Stage Of PAD Research Articles

Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in Germany.

To present the short- and long-term outcomes of lower extremity bypass (LEB) surgery in patients with critical limb-threatening ischaemia (CLTI), comparing diabetic (DM) and non-diabetic (non-DM) patients. Retrospective analysis of anonymised data from a nationwide health insurance company (AOK). Data from 22,633 patients (DM: n = 7266; non-DM: n = 15,367; men: n = 14,523; women: n = 8110; mean patient age: 72.5 years), who underwent LEB from 2010 to 2015, were analysed. The cut-off date for follow-up was December 31, 2018 (mean follow-up period: 55 months). Perioperative mortality was 10.0% for DM and 8.2% for non-DM (p < 0.001). Patients with crural/pedal bypasses (n = 8558) had a significantly higher perioperative mortality (10.3%) than those with above-the-knee (n = 7246; 5.8%; p < 0.001) and below-the-knee bypasses (n = 6829; 8.9%; p = 0.003). The 9-year survival rates in DM patients were significantly worse, at 21.5%, compared to non-DM, at 31.1% (p < 0.001). This applied to both PAD stage III (DM: 34.4%; non-DM: 45.7%; p < 0.001) and PAD stage IV (DM: 18.5%; non-DM: 25.0%; p < 0.001). Patients with crural/pedal bypasses had a significantly inferior survival rate (25.5%) compared to those with below-the-knee (27.7%; p < 0.001) and above-the-knee bypasses (31.7%; p < 0.001). Perioperative and long-term outcomes regarding survival and major amputation rate for CLTI patients undergoing LEB are consistently worse for DM patients compared to non-DM patients.

Prefrontal EEG slowing, synchronization, and ERP peak latency in association with predementia stages of Alzheimer's disease.

Early screening of elderly individuals who are at risk of dementia allows timely medical interventions to prevent disease progression. The portable and low-cost electroencephalography (EEG) technique has the potential to serve it. We examined prefrontal EEG and event-related potential (ERP) variables in association with the predementia stages of Alzheimer's disease (AD). One hundred elderly individuals were recruited from the GARD cohort. The participants were classified into four groups according to their amyloid beta deposition (A+ or A-) and neurodegeneration status (N+ or N-): cognitively normal (CN; A-N-, n = 27), asymptomatic AD (aAD; A + N-, n = 15), mild cognitive impairment (MCI) with AD pathology (pAD; A+N+, n = 16), and MCI with non-AD pathology (MCI(-); A-N+, n = 42). Prefrontal resting-state eyes-closed EEG measurements were recorded for five minutes and auditory ERP measurements were recorded for 8 min. Three variables of median frequency (MDF), spectrum triangular index (STI), and positive-peak latency (PPL) were employed to reflect EEG slowing, temporal synchrony, and ERP latency, respectively. Decreasing prefrontal MDF and increasing PPL were observed in the MCI with AD pathology. Interestingly, after controlling for age, sex, and education, we found a significant negative association between MDF and the aAD and pAD stages with an odds ratio (OR) of 0.58. Similarly, PPL exhibited a significant positive association with these AD stages with an OR of 2.36. Additionally, compared with the MCI(-) group, significant negative associations were demonstrated by the aAD group with STI and those in the pAD group with MDF with ORs of 0.30 and 0.42, respectively. Slow intrinsic EEG oscillation is associated with MCI due to AD, and a delayed ERP peak latency is likely associated with general cognitive impairment. MCI individuals without AD pathology exhibited better cortical temporal synchronization and faster EEG oscillations than those with aAD or pAD. The EEG/ERP variables obtained from prefrontal EEG techniques are associated with early cognitive impairment due to AD and non-AD pathology. This result suggests that prefrontal EEG/ERP metrics may serve as useful indicators to screen elderly individuals' early stages on the AD continuum as well as overall cognitive impairment.

