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The focus on sustainable utilization of agricultural waste is currently a leading area of scientific research, driving significant advancements in technology and circular economy models. The fundamental capacity of bio-based products, bioprocessing techniques, and the crucial involvement of microbial treatments are opening opportunities for efficient solutions in various industries. One of the most popular green vegetables, peas are members of the Fabaceae family and have a pod-like structure. Every year, a significant amount of pea pods is discarded as waste products of peas that have negative impacts on our environment. In this comprehensive review, we explore innovative methods for utilizing pea pods to minimize their environmental footprint and optimize their viability across multiple industries. A large portion of the pea processing industry's output consists of pea pods. Variety of proteins, with major classes being globulin and albumin (13%), dietary fiber (43–58%), and minerals are abundant in these pods. Because of their diverse physiochemical properties, they find applications in many diverse fields. The porous pea pods comprised cellulose (61.35%) and lignin (22.12%), which could make them superior adsorbents. The components of these byproducts possess valuable attributes that make them applicable across treatment of wastewater, production of biofuels, synthesis of biocolors, development of nutraceuticals, functional foods, and enzymes for the textile industry, modification of oil, and inhibition of steel corrosion.

Considering the substantial increase in deployment, photovoltaics are hovering to emerge as the predominant worldwide energy producer in the foreseeable future. Nevertheless, the operating efficiency and endurance of photovoltaic (PV) systems are significantly stalled by the heightened operating temperatures encountered by solar radiation. This article comprehensively analyzes novel active and passive PV cooling techniques, encompassing their operational mechanisms, cooling efficiency, and eventual implementations in solar devices. Extensive scholarly research has examined various PV cooling methods and techniques to optimize system cooling and efficiency. The primary goal of this effort is to compile a reference for future researchers and specialists by reviewing and comparing the results of current investigations. The study also comprised a bibliometric analysis that provides valuable insights into the influence of research on incorporating cooling systems into solar systems. These insights play a decisive role in recognizing new trends and progressing the field towards more efficient systems, hence advancing upcoming development. Furthermore, an extensive classification and assessment of every conceivable cooling technology was furnished to facilitate a comparison among diverse cooling methodologies. The research was structured in a tabular manner, containing the following details for each cooling technique: solar panel type, cooling method, cooling fluid or substance used, research category, average temperature reduction resulting from cooling, and enhanced electrical efficiency. The study indicates that cooling methods significantly enhance electrical efficiency, with potential increases varying from 0.28 % to 97.6 %. Additionally, this application is assessed to decrease the solar panel's operative temperature, ranging from 0.8 °C to 39.9 °C.

Our study pioneers an innovative use of unsupervised machine learning, a powerful tool for navigating unclassified data, to unravel the complexities of subsurface seismic activities and extract meaningful patterns. Our central objective is to comprehensively characterize seismicity within an active region by identifying distinct seismic clusters in spatial distribution, thereby gaining a deeper understanding of subsurface stress distribution and tectonic dynamics. Employing a diverse range of clustering algorithms, with particular emphasis on Fuzzy C-Means (FCM), our research meticulously dissects the intricate physical processes that govern a complex tectonic zone. This technique effectively delineates distinct tectonic zones, aligning seamlessly with established seismological knowledge and underscoring the transformative potential of Artificial Intelligence (AI) in analyzing regional subsurface phenomena, even under conditions of data scarcity. Moreover, associating earthquakes with specific seismogenic structures significantly enhances seismic hazard analyses, potentially paving the way for autonomous insights that inform engineering hazard assessments.

