Early Type Research Articles

Myocardial work analysis for early detection of type 1 CTRCD and patient risk stratification

Abstract Aim This prospective longitudinal study analyses the potential role of Myocardial Work in early detection of cardiotoxicity during chemotherapy and its added value for prognosis and patients' risk stratification. Methods We enrolled 47 consecutive female patients with HER2-positive breast cancer referred for anti-cancer therapy based on anthracycline and taxane. Patients with depressed LV function at baseline were excluded. Medical therapy, clinical parameters and echocardiographic data were recorded at baseline and at 3, 6, 12 months follow-up. Additionally, cuff blood pressure was measured at the time of 2D-TTE examination and adequate echocardiographic images were stored for off-line analysis. Results CTRCD was detected in 17 patients (36%) while 30 patients remained free of CTRCD (64%). There were no intergroup differences for age, body mass index, resting heart rate and brachial arterial pressure. Both groups presented unaltered LV systolic function after 3 months follow-up yet overt cardiac dysfunction showed up in the CTRCD group at 6 months with significant decline in LVEF, GLS, MWI, MWE and CW from baseline values (LVEF, %: 56.0±4.1 vs 52.2±6.5; GLS, %: −20.9±1.9 vs −17.6±3.2; MWI, mmHg%: 2125±348 vs 1704±620; MWE, %: 95±2.6 vs 93±3.9 and CW, mmHg%: 2562±3567 vs 2212±455, p<0.05). Additionally, GLS, MWI and MWE at 6 months were significantly worse in the CTRCD group vs non-CTRCD group (GLS, %: −17.6±3.2 vs −20.6±1.8; MWI, mmHg%: 1704±620 vs 2087±347; MWE, %: 93±3.9 vs 96±1.5, p<0.05). Depressed LV systolic function persisted after 1 year follow-up (Figure 1). After 3 months, only de relative change in GLS and WW from baseline were significantly worse in CTRCD vs non-CTRCD (ΔGLS: +3.7±11 vs −3.9±10, ΔWW: +46.1±83 vs +2.2±45). Whereas no correlation was found, the combination of both ΔGLS and ΔWW at 3 months showed stronger prognostic value for CTRCD than each parameter alone, AUC of 0.72 (Figure 2). Conclusion These findings point the superiority of Myocardial Work for early type 1 CTRCD detection in comparison to the current diagnostic tools. Additionally, we suggest the add-on value of ΔWW on top of ΔGLS quantification for better patient risk stratification. These are promising results for better clinical surveillance of cardiac function during cancer treatment. Funding Acknowledgement Type of funding sources: None.

Early Fault Warning and Identification in Condition Monitoring of Bearing via Wavelet Packet Decomposition Coupled With Graph

It has been well known that the fault of rolling element bearings (REBs) is one of the biggest causes for machine breakdown; thus, the early detection and type identification of a fault during REBs successive operations is necessary to help users take predictive maintenance action and/or schedule in order to avoid major machine failures. Wavelet packet decomposition (WPD) is a widely used technique to analyze vibration signal for health monitoring of REBs, but the resulting wavelet packet coefficients (WPCs) are still in high dimensionality, making them impossible for the direct use in practical usage. Keeping along the research line of high-level analysis for WPD enhancement, this article presents a new dynamic modeling approach, called graph-modeled wavelet packet coefficients (GMWPCs), that integrates WPD and graph theory in order to extract the correlation information between WPCs. By means of an adaptive input weight fusion, the GMWPCs can automatically confirm the weight of the frequency sub-band where the fault-induced information is more evident. By virtue of GMWPCs, a new two-phase framework for early warning detection and fault identification is proposed finally, which is able to not only detect the time location of the fault in its very early stage but also identify the fault type. We conducted different experiments to validate the early warning detection and fault identification separately. Experimental results, outperforming the state of the arts, verify the adequacy and effectiveness of the proposed framework and meanwhile reveal its appropriate use for real engineering applications.

