Aortic arch pathology often requires staged segmental repairs. Total aortic arch replacement with frozen elephant trunk (FET) offers surgical options for these pathologies. The Jotec E-vita Open NEO™ ...branched prosthesis was introduced in 2020; we sought to share our initial experience focusing on the prosthesis selection strategies, surgical techniques, anastomosis-bleeding and graft-oozing control methods, and early clinical outcomes from two Asian centers.
We performed a retrospective cohort study in patients with aortic arch pathologies who underwent total arch replacement using the FET procedure with Jotec E-vita Open NEO™ branched prosthesis from two Asian centers between October 2020 and August 2021. The primary outcome was overall 30-day mortality, and the secondary outcomes were operative complications.
Twenty-five consecutive patients underwent total arch replacement with FET with the novel hybrid prosthesis. Overall 30-day mortality from both centers was 0%. Overall mean operative, cardiopulmonary bypass, hypothermic circulatory arrest, and selective antegrade cerebral perfusion times were 353.4±80.5, 183.2±39.6, 57.2±14.7, and 138.2±28.6 minutes, respectively. No patient developed stroke. Permanent spinal cord injury (SCI) was recorded in one patient (4%) and one (4%) had transient lower limb weakness that resolved after spinal drainage. There was no requirement of re-sternotomy for hemostasis.
We reported a multicenter Asian case series with the novel FET hybrid prosthesis demonstrating the feasibility and safety of promising initial clinical outcomes. The technique of circumferential reinforcement of vascular anastomosis for hemostasis may be one of the methods for lowering the rates of re-sternotomy for hemostasis, and proper surgical or transfusion strategies would overcome the excessive oozing of the prosthesis. Long-term follow-up is required for further evaluation of aortic pathology progression and device-related outcomes.
This study aims to investigate the influence of Search Engine Optimization (SEO) aspects on Online Promotion among Malaysian SME companies. The literature identifies four SEO dimensions that ...influence Online Promotion: SEO Connectivity, SEO Competitiveness, SEO Experience, and SEO Techniques. The online survey received 153 responses from Malaysian SME service providers. In addition to descriptive statistics, the data were subjected to Partial Least Squares-Structural Equation Modelling (PLS-SEM) analysis. The proposed framework builds a strong relationship between SEO Dimensions and Online Promotion for Malaysian SME businesses. According to the analysis findings, there is a significant relationship between SEO Competitiveness and Online Promotion for Malaysian SME businesses. In addition, the data found a significant relationship between SEO Experience and Online Promotion. The value of SEO Competitiveness and SEO Experience, as well as the responses to the study, show that these tactics are frequently used in Online Promotion for SME companies in Malaysia. The findings will help company decision-makers enhance their internet presence and reach. It may result in decreased marketing expenses and a rise in new clients, consequently boosting the company's sales revenue.
Background
As new therapeutic options become available, better understanding the potential impact of emerging therapies on clinical outcomes of hepatits D virus (HDV) is critical.
Objective
The aim ...of this study was to develop a natural history model for patients with hepatitis D virus.
Methods
We developed a model (decision tree followed by a Markov cohort model) in adults with chronic HDV infection to assess the natural history and impact of novel treatments on disease progression versus best supportive care (BSC). The model time horizon was over a lifetime (up to 100 years of age); state transitions and health states were defined by responder status. Patients in fibrosis stages 0 through 4 received treatment; decompensated patients were not treated. Response was defined as the combined response endpoint of achievement of HDV-RNA undetectability/≥2-log
10
decline and alanine aminotransferase normalization; response rates of 50% and 75% were explored. Health events associated with advanced liver disease were modeled as the number of events per 10,000 patients. Scenario analyses of early treatment, alternate treatment response, and no fibrosis regression for treatment responders were also explored.
Results
The model was able to reflect disease progression similarly to published natural history studies for patients with HBV/HDV infection. In a hypothetical cohort of patients reflecting a population enrolled in a recent clinical trial, fewer advanced liver disease events were observed with a novel HDV treatment versus BSC. Fewer liver-related deaths were observed under 50% and 75% response (900 and 1,358 fewer deaths, respectively, per 10,000 patients). Scenario analyses showed consistently fewer advanced liver disease events with HDV treatment compared with BSC, with greater reductions observed with earlier treatment.
Conclusion
This HDV disease progression model replicated findings from natural history studies. Furthermore, it found that a hypothetical HDV treatment results in better clinical outcomes for patients versus BSC, with greater benefit observed when starting treatment early. This validated natural history model for HBV/HDV infection can serve as a foundation for future clinical and economic analyses of novel HDV treatments that can support healthcare stakeholders in the management of patients with chronic HDV.
Kueishan Island is a young volcanic island in the southernmost edge of the Okinawa Trough in the northeastern part of Taiwan. A cluster of hydrothermal vents is located off the southeastern tip of ...the Island at water depths between 10 and 80 m. This paper presents the results of the first study on the microbial communities in bottom sediments collected from the shallow‐water hydrothermal vents of Kueishan Island. Small‐subunit ribosomal RNA gene‐based high‐throughput 454 pyrosequencing was used to characterize the assemblages of bacteria, archaea, and small eukaryotes in sediment samples collected at various distances from the hydrothermal vents. Sediment from the vent area contained the highest diversity of archaea and the lowest diversity of bacteria and small eukaryotes. Epsilonproteobacteria were the most abundant group in the vent sediment, but their abundance decreased with increasing distance from the vent area. Most Epsilonproteobacteria belonged to the mesophilic chemolithoautotrophic genera Sulfurovum and Sulfurimonas. Recent reports on these two genera have come from deep‐sea hydrothermal vents. Conversely, the relative contribution of Gammaproteobacteria to the bacterial community increased with increasing distance from the vent area. Our study revealed the contrasting effects of venting on the benthic bacterial and archaeal communities, and showed that the sediments of the shallow‐waters hydrothermal vents were dominated by chemoautotrophic bacteria. The present work broadens our knowledge on microbial diversity in shallow‐water hydrothermal vent habitats.
