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The blue shark Prionace glauca plays a critical role as a predator in marine ecosystems but is threatened by by‐catch. To obtain more precise biological data, a Bayesian approach was used, and 536 vertebrae samples collected during 1 year at the landing stage called "Playita Mía" Manta, Ecuador, were analysed. The objective was to estimate the age and growth parameters of the species. The size of the specimens varied between 116 and 310 cm in total length (TL). Using a Bayesian approach based on the Markov Chain Monte Carlo (MCMC) method, growth parameters were evaluated. The von Bertalanffy model was the one that best fitted the data and provided more adequate estimates (females: L∞ = 325.50 cm, L0 = 53.23 cm, and k = 0.12 years; males: L∞ = 331.47 cm, L0 = 51.59 cm, k = 0.12 years −1; combined sexes: L∞ = 329.65 cm, L0 = 53.64 cm, k = 0.11 year−1). The results indicated that females and males have a similar growth, and that the species has a slow growth. Further studies using multi‐model Bayesian approaches and covering a broader range of sizes in the Pacific Ocean are suggested. These studies will provide crucial information for the management and conservation of this species. [ABSTRACT FROM AUTHOR]

Background: Nearly 45 million individuals worldwide are internally displaced annually by conflicts. While the psychological effects of war have been extensively documented, there is less understanding of the psychological and mental health symptoms experienced by internally displaced persons (IDPs) as a result of forced displacement. (IDPs). Aim: This study aims to assess the mental health status of people displaced in Hamam Al-Alil Camp. Methods: The cross-sectional survey study design was performed in Hamam Al-Alil camps (Situated on the western bank of the Tigris River in the Nineveh Governorate in Iraq, to the south of Mosul) for the period of 26th December 2017 throughout 1st March 2018. The sample of the study consists of (869) participants. Results: The study distributed 869 surveys which show that the estimation of females was (54%), while males (46%), most of the participants in this study were at age (18-30) years old, and a majority of the participants reported at least one or more mental conditions such as PTSD and anxiety Conclusions: Most of the participants were female and housewives (54%) (52%) respectively, and in terms of age (39%) they ranged in age from 18 to 30 years old as well as Hamam Al-Alil residents people reported a high prevalence of mental health symptoms. Recommendation: Resettlement partners must be mindful of the specific health concerns within this population to effectively meet the needs of the community. [ABSTRACT FROM AUTHOR]

The MANTA device is a plug-based vascular closure device (VCD) designed for large bore femoral arterial access site closure. It showed promising results in transcatheter aortic valve replacement cases. In this study, we report our results and evaluate the MANTA VCD in percutaneous endovascular aortic aneurysm repair (pEVAR). All data of consecutive patients who underwent an elective pEVAR between October 2018 and December 2022 were retrospectively reviewed. In all patients at least one common femoral artery was intended to close with the MANTA VCD. Depending on the sheath size, the 14Fr or 18Fr MANTA VCD was used. On the preoperative computed tomography scan, the diameter of the common femoral artery (CFA) was measured and the amount of calcification based on the Peripheral Arterial Calcium Scoring System (PACSS) was scored. Primary outcome was procedural technical success. Procedural technical success was defined as placement of the MANTA closure device resulting in vascular closure with patent CFA, without requiring immediate open or endovascular surgery. The secondary outcomes were access site complications requiring reintervention and all-cause mortality at 30-day follow-up. In total, 152 consecutive patients underwent pEVAR with 291 common femoral artery closure procedures with the Manta VCD. Mean age was 74.1 ± 6.4 years, with a mean body mass index of 27.7 ± 4.4 kg/m2. The mean diameter of the CFA was 10.5 ± 1.9 mm. In 52.6% of the cases, there were no calcification on the preoperative computed tomography scan. The 18Fr and 14Fr Manta VCD were used 169 and 122 times, respectively. The technical success rate was 96.6%. Major vascular complications were reported in 4.5% of the cases, without any death-related events. This single-center retrospective cohort study analyzed the procedural technical success, major vascular complications and all-cause mortality at 30-day follow-up of the MANTA vascular closure device in 152 pEVAR patients with 291 common femoral artery closure procedures. The technical success rate was 96,6%. Major vascular complications were reported in 4.5% of the cases, without any death related events. We concluded that the MANTA device is a safe and feasible option with a high rate of technical success in patients undergoing pEVAR. [ABSTRACT FROM AUTHOR]

TAVI requires a large-bore arteriotomy. Closure is usually performed by the suture system. Some studies report a vascular complication rate of up to 21%. MANTA is a recently developed percutaneous closure system dedicated to large caliber vessels based on an anchoring system. Early studies report a lower rate of vascular complications with MANTA devices. This single-center retrospective study included all patients who underwent femoral TAVI at the Brest University Hospital from 20 November 2019 to 31 March 2021. The primary endpoint is the rate of vascular complications (major and minor) pre and post-TAVI procedure. In total, 264 patients were included. There were no significant differences in vascular complications (major and minor) between the two groups (13.6% in the MANTA group versus 21.2% in the PROSTAR group; p = 0.105), although there was a tendency to have fewer minor vascular complications in the Manta group (12.1% versus 20.5%; p = 0.067). Manta was associated with a lower rate of bleeding complications (3.8% versus 15.2%; p = 0.002), predominantly minor complications with fewer closure failures (4.5% versus 13.6%; p = 0.01), less use of covered stents (4.5% versus 12.9%; p = 0.016), and with no difference in the need for vascular surgery compared to the Prostar group (1.5% versus 2.3%; p = 0.652). On the other hand, Manta was associated with a higher rate of femoral stenosis (4.5% versus 0%; p = 0.013) without clinical significance (1.5% versus 0%; p = 0.156). The Manta and Prostar devices are equivalent in terms of vascular complications. The Manta, compared to the Prostar, is associated with fewer bleeding complications. [ABSTRACT FROM AUTHOR]

