The 3^3He(e, e′'d)p Reaction in qω\omega-constant Kinematics

The cross section for the $^3$He(e, e$'$d)p reaction has been measured as a function of the missing momentum $p_m$ in q$\omega$ -constant kinematics at beam energies of 370 and 576 MeV for values of the three-momentum transfer $q$ of 412, 504 and 604 \mevc. The L(+TT), T and LT structure functions have been separated for $q$ = 412 and 504 \mevc. The data are compared to three-body Faddeev calculations, including meson-exchange currents (MEC), and to calculations based on a covariant diagrammatic expansion. The influence of final-state interactions and meson-exchange currents is discussed. The $p_m$-dependence of the data is reasonably well described by all calculations. However, the most advanced Faddeev calculations, which employ the AV18 nucleon-nucleon interaction and include MEC, overestimate the measured cross sections, especially the longitudinal part, and at the larger values of $q$. The diagrammatic approach gives a fair description of the cross section, but under(over)estimates the longitudinal (transverse) structure function.Comment: 17 pages, 7 figure

Meta-Analysis of Genome-Wide Association Studies for Abdominal Aortic Aneurysm Identifies Four New Disease-Specific Risk Loci

Rationale: Abdominal aortic aneurysm (AAA) is a complex disease with both genetic and environmental risk factors. Together, 6 previously identified risk loci only explain a small proportion of the heritability of AAA. Objective: To identify additional AAA risk loci using data from all available genome-wide association studies (GWAS). Methods and Results: Through a meta-analysis of 6 GWAS datasets and a validation study totalling 10,204 cases and 107,766 controls we identified 4 new AAA risk loci: 1q32.3 (SMYD2), 13q12.11 (LINC00540), 20q13.12 (near PCIF1/MMP9/ZNF335), and 21q22.2 (ERG). In various database searches we observed no new associations between the lead AAA SNPs and coronary artery disease, blood pressure, lipids or diabetes. Network analyses identified ERG, IL6R and LDLR as modifiers of MMP9, with a direct interaction between ERG and MMP9. Conclusions: The 4 new risk loci for AAA appear to be specific for AAA compared with other cardiovascular diseases and related traits suggesting that traditional cardiovascular risk factor management may only have limited value in preventing the progression of aneurysmal disease

Standardized definitions and clinical endpoints in trials investigating endovascular repair of aortic dissections.

OBJECTIVES Endovascular therapy is a rapidly expanding option for the treatment of patients with aortic dissection (AD) and various studies have been published. These trials, however, are often difficult to interpret and compare because they do not utilize uniform clinical endpoint definitions. METHODS The DEFINE Group is a collaborative effort of an ad hoc multidisciplinary team from various specialties involved in AD therapy in Europe and the United States. DEFINE's goal was to arrive at a broad based consensus for baseline and endpoint definitions in trials for endovascular therapy of various vascular pathologies. In this project, which started in December 2006, the individual team members reviewed the existing pertinent literature. Following this, a series of telephone conferences and face-to-face meetings were held to agree upon definitions. Input was also obtained from regulatory (United States Food and Drug Administration) and industry (device manufacturers with an interest in peripheral endovascular revascularization) stakeholders, respectively. RESULTS These efforts resulted in the present document containing proposed baseline and endpoint definitions for clinical and morphological outcomes. Although the consensus has inevitably included certain arbitrary consensus choices and compromises, adherence to these proposed standard definitions would provide consistency across future trials, thereby facilitating evaluation of clinical effectiveness and safety of various endovascular revascularization techniques. CONCLUSIONS This current document is based on a broad based consensus involving relevant stakeholders from the medical community, industry and regulatory bodies. It is proposed that the consensus document may have value for study design of future clinical trials in endovascular AD therapy as well as for regulatory purposes

Systematic approach to ruptured abdominal aortic aneurysm in the endovascular era: Intention-to-treat eEVAR protocol

Emergency endovascular aneurysm repair (eEVAR) for ruptured abdominal aortic aneurysms (rAAA) is still a relatively new treatment option. A pre-defined strategy of an eEVAR first approach for rAAA is associated with improved mortality rates. After establishing and implementing the Intention-to-treat eEVAR protocol for rAAAs the mortality and morbidity rates improved significantly. The presented Intention-to-treat eEVAR protocol starts at the first telephone call to the ambulance department and lasts until the post-operative care unit. The protocol involves the close collaboration between the ambulance department, vascular surgeon, emergency department physicians, anaesthesiologists, operating room staff and, radiology technicians. The availability of a variety of off-the-shelf stent-grafts, and an operating room that is adequately equipped to perform endovascular procedures is crucial in obtaining better outcomes. High volume centres that offer open surgical repair as well as eEVAR for rAAA show that the Intention-to-treat eEVAR protocol is achievable and appears to be associated with favorable mortality over open repair with appropriate case selection. Unstable or older patients with rAAA may particularly benefit by eEVAR

