Complicated Type Research Articles

DISSEMINATED STRONGYLOIDIASIS IN A PATIENT WITH ACUTE LYMPHOCYTIC LEUKEMIA

DISSEMINATED STRONGYLOIDIASIS IN A PATIENT WITH ACUTE LYMPHOCYTIC LEUKEMIA

A CASE OF MYCOBACTERIUM AVIUM COMPLEX PULMONARY INFECTION WITH SEVERE EOSINOPHILIA TREATED WITH MEPOLIZUMAB

A CASE OF MYCOBACTERIUM AVIUM COMPLEX PULMONARY INFECTION WITH SEVERE EOSINOPHILIA TREATED WITH MEPOLIZUMAB

INVASIVE PULMONARY FUSARIOSIS WITH SUPERIMPOSED HISTOPLASMOSIS IN AN IMMUNOCOMPETENT HOST

INVASIVE PULMONARY FUSARIOSIS WITH SUPERIMPOSED HISTOPLASMOSIS IN AN IMMUNOCOMPETENT HOST

NON-HODGKIN FOLLICULAR LYMPHOMA COMPLICATED BY HISTOPLASMOSIS-INDUCED CHYLOTHORAX AND PNEUMOHYDROPERICARDITIS SECONDARY TO AN ESOPHAGOPERICARDIAL FISTULA

NON-HODGKIN FOLLICULAR LYMPHOMA COMPLICATED BY HISTOPLASMOSIS-INDUCED CHYLOTHORAX AND PNEUMOHYDROPERICARDITIS SECONDARY TO AN ESOPHAGOPERICARDIAL FISTULA

FATAL ASPERGILLUS TRACHEOBRONCHITIS IN AN IMMUNOCOMPROMISED HOST ASSOCIATED WITH PARAINFLUENZA VIRUS INFECTION

FATAL ASPERGILLUS TRACHEOBRONCHITIS IN AN IMMUNOCOMPROMISED HOST ASSOCIATED WITH PARAINFLUENZA VIRUS INFECTION

The interaction of verbal and non-verbal components in English methodical discourse

The article presents and analyzes the examples of creolized texts of the English-language methodological discourse in order to identify and describe the relationship between verbal and non-verbal components. The importance of referring to such a semiotically complicated type of texts in modern linguistics is discussed. The author supports the idea that the methodical discourse, which is part of the institutional one, is dialogic in nature, where the communication of the participants is a crucial thing. The success of communication is ensured by the syncretic relationship of the verbal and non-verbal components of the discourse, which helps the recipient to perceive the text more fully, to decode the meanings implemented by the author. The organization of the English-language methodological discourse is analyzed in terms of the saturation of texts with verbal and non-verbal components of information transfer and their quantitative correlation. Examples from the texts of English-language books on the methodology of teaching English are considered in detail. The purpose of this study was to consider the typology of non-verbal elements in methodological texts and to determine their relationship with the verbal part (the test itself).

Sternal Fractures Due to Blunt Chest Trauma: A Diagram of Management

<p>Objective: Sternal fractures due to blunt chest trauma become more common with increasing road traffic accidents. The outcomes of patients with isolated sternal fracture are promising. However, complicated sternal fractures are associated with injuries of the thorax and other organs, and the diagnosis and treatment are challenging. This article reviews the clinical features of sternal fractures due to blunt chest trauma and sum up a management diagram. Methods: Literature was retrieved in the PubMed, Google Scholar and “Baidu” Scholar for English articles published since 2011. The recruited articles were taken as study materials of this review. Results: The misdiagnosed rate was 5.53% for chest roentgenograph and was 6.25% for sonography in diagnosing sternal fractures. Sternal fractures were a complicated type with associated injuries of other organs in an absolute majority, while they were an isolated type in only 1.17% of patients. Only small portions of patients have an abnormal electrocardiographic finding and (or) an elevated cardiac enzyme level. Surgical treatment was necessary in almost 60% of patients and conservative in about 40%. The outcomes of patients were promising and patients with a poor prognosis were usually not due to the sternal fracture but due to the associated injuries instead. Conclusions: Isolated sternal fractures do not need routine admission but a pain relief. Patients with an abnormal finding of electrocardiogram and (or) an elevated cardiac enzyme level are recommend admitted for monitoring to exclude heart injury and for necessary conservative treatment. A surgical treatment of sternal fixation of sternal fractures are warranted for majority of patients with complicated/displaced sternal fractures. The outcomes of patients are generally promising.</p> <p> </p>

