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A 54-year-old woman presented with an enlarging, pulsatile left neck mass and a history of Takayasu arteritis. She had seven prior cervical vascular reconstructions, including a prosthetic right-to-left carotid crossover, and left vertebral and subclavian bypasses done with saphenous vein. The skin of her neck was scarred and thin. The anastomotic pseudoaneurysms were resected, the left carotid bifurcation was reconstructed with the cryopreserved femoral artery because of the concern about wound healing, and the subclavian and vertebral vein grafts were reimplanted. Intraoperative management, clamp sites and sequence, manner of shunting, choice of conduit, and wound healing were important considerations.

Transcranial electrical stimulation (tES) is considered effective and safe for depression, albeit modestly, and prone to logistical burdens when performed in external facilities. Investigation of portable tES (ptES), and potentiation of ptES with remote psychological interventions have shown positive, but preliminary, results.We report the rationale and design of an ongoing multi-arm, randomized, double-blind, sham-controlled clinical trial with digital features, using ptES and internet-based behavioral therapy (iBT) for major depressive disorder (MDD) (NCT04889976).We will evaluate the efficacy, safety, tolerability and usability of (1) active ptES + active iBT ('double-active'), (2) active ptES + sham iBT ('ptES-only'), and (3) sham ptES + sham iBT ('double-sham'), in adults with MDD, with a Hamilton Depression Rating Scale - 17 item version (HDRS-17) score ≥ 17 at baseline, during 6 weeks. Antidepressants are allowed in stable doses during the trial.We primarily co-hypothesize changes in HDRS-17 will be greater in (1) 'double-active' compared to 'ptES-only,' (2) 'double-active' compared to 'double-sham,' and (3) 'ptES-only' compared to 'double-sham.' We aim to enroll 210 patients (70 per arm).Our results should offer new insights regarding the efficacy and scalability of combined ptES and iBT for MDD, in digital mental health.

Aneurysms of the superior mesenteric artery (SMA) and its branches are rare and account for only 6% to 15% of all visceral artery aneurysms. In the present report, we have described our 30-year experience with the management of aneurysms of the SMA and its branches at a high-volume referral center.A retrospective review of all patients with a diagnosis of an aneurysm of the SMA or one of its branches from 1988 to 2018 was performed. Pseudoaneurysms and mycotic aneurysms were excluded. The clinical presentation, etiology, aneurysm shape and size, treatment modalities, and outcomes were analyzed. The growth rate of the aneurysms was estimated using linear regression.A total of 131 patients with 144 aneurysms were reviewed. The patients were primarily men (64%), with a median age of 60 years. Of the 144 aneurysms, 57 were fusiform, 30 were saccular, and 57 were dissection-associated aneurysms. Of the 131 patients, 41 had had an isolated SMA branch aneurysm. Degenerative aneurysms were the most common etiology (66%). A total of 35 patients (27%) were symptomatic at presentation. Of the 144 aneurysms, 111 had multiple computed tomography angiograms available, with a median follow-up of 43.6 months (interquartile range, 10.6-87.2 months). Only 18 aneurysms (16%) had had an estimated growth rate of ≥1.0 mm/y. The initial aneurysm size was significantly associated with the growth rate for the fusiform aneurysms (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.0-1.3]; P = .02) but not for the saccular (OR, 0.91; 95% CI, 0.76-1.1; P = 1.1) or dissection-associated (OR, 1.2; 95% CI, 0.91-1.5; P = .20) aneurysms. Acute abdominal pain (OR, 5.9; 95% CI, 1.6-22; P = .01) and chronic abdominal pain (OR, 3.7; 95% CI, 1.1-13; P = .04) were associated with aneurysm growth. Only two patients had a ruptured aneurysm, both of whom presented with rupture with no prior imaging studies. These two patients had a diagnosis of fibromuscular dysplasia and systemic lupus erythematosus, respectively. Of the 131 patients, 46 (34%) had undergone operative repair, including 36 open revascularizations and 8 endovascular procedures. The average aneurysm size for these 46 patients was 24.0 ± 8.6 mm. One patient died perioperatively, and nine patients experienced perioperative complications (25%). Of the 144 aneurysms, 91 were 20 mm, with an average size of 13.4 ± 3.1 mm. These 91 aneurysms had been followed up for a median of 120.8 months (interquartile range, 30.5-232.2 months), with no ruptures within this cohort during the follow-up period.The present study represents one of the largest series on aneurysms of the SMA and its branches. Our results showed that aneurysms of the SMA are relatively stable. Patients with symptomatic and fusiform aneurysms had a greater risk of growth. Aneurysms 20 mm with a degenerative etiology can be safely monitored without treatment.

