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PURPOSE: To describe and compare mid-term outcomes from 2 real-world data collection efforts on fenestrated and branched endovascular aortic repair (fbEVAR) for complex abdominal aortic aneurysms (AAAs) in France and to evaluate the potential of health care databases for long-term post-market surveillance (PMS) and continued reimbursement approval. METHODS: Two real-world studies were conducted in France: a retrospective health care database study (SNDS) and a prospective clinical study. In the SNDS study, data from implantation and/or hospital stays occurring during follow-up were extracted for all patients treated with the study devices from April 2012 to December 2018. In the clinical study, high-risk patients undergoing fbEVAR with the study devices were enrolled consecutively at 15 sites in France from December 2016 to November 2018. RESULTS: Data from 1073 patients were extracted from SNDS and compared with analogous variables from 186 patients in the clinical study. Most demographic details were similar between studies (SNDS vs clinical: mean age, 71.9 vs 71.8 years; men, 91.0% vs 89.8%), as was 30-day mortality (SNDS: 5.5%, clinical: 4.3%). Patients received custom-made fenestrated or branched devices (SNDS: 80.7%, clinical: 96.2%) or CE-marked Zenith Fenestrated devices (SNDS: 19.3%, clinical: 3.8%). Initial or technical success was above 94% for both studies. Two-year freedom from all-cause mortality was 80.0% (SNDS) and 85.1% (clinical study). Two-year freedom from aneurysm-related mortality was 93.8% (SNDS) and 94.6% (clinical study). Detailed imaging outcomes were not captured within SNDS; however, information on secondary procedures to restore patency was available and used as a surrogate measure for secondary interventions. Two-year freedom from secondary interventions was 73% for the SNDS study. In the clinical study, at 2 years, aneurysm stability or shrinkage was observed in 92.3% of patients, freedom from target vessel primary patency loss was above 95% for all visceral target vessels, and freedom from secondary interventions was 79.1%. CONCLUSION: Real-world outcomes from the SNDS and clinical study suggest positive mid-term outcomes in high-risk populations following fbEVAR for complex AAAs. The similarities between these studies suggest that the use of health care databases may be an alternative to prospective clinical studies for long-term follow-up and PMS. CLINICAL IMPACT: Positive results following endovascular repair of complex abdominal aortic aneurysms are observed from data extracted from both the French health care database and a post-market clinical study despite initial high-risk patient status and diverse center experience. These outcomes parallel more rigorously designed studies and suggest that with careful study design, real-world data collections have high translatable value to add to the clinical understanding of fenestrated and branched endovascular aortic repair (fbEVAR).
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Cardiovascular infections are the most severe and potentially lethal among the persistent focalized Coxiella burnetii infections. While aortic infections on aneurysms or prostheses are well-known, with specific complications (risk of fatal rupture), new non-aortic vascular infections are increasingly being described thanks to the emerging use of 18-fluorodeoxyglucose positron emission tomography (18F-FDG PET-scan). Here, we describe an infection of a femoro-popliteal bypass that would not have been diagnosed without the use of PET-scan. It is well-known that vascular prosthetic material is a site favorable for bacterial persistence, but the description of unusual anatomical sites, outside the heart or aorta, should raise the clinicians' awareness and generalize the indications for PET-scan, with careful inclusion of the upper and lower limbs (not included in PET-scan for cancer), particularly in the presence of vascular prostheses. Future studies will be needed to precisely determine their optimal management.
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Complementary metal-oxide semiconductor (CMOS) image sensor sensitivity in the near-infrared spectrum is limited by the absorption length in silicon. To deal with that limitation, we evaluate the implementation of a polysilicon nano-grating inside a pixel, at the transistor gate level of a 90 nm standard CMOS process, through opto-electrical simulations. The studied pixel structure involves a polysilicon nano-grating, designed with the fabrication layer of the transistor gate, which does not require any modifications in the process flow. The diffraction effect of the nano-grating increases the length of the light path in the photosensitive area and thus increases the photoelectric conversion efficiency. The nano-grating is integrated in combination with deep trench isolations to reduce cross talk between pixels. Coupled optical and electrical simulations report 33% external quantum efficiency improvement and 7% cross talk reduction at 850 nm.
