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Abstract The aim of this case report is to show the hospital dental approach to a patient with Niemann-Pick disease (NPD) type B. After her caregivers reported poor oral health, a 10-year-old girl was referred to a hospital. She was diagnosed with NPD type B 4 years ago, with involvement of the brain, nerves, liver, spleen, bone marrow, and lungs. A dental physical examination revealed chronic carious lesions in ten teeth, as well as four residual roots and poor oral hygiene. We chose a surgical block treatment based on the altered complementary exams, dental demands, and the systemic compromise caused by NPD type B. All decayed elements were restored with glass ionomer cement, and residual roots were extracted. The patient had no clinical signs of infection or hemorrhage after 20 days of post-surgical follow-up. Although rare, the presence of patients with NPD type B in the dental routine can occur, necessitating the development of an individualized and multidisciplinary treatment plan.

Abstract Background Understanding the distinct anatomical differences between patients with type B aortic dissection (TBAD) and control patients (CPs) can enhance our knowledge of normal and pathological aortic dimensions. This study aimed to deepen our knowledge of these dimensions by measuring and comparing the anatomical indices of the aortic arch in male patients with TBAD and non-TBAD male patients. Methods In this cross-sectional observational study, 62 TBAD patients (TBADPs) and 43 CPs were assessed. Using a fit centerline approach, we identified three pivotal anatomical landmarks: Point A, Point B, and Point C. These landmarks represented intersections of the aortic arch with the brachiocephalic trunk, left common carotid artery, and left subclavian artery, respectively. These points defined Zones 1, 2, and 3, which collectively span the entire proximal aorta from the proximal end of the aortic valve to Point C. Our analyses compared key anatomical indices such as diameter of the circumscribed circle (Dcirc), ellipticity, curvature, tortuosity between TBADP and CP at critical points and regions. Results TBADPs showed a more circular cross-sectional shape at Points A, B and C, as indicated by reduced values of Dcirc_A (P = 0.031), ellipticity_A (P = 0.034) and ellipticity_B (P = 0.048), together with a significant decrease in Dcirc_C (P = 0.015) and ellipticity_C (P = 0.007). The aortic arch in TBADPs showed enhanced tortuosity in Zone 1 (p = 0.002) and extended elongation in Zone 3 (p = 0.001). Conclusions The study found that the aortic arch in male TBAD patients is more circular near its primary branches, has greater tortuosity in Zone 1, and is longer in Zone 3 compared to male control patients.

Background: Understanding the distinct anatomical differences between patients with type B aortic dissection (TBAD) and control patients (CPs) can enhance our knowledge of normal and pathological aortic dimensions. This study aimed to deepen our knowledge of these dimensions by measuring and comparing the anatomical indices of the aortic arch in male patients with TBAD and non-TBAD male patients. Methods: In this cross-sectional observational study, 62 TBAD patients (TBADPs) and 43 CPs were assessed. Using a fit centerline approach, we identified three pivotal anatomical landmarks: Point A, Point B, and Point C. These landmarks represented intersections of the aortic arch with the brachiocephalic trunk, left common carotid artery, and left subclavian artery, respectively. These points defined Zones 1, 2, and 3, which collectively span the entire proximal aorta from the proximal end of the aortic valve to Point C. Our analyses compared key anatomical indices such as diameter of the circumscribed circle (Dcirc), ellipticity, curvature, tortuosity between TBADP and CP at critical points and regions. Results: TBADPs showed a more circular cross-sectional shape at Points A, B and C, as indicated by reduced values of Dcirc_A (P = 0.031), ellipticity_A (P = 0.034) and ellipticity_B (P = 0.048), together with a significant decrease in Dcirc_C (P = 0.015) and ellipticity_C (P = 0.007). The aortic arch in TBADPs showed enhanced tortuosity in Zone 1 (p = 0.002) and extended elongation in Zone 3 (p = 0.001). Conclusions: The study found that the aortic arch in male TBAD patients is more circular near its primary branches, has greater tortuosity in Zone 1, and is longer in Zone 3 compared to male control patients. [ABSTRACT FROM AUTHOR]

The aim of this case report is to show the hospital dental approach to a patient with Niemann-Pick disease (NPD) type B. After her caregivers reported poor oral health, a 10-year-old girl was referred to a hospital. She was diagnosed with NPD type B 4 years ago, with involvement of the brain, nerves, liver, spleen, bone marrow, and lungs. A dental physical examination revealed chronic carious lesions in ten teeth, as well as four residual roots and poor oral hygiene. We chose a surgical block treatment based on the altered complementary exams, dental demands, and the systemic compromise caused by NPD type B. All decayed elements were restored with glass ionomer cement, and residual roots were extracted. The patient had no clinical signs of infection or hemorrhage after 20 days of post-surgical follow-up. Although rare, the presence of patients with NPD type B in the dental routine can occur, necessitating the development of an individualized and multidisciplinary treatment plan. [ABSTRACT FROM AUTHOR]

We show that the order complex of the poset of nonempty intervals, ordered by inclusion, is a Tchebyshev triangulation of the order complex of the original poset. Besides studying the properties of this transformation, we show that the dual of the type B permutohedron is combinatorially equivalent to the suspension of the order complex of the poset of nonempty intervals of a Boolean algebra (with the minimum and maximum elements removed). [ABSTRACT FROM AUTHOR]

This article reports a case with the chief complaint of “hepatosplenomegaly to be investigated” and a confirmed diagnosis of Niemann-Pick disease type B after various tests, and a literature review was conducted to summarize the heterogeneous manifestations of liver involvement in type B Niemann-Pick disease, in order to improve the clinical management of difficult and rare liver diseases. [ABSTRACT FROM AUTHOR]

