Predictors of complications in acute type B aortic dissection

Objectives: Medical treatment is generally advocated for patients with acute type B aortic dissection without complications. The objective of this retrospective analysis was to determine whether there are any initial findings that can help predict the long-term course of the disease. Methods: Case records of the 130 patients treated for type B aortic dissection between 1988 and 1997 were reviewed; 41 (31%) were operated on in the acute phase (≪14 days), 31 (24%) were operated on in the chronic phase and 58 (45%) were treated medically. Results: Overall acute mortality was 10.8%; 22% for patients operated on in the early phase and 5.6% for medically treated patients. Age (P=0.002), persistent pain (P=0.01) and malperfusion (P=0.001) were significant independent predictors of the need for surgery. Paraplegia/para paresis (P=0.0001), leg ischaemia (P=0.003), pleural effusion (P=0.003), rupture (P=0.0001), shock (P=0.0001), age (P=0.003), cardiac failure (P=0.002) and aortic diameter ≫4.5cm (P=0.002) were significant predictors of poor survival. Age and shock also emerged as independent risk factors. Patients without malperfusion (P=0.0001), pleural effusion (P=0.003), rupture (P=0.0001) and shock (P=0.0001) had a significantly better event-free survival (freedom from repeat surgery and death). The actuarial survival rate for high-risk patients (malperfusion, rupture, shock) was 62% at 1 year and 40% at 5 years; the corresponding values for low-risk patients were 94 and 84%, respectively. Conclusions: Rupture, shock and malperfusion are significant predictors of poor survival in patients with acute type B aortic dissectio

Simultane Behandlung von obliterativen Karotispathologien und koronarer Herzkrankheit: Aktuelles Konzept und Resultate der letzten 5Jahre

Zusammenfassung: Einführung: Die kombinierte Karotisendarteriektomie und aorto-coronare Baypassoperation (C-CABG) weisen ein hohes peri-operatives Risiko auf. Als Alternative wird in letzter Zeit das Stenting der Artera carotis interna propagiert. Das Fehlen von Level I Evidenz hat uns motiviert, die Resultate unserer C-CABG der letzten 5 Jahre zu evaluieren. Methoden und Patienten: Retrospektive Monozenterstudie von 113C-CABG, durchgeführt zwischen Januar 2000 und Dezember 2004. Das mediane Alter der Patienten betrug 65Jahre (22Patienten waren 80Jahre alt oder älter). Die Karotisendarteriektomie wurde vor der aortokoronaren Bypassoperation in derselben Narkose durchgeführt. Resultate: Die 30-Tages-Mortalität war ausschließlich kardial bedingt und betrug 4,4% (5/113). Die neurologischen Komplikationen waren ein Schlaganfall, der innerhalb von 30Tagen vollständig regredient war, und 3TIA (3,5%, 4/113). Schlussfolgerung: C-CABG mit initial durchgeführter Karotisendarteriektomie ist ein sicheres Verfahren mit niedriger neurologischer Komplikationsrate. Der riskante Anteil des kombinierten Eingriffs ist nicht die Karotisendarteriektomie, sondern die aortokoronare Revaskularisation. Demzufolge scheint das Stenting beim kombinierten Eingriff als Alternative nicht gerechtfertigt, solange keine klaren Vorteile hinsichtlich der Früh- und Langzeitresultate gegenüber der alleinigen Karotisendarteriektomie vorliege

Collected world experience about the performance of the snorkel/chimney endovascular technique in the treatment of complex aortic pathologies: The PERICLES registry

Objectives: We sought to analyze the collected worldwide experience with use of snorkel/chimney endovascular aneurysm repair (EVAR) for complex abdominal aneurysm treatment. Background: EVAR has largely replaced open surgery worldwide for anatomically suitable aortic aneurysms. Lack of availability of fenestrated and branched devices has encouraged an alternative strategy utilizing parallel or snorkel/chimney grafts (ch-EVAR). Methods: Clinical and radiographic information was retrospectively reviewed and analyzed on 517 patients treated by ch-EVAR from 2008 from 2014 by prearranged defined and documented protocols. Results: A total of 119 patients in US centers and 398 in European centers were treated during the study period. US centers preferentially used Zenith stent-grafts (54.2%) and European centers Endurant stent-grafts (62.2%) for the main body component. Overall 898 chimney grafts (49.2% balloon expandable, 39.6% self-expanding covered stents, and 11.2% balloon expandable bare metal stents) were placed in 692 renal arteries, 156 superior mesenteric arteries (SMA), and 50 celiac arteries. At a mean follow-up of 17.1 months (range: 1-70 months), primary patency was 94%, with secondary patency of 95.3%. Overall survival of patients in this high-risk cohort for open repair at latest follow-up was 79%. Conclusions: This global experience represents the largest series in the ch-EVAR literature and demonstrates comparable outcomes to those in published reports of branched/fenestrated devices, suggesting the appropriateness of broader applicability and the need for continued careful surveillance. These results support ch-EVAR as a valid off-the-shelf and immediately available alternative in the treatment of complex abdominal EVAR and provide impetus for the standardization of these techniques in the future

