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The objective of this study was to extract the rapeseed protein from by-products and further examine the effect of lab-made rapeseed protein on the droplet size, microstructure, colour, encapsulation and apparent viscosity of emulsions. Rapeseed protein-stabilised emulsions with an increasing gradient of milk fat or rapeseed oil (10, 20, 30, 40 and 50%, v/v) were fabricated using a high shear rate homogenisation. All emulsions showed 100% oil encapsulation for 30 days of storage, irrespective of lipid type and the concentration used. Rapeseed oil emulsions were stable against coalescence, whereas the milk fat emulsion showed a partial micro-coalescence. The apparent viscosity of emulsions raised with increased lipid concentrations. Each of the emulsions showed a shear thinning behaviour, a typical behaviour of non-Newtonian fluids. The average droplet size was raised in milk fat and rapeseed oil emulsions when the concentration of lipids increased. A simple approach to manufacturing stable emulsions offers a feasible hint to convert protein-rich by-products into a valuable carrier of saturated or unsaturated lipids for the design of foods with a targeted lipid profile.

The objective of the present study is to simulate the spectral gamma-ray response of the Swiss Airborne Gamma-Ray Spectrometry system (SAGRS) using Monte Carlo radiation transport codes. The SAGRS is mounted in the cargo bay of a AS-332M1 Super Puma helicopter from the Swiss Air Force and consists of four prismatic NaI(Tl) scintillation crystals with a total volume of 16.8 l. We developed a high-fidelity Monte Carlo model of the SAGRS including the detector system and the helicopter using the multi-purpose radiation transport code FLUKA. As part of the measurement campaign ARM22c organized by the National Emergency Operations Centre (NEOC), we performed hover and line flights in combination with ground measurements using certified 133Ba and 137Cs point sources to validate our model. The performed measurements revealed a significant impact of the helicopter fuel on the detector response for various solid angles. In general, we found an excellent agreement between the measured and simulated detector response with relative errors in the full energy peak

Background Arterioureteral fistula refers to the anomalous fistulous connection between the iliac artery and the ureter. It is often associated with pelvic malignancy, abdominal surgery, and radiation. As it is a potentially life-threatening condition, prompt diagnosis and management is essential. Methods We performed a retrospective analysis of patients treated for arterioureteral fistula in a single-vascular institution from January 2013 to March 2019. Preoperative assessment included physical and laboratory examinations and medical history, with diagnosis established through computed tomography angiography, digital subtraction angiography, or ureteroscopy. Parameters analyzed included perioperative mortality and morbidity as well as treatment durability during midterm follow-up. Results Nine patients with ten arterioureteral fistulas were included in the study. Macroscopic hematuria was the main presenting symptom, with 2 patients admitted due to hemorrhagic shock. Endovascular treatment was carried out in 6 patients. In 4 cases, single stent-graft deployment inside the common iliac artery was performed, in one case in combination with plugging of the internal iliac artery. One patient underwent implantation of an iliac-branched device, whereas in another patient coiling of the internal iliac artery sufficed for management of the fistula. Open surgical repair was carried out in three cases. Perioperative mortality was zero; one patient had prolonged hospital stay due to superficial wound infection. Recurrent hematuria and stent-graft infection were observed during follow-up in three patients after endovascular repair, all of them treated through open surgery with no further complications. One patient developed an enterocutaneous fistula after open repair during follow-up and required redo surgery. Discussion Arterioureteral fistula is a challenging clinical scenario demanding prompt diagnosis and management. Open surgery remains the treatment of choice in cases of preexisting vascular reconstruction or manifest infection. Endovascular techniques offer a viable solution in significantly comorbid patients or in patients presenting with acute, life-threatening bleeding. Rigorous follow-up is required regardless of treatment modality due to the considerable rate of reinterventions.

Purpose Open surgical repair of type Ia endoleak after endovascular aortic aneurysm repair/sealing (EVAR/EVAS) is associated with significant perioperative mortality and morbidity. Current endovascular redo techniques face limitations, especially when the infrarenal landing zone is inadequate and the previous endograft is rigid and features a short or no main body. We present a novel concept for the treatment of type Ia endoleak using a custom-made branched device. Technique The 5-branch-device (Cook Medical, Bloomington, IN, USA) consists of a nitinol skeleton with branches, covered with a low-profile polyester fabric loaded in an 18F sheath. The device features a minimum of 2 proximal sealing stents and includes branches for renovisceral vessels as well as an additional 8 mm branch for the contralateral iliac limb. Implantation and sealing in the renovisceral vessels is carried out in standard fashion, using transfemoral and transaxillary access. Distal sealing is achieved by tapering the branched component into the ipsilateral iliac limb and using a bridging balloon-expandable or self-expandable stent-graft through the additional branch to the preexisting contralateral iliac limb. Conclusion Treatment of type Ia endoleak with a new custom-made device enables sufficient proximal seal while minimizing suprarenal aortic coverage and facilitates adequate component overlap. The low profile branched design accommodates implantation through the preexisting endograft and catheterization of target vessels.