Early infancy growth, body composition and type of feeding in late and moderate preterms.

BackgroundLate and moderate preterm (LMPT) infants are at risk for adverse later life outcomes. We determined the association between feeding method at enrolment and growth and body composition of LMPT infants until 3 months corrected age (3mCA).MethodsInfants born between 32+0 and 36+6 weeks of gestation (n = 107) were enrolled up to 4 weeks corrected age and stratified according to feeding at enrolment. We performed anthropometric measurements at enrolment, term equivalent age (TEA) and 3mCA, including skinfold measurements and body composition using dual X-ray absorptiometry (DEXA).ResultsFeeding method at enrolment was associated with fat mass (FM) (breast 554.9 g, mixed 716.8 g, formula 637.7 g, p = 0.048), lean body mass (LM) (2512 g, 2853 g, 2722 g, respectively, p = 0.009) and lean mass index (LMI) (10.6 kg/m2, 11.6 kg/m2,11.2 kg/m2 respectively, p = 0.008) at TEA, but not 3mCA. Breastfed infants demonstrated greater increase in LM (breast 1707 g, mixed 1536 g, formula 1384 g, p = 0.03) and LMI (1.23 kg/m2, 0.10 kg/m2, 0.52 kg/m2, respectively, p = 0.022) between TEA and 3mCA.ConclusionsBreastfed LMPT infants have lower FM and greater LM increase and LMI increase up to 3mCA compared to formula or mixed-fed infants. These findings stress the importance of supporting breastfeeding in this population.Impact Infants born late and moderate preterm age who are exclusively breastfed soon after birth gain more lean mass up to 3 months corrected age compared to mixed- or formula-fed infants.Breastfed infants have lower lean and fat mass at term equivalent age compared to mixed- and formula-fed infants.This is the first study exploring this population’s growth and body composition in detail at 3 months corrected age.Our results underline the importance of supporting mothers to initiate and continue breastfeeding at least until 3 months corrected age.

Comparative Upper Respiratory Tract Transcriptomic Profiling Reveals a Potential Role of Early Activation of Interferon Pathway in Severe COVID-19.

Infection with SARS-CoV-2 results in Coronavirus disease 2019 (COVID-19) is known to cause mild to acute respiratory infection and sometimes progress towards respiratory failure and death. The mechanisms driving the progression of the disease and accumulation of high viral load in the lungs without initial symptoms remain elusive. In this study, we evaluated the upper respiratory tract host transcriptional response in COVID-19 patients with mild to severe symptoms and compared it with the control COVID-19 negative group using RNA-sequencing (RNA-Seq). Our results reveal an upregulated early type I interferon response in severe COVID-19 patients as compared to mild or negative COVID-19 patients. Moreover, severely symptomatic patients have pronounced induction of interferon stimulated genes (ISGs), particularly the oligoadenylate synthetase (OAS) family of genes. Our results are in concurrence with other studies depicting the early induction of IFN-I response in severe COVID-19 patients, providing novel insights about the ISGs involved.

Congenital alveolar rhabdomyosarcoma - case report

Rhabdomyosarcoma is the most common soft tissue sarcoma of childhood and is very rare in the neonatal period. At this age, the alveolar type is a remarkably uncommon variety. We report a 56 days old female with alveolar RMS of the right eye noted since the age of 7 days with fast progression and unfavorable prognosis. Congenital alveolar RMS is an important cause of neonatal onset rapidly progressive proptosis. Early onset, alveolar type, and late diagnosis were poor prognostic factor.