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The study of personality type and its impact on various facets of life has always generated a great deal of interest among researchers, academicians, and the public in general. This paper specifically explores the relationship between Type A personality and Type B personality with Job Satisfaction and Life Satisfaction. It also attempts to highlight the nature of the relation between Job Satisfaction and Life Satisfaction. The scales used in this study were Jenkins Activity Survey (Jenkins, Hames, Zyzanski, Rosenman, & Friedman, 1969); Job Satisfaction Scale (Spector, 1985); and Satisfaction with Life Scale (Diener, Emmnos, Larsen, & Griffin, 1985). The data was collected from a sample of 60 working individuals in the age range of 25 years to 60 years. Quantitative analysis was carried out involving Descriptive Analysis, Correlation analysis and Independent samples t-test. Descriptive analysis showed that the mean score of Type B was much higher than Type A in Job Satisfaction. Even though a similar trend was observed with regard to Life Satisfaction, the difference was only marginal. t-test showed that Type Aand Type B differed significantly only on Job Satisfaction (p<0.05). Correlational analysis show a moderate positive relation between Job satisfaction and Life satisfaction (p<0.01). It can be inferred that as Personality types have a significant impact on an individual's Job Satisfaction, organizations need to conduct personality assessments of their employees and ensure their optimal placements. This will enhance utilization of full potential of the employees, build-up of positive job-related attitudes, workplace well-being and increase overall productivity. A favourable work environment and high job satisfaction will have a spillover effect on life satisfaction too. Hence, organizations will be benefitted by having employees experience subjective well-being and possess favourable work-related attitudes. [ABSTRACT FROM AUTHOR]

In the early 1990s, Billera and Sturmfels introduced the monotone path polytope (MPP), an important case of the general theory of fiber polytopes, which has led to remarkable combinatorics. Given a pair (P , φ) of a polytope P and a linear functional φ , the MPP is obtained from averaging the fibers of the projection φ (P) . They also showed that MPPs of (regular) simplices and hyper-cubes are combinatorial cubes and permutahedra respectively. As a natural follow-up we investigate the monotone paths of cross-polytopes for a generic linear functional φ . We show the face lattice of the MPP of the cross-polytope is isomorphic to the lattice of intervals in the sign poset from oriented matroid theory. We also describe its f-vector, some geometric realizations, an irredundant inequality description, the 1-skeleton and we compute its diameter. In contrast to the case of simplices and hyper-cubes, monotone paths on cross-polytopes are not always coherent. [ABSTRACT FROM AUTHOR]

Abstract Background Contemporary management of uncomplicated type B aortic dissections (uTBAD) is based on the acuity and various morphological features. Medical therapy is mandatory, while the risks of early thoracic endovascular aortic repair (TEVAR) are balanced against the potential for rupture, complex surgery, and death. Improved aortic morphology following TEVAR is documented, but evidence for improved overall survival is lacking. The costs and impact on quality of life are also needed. Methods The trial is a randomized, open-label, superiority clinical trial with parallel assignment of subjects at 23 clinical sites in Denmark, Norway, Sweden, Finland, and Iceland. Eligibility includes patients aged ≥ 18 with uTBAD of

IntroductionPheochromocytomas combined with aortic dissections are rare. Treatment of aortic dissection can be complicated by the presence of pheochromocytomas.Case presentationwe present the case of a 48-year-old male who visited the hospital with chest and back pain for 13 h. Enhanced computed tomography (CT) revealed a type B aortic dissection combined with a left adrenal mass (72 mm). Elevated 24-h urinary vanillylmandelic acid levels can aid in the diagnosis of pheochromocytomas. Aortic dissection due to unstable hypertension secondary to pheochromocytoma is rare and complicates the procedure. Thoracic endovascular aortic repair was performed, and antihypertensive treatments were administered after surgery. After hypertension was addressed and the patient was stable, laparoscopic resection of the adrenal mass was performed.Conclusionsdespite its rarity, it is important to consider pheochromocytoma as a differential factor for unstable hypertension when an aortic dissection is found.

A 63-year-old man had presented for emergency endovascular treatment of acute type B aortic dissection complicated by acute occlusion of the true lumen of the infrarenal aorta and a Crawford type III thoracoabdominal aortic aneurysm. These findings precluded the use of a conventional endovascular approach. A novel technique was developed with the insertion of guidewires through the left femoral and subclavian arteries to deliver stent grafts to cover the dissection entry tear and exclude the thoracoabdominal aortic aneurysm. A femorofemoral bypass was performed to preserve the circulation. The procedure and follow-up course were uneventful. This technique appears to be a promising tool for thoracic endovascular aortic repair in emergency setting. More experience with the method is warranted.

Background : Contemporary management of uncomplicated type B aortic dissections (uTBAD) is based on the acuity and various morphological features. Medical therapy is mandatory, while the risks of early thoracic endovascular aortic repair (TEVAR) are balanced against the potential for rupture, complex surgery, and death. Improved aortic morphology following TEVAR is documented, but evidence for improved overall survival is lacking. The costs and impact on quality of life are also needed. Methods: The trial is a randomized, open-label, superiority clinical trial with parallel assignment of subjects at 23 clinical sites in Denmark, Norway, Sweden, Finland, and Iceland. Eligibility includes patients aged ≥ 18 with uTBAD of < 4 weeks duration. Recruited subjects will be randomized to either standard medical therapy (SMT) or SMT + TEVAR, where TEVAR must be performed between 2–12 weeks from the onset of symptoms. Discussion: This trial will evaluate the primary question of whether early TEVAR improves survival at 5 years among uTBAD patients. Moreover, the costs and the impact on quality of life should provide sorely needed data on other factors that play a role in treatment strategy decisions. The common Nordic healthcare model, with inclusion of all aortic centers, provides a favorable setting for carrying out this trial, while the robust healthcare registries ensure data validity. Trial registration: ClinicalTrials.gov NCT05215587. Registered on January 31, 2022. [ABSTRACT FROM AUTHOR]