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The parallel evolution of similar ecotypes in response to comparable environmental conditions is believed to reveal the importance of divergent selection in phenotypic diversifying processes. Systems characterized by the presence of multiple replicate populations expressing resource polymorphism thus provide an ideal opportunity to address the occurrence and factors affecting the parallel evolution of ecotypes. Previous studies have shown that brook charr (Salvelinus fontinalis) exhibit resource polymorphism in some Canadian Shield lakes, where a littoral ecotype feeds mainly on zoobenthos and a pelagic ecotype feeds mostly on zooplankton. Using morphological traits and geometric morphometric analyses on 18 native brook charr populations, we explicitly tested (i) whether brook charr ecotypes show parallel evolution across populations (i.e. the same morphological traits discriminate ecotypes among lakes) and (ii) whether interspecific competition decreases the amplitude of morphological differentiation between ecotypes, if any, because brook charr experience some level of competitive exclusion from the littoral habitat in the presence of creek chub or white sucker. We observed a low level of parallel evolution, where the littoral ecotype was overall stouter with longer fins and smaller eyes than the pelagic ecotype. Interspecific competition had no clear impacts on the amplitude of morphological differentiation. We also observed that inter-lake morphological differences are greater than between ecotypes within lakes, suggesting an important effect of local environmental factors on population morphology. Early-stage of diversification as well as phenotypic plasticity and morphological integration could explain why resource polymorphism is still subtle in brook charr populations.
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Somatotipos , Trucha , Animales , Canadá , Ecología , Fenotipo , Trucha/genéticaRESUMEN
Single-Photon Avalanche Diodes (SPAD) in Complementary Metal-Oxide Semiconductor (CMOS) technology are potential candidates for future "Light Detection and Ranging" (Lidar) space systems. Among the SPAD performance parameters, the Photon Detection Probability (PDP) is one of the principal parameters. Indeed, this parameter is used to evaluate the SPAD sensitivity, which directly affects the laser power or the telescope diameter of space-borne Lidars. In this work, we developed a model and a simulation method to predict accurately the PDP of CMOS SPAD, based on a combination of measurements to acquire the CMOS process doping profile, Technology Computer-Aided Design (TCAD) simulations, and a Matlab routine. We compare our simulation results with a SPAD designed and processed in CMOS 180 nm technology. Our results show good agreement between PDP predictions and measurements, with a mean error around 18.5%, for wavelength between 450 and 950 nm and for a typical range of excess voltages between 15 and 30% of the breakdown voltage. Due to our SPAD architecture, the high field region is not entirely insulated from the substrate, a comparison between simulations performed with and without the substrate contribution indicates that PDP can be simulated without this latter with a moderate loss of precision, around 4.5 percentage points.
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OBJECTIVE: The aim of this study was to assess the impact of sex on the management and outcome of patients according to aortic stenosis (AS) severity. INTRODUCTION: Sex differences in the management and outcome of AS are poorly understood. METHODS: Doppler echocardiography data of patients with at least mild-to-moderate AS [aortic valve area (AVA) ≤1.5 cm2 and peak jet velocity (VPeak) ≥2.5 m/s or mean gradient (MG) ≥25 mmHg] were prospectively collected between 2005 and 2015 and retrospectively analysed. Patients with reduced left ventricular ejection fraction (<50%), or mitral or aortic regurgitation >mild were excluded. RESULTS: Among 3632 patients, 42% were women. The mean indexed AVA (0.48 ± 0.17 cm2/m2), VPeak (3.74 ± 0.88 m/s), and MG (35.1 ± 18.2 mmHg) did not differ between sexes (all P ≥ 0.18). Women were older (72.9 ± 13.0 vs. 70.1 ± 11.8 years) and had more hypertension (75% vs. 70%; P = 0.0005) and less coronary artery disease (38% vs. 55%, P < 0.0001) compared to men. After inverse-propensity weighting (IPW), female sex was associated with higher mortality (IPW-HR: 1.91 [1.14-3.22]; P = 0.01) and less referral to valve intervention (competitive model IPW-HR: 0.88 [0.82-0.96]; P = 0.007) in the whole cohort. This excess mortality in women was blunted in concordant non-severe AS initially treated conservatively (IPW-HR = 1.03 [0.63-1.68]; P = 0.88) or in concordant severe AS initially treated by valve intervention (IPW-HR = 1.25 [0.71-2.21]; P = 0.43). Interestingly, the excess mortality in women was observed in discordant low-gradient AS patients (IPW-HR = 2.17 [1.19-3.95]; P = 0.01) where women were less referred to valve intervention (IPW-Sub-HR: 0.83 [0.73-0.95]; P = 0.009). CONCLUSION: In this large series of patients, despite similar baseline hemodynamic AS severity, women were less referred to AVR and had higher mortality. This seemed mostly to occur in the patient subset with discordant markers of AS severity (i.e. low-gradient AS) where women were less referred to AVR.
