Introduction: This systematic review with network meta-analysis aimed at comparing the medium-term results of open surgery (OS), fenestrated endovascular repair (FEVAR), and chimney endovascular repair (ChEVAR) in patients with juxta/pararenal abdominal aortic aneurysms (JAAAs/PAAAs). Materials and methods: MEDLINE, SCOPUS, and Web of Science were searched from inception date to 1st July 2022. Any studies comparing the results of two or three treatment strategies (ChEVAR, FEVAR, or OS) on medium-term outcomes in patients with JAAAs/PAAAs were included. Primary outcomes were all-cause mortality, aortic-related reintervention, and aortic-related mortality, while secondary outcomes were visceral stent/bypass occlusion/occlusion, major adverse cardiovascular events (MACEs), new onset renal replacement therapy (RRT), total endoleaks, and type I/III endoleak. Results: FEVAR (OR = 1.53, 95%CrI 1.03–2.11) was associated with higher medium-term all-cause mortality than OS. Sensitivity analysis including only studies that analysed JAAA showed that FEVAR (OR = 1.65, 95%CrI 1.08–2.33) persisted to be associated with higher medium-term mortality than OS. Both FEVAR (OR = 8.32, 95%CrI 3.80–27.16) and ChEVAR (OR = 5.95, 95%CrI 2.23–20.18) were associated with a higher aortic-related reintervention rate than OS. No difference between different treatment options was found in terms of aortic-related mortality. FEVAR (OR = 13.13, 95%CrI 2.70–105.2) and ChEVAR (OR = 16.82, 95%CrI 2.79–176.7) were associated with a higher rate of medium-term visceral branch occlusion/stenosis compared to OS; however, there was no difference found between FEVAR and ChEVAR. Conclusions: An advantage of OS compared to FEVAR and ChEVAR after mid-term follow-up aortic-related intervention and vessel branch/bypass stenosis/occlusion was found. This suggests that younger, low-surgical-risk patients might benefit from open surgery of JAAA/PAAA as a first approach.

The epidemic control approach was based on non-pharmacological measures in the first year of the COVID-19 pandemic, followed by vaccine uptake in the second year. Vaccine uptake depends on the individual attitude toward vaccination. The aim was to assess the changes in attitudes regarding COVID-19 vaccine protection during the pandemic and to determine the vaccination uptake concerning these attitudes. A panel study on COVID-19 vaccine attitudes and vaccination against COVID-19 was conducted in Belgrade, Serbia. The first survey was carried out in May–June 2020, and the second survey was organized in August–September 2021. During the baseline testing performed in 2020, 64.4% of respondents believed that the future vaccine against COVID-19 could protect against the COVID-19 disease, while 9.7% thought that it could not, and 25.9% were unsure. One year later, in the second survey, the percentage of participants with positive attitudes was slightly lower (64.7% vs. 62.5%). However, negative attitudes turned positive in 34% of cases, and 28.9% became unsure about vaccine protection (p < 0.001). Out of the 390 participants included in the study, 79.7% were vaccinated against COVID-19 until follow-up. There is a statistically significant difference in vaccination uptake compared to the baseline attitude about the protection of the COVID-19 vaccine. The main finding of our study is that the majority of participants who were vaccine hesitant during the baseline testing changed their opinion during the follow-up period. Additionally, the baseline attitude about the protection of the COVID-19 vaccine has been shown to be a potential determinant of vaccination uptake.

Article: Aorto caval fistulas - International Angiology 2024 Sep 09 - Minerva Medica - Journals

Multiple sclerosis (MS) is an immune-mediated disorder of central nervous system. It most frequently occurs in young female adults, and the prevalence increases with latitude. So far, over 200 genes, loci and single nucleotide polymorphisms (SNPs) have been linked with MS, although each one contributing only slightly in the overall etiology of the disease. The HLA-DRB1*15:01 haplotype has been shown to have the strongest association with MS occurrence risk in genome-wide association studies (GWAS), while HLA-A*02 has been shown to have a protective effect. The exact etiology of MS is still unclear, but there seems to exist an interplay between genetic burden of an individual, and environmental factors which contribute to MS occurrence such as Epstein-Barr virus (EBV) infection, vitamin D levels, smoking status, and early life obesity. An interaction between HLA-DRB1*15:01 and EBV infection, the strongest environmental risk factor for MS, has been observed. It has been suggested that this interaction is a result of HLA-DRB1*15:01 acting as a coreceptor for EBV, thus providing a pathophysiological explanation connecting environmental with genetic MS risk factors. A recent study including participants from two case-control studies with over 13.000 individuals showed that an interaction exists between sun exposure, vitamin D levels, and HLA-DRB*15:01 carrier status, leading to increased risk of MS in individuals with lower sun exposure, vitamin D deficient, and HLA-DRB*15:01 positive. The interaction of HLA-DRB1*15:01 with smoking has been observed in a meta-analysis, while the same study only showed an interaction of smoking with the absence of HLA-A*02 in a subset of studies. The risk of MS has been shown to vary in obese individuals, with obese individuals with the susceptible genotype (HLA-DRB1*15:01+, HLA-A*02-) having 16x higher odds of having MS compared with non-obese persons with a non-susceptible genotype.