Aggressive Strategies Research Articles

Elevated reactive aggression in forebrain‐specific Ccn2 knockout mice

AbstractCellular communication network factor 2 (CCN2) is a matricellular protein that plays important roles in connective tissue. CCN2 is also expressed in the nervous system; however, its role is still unclear. To explore CCN2 function in the brain, we generated forebrain‐specific Ccn2 knockout (FbCcn2 KO) mice. In this study, we examined the behavioral phenotypes of FbCcn2KO mice. Male mice lacking CCN2 in the forebrain exhibited normal locomotion, sensorimotor gating, and social behaviors but signs of anxiety and elevated reactive aggression. We checked the c‐fos expression in aggression‐related brain regions following the resident‐intruder task (RIT), an aggression test. RIT‐induced c‐fos levels in the medial amygdala (MeA) were higher in FbCcn2−/− mice as compared to controls. However, in the prefrontal cortex, RIT‐induced c‐fos levels in FbCcn2−/− mice were lower than controls. Our results suggested in male mice lacking CCN2 in the olfaction‐related regions, olfactory social cues elicit greater signals in the MeA, resulting in greater reactive aggression in the RIT. Further, lacking CCN2 in the prefrontal cortex, the major area related to inhibitory control and emotion regulation, may lead to signs of anxiety and the failure to suppress aggressive behaviors. Our model is useful in elaborating the mechanism underlying reactive aggression and therapeutic strategies.

Estimation of Optimal Hedge Ratio: A Wild Bootstrap Approach

This paper proposes a new approach to estimating the minimum variance hedge ratio (MVHR) based on the wild bootstrap and evaluates the approach using a spectrum of conservative to aggressive alternative hedging strategies associated with the percentiles of the MVHR’s bootstrap distribution. This approach is suggested to be more informative and effective relative to the conventional method of hedging solely based on a single-point estimate. Furthermore, the percentile-based MVHRs are robust to influential outliers, non-normality, and unknown forms of heteroskedasticity. The bootstrap percentile-based hedging strategies’ effectiveness is compared with those from the naïve method and the asymmetric DCC-GARCH model for a range of financial assets and commodities. The bootstrap percentile-based hedging technique is identified to outperform its alternatives in terms of hedging effectiveness, downside risk, and return variability, suggesting its superiority to other methods in both the literature and in practice.

Banking on Efficiency: A Comparative Analysis of Working Capital Management with respect to SBI and AXIS Banks

Working capital management is crucial in this day of Globalization, privatization, and liberalization. Modern companies must use both aggressive and conservative approaches. It is clear that the corporation reduces its working capital to accept more risk in exchange for larger gains and losses; conversely, it increases its working capital level to increase liquidity. To get adequate working capital, a corporation must strike a balance between profitability and liquidity. This study looks at how public and private sector banks managed their working capital between 2008 and 2013. Financial ratios were calculated, and the banks' financial statements for the relevant period were inspected. This study attempts to identify the primary reasons of short-term funding challenges at public and private sector banks. It demonstrates the importance of working capital management in public and private sector banks and, using the T test, the cause of short-term insolvency. It may be claimed that both public and private sector banks are adopting an aggressive strategy, focused on profit maximization while not ignoring short-term solvency

Short-term Functional Outcomes and Treatment Trends between Branch Atheromatous Disease and Lacunar Infarction: Retrospective Cohort Study of the Nationwide Multicenter Registry.

Branch atheromatous disease (BAD) is a form of ischemic stroke that presents with imaging findings similar to those of lacunar infarction, but has a different pathogenesis and is known to cause progressive paralysis. Due to regional variations, the epidemiology of BAD is not wellunderstood, and its relationship with functional prognosis remains unclear. Using a comprehensive Japanese stroke database, we investigated its epidemiological characteristics and associations with functional outcomes. In this multicenter cohort study, we retrospectively analyzed data from the Saiseikai Stroke Database (2013-2021) including 27 hospitals. We used multivariable logistic regression to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of BAD compared with LI for functional outcomes at discharge. Ischemic stroke caused by BAD or LI was included and demographic characteristics and clinical data were evaluated and contrasted between BAD and LI. Of the 5,966 analyzed patients, 1,549 (25.9%) had BAD and 4,434 (74.1%) had LI. BAD was associated with worse functional outcomes (adjusted OR of 2.77, 95%CI: 2.42-3.17, relative to LI) and extended hospital stays (median 19 days for BAD vs. 13 days for LI). Moreover, aggressive treatment strategies, including the use of argatroban and dual antiplatelet therapy, were more common in BAD patients. BAD presented worse functional outcomes and longer hospital stays than LI, necessitating treatment plans that take into account its progression and prognosis.

