Computed tomography assessment of abdominal aortic aneurysm morphology after endograft exclusion

AbstractObjectives: Assessment of the long-term function of endografts to exclude abdominal aortic aneurysm (AAA) includes determination of aneurysm dimensions and morphologic changes that occur after implantation. This study reports the dimensional analysis of patients treated with AneuRx bifurcated endoprostheses with postintervention, 1-year (n = 51), 2-year (n = 28), and 3-year (n = 10) postimplantation contrast computed tomography data. Methods: Maximal diameter (D) and cross-sectional area (CSA) of the AAA were measured from axial computed tomography images. Total volume, AAA thrombus volume (AAA volume minus the volume of the device and luminal blood flow), diameter of the aorta at the level of the renal arteries and within the device, distance from the renal arteries to the device, length of the device limbs, and the angle of the proximal neck were also determined at the same follow-up intervals after deployment with computed tomography angiograms reconstructed in an interactive environment. Results: Fifty-one of 98 consecutively treated patients with the AneuRx bifurcated prosthesis (29 “stiff” and 22 “flexible” body devices) had complete data from the postprocedure and follow-up computed tomography studies available for analysis. Max D, CSA, total volume of the AAA, and AAA thrombus volume decreased sequentially from year to year compared with the postimplantation values. D and CSA decreased or were unchanged in all except four patients, two who had unrestricted enlargement of the aneurysm with eventual rupture and one who had surgical conversion for continued expansion despite four diagnostic angiograms and attempted embolizations. Total volume of the AAA increased in 11 of 51 patients at 1 year, eight of whom had endoleaks at some interval during the follow-up. Thrombus volume increased more than 5% in four of these patients, including the two with eventual rupture and the one conversion. Patients with endoleaks who had spontaneous thrombosis or were successfully treated either remained at the same volume or had decreased volume on subsequent examinations. D at the renal arteries increased an average of 0.9 mm during the first year, with a concomitant increase of 2.8 mm within the proximal end of the device related to the self-expanding nature of the Nitinol suprastructure. Subsequent enlargement of the proximal neck continued at a slow rate in some cases but never exceeded the diameter of the endoluminal device. The distance from the renal arteries to the device increased by an average of 3 mm over the first year, with the greatest increases occurring in patients with a “stiff” body device and those with rapid regression (>10% total volume) in 1 year. As regression of the AAA occurred, the angle of the proximal neck varied from -5° to +25° from the original alignment. Limb length varied from -8 mm to +10 mm, with no consistent pattern for the change, that is, ipsilateral or contralateral limb. Conclusion: Significant variation in the quantitation of aneurysm size occurs depending on the technique of computed tomography assessment used. In most patients diameter assessment is adequate, although volumetric analysis appears to be very helpful in certain patients who do not show aneurysm regression, or in whom the diameter increases or where endoleaks persist. Three-dimensional reconstruction and volumetric analysis are also useful to assess the mechanism by which the endovascular device accommodates to morphology changes and to determine criteria for reintervention. (J Vasc Surg 2001;33:S1-10.

The reported durations of GOES Soft X-Ray flares in different solar cycles

The Geostationary Orbital Environmental Satellites (GOES) Soft X-ray (SXR) sensors have provided data relating to, inter alia, the time, intensity and duration of solar flares since the 1970s. The GOES SXR Flare List has become the standard reference catalogue for solar flares and is widely used in solar physics research and space weather. We report here that in the cur- rent version of the list there are significant differences between the mean du- ration of flares which occurred before May 1997 and the mean duration of flares thereafter. Our analysis shows that the reported flare timings for the pre-May 1997 data were not based on the same criteria as is currently the case. This finding has serious implications for all those who used flare duration (or fluence, which depends on the chosen start and end times) as part of their analysis of pre-May 1997 solar events, or statistical analyses of large sam- ples of flares, e.g. as part of the assessment of a Solar Energetic Particle fore- casting algorithm

Explant analysis of AneuRx stent grafts: relationship between structural findings and clinical outcome

AbstractObjectiveWe reviewed the structural findings of explanted AneuRx stent grafts used to treat abdominal aortic aneurysms, and relate the findings to clinical outcome measures.MethodsWe reviewed data for all bifurcated AneuRx stent grafts explanted at surgery or autopsy and returned to the manufacturer from the US clinical trial and worldwide experience of more than 33,000 implants from 1996 to 2003. Devices implanted for more than 1 month with structural analysis are included in this article. Explant results were analyzed in relation to cause of explantation and pre-explant evidence of endoleak, enlargement, or device migration.ResultsOne hundred twenty explanted stent grafts, including 37 from the US clinical trial, were analyzed. Mean implant duration was 22 ± 13 months (range, 1-61 months). Structural abnormalities included stent fatigue fractures, fabric abrasion holes, and suture breaks. The mean number of nitinol stent strut fractures per explanted device was 3 ± 4, which represents less than 0.2% of the total number of stent struts in each device. The mean number of fabric holes per explanted device was 2 ± 3, with a median hole size of 0.5 mm2. Suture breaks were seen in most explanted devices, but composed less than 1.5% of the total number of sutures per device. “For cause” explants (n = 104) had a 10-month longer implant duration (P = .007) compared with “incidental” explants (n = 16). “For cause” explants had more fractures (3 ± 5; P = .005) and fabric holes (2 ± 3; P = .008) per device compared with “incidental” explants, but these differences were not significant (P = .3) when adjusted for duration of device implantation. Among clinical trial explants the number of fabric holes in grafts in patients with endoleak (2 ± 3 per device) was no different from those without endoleak (3 ± 4 per device; P = NS). The number of fatigue fractures or fabric holes was no different in grafts in clinical trial patients with pre-explant aneurysm enlargement compared with those without enlargement. Pre-explant stent-graft migration was associated with a greater number of stent strut fractures (5 ± 7 per device; P = .04) and fabric holes (3 ± 3 per bifurcation; P = .03) compared with explants without migration. Serial imaging studies revealed inadequate proximal, distal, or junctional device fixation as the probable cause of rupture or need for conversion to open surgery in 86% of “for cause” explants. Structural device abnormalities were usually remote from fixation sites, and no causal relationship between device findings and clinical outcome could be established.ConclusionsNitinol stent fatigue fractures, fabric holes, and suture breaks found in explanted AneuRx stent grafts do not appear to be related to clinical outcome measures. Longer term studies are needed to confirm these observations

