Ruptured abdominal aorto-iliac aneurysms: Diagnosis, treatment, abdominal compartment syndrome, and role of simulation-based training

Ruptured abdominal aortic aneurysms (rAAA), with or without iliac involvement, are a lifethreatening scenario with high mortality even after surgical therapy. Several factors have contributed to improving perioperative outcomes in recent years, including the progressive use of endovascular aortic repair (EVAR) and intraoperative balloon occlusion of the aorta, a dedicated treatment algorithm with centralization of care to high-volume centres, and optimized perioperative management protocols. Nowadays, EVAR is applicable in the majority of scenarios even in the emergency setting. Among the factors that influence the postoperative course of rAAA patients, abdominal compartment syndrome (ACS) is a rare but life-threatening complication. As its early clinical diagnosis is often missed but crucial to initiate an emergent surgical decompression therapy, dedicated surveillance protocols and transvesical measurement of the intraabdominal pressure are key for prompt diagnosis and immediate treatment of ACS. Further improvement of rAAA patients’ outcome may be achieved by the implementation of simulation-based training (of both technical and nontechnical skills for surgeons as well as all involved healthcare personnel in multidisciplinary teams) and by transfer of all rAAA patients to specialized vascular centres with advanced experience and high caseload

Means and methods for modulating lipid metabolism

The invention relates to means and methods for the modulation of lipid metabolism in an individual. Among others, it relates to a novel regulator of levels of plasma lipids and hepatic lipids and the use thereof for therapeutic intervention. Provided is a modulator of the Small leucine-rich protein 1 (human) (SMLR1) gene, a SMLR1 gene product, and/or a transcriptional regulator of SMLR1. Also provided is the use of the SMLR1 gene, a SMLR1 gene product, and/or a transcriptional regulator of SMLR1, as target in a method of modulating lipid metabolism in a subject

BicAT: a biclustering analysis toolbox

Summary: Besides classical clustering methods such as hierarchical clustering, in recent years biclustering has become a popular approach to analyze biological data sets, e.g. gene expression data. The Biclustering Analysis Toolbox (BicAT) is a software platform for clustering-based data analysis that integrates various biclustering and clustering techniques in terms of a common graphical user interface. Furthermore, BicAT provides different facilities for data preparation, inspection and postprocessing such as discretization, filtering of biclusters according to specific criteria or gene pair analysis for constructing gene interconnection graphs. The possibility to use different biclustering algorithms inside a single graphical tool allows the user to compare clustering results and choose the algorithm that best fits a specific biological scenario. The toolbox is described in the context of gene expression analysis, but is also applicable to other types of data, e.g. data from proteomics or synthetic lethal experiments. Availability: The BicAT toolbox is freely available at and runs on all operating systems. The Java source code of the program and a developer's guide is provided on the website as well. Therefore, users may modify the program and add further algorithms or extensions. Contact: [email protected]

Long-Term Outcomes in Thoracic Endovascular Aortic Repair for Complicated Type B Aortic Dissection or Intramural Hematoma Depending on Proximal Landing Zone

Thoracic endovascular aortic repair (TEVAR) is the preferred treatment for complicated type B aortic dissection (TBAD) or intramural hematoma (IMH). This study aimed to investigate the association of the proximal landing zone and its morphology with long-term outcomes in patients with TBAD or IMH. A total of 94 patients who underwent TEVAR for TBAD or IMH between 10/2003 and 01/2020 were included. The cohort was divided according to the proximal landing in Ishimaru zone 2 or 3 and the presence of a healthy landing zone (HLZ; non-dissected or aneurysmatic, ≥2 cm length). Primary outcome was freedom from aortic reintervention. Secondary endpoints were freedom from aortic growth, stroke, spinal cord ischemia, retrograde dissection, proximal stent-graft induced new entry (pSINE), debranching failure, and mortality. Outcomes were assessed using Cox proportional hazard models with mortality as a competing risk. A proximal TEVAR landing in zone 2 was associated with higher rates of reinterventions compared to zone 3 (33% vs. 15%, p = 0.031), spinal cord ischemia (8% vs. 0%, p = 0.037), and pSINE (13% vs. 2%, p = 0.032). No difference was found for the other outcomes, including mortality. Landing in dissected segments was not associated with impaired results. Proximal TEVAR landing in zone 3 may be preferable with regard to long-term aortic reintervention in patients with TBAD or IMH

