Pan-aortic hybrid treatment of mega-aorta syndrome

Hybrid procedures combining traditional open and newer endovascular techniques are increasingly used to treat complex aortic disease. We present a novel approach for total aortic replacement, including hybrid repair of the arch and thoracoabdominal aorta, in a patient with “mega-aorta syndrome.” A two-stage approach using a valve-sparing aortic root replacement, total arch replacement (stage I elephant trunk), and left carotid-axillary bypass was used to treat the root, proximal-mid arch, and left subclavian aneurysmal pathology. This was followed by a hybrid distal arch/Extent II thoracoabdominal aneurysm repair 3 months later. After 15 months follow-up, the patient remains asymptomatic with an intact repair, no endoleak, and normal ventricular and aortic valve function. This case demonstrates a novel “pan-aortic” hybrid approach for repair of extensive thoracic aortic disease

Safe efficacy of three strychnine alkaloid bait concentrations for hand-baiting control of plains pocket gophers

In November 1990, field efficacy studies using milo baits formulated with 0.35%, 0.75%, or 1.30% strychnine alkaloid were compared to a placebo (0.0% strychnine) for controlling plains pocket gophers (Geomys bursarius) near Pleasanton, Texas. These data were required by the US Environmental Protection Agency (EPA) as partial fulfillment for the maintenance of the rodenticide registrations of the US Department of Agriculture. Each of four treatment units (TUs) within a block (2) was randomly assigned one of the four baits. Within each TU, 15 gophers were captured (balanced roughly for gender) and instrumented with radio transmitters. Following a pretreatment acclimation averaging 4.1 days, bait (4 g) was placed in active pocket gopher burrows by hand-baiting. Pocket gopher mortality was measured by monitoring the fate of radio-equipped pocket gophers (n=123) both pretreatment and post-treatment. Lack of gopher movement on two consecutive days indicated death, and the carcass was retrieved. Strychnine mortality was based on chemical analyses of carcasses, and it occurred in 0.0%, 66.7%, 96.3%, and 89.7% of gophers from the 0.0%, 0.35%, 0.75% and 1.30% TUs, respectively. Natural mortality was 7% on the placebo TUs. All three strychnine treatments provided significantly increased mortality over the placebo (P\u3c0.0001) using Fisher\u27s exact test for paired comparisons. A difference in gopher mortality occurred between the 0.32% and 0.77% strychnine treatments (P=0.003), but not between the other comparisons (0.32% vs 1.30%, P=0.18 and 0.77% vs. 1.30%, P=0.24). Gopher carcasses recovered post-treatment indicated 68 of 86 (79.1%) had strychnine alkaloid residues. The non-target strychnine hazard (using least squares means) by treatment were 4.85 ppm (0.35%), 8.04 ppm (0.75%), and 9.47 ppm (1.30%). Carcass residue differences were not detected among strychnine treatments (F=2.48, df=2,3, P=0.23). Fortunately, non-target exposure was greatly decreased because all carcasses with strychnine residues were recovered underground at a mean depth of 0.51 m (SE=0.027, range 0.15–1.17 m). Placebo-baited TUs had 27 survivors and 2 deaths from unknown causes. None had detectable strychnine levels. No non-target mortalities were documented during carcass searches and radio-tracking activities

DePaul University Centennial Essays and Images

A collection of eight essays honoring DePaul University’s centennial. The book has three parts: Mission and Governance; Campus Culture and Student Life; and Making the Modern University.https://via.library.depaul.edu/vincentian_ebooks/1020/thumbnail.jp

Intrathoracic subclavian artery aneurysm repair in the thoracic endovascular aortic repair era

