Landing Zone Research Articles

What is the Optimal Proximal Landing Zone of the Stent Graft in Treatment of Aortic Type B Dissection?

Retrograde type A aortic dissection (RTAD) represents a serious complication of endovascular treatment for type B aortic dissection (TBAD). To avoid RTAD, it is recommended to land the proximal end of the stent graft in a non-dissected aortic segment. In this study, we investigated whether landing in the dissection area increased the number of events at the proximal site. We conducted a retrospective review of endovascular treatments for TBAD at a single institution between 2009 and 2022. Patients were divided into two groups: group A, with a proximal landing zone entirely within the dissected area, and group B, with the proximal extent of the seal zone in the non-dissected area. We evaluated the occurrence of proximal events, including RTAD, and examined long-term outcomes to assess the validity of landing in the dissection area. The study included eighty-nine patients who underwent endovascular treatment for TBAD. New intimal tears in the proximal landing site occurred in 3 cases (3.4%), with 1 case (2%) in group A and 2 cases (5.1%) in group B, showing no significant difference. Among the three cases, one (1.1%) in group B with zone 2 landing resulted in RTAD. At 60months, the overall survival was 85%, and freedom from aorta-related mortality was 88%, with no significant difference between the groups. Even if the proximal landing is in a dissected area, a treatment strategy performed in zone 3 without proximal landing in zone 2, seeking a non-dissected area, can still provide sufficient therapeutic effects. Level of Evidence 3 Retrospective single-center cohort analysis.

Spatial Distribution and Association of Gastropods in Mangrove Ecosystem in The Coast of Nusa Lembongan and Perancak Bali

Lembongan Island and Perancak are two areas located in Bali Province that have mangrove ecosystems that are utilized as ecotourism areas with different geomorphologies. This study was conducted with the aim to determine the density and spatial distribution of gastropods and their relationship with environmental characteristics using a multivariate analysis approach i.e., Correspondence Analysis (CA) and Principal Component Analysis (PCA). Sampling used a purposive sampling method consisting of 3 zones based on distance from the sea, namely the sea, middle and land zones. The results showed that the most gastropod species in Lembongan Island were found in the sea zone with 17 which the most gastropod species is Pyrene ocellata, while in Perancak the most gastropod species were found in the middle zone with 13 which the most gastropod species is Sphaerasiminea miniata. Environmental characteristics such as temperature, pH, ORP, salinity and dissolved oxygen still support the survival of gastropods. There is twelve mangrove species have found, were Rhizopora stylosa, Rhizopora apiculata, Rhizopora mucronata, Rhizopora lamarckii, Bruguiera gymnorrhiza, Ceriops tagal, Avicennia marina, Avicennia alba, Avicennia rumphiana, Avicennia officinalis, Sonneratia alba, and Xylocarpus granatum.

Utilizing Single-Branched Stent in Combination With Fenestration or Chimney for Endovascular Repair of Aortic Arch Lesions With Aberrant Subclavian Artery.

