| 2. |
- Olsson, Karl Wilhelm, 1985-, et al.
(författare)
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Outcomes after endovascular aortic intervention in patients with connective tissue disease
- 2023
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Ingår i: JAMA Surgery. - : American Medical Association (AMA). - 2168-6254 .- 2168-6262. ; 158:8, s. 832-839
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Endovascular treatment is not recommended for aortic pathologies in patients with connective tissue diseases (CTDs) other than in redo operations and as bridging procedures in emergencies. However, recent developments in endovascular technology may challenge this dogma.Objective: To assess the midterm outcomes of endovascular aortic repair in patients with CTD.Design, Setting, and Participants: For this descriptive retrospective study, data on demographics, interventions, and short-term and midterm outcomes were collected from 18 aortic centers in Europe, Asia, North America, and New Zealand. Patients with CTD who had undergone endovascular aortic repair from 2005 to 2020 were included. Data were analyzed from December 2021 to November 2022.Exposure: All principal endovascular aortic repairs, including redo surgery and complex repairs of the aortic arch and visceral aorta.Main Outcomes and Measures: Short-term and midterm survival, rates of secondary procedures, and conversion to open repair.Results: In total, 171 patients were included: 142 with Marfan syndrome, 17 with Loeys-Dietz syndrome, and 12 with vascular Ehlers-Danlos syndrome (vEDS). Median (IQR) age was 49.9 years (37.9-59.0), and 107 patients (62.6%) were male. One hundred fifty-two (88.9%) were treated for aortic dissections and 19 (11.1%) for degenerative aneurysms. One hundred thirty-six patients (79.5%) had undergone open aortic surgery before the index endovascular repair. In 74 patients (43.3%), arch and/or visceral branches were included in the repair. Primary technical success was achieved in 168 patients (98.2%), and 30-day mortality was 2.9% (5 patients). Survival at 1 and 5 years was 96.2% and 80.6% for Marfan syndrome, 93.8% and 85.2% for Loeys-Dietz syndrome, and 75.0% and 43.8% for vEDS, respectively. After a median (IQR) follow-up of 4.7 years (1.9-9.2), 91 patients (53.2%) had undergone secondary procedures, of which 14 (8.2%) were open conversions.Conclusions and Relevance: This study found that endovascular aortic interventions, including redo procedures and complex repairs of the aortic arch and visceral aorta, in patients with CTD had a high rate of early technical success, low perioperative mortality, and a midterm survival rate comparable with reports of open aortic surgery in patients with CTD. The rate of secondary procedures was high, but few patients required conversion to open repair. Improvements in devices and techniques, as well as ongoing follow-up, may result in endovascular treatment for patients with CTD being included in guideline recommendations.
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| 3. |
- Robson, Harry K., et al.
(författare)
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Walnuts, salmon and sika deer : Exploring the evolution and diversification of Jōmon “culinary” traditions in prehistoric Hokkaidō
- 2020
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Ingår i: Journal of Anthropological Archaeology. - : Elsevier BV. - 0278-4165 .- 1090-2686. ; 60
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Tidskriftsartikel (refereegranskat)abstract
- The goal of this contribution is to stimulate a wider reflection on the role of food consumption practices throughout prehistory. We focussed on the Jmon communities of Hokkaid Island in Northern Japan since these mobile foragers underwent a process of economic diversification and intensification, eventually leading to higher levels of sedentism across the Pleistocene-Holocene transition. Moreover, dynamic social settings and expansion of the subsistence base at the start of the Holocene would have provided rich opportunities for novel food combinations, and potentially, the rise of diverse regional cuisines. We investigated tool kits and resource landscapes, and sampled pottery from a range of sites, phases and regions. We then applied organic residue analysis to confirm the actual spatiotemporal patterning in cuisine. Although we predicted that ruminants and nuts would have played a major role in local cuisine, especially in inland areas, our results indicate that aquatic resources were central to pottery-based cuisines across the island, and that other food groups had probably been processed in other ways. While organic residue analysis enabled us to reconstruct some major patterns in Jmon cuisine, we conclude that archaeologists will need to look beyond the cooking pot to fully appreciate the full diversity of local foodways.
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| 4. |
- Uchiyama, Junzo, et al.
(författare)
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Disaster, survival and recovery : the resettlement of Tanegashima Island following the Kikai-Akahoya 'super-eruption', 7.3ka cal BP
- 2023
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Ingår i: Antiquity. - 0003-598X .- 1745-1744. ; 97:393, s. 557-575
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Tidskriftsartikel (refereegranskat)abstract
- Archaeologists have traditionally framed the impacts of natural disasters in terms of societal collapse versus cultural resilience. The 7.3ka cal BP Kikai-Akahoya (K-Ah) ‘super-eruption’ in south-western Japan was among the largest volcanic events of the Holocene. Here, the authors deploy a multi-proxy approach to examine how K-Ah devastated Tanegashima Island. While local Jōmon populations were annihilated, surrounding communities survived and eventually returned, adjusting their subsistence base to survive in the damaged environment. The article concludes that neither ‘collapse’ nor ‘resilience’ fully capture the complex dynamics of this process and that more research is needed to understand how disasters shape cultural trajectories.
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