Endoleaks after endovascular graft treatment of aortic aneurysms: Classification, risk factors, and outcome

AbstractPurpose: Incomplete endovascular graft exclusion of an abdominal aortic aneurysm results in an endoleak. To better understand the pathogenesis, significance, and fate of endoleaks, we analyzed our experience with endovascular aneurysm repair. Methods:Between November 1992 and May 1997, 47 aneurysms were treated. In a phase I study, patients received either an endovascular aortoaortic graft (11) or an aortoiliac, femorofemoral graft (8). In phase II, procedures and grafts were modified to include aortofemoral, femorofemoral grafts (28) that were inserted with juxtarenal proximal stents, sutured endovascular distal anastomoses within the femoral artery, and hypogastric artery coil embolization. Endoleaks were detected by arteriogram, computed tomographic scan, or duplex ultrasound. Classification systems to describe anatomic, chronologic, and physiologic endoleak features were developed, and aortic characteristics were correlated with endoleak incidence. Results: Endoleaks were discovered in 11 phase I patients (58%) and only six phase II patients (21%; p < 0.05). Aneurysm neck lengths 2 cm or less increased the incidence of endoleaks (p < 0.05). Although not significant, aneurysms with patent side branches or severe neck calcification had a higher rate of endoleaks than those without these features (47% vs 29% and 57% vs 33%, respectively), and patients with iliac artery occlusive disease had a lower rate of endoleaks than those without occlusive disease (18% vs 42%). Endoleak classifications revealed that most endoleaks were immediate, without outflow, and persistent (71% each), proximal (59%), and had aortic inflow (88%). One patient with a persistent endoleak had aneurysm rupture and died. Conclusions: Endoleaks complicate a significant number of endovascular abdominal aortic aneurysm repairs and may permit aneurysm growth and rupture. The type of graft used, the technique of graft insertion, and aortic anatomic features all affect the rate of endoleaks. Anatomic, chronologic, and physiologic classifications can facilitate endoleak reporting and improve understanding of their pathogenesis, significance, and fate. (J Vasc Surg 1998;27:69-80.

Swarmodroid 1.0: A Modular Bristle-Bot Platform for Robotic Active Matter Studies

Large swarms of extremely simple robots (i.e., capable just of basic motion activities, like propelling forward or self-rotating) are widely applied to study collective task performance based on self-organization or local algorithms instead of sophisticated programming and global swarm coordination. Moreover, they represent a versatile yet affordable platform for experimental studies in physics, particularly in active matter - non-equilibrium assemblies of particles converting their energy to a directed motion. However, a large set of robotics platforms is being used in different studies, while the universal design is still lacking. Despite such platforms possess advantages in certain application scenarios, their large number sufficiently limits further development of results in the field, as advancing some study requires to buy or manually produce the corresponding robots. To address this issue, we develop an open-source Swarmodroid 1.0 platform based on bristle-bots with reconfigurable 3D-printed bodies, external control of motion velocity, and basic capabilities of velocity profile programming. In addition, we introduce AMPy software package in Python featuring OpenCV-based extraction of robotic swarm kinematics accompanied by the evaluation of key physical quantities describing the collective dynamics. We perform a detailed analysis of individual Swarmodroids' motion characteristics and address their use cases with two examples: a cargo transport performed by self-rotating robots and a velocity-dependent jam formation in a bottleneck by self-propelling robots. Finally, we provide a comparison of existing centimeter-scale robotic platforms, a review of key quantities describing collective dynamics of many-particle systems, and a comprehensive outlook considering potential applications as well as further directions for fundamental studies and Swarmodroid 1.0 platform development.Comment: 18 pages, 7 figures, 1 table + Supplementary Information. Comments are welcom

Collective oscillations of excitable elements: order parameters, bistability and the role of stochasticity

We study the effects of a probabilistic refractory period in the collective behavior of coupled discrete-time excitable cells (SIRS-like cellular automata). Using mean-field analysis and simulations, we show that a synchronized phase with stable collective oscillations exists even with non-deterministic refractory periods. Moreover, further increasing the coupling strength leads to a reentrant transition, where the synchronized phase loses stability. In an intermediate regime, we also observe bistability (and consequently hysteresis) between a synchronized phase and an active but incoherent phase without oscillations. The onset of the oscillations appears in the mean-field equations as a Neimark-Sacker bifurcation, the nature of which (i.e. super- or subcritical) is determined by the first Lyapunov coefficient. This allows us to determine the borders of the oscillating and of the bistable regions. The mean-field prediction thus obtained agrees quantitatively with simulations of complete graphs and, for random graphs, qualitatively predicts the overall structure of the phase diagram. The latter can be obtained from simulations by defining an order parameter q suited for detecting collective oscillations of excitable elements. We briefly review other commonly used order parameters and show (via data collapse) that q satisfies the expected finite size scaling relations.Comment: 19 pages, 7 figure

