Impact of operative indication and surgical complexity on outcomes after thoracic endovascular aortic repair at National Surgical Quality Improvement Program Centers

IntroductionThoracic endovascular aortic repair (TEVAR) devices are increasingly being utilized to treat aortic pathologies outside of the original Food & Drug Administration (FDA) approval for nonruptured descending thoracic aorta aneurysms (DTAs). The objective of this study was to evaluate the outcomes of patients undergoing TEVAR, elucidating the role of surgical and pathologic variables on morbidity and mortality.MethodsNational Surgical Quality Improvement Program (NSQIP) data were reviewed for all patients undergoing endovascular thoracic aorta repair from 2005 to 2007. The patients' operative indication and surgical complexity were used to divide them into study and control populations. Comorbid profiles were assessed utilizing a modified Charlson Comorbidity Index (CCI). Thirty-day occurrences of mortality and serious adverse events (SAEs) were used as study endpoints. Univariate and multivariate models were created using demographic and clinical variables to assess for significant differences in endpoints (P ≤ .05).ResultsA total of 440 patients undergoing TEVAR were identified. When evaluating patients based on operative indication, the ruptured population had increased mortality and SAE rates compared to the nonruptured DTA population (22.6% vs 6.2%;P < .01 and 35.5% vs 9.1%;P < .01, respectively). Further analysis by surgical complexity revealed increased mortality and SAE rates when comparing the brachiocephalic aortic debranching population to the noncovered left subclavian artery population (23.1% vs 6.5%; P = .02 and 30.8% vs 9.1%; P < .01, respectively). Multivariate analysis demonstrated that operative indication was not a correlate of mortality or SAEs (odds ratio [OR], 0.95; P = .92 and OR, 1.42; P = .39, respectively); however, brachiocephalic aortic debranching exhibited a deleterious effect on mortality (OR, 8.75; P < .01) and SAE rate (OR, 6.67; P = .01).ConclusionThe operative indication for a TEVAR procedure was not found to be a predictor of poor patient outcome. Surgical complexity, specifically the need for brachiocephalic aortic debranching and aortoiliac conduit, was shown to influence the occurrence of SAEs in a multivariate model. Comparative data, such as these, illustrate real-world outcomes of patients undergoing TEVAR outside of the original FDA-approved indications. This information is of paramount importance to various stakeholders, including third-party payers, the device industry, regulatory agencies, surgeons, and their patients

Design of an 8-40 GHz Antenna for the Wideband Instrument for Snow Measurements (WISM)

Measurement of land surface snow remains a significant challenge in the remote sensing arena. Developing the tools needed to remotely measure Snow Water Equivalent (SWE) is an important priority. The Wideband Instrument for Snow Measurements (WISM) is being developed to address this need. WISM is an airborne instrument comprised of a dual-frequency (X- and Ku-bands) Synthetic Aperture Radar (SAR) and dual-frequency (K- and Ka-bands) radiometer. A unique feature of this instrument is that all measurement bands share a common antenna aperture consisting of an array feed reflector that covers the entire bandwidth. This paper covers the design and fabrication of the wideband array feed which is based on tightly coupled dipole arrays. Implementation using a relatively new multi-layer microfabrication process results in a small, 6x6 element, dual-linear polarized array with beamformer that operates from 8 to 40 gigahertz

Experimental characterization of photoemission from plasmonic nanogroove arrays

Metal photocathodes are an important source of high-brightness electron beams, ubiquitous in the operation of both large-scale accelerators and table-top microscopes. When the surface of a metal is nano-engineered with patterns on the order of the optical wavelength, it can lead to the excitation and confinement of surface plasmon polariton waves which drive nonlinear photoemission. In this work, we aim to evaluate gold plasmonic nanogrooves as a concept for producing bright electron beams for accelerators via nonlinear photoemission. We do this by first comparing their optical properties to numerical calculations from first principles to confirm our ability to fabricate these nanoscale structures. Their nonlinear photoemission yield is found by measuring emitted photocurrent as the intensity of their driving laser is varied. Finally, the mean transverse energy of this electron source is found using the solenoid scan technique. Our data demonstrate the ability of these cathodes to provide a tenfold enhancement in the efficiency of photoemission over flat metals driven with a linear process. We find that these cathodes are robust and capable of reaching sustained average currents over 100 nA at optical intensities larger than 2 GW/cm$^2$ with no degradation of performance. The emittance of the generated beam is found to be highly asymmetric, a fact we can explain with calculations involving the also asymmetric roughness of the patterned surface. These results demonstrate the use of nano-engineered surfaces as enhanced photocathodes, providing a robust, air-stable source of high average current electron beams with great potential for industrial and scientific applications.Comment: 9 pages, 9 figure

Design of an 8-40 GHz Antenna for the Wideband Instrument for Snow Measurements (WISM)