Analysis Of Local Msme Development Strategy "Vis A Vis" The Development Of National Chain Minimarket Retail In Palembang City

The phenomenon of the proliferation of National Chain Minimarket Retail Groups has become a scourge for local MSMEs in Indonesia. Although the government continues to provide space for local MSMEs through Permendagri No. 53/M-DAG/PER/12/2008 which requires the establishment of minimarkets to pay attention to the existence of traditional markets and smaller neighborhood stalls/shops. However, some regions are actually utilizing the momentum of the existence of modern minimarkets, one of which is Yogyakarta through the Mayor's Regulation which issued a policy so that the national chain minimarket retail group empowers local MSMEs and is given a special place to market local products. Palembang, which is known for its pempek as a culinary specialty, has enormous potential for the development of local MSMEs, but MSME players who become industry players are still not ideal. This study aims to analyze how the development strategy of Local MSMEs "vis a vis" the massive development of national chain minimarket retail in Palembang City. This research uses a mixed method approach, which consists of two approaches, namely quantitative and qualitative. Mixed methods used are descriptive qualitative using SWOT analysis (strengths, weaknesses, opportunities, threats) to analyze the development strategy of local MSMEs in Palembang City. As well as quantitative descriptive using the IFAS and EFAS matrix to calculate the weighting, rating, and formulation of the development strategy position of Local MSMEs in Palembang City. The results of this study indicate that based on the results of the SWOT diagram analysis, the X and Y axes are obtained. The straight line in the diagram above shows the coordinates in quadrant 1 position. Quadrant 1 is a very favorable situation, where local wisdom MSME players can have strengths and opportunities that can be utilized so that it is suitable to use the SO (strength-opportunity) strategy to develop local wisdom MSME businesses supported by aggressive growth strategies, namely 1) Maintaining Public Interest by Optimizing Support Programs from the Government; 2) Optimizing Sales Without Limiting Target Markets both domestically and abroad; 3) Utilizing Community Expertise to Intervene Local Products to National Chain Minimarkets; and Creating Training Programs from the Association of Local Culinary Business Groups to Maintain the Authentic Taste of Products.

Healthcare costs and medical utilization patterns associated with painful and severe painful diabetic peripheral neuropathy.

Painful diabetic peripheral neuropathy (DPN) is a common complication in patients with diabetes. It is associated with a poor quality of life and high costs of care. This study investigated the impact of painful DPN on healthcare costs and resource utilization. This was a retrospective analysis of administrative claims of adult patients with diabetes (type 1 or 2) from Optum's de-identified Clinformatics® Data Mart Database. Patients were assigned to four cohorts by presence of DPN and pain severity, based on diagnoses and prescription patterns in a one-year baseline. All-cause and diabetes-associated costs were calculated for the year following the index DPN diagnosis. Risk factors associated with presence of severely painful DPN were evaluated. Relative to those without DPN, patients who had DPN without pain, painful DPN (PDPN), or severe PDPN incurred respective increases of $3,093, $9,349, and $20,887 in average annual all-cause costs. More than half of costs from painful/severe DPN were for prescriptions and inpatient hospitalization. Severe PDPN was associated with elevated odds of diabetic amyotrophy (OR: 8.09; 95% CI: 6.84-9.56), diabetic foot ulcers (OR: 6.54, 95% CI: 6.32-6.76), and loss of mobility (OR: 2.54, 95% CI: 2.48-2.60), among other complications. Painful DPN is associated with higher healthcare costs and resource utilization, and a greater risk of debilitating conditions that limit quality of life. Future research should focus on better treatment options and more aggressive pain management strategies to reduce the negative impacts of DPN.

