Quantum-enhanced sensing on optical transitions through finite-range interactions.

The control over quantum states in atomic systems has led to the most precise optical atomic clocks so far1-3. Their sensitivity is bounded at present by the standard quantum limit, a fundamental floor set by quantum mechanics for uncorrelated particles, which can-nevertheless-be overcome when operated with entangled particles. Yet demonstrating a quantum advantage in real-world sensors is extremely challenging. Here we illustrate a pathway for harnessing large-scale entanglement in an optical transition using 1D chains of up to 51 ions with interactions that decay as a power-law function of the ion separation. We show that our sensor can emulate many features of the one-axis-twisting (OAT) model, an iconic, fully connected model known to generate scalable squeezing4 and Greenberger-Horne-Zeilinger-like states5-8. The collective nature of the state manifests itself in the preservation of the total transverse magnetization, the reduced growth of the structure factor, that is, spin-wave excitations (SWE), at finite momenta, the generation of spin squeezing comparable with OAT (a Wineland parameter9,10 of -3.9 ± 0.3 dB for only N = 12 ions) and the development of non-Gaussian states in the form of multi-headed cat states in the Q-distribution. We demonstrate the metrological utility of the states in a Ramsey-type interferometer, in which we reduce the measurement uncertainty by -3.2 ± 0.5 dB below the standard quantum limit for N = 51 ions.

Exploring large-scale entanglement in quantum simulation.

Entanglement is a distinguishing feature of quantum many-body systems, and uncovering the entanglement structure for large particle numbers in quantum simulation experiments is a fundamental challenge in quantum information science1. Here we perform experimental investigations of entanglement on the basis of the entanglement Hamiltonian (EH)2 as an effective description of the reduced density operator for large subsystems. We prepare ground and excited states of a one-dimensional XXZ Heisenberg chain on a 51-ion programmable quantum simulator3 and perform sample-efficient 'learning' of the EH for subsystems of up to 20 lattice sites4. Our experiments provide compelling evidence for a local structure of the EH. To our knowledge, this observation marks the first instance of confirming the fundamental predictions of quantum field theory by Bisognano and Wichmann5,6, adapted to lattice models that represent correlated quantum matter. The reduced state takes the form of a Gibbs ensemble, with a spatially varying temperature profile as a signature of entanglement2. Our results also show the transition from area- to volume-law scaling7 of von Neumann entanglement entropies from ground to excited states. As we venture towards achieving quantum advantage, we anticipate that our findings and methods have wide-ranging applicability to revealing and understanding entanglement in many-body problems with local interactions including higher spatial dimensions.

Hernia of Umbilical Cord: An Enigma.

Introduction: Hernia of the umbilical cord (HUC) is an uncommon problem which is often misdiagnosed, leading to inadequate treatment and various complications which cause increased morbidity and mortality in neonates. To address this issue, we took up this study. Materials and Methods: Patients diagnosed with HUC from January 1, 2017, to December 31, 2021, were retrospectively analyzed. The following data of all these patients were collected and retrospectively analyzed: demography, radiological investigations, echocardiography, contents of hernia, type of surgery performed, and outcome. Results: Eighteen out of 19 patients included in the study were taken up for surgery after baseline investigations and echocardiography. Out of 19 patients, 15 were discharged successfully and are on regular follow-up. Of the remaining four patients, an anastomotic leak occurred in two and they went into sepsis and succumbed. One of the patients died before any intervention and one succumbed on 3rd postoperative day due to sepsis. Conclusion: Timely referral and intervention can save precious lives. We need to educate doctors and health-care providers so that proper diagnosis and timely management can be done for this anomaly which is associated with less morbidity and a lower rate of associated anomalies.

Facial skin characteristics and concerns in Indonesia: A cross-sectional observational study.