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Estenosis de la Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Femenino , Humanos , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Volumen Sistólico , Resultado del Tratamiento , Función Ventricular IzquierdaRESUMEN
Ecological opportunity occurs when a resource becomes available through a decrease of interspecific competition and another species colonizes the vacant niche through phenotypic plasticity and intraspecific competition. Brook charr exhibit a resource polymorphism in some Canadian Shield lakes, where a littoral ecotype feeds mainly on zoobenthos and a pelagic ecotype feeds mostly on zooplankton. The objectives of this study were to test that (i) resource polymorphism is common in these brook charr populations, (ii) the presence creek chub and white sucker, two introduced species competing with brook charr for littoral resources, will decrease the phenotypic divergence between the two brook charr ecotypes, and (iii) the ecological release from introduced species will increase population and/or individual niche widths in brook charr. The study was based on 27 lakes and five indicators of resource use (stomach content, liver δ13C, muscle astaxanthin concentration, pyloric caecum length, and gill raker length). Our results indicate that within-lake differences in resource use by both ecotypes are common and stable through time. When facing interspecific competition, both littoral and pelagic brook charr incorporated more pelagic prey into their diet but maintained the amplitude of their differences in resource use, which contradicts our second prediction. Finally, we did not find any significant effect of introduced species on population and individual niche widths of brook charr. We suggest that the difference in feeding mode among distantly related competitors could prevent the complete exclusion of a species from a given niche and explain the lack of response to the ecological release.
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Lagos , Trucha , Animales , Canadá , Especies Introducidas , ZooplanctonRESUMEN
OBJECTIVE: The AMBUVASC trial evaluated the cost effectiveness of outpatient vs. inpatient hospitalisation for endovascular repair of lower extremity arterial disease (LEAD). METHODS: AMBUVASC was a national multicentre, prospective, randomised controlled trial conducted in nine public and two private French centres. The primary endpoint was the incremental cost effectiveness ratio (ICER), defined by cost per quality adjusted life year (QALY). Analysis was conducted from a societal perspective, excluding indirect costs, and considering a one month time horizon. RESULTS: From 16 February 2016 to 29 May 2017, 160 patients were randomised (80 per group). A modified intention to treat analysis was performed with 153 patients (outpatient hospitalisation: n = 76; inpatient hospitalisation: n = 77). The patients mainly presented intermittent claudication (outpatient arm: 97%; inpatient arm: 92%). Rates of peri-operative complications were 20% (15 events) and 18% (14 events) for the outpatient and inpatient arms respectively (p = .81). Overall costs (difference: 187.83; 95% confidence interval [CI] -275.68-651.34) and QALYs (difference: 0.00277; 95% CI -0.00237 - 0.00791) were higher for outpatients due to more re-admissions than the inpatient arm. The mean ICER was 67 741 per QALY gained for the base case analysis with missing data imputed using multiple imputation by predictive mean matching. The outpatient procedure was not cost effective for a willingness to pay of 50 000 per QALY and the probability of being cost effective was only 59% for a 100 000/QALY threshold. CONCLUSION: Outpatient hospitalisation is not cost effective compared with inpatient hospitalisation for endovascular repair of patients with claudication at a 50 000/QALY threshold.