Experimental investigation on fracture characteristics by liquid nitrogen compound fracturing in coal

The stimulation efficiency of hydraulic fracturing in coalbed methane (CBM) reservoir are low due to high filtration. In this study, a new compound fracturing method is proposed to improve the CBM reservoir fracturing efficiency combining the advantages of liquid nitrogen (LN2) fracturing and hydraulic fracturing. The compound fracturing starts from LN2 fracturing forming complex fractures and non-filtration zones, follows by injecting nitrogen gas (N2) to displace LN2 near the borehole into the fracture tips and prevent subsequent sand-carrying fluids from freezing in the borehole, and finishes by using sand-fluid mixtures carrying proppant into the frozen coal seam. To test the feasibility, fracturing experiments were conducted to investigate the performances of LN2 compound fracturing. The lab results show that LN2 compound fracturing can create more complex and highly conductive fracture networks than water fracturing and pure LN2 fracturing. Compared with LN2 fracturing, the average fracture aperture, fractures number, and total fracture volume induced by compound fracturing increased by 28%, 10%, and 34%, respectively. Compared with water fracturing, the fractures number, and total fracture volume induced by compound fracturing increased by 55% and 42%, respectively. The reason for the improved conductivity as follows: in the pad stage of the compound fracturing, coal is fractured by LN2 with low viscosity and low temperature, forming a large number of small-scale fractures. In the slurry stage, coal is fractured by water, which further activates the small-scale fractures, increasing the number and aperture of fractures. The key findings obtained in this work is the proposed LN2 compound fracturing method that helps sustainable development of CBM resources in an efficient and environmentally friendly way.

Can hippocampal subfield measures supply information that could be used to improve the diagnosis of Alzheimer's disease?

The diagnosis of Alzheimer's disease (AD) needs to be improved. We investigated if hippocampal subfield volume measured by structural imaging, could supply information, so that the diagnosis of AD could be improved. In this study, subjects were classified based on clinical, neuropsychological, and amyloid positivity or negativity using PET scans. Data from 478 elderly Korean subjects grouped as cognitively unimpaired β-amyloid-negative (NC), cognitively unimpaired β-amyloid-positive (aAD), mild cognitively impaired β-amyloid-positive (pAD), mild cognitively impaired-specific variations not due to dementia β-amyloid-negative (CIND), severe cognitive impairment β-amyloid-positive (ADD+) and severe cognitive impairment β-amyloid-negative (ADD-) were used. NC and aAD groups did not show significant volume differences in any subfields. The CIND did not show significant volume differences when compared with either the NC or the aAD (except L-HATA). However, pAD showed significant volume differences in Sub, PrS, ML, Tail, GCMLDG, CA1, CA4, HATA, and CA3 when compared with the NC and aAD. The pAD group also showed significant differences in the hippocampal tail, CA1, CA4, molecular layer, granule cells/molecular layer/dentate gyrus, and CA3 when compared with the CIND group. The ADD- group had significantly larger volumes than the ADD+ group in the bilateral tail, SUB, PrS, and left ML. The results suggest that early amyloid depositions in cognitive normal stages are not accompanied by significant bilateral subfield volume atrophy. There might be intense and accelerated subfield volume atrophy in the later stages associated with the cognitive impairment in the pAD stage, which subsequently could drive the progression to AD dementia. Early subfield volume atrophy associated with the β-amyloid burden may be characterized by more symmetrical atrophy in CA regions than in other subfields. We conclude that the hippocampal subfield volumetric differences from structural imaging show promise for improving the diagnosis of Alzheimer's disease.

Treatment of Lymph Fistula after Vascular Surgery with Low-Dose Radiotherapy

<h3>Purpose/Objective(s)</h3> After vascular reconstructions in the groin area, a persistent lymph fistula regularly threatens the prognosis of the affected extremity. Rapid, effective treatment of the lymph fistula is therefore essential in order to be able to prevent amputation. As part of a pilot study, we wanted to analyze the chances and limitations of radiotherapy in the treatment of lymphatic fistulas. <h3>Materials/Methods</h3> As part of an internal quality control, patients were identified for this study who acquired a lymph fistula in the groin as a result of vascular surgery due to <i>peripheral artery disease</i> stage IV and were irradiated at the University Hospital Düsseldorf. <h3>Results</h3> Eight men aged 66 + 12, 4 years underwent vascular surgery for PAD stage IV. Surgery was performed in these patients via the groin and all men subsequently had a persistent lymphatic fistula with a secretion greater than 50 ml/day. Five patients were irradiated with a fractionation of 10 × 0.4 Gy and 3 patients with a fractionation of 10 × 0.3 Gy. In all patients, the lymphatic fistula dried up within the irradiation series. No higher-grade complications occurred. <h3>Conclusion</h3> Irradiation of the groin in the case of a persistent lymphatic fistula could be a therapeutic option to avoid amputations due to wound infections after vascular reconstruction in the groin. Prospective randomized studies would be desirable in order to be able to better evaluate the role of radiotherapy in the treatment of lymphatic fistulas.