ObjectiveIntrathoracic subclavian artery aneurysms (SAAs) are rare aneurysms that often occur in association with congenital aortic arch anomalies and/or concomitant thoracic aortic pathology. The advent of thoracic endovascular aortic repair (TEVAR) methods may complement or replace conventional open SAA repair. Herein, we describe our experience with SAA repair in the TEVAR era.MethodsA retrospective review was performed of all intrathoracic SAAs repaired at a single institution since United States Food and Drug Administration approval of TEVAR in 2005.ResultsNineteen patients underwent 20 operations to repair 22 (13 native, nine aberrant) SAAs with an intrathoracic component. Mean SAA diameter was 3.1 cm (range, 1.6-6.0 cm). Mean patient age was 57 years (range, 24-80 years). Twenty-one percent (n = 4) of patients had a connective tissue disorder (two Loeys-Dietz, two Marfan). Thirty-six percent (n = 8) of SAAs were repaired by open techniques and 64% (n = 14) via a TEVAR-based approach. All TEVAR cases required proximal landing zone in the aortic arch (zone 0-2), and revascularization of at least one arch vessel was required in 83% (10/12) of patients. Concomitant repair of associated aortic pathology was performed in 50% (n = 10) of operations. Thirty-day/in-hospital rates of death, stroke, and permanent paraplegia/paraparesis were 5% (n = 1), 5% (n = 1), and 0%, respectively. Over mean (standard deviation) follow-up of 24 (21) months, 16% (n = 3) of patients required reintervention for subclavian artery bypass graft revision (n = 2) or type II endoleak (n = 1).ConclusionsThis is the largest single-institution series to date of TEVAR for SAA repair. Modern endovascular techniques expand SAA repair options with excellent results. The majority of SAAs and nearly all aberrant SAAs (Kommerell's diverticulum) can now be repaired using a TEVAR-based approach without the need for sternotomy or thoracotomy

Risk factors for 1-year mortality after thoracic endovascular aortic repair

ObjectiveThoracic endovascular aortic repair, although physiologically well tolerated, may fail to confer significant survival benefit in some high-risk patients. In an effort to identify patients most likely to benefit from intervention, the present study sought to determine the risk factors for 1-year mortality after thoracic endovascular aortic repair.MethodsA retrospective review was performed on prospectively collected data from all patients undergoing thoracic endovascular aortic repair from 2002 to 2010 at a single institution. Univariate analysis and multivariate Cox proportional hazards regression analysis were used to identify risk factors associated with mortality within 1 year after thoracic endovascular aortic repair.ResultsDuring the study period, 282 patients underwent at least 1 thoracic endovascular aortic repair; index procedures included descending aortic repair (n = 189), hybrid arch repair (n = 55), and hybrid thoracoabdominal repair (n = 38). The 30-day/in-hospital mortality was 7.4% (n = 21) and the overall 1-year mortality was 19% (n = 54). Cardiopulmonary pathologies were the most common cause of nonperioperative 1-year mortality (22%, n = 12). Multivariate modeling demonstrated 3 variables independently associated with 1-year mortality: age older than 75 years (hazard ratio, 2.26; P = .005), aortic diameter greater than 6.5 cm (hazard ratio, 2.20; P = .007), and American Society of Anesthesiologists class 4 (hazard ratio, 1.85; P = .049). A baseline creatinine greater than 1.5 mg/dL (hazard ratio, 1.79; P = .05) and congestive heart failure (hazard ratio, 1.87; P = .08) were also retained in the final model. These 5 variables explained a large proportion of the risk of 1-year mortality (C statistic = 0.74).ConclusionsAge older than 75 years, aortic diameter greater than 6.5 cm, and American Society of Anesthesiologists class 4 are independently associated with 1-year mortality after thoracic endovascular aortic repair. These clinical characteristics may help risk-stratify patients undergoing thoracic endovascular aortic repair and identify those unlikely to derive a long-term survival benefit from the procedure

Demonstrating the potential of low-cost GPS units for the remote measurement of tides and water levels using interferometric reflectometry