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Atención Ambulatoria/economía , Procedimientos Endovasculares/economía , Costos de Hospital , Hospitalización/economía , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/economía , Enfermedad Arterial Periférica/terapia , Anciano , Ahorro de Costo , Análisis Costo-Beneficio , Procedimientos Endovasculares/efectos adversos , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico por imagen , Estudios Prospectivos , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Factores de Tiempo , Resultado del TratamientoRESUMEN
A 35-year-old man, with a deep pectus excavatum due to a Marfan syndrome treated 9 years before for an acute type A dissection involving only the aortic arch, by a Bentall surgery, was admitted for acute chest pain. Computed tomography (CT) scan showed an acute type non-A non-B dissection extending to the iliac. After 5 days with strict arterial blood pressure management, the patient had recurrent refractory chest pain and a hybrid technique associating full supra-aortic vessels debranching and STABILISE technique during the same procedure was performed. The patient had an uneventful recovery with CT scan showing complete aortic arch aneurysm exclusion.
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Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Síndrome de Marfan/complicaciones , Adulto , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/etiología , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/etiología , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Procedimientos Endovasculares/instrumentación , Humanos , Masculino , Síndrome de Marfan/diagnóstico , Stents , Resultado del TratamientoRESUMEN
BACKGROUND: Open surgical repair (OSR) for thoracoabdominal aortic aneurysms (TAA) is associated with a high pulmonary and renal morbidity rate. Ischemic preconditioning (IPC) is a mechanism of protection against the deleterious effects of ischemia-reperfusion. To our knowledge IPC has never been tested during OSR for TAA. METHODS: The primary objective of the study is to evaluate the efficacy of IPC during OSR for TAA with respect to acute kidney injury (AKI) according to KDIGO and pneumonia/prolonged ventilation-time during the first 8 postoperative days. The secondary objectives are to compare both arms with respect to cardiac complications within 48 h, renal and pulmonary complications within 21 days and mortality at 60 days. To assess the efficacy of IPC with respect to pulmonary and renal morbidity, a cox model for competing risks will be used. Assuming that the event occurs among 36% of the patients when no IPC is performed, the allocation of 55 patients to each arm should allow detecting a hazard ratio of at least 2.75 with a power of 80% when admitting 5% for an error of first kind. This means that 110 patients, enrolled in this multicenter study, may be randomised within 36 months of the first randomization. Randomization will be performed to allocate patients either to surgery with preconditioning before aortic cross clamping (Arm 1) or to surgery without preconditioning before aortic cross clamping (Arm 2). Randomization takes place during the intervention after intravenous injection of heparin, or after the start of femoral assistance. The procedure for IPC will be a supra-visceral thoracic aortic cross clamping for 5 min followed by an unclamping period of 5 min. This procedure will be repeated twice before starting thoracic aortic cross clamping needed to perform surgery. CONCLUSIONS: Our hypothesis is that ischemic preconditioning could reduce clinical morbidity and the incidence of lung damage associated with supra-visceral aortic clamping. TRIAL REGISTRATION: EPICATAStudy registered in ClinicalTrial.gov / number: NCT03718312 on Oct.24.2018 URL number.
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Aneurisma de la Aorta Torácica , Precondicionamiento Isquémico , Daño por Reperfusión/prevención & control , Lesión Renal Aguda/etiología , Lesión Renal Aguda/prevención & control , Aorta/cirugía , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular , Puente Cardiopulmonar , Constricción , Cardiopatías/etiología , Cardiopatías/prevención & control , Humanos , Hipotermia Inducida , Isquemia/etiología , Isquemia/prevención & control , Precondicionamiento Isquémico/métodos , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/prevención & control , Morbilidad , Ensayos Clínicos Controlados Aleatorios como Asunto , Daño por Reperfusión/etiología , Resultado del TratamientoRESUMEN
A new methodology is presented using well known electrical characterization techniques on dedicated single devices in order to investigate backside interface contribution to the measured pixel dark current in BSI CMOS image sensors technologies. Extractions of interface states and charges within the dielectric densities are achieved. The results show that, in our case, the density of state is not directly the source of dark current excursions. The quality of the passivation of the backside interface appears to be the key factor. Thanks to the presented new test structures, it has been demonstrated that the backside interface contribution to dark current can be investigated separately from other sources of dark current, such as the frontside interface, DTI (deep trench isolation), etc.