Contains fulltext : 249977.pdf (Publisher’s version ) (Closed access) BACKGROUND: It is important to evaluate whether a new treatment for heart failure with reduced ejection fraction (HFrEF) provides additive benefit to background foundational treatments. As such, we aimed to evaluate the efficacy and safety of empagliflozin in patients with HFrEF in addition to baseline treatment with specific doses and combinations of disease-modifying therapies. METHODS: We performed a post-hoc analysis of the EMPEROR-Reduced randomised, double-blind, parallel-group trial, which took place in 520 centres (hospitals and medical clinics) in 20 countries in Asia, Australia, Europe, North America, and South America. Patients with New York Heart Association (NYHA) classification II-IV with an ejection fraction of 40% or less were randomly assigned (1:1) to receive the addition of either oral empagliflozin 10 mg per day or placebo to background therapy. The primary composite outcome was cardiovascular death and heart failure hospitalisation; the secondary outcome was total heart failure hospital admissions. An extended composite outcome consisted of inpatient and outpatient HFrEF events was also evaluated. Outcomes were analysed according to background use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) or angiotensin receptor neprilysin inhibitors (ARNIs), as well as β blockers and mineralocorticoid receptor antagonists (MRAs) at less than 50% or 50% or more of target doses and in various combinations. This study is registered with ClinicalTrials.gov, NCT03057977. FINDINGS: In this post-hoc analysis of 3730 patients (mean age 66·8 years [SD 11·0], 893 [23·9%] women; 1863 [49·9%] in the empagliflozin group, 1867 [50·1%] in the placebo group) assessed between March 6, 2017, and May 28, 2020, empagliflozin reduced the risk of the primary outcome (361 in 1863 participants in the empagliflozin group and 462 of 1867 in the placebo group; HR 0·75 [95% CI 0·65-0·86]) regardless of background therapy or its target doses for ACE inhibitors or ARBs at doses of less than 50% of the target dose (HR 0·85 [0·69-1·06]) and for doses of 50% or more of the target dose (HR 0·67 [0·52-0·88]; p(interaction)=0·18). A similar result was seen for β blockers at doses of less than 50% of the target dose (HR 0·66 [0·54-0·80]) and for doses of 50% or more of the target dose (HR 0·81 [0·66-1·00]; p(interaction)=0·15). Empagliflozin also reduced the risk of the primary outcome irrespective of background use of triple therapy with an ACE inhibitor, ARB, or ARNI plus β blocker plus MRA (given combination HR 0·73 [0·61-0·88]; not given combination HR 0·76 [0·62-0·94]; p(interaction)=0·77). Similar patterns of benefit were observed for the secondary and extended composite outcomes. Empagliflozin was well tolerated and rates of hypotension, symptomatic hypotension, and hyperkalaemia were similar across all subgroups. INTERPRETATION: Empagliflozin reduced serious heart failure outcomes across doses and combinations of disease-modifying therapies for HFrEF. Clinically, these data suggest that empagliflozin might be considered as a foundational therapy in patients with HFrEF regardless of their existing background therapy. FUNDING: Boehringer Ingelheim and Eli Lilly and Company.

Branched endovascular aneurysm repair (B-EVAR) is increasingly becoming the treatment of choice for thoracoabdominal aneurysms and can be applied to pathologies extending from the aortic arch to the iliac bifurcation. There is a multitude of different configurations for branched devices, with several companies developing either custom-made endografts or off-the-shelf systems that can accommodate aneurysms in the acute setting. Despite increasing B-EVAR applicability, endovascular treatment of thoracoabdominal aneurysms remains a challenging clinical scenario with a number of perioperative parameters and technical aspects influencing outcome. This chapter will provide an overview of specific challenges and pitfalls associated with B-EVAR, tips and tricks for accurate endograft planning and implantation, as well as perioperative patient management and follow-up.

This paper deals with the constraints imposed on error compensation systems by their implementation strategies. Constraints stemming from the structure of the control system with an NCK architecture of the ADCBI type are presented. Practical realizations of compensation and potential solutions offered by contemporary commercial CNC controllers are discussed.

Aim: To clinically validate the 40-gene expression profile (40-GEP) test for cutaneous squamous cell carcinoma patients and evaluate coupling the test with individual clinicopathologic risk factor-based assessment methods. Patients & methods: In a 33-site study, primary tumors with known patient outcomes were assessed under clinical testing conditions (n = 420). The 40-GEP results were integrated with clinicopathologic risk factors. Kaplan–Meier and Cox regression analyses were performed for metastasis. Results: The 40-GEP test demonstrated significant prognostic value. Risk classification was improved via integration of 40-GEP results with clinicopathologic risk factor-based assessment, with metastasis rates near the general cutaneous squamous cell carcinoma population for class 1 and ≥50% for class 2B. Conclusion: Combining molecular profiling with clinicopathologic risk factor assessment enhances stratification of cutaneous squamous cell carcinoma patients and may inform decision-making for risk-appropriate management strategies.

Objective Over 50% of newly diagnosed cutaneous squamous cell carcinoma (cSCC) lesions occur in the head and neck (cSCC‐HN), and metastasis to nodal basins in this region further complicates surgical and adjuvant treatment. The current study addressed whether the 40‐gene expression profile (40‐GEP) test can predict metastatic risk in cSCC‐HN with improved accuracy and provide independent prognostic value to complement current risk assessment methods. Study Design Multicenter, retrospective cohort study. Methods Formalin‐fixed paraffin‐embedded primary tumor tissue and associated clinical data from patients with cSCC‐HN (n = 278) were collected from 33 independent centers. Samples were analyzed via the 40‐GEP test. Cases were staged per American Joint Committee on Cancer, Eighth Edition (AJCC8) and Brigham and Women's Hospital (BWH) criteria after comprehensive medical record and pathology report review. Metastasis‐free survival (MFS) rates were determined, and risk factors were analyzed via Cox regression. Results The 40‐GEP test classified the cohort into low (Class 1, n = 126; 45.3%), moderate (Class 2A, n = 134; 48.2%), and high (Class 2B, n = 18; 6.5%) metastatic risk at 3 years postdiagnosis. Regional/distant metastasis occurred in 54 patients (19.4%). MFS rates were 92.1% (Class 1), 76.1% (Class 2A), and 44.4% (Class 2B; p