The study was to figure out the feasibility, efficacy, and safety of a single-branched stent graft, namely Castor, in combination with fenestration or chimney in the context of aortic arch lesions presenting with aberrant subclavian artery (ASA) and/or Kommerell's diverticulum (KD). All consecutive patients with aortic arch lesions and ASA and/or KD receiving Castor from June 2018 to June 2023 were investigated. Incorporating 18 patients, the study encompassed 11 cases with KD, 3 cases with dysphagia; 2 cases of right-sided aortic arch with left-sided aberrant left subclavian artery (ALSA), and 16 cases of left-sided aortic arch with right-sided aberrant right subclavian artery (ARSA). The mean operation time was 132±23 minutes. The mean measured proximal aortic diameter was 30.9±1.6 mm, and proximal diameter of Castor stent was 34 (32, 34.5) mm, with oversize of 9.1±1.6%; the mean measured branch diameter was 8.8±0.97 mm, and branch diameter of Castor stent was 10 (8, 10) mm, with oversize of 0.86±0.57 mm. Technical success rate was 100%, and no in-hospital mortality, no stroke, and no endoleak were identified. One (5.6%) case with spinal cord ischemia and one (5.6%) case with poor healing of operative site were identified. During the follow-up period, no aortic-related death or secondary intervention was recorded. The maximal aortic diameter was significantly reduced at the sixth postoperative month (padj=0.031); KD diameter was significantly reduced at the third (padj=0.001) and sixth (padj<0.001) postoperative month. Totally endovascular repair of aortic arch lesions with ASA and KD via Castor stent in combination with fenestration or chimney is feasible, effective, and safe, which can achieve an encouraging medium-term outcome and provide excellent remodeling at the lesions. Single branched stent in combination with fenestration or chimney achieved a sufficient proximal landing zone and provided an encouraging medium-term outcome in this retrospective review of 18 patients receiving endovascular treatment of pathological aortic arch with aberrant subclavian artery and/or Kommerell's diverticulum. The authors suggest this time-saving and efficient technique to establish systematic experience for the treatment in this kind of patients.

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.

Editor's Choice – Sex Related Anatomical Differences in Patients With Aortic Arch Pathology and Their Impact on the Feasibility of Double and Triple Branched Endografts

To evaluate sex based differences in ascending aorta and arch anatomy in patients with underlying proximal aortic disease and to evaluate their impact on feasibility for total endovascular repair with custom made, branched arch devices. This was a retrospective cross sectional review of all patients undergoing open and or total endovascular arch repair due to distal ascending aorta and or aortic arch pathologies in a single high volume aortic centre between 2012 and 2022. Anatomical ascending aorta and aortic arch parameters were analysed on a flow centreline on a dedicated 3D workstation. Sex related differences of the ascending aorta, aortic arch, and supra-aortic vessels were evaluated. Subsequently, four endovascular devices were assessed for feasibility: double and triple branched devices both for the Zenith (Cook Medical) and Relay (Terumo Aortic) platforms, first in accordance with the instructions for use and then considering the possibility of adjunctive cervical debranching. The primary endpoints were sex specific differences in aortic anatomy, while secondary endpoints included sex based feasibility of branched endograft devices. During the study period, 395 patients underwent total aortic arch repair, of whom 152 (51 female, 33.5%) had high quality computed tomography angiograms available and were included in the study. Female patients had a shorter proximal landing zone than males (22 mm vs. 47 mm; p < .001). Left subclavian artery dissection was more frequent in men (24.8% vs. 3.9%; p < .001). Other anatomical parameters showed a similar distribution between sexes. Female patients presented a lower feasibility for double branched devices (35.3% vs. 58.4%; p= .015) as well as a tendency for lower feasibility rates for triple branched devices (31.4% vs. 47.5%; p= .081). Although most ascending aortic and arch parameters showed similar trends in both sexes, the availability of a suitable proximal landing zone was lower in female patients. Consequently, female patients had lower feasibility rates for double arch branched endografts and, to lesser extent, for triple arch branched endografts.

Mississippian (Lower Carboniferous) Facies Heterogeneity and Distribution within the Mixed Carbonate-Siliciclastic Reservoirs of the Midcontinent STACK Play, Oklahoma, USA

Summary The objective of this study is to evaluate facies heterogeneity, including both lateral and vertical distributions within the mixed carbonate and siliciclastic reservoirs of the Mississippian System (Lower Carboniferous). This research and statistical approach will aid in future investigations related to determining optimal landing zones, enhancing completion designs, and providing geologic insight into fracture driven well interference studies to increase production efficiency. This study integrates well log, petrographic, sedimentologic, and conventional core analyses along a set of transects across the Anadarko Basin and includes the development of core-based facies logs. Statistical analysis indicates that the Mississippian System in the STACK play of the Anadarko Basin is fundamentally a highly layered rhythmic succession in which a variety of carbonate rock types, siliciclastic rock types, and chert tend to form couplets with siltstone. Thickness-frequency distributions and Markov chain analysis indicate that sediment thickness and lithologic transitions were stochastically regulated and that lithologic cyclicity is not apparent. Overall lithologic trends indicate a transition from carbonate to sandstone in the midramp and from carbonate to mudstone and siltstone in the outer ramp. Stratal geometry defines a series of south-prograding clinoforms, and detailed analysis of vertical trends in the distribution of mudstone, siltstone, sandstone, chert, and carbonate facilitates identification of shoaling-upward parasequences that can be correlated regionally.

