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This paper presents the process of conducting the structural analysis of AlAinSat-1 CubeSat through a numerical solution using Siemens NX. AlAinSat-1 is a 3U remote-sensing CubeSat carrying two earth observation payloads. The CubeSat is scheduled for launch on SpaceX Falcon 9 rocket. To ensure the success of the mission and its ability to withstand the launch environment, several scenarios should be analyzed. For AlAinSat-1 model the finite element analysis (FEA) method is used, and four types of structural analyses are considered: modal, quasi-static, buckling, and random vibration analyses. The workflow cycle includes idealizing, meshing, assembling, applying connections and boundary conditions, and eventually running the simulation utilizing the Siemens Nastran solver. The simulation results of all analysis types indicate that the model can safely withstand the loads exerted during launch. Also, the numerical results of the Command and Data Handling Subsystem (CDHS) module of AlAinSat-1 are experimentally validated through a vibration test conducted using an LV8 shaker system. The module successfully passed the test based on the test success criteria provided by the launcher.

Introduction: The primary aim was to describe the outcome, the compliance with inclusion criteria and the characteristics of patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA). The secondary aim was to calculate the cost of ECPR for the patients and the public Belgian healthcare system. Methods: Single-centre retrospective cohort study in Antwerp University Hospital. We included all patients who underwent ECPR for OHCA from 2018 to 2020. Medical records were assessed to determine the clinical outcome and invoices were assessed to calculate the charged fees. We collected all relevant cost components at the most detailed level (micro costing technique). Results: Sixty-five patients who received ECPR for OHCA were included. Thirty-eight patients (58%) died within one week after ECPR initiation. After one year, twelve patients (18.5%) were still alive of which ten (15.4%) had a good neurological outcome (Cerebral Performance Category (CPC) 1 or 2). Forty-nine patients (75.4%) met the ECPR inclusion criteria. A total of 2,552,498.34 euro was charged. The patients and the public Belgian healthcare system contributed to a 255,250 euro cost for each survivor after one year with good neurological outcome. Conclusion: Our analysis highlights the complex interplay between clinical efficacy and financial implications in the utilization of ECPR. While ECPR demonstrates potential in improving survival rates and neurological outcomes among cardiac arrest patients, its adoption presents substantial economic challenges. Inappropriate patient selection may lead to significant increases in resource utilisation without improved outcome.

We will present exact solutions for three variations of the stochastic Korteweg de Vries–Burgers (KdV–Burgers) equation featuring variable coefficients. In each variant, white noise exhibits spatial uniformity, and the three categories include additive, multiplicative, and advection noise. Across all cases, the coefficients are time-dependent functions. Our discovery indicates that solving certain deterministic counterparts of KdV–Burgers equations and composing the solution with a solution of stochastic differential equations leads to the exact solution of the stochastic Korteweg de Vries–Burgers (KdV–Burgers) equations.

Primary total hip arthroplasty with cementless stems has numerous advantages over cemented total hip arthroplasty in patients with good bone quality. To enhance osseointegration with ingrowth into the implant, various surface treatments have been proposed. Multiple biomechanical studies in animals have shown that bioactive coatings enhance osseointegration and increase construct stability. Bony ingrowth in humans can only be assessed in rare instances of periprosthetic femoral fractures. In this case report, we describe the findings after a periprosthetic fracture mandating stem exchange in a patient who experienced a fall 8 weeks after implantation. The retrieved proximal Bonit (DOT GmbH, Rostock, Germany) coated stem showed substantial macroscopically visible trabecular bone. This finding supports results from animal studies that showed enhanced metaphyseal bone ingrowth with Bonit coating of implants.

