The Effects of Protrusion into the Outflow Vein on Outcomes of Stent Grafts Used to Treat Cephalic Arch Stenoses in Dysfunctional Brachiocephalic Fistulae.

PURPOSE: To assess long-term patency rates of cephalic arch stent grafts in brachiocephalic fistulae and the importance of device position. MATERIALS AND METHODS: This retrospective study reviewed 152 patients with dysfunctional brachiocephalic fistulae and cephalic arch stenosis treated with stent grafts (Viabahn; W. L. Gore) at a single tertiary center between 2012 and 2021. The median age was 67.5 years (range, 25-91 years), and the median follow-up period was 637 days (range, 3-3,368 days). A grading system of protrusion was applied: (a) Grade 0, no protrusion; (b) Grade 1, perpendicular; and (c) Grade 2, in-line protrusion. Subsequent fistulograms were available in 133 (88%) of the 152 patients and were assessed for central vein stenosis within 10 mm of the stent graft. Clinical records were assessed for sequelae of stent graft protrusion. Stent graft primary and cumulative circuit patencies were calculated using the Kaplan-Meier method. RESULTS: Protrusion was documented in 106 (70%) stent grafts-56 Grade 1 and 50 Grade 2. Central vein stenosis was seen in 1 (2%) case of no protrusion (Grade 0) and 38 (40%) cases of protrusion (P < .0001). There was no significant difference in stenosis between Grade 1 and 2 protrusion (P = .15). No adverse clinical sequelae occurred in 147 (97%) patients. Eight patients had a new access subsequently formed in the same arm, and 3 of these 8 patients developed symptoms due to the previous stent graft protrusion (all Grade 2). The primary patency rates of the stent-grafts at 6 and 12 months were 73% and 50%, respectively. The cumulative access circuit patency rates at 1, 2, and 5 years were 84%, 72%, and 54%, respectively. CONCLUSIONS: This study demonstrated that protrusion of a cephalic arch stent graft into the central vein is safe and only clinically relevant when a subsequent ipsilateral access is created.

Interactions and stabilisation of acetone, sulfur dioxide and water with 1-octyl-3-methylimidazolium tetrafluoroborate [OMIM][BF4] at low temperatures.

The interactions between three small molecules, water (H2O), sulfur dioxide (SO2) and acetone ((CH3)2CO), with the ionic liquid (IL) 1-octyl-3-methylimidazolium tetrafluoroborate, [OMIM][BF4], have been determined using line of sight temperature programmed desorption (LOSTPD) from a gold surface. Multilayers of the IL were deposited by physical vapour deposition with multilayers of the small molecular species (adsorbed from the gas phase) at 90 K. LOSTPD was then carried out with the small molecular species desorbing first from the mixed multilayer, followed at higher temperatures by desorption of the IL from the gold surface. The IL had a high activation energy for desorption of 126(6) kJ mol-1. Pure acetone showed a desorption activation energy of 38(2) kJ mol-1, which increased to 45-61 kJ mol-1 when it was pre-adsorbed below an overlying porous layer of the ionic liquid at 90 K. The stabilised acetone is thought to be associated with pores containing ionic moieties. Destabilised acetone was also observed and thought to originate from pores containing octyl chains. The quantity of stabilised acetone scaled with the amount of IL, being ≈1.1 molecules per IL ion pair. SO2 and H2O were co-adsorbed with the IL at 90 K leading to an intimate mixture of the two. For pure SO2 the desorption energy was 32(2) kJ mol-1, which increased to 40-52 kJ mol-1 for relative concentrations up to 6 SO2 molecules per IL ion pair. For pure water the activation energies were 49(5) kJ mol-1 and 43(1) kJ mol-1 for amorphous and crystalline ice respectively. When co-adsorbed with the IL the stabilisation energies were 42-49 kJ mol-1, but up to 505 water molecules per IL ion pair could be stabilised to some degree. The desorption mechanisms and the reasons for these interactions are discussed.

Electroanalysis of Neutral Precursors in Protic Ionic Liquids and Synthesis of High-Ionicity Ionic Liquids.

