Below-the-knee endovascular revascularizations – the clinic’s experience

Scopul lucrării. Intervenția endovasculară infrageniculată (BTK) este o alternativă atrăgătoare, cu riscuri mai mici de mortalitate perioperatorie sau de complicații la intervenția chirurgicală deschisă. Angioplastia transluminală percutanată cu sau fără stentare a devenit o metodă recunoscută, fiind din ce în ce mai utilizată în tratamentul bolii ocluzive arteriale. Ne-am propus să determinăm rezultatele timpurii ale pacienților cu ischemie cronică care amenință membrele (CLTI) cu leziuni BTK. Materiale și metode. Am efectuat un număr de 194 de proceduri endovasculare de la 1 ianuarie până la 31 decembrie 2022, dintre care 18 cazuri au fost doar la nivel tibio-peronier și 44 au fost combinate tibio-peronier și femuro-popliteu. Pacienții cu proceduri BTK au fost încadrați în clasele 4 până la 6 conform scalei Rutherford pentru boala arterială periferică (PAD). Permeabilitatea primară, permeabilitatea primară asistată sau, în unele cazuri, permeabilitatea secundară a fost evaluată la 1 lună și 6 luni prin imagistică Doppler. Rezultate. Abordarea endovasculară este de preferat la un anumit subgrup de pacienți cu leziuni BTK extinse. Amputația majoră a fost evitată într-un număr semnificativ de cazuri. Am găsit o corelație între diabet sau boala cronică de rinichi și un risc crescut de PAD avansată. Am evaluat comorbiditățile pacientului, tipul de leziune în relație cu permeabilitatea post-procedură. Nu au existat cazuri de complicații sistemice sau deces în perioada de urmărire a pacienților. Concluzii. Tratamentul endovascular al leziunilor BTK este un tratament eficient și sigur la pacienții care se confruntă cu CLTI, oferă o prezervare ridicată a membrelor și rate scăzute de complicații. Descoperirile noastre susțin tratamentul endovascular ca opțiune primară pentru pacienții care se confruntă cu CLTI din cauza bolii ocluzive BTK.Aim of study. Endovascular below-the-knee (BTK) intervention is an appealing alternative with lower risks of perioperative mortality or complications to open surgery. Percutaneous transluminal angioplasty with or without stenting has become a recognized method, being increasingly used in the treatment of arterial occlusive disease. We aimed to determine early results of chronic limb threatening ischemia (CLTI) patients with BTK lesions. Materials and methods. We performed a number of 194 endovascular procedures from the 1st of January, until the 31st of December, 2022, of which 18 cases were only at the tibial-peroneal level and 44 were tibial- peroneal and femoral-popliteal combined. The patients with BTK procedures were class 4 to 6 according to Rutherford’s scale for peripheral arterial disease (PAD). Primary patency, primary-assisted patency or in some cases secondary patency was assessed at 1 month and 6 months by Duplex ultrasound imaging. Results. The endovascular approach is preferable in a certain subgroup of patients with extended BTK lesions. Major amputation was avoided in a significant number of cases. We found a correlation between diabetes or chronic kidney disease and an increased risk of advanced PAD. We assessed the patient’s comorbidities, type of lesion and patency outcome. There were no cases of systemic complications or death during the follow-up period. Conclusions. Endovascular treatment of BTK lesions is an effective and safe treatment in patients experiencing CLTI, providing high limb preservation and low complication rates. The findings support endovascular treatment as a primary option for patients experiencing CLTI due to BTK occlusive disease

Hybrid revascularizations in peripheral arterial disease. Indication, techniques, results

