Aortic Morphology Following Endovascular Repair of Acute and Chronic Type B Aortic Dissection: Implications for Management

AbstractObjectiveThe study aimed to define early clinical outcomes, and medium term morphological changes, following endovascular treatment of acute (AAD) and chronic (CAD) Type B aortic dissections.Main outcomesThe cohort comprised 78 patients who underwent endovascular repair for AAD (38) and CAD (40). Early and late clinical outcomes were prospectively recorded. All patients underwent serial follow up with CT scanning. False lumen thrombosis rates, true, false and total aortic short axis diameter were recorded at the mid point of the endograft and below this level in the thoracic aorta. The total maximum aortic diameter in the thoracic, abdominal aorta was quantified.ResultsThe 30-d mortality was 2.6% in AAD and 7.5% in CAD. The 30-d stroke and paraplegia rates were 5.3% and 0% in AAD. There were no cases of stroke or paraplegia in patients with CAD. At 30 months follow up, the cumulative survival for the two groups was 93% for AAD and 66.5% for CAD (P=0.015, Kaplan Meier) and the cumulative re-intervention rate was 62% and 55% in AAD and CAD respectively (P=0.961, Kaplan-Meier). False lumen thrombosis rates were equivalent in the two groups and were higher at the level of the endograft than below this level (P<0.05). Aortic remodelling was greater in AAD, whereas the aortic dimensions after treatment of CAD remained relatively static. Up to 20% of patients in both groups demonstrated enlargement of the thoracic aorta.ConclusionsThe data support the use of endovascular repair of the thoracic aorta in Type B aortic dissection. 30-d outcomes are acceptable. Patients with AAD demonstrate significant aortic remodelling whereas patients with CAD do not. This has significant implications for practice as patients with CAD must rely on maintenance of false lumen thrombosis to preserve the integrity of the endovascular repair

Measurement of Linear Stark Interference in 199Hg

We present measurements of Stark interference in the 6$^1S_0$ $\rightarrow$ 6$^3P_1$ transition in $^{199}$Hg, a process whereby a static electric field $E$ mixes magnetic dipole and electric quadrupole couplings into an electric dipole transition, leading to $E$-linear energy shifts similar to those produced by a permanent atomic electric dipole moment (EDM). The measured interference amplitude, $a_{SI}$ = $(a_{M1} + a_{E2})$ = (5.8 $\pm$ 1.5)$\times 10^{-9}$ (kV/cm)$^{-1}$, agrees with relativistic, many-body predictions and confirms that earlier central-field estimates are a factor of 10 too large. More importantly, this study validates the capability of the $^{199}$Hg EDM search apparatus to resolve non-trivial, controlled, and sub-nHz Larmor frequency shifts with EDM-like characteristics.Comment: 4 pages, 4 figures, 1 table; revised in response to reviewer comment

Improved limit on the permanent electric dipole moment of 199Hg

We report the results of a new experimental search for a permanent electric dipole moment of 199Hg utilizing a stack of four vapor cells. We find d(199Hg) = (0.49 \pm 1.29_stat \pm 0.76_syst) x 10^{-29} e cm, and interpret this as a new upper bound, |d(199Hg)| < 3.1 x 10^{-29} e cm (95% C.L.). This result improves our previous 199Hg limit by a factor of 7, and can be used to set new constraints on CP violation in physics beyond the standard model.Comment: 4 pages, 4 figures. additional reference, minor edits in response to reviewer comment

