Direct Branches Research Articles

Outcomes of Small Renal Artery Targets in Patients Treated by Fenestrated-Branched Endovascular Aortic Repair

The aim was to evaluate renal related outcomes in patients who had incorporation of a small (<4.0mm) renal artery (RA) during fenestrated-branched endovascular aortic repair (F-BEVAR). A total of 215 consecutive patients enrolled in a prospective F-BEVAR trial were reviewed. Computed tomography angiography centreline of flow reconstruction was used to measure mean RA diameter. Patients who had at least one <4.0mm main or accessory RA incorporated by fenestration or directional branch (study group) were compared with patients who had incorporation of two≥5.0mm RAs (control group). Endpoints were technical success of RA incorporation, RA rupture and kidney loss, primary and secondary RA patency, RA branch instability and re-interventions, and renal function deterioration. Twenty-four patients with 28<4.0mm RAs (16 accessory and 12 main RAs) were compared with 144 patients with 288≥5.0mm incorporated RAs. Study group patients were significantly younger than controls (72±8 vs. 75±8 years, p=.04) and more often females (46% vs. 21%, p=.018); there were no differences in cardiovascular risk factors and aneurysm extent. Technical success was 92% for <4.0mm and 99% for ≥5.0mm RA incorporation (p=.05). Inadvertent RA rupture occurred in three patients in the study group (13%) and in one (1%) in the control group (p=.009) resulting in kidney loss in two study group patients (8%) and one (1%) control group patient (p=.05). At one year, primary patency was 79±9% vs. 94±1% (p<.001) and secondary patency was 84±8% vs. 97±1% (p<.001) for study vs. control group; freedom from branch instability was 79±9% vs. 93±2% (p=.005), respectively. There were no differences in re-intervention rates and renal function deterioration between the groups. The mean follow up time was 21±14 months. Incorporation of <4.0mm RAs during F-BEVAR is associated with lower technical success, higher risk of arterial disruption and kidney loss, and lower patency rates at one year.

Estudo anatômico do ramo infrapatelar do nervo safeno em humanos

Objective To perform an anatomical study of the location of the infrapatellar branch of the saphenous nerve in relation to the structures of the knee. Methods An anatomical study was performed by dissection of 18 humans knees (9 right and 9 left knees). After exposure of the infrapatellar branch and its direct and indirect branches, they were then measured. We adopted a quadrant in the medial region of the knee delimited by two transversal planes as a parameter of the study. Results In 17 of the 18 knees (94.4%) studied, a single infrapatellar branch was observed. The infrapatellar branch emerged as fibers of the womb of the sartorius muscle in 17 of the 18 knees (94.4%). In relation to the branch, we observed that in 100% of the knees the infrapatellar branch had at least one primary branch, resulting in a superior branch and an inferior branch. In 9 limbs (50% of the cases) this branch occurred outside the proposed quadrant, and, in the remaining limbs, it occurred within the quadrant. Conclusion The infrapatellar saphenous nerve branch was found in all dissected knees, and, in 94.4% of the cases, it was of the penetrating type; in 100% of the cases, it originated two primary direct branches. The direct and indirect branches presented great variability regarding their path.

Systematization, description, and territory of arteries that promote vascularization of the midbrain and rhombencephalon in the ostrich (Struthio camelus).

Brain specimens from 30 ostriches were injected with red-dyed latex via the internal carotid arteries (Aa.). The ventral tectal mesencephalic artery (a.), invariably a medium-sized single vessel, was, on the right side, a collateral branch of the caudal branch of the carotid artery (53.4%), a direct branch of the carotid artery (43.3%) and a direct branch of the basilar artery (3.3%) and on the left side, a collateral branch of the caudal branch of the carotid artery (66.7%), a direct branch of the carotid artery (30%), and a direct branch of the basilar artery (3.3%). It vascularized only the ventral half of the optic lobe, with no involvement in cerebellar vascularization on the right (93.3%) and left (80%) sides, extending to the ventrorostral-most cerebellar lobules, which were vascularized on the right (6.7%) and left (20%) sides. The caudal ventral cerebellar arteries were a single vessel on the right (96.7%) and left (93.3%) sides. Its first branch was a common trunk: dorsal spinal-caudal cerebellar on the right (60%) and left (56.6%) sides. Its second branch was the caudal cerebellar artery on the right (76.7%) and left (86.7%) sides. Its third branch was the second component of the caudal cerebellar artery on the right (6.7%) and left (3.3%) sides. The midbrain was vascularized by dorsal and ventral tectal mesencephalic arteries. The cerebellum was vascularized by branches of the caudal ventral cerebellar artery and by the dorsal cerebellar artery.