Delirium

60 unnumbered pages : color illustrations Printed by archival inkjet in a numbered edition of 30 copies, signed. Delirium is a book born of the Covid-19 pandemic and time spent in lock-down. The text uses a paragraph from the 1866 masterpiece Crime and Punishment by Fyodor Dostoyevsky. Towards the end of the book, his protagonist, Rodion Romanovich Raskolnikov, has a feverish dream. This strangely prophetic text is quoted and used as the narrative line in this book. Highly manipluated images of jewel-like approximations of the corona virus appeared all over the web in the first few months of the pandemic and serve as the illustrations --information sheet laid in. Delirium is printed in 2020 by archival inkjet on acid-free Mohawk paper in a signed and numbered edition of 30. It has been handbound by the artist. The font used is Northwoods, by Cultivated Mind Foundry in Vancouver, BC, Canada. It was chosen because it is similar to a 19th century schoolbook printer typeface, yet still appears quite modern. Like many of their fonts, Northwoods was originally created with a sign-painters brush. --Colophon. Mounted sticker on box: Winner of 2020 AIGA 50 Books / 50 Covers, one of best 50 books of 2020. Library has copy no. 25. In phase box.https://digitalcommons.risd.edu/specialcollections_artistsbooks/1447/thumbnail.jp

Role of Hepatic Stellate Cells in the Early Phase of Liver Regeneration in Rat: Formation of Tight Adhesion to Parenchymal Cells

We investigated activation mechanisms of hepatic stellate cells (HSCs) that are known to play pivotal roles in the regeneration process after 70% partial hepatectomy (PHx). Parenchymal liver cells (PLCs) and non-parenchymal cells (NPLCs) were isolated and purified from the regenerating livers at 1, 3, 7, 14 days after PHx. Each liver cell fraction was stained by immunocytochemistry using an anti-desmin antibody as a marker for HSCs, anti-alpha-smooth muscle actin (alpha-SMA) as a marker for activated HSCs, and 5-bromo-2'-deoxyuridine (BrdU) for detection of proliferating cells. Tissue sections from regenerating livers were also analyzed by immunohistochemistry and compared with the results obtained for isolated cell fractions. One and 3 days after PHx, PLC-enriched fraction contained HSCs adhered to PLCs. The HSCs adhered to PLCs were double positive for BrdU and alpha-SMA, and formed clusters suggesting that these HSCs were activated. However, HSC-enriched fraction contained HSCs not adhered PLCs showed positive staining for anti-desmin antibody but negative for anti-alpha-SMA antibody. These results suggest that HSCs are activated by adhering to PLCs during the early phase of hepatic regeneration

Relevance of Type II Endoleak After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms: A Retrospective Single-Center Cohort Study

Introduction: Endovascular aortic repair (EVAR) is widely used as an alternative to open repair in elective and even in emergent cases of ruptured abdominal aortic aneurysm (rAAA). One of the most frequent complications after EVAR is type II endoleak (T2EL). In elective therapy, evidence-based therapeutic recommendations for T2EL are limited. Completely unclear is the role of T2EL after EVAR for rAAA (rEVAR). This study aims to investigate the significance of T2ELs after rEVAR. Patients and methods: This is a retrospective single-center data analysis of all patients who underwent rEVAR between January 2010 and December 2020 with primary T2EL. The outcome criteria were overall and T2EL-related mortality and reintervention rate as well as development of aneurysm diameter over follow-up (FU). Results: During the study period between January 2010 and December 2020, 35 (25%) out of 138 patients with rEVAR presented a primary postoperative T2EL (age 74±11 years, 34 males). At rupture, mean aneurysm diameter was 73±12 mm. Follow-up was 26 (0–172) months. The reintervention-free survival was 69% (95% confidence interval [CI]: 55%–86%) at 30 days, 58% (95% CI: 43%–78%) at 1 year, and 52% (95% CI: 36%–75%) at 3 years. In 40% (n=14), T2ELs resolved spontaneously within a median time of 3.4 (0.03–85.6) months. The overall and T2EL reintervention rates were 43% (n=15) and 9% (n=3), respectively. Within 30 days, 11 patients (31%) required reintervention, of which 2 were T2EL related. Aneurysm sac growth by ≥5 mm was seen in 3 patients (9%), and aneurysm shrinkage rate was significantly higher in sealed T2EL group (86% vs 5%, p<0.0001). The overall survival was 85% (95% CI: 74%–98%) at 30 days, 75% (95% CI: 61%–92%) at 1 year, and 67% (95% CI: 51%–87%) at 3 years. Six deaths were aneurysm related, while 1 was T2EL related within the first 30 days due to persistent hemorrhage. During FU, one more patient died due to a T2EL-related secondary rupture (T2EL-related mortality, 5.7%, n=2). Multivariable analysis revealed that arterial hypertension was associated with an increased risk for reintervention (hazard ratio [HR]: 27.8, 95% CI: 1.48–521, p=0.026) and age was associated with an increased risk for mortality (HR 1.14, 95% CI: 1.04–1.26, p=0.005). Conclusion: T2ELs after rEVAR showed a benign course in most cases. In the short term, the possibility of persistent bleeding should be considered. In the mid term, a consequent FU protocol is required to detect known late complications after EVAR at an early stage and to prevent secondary rupture and death