Martian Dust Storm Spatial‐Temporal Analysis of Tentative Landing Areas for China's Tianwen‐3 Mars Mission

AbstractChina's first Mars sampling return mission (Tianwen‐3) is designed to launch and retrieve samples around 2030. Three tentative landing areas (TLAs) (Amazonis, Chryse and Utopia Planitiae, i.e., TLA‐A, TLA‐C and TLA‐U) are selected based on elevation &lt;−2,000 m and latitude between 17° and 30°N. As a dominant feature of Martian meteorology, dust storms manifest in all seasons and affect the accuracy and safety of Mars exploration missions. Tianwen‐3's landing, sampling and ascent phases are in the dust storm season. Therefore, analyzing dust storm activity around landing areas is significant for the Tianwen‐3 mission. According to Mars Daily Global Maps taken by Mars Orbiter Camera spanning Martian years 24–28, 2,476 dust storm events around the three TLAs were identified in this research. Dust storm temporal probabilities within TLA‐A, TLA‐C and TLA‐U were calculated as 0%–44.69%, 0%–66.29% and 0%–33.64%, separately. Dust storm spatial probabilities around the TLA‐A, TLA‐C and TLA‐U were computed, with ranges of 0%–10.71%, 0%–14.55% and 0%–19.96% during the T1 period (Ls = 161–309°), and 0%–6.75%, 0%–7.65% and 0%–8.26% during the T2 period (Ls = 342‐55°), respectively. Finally, considering the temporal and spatial distribution of dust storms, we recommend the T2 period as the launch scenario. Three safe periods (Ls = 2–18°, 4–12°, and 356–4°) were assigned for the entry‐descent‐landing (EDL) phase, along with one period (Ls = 45–55°) for the take‐off and ascent phase. Five circular landing zones with dust storm spatial probability &lt;3% were selected for the Tianwen‐3 mission.

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.

Initial Experience of the Covered Endovascular Reconstruction of Iliac Bifurcation Technique.

The distal landing zone in iliac arteries represents an important issue during endovascular repair of abdominal aortic aneurysms (EVAR). The aim of this study is to present a case series for landing in the external iliac artery (EIA) during EVAR while preserving blood flow in the internal iliac artery (IIA) with the covered endovascular reconstruction of the iliac bifurcation (CERIB) technique. This is a single-center, retrospective analysis of prospectively collected data of patients that underwent EVAR either for intact abdominal aortic aneurysm (AAA) or previous failed EVAR from December 2022 up to September 2023. Indications for treatment were presence of common iliac artery aneurysm (CIAA), short CIA, or endoleak type Ib (ETIb). For the distal sealing zone, we used balloon-expandable covered stent (BXCS). Primary outcomes were technical success and first-month patency rate. Secondary outcomes were endoleak and re-intervention rate. Sixteen patients being treated with 20 CERIBs were included in the study. Four patients had a previous failed EVAR, while 3 patients were treated urgently for a symptomatic para-renal aneurysm. The indications for treatment were EIb (n=2), short CIA (n=4), CIAA with narrow lumen (n=3), and CIA aneurysm (n=11). Platforms that were used were the Cook Zenith Alpha (n=5), Gore C3 (n=2 and 3 limbs), Endurant IIs (n=2, and 3 limbs), and a t-branch device (n=3). Technical success rate was 100% with no adjunctive procedure. No death or re-intervention was recorded for all patients at postoperative 30-day period and at 6 months for 2 patients. At first-month CTA, patency rate was 100% (20/20), while in 2 patients that had 6-month CTA, the patency was also 100% (2/2). No kinking or stenosis was also noted. Two patients had ETIII after branched EVAR (BEVAR), 2 patients had ETII, and 1 patient had gutter ET in the area of the CERIB. The CERIB technique seems to be effective and safe in the early period. It is suitable with a variety of commercial endograft platforms. It may be a valuable alternative to iliac branch devices when there are anatomical considerations. Longer follow-up is needed to conclude for long-term patency and durability. The distal landing zone in iliac arteries represents an important issue during EVAR while it is important to preserve blood flow in the internal iliac artery. The covered endovascular reconstruction of the iliac bifurcation (CERIB) technique is a technique for the preservation of internal iliac arteries during EVAR, while it is suitable with a variety of commercial endograft platforms. The CERIB technique seems to be effective and safe in the early period. It may be valuable alternative to iliac branch devices when there are anatomical considerations.