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OBJECTIVES: With a focus on renal function, the goal of this multicentre study was to assess peri-operative complications and late mortality of open surgical repair (OSR) of juxtarenal abdominal aortic aneurysms (JRAAA). METHODS: From February 2005 to December 2015, 315 consecutive patients undergoing elective OSR of a JRAAA in five French academic centres were evaluated retrospectively. The definition of JRAAA was an aortic aneurysm extending up to but not involving the renal arteries, i.e., a short neck <10 mm. End points included post-operative death; acute kidney injury (AKI) defined by the RIFLE (Risk, Injury, Failure, Loss of function, End stage renal disease) criteria; and long term follow-up with freedom from chronic renal decline (CRD) and any graft related complications. Factors predictive of renal insufficiency were determined by multivariable analysis. RESULTS: Of 315 patients, 292 (92.6%) were men (mean age 68 ± 8 years), and 73 (23.2%) had baseline chronic kidney disease (CKD) with an estimated glomerular filtration rate of <60 mL/min/1.73 m2. The level of aortic clamping was supracoeliac (n = 11), suprarenal (n = 235), or inter-renal above one renal artery (n = 69). The mean duration of renal artery clamping was 24 ± 7 min (range 10-55 min). Eleven patients (3.5%) presented with a renal artery stenosis that was treated conservatively. Perfusion of the renal arteries with a chilled Ringer's solution was used selectively in seven patients (2.2%). The overall 30 day mortality was 0.9% (three patients). AKI occurred in 53 patients (16.8%). Nine patients (2.9%) required temporary dialysis and one patient required chronic dialysis. Predictors of AKI were pre-existing CKD (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.13-4.48; p = .021], diabetes (OR 3.15, 95% CI 1.48-6.71; p = .003), hypertension (OR 3.38, 95% CI 1.33-8.57; p = .01), and age (OR 1.05, 95% CI 1.01-1.10; p = .014). The level of aortic clamping and duration of renal artery clamping were not associated with an increased risk of AKI. The Kaplan-Meier survival estimate was 71% ± 5% at five years. Predictors of CRD during follow up were AKI (hazard ratio [HR] 15.81, 95% CI 5.26-47.54; p = .001), diabetes (HR 4.56, 95% CI 1.57-13.17; p = .005), and pre-existing CKD (HR 2.93, 95% CI 1.19-7.20; p = .019), with freedom from CRD of 89% ± 3% at five years. Surveillance imaging was obtained by computed tomography angiography in 290 patients (92.6%) at a mean follow up of 4.3 ± 2.4 years. Renal artery occlusion occurred in two patients (0.7% of imaged renal arteries). One patient (1.9%) had an aneurysm of the visceral aorta and eight patients had a descending thoracic aneurysm. CONCLUSIONS: This multicentre study suggests that in fit patients, open JRAAA repair can be performed with acceptable operative risk with durable results in terms of both graft integrity and preservation of renal function.
