Superficial femoral artery eversion endarterectomy: A useful adjunct for infrainguinal bypass in the presence of limited autogenous vein

AbstractPurpose: To evaluate, in a group of technically high-risk patients, the results of infrainguinal revascularization using a conduit constructed with endarterectomized superficial femoral artery (SFA) and available arm or saphenous vein.Methods: Of 237 consecutive lower extremity vein graft bypass procedures performed in 195 patients from July 1992 through August 1996, 15 SFA eversion endarterectomies (in 10 men and five women; median age, 70 years) were performed and used as a composite bypass conduit with available autogenous vein for the treatment of limb-threatening ischemia. In each case, an occluded SFA was divided 8 to 15 cm distal to its origin, proximally endarterectomized, and sewn end-to-end to a segment of vein to provide adequate conduit length for bypass grafting. Indications for this technique were unavailability of vein as a result of failed previous bypass grafting (n = 10) or previous coronary artery bypass grafting (n = 5). Veins were sewn distally to a below-knee popliteal artery (n = 4; 27%) or tibial artery (n = 11; 73%).Results: Primary patency, secondary patency, and limb salvage rates at 36 months by life table analyses for the 237 grafts were 62.3%, 81.0%, and 77.2%, respectively. The 15 composite SFA-vein bypass grafts had 36-month primary patency, secondary patency, and limb salvage rates of 60.0%, 72.0%, and 65.9%, respectively (mean follow-up, 15 months). Currently, eight of these patients (53%) have patent bypass grafts; two (13%) died at 4 and 18 months after the operation with patent grafts; two (13%) underwent amputations for progressive foot gangrene despite a patent bypass graft; and three (20%) had grafts that thrombosed at 4, 5, and 10 months. Typical hyperplastic intrinsic graft-threatening stenoses developed in two patients (13%) in the SFA segment at 4 and 8 months; they were discovered by routine duplex scan surveillance.Conclusion: Composite SFA eversion endarterectomy/vein graft conduits yield acceptable results, behave similarly to other autogenous conduits used for technically high-risk infrainguinal revascularization, and are beneficial when autogenous vein is limited

Must naive realists be relationalists?

Relationalism maintains that perceptual experience involves, as part of its nature, a distinctive kind of conscious perceptual relation between a subject of experience and an object of experience. Together with the claim that perceptual experience is presentational, relationalism is widely believed to be a core aspect of the naive realist outlook on perception. This is a mistake. I argue that naive realism about perception can be upheld without a commitment to relationalism

3D multi-agent models for protein release from PLGA spherical particles with complex inner morphologies

In order to better understand and predict the release of proteins from bioerodible micro- or nanospheres, it is important to know the influences of different initial factors on the release mechanisms. Often though it is difficult to assess what exactly is at the origin of a certain dissolution profile. We propose here a new class of fine-grained multi-agent models built to incorporate increasing complexity, permitting the exploration of the role of different parameters, especially that of the internal morphology of the spheres, in the exhibited release profile. This approach, based on Monte-Carlo (MC) and Cellular Automata (CA) techniques, has permitted the testing of various assumptions and hypotheses about several experimental systems of nanospheres encapsulating proteins. Results have confirmed that this modelling approach has increased the resolution over the complexity involved, opening promising perspectives for future developments, especially complementing in vitro experimentation

A Two Micron All-Sky Survey View of the Sagittarius Dwarf Galaxy: II. Swope Telescope Spectroscopy of M Giant Stars in the Dynamically Cold Sagittarius Tidal Stream

