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Ferredoxin-NAD(P) + oxidoreductases are important enzymes for redox balancing in n-butanol production by Clostridium acetobutylicum, but the encoding genes remain unknown. Here, the authors identify the long sought-after genes and increase n-butanol production by optimizing the levels of the two enzymes.

Abstract Background While sleep disruption is a common complaint among children with cystic fibrosis (CF), only a few studies have investigated insomnia in adults. The aim of this study was to identify factors associated with insomnia in clinically stable adult CF patients. Methods Twenty-eight CF patients (18M/10F), with a median age of 27 (22–34) (median (interquartile range) years and a median of forced expiratory volume in one second of 72 (39–93) % predicted completed questionnaires on insomnia (Insomnia Severity Index, ISI), sleep quality (PSQI), daytime sleepiness (Epworth), restless legs syndrome (IRLS), pain (NRS), anxiety/depression (HAD) and quality of life (CFQ-R 14+). Respiratory assessment data, including symptoms, sputum analysis, arterial blood gases, 6-min walking test, pulmonary function tests and polysomnographic variables, were also analyzed. Results Forty-three percent of patients were insomniac (ISI > 7). Compared with non-insomniac patients (ISI ≤ 7), insomniac patients had more severely impaired quality of life and a higher HAD score: median anxiety score of 9 (8–11) vs 4 (3–6) (p

Hybrid supercapacitors have been developed in the pursuit of increasing the energy density of conventional supercapacitors without affecting the power density or the lifespan. Potassium-ion hybrid supercapacitors (KIC) consist of an activated carbon capacitor-type positive electrode and a graphitic battery-type negative one working in an electrolyte based on potassium salt. Overcoming the inherent potassium problems (irreversible capacity, extensive volume expansion, dendrites formation), the non-reproducibility of the results was a major obstacle to the development of this KIC technology. To remedy this, the development of an adequate formation protocol was necessary. However, this revealed a cell-swelling phenomenon, a well-known issue whether for supercapacitors or Li-ion batteries. This phenomenon in the case of the KIC technology has been investigated through constant voltage (CV) tests and volume measurements. The responsible phenomena seem to be the solid electrolyte interphase (SEI) formation at the negative electrode during the first use of the system and the perpetual decomposition of the electrolyte solvent at high voltage. Thanks to these results, a proper formation protocol for KICs, which offers good energy density (14 Wh·kgelectrochemical core−1) with an excellent stability at fast charging rate, was developed.

Rechargeable batteries play a decisive role in the deployment of low-carbon electric mobility. However, their environmental cost in terms of resource depletion, toxicity, and end-of-life recovery, among others, must not be overlooked. Because of the massive volume of batteries foreseen to be deployed worldwide and the rapid evolution of the battery industry with the emergence of new high-density energy technologies, it is necessary to analyse their technological feasibility according to a lifecycle approach, in order to identify the environmental impacts of these innovations when they are at a low level of maturity. The objective is to integrate environmental performance criteria early in the development of these new generations of batteries. This work aimed at supporting the actors involved in the technological research to incorporate the environmental dimension into their R&D activities. Thus, two technologies (advanced lithium-ion and lithium-sulphur) with different technological maturities were analysed through a multi-criteria environmental assessment approach. The method applied fulfils the support requirements of the upstream actors during the implementation of their R&D activities in the design of future generations of batteries for electric mobility.

L’expérience de la migration, une constante pour les Centraméricains, est une thématique récurrente dans la production littéraire de la région. Ce travail s’intéresse plus particulièrement à la représentation de sujets périphériques migrants à travers l’analyse de trois nouvelles d’auteur·e·s centraméricain·e·s. À partir de l’exploitation du concept de « littérature hétérogène » et de la dichotomie centre/périphérie, nous étudierons comment la présentation de personnages périphériques immergés dans un espace hégémonique permet de mettre en œuvre des reconfigurations identitaires tout en questionnant la validité d’une confrontation entre ces deux pôles.

