Distal Zone Research Articles

Some ecological aspects of Monogeneans (Platyhelminthes) ectoparasites of Enteromius guirali Thominot, 1886 (Pisces: Cyprinidae) from Cesala River in Cameroon.

Fish are exposed to various parasites such as monogeneans which are flatworms that preferentially affect the gills and skin of these hosts. This study represents the first investigation concerning the distribution of monogenean infracommunities of Enteromius guirali in Cameroon. A total of 100 fish were collected from Cesala River and preserved in 8% formalin solution. Parasite community consisted of Dactylogyrus mendehei and D. nyongensis. These monogenean species adopted an aggregated distribution. Their mean intensities and prevalence increased with host size. Both sides of E. guirali were similarly infested, and no preference for gill arches was recorded for each parasite species. Posterior hemibranch was always the most parasitized, showing the highest parasitic load. Median sector and distal filamentous zone were highly colonized by both monogenean species. This study contributes to understand that the large gill surface offered by great hosts, heterogeneity, bilateral symmetrically of the host's gill system on one hand, and the morphology of haptoral parts and reproduction of parasites, on the other hand, are the main factors which determine the distribution of studied component community.

The comparison of the efficacy of 3D fast spoiled gradient echo sequence and steady state free precession sequence in imaging vascular compression in patients with trigeminal neuralgia

Aims: Trigeminal neuralgia is a condition characterized by sudden and intense pain in the face, affecting the fifth cranial nerve. While it can occur for various reasons, vascular compression is a well-known cause. Additionally, conditions such as tumors, arachnoid cysts, idiopathic inflammation, damage, or demyelination can result in trigeminal neuralgia, extending to the distal branches of the trigeminal nerve from the pons. We aimed to investigate the diagnostic efectiveness of post-contrast three-dimensional fast spoiled gradient echo images (3D-FSPGR) in addition to steady-state free precession (SSFP) images in the imaging of trigeminal neuralgia. Methods: A total of 33 patients with a preliminary diagnosis of trigeminal neuralgia between May 2022 and October 2023 were investigated and five individuals were excluded. Among the remaining 28 patients, vascular compression was observed in only 14 patients. Trigeminal nerve thickness on both side, the distance between trigeminal nerve and superior cerebellar artery on both side, presence of vascular compression, level of the compression, presence or absence of displacement and atrophy were reported for each sequences. The findings and results were compared using independent sample T-test and paired T-test. Results: The mean age of the patient group was calculated to be 56.29 ± 4.5, while for the control group, it was 52.07 ± 3.09. Trigeminal nerve thickness wasn’t different between patient with or without vascular compression (p=0.874 for right side on SSFP, p=0.804 for left side on SSFP, p=0.667 for right side on 3D-FSPGR and 0.769 for left side on 3D-FSPGR). In 10 patients, unilateral compression of the trigeminal nerve was observed, while in 4 patients, it was bilateral. In the right trigeminal nerve, vascular compression was observed in SSFP images in 5 cases in the transitional zone, 2 cases in the nerve root entry zone, and 1 case distally. In 3D-FSPGR images, it was interpreted as being in the transitional zone in 4 cases, in the NR entry zone in 3 cases, and distally in 1 case. On the other hand, for the left trigeminal nerve, vascular compression was observed in both SSFP and 3D FSGPR images in 5 cases in the nerve root entry zone, 3 cases in the distal zone, and 2 cases in the transitional zone. Conclusion: Both SSFP and 3D-FSPGR images can provide comparable information regarding the spatial relationship between the trigeminal nerve and vascular structures. Contrast enhanced imaging allows us diferentiate the tumoral and infammatory demyelinating processes from vascular compression, we recommended to continue with SSFP images in cases where contrast enhanced 3D FSGPR images are inconclusive.

