National Vascular Registry: 2015 Annual Report.

The National Vascular Registry is commissioned by the Healthcare Quality Improvement Partnership (HQIP) to measure the quality and outcomes of care for patients who undergo major vascular surgery in NHS hospitals in England and Wales. It aims to provide comparative information on the performance of NHS vascular units and thereby support local quality improvement as well as inform patients about major vascular interventions delivered in the NHS. As such, all NHS hospitals in England, Wales, Scotland and Northern Ireland are encouraged to participate in the Registry. The measures used to describe the patterns and outcomes of care are drawn from various national guidelines including: the “Provision of Services for Patients with Vascular Disease” document and the Quality Improvement Frameworks published by the Vascular Society, and the National Institute for Health and Care Excellence (NICE) guidelines on stroke and peripheral arterial disease. This report provides a description of the care provided by NHS vascular units, and contains information on the process and outcomes of care for: (i) patients undergoing abdominal aortic aneurysm (AAA) repair, (ii) patients undergoing carotid endarterectomy, (iii) patients undergoing a revascularisation procedure (angioplasty/stent or bypass) or major amputation for lower-limb peripheral arterial disease (PAD). In addition, the report presents the findings of an organisational audit conducted in August 2015

National Vascular Registry: 2014 Progress Report.

The National Vascular Registry is commissioned by the Healthcare Quality Improvement Partnership (HQIP) to measure the quality and outcomes of care for patients who undergo major vascular surgery in NHS hospitals in England and Wales. It aims to provide comparative information on the performance of NHS hospitals and thereby support local quality improvement as well as inform patients about the care delivered in the NHS. As such, all NHS hospitals in England, Wales, Scotland and Northern Ireland are encouraged to participate in the Registry. The measures used to describe the patterns and outcomes of care are drawn from various national guidelines including: the “2014 The Provision of Services for Patients with Vascular Disease” and the Quality Improvement Frameworks published by the Vascular Society, and the National Institute for Health and Care Excellence (NICE) guidelines on stroke and peripheral arterial disease. In 2014, the Registry published NHS trust and surgeon-level information for elective infrarenal Abdominal Aortic Aneurysm (AAA) repair and carotid endarterectomy on the Registry website. From 28 October, information on both procedures has been available on the www.vsqip.org.uk website for all UK NHS trusts that currently perform them. For English NHS trusts, the same information was published for individual consultants, as part of NHS England’s “Everyone Counts: Planning for Patients 2013/4” initiative. Consultant-level information was also published for NHS hospitals in Wales, Scotland and Northern Ireland for consenting surgeons. This progress report aims to complement that information by (1) providing an overview of care delivered by the NHS at a national level, and (2) describing various developments within the National Vascular Registry. The Registry will publish its next annual report on major vascular surgery in November 2015

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

Efficient magneto-optical trapping of Yb atoms with a violet laser diode

We report the first efficient trapping of rare-earth Yb atoms with a high-power violet laser diode (LD). An injection-locked violet LD with a 25 mW frequency-stabilized output was used for the magneto-optical trapping (MOT) of fermionic as well as bosonic Yb isotopes. A typical number of $4\times 10^6$ atoms for $^{174}$Yb with a trap density of $\sim 1\times10^8/$cm$^3$ was obtained. A 10 mW violet external-cavity LD (ECLD) was used for the one-dimensional (1D) slowing of an effusive Yb atomic beam without a Zeeman slower resulting in a 35-fold increase in the number of trapped atoms. The overall characteristics of our compact violet MOT, e.g., the loss time of 1 s, the loading time of 400 ms, and the cloud temperature of 0.7 mK, are comparable to those in previously reported violet Yb MOTs, yet with a greatly reduced cost and complexity of the experiment.Comment: 5 pages, 3 figures, 1 table, Phys. Rev. A (to be published

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

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

Metabonomic Investigation of Liver Profiles of Nonpolar Metabolites Obtained from Alcohol-Dosed Rats and Mice Using High Mass Accuracy MSn Analysis