Variation of Fertility and Phenological Synchronization in Cunninghamia lanceolata Seed Orchard: Implications for Seed Production

Reproductive synchronicity between parents influences the seed production and quality in seed orchards. Our objective was to determine clonal variation in fertility and phenological synchronization, as well as their effect on seed production, in a Chinese fir (Cunninghamia lanceolata) open-pollinated seed orchard. Significant variation of female fertility and male phenological synchronization occurred in the clones. The flowering of the male was 2 days earlier than the female. The gamete contribution of female and male were unbalanced between clones (the phenological synchronization indexes (POij) were 0.000–0.585 (as female) vs. 0.000–0.385 (as male)). In general, the average POij value of as a male was lower than as a female, but the number of male flowers were significantly higher than female, indicating that the management of female flowers should be enhanced. The average POij of self-pollination was 0.298, higher than cross-pollination (0.236), indicating that there was a larger probability to selfing in the orchard. The middle phenological type possessed higher phenological synchronization indexes than early and late phenological type. Genetic control was stronger for number of female flowers (H2 = 0.277) than for male and female initial stages and flower duration (H2 = 0.193–0.239). We found a positive correlation between POij and TSW (r = 0.756), SOsc (r = 0.612), and Cp (r = 0.337), suggesting the phenological synchronization determined the seed quality and yield. Comprehensively, this study provided fertility and phenology information for management of a Chinese fir seed orchard, as well as a reference for the establishment of advanced seed orchards of conifer trees.

Photoperiod effect on vegetative growth and bulbing initiation of four garlic genotypes

Abstract. Kendarini N, Aisyah SI, Maharijaya A, Sobir. 2022. Photoperiod effect on vegetative growth and bulbing initiation of four garlic genotypes. Biodiversitas 23: 4716-4723. The main factors influencing garlic growth and development were genetics, photoperiod, and temperature. Low temperature and short photoperiod were required for initial growth, followed by a long photoperiod and high temperature for bulbing and bolting. The study was conducted to evaluate the response of garlic genotypes to photoperiod on the vegetative growth and bulbing initiation, and physiological traits (C/N ratio, GA, and total chlorophyll content). Four garlic genotypes used in this experiment consisted of two Chinese garlic genotypes (hardneck and softneck) and two local garlic cultivars (Sangga Sembalun and Tawangmangu Baru). The garlic plants were subjected to the treatment of short photoperiod (control) and long photoperiod (night break and extension methods). The results showed that the Chinese hardneck and softneck had plant vegetative growth with a higher vigor than Sangga Sembalun and Tawangmangu Baru in all photoperiod treatments. Sangga Sembalun and Tawangmangu Baru had bulbing index below 0.3 in all photoperiods. The Chinese hardneck and softneck genotypes had bulbing index greater than 0.5 in all photoperiod treatments, except the hardneck in the night break treatment. The bulbing initiation in Chinese garlic genotypes was delayed in long photoperiod treatments. High temperature during the experiment affected bulbing initiation in long photoperiod treatment. The garlic genotypes had different responses to photoperiod treatments in C/N ratio, GA, and total chlorophyll content. The vegetative growth increased under extension treatment, and night break accelerated bulb formation. Long photoperiod increased C content and C/N ratio in the leaves while it decreased N content and photosynthetic pigment content. The late maturity time (Chinese hardneck and Chinese softneck) depended on long photoperiods for the bulbing formation. In contrast, local garlic cultivars with the early and mid-season types (Sangga Sembalun and Tawangmangu Baru) were insensitive to photoperiod.

Transcription and splicing regulation by NLRC5 shape the interferon response in human pancreatic β cells.

IFNα is a key regulator of the dialogue between pancreatic β cells and the immune system in early type 1 diabetes (T1D). IFNα up-regulates HLA class I expression in human β cells, fostering autoantigen presentation to the immune system. We observed by bulk and single-cell RNA sequencing that exposure of human induced pluripotent-derived islet-like cells to IFNα induces expression of HLA class I and of other genes involved in antigen presentation, including the transcriptional activator NLRC5. We next evaluated the global role of NLRC5 in human insulin-producing EndoC-βH1 and human islet cells by RNA sequencing and targeted gene/protein determination. NLRC5 regulates expression of HLA class I, antigen presentation–related genes, and chemokines. NLRC5 also mediates the effects of IFNα on alternative splicing, a generator of β cell neoantigens, suggesting that it is a central player of the effects of IFNα on β cells that contribute to trigger and amplify autoimmunity in T1D.