BACKGROUND: Facial skin characteristics and appearance vary according to ethnicity. While much of this knowledge is derived from the Caucasian population, lately there have been efforts to gain such understanding in various regions in Asia.  In this paper, we have built an understanding of such features in Indonesia. In Indonesia, a section of females wears a traditional veil (hijab) to cover the scalp and part of face. The influence of the hijab on facial skin attributes was also investigated. METHODS: In a cross-sectional observational study design involving 419 female volunteers in Jakarta, Indonesia, facial skin attributes (colour, radiance, hydration, trans-epidermal water loss [TEWL], wrinkles, fine lines, pores, and sebum levels) and conditions (melasma, post-inflammatory hyperpigmentation (PIH), solar lentigines/ senile lentigines, seborrheic keratoses and acne) were assessed by trained operators and dermatologists using standard validated instruments and scales. RESULTS: With age, facial skin colour showed darkening in cheek; forehead on the other hand showed slight lightening. The skin evenness and radiance decreased, substantially. Aging attributes measured in terms of lines, wrinkles, and under-eye dark circles showed deterioration with age; the decline was progressively faster than colour change. Facial image data analysis corroborated these findings. Skin hydration remained similar across the age groups even though the skin barrier function measured in terms of TEWL improved with age. Sebum levels in the skin were similar up to the age of 50 but declined in the next group of 50-60 year. Pore severity increased with age. Melasma, seborrheic keratosis and PIH showed a high prevalence (>∼50%) at the young age group (20-30 years), itself. Melasma prevalence attained 100% in the age group of 41-50 year and onwards, and its severity similarly showed a steady rise with age. PIH on the other hand showed a steady decline with age. Solar lentigines prevalence (∼30%) did not change much across age groups, and the severity scores were similar in age groups up to 50 year but increased substantially in 51-60-year age groups. Seborrheic keratosis was similar (∼47%) in age groups up 20-40 year but steadily increased in upper age groups. Its severity was similar in the age groups of 20-30 year and 31-40 year but showed a two-fold increase in subsequent age groups. Acne was 10% in the age group of 20-30 year and declined gradually to 0.7% in the 51-60-year age group. Hijab wearers showed slight protection in skin colour darkening and improvement of evenness and radiance but were similar on aging (fine lines and wrinkles on crow's feet, under eye and peri-oral areas) markers to non-wearers. In general, in majority of age-groups, hijab wearers showed a higher prevalence of melasma, solar/senile lentigines, seborrheic keratosis and PIH.

Superior even skin tone and anti-ageing benefit of a combination of 4-hexylresorcinol and niacinamide.

OBJECTIVES: To demonstrate the synergistic effect of 4-hexylresorcinol (4-HR) with niacinamide in boosting anti-melanogenic efficacy in vitro and establish the in vivo efficacy and safety of the combination in a human trial. METHODS: Primary human epidermal melanocytes and 3D pigmented skin equivalents were treated with 4-HR, niacinamide, and their combinations for their effect on pigmentation. This was followed by a randomized, double-blind, split-face clinical study in Chinese subjects, and effects on skin tone, hyperpigmentation, fine lines and wrinkles, hydration, and skin firmness were measured for a 12-week study period. RESULTS: In vitro tyrosinase enzyme activity studies showed that 4-HR is one of the most potent tyrosinase inhibitors. The combination of 4-HR and niacinamide showed a synergistic reduction in melanin production in cultured melanocytes and lightened the 3D skin equivalent model. In vitro as well as in the human trial, the combination of 4-HR and niacinamide showed significantly improved efficacy over niacinamide alone on hyperpigmentation spots as measured by L*, the visual appearance of fine lines and wrinkles in crow's feet and perioral area and skin firmness, with no product-related adverse events. CONCLUSIONS: A formulation containing a combination of 4-HR and niacinamide delivered superior skin tone and anti-ageing benefits significantly better than niacinamide alone with no adverse events. This study demonstrates that a product designed to affect multiple pathways of melanogenesis, inflammation, and ageing may provide an additional treatment option, beyond hydroquinone and retinoids, for hyperpigmentation and ageing.