Strategic Management to Increase Visitors of Mount Kayoe Putih, Kupang Village, Mojokerto District

This study aimed to describe and analyze the strategic management to increase tourist visits to Bukit Kayoe Putih in Desa Kupang, Kabupaten Mojokerto. Using a SWOT analysis approach, this research highlighted the potential and challenges faced by this tourist attraction. The study employed a descriptive qualitative method with data collection techniques including interviews, observations, and documentation. The analysis results indicated that Bukit Kayoe Putih was well-suited to employ aggressive strategies and SO strategies to enhance tourist visits. The recommended strategies included the development of tourist attractions, conservation of eucalyptus trees, involvement of the local community in tourism development, and increased socialization with the local community. Additionally, infrastructure improvements, enhancement of tourist facilities, and better service quality were also the focus of tourism development strategies at Bukit Kayoe Putih. It was hoped that the findings of this study would contribute positively to increasing tourist visits and improving the local community's economy in the region.

Densification of Alloying Anodes for High Energy Lithium-Ion Batteries: Critical Perspective on Inter- Versus Intra-Particle Porosity.

High Li-storage-capacity particles such as alloying-based anodes (Si, Sn, Ge, etc.) are core components for next-generation Li-ion batteries (LIBs) but are crippled by their intrinsic volume expansion issues. While pore pre-plantation represents a mainstream solution, seldom do this strategy fully satisfy the requirements in practical LIBs. One prominent issue is that porous particles reduce electrode density and negate volumetric performance (WhL-1) despite aggressive electrode densification strategies. Moreover, the additional liquid electrolyte dosage resulting from porosity increase is rarely noticed, which has a significant negative impact on cell gravimetric energy density (Whkg-1). Here, the concept of judicious porosity control is introduced to recalibrate existing particle design principles in order to concurrently boost gravimetric and volumetric performance, while also maintaining the battery's cycle life. The critical is emphasized but often neglected role that intraparticle pores play in dictating battery performance, and also highlight the superiority of closed pores over the open pores that are more commonly referred to in the literature. While the analysis and case studies focus on silicon-carbon composites, the overall conclusions apply to the broad class of alloying anode chemistries.

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for pancreatic cystic lesions: current status and future prospects.

Pancreatic cystic lesions (PCLs) have increased in prevalence due to the increased usage and advancements in cross-sectional abdominal imaging. Current diagnostic techniques cannot distinguish between PCLs requiring surgery, close surveillance, or expectant management. This has increased the morbidity and healthcare costs from inappropriately aggressive and conservative management strategies. Endoscopic ultrasound (EUS) needle-based confocal laser endomicroscopy (nCLE) allows for microscopic examination and delineation of the surface epithelium of PCLs. Landmark studies have identified characteristics distinguishing various types of PCLs, confirmed the high diagnostic yield of EUS-nCLE (especially for PCLs with an equivocal diagnosis), and shown that EUS-nCLE helps to change management and reduce healthcare costs. Refining procedure technique and reducing procedure length have improved the safety of EUS-nCLE. The utilization of artificial intelligence and its combination with other EUS-based advanced diagnostic techniques would further improve the results of EUS-based PCL diagnosis. A structured training program and device improvements to allow more complete mapping of the pancreas cyst epithelium will be crucial for the widespread adoption of this promising technology.

Statistical Analysis of Overseas Tourist Arrivals to South Africa in Assessing the Impact of COVID-19 on Sustainable Development

The COVID-19 pandemic has harmed the global tourism and hospitality industry, crippling foreign currency earnings and employment in many countries, South Africa (SA) included. This study aims to evaluate the impact of the COVID-19 pandemic on overseas tourist arrivals to SA, and to make an inference on the country’s foreign currency earnings on economic development. The Box–Jenkins methodology is used in fitting non-seasonal integrated autoregressive moving average (ARIMA) and seasonal ARIMA (SARIMA) models to quantify and characterise the number of overseas tourists to SA. The ARIMA 1,0,1(0,1,1)12 model is the best fitting model for the overseas tourist arrivals data to SA, as confirmed by the Akaike Information Criterion (AIC). The model shows good forecasting power in the absence of the COVID-19 pandemic, as evidenced by the validation results. The difference between forecasts and actual values after the validation phase shows the negative impact of the COVID-19 pandemic on overseas tourist arrivals to SA and the challenges it poses to the statistical modelling of tourist arrivals to SA, considering the pandemic was the first of its kind. The COVID-19 pandemic exposed the tourism industry’s vulnerability to economic shocks, showing the need for aggressive marketing strategies that may revamp the tourism sectors to levels previously expected before and or after COVID-19 for sustainable development.

Treatment and Staging Intensification Strategies Associated with Radical Prostatectomy for High-Risk Prostate Cancer: Efficacy Evaluation and Exploration of Novel Approaches.