Arabidopsis uses a molecular grounding mechanism and a biophysical circuit breaker to limit floral abscission signaling

Abscission is the programmed separation of plant organs. It is widespread in the plant kingdom with important functions in development and environmental response. In Arabidopsis, abscission of floral organs (sepals, petals, and stamens) is controlled by two receptor-like protein kinases HAESA (HAE) and HAESA LIKE-2 (HSL2), which orchestrate the programmed dissolution of the abscission zone connecting floral organs to the developing fruit. In this work, we use single-cell RNA sequencing to characterize the core HAE/HSL2 abscission gene expression program. We identify the MAP KINASE PHOSPHATASE-1/MKP1 gene as a negative regulator of this pathway. MKP1 acts prior to activation of HAE/HSL2 signaling to establish a signaling threshold required for the initiation of abscission. Furthermore, we use single-cell data to identify genes expressed in two subpopulations of abscission zone cells: those proximal and those distal to the plane of separation. We identify INFLORESCENCE DEFICIENT IN ABSCISSION/IDA family genes, encoding activating ligands of HAE/HSL2, as enriched in distal abscission zone cells at the base of the abscising organs. We show how this expression pattern forms a biophysical circuit breaker whereby, when the organ is shed, the source of the IDA peptides is removed, leading to cessation of HAE/HSL2 signaling. Overall, this work provides insight into the multiple control mechanisms acting on the abscission-signaling pathway.

Extensor Tendon Repair.

Extensor tendon injuries are a common condition that hand surgeons must be prepared to treat. The area of extensor tendon injury can traditionally be broken down into 9 zones. Physical examination is the best way to diagnose extensor tendon injury with a loss of active extension in the injured digit. The tenodesis effect may be utilized to aid in diagnosis: wrist flexion should cause passive extension at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints if the extensor tendon is in continuity. Repair of extensor tendon injuries depends on the zone of injury and the thickness of the tendon, which determines its ability to hold core sutures. For zone-I and II injuries, several "figure of 8" buried sutures can be utilized or a running type of suture may be employed. For zone-III to VII injuries, 1 or 2 core sutures and a supplementary running suture can be utilized. Several alternative techniques have been previously described. These include variations in the number of core strands, repair configuration, and suture caliber, as well as the use of epitendinous repair. Alternative treatments also include nonoperative treatment, which is typically reserved for partial tendon injuries and for patients who are unable to tolerate a surgical procedure. The techniques that we describe are tailored to the thickness of the tendon. Running sutures are applicable to any zone, whereas core sutures are best utilized in zones III through VII. The running interlocking horizontal mattress technique has been found to be stiffer and faster to accomplish compared with the other techniques, and was found to have good to excellent clinical results in a study of lacerations in zones IV and V1,2. Repair of extensor tendon lacerations has demonstrated good long-term outcomes if performed in a timely manner after injury. A previous study showed good to excellent function in up to 64% of acute extensor tendon repairs, more fingers lost the ability to flex fully than lost the ability to extend3. Systematic reviews have suggested that dynamic rehabilitation may not provide superior long-term benefit compared with static splinting4. The Elson test should be performed under a digital nerve block in order to properly assess the integrity of the central slip.In distal zone I and III injuries, suture anchors or bone tunnels may be utilized when there is no remaining tendon on the distal end of the laceration.When preparing the tendon ends for repair, it is important to handle the tendon delicately-preferably through the cut end of the tendon rather than the tendon itself.In zone-VII injuries, the injured tendon may lie beneath the extensor retinaculum. In such cases, windowing of the extensor retinaculum may decrease adhesion formation and facilitate repair. MCP = metacarpophalangealPIP = proximal interphalangealDIP = distal interphalangealIP = interphalangealROM = range of motionRMS = relative motion splintRIHM = running interlocking horizontal mattress.

Similar sources but distinct δ13C signatures in adjacent low-temperature travertines from Laguna Amarga (Southern Patagonian Andes)