OBJECTIFS: Démontrer l'effet synergique du 4-hexylrésorcinol (4-HR) associé au niacinamide pour stimuler in vitro l'efficacité antimélanogène, et établir l'efficacité et la sécurité d'emploi in vivo de cette association dans un essai chez l'homme. MÉTHODES: Des mélanocytes épidermiques humains primaires et des équivalents cutanés pigmentés en 3D ont été traités avec du 4-HR, du niacinamide et leurs combinaisons pour leur effet sur la pigmentation. Ceci a été suivi d'une étude clinique randomisée, en double aveugle en hémi-visage chez des sujets chinois, et les effets sur le teint, l'hyperpigmentation, les rides et ridules, l'hydratation et la fermeté de la peau ont été mesurés pendant une durée d'étude de 12 semaines. RÉSULTATS: Les études in vitro sur l'activité enzymatique de la tyrosinase ont montré que le 4-HR est l'un des inhibiteurs de la tyrosinase les plus puissants. L'association du 4-HR et du niacinamide a montré une réduction synergique de la production de mélanine dans les mélanocytes de culture et donné de la luminosité au modèle cutané 3D équivalent. Également in vitro avec l'étude chez l'homme, l'association du 4-HR et du niacinamide a fait ressortir une efficacité significativement plus élevée qu'avec le niacinamide seul sur les taches d'hyperpigmentation mesurées par L*, l'aspect visuel des rides et ridules des pattes d'oie et de la zone périorale, et la fermeté de la peau, sans événements indésirables liés au produit. CONCLUSIONS: Une formulation contenant une association de 4-HR et de niacinamide a permis d'obtenir un teint et un effet anti-âge nettement supérieurs à ceux du niacinamide seul, sans événements indésirables. Cette étude démontre qu'un produit conçu pour toucher plusieurs voies de mélanogenèse, d'inflammation et de vieillissement peut constituer une nouvelle option thérapeutique, au-delà de l'hydroquinone et des rétinoïdes, pour l'hyperpigmentation et le vieillissement.

Potential inhibitors and plant based technology: An alternative approach to treat corona virus.

The current pneumonia outbreak, which began in early December 2019 near Wuhan City, Hubei Province, China, is caused by a novel corona virus (CoV) known as '2019-nCoV' or '2019 novel corona virus or COVID-19' by the World Health Organization (WHO). Vaccines are available to prevent corona virus contagious infection or to reduce the viral load in body but virus is continuously mutating itself to infect people at severity. In this critical scenario this review provide a compiled study for techniques and tools that can be used to treat corona virus infections and its variants by some modern techniques and natural products such as inhibitors, siRNA technique and plant based approaches. This review focuses on healthy treatment and strategies that can be used effectively to treat the disease globally by reducing the post COVID symptoms.

Quantum Information Scrambling in a Trapped-Ion Quantum Simulator with Tunable Range Interactions.

In ergodic many-body quantum systems, locally encoded quantum information becomes, in the course of time evolution, inaccessible to local measurements. This concept of "scrambling" is currently of intense research interest, entailing a deep understanding of many-body dynamics such as the processes of chaos and thermalization. Here, we present first experimental demonstrations of quantum information scrambling on a 10-qubit trapped-ion quantum simulator representing a tunable long-range interacting spin system, by estimating out-of-time ordered correlators (OTOCs) through randomized measurements. We also analyze the role of decoherence in our system by comparing our measurements to numerical simulations and by measuring Rényi entanglement entropies.

Cross-Platform Verification of Intermediate Scale Quantum Devices.

We describe a protocol for cross-platform verification of quantum simulators and quantum computers. We show how to measure directly the overlap Tr[ρ_{1}ρ_{2}] and the purities Tr[ρ_{1,2}^{2}], and thus a fidelity of two, possibly mixed, quantum states ρ_{1} and ρ_{2} prepared in separate experimental platforms. We require only local measurements in randomized product bases, which are communicated classically. As a proof of principle, we present the measurement of experiment-theory fidelities for entangled 10-qubit quantum states in a trapped ion quantum simulator.

Importance of ocean salinity for climate and habitability.

Modeling studies of terrestrial extrasolar planetary climates are now including the effects of ocean circulation due to a recognition of the importance of oceans for climate; indeed, the peak equator-pole ocean heat transport on Earth peaks at almost half that of the atmosphere. However, such studies have made the assumption that fundamental oceanic properties, such as salinity, temperature, and depth, are similar to Earth. This assumption results in Earth-like circulations: a meridional overturning with warm water moving poleward at the surface, being cooled, sinking at high latitudes, and traveling equatorward at depth. Here it is shown that an exoplanetary ocean with a different salinity can circulate in the opposite direction: an equatorward flow of polar water at the surface, sinking in the tropics, and filling the deep ocean with warm water. This alternative flow regime results in a dramatic warming in the polar regions, demonstrated here using both a conceptual model and an ocean general circulation model. These results highlight the importance of ocean salinity for exoplanetary climate and consequent habitability and the need for its consideration in future studies.

Consensus on the Management of Posterior Urethral Valves from Antenatal Period to Puberty.