The management of high-risk prostate cancer (PCa) presents a significant clinical challenge, often necessitating treatment intensification due to the potential presence of micrometastases. While radical prostatectomy (RP) constitutes one of the primary treatment modalities, the integration of neoadjuvant and adjuvant therapies suggests a paradigm shift towards more aggressive treatment strategies, also guided by new imaging modalities like positron emission tomography using prostate-specific membrane antigen (PSMA-PET). Despite the benefits, treatment intensification raises concerns regarding increased side effects. This review synthesizes the latest evidence on perioperative treatment intensification and de-escalation for high-risk localized and locally advanced PCa patients eligible for surgery. Through a non-systematic literature review conducted via PubMed, Scopus, Web of Science, and ClinicalTrials.gov, we explored various dimensions of perioperative treatments, including neoadjuvant systemic therapies, adjuvant therapies, and the role of novel diagnostic technologies. Emerging evidence provides more support for neoadjuvant systemic therapies. Preliminary results from studies suggest the potential for treatments traditionally reserved for metastatic PCa to show apparent benefit in a non-metastatic setting. The role of adjuvant treatments remains debated, particularly the use of androgen deprivation therapy (ADT) and adjuvant radiotherapy in patients at higher risk of biochemical recurrence. The potential role of radio-guided PSMA lymph node dissection emerges as a cutting-edge approach, offering a targeted method for eradicating disease with greater precision. Innovations such as artificial intelligence and machine learning are potential game-changers, offering new avenues for personalized treatment and improved prognostication. The intensification of surgical treatment in high-risk PCa patients is a dynamic and evolving field, underscored by the integration of traditional and novel therapeutic approaches. As evidence continues to emerge, these strategies will refine patient selection, enhance treatment efficacy, and mitigate the risk of progression, although with an attentive consideration of the associated side effects.

The Predictive Value of Estimation of N Terminal - Pro B- Type Natriuretic Peptide in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention for the Outcome of Myocardial Reperfusion

Abstract Background Primary PCI is considered to be the preferred reperfusion strategy for STEMI. The goal of reperfusion is to resume normal blood flow to the cardiac tissues, and not just to achieve an open epicardial artery. Aim of the work The aim of this study was to evaluate the predictive value of NT-pro BNP before primary PCI in patients presenting with STEMI, for myocardial reperfusion assessed by the degree of ST resolution in the ECG 90 minutes post primary PCI, the TIMI flow and the MBG post primary PCI. Patients and Methods This study included 40 patients who presented to emergency departments of Ain Shams University hospitals and Misr University for Sciences and Technology hospital from September 2021 till June 2022, diagnosed with STEMI and had been revascularized by primary PCI as per the recommendations of The European society of cardiology guidelines for diagnosis and management of ST elevation myocardial infarction published in 2017. Serum samples for NT-pro BNP level were obtained before primary PCI to be correlated with the TIMI flow grade, the MBG, and the ST resolution post primary PCI. Results Our study had demonstrated that a higher baseline NT-pro BNP level is significantly associated with higher risk of poor myocardial reperfusion following primary PCI expressed by ST resolution less than 50%, TIMI flow grade less than 3 as well as MBG less than 3 and was also associated with higher incidence of No Reflow. Conclusion Initial NT-pro BNP level in STEMI patients correlates with myocardial reperfusion following primary PCI. This supports the potential use of NT-pro BNP as an early marker for risk stratification of patients with STEMI. High risk patients will be in need of more aggressive complementary treatment strategies to improve microvascular perfusion and optimization of the medical therapies to help decrease the development of heart failure.

Lambda-like ST-elevation in Acute MI: A Risk Predictor of Fatal Ventricular Arrhythmia

Despite the increasing use of reperfusion strategies and guideline-directed medical therapy, acute MI remains a leading cause of mortality. Certain ECG abnormalities are associated with lethal ventricular arrhythmia and significant in-hospital mortality during acute MI. This report presents a case of fatal ventricular arrhythmia in a patient with acute MI, highlighting a specific ECG finding – lambda-like ST-elevation. Lambda-like ST-elevation on the ECG in acute MI may serve as a critical indicator for clinicians, predicting the risk of fatal ventricular arrhythmias, cardiogenic shock and sudden cardiac death. Early recognition and aggressive intervention strategies could significantly reduce morbidity and mortality.