Energy efficiency is a key issue for modern high performance computing. Superconductive digital electronics has already demonstrated superior performances in terms of speed and energy dissipations. However, there is still the open issue of the realization of effective submicron scale superconductive memories. Superconducting nanowires represent the state-of-the-art of single-photon detectors. Their technology has also been used to realize three-terminal active devices, where the output response is triggered by a current pulse. The combination of the electrothermal mechanism of the nanowire and the magnetic coupling with a suitable material can be used for the realization of a nanowire-based memory device scalable to nanoscale. The principle of operation and material requirements are presented here. In particular, the feasibility of the proposed device using EuS as magnetic material and NbN as nanowire is discussed. By using a physical model of the nanowire dynamics, in terms of the spatial distribution of electron and phonon temperatures, the feasibility of the proposed device has been verified, through numerical simulations. The device configurations considered have the specific goal of realizing reliable and high-speed read and write operations, with the possibility of scalability to nanoscale.

Direct stick embolization (DSE) of high-flow peripheral arteriovenous malformations (AVMs) has previously been reported using n-butyl cyanoacrylate and ethanol. The use of ethylene vinyl alcohol copolymer (Onyx; Covidien, Plymouth, Minn) through this delivery route has been extremely limited, particularly in the peripheral interventional realm, owing to concerns about technique and conduit for delivery, skin discoloration, and ulceration. We describe three patients with relatively focal, symptomatic, congenital high-flow AVMs of the upper and lower extremity treated successfully by multifaceted approaches including transvenous coil embolization of the nidus venous outflow, transarterial embolization, and DSE of the AVM nidus with Onyx. Successful delivery of Onyx into the AVM nidus was achieved without nontarget embolization. Sustained symptomatic relief without recurrence or associated complications was achieved at 1 month, 3 months, and 6 months of follow-up. Nidus embolization is a key technical maneuver for optimal treatment of high-flow AVMs, although it is not always easily achievable by the transarterial route in more extensive, convoluted angioarchitectural varieties. With appropriate technical considerations and precautionary measures, Onyx can be safely and effectively delivered through DSE into the AVM nidus with satisfactory short-term and midterm clinical outcomes. This maneuver expands the armamentarium of the treating vascular surgeon facing complicated peripheral AVMs.

