•Respiratory viruses are potentially implicated in one quarter to one-third of adult cases of community-acquired pneumonia.•In such cases influenza is the most frequently detected viral ...pathogen.•Failure to test for respiratory viruses in hospitalised patients may lead to missed opportunities for early therapeutic intervention.
Community-acquired pneumonia (CAP) is an important respiratory disease and the fifth leading cause of mortality in Europe. The development of molecular diagnostic tests has highlighted the contributions of respiratory viruses to the aetiology of CAP, suggesting the incidence of viral pneumonia may have been previously underestimated. We performed a systematic review and meta-analysis to describe the overall identification of respiratory viruses in adult patients with CAP in Europe, following PRISMA guidelines (PROSPERO; CRD42016037233). We searched EMBASE, MEDLINE, CINAHL, WHOLIS, COCHRANE library and grey literature sources for relevant studies, and screened these against protocol eligibility criteria. Two researchers performed data extraction and risk of bias assessments, independently, using a piloted form. Results were synthesised narratively, and random effects meta-analyses performed to calculate pooled estimates of effect; heterogeneity was quantified using I2. Twenty-eight studies met inclusion criteria of which 21 were included in the primary meta-analysis. The pooled proportion of patients with identified respiratory viruses was 22.0% (95% CI: 18.0%–27.0%), rising to 29.0% (25.0%–34.0%) in studies where polymerase chain reaction (PCR) diagnostics were performed. Influenza virus was the most frequently detected virus in 9% (7%–12%) of adults with CAP. Respiratory viruses make a substantial contribution to the aetiology of CAP in adult patients in Europe; one or more respiratory viruses are detected in about one quarter of all cases.
Abstract Objective To report the long-term results of stenting for chronic ilio-caval obstructive lesions. Material and methods From January 1996 to January 2008, 89 patients (72 women, 17 men; ...median age 43 years) were admitted for endovascular treatment of chronic disabling non-malignant obstructive ilio-caval lesions. Patients were classified as C2 in 15 cases, C3 in 59, C4 in seven, C5 in two and C6 in six. Median preoperative venous disability score (VDS) and venous clinical severity score (VCSS) were 2 and 9, respectively. Aetiology was primary in 52 patients, secondary in 35 and congenital in two. Lesions were bilateral in seven cases, eight patients had inferior vena cava (IVC) involvement and 18 had common femoral vein (CFV) obstructive lesions. Complete occlusion was found in 30 cases. Results Technical success was achieved in 98%. The median hospital stay was 2 days. During a median follow-up of 38 months (range: 1–144 months), one patient died and five cases of thromboses occurred. Iterative stenting was performed for restenosis in six cases. Primary, assisted-primary and secondary patency rates, in terms of intention to treat, were 83%, 89% and 93%, respectively, at 3 and 10 years, with a median VDS of 1. Univariate analysis found that significant factors affecting patency were CFV involvement for primary patency and history of deep venous thrombosis (DVT) and CFV involvement for secondary patency. The last 46 patients had statistically more severe lesions than the first 43 (higher VDS, more secondary lesions, more occlusions, more stented segments, higher length of stented vein), and in spite of which patency rates are not different. Conclusion Endovenous angioplasty, combined with stenting, is a sure, safe, effective and very minimally invasive technique which provides good long-term patency rates. Currently, it is recognised as the technique of choice for the treatment of ilio-caval obstructive lesions. Surgery should be proposed only in case of failure.
Dedicated to the memory of Gregory M. Maney, Bringing Down Dividesengages with and continues Maney's work on international conflicts, peace and justice movements and community-based research to ...explore three types of divides: attributional divides, ideological divides, and epistemological divides.
We present indium antimonide-based devices for mid-infrared (mid-IR) detection with enhanced sensitivity. InSb devices will be useful for many applications, such as gas sensing and imaging. InSb ...avalanche photodiodes (APDs) monolithically integrated with GaAs substrates were fabricated with diameters ranging from 90 to 200 μm and extensively characterized at temperatures ranging from 77 K to 300 K. At 120 K a zero-bias responsivity of 2 A/W was measured, corresponding to a quantum efficiency of 55%. An experimental gain value of 10 at a reverse bias of -3 V was obtained at 120 K, which to the best of our knowledge, is the highest ever reported for InSb APDs. These results pave the way for the development of a monolithically integrated mid-IR array with added gain and wavelength tunability.