This poster describes the implementation of a 6x6 element, dual linear polarized array with beamformer that operates from about 8-40 GHz. It is implemented using a relatively new multi-layer microfabrication process. The beamformer includes baluns that feed dual-polarized differential antenna elements and reactive splitters that cover the full frequency range of operation. This fixed beam array (FBA) serves as the feed for a multi-band instrument designed to measure snow water equivalent (SWE) from an airborne platform known as the Wideband Instrument for Snow Measurements (WISM)

A Baker\u27s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2018

© The Author(s) 2019 Phytochemical investigation of methanolic extract of Limonium leptophyllum (Plumbaginaceae), led to the isolation of 1 new isoflavonoid with a rare 5-membered dihydrofuran ring (1, leptoisoflavone A) and 8 known compounds. The known isolated compounds were identified as euchrenone b9 (2), auriculasin (3), kaempferol (4), avicularoside (5), myrice-tin-3-arabinoside (6), trans-N-feruloyltyramine (7), trans-N-caffeoyltyramine (8), and β-sitosterol (9). The crude methanolic extract exhibited moderate activity toward endocannabinoid receptors. Auriculasin (3) showed activity toward cannabinoid receptor type 1 (86.7% displacement with IC50 8.92 μM)

Dislocation interactions during low-temperature plasticity of olivine and their impact on the evolution of lithospheric strength

The strength of the lithosphere is typically modelled based on constitutive equations for steady-state flow. However, strain hardening may cause significant evolution of strength in the colder load-bearing portion of the lithosphere. Recent rheological data from low-temperature deformation experiments on olivine suggest that strain hardening occurs due to the presence of temperature-independent back stresses generated by long-range elastic interactions among dislocations. These interpretations provided the basis for a flow law that incorporates hardening by the development of back stress. Here, we test this dislocation-interaction hypothesis by examining the microstructures of olivine samples deformed plastically at room temperature either in a deformation-DIA apparatus at differential stresses of ≤4.3GPa or in a nanoindenter at applied contact stresses of ≥10.2GPa. High-angular resolution electron backscatter diffraction maps reveal the presence of geometrically necessary dislocations with densities commonly above 1014m−2 and intragranular heterogeneities in residual stress on the order of 1 GPa in both sets of samples. Scanning transmission electron micrographs reveal straight dislocations aligned in slip bands and interacting with dislocations of other types that act as obstacles. The resulting accumulations of dislocations in their slip planes, and associated stress heterogeneities, are consistent with strain hardening resulting from long-range back-stresses acting among dislocations and thereby support the form of the flow law for low-temperature plasticity. Based on these observations, we predict that back stresses among dislocations will impart significant mechanical anisotropy to deformed lithosphere by enhancing or reducing the effective stress. Therefore, strain history, with associated microstructural and micromechanical evolution, is an important consideration for models of lithospheric strength. The microstructural observations also provide new criteria for identifying the operation of back-stress induced strain hardening in natural samples and therefore provide a means to test the applicability of the flow law for low-temperature plasticity.This research was supported by Natural Environment Research Council grants NE/M000966/1 to LNH, AJW, and DW and 1710DG008/JC4 to LNH and AJW; European Plate Observing System Transnational Access grant EPOS-TNA-MSL 2018-022 to LNH; Advanced Photon Source General User Proposal 55176 to LNH, DLG, and WBD; and National Science Foundation Awards EAR-1361319 to WBD, EAR-1625032 to JMW, and EAR-1806791 to KMK

The natural history of thin melanoma and the utility of sentinel lymph node biopsy

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141184/1/jso24765_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141184/2/jso24765.pd

Phenotypic and Functional Properties of Helios+ Regulatory T Cells

Helios, an Ikaros family transcription factor, is preferentially expressed at the mRNA and protein level in regulatory T cells. Helios expression previously appeared to be restricted to thymic-derived Treg. Consistent with recent data, we show here that Helios expression is inducible in vitro under certain conditions. To understand phenotypic and functional differences between Helios+ and Helios− Treg, we profiled cell-surface markers of FoxP3+ Treg using unmanipulated splenocytes. We found that CD103 and GITR are expressed at high levels on a subset of Helios+ Treg and that a Helios+ Treg population could be significantly enriched by FACS sorting using these two markers. Quantitative real-time PCR (qPCR) analysis revealed increased TGF-β message in Helios+ Treg, consistent with the possibility that this population possesses enhanced regulatory potential. In tumor-bearing mice, we found that Helios+ Treg were relatively over-represented in the tumor-mass, and BrdU studies showed that, in vivo, Helios+ Treg proliferated more than Helios− Treg. We hypothesized that Helios-enriched Treg might exert increased suppressive effects. Using in vitro suppression assays, we show that Treg function correlates with the absolute number of Helios+ cells in culture. Taken together, these data show that Helios+ Treg represent a functional subset with associated CD103 and GITR expression