This study examined the waters and carbonates from two cold spring travertines (ca. 13 °C) located on the sun-exposed (north-facing travertine) and sun-shaded (south-facing travertine) margins of Laguna Amarga, an alkaline lake from the semiarid region of the eastern Patagonian Andes (51°S).The travertines are composed of calcite + low-Mg calcite ± aragonite. Both exhibit similar sedimentological transitions along their longitudinal profiles. In the proximal zones, biologically-influenced carbonates form in wetland-like environments. Spherulitic calcite precipitates in association with extracellular polymeric substances in microbial biofilms containing cyanobacteria-like molds at the vent of the south-facing travertine, while aragonite spherulite formation at the north-facing travertine vent also involves sulfate-reducing bacteria, as indicated by their close association with framboidal pyrite. Downstream, in the intermediate and distal zones, crystalline dendrites predominantly precipitate due to increased turbulence-induced CO2 degassing.Both travertines share a similar range of carbonate 87Sr/86Sr composition (0.70720–0.70740) and isotopic signatures of the spring waters, including δ2H (ca. -110 ‰ VSMOW), δ18Owater (ca. -14 ‰ VSMOW) and δ13C-DIC (ca. -5 ‰ VPDB), suggesting common sources and processes influencing fluid composition. This points to the dissolution of carbonates from mudstone-rich marine units of the Lower Cretaceous (δ13C ca. -1 ‰ VPDB) and Upper Cretaceous (δ13C ca. -10 ‰ VPDB) during shallow subsurface circulation of meteoric waters through the bedrock. The carbon isotopic composition of the deposits resembles those of endogenic travertines (δ13Ctrav − 1.2 to 5.3 ‰ VPDB), with the highest δ13Ctrav values associated with carbonates from the vents. However, the involvement of deep CO2 sources is unclear and epigenic processes capable of producing the observed 13C enrichments are discussed.Despite their common sources, similar sedimentological features and δ18Otrav compositional range (−12.4 to −10.1 ‰ VPDB), the δ13Ctrav values are lower in the south-facing travertine (−1.2 to 1.9 ‰ VPDB) compared to the north-facing travertine (1.8 to 5.3 ‰ VPDB). This disparity is inferred to result from variations in local environmental conditions due to different levels of insolation, which favored the incorporation of soil-derived CO2 in the south-facing travertine and likely increased photosynthetic productivity in the north-facing travertine, thereby shifting their δ13Ctrav signatures to lower and higher values, respectively. These relationships highlight the sensitivity of low-temperature spring carbonates to subtle environmental changes at basin scales.

Distribution of transitional flow deposits in sedimentary environments of mixed sand-mud turbidite system

Predicting facies distribution in turbidite systems is essential for resource exploration and identifying geohazards from an economic standpoint. Models that describe facies distribution depend heavily on understanding the mechanisms of particle transport and deposition. These processes are closely tied to the volume, concentration, and composition of sediment gravity flows, which display a range of behaviours between turbulent and laminar flow extremes. Recently, there has been a rise in studies on transitional flow deposits, although they remain much less understood than fully turbulent or laminar flows.For the first time, the distribution of Structured sandstone–mudstone associated with transitional flow deposits has been quantitatively presented for various sedimentary environments within the turbidite system. The distribution of Structured sandstone–mudstone was analysed for six areas of the Ropianka Fm (Skole Nappe, Polish Outer Carpathians) across twelve sedimentary environments, including channels, channel-levees, channel-mouths, and sub-environments of the depositional lobe. An increased amount of Structured sandstone–mudstone was observed in proximal settings away from the transport axis and in the distal parts of the turbidite system. It was found that flow transformation can occur in both proximal and distal zones of the turbidite system. Structured sandstone–mudstone in proximal zones is more often deposited from diluted mud-laden flows of small volume, where fine-grained cohesive material likely underwent vertical segregation. In contrast, Structured sandstone–mudstone formed basinward tend to be initially formed by larger flows. In proximal part of depositional lobe setting, the flow transformation due to longitudinal or longitudinal and vertical segregation of fine-grained cohesive material occurs slowly. At this point the velocity of sediment gravity flow is too high and the concentration of cohesive particles is too low for common development of cohesive bonds. Flow transformation accelerates in lobe fringe and lobe distal fringe/interlobe, due to flow deceleration, changes in sand-to-mud ratio, and the time required for development of cohesive bonds and the transition to a transitional flow regime, leading to increased deposition of Structured sandstone–mudstone distally.

Finite element analysis of macro-crack behavior in the cortical bone of a human tibia

The bone is a biological tissue that possesses a highly complicated hierarchical structure; hence, the tissue components of the bone exhibit variable mechanical proper-ties and a complex bone geometry. This is why the creation of a three-dimensional mod-el through CAD software facilitates the study of the mechanical behavior of bones. Com-bining the concepts of linear elastic fracture mechanics and finite element analysis pro-vides a practical solution to study the fracture behavior of the tibial bone. The objective of this study is to analyze the behavior of cracks in the cortical bone of the human tibia us-ing stress intensity factors in mode I, II, and III as rupture criteria to assess the bone damage response. The tibial bone is one of the most common sites for lower limb stress fractures, which pose problematic injuries. The results investigating the effect of the crack position in the bone demonstrate that the risk of crack propagation is mainly due to mode I opening and is highly favored in the distal zone compared to the middle and proximal regions, regardless of bone density. For the second case study, it is observed that regardless of the crack size, the maximum values of stress intensity factors KI are obtained in the distal zone. Regarding the effect of crack orientation, the results indicate the dominance of mode II for angles α = – 45°, 30°, 45°, leading to high values of stress intensity factors KII.

