Patient-specific risk factors for reintervention following primary endovascular treatment of iliac artery disease.

OBJECTIVE: Predictive models for reintervention may guide clinicians to optimize selection, education, and follow-up of patients undergoing endovascular iliac revascularization. Although the impact of lesion- and device-related characteristics on iliac restenosis and reintervention risk is well-defined, data on patient-specific risk factors are scarce and conflicting. This study aimed to explore the value of patient-related factors in predicting the need for clinically driven target-vessel revascularization (CD-TVR) in patients undergoing primary endovascular treatment of iliac artery disease. METHODS: Consecutively enrolled patients undergoing endovascular revascularization for symptomatic iliac artery disease at a tertiary vascular referral center between January 2008 and June 2020 were retrospectively analyzed. Primary and secondary outcomes were CD-TVR occurrence within 24 months and time to CD-TVR, respectively. Patients who died or did not require CD-TVR within 24 months were censored at the date of death or at 730 days, respectively. Multiple imputation was used to account for missing data in primary analyses. RESULTS: A total of 1538 iliac interventions were performed in 1113 patients (26% females; 68 years). CD-TVR occurred in 108 limbs (74 patients; 7.0%) with a median time to CD-TVR of 246 days. On multivariable analysis, increasing age was associated with lower likelihood of CD-TVR (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.50-0.83; P = .001) and decreased risk of CD-TVR at any given time (hazard ratio [HR], 0.66; 95% CI, 0.52-0.84; P = .001). Similarly, a lower likelihood of CD-TVR (OR, 0.75; 95% CI, 0.59-0.95; P = .017) and decreased risk of CD-TVR at any given time (HR, 0.73; 95% CI, 0.58-0.93; P = .009) were observed with higher glomerular filtration rates. Lastly, revascularization of common vs external iliac artery disease was associated with lower likelihood of CD-TVR (OR, 0.48; 95% CI, 0.24-0.93; P = .030) and decreased risk of CD-TVR at any given time (HR, 0.48; 95% CI, 0.25-0.92; P = .027). No associations were observed between traditional cardiovascular risk factors (sex, hypertension, higher low-density lipoprotein cholesterol, higher hemoglobin A1c, smoking) and CD-TVR. CONCLUSIONS: In this retrospective cohort study, younger age, impaired kidney function, and external iliac artery disease were associated with CD-TVR. Traditional markers of cardiovascular risk were not seen to predict reintervention.

PFAS Exposure is Associated with a Lower Spermatic Quality in an Arctic Seabird.

Several studies have reported an increasing occurrence of poly- and perfluorinated alkyl substances (PFASs) in Arctic wildlife tissues, raising concerns due to their resistance to degradation. While some research has explored PFAS's physiological effects on birds, their impact on reproductive functions, particularly sperm quality, remains underexplored. This study aims to assess (1) potential association between PFAS concentrations in blood and sperm quality in black-legged kittiwakes (Rissa tridactyla), focusing on the percentage of abnormal spermatozoa, sperm velocity, percentage of sperm motility, and morphology; and (2) examine the association of plasma levels of testosterone, corticosterone, and luteinizing hormone with both PFAS concentrations and sperm quality parameters to assess possible endocrine disrupting pathways. Our findings reveal a positive correlation between the concentration of longer-chain perfluoroalkyl carboxylates (PFCA; C11-C14) in blood and the percentage of abnormal sperm in kittiwakes. Additionally, we observed that two other PFAS (i.e., PFOSlin and PFNA), distinct from those associated with sperm abnormalities, were positively correlated with the stress hormone corticosterone. These findings emphasize the potentially harmful substance-specific effects of long-chain PFCAs on seabirds and the need for further research into the impact of pollutants on sperm quality as a potential additional detrimental effect on birds.

Sex-specific effects of low-dose of acetamiprid on corticosterone levels but not on oxidative stress in House sparrows.