We present moderate resolution (~6 km/s) spectroscopy of 284 M giant candidates selected from the Two Micron All Sky Survey photometry. Radial velocities (RVs) are presented for stars mainly in the south, with a number having positions consistent with association to the trailing tidal tail of the Sagittarius (Sgr) dwarf galaxy. The latter show a clear RV trend with orbital longitude, as expected from models of the orbit and destruction of Sgr. A minimum 8 kpc width of the trailing stream about the Sgr orbital midplane is implied by verified RV members. The coldness of this stream (dispersion ~10 km/s) provides upper limits on the combined contributions of stream heating by a lumpy Galactic halo and the intrinsic dispersion of released stars, which is a function of the Sgr core mass. The Sgr trailing arm is consistent with a Galactic halo containing one dominant, LMC-like lump, however some lumpier halos are not ruled out. An upper limit to the total M/L of the Sgr core is 21 in solar units. A second structure that roughly mimics expectations for wrapped, leading Sgr arm debris crosses the trailing arm in the Southern Hemisphere; however, this may also be an unrelated tidal feature. Among the <13 kpc M giants toward the South Galactic Pole are some with large RVs that identify them as halo stars, perhaps part of the Sgr leading arm near the Sun. The positions and RVs of Southern Hemisphere M giants are compared with those of southern globular clusters potentially stripped from the Sgr system and support for association of Pal 2 and Pal 12 with Sgr debris is found. Our discussion includes description of a masked-filtered cross-correlation methodology that achieves better than 1/20 of a resolution element RVs in moderate resolution spectra.Comment: 41 pages, 6 figures, Astronomical Journal, in press (submitted Nov. 24, 2003; tentatively scheduled for July 2004 issue

Holocene drainage systems of the English Fenland : roddons and their environmental significance

The roddons of the English Fenlands are fossilised silt and sand-filled tidal creek systems of mid- to late-Holocene age, incised into contemporaneous clay deposits. However, anthropogenic change (drainage and agriculture) has caused the former channels to become positive topographical features. Three stratigraphically discrete generations of roddon have been discriminated. They all show well-developed dendritic meander patterns, but there is little or no evidence of sand/silt infill during meandering; thus, unlike modern tidal creeks and rivers they typically lack laterally stacked point bar deposits, suggesting rapid infill. Major “trunk” roddons are rich in fine sands and there is little change in grain size from roddon mouth to the upper reaches, suggesting highly effective sand transport mechanisms and uniform conditions of deposition. Tributaries are silt-rich, while minor tributaries also have a significant clay component. During infill, active drainage networks appear to have been choked by sediment, converting mudflat/salt-marsh environments into widespread peat-forming freshwater reed swamps

Plasma Interleukin-6 (IL-6), Angiopoietin-2, and C-Reactive Protein Levels Predict Subsequent Type 1 Myocardial Infarction in Persons With Treated HIV Infection

BackgroundHIV infection leads to endothelial activation, promoting platelet adhesion, and accelerating atherosclerosis. Our goal was to determine whether biomarkers of endothelial activation and hemostasis/thrombosis were elevated in people with treated HIV (PWH) before myocardial infarction (MI).MethodsIn a case-control study nested within the CFAR Network of Integrated Clinical Systems (CNICS) cohort, we compared 69 adjudicated cases with type 1 MI with 138 controls matched for antiretroviral therapy regimen. We measured angiopoietin-1, angiopoietin-2 (ANG-2), intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13), von Willebrand factor, C-reactive protein (CRP), interleukin-6 (IL-6), plasminogen activation inhibitor-1, P-selectin, serum amyloid-A, soluble CD14, and apolipoprotein A1 in stored plasma. Conditional logistic regression identified associations with subsequent MI, with and without adjustment for Atherosclerotic Cardiovascular Disease (ASCVD) and Veterans Aging Cohort Study (VACS) scores.ResultsHigher IL-6 was associated with MI after adjustment for ASCVD score (adjusted odds ratio [AOR] 1.51, 95% confidence interval [95% CI]: 1.05 to 2.17 per standard-deviation-scaled log 2 increment). In a separate model adjusting for VACS score, higher ANG-2 (AOR 1.49, 95% CI: 1.04 to 2.14), higher CRP (AOR 1.45, 95% CI: 1.06 to 2.00), and higher IL-6 (AOR 1.68, 95% CI: 1.17 to 2.41) were associated with MI. In a sensitivity analysis excluding PWH with viral load ≥400 copies/mL, higher IL-6 remained associated with MI after adjustment for ASCVD score and after adjustment for VACS score.ConclusionsAmong PWH, higher levels of plasma IL-6, CRP, and ANG-2 predict subsequent type 1 MI, independent of conventional risk scores. IL-6 had the most consistent associations with type 1 MI, regardless of viral load suppression