Background: The prevalence of microbial infectious diseases is a major contributor to morbidity and mortality on a global scale due to the emergence of antibiotic-resistant microbes, despite the fact that many new antibiotics have been introduced for several decades. In present scenario, the potential utilization of natural plant derived extracts for medicinal and therapeutic purposes has increased remarkably due to adverse effects of synthetic drugs and resistance among pathogenic microbes. Aim of the study: Verbascum thapsus L. (Common mullein) has been traditionally used as a medicine for lung, skin and throat and many other disorders since time immemorial, therefore, the current study was aimed to evaluate the antimicrobial activity of leaf and root extracts of Verbascum thapsus against pathogenic bacterial and fungal strains and its phytochemical composition by spectral studies. Methods: Soxhlet extraction method was employed for extraction process by using varying polarity solvents like hexane, ethyl acetate and methanol. Phytochemical analysis of methanol extract was determined by Fourier Transform-Infrared Spectroscopy (FTIR) and Gas Chromatography-Mass Spectrometry (GC–MS). Antimicrobial activity was evaluated by determining the MIC and MBC/MFC of each extract by broth dilution method. Results: The antimicrobial competence of each extract sample was evaluated against six pathogenic bacterial strains and three fungal strains. Methanolic extract of leaves and the ethyl acetate extract of roots of Verbascum thapsus exhibited significant zones of inhibition against all the tested microorganisms. The highest inhibition zone was observed against the bacterial strain Bacillus subtilis (24.1±0.18 mm) followed by Streptococcus pyogenes (22.9±0.64 mm) and the fungal strain Aspergillus niger (22.8±0.55 mm) at a concentration of 500 μg/ml. Methanolic leaf extract strongly inhibited the growth of tested microbial strains with MIC ranged from 15.625 to 125 μg/ml. The FTIR and GCMS analysis confirms the presence of bioactive compound, possessing broad range of therapeutic activities. Conclusion: This Presence of various important phytoconstituents and broad-spectrum antimicrobial activity points Verbascum thapsus as a promising source for the isolations of molecules responsible for antimicrobial activities.

In this paper, we present a dynamic model of syphilis. The goal of this work is to provide a mathematical model for syphilis disease that contains information about the suspect, infected, recovered, and exposed. Boundedness, positivity, and unique solutions at equilibrium points are used in the qualitative and quantitative study of a proposed model using the power law kernel. The Routh-Hurwitz stability criteria are used to address the model's local and global stability. Chaos control will use the regulate for linear responses approach to bring the system to stabilize according to its points of equilibrium. Using Lyapunov function tests, the global stability of free and endemic equilibrium points is confirmed. The Lipschitz condition and fixed point theory are utilized to satisfy the requirements for the existence and uniqueness of the exact solution. The generalized form of the power law kernel is solved using a two-step Lagrange polynomial method to investigate the impact of the fractional operator using numerical simulations that illustrate the effects of various parameters on the illness.

In this work, we aim to propose a hybrid fractional-order model for investigation and observation of the tuberculosis (TB) disease involving constant-proportional Caputo (CPC) operator. We treat the proposed model’s positivity, boundedness, well-posedness, and biological viability with a reproductive number. We prove the existence and uniqueness of the solutions to the proposed model using the fixed-point theorem. For the proposed model, Ulam Hyres’ stability is also presented. To evaluate the fractional integral operator, we use different techniques to invert the proportional-caputo (PC) and constant-proportional caputo (CPC) operators. We also use our suggested model’s fractional differential equations to derive the eigenfunctions of the CPC operator. There is a detailed discussion of additional analysis of the CPC and Hilfer generalized proportional operators. To solve the suggested model, we employ the Laplace Adomian Decomposition (LADM) technique. Fractional order enhances the dynamics of the epidemic model and has a significant impact on the persistence and extinction of the infection. We see that the CPC operator yields excellent results when applied to the TB version’s mathematical modelling. The suggested strategy is a straightforward, useful, and practical plan for resolving and comprehending a range of non-linear physical models. This study serves as an illustration of the application of fractional derivatives in epidemiology.

Treponema pallidum, a spiral-shaped bacterium, is responsible for the sexually transmitted disease syphilis. Millions of people in less developed countries are getting the disease despite the accessibility of effective preventative methods like condom use and effective and affordable treatment choices. The disease can be fatal if the patient does not have access to adequate treatment. Prevalence has hovered between endemic levels in industrialized countries for decades and is currently rising. Using the Mittag-Leffler kernel, we develop a fractal-fractional model for the syphilis disease. Qualitative as well as quantitative analysis of the fractional order system are performed. Also, fixed point theory and the Lipschitz condition are used to fulfill the criteria for the existence and uniqueness of the exact solution. We illustrate the system’s Ulam–Hyers stability for disease-free and endemic equilibrium. The analytical solution is supported by numerical simulations that show how the dynamics of the spread of syphilis within the population are influenced by fractional-order derivatives. The outcomes show that the suggested methods are effective in delivering better results. Overall, this research helps to develop more precise and comprehensive approaches to understanding and regulating syphilis disease transmission and progression.