Device-specific Outcomes Following Endovascular Aortic Aneurysm Repair

AbstractObjectiveTo compare aneurysm morphology, initial outcomes and mid-term results in patients receiving Talent or Zenith grafts for elective endovascular aneurysm repair (EVR).MethodsOver a 6-year time period ending in 2007, 286 patients underwent elective EVR of infra-renal abdominal aortic aneurysms using Talent or Zenith devices. Patient demographics, aneurysm morphology and initial outcomes (primary-assisted technical success rates, 30-day limb occlusion, re-intervention and mortality) were compared using chi-squared tests or Student's t-tests. Kaplan–Meier curves were calculated to compare cumulative rates of freedom from type I or III endoleak, re-intervention, endograft patency and overall survival over mid-term follow-up.ResultsAdverse aneurysm morphology was more common in patients receiving Zenith stent grafts, with a greater proportion of shorter neck lengths (<10mm, 12.9% vs 0%; p≤0.001) and severe neck angulation (>60°, 25.0% vs 10.3%; p=0.002). Equivalent primary-assisted technical success rates were achieved with both Talent and Zenith grafts (94.0% vs 96.1%; p=0.41). A significant number of adjunctive procedures were required in both groups to obtain a proximal endograft seal, with relatively more procedures performed in the Talent group (28.6% vs 12.4%; p=0.003). Early outcomes were similar for 30-day re-intervention (5.3% vs 3.9%; p=0.91), 30-day limb occlusion (1.5% vs 2.6%; p=0.51), 30-day morbidity (6.8% vs 11.8%; p=0.15) and 30-day mortality (4.5% vs 3.9%; p=0.80).The cumulative incidence of freedom from re-intervention was 88.3±2.9%, 86.1±3.3% and 84.1±3.9% at 1, 2 and 3 years respectively. There were no significant differences between Talent and Zenith groups for re-intervention, type I or III endoleak or limb occlusion rates over the same time period. Overall patient survival was 88.4±2.85% at 1 year, 83.7±4.0% at 2 years and 78.9±5.5% at 3 years.ConclusionsEquivalent primary-assisted technical success rates can be achieved using either Talent or Zenith endografts for endovascular aneurysm repair, but operating teams should be prepared to perform additional adjunctive procedures to obtain a primary proximal seal with either stent. The Zenith endograft performed well in the context of less favourable pre-operative aneurysm morphology. Both Talent and Zenith endografts appeared equally durable in the medium term

Endovascular Repair of an Aortic Arch Aneurysm using a Branched-Stent Graft

AbstractIntroductionAortic arch aneurysm repair continues to pose a formidable technical challenge in a patient population with significant co-morbidity.ReportWe present a successful endovascular repair of an 8.4cm aortic arch aneurysm, in a 74 year old man, who's previous median sternotomy showed signs of delayed healing, precluding open repair.DiscussionApplied endovascular techniques obviated the need for aortic clamping, cardiac bypass, or hypothermic circulatory arrest, via an approach that was potentially infected

Editor's Choice - Assessment of International Outcomes of Intact Abdominal Aortic Aneurysm Repair over 9 Years

Background: Case mix and outcomes of complex surgical procedures vary over time and between regions. This study analyses peri-operative mortality after intact abdominal aortic aneurysm (AAA) repair in 11 countries over 9 years. Methods: Data on primary AAA repair from vascular surgery registries in 11 countries for the years 2005-2009 and 2010-2013 were analysed. Multivariate adjusted logistic regression analyses were carried out to adjust for variations in case mix. Results: A total of 83,253 patients were included. Over the two periods, the proportion of patients >= 80 years old increased (18.5% vs. 23.1%; p <.0001) as did the proportion of endovascular repair (EVAR) (44.3% vs. 60.6; p <.0001). In the latter period, 25.8% of AAAs were less than 5.5 cm. The mean annual volume of open repairs per centre decreased from 12.9 to 10.6 between the two periods (p <.0001), and it increased for EVAR from 10.0 to 17.1 (p <.0001). Overall, peri-operative mortality fell from 3.0% to 2.4% (p <.0001). Mortality for EVAR decreased from 1.5% to 1.1% (p <.0001), but the outcome worsened for open repair from 3.9% to 4.4% (p = .008). The peri-operative risk was greater for octogenarians (overall, 3.6% vs. 2.1%, p <.0001; open, 9.5% vs. 3.6%, p <.0001; EVAR, 1.8% vs. 0.7%, p <.0001), and women (overall, 3.8% vs. 2.2%, p <.0001; open, 6.0% vs. 4.0%, p <.0001; EVAR, 1.9% vs. 0.9%, p <.0001). Peri-operative mortality after repair of AAAs Conclusions: In this large international cohort, total peri-operative mortality continues to fall for the treatment of intact AAAs. The number of EVAR procedures now exceeds open procedures. Mortality after EVAR has decreased, but mortality for open operations has increased. The peri-operative mortality for small AM treatment, particularly open surgical repair, is still considerable and should be weighed against the risk of rupture. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.Peer reviewe

What Drives False Memories in Psychopathology? A Case for Associative Activation

In clinical and court settings, it is imperative to know whether posttraumatic stress disorder (PTSD) and depression may make people susceptible to false memories. We conducted a review of the literature on false memory effects in participants with PTSD, a history of trauma, or depression. When emotional associative material was presented to these groups, their levels of false memory were raised relative to those in relevant comparison groups. This difference did not consistently emerge when neutral or nonassociative material was presented. Our conclusion is supported by a quantitative comparison of effect sizes between studies using emotional associative or neutral, nonassociative material. Our review suggests that individuals with PTSD, a history of trauma, or depression are at risk for producing false memories when they are exposed to information that is related to their knowledge base