Background: Stomach cancer is the fifth most common malignancy. In 2012, 952,000 cancers were diagnosed worldwide, which led to 723,000 deaths. Elderly men are the most frequently observed category of gastric cancer patients, mostly affecting the antrum. The objective of this study was to analyze the association of age with sex, tumor sites, types of surgical intervention, and diagnosed anatomical pathologies in cases of gastric cancer. Methods: This cross-sectional descriptive study analyzed the associations between age, sex, tumor sites, types of surgical intervention, and diagnosed anatomical pathologies among the total gastric cancer incidences during medical treatments from January 2016 to May 2019. The study samples were collected from the total gastric cancer respondents who met the inclusion criteria during medical treatments within the study period. Results: Gastric cancer was most frequently observed among females (56%) and those aged 50–70 years old (47%). Most respondents had advanced stages of gastric cancer at first enrollment at our institution. The most frequently found tumor site was the corpus (43%). The most frequently performed type of surgical intervention was jejunostomy feeding (26%), and the most frequently diagnosed anatomical pathology was adenocarcinoma with poorly differentiation (39%). Overall, age had statistically significant correlations with sex (p 50 years old), gastric cancer was more prevalent in women than men, and the gastric tumor tended to be more distal. Non-cardia gastric cancers were more prevalent than cardia gastric cancers.

A two-stage growth trial using identical diets was conducted to examine the viability of partially replacing soybean meal (SBM) with corn distiller’s dried grain with solubles (DDGS) simulating the commercial growth cycle of shrimp from 1 g to 19 g body weight. In both trials, the reference diet was formulated using 25 % SBM, 8 % fish meal (FM) and 20 % poultry by-product meal (PBPM). Test diets were formulated by replacing SBM with 5 %, 10 % and 15 % of DDGS, respectively. All diets contain approximately 36 % crude protein and 7 % crude lipid. In trial 1, fifteen shrimp with average initial weight of 1.04 ± 0.04 g were stocked into 98 l aquaria tank (equivalent to 150 shrimp m-2) in a completely randomized design with ten replicates per treatment and fed with the experimental diets for 52 days. In trial 2, shrimp (5.2 ± 0.2 g) were stocked randomly into 200 L clear tanks at a density of 50 shrimp per tank (equivalent to 250 shrimp m-2) with eight replicates per treatment and fed for 84 days. The results showed growth performance of shrimp in both studies was not affected as the dietary SBM was partially replaced with DDGS. There were no significant differences observed in terms of crude protein, fat content, dry matter and ash content of the shrimp in both studies. The results from this study demonstrated that corn DDGS could be used up to 15 % in commercial feed formulations without causing any adverse effect on growth, feed conversion, nutrient utilization efficiency and whole body composition. Since the price per unit protein of corn DDGS is much cheaper than SBM, the use of corn DDGS could offer the development of sustainable and economically sound practical diets for Pacific white leg shrimp L. vannamei.

Introduction: The second-generation cryoballoon (CB) has emerged in the last decade as an effective treatment for atrial fibrillation (AF). This study sought to analyze the rate of PV reconnection following CB ablation, evaluate the most frequent PV sites of conduction recovery and finally to assess procedural and biophysical indicators of reconnection in a large cohort of patients undergoing repeat ablation for recurrence of atrial arrhythmias. Methods and Results: A total of 300 consecutive patients (189 males, 63%; mean age 63.0 ± 11.1 years) underwent a repeat ablation after 18.2 ± 10.8 months from the index CB ablation. All repeat ablations were performed using a 3-dimensional electro-anatomical mapping system. Among all 1178 PVs, 209 (17.7%) showed a late PV reconnection in 177 patients (1.18 per patient), at the time of repeat ablation procedure. Overall, persistent PV isolation could be documented in 969 of 1178 PVs (82.3%). In 123 of 300 patients (41%), persistent isolation could be demonstrated in all PVs, whereas PV reconnection could be documented in 177 patients (59%). In the multivariable analysis, nadir temperature (p = 0.03), time to PV isolation (p = 0.01) and failure to achieve − 40 °C within 60 s (p = 0.05) were independently associated with late PV reconnection. Conclusions: The rate of late PV reconnection after CB ablation was low (1.18 PVs/patient). The most frequent sites of reconnections were the superior-anterior portions for the upper PVs and the inferior-posterior portions for the lower PVs. Faster time to isolation, colder nadir temperatures and achievement of − 40 °C within 60 s were associated with durable PV isolation.