Continuing our studies on the mechanisms underlying the cytotoxicity of potential drugs, we have described several aspects of the in vitro anticancer activity of ruthenium(II) and platinum(II) complexes with bioactive, synthetic aminoflavone ligands. We examined the mechanism of proapoptotic activity of cis-dichlorobis(3-imino-2-methoxyflavanone)ruthenium(II), cis-dichlorobis(3-imino-2-ethoxyflavanone)ruthenium(II), and trans-dichlorobis(3-aminoflavone)platinum(II). Cisplatin was used as a reference compound. The cytotoxicity was investigated by MTT assay. The mechanism of proapoptotic activity of the tested compounds was investigated by evaluation of caspase-8 activity, cytometric analysis of annexin-V positive cells, and mitochondrial potential loss measurement. The results showed that ruthenium compounds break partially or completely the cisplatin resistance by activating the caspase 8-dependent apoptosis pathway and loss of mitochondrial membrane potential. Platinum compounds also have a cytostatic effect, but their action requires more exposure time. Potential mechanisms underlying drug resistance in the two pairs of cancer cell lines were investigated: total glutathione content, P-glycoprotein activity, and differences in the activity of DNA repair induced by nucleotide excision. Results showed that cisplatin-resistant cells have elevated glutathione levels relative to sensitive cells. Moreover, they indicated the mechanisms enabling cells to avoid apoptosis caused by DNA damage. Pg-P activity has no effect on the development of cisplatin resistance in the cell lines described.

To evaluate the incidence of acute renal failure and chronic kidney disease due to occlusion of accessory renal arteries during endovascular aneurysm repair of infrarenal abdominal aortic aneurysm. We retrospectively reviewed the course of 181 patients (mean age, 71, SD ± 9 years) who underwent EVAR of infrarenal abdominal aortic aneurysm. The renal vessel anatomy was analyzed in all pre- and postoperative CT scans. Diameter and origin of accessory renal arteries were evaluated. Renal function was determined by pre- and postoperative serum creatinine and eGFR levels. Long-term follow-up (>3 months) of patients was available in 121 cases (66.9%). Acute kidney injury and chronic kidney failure were defined according to guidelines of “Kidney Disease: Improving Global Outcomes” (KDIGO). In 65 of 181 patients (33.9%), 82 accessory renal arteries were identified preoperatively. In 19 of 181 patients (10.5%), one or more accessory renal arteries were covered and subsequently occluded by the implanted stent-graft device. Neither acute kidney injury (10.3% vs 12.5%; p = .785) nor chronic kidney disease (10.7% vs 15.38%; p = .452) was detected significantly more often in patients with covered accessory renal artery. The only significant predictor of acute kidney injury was the preoperative serum creatinine level (1.12 mg/dl vs. 0.98 mg/dl; p = .03). Significant predictors for chronic kidney disease were preoperative serum creatinine, eGFR, and impaired renal function (p

MINI: The objective of this study was to evaluate the outcome of endovascular repair of chronic aortic arch dissecting aneurysms with a custom-made branched endograft during follow-up after acute type A aortic dissection open repair. Unmatched outcomes are reported in a population at high risk for a redo sternotomy. OBJECTIVE The objective of this study was to evaluate the outcome of endovascular aortic arch repair for chronic dissection with a custom-made branched endograft. BACKGROUND Acute type A aortic dissections are often treated with prosthetic replacement of the ascending aorta. During follow-up, repair of an aneurysmal evolution of the false lumen distal to the ascending prosthesis can be a challenge both for the surgeon and the patient. METHODS We conducted a multicenter, retrospective study of consecutive patients from 14 vascular units treated with a custom-made, inner-branched device (Cook Medical, Bloomington, IN) for chronic aortic arch dissection. Rates of in-hospital mortality and stroke, technical success, early and late complications, reinterventions, and mortality during follow-up were evaluated. RESULTS Seventy consecutive patients were treated between 2011 and 2018. All patients were considered unfit for conventional surgery. In-hospital combined mortality and stroke rate was 4% (n = 3), including 1 minor stroke, 1 major stroke causing death, and 1 death following multiorgan failure. Technical success rate was 94.3%. Twelve (17.1%) patients required early reinterventions: 8 for vascular access complication, 2 for endoleak correction, and 2 for pericardial effusion drainage. Median follow-up was 301 (138-642) days. During follow-up, 20 (29%) patients underwent secondary interventions: 9 endoleak corrections, 1 open repair for prosthetic kink, and 10 distal extensions of the graft to the thoracic or thoracoabdominal aorta. Eight patients (11%) died during follow-up because of nonaortic-related cause in 7 cases. CONCLUSIONS Endovascular treatment of aortic arch chronic dissections with a branched endograft is associated with low mortality and stroke rates but has a high reintervention rate. Further follow-up is required to confirm the benefits of this novel approach.