Alcoholism is a complex disorder that, in man, appears to be genetically influenced, although the underlying genes and molecular pathways are not completely known. Here the intragastric alcohol feeding model in rodents was used together with high mass accuracy LC/MS(n) analysis to assess the metabonomic changes in nonpolar metabolite profiles for livers from control and alcohol treated rats and mice. Ion signals with a peak area variance of less than 30% (based on repeat analysis of a pooled quality control sample analysed throughout the batch) were submitted to multivariate statistical analysis (using principal components analysis, PCA). PCA revealed robust differences between profiles from control and alcohol-treated animals from both species. The major metabolites seen to differ between control and alcohol-treated animals were identified using high accuracy MS(n) data and verified using external search engines (http://www.lipidmaps.org; http://www.hmdb.ca; http://www.genome.jp/kegg/) and authentic standards. The main metabolite classes to show major changes in the alcoholic liver-derived samples were fatty acyls, fatty acid ethyl esters, glycerolipids and phosphatidylethanol homologues. Significant metabolites that were up-regulated by alcohol treatment in both rat and mouse livers included fatty acyls, metabolites such as octadecatrienoic acid and eicosapentaenoic acid, a number of fatty acid ethyl esters such as ethyl arachidonate, ethyl docosahexaenoic acid, ethyl linoleate and ethyl oleate and phosphatidylethanol (PEth) homologues (predominantly PEth 18:0/18:2 and PEth 16:0/18:2; PEth homologues are currently considered as potential biomarkers for harmful and prolonged alcohol consumption in man). A number of glycerophospholipids resulted in both up-regulation (m/z 903.7436 [M+H](+) corresponding to a triglyceride) and down-regulation (m/z 667.5296 [M+H](+) corresponding to a diglyceride). Metabolite profiles were broadly similar in both mouse and rat models. However, there were a number of significant differences in the alcohol-treated group particularly in the marked down-regulation of retinol and free cholesterol in the mouse compared to the rat. Unique markers for alcohol treatment included ethyl docosahexaenoic acid. Metabolites were identified with high confidence using predominantly negative ion MS(n) data for the fatty acyl components to match to www.lipidmaps.org MS and MS/MS databases; interpreting positive ion data needed to take into account possible adduct ions which may confound the identification of other lipid classes. The observed changes in lipid profiles were consistent with alcohol induced liver injury in humans

Reused Cultivation Water Accumulates Dissolved Organic Carbon and Uniquely Influences Different Marine Microalgae

Reusing growth medium (water supplemented with nutrients) for microalgae cultivation is required for economical and environmentally sustainable production of algae bioproducts (fuels, feed, and food). However, reused medium often contains microbes and dissolved organic matter that may affect algae growth. While the accumulation of dissolved organic carbon (DOC) in reused medium has been demonstrated, it is unclear whether DOC concentrations affect algae growth or subsequent rates of algal DOC release. To address these questions, lab-scale experiments were conducted with three marine microalgae strains, Navicula sp. SFP, Staurosira sp. C323, and Chlorella sp. D046, grown in medium reused up to four times. Navicula sp. and Chlorella sp. grew similarly in reused medium as in fresh medium, while Staurosira sp. became completely inhibited in reused medium. Across the three algae, there was no broad trend between initial DOC concentration in reused medium and algae growth response. Navicula sp. released less DOC overall in reused medium than in fresh medium, but DOC release rates did not decrease proportionally with increased DOC concentrations. Net DOC accumulation was much lower than gross DOC released by Navicula sp. and Staurosira sp., indicating the majority of released DOC was degraded. Additionally, biodegradation experiments with reused media showed no further net decrease in DOC, suggesting the accumulated DOC was recalcitrant to the associated bacteria. Overall, these results suggest that taxa-specific factors may be responsible for algae growth response in reused medium, and that DOC release and accumulation are insensitive to prior cultivation rounds. Choosing an algae strain that is uninhibited by accumulated DOC is therefore critical to ensure successful water reuse in the algae industry

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

Timing of carotid endarterectomy and clinical outcomes.

The timing of carotid endarterectomy (CEA) for symptomatic ipsilateral carotid artery stenosis has evolved in practice over time. Key landmark trials outlined the benefit of performing CEA in the recently symptomatic carotid artery stenosis, defined as revascularisation within 6 months of the index neurological event. Further evidence and sub-analysis demonstrate that performing CEA within 2 weeks of symptoms has the maximal benefit in reducing stroke free survival and is associated with a safe perioperative complication profile. This has translated into guideline recommendations and widespread clinical practice. The case for performing urgent CEA (within 48 hours of index neurological event) over early CEA (within 2 weeks) has been put forward and studied. Data examining perioperative complications for urgent CEA are mostly derived from retrospective single series studies. A moderate balance exists in the literature for the safety and risk of urgent CEA. Although many studies present acceptable perioperative stroke and mortality rates associated with urgent CEA, evidence still exists that the perioperative complications may not be insignificant. This is particularly the case if the presenting neurology is a stroke, rather than a transient ischaemic attack (TIA) or amaurosis fugax. This should be contextualised in the practice of modern aggressive medical therapy with dual antiplatelets and statins, with evidence suggesting a reduction in recurrent ischaemic events prior to surgical intervention. Careful patient selection, presenting neurology and medical therapy is likely to be a key feature in considering urgent CEA versus early CEA