Addressing urban social and spatial stratification: testing the potential for integration of public housing

The legacy of public housing in the American city is dominated by a condition of social and spatial stratification. In New York City, inadequate funding exacerbates the conditions of isolated public housing residents, raising questions about the stability and sustainability of public housing. At a time when a severe housing crisis is impacting on the affordability of and access to urban housing generally, addressing this legacy of public housing can be the impetus for a long-term vision that integrates public housing into the fabric of the city, providing new housing options for public housing residents while merging them into mixed-income neighbourhoods with redefined public spaces and increased services and amenities. This approach to a long-term vision, built around high-density mid-rise development, contrasts with the incremental approach currently expedient due to the social and political climate surrounding public housing. However, current resistance to an aggressive strategy belies another part of the legacy of public housing: the major demolition of city streets and blocks that made possible the anti-urban planning that undergirds this isolation and stratification. Empirical evidence supports urban design that builds on the nineteenth-century city’s urban form of small blocks and active streets as the foundation for vital urban neighbourhoods. This study of the political and urban design efforts to address the severe challenges facing public housing tests the potential for a path, when the political and social climate allows, for an aggressive strategy to preserve public housing that centres on social and spatial integration.

Tax aggressiveness in a scenario of economic crisis and financial difficulty: an analysis of companies listed on B3

Objective: This study aimed to examine the relationship between economic crisis scenarios, financial difficulties, and tax aggressiveness in companies listed on B3. Methodology: This descriptive and documentary study employed a quantitative approach, incorporating a sample of 326 companies. Data analysis entailed using descriptive statistics and regression analysis with panel data. Results: The findings of this study suggest that a crisis environment does not promote the adoption of aggressive tax strategies by the companies within the sample. This contradicts established literature, which has posited that there is a heightened effort to decrease tax liability during periods of crisis. Nonetheless, it was observed that companies experiencing financial difficulties tend to adopt aggressive tax strategies in an effort to alleviate their tax burdens. Study Contributions: This research aims to contribute to discussing tax aggressiveness among Brazilian companies during economic crises, pointing out discrepancies with previous studies. Additionally, it seeks to broaden the understanding of tax aggressiveness in situations of crisis and financial difficulty, thereby enhancing the body of knowledge in the tax domain.

Strategi Pengembangan Usaha Ternak Kerbau di Kabupaten Sumba Timur

Buffalo livestock in the culture of the people of East Sumba have a large role, both as working livestock, social and cultural livestock such as traditional mourning events, weddings and traditional houses. However, the government's role in developing the buffalo farming business is very low and the lack of development by breeders causes a decline in buffalo livestock productivity, resulting in a decline in population and an impact on fluctuating buffalo livestock prices. This research aims to: (1) develop a strategy for developing the buffalo population in East Sumba Regency. This research uses SWOT analysis to formulate a strategy for developing a buffalo livestock business. This research uses a survey method and purposive sampling with the minimum criteria of having three buffalo, having sold livestock in the last two years and being a fairly influential figure in the village. Primary and secondary data are used to answer the objectives of this research. The results of the SWOT analysis show that the buffalo farming business is in quadrant I with an X value = 0.16 and a Y value = 0.52. The strategy used is an aggressive strategy. The strategy for developing buffalo livestock is optimizing pastures by using feed processing technology so that feed is always available and increasing the production and productivity of buffalo livestock to maintain the availability and demand for buffalo livestock.

Effect of GST on WCM and Profitability of FMCG Sector in India

Working capital primarily consists of a company’s current assets, or the part of its financial resources that are converted from one kind of resource to another as operations are carried out on a daily basis. Working capital management is regarded as a key component of a company’s profitability. This study examines the working capital relationship with firm’s profitability. An optimal working capital is essential for enhancing the value of an organization. The impact of GST is significantly evident on all transactions of FMCG sectors, especially during stock transfer between two branches of a company, during which period the funds get blocked. This study considered 55 FMCG manufacturing firms, listed in BSE for a period of 12 years starting from 2012 to 2023. Multiple regression model was used to test the hypothesis. The study established a low working capital turnover ratio, which indicates quick realization of inventory, and creates the demand for funds to procure more stock for production purpose. The working capital turnover was used to gauge aggressive investing practices. An aggressive investment strategy is indicated by a low working capital turnover ratio, and a conservative strategy is indicated by a high ratio.

