Recognizing the impact of the decision making by the dialysis access surgeon on the successful placement of autogenous arteriovenous hemodialysis access, the Society for Vascular Surgery assembled a ...multispecialty panel to develop practice guidelines in arteriovenous access placement and maintenance with the aim of maximizing the percentage and functionality of autogenous arteriovenous accesses that are placed. The Society commissioned the Knowledge and Encounter Research Unit of the Mayo Clinic College of Medicine, Rochester, Minnesota, to systematically review the available evidence in three main areas provided by the panel: timing of referral to access surgeons, type of access placed, and effectiveness of surveillance. The panel then formulated practice guidelines in seven areas: timing of referral to the access surgeon, operative strategies to maximize the placement of autogenous arteriovenous accesses, first choice for the autogenous access, choice of arteriovenous access when a patient is not a suitable candidate for a forearm autogenous access, the role of monitoring and surveillance in arteriovenous access management, conversion of a prosthetic arteriovenous access to a secondary autogenous arteriovenous access, and management of the nonfunctional or failed arteriovenous access. For each of the guidelines, the panel stated the recommendation or suggestion, discussed the evidence or opinion upon which the recommendation or suggestion was made, detailed the values and preferences that influenced the group's decision in formulating the relevant guideline, and discussed technical remarks related to the particular guideline. In addition, detailed information is provided on various configurations of autogenous and prosthetic accesses and technical tips related to their placement.
Magnetism in Fe-based superconductors Lumsden, M D; Christianson, A D
Journal of physics. Condensed matter,
05/2010, Letnik:
22, Številka:
20
Journal Article
Recenzirano
Odprti dostop
In this review, we present a summary of experimental studies of magnetism in Fe-based superconductors. The doping dependent phase diagram shows strong similarities to the generic phase diagram of the ...cuprates. Parent compounds exhibit magnetic order together with a structural phase transition, both of which are progressively suppressed with doping, allowing superconductivity to emerge. The stripe-like spin arrangement of Fe moments in the magnetically ordered state shows identical in-plane structure for the RFeAsO (R = rare earth) and AFe(2)As(2) (A = Sr, Ca, Ba, Eu and K) parent compounds, notably different than the spin configuration of the cuprates. Interestingly, Fe(1 + y)Te orders with a different spin order despite having very similar Fermi surface topology. Studies of the spin dynamics of the parent compounds show that the interactions are best characterized as anisotropic three-dimensional interactions. Despite the room temperature tetragonal structure, analysis of the low temperature spin waves under the assumption of a Heisenberg Hamiltonian indicates strong in-plane anisotropy with a significant next-nearest-neighbor interaction. For the superconducting state, a resonance, localized in both wavevector and energy, is observed in the spin excitation spectrum as for the cuprates. This resonance is observed at a wavevector compatible with a Fermi surface nesting instability independent of the magnetic ordering of the relevant parent compound. The resonance energy (E(r)) scales with the superconducting transition temperature (T(C)) as E(r) ∼ 4.9k(B)T(C), which is consistent with the canonical value of ∼ 5k(B)T(C) observed for the cuprates. Moreover, the relationship between the resonance energy and the superconducting gap, Δ, is similar to that observed for many unconventional superconductors (E(r)/2Δ ∼ 0.64).
The Society for Vascular Surgery pursued development of clinical practice guidelines for the management of the left subclavian artery with thoracic endovascular aortic repair (TEVAR). In formulating ...clinical practice guidelines, the society selected a panel of experts and conducted a systematic review and meta-analysis of the literature. They used the grading of recommendations assessment, development, and evaluation (GRADE) method to develop and present their recommendations. The overall quality of evidence was very low. The committee issued three recommendations. Recommendation 1: In patients who need elective TEVAR where achievement of a proximal seal necessitates coverage of the left subclavian artery, we suggest routine preoperative revascularization, despite the very low-quality evidence (GRADE 2, level C). Recommendation 2: In selected patients who have an anatomy that compromises perfusion to critical organs, routine preoperative LSA revascularization is strongly recommended, despite the very low-quality evidence (GRADE 1, level C). Recommendation 3: In patients who need urgent TEVAR for life-threatening acute aortic syndromes where achievement of a proximal seal necessitates coverage of the left subclavian artery, we suggest that revascularization should be individualized and addressed expectantly on the basis of anatomy, urgency, and availability of surgical expertise (GRADE 2, level C).
