978-118 Exercise Capacity and Coronary Flow Reserve in Patients with Intermediate Coronary Stenoses

In patients with coronary disease, exercise time is a predictor of disease severity. More severe disease is associated with shorter exercise time due to greater ischemia. In patients with intermediate coronary stenoses, however, it is unclear whether stenosis severity predicts functional effects. Thus, we examined the relationship between exercise time and the angiographic and physiologic significance of 25 intermediate coronary stenoses (40–70%). Using an intracororary Doppler flow wire we measured coronary flow reserve (CFR) as the ratio of adenosine-induced hyperemic coronary flow velocity to resting velocity. Stenosis severity was determined by quantitative angiography. Patients subsequently underwent maximal exercise testing on a Bruce protocol. No patient had left ventricular dysfunction, ischemia in other vascular distributions or other diseases known to limit exercise capacity. Exercise time was normalized for age and gender according to the method of Bruce. Total exercise time ranged from 3.9 to 12.8min while normalized time ranged from 37 to 152% of predicted. CFR ranged from 1.0 to 3.5 (normal≥2.0) and was directly related to exercise time (r=0.7, p<0.0001, SEE=2.1) and normalized exercise time (r=0.7 p<0.0001, SEE=25), Normalized exercise time was 72±21% of predicted in patients with an abnormal CFR vs 125±23% of predicted in those with normal CFR (p<0.0001). There was no relationship between angiographic percent stenosis and exercise time (r=-0.01) or normalized exercise time (r=-0.01). Normalized exercise time was ≥100% of predicted in 9 of 11 patients with a normal CFR, and <100% in 13 of 14 patients with abnormal CFR. The sensitivity, specificity and predictive accuracy of normalized exercise time for CFR were 93%, 82% and 88%, respectively. Thus, in patients with intermediate coronary stenoses and no other exercise limitations, treadmill exercise time is a useful marker of the physiologic severity of disease

Ammonia‐oxidizing archaea and nitrite‐oxidizing nitrospiras in the biofilter of a shrimp recirculating aquaculture system

This study analysed the nitrifier community in the biofilter of a zero discharge, recirculating aquaculture system ( RAS ) for the production of marine shrimp in a low density (low ammonium production) system. The ammonia‐oxidizing populations were examined by targeting 16 S rRNA and amoA genes of ammonia‐oxidizing bacteria ( AOB ) and archaea ( AOA ). The nitrite‐oxidizing bacteria ( NOB ) were investigated by targeting the 16 S rRNA gene. Archaeal amoA genes were more abundant in all compartments of the RAS than bacterial amoA genes. Analysis of bacterial and archaeal amoA gene sequences revealed that most ammonia oxidizers were related to N itrosomonas marina and N itrosopumilus maritimus . The NOB detected were related to N itrospira marina and N itrospira moscoviensis, and Nitrospira  marina ‐type NOB were more abundant than N . moscoviensis ‐type NOB . Water quality and biofilm attachment media played a role in the competitiveness of AOA over AOB and Nitrospira  marina‐ over N . moscoviensis‐ type NOB .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95109/1/fem1448.pd

Results of the ANCHOR prospective, multicenter registry of EndoAnchors for type Ia endoleaks and endograft migration in patients with challenging anatomy

ObjectiveProximal attachment site complications continue to occur after endovascular repair of abdominal aortic aneurysms (EVAR), specifically type Ia endoleak and endograft migration. EndoAnchors (Aptus Endosystems, Sunnyvale, Calif) were designed to enhance endograft proximal fixation and sealing, and the current study was undertaken to evaluate the potential benefit of this treatment.MethodsDuring the 23-month period ending in December 2013, 319 subjects were enrolled at 43 sites in the United States and Europe. EndoAnchors were implanted in 242 patients (75.9%) at the time of an initial EVAR procedure (primary arm) and in 77 patients with an existing endograft and proximal aortic neck complications (revision arm). Technical success was defined as deployment of the desired number of EndoAnchors, adequate penetration of the vessel wall, and absence of EndoAnchor fracture. Procedural success was defined as technical success without a type Ia endoleak at completion angiography. Values are expressed as mean ± standard deviation and interquartile range.ResultsThe 238 male (74.6%) and 81 female (25.4%) subjects had a mean age of 74.1 ± 8.2 years. Aneurysms averaged 58 ± 13 (51-63) mm in diameter at the time of EndoAnchor implantation (core laboratory measurements). The proximal aortic neck averaged 16 ± 13 (7-23) mm in length (42.7% <10 mm and 42.7% conical) and 27 ± 4 mm (25-30 mm) in diameter; infrarenal neck angulation was 24 ± 15 (13-34) degrees. The number of EndoAnchors deployed was 5.8 ± 2.1 (4-7). Technical success was achieved in 303 patients (95.0%) and procedural success in 279 patients (87.5%), 217 of 240 (89.7%) and 62 of 77 (80.5%) in the primary and revision arms, respectively. There were 29 residual type Ia endoleaks (9.1%) at the end of the procedure. During mean follow-up of 9.3 ± 4.7 months, 301 patients (94.4%) were free from secondary procedures. Among the 18 secondary procedures, eight were performed for residual type Ia endoleaks and the others were unrelated to EndoAnchors. There were no open surgical conversions, there were no aneurysm-related deaths, and no aneurysm ruptured during follow-up.ConclusionsUse of EndoAnchors to treat existing and acute type Ia endoleaks and endograft migration was successful in most cases. Prophylactic use of EndoAnchors in patients with hostile aortic neck anatomy appears promising, but definitive conclusions must await longer term follow-up data

A Multisite Preregistered Paradigmatic Test of the Ego-Depletion Effect

We conducted a preregistered multilaboratory project (k = 36; N = 3,531) to assess the size and robustness of ego-depletion effects using a novel replication method, termed the paradigmatic replication approach. Each laboratory implemented one of two procedures that was intended to manipulate self-control and tested performance on a subsequent measure of self-control. Confirmatory tests found a nonsignificant result (d = 0.06). Confirmatory Bayesian meta-analyses using an informed-prior hypothesis (δ = 0.30, SD = 0.15) found that the data were 4 times more likely under the null than the alternative hypothesis. Hence, preregistered analyses did not find evidence for a depletion effect. Exploratory analyses on the full sample (i.e., ignoring exclusion criteria) found a statistically significant effect (d = 0.08); Bayesian analyses showed that the data were about equally likely under the null and informed-prior hypotheses. Exploratory moderator tests suggested that the depletion effect was larger for participants who reported more fatigue but was not moderated by trait self-control, willpower beliefs, or action orientation