Acute and contained rupture of the descending thoracic aorta: Treatment with endovascular stent grafts

AbstractPurpose: The purpose of this study was to evaluate feasibility and safety of endovascular stent grafting for the treatment of patients with rupture of the descending thoracic aorta. Methods: Thirteen patients with rupture of the descending thoracic aorta were treated with endovascular stent grafting. Six patients were treated on the day of diagnosis because their vital signs were unstable, and the other seven patients were treated electively. Five patients had infection or potential infection, and the other eight patients did not. Expanded polytetrafluoroethylene-covered or polyester-covered Z stents were used in all patients. Results: Stent grafts were successfully placed in all patients. No endoleaks were observed at the end of the procedure. However, rebleeding was observed within 2 weeks of the procedure in two patients with infection. Six patients (46%) died within 5 months of the procedure (mean survival period, 61 ± 60 days). All five patients with infection (100%) died, and only one of eight patients without infection (13%) died (P <.01). The remaining seven patients are alive during the mean follow-up period of 21 months (overall survival rate, 54%), although additional surgical interventions, including surgical conversion in one case and upper extremity extraanatomic bypass in the other, were necessary in two of these patients. Conclusion: Endovascular stent grafting may be a safe and feasible method for the treatment of rupture of the descending thoracic aorta in selected patients without infection. However, its usefulness in terms of long-term prognosis appears to be extremely limited, especially in patients with infection. (J Vasc Surg 2003;37:100-5.

Specific inhibition of p38 mitogen-activated protein kinase with FR167653 attenuates vascular proliferation in monocrotaline-induced pulmonary hypertension in rats

AbstractObjectivesp38 mitogen-activated protein kinase is associated with many clinical entities characterized by inflammation. We postulated that inhibition of p38 mitogen-activated protein kinase with FR167653 attenuates inflammation and the development of pulmonary hypertension in monocrotaline-treated rats.MethodsRats were divided into 4 groups: (1) the control group (daily 0.9% saline), (2) the FR group (daily FR167653, 2 mg · kg−1 · d−1), (3) the MCT group (daily 0.9% saline the day after a single monocrotaline dose, 60 mg/kg), and (4) the MCT+FR group (daily FR167653, 2 mg · kg−1 · d−1, the day after a single MCT dose). Body weight, pulmonary artery pressure, and morphometric changes of the pulmonary artery with the histopathologic method were observed weekly for 4 weeks. Also, p38 mitogen-activated protein kinase activity and inflammatory cytokine expression in the lung were measured.ResultsFour weeks after monocrotaline administration, mean pulmonary artery pressure in the MCT+FR group was lower than in the MCT group (MCT+FR vs MCT: 24.7 ± 1.9 vs 36.5 ± 2.1 mm Hg; P < .05). In morphometric analysis the percentage of medial wall thickness and the percentage of muscularization in the MCT+FR group were reduced compared with those in the MCT group after 4 weeks (P < .05); however, the number of macrophages was not significantly different. p38 mitogen-activated protein kinase activity was significantly attenuated in the MCT+FR group compared with in the MCT group (7.2 ± 0.52 vs 2.1 ± 0.23 fold-increase, P < .05, at 1 week). Although mRNA levels of tumor necrosis factor α and interleukin 1β were reduced in the MCT+FR group compared with in the MCT group (tumor necrosis factor α: 1.18 ± 0.36 vs 3.05 ± 1.12 fold-increase, P < .05, at 2 weeks; interleukin 1β: 2.2 ± 0.34 vs 4.4 ± 1.09 fold-increase, P < .05, at 1 week), FR167653 did not suppress increased monocyte chemotactic protein 1 mRNA expression induced by monocrotaline (3.2 ± 0.62 vs 3.1 ± 0.42 fold-increase, at 1 week).ConclusionFR167653 significantly attenuates the expression of inflammatory cytokines, ultimately preventing the progression of pulmonary hypertension. These results suggest that p38 mitogen-activated protein kinase might play a central role in the molecular events that underlie the development and progression of pulmonary hypertension

Mineralogy and crystallography of some Itokawa particles returned by the Hayabusa asteroidal sample return mission

