Fenestrated and Scalloped Endovascular Grafts in Zone 0 and Zone 1 for Aortic Arch Disease.

BACKGROUND: The aim of this study is to present midterm results of thoracic endovascular aortic repair (TEVAR) using scalloped or fenestrated custom-made endovascular grafts (CMEGs) in aortic arch Zones 0 and 1. METHODS: A retrospective review of prospectively collected data involving consecutive patients with aortic arch disease treated by scalloped or fenestrated Relay Plus stent grafts (Terumo Aortic, Sunrise, FL) landed in Zones 0 and 1. Patient demographics, operative details, clinical outcomes, and complications were analyzed. RESULTS: Between February 2014 and February 2020, 14 patients (9 male and 5 female) with a median age of 66 years (range 48-84) underwent scalloped or fenestrated TEVAR to preserve flow to the supra-aortic trunks (SATs). In 6 cases the landing zone was Zone 0 and in 8, Zone 1. Target vessels for the scallops were left common carotid artery in 8 cases (Zone 1) and innominate artery (IA) in 1 (Zone 0). All 5 fenestrations were designed to preserve the IA (Zone 0). Technical success was 100% with no endoleaks on completion angiography. One fatal perioperative stroke (7%) occurred in a patient with a fenestration for the IA and atherosclerotic plaques in the arch. During median follow-up of 37.5 (3-72) months, no other patient died, and all the target vessels and cervical revascularizations remained patent. There was no paraplegia, no retrograde dissection, and no other complication. Two patients (14%) with scallops in Zone 1 developed late endoleak: 1 type Ib at 6 months and 1 type Ia endoleak at 12 months. There were no endoleaks at all in the group of fenestrated endografts (Zone 0). CONCLUSIONS: When anatomy allows, endovascular treatment using scalloped or fenestrated CMEGs in Zones 0 and 1 is a feasible technique to treat patients with aortic arch disease involving the SATs.

Unravelling the ecological impacts of large-scale offshore wind farms in the Mediterranean Sea.

The need for alternative energy systems like offshore wind power to move towards the Green Deal objectives is undeniable. However, it is also increasingly clear that biodiversity loss and climate change are interconnected issues that must be tackled in unison. In this paper we highlight that offshore wind farms (OWF) in the Mediterranean Sea (MS) pose serious environmental risks to the seabed and the biodiversity of many areas due to the particular ecological and socioeconomic characteristics and vulnerability of this semi-enclosed sea. The MS hosts a high diversity of species and habitats, many of which are threatened. Furthermore, valuable species, habitats, and seascapes for citizens' health and well-being coexist with compounding effects of other economic activities (cruises, maritime transport, tourism activities, fisheries and aquaculture) in a busy space on a narrower continental shelf than in other European seas. We argue that simply importing the OWF models from the northern European seas, which are mostly based on large scale projects, to other seas like the Mediterranean is not straightforward. The risks of implementing these wind farms in the MS have not yet been well evaluated and, considering the Precautionary Principle incorporated into the Marine Strategy Framework Directive and the Maritime Spatial Planning Directive, they should not be ignored. We propose that OWF development in the MS should be excluded from high biodiversity areas containing sensitive and threatened species and habitats, particularly those situated inside or in the vicinity of Marine Protected Areas or areas with valuable seascapes. In the absence of a clearer and comprehensive EU planning of wind farms in the MS, the trade-off between the benefits (climate goals) and risks (environmental and socioeconomic impacts) of OWF could be unbalanced in favor of the risks.

Risk Factors for Commercial Sexual Exploitation of Children and Adolescents: Results of an International Delphi Panel.

BACKGROUND: Commercial sexual exploitation of children and adolescents (CSECA) is a worldwide problem. The need to improve current detection and intervention protocols motivated this analysis, which aimed to use expert opinion to identify indicators (symptoms, conduct, or behaviors) that may help to predict the risk of suffering CSECA and to detect those who are suffering from it, as well as the type of detection tools and protocols that should be used. METHOD: An international multidisciplinary group of experts in CSECA was invited to take part in this study. A two-round digital Delphi panel was undertaken with 22 experts. An ad hoc questionnaire was created, which included 41 questions about CSECA risk factors and interventions that should be considered during detection. RESULTS: The main indicators identified included normalization of dynamics of sexual exchange within the family, family history of sexual exploitation, and sexually transmitted infections. Predictive characteristics included economic extortion, lack of documentation, and family estrangement. Additionally, 95.5% of participants agreed that multiple victimizations in childhood should be considered for CSECA detection. CONCLUSIONS: This study provides information that may be very useful in the development/improvement of instruments for CSECA detection. With this approach we hope to promote the creation of tools adapted to the Spanish cultural context.

Parent and Teacher Depictions of Gender Gaps in Secondary Student Appraisals of Their Academic Competences.

The present study examines a group of secondary teachers' and parents' appraisals of gender gaps in secondary students' self-assessment of competence in Science, Technology, Engineering, and Mathematics (STEM) and non-STEM domains. Eight focus groups with 39 parents and 34 secondary teachers were conducted for this purpose. In light of the observed gender gaps in students' performance and self-perception of ability in the different subject areas, the participants were particularly surprised by girls' underestimation of their abilities in STEM subjects, compared with boys' tendency to overestimate their abilities in STEM. Most participants agreed on the need for measures to combat these inaccuracies and discussed possible causes. Some participants associated these gender disparities in students' self-assessment of ability with gender gaps in their choices of subject areas and occupations. The role played by school, teachers, families, and other socialization agents in reinforcing gender stereotypes about academic competence was also discussed in most of the focus groups. Interestingly, some teachers questioned why gender attainments obtained in schools do not serve as an example when it comes to neutralizing the sexism and gender inequality messages offered by the media and society. Likewise, technology teachers proposed changes in school practices to close gender gaps in certain areas (i.e., boys' appropriation of the playground, or the reproduction of gender roles in the classroom). Few parents acknowledged their unconscious reproduction of gender roles and stereotypes in raising their children.