Analysis of the results of optical coherence tomography to assess the effectiveness and safety of implantable bioresorbable stenting frames in the long term

Objective: to evaluate the effectiveness and safety of implantation of everolimus-coated bioabsorbable vascular scaffolds (BSCs) based on the results of optical coherence tomography (OCT) in patients with coronary artery disease who have previously undergone percutaneous coronary intervention (PCI). Materials and methods: OCT data from 23 patients with coronary artery disease (CAD) were studied 10 years or more after intervention with BVS implantation. Standard criteria based on OCT analysis were used to evaluate the efficacy of BVS. The stented segment, proximal zone before the stent, and distal zone after the stent were the areas of interest. Results: in the long-term period, the structure of the artery in the area of the installed biodegradable scaffolds is a combination of fragments of an atherosclerotic plaque, a resorbed scaffold, and neointima. When visualized using coherence tomography, this structure appears as a monolayer with high signal intensity. In 42.3% of patients, structures similar to fragments of the stenting frame were visualized, but smaller in size, with a disconnected structure, without clear contours and the absence of a typical shape. In 15.4% of cases, pronounced positive remodeling of the coronary artery in the area of the installation of the bioresorbable frame was noted. Conclusions: analysis of coherence tomography data showed that the use of biodegradable frames is effective and safe, the process of degradation of the frames occurs with an increase in diameter in the stented zone and the formation of a protective monolayer, while maintaining the patency of all side branches in the implantation zone.

Endovascular Treatment of Aortoiliac Aneurysms With the Bell-Bottom Technique: A Systematic Review and Meta-Analysis.

Aneurysmal degeneration of the common iliac artery (CIA) can pose a challenge to achieve distal landing zone sealing at the time of endovascular abdominal aortic aneurysm repair (EVAR). The aim of this study was to summarize the current literature regarding the bell-bottom technique (BBT) for ectatic CIAs during EVAR. This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible articles were identified through a comprehensive search of PubMed, Scopus, and Cochrane Central published until April 2023. A meta-analysis was conducted using the random effects model and the I2 statistic was used to assess for heterogeneity. The primary endpoints were type Ib/III endoleak, graft occlusion/limb embolization, and reintervention rate. Secondary endpoints included perioperative adverse events and mortality. Overall, twenty-six studies and 4332 patients with flared limbs were included. The pooled estimate for type Ib/III endoleak was 4% (95% CI: 2-6, I2 = 85.6%), for reintervention rate was 9% (95% CI: 6-12, I2 = 90.4%), and for overall mortality was 10% (95% CI: 4-19, I2 = 97.3%). No aneurysm related deaths were recorded. Comparative analysis showed similar type Ib/III endoleak, graft occlusion, and reintervention rates between the EVAR BBT, iliac branch endoprosthesis (IBE), and embolization of the internal iliac artery followed by extension of the iliac limb to the external iliac artery (EIE) groups. The use of flared limbs could be considered a reasonable first line choice for EVAR cases with CIA ectasia as it is simpler, allows for future IBE or EIE and does not increase the risk for type Ib/III endoleak or graft occlusion. Further comparative studies with longer follow-up are needed.