A 3D SEMIANALYTICAL MODEL FOR SIMULATING THE PROPPANT STRESSES AND EMBEDMENT IN FRACTURED RESERVOIR ROCKS

Hydraulic fracturing uses substantial amounts of proppants to keep the fracture open. The arrangement of proppants inside the fracture depends on several parameters that are included in the pad stage, slurry stage, and rock properties. Lower amounts of proppants can befitted close to the fracture tip due to the limited fracture width. Therefore only one layer of proppants might form, either as a compacted monolayer or a less compacted partial monolayer. The interaction of rock and proppant during drawdown can lead to proppant embedment in ductile formations, and proppant or rock crushing in brittle formations. Both cases cause a loss of fracture conductivity, which directly impacts well productivity. A better understanding of the relationship that exists between proppants and rocks can allow better treatment designs. This interaction is investigated in this study through the development of a semianalytical model. This model uses the basis of contact mechanics for sphere-plane interactions to find the deformation profile of the fracture. Different parameters were considered in this study, including proppant size and arrangement. The results were compared with an existing analytical model and a numerical model. The simulation results suggest that using nonuniform proppant sizes in a fractured rock can have a significant impact on the crushing and embedment of proppants. Furthermore, a mixture of proppant sizes can provide a better fracture conductivity for the cases considered in this study. The ultimate compressive strength of the larger-sized proppants is a critical parameter in the success of this design.

Acute and Long-Term Outcomes of ST-Elevation Myocardial Infarction in Cancer Patients, a 'Real World' Analysis with 175,000 Patients.

Acute myocardial infarction (AMI) and cancer are common and serious diseases. As the prognosis and treatment of both diseases has improved, more cancer patients will suffer an AMI. Unfortunately, data on these "double hit" patients is scarce. From the largest public German health insurance, anonymized data of all patients with pre-existing cancer who were hospitalized due to ST-elevation MI (STEMI) between 2010 and 2017 were analyzed and followed-up until 2018. Of 175,262 STEMI patients, 27,213 had pre-existing cancer (15.5%). Most frequent were skin (24.9%), prostate (17.0%), colon (11.0%), breast (10.9%), urinary tract (10.6%), and lung cancer (5.2%). STEMI patients with malignancies were older and presented more often with coronary three-vessel disease, atrial arrhythmias, chronic kidney disease, chronic heart failure, cerebrovascular and peripheral artery disease (PAD, each p < 0.001). They showed more often previous AMI, percutaneous coronary interventions (PCI), cardiac surgery, and stroke (all p < 0.001). Acute PCIs were applied between 2 and 6% less frequently compared to those without cancer. In-hospital adverse events occurred more frequently in cancer. Eight-year survival was 57.3% (95% CI 57.0-57.7%) without cancer and ranged between 41.2% and 19.2% in distinct cancer types. Multivariable Cox regression for all-cause mortality found, e.g., lung cancer (HR 2.04), PAD stage 4-6 (HR 1.78), metastasis (HR 1.72), and previous stroke (HR 1.44) to have the strongest impact (all p < 0.001). In this large "real world" data, prognosis after STEMI in cancer patients was markedly reduced but differed widely between cancer types. Of note, no withholding of interventional treatments in cancer patients could be observed.

Preclinical amyloid‐PET SUVr in the precuneus and posterior cingulate associations with MoCA scores are driven by language domain subscores

AbstractBackgroundβ‐amyloid (Aβ) deposition in the brain is the earliest pathological change supporting a diagnosis of preclinical Alzheimer’s disease (pAD). Such deposition can be quantified using amyloid‐PET scans, which also enable a quantitative evaluation of the distribution of the pathology in pAD. Cognitive screening instruments such as the Montreal Cognitive Assessment (MoCA) are widely used to detect cognitive decline as one transitions from pAD to mild cognitive impairment or dementia due to AD, but have little proven utility in tracking cognitive decline during the stage of pAD. The present study sought to identify potential relationships between regional Aβ deposition and domain specific subscales and items comprising the MoCA in pAD.MethodNinety‐nine clinically normal participants with a MoCA score ≥ 23 underwent F18‐florbetapir PET/CT scanning and regional standardized uptake value ratio (SUVr) was determined using the Siemens Syngo.via® Neurology software package. Relationships between regional SUVr and MoCA test performance as well as MoCA domain scores were analyzed using linear regression models adjusted for age and education.ResultSubjects included 68 women and 31 men with a mean age of 74.2±6.3 years, education 16.7±2.6 years, and MoCA 26.6± 1.9. The adjusted linear regression analyses demonstrated that reduced global MoCA score was associated with increased regional SUVr in the precuneus and posterior cingulate regions only (p&lt;0.05). This relationship appeared to be driven predominantly by the language domain index score rather than other subdomains of the MoCA (R2=0.122; p= 0.003).ConclusionThese data demonstrate that increased Aβ deposition in the precuneus and posterior cingulate (the earliest brain regions affected with Aβ pathology) are associated with decreased global cognitive performance, driven by language domain subscores in individuals with pAD. Further research using more sensitive domain‐specific tests in cognitively normal individuals may help determine optimal low‐cost, non‐invasive, neuropsychological predictors of pAD.