Protic ionic liquids (PILs) are ionic liquids that are formed by transferring protons from Brønsted acids to Brønsted bases. While they nominally consist entirely of ions, PILs can often behave as though they contain a significant amount of neutral species (either molecules or ion clusters), and there is currently a lot of interest in determining the degree of "ionicity" of PILs. In this contribution, we describe a simple electroanalytical method for detecting and quantifying residual excess acids in a series of ammonium-based PILs (diethylmethylammonium triflate [dema][TfO], dimethylethylammonium triflate [dmea][TfO], triethylammonium trifluoroacetate [tea][TfAc], and dimethylbutylammonium triflate [dmba][TfO]). Ultra-microelectrode voltammetry reveals that some of the accepted methods for synthesizing PILs can readily result in the formation of nonstoichiometric PILs containing up to 230 mM excess acid. In addition, vacuum purification of PILs is of limited use in cases where nonstoichiometric PILs are formed. Although excess bases can be readily removed from PILs under ambient conditions, excess acids cannot be removed, even under high vacuum. The effects of excess acid on the electrocatalytic oxygen reduction reaction (ORR) in PILs have been studied, and the onset potential of the ORR in [dema][TfO] increases by 0.8 V upon addition of acid to PIL. On the basis of the results of our analyses, we provide some recommendations for the synthesis of highly ionic PILs.

Results of Stent Graft Placement to Treat Cephalic Arch Stenosis in Hemodialysis Patients with Dysfunctional Brachiocephalic Arteriovenous Fistulas.

PURPOSE: To determine effectiveness of the VIABAHN (W.L. Gore & Associates, Flagstaff, Arizona) stent graft to treat cephalic arch stenosis in patients with dysfunctional brachiocephalic arteriovenous fistulas after inadequate venoplasty response. MATERIALS AND METHODS: Between 2012 and 2015, patients with failed venoplasty of symptomatic cephalic arch stenosis received a VIABAHN stent graft. Follow-up venography was performed at approximately 3, 6, and 12 months. Data were retrospectively analyzed with patency estimated using Kaplan-Meier and log-rank methodology. There were 39 patients included. RESULTS: Technical and clinical success was 100%. Primary target lesion patency was 85% (95% confidence interval [CI], 69%-93%), 67% (95% CI, 50%-80%), and 42% (95% CI, 25%-57%) at 3, 6, and 12 months. There was no significant difference in patency with regard to sex or age (P = .8 and P = .6, respectively). Primary assisted patency was 95% (95% CI, 82%-99%) at 3, 6, and 12 months. Access circuit primary patency was 85% (95% CI, 69%-93%), 67% (95% CI, 50%-80%), and 42% (95% CI, 25%-57%) at 3, 6, and 12 months. There was no significant difference in patency between patients with the stent graft as the first treatment episode in the cephalic arch and those that had previous intervention at this site (P = .98). There were 48 repeat venoplasty procedures performed in the cephalic arch to maintain patency, including 7 repeat VIABAHN insertions. No complications were encountered. CONCLUSIONS: The VIABAHN stent graft is a safe, effective, and durable device for treating cephalic arch stenosis when venoplasty fails.

Cost analysis of the Hemodialysis Reliable Outflow (HeRO) Graft compared to the tunneled dialysis catheter.