Settings Trace elements and garnet formation in a distal skarn zone: a case study of the Rudnik deposit, Central Serbia

The Rudnik Pb-Zn deposit is hosted in skarns and hornfels formed in the late Oligocene by contact metamorphism of limestones, sandstones and shales. Garnets, together with epidote, represent the main non-metallic minerals in the Rudnik skarn. In the distal skarn zone, the garnets are rare and their occurrence is related to the flow path of hydrothermal fluids. To constrain the hydrothermal and physicochemical conditions, in situ elemental SEM-WDS and LA-ICP-MS analyses, and fluid inclusion microthermometric measurements, were made. The Rudnik garnets from the distal skarn zone are predominantly of andradite-grossular composition (Adr39.3–88.9Grs2.9–53.9Alm0.5–10.0), with a small amount of spessartine. Generally, the Fe-rich garnets show a positive Eu anomaly with LREE enrichment and a HREE flat pattern, with homogenization temperatures and salinities of fluid inclusions ranging from 373 to 392°C and from 14.25 to 15.27% NaCl equivalent, respectively. The trace elements and microthermometric properties indicate that the garnets formed at moderately high temperatures, mildly acidic pH levels and increased oxygen fugacity

Commentator Discussion: Transcatheter electrosurgical aortic septostomy optimizes distal landing zone in chronic dissection

Commentator Discussion: Transcatheter electrosurgical aortic septostomy optimizes distal landing zone in chronic dissection

Eurasian Arctic Rifted Margin Composite Tectono-Sedimentary Element

The Eurasian Arctic Rifted Margin (EARM) spans a poorly studied transition region between the Eurasian continental shelf and the deep-water Nansen Basin. It is a conjugate margin to the Lomonosov Ridge, as both domains were united before the opening of the oceanic Eurasia Basin. The EARM is considered as a Composite Tectono-Sedimentary Element (CTSE) consisting of two individual tectono-sedimentary elements (TSEs): (1) an undefined group of poorly known pre-rift Mesozoic and Paleozoic sedimentary successions; and (2) Late Cretaceous–Paleocene synrift strata. The latter are bounded by a c. 56 Ma break-up unconformity and are overlain by the Eurasia Basin prograded margin TSE, which is not included in EARM. In the absence of drilled wells, we utilize multichannel seismic reflection (MCS) data for seismic stratigraphic correlations with nearby, better-explored, areas. The EARM CTSE is subdivided into three along-strike segments (from west to east): Svalbard–Barents Sea, the North Kara Sea and the Taimyr–Laptev Sea. Across-strike, the EARM CTSE is composed of a proximal zone of stretched crust characterized by normal faulting and a relatively narrow distal transition zone that may contain unroofed serpentinized mantle. The lack of drilled wells makes it challenging to evaluate the petroleum potential of the CTSE, although some indications of a working petroleum system presence exist.

Review: Flow Diversion for the Treatment of Middle Cerebral Artery Aneurysms.

The invention of flow diverting stents (FDS) is a novel milestone in the field of endovascular aneurysm therapy, promoting physiological healing of the vessel segment contrary to prior deconstructive treatment strategies, such as coiling. The effects of FDS are based on changes in flow patterns, segmental wall stabilization, and the growth of a neointima. Although flow diversion is already well established for cerebral aneurysms in proximal segments, peripheral locations remain challenging. Especially the middle cerebral artery (MCA) with its predominance of non-collateralized perforators and functional end arteries that supply the eloquent areas of the brain is of major concern.The literature was reviewed for flow diversion of the MCA and antiplatelet therapy.Resulting from the special anatomical characteristics of the MCA, FDS implantation in this territory is completely different from the proximal vessel segments. Still, flow diversion represents an effective endovascular strategy, especially in otherwise non-accessible or sufficiently treatable lesions. However, the risk of ischemic adverse events might be increased. Special attention to the individual decision regarding device selection, antiplatelet regimen, and exact definition of the proximal and distal landing zone considering the jailed side branches is essential for a good angiographic and clinical outcome. · MCA aneurysms can be sufficiently treated by FDS.. · The anatomic and hemodynamic characteristics of the MCA result in an increased risk of thromboembolism.. · Individual device selection and antiplatelet regimen are essential for treatment success.. · Schüngel M, Wohlgemuth WA, Elolf E et al. Review: Flow Diversion for the Treatment of Middle Cerebral Artery Aneurysms. Fortschr Röntgenstr 2024; DOI 10.1055/a-2343-0046.

Discussing on the Aortic Coverage in Type B Aortic Dissection Treatment: A Comprehensive Scoping Review.