Background: Clinical management of vaso-vagal syncope (VVS) remains challenging since no therapy has proven to completely prevent VVS recurrence. Objective: The purpose of this study was to analyze the mid-term outcome of cryoballoon (CB) cardioneuroablation achieved by pulmonary vein isolation (PVI) in patients with VVS. Methods: Patients who underwent CB cardioneuroablation in our centers between January 2014 to June 2018 were included. All patients had a history of VVS or pre-syncope despite therapeutic attempts with medical and/or pacing treatments. Patients were excluded in case of structural heart diseases, cerebrovascular diseases or suspected drug-related syncope. Both heart rate (HR) and atrio-ventricular (AV) interval were analyzed on the 12-lead electrocardiogram (ECG) the day before the procedure, the day after, and in the follow-up. Results: In total, 26 patients (76.9% males, 37.5 ± 9.0 years old) were included. All patients underwent a successful procedure with the 28 mm second-generation Arctic Front Advance CB. No major complication occurred. At a mean follow-up of 20.1 ± 11.6 months the freedom from VVS or reflex pre-syncope was 83,7%, with 22 patients free from any clinical recurrence. Basal HR significantly increased the day after the procedure (57.2 bpm vs 78.3 bpm, p

Objectives: Chlamydia pneumoniae is a difficult to diagnose respiratory pathogen. This study was performed to systematically characterize humoral immune responses to selected C. pneumoniae antigens in order to provide novel serodiagnostic perspectives for clinical and epidemiological issues. Methods: Based on a literature search, gene library screening, and serological proteome analysis, 15 immunogenic surface-associated, virulence-associated, and hypothetical C. pneumoniae antigens were selected, recombinantly expressed, and lined on a nitrocellulose strip. Specific IgM and IgG reactivity was measured in a total of 172 PCR- and micro-immunofluorescence testing (MIF)-characterized serum samples from patients with respiratory infections. A theoretical model was conceived to approximate a putative course of C. pneumoniae antigen expression and assess the potential of early and late antigens. Results: While surface antigens performed poorly, the virulence-associated TARP was a reliable antigen for IgM detection, with a sensitivity of 80.0% and a diagnostic specificity of 90.2%. The hypothetical protein YwbM proved powerful for IgG detection with MIF-correlative sensitivities of up to 94.4% and a diagnostic specificity of 95.1%. Conclusions: This study provides new insights into antibody profiles to immunogenic proteins in C. pneumoniae infection. The study findings offer antigen candidates for more reliable and standardized serological investigations of C. pneumoniae infections, including studies on seroprevalence and epidemiology. Keywords: Chlamydia pneumoniae, Serodiagnosis, Line assay, Recombinant antigen

Background: The new version of inner lumen mapping catheter (Achieve Advance™; Medtronic, Minnesota, USA) includes a new solid core which provides improved rotational response, as compared to the current Achieve Mapping Catheter. In the present study, we sought to analyze the rate of visualisation of real-time recordings using this new device comparing it with a large cohort of patients having undergone second generation cryoballoon (CB) ablation using the previous Achieve mapping catheter. Methods: All patients having undergone CB ablation using the Achieve Advance and the last 150 consecutive patients having undergone CB ablation using the previous Achieve were analysed. Exclusion criteria were presence of an intracavitary thrombus, uncontrolled heart failure, moderate or severe valvular disease and contraindications to general anesthesia. Results: A total of 200 consecutive patients (60.1 ± 9.5 years, 75% males) were evaluated (50 Achieve Advance and 150 old Achieve). Real-time recordings were significantly more prevalent in the “new Achieve Advance” population compared with the “old Achieve” group (73.5% vs 56.8%; p = 0.0001). Real-time recordings could be more frequently visualized in the “Achieve Advance” group in all veins except RIPV (LSPV: 86% vs 71.3%, p = 0.04; LIPV: 84% vs 62.7%, p = 0.005; RSPV: 78% vs 52%, p