Objective: The objective of this study was to investigate the feasibility of a specific custom-made fenestrated aortic cuff in the treatment of complex abdominal aortic aneurysms (AAAs).Methods: Between 2013 and 2016, a total of 57 custom-made Fenestrated Anaconda (Vascutek, Inchinnan, Scotland, UK) aortic cuffs were placed in 38 centers worldwide. All centers were invited to participate in this retrospective analysis. Postoperative and follow-up data included the presence of adverse events, necessity for reintervention, and renal function.Results: Fifteen clinics participated, leading to 29 cases. Median age at operation was 74 years (interquartile range [IQR], 71-78 years); five patients were female. Two patients were treated for a para-anastomotic AAA after open AAA repair, 19 patients were treated because of a complicated course after primary endovascular AAA repair, and 8 cases were primary procedures for AAA. A total of 76 fenestrations (mean, 2.6 per case) were used. Four patients needed seven adjunctive procedures. Two patients underwent conversion, one because of a dissection of the superior mesenteric artery and one because of perforation of a renal artery. Median operation time was 225 minutes (IQR, 150-260 minutes); median blood loss, 200 mL (IQR, 100-500 mL); and median contrast volume, 150 mL (IQR, 92-260 mL). Primary technical success was achieved in 86% and secondary technical success in 93%. The 30-day morbidity was 7 of 29 with amortality rate of 4 of 29. Estimated glomerular filtration rate remained unchanged before and after surgery (76 to 77 mL/min/m(2)). Between preoperative and median follow-up of 11 months, estimated glomerular filtration rate was reduced statistically significantly (76 to 63 mL/min/m(2)). During follow-up, 9 cases had an increase in aneurysm sac diameter (5 cases > 5 mm); 14 cases had a stable or decreased aneurysm sac diameter; and in 2 cases, no aneurysm size was reported. No type I endoleak was reported, and two cases with a type III endoleak were treated by endovascular means during follow-up. Survival, reintervention-free survival, and target vessel patency at 1 year were 81% +/- 8%, 75% +/- 9%, and 99% +/- 1%, respectively. After 2 years, these numbers were 81% +/- 8%, 67% +/- 11%, and 88% +/- 6%, respectively. During follow-up, the two patients with a type III endoleak needed endograft-related reinterventions.Conclusions: Treatment with this specific custom-made fenestrated aortic cuff is feasible after complicated previous (endovascular) aortic repair or in complex AAAs. The complexity of certain AAA cases is underlined in this study, and the Fenestrated Anaconda aortic cuff is a valid option in selected cases in which few treatment options are left.

Early complications after aortic surgery, such as bleeding, vessel occlusion, and organ ischemia require quick and targeted diagnostics to reduce the morbidity and mortality. Ultrasound can be used for quick bedside diagnosis of vascular and organ complications. The possibilities of color duplex and contrast-enhanced ultrasound for the detection of vascular and organ complications after aortic surgery are presented. Vascular access complications, such as acute vessel occlusion, stenosis, dissection, bleeding, hematoma, and false aneurysms can be detected by color duplex ultrasound. The differentiation between hematoma and active bleeding is possible with contrast-enhanced ultrasound. Ultrasound contrast imaging enables the evaluation of hemodynamically relevant dissections and intraluminal thrombi. Furthermore, contrast-enhanced ultrasound enables the differential diagnostics of acute kidney failure and a differentiation between complete or partial organ ischemia. The use of bedside ultrasound for quick detection of early complications after aortic surgery enables optimization of the perioperative management of complications. Further diagnostic and therapeutic interventions can be used in a targeted manner, if necessary. Unnecessary exposure to nephrotoxic radiopaque agents and X‑rays and the risks involved in transportation of critically ill patients can therefore be avoided.

Purpose: The work objective includes optimization of the casting production and heat treatment processes that will simultaneously maximize the combination of strength, hardness, and ductility for hypereutectic Al-Si compositions with Si volume fractions of as much as 25 vol.%. In addition, such an in-situ formed composite alloy will attain a unique combination of low production cost, high potential recycled content, and functional characteristics suitable for mission critical aerospace and vehicular applications. Design/methodology/approach: The unique High Pressure Die Casting Universal Metallurgical Simulator and Analyser (HPDC UMSA) was used for melting, cyclic melt treatment, and solidification of the hypereutectic Al-Si-X (A390). The produced as-cast structures contained colonies of nano-diameter Si whiskers and other morphologies, and absence of primary silicon particles. Heat treated structures rendered nano and ultrafine metal matrix composites. Findings: New developed as-cast Al-Si materials containing nano-diameter Si whiskers, without primary silicon particles required ultra short time heat treatment to result in nano and ultrafine metal matrix composite, rendering their hardness, strength and wear resistance, and the same time retaining toughness and ductility. Research limitations/implications: The cast samples were produced in laboratory conditions and potential tensile strength was estimated from empirical correlation with micro-hardness measurements. In the future, the comprehensive mechanical properties need to be tested. Practical implications: These ultrafine Si, Al-MMCs can be net-shape formed by modified HPDC technology or consolidated from spray-atomized alloy powder. Originality/value: Optimization of the entire production process for the hypereutectic Al-Si alloy compositions achieved a uniform distribution of ~ 25 vol.% of ultrafine Si particles in ductile FCC-Al matrix further reinforced by age hardening with nano-scale spinodal GP-zones. The associated mechanical property and ductility improvements will open a wide range of critical lightweighting components in transportation: aerospace, terrestrial vehicle and marine to the optimized hypereutectic Al-Si alloys. Presently, these components do not use the commercial HPDC A390 alloys due to their limited ductility and strength. Proposed new technology will allow conversion of various cast airspace alloys with ultrahigh mechanical properties to the automotive applications.