The objective of this study is to investigate and address the question surrounding the determination of the optimal endograft length of coverage during TEVAR for type B aortic dissection (TBAD), with a particular emphasis on the distal landing zone (DLZ). MEDLINE, Scopus, and Web of Science databases were used. The PRISMA-ScR statement was followed. Several variables can contribute to the length of coverage during TEVAR in TBAD patient. Baseline patient's characteristics, TBAD-related features, the type of endoprosthesis, and postoperative graft behaviour may contribute to the choice of coverage. No robust data have been published regarding the optimal length of TEVAR. Therefore, reporting the percentage of covered aorta and improving computational studies should be valorised to improve postoperative outcomes.

Transcatheter electrosurgical aortic septostomy optimizes distal landing zone in chronic dissection

ObjectiveEfficacy of thoracic endovascular aortic repair (TEVAR) for chronic type B aortic dissection (CTBAD) is dependent on eliminating retrograde false lumen perfusion and remodeling the aorta. We describe the efficacy of a novel transcatheter electrosurgical technique to fenestrate the dissection flap and create a distal seal zone for TEVAR in CTBAD. MethodsA retrospective review of the Emory Aortic Database from 2016 to 2023 identified 33 patients who underwent TEVAR with intentional endovascular rupture of the dissection flap (Knickerbocker; KNICK) for CTBAD. In 11 patients, we performed transcatheter electrosurgical aortic septostomy (TECSAS) before KNICK. The technical aspects of TECSAS + KNICK are described and results compared with TEVAR + KNICK alone. ResultsDissection chronicity, aortic size, and preoperative demographics were similar between groups. Technical success was 100%, with zero stroke or paraplegia in both groups. Thirty-day mortality for TECSAS versus KNICK was 0% versus 13.6% (P = .199). Median follow-up was shorter after TECSAS versus KNICK, although not statistically significant (14.6 months vs 21.9 months; P = .065). Elimination of retrograde false lumen perfusion (TECSAS 100% vs KNICK 68.2%; P = .035) and complete false lumen thrombosis or obliteration (TECSAS 91.9% vs KNICK 54.6%; P = .037) were more frequent after the TECSAS procedure. Aortic reinterventions were less frequent after TECSAS versus KNICK (0% vs 13.6%, P = .199), although not statistically significant. ConclusionsThe addition of TECSAS to intentional endovascular rupture of the dissection flap in CTBAD improves distal seal, eliminating retrograde false lumen perfusion. This technique is a safe and precise method to fenestrate a dissection flap and optimize TEVAR in CTBAD.

Clinical outcomes of celiac artery coverage vs preservation during thoracic endovascular aortic repair

ObjectiveAdequate proximal and distal seal zones are necessary for successful thoracic endovascular aortic repair (TEVAR). Often, the achievement of an adequate distal seal zone requires celiac artery (CA) coverage by endograft with or without preservation of CA blood flow. The outcomes of CA coverage without its flow preservation were studied only in small case series. This study aims to determine the difference in outcomes between CA coverage with vs without preservation of CA blood flow during TEVAR using a multi-institutional national database. MethodsThe Vascular Quality Initiative database was reviewed for all TEVAR patients distally landing in zone 6. The cohort was divided into TEVAR with vs without CA flow preservation. Demographic, clinical, and perioperative characteristics, as well as postoperative mortality, morbidities, and complications, were compared between the groups. Univariate and multivariate regression analyses were performed. ResultsOf 25,549 reviewed patients, 772 had a distal landing in Zone 6, 212 of which (27.5%) had TEVAR without CA flow preservation, whereas 560 (72.5%) underwent TEVAR with CA flow preservation. Indications for TEVAR were aneurysm in 431 (55.8%), dissection in 247 (32.0%), or other in 94 (12.2%) cases. Patients who underwent TEVAR without CA flow preservation had statistically significantly higher rates of 30-day mortality (11.3% vs 5.9%; P = .010), 30-day disease/treatment-related mortality (8.0% vs 4.3%; P = .039), as well as a tendency of increased intestinal ischemia requiring intervention (1.9% vs 0.5%; P = .077). After adjusting for potential confounders, CA coverage without flow preservation was associated with more than a two-fold increase in the overall 30-day mortality (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.35-5.92; P = .006) and 30-day disease/treatment-related mortality (OR, 2.72; 95% CI, 1.11-6.72; P = .029). In a sub-group analysis based on disease pathology, these results persisted only in the aneurysm group (30-day mortality [OR, 2.36; 95% CI, 1.01-5.48; P = .047]; 30-day disease/treatment-related mortality [OR, 2.88; 95% CI, 1.08-7.67; P = .034]), whereas there was no significant association between CA flow preservation status and the endpoints in the dissection subgroup (30-day mortality [OR, 1.16; 95% CI, 0.22-6.05; P = .856], 30-day disease/treatment-related mortality [OR, 0.90; 95% CI, 0.16-5.19; P = .911]). ConclusionsCA coverage during TEVAR without preservation of its blood flow is associated with significantly higher mortality in patients with aortic aneurysm, but not dissection. In patients with aortic aneurysm, CA flow should be preserved during TEVAR whenever feasible, whereas in patients with dissection, it may be safe to cover CA without preservation of its flow. Prospective studies should be done to confirm these findings and compare the open vs endovascular revascularization techniques on outcomes.

