A Case Report: Is the Lack of Sufficient Radial Force Unfreezing the “Frozen Elephant Trunk”?

The “frozen elephant trunk” is a hybrid technique to treat aortic arch and proximal descending aortic pathologies in a single step. Despite its encouraging early and long-term results, some stent-graft-related adverse events have been reported. Here, we describe a possible treatment option to "re-freeze" the FET in case of loss of landing zone. We report a patient who developed significant kinking of the FET over the course of the first 2 postoperative years. The 1-year follow-up computed tomography angiography (CTA) showed significant kinking and proximal migration of the endograft portion of the FET, resulting in new thrombus formation. Due to kinking and thrombus progression in subsequent CTA follow-ups (2 years and 2½ years) with risk for peripheral embolization, a secondary endovascular repair was indicated. Transfemoral relining of the stent component with a thoracic aortic endovascular repair (Zenith®TX2®30142) stent-graft was performed. In the context of postoperative aneurysm sac shrinkage, the low radial force and lack of longitudinal stiffness of the hybrid graft may lead to proximal migration, thus secondary kinking, emphasizing the importance of an adequate degree of oversizing of the primary graft and an appropriate follow-up. Selection of a suitable graft for a particular pathology concerning the radial force and longitudinal stiffness is furthermore important

Challenges and opportunities in polysaccharides research and technology: The EPNOE views for the next decade in the areas of materials, food and health care

International audienceThe European Polysaccharide Network of Excellence (EPNOE) is a research and education network connecting 16 academic and research institutions and a large number of companies with its focus on polysaccharide expertise development and polysaccharide-related research for innovation in business and industry. EPNOE has two main missions in the field of polysaccharide applications in materials, food, and pharmacy/medicine, which are to organise education in polysaccharide science and to perform basic and applied research for the development of new products derived from polysaccharides. In 2009, the EPNOE network prepared a research road map vision to 2020 focussed on polysaccharide use in material structuring, food and health, taking both research and education into consideration. The research road map was prepared from various social, political, industrial and scientific inputs coming from within and outside EPNOE: (1) results of four brain-storming sessions by EPNOE scientists and students, (2) individual contributions of EPNOE scientists and (3) individual contributions of scientists outside EPNOE through an internet review. The result is described in this article

Burden of Stroke in Europe:An Analysis of the Global Burden of Disease Study Findings From 2010 to 2019

BACKGROUND:While most European Regions perform well in global comparisons, large discrepancies within stroke epidemiological parameters exist across Europe. The objective of this analysis was to evaluate the stroke burden across European regions and countries in 2019 and its difference to 2010.METHODS:The GBD 2019 analytical tools were used to evaluate regional and country-specific estimates of incidence, prevalence, deaths, and disability-adjusted life years of stroke for the European Region as defined by the World Health Organization, with its 53 member countries (EU-53) and for European Union as defined in 2019, with its 28 member countries (EU-28), between 2010 and 2019. Results were analyzed at a regional, subregional, and country level.RESULTS:In EU-53, the absolute number of incident and prevalent strokes increased by 2% (uncertainty interval [UI], 0%–4%), from 1 767 280 to 1 802 559 new cases, and by 4% (UI, 3%–5%) between 2010 and 2019, respectively. In EU-28, the absolute number of prevalent strokes and stroke-related deaths increased by 4% (UI, 2%–5%) and by 6% (UI, 1%–10%), respectively. All-stroke age-standardized mortality rates, however, decreased by 18% (UI, −22% to −14%), from 82 to 67 per 100 000 people in the EU-53, and by 15% (UI, −18% to −11%), from 49.3 to 42.0 per 100 000 people in EU-28. Despite most countries presenting reductions in age-adjusted incidence, prevalence, mortality, and disability-adjusted life year rates, these rates remained 1.4×, 1.2×, 1.6×, and 1.7× higher in EU-53 in comparison to the EU-28.CONCLUSIONS:EU-53 showed a 2% increase in incident strokes, while they remained stable in EU-28. Age-standardized rates were consistently lower for all-stroke burden parameters in EU-28 in comparison to EU-53, and huge discrepancies in incidence, prevalence, mortality, and disability-adjusted life-year rates were observed between individual countries.<br/

Multilayer Polysaccharide Nanofilms for Controlled Delivery of Pentoxifyllin and Possible Treatment of Chronic Venous Ulcer