OBJECTIVES: Patients surviving acute aortic dissection are at risk of developing a post-dissection thoraco-abdominal aortic aneurysm (PD-TAAA) during follow up, regardless of the type of treatment in the acute setting. Fenestrated and branched stent grafting (F/B-TEVAR) has been used with success to treat PD-TAAA, albeit reported only with short-term results. The aim of this study was to report mid-term results in a cohort of 71 patients. METHODS: This was a retrospective analysis of a prospectively maintained database including all patients with PD-TAAAs who underwent F/B-TEVAR within the period January 2010 - April 2017 at two vascular institutions experienced in endovascular techniques. RESULTS: A total of 71 consecutive patients (56 male, mean age 63.8 ± 10.6 years) were treated. Technical success was achieved in 68/71 (95.8%) patients. In hospital mortality was four (5.6%) patients. Peri-operative morbidity was 19.6%. Three (4.2%) patients developed severe spinal cord ischaemia, one of these patients 12 months post-operatively. Mean follow up was 25.3 months (1-77 months). Cumulative survival rates at 12, 24, and 36 months were 84.7 ± 4.5%, 80.7 ± 5.1%, and 70.0 ± 6.7%, respectively. Estimated freedom from re-intervention at 12, 24, and 36 months was 80.7 ± 5.3%, 63.0 ± 6.9%, and 52.6 ± 8.0%, respectively. The main reasons for re-intervention were endoleak from visceral/renal arteries and iliac endoleak requiring extension. Target vessel occlusion occurred in 8/261 (3.1%) vessels (renal artery n = 4; superior mesenteric artery n = 2; coeliac artery n = 2). Mean aneurysm sac regression during follow up was 9.2 ± 8.8 mm, with a false lumen thrombosis rate of 85.4% for patients with a follow up longer than 12 months. No ruptures occurred during follow up. CONCLUSION: F/B-TEVAR for post-dissection TAAA is feasible and associated with low peri-operative mortality and peri-operative morbidity. Mid-term results demonstrate a high rate of aneurysm sac regression. Rigorous follow up is required because of the significant re-intervention rate. Longer bridging covered stents for target vessels are advised. ispartof: Eur J Vasc Endovasc Surg vol:57 issue:1 pages:102-109 ispartof: location:England status: published

Voltage-source integrated gate drivers can be used to drive FET transistors at wide frequency ranges, even up to 30 MHz. However, many problems arise such as: problems with heat dissipation, high output impedance, gate waveform distortion. This paper presents a current-source gate driver with a step-down transformer, dedicated for high frequency driving of GaN FETs. The usage of a step-down transformer provides impedance and voltage matching between primary and secondary side. Theoretical analysis, optimization model, simulation results and laboratory setup results are included. TP65H035WS GaN cascode transistor was driven at two frequency values of about 13.56 MHz and 27.12 MHz.

Objective: To date, information on the fenestrated Anaconda endograft is limited to case series with a small sample size. This study was performed to assess the technical and clinical outcome of this device in a large international case series. Methods: All worldwide centers having treated more than 15 complex abdominal aortic aneurysms (AAA) or type IV thor- acoabdominal aortic aneurysm patients with the fenestrated Anaconda endograft were approached. Main outcome pa- rameters were procedural technical success, postoperative and follow-up clinical outcome for endoleaks, target vessel patency, reintervention rate, and patient survival. Results: Three hundred thirty-five consecutive cases treated between June 2010 and May 2018 in 11 sites were included. Patients were treated for a short neck infrarenal (n = 98), juxtarenal (n =191), suprarenal AAA (n = 27), or type IV thoracoabdominal aortic aneurysm (n =19). Mean age was 73.6 ? 4.6 years (292 male). Endografts contained a total of 920 fenestrations, with a mean of 2.7 ? 0.8 fenestrations per case. Technical success was 88.4% (primary, 82.7%; assisted primary 5.7%). In 6.9% of cases, a pro- cedural type IA endoleak was observed, spontaneously disappearing in 82.6% during early follow-up. The development of a type IA endoleak was associated with greater neck angulation (odds ratio [OR], 0.94; P = .01), three fenestrations (OR, 42.7; P = .01) and the presence of augmented proximal rings (OR, 0.17; P = .03). Median follow-up was 1.2 years (interquartile range, 0.4-2.6). The mean estimated glomerular filtration rate deteriorated from 67.6 ? 19.3 mL/min/1.73 m 2 preoperatively to 59.3 ? 22.7 mL/min/ 1.73 m 2 at latest follow-up ( P = .00). The freedom from AAA growth were 97.9 ? 0.9% (n =190) and 86.4 ? 3.0% (n = 68), with a freedom from AAA rupture of 99.7 ? 0.3% (n = 191) and 99.1 ? 0.7% (n = 68), at 1 and 3 years, respectively. The endoleak-free survival, excluding spontaneously resolved procedural endoleaks, at 1 and 3 years was 73.4 ? 2.6 (n = 143) and 65.6 ? 3.4% (n = 45), respectively. The target vessel patency at one and three years were 96.4 ? 0.7% (n = 493) and 92.7 ? 1.4% (n = 156), respectively. A total of 75 reinterventions were done in 64 cases (19.1%), of which 25 cases for an endoleak. The reintervention-free survival at 1 and 3 years were 83.6 ? 2.2% (n = 190) and 71.0 ? 3.7% (n = 68), respectively. No deaths during procedure, extending within 24 hours postoperatively, were observed. Within 30 days 14 patients (4.2%) died and during follow-up another 39 patients (11.6%) died. Three deaths were considered AAA related (one rupture, one endograft infection, and one bilateral renal artery occlusion). The estimated cumulative survival at 1 and 3 years were 89.8 ? 1.8% (n =191) and 79.2 ? 3.0% (n = 68), respectively. Conclusions: The custom-made fenestrated Anaconda endograft is a valuable option for the treatment of a complex AAA. A procedural type IA endoleak is seen relatively frequently, but spontaneously resolves in most cases. (J Vasc Surg 2020;72:25-35.)