Stringent upper limit on the direct 3α decay of the Hoyle state in C12

We investigate an implication of the most recent observation of a second $J^\pi = 2^+$ state in $^{12}$C, which was measured using the $^{12}$C($\gamma$,$\alpha$)$^8$Be$_{\textrm{(g.s.)}}$ reaction. In addition to the dissociation of $^{12}$C to an $\alpha$-particle and $^8$Be in its ground state, a small fraction of events (2%) were identified as direct decays and decays to excited states in $^8$Be. This allowed a limit on the direct 3$\alpha$ partial decay width to be determined as $\Gamma_{3\alpha} < 32(4)$ keV. Since this 2$^+$ state is predicted by all theoretical models to be a collective excitation of the Hoyle state, the 3$\alpha$ partial width of the Hoyle state is calculable from the ratio of 3$\alpha$ decay penetrabilities of the Hoyle and 2$^+$ states. This was calculated using the semi-classical WKB approach and we deduce a stringent upper limit for the direct decay branching ratio of the Hoyle state of ${\Gamma_{3\alpha} \over \Gamma} < 5.7 \times 10^{-6}$, over an order of magnitude lower than previously reported. This result places the direct measurement of this rare decay mode beyond current experimental capabilities.

Outcomes of target vessel endoleaks after fenestrated-branched endovascular aortic repair

ObjectiveThe objective of this study was to determine the incidence rate, outcomes, and risk factors of target vessel-related endoleaks after fenestrated-branched endovascular aortic repair (F-BEVAR) for pararenal aneurysms or thoracoabdominal aortic aneurysms (TAAAs). MethodsWe reviewed consecutive patients treated by F-BEVAR between 2007 and 2017. Target vessel endoleaks were identified by computed tomography angiography (CTA). Follow-up included CTA and duplex ultrasound before discharge, at 2 months, at 6 months, and annually thereafter. Primary endoleaks were detected by predismissal CTA; secondary endoleaks were absent on the first CTA and were identified during follow-up. End points were spontaneous resolution of primary endoleaks, secondary interventions, and aneurysm rupture. Multivariable analyses were performed for risk factors of target vessel endoleaks and predictors of spontaneous resolution. ResultsA total of 382 patients (mean age, 75 ± 8 years; 75% male) underwent F-BEVAR for 195 pararenal aneurysms and 187 TAAAs with 1204 renal-mesenteric arteries targeted by 981 fenestrations and 223 directional branches. Fifty-two target vessel endoleaks were identified in 41 patients; 41 were type IIIC (interattachment), 10 were type IC (distal bridging stent sealing zone), and 1 was type IIIB (bridging stent fabric tear). Thirty-three patients (9%) had primary target vessel endoleaks in 41 target vessels (3%). Eight patients (2%) developed 11 secondary target vessel endoleaks. Directional branches were more prone to primary endoleaks (13/223 [6%]) in comparison to fenestrations (28/981 [3%]; P = .03). However, branch endoleaks resolved more often spontaneously (11/14 [79%]) compared with fenestration endoleaks (14/38 [37%]; P = .008). Other risk factors for target vessel endoleaks included inner aortic diameter ≥30 mm at the target vessel origin, four or more targeted vessels, TAAA (for primary endoleaks), and physician-modified endograft (for secondary endoleaks). Four patients with primary endoleaks underwent successful reintervention before discharge, and 29 were observed with a mean follow-up of 24 ± 21 months. Of the 41 primary endoleaks, 25 resolved spontaneously in 20 patients (61%) at first follow-up with no recurrences. Of the observed endoleaks, 11 persisted in 9 patients, and 8 of those endoleaks were treated in 7 patients. All secondary target vessel endoleaks required reintervention. There was one possible aneurysm rupture attributed to persistent secondary target vessel endoleak. ConclusionsTarget vessel endoleak on CTA at discharge occurs in 1 of 10 patients treated by F-BEVAR. Of these, two-thirds resolve spontaneously, especially those affecting directional branches. Among patients with a persistent endoleak, endovascular reintervention is usually successful and aneurysm rupture is rare.