Kronične rane predstavljajo velik socialno-ekonomski problem v zahodnem svetu. Eno najpomembnejših vrst kroničnih ran predstavlja kronična venozna razjeda, ki je odgovorna za okoli 80% vseh kroničnih razjed. Nova histo-patološka spoznanja so pokazala, de je lokalno, kronično vnetje v veliki meri odgovorno za patološke procese, ki vodijo do nastanka razjede kot tudi do upočasnjenega procesa celjenja. V tej študiji je predstavljen nov možen pristop k terapiji kronične venozne razjede, ki temelji na lokalnem dajanju potentne protivnetne zdravilne učinkovine, pentoksifilin (PTX). V ta namen so bile razvite ne-toksične polisaharidne večslojne medicinske obloge iz hitozana in alginata, ki zraven nadzorovanega sproščanja zdravilne učinkovine, že same pozitivno vplivajo na potek celjenja kroničnih ran. V okviru razvoja in optimizacije postopkov priprave omenjenih medicinskih oblog so bili pripravljeni in okarakterizirani najprej 2D modelni večslojni nosilni materiali, ter nato še obložena 3D alginatna koprena. S pomočjo različnih analiznih metod, smo dokazali uspešno pripravo večslojnih medicinskih oblog z dodanim PTX. Z analizo in vitro sproščanja je bilo pokazano, da tako pripravljene medicinske obloge omogočajo nadzorovano, dvo-stopenjsko sproščanje vodotopnega PTX. S pomočjo študij na humanih kožnih celicah smo pokazali biokompatibilnost večslojnih matric z dodatkom PTX. Za konec smo na osnovi eksperimenta na humanih monocitih potrdili tudi, da so pripravljene večslojne medicinske obloge preko delovanja PTX, uspešno zavrle sproščanje TNF-alfa, ki je ključen vnetni mediator pri kroničnih venoznih razjedah.Chronic wounds represent a huge socio-economical problem in the western sociality. One of the most common types of chronic wounds, is the chronic venous ulceration, which accounts for 80% of all chronic wounds. New histo-pathological insights have revealed that chronic local inflammation, which is believed to be preferentially caused by by chronic venous insufficiency, is one of the major causes for the development and poor healing of chronic wounds. In this study we represent a new approach for the treatment of chronic venous ulcers, which is based on the local application of a potent anti-inflammatory drug, pentoxifyllin (PTX). TO achieve controlled release of PTX, and hence provide an efficient and safe local treatment, a non-toxic, multi-layered polysaccharide matrix based on alginate and chitosan was developed. Besides the controlled drug release, such composition has a well-known positive effect on wound healing on its own. As part of their development, 2D model multilayer matrices, as well as functionalized 3D alginate fleece was prepared and characterized. With the help of different analytical methods, it was possible to demonstrate the successful preparation of multilayer matrices with the added PTX. By analysing the in vitro release, it has been shown that the prepared matrices allow a controlled release of the incorporated substance. Further analysis of the drug release profiles has shown, that a two-step release mechanism of the substance was achieved. The biocompatibility of multilayer matrixces with the added PTX was demonstrated through cellular studies on human skin derived fibroblasts. Additional cellular testing using human monocytes confirmed our hypothesis, that the controlled release of PTX is able to inhibit the secretion of TNF-alpha

Analysis of Target Vessel Instability in Fenestrated Endovascular Repair (f-EVAR) in Thoraco-Abdominal Aortic Pathologies.

Objective: The aim of this study was to evaluate the influence of target vessel anatomy and post-stenting geometry on the outcome of fenestrated endovascular aortic repair (f-EVAR). Methods: A retrospective review of data from a single center was conducted, including all consecutive fenestrated endovascular aortic repairs (f-EVARs) performed between September 2018 and December 2023 for thoraco-abdominal aortic aneurysms (TAAAs) and complex abdominal aortic aneurysms (cAAAs). The analysis focused on the correlation of target vessel instability to target vessel anatomy and geometry after stenting. The primary endpoint was the cumulative incidence of target vessel instability. Secondary endpoints were the 30-day and follow-up re-interventions. Results: A total of 136 patients underwent f-EVAR with 481 stented target vessels. A total of ten target vessel instabilities occurred including three in visceral and seven instabilities in renal vessels. The cumulative incidence of target vessel instability with death as the competing risk was 1.4%, 1.8% and 3.4% at 1, 2 and 3 years, respectively. In renal target vessels (260/481), a diameter ≤ 4 mm (OR 1.21, 95% CI 1.035-1.274, p = 0.009) and an aortic protrusion ≥ 5.75 mm (OR 8.21, 95% CI 3.150-12-23, p = 0.027) was associated with an increased target vessel instability. In visceral target vessels (221/481), instability was significantly associated with a preoperative tortuosity index ≥ 1.25 (HR 15.19, CI 95% 2.50-17.47, p = 0.045) and an oversizing ratio of ≥1.25 (HR 7.739, CI % 4.756-12.878, p = 0.049). Conclusions: f-EVAR showed favorable mid-term results concerning target vessel instability in the current cohort. A diameter of ≤4 mm and an aortic protrusion of ≥5.75 mm in the renal target vessels as well as a preoperative tortuosity index and an oversizing of the bridging stent of ≥1.25 in the visceral target vessels should be avoided