To evaluate short term outcomes related to the use of the Zenith TX2 Dissection Endovascular Graft (ZDEG) and the Zenith Dissection Bare stent (ZDES) for the treatment of Stanford type B aortic dissections.This retrospective multicenter case cohort study collated data from 10 European institutions for patients with both complicated and uncomplicated type B aortic dissection treated with ZDEG and ZDES between 2011 and 2018. The primary end point was mortality at 30 and 90 days. Secondary end points included complications related to TEVAR, such as, type Ia endoleak, stroke, paraparesis, paraplegia, and retrograde type A dissection (RTAD). Statistical analysis was carried out using the t test, or one-way analysis of variance and the χWe treated 120 patients (87 male; mean age, 62.7 ± 12.2years) either in the acute 76 (63.3%), subacute 16 (13.3%), or chronic 28 (23.3%) phase. Seven patients (5.8%) died within 30 days after the index procedure and two (1.7%) between 30 and 90 days. There was one instance of postoperative RTAD in a patient treated for rupture. Stroke and paraplegia occurred in three (2.5%) and five (4.2%), patients, respectively. Eight patients (6.7%) had a type Ia endoleak in the perioperative period. There were no instances of paraplegia, no permanent dialysis, and no requirement for adjunctive superior mesenteric or celiac artery stenting in the 33 patients (27.5%) who were treated by concurrent placement of ZDES distal to the ZDEG. The length and distal oversizing of ZDEG components used was less in this group.The present series demonstrates a low (1%) RTAD rate and favorable morbidity and mortality. The lower rate of paraplegia, dialysis, and visceral artery stenting in the cohort that had adjunctive use of ZDES is compelling and merits further assessment.

Nucleotide excision repair (NER) is a DNA repair pathway present in all domains of life. In bacteria, UvrA protein localizes the DNA lesion, followed by verification by UvrB helicase and excision by UvrC double nuclease. UvrA senses deformations and flexibility of the DNA duplex without precisely localizing the lesion in the damaged strand, an element essential for proper NER. Using a combination of techniques, we elucidate the mechanism of the damage verification step in bacterial NER. UvrA dimer recruits two UvrB molecules to its two sides. Each of the two UvrB molecules clamps a different DNA strand using its β-hairpin element. Both UvrB molecules then translocate to the lesion, and UvrA dissociates. The UvrB molecule that clamps the damaged strand gets stalled at the lesion to recruit UvrC. This mechanism allows UvrB to verify the DNA damage and identify its precise location triggering subsequent steps in the NER pathway.

Improving healthy food access in low-income communities continues to be a public health challenge. One strategy for improving healthy food access has been to introduce community food stores, with the mission of increasing healthy food access; however, no study has explored the experiences of different initiatives and models in opening and sustaining healthy food stores. This study used a case study approach to understand the experiences of healthy food stores in low-income communities. The purpose of this paper is to describe the methodology used and protocol followed. A case study approach was used to describe seven healthy food stores across urban settings in the U.S. Each site individually coded their cases, and meetings were held to discuss emerging and cross-cutting themes. A cross-case analysis approach was used to produce a series of papers detailing the results of each theme. Most case studies were on for-profit, full-service grocery stores, with store sizes ranging from 900 to 65,000 square feet. Healthy Food Availability scores across sites ranged from 11.6 (low) to 26.5 (high). The papers resulting from this study will detail the key findings of the case studies and will focus on the challenges, strategies, and experiences of retail food stores attempting to improve healthy food access for disadvantaged communities. The work presented in this special issue will help to advance research in the area of community food stores, and the recommendations can be used by aspiring, new, and current community food store owners.

Fruhkomplikationen nach Aorteneingriffen wie Blutung, Gefasverschluss oder Organischamie erfordern eine rasche und zielfuhrende Diagnostik, um Morbiditat und Mortalitat zu senken. Der bettseitige Ultraschall kann zur schnellen Diagnostik bei Gefas- und Organkomplikationen eingesetzt werden. Es werden die Moglichkeiten der Farbduplex- und Kontrastmittelsonographie nach Aorteneingriffen zur Diagnostik bei Gefas- und Organkomplikationen dargestellt. Gefaszugangskomplikation wie akuter Verschluss, Stenose, Dissektion, Blutung, Hamatom oder Aneurysma spurium lassen sich mittels Farbduplexsonographie diagnostizieren. Die Unterscheidung zwischen Hamatom und aktiver Blutung ist mittels Kontrastmittelsonographie moglich. Die Relevanz von Dissektionen oder intraluminalen Thromben kann durch die Ultraschallkontrastdarstellung eingeschatzt werden. Die Kontrastmittelsonographie ermoglicht ferner die Differenzialdiagnostik des akuten Nierenversagens sowie eine Unterscheidung zwischen kompletter und partieller Organischamie. Der Einsatz des bettseitigen Ultraschalls zur schnellen Diagnostik bei Fruhkomplikationen nach Aorteneingriffen ermoglicht eine Optimierung des perioperativen Komplikationsmanagements und damit die zielgerichtete Einleitung weiterer diagnostischer und therapeutischer Masnahmen, wenn erforderlich. Eine unnotige, nephrotoxische Kontrastmittel- und Strahlenexposition sowie das Risiko des Transports von kritisch kranken Patienten konnen so vermieden werden.

In order to achieve required mechanical properties of hardened elements, such as gear wheels, dual-frequency induction heating may be used. Dual-frequency allows heating only the outline of the gear, due to mixed penetration depth of the subject frequencies. This method of hardening requires the process to be very short as heat may spread by means of conduction. This study presents a 3 kW prototype inverter and its control scheme is used to generate dual-frequency output current. The overall efficiency of the inverter is 96%. An analysis of the output resonant circuit is made to find the resonant frequencies. Finally, circuit and finite element method (FEM) simulations are coupled to analyse the effect of dual-frequency current on the magnetic field, current density, and energy density on the surface of a gear wheel.