Scopul lucrării. Pe parcursul ultimului deceniu, tratamentul combinat (hibrid) care constă în tehnici chirurgicale endovasculare și deschise simultane sau succesive pe același segment vascular pare a fi cel mai bun tratament dacă se dorește obținerea unui flux adecvat. Obiectivul principal a fost evaluarea indicației, fezabilității și eficienței tehnicilor de revascularizare hibridă utilizate pentru pacienții cu boală arterială ocluzivă multi-nivel (MAOD). Materiale și metode. Acesta a fost un studiu observațional, nerandomizat. Tipul de tehnică de revascularizare utilizată a fost aleasă în funcție de localizarea și morfologia leziunilor arteriale, stadiul bolii, comorbiditățile, factorii de risc și echipamentul tehnic necesar. Rezultate. Majoritatea leziunilor au fost localizate la nivelul arterelor femurale și iliace. Pacienții au beneficiat de proceduri hibride inițiale: simultane și consecutive: clasice urmate de endovasculare (CE) sau endovasculare urmate de clasice (EC). Permeabilitatea medie primară pentru EC a fost semnificativ mai mare decât pentru CE. Tehnica hibridă simultană are câteva avantaje: că nu există întârziere în obținerea revascularizării complete a membrului ischemic, spitalizarea și minimizarea ratei complicațiilor prin utilizarea locului de puncție ca loc pentru anastomoza proximală. Concluzii. Implementarea tehnicilor hibride în practica curentă de chirurgie vasculară și posibilitatea realizării acestora în sălile de operații hibride oferă opțiuni de tratament pacienților cu risc operator ridicat. Succesul tehnic și rezultatele pe termen scurt și mediu ale ratelor de permeabilitate primară și de salvare a membrelor pentru tehnicile hibride sunt aceleași sau mai bune decât procedurile convenționale endovasculare și chirurgicale deschise.Aim of study. Over the course of the last decade, the combined treatment (hybrid) which consists of simultaneous or successive endovascular and open surgical techniques on the same vascular segment appears to be the best treatment if an adequate inflow and outflow are to be obtained. The main objective was to evaluate the indication, feasibility and efficiency of the hybrid revascularization techniques used for patients with multilevel arterial occlusive disease (MAOD). Materials and methods. This was an observational, non-randomized study. The type of revascularization technique used was chosen according to the localization and morphology of the arterial lesions, disease stage, comorbidities, risk factors and necessary technical equipment. Results. Most of the lesions were located at the level of the femoral and iliac arteries. The patients benefited from initial hybrid procedures: simultaneous and consecutive: classic followed by endovascular (CE) or endovascular followed by classic (EC). The mean primary patency for our EC was significantly higher than the CE. The simultaneous hybrid technique has some advantages: that there is no delay in establishing the complete revascularization of the ischaemic limb, the in-hospital stay and minimizing the complication rate by utilizing the puncture site as a site for the proximal anastomosis. Conclusions. Implementing the hybrid techniques into current vascular surgery practice and the possibility of doing them in hybrid operating theatres offers treatment options to the patients with high operating risk. Technical success and short- and medium-term results of primary patency and limb salvage rates for hybrid techniques are the same or better than conventional endovascular and open surgical procedures

Local treatment in patients with venous ulcers of the lower limb

Scopul lucrării. Ulcerele venoase ale membrelor inferioare sunt răni ale pielii fără tendință de vindecare după 3 sau mai multe luni și tulburări arteriale, venoase sau limfatice subiacente, cum ar fi hipertensiunea venoasă sau ischemia. Materiale și metode. Am efectuat un studiu descriptiv observațional, în care am urmărit evoluția pacienților internați în Secția Chirurgie Vasculară, cu diagnosticul de insuficiență venoasă cronică clasa C6 CEAP în perioada ianuarie 2014 - mai 2023, la care s-a practicat grefă de piele liberă despicată la nivelul ulcerului venos, precedata de tratamentul insuficienței venoase și tratamentul local al ulcerului venos cu aspirație negativă. S-au monitorizat efectele aspirației negative în evoluția aspectului ulcerului, rezultatele antibiogramei și rolul acesteia în gradul de acolare a grefei de piele. Rezultate. Dintre pacienții diagnosticați cu insuficiență venoasă cronică în Clinica noastră, unora li s-a practicat aspirație negativă și grefă de piele liber despicată. Se observă o prevalență a femeilor (65%) apte de munca. Perioada de spitalizare a variat între 4 și 85 zile, 62% fiind spitalizați între 10 și 28 zile. Cu ajutorul aspirației negative s-a reușit negativarea antibiogramei într-un interval cuprins între 6 și 40 zile, la majoritatea obținându-se un rezultat favorabil la circa 10-20 zile și cu un grad de acolare a grefei de piele ce depășește 75%. Concluzii. Ulcerele venoase sunt răni dureroase, care drenează, cu risc crescut de infecție, amputație și chiar moarte. Scopul terapeutic este de a îndepărta resturile pentru a obține un pat ulceros curat și pentru a transforma o rană cronică într-o rană acută cu un răspuns inflamator adecvat.Aim of study. Venous leg ulcers are skin wounds associated with no tendency to heal after 3 or more months and underlying arterial, venous or lymphatic disorders, such as venous hypertension or ischemia. They are known to have a high recurrence rate. Materials and methods. An observational descriptive study was performed at the Vascular Surgery Clinic of St. Spiridon Hospital from January 2014 to May 2023 in patients with CEAP class C6 of chronic venous insufficiency. Free split skin-grafting was used for venous ulcer management following treatment of venous insufficiency and topical negative pressure wound therapy. The effects of negative pressure on ulcer healing, antibiogram results and skin graft adhesion were monitored. Results. From the patients diagnosed with chronic venous insufficiency at our Clinic, some of them were treated with negative pressure and free split skin-grafting. The prevalence of venous ulcers was higher in women (65%) who were partly of employable age. Hospitalization length of stay ranged between 4 and 85 days, with 62% of patients being hospitalized for 10 to 28 days. Negative pressure wound therapy eliminated microbial contamination in 6 to 40 days and most patients showed a favourable outcome at 10 to 20 days post-treatment. Skin graft adhesion was successful in more than 75% of patients. Conclusions. Venous ulcers are painful draining wounds with increased risk for infection, amputation and even death. The therapeutic goal is to remove debris in order to achieve a clean ulcerous bed and to convert a chronic wound into an acute wound with a proper inflammatory response