Technical Aspects and Outcome of Multi-Staged and Single-Staged Thoracoabdominal Fenestrated Endovascular Aortic Repair.

In some cases of endovascular thoracoabdominal or juxtarenal aortic aneurysm repair, a thoracic endograft in combination with a fenestrated renovisceral device may be needed in order to create a sufficient proximal landing zone. This study aimed to evaluate the technical aspects and postoperative morbidity of a single- or 2-stage approach. Eighty-seven consecutive patients undergoing thoracic endovascular aortic repair (TEVAR) in combination with elective fenestrated repair (fenestrated endovascular aortic repair [FEVAR]; fenestrated Anaconda device) from 2015 to 2022 were included in this retrospective bicentric study. Underlying pathologies, aortic morphology, technical details, and postoperative morbidity were recorded. Single-staged ("1S," n=61) and 2-staged ("2S," n=26) interventions were compared. Indications were thoracoabdominal aneurysms (TAAAs) (Crawford I-IV) (n=56, 64%) and juxtarenal aneurysms (n=31, 36%). In 2S, the proportion of TAAA was higher than in 1S (2S: 77%, 1S: 59%; p=0.001). In 2S, the covered length of the descending aorta was longer (1S: 128±60 mm, 2S: 202±64 mm; p=0.003). Temporary aneurysm sack perfusion (TASP) was established in 11 (18%) of 1S and 1 (4%) of 2S patients (p=0.079), as well as cerebrospinal fluid (CSF) drainage catheter in 48 (79%) of 1S and 19 (73%) of 2S. The rate of spinal cord ischemia (SCI) and the severity of SCI were not different in both groups, with a total of 3 cases of persisting paraplegia. The rate of access complications was higher in 2S (n=6, 23%) than in 1S (n=4, 7%; p=0.027). Postoperative 30 day morbidity did not significantly differ in both groups and neither did 30 day mortality (4.6% in 1S vs 3.8% in 2S; p=0.083). The combination of TEVAR and FEVAR using a fenestrated endograft is feasible and safe. Aortic morphology does not change significantly after endovascular repair. A single-staged strategy is feasible with excellent results, especially in Crawford IV, Crawford V, or juxtarenal aneurysms. Two-staged repair is recommended in cases with long aortic coverage and a higher American Society of Anesthesiologists (ASA) class. Follow-up data are needed to evaluate the long-term stability of the TEVAR/FEVAR interconnection. Our study has revealed the safety and efficacy of the combination of TEVAR and FEVAR in the treatment of TAAAs and juxtarenal aneurysms with compromised supravisceral landing zones. A single-staged concept is not necessary in all cases. Staged procedures may reduce postoperative morbidity in cases with long aortic coverage and higher ASA class.