Высокодисперсионные электростатические зеркала вращательной симметрии с времяпролетной фокусировкой по энергии третьего порядка

Expressions describing the time of flight of charged particles taking into account time-of-flight chromatic aberrations in electrostatic mirrors of rotational symmetry are presented. The conditions of time-of-flight focusing by particle energy up to the third order inclusively in the three-electrode mirrors, the electrodes of which are coaxial cylinders of equal diameter, were determined by numerical calculations. Various modes of operation of such mirrors are considered: 1) space-time-of-flight focusing in the Gaussian plane of the mirror; 2) space-time-of-flight focusing in the focal plane of the mirror; 3) time-of-flight focusing in telescopic mode; 4) time-of-flight focusing in collimator mode. The results of calculations are presented for two fundamental solutions of the equation of paraxial trajectories. One of these solutions describes trajectories whose direct and reverse branches coincide, and the second solution describes trajectories whose direct and reverse branches are symmetrical with respect to the axis of symmetry of the field. It is shown that the time-of-flight dispersion of the mirror by mass, determined on the basis of the second solution, is several times higher than that obtained on the basis of the first solution for all modes of its operation.

Knowledge-Biased Sampling-Based Path Planning for Automated Vehicles Parking

We consider automated vehicles operation in constrained environments, i.e. the automated parking (AP). The core of AP is formulated as a path planning problem, and Rapidly-exploring Randomized Tree (RRT) algorithm is adopted. To improve the baseline RRT, we propose several algorithmic tweaks, i.e. reversed RRT tree growth, direct tree branch connection using Reeds-Shepp curves, and RRT seeds biasing via regulated parking space/vehicle knowledge. We prove that under these tweaks the algorithm is complete and feasible. We then examine its performance (time, success rate, convergence to the optimal path) and scalability (to different parking spaces/vehicles) via batched simulations. We also test it using a real vehicle in a realistic parking environment. The proposed solution presents itself more applicable when compared with other baseline algorithms.

Outcomes of endovascular repair of chronic postdissection compared with degenerative thoracoabdominal aortic aneurysms using fenestrated-branched stent grafts

ObjectiveThe objective of this study was to analyze outcomes of fenestrated-branched endovascular aneurysm repair (F/BEVAR) for treatment of postdissection and degenerative thoracoabdominal aortic aneurysms (TAAAs). MethodsWe reviewed the clinical data of 240 patients with extent I to extent III TAAAs enrolled in seven prospective physician-sponsored investigational device exemption studies from 2014 to 2017. All patients had manufactured off-the-shelf or patient-specific fenestrated-branched stent grafts used to target 888 renal-mesenteric arteries with a mean of 3.7 vessels per patient. End points included mortality, major adverse events (any-cause mortality, stroke, paralysis, dialysis, myocardial infarction, respiratory failure, bowel ischemia, and estimated blood loss >1 L), technical success, target artery patency, target artery instability, occlusion or stenosis, endoleak, rupture or death, reintervention, and renal function deterioration. ResultsThere were 50 patients (21%) treated for postdissection TAAAs and 190 (79%) who had degenerative TAAAs. Postdissection TAAA patients were significantly younger (67 ± 9 years vs 74 ± 8 years; P < .001), were more often male (76% vs 52%; P = .002), and had more prior aortic repairs (84% vs 67%; P = .02) and larger renal (6.4 ± 1.2 mm vs 5.8 ± 0.9 mm; P < .001) and mesenteric (8.9 ± 1.7 mm vs 7.8 ± 1.4 mm; P < .001) target artery diameters. There was no difference in aneurysm diameter (66 ± 13 mm vs 67 ± 11 mm; P = .50), extent I or extent II TAAA classification (64% vs 56%; P = .33), and length of supraceliac coverage (22 ± 9.5 cm vs 20 ± 10 cm; P = .38) between postdissection and degenerative patients, respectively. Preloaded guidewire systems (66% vs 43%; P = .003) and fenestrations as opposed to directional branches (58% vs 24%; P < .001) were used more frequently to treat postdissection patients. Technical success was 100% for postdissection TAAAs and 99% for degenerative TAAAs (P = .14). At 30 days, there was no difference in mortality (2% postdissection, 3% degenerative), major adverse events (24% postdissection, 26% degenerative; P = .73), spinal cord injury (6% postdissection, 12% degenerative; P = .25), paraplegia (2% postdissection, 7% degenerative; P = .19), and dialysis (0% postdissection, 5% degenerative; P = .24). Mean follow-up was 14 ± 12 months. Endoleaks were significantly more frequent in patients with postdissection TAAAs (76%) compared with degenerative TAAAs (43%; P < .001). At 2 years, there was no difference in patient survival (84% ± 7% vs 72% ± 4%; P = .13), freedom from aorta-related death (98% ± 2% vs 94% ± 2%; P = .45), primary (95% ± 2% vs 97% ± 1%; P = .93) and secondary target artery patency (99% ± 1% vs 98% ± 1%; P = .48), target artery instability (89% ± 3% vs 91% ± 1%; P = .17), and freedom from reintervention (58% ± 10% vs 67% ± 5%; P = .23) for postdissection and degenerative TAAAs, respectively. ConclusionsDespite minor differences in demographics, anatomic factors, and stent graft design, F/BEVAR was safe and effective with nearly identical outcomes in patients with postdissection and degenerative TAAAs. Larger clinical experience and longer follow-up are needed to better evaluate differences in mortality, spinal cord injury, target artery instability, and reintervention.