A low-cost [$30 (U.S. dollars)] consumer grade GPS receiver with a sideways-mounted antenna has been applied to measure tidal water levels at a mesotidal coastal site using an interferometric reflectometry approach. The proof-of-concept system was installed approximately 16 m above mean sea level in close proximity to a conventional bubbler tide gauge that provided validation data. The received signal-to-noise ratios (SNR) for the satellites in view were recorded for several months during two successive years and the observed frequencies of the interferometric oscillations used to calculate the difference in elevation between the receiver and the water surface. Comparisons with concurrent and historic in situ tide gauge data at the site initially helped to identify a calibration issue with the in situ gauge. The GPS-based measurements were shown to be in excellent agreement with the corrected in situ gauge, exhibiting a root-mean-square difference of 5.7 cm over a tidal range exceeding 3 m at spring tides and a daily averaged RMS of 1.7 cm. The SNR data from the low-cost GPS receivers are shown to provide significantly higher-quality data for this purpose compared with high-end geodetic grade receivers at similar sites. This low-cost, widely available technology has the potential to be applied globally for monitoring water levels in a wide variety of circumstances and applications that would otherwise be cost or situation prohibitive. It could also be applied as an independent cross check and quality control measure for conventional water-level gauges

The beginning of time? Evidence for catastrophic drought in Baringo in the early nineteenth century

New developments in the collection of palaeo-data over the past two decades have transformed our understanding of climate and environmental history in eastern Africa. This article utilises instrumental and proxy evidence of historical lake-level fluctuations from Baringo and Bogoria, along with other Rift Valley lakes, to document the timing and magnitude of hydroclimate variability at decadal to century time scales since 1750. These data allow us to construct a record of past climate variation not only for the Baringo basin proper, but also across a sizable portion of central and northern Kenya. This record is then set alongside historical evidence, from oral histories gathered amongst the peoples of northern Kenya and the Rift Valley and from contemporary observations recorded by travellers through the region, to offer a reinterpretation of human activity and its relationship to environmental history in the nineteenth century. The results reveal strong evidence of a catastrophic drought in the early nineteenth century, the effects of which radically alters our historical understanding of the character of settlement, mobility and identity within the Baringo–Bogoria basin

Stroke awareness and knowledge in an Urban New Zealand population

© 2015 National Stroke Association. Background Stroke is the third most common cause of death and a major cause of chronic disability in New Zealand. Linked to risk factors that develop across the life-course, stroke is considered to be largely preventable. This study assessed the awareness of stroke risk, symptoMS detection, and prevention behaviors in an urban New Zealand population. Methods Demographics, stroke risk factors awareness, symptoMS responsiveness, and prevention behaviors were evaluated using a structured oral questionnaire. Binomial logistic regression analyses were used to identify predictors of stroke literacy. Results Although personal experience of stroke increased awareness of symptoms and their likeliness to indicate the need for urgent medical attention, only 42.7% of the respondents (n = 850) identified stroke as involving both blood and the brain. Educational attainment at or above a trade certificate, apprenticeship, or diploma increased the awareness of stroke symptoms compared with those with no formal educational attainment. Pacific Island respondents were less likely than New Zealand Europeans to identify a number of stroke risk factors. Ma¯ori, Pacific Island, and Asian respondents were less likely to identify symptoms of stroke and indicate the need for urgent medical attention. Conclusions The variability in stroke awareness and knowledge may suggest the need to enhance stroke-related health literacy that facilitates understanding of risk and of factors that reduce morbidity and mortality after stroke in people of Ma¯ori and Pacific Island descent and in those with lower educational attainment or socioeconomic status. It is therefore important that stroke awareness campaigns include tailored components for target audiences

Lack of Serologic Evidence of Neospora caninum in Humans, England

Retrospective testing of 3,232 serum samples from the general population and 518 serum samples from a high-risk group showed no evidence of human exposure to Neospora caninum in England. Results were obtained by using immunofluorescence antibody testing and ELISA to analyze frequency distribution