Survival After Endovascular Aneurysm Sealing Compared With Endovascular Aneurysm Repair

Introduction Endovascular aneurysm sealing (EVAS) is a sac-filling device with a blunted systemic inflammatory response compared to conventional endovascular aneurysm repair (EVAR), with a suggested impact on all-cause mortality. This study compares mortality after both EVAS and EVAR. Materials and Methods This is a retrospective observational study including data from 2 centres, with ethical approval. Elective procedures on asymptomatic infrarenal aneurysms performed between January 2011 until April 2018 were enrolled. Laboratory values (serum creatinine, haemoglobin, white blood cell count, platelet count) were measured pre- and postoperatively and at 1 and 2 years, respectively. Mortality and cause of death were recorded during follow-up. Results A total of 564 patients were included (225 EVAS, 369 EVAR), after propensity score matching there were 207 patients in both groups. Baseline characteristics were similar, except for larger neck angulation and more pulmonary disease in the EVAR group. The median follow-up time was 49 (EVAS) and 44 (EVAR) months. No significant differences regarding creatinine and haemoglobin were observed. Preoperative white blood cell count was higher in the EVAR group (p=0.011), without significant differences during follow-up. Median platelet count was lower in the EVAR group preoperatively (p=0.001), but was significantly higher at 1 year follow-up (p=0.003). There were 43 deaths within the EVAS group (20.8%) and 52 within the EVAR group (25.1%) (p=0.293). Of these, 4 were aneurysm related (EVAS n=3, EVAR n=1; p=0.222) and 14 cardiovascular (EVAS n=6, EVAR n=8, p=0.845). For the EVAS cohort, survival was 95.5% at 1 year and 74.9% at 5 years. For the EVAR cohort, this was 93.3% at 1 year and 75.5% at 5 years. No significant differences were observed in causes of death. Conclusion This study showed comparable survival rates through 5 years between EVAS and EVAR with a tendency toward higher inflammatory response in the EVAR patients through the first 2 years

Sinteza i preliminarna ispitivanja antikonvulzivnog djelovanja derivata benzotiazol-2-il tiadiazola

Various N-(5-chloro-6-substituted-benzothiazol-2-yl)-N\u27-(substituted phenyl)-[1,3,4]thiadiazole-2,5-diamines (5a-t) were designed and synthesized starting from substituted acetophenones. Structures of all the compounds were confirmed on the basis of spectral and elemental analyses. All the newly synthesized compounds were screened for their anticonvulsant activity and were compared with the standard drug phenytoin sodium. Interestingly, all the compounds showed protections against seizures in the range 50-100 % indicative of the promising nature of the compounds against the seizure spread. Compounds 5b and 5c showed complete protection against MES induced seizures.U radu je opisano dizajniranje i sinteza različitih N-(5-klor-6-supstituiranih-benzotiazol-2-il)-N\u27-(supstituiranih fenil)-[1,3,4]tiadiazol-2,5-diamina (5a-t) polazeći od odgovarajućih acetofenona. Strukture spojeva određene su na temelju spektroskopskih podataka i elementarne analize. Ispitano je antikonvulzivno djelovanje svih novosintetiziranih spojeva i uspoređeno s djelovanjem natrijeve soli fenitoina. Spojevi 5b i 5c pružaju potpunu zaštitu od konvulzija uzrokovanih MES-om, a svi spojevi štite od konvulzija u rasponu od 50 do 100 %

Migration After Endovasclar Aneurysm Sealing in Conjunction With Chimney Grafts

Purpose: To assess the incidence of migration after endovascular aneurysm sealing (EVAS) in conjunction with chimney grafts (chEVAS) for repair of abdominal aortic aneurysms (AAAs). Materials and Methods: A retrospective, observational cohort study was conducted of 31 patients (mean age 75.7 years; 27 men) treated for juxtarenal AAA between April 2013 and December 2018 at single centers in New Zealand and the Netherlands. The majority of patients received >1 chimney graft (13 single, 13 double, and 5 triple) during chEVAS. Six patients had only the first postoperative scan, so the migration analysis was based on 25 patients. Results: Median seal length assessed on the first postoperative computed tomography scan was 36.5 mm. The assisted technical success rate was 93.5% with 2 technical failures. Median time to final imaging follow-up was 17 months in 25 patients. At the latest follow-up, there were no cases of caudal migration >10 mm. Freedom from caudal movement of 5 to 9 mm was estimated as 86.1% at 1 year and 73.9% at 2 years; freedom from clinically relevant migration (movement requiring reintervention) was 100% at both time intervals. However, at 3 years there were 2 cases of caudal movement of 5 to 9 mm and a type Ia endoleak warranting reintervention. No correlation between migration and aneurysm growth (p=0.851), endoleak (p=0.562), or the number of chimney grafts (p=0.728) was found. During follow-up, 2 patients (7%) had aneurysm rupture and 10 (33%) had reinterventions. Eight patients (27%) died; 2 were aneurysm-related (7%) and due to the consequences of a reintervention. Conclusion: In the 2 years following chEVAS, there was no caudal migration >10 mm, but nearly a quarter of patients had caudal movement of 5 to 9 mm. A trend was observed toward ongoing migration that required intervention at 3-year follow-up. chEVAS is technically challenging and should be considered only for patients with no viable alternative treatment option