BMO spaces associated with semigroups of operators

We study BMO spaces associated with semigroup of operators and apply the results to boundedness of Fourier multipliers. We prove a universal interpolation theorem for BMO spaces and prove the boundedness of a class of Fourier multipliers on noncommutative Lp spaces for all 1 < p < \infty, with optimal constants in p.Comment: Math An

Searches for lepton-flavour-violating decays of the Higgs boson in s=13\sqrt{s}=13 TeV pp\mathit{pp} collisions with the ATLAS detector

This Letter presents direct searches for lepton flavour violation in Higgs boson decays, H → eτ and H → μτ , performed with the ATLAS detector at the LHC. The searches are based on a data sample of proton–proton collisions at a centre-of-mass energy √s = 13 TeV, corresponding to an integrated luminosity of 36.1 fb−1. No significant excess is observed above the expected background from Standard Model processes. The observed (median expected) 95% confidence-level upper limits on the leptonflavour-violating branching ratios are 0.47% (0.34+0.13−0.10%) and 0.28% (0.37+0.14−0.10%) for H → eτ and H → μτ , respectively.publishedVersio

Combination of searches for Higgs boson pairs in pp collisions at \sqrts = 13 TeV with the ATLAS detector

This letter presents a combination of searches for Higgs boson pair production using up to 36.1 fb(-1) of proton-proton collision data at a centre-of-mass energy root s = 13 TeV recorded with the ATLAS detector at the LHC. The combination is performed using six analyses searching for Higgs boson pairs decaying into the b (b) over barb (b) over bar, b (b) over barW(+)W(-), b (b) over bar tau(+)tau(-), W+W-W+W-, b (b) over bar gamma gamma and W+W-gamma gamma final states. Results are presented for non-resonant and resonant Higgs boson pair production modes. No statistically significant excess in data above the Standard Model predictions is found. The combined observed (expected) limit at 95% confidence level on the non-resonant Higgs boson pair production cross-section is 6.9 (10) times the predicted Standard Model cross-section. Limits are also set on the ratio (kappa(lambda)) of the Higgs boson self-coupling to its Standard Model value. This ratio is constrained at 95% confidence level in observation (expectation) to -5.0 &lt; kappa(lambda) &lt; 12.0 (-5.8 &lt; kappa(lambda) &lt; 12.0). In addition, limits are set on the production of narrow scalar resonances and spin-2 Kaluza-Klein Randall-Sundrum gravitons. Exclusion regions are also provided in the parameter space of the habemus Minimal Supersymmetric Standard Model and the Electroweak Singlet Model. For complete list of authors see http://dx.doi.org/10.1016/j.physletb.2019.135103</p

Search for flavour-changing neutral currents in processes with one top quark and a photon using 81 fb⁻¹ of pp collisions at \sqrts = 13 TeV with the ATLAS experiment

A search for flavour-changing neutral current (FCNC) events via the coupling of a top quark, a photon, and an up or charm quark is presented using 81 fb−1 of proton–proton collision data taken at a centre-of-mass energy of 13 TeV with the ATLAS detector at the LHC. Events with a photon, an electron or muon, a b-tagged jet, and missing transverse momentum are selected. A neural network based on kinematic variables differentiates between events from signal and background processes. The data are consistent with the background-only hypothesis, and limits are set on the strength of the tqγ coupling in an effective field theory. These are also interpreted as 95% CL upper limits on the cross section for FCNC tγ production via a left-handed (right-handed) tuγ coupling of 36 fb (78 fb) and on the branching ratio for t→γu of 2.8×10−5 (6.1×10−5). In addition, they are interpreted as 95% CL upper limits on the cross section for FCNC tγ production via a left-handed (right-handed) tcγ coupling of 40 fb (33 fb) and on the branching ratio for t→γc of 22×10−5 (18×10−5). © 2019 The Author(s

Search for low-mass resonances decaying into two jets and produced in association with a photon using pp collisions at s=13 TeV with the ATLAS detector