Zusammenfassung Einleitung Viszeralarterienaneurysmen (VAA) sind selten und werden meist als Zufallsbefund entdeckt. Die Indikation zur Behandlung besteht bei symptomatischen Patienten, Pseudoaneurysmen sowie bei asymptomatischen Patienten bei einer Größe von mehr als 2,5 cm (Viszeralarterienaneurysmen) bzw. mehr als 3 cm (Nierenarterienaneurysmen), bei Schwangeren und vor einer Lebertransplantation. Neben der erfolgreichen, operativen oder endovaskulären Ausschaltung des Aneurysmas ist der Erhalt der Organperfusion wichtig. Die folgende Arbeit stellt das Management von Viszeralarterienaneurysmen und die Erfahrungen über einen Zeitraum von mehr als 20 Jahren dar und zeigt einen Behandlungsalgorithmus auf. Patienten Zwischen 1995 und 2018 wurden am Universitätsklinikum Regensburg 179 VAA diagnostiziert (84 Männer, 95 Frauen, medianes Alter 62 (18 – 87) Jahre). 113-mal (63%) lag ein Milzarterien-, 21- bzw. 22-mal (je 12%) ein Nieren- und Leberarterienaneurysma vor. 14-mal (8%) fand sich ein Aneurysma der gastropankreatikoduodenalen Arkade, 9-mal (5%) der A. mesenterica superior/inferior. 110 (62%) Patienten wurden bei fehlender Behandlungsindikation nachbeobachtet, 34 (19%) offen und 35 (19%) endovaskulär behandelt. Bei allen wurde präoperativ eine Bildgebung, meist mit CT-Angiografie durchgeführt. Ergebnisse Von den 69 therapierten Patienten mit VAA wurden 51 (74%) elektiv und 18 (26%) notfallmäßig wegen Blutung behandelt. 16 Notfallpatienten wurden endovaskulär, 2 offen chirurgisch behandelt. Postoperativ fand sich 2-mal eine partielle Minderdurchblutung der Leber, die folgenlos blieb. Einmal musste Dünndarm teilreseziert werden. 32/51 (63%) elektive VAA wurden offen, 19/51 (37%) endovaskulär therapiert. Leber und Darm blieben bei beiden Verfahren intakt. Bei den 21 Milz- und Nierenarterienaneurysmen wurde operativ 4-mal die Milz, 1-mal die Niere komplett entfernt, zusätzlich fanden sich postoperativ 3 Nierenteilinfarkte (gesamt 8/21 [38%]). Postinterventionell zeigte sich bei den 14 Milz- und Nierenarterienaneurysmen 2-mal ein Milz- und 3-mal ein Nierenteilinfarkt, 2-mal wurde die Milz später entfernt (gesamt 7/14 [50%]). Zum Nachweis der Organperfusion wurde die CT-Angiografie, vor allem aber der Kontrastmittelultraschall (CEUS) durchgeführt. Schlussfolgerung Bei Blutung und Pseudoaneurysmen ist die endovaskuläre Therapie das Vorgehen der ersten Wahl. Bei elektiven Eingriffen spielt die sorgfältige Planung im Hinblick auf die technische Machbarkeit der Aneurysmaausschaltung, aber auch der Erhalt der Organperfusion, vor allem bei Milz- und Nierenarterienaneurysmen, eine entscheidende Rolle. Eine bildgebende Nachsorge, vorzugsweise mit Ultraschall, wird dringend empfohlen. Vor bzw. nach Splenektomie oder bei funktioneller Asplenie sind entsprechende Impfungen vorgeschrieben.

ZusammenfassungKomplikationen während der Nachsorge, wie das Versagen der Abdichtung und Migration mit Endoleckage, sind die Achillesferse der endovaskulären abdominellen (EVAR) sowie thorakalen (TEVAR) Aneurysmareparatur. Anatomische Merkmale im Bereich der proximalen und distalen Landungszone einschließlich Thrombus, Verkalkung, Kinking und Halsdilatation können die Nachhaltigkeit einer endovaskulären Reparatur beeinträchtigen. Endoanchors wurden entwickelt, um die Sicherheit einer handgenähten Aortenanastomose nachzuahmen. Dieser Bericht gibt einen Überblick über die aktuelle Literatur zur Verwendung von Endoanchors bei EVAR und TEVAR. Zu den Indikationen für die Anwendung gehören die primäre Implantation zur Sicherung der proximalen oder distalen Landungszone im Falle einer „hostile“-Anatomie oder einer intraoperativen Typ-I-Endoleckage/suboptimalen Apposition an die Aortenwand sowie die sekundäre Anwendung zur Behandlung von Typ-I-Endoleckagen und Stentprothesenmigration häufig in Kombination mit einer proximalen oder distalen Verlängerung der Stentprothese. Abschließend werden die perioperativen Ergebnisse der ersten 100 Patienten analysiert, die mit TEVAR/EVAR und Endoanchors primär oder sekundär bei Re-Interventionen in unserer Abteilung behandelt wurden. In dem Zeitraum von März 2011 bis November 2015 wurden 100 Patienten (85 Männer; 15 Frauen) mit einem Durchschnittsalter von 70 ± 9,7 Jahren behandelt. 82 Anwendungen erfolgten in der abdominellen und 18 in der thorakalen Aorta. Die Implantation wurde während des primären EVAR-/TEVAR-Eingriffes in 80 Fällen durchgeführt (Gruppe A), 20 Patienten wurden sekundär behandelt (Gruppe B). Der technische Erfolg der Implantation betrug 100%. Der klinische Erfolg betrug 98%. Keine Endoanchors wurden verloren. Die perioperative Mortalität betrug 4%, die Morbidität 7%. Im Rahmen der 30-Tages-Kontrolle zeigten sich bei 8/96 überlebenden Patienten Endoleckagen. Bei 7/8 Patienten handelte es sich um Typ-II-Endoleckagen, lediglich ein Patient mit sekundärer, proximaler Verlängerung einer thorakalen Stentprothese zeigte eine persistierende Typ-I-Endoleckage.