Objectives The aim was to analyze the role played by anatomy and stent graft in the incidence of incomplete apposition to aortic arch. Methods Between 2007 and 2014 data including available and ...suitable computed tomographic angiography (CTA) imaging of patients who had undergone thoracic endovascular aortic repair were reviewed. The study included 80 patients (65 men, 54 ± 21 years) treated for traumatic aortic rupture ( n = 27), thoracic aortic aneurysm ( n = 15), type B aortic dissection ( n = 24), penetrating aortic ulcer ( n = 5), intramural hematoma ( n = 2), aorto-oesophageal fistula ( n = 2), and aortic mural thrombus ( n = 5). Pre- and post-operative CTA images were analyzed to characterize bird beak in terms of length and angle, and to calculate aortic angulation within a 30 mm range at the proximal deployment zone. Results Bird beak configuration was detected in 46 patients (57%): mean stent protrusion length was 16 mm (range: 8–29 mm) and mean bird beak angle was 20° (range: 7–40°). The bird beak effect was significantly more frequent after traumatic aortic rupture treatment ( p = .05) and in landing zone 2 ( p = .01). No influence of either stent graft type or generation, or degree of oversizing was observed ( p = .29, p = .28, p = .81 respectively). However, the mean aortic angle of patients with bird beak was higher in the Pro-form group than that in the Zenith TX2 group (62° vs. 48°, p = .13). Multivariate analysis identified the aortic angle of the deployment zone as the unique independent risk factor of malapposition (HR = 1.05, 95% CI 1–1.10, p = .005). The cutoff value of 51° was found to be predictive of bird beak occurrence with a sensitivity of 58% and a specificity of 85%. Conclusions Assessment of proximal landing zone morphology to avoid deployment zones generating an aortic angle of over 50° can be recommended to improve aortic curvature apposition with the current available devices.
Background Optimal management of aorta mural thrombus (AMT) continues to be controversial. The aim of this study was to describe the management of AMT in the thoracic aorta with either conservative ...or stentgraft treatment and to analyze the role of morphological characteristics of thrombus in the selection of suitable candidates for intervention. Methods A retrospective review was conducted of all patients admitted for thoracic AMT. Clinical data, treatment used, and outcomes were recorded. Patients were divided in two groups according to the treatment used: either conservative or stentgraft. Morphological features of thrombus, including size, sessile or pedunculated aspect and mobility, were compared between the two groups. Results From January 2006 to March 2013, 13 consecutive patients (nine male, mean age 53, range 37–76) were admitted for symptomatic ( n = 8) or asymptomatic AMT ( n = 5). All patients received unfractionated heparin. Management of primary aortic thrombus required stentgraft in seven patients, aortic thrombectomy in one, and anticoagulation therapy alone in five. Indications for intervention were recurrent embolism ( n = 4), occurrence of embolism under heparin ( n = 1), or persistent thrombus ( n = 2). Endovascular exclusion of AMT was successful in all cases, with no complications or deaths at 30 days and no recurrence at midterm. Analysis of the morphological features of the thrombus identified solely the high degree mobility as associated with adverse outcome ( p = .048). Conclusion In our experience, stentgraft exclusion of AMT is an effective approach. Systematic evaluation of thrombus mobility by a real-time imaging study can be helpful to better define the indications for radical treatment of the aortic lesion.
Objectives/Background ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus) is a prospective multicentre randomized controlled trial including consecutive patients with ...ruptured aorto-iliac aneurysms (rAIA) eligible for treatment by either endovascular (EVAR) or open surgical repair (OSR). Inclusion criteria were hemodynamic stability and computed tomography scan demonstrating aorto-iliac rupture. Methods Randomization was done by week, synchronously in all centers. The primary end point was 30 day mortality. Secondary end points were post-operative morbidity, length of stay in the intensive care unit (ICU), amount of blood transfused (units) and 6 month mortality. Results From January 2008 to January 2013, 107 patients (97 men, 10 women; median age 74.4 years) were enrolled in 14 centers: 56 (52.3%) in the EVAR group and 51 (47.7%) in the OSR group. The groups were similar in terms of age, sex, consciousness, systolic blood pressure, Hardman index, IGSII score, type of rupture, use of endoclamping balloon, and levels of troponin, creatinine, and hemoglobin. Delay to treatment was higher in the EVAR group (2.9 vs. 1.3 hours; p < .005). Mortality at 30 days and 1 year were not different between the groups (18% in the EVAR group vs. 24% in the OSR group at 30 days, and 30% vs. 35%, respectively, at 1 year). Total respiratory support time was lower in the EVAR group than in the OSR group (59.3 hours vs. 180.3 hours; p = .007), as were pulmonary complications (15.4% vs. 41.5%, respectively; p = .050), total blood transfusion (6.8 vs. 10.9, respectively; p = .020), and duration of ICU stay (7 days vs. 11.9 days, respectively; p = .010). Conclusion In this study, EVAR was found to be equal to OSR in terms of 30 day and 1 year mortality. However, EVAR was associated with less severe complications and less consumption of hospital resources than OSR.