RS12. Sustained Late Branch Patency and Low Incidence of Persistent Type Ia Endoleaks Following Snorkel/chimney EVAR Shown in the Updated PERICLES Registry

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Simultane Behandlung von obliterativen Karotispathologien und koronarer Herzkrankheit

Einführung: Die kombinierte Karotisendarteriektomie und aorto-coronare Baypassoperation (C-CABG) weisen ein hohes peri-operatives Risiko auf. Als Alternative wird in letzter Zeit das Stenting der Artera carotis interna propagiert. Das Fehlen von Level I Evidenz hat uns motiviert, die Resultate unserer C-CABG der letzten 5 Jahre zu evaluieren. Methoden und Patienten: Retrospektive Monozenterstudie von 113C-CABG, durchgeführt zwischen Januar 2000 und Dezember 2004. Das mediane Alter der Patienten betrug 65Jahre (22Patienten waren 80Jahre alt oder älter). Die Karotisendarteriektomie wurde vor der aortokoronaren Bypassoperation in derselben Narkose durchgeführt. Resultate: Die 30-Tages-Mortalität war ausschließlich kardial bedingt und betrug 4,4% (5/113). Die neurologischen Komplikationen waren ein Schlaganfall, der innerhalb von 30Tagen vollständig regredient war, und 3TIA (3,5%, 4/113). Schlussfolgerung: C-CABG mit initial durchgeführter Karotisendarteriektomie ist ein sicheres Verfahren mit niedriger neurologischer Komplikationsrate. Der riskante Anteil des kombinierten Eingriffs ist nicht die Karotisendarteriektomie, sondern die aortokoronare Revaskularisation. Demzufolge scheint das Stenting beim kombinierten Eingriff als Alternative nicht gerechtfertigt, solange keine klaren Vorteile hinsichtlich der Früh- und Langzeitresultate gegenüber der alleinigen Karotisendarteriektomie vorliege

Diet and Physical Activity for the Prevention of Noncommunicable Diseases in Low- and Middle-Income Countries: A Systematic Policy Review

Background: Diet-related noncommunicable diseases (NCDs) are increasing rapidly in low-and middle-income countries (LMICs) and constitute a leading cause of mortality. Although a call for global action has been resonating for years, the progress in national policy development in LMICs has not been assessed. This review of strategies to prevent NCDs in LMICs provides a benchmark against which policy response can be tracked over time. Methods and Findings: We reviewed how government policies in LMICs outline actions that address salt consumption, fat consumption, fruit and vegetable intake, or physical activity. A structured content analysis of national nutrition, NCDs, and health policies published between 1 January 2004 and 1 January 2013 by 140 LMIC members of the World Health Organization (WHO) was carried out. We assessed availability of policies in 83% (116/140) of the countries. NCD strategies were found in 47% (54/116) of LMICs reviewed, but only a minority proposed actions to promote healthier diets and physical activity. The coverage of policies that specifically targeted at least one of the risk factors reviewed was lower in Africa, Europe, the Americas, and the Eastern Mediterranean compared to the other two World Health Organization regions, South-East Asia and Western Pacific. Of the countries reviewed, only 12% (14/116) proposed a policy that addressed all four risk factors, and 25% (29/116) addressed only one of the risk factors reviewed. Strategies targeting the private sector were less frequently encountered than strategies targeting the general public or policy makers. Conclusions: This review indicates the disconnection between the burden of NCDs and national policy responses in LMICs. Policy makers urgently need to develop comprehensive and multi-stakeholder policies to improve dietary quality and physical activity