Neuroforaminal stenosis (NFS), a narrowing of the intervertebral foramen, is a cause of disability in the aging population. Formal magnetic resonance imaging (MRI) classification of NSF has been ...developed recently and contradictory findings have been reported. This study aims to assess whether in-plane, anatomically conformed two-dimensional (2D) views of the neuroforamen characterize NFS more accurately than traditional axial, coronal, and sagittal views in healthy individuals with and without simulated scoliosis.
This observational study was approved by the designated institutional review board at our academic tertiary care center. Four volunteers underwent lumbar spine MRI twice, once in the supine position and once with intentionally introduced hip tilt. The latter resulted in lumbar curvature mimicking positioning errors approximating degenerative lumbar scoliosis. Anatomically oriented cuts such as axial with endplate correction and coronally obliqued parasagittals, also called coronal obliques, were performed. Standard sagittal and axial views were also performed in both the supine and rotated groups.
Coronal oblique and anatomically oriented axial views demonstrated the highest correlation with true neuroforaminal caliber. Deviation from anatomical congruence resulted in false measurements of neuroforaminal size. The hip-tilt studies produced MR that were less favorable to characterization of the caliber of neuroforamina. Coronal sections demonstrated reliability only when performed at the mid-pedicular lines. Standard axial views were reliable only when taken at the upper one-third of the neuroforamen. Coronal oblique views demonstrated superiority when evaluating consecutive neuroforamen on one image compared to non-obliqued parasagittal slices.
To minimize error in neuroforaminal analysis, imaging specialists should perform anatomically oriented cuts to conform to individual patient anatomy. When this cannot be performed due to a patient's spine rotation or position, the MRI reader should view oblique, axial, and coronal images simultaneously and dynamically for proper foraminal characterization.
Juvenile
Epinephelus coioides were exposed to three nominal concentrations (8, 32, 128 mg wet sediments L−1) of suspended sediments (SS) from Port Shelter (PS), Mirs Bay (MB) and Victoria Harbour ...(VH) for 10 and 30 days using semi‐static system. Sediments from VH contained higher concentrations of Cu and polycyclic aromatic hydrocarbons (PAHs) than sediments from PS and MB. Gill damages including lamellar blood sinus dilation and vascular congestion were prevalent after just 10 days of exposure to SS. Fish exposed to SS at the highest concentration of 128 mg L−1 showed higher incidence of lamellar aneurism. Hyperplasia in the base of lamellae was recorded in fish that had been exposed to contaminated SS from VH. Significant increases in the density of chloride cells and mucous cells were found on the gills of fish that had been exposed to 128 mg L−1 of SS from PS. Clogging of gills by SS produced hypoxic‐like responses in fish. Polluted sediments from VH produced addictive or synergistic effects between SS and chemical contaminants on fish.
Food selection by the marine cladoceran
Penilia avirostris was studied in the field by HPLC analysis of phytoplankton marker pigments and in the laboratory by microscopic measurement of cell removal. ...Comparison between pigment composition in natural phytoplankton and in
P. avirostris showed that
P. avirostris preferred diatoms, cryptophytes and chlorophytes, and ignored prymnesiophytes and dinoflagellates. Peridinin, the marker pigment for dinoflagellates was found in
P. avirostris only when the dinoflagellate populations were dominated by
Prorocentrum. Pigment degradation rates ranged from 13.73% for alloxanthin to 36.62% for chlorophyll
a. Clearance rates measured in the laboratory provided further evidence of strong preference for diatoms and cryptophytes, and avoidance of dinoflagellates. Microscopic counts suggested that
P. avirostris was feeding on prymnesiophytes, although ingestion of prymnesiophytes could not be confirmed by pigment analysis.
Eutrophication is one of the major factors contributing to the globally increasing occurrence of harmful algal blooms, which may consequently do harms to aquatic lives in the regional ecosystems. ...Tolo Harbor, a semi-enclosed bay located in the north-eastern part of Hong Kong, has a long history of eutrophication and frequent algal blooms occurrence. This paper presents a 11-month (September 2010–July 2011) examination of the spatial and seasonal variations in the size structure and pigment composition of phytoplankton after 12 years of nutrient reduction. Concentration of chlorophyll a (Chl a) increased landward and the phytoplankton was dominated by algae in the 2–20 and 20–200 μm size fractions. Algal blooms were recorded in the inner part of Tolo Harbor in May (dinoflagellate bloom) and June (diatom bloom) 2011. High performance liquid chromatography (HPLC) analysis revealed that the composition of phytoplankton pigments varied seasonally, but did not differ between the inner and outer parts of the harbor. The prevalence of fucoxanthin in all size fractions indicated that diatoms were the most dominant phytoplankton taxa. Peridinin, an unambiguous marker of dinoflagellates, appeared sporadically. The presence of cryptophytes, green algae, prymnesiophytes, and cyanobacteria was denoted by the pigments alloxanthin, chlorophyll b, 19′-hexanoyloxyfucoxanthin, and zeaxanthin, respectively. Nutrient concentrations correlated poorly with Chl a concentrations from micro- (20–200 μm) and nano-sized (2–20 μm) algal cells while temperature affected significantly the pigment concentrations of pico-sized (<2 μm) and taxonomically minor algal groups.
•Dominance of algae in the 2–220 and 20–200 μm size fractions.•Prevalence of diatoms (by fucoxanthin concentrations) in all size fractions.•Strong influence of water temperature to the pigment concentrations of small and minor algal groups.
