Durability of the Endurant stent graft in patients undergoing endovascular abdominal aortic aneurysm repair

ObjectiveSeveral studies have confirmed the excellent early performance of the Endurant (Medtronic Endovascular, Santa Rosa, Calif) endoprosthesis to treat abdominal aortic aneurysms (AAAs). However, data about the long-term durability of the device are still lacking. We conducted this prospective two-center single-arm study to assess the late outcomes of the endograft in patients undergoing AAA repair.MethodsAn intention-to-treat analysis was performed for all comers with AAAs who were implanted with an Endurant endograft between November 2007 and December 2010. Clinical and radiologic data were prospectively collected and analyzed. The primary end point was any AAA-related reintervention. Secondary end points were overall mortality, aneurysm shrinkage, all types of endoleak, and device-related complications.ResultsDuring the study period, 273 patients underwent implantation of the Endurant stent graft. The median follow-up time for the primary end point was 42 months (interquartile range, 30.7-50.7). AAA-related reinterventions were required in 26 patients (10%), resulting in a reintervention-free probability of 93%, 90%, and 87% at 3, 4, and 5 years, respectively. The leading cause for reintervention was iliac limb occlusion (n = 10). Only one AAA-related death (0.3%) was reported within an overall mortality of 29% (n = 78). The median aneurysm shrinkage was 9 mm (interquartile range, 3-15). Five type I (2%) and one type III (0.4%) endoleaks were identified. No proximal and two distal limb migrations (1%) were observed.ConclusionsOur study confirms late durability of the Endurant endoprosthesis for AAA repair, with very encouraging freedom from reintervention rates and overall outcomes

Endovascular treatment as first line approach for infrarenal aortic occlusive disease

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Surgical treatment of axillary artery aneurysms through a transaxillary approach

BACKGROUND: Axillary artery aneurysms are rare. Due to their anatomical peculiarities, their therapeutic management is individualized. Minimal invasive endovascular treatments are gaining increased popularity. However, surgical solutions are associated with better long-term patency. CASE REPORT: We describe two cases of isolated axillary artery aneurysm, managed with surgical resection and graft interposition. The patients had not experienced any ischemic symptoms, pain or disabling swelling of the upper extremity. One patient underwent in situ reconstruction with a venous graft and the other with a prosthetic graft. The early postoperative recovery was uneventfull. After a follow-up time of 12 months, both reconstructions remain patent and with not upper limb symptoms. CONCLUSION: Surgical repair of axillary artery aneurysms is associated with good results, but larger cohorts are necessary to confirm our experience

Instrumental performance and results from testing of the BLAST-TNG receiver, submillimeter optics, and MKID arrays

Polarized thermal emission from interstellar dust grains can be used to map magnetic fields in star forming molecular clouds and the diffuse interstellar medium (ISM). The Balloon-borne Large Aperture Submillimeter Telescope for Polarimetry (BLASTPol) flew from Antarctica in 2010 and 2012 and produced degree-scale polarization maps of several nearby molecular clouds with arcminute resolution. The success of BLASTPol has motivated a next-generation instrument, BLAST-TNG, which will use more than 3000 linear polarization sensitive microwave kinetic inductance detectors (MKIDs) combined with a 2.5m diameter carbon fiber primary mirror to make diffraction-limited observations at 250, 350, and 500 $\mu$m. With 16 times the mapping speed of BLASTPol, sub-arcminute resolution, and a longer flight time, BLAST-TNG will be able to examine nearby molecular clouds and the diffuse galactic dust polarization spectrum in unprecedented detail. The 250 $\mu$m detector array has been integrated into the new cryogenic receiver, and is undergoing testing to establish the optical and polarization characteristics of the instrument. BLAST-TNG will demonstrate the effectiveness of kilo-pixel MKID arrays for applications in submillimeter astronomy. BLAST-TNG is scheduled to fly from Antarctica in December 2017 for 28 days and will be the first balloon-borne telescope to offer a quarter of the flight for "shared risk" observing by the community.Comment: Presented at SPIE Millimeter, Submillimeter, and Far-Infrared Detectors and Instrumentation for Astronomy VIII, June 29th, 201