La expresión territorial y transformaciones en el desarrollo urbano de la ciudad de Manta en el Ecuador es una característica de la ciudad intermedia, que muestra un gran crecimiento demográfico, unido a un extraordinario consumo de suelo para usos urbanos, determinado por la vocación de puerto y ubicación estratégica. La presente investigación se direccionó en analizar las transformaciones en el desarrollo urbano de Manta, desde la ciudad colonial hasta la fragmentada. Para ello, fue necesario la aplicación de una metodología descriptiva, bajo un enfoque cualitativo a través del análisis documental en donde se identificó, revisó y clasificó de forma rigurosa la literatura especializada que permitió deducir el paso del modelo compacto y urbano polinuclear, propio de las fases iniciales de la investigación, al disperso fragmentado y sectorial; sustentado en los ejes viales principales que son utilizados de manera poco homogénea en zonas periféricas, sin una adecuada planificación de las áreas de expansión que ha inducido a un crecimiento urbano fragmentado. Entre los principales hallazgos se identificó como la dinámica económica vinculada a las actividades portuarias, fabriles y pesca de exportación, supusieron la mayor expansión de la superficie urbana consolidando un patrón de baja densidad apoyado en los nuevos ejes viarios. El resultado es una ocupación dispersa, desordenada, claramente segregada y donde las escasas políticas urbanas han alentado la inversión inmobiliaria en las zonas mejor dotadas de equipamientos, servicios y conectividad.

Background: Large-bore arteriotomies can be percutaneously closed with suture-based or plug-based vascular closure device (VCD) strategies. The efficacy of both techniques remains controversial. Aims: We conducted a meta-analysis of comparative studies between both VCD strategies, focusing on the most commonly applied VCDs (MANTA and ProGlide). Methods: We searched MEDLINE, the Cochrane Central Register of Controlled Trials and Google scholar for observational studies (OS) and randomized controlled trials (RCT) comparing vascular closure with the MANTA-based and the ProGlide-based technique. The principal endpoint of this analysis was access-site related vascular complications. Both study types were analyzed separately. Results: Access-site related vascular complications were less frequent after vascular closure with the MANTA technique in the analysis of OS (RR 0.61 [95%CI 0.43–0.89], p = 0.01, I2 = 0%), but more frequent in the analysis of RCT data (RR 1.70 [95%CI 1.16–2.51], p = 0.01, I2 = 0%). Both data sets provided no significant difference between the VCD techniques in terms of overall bleeding events (OS: RR 0.57 [95%CI 0.32–1.02], p = 0.06, I2 = 70%; and RCT: RR 1.37 [95%CI 0.82–2.28], p = 0.23, I2 = 30%). RCT data showed that endovascular stenting or vascular surgery due to VCD failure occurred more often after MANTA application (RR 3.53 [95%CI 1.07–11.33], p = 0.04, I2 = 0%). Conclusions: While OS point to favorable outcomes for large-bore vascular closure with the MANTA-based technique, RCT data show that this strategy is associated with more access-site related vascular complications as well as endovascular stenting or vascular surgery due to device failure compared with the ProGlide-based technique. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Large series of percutaneous femoral access for extracorporeal circulation in minimally invasive cardiac surgery (MICS) are scarcely reported. METHODS This is a single-centre study describing the use of percutaneous femoral access in patients undergoing MICS via minithoracotomy. Femoral artery closure was performed with a plug-based closure device. To reduce the risk for vascular complications, intraoperative ultrasound assessment of correct deployment of the arterial closure device was done during the later period of the study. RESULTS During a 5-year period, 650 patients underwent percutaneous femoral cannulation and decannulation with device closure of the femoral artery puncture. Two hundred and seven patients (31.8%) were operated in the early phase of the experience (August 2017–August 2019), without the use of intraoperative ultrasound assessment of closure device deployment. During the later period of our experience (August 2019–September 2022), 443 patients (68.2%) were operated, of whom all underwent intraoperative ultrasound assessment of closure device deployment. Of the patients operated without intraoperative ultrasound assessment, 6 patients (2.9%) experienced vascular complications compared with none of the patients in whom intraoperative ultrasound-assessment was used (P  < 0.001). In total, 15 patients (2.3%) underwent conversion to surgical cutdown owing to incomplete haemostasis or femoral artery stenosis/occlusion and the mechanism was intravascular deployment of the closure device in all 15 cases. CONCLUSIONS Percutaneous femoral access in MICS is safe and the need for surgical cutdown was infrequent. The risk for vascular complications is minimized with the use of intraoperative ultrasound assessment of the correct positioning of the vascular closure device. CLINICAL TRIAL REGISTRATION NUMBER http://www.clinicaltrials.gov ; Unique identifier: NCT05462769. [ABSTRACT FROM AUTHOR]

The forced migration of nearly 6 million Venezuelans is a global issue that is transforming urban contexts, particularly in Latin America. Ecuador is the third main recipient country of displaced Venezuelans. The lack of State migration policies and the deteriorating economic situation throughout the region have had significant impacts on migrants. While food security and migration have been studied extensively in Latin America, their intersection remains under-explored. Through a systematic review and focus group research, this exploratory study analyzes the food security conditions of Venezuelans in Ecuador and the impacts of the COVID-19 pandemic on the levels of food insecurity using an intersectional approach. Quantitative, systematic review results demonstrate that demands for food assistance outweighed the planning and provisions supplied by both state and non-state actors. Focus groups results support the findings from the systematic review and demonstrate that in the medium-sized port cities of Manta and Machala, food demands during the pandemic lockdown measures were met through the direct food supply and resilience strategies, including the securing of personal loans and bartering. In contrast, in the cities of Quito and Huaquillas, strict enforcement of COVID-19 lockdown measures, reduced access to work and systematic food access and increased reliance on food assistance from non-governmental actors. This study also found that the impacts of food (in)security in the context of COVID-19 disproportionately affected women in all cities, as they offered their food rations to meet the needs of their children, grandchildren, or other dependents. [ABSTRACT FROM AUTHOR]