Formation of oriented particles in an amorphous host: ZnS nanocrystals in silicon

Processes for incorporating randomly oriented crystalline precipitates in an amorphous host can be traced back to the 17th century when Cassius produced “gold ruby” glass. In this glass, octahedral colloidal precipitates of gold scatter light by the Mie process to produce a deep red color. In contrast to gold ruby glass, we describe a type of material in which the crystalline precipitates are crystallographically aligned in a coherent manner—even though they are dispersed in an amorphous matrix. Ion implantation and thermal processing are first used to form zinc sulfide nanocrystals that are coherently oriented with respect to a crystalline Si host. The Si is then amorphized by ion irradiation leaving the highly radiation-resistant ZnS precipitates in an aligned crystalline state. The process is anticipated to find applications in the creation of surfaces with unique optoelectronic properties. © 1999 American Institute of Physics.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69678/2/APPLAB-74-5-697-1.pd

Gender-specific 30-day outcomes after carotid endarterectomy and carotid artery stenting in the Society for Vascular Surgery Vascular Registry

ObjectiveAlthough the optimal treatment of carotid stenosis remains unclear, available data suggest that women have higher risk of adverse events after carotid revascularization. We used data from the Society for Vascular Surgery Vascular Registry to determine the effect of gender on outcomes after carotid endarterectomy (CEA) and carotid artery stenting (CAS).MethodsThere were 9865 patients (40.6% women) who underwent CEA (n = 6492) and CAS (n = 3373). The primary end point was a composite of death, stroke, and myocardial infarction at 30 days.ResultsThere was no difference in age and ethnicity between genders, but men were more likely to be symptomatic (41.6% vs 38.6%; P < .003). There was a higher prevalence of hypertension and chronic obstructive pulmonary disease in women, whereas men had a higher prevalence of coronary artery disease, history of myocardial infarction, and smoking history. For disease etiology in CAS, restenosis was more common in women (28.7% vs 19.7%; P < .0001), and radiation was higher in men (6.2% vs 2.6%; P < .0001). Comparing by gender, there were no statistically significant differences in the primary end point for CEA (women, 4.07%; men, 4.06%) or CAS (women, 6.69%; men, 6.80%). There remains no difference after stratification by symptomatology and multivariate risk adjustment.ConclusionsIn this large, real-world analysis, women and men demonstrated similar results after CEA or CAS. These data suggest that, contrary to previous reports, women do not have a higher risk of adverse events after carotid revascularization

A Chandra Observation of the Obscured Star-Forming Complex W40

The young stellar cluster illuminating the W40 H II region, one of the nearest massive star forming regions, has been observed with the ACIS detector on board the Chandra X-ray Observatory. Due to its high obscuration, this is a poorly-studied stellar cluster with only a handful of bright stars visible in the optical band, including three OB stars identified as primary excitation sources. We detect 225 X-ray sources, of which 85% are confidently identified as young stellar members of the region. Two potential distances of the cluster, 260 pc and 600 pc, are used in the paper. Supposing the X-ray luminosity function to be universal, it supports a 600 pc distance as a lower limit for W40 and a total population of at least 600 stars down to 0.1 Mo under the assumption of a coeval population with a uniform obscuration. In fact, there is strong spatial variation in Ks-band-excess disk fraction and non-uniform obscuration due to a dust lane that is identified in absorption in optical, infrared and X-ray. The dust lane is likely part of a ring of material which includes the molecular core within W40. In contrast to the likely ongoing star formation in the dust lane, the molecular core is inactive. The star cluster has a spherical morphology, an isothermal sphere density profile, and mass segregation down to 1.5 Mo. However, other cluster properties, including a \leq{1} Myr age estimate and ongoing star formation, indicate that the cluster is not dynamically relaxed. X-ray diffuse emission and a powerful flare from a young stellar object are also reported.Comment: Accepted for publication in The Astrophysical Journal. 60 pages, 16 figure

Bidirectional lipid droplet velocities are controlled by differential binding strengths of HCV Core DII protein

Host cell lipid droplets (LD) are essential in the hepatitis C virus (HCV) life cycle and are targeted by the viral capsid core protein. Core-coated LDs accumulate in the perinuclear region and facilitate viral particle assembly, but it is unclear how mobility of these LDs is directed by core. Herein we used two-photon fluorescence, differential interference contrast imaging, and coherent anti-Stokes Raman scattering microscopies, to reveal novel core-mediated changes to LD dynamics. Expression of core protein’s lipid binding domain II (DII-core) induced slower LD speeds, but did not affect directionality of movement on microtubules. Modulating the LD binding strength of DII-core further impacted LD mobility, revealing the temporal effects of LD-bound DII-core. These results for DII-core coated LDs support a model for core-mediated LD localization that involves core slowing down the rate of movement of LDs until localization at the perinuclear region is accomplished where LD movement ceases. The guided localization of LDs by HCV core protein not only is essential to the viral life cycle but also poses an interesting target for the development of antiviral strategies against HCV