Environmental variation of the low-mass IMF.

We use a series of magnetohydrodynamic simulations including both radiative and protostellar outflow feedback to study environmental variation of the initial mass function (IMF). The simulations represent a carefully-controlled experiment whereby we keep all dimensionless parameters of the flow constant except for those related to feedback. We show that radiation feedback suppresses the formation of lower mass objects more effectively as the surface density increases, but this only partially compensates for the decreasing Jeans mass in denser environments. Similarly, we find that protostellar outflows are more effective at suppressing the formation of massive stars in higher surface density environments. The combined effect of these two trends is towards an IMF with a lower characteristic mass and a narrower overall mass range in high surface density environments. We discuss the implications for these findings for the interpretation of observational evidence of IMF variation in early type galaxies.

Late Jurassic and Early Cretaceous magmatism along the northeastern margin of the Inner Mongolia Plateau and its tectonic significance

The Inner Mongolia Plateau is located in the north of the Late Palaeozoic Hegenshan ophiolitic mélange belt, and its Mesozoic magmatism impacts our understanding of the tectonic evolution affected by the closing of the Mongol‐Okhotsk Ocean and Palaeo‐Pacific Ocean. Here, we present new U–Pb ages, whole‐rock geochemistry and Hf isotopes from the Late Mesozoic magmatic rocks in the Dalai area along the northeastern margin of the Inner Mongolia Plateau. The Late Jurassic rock types include medium‐fine‐grained phenocryst‐bearing and porphyritic monzogranites as well as medium‐fine‐grained monzogranites with the precise age range of 167.7–159.8 Ma. The Early Cretaceous rock types consist of fine‐grained biotite monzogranite and medium‐fine‐grained biotite monzogranite with the precise age range of 140.9–130.7 Ma. The geochemistry data show that the Late Jurassic and Early Cretaceous rocks are peraluminous granites and high‐K calc‐alkaline series and can be classified as A‐type granite. These granites are enriched in large‐ionlithophile elements such as Rb, Th and U, depleted in the high‐field‐strength elements such as Nb, Sr, P, and Ti. Rare earth elements have high total concentrations and present the light rare earth elements enriched with the heavy rare earth elements depleted. Zircon Hf isotopes show that εHf(t) ranges from +8.0 to +15.9 from the Late Jurassic rocks and +6.9 to +13.5 from the Early Cretaceous rocks. Our new results reveal that the Late Jurassic and the Early Cretaceous magmas were derived from partial melting of the younger lower crust, and the Early Cretaceous rocks are more strongly contaminated than the Jurassic intrusions. The Late Jurassic rocks in the Dalai area were formed from a post‐collisional setting related to the closure of the Mongol‐Okhotsk Ocean in the Early‐Middle Jurassic. The Early Cretaceous intrusions were formed from a transition setting from post‐collision to syn‐collision associated with the superposition of the Mongol‐Okhotsk Ocean and the Palaeo‐Pacific Ocean tectonic domain.

Peripheral Blood circRNA Microarray Profiling Identities hsa_circ_0001831 and hsa_circ_0000867 as Two Novel circRNA Biomarkers for Early Type 2 Diabetic Nephropathy.