Background: Extended downstream endovascular management has been applied in acute complicated type B aortic dissection (acTBAD), distally to standard thoracic endovascular aortic repair (TEVAR), using bare metal stents, with or without lamina disruption, using balloon inflation. The aim of this systematic review was to assess technical success, 30-day mortality, and mortality during followup in patients with acTBAD managed with the Provisional Extension To Induce Complete Attachment (PETTICOAT) or stent-assisted balloon-induced intimal disruption and relamination (STABILISE) technique. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement was followed. A search of the English literature, via Ovid, using MEDLINE, EMBASE, and CENTRAL databases, until 30th August 2022, was executed. Randomized controlled trials and observational studies (published between 2000-2022), with =5 patients, reporting on technical success, 30-day mortality and mortality during the available follow-up among patients that underwent PETTICOAT or STABILISE technique for acTBAD were eligible. The Newcastle-Ottawa Scale was applied to assess the risk of bias. Primary outcomes were technical success and 30-day mortality, and secondary outcome was mortality during the available follow-up. Results: Thirteen studies were considered eligible, twelve in the quantitative analysis. In total, 418 patients with acTBAD managed with the PETTICOAT (83%) or STABILISE (17%) technique were included. Technical success ranged between 97-100%, 99% for the PETTICOAT and 100% for the STABILISE sub-cohort. Thirty-day mortality was estimated at 3.7% (12/321), 1.4% for the STABILISE and 4.4% for the PETTICOAT technique. All studies reported the mean available follow-up which was estimated at 20 months (range 3-168 months), 22 months (mean value) for the PETTICOAT and 17 months (mean value) for the STABILISE technique. Twenty-three patients died during follow-up, with an estimated mortality rate at 5.7% for the total cohort. The mortality during follow-up was 0% for the STABILISE and 7.0% for the PETTICOAT approach. Conclusions: Both, the PETTICOAT and STABILISE techniques presented less than 4% perioperative mortality in patients with acTBAD with high technical success rate. The mid-term mortality rate was at 6%. However, the heterogeneity in the available studies' highlights the need for further prospective studies, including larger volume and longer follow-up. [ABSTRACT FROM AUTHOR]

Arachidonate 15-lipoxygenase (ALOX15) and arachidonate 15-lipoxygenase, type B (ALOX15B) catalyze the dioxygenation of polyunsaturated fatty acids and are upregulated in human alternatively activated macrophages (AAMs) induced by Th2 cytokine interleukin-4 (IL-4) and/or interleukin-13. Known primarily for roles in bioactive lipid mediator synthesis, 15-lipoxygenases (15-LOXs) have been implicated in various macrophage functions including efferocytosis and ferroptosis. Using a combination of inhibitors and siRNAs to suppress 15-LOX isoforms, we studied the role of 15-LOXs in cellular cholesterol homeostasis and immune function in naïve and AAMs. Silencing or inhibiting the 15-LOX isoforms impaired sterol regulatory element binding protein (SREBP)-2 signaling by inhibiting SREBP-2 processing into mature transcription factor and reduced SREBP-2 binding to sterol regulatory elements and subsequent target gene expression. Silencing ALOX15B reduced cellular cholesterol and the cholesterol intermediates desmosterol, lanosterol, 24,25-dihydrolanosterol, and lathosterol as well as oxysterols in IL-4-stimulated macrophages. In addition, attenuating both 15-LOX isoforms did not generally affect IL-4 gene expression but rather uniquely impacted IL-4-induced CCL17 production in an SREBP-2-dependent manner resulting in reduced T cell migration to macrophage conditioned media. In conclusion, we identified a novel role for ALOX15B, and to a lesser extent ALOX15, in cholesterol homeostasis and CCL17 production in human macrophages.

Ehlers-Danlos is a connective tissue disorder characterized by hypermobile joints, hyperextensible skin, and increased bleeding tendency. We report a case involving endovascular repair of an intussusception of aortic dissection that occurred in an Ehlers-Danlos patient following surgical repair of an intercostal artery bleed. Given the rarity of Ehlers-Danlos, continued reporting of treatment outcomes is important for refining complication management in this population. Our experience lends support for endovascular rescue of failed aortic repair that may arise in Ehlers-Danlos patients and contributes to the otherwise small body of literature concerning endovascular intervention in this population overall. [ABSTRACT FROM AUTHOR]

A generalization of the Stirling numbers of the second kind of type B is given in two different directions. One generalization is via their q-analogue and the other one uses r distinguished elements. Both directions are explained and proved in a combinatorial way using generalized restricted growth words which we define here for type B. Moreover, we present their ordinary and exponential generating functions, where the exponential generating function is also used to present the r-variant as connection constants between two bases of ℝ[x]. [ABSTRACT FROM AUTHOR]

Five Type A CAIs from three CV3 chondrites (Vigarano, Northwest Africa 3118, Allende), which differ in age by no more than ∼105 years, show mineralogical and textural evidence of gradual transition into Type Bs, indicating that Type B inclusions formed by evolution of Type A CAIs in the solar nebula. This model differs from the conventional condensation model in which aggregates of condensate grains form different kinds of CAIs depending on the relative populations of different kinds of grains. In our model the pyroxene forms nearly isochemically by reaction of perovskite with melilite under highly reducing conditions. Anorthite requires the addition of silica from the gas, and originally forms as veins and reaction rims on gehlenitic melilite within Fluffy Type As. Later partial re-melting of these assemblages results in the formation of poikilitic pyroxene and anorthite that enclose rounded (partially melted) tablets of melilite. Oxygen isotopes in four of the CAIs support the formation of Ti-rich 16O-depleted pyroxene from 16O-depleted perovskite, but not in the fifth CAI. An alternative possibility is that Ti-rich 16O-depleted pyroxene is the result of later solid-state exchange that preferentially affects the most Ti-rich pyroxene. Regardless of the origin of the 16O-depleted pyroxene, we give a model for nebular reservoir evolution based on sporadic FU-Orionis flare-ups in which the 16O-rich region near the proto-Sun fluctuated in size depending on whether the proto-Sun was in flare-up stage or quiescent. [ABSTRACT FROM AUTHOR]