BACKGROUND: In end-stage renal disease patients with central venous obstruction, who have limited vascular access options, the Hemodialysis Reliable Outflow (HeRO) Graft is a new alternative with a lower incidence of complications and longer effective device life compared to tunneled dialysis catheters (TDCs). We undertook an economic analysis of introducing the HeRO Graft in the UK. METHODS: A 1-year cost-consequence decision analytic model was developed comparing management with the HeRO Graft to TDCs from the perspective of the National Health Service in England. The model comprises four 3-month cycles during which the vascular access option either remains functional for hemodialysis or fails, patients can experience access-related infection and device thrombosis, and they can also accrue associated costs. Clinical input data were sourced from published studies and unit cost data from National Health Service 2014-15 Reference Costs. RESULTS: In the base case, a 100-patient cohort managed with the HeRO Graft experienced 6 fewer failed devices, 53 fewer access-related infections, and 67 fewer device thromboses compared to patients managed with TDCs. Although the initial device and placement costs for the HeRO Graft are greater than those for TDCs, savings from the lower incidence of device complications and longer effective device patency reduces these costs. Overall net annual costs are £2600 for each HeRO Graft-managed patient compared to TDC-managed patients. If the National Health Service were to reimburse hemodialysis at a uniform rate regardless of the type of vascular access, net 1-year savings of £1200 per patient are estimated for individuals managed with the HeRO Graft. CONCLUSIONS: The base case results showed a marginal net positive cost associated with vascular access with the HeRO Graft compared with TDCs for the incremental clinical benefit of reductions in patency failures, device-related thrombosis, and access-related infection events in a patient population with limited options for dialysis vascular access.

Adsorption, Desorption, and Reaction of 1-Octyl-3-methylimidazolium Tetrafluoroborate, [C8C1Im][BF4], Ionic Liquid Multilayers on Cu(111).

Multilayers of 1-octyl-3-methylimidazolium tetrafluoroborate [C8C1Im][BF4] have been deposited on a Cu(111) surface by evaporation in UHV. XPS shows that [C8C1Im][BF4] adsorbs without decomposition for substrate temperatures < 300 K. XPS and UPS data indicate that ionic liquid (IL) deposition onto a 120 K Cu(111) surface results in the IL forming multilayers by a simultaneous-multilayer growth process. IL deposition onto a room temperature Cu(111) surface results in a different arrangement where at a coverage of one monolayer the IL forms droplets of about 100 Å height covering only about 1/10th of the surface. Multilayers deposited at 120 K convert to the room temperature arrangement upon heating. Further heating above room temperature causes the IL multilayer droplets to desorb leaving an IL monolayer of ≈6 Å thickness at ≈430 K. At higher temperatures, this monolayer reacts with the surface and BF3 is emitted, leaving products containing C, N, and some F on the surface. We propose a surface reaction where [BF4](-) ions react to form chemisorbed fluorine (Cu-F) and gaseous BF3, with the remaining [C8C1Im](+) decomposing on the Cu(111) in an unidentified manner.

Quantitative adsorbate structure determination for quasicrystals using x-ray standing waves.

The quantitative structure determination of adsorbed species on quasicrystal surfaces has so far appeared to present insurmountable problems. The normal incidence standing x-ray wave field technique offers a simple solution, without extensive data sets or large computations. Its application to quasicrystals raises several conceptual difficulties that are related to the phase problem in x-ray diffraction. We demonstrate their solution for the case of Si atoms adsorbed on the decagonal Co-rich modification of the Al-Co-Ni quasicrystal to determine the local structure, comprising 6-atom clusters in particular hollow sites.

Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). This Guideline was also reviewed and endorsed by the Governing Board of the American Society for Gastrointestinal Endoscopy (ASGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations The following recommendations should only be applied after a thorough diagnostic evaluation including a contrast-enhanced computed tomography (CT) scan. 1 Prophylactic colonic stent placement is not recommended. Colonic stenting should be reserved for patients with clinical symptoms and imaging evidence of malignant large-bowel obstruction, without signs of perforation (strong recommendation, low quality evidence). 2 Colonic self-expandable metal stent (SEMS) placement as a bridge to elective surgery is not recommended as a standard treatment of symptomatic left-sided malignant colonic obstruction (strong recommendation, high quality evidence). 3 For patients with potentially curable but obstructing left-sided colonic cancer, stent placement may be considered as an alternative to emergency surgery in those who have an increased risk of postoperative mortality, I. e. American Society of Anesthesiologists (ASA) Physical Status ≥ III and/or age > 70 years (weak recommendation, low quality evidence). 4 SEMS placement is recommended as the preferred treatment for palliation of malignant colonic obstruction (strong recommendation, high quality evidence), except in patients treated or considered for treatment with antiangiogenic drugs (e. g. bevacizumab) (strong recommendation, low quality evidence).