PurposeType 2 diabetes mellitus (T2DM) increases the incidence of diabetic nephropathy (DN) and eventually progresses to end-stage renal disease. Circular RNAs (circRNAs) are a class of non-coding RNAs that are promising as diagnostic biomarkers and therapeutic targets for human diseases. The aim of this study was to analyze the differential expression of circRNAs (DECs) in peripheral blood from patients with early type 2 diabetic nephropathy (ET2DN), T2DM and controls, which will facilitate to discover some new biomarkers for ET2DN.Patients and MethodsTwenty ET2DN patients, 20 T2DM patients, and 20 normal controls were included in this study. Blood samples from 3 random subjects of age- and sex-matched patients in each group, respectively, were used to detect circRNA expression profiles by circRNA microarray, and the circRNA expression of remaining subjects was validated by real-time quantitative polymerase chain reaction (qRT-PCR). Further functional assessment was performed by bioinformatic tools.ResultsThere were 586 DECs in ET2DN vs T2DM group (249 circRNAs were upregulated and 337 circRNAs were downregulated); 176 circRNAs were upregulated and 101 circRNAs were downregulated in T2DM vs control group; 57 circRNAs were upregulated and 5 circRNAs were downregulated in ET2DN vs control group. The functional and pathway enrichment of DECs were analyzed by GO and KEGG. qRT-PCR results revealed that hsa_circ_0001831 and hsa_circ_0000867 were significantly upregulated in ET2DN group compared to both of T2DM and control group. The ROC curve demonstrated that hsa_circ_0001831 and hsa_circ_0000867 have high sensitivity and specificity associated with ET2DN.ConclusionOur study showed the expression profiles of circRNAs in ET2DN patients and demonstrated that hsa_circ_0001831 and hsa_circ_0000867 can be used as novel diagnostic biomarkers for ET2DN.

Tirzepatide: Does the Evidence to Date Show Potential for the Treatment of Early Stage Type 2 Diabetes?

Tirzepatide is a novel “twincretin” with glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide receptor agonist activity, which was recently approved by the Food and Drug Administration for the treatment of type 2 diabetes mellitus. In this review, we discuss preclinical and mechanistic human studies, which demonstrate improvements in insulin sensitivity and beta-cell function with the use of tirzepatide, as compared to placebo and glucagon-like peptide 1 receptor agonists. We then discuss SURPASS trials 1–5, which evaluated the safety and efficacy of tirzepatide for type 2 diabetes mellitus as either monotherapy or combination therapy with other antidiabetic agents. The magnitude of tirzepatide’s effects and the efficacy relative to other anti-diabetes medications on weight, glycemic control, and beta-cell function may prove beneficial for the treatment of early type 2 diabetes mellitus. Further studies, including data on cardiovascular outcomes and long-term safety, will continue to elucidate the role of tirzepatide in the treatment algorithm of type 2 diabetes mellitus.

916P Deep learning-based multimodal ensemble algorithm for multi-cancer detection and classification using cf-WGS

Various cell-free DNA (cfDNA) features have been investigated for their potential use in early cancer detection and cancer type classification. In this study, we developed a multimodal ensemble algorithm which integrates two independent deep learning models in which one uses regional mutational density (RMD) and mutational signature as a training feature and the other uses cfDNA fragment end motif frequency and size (FEMs) profile. Cell-free whole genome sequencing data was generated from 1,088 patients (stage I: 31.9%, II: 23.8%, III: 17.5%, IV: 11.6%, unknown: 15.2%) with breast (n=418), ovarian (n=130), pancreatic (n=97), lung (n=92), esophageal (n=142), liver (n=157), and colon cancer (n=52) and 728 healthy controls. Sequence data was produced on average of 80 million reads using Novaseq 6000. Training (60%), validation (20%) and test (20%) dataset were split stratifying cancer type and stages. RMD and FEMS models were trained using multilayer perceptron and convolutional neural networks respectively. The average value of predicted probabilities from each model was used as the final ensemble prediction. Cancer detection performance reached an accuracy of 92.8% [95% confidence interval (CI): 90.1% to 95.2%] and an AUC of 0.979 (CI: 0.964 to 0.990) in the test dataset which consist of 229 cancer patients and 146 healthy controls. Cancer detection sensitivity was 91.7% (CI: 86.0% to 96.5%) at a specificity of 95%. In multi-cancer classification, the top 1 and 2 accuracy were 78.2% (CI: 77.9% to 78.2%) and 89.5% (CI: 89.3% to 89.6%) respectively. We developed a deep learning-based multimodal ensemble algorithm for multi-cancer detection and classification. Integrating a variety of cfDNA features all together enabled highly sensitive and accurate prediction. This result shows a great potential of cfDNA WGS-based liquid biopsy in general population multi-cancer screening.