A giant adrenal pseudocyst presenting with right hypochondralgia and fever: a case report

<p>Abstract</p> <p>Introduction</p> <p>Adrenal pseudocysts are rare cystic masses that arise from the adrenal gland and which are usually non-functional and asymptomatic. Adrenal pseudocysts consist of a fibrous wall without an epithelial or endothelial lining. We report the case of a patient with a giant adrenal pseudocyst presenting with right hypochondralgia and high fever.</p> <p>Case presentation</p> <p>A 52-year-old Japanese man was admitted with right hypochondralgia and a chill. Abdominal computed tomography revealed a well-defined cystic mass measuring 19 cm which was located in the right adrenal region and the contents of which were not enhanced with contrast medium. Abdominal ultrasonography revealed a heterogeneously hypo-echoic lesion with a peripheral high-echoic rim. Serum hormonal levels were almost normal. Despite treatment with antibiotics, the high fever persisted. Based on these findings, we made a preoperative diagnosis of a right adrenal cyst with infection. However, the possibility of malignancy still remained. The patient underwent laparotomy and right adrenal cyst excision with partial hepatectomy in order to relieve the symptoms and to confirm an accurate diagnosis. Histological examination revealed an adrenal pseudocyst with infection. His condition improved soon after the operation.</p> <p>Conclusion</p> <p>We report a case of a giant adrenal pseudocyst with infection. Surgery is required for symptomatic cases in order to relieve the symptoms and in cases of uncertain diagnosis.</p

Diffusive dynamics and jamming in ensembles of robots with variable friction

In the present paper, we experimentally study the diffusive dynamics in ensembles of self-propelled and self-rotating bristle-bots. Considering the dependence of the system dynamics on the packing density of robots as well as on the friction between individual robots, we show that the friction slightly affects the diffusive dynamics but leads to a significant change in the jamming transition corresponding to the formation of rigid clusters of robots

Transcriptomic profiles conducive to immune-mediated tumor rejection in human breast cancer skin metastases treated with Imiquimod

Imiquimod is a topical toll-like-receptor-7 agonist currently used for treating basal cell carcinoma. Recently, imiquimod has demonstrated tumor regression in melanoma and breast cancer skin metastases. However, the molecular perturbations induced by imiquimod in breast cancer metastases have not been previously characterized. Here, we describe transcriptomic profiles associated with responsiveness to imiquimod in breast cancer skin metastases. Baseline and post-treatment tumor samples from patients treated with imiquimod in a clinical trial were profiled using Nanostring technology. Through an integrative analytic pipeline, we showed that tumors from patients who achieved a durable clinical response displayed a permissive microenvironment, substantiated by the upregulation of transcripts encoding for molecules involved in leukocyte adhesion and migration, cytotoxic functions, and antigen presentation. In responding patients, Imiquimod triggered a strong T-helper-1 (Th-1)/cytotoxic immune response, characterized by the coordinated upregulation of Th-1 chemokines, migration of Th-1 and cytotoxic T cells into the tumor, and activation of immune-effector functions, ultimately mediating tumor destruction. In conclusion, we have shown that topical imiquimod can induce a robust immune response in breast cancer metastases, and this response is more likely to occur in tumors with a pre-activated microenvironment. In this setting, imiquimod could be utilized in combination with other targeted immunotherapies to increase therapeutic efficacy

Secondary Endoleak Management Following TEVAR and EVAR.

Endovascular abdominal and thoracic aortic aneurysm repair and are widely used to treat increasingly complex aneurysms. Secondary endoleaks, defined as those detected more than 30 days after the procedure and after previous negative imaging, remain a challenge for aortic specialists, conferring a need for long-term surveillance and reintervention. Endoleaks are classified on the basis of their anatomic site and aetiology. Type 1 and type 2 endoleaks (EL1 and EL2) are the most common endoleaks necessitating intervention. The management of these requires an understanding of their mechanics, and the risk of sac enlargement and rupture due to increased sac pressure. Endovascular techniques are the main treatment approach to manage secondary endoleaks. However, surgery should be considered where endovascular treatments fail to arrest aneurysm growth. This chapter reviews the aetiology, significance, management strategy and techniques for different endoleak types

External representations and scientific understanding

This paper provides an inferentialist account of model-based understanding by combining a counterfactual account of explanation and an inferentialist account of representation with a view of modeling as extended cognition. This account makes it understandable how the manipulation of surrogate systems like models can provide genuinely new empirical understanding about the world. Similarly, the account pro- vides an answer to the question how models, that always incorporate assumptions that are literally untrue of the model target, can still provide factive explanations. Finally, the paper shows how the contrastive counterfactual theory of explanation can provide tools for assessing the explanatory power of models.Peer reviewe