Vaporisation and thermal decomposition of dialkylimidazolium halide ion ionic liquids.

Vaporisation and liquid phase thermal decomposition, TD, of two halide ion ionic liquids, 1-octyl-3-methylimidazolium chloride, [C8C1Im]Cl, and 1-octyl-3-methylimidazolium iodide, [C8C1Im]I, are investigated using temperature programmed desorption (TPD) line of sight mass spectrometry (LOSMS) at ultra-high vacuum (UHV). The ability to use MS to distinguish between vaporisation and TD allows the thermodynamics/kinetics of both vaporisation and TD to be investigated within the same experiments. Vaporisation of both halide ion ionic liquids is demonstrated. For both [C8C1Im]Cl and [C8C1Im]I the vapour is shown to be composed of neutral ion pairs (NIPs). The enthalpy of vaporisation at temperature T, ΔvapHT, was experimentally determined as ΔvapH455 = 151 ± 10 kJ mol(-1) for [C8C1Im]Cl and ΔvapH480 = 149 ± 8 kJ mol(-1) for [C8C1Im]I. Extrapolation of ΔvapHT to the reference temperature, 298 K, gave ΔvapH298 = 166 ± 10 kJ mol(-1) for [C8C1Im]Cl and ΔvapH298 = 167 ± 8 kJ mol(-1) for [C8C1Im]I, higher than most ΔvapH298 values measured to date for other [C8C1Im](+)-containing ionic liquids. In addition, predictions of ΔvapH298 for other halide ion ionic liquids are made. Liquid phase TD is shown to proceed via nucleophilic substitution to give two sets of products: 1-octylimidazole and methylhalide, and 1-methylimidazole and 1-octylhalide. The activation energy of TD at a temperature T, Ea,TD,T, is measured for the nucleophilic substitution of [C8C1Im]I to give methyliodide; Ea,TD,480 = 136 ± 15 kJ mol(-1). Ea,TD,T is measured for the nucleophilic substitution of [C8C1Im]Cl to give methylchloride; Ea,TD,455 = 132 ± 10 kJ mol(-1). The fact that ΔvapHT and Ea,TD,T are the same (within error) for both ionic liquids is commented upon, and conclusions are drawn as to the thermal stability of these ionic liquids.

Mono- and multi-layer adsorption of an ionic liquid on Au(110).

Ultraviolet photoelectron spectroscopy (UPS), work function measurements, low energy electron diffraction (LEED) and scanning tunnelling microscopy (STM) have been used to study the adsorption and desorption of 1-ethyl-3-methylimidazolium bis[(trifluoromethyl)sulfonyl]imide, [C(2)C(1)Im][Tf(2)N], on the (1×2) clean surface reconstruction of Au(110) in the temperature range 100-674 K. The ionic liquid adsorbed without decomposition, and desorbed without leaving any residue on the surface. For adsorption at room temperature a monolayer of strongly bound ionic liquid was formed with four interface states visible in UP spectra. STM at 100 K showed that the monolayer consisted of well-ordered rows of adsorbed ionic liquid aligned parallel to the close packed rows of surface gold atoms (the [110] direction) with a separation of ×2 (the same as the clean surface reconstruction) between the rows in the orthogonal [001] direction. Multilayer adsorption at room temperature occurred by droplet formation followed by smoothing of the droplets to a layered morphology with time. Heating caused multilayer desorption at temperatures in the 363-383 K range, followed by partial monolayer desorption at 548 K to produce a Au(110)-(1×3) reconstructed surface with sub-monolayer domains of ionic liquid. Desorption of the remaining ionic liquid at 600 K caused the gold surface to reconstruct back to the clean (1×2) reconstruction.

The enthalpies of vaporisation of ionic liquids: new measurements and predictions.