The use of the last generation of Raschig’s structured packings, Raschig SuperPack (RSP) has been investigated for scrubbing columns operating at high liquid loads, for their potential to increase capacity while maintaining mass transfer efficiencies at high levels. IFPEN has measured pressure drops, flooding limits, liquid and gas side mass transfer coefficients and interfacial areas for the RSP 200X. Flooding limits were in agreement with literature, however at high liquid loads and for tested X-Style RSP they were 30-40% lower than those calculated with the Winsorp Software. This indicates that extrapolation of flooding models should be used with caution to size column diameters for fluid systems and liquid loads that differ from those from which these models were derived. With the support of the present results a modified version of Winsorp has been elaborated for high liquid loads and X-Style RSP. RSP 200X develops a high interfacial area, close to the one of a standard 250 m2/m3 structured packing. One important difference however has been noted about the impact of the gas flowrate on the interfacial area. While for standard packings the gas flow rate is often considered to have only a small effect on area when operating below the loading point, the effect measured on RSP200X is significant and of the same order as for liquid load. Measurements of kLae further confirm that these latest generations of packings show different trends when compared to standard structured packings. Detailed characterization tests are therefore highly recommended to estimate the performances of these packings in terms of hydraulics and mass transfer properties. In some distant future, it is believed that CFD calculations (gas and gas/liquid) will help to better understand and model such phenomena.

Molybdenum carbide was supported on three types of carbon support—activated carbon; multi-walled carbon nanotubes; and carbon nanofibers—using ammonium molybdate and molybdic acid as Mo precursors. The use of activated carbon as support afforded an X-ray amorphous Mo phase, whereas crystalline molybdenum carbide phases were obtained on carbon nanofibers and, in some cases, on carbon nanotubes. When the resulting catalysts were tested in the hydrodeoxygenation (HDO) of guaiacol in dodecane, catechol and phenol were obtained as the main products, although in some instances significant amounts of cyclohexane were produced. The observation of catechol in all reaction mixtures suggests that guaiacol was converted into phenol via sequential demethylation and HDO, although the simultaneous occurrence of a direct demethoxylation pathway cannot be discounted. Catalysts based on carbon nanofibers generally afforded the highest yields of phenol; notably, the only crystalline phase detected in these samples was Mo2C or Mo2C-ζ, suggesting that crystalline Mo2C is particularly selective to phenol. At 350 °C, carbon nanofiber supported Mo2C afforded near quantitative guaiacol conversion, the selectivity to phenol approaching 50%. When guaiacol HDO was performed in the presence of acetic acid and furfural, guaiacol conversion decreased, although the selectivity to both catechol and phenol was increased.

Le recueil de contes Madre Milpa, de l’écrivain guatémaltèque Carlos Samayoa Chinchilla, offre au lecteur un cheminement à travers les pages de l’histoire du Guatemala, traversant les frontières entre passé et présent, réalité et fiction. Dans cet article nous analysons les procédés narratifs qui permettent la construction d’une identité guatémaltèque réévaluée à partir de l’exploitation, la reconfiguration ou la transgression de diverses sources d’inspiration comme le mythe, la légende ou l’histoire officielle.

Resumen: Este artículo analiza algunas dificultades que conlleva la traducción jurada inglés-español. Se indaga en el contexto legal existente en España en torno a la figura profesional del traductor jurado. El análisis está enfocado a ilustrar ciertos problemas inherentes a toda traducción jurada, de las que se ofrecen algunos consejos de buenas prácticas. Al igual que en la traducción de los otros ámbitos, en contextos legales descifrar correctamente la verdadera intención del emisor constituye una de las mayores dificultades. La complejidad suele aumentar con la longitud de las oraciones y los párrafos. A esto se le suma el necesario dominio del lenguaje especializado. Abstract: This paper analyses some of the difficulties involved in English-Spanish legal translation and describes the legal context of the sworn translators in Spain. The analysis focuses on a number of challenges inherent to all legal translations, and offers advice for good practice. In legal translation contexts –as in translation of any other field– correctly deciphering the real intention of the author is one of the greatest challenges; complexity particularly increases with the length of sentences and paragraphs, not to mention the necessary command of the specialized language.