Abstract Background Pasteurella multocida is the etiological agent responsible for several diseases in a wide range of hosts around the world and thus, causes serious economic losses. Acute septicemia associated with capsular type B P. multocida has recently emerged in Europe and continuous outbreaks of these acute processes have been described in Spain since they were first detected in pigs in 2009 and cattle in 2015. The scarcity of studies on the antimicrobial susceptibility of this capsular type of P. multocida and growing concern about the general increase of antimicrobial resistance mean that studies related to the performance of type B P. multocida against antibiotics are necessary to establish accurate treatments and to monitor antimicrobial resistances. Results Seventy-six isolates of P. multocida type B from pigs and cattle with acute septicemia were tested for susceptibility to 10 different antimicrobials. Bovine isolates were susceptible to all the antibiotics we tested except for lincomycin (94.4% of isolates were resistant). However, the antimicrobials we tested were less effective against swine isolates, of which none were susceptible to lincomycin. Furthermore, 29.3% swine isolates were resistant to tetracycline, 27.6% to penicillin, 20.7% to oxytetracycline, 17.3% to chloramphenicol, 15.5% to gentamicin, and 3.4% to enrofloxacin; no resistance to ceftiofur was detected. No multidrug resistant isolates were detected from cattle, while 25.86% of swine isolates were resistant to three or more antibiotic classes. Conclusions In this study, the lower resistance rates and multidrug resistant isolates reported for P. multocida type B derived from cattle compared to those isolated from pigs may be related to the increased use of antibiotics in the porcine industry in Spain. Lincomycin is not recommended for the treatment of acute septicemia in pigs or cattle, rather, the use of ceftiofur, enrofloxacin, or gentamicin is indicated as an emergency treatment in the early stages of disease; once the susceptibility results are known, the use of tetracyclines, penicillin, or chloramphenicol should be prioritized. The increase in multidrug resistant isolates and antimicrobial resistance rates indicates that more attention should be paid to prevention as well as the responsible use of antibiotics.

Type B aortic dissection with high-risk features such as a large entry tear, false lumen, and circumferential dissection has a greater chance of progression and rupture without definitive surgical intervention. Traditional thoracic endovascular aortic repair of dissection with proximal zone 1 landing requires extensive aortic arch debranching to minimize the risk of ischemic stroke with endograft deployment. Recent developments in endovascular grafts for thoracic endovascular aortic repair have allowed for an optimized approach in challenging cases. We present the case of a 53-year-old male with circumferential type B aortic dissection and higher-risk features treated with a staged right-to-left carotid bypass and subsequent thoracic endovascular aortic repair with a GORE Ⓡ TAG Ⓡ Thoracic Branch Endoprosthesis for zone 1 proximal landing., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Background: Extended downstream endovascular management has been applied in acute complicated type B aortic dissection (acTBAD), distally to standard thoracic endovascular aortic repair (TEVAR), using bare metal stents, with or without lamina disruption, using balloon inflation. The aim of this systematic review was to assess technical success, 30-day mortality, and mortality during follow-up in patients with acTBAD managed with the Provisional Extension To Induce Complete Attachment (PETTICOAT) or stent-assisted balloon-induced intimal disruption and relamination (STABILISE) technique. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement was followed. A search of the English literature, via Ovid, using MEDLINE, EMBASE, and CENTRAL databases, until 30th August 2022, was executed. Randomized controlled trials and observational studies (published between 2000–2022), with ≥5 patients, reporting on technical success, 30-day mortality and mortality during the available follow-up among patients that underwent PETTICOAT or STABILISE technique for acTBAD were eligible. The Newcastle-Ottawa Scale was applied to assess the risk of bias. Primary outcomes were technical success and 30-day mortality, and secondary outcome was mortality during the available follow-up. Results: Thirteen studies were considered eligible, twelve in the quantitative analysis. In total, 418 patients with acTBAD managed with the PETTICOAT (83%) or STABILISE (17%) technique were included. Technical success ranged between 97–100%, 99% for the PETTICOAT and 100% for the STABILISE sub-cohort. Thirty-day mortality was estimated at 3.7% (12/321), 1.4% for the STABILISE and 4.4% for the PETTICOAT technique. All studies reported the mean available follow-up which was estimated at 20 months (range 3–168 months), 22 months (mean value) for the PETTICOAT and 17 months (mean value) for the STABILISE technique. Twenty-three patients died during follow-up, with an estimated mortality rate at 5.7% for the total cohort. The mortality during follow-up was 0% for the STABILISE and 7.0% for the PETTICOAT approach. Conclusions: Both, the PETTICOAT and STABILISE techniques presented less than 4% perioperative mortality in patients with acTBAD with high technical success rate. The mid-term mortality rate was at 6%. However, the heterogeneity in the available studies’ highlights the need for further prospective studies, including larger volume and longer follow-up.

Background: Four-dimensional flow magnetic resonance imaging (4D flow MRI) can accurately visualize and quantify flow and provide hemodynamic information such as wall shear stress (WSS). This imaging technique can be used to obtain more insight in the hemodynamic changes during cardiac cycle in the true and false lumen of uncomplicated acute Type B Aortic Dissection (TBAD). Gaining more insight of these forces in the false lumen in uncomplicated TBAD during optimal medical treatment, might result in prediction of adverse outcomes. Methods: A porcine aorta dissection model with an artificial dissection was positioned in a validated ex-vivo circulatory system with physiological pulsatile flow. 4D flow MR images with 3 set heartrates (HR; 60 bpm, 80 bpm and 100 bpm) were acquired. False lumen volume per cycle (FLV), mean and peak systolic WSS were determined from 4D flow MRI data. For validation, the experiment was repeated with a second porcine aorta dissection model. Results: During both experiments an increase in FLV (initial experiment: ΔFLV = 2.05 ml, p < 0.001, repeated experiment: ΔFLV = 1.08 ml, p = 0.005) and peak WSS (initial experiment: ΔWSS = 1.2 Pa, p = 0.004, repeated experiment: ΔWSS = 1.79 Pa, p = 0.016) was observed when HR increased from 60 to 80 bpm. Raising the HR from 80 to 100 bpm, no significant increase in FLV (p = 0.073, p = 0.139) was seen during both experiments. The false lumen mean WSS increased significant during initial (2.71 to 3.85 Pa; p = 0.013) and non-significant during repeated experiment (3.22 to 4.00 Pa; p = 0.320). Conclusion: 4D flow MRI provides insight into hemodynamic dimensions including WSS. Our ex-vivo experiments showed that an increase in HR from 60 to 80 bpm resulted in a significant increase of FLV and WSS of the false lumen. We suggest that strict heart rate control is of major importance to reduce the mean and peak WSS in uncomplicated acute TBAD. Because of the limitations of an ex-vivo study, 4D flow MRI will have to be performed in clinical setting to determine whether this imaging model would be of value to predict the course of uncomplicated TBAD. [ABSTRACT FROM AUTHOR]

