Long-term outcome after early infrainguinal graft failure

AbstractPurpose: To determine the long-term outcome and prognostic factors after early infrainguinal graft failure (<30 days).Methods: Retrospective analysis of limb salvage data, patency data, and prognostic risk factors in 112 new infrainguinal bypass grafts from 1985 to 1995 that occluded within 30 days of operation.Result: Thirty-six femoropopliteal and 76 femorotibial/femoropedal arterial bypass (“index”) procedures were performed for rest pain (50%), tissue loss (31%), or disabling claudication (19%). In 103 patients, an immediate additional revascularization (“takeback”) procedure was performed at the time of early graft failure. Life table analysis of the takeback procedures for threatened limbs (n = 84) revealed limb salvage rates of 74%, 54%, 40%, and 31% at 1 month, 1 year, 3 years, and 5 years, respectively. The 1-month limb salvage rate (threatened limbs) was 12% (1 of 8) in patients who were not taken back for revascularization and 33% (4 of 12) in patients who had undergone more than one takeback procedure within 30 days. The secondary graft patency rates for the takeback procedures (n = 103) were 70%, 37%, 27%, and 23% at 1 month, 1 year, 3 years, and 5 years, respectively. Univariate and life table analysis revealed that patients who were given anticoagulation medication after the index procedure (before graft thrombosis) or patients who had undergone previous ipsilateral leg revascularization had significantly lower rates of limb salvage and graft patency (p < 0.05). The limb salvage rate was also significantly worse in patients who had single-vessel runoff compared with those who had multiple-vessel runoff (p < 0.01). Thrombectomy and revision or complete graft replacement had a better secondary patency rate than thrombectomy alone (p < 0.05). Autogenous vein grafts had better outcome than polytetrafluoroethylene-containing grafts, but statistical significance was not achieved. No significant differences in limb salvage or graft patency rates were found between femoropopliteal versus femorotibial/femoropedal bypass grafting, age, gender, previous inflow surgery, diabetes, hypertension, smoking, or cardiac, renal, or pulmonary disease.Conclusion: The long-term limb salvage and graft patency rates after takeback revascularization procedures for early graft failure are poor. Despite poor outcome, a single takeback procedure appears warranted in all patients. Multiple takeback procedures, however, do not appear to be justified, especially in patients who are given anticoagulation medication after the index bypass procedure, repeat leg bypass procedures, or if there is no potential for graft revision

Prospects for Nonlinear Laser Diagnostics in the Jet Noise Laboratory

Two experiments were conducted to test whether optical methods, which rely on laser beam coherence, would be viable for off-body flow measurement in high-density, compressible-flow wind tunnels. These tests measured the effects of large, unsteady density gradients on laser diagnostics like laser-induced thermal acoustics (LITA). The first test was performed in the Low Speed Aeroacoustics Wind Tunnel (LSAWT) of NASA Langley Research Center's Jet Noise Laboratory (JNL). This flow facility consists of a dual-stream jet engine simulator (with electric heat and propane burners) exhausting into a simulated flight stream, reaching Mach numbers up to 0.32. A laser beam transited the LSAWT flow field and was imaged with a high-speed gated camera to measure beam steering and transverse mode distortion. A second, independent test was performed on a smaller laboratory jet (Mach number < 1.2 and mass flow rate < 0.1 kg/sec). In this test, time-averaged LITA velocimetry and thermometry were performed at the jet exit plane, where the effect of unsteady density gradients is observed on the LITA signal. Both experiments show that LITA (and other diagnostics relying on beam overlap or coherence) faces significant hurdles in the high-density, compressible, and turbulent flow environments similar to those of the JNL

Shape of the northern hemisphere of Mars from the Mars Orbiter Laser Altimeter (MOLA)

Eighteen profiles of ∼N-S-trending topography from the Mars Orbiter Laser Altimeter (MOLA) are used to analyze the shape of Mars' northern hemisphere. MOLA observations show smaller northern hemisphere flattening than previously thought. The hypsometric distribution is narrowly peaked with >20% of the surface lying within 200 m of the mean elevation. Low elevation correlates with low surface roughness, but the elevation and roughness may reflect different mechanisms. Bouguer gravity indicates less variability in crustal thickness and/or lateral density structure than previously expected. The 3.1-km offset between centers of mass and figure along the polar axis results in a pole-to-equator slope at all longitudes. The N-S slope distribution also shows a subtle longitude-dependent variation that may represent the antipodal effect of the formation of Tharsis