Introduction

Few studies have been undertaken to assess the possible effects of bisphenol A (BPA) on the reproductive hormone balance in animals or humans with often contradictory results. We investigated possible direct endocrine disruption by BPA of the fetal testes of 2 rat strains (14.5-17.5 days post-coitum) and humans (8-12 gestational weeks) and under different culture conditions. BPA concentrations of 10(-8)M and 10(-5)M for 72 h reduced testosterone production by the Sprague-Dawley fetal rat testes, while only 10-5M suppressed it in the Wistar strain. The suppressive effects at 10-5M were seen as early as 24h and 48 h in both strains. BPA at 10(-7)-10(-5)M for 72 h suppressed the levels of fetal rat Leydig cell insulin-like factor 3 (INSL3). BPA exposure at 10(-8)M, 10(-7)M, and 10(-5)M for 72 h inhibited testosterone production in fetal human testes. For the lowest doses, the effects observed occurred only when no gonadotrophin was added to the culture media and were associated with a poorly preserved testicular morphology. We concluded that (i) BPA can display anti-androgenic effects both in rat and human fetal testes; (ii) it is essential to ascertain that the divergent effects of endocrine disruptors between species in vitro do not result from the culture conditions used, and/or the rodent strain selected; (iii) the optimization of each in vitro assay for a given species should be a major objective rather than the search of an hypothetical trans-species consensual model-system, as the organization of the testis is intrinsically different between mammalian species; (iv) due to the uncertainty existing on the internal exposure of the human fetal testis to BPA, and the insufficient number of epidemiological studies on the endocrine disruptive effects of BPA, caution should be taken in the extrapolation of our present results to the human reproductive health after fetal exposure to BPA.

Au cours des dix dernières années, l'injection de gaz miscibles dans les puits de pétrole a connu un nouvel essor avec l'intérêt suscité par l'emploi de gaz carbonique principalement aux Etats-Unis. Mais d'autres gaz non hydrocarbonés sont susceptibles d'être utilisés pour la récupération assistée du pétrole. C'est ainsi que l'azote ou les gaz de fumées constituent une solution de rechange éventuelle. Dans cette perspective, on peut se limiter en première analyse à l'étude économique de l'utilisation de l'azote pour des champs à terre dans des conditions Europe de l'Ouest mi-1984 avec un facteur de marche des installations de surface de 340 jours/an et une durée de vie du projet de 10 ans. Des différents résultats, il ressort que - pour des faibles demandes, chaque cas doit être l'objet d'un examen particulier; cette attitude résulte du prix de vente minimum rentable élevé d'obtention de l'azote sous forme liquide par distillation cryogénique de l'air, qui en général est compris, pour un taux de rentabilité interne de 15 %, entre 850 et 550 FF/t pour des capacités de production de 100 à 500 t/j; - pour des débits plus importants, la construction d'une unité de production d'azote gazeux sur le site même apparaît comme la solution la plus intéressante. En effet, pour des demandes comprises entre 1 500 et 5 000 t/j, on peut ainsi produire de l'azote sous 24 10·6 Pa abs à un prix de vente minimum rentable, pour un taux de rentabilité interne de 15 %, d'environ 200 FF/t, voire même 150 FF/t. In the last ten years, miscible gas flooding has taken great strides owing to the development of carbon dioxide, especially in the United States. But other non-hydrocarbon gases are likely to be used for Enhanced Oil Recovery. For example, nitrogen or flue gases appear as a possible replacement solution. With this outlook, a first analysis has been realised, limited to an economic study of using nitrogen for onshore fields under Western European Conditions Mid-1984, with a surface installations stream factor of 340 days per year and a lifetime of 10 years for the project. The differents results show that:(a) For small demands, each case must be examined in particular. The reason for this is the high economic cost of liquid nitrogen produced by cryogenic air separation which is generally between FF 850 and 550 per metric ton (based on an internal rate of return of 15%) for production capacities of 100 to 500 tons per day. (b) For larger outputs, the building of a gaseous nitrogen production plant on the site itself appears as the most interesting solution. Indeed, for demands between 1500 and 5000 metric tons per day, nitrogen can thus be produced under a pressure of 24 × 10·6 Pa abs at an economic cost of about FF 200 or even FF 150 per ton (based on an internal rate of return of 15%).