Bovine Brucellosis, a zoonotic disease, can infect cattle in tropical and subtropical areas. It remains a critical issue for both human and animal health in many parts of the world, especially those where livestock is an important source of food and income. An efficient method for monitoring the illness’s increasing prevalence and developing low-cost prevention strategies for both its effects and recurrence is brucellosis disease modeling. We create a fractional-order model of Bovine Brucellosis using a discrete modified Atangana–Baleanu fractional difference operator of the Liouville–Caputo type. An analysis of the suggested system’s well-posedness and a qualitative investigation are both conducted. The examination of the Volterra-type Lyapunov function for global stability is supported by the first and derivative tests. The Lipschitz condition is also used for the model in order to meet the criterion of the uniqueness of the exact solution. We created an endemic and disease-free equilibrium. Solutions are built in the discrete generalized form of the Mittag-Leffler kernel in order to analyze the effect of the fractional operator with numerical simulations and emphasize the effects of the sickness due to the many factors involved. The capacity of the suggested model to forecast an infectious disease like brucellosis can help researchers and decision-makers take preventive actions.

Summary: Background: Patients with inflammatory bowel disease (IBD) treated with anti-TNF therapy exhibit attenuated humoral immune responses to vaccination against SARS-CoV-2. The gut microbiota and its functional metabolic output, which are perturbed in IBD, play an important role in shaping host immune responses. We explored whether the gut microbiota and metabolome could explain variation in anti-SARS-CoV-2 vaccination responses in immunosuppressed IBD patients. Methods: Faecal and serum samples were prospectively collected from infliximab-treated patients with IBD in the CLARITY-IBD study undergoing vaccination against SARS-CoV-2. Antibody responses were measured following two doses of either ChAdOx1 nCoV-19 or BNT162b2 vaccine. Patients were classified as having responses above or below the geometric mean of the wider CLARITY-IBD cohort. 16S rRNA gene amplicon sequencing, nuclear magnetic resonance (NMR) spectroscopy and bile acid profiling with ultra-high-performance liquid chromatography mass spectrometry (UHPLC-MS) were performed on faecal samples. Univariate, multivariable and correlation analyses were performed to determine gut microbial and metabolomic predictors of response to vaccination. Findings: Forty-three infliximab-treated patients with IBD were recruited (30 Crohn's disease, 12 ulcerative colitis, 1 IBD-unclassified; 26 with concomitant thiopurine therapy). Eight patients had evidence of prior SARS-CoV-2 infection. Seventeen patients (39.5%) had a serological response below the geometric mean. Gut microbiota diversity was lower in below average responders (p = 0.037). Bilophila abundance was associated with better serological response, while Streptococcus was associated with poorer response. The faecal metabolome was distinct between above and below average responders (OPLS-DA R2X 0.25, R2Y 0.26, Q2 0.15; CV-ANOVA p = 0.038). Trimethylamine, isobutyrate and omega-muricholic acid were associated with better response, while succinate, phenylalanine, taurolithocholate and taurodeoxycholate were associated with poorer response. Interpretation: Our data suggest that there is an association between the gut microbiota and variable serological response to vaccination against SARS-CoV-2 in immunocompromised patients. Microbial metabolites including trimethylamine may be important in mitigating anti-TNF-induced attenuation of the immune response. Funding: JLA is the recipient of an NIHR Academic Clinical Lectureship (CL-2019-21-502), funded by Imperial College London and The Joyce and Norman Freed Charitable Trust. BHM is the recipient of an NIHR Academic Clinical Lectureship (CL-2019-21-002). The Division of Digestive Diseases at Imperial College London receives financial and infrastructure support from the NIHR Imperial Biomedical Research Centre (BRC) based at Imperial College Healthcare NHS Trust and Imperial College London. Metabolomics studies were performed at the MRC-NIHR National Phenome Centre at Imperial College London; this work was supported by the Medical Research Council (MRC), the National Institute of Health Research (NIHR) (grant number MC_PC_12025) and infrastructure support was provided by the NIHR Imperial Biomedical Research Centre (BRC). The NIHR Exeter Clinical Research Facility is a partnership between the University of Exeter Medical School College of Medicine and Health, and Royal Devon and Exeter NHS Foundation Trust. This project is supported by the National Institute for Health Research (NIHR) Exeter Clinical Research Facility. The views expressed are those of the authors and not necessarily those of the NIHR or the UK Department of Health and Social Care.

