Remodeling of Abdominal Aortic Angulation and Curvature After Endovascular Aneurysm Repair in Patients With vs Without Late Type Ia Endoleak or Endograft Migration

Purpose: To investigate aortic remodeling of the supra- and infrarenal aorta from preoperative to 1 month and midterm follow-up after endovascular aneurysm repair (EVAR) by analyzing changes in angulation and curvature in patients with vs without late type Ia endoleak or device migration. Materials and Methods: From a multicenter database, 35 patients (mean age 76 +/- 5 years; 31 men) were identified with late (>1 year) type Ia endoleak or endograft migration (>= 10 mm) and defined as the complication group. The control group consisted of 53 patients (mean age 75 +/- 7 years; 48 men) with >1-year computed tomography angiography (CTA) follow-up and no evidence of endoleaks. Suprarenal and infrarenal angles were measured on centerline reconstructions of the preoperative, 1-month, and midterm CTA scans. The value and location relative to baseline of maximum suprarenal and infrarenal curvature were determined semiautomatically using dedicated software. Changes were determined at 1 month compared with the preoperative CTA and at midterm compared with 1 month. Results: Preoperative suprarenal angulation was significantly greater in the complication group compared to the controls (34 degrees +/- 18 degrees vs 24 degrees +/- 17 degrees, p=0.008). It decreased significantly at 1 month in the complication group (29 degrees +/- 16 degrees, p=0.011) and at midterm follow-up in the controls (20 degrees +/- 19 degrees, p Conclusion: At midterm follow-up, significant differences in supra- and infrarenal angulation and curvature were observed between patients with vs without type Ia endoleak or migration. The location of the maximum curvature shifted distally in patients with complications. The aortic morphology is more stable during midterm follow-up in the patients without endoleaks

Characterisation of non-obese diabetic patients with marked insulin resistance identifies a novel familial partial lipodystrophy-associated PPARγ mutation (Y151C)

Familial partial lipodystrophy (FPLD) is a rare metabolic disorder with clinical features that may not be readily recognised. As FPLD patients require a specific therapeutic approach, early identification is warranted. In the present study we aimed to identify cases of FPLD among non-obese patients with type 2 diabetes mellitus and marked insulin resistance. We searched the databases of three diabetic outpatient clinics for patients with marked insulin resistance, arbitrarily defined as the use of ≥100 U insulin/day, and BMI ≤ 27 kg/m(2). In all patients, metabolic variables and anthropomorphic measurements were evaluated and DNA was sequenced for mutations in the genes encoding lamin A/C (LMNA), peroxisome proliferator-activated receptor γ (PPARγ) and cell death-inducing DFFA-like effector c (CIDEC). Out of 5,221 diabetic individuals, 24 patients fulfilled all criteria. Twelve patients were willing to participate, of whom five showed clinical features of lipodystrophy. In three of these patients the clinical diagnosis of FPLD was confirmed by the presence of mutations in LMNA or PPARG; one patient harboured a novel heterozygous mutation (Y151C) in PPARG. The Y151C mutant displayed impaired DNA-binding capacity and hence reduced transcriptional activity compared with wild-type PPARγ. Dominant-negative activity was absent. The combination of BMI ≤ 27 kg/m(2) and the use of >100 U insulin/day increases the chance of identifying lipodystrophy. Thus careful assessment of clinical features of FPLD should be considered in these patients, allowing earlier therapeutic intervention

The mechanics of setting up a COVID-19 response: Experiences of the COVID-19 epidemic from Groote Schuur Hospital, Cape Town, South Africa