LAPAROSCOPIC TREATMENT OF RIGHT INGUINAL HERNIA RE-RECURRENCE

Abstract We report the case of an 81-year-old man presenting with a right inguinal hernia re-recurrence. He had undergone a laparoscopic transabdominal preperitoneal hernioplasty in 2001. The recurrence occurred in 2021, and therefore, he had to be treated with an open approach. Past medical history included arterial hypertension, COPD, coronary artery stenting for ischemic heart disease, stage II chronic renal failure. Previous surgeries consisted of bilateral iliac arteries, percutaneous angioplasty and stenting with a right femoral arterial access, laminectomy of L3–L5, and laparoscopic cholecystectomy. Surgical procedure Laparoscopy confirmed a right hernia re-recurrence. Herniated ileal loop was completely reduced. Peritoneal incision was performed with a lateral-to-medial approach. The mesh was dissected away from the pre-peritoneal fat. The shrunk mesh was pulled downwards to allow the identification of the epigastric vessels, which were then dissected according to a cranial-to-caudal approach. The large hernia sac was completely reduced thus exposing the re-recurrence orifice. Dissection was carried out towards the Bogros’ space. Epigastric vessels were detached from the mesh thus allowing to expose the medial part of the myopectineal orifice. Cooper’s ligament and pubic symphysis were therefore identified. The epigastric and spermatic vessels were freed from the mesh only after the critical view of the myopectineal orifice (MPO) was achieved. The mesh was completely mobilized from the peritoneum and removed. A “landing zone” was obtained, a 15 × 10 cm self-fixating mesh positioned around the re-recurrence orifice. Peritoneum closure was performed by means of a 3–0 running barbed suture from medial to lateral.

Navigating Land Conservation, Utilization, and Market Solutions: Insights from the Lanyang River Watershed, Taiwan

In the current fraught relationship between nature and human society, land conservation and utilization have spawned intensive conflicts that require mediation. The present study explores this issue of coordination between nature and society in a fragile watershed located in northeastern Taiwan: the Lanyang River Watershed. Land zoning in this area has been historically classified and legally implemented, and additional development is constrained by an application review process. Currently, additional land utilization is still in demand in sensitive areas of this watershed, such as for mining and tilling. Due to the geographically, geologically, and climatically fragile characteristics of the watershed, the hillside residents have benefited from the conservation of nature with comprehensive ecosystem services but are at the forefront of the loss of life and property caused by forest ecosystem degradation. They are one of the key local resource users and main stakeholders. Applying the contingent valuation method to survey the hillside residents, the present study assessed the economic value they receive from the comprehensive ecosystem services offered by the natural forest ecosystems. Their opinions are explored using a survey on their awareness of ecosystem damage, their opinions on damage compensation, and on the feasible compensation channels for damage. As the study results ascertained the high value of the comprehensive ecosystem services continuously delivered by the conserved forest ecosystem, the study affirmed that conservation in the area classified and zoned as sensitive is an economic beneficial policy. With a high regard for ecosystem services and awareness of the impact of degradation and of the general agreement for the feasibility of channels of damage compensation, the continuity of conservation for these comprehensive ecosystem services is the preferred strategy for the local hillside residents. To emphasize this further, the opinions of the local community at the intersection of nature and society, where there is a delineated land zoning framework, strongly favor conservation over intensive resource exploitation and agricultural expansion, making further development an unfavorable strategy.

Phytoremediation of soils contaminated as a result of military and anthropogenic impact

Military conflicts and anthropogenic accidents cause significant soil contamination with heavy metals, oil products, pesticides, and other toxic substances. The purpose of this study was to highlight the factors of influence of military-anthropogenic load on soils and to analyse the available methods of their remediation. The study summarised the available and promising phytoremediation methods with an assessment of their impact on soil contamination by chemicals that are typical pollutants during military conflicts. The study summarised, classified, and compared the groups of pollutants that are most common during military operations; analysed the impact of pollutants on the fertile soil layer and their mobility; and analysed the available remediation methods. It was found that the available soil remediation technologies, which can be used individually or in combination, provide the necessary tools to address the problem of chemical contamination of soils due to toxic products such as explosive derivatives and heavy metals. The degree of economic feasibility was considered, which, accordingly, suggested that soil phytoremediation may be the most economically feasible under certain conditions. This opens wide possibilities for further investigations, where the synergy of ecology, economics, and agrobiology will enable the development of mechanisms for optimising soil phytoremediation methods, considering their type, profile, and intended use. An algorithm of actions for remediation of soils as a result of military-anthropogenic load was proposed, which includes a related set of related actions on zoning, demining, assessment, and return of land to industrial use. The findings of this study can be used to clean industrial areas that have been contaminated during production processes or accidents