Understanding the microscopic processes affecting the bulk thermal conductivity is crucial to develop more efficient thermoelectric materials. PbTe is currently one of the leading thermoelectric ...materials, largely thanks to its low thermal conductivity. However, the origin of this low thermal conductivity in a simple rocksalt structure has so far been elusive. Using a combination of inelastic neutron scattering measurements and first-principles computations of the phonons, we identify a strong anharmonic coupling between the ferroelectric transverse optic mode and the longitudinal acoustic modes in PbTe. This interaction extends over a large portion of reciprocal space, and directly affects the heat-carrying longitudinal acoustic phonons. The longitudinal acoustic-transverse optic anharmonic coupling is likely to play a central role in explaining the low thermal conductivity of PbTe. The present results provide a microscopic picture of why many good thermoelectric materials are found near a lattice instability of the ferroelectric type.
Abstract
Low dimensional quantum magnets are interesting because of the emerging collective behavior arising from strong quantum fluctuations. The one-dimensional (1D)
S
= 1/2 Heisenberg ...antiferromagnet is a paradigmatic example, whose low-energy excitations, known as spinons, carry fractional spin
S
= 1/2. These fractional modes can be reconfined by the application of a staggered magnetic field. Even though considerable progress has been made in the theoretical understanding of such magnets, experimental realizations of this low-dimensional physics are relatively rare. This is particularly true for rare-earth-based magnets because of the large effective spin anisotropy induced by the combination of strong spin–orbit coupling and crystal field splitting. Here, we demonstrate that the rare-earth perovskite YbAlO
3
provides a realization of a quantum spin
S
= 1/2 chain material exhibiting both quantum critical Tomonaga–Luttinger liquid behavior and spinon confinement–deconfinement transitions in different regions of magnetic field–temperature phase diagram.
In quantum magnets, magnetic moments fluctuate heavily and are strongly entangled with each other, a fundamental distinction from classical magnetism. Here, with inelastic neutron scattering ...measurements, we probe the spin correlations of the honeycomb lattice quantum magnet YbCl
. A linear spin wave theory with a single Heisenberg interaction on the honeycomb lattice, including both transverse and longitudinal channels of the neutron response, reproduces all of the key features in the spectrum. In particular, we identify a Van Hove singularity, a clearly observable sharp feature within a continuum response. The demonstration of such a Van Hove singularity in a two-magnon continuum is important as a confirmation of broadly held notions of continua in quantum magnetism and additionally because analogous features in two-spinon continua could be used to distinguish quantum spin liquids from merely disordered systems. These results establish YbCl
as a benchmark material for quantum magnetism on the honeycomb lattice.
Objectives Despite advances in endovascular therapies, critical limb ischemia (CLI) continues to be associated with high morbidity and mortality. Patients without direct revascularization options ...have the worst outcomes. We sought to explore the feasibility of conducting a definitive trial of a bone marrow-derived cellular therapy for CLI in this “no option” population. Methods A pilot, multicenter, prospective, randomized, double-blind, placebo-controlled trial for “no option” CLI patients was performed. The therapy consisted of bone marrow aspirate concentrate (BMAC), prepared using a point of service centrifugation technique and injected percutaneously in 40 injections to the affected limb. Patients were randomized to BMAC or sham injections (dilute blood). We are reporting the 12-week data. Results Forty-eight patients were enrolled. The mean age was 69.5 years (range, 42-93 years). Males predominated (68%). Diabetes was present in 50%. Tissue loss (Rutherford 5) was present in 30 patients (62.5%), and 18 (37.5%) had rest pain without tissue loss (Rutherford 4). Patients were deemed unsuitable for conventional revascularization based on multiple prior failed revascularization efforts (24 50%), poor distal targets (43 89.6%), and medical risk (six 12.5%). Thirty-four patients were treated with BMAC and 14 with sham injections. There were no adverse events attributed to the injections. Renal function was not affected. Effective blinding was confirmed; blinding index of 61% to 85%. Subjective and objective outcome measures were effectively obtained with the exception of treadmill walking times, which could only be obtained at baseline and follow-up in 15 of 48 subjects. This pilot study was not powered to demonstrate statistical significance but did demonstrate favorable trends for BMAC versus control in major amputations (17.6% vs 28.6%), improved pain (44% vs 25%), improved ankle brachial index (ABI; 32.4% vs 7.1%), improved Rutherford classification (35.3% vs 14.3%), and quality-of-life scoring better for BMAC in six of eight domains. Conclusions In this multicenter, randomized, double-blind, placebo-controlled trial of autologous bone marrow cell therapy for CLI, the therapy was well tolerated without significant adverse events. The BMAC group demonstrated trends toward improvement in amputation, pain, quality of life, Rutherford classification, and ABI when compared with controls. This pilot allowed us to identify several areas for improvement for future trials and CLI studies. These recommendations include elimination of treadmill testing, stratification by Rutherford class, and more liberal inclusion of patients with renal insufficiency. Our strongest recommendation is that CLI studies that include Rutherford 4 patients should incorporate a composite endpoint reflecting pain and quality of life.