Calcification Propensity in Serum and Cardiovascular Outcome in Peripheral Artery Disease.

Peripheral artery disease (PAD) has been shown to be linked to elevated cardiovascular risk. The novel T50 test quantifies calcification propensity of serum and has been associated with cardiovascular events and mortality in patients with chronic kidney disease (CKD) and in the general population. This study investigated the association of calcification propensity measured by the T50 test in 287 patients with PAD without severe CKD. Major cardiovascular events (MACEs) including nonfatal stroke and nonfatal myocardial infarction and all-cause death (MACE + ) were evaluated after a median follow-up of 4 years and long-term cardiovascular and all-cause mortality after a median follow-up of 8.7 years by Kaplan-Meier and Cox regression analyses. Mean T50 time was 268 ± 63 minutes in the study cohort (age 69 ± 10 years, 32% women, 47% diabetes). Low T50 values that signify high calcification propensity were significantly associated with the occurrence of MACE+ (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.55-0.94). This association sustained multivariate adjustment for cardiovascular risk factors (CVRFs), Fontaine PAD stage, and prevalent media sclerosis (HR: 0.65; CI: 0.47-0.91). Cardiovascular mortality was significantly associated with T50 after multivariate adjustment for CVRF (HR: 0.72; CI 0.53-0.99), but not all-cause mortality (HR: 0.80; CI: 0.64-1.01). In conclusion, calcification propensity associates with MACE+ and cardiovascular mortality in patients with PAD.

Analyses of the pericyte transcriptome in ischemic skeletal muscles

BackgroundPeripheral arterial disease (PAD) affects millions of people and compromises quality of life. Critical limb ischemia (CLI), which is the most advanced stage of PAD, can cause nonhealing ulcers and strong chronic pain, and it shortens the patients’ life expectancy. Cell-based angiogenic therapies are becoming a real therapeutic approach to treat CLI. Pericytes are cells that surround vascular endothelial cells to reinforce vessel integrity and regulate local blood pressure and metabolism. In the past decade, researchers also found that pericytes may function as stem or progenitor cells in the body, showing the potential to differentiate into several cell types. We investigated the gene expression profiles of pericytes during the early stages of limb ischemia, as well as the alterations in pericyte subpopulations to better understand the behavior of pericytes under ischemic conditions.MethodsIn this study, we used a hindlimb ischemia model to mimic CLI in C57/BL6 mice and explore the role of pericytes in regeneration. To this end, muscle pericytes were isolated at different time points after the induction of ischemia. The phenotypes and transcriptomic profiles of the pericytes isolated at these discrete time points were assessed using flow cytometry and RNA sequencing.ResultsIschemia triggered proliferation and migration and upregulated the expression of myogenesis-related transcripts in pericytes. Furthermore, the transcriptomic analysis also revealed that pericytes induce or upregulate the expression of a number of cytokines with effects on endothelial cells, leukocyte chemoattraction, or the activation of inflammatory cells.ConclusionsOur findings provide a database that will improve our understanding of skeletal muscle pericyte biology under ischemic conditions, which may be useful for the development of novel pericyte-based cell and gene therapies.

