COMPARISON OF TWO DIFFERENT TECHNIQUES FOR ISOLATED LEFT SUBCLAVIAN ARTERY REVASCULARIZATION DURING THORACIC ENDOVASCULAR AORTIC REPAIR

Introduction - Endovascular repair of distal aortic arch/descending thoracic aortic diseases (TEVAR) may require the intentional coverage of the left subclavian artery (LSA) to increase the proximal landing zone and secure the sealing of the aortic lesion. Coverage without revascularization of the LSA may lead to cerebrovascular events, spinal cord deficits or upper arm ischemia. Up to date, no guidelines exist reporting which type of intervention should be preferred to revascularized the LSA. The aim of our paper is to analyze the results the isolated LSA revascularization during TEVAR, comparing the carotid-subclavian by-pass (CSbp) and the \u201cdouble barrel\u201d technique (DB). Methods - This is a multicenter, observational descriptive study. Inclusion criteria was TEVAR with isolated LSA revascularization. This experience includes patients observed from January 2012 to December 2016; for the final analysis, the end of study was December 31st 2016. All patients underwent follow-up program with computed-tomography angiography evaluation at 1, 6 and 12 months, on yearly basis thereafter. Primary end-points were early and long-term survival, LSA graft patency, freedom from TEVAR-related and aortic-related mortality (ARM), and freedom from reintervention. Categorical variables were presented using frequencies and percentages, continuous variables were presented with mean \uf0b1 standard deviation (SD). Cumulative survival, freedom from ARM and freedom from reintervention rates were estimated using the Kaplan-Meier method with 95% confidence interval (CI). A P value < .05 was considered significant. Results - During the study period we performed 308 TEVARs: in 73 (24%) cases the LSA was intentionally covered. Revascularization was performed with CSbp in 42 (57.5%), and DB in 31 (43.5%). The two groups were comparable for demographic data, comorbidities, risk factors and type of aortic disease treated. Overall, primary technical success was 100%. The DB was more frequently used when LSA had an acute angle (47 \ub1 17 vs. 63.5 \ub1 20, P = .020) at its origin, and when the distance between the LSA and the ipsilateral vertebral artery was longer (48 \ub1 11 vs. 36 \ub1 12, P = .007). The two groups did not differ significantly in terms of major complications (CSbp 7 vs. DB 11; P = .112), and in-hospital mortality (CSbp 1 vs. DB 1; P = 1.0). At a mean follow-up of 24 \ub1 20 mesi (range, 3-72), no LSA graft thrombosis was observed; the two groups did not differ significantly in terms of ARM (CSbp, 97 \ub1 3 vs. DB, 96 \ub1 4, log-rank = .868), need of aortic reintervention (CS 2 vs. DB 2; P = .836), or endoleak development (CSbp 2 vs. DB 1; P = .695). Conclusion - In our experience, LSA revascularization was safe and effective with both the techniques; at mid-term, both techniques offered durable results with no graft thrombosis

Diabetes Affects Antibody Response to SARS-CoV-2 Vaccination in Older Residents of Long-term Care Facilities: Data From the GeroCovid Vax Study

Objective: Type 2 diabetes may affect the humoral immune response after vaccination, but data concerning coronavirus disease 19 (COVID-19) vaccines are scarce. We evaluated the impact of diabetes on antibody response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in older residents of long-term care facilities (LTCFs) and tested for differences according to antidiabetic treatment. Research design and methods: For this analysis, 555 older residents of LTCFs participating in the GeroCovid Vax study were included. SARS-CoV-2 trimeric S immunoglobulin G (anti-S IgG) concentrations using chemiluminescent assays were tested before the first dose and after 2 and 6 months. The impact of diabetes on anti-S IgG levels was evaluated using linear mixed models, which included the interaction between time and presence of diabetes. A second model also considered diabetes treatment: no insulin therapy (including dietary only or use of oral antidiabetic agents) and insulin therapy (alone or in combination with oral antidiabetic agents). Results: The mean age of the sample was 82.1 years, 68.1% were women, and 25.2% had diabetes. In linear mixed models, presence of diabetes was associated with lower anti-S IgG levels at 2 (β = -0.20; 95% CI -0.34, -0.06) and 6 months (β = -0.22; 95% CI -0.37, -0.07) after the first vaccine dose. Compared with those without diabetes, residents with diabetes not using insulin had lower IgG levels at 2- and 6-month assessments (β = -0.24; 95% CI -0.43, -0.05 and β = -0.30; 95% CI -0.50, -0.10, respectively), whereas no differences were observed for those using insulin. Conclusions: Older residents of LTCFs with diabetes tended to have weaker antibody response to COVID-19 vaccination. Insulin treatment might buffer this effect and establish humoral immunity similar to that in individuals without diabetes