Effect of Different Sources and Levels of Sulphur in Sesame on Yield, Nutrient Uptake and Soil Fertility in Acid Alfisols of Odisha, India

Aims: To examine the impact of different sources and levels of Sulphur on yield and oil content of sesame in acid Alfisols of Dhenkanal district of Odisha. Study Design: Randomized Block Design with three replications. Place and Duration of Study: During 2018 and 2019, this experiment was carried out at the Odisha University of Agriculture and Technology's Regional Research and Technology Transfer Station, which is located in Mahisapat, Dhenkanal district, Mid Central Table Land Zone, Odisha. Methodology: The treatments were T1- STBFR (S control), T2- STBFR + 30 kg ha-1 S from Ammonium Phosphate Sulphate, T3- STBFR + 40 kg ha-1 S from Ammonium Phosphate Sulphate, T4- STBFR + 30 kg ha-1 S from Gypsum, T5- STBFR + 40 kg ha-1 S from Gypsum, T6- STBFR + 30 kg ha-1 S from SSP, T7- STBFR + 40 kg ha-1 S from SSP. Results: Among seven treatments, T7 (STBFR along with 40 kg ha-1 S from SSP) was superior among all the sources and doses w.r.t. yield components and yield. The quality parameters like oil content under different sulphur fertilization was found to be maximum with STBFR along with 40 kg ha-1 S from SSP. Highest total nutrient uptake in terms of N, P, K and S of 55, 26, 37 and 5 kg/ha was recorded with the same treatment. Conclusion: Sulphur fertilization (T7) in the acid Alfisols of Odisha exhibited improved yield, oil content and nutrient uptake in sesame.

TEVAR with fenestrations of all supra-aortic branches for traumatic aortic pseudoaneurysm: Case report and systematic review.

Blunt thoracic aortic injuries (BTAIs) involving the aortic arch are a challenging condition. Thoracic endovascular aortic repair (TEVAR) with fenestration, which expands the proximal landing zone, is able to exclude the injury while preserving blood flow in supra-aortic branches. Here we report a case of TEVAR with fenestrations of all supra-aortic branches for traumatic aortic pseudoaneurysm and perform a systematic review. A 24-year-old man suffering a blunt thoracic injury and a left femoral fracture was sent to our hospital. A pseudoaneurysm was found in the aortic arch between the brachiocephalic artery and the left common carotid artery. The patient underwent emergent TEVAR with fenestrations of all supra-aortic branches, which excluded the pseudoaneurysm and preserved the patency of all branches. The orthopedic team then treated the femoral fracture. The patient's recovery was unremarkable. We performed a systematic review on TEVAR with fenestrations for BTAI. Six patients (75%) received TEVAR with single fenestration, 1 patient (12.5%) received TEVAR with two fenestrations, and 1 patient (12.5%) had fenestrations of all supra-aortic branches. Except one patient died in the perioperative, other patients survived without stent-related complications in the short-term follow-up. TEVAR with fenestration is feasible for treating BTAI involving the aortic arch in selected patients.

Current expert-based opinions on endovascular treatment of blunt thoracic aortic injury: A state-of-the-art narrative review on indications, techniques, results, and challenges.