Background: Pulmonary vein isolation (PVI) modulates the intrinsic cardiac autonomic nervous system (ANS). We evaluated the impact of PVI on 5 non-invasive autonomic tests. Methods: Thirty patients (76% male, mean age 60.37 ± 9.02 years) with paroxysmal atrial fibrillation (AF) underwent cryoballoon-guided PVI. Five autonomic tests were performed 24hrs before and after PVI (N = 30) and repeated after 6months (N = 22). Parasympathetic function was measured by heart rate (HR) variability during deep breathing (E/I ratio, I-E difference), Valsalva maneuver (Valsalva-ratio) and head-up tilt test (30/15 ratio). Sympathetic function was measured by systolic BP response to sustained handgrip and 10’ tilting and by diastolic BP response to cold water. Results: 24hrs after PVI, baseline HR increased from 57.93 ± 9.06 bpm to 71.10 ± 12.75 bpm (p

Background: Mycobacterium tuberculosis (Mtb) infection is inferred from positive results of T-cell immune conversion assays measuring Mtb-specific interferon gamma production or tuberculin skin test (TST) reactivity. Certain exposed individuals do not display T-cell immune conversion in these assays and do not develop TB. Here we report a hitherto unknown form of this phenotype: HIV-1-positive persistently TB, tuberculin and IGRA negative (HITTIN). Methods: A community-based case-control design was used to systematically screen and identify adults living with HIV (HIV+), aged 35–60 years, who met stringent study criteria, and then longitudinally followed up for repeat IGRA and TST testing. Participants had no history of TB despite living in TB hyper-endemic environments in Cape Town, South Africa with a provincial incidence of 681/100,000. Mtb-specific antibodies were measured using ELISA and Luminex. Findings: We identified 48/286 (17%) individuals who tested persistently negative for Mtb-specific T-cell immunoreactivity (three negative Quantiferon results and one TST = 0mm) over 206±154 days on average. Of these, 97·2% had documented CD4 counts

Background: β-Glucosidase assay is performed with purified or semipurified enzymes extracted from cell lysis. However, in screening studies, to find bacteria with β-glucosidase activity among many tested bacteria, a fast method without cell lysis is desirable. In that objective, we report an in vivo β-glucosidase assay as a fast method to find a β-glucosidase producer strain. Results: The method consists in growing the strains for testing in a medium supplemented with the artificial substrate p-nitrophenyl-β-glucopyranoside (pNPG). The presence of β-glucosidases converts the substrate to p-nitrophenol (pNP), a molecule that can be easily measured in the supernatant spectrophotometrically at 405 nm. The assay was evaluated using two Bifidobacterium strains: Bifidobacterium longum B7254 strain that lacks β-glucosidase activity and Bifidobacterium pseudocatenulatum B7003 strain that shows β-glucosidase activity. The addition of sodium carbonate during pNP measurement increases the sensitivity of pNP detection and avoids the masking of absorbance by the culture medium. Furthermore, we show that pNP is a stable enzymatic product, not metabolized by bacteria, but with an inhibitory effect on cell growth. The β-glucosidase activity was measured as units of enzyme per gram per minute per dry cell weight. This method also allowed the identification of Lactobacillus strains with higher β-glucosidase activity among several lactobacillus species. Conclusion: This in vivo β-glucosidase assay can be used as an enzymatic test on living cells without cell disruption. The method is simple, quantitative, and recommended, especially in studies screening for bacteria not only with β-glucosidase activity but also with high β-glucosidase activity. Keywords: Antimicrobial, Bifidobacterium, Cell lysis, Enzymatic test, Lactobacillus, p-Nitrophenol, p-Nitrophenyl-β-glucopyranoside, Screening, Screening, β-Glucosidase assay, β-Glucosidase producer strain

Flavonoids are plant derived compounds mainly present as O-glycosides. They are hydrolyzed by gut microbial enzymes to their aglycons, which represent the bioavailable and bioactive form. In this work the capability of a Bifidobacterium strain (Bifidobacterium pseudocatenulatum B7003) of being used as a probiotic starter culture to obtain fermented legume milks with an increased concentration of flavonoids in their aglycone form was studied. B7003 strain can effectively bioconvert glycosylated flavonoids while fermenting soybean or common bean derived milks. Conversely, a strain used as negative control (Bifidobacterium longum B7254) could grow on the milks but had low activity in flavonoid bioconversion. B7003 strain possesses basic safety properties, the capability of adhering to gut epithelial cells and showed resistance to simulated food processing conditions. Thus, B. pseudocatenulatum B7003 complies well with a new vision of probiotics, which, beside benefits deriving from gut transit, have additional functional properties, such as the high bioavailability of flavonoids in their aglycone form.