Background Complicated type-B dissections are catastrophic aortic lesions. Thoracic endovascular aortic repair (TEVAR) is less invasive than open surgery in treating these lesions. Morbidity and mortality are less in TEVAR than in surgery. The anatomical and clinical suitability need to be assessed in each patient. Institutional experience may also influence the outcome. Purpose The aim of this study was to evaluate the efficiency and safety of TEVAR in treating complicated type-B-dissection patients. These results are also compared between DeBakey type-IIIa and type-IIIb dissections. Patients and methods This is a prospective, nonrandomized, dual-center cohort study. Fifteen patients with complicated type-B aortic dissections were treated with TEVAR. The study was performed in two tertiary referral centers. It began in July 2015 and ended in May 2017. Six of the 15 patients suffered from DeBakey IIIa dissections, while nine of the 15 patients suffered from DeBakey IIIb dissections. The dissection onset was acute in one (6%) patient, subacute in two (13%) patients, and chronic in 12 (80%) patients. Follow-up computed tomography angiography was done 1 month, 6 months, and 1 year after the procedure. Results All-cause and aorta-specific mortality were both 0%. TEVAR caused false lumen thrombosis in 87% of cases. The endograft patency rate was 100%. The aortic diameter did not increase further in 87%. Device migration did not occur in any patient. Type IA endoleak occurred in one (6%) patient. Postimplantation syndrome occurred in one (6%) patient. Groin-wound infection occurred in one (6%) patient. A groin hematoma occurred in two (13%) patients. No strokes, paraplegia, or retrograde type-A dissections occurred. Conclusion TEVAR leads to excellent aorta-specific survival and delayed disease progression. TEVAR is safe and efficient in treating complicated type-B aortic dissection. There are no differences between DeBakey IIIa and IIIb dissections in the safety and efficiency of TEVAR. [ABSTRACT FROM AUTHOR]

Previous publications have clearly established a correlation between timing of thoracic endovascular aortic repair (TEVAR) and complications after treatment of complicated acute type B aortic dissection (ATBAD). However, the temporal association of TEVAR with morbidity after uncomplicated presentations is poorly understood and has not previously been examined using real-world national data. Therefore, the objective of this analysis was to determine whether TEVAR timing of uncomplicated ATBAD (UATBAD) is associated with postoperative complications. The Vascular Quality Initiative TEVAR and complex endovascular aneurysm repair registry was analyzed from 2010 to 2019. Procedures performed for non-dissection-related disease as well as for ATBAD with malperfusion or rupture were excluded. Because of inherent differences between timing cohorts, propensity score matching was performed to ensure like comparisons. Univariate and multivariable analysis after matching was used to determine differences between timing groups (symptom onset to TEVAR: acute, 1-14 days; subacute, 15-90 days) for postoperative mortality, in-hospital complications, and reintervention. A total of 688 cases meeting inclusion criteria were identified. After matching 187 patients in each of the 1- to 14-day and 15- to 90-day treatment groups, there were no statistically significant differences between groups. On univariate analysis, the 1- to 14-day treatment group had a higher proportion of cases requiring reintervention within 30 days (15.3%) compared with UATBAD patients undergoing TEVAR within 15 to 90 days (5.2%; P =.02). There was also a difference (P =.007) at 1 year, with 33.8% of the 1- to 14-day UATBAD patients undergoing reintervention compared with 14.5% for the 15- to 90-day group. There were no statistically significant differences on multivariable analysis for long-term survival, complications, or long-term reintervention. There was a trend toward significance (P =.08) with the 1- to 14-day group having 2.3 times the odds of requiring an in-hospital reintervention compared with the 15- to 90-day group. Timing of TEVAR for UATBAD does not appear to predict mortality or postoperative complications. However, there is a strong association between repair within 1 to 14 days and higher risk of reintervention. This may in part be related to the 1- to 14-day group's representing an inherently higher anatomic or physiologic risk population that cannot be entirely accounted for with propensity analysis. The role of optimal timing to intervention should be incorporated into future study design of TEVAR trials for UATBAD. [ABSTRACT FROM AUTHOR]

Introduction: The treatment of acute type B aortic dissection (ATBAD) is currently a challenge for vascular surgeons, because of the early morbidity and mortality rates and the high risk of late aortic events up to 50% at 5 years. This study presents the initial outcomes of ATBAD treatment using optimal medical therapy alone or combined with proximal entry tear stent-graft coverage. Additionally, it provides an analysis of the evolution of the aortic diameter and its clinical consequences during the chronic phase in each group., Materials and Methods: Conducted as a retrospective, single-center study, we enrolled all consecutive ATBAD patients (n=130) treated between 2008 and 2020. The primary analysis studies the entire patient cohort based on their initial management approach, namely, medical treatment alone for uncomplicated ATBAD (n=67) or combined with stent-graft entry tear coverage (n=63). We also conducted a subgroup analysis to investigate factors associated with disease progression in the medical management group., Results: Median follow-up was 29.5 months. During this time aneurysmal evolution was observed in: 42.4% of cases in the medical group compared with 21.8% in the stent-graft group, primarily affecting the thoracic aorta. The stent-graft group exhibited significant aortic remodeling, with a decrease in false lumen (FL) and thoracic aortic diameters. Initial aortic diameter ≥40 mm and FL ≥22 mm were independent risk factors for aneurysmal degeneration. Five-year survival was consistent at 76.1% in both groups., Conclusion: This study confirms the safety and efficacy of stent-graft entry tear coverage for ATBAD. Initial thoracic endovascular aortic repair (TEVAR) appears to reduce late aortic events by promoting aortic remodeling. Considering TEVAR's safety and potential to prevent late aortic complications, it may be considered for uncomplicated ATBAD patients with an initial aortic diameter ≥40 mm or an FL ≥22 mm., Clinical Impact: This study validates the efficacy and safety of using endovascular stent grafts to seal the proximal entry tear in cases of acute type B aortic dissections, compared to optimal medical therapy. Aortic remodelling significantly benefits from endovascular stent graft coverage of the proximal entry tear. Given the heightened risk of late aortic events observed in the medical therapy cohort, there appears to be a necessity for including endovascular interventions in the management of uncomplicated acute type B aortic dissections, particularly when aortic diameter is ≥40 mm and false lumen diameter is ≥22 mm., 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.