Blunt thoracic aortic injury (BTAI) represents one of the most devastating scenarios of vascular trauma which warrants prompt recognition with expedited management. Clinical manifestations of BTAI may not be straightforward to detect and may be misdiagnosed. Therefore, diagnosis of BTAI requires a high index of suspicion based on the mechanism of injury along with urgent transfer to centers with appropriate expertise and facilities. We provide an expert-based narrative review on endovascular treatment of BTAI highlighting indications, techniques, results, and challenges. Multiple imaging modalities can be used including computed tomography angiography, transesophageal echocardiography, magnetic resonance imaging, and intravascular ultrasound. Whilst conservative pharmacological management can be a safe option in low-grade BTAI, thoracic endovascular aortic repair has become the gold-standard strategy in most cases, replacing open surgical repair. Nevertheless, it is important to account for patient demographics particularly age, severity of injury, choice of endograft including its type and size, and endovascular technique including landing zone and left subclavian artery revascularization. Overall, TEVAR in BTAI has been shown to be an efficacious strategy with favorable early outcomes. In contrast, less is known on the long-term clinical outcomes of TEVAR in BTAI. Hence, despite the optimal early technical and clinical success rates, concerns remain about the need for long-term surveillance. The exact timing of follow-up and the integration of different modalities that can also investigate potential downstream cardiovascular effects remain hot topics for future research. Finally, industry should focus on developing more compliant endografts to improve the stiffness mismatch between the endograft and the aorta to optimize results.

Transanal eco-Doppler evaluation after hemorrhoidal artery embolization.

Hemorrhoidal artery embolization (Emborrhoid) is a novel method for the treatment of severe hemorrhoidal bleeding. Despite having a technical success rate of 93%-100%, the clinical success ranges between 63% and 94%, with a rebleeding rate of 13.6%. To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding. This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center, Treviso Regional Hospital, Italy. In a 2 months period (February-March 2022), consecutive patients with hemorrhoidal bleeding scores (HBSs) ≥ 4, Goligher scores of II or III, failure of non-operative management, and a candidate for Emborrhoid were included. Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure. The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment. The secondary endpoint was to evaluate the correlation between the flow changes and the HBS. Eleven patients underwent Emborrhoid. The overall pretreatment mean systolic peak (MSP) was 14.66 cm/s. The highest MSP values were found in the anterior left lateral (17.82 cm/s at 1 o'clock and 15.88 cm/s at 3 o'clock) and in the posterior right lateral (14.62 cm/s at 7 o'clock and 16.71 cm/s at 9 o'clock) quadrants of the anal canal. After treatment, the overall MSP values were significantly reduced (P = 0.008) although the correlation between MSP and HBS changes was weak (P = 0.570). A statistical difference was found between distal embolization compared with proximal embolization (P = 0.047). However, the coil landing zone was not related to symptoms improvement (P = 1.000). A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery (SRA) anatomy (P = 0.040). No relationship between hemorrhoidal grades (P = 1.000), SRA anatomy (P = 1.000) and treatment outcomes was found. The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease. However, the correlation between the post-operative MSP and HBS changes was weak. Hemorrhoidal grade, SRA anatomy and type of embolization were not related to treatment outcomes.

Angulation and curvature of aortic landing zone affect implantation depth in transcatheter aortic valve implantation

In transcatheter aortic valve implantation (TAVI), final device position may be affected by device interaction with the whole aortic landing zone (LZ) extending to ascending aorta. We investigated the impact of aortic LZ curvature and angulation on TAVI implantation depth, comparing short-frame balloon-expanding (BE) and long-frame self-expanding (SE) devices. Patients (n = 202) treated with BE or SE devices were matched based on one-to-one propensity score. Primary endpoint was the mismatch between the intended (HPre) and the final (HPost) implantation depth. LZ curvature and angulation were calculated based on the aortic centerline trajectory available from pre-TAVI computed tomography. Total LZ curvature (kLZ,tot\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${k}_{LZ,tot}$$\\end{document}) and LZ angulation distal to aortic annulus (αLZ,Distal\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\alpha }_{LZ,Distal}$$\\end{document}) were greater in the SE compared to the BE group (P < 0.001 for both). In the BE group, HPost was significantly higher than HPre at both cusps (P < 0.001). In the SE group, HPost was significantly deeper than HPre only at the left coronary cusp (P = 0.013). At multivariate analysis, αLZ,Distal\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\alpha }_{LZ,Distal}$$\\end{document} was the only independent predictor (OR = 1.11, P = 0.002) of deeper final implantation depth with a cut-off value of 17.8°. Aortic LZ curvature and angulation significantly affected final TAVI implantation depth, especially in high stent-frame SE devices reporting, upon complete release, deeper implantation depth with respect to the intended one.