TAVI requires a large-bore arteriotomy. Closure is usually performed by the suture system. Some studies report a vascular complication rate of up to 21%. MANTA is a recently developed percutaneous closure system dedicated to large caliber vessels based on an anchoring system. Early studies report a lower rate of vascular complications with MANTA devices. This single-center retrospective study included all patients who underwent femoral TAVI at the Brest University Hospital from 20 November 2019 to 31 March 2021. The primary endpoint is the rate of vascular complications (major and minor) pre and post-TAVI procedure. In total, 264 patients were included. There were no significant differences in vascular complications (major and minor) between the two groups (13.6% in the MANTA group versus 21.2% in the PROSTAR group; p = 0.105), although there was a tendency to have fewer minor vascular complications in the Manta group (12.1% versus 20.5%; p = 0.067). Manta was associated with a lower rate of bleeding complications (3.8% versus 15.2%; p = 0.002), predominantly minor complications with fewer closure failures (4.5% versus 13.6%; p = 0.01), less use of covered stents (4.5% versus 12.9%; p = 0.016), and with no difference in the need for vascular surgery compared to the Prostar group (1.5% versus 2.3%; p = 0.652). On the other hand, Manta was associated with a higher rate of femoral stenosis (4.5% versus 0%; p = 0.013) without clinical significance (1.5% versus 0%; p = 0.156). The Manta and Prostar devices are equivalent in terms of vascular complications. The Manta, compared to the Prostar, is associated with fewer bleeding complications.

BackgroundVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a valuable treatment option for patients in cardiogenic shock, but complications during decannulation may worsen the overall outcome. Therefore, the aim of this study was to compare the efficacy and safety of suture-based to pure plug-based vascular closure devices for VA-ECMO decannulation.MethodsIn this retrospective study, the procedural outcome of 33 patients with suture-based Perclose ProGlide closure devices was compared to 38 patients with MANTA plug-based closure devices.ResultsRate of technically correct placement of closure devices was 88% in the suture-based group and 97% in the plug-based group (p = 0.27). There was a significant reduction of severe bleeding events during VA-ECMO decannulation in plug-based versus suture-based systems (3% vs. 21%, p = 0.04). Ischemic complications occurred in 6% with suture-based and 5% with plug-based device (p = 1.00). Pseudoaneurysm formation was detected in 3% in both groups (p = 1.00). No switch to vascular surgery due to bleeding after decannulation was necessary in both groups.ConclusionBased on our retrospective analysis, we propose that plug-based vascular closure should be the preferred option for VA-ECMO decannulation. This hypothesis should be further tested in a randomized trial.

Newborns show physiological differences in low- and high-altitude settings of Ecuador; those differences are especially relevant because most important cities in Ecuador are located at high altitude, above 2500 m. This study is an epidemiological, observational, and cross-sectional research performed at San Francisco Hospital in Quito (at 2850 m) and General Hospital in Manta (at 6 m) in the Manabí province. We studied 204 full-term newborns, healthy without any prenatal comorbidities, singleton pregnancy, mestizos, and born of healthy parents born. We found significant differences between the values of red blood cells (RBC), leucocytes, hematocrit, and hemoglobin. There was a difference of 27% more in RBC, 3% at hematocrit, and 0.4 g at hemoglobin in the high-altitude cohort. The leucocyte difference is 1270 cells/µl, which means a difference of 6%. At high-altitude settings, the mean pH was lower than normal values and pO2, pCO2, and HCO3. High-altitude newborns showed RBC of > 4,500,000 cells/µl; leukocytes > 19,000; pO2 ≤ 72 mm Hg; hemoglobin > 17.50 g/dl; and hematocrit > 54%. Both cohorts showed physiological changes of transition to extrauterine life. We observed higher polycythemia, respiratory acidosis, and hypoxemia among high-altitude newborns. High-altitude setting intensifies the physiological changes in hematological and arterial blood gases parameters. [ABSTRACT FROM AUTHOR]

Arterial access-site related complications constitute a large proportion of adverse events related to cardiac interventions requiring large-bore devices and have significant implications on morbidity, mortality and hospital cost. To evaluate the safety and effectiveness of a novel percutaneous plug-based vascular closure device (VCD) in 1000 consecutive patients undergoing transfemoral transcatheter aortic valve implantation (TAVI). A single-center observational study evaluating a plug-based VCD (MANTA, Teleflex/Essential Medical Inc., Malvern, Pennsylvania, USA) in patients undergoing TAVI at the Karolinska University Hospital, Stockholm, Sweden. The primary outcome was VCD-related major vascular complication according to the criteria of the Valve Academic Research Consortium (VARC)-2. From May 2017 to September 2020 a total of 1000 consecutive patients underwent transfemoral TAVI with arterial access-site management using the MANTA VCD. VARC-2 major vascular complications occurred in 42 (4.2%) patients: 17 (1.7%) patients intraoperatively received a covered stent, 17 (1.7%) patients underwent surgical repair during hospital stay, 3 (0.3%) patients underwent vascular surgery after discharge, 3 (0.3%) patients had major bleeding and 2 (0.2%) patients had symptoms of claudication with conservative treatment. No significant differences in major complications were seen between individual interventionists irrespective of experience with the device. A larger sheath outer diameter to femoral artery inner diameter ratio was the only factor associated with a significant increase of VCD-related major vascular complications. This largest ever real-world evaluation of MANTA for large-bore arteriotomy closure in transfemoral TAVI patients indicates effective and safe arterial access-site management with low complication rates and short learning curve. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT04392492. • This is the largest ever real-world evaluation of the novel plug-based vascular closure device (VCD) MANTA. • A total of 1000 consecutive patients underwent transfemoral TAVI with arterial access-site management using the MANTA VCD. • A larger sheath diameter to femoral artery diameter ratio was associated with an increase of vascular complications. • No significant differences in major complications were seen between individual interventionists irrespective of experience. • The MANTA VCD was effective and safe for arterial access-site management with low complication rates. [ABSTRACT FROM AUTHOR]