Objective To determine the rates and risk factors of complications related to cerebrospinal fluid drainage (CSFD) during first stage and completion fenestrated-branched endovascular aortic repair (F-BEVAR) of pararenal and thoracoabdominal aortic aneurysms. Methods We reviewed the outcomes of 293 consecutive patients enrolled in a prospective, nonrandomized study to investigate outcomes of F-BEVAR between 2013 and 2018. Patients who received CSFD during first-stage thoracic endovascular aortic repair, index F-BEVAR, or completion of temporary aneurysm sac perfusion procedures were included in the analysis. CSFD complications were graded as severe or moderate if they were life threatening, escalated the level of care, or prolonged the hospital stay. Presence of substantial degenerative lumbar disease (DLD) was identified based on review of preoperative computed tomography. End points included technical difficulties during CSFD placement and CSFD-related complications. Results A total of 187 patients (mean age, 73 ± 8 years; 70% male) treated for 20 pararenal and 167 thoracoabdominal aortic aneurysms received CSFD in 240 procedures, including 51 first-stage thoracic endovascular aortic repairs, 184 index F-BEVARs, and 5 completion temporary aneurysm sac perfusion procedures. Nineteen patients (10%) had 22 CSFD-related complications after 21 aortic procedures (9%). Complications were graded as severe to moderate in 17 patients (9%). There were 12 patients (6%) with intracranial hypotension, including three (2%) who had intracranial hemorrhage and nine (5%) with post dural puncture headache requiring blood patches in six. Another six patients (3%) developed spinal hematomas resulting in paraplegia in two (1%) and transient paraparesis in two (1%). One patient had CSF leakage from the puncture site (no intervention required). Four patients had bleeding during attempted drain placement, which required postponement of F-BEVAR. Technical difficulties were experienced in 57 drain insertions (24%), more often in patients with DLD than in those without DLD (35/113 [31%] vs 22/121 [18%]; P = .03). Fluoroscopic guidance was used in 44 drain placements (18%) with a lower rate of technical difficulties compared with the blind approach (9% vs 28%; P = .01). There was a statistically nonsignificant trend toward more complications in patients with technical challenges (14% vs 7%; P = .10). Of 13 study patients who developed spinal cord injuries during aortic procedures, 4 (31%) were attributed to CSFD. Conclusions Although CSFD is widely used to prevent ischemic spinal cord injury during complex aortic repair, the risk of major CSFD-related complications is not negligible and should be carefully weighed against its potential benefits. One-third of spinal cord injuries were caused by CSF drain placement. The use of fluoroscopic guidance may decrease the risk of CSFD-related complications.

__Background:__ The closure of the valves generates shear waves in the heart walls. The propagation velocity of shear waves relates to stiffness. This could potentially be used to estimate the stiffness of the myocardium, with huge potential implications in pathologies characterized by a deterioration of the diastolic properties of the left ventricle. In an earlier phantom study we already validated shear wave tracking with a clinical ultrasound system in cardiac mode. __Purpose:__ In this study we aimed to measure the shear waves velocity in normal individuals. __Methods:__ 12 healthy volunteers, mean age=37±10, 33% females, were investigated using a clinical scanner (Philips iE33), equipped with a S5-1 probe, using a clinical tissue Doppler (TDI) application. ECG and phonocardiogram (PCG) were synchronously recorded. We achieved a TDI frame rate of >500Hz by carefully tuning normal system settings. Data were processed offline in Philips Qlab 8 to extract tissue velocity along a virtual M-mode line in the basal third of the interventricular septum, in parasternal long axis view. This tissue velocity showed a propagating wave pattern after closure of the valves. The slope of the wave front velocity in a space-time panel was measured to obtain the shear wave propagation velocity. The velocity of the shear waves induced by the closure of the mitral valve (1st heart sound) and aortic valve (2nd heart sound) was averaged over 4 heartbeats for every subject. __Results:__ Shear waves were visible after each closure of the heart valves, synchronous to the heart sounds. The figure shows one heart cycle of a subject, with the mean velocity along a virtual M-mode line in the upper panel, synchronous to the ECG signal (green line) and phonocardiogram (yellow line) in the lower panel. The slope of the shear waves is marked with dotted lines and the onset of the heart sounds with white lines. In our healthy volunteer group the mean velocity of the shear wave induced by mitral valve closure was 4.8±0.7m/s, standard error of 0.14 m/s. The mean velocity after aortic valve closure was 3.4±0.5m/s, standard error of 0.09 m/s. We consistently found that for any subject the velocity after mitral valve closure was higher than after aortic valve closure. __Conclusion:__ The velocity of the shear waves generated by the closure of the heart valves can be measured in normal individuals using a clinical TDI application. The shear wave induced after mitral valve closure was consistently faster than after aortic valve closure. Abstract P1138.

The International Society for Study of Vascular Anomalies (ISSVA) broadly categorizes vascular anomalies as vascular tumors or vascular malformations. The latter are congenital lesions that are further categorized by their flow properties and include high-flow arteriovenous malformations, slow-flow venous and lymphatic malformations, and congenital mixed syndromes, which can include a combination of malformations. Unlike vascular tumors, vascular malformations never regress and can persist and grow for the duration of the patient's lifespan. As our understanding of the natural history, hemodynamics, and treatment outcomes of these lesions has expanded and evolved over the last few decades, certain fundamental diagnostic and therapeutic principles have been established and are considered standard of care. These overarching principles are crucial to adhere to in the overall management of these lesions and are highlighted and expanded on in this report, which focuses exclusively on peripheral slow-flow venous and lymphatic malformations.