Les besoins de l'Europe occidentale en propylène utilisé en pétrochimie sont actuellement de 7,4. 10 puissance 6 t/an. Au cours des prochaines années, le taux de progression moyen de la consommation devrait être de l'ordre de 1,8%/an; ainsi en 1995, la pétrochimie européenne utiliserait environ 8,7. 10 puissance 6 t de propylène. L'essentiel de la progression de cette consommation sera dû au fort accroissement de la production de polypropylène et à un degré moindre de l'oxyde de propylène, de l'isopropanol et de l'éthyl-2 hexanol. Par contre les débouchés représentés par l'acrylonitrile et le cumène resteront pratiquement stables. La consommation de propylène dans les productions de butanols devrait diminuer. La part des besoins en propylène satisfaite par les vapocraqueurs européens qui est en 1986 de 82 %, devrait être inférieure à 75 % en 1995. Il sera de plus en plus nécessaire de se tourner vers d'autres sources d'approvisionnement. En 1986 les raffineries européennes ont produit 1,05. 10 puissance 6 t de propylène utilisé en pétrochimie et les importations ont atteint 0,3. 10 puissance 6 t. En 1995 la différence entre la consommation et la production des vapocraqueurs pourrait dépasser 2,0. 10 puissance 6 t. Il semble peu probable que les unités de craquage catalytique puissent combler le déficit sauf si les rendements en propylène augmentent très notablement. On peut s'attendre à la construction de splitters propylène/propane et à une augmentation des importations. D'autre part, en raison de la tension qui risque d'apparaître sur les prix du propylène, l'intérêt de certaines voies de synthèse actuellement considérées comme non rentables pourrait augmenter; ces nouvelles voies sont : - la déshydrogénation du propane déjà considérée dans d'autres régions (Mexique, Indonésie, Malaisie); - la métathèse entre l'éthylène et les butènes-2, pouvant eux-mêmes être produits à partir d'éthylène; - le craquage du méthanol. The needs of Western Europe for propylene used in petrochemistry are currently 7. 4 x 10 to the power of 6 metric tons per year. In the coming years, the average rate of increase should be about 1. 8 % per year. Hence in 1995 European petrochemicals should use about 8. 7 x 10 to the power of 6 tons of propylene,Most of this increase in consumption will be due to the sharp rise in polypropylene production and to a lesser extent in propylene oxide, isopropanol and 2-ethyl hexanol production. However, uses for acrylonitrile and cumene will remain fairly stable. Propylene consumption for butanol production should decrease. The share of propylene needs met by European steam crackers, which was 82% in 1986, should be less than 75% in 1995. It will be more and more necessary to turn to other sources of supply. In 1986 European refineries produced 1. 05 x 10 to the power of 6 tons of propylene used for petrochemicals, and imports amounted to 0. 3 x 10 to the power of 6 tons. In 1995 the difference between consumption and production by steam crackers could be beyond 2. 0 x 10 to the power of 6 tons. It seems improbable that catalytic cracking plants can make up for the deficit except if propylene yields were to increase a great deal. The construction of propylene/propane splitters can be expected along with an increase in imports. Likewise, due to the tension that risks could appear in propylene prices, the advantage of some synthesis routes now considered not to be profitable might increase. These new routes are :(a) dehydrogenation of propane as is already being considered in other regions (Mexico, Indonesia, Malaysia);(b) metathesis between ethylene and butenes-2, which themselves can be produced from ethylene;(c) methanol cracking.

Les procédés IFP de fabrication d'esters méthylique ou éthylique à partir d'huiles végétales offrent le double avantage d'assurer une production valorisable à la fois en tant que substitut du gasoil, notamment pour certains pays en voie de développement, et comme matière première chimique pour l'industrie. Le point clé de l'économie de la transformation réside dans la valorisation du sous produit principal qu'est la glycérine; l'intérêt de lui trouver de nouveaux débouchés est la conclusion immédiate qui ressort de toutes les études à caractère économique entreprises sur le sujet. IFP processes for manufacturing methyl or ethyl esters from vegetable oils have the double advantage of upgrading production both as a replacement for gas oil, particularly for some developing countries, and as a chemical raw material for industry. The key point in the economics of processing lies in the upgrading of the main byproduct, which is glycerine. The advantage of finding new outlets for it is the immediate conclusions shown by all the economic studies undertaken on this subject.