Metallic nanowires (NWs) and their different compounds display incredible prospects for their use in various applications including media storage, sensor and solar cell devices along with the biological drug delivery systems. In this research work, the metallic NWs like nickel nanowires (Ni-NWs) are synthesized successfully by employing electrodeposition process. Anodic aluminum oxide (AAO) templates are employed as a platform with copper metal coating which acts as an active cathode. The synthesized Ni-NWs are examined through various characterization techniques including X-ray diffraction (XRD), scanning electron microscope (SEM) and vibrating sample magnetometer (VSM) to study the crystal structure, surface morphology and magnetic properties, respectively. The XRD analysis shows the development of various diffraction planes like Ni (111), Ni (200), Ni (220) which confirms the formation of polycrystalline nickel NWs. The SEM analysis reveals that the range of diameter and length of nickel NWs are found to be ∼160 to 200 and ∼4 to 11 micron respectively showing high aspect ratio (ranged from ∼200 to 300). The ferromagnetic behavior of Ni-NWs is confirmed by the hysteresis loop carried out for parallel and perpendicular configurations having Hc = 100 and 206 Oe, respectively. The obtained results suggest that the synthesized Ni- NWs may be used for high-density media storage devices.

This study proposes a new acceptance sampling scheme, namely mean ranked sampling scheme, for efficient decision of statistical quality control. The proposed scheme is based on ranked set sampling under exponential distribution for acceptance or rejection of a lot. Two-point method on operating characteristic function is used for the derivation of plan parameters assuming approximation of exponential to normal distribution. The minimum sample sizes and acceptance numbers are obtained satisfying producer’s and consumer’s risk at certain levels of acceptable (AQL) and tolerable quality (RQL). The main advantages of proposed scheme are (i) data is selected by using free cost sampling method from a large lot and (ii) all units of selected lot are used in making decision. The probability & distribution functions for proposed mean ranked set sampling plan are derived. The OC values comparison with simple random sampling is presented. It is shown that the tables presented here can be used if mean life of units are chosen as a criterion.

Objective: To investigate the predictive validity for discharge to home or facility of 4 functional mobility outcome measures. Design: Retrospective, observational study. Setting: Urban, academic hospital in the United States. Participants: Adult patients (N=3999) admitted to medical units between June 1, 2019, and February 29, 2020, with 2 or more recorded scores on each of 4 tools: Activity Measure for Post-Acute Care (AM-PAC) 6-Clicks Basic Mobility and Daily Activity, Henry Ford Mobility Level, and The Johns Hopkins Highest Level of Mobility. Interventions: Not applicable. Main Outcome Measures: Mobility scores and discharge destination. Results: For the 3999 subjects, 51.4% went home at discharge and had higher mean scores on each measure than those not returning home. Both early (I) and later (II) time point for each measure had positive predictability for discharge home. AM-PAC 6-Clicks had the highest confidence intervals for early and later recorded scores. The c-statistic value for Basic Mobility I (cut point=16) was 0.74 and for II (cut point=18) was, 0.79. The value for Daily Activity I (cut point=18) was 0.75 and for Daily Activity II (cut point=18) was 0.80). The Johns Hopkins Highest Level of Mobility and Henry Ford Mobility Level measures were less discriminative at initial score (c-statistic 0.704 and 0.665, respectively) and final score (c-statistic 0.74 and 0.75, respectively). Conclusions: Functional outcome measures have good predictive validity for discharge destination. The AM-PAC Basic mobility score appears to have a slightly higher confidence interval than the other tools in this study design.

Tuberculosis can involve the hematological system and cause anemia, leucopenia, leukocytosis, thrombocytopenia, and thrombocytosis. Immune thrombocytopenia related to tuberculosis is rare. We present a case of a 54 years old male patient who was evaluated for isolated asymptomatic thrombocytopenia discovered on routine laboratory investigations. Work up was positive for disseminated tuberculosis. The patient responded to a tapering dose of steroids and anti-tuberculous medications with significant and persistent platelet count improvement.

Summary: Inflammatory bowel disease (IBD) is a complex autoimmune disorder recently shown to be associated with SUMOylation, a post-translational modification mechanism. Here, we have identified a link between epithelial deSUMOylases and inflammation in IBD. DeSUMOylase SENP7 was seen to be upregulated specifically in intestinal epithelial cells in both human IBD and a mouse model. In steady state, but not IBD, SENP7 expression was negatively regulated by a direct interaction and ubiquitination by SIAH2. Upregulated SENP7 in inflamed tissue displayed a distinct interactome. These changes led to an expansion of localized proinflammatory γδ T cells. Furthermore, in vivo knockdown of SENP7 or depletion of γδ T cells abrogated dextran sulfate sodium (DSS)-induced gut inflammation. Strong statistical correlations between upregulated SENP7 and high clinical disease indices were observed in IBD patients. Overall, our data reveal that epithelial SENP7 is necessary and sufficient for controlling gut inflammation, thus highlighting its importance as a potential drug target. : DeSUMOylases are contributors to cellular physiology and disease. Here, Suhail et al. demonstrate an aberrant epithelial upregulation of the deSUMOylase SENP7, leading to expansion of proinflammatory γδT cells during inflammatory bowel disease. Experimental inhibition of SENP7 was sufficient to tame inflammation, thus demonstrating therapeutic potential. Keywords: inflammation, deSUMOylases, PTMs, SUMOylation, proteomics, gut, IBD, gamma delta T cells, SENPs