Fast Quench Detection in SFCL Pancake Using Optical Fibre Sensing and Machine Learning

A fast hotspot detection technique has been implemented and patented at École Polytechnique Fédérale de Lausanne (EPFL) under the European Union project FastGrid. The optical fibre sensing based technique uses the Mach-Zehnder Interferometer (MZI) and can detect even singular hotspots in the superconductor within 15ms. The MZI setup is very sensitive to external perturbations and mechanical stresses, which can manifest in the output along with the response to hotspots. The disturbance the setup is subject to, varies with the sample being tested and the environment it is being tested in. For example, the sample length and configuration, in addition to the routing of the optical fibre can determine the extent of the stresses on the optical fibre. Previous publications, showcased experiment results on relatively simple sample configurations which were straight HTS tapes with short lengths (0.3m or 1m). This manuscript will investigate the technique feasibility for a more complicated sample type: a pancake prototype for a superconducting fault current limiter (SFCL), comprising 12m of HTS tape in a bifilar winding, with taped optical fibre along the length of the conductor. The manuscript will also give a brief overview of a machine learning based post processing technique for the experimental data, developed at EPFL to supplement the MZI based quench detection for easy and reliable quench detection in large scale applications.

Thoracoabdominal aortic aneurysmectomy in the high-risk patient

ObjectiveThe study objective was to provide a review of outcomes and management strategies for high-risk scenarios in the open repair of thoracoabdominal aortic aneurysms. MethodsSeries examining the open repair of thoracoabdominal aortic aneurysms were reviewed to identify well-described high-risk scenarios and summarize expected outcomes and management strategies in the current era. ResultsThe efforts of many have led to improved outcomes for patients undergoing the inherently challenging open repair of thoracoabdominal aortic pathologies. Several well-described high-risk scenarios include those related to preoperative comorbid conditions (preoperative pulmonary dysfunction, low ejection fraction, and renal dysfunction), anatomically high-risk cases (extent II repairs), and those with acute presentations (rupture, mycotic aneurysms, acute complicated type B aortic dissection). Several operative and perioperative techniques have been developed to mitigate the risk in these formidable cases. ConclusionsChallenges remain for several high-risk scenarios in thoracoabdominal aortic aneurysm repair. Judicious patient selection, meticulous surgical, and critical care strategies have greatly decreased the risk for many high-risk patients.

Total Arch Thoracic Endovascular Aortic Repair Using Double Fenestrated Physician-Modified Stent-Grafts: 100 Patients

Objective: The aim was to evaluate early and medium-term outcomes of double fenestrated physician-modified endovascular grafts for total endovascular aortic arch repair. Methods: This single-center retrospective analysis of prospectively-collected data included 100 patients, from January 2017 to December 2021, undergoing thoracic endovascular aortic repair (TEVAR) for zone 0. The fenestrations were a proximal larger fenestration that incorporated the brach2iocephalic trunk and left common carotid artery and a distal smaller fenestration for the left subclavian artery (LSA). Only the LSA fenestration was stented. Results: The median duration for stent-graft modification was 23±6 minutes. Of the 100 patients, 70 were men. The mean patient age was 70±10.5 years. Indications for treatment included degenerative aortic arch aneurysm (n=32), dissecting aortic arch aneurysm after type A dissections (n=23) and (n=19) after type B dissections, acute complicated type B dissection (n=16), and other pathologies (n=10). Technical success rate was 97%. The 30 day mortality was 2% (n=2). Four patients (4%) had minor stroke with full recovery. One patient (1%) had a type IA endoleak, 1 patient (1%) had a type IB endoleak, and 2 patients (2%) have a type II endoleak from the LSA. Eight patients (8%) required reintervention: 1 type IA endoleak, 1 type IB endoleak, 1 retrograde type A dissection, and 5 because of access-related complications. During a mean follow-up of 24±7.2 months, there were no aortic rupture, paraplegia, and all supra-aortic trunks were patent. Conclusions: Double homemade fenestrated TEVAR is both feasible and effective for total endovascular aortic arch repair avoiding the need for anatomical and extra-anatomical surgical revascularization. The long-term durability will need to be assessed in studies with long-term follow-up. Clinical Impact Double homemade fenestrated TEVAR is effective for total endovascular aortic arch repair avoiding the need for anatomical and extra-anatomical surgical revascularization. The standout feature of this double fenestrated device is its simple handling during operation with the proximal fenestrations being directed to the orifices of the BT and LCCA automatically when the LSA fenestration is catheterized and secured by covered stent placement. The deployment algorithm actively steers the operator away from superfluous manipulations of the device within the arch and avoids guidewire manipulation in carotid arteries. The long-term durability will need to be assessed in studies with long-term follow-up.

