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Cureus 2018 Oct 31;10(10):e3531. Epub 2018 Oct 31.

Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA.

Acute aortic dissection is a deadly disease that should be recognized promptly. We report an exceptional case of a 44-year-old African American female who presented with a rapidly progressing severe frontal headache. Initial computed tomography of the brain was negative. Read More

JAMA Netw Open 2018 Aug 3;1(4):e181281. Epub 2018 Aug 3.

Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Importance: The natural history of ascending aortic aneurysm (AsAA) is currently not well characterized.

Objective: To summarize and analyze existing literature on the natural history of AsAA.

Data Sources: A search of Ovid MEDLINE (January 1, 1946, to May 31, 2017) and Embase (January 1, 1974, to May 31, 2017) was conducted. Read More

BMJ Case Rep 2019 Jan 14;12(1). Epub 2019 Jan 14.

Cardiology Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK.

A 50-year-old man collapsed at the roadside with retrosternal pain, shortness of breath and generalised weakness. An ECG in the emergency department was reported as demonstrating ST segment elevation of up to 1.5 mm in leads V1 to V3, leading to a diagnosis of an acute ST-elevation myocardial infarction. Read More

Int J Gynecol Cancer 2019 Jan;29(1):86-93

Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.

Background And Objectives: In the Robot Assisted Surgery for High Risk Endometrial Cancer (RASHEC) trial, patients with high-risk endometrial cancer were randomly assigned to robot-assisted laparoscopic surgery (RALS) or laparotomy for pelvic and infrarenal para-aortic lymph node dissection. We here report on self-reported lower limb lymphedema (LLL), lymphocyst formation, ascites, and long-term serious adverse events 12 months after surgery.

Patients And Methods: Patients were enrolled between 2013 and 2016, and 96 patients were included in the per protocol analysis, evenly distributed between RALS and laparotomy. Read More

Int J Gynecol Cancer 2019 Jan;29(1):53-59

Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

Objective: To identify factors that affect successful adaptation of sentinel lymph node mapping and those that lead to unintended adipose-only sentinel lymph node identification.

Methods: Surgical and pathological data were prospectively collected on patients with endometrial cancer who underwent sentinel lymph node mapping with indocyanine green with or without pelvic and/or para-aortic lymph node dissection between November 2013 and April 2017. All mapping cases were performed with the robotic system. Read More

Ann Thorac Surg 2019 Jan 9. Epub 2019 Jan 9.

Department of Pediatric Cardiac Sciences, Sir Ganga Ram Hospital, New Delhi, India.

Reconstruction of the aortic arch in type B interruption requires extensive mobilisation of the descending aorta and the proximal branches of the arch to perform a tension free anastomosis. Association of coexistent type II aortopulmonary window and aberrant subclavian artery reduces the degree of mobility that can be achieved by dissection alone and usually entails sacrifice of the aberrant artery to achieve satisfactory mobilisation. We report a novel technique to use the aberrant subclavian artery as autologous tissue in the reconstruction of the aortic arch for repair of type B interruption associated with type II aortopulmonary window. Read More

J Thorac Cardiovasc Surg 2018 Dec 20. Epub 2018 Dec 20.

Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY. Electronic address:

J Thorac Cardiovasc Surg 2018 Dec 13. Epub 2018 Dec 13.

Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.

SAGE Open Med 2019 1;7:2050312118822632. Epub 2019 Jan 1.

Department of Clinical Sciences, Lund University, Malmö, Sweden.

Objectives: The aim of this study was to establish the top 10 research uncertainties in aortic dissection together with the patient organization Aortic Dissection Association Scandinavia using the James Lind Alliance concept.

Methods: A pilot survey aiming to identify uncertainties sent to 12 patients was found to have high content validity (scale content validity index = 0.91). Read More

Ann Vasc Dis 2018 Dec;11(4):557-561

Division of Cardiovascular Surgery, Kochi Medical School, Nankoku, Kochi, Japan.

We report the cases of three patients who underwent thoracic endovascular aortic repair for type B aortic dissection in which transesophageal echocardiography (TEE) was used to guide the procedure in addition to fluoroscopy. TEE was found to be advantageous because it can visualize vascular structures along with the guidewire and devices. Furthermore, it provides real-time hemodynamic and hematological information without the need for contrast injection or radiation exposure. Read More

Ann Vasc Dis 2018 Dec;11(4):490-495

Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.