Pressure-Based Diagnostics for Evaluating Treatment Confinement

SummaryIn multiple-stage hydraulic fracturing treatments performed in horizontal wells, treatment confinement is the state in which fracturing fluid and proppant flow out of the wellbore only through the specific perforations targeted for the fracturing stage. The terms treatment confinement and treatment isolation are synonymous. Isolation from previously treated intervals is a necessary condition for efficient treatment along the lateral. Failure to confine fracturing stages can be a result of failure of the fracture plug to maintain a seal or the development of casing breaches (holes) in the proximity of the fracture plug. Both conditions can be strongly impacted by proppant induced erosion.This paper is a sequel to a previous publication in which casing erosion and breaches were investigated in fracture treated horizontal wells in the Montney Formation (White et al. 2020). Integrated diagnostic methods based on data from treating pressure analysis, fiber-optic measurements, and downhole imaging were applied to investigate the root cause of failure. It was determined that treatment pressure analysis was effective in diagnosing casing and associated fracture plug integrity-loss events. This was achieved by (1) identifying treating pressure trends and anomalies during the main part of the treatment that signify confinement loss, (2) calculating near-wellbore friction at the end of treatments to compare to the friction expected for a confined treatment, and (3) analyzing step-down tests conducted during the pad stage and overflush stage at the end of the treatment to determine the near-wellbore frictional components of perforation friction and near-wellbore tortuosity. This information enables comparison of previous with current treatments for determining the effects of job design and fracture plug modifications on treatment confinement.The objective of this paper is to validate that useful conclusions on the degree of treatment confinement can be made using only stand-alone pressure-based analysis. This is achieved by comparing the analysis results with fiber-optic and post-treatment wellbore imaging measurements. Also highlighted is the use of downhole gauges for accurately calculating pipe friction, which is necessary for accurately calculating bottomhole treating pressure at the active treatment interval.

Numerical simulation of hydraulic fracture propagation in laminated shale reservoirs

Abstract The main area of the Jiaoshiba anticline of the Fuling shale gas field was taken as the research object, laboratory rock mechanical experiments and direct shear experiments were conducted to clarify the mechanical anisotropy characteristics and parameters of rock samples with rich beddings. Based on the experimental results, a 3D fracture propagation model of the target reservoir taking mechanical anisotropy, weak bedding plane and vertical stress difference into account was established by the discrete element method to analyze distribution patterns of hydraulic fractures under different bedding densities, mechanical properties, and fracturing engineering parameters (including perforation clusters, injection rates and fracturing fluid viscosity). The research results show that considering the influence of the weak bedding plane and longitudinal stress difference, the interlayer stress difference 3–4 MPa in the study area can control the fracture height within the zone of stress barrier, and the fracture height is less than 40 m. If the influence of the weak bedding plane is not considered, the simulation result of fracture height is obviously higher. Although the opening of high-density bedding fractures increases the complexity of hydraulic fractures, it significantly limited the propagation of fracture height. By reducing the number of clusters, increasing the injection rate, and increasing the volume and proportion of high-viscosity fracturing fluid in the pad stage, the restriction on fracture height due to the bedding plane and vertical stress difference can be reduced, and the longitudinal propagation of fractures can be promoted. The fracture propagation model was used to simulate one stage of Well A in Fuling shale gas field, and the simulation results were consistent with the micro-seismic monitoring results.

P1280IMPACT OF HAEMODIALYSIS IN PATIENTS UNDERGOING BYPASS SURGERY FOR PERIPHERAL ARTERY DISEASE WITH CRITICAL LIMB ISCHEMIA - 10-YEAR FOLLOW-UP STUDY -