Performance of Viabahn Balloon-Expandable Stent Compared With Self-expanding Covered Stents for Fenestrated-Branched Endovascular Aortic Repair

The objective of this study was to compare the performance between Viabahn (W. L. Gore & Associates, Flagstaff, Ariz) balloon-expandable stent (VBX) and self-expanding covered stents (SESs; Viabahn and Fluency [Bard Peripheral Vascular, Tempe, Ariz]) used as bridging stents for directional branches during fenestrated-branched endovascular aneurysm repair of complex aortic aneurysms. Patients with thoracoabdominal aortic aneurysms (type I-IV) or pararenal aortic aneurysms unsuitable for either open repair or endovascular repair with commercially available devices were prospectively enrolled into a physician-sponsored investigational device exemption trial. Descriptive statistics of the cohort included demographics, risk factors, and anatomic and device characteristics. Individual branches were grouped as either VBX or SES and were analyzed for primary patency, branch-related type I or type III endoleaks, branch instability, branch-related secondary intervention, and branch-related aortic rupture or death. Categorical variables were expressed as total and percentage and continuous variables as median (interquartile range). Kaplan-Meier curves were used to estimate long-term result. Groups were compared with the log-rank test. P value < .05 was considered statistically significant. During the period from July 2012 through April 2019, there were 263 patients treated for complex aortic aneurysm with fenestrated-branched endovascular aneurysm repair. The devices used were either a custom-manufactured device or off-the-shelf p-Branch or t-Branch devices (Cook Medical, Bloomington, Ind). The median age was 71 years (interquartile range, 66-79 years), 70% male, and 81% white. The most common cardiac risk factors were smoking (92%), hypertension (91%), hyperlipidemia (78%), and chronic obstructive pulmonary disease (52%). The total number of vessels incorporated to repair was 977, with branches representing 18.4% (179 branches). Among the 179 branches were 54 (30%) celiac artery, 56 (31%) superior mesenteric artery, 38 (21%) right renal artery, and 31 (18%) left renal artery. VBX and SES groups represented, respectively, 53% (n = 95) and 47% (n = 84) of the total (Fig).The overall cohort survival rate at 24 months was 78.5% ± 3%. There was no branch-related rupture or death. Primary patency at 24 months (VBX, 98.1%; SES, 98.6%; log-rank, P = .98), freedom from endoleak (VBX, 97.3%; SES, 98.6%; log-rank, P = .63), freedom from secondary intervention (VBX, 91.5%; SES, 95%; log-rank, P = .69), and freedom from branch instability (VBX, 95.5%; SES, 97.3%; log-rank, P = .72) were similar between groups (Fig 2). The initial experience with VBX stents demonstrated excellent primary patency and similarly low rates of branch-related complications and endoleaks, with no branch-related aortic rupture or death. Our results demonstrate that in high volume and experienced aortic center, the VBX stent is a safe and effective bridging stent option during branched endovascular aortic repair. Multicenter studies with longer follow-up are necessary to validate our initial results.Fig 2Freedom from branch instability (BI). CI, Confidence interval; SES, self-expanding covered stent; VBX, Viabahn balloon-expandable stent.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Physician-Modified Endograft With Double Inner Branches for Urgent Repair of Supraceliac Para-Anastomotic Pseudoaneurysm

Purpose: To demonstrate the feasibility of a physician-modified endograft (PMEG) with inner branches for 2 mesenteric arteries as an alternative to fenestrations or directional branches. Technique: A symptomatic 60-year-old man presented with supraceliac para-anastomotic pseudoaneurysm involving an antegrade aorta to celiac artery and superior mesenteric artery bypass. Since an off-the-shelf multibranched endograft was inappropriate, a Zenith Alpha thoracic stent-graft was modified with 2 inner branches fashioned of 8-mm Viabahn endoprostheses with preloaded guidewires. The procedure was technically successful, and the patient had no postoperative complications. Conclusion: Inner branches might offer an alternative to fenestrations or directional branches in patients with narrow aortas.

Expanded Use of Preloaded Branched and Fenestrated Endografts for Endovascular Repair of Complex Aortic Aneurysms in the US IDE Experience

Introduction - To report the expanded use of preloaded catheters and wires of fenestrations and directional branches to facilitate access to renal and mesenteric target arteries during endovascular repair of complex aortic aneurysms. Methods - Prospectively collected data from six physician-sponsored investigational device exemption (IDE) studies at US centers was analyzed. Patients were treated with fenestrated and branched aortic endografts for suprarenal (SRA) and thoracoabdominal aortic aneurysms (TAAA) between 2012 and 2017. Technical success was defined as successful intraoperative cannulation and stenting of all intended target visceral arteries. Univariate and stratified analyses were performed to identify differences between preloaded and standard devices. Results - There were 564 patients (73% men, mean age 73±8) treated for 168 SRAs (30%), 216 type IV TAAAs (30%) and 180 type I-III TAAAs (32%). Preloaded grafts (PG) were used in 387 (69%) patients and standard grafts (SG) in 177 (31%). PGs were preferentially used for type IV TAAAs (45% vs. 24%, P<.01), whereas standard devices were used more frequently among patients with type I-III TAAAs (24% vs. 49%; P<.01). The majority of custom-made devices were preloaded (65% vs. 25%; P=.01). A total of 2157 target arteries were incorporated (mean 3.9/patient) utilizing 1469 fenestrations (68%), 603 directional branches (28%), and 85 double-wide scallops (4%). Most PGs included fenestrations (80% vs. 43%, P<.01) whereas directional branches were more frequent in standard devices (17% vs. 53%, P<.01). Contrast volume, fluoroscopy time, radiation dose and operative time were not significantly different between preloaded and standard devices (Table). Upper extremity access was more frequent for PGs (87% vs. 72%, P<.01). Overall technical success was 98.8% and 30-day mortality was 1.9%. Technical success was higher for PGs compared with standard grafts (99.5% vs. 97.2%, P=.02). 30-day mortality was lower among patients undergoing procedures with PGs (1% vs. 5%; P<.01). Stroke rate was the same for PGs and SGs (2%).Tabled 1Preloaded n=387Standard n=177P valueTechnical success385/387 (99.5)172/177 (97.2).02Contrast use (cc)115±56119±67.56Fluoroscopy time (min)85±3582±37.47Total radiation dose (mGy)2474±17232672±1903.31 Open table in a new tab Conclusion - Endovascular repair of complex aortic aneurysm is safe and effective. The expanded use of preloaded catheters and wires of fenestrations and directional branches for target artery incorporation is associated with even higher technical success and lower early mortality.

