Midterm Outcomes of the Nellix Endovascular Aneurysm Sealing System: A Dual-Center Experience

Purpose: To report midterm outcomes of the Nellix Endovascular Aneurysm Sealing (EVAS) System in the treatment of abdominal aortic aneurysm (AAA). Methods: Between September 2013 and July 2014, 64 AAA patients (mean age 76.6±6.8 years; 61 men) were treated with the EVAS system at 2 centers (only procedures performed at least 12 months prior to the analysis were included). Most patients were treated for a stable AAA, while 1 patient was treated for a ruptured aneurysm. Mean aneurysm diameter was 57.3±9.3 mm. The proximal neck measured a mean 21.5±3.3 mm in diameter and 27.0±12.1 mm long; the neck angle was 16.9°±19.3°. Eleven (17.2%) patients were treated outside the instructions for use (IFU). Results: Technical success was achieved in 63 (98.4%) of 64 patients; 1 type Ia endoleak was treated intraoperatively. One (1.6%) aneurysm-related death occurred at 4 months due to a secondary aortoenteric fistula. Overall, endoleaks occurred in 3 (4.7%) patients (2 type Ia, 1 type II). The estimated rates for 18-month overall survival, freedom from aneurysm-related death, and freedom from secondary interventions were 92.7%, 98.4%, and 95.0%, respectively. Patients treated outside the IFU had a significantly higher incidence of device-related complications (p=0.03). Conclusion: The use of the Nellix device in everyday clinical practice is safe and offers promising midterm results. The risk of secondary aortoenteric fistula requires further analysis. Longer follow-up is needed to assess the actual efficacy of the device, although the risk of migration with late endoleak seems low

Women out, children out : the effect of female labor on portuguese preschool enrollment rates

This article tests whether Portuguese female activity rates have increased preschool enrollment rates. Particularly during the last 20 years, Portuguese women have assumed new roles in the marketplace and have become active workers outside of the home environment. This change has encouraged more sensible decisions with respect to preschool enrollment. Using cointegration techniques, we concluded that female activity rates and real income per capita caused a long-term increase in preschool enrollment rates. Although the percentage of agricultural gross value added to the gross domestic product and the number of preschool institutes were also found to be significant in the estimated vector error correction model, their causal relationship with preschool enrollment was only short term.COMPETE; QREN; FEDER; Fundação para a Ciência e a Tecnologia (FCT

Electrify Italy

This study explores a possible pathway to implement a new energy paradigm in Italy based on electrification. The objectives are: • To build a forward-looking vision of possible scenarios at 2022, 2030 and 2050 by integrating a multi-focus perspective on the penetration of renewables and the electrification potential of the residential, industrial and transport sectors. • To estimate the potential benefits of further electrification through the calculation of Key Performance Indicators in four different areas: energy, economy, environment and society. The study shows how the electricity triangle, a paradigm based on clean generation by renewable sources, electrification of final uses, and electricity exchange through efficient smart grids, closes the loop of clean energy and efficient consumption. This leads to improvements in energy, environment, economy and social performances, and boosts the share of renewables in final consumption

Status Update and Interim Results from the Asymptomatic Carotid Surgery Trial-2 (ACST-2)

Objectives: ACST-2 is currently the largest trial ever conducted to compare carotid artery stenting (CAS) with carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis requiring revascularization. Methods: Patients are entered into ACST-2 when revascularization is felt to be clearly indicated, when CEA and CAS are both possible, but where there is substantial uncertainty as to which is most appropriate. Trial surgeons and interventionalists are expected to use their usual techniques and CE-approved devices. We report baseline characteristics and blinded combined interim results for 30-day mortality and major morbidity for 986 patients in the ongoing trial up to September 2012. Results: A total of 986 patients (687 men, 299 women), mean age 68.7 years (SD ± 8.1) were randomized equally to CEA or CAS. Most (96%) had ipsilateral stenosis of 70-99% (median 80%) with contralateral stenoses of 50-99% in 30% and contralateral occlusion in 8%. Patients were on appropriate medical treatment. For 691 patients undergoing intervention with at least 1-month follow-up and Rankin scoring at 6 months for any stroke, the overall serious cardiovascular event rate of periprocedural (within 30 days) disabling stroke, fatal myocardial infarction, and death at 30 days was 1.0%. Conclusions: Early ACST-2 results suggest contemporary carotid intervention for asymptomatic stenosis has a low risk of serious morbidity and mortality, on par with other recent trials. The trial continues to recruit, to monitor periprocedural events and all types of stroke, aiming to randomize up to 5,000 patients to determine any differential outcomes between interventions. Clinical trial: ISRCTN21144362. © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved

Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme

Prediction of dynamic behaviour of a single-phase rectangular natural circulation loop

this paper, the thermohydraulic behaviour of a single-phase natural circulation experimental plant is presented and approached by modelling. In effect the interaction between the fluid (H2O) and the tube material (Plexiglas) causes the establishing of a unstable behaviour typical of the chaos systems. The experimental data were analysed using the Artificial Neural Networks (ANN). This technique was employed in order to simulate the transient in the loop. Moreover, the ANN technique was applied to the temperature fluid measurement in order to predict the occurrence of flow reversal. This first attempt confirms that this technique could b

The Decline of Infant Mortality in Europe, 1800-1950: Four national case studies

The basic facts about the secular decline of infant mortality in Europe have been known for nearly a century. Regristration series show that the levels of infant mortality in the late nineteenth century were still extremely high and could vary quite markedly from one country to another, ranging from about 100 per 1,000 live births in Norway and Sweden to 200 or even 250 per 1,000 in countries such as Germany, Austria and Russia. At the turn of the century, however, infant mortality began to fall almost right across the continent. By the 1950s, when national rates of infant mortality ranged between 20 and 50 per 1,000, the process of convergence was nearly completed. The fall in infant mortality, which was paralelled by a simultaneous and equally pronounced decline in fertility, was responsible for raising life expectancy in many European countries by more than 10 years over a remarkably short period of time. The countries reviewed in this publication are Sweden, England, France and Austria.child development; health policy; historical analysis; infant mortality; social policy;Europe;