The International Society for Study of Vascular Anomalies (ISSVA) broadly categorizes vascular anomalies into vascular tumors and vascular malformations. Vascular malformations are further divided based on their flow properties into slow-flow venous and lymphatic malformations, high-flow arteriovenous malformations (AVMs), and congenital mixed syndromes, which can include combinations thereof. Whether occurring in isolation or as part of a broader syndrome, congenital high-flow AVMs are arguably the most complicated, challenging, and gratifying of all vascular malformations to diagnose and manage. Various configurations exist depending on location and coexisting clinical features. Transcatheter embolization has evolved into the mainstay of treatment for most congenital peripheral AVMs with surgical excision playing a growingly limited role as an adjunctive modality. Successful treatment requires technical precision, creativity, patience, and persistence given the ever-evolving angioarchitecture and hemodynamic profile of these lesions. Despite these challenges, certain fundamental principles have been established as our understanding of the pathogenesis, natural history, hemodynamics, and treatment outcomes has expanded and evolved over the last few decades. These principles are crucial to adhere to in the overall management of these lesions and are highlighted and expanded upon herein.

We studied the dynamic instability of the vortex lattice in Nb/permalloy $(\mathrm{permalloy}={\mathrm{Ni}}_{0.8}{\mathrm{Fe}}_{0.2})$ bilayers with different Py thickness ${d}_{\mathrm{Py}}$. When ${d}_{\mathrm{Py}}$ is larger than some critical value, ${d}_{\mathrm{cr}}^{\mathrm{ESD}}$, which in our samples has been evaluated to be $\ensuremath{\simeq}125$ nm, an inhomogeneous magnetic configuration is induced in the samples as a precursor to a fully developed stripe domain state. We found that this inhomogeneous magnetic configuration of the Py layer promotes larger values of the critical velocity for the vortex lattice instability, ${v}^{*}$, with respect to the homogeneous case.

People’s vision of world phenomena is still based on the traditional mechanistic concept, which implies that process outcomes can be fully predicted and controlled. The new scientific concept that our world is characterized by complex, self-organizing processes, is so far acknowledged by few insiders. Mass media, advertising companies and information programmes tend to emphasize the success of technology (born at the end of the eighteenth century in the context of the old scientific vision), which significantly contributes to support and spread that mechanistic concept. This situation heavily impacts the management of the environment both in terms of its technical–scientific approach (where a mechanistic idea that does not integrate disciplinary knowledge continues to prevail) and in terms of its stewardship (i.e. an ethically responsible line of conduct). Instead of being solved, environmental problems are frequently shifted through time and space, and eventually magnified. Moreover, among the technicians involved in environmental assessments, as well as decision-makers and the general public, the connections regarding technical– scientific issues, ethical values and policy decisions are often not adequately considered. It’s time for a public debate on an alternative vision of real-world phenomena (according to a new scientific concept) and on its actual implications. The hope is that a valid dialogue between existing polarized views on science, technology and the environment may lead to more positive collaboration between science and environmental stewardship, where every single citizen feels committed.