Connectedness to Nature and Public (Skin) Health Perspectives: Results of a Representative, Population-Based Survey among Austrian Residents

Connectedness to nature (CN) influences motivation to have contact with outdoor natural environments. Spending leisure time in natural environments is beneficial for human health and well-being. Besides these positive effects, health risks of open-air activities are mainly related to unprotected sun light exposure-associated acute and chronic skin hazards. Thus, we conducted a cross-sectional, representative telephone survey among Austrian residents to study the association of perceived CN level with sun-exposure knowledge, tanning habits, and sun protective behaviour. In total, 1,500 study subjects (50.5% females) participated in this questionnaire survey. Although knowledge about tanning and motives to tan were similar among genders, females performed more photoprotective measures and were more connected to nature (all p &lt; 0.001) compared to males. Older age and outdoor sport were significant gender-independent predictor variables influencing perceived CN level. Additionally, level of education was relevant in male CN, whereas non-smoking and higher knowledge were predictive of female CN. This survey provides so far unreported empirical data on the relationship between nature connectedness and skin health-relevant recreational habits of Austrian residents. The findings suggest to integrate hitherto neglected gender-specific Public (Skin) Health promotion when counselling on the manifold health advantages of outdoor activities

The Flashlight-Sign: A Novel B-Flow Based Ultrasound Finding for Detection of Intraluminal, Wall-Adherent, Floating Structures of the Abdominal Aorta and Peripheral Arteries

This study aimed to evaluate the potential diagnostic value of a novel, sonographic, B-Flow (BFl)-based sign (&ldquo;flashlight sign&rdquo;, FLS) for the detection of wall-adherent, floating arterial structures (WAFAS). The FLS, characterized by a fast moving, very bright, intraluminal signal, was detected in 28 patients with WAFAS. We divided this cohort into three subgroups according to the affected vascular segments: (1) peripheral arteries (n = 10); (2) native abdominal aorta (n = 8); and (3) abdominal aorta after endovascular aortic repair (EVAR; n = 10). Clinical characteristics were analyzed and BFl-findings were compared with contrast-enhanced ultrasound (CEUS) and computed tomography angiography (CTA). Seven patients (25%) suffered from arterial embolism downstream to the FLS (EVAR, n = 4; native abdominal aorta, n = 1; peripheral arteries, n = 2). WAFAS of the abdominal aorta (native or after EVAR), as indicated by the FLS, were visible by CEUS and CTA in 60% and 93.3%, respectively. Based on the largest cohort (to this point) of patients with WAFAS, we propose a clinically useful, BFl-based sonographic sign for the detection of these underrated arterial pathologies in the abdominal aorta and the peripheral arteries

Emergent physician modified carotid fenestrated TEVAR for the treatment of a complicated acute type nonA-nonB aortic dissection with undetected multiorgan malperfusion

Complicated acute nonA-nonB dissection with malperfusion is associated with a high in-hospital mortality up to 67%. Therefore, rapid identification and treatment are critical for clinical outcomes. We report the urgent treatment of a complicated subacute aortic dissection treated with a physician-modified-endograft (PMEG) fenestrated-TEVAR (f-TEVAR) for the left common carotid artery (LCCA). A 49-year-old male patient with acute non-A non-B aortic dissection with complete true lumen collapse and associated mesenteric and renal ischemia, was referred to another vascular center for abdominal pain and received exclusively medical treatment. After 15 days of persistent pain, the patient self-referred to our center and was treated with endovascular repair. The proximal entry tear was located at the level of the left subclavian artery: a PMEG f-TEVAR was performed with fenestration for LCCA in conjunction with carotid-subclavian bypass. In addition, spot stenting of the left renal artery was performed to resolve renal malperfusion. The final angiography showed satisfactory result. The patient soon reported significant pain relief. Follow-up at 30-days was satisfactory, with no need for further intervention. A physician-modified fenestrated-TEVAR can be used in emergency setting to treat acute non-A-non-B aortic dissection in conjunction with multiorgan malperfusion, with satisfactory results even after initial delayed treatment