Abstract Background and Aims Although lower extremities bypass surgery has been commonly performed as the standard option to treat peripheral artery disease with critical limb ischemia (CLI) even in patients on haemodialysis (HD) as well as general population, higher amputation and/or mortality rates still remains major clinical problems after bypass surgery in this population. In this 10-year follow-up study, we investigated the impact of HD on outcomes after surgical revascularization in patients with CLI. Method A total of 464 patients undergoing successfully elective bypass surgery were enrolled. We compared 304 HD patients with 335 limbs and 160 non-HD (NHD) patients with 183 limbs during 10 years follow-up period. Primary outcome was amputation-free survival (AFS) rate defined as freedom rate from composited endpoint with major amputation (limb amputation above ankle level) or all-cause mortality. To minimize the differences of clinical characteristics between the two groups, propensity score-matching with all baseline variables was performed. Results Prevalence of diabetes (55.6% vs. 33.8%), ulcer/gangrene (99.1% vs. 63.5%) and infra-popliteal artery disease (58.9% vs. 32.5%) were significantly higher in HD group compared to NHD group (p&amp;lt;0.0001 in all). Pre-procedural C-reactive protein (CRP) levels was also higher in HD group [14.0 (4.0-51.5) mg/l vs. 7.0 (2.0-34.0) mg/l, p=0.0015]. Inversely, age was younger in HD group than in NHD group (67±9 years vs. 72±8 years, p&amp;lt;0.0001). The 30-day mortality rate was comparable (3.3% in HD group vs. 1.3% in NHD group, p=0.16). During follow-up period (median of 48 months), 53 amputation (17.4%) and 102 death (33.6%) in HD group, and 17 amputation (10.6%) and 23 death (14.4%) in NHD group occurred, respectively. The 10-year AFS rate was significantly lower in HD group compared to NHD group [41.3% vs. 71.3%, hazard ratio (HR) 2.33, 95% confidence interval (CI) 1.64-3.41, p&amp;lt;0.0001). Similarly, limb salvage rate and survival rate was also lower in HD group than in NHD group (72.1% vs. 87.5%, HR 1.90, 95%CI 1.12-3.39, p=0.016, and 51.8% vs. 80.4%, HR 2.78, 95%CI 1.80-4.48, p&amp;lt;0.0001, respectively). In the propensity score-matched cohort, having no significant differences of all baseline characteristics between HD and NHD group (n=125 in each), the 10-year AFS rate and survival rate was still lower in HD group compared to NHD group (53.1% vs. 72.8%, HR 2.11, 95% CI 1.34-3.39, p=0.0012 and 58.6% vs. 84.9%, HR 3.72, 95% CI 2.09-7.06, p&amp;lt;0.0001, respectively). However, the limb salvage rate was statistically comparable between the two group (81.9% vs. 84.2%, HR 1.13, 95%CI 0.55-2.38, p=0.74). In addition, pre-procedural CRP levels could predict major amputation in HD patients (HR 1.06, 95%CI 1.01-1.10, p=0.024) but not NHD patients (HR 1.09, 95%CI 0.93-1.25, p=0.27). Conclusion The long-term AFS rate and survival rate were markedly lower in HD patients compared to NHD patients. However, the limb salvage rate was even between HD and NHD after adjustment for clinical characteristics. These results suggest that detection at the early stage of PAD may potentially improve the poor outcome. Pre-procedural inflammation status may also specifically affects the poor outcome in HD group.

Risk Factors in Peripheral Artery Disease Associated with Coronary Artery Disease

Abstract Peripheral arterial disease (PAD) is a partial or complete occlusion of one or more arteries leading to a suppression of blood flow and ischemia. In the process of stenosis, numerous processes are described, among which, the most common being atherosclerosis, affecting the arteries of the inferior and coronary limbs. In the 60 patients investigated angio-coronarographically in the Emergency County Clinical Hospital of Sibiu with PAD, the prevalence of high blood pressure (HBP) and smoking was observed, among the risk factors, and 73.3% had one or more coronary lesions. The association of diabetes mellitus (DM) with PAD has shown an increase in the number of coronary lesions. There was also a strong positive correlation between the presence of left anterior descending artery (LAD) injuries and the stage of PAD regardless of other risk factors.

Non-occlusive lower limbs arteriopathy in hypertensive type 2 diabetes: Should we get interested?

Occlusive peripheral artery disease (OPAD) is a strong marker of cardiovascular events. Screening for PAD is recommended by all guidelines; however, there is no consensus on the benefit for detecting the non-occlusive stage of PAD (NOPAD). Therefore, when screening for OPAD, all patients with NOPAD are usually merged with those having normal arteries. WE aimed to assess the bio-clinical profile and morbidity related to diabetes complications in patients with NOPAD and to compare them to those with OPAD and with normal arteries at ultrasonography (UNA). In a cross-sectional, observational, prospective study with a sub-group analysis, we recruited 327 consecutive newly diagnosed type 2 diabetics, aged from 40 to 70 year from January 2009 to December 2014. We collected clinical, biological data and screened exhaustively for macro and microvascular complications. All patients had an Ankle-Brachial Index measurement and a duplex ultrasonography (DUS). The diagnosis of PAD was done on DUS. We considered as NOPAD the presence of atherosclerosis plaque and/or medial artery calcifications without stenosis. We selected the sub-group of hypertensive diabetics for analysis. Coronary risk was calculated by using the Framingham score. Among 327 newly diagnosed type 2 diabetics, 202 had hypertension, 129 women and 73 men; 12 patients had OPAD (5.9%), 111 had NOPAD (54.9%) and 79 had UNA (39.2%), aged respectively 54.8 ± 8.3, 57.1 ± 7.8 and 50.4 ± 7.9 years ( P < 10 −6 ). Arterial DUS showed both atherosclerosis and medial arterial calcifications in 90% in the PAD groups. We didn’t find significant difference between the three groups on smoking ( P = 0.824), body mass index ( P = 0.962), arterial blood pressure ( P = 0.058), glycemic status ( P = 0.975) and prevalence of metabolic syndrome ( P = 0.431). OPAD and NOPAD patients had higher LDL ( P = 0.005), higher coronary disease risk ( P = 10 −4 ), lower glomerular filtration rate ( P = 0.011) and significantly more chronic kidney disease ( P = 0.0009), coronary artery disease ( P = 0.008), atherothrombotic events ( P = 10 −4 ), peripheral diabetic neuropathy ( P = 0.024) and cognitive impairment ( P = 0.006) than those with UNA. No significant difference has been found while comparing the OPAD and NOPAD groups on all studied parameters except for cardiovascular events that are more prevalent in the OPAD group ( P = 0.009). Non-occlusive as well as occlusive PAD, is associated with a high cardiovascular morbidity when associated with type 2 diabetes and hypertension. A screening of NOPAD could help to risk stratification in hypertensive diabetics allowing them to benefit of an earlier preventive action on cardiovascular events. Clinicaltrials.gov ID: NCT02002091