In this study we have proposed a multivariate regression-cum-exponential type estimator for estimating a vector of population variance. In the present study, unknown population variance vector estimation has been discussed using multi-auxiliary variables in two-phase sampling and different cases have also been derived. A comparison between existing and the proposed multivariate, bivariate and univariate estimators has been prepared with the help of a real data for estimating population variance. A simulation study for multivariate estimator using multi-auxiliary variables has also been carried out to demonstrate the performance of the estimators. Keywords: Multivariate estimator, Multi-auxiliary variables, Two-phase sampling, Regression estimator, Variance-covariance matrix, Simulation

The quantification of anuran abundance and habitat provides valuable baseline data for future monitoring in areas of planned or anticipated human activities. We carried out the present study to see if anuran abundance is associated with habitat variables (water quality, gravel size and vegetation) in Rawalpindi–Islamabad Area, Pakistan. We used area-constrained searches and quadrat method to gather data on anuran abundance and vegetation diversity, respectively, from September, 2012 to July, 2013. We recorded 28 ± 4.83 (mean number ± SE) individuals of six anuran species from the study area. We recorded Euphlyctis cyanophlyctis (10 ± 2.39) as the most abundant anuran species while Microhyla ornata (

Pulp and Paper mills are generating millions of tons of wastewater and are major source of water pollution. In this research work, pulping wastes have been characterized and found to contain very high COD, TSS and colour. Coagulation–flocculation process was performed to find out the performance of different coagulants and flocculants like alum, ferric chloride, aluminium chloride, ferrous sulphate, poly aluminium chloride (PAC), cationic and anionic polyacrylamide polymers in individual form as well as in different combinations. The effects of dosing rate, settling time and pH were examined for reduction of COD, TSS and colour. Coagulants used in combinations were found to be more effective in reducing COD, TSS and colour instead of using individual form. The initial pH of the effluent for coagulation process was found to have remarkable effect on COD, TSS and colour removal. The most effective results were found using cationic and anionic polyacrylamide combination with ferric chloride and aluminium chloride and reduction of 76% COD, 95% TSS and 95% colour were observed at pH

