To determine the rates and risk factors of complications related to cerebrospinal fluid drainage (CSFD) during first stage and completion fenestrated-branched endovascular aortic repair (F-BEVAR) of ...pararenal and thoracoabdominal aortic aneurysms.
We reviewed the outcomes of 293 consecutive patients enrolled in a prospective, nonrandomized study to investigate outcomes of F-BEVAR between 2013 and 2018. Patients who received CSFD during first-stage thoracic endovascular aortic repair, index F-BEVAR, or completion of temporary aneurysm sac perfusion procedures were included in the analysis. CSFD complications were graded as severe or moderate if they were life threatening, escalated the level of care, or prolonged the hospital stay. Presence of substantial degenerative lumbar disease (DLD) was identified based on review of preoperative computed tomography. End points included technical difficulties during CSFD placement and CSFD-related complications.
A total of 187 patients (mean age, 73 ± 8 years; 70% male) treated for 20 pararenal and 167 thoracoabdominal aortic aneurysms received CSFD in 240 procedures, including 51 first-stage thoracic endovascular aortic repairs, 184 index F-BEVARs, and 5 completion temporary aneurysm sac perfusion procedures. Nineteen patients (10%) had 22 CSFD-related complications after 21 aortic procedures (9%). Complications were graded as severe to moderate in 17 patients (9%). There were 12 patients (6%) with intracranial hypotension, including three (2%) who had intracranial hemorrhage and nine (5%) with post dural puncture headache requiring blood patches in six. Another six patients (3%) developed spinal hematomas resulting in paraplegia in two (1%) and transient paraparesis in two (1%). One patient had CSF leakage from the puncture site (no intervention required). Four patients had bleeding during attempted drain placement, which required postponement of F-BEVAR. Technical difficulties were experienced in 57 drain insertions (24%), more often in patients with DLD than in those without DLD (35/113 31% vs 22/121 18%; P = .03). Fluoroscopic guidance was used in 44 drain placements (18%) with a lower rate of technical difficulties compared with the blind approach (9% vs 28%; P = .01). There was a statistically nonsignificant trend toward more complications in patients with technical challenges (14% vs 7%; P = .10). Of 13 study patients who developed spinal cord injuries during aortic procedures, 4 (31%) were attributed to CSFD.
Although CSFD is widely used to prevent ischemic spinal cord injury during complex aortic repair, the risk of major CSFD-related complications is not negligible and should be carefully weighed against its potential benefits. One-third of spinal cord injuries were caused by CSF drain placement. The use of fluoroscopic guidance may decrease the risk of CSFD-related complications.
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The International Society for Study of Vascular Anomalies (ISSVA) broadly categorizes vascular anomalies into vascular tumors and vascular malformations. Vascular malformations are further divided ...based on their flow properties into slow-flow venous and lymphatic malformations, high-flow arteriovenous malformations (AVMs), and congenital mixed syndromes, which can include combinations thereof. Whether occurring in isolation or as part of a broader syndrome, congenital high-flow AVMs are arguably the most complicated, challenging, and gratifying of all vascular malformations to diagnose and manage. Various configurations exist depending on location and coexisting clinical features. Transcatheter embolization has evolved into the mainstay of treatment for most congenital peripheral AVMs with surgical excision playing a growingly limited role as an adjunctive modality. Successful treatment requires technical precision, creativity, patience, and persistence given the ever-evolving angioarchitecture and hemodynamic profile of these lesions. Despite these challenges, certain fundamental principles have been established as our understanding of the pathogenesis, natural history, hemodynamics, and treatment outcomes has expanded and evolved over the last few decades. These principles are crucial to adhere to in the overall management of these lesions and are highlighted and expanded upon herein.
NbRe-based superconducting thin films recently received relevant interest in the field of low-temperature electronics. However, for these materials the electrical conduction mechanisms, in particular ...in the normal state, still need to be investigated in more detail. Here, NbRe and NbReN films of different thicknesses have been deposited on two different substrates, namely monocrystalline Si and Formula: see text buffered Si. The films were characterized by DC electrical transport measurements. Moreover, a connection with the charge carriers fluctuation processes has been made by analyzing the electrical noise generated in the normal state region. Despite the films morphology seems not to be affected by the substrate used, a lower noise level has been found for the ones grown on Formula: see text, in particular for NbReN. From this study it emerges that both NbRe and NbReN ultrathin films are of very good quality, as far as the low-temperature electrical noise and conduction are concerned, with noise levels competitive with NbN. These results may further support the proposal of using these materials in a nanowire form in the field of superconducting electronics.