Real-Time Formation-Face-Pressure Analysis Improves Acid-Fracturing Operations

This article, written by JPT Technology Editor Judy Feder, contains highlights of paper SPE 194351, “Real-Time Analysis of Formation-Face Pressures in Acid-Fracturing Treatments,” by Vibhas Pandey, SPE, and Robert Burton Jr., SPE, ConocoPhillips, and Kay Capps, Capsher Technology, prepared for the 2019 SPE Hydraulic Fracturing Technology Conference and Exhibition, The Woodlands, Texas, USA, 5–7 February. The paper has not been peer reviewed. Knowledge of formation-face pressures is critical to the success of hydraulic-fracturing treatments, especially in multistage and multiple-cluster-type horizontal-well completions. This knowledge can help in evaluating the effectiveness of acid-fracturing treatments in dynamic mode and also can enable and improve real-time decision-making during treatment execution. This paper contains a detailed discussion of methods and a software tool that has been developed to generate information that predicts formation-face pressures in real time with the help of live bottomhole-pressure data. Introduction Acid-fracturing treatments combine the basic principles of hydraulic fracturing and acid-reaction kinetics to stimulate acid-soluble formations. Unlike propped fracturing treatments, in which a viscous pad is followed by slurry-laden fluid that assists in keeping the fracture propped open to create a conductive flow path for formation fluids, the fracture conductivity in acid fracturing is generated by dissolving the formation face to create an uneven surface on the fracture walls. Multiple pad and acid stages are pumped during the course of the treatment to create a high-conductivity fracture. The acid stage then fingers through the pad and the open fracture to create differentially etched patterns on the fracture walls. The uneven, etched surfaces prevent the fracture from closing completely once the hydraulic pressure is removed, leading to a highly conductive pathway to enhance hydrocarbon flow. Once the acid contacts the formation, the bottomhole treating pressure recedes quickly, and, as acid spending continues, the effective bottomhole pressures can fall below fracture-closure stresses. Not all loss of pressure is a result of acid spending alone. The fluid fingering among fluids of highly contrasting viscosities also can result in such drops. However, the stress relief that results from acid spending dominates this behavior. Pumping additional acid in these cases only results in near-well acid or mineral reactions, which do not extend fracture penetration and may increase wellbore-integrity risks. Unfortunately, without a good estimation of effective fracture pressures, determination of when the fracture-treatment pressure dips from above closure stress to below closure stress is difficult. Determination of this critical transition was a primary driver of the study that led to the creation of a tool that can assist in determining the real-time treating pressures at the entry of the fracture during stimulation treatments. Several acid-fracturing treatments were analyzed using the tool, leading to important conclusions related to fracture-propagation modes, acid-exposure times, and effectiveness of given acid types.

Beyond the Arteries in Peripheral Artery Disease

Abstract Objectives. This study aimed to examine peripheral artery disease severity impact on psychological profile of arteriopathy patients. Material and methods. The prospective study included consecutive PAD patients admitted to the 2nd Department of Internal Medicine and the Department of Cardiology of the Emergency Clinical Hospital “Sf. Spiridon” Iasi, between January and September, 2017. Rezults. The group included 139 PAD patients, 80.6% male and 19.4% female, with an average age of 63.23±9.44 years. PAD stages have a very strong association with level of quality of life (p&lt;0.0001). All Leriche-Fontaine classification categories were significantly associated with the depressive symptoms (p&lt;0.0001). The stress level was moderate in stages IIA, IIB and III and extremely severe in the terminal stage. The prevalence of anxiety was lowest in incipient PADstages with the highest value in stage III. Conclusions. The fragment of the PhD study presented the psychological profile in the PAD staging and advocates a personalized, wide-ranging approach to the arteriopathy patient including pain and depressive-anxiety management, with amajor impact on the quality of life at terminal stages.