The enthalpies of vaporisation, Δ(vap)H(298), of seven ionic liquids (ILs) (four imidazoliums, a pyridinium, a phosphonium and an isouronium) have been determined by temperature programmed desorption using line of sight mass spectrometry. They were: 1-ethyl-3-methylimidazolium bis(pentafluoroethyl)phosphinate, [C(2)C(1)Im][PO(2)(C(2)F(5))(2)]; 1-butyl-3-methylimidazolium octylsulfate, [C(4)C(1)Im][C(8)OSO(3)]; 1-butyl-3-methylimidazolium tetrafluoroborate, [C(4)C(1)Im][BF(4)]; 1-hexyl-3-methylimidazolium tris(pentafluoroethyl)trifluorophosphate, [C(6)C(1)Im][FAP]; 1-butylpyridinium methylsulfate, [C(4)Py][C(1)OSO(3)]; trihexyl(tetradecyl)phosphonium tetrafluoroborate, [P(6,6,6,14)][BF(4)] and O-ethyl-N,N,N',N'-tetramethylisouronium trifluoromethanesulfonate, [C(2)(C(1))(4)iU][TfO]. The values were found to be consistent with a previously proposed, predictive, model in which Δ(vap)H(298) is decomposed into a Coulombic component (computable from the IL density) and van der Waals components from the anion and cation. Two previously predicted values of Δ(vap)H(298) were found to be within 6 kJ mol(-1) of the measured experimental values. Values for the van der Waals components are tabulated for eleven cations and twelve anions. Predictions are made for Δ(vap)H(298) for 13 ILs with as yet unmeasured Δ(vap)H(298) values (using experimental molar volumes), and for a further 44 ILs using estimated molar volumes.

Use of a VBX balloon expandable stent-graft for management of right brachiocephalic vein stenosis.

Here we describe the use of a VBX balloon expandable stent-graft (WL Gore, Flagstaff, AZ, USA) to treat a right brachiocephalic vein stenosis in a haemodialysis patient prior to ipsilateral upper limb arterio-venous (AV) fistula formation. Balloon expandable stent-grafts are unsuitable for treating peripheral fistula stenoses due to their susceptibility of being crushed. The right brachiocephalic vein is both relatively short in comparison to the left and is less susceptible to extrinsic compression and the use of such a device to treat stenosis here allows for very accurate placement and restoration of luminal diameter. The advantages and disadvantages of using these devices in haemodialysis access circuits are also discussed herein, in what we believe to be the first report of the application of a dedicated commercially available balloon expandable stent graft in a haemodialysis patient.

Order, disorder, and metalation of tetraphenylporphyrin (2H-TPP) on Au(111).

A thermally induced order-disorder transition of tetraphenylporphyrin (2H-TPP) on Au(111) is characterised by scanning probe microscopy and X-ray photoelectron spectroscopy-based techniques. We observed that a transition from an ordered close-packed phase to a disordered diffuse phase is correlated with an on-surface cyclodehydrogenation reaction, and that additional heating of this diffuse phase gives rise to a single distinct nitrogen environment indicative of the formation of a Au-TPP species.

Conditional deletion of beta1 integrins in the intestinal epithelium causes a loss of Hedgehog expression, intestinal hyperplasia, and early postnatal lethality.

Conditional deletion of beta1 integrins in the intestinal epithelium, unlike in epidermal and mammary epithelia, of mice does not result in decreased cell adhesion and proliferation, but instead causes a profound increase in epithelial proliferation with dysplasia and polypoid structures. The increased epithelial proliferation inhibited epithelial differentiation that caused severe malnutrition and early postnatal lethality. The striking similarities between beta1 integrin-deleted mice and neonatal mice with defective Hedgehog signaling led to the discovery that Hedgehog expression was markedly reduced in the former mice. beta1 integrins were found to drive the expression of Hedgehogs in intestinal epithelial cells in an HNF-3beta (Foxa2)-dependent fashion. The expression of Tcf-4, a transcription factor known to be required for intestinal epithelial stem cell proliferation, was increased and mislocalized in the intestinal epithelia of the beta1 integrin-deleted mice and in newborn mice treated with the Hedgehog signaling inhibitor cyclopamine. This study shows that beta1 integrins are key regulators of proliferation and homeostasis in the intestine and achieve this not through anchorage-dependent effects but by generating Hh expression and signaling.

