Comparison of single- and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms

Objective: The aim of this study was to compare outcomes of single or multistage approach during fenestrated-branched endovascular aortic repair (FB-EVAR) of extensive thoracoabdominal aortic aneurysms (TAAAs). Methods: We reviewed the clinical data of consecutive patients treated by FB-EVAR for extent I to III TAAAs in 24 centers (2006-2021). All patients received a single brand manufactured patient-specific or off-the-shelf fenestrated-branched stent grafts. Staging strategies included proximal thoracic aortic repair, minimally invasive segmental artery coil embolization, temporary aneurysm sac perfusion and combinations of these techniques. Endpoints were analyzed for elective repair in patients who had a single- or multistage approach before and after propensity score adjustment for baseline differences, including the composite 30-day/in-hospital mortality and/or permanent paraplegia, major adverse event, patient survival, and freedom from aortic-related mortality. Results: A total of 1947 patients (65% male; mean age, 71 ± 8 years) underwent FB-EVAR of 155 extent I (10%), 729 extent II (46%), and 713 extent III TAAAs (44%). A single-stage approach was used in 939 patients (48%) and a multistage approach in 1008 patients (52%). A multistage approach was more frequently used in patients undergoing elective compared with non-elective repair (55% vs 35%; P < .001). Staging strategies were proximal thoracic aortic repair in 743 patients (74%), temporary aneurysm sac perfusion in 128 (13%), minimally invasive segmental artery coil embolization in 10 (1%), and combinations in 127 (12%). Among patients undergoing elective repair (n = 1597), the composite endpoint of 30-day/in-hospital mortality and/or permanent paraplegia rate occurred in 14% of single-stage and 6% of multistage approach patients (P < .001). After adjustment with a propensity score, multistage approach was associated with lower rates of 30-day/in-hospital mortality and/or permanent paraplegia (odds ratio, 0.466; 95% confidence interval, 0.271-0.801; P = .006) and higher patient survival at 1 year (86.9±1.3% vs 79.6±1.7%) and 3 years (72.7±2.1% vs 64.2±2.3%; adjusted hazard ratio, 0.714; 95% confidence interval, 0.528-0.966; P = .029), compared with a single stage approach. Conclusions: Staging elective FB-EVAR of extent I to III TAAAs was associated with decreased risk of mortality and/or permanent paraplegia at 30 days or within hospital stay, and with higher patient survival at 1 and 3 years

Counter pulses on the field-programmable gate array

Проведено аналіз лічильників відеоімпульсів. Обґрунтовано вибір засобів та методів вимірювання кількості відеоімпульсів за одиницю часу. На базі проведеного аналізу розроблено схеми електричні структурна та принципова. Проведено розрахунок компаратора та стабілізатора напруги. Розроблено алгоритм роботи лічильник на програмованій логічній матриці. Діапазон вимірювання амплітуди вхідного сигналу 5 …20 В, довжина імпульсу не менше 8 нс, мінімальний інтервал між імпульсами 10 мкс, похибка вимірювання 0,01 %, напруга живлення +12 В. Пристрій управляється двома кнопками “Старт/Стоп” та “Скид”.The analysis of video pulse counters is carried out. The choice of means and methods of measuring the number of video pulses per unit time is substantiated. On the basis of the conducted analysis are developed electric schemes of structural and principle. The calculation of the comparator and voltage stabilizer is performed. An algorithm for running a meter on a programmable logic matrix has been developed. The range of measurement of the amplitude of the input signal 5 …20 V, pulse length not less than 8 ns, measurement error of 0.01%, supply voltage +12 V. The device is controlled by two buttons "Start / Stop" and "Reset".Вступ 8 1 Основна частина 10 1.1 Аналіз технічного завдання 10 1.2 Проектування схеми електричної структурної 11 1.3 Обґрунтування вибору типу та структури ПЛМ 12 1.3.1 Компаратор 18 1.3.3 Індикатор 27 1.3.3.1 Контролер HD45780 27 1.3.4 Пристрій для формування затриманих коротких імпульсів 33 1.3.5 Блок підрахунку імпульсів частотою 1 МГц 35 1.3.6 Блок аналізу коду на перевищення роздільної здатності вимірювача періоду 36 1.3.7 Стабілізатори 39 1.4 Проектування друкованого вузла 40 2 Початок роботи з Mathcad 43 3 Безпека життєдіяльності, основи охорони праці 47 3.1 Розрахунок коефіцієнту природнього освітлення 47 3.2 Види іонізуючого випромінювання та їх властивості 50 3.3 Висновки 54 Перелік посилань 55 Додатки 5

XII Міжнародна науково-практична конференція магістрантів та аспірантів. Частина 2

До збірки включено тези доповідей, представлених на ХІІ Міжнародній науково-практичній конференції магістрантів та аспірантів, яка відбулась 17–20 квітня 2018 року

A clinical-in silico study on the effectiveness of multipoint bicathodic and cathodic-anodal pacing in cardiac resynchronization therapy

Up to one-third of patients undergoing cardiac resynchronization therapy (CRT) are nonresponders. Multipoint bicathodic and cathodic-anodal left ventricle (LV) stimulations could overcome this clinical challenge, but their effectiveness remains controversial. Here we evaluate the performance of such stimulations through both in vivo and in silico experiments, the latter based on computer electromechanical modeling. Seven patients, all candidates for CRT, received a quadripolar LV lead. Four stimulations were tested: right ventricular (RVS); conventional single point biventricular (S-BS); multipoint biventricular bicathodic (CC-BS) and multipoint biventricular cathodic-anodal (CA-BS). The following parameters were processed: QRS duration; maximal time derivative of arterial pressure (dPdtmax); systolic arterial pressure (Psys); and stroke volume (SV). Echocardiographic data of each patient were then obtained to create an LV geometric model. Numerical simulations were based on a strongly coupled Bidomain electromechanical coupling model. Considering the in vivo parameters, when comparing S-BS to RVS, there was no significant decrease in SV (from 45 \ub1 11 to 44 \ub1 20 ml) and 6% and 4% increases of dPdtmax and Psys, respectively. Focusing on in silico parameters, with respect to RVS, S-BS exhibited a significant increase of SV, dPdtmax and Psys. Neither the in vivo nor in silico results showed any significant hemodynamic and electrical difference among S-BS, CC-BS and CA-BS configurations. These results show that CC-BS and CA-BS yield a comparable CRT performance, but they do not always yield improvement in terms of hemodynamic parameters with respect to S-BS. The computational results confirmed the in vivo observations, thus providing theoretical support to the clinical experiments