Background: Contemporary national outcomes of open and endovascular aortic repair for descending thoracic aortic aneurysms (DTAAs) and thoracoabdominal aortic aneurysms (TAAAs) are unclear. This study evaluated this issue by using The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD)., Methods: From July 1, 2017 to June 30, 2022, study investigators identified 3522 adults who underwent planned DTAA repair (open, 328; endovascular, 1895) or TAAA repair (open, 870; endovascular, 429), after excluding ascending aorta or aortic arch aneurysms (zone 0, 1, or 2), interventions with a proximal extent in zone 0 or zone 1, juxtarenal or infrarenal aortic interventions, hybrid procedures, aortic trauma, and aortic infection., Results: Most DTAA interventions (85.2%) were endovascular repairs, whereas most TAAA interventions were open repairs (66.9%). For DTAA interventions, the operative mortality, permanent stroke rate, and rate of spinal cord injury were 4.2%, 3.8%, and 2.4% for endovascular repairs and 9.2%, 8.5%, and 4.6% for open repairs, respectively (all P < .05). For TAAA interventions, the operative mortality, permanent stroke rate, and rate of spinal cord injury were 6.5%, 2.1%, and 3.0% for endovascular repairs and 11.7%, 6.0%, and 12.2% for open repairs, respectively (all P < .05). Increasing annual open TAAA repair volume was associated with lower odds of experiencing the composite of operative mortality, permanent stroke, or spinal cord injury., Conclusions: On the basis of STS ACSD data, endovascular repair was the predominant approach for treating DTAA, whereas most patients undergoing TAAA interventions had an open surgical repair. Outcome differences between open and endovascular approaches may be related to patient selection. Increasing center experience with open TAAA repair is associated with improved outcomes., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Acute lymphoblastic leukemia (ALL) typically responds better when treated with multiagent chemotherapy in the pediatric and young adolescent populations. Treatment of relapsed/refractory (RR) ALL remains a challenge. Even after stem-cell transplantation and intensive chemotherapy, the prognosis of RR-ALL remains grave. The advent of chimeric antigen receptors has demonstrated promising results in RR-ALL. Chimeric antigen receptor-modified T cells (CAR-T) and engineered T cells are used to target cancer cells. In 2017, the US Food and Drug Administration approved CD19-specific CAR-T (tisagenlecleucel) therapy for RR-B-cell ALL in patients under 25 years old. In this systematic review, we discuss the efficacy and safety of CD19-specific CAR-T therapy in RR-B-cell ALL in the pediatric and young adult population. We searched the PubMed, Embase, Web of Science, Cochrane Library, and clinical trials databases. A total of 448 patients received a CD19-specific CAR-T product, and 446 patients had evaluable data. The age range was 0 to 30 years. The incidence rate of complete remission was 82%. The cumulative incidence of relapse after CD19-specific CAR-T therapy is 36%. Similarly, the incidence rate of grade 3 or higher adverse events of neutropenia, thrombocytopenia, neurotoxicity, infections, and cytokine release syndrome were 38%, 23%, 18%, 29%, and 19%, respectively. Our subgroup analysis shows the incidence rate of minimal residual negative complete remission was 69% with the CD28z costimulatory domain, 81% with the 4-1BB domain, and 77% with fourth-generation CD19-specific CAR-T therapy., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The oldest segments of the population are expanding rapidly, and the number of thoracic endovascular aortic repairs (TEVARs) performed in the elderly parallels this trend. We describe our institutional TEVAR experience in octogenarians and nonagenarians., Methods: All patients 80 years and older undergoing TEVAR at a single institution were reviewed using a prospectively maintained database. Baselines demographics, operative details, and outcomes were retrospectively analyzed., Results: Twenty-five octogenarians and nonagenarians (age, 84.8 ± 3.7 years; 64% male) underwent TEVAR between January 2014 and January 2019. The most common preoperative comorbidities were hypertension (n = 24; 96%) and tobacco use (n = 18; 72%), and the mean modified frailty index was 0.32 ± 0.17. Degenerative aneurysms constituted the majority of aortic pathologies (60%), and most patients were symptomatic (64%), with a mean maximal aortic diameter of 62.7 ± 15.6 mm. Endoleaks were noted in 3 (12%) patients. Intensive care unit length of stay was 2.0 (1.5, 3.0) days, and the total length of stay was 5.0 (3.0, 7.0) days. In-hospital mortality was 12% (n = 3), while the overall 30-day mortality was 16% (n = 4). The median follow-up was 469.0 (76.0, 586.0) days. On univariate analysis, the presence of a postoperative complication was associated with a significantly increased risk of 30-day mortality (P < 0.01)., Conclusions: Despite the inherently elevated operative risk among the elderly, this study demonstrates reasonable success rates for TEVAR in octogenarian and nonagenarian patients. In properly selected patients, advanced age alone should not be a prohibitive factor for TEVAR., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Perioperative infection of an aortic graft is one of the most devastating complications of vascular surgery, with a mortality rate of 10% to 30%. The rate of amputation of the lower limbs is generally >25%, depending on the graft material, the location of the graft and infection, and the bacterial virulence. In vitro studies suggest that an antibiotic-impregnated graft may help prevent perioperative graft infection. In a pilot animal study, we tested a locally developed technique of bonding Dacron aortic grafts with three antimicrobial agents to evaluate the ensuing synergistic preventive effect on direct perioperative bacterial contamination., Methods: We surgically implanted a 6-mm vascular knitted Dacron graft in the infrarenal abdominal aorta of six Sinclair miniature pigs. Two pigs received unbonded, uninoculated grafts; two received unbonded, inoculated grafts; and two received inoculated grafts that were bonded with chlorhexidine, rifampin, and minocycline. Before implantation, the two bonded grafts and the two unbonded grafts were immersed for 15 minutes in a 2-mL bacterial solution containing 1 to 2 × 10(7) colony-forming units (CFU)/mL of Staphylococcus aureus (ATCC 29213). Two weeks after graft implantation, the pigs were euthanized, and the grafts were surgically excised for clinical, microbiologic, and histopathologic study., Results: The two bonded grafts treated with S aureus showed no bacterial growth upon explant, whereas the two unbonded grafts treated with S aureus had high bacterial counts (6.25 × 10(6) and 1.38 × 10(7) CFU/graft). The two control grafts (unbonded and untreated) showed bacterial growth (1.8 × 10(3) and 7.27 × 10(3) CFU/graft) that presumably reflected direct, accidental perioperative bacterial contamination; S cohnii ssp urealyticus and S chromogenes, but not S aureus, were isolated. The histopathologic and clinical data confirmed the microbiologic findings. Only pigs that received unbonded grafts showed histopathologic evidence of a perigraft abscess., Conclusions: Our results suggest that bonding aortic grafts with this triple antimicrobial combination is a promising method of reducing graft infection resulting from direct postoperative bacterial contamination for at least 2 weeks. Further studies are needed to explore the ability of this novel graft to combat one of the most feared complications in vascular surgery., (Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Objective: Pseudoaneurysm (PSA) formation is a complication of hemodialysis access. Open repair requires PSA resection, interposition graft placement, and insertion of a catheter as a bridge. Endovascular stent graft repair is an alternative that permits immediate use of the access site. The objective of this study was to determine the efficacy of stent grafts for repair of arteriovenous fistula and arteriovenous graft PSA., Methods: A retrospective review of medical records from October 2007 to March 2011 revealed 24 patients with a PSA who underwent endovascular repair using a stent graft. Indications for repair included PSA with symptoms (n = 11), PSA with skin erosion (n = 8), PSA with failed hemodialysis (n = 3), and PSA after balloon angioplasty of a stenosis (n = 2). Outcome measures were technical success, 30-day and 180-day patency, secondary interventions, and complications. All the statistical analyses were conducted by using software SAS 9.1 (SAS, SAS Institute, Gary, NC)., Results: Twenty-seven self-expanding stent grafts (Viabahn, W. L. Gore, n = 25; Fluency, Bard, n = 2) were used to treat hemodialysis access (arteriovenous graft, n = 13; arteriovenous fistula, n = 11) PSA in 24 patients (16 females; mean age, 55.7 years; mean body mass index, 28.4; mean PSA diameter, 19.5 mm). Comorbidities included hypertension (n = 22; 91.7%), diabetes mellitus (n = 8; 33.3%), and coronary artery disease (n = 4; 16.67%). The median time from access creation to repair was 455 days. The technical success rate was 100%. Balloon angioplasty of an outflow stenosis was performed in 56% of stent grafts. The 30- and 180-day patency rate was 100% and 69.2%, respectively. Three secondary interventions were performed for treatment of unrelated stenosis. Treatment failure occurred in five (18.5%) stent grafts due to infection (n = 3) and thrombosis (n = 2). Treatment of PSA with skin erosion was associated with failure due to infection (odds ratio, 5.0; 95% confidence interval, .38, 66.01). The remaining 22 (81.5%) stent grafts remain patent. The mean follow-up time was 268.9 days (median, 97.5)., Conclusions: Endovascular therapy is an effective and durable treatment option for patients with dialysis access PSAs. This technique permits immediate use of the hemodialysis access site as well as identification and treatment of associated stenosis. It may be considered as an alternative to open repair in patients who are anatomically suitable candidates., (Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Background: Increasing the number of arterial grafts for coronary artery bypass grafting (CABG) has been linked to improved late survival. Currently, it is not known if these long-term benefits are also true when sequential radial artery (RA) grafts are the primary means to maximizing arterial revascularization., Methods: We compared late survival of 532 consecutive patients receiving sequential RA grafts (sequential RA group: 438 men; 462 with three-vessel disease) with that of a 4,131 contemporaneous internal thoracic artery (ITA) with saphenous vein (SV) multivessel CABG cohort (conventional group). Graft failure rates were determined from symptom-driven repeat angiography films in 122 sequential RA patients performed 2 to 4,317 days after surgery. Median survival sequential RA follow-up was 5.3 years (range, 0.5 to 12.3)., Results: The sequential RA patients received a total of 1,181 RA grafts (538 sequential [30 triple] and 75 single) along with 636 SV and 533 ITA. Overall RA graft failure (80 of 272; 29%) was intermediate to that for ITA (7 of 121; 5.8%; p < 0.001) and vein (54 of 133, 41.6%; p = 0.032) grafts. Sequential versus nonsequential RA failure did not differ (77 of 252 [31%] versus 3 of 20 [15%]; p = 0.202), while failure of the proximal (36 of 123; 29%) and distal (40 of 129; 31%) components of sequential RA grafts were essentially identical. A total of 69 deaths (6 operative; 1.1%) have occurred in the sequential RA cohort. Unadjusted 10-year sequential RA cohort survival was 76.2% overall, and 79.0% for the 454 primary isolated CABG subgroup. The risk-adjusted 10-year survival using a logit propensity score was substantially better for the sequential RA cohort versus the conventional CABG cohort (risk ratio [95% confidence interval] 0.61 [0.44 to 0.85]; p = 0.003)., Conclusions: Sequential RA grafting is a safe method for maximizing arterial revascularization and is associated with excellent 10-year survival that seems to be superior to conventional or ITA/SV CABG results. Also, the similar proximal and distal sequential RA patency mitigates concerns of a clinically significant effect of increased vasoreactivity of distal segments of RA conduits.