The need for successful management of posterior urethral valves always captivates the minds of pediatric surgeons. Its success, however, depends on several factors ranging from prenatal preservation of upper tracts to postoperative pharmacological compliance. Regardless of measures available, some cases do not respond and progress to end stage. The management depends on several issues ranging from age and severity at presentation to long-term follow-up and prevention of secondary renal damage and managing valve bladder syndrome. This article is based on a consensus to the set of questionnaires, prepared by research section of Indian Association of Paediatric Surgeons and discussed by experienced pediatric surgeons based in different institutions in the country. Standard operating procedures for conducting a voiding cystourethrogram and cystoscopy were formulated. Age-wise contrast dosage was calculated for ready reference. Current evidence from literature was also reviewed and included to complete the topic.

Transmission of climate risks across sectors and borders.

Systemic climate risks, which result from the potential for cascading impacts through inter-related systems, pose particular challenges to risk assessment, especially when risks are transmitted across sectors and international boundaries. Most impacts of climate variability and change affect regions and jurisdictions in complex ways, and techniques for assessing this transmission of risk are still somewhat limited. Here, we begin to define new approaches to risk assessment that can account for transboundary and trans-sector risk transmission, by presenting: (i) a typology of risk transmission that distinguishes clearly the role of climate versus the role of the social and economic systems that distribute resources; (ii) a review of existing modelling, qualitative and systems-based methods of assessing risk and risk transmission; and (iii) case studies that examine risk transmission in human displacement, food, water and energy security. The case studies show that policies and institutions can attenuate risks significantly through cooperation that can be mutually beneficial to all parties. We conclude with some suggestions for assessment of complex risk transmission mechanisms: use of expert judgement; interactive scenario building; global systems science and big data; innovative use of climate and integrated assessment models; and methods to understand societal responses to climate risk. These approaches aim to inform both research and national-level risk assessment.

Modifications of flexible nonyl chain and nucleobase head group of (+)-erythro-9-(2's-hydroxy-3's-nonyl)adenine [(+)-EHNA] as adenosine deaminase inhibitors.

A series of terminal nonyl chain and nucleobase modified analogues of (+)-EHNA (III) were synthesized and evaluated for their ability to inhibit adenosine deaminase (ADA). The constrained carbon analogues of (+)-EHNA, 7a-7h, 10a-c, 12, 13, 14 and 17a-c appeared very potent with Ki values in the low nanomolar range. Thio-analogues of (+)-EHNA 24a-e wherein 5'C of nonyl chain replaced by sulfur atom found to be less potent compared to (+)-EHNA. Docking of the representative compounds into the active site of ADA was performed to understand structure-activity relationships. Compounds 7a (Ki: 1.1nM) 7b (Ki: 5.2nM) and 26a (Ki: 5.9nM) showed suitable balance of potency, microsomal stability and demonstrated better pharmacokinetic properties as compared to (+)-EHNA and therefore may have therapeutic potential for various inflammatory diseases, hypertension and cancer.

Characterization of two homogalacturonan pectins with immunomodulatory activity from green tea.

Two natural homogalacturonan (HG) pectins (MW ca. 20 kDa) were isolated from green tea based on their immunomodulatory activity. The crude tea polysaccharides (TPS1 and TPS2) were obtained from green tea leaves by hot water extraction and followed by 40% and 70% ethanol precipitation, respectively. Two homogenous water soluble polysaccharides (TPS1-2a and TPS1-2b) were obtained from TPS1 after purification with gel permeation, which gave a higher phagocytic effect than TPS2. A combination of composition, methylation and configuration analyses, as well as NMR (nuclear magnetic resonance) spectroscopy revealed that TPS1-2a and TPS1-2b were homogalacturonan (HG) pectins consisting of a backbone of 1,4-linked α-D-galacturonic acid (GalA) residues with 28.4% and 26.1% of carboxyl groups as methyl ester, respectively. The immunological assay results demonstrated that TPS1-2, which consisted mainly of HG pectins, showed phagocytosis-enhancing activity in HL-60 cells.

Extra-osseous Ewing's sarcoma of sciatic nerve masquerading as an infected hemangioma: A rare case report.