Results of Iliac Branch Devices in Octogenarians Within the pELVIS Registry

Purpose:To evaluate if the elderly could benefit from the implantation of iliac branch devices (IBDs) to preserve the patency of the internal iliac artery (IIA) in aneurysms involving the iliac bifurcation.Materials and Methods:From January 2005 to April 2017, 804 patients enrolled in the pELVIS registry underwent endovascular aneurysm repair with 910 IBDs due to aneurysmal involvement of the iliac bifurcation. Among the 804 patients, 157 (19.5%) were octogenarians (mean age 82.9 +/- 2.5 years; 157 men) with 171 target IIAs for preservation. Outcomes at 30 days included technical success, death, conversion to open surgery, and major complications. Outcomes evaluated in follow-up were patency of the IBD and target vessels, type I and type III endoleaks, aneurysm-related reinterventions, aneurysm-related death, and overall patient survival. Kaplan-Meier analyses were employed to evaluate the late outcome measures; the estimates are presented with the 95% confidence interval (CI).Results:Technical success was 99.4% with no intraoperative conversions or deaths (1 bridging stent could not be implanted, and the IIA was sacrificed). Perioperative mortality was 1.9%. The overall perioperative aneurysm-related complication rate was 8.9% (14/157), with an early reintervention rate of 5.1% (8/157). Median postoperative radiological and clinical follow-up were 21.8 months (range 1-127) and 29.3 months (range 1-127), respectively. Estimated rates of freedom from occlusion of the IBD, the IIA, and the external iliac artery at 60 months were 97.7% (95% CI 96.1% to 99.3%), 97.3% (95% CI 95.7% to 98.9%), and 98.6% (95% CI 97% to 99.9%), respectively. Estimated rates of freedom from type I and type III endoleaks and device migration at 60 months were 90.9% (95% CI 87% to 94.3%), 98.7% (95% CI 97.5% to 99.8%), and 98% (95% CI 96.4% to 99.6%), respectively. Freedom from all cause reintervention at 60 months was 87.4% (95% CI 82.6% to 92.2%). The estimated overall survival rate at 60 months was 59% (95% CI 52.4% to 65.6%).Conclusion:IBD implantation in octogenarians provided acceptable perioperative mortality and morbidity rates, with satisfying long-term freedom from IBD-related complications and should be considered a feasible repair option for selected elderly patients affected by aneurysms involving the iliac bifurcation

Teriflunomide treatment for multiple sclerosis modulates T cell mitochondrial respiration with affinity-dependent effects

International audienceInterference with immune cell proliferation represents a successful treatment strategy in T cell-mediated autoimmune diseases such as rheumatoid arthritis and multiple sclerosis (MS). One prominent example is pharmacological inhibition of dihydroorotate dehydrogenase (DHODH), which mediates de novo pyrimidine synthesis in actively proliferating T and B lymphocytes. Within the TERIDYNAMIC clinical study, we observed that the DHODH inhibitor teriflunomide caused selective changes in T cell subset composition and T cell receptor repertoire diversity in patients with relapsing-remitting MS (RRMS). In a preclinical antigen-specific setup, DHODH inhibition preferentially suppressed the proliferation of high-affinity T cells. Mechanistically, DHODH inhibition interferes with oxidative phosphorylation (OXPHOS) and aerobic glycolysis in activated T cells via functional inhibition of complex III of the respiratory chain. The affinity-dependent effects of DHODH inhibition were closely linked to differences in T cell metabolism. High-affinity T cells preferentially use OXPHOS during early activation, which explains their increased susceptibility toward DHODH inhibition. In a mouse model of MS, DHODH inhibitory treatment resulted in preferential inhibition of high-affinity autoreactive T cell clones. Compared to T cells from healthy controls, T cells from patients with RRMS exhibited increased OXPHOS and glycolysis, which were reduced with teriflunomide treatment. Together, these data point to a mechanism of action where DHODH inhibition corrects metabolic disturbances in T cells, which primarily affects profoundly metabolically active high-affinity T cell clones. Hence, DHODH inhibition may promote recovery of an altered T cell receptor repertoire in autoimmunity

Searching for large-scale structures around high-redshift radio galaxies with Herschel

This paper presents the first results of a far-infrared search for protocluster-associated galaxy overdensities using the Spectral and Photometric Imaging REciever (SPIRE) instrument on-board the Herschel Space Observatory. Large (∼400 arcmin2) fields surrounding 26 powerful high-redshift radio galaxies (2.0 1028.5 WHz−1) are mapped at 250, 350 and 500 μm to give a unique wide-field sample. On average, the fields have a higher than expected, compared to blank fields, surface density of 500 μm sources within 6 comoving Mpc of the radio galaxy. The analysis is then restricted to potential protocluster members only, which are identified using a far-infrared colour selection; this reveals significant overdensities of galaxies in two fields, neither of which are previously known protoclusters. The probability of finding two overdensities of this size by chance, given the number of fields observed, is 5 × 10−4. Overdensities here exist around radio galaxies with L500 MHz ≳ 1029 WHz−1 and z 1014 M⊙. However, the large uncertainty in the redshift estimation means that it is possible that these far-infrared overdensities consist of several structures across the redshift range searched

The Balloon-Borne Large Aperture Submillimeter Telescope Observatory

The BLAST Observatory is a proposed superpressure balloon-borne polarimeter designed for a future ultra-long duration balloon campaign from Wanaka, New Zealand. To maximize scientific output while staying within the stringent superpressure weight envelope, BLAST will feature new 1.8m off-axis optical system contained within a lightweight monocoque structure gondola. The payload will incorporate a 300L $^4$He cryogenic receiver which will cool 8,274 microwave kinetic inductance detectors (MKIDs) to 100mK through the use of an adiabatic demagnetization refrigerator (ADR) in combination with a $^3$He sorption refrigerator all backed by a liquid helium pumped pot operating at 2K. The detector readout utilizes a new Xilinx RFSOC-based system which will run the next-generation of the BLAST-TNG KIDPy software. With this instrument we aim to answer outstanding questions about dust dynamics as well as provide community access to the polarized submillimeter sky made possible by high-altitude observing unrestricted by atmospheric transmission. The BLAST Observatory is designed for a minimum 31-day flight of which 70$\%$ will be dedicated to observations for BLAST scientific goals and the remaining 30$\%$ will be open to proposals from the wider astronomical community through a shared-risk proposals program.Comment: Presented at SPIE Ground-based and Airborne Telescopes VIII, December 13-18, 202