Background: Use of one or more arterial grafts to revascularize two-vessel and three-vessel coronary artery disease has been shown to improve coronary artery bypass graft surgery (CABG) survival. Yet, the presumed long-term survival benefits of all-arterial CABG have not been quantified., Methods: We compared propensity-adjusted 12-year survival in two contemporaneous multivessel primary CABG cohorts with all patients receiving 2 or more grafts: (1) all-arterial cohort (n = 612; 297 three-vessel disease [49%]); and (2) single internal thoracic artery (ITA) plus saphenous vein (SV) cohort (n = 4,131; 3,187 three-vessel disease [77%])., Results: Early (30-day) deaths were similar for the all-arterial and ITA/SV cohorts (8 [1.30%] versus 69 [1.67%]) whereas late mortality was substantially greater for the ITA/SV cohort (85 [13.9%] versus 1,216 [29.4%]; p < 0.0001). The risk-adjusted 12-year survival was significantly better for all-arterial (with a risk ratio [RR] = 0.60; 95% confidence interval [CI]: 0.48 to 0.75; p < 0.001), but this benefit was true only for three-vessel disease (RR = 0.58; 95% CI: 0.43 to 0.78; p < 0.001) and not for two-vessel disease (RR = 0.97; 95% CI: 0.66 to 1.43; p = 0.89). The all-arterial survival benefit was also true for varying risk subcohorts: no diabetes mellitus (RR = 0.50; 95% CI: 0.37 to 0.69), diabetes mellitus (RR = 0.77; 95% CI: 0.56 to 1.07), ejection fraction 40% or greater (RR = 0.60; 95% CI: 0.45 to 0.78), and ejection fraction less than 40% (RR = 0.62; 95% CI: 0.40 to 0.98). Lastly, the multivariate analysis indicated a strong long-term effect of completeness of revascularization, particularly for all-arterial patients, so that compared with patients with two grafts, survival was significantly better when three grafts (RR = 0.54; 95% CI: 0.33 to 0.87) or four grafts (RR = 0.40; 95% CI: 0.21 to 0.76) were completed., Conclusions: All-arterial revascularization is associated with significantly better 12-year survival compared with the standard single ITA with saphenous vein CABG operation, in particular for triple-vessel disease patients. The completeness of revascularization of the underlying coronary disease is critical for maximizing the long-term benefits of arterial-only grafting.