Background: Pasteurella multocida is the etiological agent responsible for several diseases in a wide range of hosts around the world and thus, causes serious economic losses. Acute septicemia associated with capsular type B P. multocida has recently emerged in Europe and continuous outbreaks of these acute processes have been described in Spain since they were first detected in pigs in 2009 and cattle in 2015. The scarcity of studies on the antimicrobial susceptibility of this capsular type of P. multocida and growing concern about the general increase of antimicrobial resistance mean that studies related to the performance of type B P. multocida against antibiotics are necessary to establish accurate treatments and to monitor antimicrobial resistances. Results: Seventy-six isolates of P. multocida type B from pigs and cattle with acute septicemia were tested for susceptibility to 10 different antimicrobials. Bovine isolates were susceptible to all the antibiotics we tested except for lincomycin (94.4% of isolates were resistant). However, the antimicrobials we tested were less effective against swine isolates, of which none were susceptible to lincomycin. Furthermore, 29.3% swine isolates were resistant to tetracycline, 27.6% to penicillin, 20.7% to oxytetracycline, 17.3% to chloramphenicol, 15.5% to gentamicin, and 3.4% to enrofloxacin; no resistance to ceftiofur was detected. No multidrug resistant isolates were detected from cattle, while 25.86% of swine isolates were resistant to three or more antibiotic classes. Conclusions: In this study, the lower resistance rates and multidrug resistant isolates reported for P. multocida type B derived from cattle compared to those isolated from pigs may be related to the increased use of antibiotics in the porcine industry in Spain. Lincomycin is not recommended for the treatment of acute septicemia in pigs or cattle, rather, the use of ceftiofur, enrofloxacin, or gentamicin is indicated as an emergency treatment in the early stages of disease; once the susceptibility results are known, the use of tetracyclines, penicillin, or chloramphenicol should be prioritized. The increase in multidrug resistant isolates and antimicrobial resistance rates indicates that more attention should be paid to prevention as well as the responsible use of antibiotics. [ABSTRACT FROM AUTHOR]

This Society for Vascular Surgery/Society of Thoracic Surgeons (SVS/STS) document illustrates and defines the overall nomenclature associated with type B aortic dissection. The contents describe a new classification system for practical use and reporting that includes the aortic arch. Chronicity of aortic dissection is also defined along with nomenclature in patients with prior aortic repair and other aortic pathologic processes, such as intramural hematoma and penetrating atherosclerotic ulcer. Complicated vs uncomplicated dissections are clearly defined with a new high-risk grouping that will undoubtedly grow in reporting and controversy. Follow-up criteria are also discussed with nomenclature for false lumen status in addition to measurement criteria and definitions of aortic remodeling. Overall, the document provides a facile framework of language that will allow more granular discussions and reporting of aortic dissection in the future. [ABSTRACT FROM AUTHOR]

Kesintili arkus aorta nadir rastlanan, fatal seyirli konjenital kardiyak bir anomali olup, aorta ascendens ile aorta descendens arasındaki bir segmentte atrezinin olması şeklinde tanımlanır ve %98 oranında diğer kardiovasküler anomalilerle birlikte bulunur. Üç tipi mevcuttur. Tip A’ da kesinti, a. subclavia sinistra’nın distalindedir. Tip B’de, a. carotis communis sinistra ile a. subclavia sinistra, tip C’de, a. carotis communis sinistra ile a. carotis communis dextra arasındadır. Selçuk Üniversitesi pediatrik kardiyoloji kliniğine başvuran postnatal 5. gününde bir erkek bebeğin çekilen ekokardiyografisinde; truncus brachiocephalicus’un distalinden itibaren tip B kesintili arkus aorta, ventriküler septal defekt, biküspit aorta, patent ductus arteriosus, atrial septal defekt, annulus aorticus hipoplazisi tespit edildi. Bilgisayarlı tomografi anjiyografisinde ise, a. carotis communis sinistra ile a. subclavia sinistra arasında bağlantı olmadığı görüldü. Bu vakada, arcus aorta anomalisi ve eşlik eden diğer kardiovasküler anomalilerin erken tanı ve tedavisinde radyolojik görüntüleme yöntemlerinin önemi vurgulanmaktadır

Effectiveness and optimal timing of endovascular treatment for type B aortic dissection (AD) remain controversial. An extensive search of literature (January 1999-December 2017) was conducted using PubMed, Cochrane Library and Science-Direct databases for studies on endovascular repair for acute/chronic type B AD; ≥10 patients; not reviews; and reporting predefined baseline data and ≥50% of predefined study outcomes, which were extracted and analysed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses. Primary outcomes were in-hospital all-cause mortality and aorta-related mortality. Based on 92 publications (5956 patients), pooled estimate for overall in-hospital mortality was 7.0% [95% CI, 6.2%–7.8%]. Major perioperative complications included stroke (4.2% [3.6%–4.9%]), spinal cord ischemia (3.3% [2.8%–3.9%]), retrograde type A AD (3.2% [2.7%–3.9%]), type I endoleak (4.9% [3.8%–6.2%]), visceral ischemia (3.1% [2.5%–3.8%]) and acute renal failure requiring haemodialysis (5.1% [4.3%–5.9%]). Mid-term mortality incidence was 8.9% [7.2%–10.9%], and secondary intervention rate was 12.5% [10.5%–15.0%] with 6.1% [5.3%–7.2%] conversion to open surgery. Institutions with ≥40 endovascular treatment caseload had significantly lower rates of in-hospital and aorta-related mortality, stroke, type I endoleak, renal failure and retrograde type A AD. Patients treated in the acute phase had significantly higher incidence of in-hospital or aorta-related mortality and renal failure. Patients with chronic dissection required significantly more often secondary intervention during follow-up. Endovascular stent-graft for type B AD therefore appeared feasible and safe with a low incidence of mortality and perioperative complications, particularly for delayed intervention and centres with ≥40 caseload. Standardized and long-term follow-up data are warranted. • Endovascular treatment of type B aortic dissection was feasible and safe. • Institutions with ≥40 TEVAR caseload had lower in-hospital mortality and morbidities. • Chronic type B AD underwent TEVAR had lower in-hospital mortality and higher follow-up secondary intervention. [ABSTRACT FROM AUTHOR]