When distributed switch-and-stay combining meets buffer in IoT relaying networks

This paper studies the IoT relaying networks, where one decode-and-forward (DF) relay equipped with a buffer helps determine whether to receive the data from the source or send the data to the destination. Moderate shadowing environments are considered and the source can also communicate with the destination through the direct link. Although the opportunistic selection (OS) technique can select one better branch among the direct and buffer-aided relay branches, it requires to estimate the channel parameters of two branches, and the branch switching may occur frequently. To deal with these disadvantages, we employ the distributed switch-and-stay combining (DSSC) technique for the buffer-aided relay network, in which the same branch goes on being employed until the current branch cannot support the data transmission no longer. In this protocol, the branch switching depends on the buffer state and the state transition in the buffer is also affected by the branch switching. For this communication scenario where the buffer meets the DSSC, we study the system performance by deriving the analytical outage probability and the asymptotic expression with high regime of transmit power. From the asymptotic expression, we find that DSSC can effectively exploit the system spatio-temporal resources and it obtains the same performance of the OS with ease of implementation. Moreover, the system performance improves with the buffer size. We finally provide some simulation and numerical results to demonstrate the merits of the DSSC-based buffer-aided IoT relaying networks.

Outcomes of directional branches using self-expandable or balloon-expandable stent grafts during endovascular repair of thoracoabdominal aortic aneurysms

ObjectiveThe objective of this study was to evaluate outcomes of directional branches using self-expandable stent grafts (SESGs) or balloon-expandable stent grafts (BESGs) during fenestrated-branched endovascular aneurysm repair of thoracoabdominal aortic aneurysms. MethodsPatients treated by fenestrated-branched endovascular aneurysm repair were enrolled in a prospective study from 2014 to 2018. We included in the analysis patients who had target vessels incorporated by directional branches using either SESG (Fluency [Bard, Covington Ga] or Gore Viabahn [W. L. Gore & Associates, Flagstaff, Ariz]) or BESG (Gore VBX). Target artery instability (TAI) was defined by a composite of any stent stenosis, separation, or type IC or type IIIC endoleak requiring reintervention and stent occlusion, aneurysm rupture, or death due to target artery complication. End points included technical success, target artery patency, freedom from TAI, freedom from type IC or type IIIC endoleak, and freedom from target artery reintervention. ResultsThere were 126 patients (61% male; mean age, 73 ± 8 years) included in the study. A total of 335 renal-mesenteric arteries were targeted by directional branches using SESGs in 62 patients and 176 arteries or BESGs in 54 patients and 159 arteries. Patients in both groups had similar thoracoabdominal aortic aneurysm classification and aneurysm and target artery diameter, but SESG patients had significantly (P < .05) shorter stent length (−7 mm) and larger stent diameter (+1 mm) and more often had adjunctive bare-metal stents (72% vs 15%). Technical success was achieved in 99% of patients, with one 30-day death (0.7%). Mean follow-up was significantly longer among patients treated by SESGs compared with BESGs (23 ± 12 months vs 8±8 months; P < .0001). TAI occurred in 27 directional branches (8%), including 11 type IC endoleaks (2 SESGs, 9 BESGs), 10 stenoses (3 SESGs, 7 BESGs), 4 occlusions (3 SESGs, 1 BESGs), 4 type IIIC endoleaks (2 SESGs, 2 BESGs), and 1 stent separation (SESG), resulting in 20 target artery reinterventions in 16 patients (5 SESGs and 11 BESGs). At 1 year, SESGs had higher primary patency (97% ± 2% vs 96% ± 2%; P = .004), freedom from TAI (96% ± 2% vs 88% ± 3%; P < .0001), freedom from type IC or type IIIC endoleaks (98% ± 1% vs 92% ± 3%; P = .0004), and freedom from target artery reinterventions (98% ± 1% vs 88% ± 4%; P < .0001) compared with BESGs. There was no difference in secondary patency for SESGs and BESGs (98% ± 1% vs 99% ± 1%; P = .75). Factors associated with TAI were large stent diameter (odds ratio, 0.6; P < .0001) and use of VBX stent graft (odds ratio, 6.5; P < .0001). ConclusionsDirectional branches were associated with high technical success and low rates of stent occlusion, independent of stent type. However, primary patency, freedom from TAI, and freedom from type IC or type IIIC endoleaks was lower for BESGs compared with SESGs.