La consommation d'éthylène en Europe occidentale augmentera très faiblement; elle était en 1986 de 12,6. 10 puissance 6 t/an et on peut estimer qu'elle se montera à 13,1. 10 puissance 6 en 1995. Si l'on excepte le polyéthylène linéaire et le polyéthylène basse densité radicalaire, le rythme d'accroissement de la production des principaux dérivés de l'éthylène sera très modéré, en raison d'une part du ralentissement de la consommation européenne et d'autre part des effets de la concurrence des produits venant d'Arabie Saoudite et du Canada, qui se feront de plus en plus sentir sur le marché européen lui-même et sur ses débouchés à l'exportation. Les perspectives offertes par le polyéthylène linéaire sont bonnes, mais sa progression s'effectuera au détriment du polyéthylène basse densité radicalaire. Dans la production de film qui est leur principale application, l'épaisseur nécessaire pour un service déterminé est beaucoup plus faible si on utilise le polyéthylène linéaire; la substitution entraîne une baisse de tonnage global consommé. La production de polyéthylène basse densité radicalaire en Europe occidentale sera en nette régression; elle atteint actuellement 4,2. 10 puissance 6 t/an mais ne devrait pas dépasser 3,5. 10 puissance 6 en 1995. Ethylene consumption in Western Europe will increase very slightly. In 1986 it was 12. 6 x 10 to the power of 6 metric tons per year, and it can be expected to rise to 13. 1 x 10 to the power of 6 tons in 1995. Without including linear low density polyethylene and conventional low density polyethylene, the growth rate of the production of the principal ethylene derivatives will be very moderate because of both the slowing down of European consumption and the competitive effects of products coming from Saudi Arabia and Canada, which will affect more and more the export markets and even the European market. The outlook for linear polyethylene is good, but it will progress to the detriment of polyethylene. For producing film which is the main utilization, the thickness required for a specific use if much thinner with linear low density polyethylene than with conventional low density polyethylene. Substitution results in a lower overall tonnage consumed. The production of conventional low density polyethylene in Western Europe will show a clearcut decrease. It is today 4. 2 x 10 to the power of 6 tons per year but should not be higher than 3. 5 x 10 to the power of 6 tons in 1995.

Des truites arc-en-ciel immatures ont été soumises à des conditions statiques d'exposition à 10 et 100 µg/l de 3,3', 4,4'-tétrachlorobiphényle (TCB) ou de benzo(a)pyrène (BaP) dissous dans l'acétone, pendant 72 h, puis transférées en eau courante non contaminée. Parallèlement un groupe de poissons a servi de lot témoin. Une partie des poissons a été sacrifiée en fin de période d'exposition, l'autre partie faisant l'objet d'un abattage après 2 semaines en eau propre. Le foie, les rosettes olfactives, les branchies et le rein ont été prélevés sur les poissons et, des microsomes et cytosols ont été préparés pour chacun des tissus par ultracentrifugation dans un tampon approprié. Les activités éthoxyrésorufine-o-dééthylase (EROD), glucuronosyl transférase (UDPGT) et glutathion-Stransférase (GST) ont été mesurées. Les résultats de l'exposition au BaP montrent qu'aux deux concentrations testées, l'activité EROD a été significativement augmentée par rapport au lot témoin, pour le foie (x 11 à 33 fois) et la branchie (x 5 à 7 fois). Seule la dose la plus élevée a permis d'augmenter l'activité de cette enzyme dans le rein et la rosette olfactive. A la fin de la période de dépuration, il n'est observé aucune différence significative entre les lots traités et témoins. Les transferases apparaissent peu sensibles au B(a)P. Après 72 h d'exposition au TCB, l'activité EROD du foie, des branchies, des rosettes et du rein est très significativement augmentée (5 à 50 fois selon le tissu) par rapport au témoin, aux deux concentrations testées. Cette induction est encore plus nette après la période de 2 semaines en eau propre. L'activité UDPGT hépatique est doublée en fin de traitement pour les deux doses et se maintient à ce niveau au cours de la période de dépuration. Les GST sont légèrement induites dans le foie après les 15 jours de dépuration. Ce travail confirme la grande sensibilité de l'activité EROD des truites arc-en-ciel aux hydrocarbures aromatiques polycycliques et aux PCB et souligne les possibilités et les limites d'utilisation de cette activité en tant que biomarqueur d'exposition à ces polluants.

COSWEETTM, developed for the treatment of COS containing natural gases, is based on a combination of deacidification with any alkanolamine solution and COS hydrolysis on a metal oxide based catalyst. Nearly complete COS conversion is reached, even at a relatively low operating temperature. Coupled with a classical sweetening unit, in which an adapted alkanolamine solvent is used in order to optimise the removal of H2S, CO2, as well as the H2S/CO2 selectivity, the high catalyst activity and the original integration of the scheme secure the COS removal at minimum extra cost. Benefits on capital and operating expenditures of the plant result both from the reduction of the absorption column and solvent flow rate and from the quality of the acid gas which has positive consequences on the design of the sulfur recovery facilities units, including Claus unit. This paper presents the complete development process approach and the results obtained on COS conversion, the model and simulation tool as well as a case study showing the advantages of coupling COSWEETTM to amine based solvent.