Neonicotinoid insecticides are widely used in agriculture and have been linked to various detrimental physiological effects on wild birds. Despite this, the impact of acetamiprid - a less studied member of the neonicotinoid family - on the hypothalamic-pituitary-adrenal axis responsible for the hormonal regulation of the response to stress has rarely been examined in birds. In our study, we explored the effects of acetamiprid on feather levels of corticosterone, the major end product of the HPA, and blood oxidative status of House sparrows (Passer domesticus), following the ingestion of a low, field-realistic dose during two consecutive experiments in 2015 and 2016. We involved 112 birds in each experiment - 56 males and 56 females - that were administered a placebo or a dose of acetamiprid equivalent to 0.5% of the LD50 of the Zebra finch over the entire duration of the experiments, which lasted approximately three weeks. We measured corticosterone concentrations in feathers grown during an acclimation phase before ingestion and in newly grown feather after the experiment and assessed three oxidative stress markers in the blood. We found no impact of acetamiprid on oxidative stress markers. However, in 2015, male sparrows that ingested acetamiprid exhibited higher corticosterone levels in their feathers compared to those that received a placebo. No such difference was found in females. Interestingly, this effect was not observed in year 2016, which was characterised by less stressful conditions for the birds. These findings offer the first evidence of a potential effect of acetamiprid on corticosterone levels in a songbird, suggesting that ingesting this compound at very low dose may alter the endocrine physiology of the response to stress.

Reintervention Rate after Treatment with the INCRAFT AAA Ultra-Low-Profile Stent Graft System.

BACKGROUND: The INCRAFT stent graft system is an ultra-low-profile endograft for the exclusion of infrarenal aortic aneurysms. In the market approval studies, an increased rate of device-related complications was observed and the endograft was approved with mandated postmarketing investigations. Our aim was to analyze mid-term outcomes of a real-world patient cohort treated with the INCRAFT endograft. METHODS: Consecutive patients treated with the INCRAFT endograft between February 2015 and December 2022 at a single institution were included. In accordance with the Society for Vascular Surgery reporting standards, safety endpoints were reported and outcome endpoints included reinterventions, technical success, aortic-related and overall-mortality, endoleak, stent fracture, and endograft migration >5 mm. RESULTS: Eighty patients (85% male) with a mean age of 76 ± 7 years were included. Fifty-two patients (65%) were treated within the endograft's instruction for use. Mean aortic diameter was 59 ± 10 mm and 91% of the procedures were performed percutaneously. Mean follow-up (FU) was 37 ± 25 months and there was no aortic- or procedure-related mortality. Reinterventions occurred in 25 patients (31%) with a freedom from reintervention at 1, 3, and 5 years of 84%, 66%, and 55%. The most frequent reinterventions were limb graft stenting (23%) and type II endoleak embolization (14%). Limb occlusion rate was 9% and in 3 patients (4%) distal endograft migrations >5 mm occurred. Persisting type II endoleaks were observed in 29% and aneurysm diameter was stable in 41% and had shrunk in 38%. Three type III endoleaks (4%) developed during FU and 4 open conversions (5%) were necessary. No known risk factors, including treatment outside instruction for use, were predictive for reinterventions. CONCLUSIONS: Treatment of infrarenal aortic aneurysms with the INCRAFT stent graft system was safe and successful. Nevertheless, a substantial rate of reinterventions was necessary during FU to maintain endograft patency and prevent aneurysm growth.

Identification of microorganisms by a rapid PCR panel from positive blood cultures leads to faster optimal antimicrobial therapy - a before-after study.

BACKGROUND: The BioFire® FilmArray® Blood Culture Identification Panel 1 (BF-FA-BCIP) detects microorganisms with high accuracy in positive blood cultures (BC) - a key step in the management of patients with suspected bacteraemia. We aimed to compare the time to optimal antimicrobial therapy (OAT) for the BF-FA-BCIP vs. standard culture-based identification. METHODS: In this retrospective single-centre study with a before-after design, 386 positive BC cases with identification by BF-FA-BCIP were compared to 414 controls with culture-based identification. The primary endpoint was the time from BC sampling to OAT. Secondary endpoints were time to effective therapy, length of stay, (re-)admission to ICU, in-hospital and 30-day mortality. Outcomes were assessed using Cox proportional hazard models and logistic regressions. RESULTS: Baseline characteristics of included adult inpatients were comparable. Main sources of bacteraemia were urinary tract and intra-abdominal infection (19.2% vs. 22.0% and 16.8% vs. 15.7%, for cases and controls, respectively). Median (95%CI) time to OAT was 25.5 (21.0-31.2) hours with BF-FA-BCIP compared to 45.7 (37.7-51.4) hours with culture-based identification. We observed no significant difference for secondary outcomes. CONCLUSIONS: Rapid microorganism identification by BF-FA-BCIP was associated with a median 20-h earlier initiation of OAT in patients with positive BC. No impact on length of stay and mortality was noted. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04156633, registered on November 5, 2019.