Modeled buoyancy of eggs and larvae of the deep-sea shrimp Aristeus antennatus (Crustacea: Decapoda) in the northwestern Mediterranean Sea.

Information on the buoyancy of eggs and larvae from deep-sea species is rare but necessary for explaining the position of non-swimming larvae in the water column. Due to embryonic morphology and ecology diversities, egg buoyancy has important variations within one species and among other ones. Nevertheless, it has hardly been explored if this buoyancy variability can be a strategy for deep-sea larvae to optimize their transport beyond their spawning areas. In the northwestern Mediterranean Sea, protozoea and mysis larvae of the commercial deep-sea shrimp Aristeus antennatus were recently found in upper layers, but to present, earlier stages like eggs and nauplii have not been collected. Using a Lagrangian transport model and larval characteristics, we evaluate the buoyancy and hydrodynamic effects on the transport of A. antennatus' larvae in the northwestern Mediterranean Sea. The transport models suggested that 75% of buoyant eggs released between 500 and 800 m depth (i.e., known spawning area), reached the upper water layers (0-75 m depth). Then, according to the modeled larval drifts, three spawning regions were defined in the studied area: 1) the northern part, along a continental margin crossed by large submarine canyons; 2) the central part, with two circular circulation structures (i.e., eddies); and 3) the southern part, with currents flowing through a channel. The number of larvae in the most upper layer (0-5 m depth) was higher if the larval transport model accounted for the ascent of eggs and nauplii (81%) instead of eggs reaching the surface before hatching (50%). The larvae reaching the most water upper layer (0-5 m depth) had higher rates of dispersal than the ones transported below the surface layer (deeper than 5 m depth). The results of larval dispersal simulations have implications for the understanding of A. antennatus larval ecology and for management decisions related to the shrimp fisheries in the northwestern Mediterranean Sea.

Morphological, histological and immunohistochemical study of the area postrema in the dog.

Circumventricular organs are specialized brain structures that are located mainly at the midsagittal line, around the third and fourth ventricles, often protruding into the lumen. They are positioned at the interface between the neuroparenchyma and the ventricular system of the brain. These highly vascularized nervous tissue structures differ from the brain parenchyma, as they lack a blood-brain barrier. Circumventricular organs have specialized sensory and secretory functions. It is essential for any pathologist who evaluates brain sections to have a solid knowledge of microscopic neuroanatomy and to recognize these numerous specialized structures within the nervous system as normal and not mistake them for pathological changes. The purpose of this study was to provide, for the first time, a detailed and complete histological description of the healthy canine area postrema and to determine its resemblance to that of other mammalian species. Anatomical dissections with routine histological and immunohistochemical techniques were carried out on ten canine brains. The cellular composition of area postrema proved to be largely comparable to that of other mammal species.

Endovascular Treatment of Aortic Arch Lesions Using Scalloped Endografts.

OBJECTIVE: To present our early and midterm results using thoracic endovascular aortic repair (TEVAR) with a custom-made proximal scalloped stent graft to accommodate left common carotid artery (LCCA) and innominate artery (IA) in treating aortic lesions involving the arch. MATERIALS AND METHODS: Between February 2014 and April 2017, select patients presenting with aortic arch lesions and short proximal landing zone were treated by proximal scalloped Relay Plus stent grafts. Patient demographics, operative details, clinical outcomes, and complications were analyzed. RESULTS: Six patients (50% male) with a median age of 71 years (range, 60-82) underwent scalloped TEVAR using thoracic custom-made Relay Plus stent graft to preserve flow in the proximal supra-aortic trunks. Target vessels for the scallop were LCCA in 5 cases and IA in 1 case. The technical success rate was 100%, and proximal seal was achieved in all cases with no type I endoleaks on completion angiography. The median follow-up period was 20 (7-32) months. No conversion to open surgical repair and no aortic rupture occurred. One patient had a distal type I endoleak on the 6-month computed tomography (CT) scan, and 1 patient had a proximal type I endoleak on the 12-month CT scan. There was no stroke, paraplegia, retrograde type A dissection, or other aortic-related complication. We routinely used temporary rapid right ventricular pacing to obtain a near-zero blood pressure level during the graft deployment. No complications were observed related to the use of rapid pacing. CONCLUSION: When anatomy allows, proximal scalloped stent graft to accommodate LCCA and IA is a viable therapeutic option in treating aortic lesions involving the arch with short proximal landing zones. In addition, these findings represent a strong argument for the use of temporary rapid pacing during graft deployment.

[The development and validation of two scales on retribution practices: PRG-13 and PRE-21]. / Desarrollo y validación de dos escalas sobre las prácticas de retribución: PRG-13 y PRE-21.

The present study outlines the development process of two scales that measure general and specific retribution practices in organisations. Historically, retribution has been the subject of research of other social sciences such as Sociology and Business Administration. In Psychology, and more specifically in Work and Organisational Psychology, there are hardly any studies or inventories designed to evaluate retribution practices. In order to accomplish the objectives, a sample of 237 employees was selected, 42.6% of whom were women and 57.4% were men. We performed and exploratory factorial analysis using principal axis factoring as extraction method and an oblique rotation (oblimin) to analyse the two scales. The former is made up of four factors and the latter is a two-factor scale. The reliability coefficients of the six subscales we obtained ranged between .72 and .89. External validity was analysed using the correlations obtained between the two inventories and the Balanced Scorecard. The two tools were found to be two potentially useful scales to evaluate retribution practices.