Venous Thoracic Outlet Syndrome Caused by Double Compression of the Axillosubclavian Vein:A Case Report

Introduction: In venous thoracic outlet syndrome (VTOS), pathology around the axillosubclavian vein causes venous compression with the subsequent development of upper extremity symptoms. This case report describes the analysis of all possible compression sites and subsequent treatment of VTOS patients with multiple compression points. Report: A 22 year old male presented with severe pain and swelling in his right arm, which persisted after a conservatively managed primary upper extremity deep vein thrombosis. Compression of the axillosubclavian vein was seen both at the level of the pectoralis minor and the costoclavicular spaces. Both compression points were successfully treated by combining thoracic outlet decompression surgery with pectoralis minor tenotomy. Discussion: This report underlines the importance of considering the possibility of multiple compression sites in patients with VTOS. Incomplete surgical release of all compression points leaves patients prone to re-thrombosis and/or persistent post-thrombotic syndrome. Timely recognition of all abnormalities on venography may allow for adjustment of surgical treatment accordingly

No Differences in Perioperative Outcome between Symptomatic and Asymptomatic AAAs after EVAR: An Analysis from the ENGAGE Registry

AbstractAimThis study aimed to compare the differences in perioperative outcome after endovascular repair of symptomatic abdominal aneurysms (S-AAAs) and elective non-symptomatic AAAs (E-AAAs). Data from the ENGAGE Registry were used for the analysis.MethodsBetween March 2009 and December 2010, 1200 AAA patients were enrolled from 79 sites in 30 countries and treated with an Endurant Stent Graft. S-AAAs defined as AAAs accompanied by abdominal or back pain, without rupture, were present in 185 (15.4%) patients and E-AAAs in 1015 (84.6%) patients. Multivariate logistic regression was used to compare results.ResultsAt baseline, E-AAA patients had larger aneurysms on average (P = 0.006) and scored higher ASA classification more often (P = 0.001). Further analyses were corrected for baseline differences. Operation time and technical success were comparable, and S-AAAs were admitted to the Intensive Care Unit (ICU) as often as E-AAAs (35.7% vs. 33.4%, P = 0.479). Post-operative hospitalisation was similar (4.83 ± 5.29 in E-AAAs and 4.37 ± 3.49 in S-AAAs, P = 0.360). No differences in the occurrence of major adverse events, including mortality, within the 30-day post-implantation were seen between S-AAA and E-AAA patients, respectively, 3.2% and 4.2% (P = 0.572).ConclusionWith contemporary devices and technical proficiency, there is no difference in outcome between symptomatic AAA and elective non-symptomatic AAA patients if treated with endovascular techniques

SBC2011-53463 IN VITRO THREE DIMENSIONAL IMAGING OF HUMAN CAROTID ATHEROSCLEROTIC PLAQUES USING ULTRASONOGRAPHY

INTRODUCTION Ruptured atherosclerotic plaques in the carotid artery are the main cause of stroke (70-80%). To prevent it, carotid endarterectomy is the procedure of choice in patients with a recent symptomatic 70-99% stenosis. Today, the selection of candidates is based on stenosis size only. However, endarterectomy is beneficial for only 1 out of 6 patients [1], the patients with unstable plaques To determine the mechanical properties of healthy coronary arteries an in vitro model was developed by Van Den Broek et al. [2]. In this model an arterial segment can be fixed in a water bath, and a pressure pump induces a pulsatile pressure through the segment. By using ultrasonography (US), distension of the vessel wall can be visualized in 2D (ART.LAB, Esaote Europe, The Netherlands). With this in vitro model the pressure-diameter and pressure-axial force relation can be obtained. In this study, human atherosclerotic segments obtained from an endarterectomy procedure are used to determine the mechanical properties of the atherosclerotic components (local ethical committee approval was obtained for this study). The aim of this study is to adjust the existing set-up for use on atherosclerotic plaques and to design a tool for the conversion of 2D utrasound datasets to 3D data, to obtain the geometry of the artery including pressure and distension information over time. Eventually these datasets will be used as input for inverse numerical computations for the determination of mechanical properties of the plaques