Risk factors for postpartum haemorrhage in women with histologically verified placenta accreta spectrum disorders: a retrospective single-centre cross-sectional study.

BACKGROUND: Placenta accreta spectrum (PAS) disorders have been reported with an increasing frequency of up to 3%. The increase in the incidence can be explained by the rising rate of Caesarean section (CS), assisted reproductive technology (ART) and previous uterine surgeries. PAS disorders are usually associated with postpartum haemorrhage (PPH). In our study, we investigated the risk factors for increased blood loss in women with histologically verified PAS disorders independent of delivery mode. METHODS: In a retrospective single-centre cross-sectional study, 2,223 pregnant women with histologically verified PAS disorders were included. Risk factors for PPH in women with PAS disorders were examined and compared between women with PPH (study group; n = 879) and women with normal blood loss (control group; n = 1150), independent of delivery mode. PAS disorders were diagnosed histologically from the following specimens: placenta, placental-bed specimens, uterine curettage, uterine resection and/or total/partial hysterectomy. Medical data were extracted from clinical records of pregnant women with PAS disorders delivering at the University Hospital Basel between 1986 and 2019. The placenta data of women with PAS disorders were obtained and identified through a search from the database of the Department of Pathology, University Hospital Basel. RESULTS: Between 1986 and 2019, there were 64,472 deliveries at the University Hospital Basel. PAS disorders were histologically verified in 2,223 women (2,223/64,472), and the prevalence of PAS disorders was 3.45%. A total of 879 women with PAS disorders showed PPH, independent of delivery mode (43.3%). Due to missing data for 194 women, the final analysis was conducted with the remaining 2,029 women. Placenta praevia (O.R. = 6.087; 95% CI, 3.813 to 9.778), previous endometritis (O.R. = 3.011; 95% CI, 1.060 to 9.018), previous manual placenta removal (O.R. = 2.530; 95% CI, 1.700 to 3.796), ART (O.R. = 2.169; 95% CI, 1.593 to 2.960) and vaginal operative birth (O.R. = 1.715; 95% CI, 1.225-2.428) can be considered important risk factors, and previous CS (O.R. = 1.408; 95% CI, 1.016 to 1.950) can be considered a moderate potential risk factor of PPH in women with PAS disorders. CONCLUSIONS: Placenta praevia, previous endometritis, previous placenta removal, ART and vaginal operative birth can be considered important risk factors of PPH in women with PAS disorders. STUDY REGISTRATION: The study was registered under http://www. CLINICALTRIALS: gov (NCT05542043) on 15 September 2022.

Birds of different morphs use slightly different strategies to achieve similar reproductive performance following heatwave exposure.

Responses to extreme climatic events may differ between individuals of distinct morphs which differ in life-history strategies, resulting in climate change 'winners' and 'losers' within species. We examined the reproductive performance and carry-over effects on offspring of black- and red-headed Gouldian finches Erythrura gouldiae after exposure to simulated heatwaves of moderate or severe intensity. We expected black-headed pairs' reproductive performance to decline after the severe heatwave because only the condition of black-headed females deteriorates during such a heatwave. Supporting the fact that Gouldian finches of different morphs use alternative reproductive strategies, we found that black-headed females initiated egg-laying a month earlier than red-headed females after experiencing a severe heatwave. We also found that this severe heatwave resulted in shorter spermatozoa in males irrespective of their morph. Despite these effects associated with heatwave intensity, the overall reproductive performance of both morphs was not affected by this factor, which was possibly due to an increased nestling provisioning rate by parents after exposure to the severe heatwave. However, offspring still bore the cost of parental exposure to the severe heatwave, as they showed a reduced condition (lower plasma antioxidant capacity and transient lower breathing rate) and higher oxidative damage (at least in fledglings with black-headed parents). These results suggest that inter-morph phenotypic variability in the Gouldian finch does not result in clear differences in reproductive performance following heatwave exposure, despite basal phenotypic differences between morphs. Whether animals using alternative reproductive strategies are, in the end, differently affected by climate changes will likely depend on the capacity of their offspring to recover from altered developmental conditions.