Background: The use of veno–arterial extracorporeal membrane oxygenation (VA‐ECMO) decannulation with different percutaneous closure devices has been increasing. At our center, ProGlide devices have been used since November 2018, and Manta devices became an alternative since March 2020. This study aimed to compare the success and complication rates and the clinical outcomes of ProGlide and Manta devices for VA‐ECMO decannulation after arteriotomy wound closure. Methods: We retrospectively reviewed the results of bedside VA‐ECMO decannulation between November 2018 and June 2021. Patients with VA‐ECMO who could be bridged to recovery were recruited and divided into the ProGlide or Manta group based on the closure device used. Procedure time, amount of blood loss, amount of blood products transfused, and use of vasoactive medications during the procedure were documented. Clinical examination and Doppler ultrasound were performed to detect any complications. Results: After the closure technique, ProGlide was used in 44 patients and Manta was used in 13. There was no significant difference in the success rate between the ProGlide and Manta groups (86.4% vs. 100%). Amount of blood loss was greater in the ProGlide group than in the Manta group (290 [100–400] ml vs. 50 [50–100] ml), and more patients in the ProGlide group required an increased dose of inotropes during the procedure (59.1% vs. 15.4%), but the transfusion requirement was similar between the two groups. Conclusions: The success rate of hemostasis using arteriotomy wound closure during VA‐ECMO decannulation was similar between the two devices. [ABSTRACT FROM AUTHOR]

Introduction: The phase 2 MANTA and MANTA-RAy studies were developed in consultation with global regulatory authorities to investigate potential impacts of filgotinib, a Janus kinase 1 preferential inhibitor, on semen parameters in men with active inflammatory diseases. Here we describe the methods and rationale for these studies. Methods and Rationale: The MANTA and MANTA-RAy studies included men (aged 21–65 years) with active inflammatory bowel disease (IBD) and rheumatic diseases, respectively. Participants had no history of reproductive health issues, and the following semen parameter values (≥ 5th percentile of World Health Organization reference values) at baseline: semen volume ≥ 1.5 mL, total sperm/ejaculate ≥ 39 million, sperm concentration ≥ 15 million/mL, sperm total motility ≥ 40% and normal sperm morphology ≥ 30%. Each trial included a 13-week, randomized, double-blind, placebo-controlled period (filgotinib 200 mg vs placebo, up to N = 125 per arm), for pooled analysis of the week-13 primary endpoint (proportion of participants with ≥ 50% decrease from baseline in sperm concentration). All semen assessments were based on two samples (≤ 14 days apart) to minimize effects of physiological variation; stringent standardization processes were applied across assessment sites. From week 13, MANTA and MANTA-RAy study designs deviated owing to disease-specific considerations. All subjects with a ≥ 50% decrease in sperm parameters continued the study in the monitoring phase until reversibility, or up to a maximum of 52 weeks, with standard of care as treatment. Overall conclusions from MANTA and MANTA-RAy will be based on the totality of the data, including secondary/exploratory measures (e.g. sperm motility/morphology, sex hormones, reversibility of any effects on semen parameters). Conclusions: Despite the complexities, the MANTA and MANTA-RAy studies form a robust trial programme that is the first large-scale, placebo-controlled evaluation of potential impacts of an advanced IBD and rheumatic disease therapy on semen parameters. Trial Registration: EudraCT numbers 2017-000402-38 and 2018-003933-14; ClinicalTrials.gov identifiers NCT03201445 and NCT03926195. Plain Language Summary: Filgotinib is a treatment for patients with ulcerative colitis and rheumatoid arthritis, and is being studied in other inflammatory diseases. Filgotinib works by blocking Janus kinase 1, an intracellular protein involved in inflammatory signalling processes. We designed the MANTA and MANTA-RAy trials with global health agencies to find out if filgotinib decreases the quality of semen in men with active inflammatory bowel disease (ulcerative colitis or Crohn's disease) (MANTA) or rheumatic disease (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis or non-radiographic axial spondylitis) (MANTA-RAy). This paper describes the design of the two trials. Patients had normal sperm measurements and could not have had previous reproductive health issues. Nearly 250 patients were included in each trial. In both MANTA and MANTA-RAy, half of the patients were treated with 200 mg of filgotinib once a day for 13 weeks, and the other half with placebo. We determined if any patients had a decrease in number of sperm cells per millilitre (sperm concentration) by at least half after 13 weeks of treatment. We then monitored any patients who had such a decrease in sperm concentration for up to 52 weeks (while they received standard of care treatment) or until the decrease was reversed. The conclusions from the trials will be in a different paper and will be based on all the final data, including changes in sex hormones. This is the first large-scale clinical trial programme to measure the effect of a treatment on sperm in men with inflammatory bowel disease or rheumatic diseases. [ABSTRACT FROM AUTHOR]

Aims As the indications to transcatheter aortic valve replacement (TAVR) expand to patients at increasingly lower risk, procedure-related vascular and bleeding complications events must be minimized. We aimed to evaluate the impact of different large-bore arterial access closure devices on clinical outcomes after TAVR. Methods and results We searched for papers that reported outcomes according to the type of vascular closure device/technique used after TAVR and performed a Bayesian network meta-analysis (NMA). Fifteen studies involving 9259 patients who underwent access site closure using PROSTAR™ XL percutaneous vascular surgical system (Abbott Vascular, Santa Clara, CA, USA), Perclose ProGlide™ suture-mediated closure system (Abbott), or MANTATM vascular closure device (Teleflex, Morrisville, NC, USA) were included. NMA showed MANTA to have the highest likelihood of reducing a primary composite endpoint of intra-hospital death, major vascular complications, and major or life-threatening bleedings [surface under the cumulative ranking curve analysis (SUCRA) 94.8%], but this was mitigated when only randomized clinical trials and propensity-matched cohorts were included (SUCRA 56.1%). The ProGlide showed the highest likelihood to reduce major or life-threatening bleedings, especially with increasing procedural complexity, and the MANTA device to reduce major and minor vascular complications. The ProStar XL device performed poorly in all explored endpoints. Conclusion Available evidence summarized through a NMA shows that ProGlide and MANTA devices appear to be both valid vascular closure devices globally and to be the best options to minimize vascular complications and reduce bleeding in patients undergoing TAVR, respectively. [ABSTRACT FROM AUTHOR]