Objective To investigate the combination inhibitory effect of the important components of baicalein and wogonin of suduxing, a new anti-hepatitis B virus (HBV) Chinese herbal on entecavir (ETV)-resistant mutant virus, and to find the optimal ratio of the two components. Methods The ETV-resistant HBV stable replication cell line HepG2. A64 was divided into the baicalein group, the wogonin group, the combined drug group, and the control group, respectively. According to the toxicity test results of baicalein and wogonin, cells in the the baicalein group were treated with baicalein at 4, 8, and 16 μ, mol/L, respectively, and recorded as the B4, B8, and B16 groups; cells in the wogonin group were treated with wogonin at 3, 6, and 12 μ, mol/L, respectively, and recorded as the W3, W6, and W12 groups. The first part of cells in the combined drug group was treated with baicalein (4 μ,mol/L) and the wogonin of different concentrations ( 3, 6, 12 μ,mol/L), respectively, and recorded as B4 + W3, B4 + W6, B4 + W12 groups ; the second part of cells in the combined drug group were treated with baicalein (8 μ,mol/L) and wogonin of different concentrations ( 3, 6, 12 μ, mol/L), recorded as B8 + W3, B8 + W6, B8 + W12 groups; the third part of cells in the combined drug group were treated with baicalein ( 16 μ,mol/L) and wogonin of different concentrations ( 3, 6, 12μ, mol/L), recorded as B16 + W3, B16 + W6, B16 + Wl2 groups. The cells in the control group were treated with an equal amount of DMEM medium. Cells of each group were cultured for 96 h, the HBV DNA in the cell supernatant was detected by the PCR-fluorescent probe "one-tube method", and the HBV DNA inhibition rate was calculated; the HBsAg in the cell supernatant was detected by the double antibody sandwich method, and the HBsAg inhibition rate was calculated; HBV total DNA and HBV covalently closed circular DNA ( cccDNA) were detected by fluorescence quantitative PCR method, and the inhibition rate of HBV total DNA and HBV cccDNA was calculated. The Q method of Jin Zhengjun was used to evaluate the synergism between baicalein and wogonin. Results The inhibition rates of HBV DNA, HBsAg in the cell supernatant, intracellular total DNA and cccDNA of the baicalein group, the wogonin group, and the combined drug group were higher than those in the control group ( all P < 0.05 ). The HBV DNA inhibition rate in the cell supernatant of the combined drug group was higher than that of each single drug ( all P <0.05), the B16 + W3 group had the highest Q value (0.970). The HBsAg inhibition rates in the cell supernatants of the B8 + W12, B16 + W3, and B16 + W12 groups were higher than that of each single group ( P < 0.05) The Q value of the B16 + W3 group was the highest (0.886). The inhibition rates of intracellular total HBV DNA of the combined drug group were higher than those of the baicalein group and wogonin group with the same drug concentration ( all P < 0.05) . The B16 + W3 group had the highest Q value ( 1.183). The inhibition rates of HBV cccDN A in the cells of B16 + W3, B16 + W6, and B16 + W12 groups were higher than those of the baicalein group and wogonin group with the same drug concentration, of which the B16 + W3 group had the highest Q value (0.972). Conclusions The baicalein and wogonin have inhibitory effects either individual or combination on ETV-resistant HBV DNA, HBV cccDNA, and HBsAg in HepG2. A64 cells. Inhibition effect of baicalein combined with wogonin is stronger than that of each single drug with the same drug concentration. The combination of 16μ, mol/L baicalein and 3μ, mol/L wogonin (5:1) has the optimal inhibitory effect. [ABSTRACT FROM AUTHOR]

Acute aortic dissection (AAD) cases are thought to have high blood pressure (BP) on admission; however, little data are available on BP prior to admission. The purpose of this study was to investigate systolic blood pressure (SBP) very early after symptom onset and before hospital transfer in patients with AAD to determine whether SBPs were high, and also whether SBPs were higher or lower compared with SBPs at hospital admission. We obtained results using three-year data derived from the Tokyo Acute Aortic Super Network Database. First, we selected 830 patients with AAD for which the "duration from symptom onset to first medical contact by ambulance crews" (SO-FMC) was within 60 min. We examined the SBPs of such patients. Next, we selected 222 patients with AAD whose SBPs were measured both at FMC, within 15 min after symptom onset, and at hospital admission, and compared SBPs at FMC with those at hospital admission. Among types A (n = 190) and B (n = 117), in patients with an SO-FMC ≤ 15 min, the median SBP was 100 mmHg and 178 mmHg (p < 0.001), respectively; 9% and 50% (p < 0.001) of such patients, respectively, exhibited an SBP ≥ 180 mmHg; and 43% and 10% (p < 0.001) of such patients, respectively, had an SBP < 90 mmHg. Of patients with types A (n = 124) and B (n = 98) AAD whose SBPs were measured both at FMC, within 15 min after symptom onset, and at hospital admission, SBPs at FMC were higher than those at hospital admission for the SBP ≥ 180 mmHg subgroups of both type A (194 mmHg vs. 159 mmHg, p < 0.001) and type B (199 mmHg vs. 186 mmHg, p < 0.001). Approximately 10 min after symptom onset and before hospital transfer, the measured SBPs of many patients with type A AAD were not necessarily high. However, the SBPs of cases with type B AAD were high as previously reported for SBP on admission. In addition, for the subgroup of SBP ≥ 180 mmHg at FMC within 15 min after symptom onset, SBPs at FMC were significantly higher than those at hospital admission for both types A and B; the higher SBP at symptom onset may have been partially associated with being a trigger of AD. [ABSTRACT FROM AUTHOR]

Abstract Background The MDACC group recommends to extend the current borderline classification for pancreatic cancer into three groups: type A patients with resectable/borderline tumor anatomy, type B with resectable/borderline resectable tumor anatomy and clinical findings suspicious for extrapancreatic disease and type C with borderline resectable and marginal performance status/severe pre-existing comorbidity profile or age>80. This study intents to evaluate the proposed borderline classification system in a multicenter patient cohort without neoadjuvant treatment. Methods Evaluation was based on a multicenter database of pancreatic cancer patients undergoing surgery from 2005 to 2016 (n = 1020). Complications were classified based on the Clavien-Dindo classification. χ2-test, Kaplan–Meier estimator and Cox regression hazard model were used for statistical analysis. Results Most patients (55.1%) were assigned as type A patients, followed by type C (35.8%) and type B patients (9.1%). Neither the complication rate, nor the mortality rate revealed a correlation to any subgroup. Type B patients had a significant worse progression free (p < 0.001) and overall survival (p = 0.005). Type B classification was identified as an independent prognostic marker for progression free survival (p = 0.005, HR 1.47). Conclusion The evaluation of the proposed classification in a cohort without neoadjuvant treatment did not justify an additional medical borderline subgroup. A new subgroup based on prognostic borderline patients might be the main target group for neoadjuvant protocols in future. [ABSTRACT FROM AUTHOR]