Oxidative costs of cooperation in cooperatively breeding Damaraland mole-rats.

Within cooperatively breeding societies, individuals adjust cooperative contributions to maximize indirect fitness and minimize direct fitness costs. Yet, little is known about the physiological costs of cooperation, which may be detrimental to direct fitness. Oxidative stress, the imbalance between reactive oxygen species (by-products of energy production) and antioxidant protection, may represent such a cost when cooperative behaviours are energetically demanding. Oxidative stress can lead to the accumulation of cellular damage, compromising survival and reproduction, thus mediating the trade-off between these competing life-history traits. Here, we experimentally increased energetically demanding cooperative contributions in captive Damaraland mole-rats (Fukomys damarensis). We quantified oxidative stress-related effects of increased cooperation on somatic and germline tissues, and the trade-off between them. Increased cooperative contributions induced oxidative stress in females and males, without increasing somatic damage. Males accumulated oxidative damage in their germline despite an increase in antioxidant defences. Finally, oxidative damage accumulation became biased towards the germline, while antioxidant protection remained biased towards the soma, suggesting that males favour the maintenance of somatic tissues (i.e. survival over reproduction). Our results show that heightened cooperative contributions can ultimately affect direct fitness through oxidative stress costs, which may represent a key selective pressure for the evolution of cooperation.

Social dominance, but not parasite load, affects sperm quality and sperm redox status in house sparrows.

Sperm performance is an important component of male reproductive success. However, sperm production is costly and males need to optimize their investment in sperm quality versus the somatic traits involved in mating success, e.g. their social status. As oxidative stress affects both sperm performance and somatic functions, it has been hypothesized to mediate such a trade-off. According to the oxidation-based soma/germline trade-off hypothesis, dominant males should favour the antioxidant protection of their somatic tissues, and subordinate males should favour the antioxidant protection of their sperm. We tested this hypothesis by experimentally infecting wild-caught house sparrows Passer domesticus with Coccidia Isopora sp., an internal parasite known to deplete antioxidant resources. We predicted that (i) increased parasite load affects sperm oxidative status and sperm performance and that (ii) males with experimentally high parasite load adjust the antioxidant protection of their soma versus their sperm according to their social status. Despite a 5400% increase in parasite load, sperm performance and somatic and spermatic oxidative status remained unaffected, irrespective of male social status. Nevertheless, males increased their sperm performance over time, a pattern mirrored by an increase in the antioxidant protection of their sperm. Moreover, males at the lower end of the hierarchy always produced sperm of lower velocity, suggesting that they were constrained and privileged their soma over their germline. To conclude, high parasite loads do not necessarily affect sperm performance and oxidative status. In contrast, social hierarchy and the relative investment in soma versus sperm antioxidant protection are determinants of sperm performance.

Is sperm morphology functionally related to sperm swimming ability? A case study in a wild passerine bird with male hierarchies.