Publikācija veltīta civiltiesiskajā regulējumā lietotā jēdziena „manta” satura noskaidrošanas problemātikai. Rakstā, pirmkārt, atspoguļota pastāvošā viedokļu dažādība jautājumā par to, kas civiltiesībās saprotams ar jēdzienu „manta”. Otrkārt, rakstā aplūkots jēdziens „manta” īstā nozīmē, šī jēdziena pazīmes un jēdzieniskā atšķirība no „ķermenisku lietu kopības” un „mantojuma”, kā arī aplūkots jautājums par mantas sastāvu, mantas masām un surogācijas principa nozīmi. Rakstā izvirzīta tēze, ka ar jēdzienu „manta” īstā nozīmē saprotams to naudā novērtējamo tiesību kopums (jeb „tiesību kopība” CL 849. p. 1. d. izpratnē), kas pieder konkrētam tiesību subjektam un kas kalpo kā viņa atbildības objekts, uz ko var tikt vērsta piedziņa par labu šī subjekta kreditoriem.

Background: Vascular and bleeding complications are common after transcatheter aortic valve implantation (TAVI) and are associated with worse outcomes. The plug-based Manta (M) vascular closure device (VCD) is a novel option to achieve haemostasis for large-bore arterial access sites.Objective: We aimed to compare vascular and bleeding complications between the M-VCD and the established suture-based Perclose ProGlide (P)-VCD.Methods: From February to September 2019 a total of 578 patients underwent transfemoral TAVI at a single high-volume centre. Access site closure was performed using M-VCD in 195 patients (33.7%) and P-VCD in 383 patients (66.3%). We assessed vascular and access site-related complications as well as bleeding events according to the Valve Academic Research Consortium-2 definition.Results: Overall vascular complications occurred less frequently in the M-VCD group (10.7% vs. 19.0%, p = 0.011) driven by a significantly lower rate of major vascular events (2.0% vs. 6.5%, p = 0.025). Access site-related complications were significantly less frequent in the M-VCD cohort (10.7% vs. 16.6%, p = 0.048). The M-VCD was associated with significantly lower rates of major (0.5% vs. 4.4%, p = 0.009) and life-threatening bleeding (0% vs. 2.3%, p = 0.032). In multivariable analysis, the use of M-VCD was the only independent predictor of vascular complications (odds ratio 0.54, 95% confidence interval 0.32-0.91, p = 0.022).Conclusions: The M-VCD was associated with a reduction of vascular and access-site complications as well as severe bleeding after transfemoral TAVI compared to the P-VCD in this observational study. [ABSTRACT FROM AUTHOR]

Se explora descriptivamente el fenómeno de la segunda revolución industrial y su relación con la pesca del atún en la ciudad de Manta, Ecuador. Manta llegó a ser conocida como la capital mundial del atún en el siglo XX, y las transformaciones de este fenómeno pueden percibirse desde la cantonización de San Pablo de Manta, hasta el origen y desarrollo de la pesca del atún con fines de exportación. Metodológicamente hemos consultado fuentes transversales, como entrevistas personales, fuentes bibliográficas y documentales, de diferentes archivos internacionales, nacionales y locales.

Microplastics (MPs) (plastic particles < 5 mm in size) have become the most ubiquitous type of anthropogenic litter contaminating aquatic environments worldwide, and are capable of harming aquatic organisms and entering the food web. Microplastic research has rapidly evolved over several decades, with many studies sampling microplastic in surface waters. For sea surface sampling of MPs, different net devices have been used. But although there is an increasing number of studies using these devices to quantifying MPs in different aquatic environments, data comparison is difficult due to the lack of standardised, harmonised sampling methods and data reporting units. The Manta net device is actually the most commonly used method for sea surface sampling of MPs. The three main parts of this net are: the floating/stabilizing part, the opening mouth and the net bag, and each of them can have its own specifications. These specifications, along with the sampling methods, can be critical for the efficiency of the sampling accurate quantification of MPs in the aquatic environments. The use of different mesh sizes, inconsistency in trawling duration, speed and distance, and in the net opening dimensions, make it impossible to compare the studies between each other. This review analyzes the methodologies and characteristics of Manta nets used for MPs sampling, discussing factors that can impact the efficiency of the sampling and the quantification of MPs, and proposes recommendations in order to improve and standardize the sampling protocol.