Clinical presentation of bacille Calmette-Guérin (BCG) infections after BCG instillation therapy.

To investigate the timing of the clinical presentation of various types of bacille Calmette-Guérin (BCG) infections in a Finnish population of patients with bladder cancer treated with BCG instillation therapy. We identified patients with a history of post-instillation BCG infection from 1996 to 2016 using the Finnish Cancer Registry and the Finnish National Infectious Diseases Registry. We categorised infections as systemic if the infection was found in the non-urogenital system and genitourinary (GU) if the infection affected the urogenital tract. We calculated the time interval between the last BCG instillation and the presentation of the infection. The infection was considered late if the time interval was ≥1 year. A total of 100 patients with BCG infection were identified during the study period. In all, 39 (39%) infections presented as systemic and 61 (61%) were in the GU tract. The majority of the systemic infections presented rapidly after the last instillation, while five (13%) presented after a latency of ≥1 year. The presentation of GU infections was more heterogeneous, with 12 (20%) presenting as late infections. This study confirms the concept of early and late infection types, especially among systemic infections. However, late infections appeared to be rarer than previously described. Urologists should be aware of the possibility of late BCG infection if patients develop symptoms even several years after the BCG regimen.

Nonalcoholic fatty liver disease in a group of Iraqi obese children attending children welfare teaching hospital

Background: Background: Although liver biopsy is the gold standard method for diagnosing and staging non-alcoholic fatty liver disease (NAFLD), the majority of patients can be effectively diagnosed non-invasively with tests that are routinely available in the clinic today as abdominal ultrasound. Aim of the study: to study the prevalence of NAFLD as a complication among obese children and some of its related variables. Patients and methods: A cross-sectional case-control study was conducted on 71 obese cases with an age range of 2-15 years in the medical city of Baghdad from the 1st of September 2014 to the 1st of September 2015. Obese children were selected according to their Body Mass Index which should be 97th centile according to the Center for Disease Control and Prevention growth charts. We depended on abdominal ultrasound to look for FLD. Results; Most of the cases are school-age. Of these cases 17 (23.9%) were pre-hypertensive and 10 (14.1%) were hypertensive so obesity was significantly correlated with increased blood pressure. Bone age was advanced in 38 (53.5%) meaning that it had an obvious correlation with obesity. Formula-fed cases 20 (28.2%). Family history of obesity was 51 (71.8%). FLD among obese children; in the obese group; the prevalence of FLDr was 25 (35.2%). Males were 19 (76%). In obese with FLD 8 (32%) of them were hypertensive. Bone age was advanced in 18 (72%) of them. Ten (40%) were formula fed. Total serum bilirubin 3 (12%). Alanine aminotransferase 18 (72%) and Aspartate aminotransferase 13 (52%)were elevated. 13 (52%) had elevated Fasting blood glucose. Four (16%) had elevated Triglyceride levels. All of these values are more in obese with fatty liver than in obese without FLD. Conclusions; Non-alcoholic fatty liver disease is associated with significant comorbid conditions as they have more prevalence of hypertension and increased lipid profile. There is a significant correlation between early feeding type and the growing problem which is excessive TV watching and digital games playing using mobile phones by most of them.