BACKGROUND: Sexual selection continues after copulation via either sperm competition or cryptic female choice, and favors sperm traits that maximize sperm competitiveness. Both sperm swimming velocity and longevity are important determinants of the outcome of sperm competition. Theoretically, sperm morphology can influence sperm velocity at least in three different non-exclusive ways: (i) longer sperm may generate more propelling thrust, (ii) bigger midpieces may produce more energy, and/or (iii) larger flagella or mid-pieces relative to the head size may compensate for the drag forces around the head. A growing number of studies have investigated the relationship of sperm morphology with sperm performance, which remains equivocal at both the inter- and intra-specific levels. Here, we used House Sparrows to test the functional relationship between sperm morphology with sperm velocity and longevity. Based on a previous study showing that sperm swimming ability covaries with social rank, we predicted that -if a functional relationship exists-1) sperm morphology should differ across social ranks, and 2) correlations between sperm morphology and sperm velocity and/or sperm longevity should be constant across social ranks. RESULTS: We found no differences in sperm morphology across social ranks. Moreover, we found that sperm morphology may be correlated with sperm velocity, but such relationship varied across social ranks. This result contradicts the hypothesis of a functional relationship between sperm morphology and sperm performance. Finally, after experimentally manipulating social ranks, we observed that relationships between sperm morphology and sperm velocity and/or sperm longevity disappeared or changed direction. CONCLUSIONS: We suggest that in species with internal fertilization, while sperm morphology is likely constrained by the morphology of the female sperm storage organs, selection may act upon physiological traits that enhance sperm performance. Hence, these two selection forces could decouple sperm performance from sperm morphology.

Effects of an early-life paraquat exposure on adult resistance to oxidative stress, plumage colour and sperm performance in a wild bird.

Early-life stressful conditions can shape individual phenotypes and ultimately influence fitness. Oxidative stress is a pervasive threat that affects many fitness-related traits and can modulate life-history trade-offs. Yet, the extent to which exposure to oxidative stress during early life can have long-lasting effects on key fitness-related traits remains to be elucidated, particularly in natural populations of vertebrates. Using a wild population of great tits Parus major, we experimentally dosed 11-day-old birds with paraquat, a pro-oxidant molecule, aiming at increasing oxidative stress. One year later, we recaptured 39 of them as adult recruiting breeders and quantified effects of the paraquat exposure on their resistance to oxidative stress, carotenoid-based plumage coloration and male sperm performance. Despite the absence of a short-term effect of paraquat on oxidative stress measured two days later, the pre-fledging exposure to paraquat induced a reduction in individual oxidative damage measured at adulthood. Paraquat-dosed individuals also had brighter plumage, but no effect was observed on male sperm performance. For the first time in a natural population of vertebrates, we experimentally show that an early-life acute exposure to a pro-oxidant has long-lasting effects on individual resistance to oxidative stress at adulthood. Our results are in line with the environmental matching and the hormesis hypotheses but may also reflect selective disappearance of individuals with lower resistance to oxidative stress.

Sensitive and selective quantification of free and total malondialdehyde in plasma using UHPLC-HRMS.

Quantification of malondialdehyde (MDA) as a marker of lipid peroxidation is relevant for many research fields. We describe a new sensitive and selective method to measure free and total plasmatic MDA using derivatization with 2,4-dinitrophenylhydrazine (DNPH) and ultra-HPLC-high-resolution MS. Free and total MDA were extracted from minute sample amounts (10 µl) using acidic precipitation and alkaline hydrolysis followed by acidic precipitation, respectively. Derivatization was completed within 10 min at room temperature, and the excess DNPH discarded by liquid-liquid extraction. Quantification was achieved by internal standardization using dideuterated MDA as internal standard. The method's lowest limit of quantification was 100 nM and linearity spanned greater than three orders of magnitude. Intra- and inter-day precisions for total MDA were 2.9% and 3.0%, respectively, and those for free MDA were 12.8% and 24.9%, respectively. Accuracy was 101% and 107% at low and high concentrations, respectively. In human plasma, free MDA levels were 120 nM (SD 36.26) and total MDA levels were 6.7 µM (SD 0.46). In addition, we show the applicability of this method to measure MDA plasma levels from a variety of animal species, making it invaluable to scientists in various fields.

Social dominance explains within-ejaculate variation in sperm design in a passerine bird.