Biased numerical cognition impairs economic decision-making in Parkinson’s disease

Objective Previous findings suggest a context-dependent bihemispheric allocation of numerical magnitude. Accordingly, we predicted that lateralized motor symptoms in Parkinson's disease (PD), which reflect hemispheric asymmetries, would induce systematic lateralized biases in numerical cognition and have a subsequent influence on decision-making. Methods In 20 PD patients and matched healthy controls we assessed numerical cognition using a number-pair bisection and random number generation task. Decision-making was assessed using both the dictator game and a validated questionnaire. Results PD patients with predominant right-sided motor symptoms exhibited pathological biases toward smaller numerical magnitudes and formulated less favorable prosocial choices during a neuroeconomics task (i.e., dictator game). Conversely, patients with left-sided motor symptoms exhibited pathological biases toward larger numerical magnitudes and formulated more generous prosocial choices. Our account of context-dependent hemispheric allocation of numerical magnitude in PD was corroborated by applying our data to a pre-existing computational model and observing significant concordance. Notably, both numerical biasing and impaired decision-making were correlated with motor asymmetry. Interpretation Accordingly, motor asymmetry and functional impairment of cognitive processes in PD can be functionally intertwined. To conclude, our findings demonstrate context-dependent hemispheric allocation and encoding of numerical magnitude in PD and how biases in numerical magnitude allocation in Parkinsonian patients can correspondingly impair economic decision-making

Photosynthesis in poor nutrient soils, in compacted soils, and under drought

Plants require the uptake of nutrients (in most cases via roots) and their incorporation into plant organs for growth. In non-woody species, 83% of fresh weight is water, 7% is carbon, 5% is oxygen, with the remaining 5% including hydrogen and such nutrients. In natural ecosystems, availability of nutrients in soils is heterogeneous, and many species often adapt their growth to the amount of nutrients that roots can take up by exploring the available soil volume. In agricultural areas, the lack of some nutrients is frequent. In both cases, plants must also face periods of drought and soil compaction. These environmental stresses are therefore not uncommon in natural ecosystems and crops, and the stressed plants often experience a decrease in photosynthetic CO2 fixation. In this chapter, we review changes observed in photosynthesis in response to nutrient deficiencies, soil compaction, and drought. The current knowledge on photosynthesis in carnivorous plants, as a special case of plant species growing in nutrient poor soils, is also included. Pigment limitations (chlorosis and/or necrosis), stomatal limitations, ultrastructural effects and mesophyll conductance limitations, photochemistry (primary reactions), carboxylation and Calvin-cycle reactions, and carbohydrate metabolism and transport will be discussed. With regard to nutrients, we have focused on the most common nutrition-related stresses in plants, the deficiencies of macro- (nitrogen, phosphorous, and potassium) and micronutrients (iron, manganese, copper, and zinc). Other nutrient deficiencies (or toxicities, both in the cases of essential nutrient excess or heavy metals) are not reviewed here. For other nutrient deficiencies and toxicities, and the role of the above-mentioned, and other nutrients (such as calcium and magnesium) in gas exchange, and as intracellular signal transducers, enzyme activators, and structure and function stabilizers of biological membranes, readers are referred to papers published elsewhere (Marschner H, Mineral nutrition of higher plants. Academic, London, 1995; Cakmak I, Kirkby EA, Physiol Plant 133:692–704, 2008; Morales F, Warren CR, Photosynthetic responses to nutrient deprivation and toxicities. In: Flexas J, Loreto F, Medrano H (eds) Terrestrial photosynthesis in a changing environment: a molecular, physiological and ecological approach. Cambridge University Press, Cambridge, pp 312–330, 2012; Hochmal AK, Schulze S, Trompelt K, Hippler M, Biochim Biophys Acta 1847:993–1003, 2015).This study was supported by the Spanish Ministry of Economy and Competitiveness (MINECO; projects AGL2012-31988, AGL2013-42175-R, AGL2016-75226-R, and AGL2016-79868-R, co-financed with FEDER), the Aragón Government (Group A03), grant LO1204 (Sustainable development of research in the Centre of the Region Haná) from the National Program of Sustainability I, and by the Czech Science Foundation Agency (project 16-07366Y). FM wishes to thank JC Martínez for his help with some periodic bibliographic searches.Peer reviewe

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous