228 research outputs found

    Endovascular Repair of Thoracoabdominal Aortic Aneurysms

    Get PDF

    Comparing marine survival among Chinook and coho salmon and steelhead trout in the Salish Sea

    Get PDF
    Recent work on marine survival in Chinook and coho salmon and steelhead trout has shown a decline in marine survival in the Salish Sea that was not evident in other regions. For Chinook, the decline was not explained well by oceanographic patterns, and for coho, regional-scale patterns were suggested as important in understanding survival. Recent work on the development of indicators of Puget Sound steelhead survival has shown that predator abundance and patterns in hatchery releases, as well as oceanographic conditions are informative in predicting marine survival. While the three species of focus for the Salish Sea Marine Survival Project have different life-histories, and are therefore subjected to variable pressures at multiple scales, this current analysis aims to answer three questions: 1.) Are there similarities in survival trends among the three species? 2.) Do regional patterns in survival emerge when survival trends are evaluated concurrently across the three species? 3.) Does release strategy (yearling or subyearling) confer a survival advantage, and if so, is this consistent across all species? To evaluate survival time series, we used multivariate time series analysis with multiple groupings (species, spatial, and release strategy) to identify commonalities among species. Observed commonalities will aid in the development of indicators of marine survival for coho and Chinook by focusing efforts on appropriate spatial or temporal attributes. A hypothesis-driven approach similar to that employed for the development of indicators for steelhead survival will be used to relate coho and Chinook to environmental, biological, and anthropogenic factors influencing survival

    Evaluation of a new imaging software for aortic endograft planning

    Get PDF
    Objective: The aim of this study was to evaluate a new 3D Workstation workflow (EVAR Assist, Advantage Windows, GE Healthcare, Chalfont, UK) (EA-AW) designed to simplify complex EVAR planning. Patients and methods: All pre-operative computed tomography (CT) scans of patients who underwent repair at our institution of a complex aortic aneurysm using fenestrated endovascular repair (f-EVAR) between January and September 2014, were reviewed. For each patient, imaging analysis (12 measures: aortic diameters and length and "clock position" of visceral artery) was performed on two different workstations: Aquarius (TeraRecon, San Mateo, CA, USA) and EA-AW. According to a standardized protocol, three endovascular surgeons experienced in aortic endograft planning, performed image analyses and data collection independently. We analyzed an internal assessment between observers (on the Aquarius 3DWS) and an external assessment comparing these results with the planning center (PC) data used to custom the fenestrated endografts of the patients enrolled in this study. Finally, we compared both 3DWS data to determine the accuracy and the reproducibility. A p-value < .05 was considered as statistically significant. Complete agreement between operators was defined as 1.0. Results: Intra and inter observer variability (interclass correlation coefficients - ICC: 0.81- .091) was very low and confirmed the reliability of our planners. The ICC comparison between EA-AW and Aquarius was excellent (> 0.8 for both), thus confirming the reproducibility and reliability of the new EA-AW application. Aortic and iliac necks diameters and lengths were similarly reported with both workstations. In our study, the mean difference in distance and orientation evaluation of target vessels evaluated by the two workstations was marginal and has no impact on clinical practice in term of device manufacturing. Conclusions: We showed that complex EVAR planning can be performed with this new dedicated 3D workstation workflow with a good reproducibility

    Reconstructing historical patterns of primary production in Puget Sound using growth increment data from shells of long-lived geoducks (Panopea generosa)

    Get PDF
    Bottom-up hypotheses predict that changes in primary production affect marine survival of species like Pacific salmon. Long term records of primary production would provide important data to test these predictions. However, direct observations of primary production (in situ fluorometers, water chemistry, and satellite observations of color back-scatter) have relatively short time series (\u3c 30 years). We investigated whether growth increments of geoduck clams (Panopea generosa) are correlated with primary production in different sub-basins of greater Puget Sound. Geoduck are long-lived (older specimens live \u3e100 years), widely distributed throughout the Salish Sea, and deposit annual growth rings in their shells. Shell samples from aged geoducks were by the Washington Department of Fish and Wildlife in four sub-basins within greater Puget Sound (Strait of Jan de Fuca, Southern Strait of Georgia, South Puget Sound, and Central Basin). Geoduck shells from Saratoga passage were provided by the Tulalip Tribe. Using growth indices, the known correlation of growth indices with sea surface temperature and other long-term measurements, and existing basin-level records of temperature and primary production, we modeled historical patterns of primary production in different regions of greater Puget Sound. Analyses show that the relationship between geoduck growth, temperature, and primary production varies between sub-basins, and stable isotope analysis suggests that geoducks may be more than just primary consumers. These issues make reconstruction of a historical record of primary production from growth increments challenging. Nevertheless, analyses suggest that residual growth (after accounting for temperature variation) can explain variation in annual marine survival of local coho and chinook salmon stocks. This indicates the method has promise for retrospective hypothesis testing