The effect of landing zone toricity on scleral lens fitting characteristics and optics.

The fit and optical performance of a scleral lens is affected by the alignment of the landing zone with the underlying ocular surface. The aim of this research was to quantify the effect of landing zone toricity upon scleral lens fitting characteristics (rotation and decentration) and optics (lens flexure) during short-term wear. Scleral lenses with nominal landing zone toricities of 0, 100, 150 and 200 μm were worn in a randomised order by 10 young healthy participants (mean [SD] 24 [7] years) for 30 min, with other lens parameters held constant. Scleral toricity was quantified using a corneo-scleral profilometer, and lens flexure, rotation, and decentration were quantified using over-topography during lens wear. Repeated measures analyses were conducted as a function of landing zone toricity and residual scleral toricity (the difference between scleral and lens toricity) for eyes with 'low' magnitude scleral toricity (mean: 96 μm) and 'high' magnitude scleral toricity (mean: 319 μm). Toric landing zones significantly reduced lens flexure (by 0.37 [0.21] D, p < 0.05) and lens rotation (by 20 [24]°, p < 0.05) compared with a spherical landing zone. Horizontal and vertical lens decentration did not vary significantly with landing zone toricity. These trends for flexure, rotation, and decentration were also observed for eyes with 'low' and 'high' magnitude scleral toricity as a function of residual scleral toricity. Landing zones with 100-200 μm toricity significantly reduced lens flexure (by ~62%) and rotation (by ~77%) but not horizontal or vertical lens decentration, compared with a spherical landing zone, when controlling for other confounding variables. The incorporation of a toric landing zone, even for eyes with lower magnitude scleral toricity (~100 μm), may be beneficial, particularly for front surface optical designs.

Long-term Outcomes With Expanded Polytetrafluoroethylene Valved Conduits in Pediatric Patients

BackgroundThe expanded polytetrafluoroethylene (ePTFE) valved conduit (VC) has been reported for pulmonary valve replacement (PVR). The purpose of this study was to review long-term outcomes of our trileaflet ePTFE VC. MethodsThis multicenter study was performed with institutional review board approval from each institution. Our VC is fashioned from commercially available ePTFE tube grafts (for the conduit) and 0.1-mm-thick ePTFE membrane (for the trileaflet material). The patients were followed up in our clinic. Valve function was assessed by echocardiography in the operating room and at follow-up clinic visits after implantation. ResultsFifty-five patients received ePTFE VC between 2012 and 2023 (16-28 mm in diameter). Patients’ age at the time of implantation ranged from 6 months to 20 years (median, 7.5 years). Clinical follow-up ranged from 4 days to 10.1 years (average, 3.6 years). There were no hospital deaths. There were 2 non–valve-related late deaths. There have been no cases of endocarditis. Two patients required balloon dilation for the distal pulmonary artery stenosis, and 1 patient required residual ventricular septal defect closure. Five patients have received transcatheter PVR (TPVR) because of increased pressure gradient across the VC. Freedom from TPVR at 10 years was 90%. No valves required explantation or surgical replacement. ConclusionsCompared with historical data for other PVR options, our ePTFE VC shows excellent long-term performance and, when required, provides an easily accessible “landing zone” for TPVR. Our technique is easily learned, is reproducible, and can be a valuable option for surgeons performing PVR in pediatric patients.