Notes

Significant zinc oxide launch via widely-used commercial lithopone colors beneath photo voltaic irradiation.
We observe that activity in vmPFC does not predict take/pass choices, but rather is highly associated with outcome evaluation. By contrast, both PPC and bilateral vSTR (bilaterally) mediate the relationship between expected value and choice. Interregional mediation analyses reveal that vSTR fully mediates between PPC and choice, and this is supported by DCM. Together these results suggest that vSTR, and not vmPFC nor PPC, functions as an important driver of choice. We developed a new reinforcement technique, the Gorget-Like Cuddling (GOCU) suture, to prevent suture line bleeding during aortic surgery. After continuous aortic anastomosis with thick outer felt, an additional 2-0 Ticron (Medtronic, Minneapolis, MN) suture is placed distal from the first suture line. This GOCU suture directly holds the needle holes. Wall tension on the anastomosis can also be reduced to prevent longitudinal dilatation of the aorta. This technique can contribute to hemostasis for a fragile aortic wall in cases like acute aortic dissection. OBJECTIVES to perform a post-implantation geometrical analysis and to evaluate early and mid-term outcomes of new-generation balloon-expandable covered stents, used in the kissing conformation to treat obstructive lesions involving the aortic bifurcation. METHODS a single-center retrospective review of all patients who underwent endovascular reconstruction of the aorto-iliac bifurcation for obstructive disease, with the use of Viabahn balloon expandable stents (VBX, W. L. Gore & Associates, Flagstaff, AZ-USA) deployed in the kissing conformation, from March 2018 to June 2019 was carried out. Two same-size kissing VBXs were simultaneously deployed from the distal aorta (1.5-2 cm above the aortic bifurcation) to the common iliac arteries; a kissing post-ballooning using compliant balloons was routinely performed to flare the proximal part of the VBX, in order to adapt to the aortic diameter and morphology. A post-operative angio-CT scan was obtained for all patients for the geometrical assessment. "Precision" o-up, no cases of limb occlusion or restenosis occurred. CONCLUSIONS the use of kissing VBX stents may represent a valid option for the treatment of obstructive lesions involving the aortic bifurcation, with excellent early and mid-term outcomes and achievement of optimal stents geometry. A 67 year old male with a history of aortobifemoral bypass graft (ABF) for critical limb ischaemia 10 months prior at a regional hospital was transferred to our centre with one week history of rigors and three months of a chronic discharging left groin sinus. Two months prior he had a right sided ureteric stent inserted for ureteric obstruction. Routine bloods revealed an acute on chronic renal injury and subsequent non-contrast computed tomography (CT) demonstrated left sided hydroureter and hydronephrosis suggestive of extrinsic compression by the left bypass graft limb. A new left sided ureteric stent was inserted and the right exchanged with no gross signs of infection. His impaired renal function precluded intravenous contrast and so a CT with oral contrast showed circumferential oral contrast and gas surrounding the right limb of his ABF. Urgent gastroscopy revealed periprosthetic erosion with the ABF limb traversing the distal third part of the duodenum. He underwent bilateral axillofemoral bypass grafts, laparotomy with explantation of the ABF and primary duodenojejunostomy. Bilateral ureters were compressed by overlying graft limbs. Bilateral groins were infected with frank pus on exploration and were associated with impending anastomotic disruption of his previous ABF distal anastomoses. His postoperative course was complicated by colonic ischaemia with perforation leading to irreversible multi-organ failure. This patient was remarkably well on presentation with life threatening pathology. He had no abdominal symptoms or gastrointestinal bleeding. This case demonstrates the diagnostic and management difficulties of periprosthetic erosions and the consequences of graft tunneling superficial to ureters. PURPOSE To describe a modification technique using the low-profile Cook Zenith Alpha™ thoracic stent graft, and addition of a preloaded wire system, for urgent repair of pararenal (PRA) and thoracoabdominal (TAAA) aortic aneurysms. METHODS We analyzed 20 consecutive patients who underwent urgent physician modified endograft (PMEG) repair of PRA and TAAA at two institutions. The low-profile Cook Zenith Alpha™ Thoracic stent graft was modified in according with each specific patient anatomic characteristics. Endpoints were technical success, 30-day mortality and major adverse events (MAEs). RESULTS Technical success was achieved in all patients (100%). A total of 76 renal-mesenteric arteries were incorporated by fenestrations (70%) or directional branches (30%) with an average of 3.7±0.6 vessels per patient. There were six different types of stent configuration. The most common design consisted of four fenestrations (nine patients, 45%). The average of modification time was 110±27 minutes. Total procedure time (including the time for open component) was 242±75 minutes. There was no death within the first 30-day or hospital stay. MAEs occurred in 10 patients (50%). The most common MAEs were acute kidney injury (by RIFLE criteria) in six patients (30%), EBL >1 L and respiratory failure requiring reintubation in two patients (10%) each, paraplegia and ischemic colitis in one patient (5%) each. One patient (5%) required temporary, new-onset dialysis. selleck chemicals CONCLUSION PMEG using low - profile Zenith Alpha™ thoracic stent graft was safe with no early mortality and acceptable early morbidity. OBJECTIVES To evaluate the feasibility and midterm outcomes of iliac branch devices (IBDs) to preserve the internal iliac artery (IIA) perfusion in emergent endovascular repair of ruptured aorto-iliac aneurysms. METHODS Between December 2012 and July 2017, a total of 8 IBDs were implanted in 6 patients (median age 65 years; all men) in a single tertiary referral center. The indication for IBD implantation was a ruptured abdominal aortic aneurysm with a concomitant common iliac artery (CIA) aneurysm (n=4) or an isolated CIA aneurysms (n=2). The main outcome measures were technical and clinical success. Secondary outcomes were primary and primary assisted patency, occurrence of types I/III endoleaks and re-interventions. RESULTS All patients were hemodynamically stable during the procedures, which were performed under local anesthesia. Technical success was achieved in all cases (median total procedure time 188 min, median IBD procedure time 28 min). Median follow-up was 34 months (IQR 19 -78). There were no deaths during follow up and no major complications unrelated to the IBD.
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