The SARS-CoV-2 pandemic has challenged the provision of healthcare in ways that are unprecedented in our lifetime. Planning for the sheer numbers expected during the surge has required public hospitals to de-escalate all non-essential clinical services to focus on COVID-19. Western Cape Province was the initial epicentre of the COVID-19 epidemic in South Africa (SA), and the Cape Town metro was its hardest-hit geographical region. We describe how we constructed our COVID-19 hospital-wide clinical service at Groote Schuur Hospital, the University of Cape Town’s tertiary-level teaching hospital. By describing the barriers and enablers, we hope to provide guidance rather than a blueprint for hospitals elsewhere in SA and in low-resource countries that face similar challenges now or during subsequent waves

The effectiveness and cost-evaluation of manual therapy and physical therapy in patients with sub-acute and chronic non specific neck pain. Rationale and design of a Randomized Controlled Trial (RCT)

Contains fulltext : 88910.pdf (publisher's version ) (Open Access)BACKGROUND: Manual Therapy applied to patients with non specific neck pain has been investigated several times. In the Netherlands, manual therapy as applied according to the Utrecht School of Manual Therapy (MTU) has not been the subject of a randomized controlled trial. MTU differs in diagnoses and treatment from other forms of manual therapy. METHODS/DESIGN: This is a single blind randomized controlled trial in patients with sub-acute and chronic non specific neck pain. Patients with neck complaints existing for two weeks (minimum) till one year (maximum) will participate in the trial. 180 participants will be recruited in thirteen primary health care centres in the Netherlands.The experimental group will be treated with MTU during a six week period. The control group will be treated with physical therapy (standard care, mainly active exercise therapy), also for a period of six weeks.Primary outcomes are Global Perceived Effect (GPE) and functional status (Neck Disability Index (NDI-DV)). Secondary outcomes are neck pain (Numeric Rating Scale (NRS)), Eurocol, costs and quality of life (SF36). DISCUSSION: This paper presents details on the rationale of MTU, design, methods and operational aspects of the trial. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00713843

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Atomic force microscopic studies on the growth of self-assembled monolayer on SrTiO3 surfaces

The growth mechanism of octadecyltrichlorosilane (OTS) on SrTiO3 substrates has been investigated by wettability and force microscopy measurements. The films were formed by the self-assembly technique. It was found that growth proceeded via two types of islands: large `fractal-like' islands and smaller circular patches of molecules. The patches grow by attachment of monomers and coalescence with other islands. The overall growth mode obeyed first order Langmuir kinetics and is found to be similar to the growth of alkylsiloxanes on SiO2 and mica. The difference between growth on SrTiO3 and SrTiO3:Nb is that the growth rate is slower on the latter substrate

Spectroscopic characterisation of self-assembled monolayers of alkylsiloxanes on SrTiO3

Self-assembled previous termmonolayersnext term of alkyltrichlorosilanes have been successfully prepared on SrTiO3 substrates. previous termCharacterisationnext term has been performed by atomic force microscopy (AFM), wettability, ellipsometry, angle resolved X-ray photoemission spectroscopy (ARXPS) and reflection absorption infrared spectroscopy (RAIRS). It is found that dense and ordered previous termmonolayersnext term form if environmental conditions are controlled. Good agreement is found for the ellipsometry thickness and the ARXPS thickness. From simulations of absorption spectra, we find that the molecules are oriented with an average tilt angle of ¿11° with respect to the surface normal on the (001) and (110) faces. On the niobium-doped SrTiO3 substrate, however, the tilt angle increases to ¿35°

Binary mixtures of self-assembled monolayers on SrTiO3: Experimental evidence for phase segregation

The formation of monolayers from mixed solutions of alkylsiloxane molecules on the surface of SrTiO3 has been studied. The monolayers were formed by self-assembly from dilute n-hexadecane solutions of two binary mixtures of long- and short-chain alkyltrichlorosilanes. These films have been studied by atomic and lateral force microscopy and wettability measurements. One mixture showed evidence of phase segregation on the vicinal surface of a SrTiO3 (001) crystal. The long-chain molecules are found to preferably adsorb at or migrate toward the step ledge, probably to increase their van der Waals interaction and minimize the surface free energy