Beliefs about the Minds of Others Influence How We Process Sensory Information

Attending where others gaze is one of the most fundamental mechanisms of social cognition. The present study is the first to examine the impact of the attribution of mind to others on gaze-guided attentional orienting and its ERP correlates. Using a paradigm in which attention was guided to a location by the gaze of a centrally presented face, we manipulated participants' beliefs about the gazer: gaze behavior was believed to result either from operations of a mind or from a machine. In Experiment 1, beliefs were manipulated by cue identity (human or robot), while in Experiment 2, cue identity (robot) remained identical across conditions and beliefs were manipulated solely via instruction, which was irrelevant to the task. ERP results and behavior showed that participants' attention was guided by gaze only when gaze was believed to be controlled by a human. Specifically, the P1 was more enhanced for validly, relative to invalidly, cued targets only when participants believed the gaze behavior was the result of a mind, rather than of a machine. This shows that sensory gain control can be influenced by higher-order (task-irrelevant) beliefs about the observed scene. We propose a new interdisciplinary model of social attention, which integrates ideas from cognitive and social neuroscience, as well as philosophy in order to provide a framework for understanding a crucial aspect of how humans' beliefs about the observed scene influence sensory processing

Modelling the probability of microhabitat formation on trees using cross-sectional data

The rate of TreM formation per unit diameter growth was modelled as a function of tree diameter at breast height (DBH), and the model was calibrated considering cross-sectional observations TreMs on trees of different sizes. The model predicted realistic TreM formation rates at the tree and stand levels in forests dominated by Abies alba and Fagus sylvatica. This approach opens new perspectives to the analysis of forest biodiversity conservation strategies

Forest canopy restoration has indirect effects on litter decomposition and no effect on denitrification

Forest restoration has potential to recover degraded ecosystem functions in disturbed environments. Decomposition and denitrification are two critical functions involved in forest nutrient cycling that are often compromised in degraded ecosystems. As forest canopy structure develops following initial plantings, it may indirectly impact ecosystem functions by altering abiotic conditions. It is likely, however, that there are other abiotic factors that affect decomposition and denitrification that are unrelated to forest canopy structure. Here, we aimed to determine whether forest canopy openness, topography, and soil sand content would affect litter decomposition and denitrification by regulating the microclimate, the herbaceous plant layer, soil chemistry, and soil moisture. Research occurred in restored native temperate rainforest patches in two New Zealand cities. Urban forests are an excellent context for measuring impact of canopy restoration on ecosystem properties such as microclimate due to the extreme swings in city conditions (e.g., urban heat island). Decomposition rates were determined using leaf litter bags and denitrification rates through denitrification enzyme activity assays. We used structural equation modeling to quantify the direct and indirect drivers of these ecosystem functions. Results indicated that decomposition rates were positively related to soil moisture, relative humidity, and herbaceous plant cover. Interestingly, forest canopy openness indirectly affected decomposition through counteracting forces, meaning greater canopy openness in young forests permitted dense herbaceous plant growth which enhanced decomposition, while less canopy openness in older forests enhanced humidity levels which increased decomposition. Denitrification was negatively related to soil pH and positively related to soil moisture, but these abiotic factors were unrelated to the forest canopy. Discovering drivers of ecosystem functions can improve approaches to the restoration of degraded ecosystems, especially in disturbed urban areas. Identifying counteracting effects on ecosystem functions could improve management by focusing restoration actions on specific drivers to elicit desired changes. Some ecosystem processes, like denitrification, are not affected by forest canopy restoration or management, but are instead driven by edaphic and landscape factors

An 8-mm diameter fibre robot positioner for massive spectroscopy surveys

This article has been accepted for publication in Monthly Notices of Royal Astronomical Society © 2015 The Authors. Published by Oxford University Press on behalf of the Royal Astronomical Society. All rights reservedMassive spectroscopic survey are becoming trendy in astrophysics and cosmology, as they can address new fundamental knowledge such as understanding the formation of the Milky Way and probing the nature of the mysterious dark energy. To enable massive spectroscopic surveys, new technology has been developed to place thousands of optical fibres at a given position on a focal plane. This technology needs to be: (1) accurate, with micrometer positional accuracy; (2) fast to minimize overhead; (3) robust to minimize failure; and (4) low cost. In this paper, we present the development, properties, and performance of a new single 8-mm in diameter fibre positioner robot, using two 4-mm DC-brushless gearmotors, that allows us to achieve accuracies up to 0.07 arcsec (5 μm). This device has been developed in the context of the Dark Energy Spectroscopic InstrumentWe acknowledge support from the Spanish MICINNs Consolider-Ingenio 2010 Program me under grant MultiDark CSD2009-00064, HEPHACOS S2009/ESP-1473, and MINECO Centro de Excelencia Severo Ochoa Programme under grant SEV-2012-0249. We also thank the support from a CSIC-AVS contract through MICINN grant AYA2010-21231-C02- 01, and CDTI grant IDC-20101033; and support from the Spanish MINECO research grants AYA2012-31101 and FPA2012-34694. JPK, PH and LM acknowledge support from the ERC advanced grant LIDA and from an SNF Interdisciplinary grant