Long-term results of stent-graft placement to treat central venous stenosis and occlusion in hemodialysis patients with arteriovenous fistulas.

PURPOSE: To determine the effectiveness of stent-grafts for the treatment of central venous disease in hemodialysis patients with functioning arteriovenous (AV) fistulas. MATERIALS AND METHODS: Between October 2004 and March 2010, 42 VIABAHN stent-grafts were deployed in central veins of 30 patients (16 men, 14 women; mean age 60 y) with functioning AV fistulas and central venous disease that did not respond to percutaneous transluminal angioplasty (PTA). Eighteen patients had central vein stenosis and 12 had occlusion. Previous PTA and/or bare metal stent placement had been performed in 23 patients (77%). Surveillance was carried out at 3, 6, 9, 12, 18, and 24 months with diagnostic fistulography. The mean follow-up was 705 days (range, 66-1,645 d). Statistical analysis included Kaplan-Meier and log-rank studies. RESULTS: Technical success rate was 100%. Primary patency rates were 97%, 81%, 67%, and 45% at 3, 6, 12, and 24 months, respectively. Primary assisted patency rates were 100%, 100%, 80%, and 75% at 3, 6, 12, and 24 months, respectively. Patients without previous procedures had significantly shorter times to repeat intervention (P = .018) than those who had undergone PTA or bare metal stent placement previously. Patients with occlusive lesions had a significantly shorter primary patency interval (P = .05) than patients with stenoses. Occluded veins were more likely to require further stent-grafts (P = .02). Twelve patients required further stent-grafts to maintain patency. There was one minor complication. CONCLUSIONS: Stent-graft placement to treat central venous disease in hemodialysis patients with autogenous AV fistulas is safe and effective if PTA fails to maintain luminal patency.

Charging of ionic liquid surfaces under X-ray irradiation: the measurement of absolute binding energies by XPS.

Ionic liquid surfaces can become electrically charged during X-ray photoelectron spectroscopy experiments, due to the flux of photoelectrons leaving the surface. This causes a shift in the measured binding energies of X-ray photoelectron peaks that depends on the magnitude of the surface charging. Consequently, a charge correction method is required for ionic liquids. Here we demonstrate the nature and extent of surface charging in ionic liquids and model it using chronopotentiometry. We report the X-ray photoelectron spectra for a range of imidazolium based ionic liquids and investigate the use of long alkyl chains (C(n)H(2n+1), n ≥ 8) and the imidazolium nitrogen, both of which are part of the ionic liquid chemical structure, as internal references for charge correction. Accurate and reproducible binding energies are obtained which allow comparisons to be made across ionic liquid-based systems.

Erratum: Preoperative assessment for percutaneous and open surgical arteriovenous fistula creation in patients for haemodialysis.

[This corrects the article DOI: 10.1093/ckj/sfz121.][This corrects the article DOI: 10.1093/ckj/sfz121.].

Preoperative assessment for percutaneous and open surgical arteriovenous fistula creation in patients for haemodialysis.

Preoperative assessment prior to surgical arteriovenous fistulas (AVFs) including ultrasound-guided mapping has been shown to have beneficial effects on their immediate success as well as early outcomes. This has led to their wide acceptance and adoption however clinical practice criteria is variable and is reflected in variabilities in practice. When transposing this to percutaneously created endovascular AVFs (endoAVFs), variable preoperative assessment criteria could equally result in variable practice and potentially subsequent and expectant outcomes. We aimed to review literature on reported validated methodologies and workflows of preoperative assessment for surgical AVF creation as reported in highest levels of available evidence, specifically randomized controlled trials. Published practice recommendations and guidelines on best clinical practice as well as systematic reviews and meta-analyses of published studies were also reviewed. Data on practice methodology from identified trial publications and protocols was collated and a summative narrative synthesis was carried out which compared these methodologies to additional assessments that may be required when targeting assessment for percutaneous endoAVF formation, based on our units experience as part of an international multicentre trial. In this review we present a brief overview of published literature and guidelines and propose a unified and uniform workflow for preoperative assessment for surgical AVFs and endoAVFs to aide clinical and imaging practice.