Introduction Sex hormones have been implicated in the etiology of a number of diseases. To better understand disease etiology and the mechanisms of disease-risk factor associations, this analysis aimed to investigate the associations of anthropometric, sociodemographic and behavioural factors with a range of circulating sex hormones and sex hormone-binding globulin. Methods Statistical analyses of individual participant data from 12,330 male controls aged 25–85 years from 25 studies involved in the Endogenous Hormones Nutritional Biomarkers and Prostate Cancer Collaborative Group. Analysis of variance was used to estimate geometric means adjusted for study and relevant covariates. Results Older age was associated with higher concentrations of sex hormone-binding globulin and dihydrotestosterone and lower concentrations of dehydroepiandrosterone sulfate, free testosterone, androstenedione, androstanediol glucuronide and free estradiol. Higher body mass index was associated with higher concentrations of free estradiol, androstanediol glucuronide, estradiol and estrone and lower concentrations of dihydrotestosterone, testosterone, sex hormone-binding globulin, free testosterone, androstenedione and dehydroepiandrosterone sulfate. Taller height was associated with lower concentrations of androstenedione, testosterone, free testosterone and sex hormone-binding globulin and higher concentrations of androstanediol glucuronide. Current smoking was associated with higher concentrations of androstenedione, sex hormone-binding globulin and testosterone. Alcohol consumption was associated with higher concentrations of dehydroepiandrosterone sulfate, androstenedione and androstanediol glucuronide. East Asians had lower concentrations of androstanediol glucuronide and African Americans had higher concentrations of estrogens. Education and marital status were modestly associated with a small number of hormones. Conclusion Circulating sex hormones in men are strongly associated with age and body mass index, and to a lesser extent with smoking status and alcohol consumption. This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Odd-frequency triplet Cooper pairs are believed to be the carriers of long-range superconducting correlations in ferromagnets. Such triplet pairs are generated by inhomogeneous magnetism at the interface between a superconductor (S) and a ferromagnet (F). So far, reproducible long-range effects were reported only in complex layered structures designed to provide the magnetic inhomogeneity. Here we show that spin triplet pair formation can be found in simple unstructured Nb/Permalloy (Py = Ni_0.8Fe_0.2)/Nb trilayers and Nb/Py bilayers, but only when the thickness of the ferromagnetic layer ranges between 140 and 250 nm. The effect is related to the emergence of an intrinsically inhomogeneous magnetic state, which is a precursor of the well-known stripe regime in Py that in our samples sets in at thickness larger than 300 nm., Comment: accepted for publication on New Journal of Physics, available online http://iopscience.iop.org/article/10.1088/1367-2630/aa5de8

Bulk heterojunction films made of polychiral single-walled carbon nanotubes (SWCNTs) form efficient heterojunction solar cells with n-type crystalline silicon (n-Si), due to their superior electronic, optical, and electrical properties. The films are multi-functional, since their hierarchical surface morphology provides a biomimetical anti-reflective, air-stable, and hydrophobic encapsulation for Si. Also, the films have a large effective area conferring them high optical absorption, which actively contribute to the solar energy harvesting together with Si. Here, we report photovoltaic devices with photoconversion efficiency up to 12% and a record 100% internal quantum efficiency (IQE). Such unprecedented IQE value is truly remarkable and indicates that every absorbed photon from the device, at some wavelengths, generates a pair of separated charge carriers, which are collected at the electrodes. The SWCNT/Si devices favor high and broadband carrier photogeneration; charge dissociation of ultra-fast hot excitons; transport of electrons through n-Si and high-mobility holes through the SWCNT percolative network. Moreover, by varying the film thickness, it is possible tailoring the physical properties of such a two-dimensional interacting system, therefore the overall device features. These results not only pave the way for low-cost, high-efficient, and broadband photovoltaics, but also are promising for the development of generic SWCNT-based optoelectronic applications.

Films of multiwall carbon nanotubes (CNTs), arranged on Si/SiO2 substrates, are used as templates for Nb films with thickness in the range 3e50 nm deposited by sputtering. The resulting aggregates show normal state and superconducting properties similar to those observed in networks of superconducting nanowires (SNW) obtained by other methods. Decreasing the Nb thickness, when the normal state resistance becomes larger than the quantum resistance, a superconductor-insulator transition is observed. Moreover, thermally activated phase slips in thicker samples, evolving in quantum phase slips in thinner nanowires, are observed in the superconducting state. The experimental results indicate that the template method based on CNTs is a promising alternative to the much more expensive nanolithography techniques for obtaining SNWs. Even more important, they indicate CNT films as versatile elements in nanostructured electronic devices.