Le lambeau perforant de l’artère fémorale profonde : une étude anatomique morphométrique

Within the framework of mammary reconstruction, since 2012 when Allen first described it, the profunda femoral artery perforator flap (PAP) takes an important place in the current therapeutic options. This anatomical study aims to analyze the anatomy and morphologic consideration of the PAP: position of the perforating artery; length of the pedicle, area and volume of vascularization. Sixteen flaps were harvested on fresh subjects at the University Department of Anatomy of Rockfeller, Lyon. The first direct cutaneous branch from the deep femoral vessels was located between or through the adductor magnus and gracilis muscles. Pedicle location, diameter, length and position regard to the great saphenous vein were recorded. A flap based on this vessel was designed. Height, width, and surface of the skin paddle were recorded. Three-dimensional computed tomographic angiography was used to analyze the area and volume of cutaneous territory supplied by the studied perforator. On the 16 analyzed flaps, localization of the perforating artery is on average to 8.2cm of the pubic tuber and 3.7cm behind a line connecting the pubic tuber to the internal femoral condyle. The length of the pedicle is on average of 11.7cm and the average area of skin perfused was 94,68cm2. The way of this perforating arterty is primarily through the adductor magnus. On the radiological images of the 8 flaps, the analysis shows an average surface of 111,25cm2 and a mean volume of 325.3cm3. PAP is an interesting therapeutic choice within the framework of a mammary reconstruction. Its surface and its volume associated with a discrete scar make a valid indication within the framework of this surgery.

Endosteal blood supply of the mandible: anatomical study of nutrient vessels in the condylar neck accessory foramina.

In the mandible, the condylar neck vascularization is commonly described as mainly periosteal; while the endosteal contribution is still debated, with very limited anatomical studies. Previous works have shown the contribution of nutrient vessels through accessory foramina and their contribution in the blood supply of other parts of the mandible. Our aim was to study the condylar neck's blood supply from nutrient foramina. Six latex-injected heads were dissected and two hundred mandibular condyles were observed on dry mandiblessearching for accessory bone foramina. Latex-injected dissections showed a direct condylar medular arterial supply through foramina. On dry mandibles, these foramina were most frequently observed in the pterygoid fovea in 91% of cases. However, two other accessory foraminaareas were identified on the lateral and medial sides of the mandibularcondylar process, confirming the vascular contribution of transverse facial and maxillary arteries. The maxillary artery indeed provided both endosteal and periosteal blood supply to the condylar neck, with three different branches: an intramedullary ascending artery (arising from the inferior alveolar artery), a direct nutrient branch and some pterygoid osteomuscularbranches.

Thermodynamic Optimization of a SOFC-CHP System with Exhaust Gas Recirculation Employing an In-House Numerical Simulator

Thermodynamic optimization of a solid oxide fuel cell-combined heat and power system is the first step for its commercialization. This study suggests a thermodynamically optimized SOFC-CHP system through numerical modeling and simulation. An in-house numerical simulator is developed, which utilizes design variables of system components and their empirical correlations to enhance the accuracy of simulation. It is developed with C# language, equipped with graphical user interface by making use of Windows Presentation Foundation. Two system layout designs are comparatively analyzed: Direct Combustion Branching (DC Branching) and Direct Combustion Branching equipped with Anode exhaust gas Recirculation (DC Branching AR). The thermodynamic performance of two system layouts are compared in the aspects of efficiency and power. It is found that employing anode exhaust gas recirculation enhances thermodynamic efficiencies but reduces net electrical power.

Landers 1992 “Reloaded”: Integrative Dynamic Earthquake Rupture Modeling

AbstractThe 1992 Mw 7.3 Landers earthquake is perhaps one of the best studied seismic events. However, many aspects of the dynamics of the rupture process are still puzzling, for example, the rupture transfer between fault segments. We present 3‐D spontaneous dynamic rupture simulations, incorporating the interplay of fault geometry, topography, 3‐D rheology, off‐fault plasticity, and viscoelastic attenuation. Our preferred scenario reproduces a broad range of observations, including final slip distribution, shallow slip deficits, and mapped off‐fault deformation patterns. We demonstrate good agreement between synthetic and observed waveform characteristics and associated peak ground velocities. Despite very complex rupture evolution, ground motion variability is close to what is commonly assumed in Ground Motion Prediction Equations. We examine the effects of variations in modeling parameterization within a suite of scenarios including purely elastic setups and models neglecting viscoelastic attenuation. Source dynamics of all models include dynamic triggering over large distances and direct branching; rupture terminates spontaneously on most of the principal fault segments. Sustained dynamic rupture of all fault segments in general, and rupture transfers in particular, constrain amplitude and orientation of initial fault stresses and friction. We conclude that physically consistent in‐scale earthquake rupture simulations can augment earthquake source observations toward improving the understanding of earthquake source physics of complex, segmented fault systems.