Microbial contamination, seed browning, bad taste and lipid oxidation are primary causes of quality deterioration in stored hazelnuts, affecting their marketability. The feasibility of NIR ...spectroscopy to detect flawed kernels and estimate lipid oxidation in in-shell and shelled hazelnuts was investigated. ‘Mortarella’ hazelnuts were measured twice by NIR spectroscopy, first in-shell, and then as kernels. Afterwards, the kernels were evaluated visually, externally and internally, and by sensory evaluation with a subsequent measurement of fat oxidation. A satisfactory PLS model was created for the detection of flawed kernels. For lipid oxidation estimation the best performance of PLS models was obtained by first removing the flawed kernels from the calibration set. The PLS model for the K232 extinction coefficient, that is indicative of lipid primary oxidation, was able to predict K232 for both in-shell (R2 = 0.79) and shelled (R2 = 0.85) hazelnuts. Our results suggest, for shelled hazelnuts, a two-step NIR procedure: a first PLS model to detect and separate flawed kernels and then a second PLS model to grade healthy kernels by lipid oxidation levels.
Aneurysms of the superior mesenteric artery (SMA) and its branches are rare and account for only 6% to 15% of all visceral artery aneurysms. In the present report, we have described our 30-year ...experience with the management of aneurysms of the SMA and its branches at a high-volume referral center.
A retrospective review of all patients with a diagnosis of an aneurysm of the SMA or one of its branches from 1988 to 2018 was performed. Pseudoaneurysms and mycotic aneurysms were excluded. The clinical presentation, etiology, aneurysm shape and size, treatment modalities, and outcomes were analyzed. The growth rate of the aneurysms was estimated using linear regression.
A total of 131 patients with 144 aneurysms were reviewed. The patients were primarily men (64%), with a median age of 60 years. Of the 144 aneurysms, 57 were fusiform, 30 were saccular, and 57 were dissection-associated aneurysms. Of the 131 patients, 41 had had an isolated SMA branch aneurysm. Degenerative aneurysms were the most common etiology (66%). A total of 35 patients (27%) were symptomatic at presentation. Of the 144 aneurysms, 111 had multiple computed tomography angiograms available, with a median follow-up of 43.6 months (interquartile range, 10.6-87.2 months). Only 18 aneurysms (16%) had had an estimated growth rate of ≥1.0 mm/y. The initial aneurysm size was significantly associated with the growth rate for the fusiform aneurysms (odds ratio OR, 1.13; 95% confidence interval CI, 1.0-1.3; P = .02) but not for the saccular (OR, 0.91; 95% CI, 0.76-1.1; P = 1.1) or dissection-associated (OR, 1.2; 95% CI, 0.91-1.5; P = .20) aneurysms. Acute abdominal pain (OR, 5.9; 95% CI, 1.6-22; P = .01) and chronic abdominal pain (OR, 3.7; 95% CI, 1.1-13; P = .04) were associated with aneurysm growth. Only two patients had a ruptured aneurysm, both of whom presented with rupture with no prior imaging studies. These two patients had a diagnosis of fibromuscular dysplasia and systemic lupus erythematosus, respectively. Of the 131 patients, 46 (34%) had undergone operative repair, including 36 open revascularizations and 8 endovascular procedures. The average aneurysm size for these 46 patients was 24.0 ± 8.6 mm. One patient died perioperatively, and nine patients experienced perioperative complications (25%). Of the 144 aneurysms, 91 were <20 mm, with an average size of 13.4 ± 3.1 mm. These 91 aneurysms had been followed up for a median of 120.8 months (interquartile range, 30.5-232.2 months), with no ruptures within this cohort during the follow-up period.
The present study represents one of the largest series on aneurysms of the SMA and its branches. Our results showed that aneurysms of the SMA are relatively stable. Patients with symptomatic and fusiform aneurysms had a greater risk of growth. Aneurysms <20 mm with a degenerative etiology can be safely monitored without treatment.
