Five patients (17%) had undergone previous surgery on the ascending aorta and/or aortic valve. The mean aortic diameter LY2109761 at intervention was 48 +/- 13 mm. Follow-up was 100% complete and averaged 53 +/- 41 months.

Results: The technical feasibility and success with deployment proximal to the entry tear was 100%, requiring partial or total coverage of the left subclavian artery in only 1 patient (3%). Hospital mortality was 17% +/- 7% (70% confidence limit) with 6 late deaths. The causes of hospital death included multiorgan

failure in 2 patients, aortic rupture in 2, and retrograde dissection in 1 patient. Three patients (10%) who survived the procedure developed neurologic complications (2 strokes and 1 transient ischemic attack). One patient required early conversion to surgery because of retrograde type A dissection. Furthermore, 4 patients developed a type Ia endoleak. A postprocedural increase in the distal aortic diameter was observed in 3 patients. The actuarial survival at 1 and PP2 5 years was 79% and 61%, respectively. Freedom from treatment failure at 1 and 5 years (including reintervention, aortic rupture, device-related complications, aortic-related death, or sudden, unexplained late death) was 82%

and 77%, respectively.

Conclusions: Endovascular stent graft placement in acute complicated type B aortic dissection proves to be a promising alternative therapeutic treatment modality in this relatively difficult patient cohort. Refinements, especially in stent design and application, could further

improve the prognosis of patients in this life-threatening situation. (J Thorac Cardiovasc Surg 2013;145:159-65)”
“Background. To test whether receiving care from a health visitor (HV) trained in identification and psychological intervention methods prevents depression 6-18 months postnatally in women who are not depressed 6 weeks postnatally.

Method. The study was a prospective cluster trial, randomized by GP practice, with follow-up for 18 months in 101 primary care teams in the Trent area of England. The participants were women scoring < 12 on the postal Edinburgh Postnatal Depression Scale click here (EPDS) at 6 weeks postnatally (1474 intervention and 767 control women). Intervention HVs (n = 89, 63 clusters) were trained in identifying depressive symptoms using the EPDS and face-to-face clinical assessment and in providing psychologically orientated sessions based on cognitive behavioral or person-centered principles. The control group comprised HVs (n = 49, 37 clusters) providing care as usual (CAU). The primary outcome measure was the proportion of women scoring >= 12 on the EPDS at 6 months postnatally.