: Uncomplicated type B aortic dissection is generally treated with medical management including antihypertensive therapy. The purpose of this study is to investigate risk factors associated with the aortic enlargement in medically treated patients. : Between July 2004 and April 2016, 127 consecutive patients with acute type B aortic dissection were treated in our institution. Read More

Ann Vasc Dis 2018 Dec;11(4):464-472

Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan.

Thoracic endovascular aortic repair (TEVAR) for thoracic aortic disease constitutes a paradigm shift in the treatment strategy of aortic dissection, as well as thoracic aortic aneurysms. Conventionally, most patients with Stanford type B acute aortic dissection are treated using conservative medical treatment during the acute phase. However, in patients with complicated type B aortic dissection who present with life-threatening complications, TEVAR has been introduced as a novel and less-invasive alternative and has shown better early results than those observed with conventional therapy. Read More

Ann Vasc Dis 2018 Dec;11(4):437-442

Miyuki Hospital LTAC Heart Failure Center, Kumamoto, Japan.

The majority of aortic aneurysms comorbid with atherosclerosis can be asymptomatic and are discovered incidentally on routine physical examination or on imaging studies for other indications. Transthoracic echocardiography is a basic modality to assess patients with coronary artery disease and can be used for the screening of aortic aneurysm. Acute aortic dissection is a highly lethal cardiovascular emergency and requires prompt recognition. Read More

J Thorac Cardiovasc Surg 2018 Aug 24. Epub 2018 Aug 24.

Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China; Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, China. Electronic address:

Objective: The use of the frozen elephant trunk technique for type A aortic dissection in Marfan syndrome is limited by the lack of imaging evidence for long-term aortic remodeling. We seek to evaluate the changes of the distal aorta and late outcomes after frozen elephant trunk and total arch replacement for type A aortic dissection in patients with Marfan syndrome.

Methods: Between 2003 and 2015, we performed frozen elephant trunk + total arch replacement for 172 patients with Marfan syndrome suffering from type A aortic dissection (94 acute; 78 chronic). Read More

J Thorac Cardiovasc Surg 2018 Nov 23. Epub 2018 Nov 23.

ADETEC, Suresnes, France. Electronic address:

Curr Opin Cardiol 2019 Jan 9. Epub 2019 Jan 9.

Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta.

Purpose Of Review: Bicuspid aortic valve (BAV) results from fusion of two adjacent aortic valve cusps, and is associated with dilatation of the aorta, known as BAV-associated aortopathy, or bicuspid aortopathy. Bicuspid aortopathy is progressive, increasing the risk of life-threatening clinical events, such as aortic dissection. Regular monitoring and timely intervention with prophylactic surgical resection of the proximal aorta is recommended. Read More

Perfusion 2019 Jan 11:267659118816555. Epub 2019 Jan 11.

1 Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been used to deal with life-threatening complications as well as back-up or active cardiovascular support during high-risk procedures in patients undergoing transcatheter aortic valve implantation (TAVI). PubMed and MEDLINE electronic databases were searched in order to identify studies with emergency or prophylactic V-A ECMO application in association with TAVI procedures. From November 2012 to November 2017, 14 relevant studies were identified that included 5,115 TAVI patients of whom 102 (2%) required V-A ECMO (22 prophylactically, 66 as an emergency and 14 without a reported indication). Read More

Perfusion 2019 Jan 11:267659118822947. Epub 2019 Jan 11.

Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.

Objectives:: The aim of this study was to evaluate independent risk factors predictive for mortality of patients with Stanford A acute aortic dissection.

Methods:: From January 2006 to March 2015, a total of 240 consecutive patients diagnosed with acute Stanford A acute aortic dissection underwent surgical aortic repair in our center. After analysis of pre- and perioperative variables, univariate logistic and multivariate logistic regression analyses were performed for mortality of patients. Read More

J Thorac Dis 2018 Nov;10(Suppl 33):S4140-S4143

Cardiovascular Research Institute, Kurume University, Kurume, Fukuoka, Japan.

J Thorac Dis 2018 Nov;10(Suppl 33):S4133-S4136

Center for Medical Genetics, Ghent University, Ghent, Belgium.

J Thorac Dis 2018 Nov;10(Suppl 33):S3884-S3886

Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, S. Orsola Hospital, University of Bologna, Bologna, Italy.

J Thorac Dis 2018 Nov;10(Suppl 33):S3862-S3864

Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan.

J Thorac Cardiovasc Surg 2018 Nov 23. Epub 2018 Nov 23.