The meaning of life in a developing universe

The evolution of life on Earth has produced an organism that is beginning to model and understand its own evolution and the possible future evolution of life in the universe. These models and associated evidence show that evolution on Earth has a trajectory. The scale over which living processes are organized cooperatively has increased progressively, as has its evolvability. Recent theoretical advances raise the possibility that this trajectory is itself part of a wider developmental process. According to these theories, the developmental process has been shaped by a larger evolutionary process that involves the reproduction of universes. This evolutionary process has tuned the key parameters of the universe to increase the likelihood that life will emerge and develop to produce outcomes that are successful in the larger process (e.g. a key outcome may be to produce life and intelligence that intentionally reproduces the universe and tunes the parameters of ‘offspring’ universes). Theory suggests that when life emerges on a planet, it moves along this trajectory of its own accord. However, at a particular point evolution will continue to advance only if organisms emerge that decide to advance the evolutionary process intentionally. The organisms must be prepared to make this commitment even though the ultimate nature and destination of the process is uncertain, and may forever remain unknown. Organisms that complete this transition to intentional evolution will drive the further development of life and intelligence in the universe. Humanity’s increasing understanding of the evolution of life in the universe is rapidly bringing it to the threshold of this major evolutionary transition

High Resolution HDS/SUBARU chemical abundances of the young stellar cluster Palomar 1

Context. Palomar\,1 is a peculiar globular cluster (GC). It is the youngest Galactic GC and it has been tentatively associated to several of the substructures recently discovered in the Milky Way (MW), including the Canis Major (CMa) overdensity and the Galactic Anticenter Stellar Structure (GASS). Aims. In order to provide further insights into its origin, we present the first high resolution chemical abundance analysis for one red giant in Pal\,1. Methods. We obtained high resolution (R=30000) spectra for one red giant star in Pal\,1 using the High Dispersion Spectrograph (HDS) mounted at the SUBARU telescope. We used ATLAS-9 model atmospheres coupled with the SYNTHE and WIDTH calculation codes to derive chemical abundances from the measured line equivalent widths of 18 among $\alpha$, Iron-peak, light and heavy elements. Results. The Palomar~1 chemical pattern is broadly compatible to that of the MW open clusters population and similar to disk stars. It is, instead, remarkably different from that of the Sagittarius (Sgr) dwarf spheroidal galaxy. Conclusions. If Pal\,1 association with either CMa or GASS will be confirmed, this will imply that these systems had a chemical evolution similar to that of the Galactic disk.Comment: 13 pages, 9 figures, 5 tables. Accepted for publication in Astronomy and Astrophysics. Minor changes in the tex

Why the Canis Major overdensity is not due to the Warp: analysis of its radial profile and velocities

In response to criticism by Momany et al. (2004), that the recently-identified Canis Major (CMa) overdensity could be simply explained by the Galactic warp, we present proof of the existence of a stellar population in the direction of CMa that cannot be explained by known Galactic components. By analyzing the radial distribution of counts of M-giant stars in this direction, we show that the Momany et al. (2004) warp model overestimates the number of stars in the Northern hemisphere, hence hiding the CMa feature in the South. The use of a better model of the warp has little influence on the morphology of the overdensity and clearly displays an excess of stars grouped at a distance of D=7.2\pm 0.3 kpc. To lend further support to the existence of a population that does not belong to the Galactic disc, we present radial velocities of M-giant stars in the centre of the CMa structure that were obtained with the 2dF spectrograph at the AAT. The extra population shows a radial velocity of vr=109\pm4 km/s, which is significantly higher than the typical velocity of the disc at the distance of CMa. This population also has a low dispersion (13\pm4 km/s). The Canis Major overdensity is therefore highly unlikely to be due to the Galactic warp, adding weight to the hypothesis that we are observing a disrupting dwarf galaxy or its remnants. This leads to questions on what part of CMa was previously identified as the Warp and how to possibly disentangle the two structures.Comment: 5 pages, 4 figures, in press at MNRAS. Revised version with new data and discussio