Effects of elite athletes’ aim orientation on basic psychological needs and fear of failure

Purpose: This research was carried out in order to analyze elite athletes’ aim orientation, basic psychological needs and fear of failure in perspective of several variables, and to reveal the differences among these variables. Material and Methods: Sample of the research consisted of elite athletes from different branches who had been in different regions of Turkey in 2016-2017. Number of elite athletes in this research was (n=521) in total, 378 of whom were males and 173 of whom were females. These elite athletes had been chosen by random sampling. As data collection tools, Basic Psychological Needs Scale, which was adapted to Turkish by Kesici et al (2003), Fear of Failure Scale which was adapted to Turkish by Kahraman and Sungur (2016), Scale of Task and Ego Orientation in Sports that was adapted to Turkish by Toros (2004) were used in the study. Results. It was concluded that females had lower fear of “unclear future” and “experiencing shame and embarrassment” than males. It was revealed that as the age of the participants went up, their needs for relationship, fear of unclear future, fear of experiencing shame and embarrassment, and task orientation increase. It was found out that participants who had direct branches had higher “need for relationship” and “fear of unclear future” in comparison with the ones who had indirect branches. Conclusion: According to the results of the study, it was found that there was meaningful difference in sub-dimensional fear of failure in terms of gender variable, in sub-dimensional fear of failure, in basic psychological needs and in aim orientation with regards to age variable, in sub-dimensional basic psychological needs and in fear of failure in terms of branch variation (direct - indirect) variable.

Altered facial muscle innervation pattern in patients with postparetic facial synkinesis.

Using surface electrostimulation, we aimed to use facial nerve mapping (FNM) in healthy subjects and patients with postparetic facial synkinesis (PPFS) to define functional facial target regions that can be stimulated selectively. Single-center prospective cohort study. FNM was performed bilaterally in 20 healthy subjects and 20 patients with PPFS. Single-pulse surface FNM started at the main trunk of the facial nerve and followed the peripheral branches in a distal direction. Stimulation started with 0.1 mA and increased in 0.1 mA increments. The procedure was simultaneously video recorded and evaluated offline. A total of 1,873 spots were stimulated, and 1,875 facial movements were evaluated. The stimulation threshold was higher on the PPFS side (average = 9.8 ± 1.0 mA) compared to the contralateral side (4.1 ± 0.8 mA) for all stimulation sites or compared to healthy subjects (4.1 ± 0.5 mA; all P < .01). In healthy subjects, selective electrostimulation ± one unintended coactivation was possible at all sites in >80% of cases, with the exception of pulling up the corner of the mouth (65%-75%). On the PPFS side, stimulation was possible for puckering lips movements in 60%/75% (selective stimulation ± one coactivation, respectively), blinking in 55%/80%, pulling up the corner of the mouth in 50%/85%, brow raising in 5%/85, and raising the chin in 0%/35% of patients, respectively. FNM mapping for surgical planning and selective electrostimulation of functional facial regions is possible even in patients with PPFS. FNM may be a tool for patient-specific evaluation and placement of electrodes to stimulate the correct nerve branches in future bionic devices (e.g., for a bionic eye blink). 2b Laryngoscope, 130:E320-E326, 2020.

Aberrant innervation of the lateral abdominal muscles by direct branch of L4 nerve

Surgical approache through the posterior abdominal wall used for nephrectomy or other access to contents of the retroperitoneal space requires to be cognizant of the regional nerve supply to the posterolateral abdominal wall muscles. We herein report a, to our knowledge, previously undescribed direct branch from the L4 spinal nerve that formed a plexus with regional nerves to then innervate the lateral abdominal wall musculature. Such a nerve variant should be considered by the surgeon who operates this region.