The association between sex and outcomes after thoracic endovascular repair for acute type B aortic dissection

ObjectivePrior literature has found worse outcomes for female patients after endovascular repair of abdominal aortic aneurysm and mixed findings after thoracic endovascular aortic repair (TEVAR) for thoracic aortic aneurysm. However, the influence of sex on outcomes after TEVAR for acute type B aortic dissection (aTBAD) is not fully elucidated. MethodsWe identified patients who underwent TEVAR for aTBAD (<30 days) in the Vascular Quality Initiative from 2014 to 2022. We excluded patients with an entry tear or stent seal within the ascending aorta or aortic arch and patients with an unknown proximal tear location. Included patients were stratified by biological sex, and we analyzed perioperative outcomes and 5-year mortality with multivariable logistic regression and Cox regression analysis, respectively. Furthermore, we analyzed adjusted variables for interaction with female sex. ResultsWe included 1626 patients, 33% of whom were female. At presentation, female patients were significantly older (65 [interquartile range: 54, 75] years vs 56 [interquartile range: 49, 68] years; P = .01). Regarding indications for repair, female patients had higher rates of pain (85% vs 80%; P = .02) and lower rates of malperfusion (23% vs 35%; P < .001), specifically mesenteric, renal, and lower limb malperfusion. Female patients had a lower proportion of proximal repairs in zone 2 (39% vs 48%; P < .01). After TEVAR for aTBAD, female sex was associated with comparable odds of perioperative mortality to males (8.1 vs 9.2%; adjusted odds ratio [aOR]: 0.79 [95% confidence interval (CI): 0.51-1.20]). Regarding perioperative complications, female sex was associated with lower odds for cardiac complications (2.3% vs 4.7%; aOR: 0.52 [95% CI: 0.26-0.97]), but all other complications were comparable between sexes. Compared with male sex, female sex was associated with similar risk for 5-year mortality (26% vs 23%; adjusted hazard ratio: 1.01 [95% CI: 0.77-1.32]). On testing variables for interaction with sex, female sex was associated with lower perioperative and 5-year mortality at older ages relative to males (aOR: 0.96 [0.93-0.99] | adjusted hazard ratio: 0.97 [0.95-0.99]) and higher odds of perioperative mortality when mesenteric malperfusion was present (OR: 2.71 [1.04-6.96]). ConclusionsFemale patients were older, less likely to have complicated dissection, and had more distal proximal landing zones. After TEVAR for aTBAD, female sex was associated with similar perioperative and 5-year mortality to male sex, but lower odds of in-hospital cardiac complications. Interaction analysis showed that females were at additional risk for perioperative mortality when mesenteric ischemia was present. These data suggest that TEVAR for aTBAD overall has a similar safety profile in females as it does for males.

STRUKTUR DAN KOMPOSISI HUTAN MANGROVE DI NEGERI HATUSUA KECAMATAN KAIRATU KABUPATEN SERAM BAGIAN BARAT

The aim of this research is to determine the structure and composition of mangrove forests in Hatusua State, Kairatu District, West Seram Regency. And vegetation analysis was carried out by collecting data on the type, number, diameter and height of trees. In this research, the path method was used by carrying out a 100% inventory. The measuring plot area for the vegetation growth level of Seedlings, Saplings and Trees is 20 m x 20 m, a total of 46 plots for a total area of ​​1.84 ha. The research results show that the mangrove forests in Hatusua State can be divided into two from inundation, namely the middle zone and the distal zone, where in this mangrove forest there is no proximal zone because there are no mangroves that face the sea. The stratification of Hatusua State's mangrove forests is simpler than that of mainland natural forests. Mangrove trees in Hatusua Country can reach a tree height of 15 – 25 meters, which are dominated by Rhizophora apiculata, Heritiera littoralis, Parmentiera cereifera, and Intsia bijuga. The Hatusua State mangrove forest diversity index value of 1.37 seedlings, 2.30 saplings and 1.36 trees is categorized as medium because the value 1 &lt;H' &lt; 3.