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Lesión Renal Aguda/epidemiología , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Complicaciones Posoperatorias/epidemiología , Obstrucción de la Arteria Renal/epidemiología , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Lesión Renal Aguda/fisiopatología , Factores de Edad , Anciano , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/mortalidad , Implantación de Prótesis Vascular/métodos , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Estudios de Seguimiento , Francia , Humanos , Hipertensión/epidemiología , Estimación de Kaplan-Meier , Riñón/irrigación sanguínea , Riñón/fisiopatología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Arteria Renal/diagnóstico por imagen , Arteria Renal/cirugía , Obstrucción de la Arteria Renal/diagnóstico , Obstrucción de la Arteria Renal/etiología , Obstrucción de la Arteria Renal/fisiopatología , Insuficiencia Renal Crónica/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
Aquatic ecosystems are increasingly threatened by anthropogenic stressors, both at local and larger scales. For instance, runoff from intensively cultivated areas leads to higher nutrient and sediment concentrations deteriorating water quality, which potentially trigger trophic state changes. Unfortunately, we have a poor understanding of the complex relationships linking water quality degradation and different ecosystem components. Here we analyze the long-term cascading effects of several anthropogenic stressors on both submerged aquatic vegetation (SAV) and the key traits of an exploited yellow perch (Perca flavescens, YP) population from the watershed of Lake Saint-Pierre - the largest fluvial lake of the St. Lawrence River (Québec, Canada). Lake Saint-Pierre drains one of the most impacted watersheds in Eastern Canada and had sustained a YP fishery (worth up to 10 M$ CAN/year) until the population collapsed in the mid-1990s. SAV abundance has declined since the 1980s, partially overlapping with the YP collapse. Within a structural equation modeling framework, we tested the links between changes in both SAV abundance and the YP fishery with abiotic stressors acting at both local and larger scales. Our results show that both SAV and YP declines are causally associated with anthropogenic nutrient and sediment loadings from the watershed. The decline of YP landings is also explained by a reduction in SAV abundance and YP juvenile growth, mainly caused by a sharp decrease in water transparency over the last decades. These results suggest a causal association between environmental degradation due to nutrients and sediments and different components of the trophic aquatic network. Such an integrative approach is crucial for the development of management strategies that consider cultivated lands and aquatic systems as a continuum rather than separate compartments. SAV restoration is thus a critical feature contributing to water depuration and promoting the recovery of fish populations threatened by habitat degradation.
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Ecosistema , Explotaciones Pesqueras , Animales , Quebec , RíosRESUMEN
Plasma processes are known to be prone to inducing damage by charging effects. For CMOS image sensors, this can lead to dark current degradation both in value and uniformity. An in-depth analysis, motivated by the different degrading behavior of two different plasma processes, has been performed in order to determine the degradation mechanisms associated with one plasma process. It is based on in situ plasma-induced charge characterization techniques for various dielectric stack structures (dielectric nature and stack configuration). A degradation mechanism is proposed, highlighting the role of ultraviolet (UV) light from the plasma in creating an electron hole which induces positive charges in the nitride layer at the wafer center, and negative ones at the edge. The trapped charges de-passivate the SiO2/Si interface by inducing a depleted interface above the photodiode, thus emphasizing the generation of dark current. A good correlation between the spatial distribution of the total charges and the value of dark current has been observed.
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Both biotic and abiotic factors have been invoked to explain the large variations observed in the prevalence and abundance of parasites in aquatic ecosystems. However, we have only a poor knowledge of the potential interplay among these factors in natural systems. It is, therefore, important to analyze the effects of multiple potential environmental drivers together to get an integrated view of their influence on the prevalence and abundance of parasites. To this end, we selected two genera of digenean trematode parasites that require at least two hosts to complete their life cycle and use two different transmission strategies. Crepidostomum moves through a trophic pathway via consumption of infected prey by the host, while Apophallus infects its hosts via direct penetration of their skin. This study was conducted in 23 Canadian Shield lakes exhibiting orthogonal gradients of biotic (fish species richness and biomass) and abiotic (morphometry, physico-chemical) variables. We quantified prevalence and abundance of these parasites in the skin and intestine of brook charr (Salvelinus fontinalis). Our results show that biotic factors are key drivers of parasite abundance and prevalence, with Apophallus being negatively associated with the fish species richness-biomass gradient, and Crepidostomum responding more to identity of host than to the diversity gradient. Among the abiotic variables, lake area was found to be positively related to both prevalence and abundance in Apophallus. Our results suggest that taking into account the interplay of both biotic and abiotic factors is crucial for understanding patterns of parasite transmission success in boreal lakes.