Division of Cardiovascular and Thoracic Surgery, University of Texas Medical Branch-Galveston, Galveston, Tex.

Rev Med Suisse 2019 Jan;15(N° 632-633):65-68

Service des urgences, Département des centres interdisciplinaires et logistique médicale, CHUV, 1011 Lausanne.

Professionalisation of emergency medicine is currently booming. In order to offer the best care, emergency physician can refer to several new studies : 1) in a cerebral stroke, the 0° head position doesn't offer any benefit ; 2) hyperoxygenation in acute patients could raise mortality ; 3) epinephrine in prehospital cardiac arrest favors return of spontaneous circulation but worsens the neurological prognosis ; 4) systematic cross-checking reduces the risk of adverse events in the emergency department ; 5) ultrasensitive troponins better detect myocardic events, but raises the number of unusefull invasive procedures and 6) combined pre-test probability score and D-dimers potentially allows to rule out aortic dissection. Read More

Eur Heart J Cardiovasc Imaging 2019 Jan 9. Epub 2019 Jan 9.

Department of Cardiology, Shenzhen People's Hospital, the First Affiliated Hospital of Southern University of Science and Technology, the Second Clinical Medical College of Jinan University, 1017 Dongmen North Road, Shenzhen, Guangdong, China.

Turk Kardiyol Dern Ars 2019 Jan;47(1):60-62

Department of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey.

Aorto-atrial fistula is a rare anomaly of the heart that may be the result of congenital or acquired conditions, such as bacterial endocarditis, paravalvular abscess, aortic dissection, or a complication of cardiac surgery. A 50-year-old female patient presented at the clinic with the complaint of dyspnea and abdominal distention due to ascites. On admission, her functional capacity was New York Heart Association (NYHA) class III. Read More

Biomed Res Int 2018 6;2018:4514178. Epub 2018 Dec 6.

Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang Province, China.

In order to identify potential biomarkers that distinguish the embolic stroke (ES) from thrombotic stroke (TS), a profile of microRNA expression was analyzed. The GSE60319 expression profile was downloaded from the Gene Expression Omnibus (GEO) database. The GEO2R was applied to screen for differentially expressed microRNAs (DEmiRNAs) between the embolic stroke group and thrombotic stroke group. Read More

Int Heart J 2019 Jan 10. Epub 2019 Jan 10.

Department of Cardiothoracic Surgery, Drum Tower Clinical Medical College of Nanjing Medical University.

The pathogenesis of aortic dissection (AD) is unclear. The aim of this study was to explore the relationship between osteopontin (OPN) and AD. Fifty AD patients were enrolled; 29 had hypertension with AD (H-AD) and 21 no hypertension with HD (NH-AD). Read More

J Thorac Dis 2018 Nov;10(11):6192-6200

Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.

Background: Surgical management of aortic arch diseases is one of the most challenging issues in cardiovascular surgery. The aim of this study was to compare the outcome after frozen elephant trunk (FET) with conventional elephant trunk (ET) technique.

Methods: Out of a total of 551 patients after thoracic aortic surgery, we analyzed 70 consecutive patients, who underwent aortic arch replacement with ET or FET technique between 2001 and 2017 in our institution. Read More

J Thorac Dis 2018 Nov;10(11):6097-6106

Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy.

Background: Here we evaluate the usefulness of transfemoral uncovered stent implantation to avoid secondary conventional surgery for residual type A aortic dissection (TAAD) of the aortic arch after ascending aorta replacement.

Methods: From June 2009 to April 2015, 11 patients were treated with transfemoral implantation of uncovered stents in the aortic arch after surgical replacement of ascending aorta performed on average 4.7±2. Read More

JACC Cardiovasc Interv 2019 Jan;12(1):e5-e7

Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.

Trends Cardiovasc Med 2019 Feb 21;29(2):61-68. Epub 2018 Jun 21.

Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD United Kingdom.

Bicuspid aortic valve (BAV) disease remains the most common congenital cardiac disease and is associated with an increased risk of potentially fatal aortopathy including aortic aneurysm and dissection. Mutations in the NOTCH1 gene are one of only a few genetic anomalies identified in BAV disease; however evidence for defective NOTCH signaling, and its involvement in the characteristic histological changes of VSMC apoptosis and differentiation in ascending aortae of BAV patients is lacking. This review scrutinizes the evidence for the interactions of NOTCH signaling, cellular differentiation and apoptosis in the context of aortic VSMCs and provides focus for future research efforts in the diagnosis of BAV aortopathy and prevention of catastrophic complications through NOTCH signaling manipulation. Read More

Front Surg 2018 19;5:76. Epub 2018 Dec 19.

Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.

The role of lymph node dissection (LND) for renal cell carcinoma (RCC) is controversial. Notably, the conflicting evidence on the benefits and harms of LND is inherently linked to the lack of consensus on both anatomic templates and extent of lymphadenectomy. Herein, we provide a detailed overview of the most commonly dissected templates of LND for RCC, focusing on key anatomic landmarks and patterns of lymphatic drainage. Read More

EJNMMI Res 2019 Jan 7;9(1). Epub 2019 Jan 7.

Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.

Background: F-GP1 is a novel positron emission tomography (PET) tracer that targets glycoprotein IIb/IIIa receptors on activated platelets. The study objective was to explore the feasibility of directly imaging acute arterial thrombosis (AAT) with F-GP1 PET/computed tomography (PET/CT) and to quantitatively assess F-GP1 uptake. Safety, biodistribution, pharmacokinetics and metabolism were also evaluated. Read More

Theranostics 2018 7;8(22):6384-6385. Epub 2018 Dec 7.

University College London, Department of Mechanical Engineering, Multiscale Cardiovascular Engineering Group, UK.

The use of in silico tools for the interventional planning of complex vascular conditions, such as Aortic Dissections has been often limited by high computational cost, involving long timescales for accurate results to be produced and low numbers of patients, precluding the use of statistical analyses to inform individual-level models. In the paper [ 2018; 8(20):5758-5771. doi:10. Read More

J Vasc Surg 2019 Jan 3. Epub 2019 Jan 3.

W. L. Gore & Associates, Inc, TAMBE Team, Flagstaff, Ariz.

Objective: This study reports the technical aspects and 30-day outcomes of the prospective, multicenter early feasibility study designed to evaluate the GORE EXCLUDER Thoracoabdominal Branch Endoprosthesis (TAMBE; W. L. Gore & Associates, Flagstaff, Ariz). Read More

J Vasc Surg 2019 Jan 3. Epub 2019 Jan 3.

Department of Thoracic and Cardiovascular Surgery, Hôpital A de Villeneuve, Montpellier, France; CHU Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France.

Objective: A review of the literature was conducted for incidence, outcomes, and risk factors for distal stent graft-induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) of aortic dissection.

Methods: The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Seven articles reporting on 1415 patients with thoracic aortic dissection undergoing TEVAR without supplemental distal bare stenting were included. Read More

J Vasc Surg 2019 Jan 3. Epub 2019 Jan 3.

Department of Radiology, Mie University Hospital, Tsu, Japan.

Objective: The efficacy of thoracic endovascular aortic repair (TEVAR) for retrograde type A aortic dissection (r-TAAD) with the entry tear in the descending aorta has not been clarified.

Methods: The medical records of 31 patients who underwent TEVAR for r-TAAD at three institutions between May 1997 and January 2016 were retrospectively reviewed.

Results: The mean age of the patients (30 men and 1 woman) was 64 ± 11 years. Read More

J Am Heart Assoc 2019 Jan;8(1):e010940

1 University department of Cardiac Surgery Leipzig Heart Center Germany.

Background Iatrogenic coronary artery injuries during percutaneous coronary interventions ( PCI ) often require emergent surgical management. Our study evaluated the early and long-term outcomes in patients undergoing surgical treatment of iatrogenic PCI complications and identified the predictors of operative and long-term mortality. Methods and Results Pre-, intra- and post-operative data and hospital outcomes of 168 consecutive patients undergoing cardiac surgical procedures for iatrogenic complications following PCI between December 1999 and July 2015, were prospectively collected in our computerized database. Read More

J Artif Organs 2019 Jan 5. Epub 2019 Jan 5.

Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.

Although thoracic endovascular aneurysm repair (TEVAR) has been getting popularity as a less-invasive procedure, the treatment of thoracic aortic aneurysm with atherosclerotic aortic disease is still challenging. In hybrid TEVAR through the median sternotomy approach, side-biting clamp of the ascending aorta is often necessary for making an access route; however, it could cause embolic complication and aortic dissection. This study aimed to present the results of our preliminary study on the clampless aortic punch system (APS). Read More

Neurosurg Focus 2019 Jan;46(Suppl_1):V14

2Neuroradiology, San Bortolo Hospital, Vicenza, Italy.