Background: The collagen-based MANTA device (Teleflex, PA, USA) is used for closure of large-bore vascular access. There is a paucity of data on complications associated with its use in a real-life setting.Methods: We queried the "Manufacturer and User Facility Device Experience" MAUDE database between February 2019 and December 2020 for reports on MANTA device.Results: We identified 250 reports in the MAUDE database from February 2019 through December 2020. The most common failure complication of MANTA is persistent bleeding (48.8%) and vessel occlusion or stenosis (29.6%). Most complications were managed successfully with an endovascular approach (48.4%), but a high number of patients required surgical intervention (40.4%). The most commonly reported failure mechanism was the failure of deployment (22%) followed by subcutaneous deployment (7.6%), intraluminal deployment (4.8%) amd detachment of collagen (2.8%). Access site infection was rare (1.2%). The 18 Fr. MANTA was associated with a lower risk of failure of deployment compared with the 14 Fr. device but was associated with a higher risk of vessel occlusion or stenosis (32.4% vs. 16.3%, p = 0.04) and thrombosis (11.6% vs 0%, p = 0.03).Conclusions: The most common complication of the MANTA device reported to the MAUDE registry was persistent bleeding (48.8% of reports) followed by vessel occlusion (29.6%). These complications were managed successfully using an endovascular approach in 48.4% of the reports. [ABSTRACT FROM AUTHOR]

La presente investigación tiene como propósito estudiar la seguridad y turismo, desde el plan de seguridad para las zonas turísticas en Manta-Ecuador, específicamente se asume a la seguridad con visión integral para alcanzar el desarrollo de un destino turístico. Para ello se realizó una investigación de tipo descriptiva con un enfoque mixto por lo que se hizo uso de algunas herramientas como entrevistas, cuestionario para encuestas, observación. Permitiéndose obtener como resultados un esquema de plan de seguridad, mismo que se deberá adaptar a las condiciones de cada destino. Pudiéndose concluir que la seguridad es una variable precursora al cambio positivo y estable del desarrollo territorial de un destino turístico. Se concluye que el turismo es una vía para lograr el desarrollo mediante planes sistematizados por Zonas en Ecuador.

Background: Majority of EVAR procedures are performed with percutaneous arterial access, unless there is severe steno-occlusive disease in the common femoral arteries (CFA). We present our experience of using MANTA closure device with a retrospective evaluation of its safety and efficacy, in the elective setting, and in the emergent setting for ruptured aortic aneurysm., Design and Methods: Between Feb 2021 and May 2023 a total of 75 EVAR procedures were closed with a Manta device. Data was collected prospectively and analysed retrospectively. In 75 patients, 128 CFAs were closed with a Manta closure device including 4 emergent ruptured aneurysms., Results: 67 male and 8 female patients with a median age of 77 years had percutaneous EVAR using Manta as a closure device. 128 CFAs were closed with Manta closure device. 3% (4/128) had deployment failures, with three requiring surgical cut down and closure. In one patient, a second Manta device deployment achieved satisfactory haemostasis. Three deployments were complicated by pseudoaneurysms of the CFA, all requiring no further interventions/treatment. No death related to severe haemorrhage from device failure. The pre- and post-procedure CFA puncture site AP diameter was recorded in a total of 106 cases with appropriate follow-up. 66% of these (70/106) had no reduction in CFA diameter post Manta closure. 34% (36/106) had some reduction of vessel AP size CFA post EVAR. No adverse features or further treatment was required due to reduction of vessel diameter in these cases (ongoing yearly surveillance)., Conclusions: Manta closure device is safe and easy to deploy with an overall success rate of 97%. There is a short learning curve. Ultrasound assessment and precise puncture at the healthy section of femoral artery are the key to achieve successful haemostasis with Manta closure device. Our findings suggest there is an association of non-clinically significant mild reduction in CFA vessel AP diameter post Manta closure device, which does not require further intervention., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Manta and devil rays are an iconic group of globally distributed pelagic filter feeders, yet their evolutionary history remains enigmatic. We employed next generation sequencing of mitogenomes for nine of the 11 recognized species and two outgroups; as well as additional Sanger sequencing of two mitochondrial and two nuclear genes in an extended taxon sampling set. Analysis of the mitogenome coding regions in a Maximum Likelihood and Bayesian framework provided a well-resolved phylogeny. The deepest divergences distinguished three clades with high support, one containing Manta birostris, Manta alfredi, Mobula tarapacana, Mobula japanica and Mobula mobular; one containing Mobula kuhlii, Mobula eregoodootenkee and Mobula thurstoni; and one containing Mobula munkiana, Mobula hypostoma and Mobula rochebrunei. Mobula remains paraphyletic with the inclusion of Manta, a result that is in agreement with previous studies based on molecular and morphological data. A fossil-calibrated Bayesian random local clock analysis suggests that mobulids diverged from Rhinoptera around 30 Mya. Subsequent divergences are characterized by long internodes followed by short bursts of speciation extending from an initial episode of divergence in the Early and Middle Miocene (19-17 Mya) to a second episode during the Pliocene and Pleistocene (3.6 Mya - recent). Estimates of divergence dates overlap significantly with periods of global warming, during which upwelling intensity - and related high primary productivity in upwelling regions - decreased markedly. These periods are hypothesized to have led to fragmentation and isolation of feeding regions leading to possible regional extinctions, as well as the promotion of allopatric speciation. The closely shared evolutionary history of mobulids in combination with ongoing threats from fisheries and climate change effects on upwelling and food supply, reinforces the case for greater protection of this charismatic family of pelagic filter feeders.

Percutaneous closure of arteriotomy wound during peripheral venoarterial extracorporeal membrane oxygenation decannulation was shown to be safe and allow earlier mobilization. The new MantaTM vascular closure device (Essential Medical), designed for the closure of arterotomy wound created by large-bore vascular sheaths up to 25Fr during endovascular catheterization procedures, was reported to be applicable in venoarterial extracorporeal membrane oxygenation decannulation. In this article, we would like to share our experience of using real-time ultrasound guidance to ensure the safe application of Manta during bedside venoarterial extracorporeal membrane oxygenation decannulation. [ABSTRACT FROM AUTHOR]