Extra-osseous Ewing's Sarcoma (EES) arising from the peripheral nerve is rarely reported in children. Here, we report an instance of EES arising from the left sciatic nerve mimicking an infected hemangioma. This case highlights the need for a high index of suspicion and early histological diagnosis to avoid diagnostic delay.

Aqueous extract of Terminalia arjuna attenuates tert-butyl hydroperoxide-induced oxidative stress in HepG2 cell model.

Arjuna (Terminalia arjuna) is a medicinal plant used in many polyherbal hepatoprotective formulations. Although widely claimed to be antioxidant, data supporting such actions of Arjuna are limited. In the present study, we have investigated the efficacy of the aqueous extract of T. arjuna (AETA) using a standard pro-oxidant [tertiary butyl hydroperoxide (TBHP)] in HepG2 cells. Cells were incubated with AETA (5-100 µg/ml) for a range of time points (4-24 h) with or without TBHP (500 µM), and biochemical markers of oxidative stress (OS) were determined. Cells incubated with TBHP showed the significant induction of OS response in cytosol manifested as lipid hydroperoxide (76%-198%) and the generation of reactive oxygen species (60%-127%). Diminished levels of reduced glutathione (35%-60%) and total antioxidant capacity (20%-61%) suggested an altered redox state. Significant perturbations in the activities of antioxidant enzymes such as catalase (30%-56%), superoxide dismutase (25%-68%), glutathione S-transferase (29%-67%), glutathione peroxidase (24%-68%) and glutathione reductase (38%-49%) were discernible suggesting the ongoing OS in the cells. However, cells treated with AETA (100 µg/ml) along with TBHP offered significant protection by reducing levels of lipid hydroperoxide (33%-62%) and ROS (69%) and by increasing antioxidant capacity (54%-81%) and levels of reduced glutathione (49%-82%). Further, it also enhanced the activities of endogenous antioxidant enzymes (superoxide dismutase, 60%; catalase, 35%-82%; glutathione peroxidase, 42-65 %; glutathione reductase, 48%-62%; and glutathione S-transferase, 22%-100%). Taken together, these data suggest that Arjuna can protect against the oxidative damage induced by TBHP and may be effectively used as a hepatoprotective adjuvant to abrogate OS in vivo.

Response of stratospheric water vapour to warming constrained by satellite observations.

Future increases in stratospheric water vapour risk amplifying climate change and slowing down the recovery of the ozone layer. However, state-of-the-art climate models strongly disagree on the magnitude of these increases under global warming. Uncertainty primarily arises from the complex processes leading to dehydration of air during its tropical ascent into the stratosphere. Here we derive an observational constraint on this longstanding uncertainty. We use a statistical-learning approach to infer historical co-variations between the atmospheric temperature structure and tropical lower stratospheric water vapour concentrations. For climate models, we demonstrate that these historically constrained relationships are highly predictive of the water vapour response to increased atmospheric carbon dioxide. We obtain an observationally constrained range for stratospheric water vapour changes per degree of global warming of 0.31 ± 0.39 ppmv K-1. Across 61 climate models, we find that a large fraction of future model projections are inconsistent with observational evidence. In particular, frequently projected strong increases (>1 ppmv K-1) are highly unlikely. Our constraint represents a 50% decrease in the 95th percentile of the climate model uncertainty distribution, which has implications for surface warming, ozone recovery and the tropospheric circulation response under climate change.

Influence of Emblica officinalis aqueous extract on growth and antioxidant defense system of human hepatoma cell line (HepG2).

CONTEXT: Amla [Emblica officinalis Gaertn. (Euphorbiaceae)], a major constituent of several herbal formulations, is a well-known hepatoprotectant. Despite its extensive use, mechanistic understanding of its antioxidant action is rather limited. OBJECTIVE: In the current study, we investigated the effects of E. officinalis extracts (from dried fruits) on cellular oxidative state using a hepatocyte cell line (HepG2). We hypothesize that E. officinalis aqueous extracts have potency to modulate basal oxidative markers and enhance endogenous antioxidant defenses. MATERIALS AND METHODS: Cells were incubated with aqueous extracts of E. officinalis (1-100 µg/ml) for varied time points (4-24 h) and biochemical markers of oxidative stress were determined in cell lysate. DISCUSSION: Aqueous extracts of E. officinalis at 100 µg/ml can significantly modulate the basal levels of oxidative markers and enhance antioxidant defenses of the cells. CONCLUSIONS: Our findings clearly indicate the propensity of E. officinalis aqueous extracts to improve endogenous antioxidant defenses in HepG2 cells. Although further studies are required to assess their efficacy under experimentally induced oxidative, our data suggest that the hepatoprotective effects of E. officinalis reported earlier may be largely due to its potential to enhance the antioxidant defenses in vivo. RESULTS: Because E. officinalis up to 100 µg/ml concentrations had no effect on cell viability; it was considered noncytotoxic. Incubation with E. officinalis for 24 h resulted in significant diminution in the levels of lipid hydroperoxide (18-42%) and reactive oxygen species (11-29%). Furthermore; E. officinalis increased the levels of glutathione (GSH; 18-32%); antioxidant capacity (19-31%); and activities of antioxidant enzymes (superoxide dismutase; 25-41%; catalase; 39-50%; GSH peroxidase; 20-35%; GSH reductase; 26-35%; and GSH S-transferase; 12-30%).