Introduction The classical treatment of type B aortic dissection is based on either medical treatment for uncomplicated aortic dissection or open surgery. Now with improvements in endovascular intervention, it seems to be more effective, safe, and with favorable effects on aortic remodeling. Patients and methods This is a retrospective study that aimed to evaluate the effect of thoracic endovascular repair (TEVAR) on remodeling in uncomplicated acute type B aortic dissection. Serial contrast-enhanced computed tomography scans of 32 patients with acute type B aortic dissection were performed and the data were collected between March 2018 and October 2018. Thirteen patients received best medical therapy only and 19 patients received best medical therapy and TEVAR, and the effect of TEVAR on aortic remodeling was compared by a computed tomography scan. Results Data of 32 patients (20 men and 12 women) with a median age of 59 years were collected; the median follow-up period was 6 months. TEVAR resulted in an increase in the true lumen diameter (from 2.0085 to 3.039 cm) and a decrease in the false lumen diameter (from 1.8767 to 0.785 cm). However, in the medical group only, the diameters remained almost unchanged (true lumen diameter ranged from 1.9024 to 2.3898 cm and false lumen diameter ranged from 1.9045 to 1.7245 cm). Conclusion TEVAR for acute type B aortic dissection resulted in a significant increase in the true lumen diameter and decrease in the false lumen diameter. [ABSTRACT FROM AUTHOR]

Background . Influenza remains the cause of many seasonal infections, leading even to death, in all age groups, for all patient health states, under all health policies, and in all latitudes. Influenza infection needs to be thought of not only in terms of the loss of health and the exacerbation of existing diseases, but also in terms of the quantifiable financial consequences borne by the state. Objectives . The aim of the study was to compare two influenza seasons: 2013/14 and 2014/15 through an analysis of the number of samples in different age groups, collected on a weekly basis for 52 weeks, and to interpret the results in terms of type and subtype. Material and methods. Virological and epidemiological data were obtained from the SENTIN EL and NON -SENTIN EL programs. Virological tests were performed using RT-PCR and multiplex RT-PCR biological molecular methods. Results . The maximum number of confirmed cases of influenza coincides in time with the maximum number declared cases and suspected cases of influenza and influenza-like viruses. The peak occurrence of influenza-like virus detection was earlier than the peak detection of influenza virus. In the 2014/15 influenza season, significant differences in the percentage of positive samples were observed between the 5–9 and 10–14 age groups. During the 2013/14 influenza season, there was no statistically significant difference in the percentage of positive samples between the 15–25, 26–44, and 45–64 year old age groups. Conclusions . A new division of age groups allows more accurate assessment of the incidence of influenza and influenza-like illnesses and can assist health workers in preventing multiorgan influenza-related complications and deaths.

Arachidonate 15-lipoxygenase (ALOX15) and arachidonate 15-lipoxygenase, type B (ALOX15B) catalyze the dioxygenation of polyunsaturated fatty acids and are upregulated in human alternatively activated macrophages (AAMs) induced by Th2 cytokine interleukin-4 (IL-4) and/or interleukin-13. Known primarily for roles in bioactive lipid mediator synthesis, 15-lipoxygenases (15-LOXs) have been implicated in various macrophage functions including efferocytosis and ferroptosis. Using a combination of inhibitors and siRNAs to suppress 15-LOX isoforms, we studied the role of 15-LOXs in cellular cholesterol homeostasis and immune function in naïve and AAMs. Silencing or inhibiting the 15-LOX isoforms impaired sterol regulatory element binding protein (SREBP)-2 signaling by inhibiting SREBP-2 processing into mature transcription factor and reduced SREBP-2 binding to sterol regulatory elements and subsequent target gene expression. Silencing ALOX15B reduced cellular cholesterol and the cholesterol intermediates desmosterol, lanosterol, 24,25-dihydrolanosterol, and lathosterol as well as oxysterols in IL-4-stimulated macrophages. In addition, attenuating both 15-LOX isoforms did not generally affect IL-4 gene expression but rather uniquely impacted IL-4-induced CCL17 production in an SREBP-2-dependent manner resulting in reduced T cell migration to macrophage conditioned media. In conclusion, we identified a novel role for ALOX15B, and to a lesser extent ALOX15, in cholesterol homeostasis and CCL17 production in human macrophages.

The aim of the present study was to assess the prevalence of Haemophilus influenzaetype b (Hib) nasopharyngeal (NP) colonisation among healthy children where Hib vaccination using a 3p+0 dosing schedule has been routinely administered for 10 years with sustained coverage (> 90%). NP swabs were collected from 2,558 children who had received the Hib vaccine, of whom 1,379 were 12-< 24 months (m) old and 1,179 were 48-< 60 m old. Hi strains were identified by molecular methods. Hi carriage prevalence was 45.1% (1,153/2,558) and the prevalence in the 12-< 24 m and 48-< 60 m age groups were 37.5% (517/1,379) and 53.9% (636/1,179), respectively. Hib was identified in 0.6% (16/2,558) of all children in the study, being 0.8% (11/1,379) and 0.4% (5/1,179) among the 12-< 24 m and 48-< 60 m age groups, respectively. The nonencapsulate Hi colonisation was 43% (n = 1,099) and was significantly more frequent at 48-< 60 m of age (51.6%, n = 608) compared with that at 12-< 24 m of age (35.6%, n = 491). The overall resistance rates to ampicillin and chloramphenicol were 16.5% and 3.7%, respectively; the co-resistance was detected in 2.6%. Our findings showed that the Hib carrier rate in healthy children under five years was very low after 10 years of the introduction of the Hib vaccine.