Background: The direct aortic (DA) approach allows for transcatheter aortic valve implantation (TAVI) in patients with difficult peripheral vascular anatomy. The CoreValve ADVANCE Direct Aortic (ADVANCE DA) study was performed to assess the outcomes of DA TAVI with the CoreValve System (Medtronic, Minneapolis, MN) in routine practice., Methods: Patients were selected for the DA approach by local cardiac surgical teams, and TAVI was performed with patients under general anesthesia. Safety events were adjudicated according to the Valve Academic Research Consortium-2 definitions by an independent clinical events committee. All imaging data, including that from multislice computed tomography and follow-up echocardiography, were analyzed by an independent core laboratory., Results: From September 2012 to February 2014, 100 patients were enrolled (52.0% male, age 81.9 ± 5.9 years, The Society of Thoracic Surgeons Score 5.9 ± 3.2%) at 9 centers in Europe. Peripheral vascular disease was present in 51.0% of patients, and 38.0% had diabetes. Of the 100 patients enrolled, 92 underwent TAVI. At 30 days after TAVI, 98.1% were free of moderate or severe paravalvular leak. At 1 year, 16 patients had died (Kaplan-Meier rate 17.9%), 1 (1.1%) patient had had a stroke, classified as nondisabling, and 15 (17.0%) patients had received a permanent pacemaker. Most patients experienced improved quality of life as measured by the Kansas City Cardiomyopathy Questionnaire overall summary score (mean change from baseline to 1 year, 39.6 ± 26.3; p < 0.01)., Conclusions: The DA approach provides a feasible alternative for patients with challenging anatomic features that may otherwise preclude use of the TAVI procedure., (Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Cell-saving devices (CS) are frequently used in cardiac surgery to reduce transfusion requirements, but convincing evidence from randomized clinical trials is missing. Filtration of salvaged blood in combination with the CS is widely used to improve the quality of retransfused blood, but there are no data to justify this approach., Methods: To determine the contribution of CS and filters on transfusion requirements, we performed a multicenter factorial randomized clinical trial in two academic and four nonacademic hospitals. Patients undergoing elective coronary, valve, or combined surgical procedures were included. The primary end point was the number of allogeneic blood products transfused in each group during hospital admission., Results: From 738 included patients, 716 patients completed the study (CS+filter, 175; CS, 189; filter, 175; neither CS nor filter, 177). There was no significant effect of CS or filter on the total number of blood products (fraction [95% confidence interval]: CS, 0.96 [0.79, 1.18]; filter, 1.17 [0.96, 1.43]). Use of a CS significantly reduced red blood cell transfusions within 24 hours (0.75 [0.61,0.92]), but not during hospital stay (0.86 [0.71, 1.05]). Use of a CS was significantly associated with increased transfusions of fresh frozen plasma (1.39 [1.04, 1.86]), but not with platelets (1.25 [0.93, 1.68]). Use of a CS significantly reduced the percentage of patients who received any transfusion (odds ratio [95% confidence interval]: 0.67 [0.49, 0.91]), whereas filters did not (0.92 [0.68, 1.25])., Conclusions: Use of a CS, with or without a filter, does not reduce the total number of allogeneic blood products, but reduces the percentage of patients who need blood products during cardiac surgery., (Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: The European system for cardiac operative risk evaluation, the most popular European scoring system in cardiac surgery, uses the extracardiac arteriopathy as a risk factor for early mortality. We studied the effect of peripheral vascular disease (PVD) on early and late mortality in a large group of patients undergoing isolated coronary artery bypass surgery (CABG) surgery., Methods: During a ten-year period (January 1998 through December 2007) 10,626 patients underwent isolated CABG in our hospital. The primary endpoints of this study were early and late all-cause mortality. For each year of the study period, general population cohorts were matched with the patient groups for age and gender (expected survival)., Results: Out of 10,504 patients included in the analysis, 1,222 (11.63%) patients had PVD. The PVD was identified as an independent risk factor for late mortality (death at any time after hospital discharge) (hazard ratio of 1.67 [1.43 to 1.95], p < 0.0001), but not for early mortality (death within 30 days or before discharge) (hazard ratio of 1.06 [0.70 to 1.60], p = 0.776). Patients without PVD had a better survival than patients with PVD (log-rank p < 0.0001) and even a better survival compared to the normal Dutch population survival (p value < 0.002). The PVD patients had a worse than expected survival (log-rank p < 0.0001)., Conclusions: Peripheral vascular disease is an independent risk factor only for late mortality but not for early mortality. Compared with age-matched and sex-matched cohorts from the general Dutch population, the ten-year survival of patients with peripheral vascular disease was worse; whereas the survival of patients with no peripheral vascular disease was better., (2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: In this prospective study, we investigated the determinants of long-term outcome, symptoms, and left ventricular function after coronary artery bypass grafting in patients with a moderate to severely decreased left ventricular ejection fraction., Methods: Between 1997 and 1998, 75 consecutive patients with moderate to severe left ventricular dysfunction underwent coronary artery bypass grafting procedures. The operative mortality rate was 4.0%, and the 72 survivors were monitored for 8 years. The end points were mortality, symptomatic status (New York Heart Association [NYHA] functional class), and left ventricular function., Results: The total survival rate after 8 years was 89.3%. During follow-up, 8 patients died. Death was attributed to a cardiac cause in 5 patients and to a noncardiac cause in 3. There was no statistically significant difference between preoperative and late postoperative NYHA functional class, despite a statistically significant improvement that persisted for up to 4 years after CABG. The results of echocardiography showed a statistically significant improvement in the left ventricular ejection fraction (from 0.322 +/- 0.06 preoperatively to 0.463 +/- 0.02 at follow-up, p < 0.001). Multivariate analysis revealed that the left ventricular end-systolic volume index, the presence of angina pectoris, and absence of symptoms of congestive heart failure were preoperative indicators of freedom from heart failure after coronary operations (p < 0.05)., Conclusions: Coronary artery bypass grafting for patients with moderate-to-severe left ventricular dysfunction is associated with acceptable long-term results. The left ventricular end-systolic volume index is a simple noninvasive method to aid in the preoperative decision making in such patients.