Thoracic Endovascular Aortic Repair (TEVAR) First in Patients with Lower Limb Ischemia in Complicated Type B Aortic Dissection: Clinical Outcome and Morphology.

Acute Type B aortic dissection (TBAD) can cause organ malperfusion, e.g., lower limb ischemia (LLI). Thoracic endovascular aortic repair (TEVAR) represents the standard treatment for complicated TBAD; however, with respect to LLI, data is scant. The aim of this study was to investigate clinical and morphological outcomes in patients with complicated TBAD and LLI managed with a “TEVAR-first” policy. Between March 1997 and December 2021, 731 TEVAR-procedures were performed, including 106 TBAD-cases. Cases with TBAD + LLI were included in this retrospective analysis. Study endpoints were morphological/clinical success of TEVAR, regarding aortic and extremity-related outcome, including extremity-related adjunct procedures (erAP) during a median FU of 28.68 months. A total of 20/106 TBAD-cases (18.8%, 32–82 years, 7 women) presented with acute LLI (12/20 Rutherford class IIb/III). In 15/20 cases, true lumen-collapse (TLC) was present below the aortic bifurcation. In 16/20 cases, TEVAR alone resolved LLI. In the remaining four cases, erAP was necessary. A morphological analysis showed a relation between lower starting point and lesser extent of TLC and TEVAR success. No extremity-related reinterventions and only one major amputation was needed. The data strongly suggest that aTEVAR-first-strategy for treating TBAD with LLI is reasonable. Morphological parameters might be of importance to anticipate the failure of TEVAR alone.

Chronic typeB aortic dissection-what to do?

Chronic typeB aortic dissection requires optimal medical therapy. However, secondary complications like organ or extremity malperfusion or development of aneurysmal dilatation require interventional therapy. Presentation of different endovascular treatment options for complications of chronic typeB aortic dissection. Analysis of current literature with regard to indications, techniques, results, and differential indications of interventional techniques for the treatment of chronic typeB aortic dissection complications. Endovascular implantation of an aortic stent graft is interventional standard therapy for treatment of aneurysmal dilatation of the aorta following typeB dissection. Technical problems are the proximal and distal landing zones and the treatment of persistent flow in the false lumen. Endovascular treatment of chronic complicated typeB aortic dissection is increasingly used compared to open surgical treatment because not only are more complex stent grafts (fenestrated and branched devices) available but also because of newly developed techniques for effective occlusion of flow in the false lumen (e.g., candy plug).

Cardiovascular events after a dramatic reduction of HbA1c in hospitalized subjects with type 2 diabetes and high long-term glucose exposure

ObjectiveIn long-lasting diabetes, a dramatic reduction of HbA1c can precede adverse events such as worsening retinopathies or painful neuropathies. We have now analyzed its possible link with later cardiovascular events in subjects with type 2 diabetes, according to their long-term glucose exposure evaluated by skin autofluorescence (SAF) measured with an AGE-READER (Diagnoptics, Groningen, The Netherland). Research design and methodsWe studied retrospectively a cohort of patients hospitalized for uncontrolled and/or complicated type 2 diabetes from 2009 to 2017. A previous dramatic reduction of HbA1c was defined by more than −1.5 %/4 months, and later cardiovascular events as myocardial infarction, stroke, revascularization procedures, and cardiovascular-related death. Survival analyses were performed before and after categorizing the subjects for their SAF. ResultsThe 386 subjects were 57.5 % men, 62 ± 9 years old, with a 14 ± 9 years duration of diabetes, most were treated by insulin (63.7 %). The dramatic HbA1c reducers (−3.0 ± 1.5 %) represented 16.5 % of the population. During the 51 months (IQR: 30–71) of follow-up, 53 cardiovascular events occurred and were related to the SAF (2.70 ± 0.64 AUs). Linkage was established between the SAF, the reduction of HbA1c and the cardiovascular events (p = 0.017). With a SAF higher than the median (2.65 AUs), the dramatic reduction of HbA1c was related to later cardiovascular events (HR: 3.84, 95%CI: 1.68–8.76). ConclusionsA dramatic decline of HbA1c leads to a higher risk of cardiovascular events in hospitalized subjects with type 2 diabetes and a high long-term glucose exposure.