Search for leptonic decays of the dark photon at NA62

International audienceThe NA62 experiment at CERN, configured in beam-dump mode, has searched for dark photon decays in flight to electron-positron pairs using a sample of $1.4\times 10^{17}$ protons on dump collected in 2021. No evidence for a dark photon signal is observed. The combined result for dark photon searches in lepton-antilepton final states is presented and a region of the parameter space is excluded at 90% CL, improving on previous experimental limits for dark photon mass values between 50 and 600 MeV$/c^2$ and coupling values in the range $10^{-6}$ to $4\times10^{-5}$. An interpretation of the $e^+ e^-$ search result in terms of the emission and decay of an axion-like particle is also presented

Search for dark photon decays to μ+μ−\mu^+\mu^- at NA62

International audienceThe NA62 experiment at CERN, designed to study the ultra-rare decay $K^+ \to \pi^+\nu\overline{\nu}$, has also collected data in beam-dump mode. In this configuration, dark photons may be produced by protons dumped on an absorber and reach a decay volume beginning 80 m downstream. A search for dark photons decaying in flight to $\mu^+\mu^-$ pairs is reported, based on a sample of $1.4 \times 10^{17}$ protons on dump collected in 2021. No evidence for a dark photon signal is observed. A region of the parameter space is excluded at 90% CL, improving on previous experimental limits for dark photon masses between 215 and 550 MeV$/c^2$

Search for leptonic decays of the dark photon at NA62

International audienceThe NA62 experiment at CERN, configured in beam-dump mode, has searched for dark photon decays in flight to electron-positron pairs using a sample of $1.4\times 10^{17}$ protons on dump collected in 2021. No evidence for a dark photon signal is observed. The combined result for dark photon searches in lepton-antilepton final states is presented and a region of the parameter space is excluded at 90% CL, improving on previous experimental limits for dark photon mass values between 50 and 600 MeV$/c^2$ and coupling values in the range $10^{-6}$ to $4\times10^{-5}$. An interpretation of the $e^+ e^-$ search result in terms of the emission and decay of an axion-like particle is also presented

Development of a new CEDAR for kaon identification at the NA62 experiment at CERN

International audienceThe NA62 experiment at CERN utilises a differential Cherenkov counter with achromatic ring focus (CEDAR) for tagging kaons within an unseparated monochromatic beam of charged hadrons. The CEDAR-H detector was developed to minimise the amount of material in the path of the beam by using hydrogen gas as the radiator medium. The detector was shown to satisfy the kaon tagging requirements in a test-beam before installation and commissioning at the experiment. The CEDAR-H performance was measured using NA62 data collected in 2023

Development of a new CEDAR for kaon identification at the NA62 experiment at CERN

International audienceThe NA62 experiment at CERN utilises a differential Cherenkov counter with achromatic ring focus (CEDAR) for tagging kaons within an unseparated monochromatic beam of charged hadrons. The CEDAR-H detector was developed to minimise the amount of material in the path of the beam by using hydrogen gas as the radiator medium. The detector was shown to satisfy the kaon tagging requirements in a test-beam before installation and commissioning at the experiment. The CEDAR-H performance was measured using NA62 data collected in 2023