EBV-associated post transplant lymphoproliferative disease (EBV-PTLD) is a life-threatening complication that may occur after hemopoietic SCT. We prospectively screened 80 children on a weekly basis using nested quantitative PCR to evaluate EBV genome copies. EBV viral load1000 copies per 10(5) PBMC was observed in 63% of transplants, whereas it was between 1000 and 9999 copies per 10(5) PBMC in 13%, and between 10 000 and 19 999 in 10%, with no significant increase in percentage of CD20+ lymphocytes. Viral load reachedor = 20 000 copies per 10(5) PBMC in 14% of patients, and rituximab was administered to 75% of them. None of the patients except one developed a lymphoproliferative disease. Our study found that only 13% of unrelated donor HSCT recipients had a very high risk of EBV-PTLD defined asor = 20 000 geq per 10(5) PBMC associated with an increase in CD20+ lymphocyte. We suggest that rituximab could be administered in the presence of very high levels of EBV-DNA viral load or in the presence of mid levels of EBV-DNA viral load associated with an increase in the percentage of CD20+ lymphocytes. Through this approach, we significantly reduced the number of patients treated with rituximab, and consequently the acute and chronic adverse events related to this treatment.

Background and Aim: Enteric glial cells (EGC) are involved in intestinal inflammation and can be activated by exogenous stimuli, and foreign antigens (i.e. gliadin). Toll-Like Receptors (TLRs) are immune receptors able to recognize pathogen conserved molecular patterns. Whether EGC express TLRs or respond to bacterial stimuli is unknown. We aimed to investigate if TLRs are expressed by human EGC and if their expression is differentially modulated by pathogens or probiotics bacteria. Materials and Methods: Pure EGC were obtained according to method previously described by our group. Briefly, myenteric plexus preparations were isolated from ileum of patients undergoing surgery and enzimatically dissociated. Ganglia were plated and cell cultures were grown to subconfluence. After 21days, EGC were purified using Dynal Magnet® and characterized by immunofluorescence to confirm the absence of contaminating cells (i.e. fibroblasts). TLRs 1, 2, 4, 7 and 9 mRNA expression were evaluated at baseline and after 24 hours (h) incubation of EGC with the probiotic strain Lactobacillus Paracasei F19 (LP F19) and the pathogen Enteroinvasive Escherichia coli (EIEC). The bacteria/cells ratio was 0.1/1 and 100/1. Quantitative Real Time PCR was performed to evaluate specific mRNAs fold increases respect to untreated controls. Data were obtained with 3 experiments and expressed as mean±SD. Results: Human purified EGC physiologically expressed TLR 1, 2, 4, 7 and 9 mRNAs, with TLR 1 and 4 transcripts being the most expressed. With a bacteria/cells ratio of 0.1/1, EIEC induced a higher significant increase than LP F19 of TLR 2 (4.1±0.1 and 2.7±0.4; p

Background and Aim: Previous data show that psychological stress may alter gastric sensorymotor function. Neuro-hormonal mechanisms underlying this phenomenon in dyspeptic patients remain to be clarified. Aim of the present study is to assess autonomic nervous system activity and hypothalamic-pituitary-adrenal (HPA) axis hormones in response to mental stress before and after meal in dyspeptic patients. Subjects and methods: Fifteen patients with postprandial distress syndrome (PDS) (8 M, 21-40 years) and eight healthy controls (4 M, 19-28 years) underwent electrogastrography (EGG) and gastric emptying study (13C-octanoic acid breath test) using a 480 Kcal solid meal. Heart rate variability assessment (LF/HF ratio) by ECG and CRF, ACTH and cortisol on serum samples collected every 30 minutes for 5 hours were also evaluated. Dyspeptic symptoms (postprandial fullness and early satiety) were scored at same time points by analogue visual scale and expressed as sum of total symptoms scores (TSS). The study protocol, with and without a standardized mental stress (MS) test (serial numeric calculations for ten minutes) before the meal, was repeated in a random order in two different days. Results: Dyspeptic symptoms were present only in patients and were exclusively meal-related. In patients, but not in controls, MS significantly increased symptoms severity (TSS: 738±635 vs 288±301, p