Primary mediastinal small cell neuroendocrine carcinoma in a young man: a rare case report

A mediastinal small cell neuroendocrine carcinoma (MSCNEC) is a rare form of neuroendocrine tumor (NET). Due to its aggressive nature, it often recurs after treatment and has a high tendency to metastasize or spread to other parts of the body, such as the lymph nodes, lungs, liver, bones, or brain. Because of its rarity and aggressive behavior, managing MSCNEC can be challenging. However, the prognosis for this type of cancer is generally poorer compared to some other types of NETs, highlighting the need for early detection and aggressive treatment strategies. Here, we report a case of a 28-year-old nonsmoker man with small cell carcinoma of the lung presenting as a mediastinal mass with superior vena cava syndrome.

Clinical Prediction Rules for In-Hospital Mortality Outcome in Melioidosis Patients.

Melioidosis, a disease induced by Burkholderia pseudomallei, poses a significant health threat in tropical areas where it is endemic. Despite the availability of effective treatments, mortality rates remain notably elevated. Many risk factors are associated with mortality. This study aims to develop a scoring system for predicting the in-hospital mortality from melioidosis using readily available clinical data. The data were collected from Surin Hospital, Surin, Thailand, during the period from April 2014 to March 2017. We included patients aged 15 years and above who had cultures that tested positive for Burkholderia pseudomallei. The clinical prediction rules were developed using significant risk factors from the multivariable analysis. A total of 282 patients with melioidosis were included in this study. In the final analysis model, 251 patients were used for identifying the significant risk factors of in-hospital fatal melioidosis. Five factors were identified and used for developing the clinical prediction rules, and the factors were as follows: qSOFA ≥ 2 (odds ratio [OR] = 2.39, p= 0.025), abnormal chest X-ray findings (OR = 5.86, p < 0.001), creatinine ≥ 1.5 mg/dL (OR = 2.80, p = 0.004), aspartate aminotransferase ≥50 U/L (OR = 4.032, p < 0.001), and bicarbonate ≤ 20 mEq/L (OR = 2.96, p = 0.002). The prediction scores ranged from 0 to 7. Patients with high scores (4-7) exhibited a significantly elevated mortality rate exceeding 65.0% (likelihood ratio [LR+] 2.18, p < 0.001) compared to the low-risk group (scores 0-3) with a lower mortality rate (LR + 0.18, p < 0.001). The area under the receiver operating characteristic curve (AUC) was 0.84, indicating good model performance. This study presents a simple scoring system based on easily obtainable clinical parameters to predict in-hospital mortality in melioidosis patients. This tool may facilitate the early identification of high-risk patients who could benefit from more aggressive treatment strategies, potentially improving clinical decision-making and patient outcomes.

Aggressive Treatment Strategy at Index Thoracic Endovascular Aortic Surgery is Associated with Reduced Need for Short-Term Reintervention in Patients with Aortic Dissection

Thoracic endovascular aortic surgery (TEVAR) is the modern standard of treatment for patients with Type B aortic dissection, however it is unclear how the initial length of treated aorta affects long-term outcomes. This study aims to elucidate risk factors for secondary intervention after TEVAR for aortic dissection, focusing on length of aortic treatment at index operation. A retrospective multihospital chart review was completed for patients treated between 2011 and 2022 who underwent TEVAR for aortic dissection with at least 1year of post-TEVAR imaging and follow-up. Patient demographics and characteristics were analyzed. In this study, aortic zones treated only included those managed with a covered stent graft. The primary outcome measure was any need for secondary intervention. A total of 151 patients were identified. Demographics included a mean age of 57years, with 31.8% of the patients being female. Forty-three patients (28.5%) underwent secondary intervention after TEVAR, with a mean follow-up of 1.6years. The most common indication for secondary intervention was aneurysmal degeneration of the residual false lumen (76%). There was a significant difference in the number of aortic zones treated in patients who did and did not require secondary intervention (2.3 ± 1 vs. 2.7 ± 1, P=0.04). Additionally, patients with 3 or more aortic zones of treatment had a significant difference in the need for reintervention (32% secondary intervention versus 52% no secondary intervention, P=0.02). At least 3 zones of aortic treatment at index TEVAR is associated with a decreased need for overall reintervention. Modern treatment of acute and subacute type B dissection should stress an aggressive initial repair, balanced by the potential increased risk of spinal cord ischemia.