A new spin-anisotropic harmonic honeycomb iridate

The physics of Mott insulators underlies diverse phenomena ranging from high temperature superconductivity to exotic magnetism. Although both the electron spin and the structure of the local orbitals play a key role in this physics, in most systems these are connected only indirectly --- via the Pauli exclusion principle and the Coulomb interaction. Iridium-based oxides (iridates) open a further dimension to this problem by introducing strong spin-orbit interactions, such that the Mott physics has a strong orbital character. In the layered honeycomb iridates this is thought to generate highly spin-anisotropic interactions, coupling the spin orientation to a given spatial direction of exchange and leading to strongly frustrated magnetism. The potential for new physics emerging from such interactions has driven much scientific excitement, most recently in the search for a new quantum spin liquid, first discussed by Kitaev \cite{kitaev_anyons_2006}. Here we report a new iridate structure that has the same local connectivity as the layered honeycomb, but in a three-dimensional framework. The temperature dependence of the magnetic susceptibility exhibits a striking reordering of the magnetic anisotropy, giving evidence for highly spin-anisotropic exchange interactions. Furthermore, the basic structural units of this material suggest the possibility of a new family of structures, the `harmonic honeycomb' iridates. This compound thus provides a unique and exciting glimpse into the physics of a new class of strongly spin-orbit coupled Mott insulators.Comment: 12 pages including bibliography, 5 figure

Topographic Rise in the Northern Smooth Plains of Mercury: Characteristics from Messenger Image and Altimetry Data and Candidate Modes of Origin

MESSENGER observations from orbit around Mercury have revealed that a large contiguous area of smooth plains occupies much of the high northern latitudes and covers an area in excess of approx.6% of the surface of the planet [1] (Fig. 1). Smooth surface morphology, embayment relationships, color data, candidate flow fronts, and a population of partly to wholly buried craters provide evidence for the volcanic origin of these plains and their emplacement in a flood lava mode to depths at least locally in excess of 1 km. The age of these plains is similar to that of plains associated with and postdating the Caloris impact basin, confirming that volcanism was a globally extensive process in the post-heavy bombardment history of Mercury [1]. No specific effusive vent structures, constructional volcanic edifices, or lava distributary features (leveed flow fronts or sinuous rilles) have been identified in the contiguous plains, although vent structures and evidence of high-effusion-rate flood eruptions are seen in adjacent areas [1]. Subsequent to the identification and mapping of the extensive north polar smooth plains, data from the Mercury Laser Altimeter (MLA) on MESSENGER revealed the presence of a broad topographic rise in the northern smooth plains that is ~1,000 km across and rises more than 1.5 km above the surrounding smooth plains [2] (Fig. 2). The purpose of this contribution is to characterize the northern plains rise and to outline a range of hypotheses for its origin

Analysis of Successful Immune Responses in Persons Infected with Hepatitis C Virus

Although hepatitis C virus (HCV) infection is very common, identification of patients during acute infection is rare. Consequently, little is known about the immune response during this critical stage of the disease. We analyzed the T lymphocyte response during and after acute resolving HCV infection in three persons, using interferon (IFN)-γ enzyme-linked immunospot (ELISPOT) and human histocompatibility leukocyte antigen (HLA) peptide tetramer assays. Acute infection was associated with a broadly directed T helper and cytotoxic T lymphocyte (CTL) response, which persisted after resolution of clinical hepatitis and clearance of viremia. At the earliest time point studied, highly activated CTL populations were observed that temporarily failed to secrete IFN-γ, a “stunned” phenotype, from which they recovered as viremia declined. In long-term HCV-seropositive persons, CTL responses were more common in persons who had cleared viremia compared with those with persistent viremia, although the frequencies of HCV-specific CTLs were lower than those found in persons during and after resolution of acute HCV infection. These studies demonstrate a strong and persistent CTL response in resolving acute HCV infection, and provide rationale to explore immune augmentation as a therapeutic intervention in chronic HCV infection

Integrating complementary methods to improve diet analysis in fishery‐targeted species

Developing efficient, reliable, cost‐effective ways to identify diet is required to understand trophic ecology in complex ecosystems and improve food web models. A combination of techniques, each varying in their ability to provide robust, spatially and temporally explicit information can be applied to clarify diet data for ecological research. This study applied an integrative analysis of a fishery‐targeted species group—Plectropomus spp. in the central Great Barrier Reef, Australia, by comparing three diet‐identification approaches. Visual stomach content analysis provided poor identification with ~14% of stomachs sampled resulting in identification to family or lower. A molecular approach was successful with prey from ~80% of stomachs identified to genus or species, often with several unique prey in a stomach. Stable isotope mixing models utilizing experimentally derived assimilation data, identified similar prey as the molecular technique but at broader temporal scales, particularly when prior diet information was incorporated. Overall, Caesionidae and Pomacentridae were the most abundant prey families (>50% prey contribution) for all Plectropomus spp., highlighting the importance of planktivorous prey. Less abundant prey categories differed among species/color phases indicating possible niche segregation. This study is one of the first to demonstrate the extent of taxonomic resolution provided by molecular techniques, and, like other studies, illustrates that temporal investigations of dietary patterns are more accessible in combination with stable isotopes. The consumption of mainly planktivorous prey within this species group has important implications within coral reef food webs and provides cautionary information regarding the effects that changing resources could have in reef ecosystems