Attention to urban agriculture (UA) has recently grown among practitioners, scientists, and the public, resulting in several initiatives worldwide. Despite the positive perception of modern UA and ...locally grown, fresh produce, the potential food safety risks connected to these practices may be underestimated, leading to regulatory gaps. Thus, there is a need for assessment tools to evaluate the food safety risks connected to specific UA initiatives, to assist practitioners in self-evaluation and control, and to provide policy makers and scholars a means to pursue and assess food safety in city regions, avoiding either a lack or an excess of regulation that could ultimately hinder the sector. To address this aim, this paper reviews the most recent and relevant literature on UA food safety assessments. Food safety indicators were identified first. Then, a food safety assessment framework for UA initiatives was developed. The framework uses business surveys and food analyses (if available) as a data source for calculating a food safety index for single UA businesses and the whole UA landscape of a given city region. The proposed framework was designed to allow its integration into the CRFS (City Region Food System) toolkit developed by FAO (Food and Agriculture Organization of the United Nations), RUAF foundation (Resource Centres on Urban Agriculture and Food Security) and Wilfrid Laurier University.
•Connection of several biological and chemical food safety risks to UA techniques.•Identifiable food safety risk factors for diverse UA practices.•Framework for the assessment of food safety levels of UA initiatives.•Development of a risk-based assessment that can be integrated into the FAO CRFS framework.
In many crops, including grapevine, the distribution of reflecting dust on foliage is a practice potentially leading to the mitigation of environmental stresses such as excessive light and limited ...water supply. This study aimed to evaluate whether the presence of dust on the leaves may affect PSII photochemical efficiency and gas-exchange measurements, thus leading to biased results. The study was conducted in a winery located at Benevento (Italy) on Vitis vinifera L. subsp. vinifera 'Falanghina' where the application of basalt dust was tested on the canopy to alleviate the effects of water stress. The results showed that there is no difference in PSII photochemistry or gas-exchange parameters measured in the presence of dust or after cleaning the leaves. Therefore, we conclude there is no need to remove dust from leaves before performing the ecophysiological investigations, thus fastening and simplifying the data collection.
•The variation of the craters generated by fs laser irradiation with repetition rate is investigated.•The influence of the laser pulse repetition rate on removal rate and surface texture on silicon ...is addressed.•Possible effects of plume shielding on crater features and laser surface structuring at high repetition rate is discussed.
The influence of the pulse repetition rate on laser irradiation of silicon, in air, with femtosecond laser pulses is experimentally investigated in the range 10 Hz – 200 kHz. The features of the produced crater and the laser-induced periodic surface structures generated on its surface are characterized by exploiting surface profilometry and scanning electron microscopy. The experimental characterization evidences an interesting influence of the pulse repetition rate on the crater size qualitatively addressing a progressive reduction of the material removal efficiency at higher repetition rates. Moreover, also the surface structures produced by an irradiation sequence with a fixed number of laser pulses (namely N = 100) shows a clear dependence on the repetition rate. The observed effects are rationalized by considering the possible influence of plume shielding and heat accumulation effects typically observed during laser processing with high repetition rate laser systems.
Background The intimate association between glial cells and neurons within the enteric nervous system has confounded careful examination of the direct responsiveness of enteric glia to different ...neuroligands. Therefore, we aimed to investigate whether neurotransmitters known to elicit fast excitatory potentials in enteric nerves also activate enteric glia directly.
Methods We studied the effect of acetylcholine (ACh), serotonin (5‐HT), and adenosine triphosphate (ATP) on intracellular Ca2+ signaling using aequorin‐expressing and Fluo‐4 AM‐loaded CRL‐2690 rat and human enteric glial cell cultures devoid of neurons. The influence of these neurotransmitters on the proliferation of glia was measured and their effect on the expression of c‐Fos as well as glial fibrillary acidic protein (GFAP), Sox10, and S100 was examined by immunohistochemistry and quantitative RT‐PCR.
Key Results Apart from ATP, also ACh and 5‐HT induced a dose‐dependent increase in intracellular Ca2+ concentration in CRL‐2690 cells. Similarly, these neurotransmitters also evoked Ca2+ transients in human primary enteric glial cells obtained from mucosal biopsies. In contrast with ATP, stimulation with ACh and 5‐HT induced early gene expression in CRL‐2690 cells. The proliferation of enteric glia and their expression of GFAP, Sox10, and S100 were not affected following stimulation with these neurotransmitters.
Conclusions & Inferences We provide evidence that enteric glial cells respond to fast excitatory neurotransmitters by changes in intracellular Ca2+. On the basis of our experimental in vitro setting, we show that enteric glia are not only directly responsive to purinergic but also to serotonergic and cholinergic signaling mechanisms.
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