Percutaneous contrast-enhanced ultrasound-guided transabdominal sac embolization is an effective technique for treating complicated type II endoleaks after endovascular aneurysm repair

Objective: In the present study, we evaluated and compared the outcomes of transarterial embolization with those of percutaneous contrast-enhanced ultrasound-guided transabdominal sac embolization (PUSE) for type II endoleaks (T2ELs).

Long-term outcome of patients treated by TEVAR for type B aortic dissection or intramural hematoma depending on a healthy vs non-healthy proximal landing zone

Abstract Objective Thoracic endovascular aortic repair (TEVAR) is the first-line therapy for complicated type B aortic dissection (TBAD) or intramural hematoma (IMH). However, depending on the location of the primary entry tear, there is paucity of data as to whether the proximal landing zone (PLZ) of the stent prosthesis must be in a non-dissected healthy part (healthy landing zone = HLZ) or in the dissected aorta (non-healthy landing zone= non-HLZ). Methods Retrospective analysis of patients who underwent TEVAR for acute (<14 days) or subacute (<3 months) TBAD or IMH from 2003–2020 at a single center. A HLZ was defined as a non-dissected aortic segment (length ≥2 cm). Primary endpoints were freedom from aortic reintervention and -growth (≥5 mm). Secondary endpoints involved stroke, retrograde type A aortic dissection, proximal stent graft induced new entry (pSINE), debranching failure, 30-day and overall mortality. Results 94 patients (age 70 years (interquartile-range (IQR): 59 to 78) were included. 84 (89%) presented with a TBAD and only ten (11%) with an IMH. CTA analysis revealed a HLZ in 62 (66%) patients. Debranching of the left subclavian artery was performed in 21 (22%) patients to extend the PLZ. The median follow-up time was 20 (IQR: 4.6 to 72.9) months. The overall aortic reintervention rate was 22%. Estimated re-intervention rate at 12 months was 13.1% for HLZ vs. 16.1% for non-HLZ and at 5 years 16.8% for HLZ 29.9% vs. for non-HLZ (P=0.187). Aortic growth was observed in 12 patients after 2.2 years (IQR: 0.8 to 5.9), with no significant difference in patients with HLZ vs. non-HLZ (11% vs 16%,P=0.535). No significant differences were observed for the secondary endpoints. 30-day mortality was 10% in both groups, P=1.0. Overall survival was 47% in the HLZ group vs. 41% in the non-HLZ group, P=0.663. A Cox proportional hazard model for reintervention with mortality as a competing risk showed a trend towards better long-term outcome for patients with a HLZ, hazard ratio 0.451 (95%-CI: 0.186–1.09, P=0.078). Conclusion In the majority of patients, it was possible to land in a HLZ. Consistently, reintervention rates, aortic growth, and mortality were higher in patients with non-HLZ compared with HLZ over the mid- and long-term. However, these differences were not statistically significant. Therefore, larger studies are urgently needed.

Buckling distortion investigation during thin plates butt welding with considering clamping influence

Welding induced buckling is generally considered as the most complicated type of out-of-plane welding distortion during thin plate section fabrication, which will significantly influence the fabrication accuracy and cost. Thin plates of 3 mm thickness with dissimilar materials were experimentally butt welded together beforehand, while clamping constraint by fixture jig and additional plate was employed. After cooling down and clamping release, out-of-plane welding distortions were measured, and characteristic of welding buckling behavior can be observed. Advanced thermal elastic plastic (TEP) FE computation with solid elements models of examined butt-welded joints were then carried out. Welding induced buckling can be represented without considering clamping constraint, while much larger difference between computed results and measurement data was obtained. When the influence of clamping constraint employed during welding experiment was considered, good agreement for both deformed tendency and magnitude of out-of-plane welding distortion can be represented. With the clarification of mechanism based on the comparison of longitudinal residual stress, plastic strain as well as shrinkage force, clamping can significantly reduce magnitude of out-of-plane welding distortion, which still could not avoid the occurrence of welding induced buckling, as well as the change of deformed shape pattern.

Current management of acute type B dissection in 2021.