Distal, dissecting, middle cerebral artery (MCA) aneurysms are changing surgically and endovascularly. Endovascular treatment requires flow diverter stenting. A good vessel visualization is crucial for safe navigation. Read More

J Robot Surg 2019 Jan 4. Epub 2019 Jan 4.

Department of Vascular and Endovascular Surgery, University of Michigan, Ann Arbor, MI, 48109, USA.

Robotic-assisted surgical approaches for vascular surgery are feasible regarding minimally invasive exposure, dissection, ligation and skeletonization for varicose vein ligation, anterior spine exposure, femoral-popliteal bypass, femoral vein harvest and aortic aneurysm repair. The authors performed a cadaveric exploration to demonstrate proof of concept and feasibility for a robotic-assisted approached. Surgeon autonomy over endoscopic vision, robotic instrumentation and retraction were noted as key benefits over existing open vascular approaches. Read More

Surg Today 2019 Jan 4. Epub 2019 Jan 4.

Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Anastomosis of the fragile aortic wall in patients with acute aortic dissection presents a challenge to cardiovascular surgeons. Reinforcement of the stump is a key to accomplishing successful anastomosis. Surgical glues such as gelatin-resorcin-formalin (GRF) glue and Bioglue are easy to use and have radically changed the process of the reinforcement and reapproximation. Read More

Am J Case Rep 2019 Jan 5;20:21-25. Epub 2019 Jan 5.

Department of Anesthesiology, University Hospitals of Geneva, Geneva, Switzerland.

BACKGROUND Patients undergoing cardiac surgery are at risk of adverse perioperative neurological complications. Cerebral oximetry monitoring is increasingly used in these patients to detect intraoperative cerebral hypoxia or ischemic events. Near-infrared spectroscopy (NIRS) uses the near-infrared region of the electromagnetic spectrum for oximetry imaging. Read More

PLoS One 2019 4;14(1):e0210022. Epub 2019 Jan 4.

Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Background: Total arch replacement (TAR) and/or stent graft implantation has been proposed as the primary surgical treatment for acute DeBakey type I aortic dissection. However, the suggestion was based on excellent outcomes of high-volume or aortic centers. How about the real results in most places around the world? The purpose of this study was intended to compared in-hospital mortality, major complications, and aortic remodeling between TAR and/or stent graft implantation in a medical center of northern Taiwan. Read More

Eur J Cardiothorac Surg 2019 Jan 3. Epub 2019 Jan 3.

The Korea Heart Foundation, Seoul, Korea.

Objectives: The aim of this study is to evaluate the locational impact of a luminal communication on aortic diameter changes and reintervention after surgical repair of acute type I aortic dissection.

Methods: Between 2009 and 2017, 304 patients underwent operation for acute type I aortic dissection. Among them, 93 patients were enrolled. Read More

Scand Cardiovasc J 2018 Nov 16:1-7. Epub 2018 Nov 16.

b Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden.

Background: In families with an inherited form of non-syndromic thoracic aortic disease (TAAD), aortic diameter alone is not a reliable marker for disease occurrence or progression. To identify other parameters of aortic function, we studied aortic stiffness in families with TAAD. We also compared diameter measurements obtained by transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI). Read More

Heart Surg Forum 2018 Nov 6;21(6):E432-E437. Epub 2018 Nov 6.

Department of Cardiovascular Surgery, the Affiliated Hospital of QingDao University, No.16 JiangSu Road, QingDao 266003, China.

Background: The study was to analyze the therapeutic effect and risk factors of in-hospital mortality in patients with acute Stanford type A aortic dissection operated by Sun's procedure.

Methods: From Jan. 2010 to March 2016, 72 patients whose data was fully accessible underwent Sun's procedure in our hospital due to acute Stanford type A aortic dissection. Read More

Eur Heart J 2019 Jan 2. Epub 2019 Jan 2.

Cardiology and Aortic Center, Royal Brompton & Harefield NHS Foundation, Trust at Imperial College, Sydney Street, London, UK.

Ann Cardiothorac Surg 2018 Nov;7(6):748-754

Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy.

Background: Minimally invasive cardiac surgery has increasingly been used for patients with valvular pathology. Two techniques of aortic occlusion are utilized with this technique: transthoracic aortic clamp (TTC) and endoaortic balloon occlusion (EAO). Both possibilities present peculiar advantages and limitations whose current evidence is based on few observational studies. Read More