This study sought to test the superiority in terms of efficacy and safety of a dedicated plug-based vascular closure device (VCD) during transcatheter aortic valve replacement (TAVR) over a suture-based VCD. Vascular complications after TAVR are relevant and often associated with VCD failure. The MASH (MANTA vs. Suture-based vascular closure after transcatHeter aortic valve replacement) trial is an international, 2-center pilot randomized controlled trial comparing the MANTA VCD (Teleflex, Wayne, Pennsylvania) versus 2 ProGlides (Abbott Vascular, Abbott Park, Illinois). The primary composite endpoint consisted of access site–related major or minor vascular complications at 30-days' follow-up. Secondary endpoints included clinically relevant access site bleeding, time to hemostasis, and modified VCD failure (defined as failure to achieve hemostasis within 5 min or requiring additional endovascular maneuvers such as endovascular stenting, surgical techniques, or additional closure devices). Adverse events were adjudicated by an independent clinical events committee according to the VARC-2 definitions. A total of 210 TAVR patients were included between October 2018 and January 2020. Median age was 81 years, 54% were male, and the median STS score was 2.7%. There was no significant difference in the primary endpoint of access site–related vascular complications between MANTA and ProGlide (10% vs. 4%; p = 0.16). Clinically significant access site bleedings were similar with both closure techniques (9% vs. 6%; p = 0.57). Modified VCD failure occurred less frequently in MANTA versus ProGlide (20% vs. 40%; p < 0.01). Suture-based closure required more often additional closure devices, whereas MANTA numerically needed more covered stents and surgical bailouts. Plug-based large-bore arteriotomy closure was not superior to suture-based closure. Plug-based closure required fewer, but a different kind of bailout maneuvers. [ABSTRACT FROM AUTHOR]

Abstract Background Despite decreasing sheath diameter, access site bleeding and vascular complications are still a major concern in transfemoral aortic valve implantation (TAVI), and may increase morbidity and even increase mortality. The aim was to compare safety of arterial closure in transfemoral TAVI with two different principles, pre-suture with ProGlide and collagen plug closure with Manta. Results Seventy-six patients treated with ProGlide and 75 with Manta were analysed. The endpoints were 1: access site vascular complications and 2: non-planned vascular or endovascular surgery at the puncture site. Complications occurred in 2 (2.7%) ProGlide and in 8 (10.7%) Manta cases, p = 0.047. During the learning phase there were no significant differences. In the established phase there was one event (2%) in the ProGlide group, compared to 6 endpoints (12.0%), p = 0.047, in the Manta group. Unplanned surgery or intervention was seen in two (2.7%) ProGlide and in 7 (9.3%) Manta patients, p = ns. There were no significant differences during the learning phase. In established use, endpoints occurred more frequently in patients treated with the Manta device (12%), than in patients treated with the ProGlide (2%), p = 0.047. Conclusion The ProGlide presuture closure device was associated with significantly lower rates of vascular complications and lower rates of surgery and interventions compared to the collagen plug Manta system. Trial registration The data were collected from Internal quality control registry on treatment of patients with valvular heart disease with or without coronary artery disease, No 2014/17280, Oslo University Hospital, Ullevål.

Conducting studies of motivation, evaluation and satisfaction of the demand of sun and beach tourism provides important information to adapt the products according to demand. The present study was conducted in situ in the city of Manta, Ecuador. Using a questionnaire, variant and bivariate statistical techniques were used to achieve the study objectives. The findings show that the main motivations of tourists are to rest, enjoy the beach and the sun, and enjoy the typical local gastronomy, which ratifies the main motivations in destinations with these characteristics. The most valuable aspects of the visit were the hospitality of the residents, the sun and the beach, and the restaurant service. The satisfaction of the destination is high, which shows the potential of this site for this type of tourism.

Background: Real world safety and effectiveness of MANTA vascular closure device (VCD) for large bore arteriotomy closure after decannulation of mechanical circulatory support (MCS) devices is not known.Methods: All consecutive patients who underwent large bore arteriotomy closure with MANTA VCD following decannulation of MCS between February to October 2019 at a large tertiary care academic medical center were included. Safety and effectiveness of MANTA VCD was assessed on immediate post-closure angiogram for 23 access sites, and immediate post-closure duplex arterial ultrasound or manual vascular examination for 1 access site each. Technical success was defined as achievement of arteriotomy closure in absence of major bleeding or access site endovascular or surgical intervention.Results: A total of 25 MANTA VCD were placed in 22 unique patients by 7 different operators. A 14 Fr or 18 Fr MANTA VCD was used in 15 (60%) and 10 (40%) of deployments, respectively via transfemoral (n = 23, 92%) or transaxillary (n = 2, 8%) access. Technical success was achieved in 24 of 25 (96%) cases. Minor access site bleeding occurred in 3 patients (12%) and failure of MANTA VCD with major access site bleeding occurred in 1 patient (4%) requiring endovascular balloon tamponade. No cases of retroperitoneal bleeding, collagen plug embolization, covered stent placement, or surgical vascular repair were observed.Conclusion: In this single center experience, the use of MANTA VCD for large bore arteriotomy closure following percutaneous decannulation of MCS devices appears to be safe and effective. Larger multicenter studies of efficacy, safety, and cost-effectiveness are needed. [ABSTRACT FROM AUTHOR]

Mobula mobular, a mobulid species once considered a Mediterranean Sea endemic, has received its common name "giant devil ray" based on repeated misidentifications of oceanic manta rays, Mobula birostris, that had strayed into the Mediterranean, where they had never been reported from before. Based on the maximum known size (350 cm disc width) of M. mobular, when compared to some of its congenerics, the giant devil ray is not giant at all. A recent revision of the phylogeny and taxonomy of genus Mobula, which included, amongst other things, the decision to consider the circumtropical spinetail devil ray M. japanica a junior synonym of M. mobular, has caused the latter species to become circumglobal, and the only known mobulid with a tail spine. As a consequence, it is here recommended that the common name of M. mobular be "spinetail devil ray". [ABSTRACT FROM AUTHOR]