Purpose: This paper present thermal and microstructural and microchemical analyses were conducted on the unmodified experimental alloy Al20Si3Cu (B390.1) solidified in the High Temperature Universal Metallurgical Simulator and Analyser (HT UMSA) under atmospheric pressure (0.1 MPa) and a relatively low solidification rate (-1.2 K/s just after end of solidification), for identification of the thermal events during solidification and the phases in the as-cast structure. Design/methodology/approach: The HT UMSA platform, using a low thermal mass stainless steel cup, enabled the acquisition of high resolution thermal analysis data. Design/methodology/approach: A new approach for de-convolution of the first derivative thermal curves allowed detailed thermal and microstructural phase histories to be documented for solidification of Al-Si alloys. Recently developed SEM/EDS methodology allowed to determine composition and distribution of individual phases that are smaller than the X–ray volume. Findings: Simultaneous consideration of thermal microstructural and microchemical information allowed detailed understanding of the series of events that take place during solidification of Al casting alloy with complex chemistry. In our hypereutectic alloy we document growth of Al(1) dendrites and formation of secondary Si(2) and Al(2) phases all at temperatures higher than the binary equilibrium Al-Si eutectic temperature of 850 K. Practical implications: Even at this slow solidification rate detailed understanding of the solidification microstructure requires consideration of non-equilibrium processes during solidification. Originality/value: We propose an original set of hypotheses that consistently explain the observed non-equilibrium solidification behaviour. Proof of these hypotheses is beyond the scope of this work.

Ruthenium compounds are a class of potential anticancer agents in a field with many emerging metal-based drugs and drug candidates. This work presents the synthesis and structural evaluation of a new Ru(II) complex of 3-hydroxyiminoflavanone with spectroscopic and crystallographic methods. Its cytostatic and hemostatic activity, as well as its behavior in solution, are compared with those of two previously described, cytotoxic Ru(II) complexes with C2-substituted 3-iminoflavanones. The synthesis of this compound results in the oxidation of one of the two coordinated 3-hydroxyiminoflavanones to 3-nitrosoflavone and reduction of Ru(III) to Ru(II). The obtained complex has moderate to low toxicity towards five human cancer cell lines, unlike similar ruthenium compounds. The article attempts to account for the difference on the basis of structural differences, solution UV–Vis studies and theoretical evaluation. As none of the tested compounds seriously alter hemostasis or red blood cell integrity in vitro, they might be suitable for further in vitro and in vivo testing.

PURPOSE: To evaluate the organ microvascularization after operative versus endovascular treatment of visceral artery aneurysms (VAAs) by contrast-enhanced ultrasound (CEUS) and colour-coded duplex sonography (CCDS). METHOD AND MATERIALS: Between April 1995 to January 2016, 168 patients (78 males, 90 females; median age: 62 years) were diagnosed with VAAs at our hospital site. 60/168 patients (36%) fulfilled treatment criteria and had either open (29/60, 48%) or endovascular (31/60, 52%) aneurysm repair. Patients' characteristics and presentations were consecutively reviewed. Technical success and organ microvascularization were determined by CCDS/CEUS and correlated to computed tomography angiography (CTA) or magnetic resonance imaging (MRI). RESULTS: 18/60 patients (30%) presented with acute bleeding. 16/18 emergency patients (89%) were treated by endovascular means. After emergency treatment, two patients showed segmental liver malperfusion by CEUS and CTA. One small bowel resection had to be performed. 42/60 patients (70%) were electively treated. 27/42 patients (64%) had open and 15/42 (36%) endovascular aneurysm repair. There were no liver or bowel infarctions after elective treatment of hepatic or mesenteric artery aneurysms (n = 13) in CCDS/CEUS and in CTA. Treatment of patients with splenic or renal artery aneurysms led to partial or complete organ loss in 42% (8/19) after operative and in 50% (5/10) after endovascular treatment (p < 0.05). CONCLUSION: The endovascular approach is the preferred therapeutic option in emergency to control bleeding. In contrast to hepatic or mesenteric procedures, patients for elective splenic or renal artery aneurysm repair have to be evaluated very carefully because of a high rate of partial or complete organ loss demonstrated by CEUS - either after open or endovascular aneurysm repair.

We report successful endovascular repair of a 61-year-old man treated for a 7.1-cm excentric aortic arch aneurysm by in situ stent graft fenestration for the brachiocephalic trunk and the left common carotid artery. Cerebral perfusion during the intervention was maintained by pump-driven extracorporal bypass to the right common carotid artery and to the left axillary artery provided with a left carotid-subclavian bypass. After 5 years of follow-up, the aortic arch in situ revascularization is still patent, the aneurysm excluded, and no endoleak detectable, although endovascular reintervention with distal aortic stent graft extension due to dilatation of the descending aorta was required.

Manifold rethinks the print model of scholarly publishing by offering an open-source platform where authors and publishers can produce iterative texts, powerful annotation tools, rich media support, and robust community dialogue. One aspect of iterative publishing is producing ‘grey literature’ texts. At the University of Minnesota Press, the Forerunners series offers authors a space to publish their creative, speculative thought quickly and accessibly. This allows authors to engage with the expertise of a university press at a much earlier stage than usual. In this piece, the authors discuss how this process affects the acquisitions and production workflows, and offer Forerunners as a case study for thinking through iterative scholarship.