Objective Increased use of continuous-flow left ventricular assist devices for long-term mechanical support necessitates a better understanding of hemodynamic changes in the native heart and the ...ascending aorta. By using patient-specific computational models, correlations of potentially adverse hemodynamic conditions with the orientation of the left ventricular assist device outflow graft and their relationship with aortic insufficiency and ischemic events were investigated. Methods Computed hemodynamic parameters, including wall shear stress, pressure in the ascending aorta, and dissipation of turbulent energy, were correlated with the orientation of the left ventricular assist device graft outflow in 5 patients (4 with the HeartMate II device Thoratec Corp, Pleasanton, Calif and 1 with the HeartWare Ventricular Assist Device HeartWare Inc, Framingham, Mass; 3 patients experienced moderate aortic insufficiency, and 2 patients experienced ischemic events). Hemodynamic conditions for aortic insufficiency and ischemic events were differentiated by linear discriminant analysis. Results Positive correlations between left ventricular assist device outflow graft orientation and wall shear stress, pressure, and turbulent energy dissipation in the ascending aorta were found ( R 2 > 0.68). Linear discriminant analysis indicated a relationship of the velocity magnitude of retrograde flow toward the aortic root with aortic insufficiency and of the turbulent energy and wall shear stress with ischemic events. Conclusions Computational fluid dynamic simulations using clinical image data indicate altered hemodynamic conditions after left ventricular assist device implantation. Consequently, the left ventricular assist device outflow graft should be placed so the jet of blood is aimed toward the lumen of the aortic arch to avoid turbulences that will increase wall shear stress and retrograde pressure of the aortic root. Further investigations are warranted to confirm these findings in a larger patient cohort.
Objectives Covered stents have been proposed as an endovascular option for recalcitrant cases of hemodialysis-related central venous occlusive disease (CVOD). This study evaluated the efficacy and ...durability of covered stents in treating CVOD to preserve a functional dialysis access circuit. Methods A retrospective review was performed of all patients with clinically significant CVOD who were treated by placement of covered stents from April 2007 to September 2010. Demographics, lesion locations and anatomic characteristics, stent graft, and access patency rates were determined. Complications, reinterventions, and factors influencing their outcomes were examined. Results In 25 patients (56% men; mean age, 57 ± 29 years) with CVOD, covered stents were used in 20 to treat symptomatic venous hypertension or in 5 at the time of access creation to enable functionality. The target lesion was accessed via the dialysis access site or the common femoral vein. The Viabahn endoprosthesis (W. L. Gore and Associates, Flagstaff, Ariz) was used in 24 patients (average size and length, 11 mm × 5 cm) and a 13-mm × 5-cm Fluency covered stent (Bard Peripheral Vascular, Tempe, Ariz) was implanted in 1 patient. Technical success was 100%, and resolution of arm edema occurred after covered stent deployment in symptomatic patients. Two postprocedural cases (8%) of thrombosis occurred, one within 30 days and another at 3 months. Both required percutaneous thrombectomy and percutaneous transluminal angioplasty (PTA). Three additional patients (12%) required PTA due to restenosis in one of the ends of the device. Covered stent primary patency (PP), assisted primary patency (APP), and secondary patency (SP) were 56%, 86%, and 100% at 12 months, respectively. Access patency rates at 12 months were 29%, 85%, and 94% for PP, APP, and SP, respectively, in patients that received a covered stent for access salvage; patency rates were 74%, 85%, and 94% for PP, APP, and SP, respectively, in patients in whom the access was created after the venous outflow restoration. Conclusions Placement of covered stents for hemodialysis-related CVOD is safe, effective in relieving symptoms, and enabled functionality of new dialysis access circuits. Further prospective and randomized studies are necessary to determine whether covered stents provide superior long-term results to those achieved with PTA and bare metal stents.
Computational fluid dynamics, which uses numeric methods and algorithms for the simulation of blood flow by solving the Navier-Stokes equations on computational meshes, is enhancing the understanding ...of disease progression in type III aortic dissections. To illustrate this, we examined the changes in patient-derived geometries of aortic dissections, which showed progressive false lumen aneurysmal dilatation (26% diameter increase) during follow-up. Total pressure was decreased by 29% during systole and by 34% during retrograde flow. At the site of the highest false lumen dilatation, the temporal average of total pressure decreased from 45 to 22 Pa, and maximal average wall shear stress decreased from 0.9 to 0.4 Pa. These first results in the study of disease progression of type III DeBakey aortic dissection with computational fluid dynamics are encouraging.
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