Purpose: Injury patterns of occupants in motor vehicle crashes are changing, with upper extremity injury becoming more common in patients treated at trauma centres. Although not life threatening, upper extremity injuries may result in long-term disability, including chronic deformity, neurovascular compromise and degenerative arthritis. The purpose of this study was to compare upper extremity injury in drivers and passengers using the Crash Injury Research Engineering Network (CIREN) database., Methods: CIREN data were used to compare upper extremity skeletal injury patterns and sources for drivers and passengers in frontal and side impacts. Occupant variables (age, gender, co-morbidity, avoidance maneuvers and restraint use) and crash variables (direction of impact, delta V and vehicle crush) were considered in the analysis., Results: Only 24.8% of all occupants in the CIREN database had upper extremity injuries. One-half of upper extremity injuries to drivers were forearm fractures compared to one-third for passengers. Occupants in side impacts were more likely (OR=5.05) to have clavicle fractures, even while controlling for driver versus passenger status and safety belt use. Air bags were more likely to be a source of forearm fracture (OR=2.31) when controlling for driver versus passenger status, direction of force, sex and age compared to other sources. Only 10% of driver fractures with air bag deployment in frontal impacts were associated with air bag fling., Conclusions: This study found that drivers and passengers have different upper extremity injury patterns but the direction of impact also plays an important role.