Residential building types as an evolutionary process: the Guangzhou area, China

The idea that an evolutionary process is inherent in the sequence of building types that characterizes an area has been pursued in Euro-America, especially by Italian architects. It has hitherto attracted comparatively little attention elsewhere in the world. Findings on the history of residential building types in the Chinese city of Guangzhou and its environs are examined in relation to this idea. Though the history of building types is very different in China from that in Euro-America, an evolutionary process is shown to have occurred in the Guangzhou area. The principal rural building type in the nineteenth century – the sanjian lianglang house – and an early urban building type – the zhutongwu – are steps in the development of a number of later building types.

Mid-term Outcomes of Physician-Modified Fenestrated or Branched Endovascular Repair for Post-dissection Thoracoabdominal Aortic Aneurysms.

To report the early experience and mid-term outcomes of physician-modified fenestrated or branched endovascular repair (PM-F/BEVAR) for patients with post-dissection thoracoabdominal aortic aneurysm (PD-TAAA). PD-TAAA patients treated with PM-F/BEVAR between December 2014 and September 2020 in our institution were retrospectively analyzed. Out of the 39 patients, technical success defined as successful deployment of all stent grafts with patent target vessels (TVs) and exclusion of the lesion without type I or III endoleak was achieved in 35 patients (89.7%). A total of 126 TVs were successfully reconstructed. Thirty-day mortality was 0%. Seven major adverse events occurred including one acute kidney injury, four renal infarctions, one retroperitoneal hematoma and one left renal artery occlusion. Seven type II endoleak and three type III endoleak were detected. During a mean 29.4 ± 15.5months follow-up period, the mortality was zero. Three renal arteries and one external iliac artery occluded in four patients. No other new onset major adverse event occurred. No patient required reintervention. One type II endoleak spontaneously resolved, while the remaining six remained stable. One early type III endoleak diminished, and one new type III endoleak occurred at 2months. The primary patency of TV was 96.8% (120/124). Shrinkage or stability of aneurysm diameter can be observed in 38 patients (97.4%). The false lumen thrombosis rate was 89.7% (35/39). The present study showed encouraging results of PM-F/BEVAR for treatment of PD-TAAAs. Level 4, Case Series.

Outcomes of thoracic endovascular aortic repair with chimney technique for aortic arch diseases.

ObjectiveThis study aimed to summarize the long-term experience of using the chimney technique in thoracic endovascular aortic repair (TEVAR) for aortic arch diseases.MethodsFrom November 2007 to June 2021, a total of 345 consecutive patients (mean age 56 ± 11.3 years, range 28–83, 302 men) with aortic arch pathologies underwent TEVAR combined with chimney technique (cTEVAR). Their medical data and follow-up results were retrospectively reviewed and analyzed.ResultsAmong the 345 patients, 278 (80.6%) received single chimneys, 53 (15.4%) received double chimneys, 7 (2%) received triple chimneys, and 7 (2%) underwent cTEVAR accompanied by other techniques (two with extra-anatomical bypass, two with in situ fenestration, and three with physician modified fenestration). A total of 412 chimney stents were used, including 27 in the innominate artery (IA), 113 in the left common carotid artery, 270 in the left subclavian artery, and two in the aberrant right subclavian artery. Early type IA endoleaks were found in 38 (11%) patients, including 12 with the double or triple chimney technique. Early type II endoleak was found in nine (2.6%) patients. Early re-intervention occurred in two patients with double chimney technique, one for chimney stent migration and the other for compression of chimney stent. The 30-day mortality was 1.2% (4 in 345). During a mean follow-up of 42 ± 22 months (range 1–108 months), major stroke occurred in nine (2.6%) patients, chimney occlusion or stenosis occurred in six (1.7%), and retrograde type A aortic dissection occurred in four (1.2%). Fourteen (4.1%) patients received the secondary intervention. The all-cause mortality was 6.7% (23 in 345). Additionally, the total adverse event rate after cTEVAR was 13.9% (48 in 345).ConclusionTEVAR with chimney technique provides a minimally invasive alternative with good chimney graft patency and low postoperative mortality during follow-up. However, the double and triple chimney techniques should be used cautiously as they seem to have a higher risk for type IA endoleak and adverse events after the operation.