Mitofusin-2 Negatively Regulates Melanogenesis by Modulating Mitochondrial ROS Generation.

Inter-organellar communication is emerging as one of the most crucial regulators of cellular physiology. One of the key regulators of inter-organellar communication is Mitofusin-2 (MFN2). MFN2 is also involved in mediating mitochondrial fusion-fission dynamics. Further, it facilitates mitochondrial crosstalk with the endoplasmic reticulum, lysosomes and melanosomes, which are lysosome-related organelles specialized in melanin synthesis within melanocytes. However, the role of MFN2 in regulating melanocyte-specific cellular function, i.e., melanogenesis, remains poorly understood. Here, using a B16 mouse melanoma cell line and primary human melanocytes, we report that MFN2 negatively regulates melanogenesis. Both the transient and stable knockdown of MFN2 leads to enhanced melanogenesis, which is associated with an increase in the number of mature (stage III and IV) melanosomes and the augmented expression of key melanogenic enzymes. Further, the ectopic expression of MFN2 in MFN2-silenced cells leads to the complete rescue of the phenotype at the cellular and molecular levels. Mechanistically, MFN2-silencing elevates mitochondrial reactive-oxygen-species (ROS) levels which in turn increases melanogenesis. ROS quenching with the antioxidant N-acetyl cysteine (NAC) reverses the MFN2-knockdown-mediated increase in melanogenesis. Moreover, MFN2 expression is significantly lower in the darkly pigmented primary human melanocytes in comparison to lightly pigmented melanocytes, highlighting a potential contribution of lower MFN2 levels to higher physiological pigmentation. Taken together, our work establishes MFN2 as a novel negative regulator of melanogenesis.

Individual Versus Sequential Saphenous Vein Grafts for on-Pump Coronary Artery Bypass Grafting - Does Smaller Coronaries in Indians Affect Graft Choice? - A Mid-Term Patency Comparison Study.

PURPOSE: Although multiarterial grafting or bilateral mammary artery use is being increasingly emphasized for contemporary coronary artery bypass grafting (CABG) practice, saphenous vein graft (SVG) still accounts for 80% of all CABG conduits (Park et al., 2020) [1]. In India, both the individual and sequential saphenous grafting techniques are used arbitrarily, and there has not been a study that compares the mid-term patency of these two. This is specially relevant in view of smaller coronaries in Indians than the Caucasian counterparts. This study aims to compare the patency for on pump CABG's. METHODS: In the present study, 323 patients underwent either sequential (group A, N = 151 grafts, each graft having two anastomoses each) or individual (group B, N = 344 grafts) saphenous vein CABG, between February 2014 and June 2017. The SVG anastomoses were created on obtuse marginal (OM1/OM2) and posterior descending artery (PDA). The graft patency of the vein grafts as well as the left internal mammary artery were assessed by serial coronary angiograms. RESULTS: Results were evaluated at 6 months, 1, 2 and 3 years post operatively. Group A showed a higher graft patency at 3 years at 80.8%, and group B, 67.1% (P = 0.002). Also, anastomoses on sequential conduits had overall better patency rates at three years (77.2% vs 67.2%, P = 0.005). The groups showed similar results at one year post operatively. CONCLUSIONS: Sequential bypass grafts were associated with superior mid-term patency compared with individual grafts. These findings suggest the more favourable results of sequential bypass grafting to be attributed to the enhanced flow haemodynamics.