Background: This study investigates the determinants of long-term outcome and modalities of late death after surgical treatment of acute type A dissection., Methods: Between 1974 and 2001, 315 consecutive patients were operated on for acute type A aortic dissection. Operative mortality was 22.9%. A series of 243 survivors of surgical treatment were followed up for as long as 27 years. Endpoints were death, cardiovascular reoperation, and neurologic events. Median follow-up was 4.5 years. Follow-up was 99.6% complete., Results: Cumulative survival of discharged patients was 96.4% +/- 1.3%, 67.7% +/- 4.7%, and 39.4% +/- 12.0% at 1, 10, and 20 years, respectively. During follow-up, 47 patients died. Cause of death was cardiac failure in 7, hemorrhage due to rupture of the distal aorta in 7, stroke in 4, respiratory insufficiency in 4, sepsis in 3, malignancy in 2, and unknown in 20 patients. Multivariate analysis revealed advanced patient age and postoperative hemodialysis as perioperative indicators of late death (p < 0.05). Freedom from cardiovascular reoperation was 90.7% +/- 2.0% at 1 year, 60.9% +/- 5.1% at 10 years and 41.9% +/- 15.0% at 20 years. A total of 58 patients required 86 cardiovascular reoperations; aortic root or ascending aorta replacement was performed in 20, distal ascending aorta and arch replacement in 13, descending aorta replacement in 6, thoracoabdominal aorta replacement in 7, abdominal aorta replacement in 7, and miscellaneous reoperations in 6 patients. Multivariate analysis revealed male sex and left coronary artery dissection as significant determinants for late cardiovascular reintervention (p < 0.05). Cumulative incidence of stroke after 20 years was 3.8%., Conclusions: Acute type A dissection represents an emergency situation with acceptable long-term results for discharged survivors of surgical treatment.

Background: We report our experience with surgery for acute type A aortic dissection with involvement of the aortic arch., Methods: From January 1986 to December 2001, 277 patients underwent surgery for acute type A aortic dissection. In 70 patients (25.3%), surgery was extended into the aortic arch: hemiarch and total arch replacement in 53 (75.7%) and 17 (24.3%) patients, respectively. Deep hypothermic circulatory arrest was used in 19 patients, antegrade selective cerebral perfusion in 38, and combined deep hypothermic circulatory arrest with antegrade selective cerebral perfusion in 13., Results: Operative mortality was 18.6% (13/70) after extended replacement into the arch versus 21.7% (45/207) after surgery limited to the ascending aorta (p = 0.62). Multivariate analysis did not reveal significant risk factors for operative mortality. Postoperatively, 5 patients (8.1%) had a new postoperative cerebral vascular accident (CVA). Multivariate analysis showed an earlier date of operation as the only independent determinant for a new postoperative CVA (p = 0.0162, RR = 0.80/year, 95% CI = 0.67 to 0.96). None of the patients, operated on with antegrade selective cerebral perfusion, had a new cerebral deficit. Comparing the different methods of cerebral protection, multivariate risk analysis revealed antegrade selective cerebral perfusion as a significant protective factor against new postoperative CVA (p = 0.0110, OR = 0.12, 95% CI = 0.02 to 0.61). Survival at 5 and 10 years was 66.6.5% and 40.0%, respectively, after replacement of the aortic arch versus 68.7% and 57.7%, respectively, after replacement of the ascending aorta (p = 0.96). Freedom from aortic arch reoperation was 96.3% at 5 and 77.0% at 10 years versus 86.6% and 75.1% in both groups, respectively (p = 0.21)., Conclusions: Extended replacement into the aortic arch during surgery for acute type A dissection does not influence early and late results. The best cerebral protection seems to be obtained with antegrade selective cerebral perfusion.