BACKGROUND: Comparative studies suggest that sperm competition exerts stabilizing selection towards an optimal sperm design - e.g., the relative size and covariation of different sperm sections or a quantitative measure of sperm shape - that maximizes male fertility, which results in reduced levels of within-male variation in sperm morphology. Yet, these studies also reveal substantial amounts of unexplained within-ejaculate variance, and the factors presiding to the maintenance of such within-male variation in sperm design at the population level still remain to be identified. Sperm competition models predict that males should progressively invest more resources in their germline as their mating costs increase, i.e., the soma/germline allocation trade-off hypothesis. When access to fertile females is determined by social dominance, the soma/germline allocation trade-off hypothesis predicts that dominant males should invest less in the control of spermatogenesis. Hence, dominance should positively correlate with within-male variance in sperm design. RESULTS: In support of this hypothesis, we found that dominant house sparrow males produce ejaculates with higher levels of within-ejaculate variation in sperm design compared to subordinate males. However, after experimentally manipulating male social status, this pattern was not maintained. CONCLUSIONS: Our results suggest that males might control variation in sperm design according to their social status to some extent. Yet, it seems that such within-ejaculate variation in sperm design cannot be rapidly adjusted to a new status. While variation in sperm design could result from various non-exclusive sources, we discuss how strategic allocation of resources to the somatic vs. the germline functions could be an important process shaping the relationship between within-male variation in sperm design and social status.

Oxidative stress affects sperm performance and ejaculate redox status in subordinate house sparrows.

Oxidative stress is the result of random cellular damage caused by reactive oxygen species that leads to cell death, ageing or illness. Most physiological processes can result in oxidative stress, which in turn has been identified as a major cause of infertility. In promiscuous species, the fertilizing ability of the ejaculate partly determines the male reproductive success. When dominance determines access to fertile females, theory predicts that lower ranking males should increase resource investment into enhancing ejaculate quality. We hypothesized that subordinate males should thus prioritize antioxidant protection of their ejaculates to protect them from oxidative stress. We put this hypothesis to the test by chronically dosing wild house sparrows with diquat (∼1 mg kg-1), a herbicide that increases pro-oxidant generation. We found that, although they increased their antioxidant levels in the ejaculate, diquat-treated males produced sperm with reduced velocity. Importantly, and contrary to our hypothesis, males at the bottom of the hierarchy suffered the largest reduction in sperm velocity. We suggest that resource access hinders individuals' ability to cope with environmental hazards. Our results point at oxidative stress as a likely physiological mechanism mediating ejaculate quality, while individual ability to access resources may play a role in constraining the extent to which such resources can be allocated into the ejaculate.

Modification of sperm quality after sexual abstinence in Seba's short-tailed bat, Carollia perspicillata.

In polygynous mating systems, few males have stable access to sexual mates. With an expected higher copulation rate, harem males may deplete seminal fluids or increase epididymal sperm maturation, generating poor sperm quality. In a first study, we reported a higher sperm quality in sneaker males of Carollia perspicillata To test whether the lower sperm quality observed in harem males was generated by an elevated copulation rate, we temporarily removed males of both social statuses from the colony. We thus assessed status-related changes of sperm quality resulting from sexual abstinence. Moreover, released from territory and female guarding, harem males were expected to show a reduction in somatic costs. On the basis of sperm competition models, we predicted a higher resource investment in the ejaculate with the reduction of pre-copulatory efforts. In line with our predictions, sperm quality of harem males improved significantly in contrast to sneaker males, whose sperm quality did not change. Without an increase in ejaculate lipid peroxidation, our results also provide evidence that the duration of sexual abstinence was not sufficient to generate sperm oxidative damage through senescence. Harem males did not show a reduction in blood lipid peroxidation or in the ratio of oxidized to reduced glutathione. In line with the maintenance of these somatic costs, harem males did not invest more superoxide dismutase to the ejaculate to maintain sperm quality. Our results suggest that a difference in copulation rate rather than an adaptation to sperm competition provides sneaker males with higher sperm quality in C. perspicillata.

Physician-modified versus chimney endografting for pararenal aortic aneurysms: a systematic review and meta-analysis.

