used to occlude an aortic sac after failed surgical ligation, another novel indication for this versatile embolic device.

Dobutamine stress echocardiography is a frequently used noninvasive method for the evaluation of inducible myocardial ischemia, myocardial viability, and preoperative cardiac risk. Although its clinical safety has been validated, side effects and complications especially with the coadministration of atropine can occur. We report a case of generalized tetany in a 49-year-old woman undergoing dobutamine stress echocardiography. (J Am Soc Echocardiogr 2002;15:1414-6.)

To compare the efficiency and accuracy of radiology reports generated by voice recognition (VR) against the traditional tape dictation-transcription (DT) method.Two hundred and twenty previously reported computed radiography (CR) and cross-sectional imaging (CSI) examinations were separately entered into the Radiology Information System (RIS) using both VR and DT. The times taken and errors found in the reports were compared using univariate analyses based upon the sign-test, and a general linear model constructed to examine the mean differences between the two methods.There were significant reductions (p0.001) in the mean difference in the reporting times using VR compared with DT for the two reporting methods assessed (CR, +67.4; CSI, +122.1s). There was a significant increase in the mean difference in the actual radiologist times using VR compared with DT in the CSI reports; -14.3s, p=0.037 (more experienced user); -13.7s, p=0.014 (less experienced user). There were significantly more total and major errors when using VR compared with DT for CR reports (-0.25 and -0.26, respectively), and in total errors for CSI (-0.75, p0.001), but no difference in major errors (-0.16, p=0.168). Although there were significantly more errors with VR in the less experienced group of users (mean difference in total errors -0.90, and major errors -0.40, p0.001), there was no significant difference in the more experienced (p=0.419 and p=0.814, respectively).VR is a viable reporting method for experienced users, with a quicker overall report production time (despite an increase in the radiologists' time) and a tendency to more errors for inexperienced users.