Background: Coronary artery bypass grafting with concomitant coronary endarterectomy (CABG/CE) is used in patients with severe coronary atherosclerosis to revascularize otherwise ungraftable targets. This study investigates the efficacy of arterial versus vein grafting for CABG/CE surgery., Methods: We reviewed our experience in 288 CABG/CE patients (63 +/- 10 years, 207 men). A total of 1,056 grafts (275 internal thoracic artery [ITA] [26%]; 221 radial [21%], 560 vein [53%]) were constructed including 325 (31%) placed to CE targets., Results: Eighteen of 288 patients died in-hospital (6.3%). Unadjusted one-year and five-year survival for the 270 discharged patients was 95.2% and 83.0%, respectively. Survival (0 to 7 years) was significantly better for patients with radial (n = 154) versus no-radial (n = 134) artery grafting (p = 0.021). Multivariate Cox regression analysis associated increased number of arterial grafts (hazard ratio [HR] = 0.64 [0.44 to 0.92]; HR [95% confidence interval]) to improved survival, while RCA endarterectomy (HR = 1.8 1.0 3.3; p = 0.054) was associated with worse survival. Repeat angiography (495 days [median]) in 68 patients encompassed 78 CE (38 vein, 24 ITA, and 16 radial) and 162 non-CE (84 vein, 40 ITA, and 38 radial) grafts. Graft failure was similar (p = 0.37) for radial (10 of 54 [19%]) and ITA (7 of 64 [11%]), and worst for vein (50 of 122 [41%]; p < 0.001). For CE targets, graft failure was worse for vein (55% vs 35%; p = 0.05) and unchanged for arterial (13% vs 15%; p = 0.88) grafts., Conclusions: Combined CABG/CE is associated with good long-term outcomes. Increased arterial grafting achieved by radial artery utilization confers a survival benefit in this high-risk population. The latter is probably derived from superior radial versus vein graft patency.