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Liposomes are potent adjuvant constituents for licensed vaccines and vaccine candidates and carriers for drug delivery. Depending on the method of preparation, liposomes vary in size distribution, either forming uniform small size vesicles or a heterogeneous mixture of small to large vesicles. Importantly, differences in liposomal size have been demonstrated to induce differential immune responses. Determination of particle size distribution could therefore be crucial for the efficacy and stability of vaccine formulations. We compared the techniques of dynamic light scattering, laser diffraction, and conventional nanoparticle tracking analysis with a novel multispectral advanced nanoparticle tracking analysis (MANTA) for particle size determination of mono- and polydisperse liposomes. MANTA reported an average 146 nm size of monodisperse liposomes but showed a multimodal distribution of polydisperse liposomes with continuous sizes from 50 to 2000 nm. However, approximately 95% of particles were in the size range of 50–1500 nm and only few particles were identified in the 1500–2000 nm range for the investigated volume. Based on our results, we conclude that MANTA is the most suitable approach and can serve as stand-alone technique for particle size characterization of heterogeneous liposome samples in the 50–2000 nm size range. [ABSTRACT FROM AUTHOR]

Manta and devil rays are filter-feeding elasmobranchs that are found circumglobally in tropical and subtropical waters. Although relatively understudied for most of the Twentieth century, public awareness and scientific research on these species has increased dramatically in recent years. Much of this attention has been in response to targeted fisheries, international trade in mobulid products, and a growing concern over the fate of exploited populations. Despite progress in mobulid research, major knowledge gaps still exist, hindering the development of effective management and conservation strategies. We assembled 30 leaders and emerging experts in the fields of mobulid biology, ecology, and conservation to identify pressing knowledge gaps that must be filled to facilitate improved science-based management of these vulnerable species. We highlight focal research topics in the subject areas of taxonomy and diversity, life history, reproduction and nursery areas, population trends, bycatch and fisheries, spatial dynamics and movements, foraging and diving, pollution and contaminants, and sub-lethal impacts. Mobulid rays remain a poorly studied group, and therefore our list of important knowledge gaps is extensive. However, we hope that this identification of high priority knowledge gaps will stimulate and focus future mobulid research.

El estudio de motivaciones y satisfacción de la gastronomía permite conocer mejor al visitante para adaptar la oferta de un destino. El presente estudio se realizó in situ en la ciudad de Manta en Ecuador, destino que cuenta con una variada gastronomía típica de la región costa, donde se tomó un cuestionario que utilizando técnicas univariantes y bivariantes sirvió para obtener los resultados. Los hallazgos muestran que los principales motivos para comer en un restaurante en Manta son “porque me agrada comer en la playa”, “por consumir un plato típico” y “porque me gusta la comida del mar” Los aspectos del servicio más valorados fueron “la variedad de los platos” y “el servicio y cortesía de los empleados” El grado de satisfacción general es alto lo que ratifica que la gastronomía es un atractivo importante en este destino con potencial internacional.

Conducting studies of motivation, evaluation and satisfaction of the demand of sun and beach tourism provides important information to adapt the products according to demand. The present study was conducted in situ in the city of Manta, Ecuador. Using a questionnaire, variant and bivariate statistical techniques were used to achieve the study objectives. The findings show that the main motivations of tourists are to rest, enjoy the beach and the sun, and enjoy the typical local gastronomy, which ratifies the main motivations in destinations with these characteristics. The most valuable aspects of the visit were the hospitality of the residents, the sun and the beach, and the restaurant service. The satisfaction of the destination is high, which shows the potential of this site for this type of tourism. [ABSTRACT FROM AUTHOR]

DNA sequence data from mitochondrial genomes and c. 1000 nuclear exons were analysed for a complete taxon sampling of manta and devilrays (Mobulidae) to estimate a current molecular phylogeny for the family. The resulting inferences were combined with morphological information to adopt an integrated approach to resolving the taxonomic arrangement of the family. The members of the genus Manta were found to consistently nest within the Mobula species and consequently the genus Manta is placed into the synonymy of Mobula. Mobula eregoodootenkee, M. japanica and M. rochebrunei were each found to be junior synonyms of M. kuhlii, M. mobular and M. hypostoma, respectively. The mitochondrial and nuclear tree topologies were in agreement except for the placement of M. tarapacana which was basal to all other mobulids in the nuclear exon analysis, but as the sister group to the M. alfredi- M. birostris-M. mobular clade in the mitochondrial genome analysis. Results from this study are used to a revise the taxonomy for the family Mobulidae. A single genus is now recognized (where there were previously two) and eight nominal species (where there were previously 11). [ABSTRACT FROM AUTHOR]

O uso de manta de contenção é um importante produto que auxilia na resistência de um solo evitando assim o desmoronamento de terra ou problemas com compactação de solo, ou até auxiliando na drenagem do solo. Alternativas vêm sendo testadas nesse meio, e aliado a crescente necessidade de produção de materiais sustentáveis, foi desenvolvida uma manta com fibras de coco verde, produto que é encontrado em grande quantidade no território brasileiro que ao se consumir o fruto, as cascas são descartadas no lixo. O objetivo desse trabalho é a confecção dessa manta, para que se possa usar em reforço ao solo e a sua comparação com a manta de poliéster, vendida no mercado atual, através de testes mecânicos.

Large, pelagic rays (family Myliobatidae) that swim by flapping movements of wing-like pectoral fins use the mobuliform mode of swimming. These rays have pectoral fins with a triangular planform and streamlined cross-sectional geometry that would minimize drag. Thrust is produced by vertical oscillations of the fins with spanwise and chordwise flexibility. The thrust is derived from lift generated by the fins. Speed is modulated by changes in oscillatory frequency, whereas the amplitude of heave remains relatively constant with speed. Mobuliform swimming is considered to be a highly efficient means of propulsion. The Strouhal number for different species of myliobatoid rays is within the optimal range for efficient propulsion, except at low swimming speeds. The design of the body, posture of the pectoral fins, and mode of swimming provide a stable platform to resist external and internal perturbations, while permitting maneuverability. The advantages of mobuliform swimming can be exploited through the biomimetic approach to develop a bioinspired autonomous underwater vehicle. [ABSTRACT FROM AUTHOR]