Review: Andesitic aquifers—hydrogeological conceptual models and insights relevant to applied hydrogeology

Research on the hydrogeology of andesitic volcanic aquifers in subduction areas is reviewed. Andesitic aquifers are of high interest in volcanic arc islands and subduction zones, where they constitute a strategic water resource. This review gathers a compilation of worldwide results and case studies to propose a generic hydrogeological conceptual model (GHCM). It is based on the geological conceptual model splitting the volcanic edifice, from upstream to downstream, into central, proximal, medial and distal zones. In this geological structure, the GHCM identifies where the main aquifer types (fractured lava, pyroclastic flows, and the volcano-sedimentary basins downstream) and the typical aquitards (lahars, fine pyroclastic falls and surges, indurated pyroclastic flow, and weathered rocks) are structured and organized. To integrate the evolution of volcanoes and some specific volcanic activities, a specific GHCM for old andesitic volcanoes or andesitic shield volcanoes is detailed. The paper also describes how the GHCM results are of use to hydrogeologists in terms of scale (from the lithological units to the regional scale), to effectively site water wells, and to sustainably manage groundwater resources in such aquifers. Among these various scales, the volcanic “flank continuum” is presented as the most adapted to support groundwater resources management. Several ways to improve this GHCM are suggested, notably to better consider the geological complexity of these aquifers.

Six Years' Experience With a Novel Dissection-Specific Stent-Graft to Prevent Distal Stent-Graft-Induced New Entry.

Thoracic endovascular aortic repair (TEVAR) in chronic dissection is associated with a risk for distal stent-graft-induced new entry (dSINE) in up to a quarter of cases. We assess the mid-term outcome of a novel dissection-specific stent-graft (DSSG), which is a custom-made device based on the Cook Alpha platform, with a modified graft design and a distal endovascular elephant trunk without any supporting stent to reduce the radial force on the dissection membrane at the distal landing zone. A retrospective single-center study of chronic dissection patients at high risk of dSINE who received an elective endovascular repair with DSSG from January 2017 to June 2023. The primary outcome is Kaplan-Meier (KM) estimated freedom from dSINE during follow-up. Secondary outcomes included technical success, aortic remodeling, and anatomical evaluation of the distal landing zone in cases with dSINE during follow-up versus those without. Thirty patients (24 males) with a median age of 66 years [range=31-78] underwent elective TEVAR with the DSSG. The majority, n=27 (90%), had previous aortic repair; 7 (23%) had established connective tissue disease, and 6 (20%) had established dSINE after previous stent-graft implantation as an indication for TEVAR. Technical success was achieved in n=29 (97%). Median follow-up was 38.5 months (4.3-76.4), and KM estimated freedom from dSINE at 1 and 3 years was 95.6% (SE 0.043) and 89% (SE 0.081), respectively Four cases developed dSINE during follow-up. The median distance from the distal stent-graft to the coeliac trunk was 74mm (range=18-123) in the dSINE group versus 26mm (range=0-74) in the non-dSINE group (p=0.049). Median proximal tangential aortic angulation in the distal landing zone was 38.5° (range=26°-50°) in the dSINE group compared to 21° (range=3-61°) in the non-dSINE group (p=0.052). The Use of a novel DSSG with low radial force for TEVAR in the setting of chronic dissection is safe and feasible, with remodeling outcomes comparable with standard TEVAR. The reduced distal radial force in the DSSG does not eliminate the risk for dSINE over time, with new entries occurring, particularly in cases where the distal landing zone is in a tortuous aortic segment and not close to the coeliac trunk. Using the novel dissection-specific stent-graft with reduced radial force is safe and feasible but does not completely eliminate the risk of dSINE occurring over time. The exact positioning of the distal stent-graft in a straight aortic segment, close to the coeliac trunk, may be of importance to further mitigate the risk.