INTRODUCTION: We performed a systematic review and meta-analysis to assess the existing published evidence regarding the safety and efficacy of the endovascular aortic repair with chimney technique (ch-EVAR) and physician-modified stent-grafts (PMSGs) for the treatment of pararenal aortic aneurysm repair. EVIDENCE ACQUISITION: A systematic search of all relevant studies reported until October 2023 according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines was performed. The pooled 30-day mortality, peri- and postoperative complication rates were estimated using fixed or random effect methods. EVIDENCE SYNTHESIS: A total of 679 study titles were identified by the initial search strategy, of which 16 were considered eligible for inclusion in the meta-analysis. A total of 1094 patients (ch-EVAR N.=861 and PMSG N.=233) (90% male) were identified. The pooled 30-day mortality rate was 3.4% for ch-EVAR and 2.6% for PMSG. The major adverse events (MAE) in the early period was 14.7% for ch-EVAR and 18.5% PMSG, respectively. Higher occlusion rate was observed of the chimney stents grafts (8.2%) than the bridging stents (1.4%) during the follow-up period. CONCLUSIONS: Ch-EVAR and physician-modified technology are safe with low 30-day mortality in elective settings for pararenal aortic aneurysms repair. No significant differences were seen between the two surgical methods regarding the early major adverse events rate. However, higher occlusion rate for the chimneys can be expected over time.

Specialized short term crisis intervention for patients with personality disorder: Effects on coercion and length of stay.

BACKGROUND: Acute crises in patients with personality disorders (PD) are often accompanied by suicidal and self-harming behavior. Their management is challenging, as both coercive measures and prolonged inpatient-treatment are known to be counterproductive. Only in crises that cannot be controlled by outpatient means, inpatient treatment is to be taken into account. This treatment should be time-limited and not involve coercion. AIMS: The aim of this study was to assess if the introduction of a specialized crisis intervention track is associated with a reduction of coercive measures as well as a shorter in-hospital stay in PD patients. METHODS: In this 8-year, hospital-wide, longitudinal, observational study, we investigated the frequency of coercive measures and the median length of in-hospital stay in 1,752 inpatient-cases with PD admitted to the Adult Psychiatry, UPK, Basel, Switzerland, between 01.01.2012 and 31.12.2019. By means of an interrupted-time-series analysis, we compared the period before and after the implementation of a specialized crisis intervention track for PD patients. RESULTS: Our data show a significant decrease in the median length of in-hospital stay and no significant reduction in the incidence rate of coercion among PD patients after the intervention. The latter is likely due to a floor effect, since there was a significant decrease in coercive measures over the entire observation period, already reaching very low rates before the intervention. CONCLUSIONS: Our study underlines the clinical importance of specialized short-term crisis management in PD, which comes along with shorter lengths of in-hospital stays and a stable low rate of coercive measure.

Dynamic contrast-enhanced MRA of the aorta using a Golden-angle RAdial Sparse Parallel (GRASP) sequence: comparison with conventional time-resolved cartesian MRA (TWIST).

PURPOSE: To compare the application of two contrast-enhanced time-resolved magnetic resonance angiography sequences on an aortic disease patient cohort: the conventional Cartesian-sampling-based, Time-resolved angiography With Interleaved Stochastic Trajectories (TWIST) sequence, and the radial-sampling-based Golden-angle RAdial Sparse Parallel (GRASP) sequence. TWIST is highly sensitive to patient movement, which can lead to blurring and reduced sharpness of vascular structures, particularly in dynamic regions like the aorta. Such motion artifacts can compromise diagnostic accuracy. Radial-sampling-based techniques are less sensitive to motion than cartesian sampling and are expected to improve the image quality in body parts subjected to motion. METHODS: 30 patients (60.9 ± 16.1y.o.) with various aortic diseases underwent a 1.5T magnetic resonance angiography examination. Assessment of image quality in the ascending aorta (AA), descending aorta (DA), and abdominal aorta (AbA) on a 4-point Likert scale (1 = excellent, 4 = non-diagnostic) as well as max. aortic diameters (Dmax) were performed. T-test and multilevel mixed-effect proportional-odds models were used for the image analysis. RESULTS: GRASP offered superior depiction of vascular structures in terms of vascular contrast for qualitative analysis (TWIST, reader 1: 1.6 ± 0.5; reader 2: 1.9 ± 0.4; reader 3: 1.1 ± 0.4; GRASP, reader 1: 1.5 ± 0.5; reader 2: 1.4 ± 0.5; reader 3: 1.0 ± 0.2) and vessel sharpness for qualitative (TWIST, reader 1: 1.9 ± 0.6; reader 2: 1.6 ± 0.6; reader 3: 2.0 ± 0.3; GRASP, reader 1: 1.4 ± 0.6; reader 2: 1.2 ± 0.4; reader 3: 1.3 ± 0.6) and quantitative analysis (TWIST, AA = 0.12 ± 0.04, DA = 0.12 ± 0.03, AbA = 0.11 ± 0.03; GRASP, AA = 0.20 ± 0.05, DA = 0.22 ± 0.06, AbA=0.20 ± 0.05). Streaking artefacts of GRASP were more visible compared to TWIST (TWIST, reader 1: 2.2 ± 0.6; reader 2: 1.9 ± 0.3; reader 3: 2.0 ± 0.5; GRASP, reader 1: 2.6 ± 0.6; reader 2: 2.3 ± 0.5; reader 3: 2.8 ± 0.6). Aortic Dmax comparison among the sequence showed no clinical relevance. CONCLUSION: GRASP outperformed TWIST in SNR, vessel sharpness, and reduction in image blurring; streaking artefacts were stronger with GRASP, but did not affect diagnostic image quality.