A search is performed for localised excesses in dijet mass distributions of low-dijet-mass events produced in association with a high transverse energy photon. The search uses up to 79.8 fb−1 of LHC proton–proton collisions collected by the ATLAS experiment at a centre-of-mass energy of 13 TeV during 2015–2017. Two variants are presented: one which makes no jet flavour requirements and one which requires both jets to be tagged as b-jets. The observed mass distributions are consistent with multi-jet processes in the Standard Model. The data are used to set upper limits on the production cross-section for a benchmark model and, separately, on generic Gaussian-shape contributions to the mass distributions, extending the current ATLAS constraints on dijet resonances to the mass range between 225 and 1100 GeV.We acknowledge the support of ANPCyT, Argentina; YerPhI, Armenia; ARC, Australia; BMWFW and FWF, Austria; ANAS, Azerbaijan; SSTC, Belarus; CNPq and FAPESP, Brazil; NSERC, NRC and CFI, Canada; CERN; CONICYT, Chile; CAS, MOST and NSFC, China; COLCIENCIAS, Colombia; MSMT CR, MPO CR and VSC CR, Czech Republic; DNRF and DNSRC, Denmark; IN2P3-CNRS, CEA-DRF/IRFU, France; SRNSFG, Georgia; BMBF, HGF, and MPG, Germany; GSRT, Greece; RGC, Hong Kong SAR, China; ISF and Benoziyo Center, Israel; INFN, Italy; MEXT and JSPS, Japan; CNRST, Morocco; NWO, Netherlands; RCN, Norway; MNiSW and NCN, Poland; FCT, Portugal; MNE/IFA, Romania; MES of Russia and NRC KI, Russian Federation; JINR; MESTD, Serbia; MSSR, Slovakia; ARRS and MIZS, Slovenia; DST/NRF, South Africa; MINECO, Spain; SRC and Wallenberg Foundation, Sweden; SERI, SNSF and Cantons of Bern and Geneva, Switzerland; MOST, Taiwan; TAEK, Turkey; STFC, United Kingdom; DOE and NSF, United States of America. In addition, individual groups and members have received support from BCKDF, the Canada Council, Canarie, CRC, Compute Canada, FQRNT, and the Ontario Innovation Trust, Canada; EPLANET, ERC, ERDF, FP7, Horizon 2020 and Marie Sklodowska-Curie Actions, European Union; Investissements d'Avenir Labex and Idex, ANR, Region Auvergne and Fondation Partager le Savoir, France; DFG and AvH Foundation, Germany; Herakleitos, Thales and Aristeia programmes co-financed by EU-ESF and the Greek NSRF; BSF, GIF and Minerva, Israel; BRF, Norway; CERCA Programme Generalitat de Catalunya, Generalitat Valenciana, Spain; the Royal Society and Leverhulme Trust, United Kingdom.info:eu-repo/semantics/publishedVersio

Simultaneous energy and mass calibration of large-radius jets with the ATLAS detector using a deep neural network

The energy and mass measurements of jets are crucial tasks for the Large Hadron Collider experiments. This paper presents a new calibration method to simultaneously calibrate these quantities for large-radius jets measured with the ATLAS detector using a deep neural network (DNN). To address the specificities of the calibration problem, special loss functions and training procedures are employed, and a complex network architecture, which includes feature annotation and residual connection layers, is used. The DNN-based calibration is compared to the standard numerical approach in an extensive series of tests. The DNN approach is found to perform significantly better in almost all of the tests and over most of the relevant kinematic phase space. In particular, it consistently improves the energy and mass resolutions, with a 30% better energy resolution obtained for transverse momenta pT > 500 GeV

Search for boosted diphoton resonances in the 10 to 70 GeV mass range using 138 fb−1 of 13 TeV pp collisions with the ATLAS detector

A search for diphoton resonances in the mass range between 10 and 70 GeV with the ATLAS experiment at the Large Hadron Collider (LHC) is presented. The analysis is based on pp collision data corresponding to an integrated luminosity of 138 fb−1 at a centre-of-mass energy of 13 TeV recorded from 2015 to 2018. Previous searches for diphoton resonances at the LHC have explored masses down to 65 GeV, finding no evidence of new particles. This search exploits the particular kinematics of events with pairs of closely spaced photons reconstructed in the detector, allowing examination of invariant masses down to 10 GeV. The presented strategy covers a region previously unexplored at hadron colliders because of the experimental challenges of recording low-energy photons and estimating the backgrounds. No significant excess is observed and the reported limits provide the strongest bound on promptly decaying axion-like particles coupling to gluons and photons for masses between 10 and 70 GeV