Objective The present study aimed at quantifying mal-positioning during thoracic endovascular aortic repair and analysing the extent to which anatomical factors influence the exact stent graft ...positioning. Methods A retrospective review was conducted of patients treated between 2007 and 2014 with a stent graft for whom proximal landing zones (LZ) could be precisely located by anatomical fixed landmarks, that is LZ 1, 2, or 3. The study included 66 patients (54 men; mean age 51 years, range 17–83 years) treated for traumatic aortic rupture ( n = 27), type B aortic dissection ( n = 21), thoracic aortic aneurysm ( n = 8), penetrating aortic ulcer ( n = 5), intramural hematoma ( n = 1), and floating aortic thrombus ( n = 4). Pharmacologic hemodynamic control was systematically obtained during stent graft deployment. Pre- and post-operative computed tomographic angiography was reviewed to quantify the distance between planned and achieved LZ and to analyze different anatomical factors: iliac diameter, calcification degree, aortic angulation at the proximal deployment zone, and tortuosity index (TI). Results Primary endoleak was noted in seven cases (10%): five type I (7%) and two type II (3%). Over a mean 35 month follow up (range 3–95 months), secondary endoleak was detected in two patients (3%), both type I, and stent graft migration was seen in three patients. Mal-positioning varied from 2 to 15 mm. A cutoff value of 11 mm was identified as an adverse event risk. Univariate analysis showed that TI and LZ were significantly associated with mal-positioning ( p = .01, p = .04 respectively), and that aortic angulation tends to reach significance ( p = .08). No influence of deployment mechanism ( p = .50) or stent graft generation ( p = .71) or access-related factors was observed. Multivariate analysis identified TI as the unique independent risk factor of mal-positioning (OR 241, 95% CI 1–6,149, p = .05). A TI >1.68 was optimal for inaccurate deployment prediction. Conclusion TI calculation can be useful to anticipate difficulties during stent graft deployment and to reduce mal-positioning.
The research investigates the relationship between intelligence quotient (IQ) and environmental degradation, aiming to understand how cognitive abilities influence environmental outcomes across ...different nations and time periods. The objective is to examine the impact of intelligence quotient (IQ) on environmental indicators such as carbon emissions, ecological demand, and the Environmental Kuznets Curve (EKC), seeking insights to inform environmental policy and stewardship. The study utilizes statistical techniques including Ordinary Least Squares (OLS), Two Stage Least Squares (2SLS), and Iteratively Weighted Least Squares (IWLS) to analyze data from 147 nations over the years 2000–2017. These methods are applied to explore the relationship between IQ and environmental metrics while considering other relevant variables. The findings reveal unexpected positive associations between human intelligence quotient and carbon emissions, as well as ecological demand, challenging conventional notions of "delay discounting." Additionally, variations in the Environmental Kuznets Curve (EKC) hypothesis are identified across different pollutants, highlighting the roles of governance and international commitments in mitigating emissions. The study concludes by advocating for the adoption of a "delay discounting culture" to address environmental challenges effectively. It underscores the complex interactions between intelligence, governance, and population dynamics in shaping environmental outcomes, emphasizing the need for targeted policies to achieve sustainability objectives.
•The study examines how intelligence quotient (IQ) relates to environmental outcomes globally.•It employs OLS, 2SLS, and IWLS to analyze 147 nations' data from 2000 to 2017.•The finding shows unexpected positive links between IQ and carbon emissions, challenging traditional assumptions.•The study also Identifies EKC variations by pollutant, emphasizing governance and international commitments in emission reduction.•The policy implications suggest an adoption of a "delay discounting culture" for effective environmental policy, stressing intelligence and governance interactions in sustainability.
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