Dendritic cells (DC) based vaccinations have been widely used for the induction of anti-tumoral immunity in clinical studies. Antigen loading of DC with whole tumor cell preparations is an attractive method whenever tumor cell material is available. In order to determine parameters for the loading procedure, we performed dose finding and timing experiments. We found that apoptotic and necrotic melanoma cells up to a ratio of one-to-one, equivalent to 1mg/ml protein per 1 x 10(6) DC, can be added to monocyte derived DC without effecting DC recovery extensively. Using the isolated protein content of tumor cells (lysate) as a parameter, up to 5 mg/ml protein per 1 x 10(6) DC can be added. To achieve significant protein uptake at least 1 mg/ml of protein have to be added for more than 24 h as tested with FITC-labelled ovalbumin. Maturation inducing cytokines can be added simultaneously with the tumor cell preparations to immature DC without affecting the uptake. Furthermore, we tested the feasibility of cryopreservation of loaded and matured DC to facilitate the generation of ready to use aliquots. DC were cryopreserved in a mix of human serum albumin, DMSO and 5% glucose. After thawing, surface expression of molecules indicating the mature status (CD83, costimulatory and MHC molecules), was found to be unaltered. Furthermore, cryopreserved DC kept the capability to stimulate allogenic T-cell proliferation in mixed leukocyte reactions at full level. Loaded and matured DC pulsed with influenza matrix peptide (IMP) retained the capacity to induce the generation of IMP-specific cytotoxic T-lymphocytes after cryopreservation as measured by ELISPOT and tetramer staining. The expression of the chemokine receptor CXCR-4 and CCR-7 remained unaltered during cryopreservation and the migratory responsiveness towards MIP-3beta was unaltered as measured in a migration assay. Thus we conclude that the large scale loading and maturation of DC with whole tumor cell preparations can be performed in a single session. These data will facilitate the clinical application of DC loaded with whole tumor cell preparations.

Background: Antegrade selective cerebral perfusion (ASCP) has proved to be a reliable method of brain protection during surgery of the thoracic aorta, but its use during aortic dissection surgery still remains controversial. In this study, we present our results after the operative repair of acute type A aortic dissections using ASCP and moderate hypothermic circulatory arrest., Methods: Between October 1995 and August 2001, 122 patients (76 men, 46 women) underwent repair of acute type A aortic dissection with the aid of ASCP and open distal anastomosis. The average age of the patients was 61 +/- 12 (mean +/- standard deviation). Preoperative complications included cardiac tamponade (n = 34; 27.0%), aortic regurgitation (n = 27; 22.1%), and new neurological deficits (n = 11; 9%)., Results: Stepwise logistic regression revealed preoperative cardiac tamponade (p = 0.018) and new neurological deficits (p = 0.017) to be independent determinants for hospital mortality (19.7%). Permanent neurological complications occurred in 7% of the patients. Independent risk factors for temporary neurological dysfunction (11.2%) included cardiac tamponade (p = 0.019) and preoperative neurological deficits (p = 0.000)., Conclusions: In our experience, the surgical treatment of acute type A aortic dissection with the aid of ASCP was associated with acceptable hospital mortality and neurologic morbidity rates.

Arteriovenous malformations between the external carotid artery and the jugular vein are very uncommon. We describe our findings in a patient with symptoms of such a spontaneous fistula.

In order to determine the relationship of the peak systolic pressure/end-systolic volume (PSP/ESV) ratio to standard ejection phase indices [ejection fraction (EF), mean normalized systolic ejection rate (MNSER), mean velocity of circumferential fiber shortening (Vcf)], and ventricular function curves (VFC), hemodynamic and angiographic studies were carried out in 38 subjects: 11 normal controls (Group I) and 27 with coronary artery disease (CAD). The CAD patients were subdivided into those without (Group II) and those with (Group III) regional asynergy. EF, MNSER and Vcf were calculated from the ventriculogram using standard formulae. The slope of the left ventricular function curve was constructed by determining left ventricular stroke work index and left ventricular end-diastolic pressure before and after ventriculography, and dividing the change in the left ventricular stroke work index by the change in the left ventricular end-diastolic pressure. Peak systolic left ventricular pressure was determined before left ventriculography; minimal systolic volume was measured from the left ventriculogram. PSP/ESV ratio in the control group (Group I) was 6.4 +/- 2.8. This differed significantly from the ratio in patients (Group II) with CAD but without asynergy (4.7 +/- 2.2 p less than 0.025) and from that in patients (Group III) with CAD and asynergy (2.4 +/- 1.4, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)