Integrating complementary methods to improve diet analysis in fishery-targeted species

Developing efficient, reliable, cost-effective ways to identify diet is required to understand trophic ecology in complex ecosystems and improve food web models. A combination of techniques, each varying in their ability to provide robust, spatially and temporally explicit information can be applied to clarify diet data for ecological research. This study applied an integrative analysis of a fishery-targeted species group—Plectropomus spp. in the central Great Barrier Reef, Australia, by comparing three diet-identification approaches. Visual stomach content analysis provided poor identification with ~14% of stomachs sampled resulting in identification to family or lower. A molecular approach was successful with prey from ~80% of stomachs identified to genus or species, often with several unique prey in a stomach. Stable isotope mixing models utilizing experimentally derived assimilation data, identified similar prey as the molecular technique but at broader temporal scales, particularly when prior diet information was incorporated. Overall, Caesionidae and Pomacentridae were the most abundant prey families (\u3e50% prey contribution) for all Plectropomus spp., highlighting the importance of planktivorous prey. Less abundant prey categories differed among species/color phases indicating possible niche segregation. This study is one of the first to demonstrate the extent of taxonomic resolution provided by molecular techniques, and, like other studies, illustrates that temporal investigations of dietary patterns are more accessible in combination with stable isotopes. The consumption of mainly planktivorous prey within this species group has important implications within coral reef food webs and provides cautionary information regarding the effects that changing resources could have in reef ecosystems

Succession of physiological stages hallmarks the transcriptomic response of the&nbsp;fungus Aspergillus niger to lignocellulose.

BackgroundUnderstanding how fungi degrade lignocellulose is a cornerstone of improving renewables-based biotechnology, in particular for the production of hydrolytic enzymes. Considerable progress has been made in investigating fungal degradation during time-points where CAZyme expression peaks. However, a robust understanding of the fungal survival strategies over its life time on lignocellulose is thereby missed. Here we aimed to uncover the physiological responses of the biotechnological workhorse and enzyme producer Aspergillus niger over its life time to six substrates important for biofuel production.ResultsWe analysed the response of A. niger to the feedstock Miscanthus and compared it with our previous study on wheat straw, alone or in combination with hydrothermal or ionic liquid feedstock pretreatments. Conserved (substrate-independent) metabolic responses as well as those affected by pretreatment and feedstock were identified via multivariate analysis of genome-wide transcriptomics combined with targeted transcript and protein analyses and mapping to a metabolic model. Initial exposure to all substrates increased fatty acid beta-oxidation and lipid metabolism transcripts. In a strain carrying a deletion of the ortholog of the Aspergillus nidulans fatty acid beta-oxidation transcriptional regulator farA, there was a reduction in expression of selected lignocellulose degradative CAZyme-encoding genes suggesting that beta-oxidation contributes to adaptation to lignocellulose. Mannan degradation expression was wheat straw feedstock-dependent and pectin degradation was higher on the untreated substrates. In the later life stages, known and novel secondary metabolite gene clusters were activated, which are of high interest due to their potential to synthesize bioactive compounds.ConclusionIn this study, which includes the first transcriptional response of Aspergilli to Miscanthus, we highlighted that life time as well as substrate composition and structure (via variations in pretreatment and feedstock) influence the fungal responses to lignocellulose. We also demonstrated that the fungal response contains physiological stages that are conserved across substrates and are typically found outside of the conditions with high CAZyme expression, as exemplified by the stages that are dominated by lipid and secondary metabolism

White Dwarfs in Globular Clusters: HST Observations of M4

Using WFPC2 on the Hubble Space Telescope, we have isolated a sample of 258 white dwarfs (WDs) in the Galactic globular cluster M4. Fields at three radial distances from the cluster center were observed and sizeable WD populations were found in all three. The location of these WDs in the color-magnitude diagram, their mean mass of 0.51($\pm 0.03$)M$_{\odot}$, and their luminosity function confirm basic tenets of stellar evolution theory and support the results from current WD cooling theory. The WDs are used to extend the cluster main-sequence mass function upward to stars that have already completed their nuclear evolution. The WD/red dwarf binary frequency in M4 is investigated and found to be at most a few percent of all the main-sequence stars. The most ancient WDs found are about 9 Gyr old, a level which is set solely by the photometric limits of our data. Even though this is less than the age of M4, we discuss how these cooling WDs can eventually be used to check the turnoff ages of globular clusters and hence constrain the age of the Universe.Comment: 46 pages, latex, no figures included, figures available at ftp://ftp.astro.ubc.ca/pub/richer/wdfig.uu size 2.7Mb. To be published in the Astrophysical Journa