Experimental optimisation of the fracturing treatment design to enhance long-term gas production in shale formations

We investigated the impact of the friction reducer, nonionic surfactant and slugs of dilute HCl on the Eagle Ford and Marcellus shales permeability during hydraulic fracturing pad stage. Moreover, we examined injecting of a nonionic surfactant or slugs of 3% HCl when the slickwater was used in the pad stage. Lastly, we investigated the impact of pumping slugs of 3% HCl when a nonionic surfactant was added to the slickwater pad fluid. Throughout fracturing pad stage, the polymer adsorption reduces both of the fluid loss and fluid flowback. However, the nonionic surfactant and HCl acid increase the fluid loss. The results recommended injecting slugs of a nonionic surfactant for both of the Eagle Ford and Marcellus shales when the pad fluid was a slickwater. Moreover, pumping slugs of 3% HCl was only recommended for the Eagle Ford when the nonionic surfactant was added to the slickwater pad fluid.

New control strategy against temperature sudden-drop in the initial stage of pad cooling process in poultry houses

Preliminary field measurements have shown substantial temperature sudden-drop (ΔTsd) at bird level in the initial stage of pad cooling process in arid regions of China. Such sudden temperature fluctuation can cause thermal stress to laying hens and this problem is attracting increasing concerns. The purpose of this study was to develop a new control strategy (NCS) to avoid or minimize ΔTsd while simplifying the operational process. Theoretical calculation and field test were conducted in this study. The key ambient thermal factor affecting ΔTsd was analysed by calculating temperature drop of cooled air existing the cooling pad (ΔTd). A countermeasure was applied by controlling the wetted pad area at each startup of the water supply pump. Field test was carried out to demonstrate the application of the NCS in a poultry house. The theoretical arithmetic results showed that ambient relative humidity (RHo) was the main factor affecting ΔTd, and ΔTsd occurred when RHo ≤ 60%. Temperature fluctuation at the bird level (Tdb,b) could be controlled within 4°C when the wetted pad area increased by 25%. The NCS operated based on RHo that was divided into three regions. For RHo > 80%, the pump would not be turned on because of poor cooling effect. For 60% < RHo < 80%, no ΔTsd would occur and the pump would be controlled by “on-off” regulation. For RHo ≤ 60%, ΔTsd occurred and the pump was turned on intermittently. Then, 4-stage cooling would be applied. Results of the field test were generally consistent with the theoretical simulation with regards to alleviation of ΔTsd that was controlled within 3.5°C. Further field verification of the NCS on the flock health and production performance is warranted. Keywords: evaporative cooling, poultry housing, new control strategy, temperature fluctuation, thermal stress DOI: 10.25165/j.ijabe.20181101.2479 Citation: Hui X, Li B M, Xin H W, Zheng W C, Shi Z X, Yang X, et al. New control strategy against temperature sudden-drop in the initial stage of pad cooling process in poultry houses. Int J Agric & Biol Eng, 2018; 11(1): 66–73.

A Comparative Study of Oral Microbiota in Infants with Complete Cleft Lip and Palate or Cleft Soft Palate.

Few reports have been published on the early microbiota in infants with various types of cleft palate. We assessed the formation of the oral microbiota in infants with complete cleft lip and palate (CLP n = 30) or cleft soft palate (CSP n = 25) in the neonatal period (T1 time) and again in the gum pad stage (T2 time). Culture swabs from the tongue, palate, and/or cleft margin at T1 and T2 were taken. We analysed the prevalence of the given bacterial species (the percentage) and the proportions in which the palate and tongue were colonised by each microorganism. At T1, Streptococcus mitis (S. mitis) were the most frequently detected in subjects with CLP or CSP (63% and 60%, resp.). A significantly higher frequency of methicillin-sensitive Staphylococcus aureus (S. aureus MSSA) was observed in CLP compared to the CSP group. At T2, significantly higher percentages of S. mitis, S. aureus MSSA, Staphylococcus epidermidis, and members of the Enterobacteriaceae family were noted in CLP infants compared to the CSP. S. mitis and Streptococcus sanguinis appeared with the greatest frequency on the tongue, whereas Streptococcus salivarius was predominant on the palate. The development of the microbiota in CLP subjects was characterised by a significant increase in the prevalence of pathogenic bacteria.