    Lower Rate of Restenosis and Reinterventions With Covered vs Bare Metal Stents Following Innominate Artery Stenting

    Get PDF
    PURPOSE: To determine any difference between bare metal stents (BMS) and balloon-expandable covered stents in the treatment of innominate artery atheromatous lesions. MATERIALS AND METHODS: A multicenter retrospective study involving 13 university hospitals in France collected 93 patients (mean age 63.2±11.1 years; 57 men) treated over a 10-year period. All patients had systolic blood pressure asymmetry >15 mm Hg and were either asymptomatic (39, 42%) or had carotid (20, 22%), vertebrobasilar (24, 26%), and/or brachial (20, 22%) symptoms. Innominate artery stenosis ranged from 50% to 70% in 4 (4%) symptomatic cases and between 70% and 90% in 52 (56%) cases; 28 (30%) lesions were preocclusive and 8 (9%) were occluded. One (1%) severely symptomatic patient had a <50% stenosis. Demographic characteristics, operative indications, and procedure details were compared between the covered (36, 39%) and BMS (57, 61%) groups. Multivariate analysis was performed to determine relative risks of restenosis and reinterventions [reported with 95% confidence intervals (CI)]. RESULTS: The endovascular procedures were performed mainly via retrograde carotid access (75, 81%). Perioperative strokes occurred in 4 (4.3%) patients. During the mean 34.5±31.2-month follow-up, 30 (32%) restenoses were detected and 13 (20%) reinterventions were performed. Relative risks were 6.9 (95% CI 2.2 to 22.2, p=0.001) for restenosis and 14.6 (95% CI 1.8 to 120.8, p=0.004) for reinterventions between BMS and covered stents. The severity of the treated lesions had no influence on the results. CONCLUSION: Patients treated with BMS for innominate artery stenosis have more frequent restenoses and reinterventions than patients treated with covered stents

    On the Unification of Process Semantics: Logical Semantics

    Get PDF
    We continue with the task of obtaining a unifying view of process semantics by considering in this case the logical characterization of the semantics. We start by considering the classic linear time-branching time spectrum developed by R.J. van Glabbeek. He provided a logical characterization of most of the semantics in his spectrum but, without following a unique pattern. In this paper, we present a uniform logical characterization of all the semantics in the enlarged spectrum. The common structure of the formulas that constitute all the corresponding logics gives us a much clearer picture of the spectrum, clarifying the relations between the different semantics, and allows us to develop generic proofs of some general properties of the semantics.Comment: In Proceedings SOS 2011, arXiv:1108.279

    Custom Made Candy Plug for Distal False Lumen Occlusion in Aortic Dissection: International Experience

    Get PDF
    Objective: To evaluate early and midterm outcomes of the Candy Plug (CP) technique for distal false lumen (FL) occlusion in thoracic endovascular aortic repair for aortic dissection (AD) in a more real world cohort of patients from an international multicentre registry. Methods: A multicentre retrospective study was conducted of all consecutive patients from the contributing centres with subacute and chronic AD treated with the CP technique from October 2013 to April 2020 at 18 centres. Results: A custom made CP was used in 155 patients (92 males, mean age 62 ± 11 years). Fourteen (9%) presented with ruptured false lumen aneurysms. Technical success was achieved in all patients (100%). Clinical success was achieved in 138 patients (89%). The median hospital stay was 7 days (1 – 77). The 30 day mortality rate was 3% (n = 5). Stroke occurred in four patients (3%). Spinal cord ischaemia occurred in three patients (2%). The 30 day computed tomography angiogram (CTA) confirmed successful CP placement at the intended level in all patients. Early complete FL occlusion was achieved in 120 patients (77%). Early (30 day) CP related re-intervention was required in four patients (3%). The early (30 day) stent graft related re-intervention rate was 8% (n = 12). Follow up CTA was available in 142 patients (92%), with a median follow up of 23 months (6 – 87). Aneurysmal regression was achieved in 68 of 142 patients (47%); the aneurysm diameter remained stable in 69 of 142 patients (49%) and increased in five of 142 patients (4%). A higher rate of early FL occlusion was detected in the largest volume centre patients (50 [88%] vs. 70 [71%] from other centres; p = .019). No other differences in outcome were identified regarding volume of cases or learning curve. Conclusion: This international CP technique experience confirmed its feasibility and low mortality and morbidity rates. Aortic remodelling and false lumen thrombosis rates were high and support the concept of distal FL occlusion in AD using the CP technique
    • …
    corecore