We studied seven Itokawa particles provided by the Japan Aerospace Exploration Agency (JAXA) as first International Announcement of Opportunity (AO) study mainly using electron and synchrotron radiation X-ray beam techniques. All the analyzed particles were collected from the first-touchdown site and composed of olivine and plagioclase with traces of Ca phosphate and chromite, and do not contain pyroxenes. Optical microscopy of these particles shows minor undulatory extinction of olivine and plagioclase, suggesting minor shock metamorphism (shock stage: S2). The electron microprobe analysis shows that olivine is Fo(70-73) and plagioclase is An(13-10)Or(5-7). The synchrotron radiation X-ray diffraction (SR-XRD) analysis of olivine crystals gives cell dimensions of a = 4.708 to 4.779 angstrom, b = 10.271 to 10.289 angstrom, c = 6.017 to 6.024 angstrom, corresponding to the Fo content of Fo(similar to 70) by Vegard's law. This composition matches the result obtained by the electron microprobe analysis. The olivine compositions of the analyzed particles are consistent with those of LL chondrites. The cell dimensions of two plagioclase crystals (a = 8.180 to 8.194 angstrom, b = 12.53 to 12.893 angstrom, c = 7.125 to 7.23 angstrom, a = 92.6 degrees to 93.00 degrees, beta = 116.36 degrees to 116.75 degrees, gamma = 90.03 degrees to 90.17 degrees) indicate that their equilibration temperatures are 800 degrees C +/- 10 degrees C. This temperature is near the peak metamorphic temperature recorded by equilibrated ordinary chondrites. The size of plagioclase crystals and the homogeneity of olivine compositions indicate that their petrologic type is &gt;= 5. We also analyzed plagioclase by SR iron X-ray absorption near-edge structure (SR-XANES) and found that its Fe3+/(Fe2+ + Fe3+) ratio is approximately 0.5. Such high Fe3+ abundance indicates the formation under a relatively oxidizing environment. Thus, all these analyses have reconfirmed that the Itokawa particles returned by the Hayabusa spacecraft are very weakly shocked equilibrated LL chondrites, which matches the results of the preliminary examination team

On the origin and evolution of the asteroid Ryugu: A comprehensive geochemical perspective

Presented here are the observations and interpretations from a comprehensive analysis of 16 representative particles returned from the C-type asteroid Ryugu by the Hayabusa2 mission. On average Ryugu particles consist of 50% phyllosilicate matrix, 41% porosity and 9% minor phases, including organic matter. The abundances of 70 elements from the particles are in close agreement with those of CI chondrites. Bulk Ryugu particles show higher δ18O, Δ17O, and ε54Cr values than CI chondrites. As such, Ryugu sampled the most primitive and least-thermally processed protosolar nebula reservoirs. Such a finding is consistent with multi-scale H-C-N isotopic compositions that are compatible with an origin for Ryugu organic matter within both the protosolar nebula and the interstellar medium. The analytical data obtained here, suggests that complex soluble organic matter formed during aqueous alteration on the Ryugu progenitor planetesimal (several 10’s of km), <2.6 Myr after CAI formation. Subsequently, the Ryugu progenitor planetesimal was fragmented and evolved into the current asteroid Ryugu through sublimation

Risk Factors for Bleeding After Endoscopic Submucosal Dissection for Gastric Cancer in Elderly Patients Older Than 80 Years in Japan.

Introduction:As the aging of people in a society advances, the number of elderly patients older than 80 years in Japan with gastric cancer continues to increase. Although delayed ulcer bleeding is a major adverse event after endoscopic submucosal dissection (ESD), little is known about characteristic risk factors for bleeding in elderly patients undergoing ESD. This study aimed to evaluate risk factors for delayed bleeding after ESD for gastric cancer in elderly patients older than 80 years.Methods:We retrospectively evaluated the incidence of delayed bleeding after ESD in 10,320 patients with early-stage gastric cancer resected by ESD between November 2013 and January 2016 at 33 Japanese institutions and investigated risk factors for delayed bleeding in elderly patients older than 80 years.Results:The incidence of delayed bleeding in elderly patients older than 80 years was 5.7% (95% confidence interval [CI]: 4.6%-6.9%, 95/1,675), which was significantly higher than that in nonelderly (older than 20 years and younger than 80 years) patients (4.5%, 4.1%-5.0%, 393/8,645). Predictive factors for ESD-associated bleeding differed between nonelderly and elderly patients. On multivariate analysis of predictive factors at the time of treatment, risk factors in elderly patients were hemodialysis (odds ratio: 4.591, 95% CI: 2.056-10.248, P < 0.001) and warfarin use (odds ratio: 4.783, 95% CI: 1.689-13.540, P = 0.003).Discussion:This multicenter study found that the incidence of delayed bleeding after ESD in Japanese patients older than 80 years was high, especially in patients receiving hemodialysis and taking warfarin. Management of ESD to prevent delayed bleeding requires particular care in patients older than 80 years

A pristine record of outer Solar System materials from asteroid Ryugu’s returned sample

Volatile and organic-rich C-type asteroids may have been one of the main sources of Earth’s water. Our best insight into their chemistry is currently provided by carbonaceous chondritic meteorites, but the meteorite record is biased: only the strongest types survive atmospheric entry and are then modified by interaction with the terrestrial environment. Here we present the results of a detailed bulk and microanalytical study of pristine Ryugu particles, brought to Earth by the Hayabusa2 spacecraft. Ryugu particles display a close compositional match with the chemically unfractionated, but aqueously altered, CI (Ivuna-type) chondrites, which are widely used as a proxy for the bulk Solar System composition. The sample shows an intricate spatial relationship between aliphatic-rich organics and phyllosilicates and indicates maximum temperatures of ~30 °C during aqueous alteration. We find that heavy hydrogen and nitrogen abundances are consistent with an outer Solar System origin. Ryugu particles are the most uncontaminated and unfractionated extraterrestrial materials studied so far, and provide the best available match to the bulk Solar System composition