Late Neck Related Adverse Events are Rare Among Patients with Wide Aortic Neck Undergoing Endovascular Aneurysm Repair with the Ovation Endograft

Patients with wide aortic necks undergoing Endovascular Aneurysm Repair (EVAR) have been shown to be at a higher risk for neck-related complications. We aim to examine outcomes of EVAR with an endograft exerting minimal outward pressure (Ovation-Endologix) in patients with a large baseline neck diameter. We performed a retrospective single center study, including consecutive patients undergoing EVAR with the Ovation system from May 2011 to April 2021. Patients were divided in Groups 1 and 2 if the 20, 23, 26, 29 mm or the 34mm proximal diameter main body was used, respectively. According to the instructions for use of the device, for neck diameters 27-30mm the 34mm main body is required. Primary endpoint was rate of neckrelated complications during follow-up, (type Ia endoleak, migration >10mm and neck-related re-interventions) and rate of aortic neck dilatation (AND). AND was determined based on multiple aortic neck diameters that were recorded and compared between the 1-month computed tomography angiography (CTA) after EVAR and the last available follow-up CTA.Secondary endpoints were peri-procedural and follow-up outcomes such as endoleaks, reinterventions and overall mortality. In total 281 patients were included, 222 in Group 1 and 59 in Group 2. Patients in Group 2 presented significantly shorter neck length, higher neck angulation and more common reversed tapered configuration. Median follow-up was 36months (Range: 6-106). Early and late type Ia endoleak was observed in 4 and 2 patients in each group, respectively (P=0.063 and P=0.195, respectively). Distal migration was observed in 2 patients in Group 2 and AND was recorded in 2 patients in each group (P=0.195). Freedom from the primary endpoint was estimated at 98%, 94%, 94% at 12-, 36-, 60-months for Group 1 and at 98%, 95%, 86% for Group 2 (P-Value 0.266). Probability of survival was 95%, 86%, 75% at 12-, 36-, 60-months for Group 1 and 83%, 77%, 72% for Group 2 (P-Value 0.226).Multivariate regression analysis identified neither Group 1 versus Group 2 nor absolute value of aortic neck diameter as significant predictors of neck-related adverse events. Neck diameters did not display significant differences over time in any of the levels evaluated. EVAR with the Ovation endograft results in low rates of late neck related complications which is also true for patients with wide baseline aortic necks.

Correlation Analysis of Computed Tomography Features and Pathological Types of Multifocal Ground-Glass Nodular Lung Adenocarcinoma.

To investigate the correlation between computed tomography (CT) image characteristics of multiple lung ground-glass nodules (GGNs) and pathological classification, the CT image data of multiple lung GGN patients confirmed by pathology (n = 132) in our hospital were collected. The imaging features of GGNs were analyzed by qualified physicians, including lesion size (diameter, volume, and mass), location, CT values (mean and relative CT values), lesion morphology (round and irregular), marginal structure (pagination and burr), internal structure (bronchial inflation sign), and adjacent structure (pleural depression). CT imaging analysis was performed for the subtype of infiltrating adenocarcinoma (IAC). In CT findings, GGNs were greatly different from adenomatous hyperplasia (AAH), pure GGN adenocarcinoma in situ (AIS), and microinvasive adenocarcinoma (MIA) in terms of marginal structure, lesion morphology, internal structure, adjacent structure, and size (P < 0.05). The mean and relative CT values of mural adenocarcinoma, acinar adenocarcinoma, and papillary adenocarcinoma of IAC subtypes were greatly different from those of AAH/AIS/MIA (P < 0.05). In summary, the CT images of GGNs can be used as the basis for the differentiation of AAH, AIS, and MIA early noninvasive types and IAC invasive types, and the CT value of the IAC subtype can be used as the basis for the classification and differentiation of IAC pathological subtypes.