START NOW WebApp-promoting emotion regulation and resilience in residential youth care and correctional institutions: study protocol for a cluster randomized controlled trial.

BACKGROUND: Adolescents and young adults in residential care and correctional institutions face various challenges, leading to negative life outcomes. Implementation barriers within these institutions, such as limited financial and spatial resources, pose significant hurdles to providing necessary support. Web-based approaches address these challenges by offering cost-effective, accessible solutions. This study aims to assess the efficacy of a newly developed web-based version of the existing evidence-based START NOW skills training in fostering emotion regulation and resilience among institutionalized adolescents and young adults. We present the study protocol (Version 5, August 2023) of the trial titled "Implementation of an e-version of the skills training START NOW for promoting emotion regulation and resilience in residential youth care and correctional institutions". METHODS: The study is a monocentric, prospective, confirmatory randomized controlled trial with 150 institutionalized adolescents and young adults with a need to improve resilience (predefined cut-offs). Participating institutions will be randomized to one of three conditions: (i) 9-week web-based group training guided by a facilitator, (ii) 9-week web-based self-help training, (iii) and treatment as usual. The primary endpoint is the change in psychological flexibility, assessed by the Avoidance and Fusion Questionnaire for Youth score, from baseline to follow-up 12 weeks post skills training. Secondary objectives encompass assessing pre-post changes in psychological flexibility and other psychological health-related outcome measures in participating adolescents, young adults, and caretakers from baseline, to post training, and to 12- and 24-week follow-ups. DISCUSSION: This study evaluates the efficacy of START NOW as web-based training for institutionalized adolescents and young adults, providing valuable insights into web-based interventions and aiming to optimize support levels. TRIAL REGISTRATION {2A AND 2B}: ClinicalTrials.gov NCT05313581. Registered on 6 April 2022.

Nestling erythrocyte resistance to oxidative stress predicts fledging success but not local recruitment in a wild bird.

Stressful conditions experienced by individuals during their early development have long-term consequences on various life-history traits such as survival until first reproduction. Oxidative stress has been shown to affect various fitness-related traits and to influence key evolutionary trade-offs but whether an individual's ability to resist oxidative stress in early life affects its survival has rarely been tested. In the present study, we used four years of data obtained from a free-living great tit population (Parus major; n = 1658 offspring) to test whether pre-fledging resistance to oxidative stress, measured as erythrocyte resistance to oxidative stress and oxidative damage to lipids, predicted fledging success and local recruitment. Fledging success and local recruitment, both major correlates of survival, were primarily influenced by offspring body mass prior to fledging. We found that pre-fledging erythrocyte resistance to oxidative stress predicted fledging success, suggesting that individual resistance to oxidative stress is related to short-term survival. However, local recruitment was not influenced by pre-fledging erythrocyte resistance to oxidative stress or oxidative damage. Our results suggest that an individual ability to resist oxidative stress at the offspring stage predicts short-term survival but does not influence survival later in life.