We report on a female patient who presented failure to thrive, laryngotracheomalacia, conductive deafness and facial dysmorphisms. A skeletal survey revealed thickening of the cranial vault, linear striations in the diametaphyses of all long bones and fan-like striations of the iliac bones. CT scan of the temporal bone showed thickening of the cranial base, sclerotic mastoids, abnormal ossicular fixation and stenosis of the otic foramina. The radiological findings led to the diagnosis of Osteopathia Striata with Cranial Sclerosis. A mutation in WTX gene confirmed the clinical and radiological diagnosis of Osteopathia Striata with Cranial Sclerosis in this patient and allowed proper genetic counseling and providing prenatal diagnosis.

Background: Vascular Ehlers-Danlos syndrome (vEDS) is a rare severe genetic disease which results from mutations in the gene encoding type III procollagen (COL3A1), characterized by vascular and/or hollow organic ruptures. No treatment is yet validated. We tested the ability of celiprolol, a beta1-adrenoceptor antagonist with a beta2-adrenoceptor agonist action, for preventing the complications of vEDS in a prospective, randomized, open, blinded endpoints trial. Methods: Fifty three previously untreated vEDS patients were randomized to a 5-year treatment with either celiprolol (n=25) or no treatment (n=28). The two groups were matched for demographic, medical historic and clinical characteristics. Celiprolol was up-titrated from 100 to 400mg by steps of 100mg every 6 months. The primary end-point was an arterial event (rupture or dissection, fatal or not) occurring during follow-up. Secondary endpoints were intestinal or uterine rupture or major clinical events, related to vEDS, judged by the event committee. Results: Mean duration of follow-up was 47 (± 15) months. The study was ended prematurely by the safety monitoring board since significant differences were reached between two groups. The primary endpoint was reached by 5 patients (20%) in the celiprolol group and by 14 patients (50%) in the control group (hazard ratio, 0.36; 95% CI, 0.15 to 0.88; P=0.04). Primary plus secondary endpoints occurred in 6 patients (24%) in the celiprolol group and in 17 patient (61%) in the control group (hazard ratio, 0.31; 95% CI, 0.14 to 0.71; P=0.0097). Conclusions: Celiprolol effectively reduced both vascular complications and organic ruptures in vEDS patients.

Abstract Fibromuscular dysplasia (FMD), formerly called fibromuscular fibroplasia, is a group of nonatherosclerotic, noninflammatory arterial diseases that most commonly involve the renal and carotid arteries. The prevalence of symptomatic renal artery FMD is about 4/1000 and the prevalence of cervicocranial FMD is probably half that. Histological classification discriminates three main subtypes, intimal, medial and perimedial, which may be associated in a single patient. Angiographic classification includes the multifocal type, with multiple stenoses and the 'string-of-beads' appearance that is related to medial FMD, and tubular and focal types, which are not clearly related to specific histological lesions. Renovascular hypertension is the most common manifestation of renal artery FMD. Multifocal stenoses with the 'string-of-beads' appearance are observed at angiography in more than 80% of cases, mostly in women aged between 30 and 50 years; they generally involve the middle and distal two-thirds of the main renal artery and in some case also renal artery branches. Cervicocranial FMD can be complicated by dissection with headache, Horner's syndrome or stroke, or can be associated with intracerebral aneurysms with a risk of subarachnoid or intracerebral hemorrhage. The etiology of FMD is unknown, although various hormonal and mechanical factors have been suggested. Subclinical lesions are found at arterial sites distant from the stenotic arteries, and this suggests that FMD is a systemic arterial disease. It appears to be familial in 10% of cases. Noninvasive diagnostic tests include, in increasing order of accuracy, ultrasonography, magnetic resonance angiography and computed tomography angiography. The gold standard for diagnosing FMD is catheter angiography, but this invasive procedure is only used for patients in whom it is clinically pertinent to proceed with revascularization during the same procedure. Differential diagnosis include atherosclerotic stenoses and stenoses associated with vascular Ehlers-Danlos and Williams' syndromes, and type 1 neurofibromatosis. Management of cases with renovascular hypertension includes antihypertensive therapy, percutaneous angioplasty of severe stenoses, and reconstructive surgery in cases with complex FMD that extends to segmental arteries. The therapeutic options for securing ruptured intracerebral aneurysms are microvascular neurosurgical clipping and endovascular coiling. Stenosis progression in renal artery FMD is slow and rarely leads to ischemic renal failure.