OBJECTIVES: Total arch replacement (TAR) using an endovascular approach has been initially introduced as the frozen elephant trunk technique (FET). In our institute, TAR using the FET with Frozenix has been used as the first-line treatment for distal aortic arch aneurysms since 2014. This study aimed to evaluate the early and long-term outcomes and demonstrate the efficacy of this procedure. METHODS: Between 2014 and 2021, 121 consecutive patients were treated with TAR using the FET with Frozenix for distal aortic arch aneurysms. Early and long-term outcomes were retrospectively analysed. RESULTS: The 30-day mortality rate was 2.5% (3/121). Of postoperative complications, paraplegia due to spinal cord injury occurred in 2 (1.7%) patients, stroke in 12 (9.9%) and acute renal failure in 10 (8.3%). At follow-up, 23 secondary aortic interventions were required and 8 (6.6%) patients underwent intended secondary thoracic endovascular aortic repair for residual descending aortic aneurysm. Late and aortic-related deaths occurred in 16 (13.2%) and 4 (3.3%) patients, respectively. The overall long-term survival rates at 1, 3 and 5 years were 87.6%, 83.1% and 65.4%, respectively, while the rates of freedom from aortic-related death at 1, 3 and 5 years were 95.7%, 95.7% and 84.8%, respectively. CONCLUSIONS: TAR using the FET with Frozenix for distal aortic arch aneurysms has acceptable early mortality and morbidity. Spinal cord injury and paraplegia occur less frequently than previously reported. The technique has satisfactory long-term survival and freedom from aortic-related death.

The risk of pneumonia and death is higher in acute stroke patients with signs of pulmonary infection on chest computed tomography (CT) at admission. However, few reports have examined the incidence of pneumonia and its predictors in subacute stroke patients. The aim of this study was to examine factors related to post-stroke pneumonia in subacute stroke patients. A total of 340 subacute stroke patients were included. Univariable logistic regression analysis was performed using variables that may contribute to pneumonia, with the development of pneumonia as the dependent variable. Multivariable logistic regression analysis using the three independent variables with the lowest p-values on the univariable logistic regression analysis was also performed to calculate adjusted odds ratios. Twenty-two patients developed pneumonia during hospitalization. The univariable logistic regression analysis showed that the top three items were serum albumin (Alb), functional Oral Intake Scale (FOIS) score, and signs of pulmonary infection on chest CT at admission. Multivariable logistic regression analysis adjusted for these three items showed that the presence of signs of pulmonary infection on chest CT at admission was the independent variable (OR: 4.45; 95% CI: 1.54–12.9). When signs of pulmonary infection are seen on admission chest CT, careful follow-up is necessary because pneumonia is significantly more likely to occur during hospitalization.

Study design A retrospective cohort study Objective To establish a logarithmic model to predict functional independence after spinal cord injury. Setting The National Hospital Organization, Murayama Medical Center, Japan. Methods Thirty-one adults with a traumatic spinal cord injury (SCI) were enrolled. The Spinal Cord Independence Measure (SCIM) III scores obtained at month 1 and 3 after admission were used to construct a simple logarithmic model to predict SCIM III scores. The validity of the predicted scores was evaluated using a linear mixed model, and agreement between the predicted and measured scores were assessed using the Bland-Altman analysis. Results In the linear mixed model, the fixed effect slope [95% CI] and the intercept [95% CI] were 1.18 [0.78, 1.58] and −1.75 [−10.3, 6.83], respectively. The scatter plot showed non-linear correlation between the predicted and actual SCIM III scores. This non-linearity became inconspicuous when Sphincter Management scores were omitted. The fixed effect slope and the intercept were 1.12 [0.89, 1.36] and −1.64 [−4.95, 1.68], respectively. A significant fixed or proportional bias was not identified on the Bland-Altman analysis of the total SCIM III score, with most scores lying between an upper limit of +15.3 and a lower limit of −19.3. Conclusion The logarithmic model provided an accurate prediction of the functional independence score of individuals with SCI in our cohort which included various neurological levels and severity of the injury. Along with its simplicity, our prediction model could be useful in daily practice.