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Trematodos , Trucha , Animales , Canadá , Ecosistema , Interacciones Huésped-Parásitos , LagosRESUMEN
BACKGROUND: Ambulatory hospitalization for endovascular repair of lower extremity peripheral arterial disease (PAD) could be a real opportunity to respond to the burden of PAD, to reduce costs, and to improve patients' empowerment. The French Society of Vascular and Endovascular Surgery (SCVE) established guidelines to facilitate the development of ambulatory hospitalization in France. METHODS: In 2017, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and MEDLINE database to conduct a systematic review of available literature. A total of 448 relevant articles were found. Twelve articles, all published after the year 2000, were included and reviewed by two independent investigators. The SCVE mandated a scientific committee to collectively establish these guidelines. RESULTS: Eligibility for ambulatory management shall be based on the assessment of the triad: (1) patient, (2) procedure, and (3) structure. Comprehensive information and a detailed procedural pathway should be provided for the patient. No age limit is recommended. American Society of Anesthesiologists I, II, and III stable patients are eligible for ambulatory intervention. Specific comorbidities such as severe obesity, sleep apnea, and/or chronic kidney failure should be assessed preoperatively. Critical limb ischemia and complex lesions have not been considered as exclusion criteria. Antiplatelet drug use (aspirin and/or clopidogrel) has not been considered as a contraindication. Femoral ultrasound-guided puncture is recommended. Manual compression or closure devices have been recommended for 7F sheath or less. A minimum of 4 hours of monitoring after percutaneous femoral access is required before discharge. CONCLUSIONS: The SCVE guidelines aim to frame the practice of ambulatory endovascular procedures for lower extremity peripheral artery disease and to give vascular interventionalists help in their routine practice.
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Procedimientos Quirúrgicos Ambulatorios/normas , Procedimientos Endovasculares/normas , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/cirugía , Pautas de la Práctica en Medicina/normas , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Toma de Decisiones Clínicas , Consenso , Procedimientos Endovasculares/efectos adversos , Francia , Adhesión a Directriz/normas , Humanos , Resultado del TratamientoRESUMEN
OBJECTIVE: The objective of this study was to compare surgical risk and early and late mortality of patients treated for anatomically classified juxtarenal aortic aneurysms (JRAs) by fenestrated endovascular aneurysm repair (F-EVAR) or open surgical repair (OSR) during a period when the two treatments were available and to validate an institutional algorithm for JRA repair. METHODS: We retrospectively included all patients treated electively in our center between January 2005 and December 2015 for JRAs classified into three anatomic categories, excluding suprarenal aneurysms. Lee score and American Society of Anesthesiologists (ASA) class evaluated preoperative surgical risk. We compared clinical and radiologic parameters between the patients treated by F-EVAR and those treated by OSR. The primary study end point was 30-day mortality. We also compared 5-year survival. RESULTS: From 2005 to 2015, there were 191 patients separated into two groups, one treated by OSR (n = 134; mean age, 69 years) and the other treated by F-EVAR (n = 57; mean age, 74 years). Patients of the F-EVAR group were significantly older (P = .001). Intensive care unit length of stay was significantly higher in the OSR group (3.4 days vs 1.5 days; P = .01). Surgical risk was significantly higher in the F-EVAR group as measured by Lee score ≥2 (OSR, 8.9 %; F-EVAR, 21%; P = .02) and ASA class 3 and class 4 (OSR, 32.8%; F-EVAR, 73.6%; P = .001), whereas 30-day postoperative mortality was not significantly different (OSR, 1.5%; F-EVAR, 0%; P = .394). The 5-year survival was not significantly different in the two groups (OSR, 82.1%; F-EVAR, 69.2%). CONCLUSIONS: In this study, despite a higher surgical risk by Lee score and higher ASA class in the group of patients treated by F-EVAR, postoperative mortality was not significantly different between these groups. In our opinion, F-EVAR and OSR of JRA are complementary.
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Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/mortalidad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/mortalidad , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
The leakage current non-uniformity, as well as the leakage current random and discrete fluctuations sources, are investigated in pinned photodiode CMOS image sensor floating diffusions. Different bias configurations are studied to evaluate the electric field impacts on the FD leakage current. This study points out that high magnitude electric field regions could explain the high floating diffusion leakage current non-uniformity and its fluctuation with time called random telegraph signal. Experimental results are completed with TCAD simulations allowing us to further understand the role of the electric field in the FD leakage current and to locate a high magnitude electric field region in the overlap region between the floating diffusion implantation and the transfer gate spacer.