The rationale for thoracic endovascular aortic repair (TEVAR) for type B aortic dissection depends on the phase of disease: acute phase, which is 'complicated', subacute to early chronic phase, which requires 'preemptive TEVAR' and chronic phase, which entails 'prevention of further dilatation and rupture'. Low operative mortality and morbidity after TEVAR for complicated acute type B aortic dissection have been reported with significant improvement during midterm survival. 'Retrograde' type A dissection, which can be described as type B0,X (X>3) according to a new reporting standard, has reportedly been treated with TEVAR with less invasiveness. TEVAR is the first and possibly the only effective strategy for acute type B dissection, so that expansion of indications for type B0,X, as described in the new reporting standard has been validated.

Initial Study of the Extended STABILISE Technique for Complete Remodeling in Aortic Dissection

Thoracic endovascular aortic repair (TEVAR) is the standard treatment for acute complicated type B aortic dissection (TBAD). However, long-term results reveal that TEVAR does not achieve a complete aortic remodeling and poses a risk of aneurysmal aortic degeneration. Distal re-entry treatment at the abdominal level seems to be necessary to obtain a complete remodeling in TBAD. Moreover, it is necessary to treat the aortoiliac bifurcation in patients with persistent true lumen collapse or limb ischemia. Between January 2018 and October 2019, 11 patients with acute or sub-acute complicated TBAD or non-A non-B aortic dissection were treated in our institution in an endovascular fashion. We performed the stent-assisted, balloon-induced intimal disruption and relamination in aortic dissection repair (STABILISE) technique in all cases, but 2 cases required complementary treatment of the aortoiliac bifurcation with a bifurcated AFX endograft system for limb ischemia due to true lumen collapse. Technical success was obtained in all patients. No procedural complications occurred. No postoperative deaths, stroke, paraplegia, mesenteric, or renal ischemia were observed, and no secondary intervention was necessary. Satisfactory aortic re-modeling was obtained after the follow-up periods with a 57.5% mean true lumen expansion. Our initial experience using the extended STABILISE (e-STABILISE) technique using a bifurcated AFX endograft did not result in any postoperative mortality or complications. Without additional data, this technique should be reserved for specific patients who require revascularization of the aortoiliac bifurcation.

Anti-Inflammatory and Anti-Angiogenic Properties of VitD3 in Ovarian Cancer

Ovarian malignancies are the most complicated type among all gynecological cancers. Their etiology is yet unknown; however, they are a heterogeneous, rapidly growing, and very fatal group of cancers. Chronic inflammation and angiogenesis appear to have major contributions in the development and progression of ovarian malignancies. Angiogenesis and inflammation are involved in the pathogenesis of ovarian cancer. Vitamin D3 (VitD3) has shown to have anti-inflammatory and anti-angiogenic properties in different types of cancers. The anti-inflammatory and anti-angiogenesis effects of VitD3 on ovarian cancer are investigated in this review.

Clinical Results and Aortic Remodeling After Endovascular Treatment for Complicated Type B Aortic Dissection With the "Fabulous" Stent System.

ObjectiveTo report the clinical outcomes and aortic remodeling after the implantation of a self-developed, biomechanically optimized, two-stage thoracic stent system named Fabulous.BackgroundGiven the efficacy of the PETTICOAT concept, the benefits of Fabulous and the behavior of remodeling in different segments need further investigation.MethodsThis is a prospective and multicenter study. From 2017 to 2019, 145 patients (mean age, 56.6 years; 88.3% male) from 14 centers were included in this cohort. The clinical results and core laboratory results were from a central electronic data capture system. Computed tomographic angiography was performed preoperatively, 1 month, 6 months and yearly thereafter and was used for volumetric analysis by 3mensio (Bilthoven, The Netherlands). After the 1-year follow-up, 97.2 and 87.6% of the clinical and imaging results of the eligible patients were available.ResultsBoth stent grafts and bare stents were successfully delivered in place in 100% of the patients. The 30-day mortality and 1-year freedom from all-cause mortality were 2.1 and 96.6%, respectively. The incidence of entry flow was 11.7% at 30 days and 6.2% at 365 days. No cases of stent-induced new entry (SINE) or reintervention were observed. After the 1-year follow-up, the true lumen/overall volume ratio reached 88%. The following subdivided segment volume changes were recorded: stent graft segment TL +56%; FL −92%, bare stent segment TL +32%; FL −75%, and there were no significant changes in the visceral segment.ConclusionsThese outcomes indicated that there were favorable clinical benefits of Fabulous stent system. This device achieved a low short-term mortality and a low incidence of reintervention. In addition, patients undergoing Fabulous stent system implantation showed remodeling both on descending aorta and on the distal aorta. The volume changes in the TL and FL varied in the different segments. The long-term follow-up is still ongoing.