MXene-Derived TiO2/Starbon Nanocomposite as a Remarkable Electrode Material for Coin-Cell Symmetric Supercapacitor.

In this study, the synthesis of a MXene (Ti3C2Tx)-derived TiO2/starbon (M-TiO2/Starbon-800 °C) nanocomposite using a facile calcination method is explored. High-temperature exposure transforms layered Ti3C2Tx into rod-like TiO2 and starbon into amorphous carbon. The resulting M-TiO2/Starbon-800 °C nanocomposite exhibits a significantly larger surface area and pore volume compared to its individual components, leading to superior electrochemical performance. In a three-electrode configuration, the nanocomposite achieved a specific capacitance (Csp) of 1352 Fg⁻¹ at 1 Ag⁻¹, while retaining more than 99% of its Csp after 50 000 charge/discharge cycles. Furthermore, when incorporated into a two-electrode symmetric coin cell, it demonstrates a Csp of 115 Fg⁻¹ along with exceptional long cycle life. Moreover, the device shows an energy density (ED) of 51 Whkg-1 and a power density (PD) of 7912 Wkg-1 at 5 Ag-1. The enhanced charge storage is attributed to the formation of a porous structure with a high specific surface area resulting from the interaction between M-TiO2 nanorods and starbon, which facilitates efficient ion penetration.

Correlation of ABO Blood Group Susceptibility to Disease Severity of SARS-COV-2: An Original Research.

COVID-19, the Ecumenical Pandemic that hit Wuhan, Hubei Province, China, in 2019 has instigated an emergency situation all over the globe. Current scientific corroborations highlighted the role of zoonotic cross-over species transmission for the spread of the deadly virus SARSCoV2. The proposition of ABO blood grouping to susceptibility for various infectious diseases has been documented in the past since blood group antigens constitute polymorphic traits that are inherited among humans, therefore are frequent targets in epidemiological studies. Aim: To correlate the ABO blood group susceptibility to disease severity in COVID-19-positive cases among Indian populations. Objectives: Association of ABO blood group patterns to disease severity in COVID-19-positive cases. Materials and Methods: A cross-sectional, observational study design was conducted among 700 confirmed COVID-19-positive cases admitted to the tertiary health care center in Maharashtra, India. The data collected were subjected to statistical analysis. Results: Blood group 'A' positive was frequent (40%) in severe COVID-19 (E group) disease, and 'O' positive blood group was frequent in moderate COVID-19 disease (34.62%). Conclusion: ABO Blood grouping can be used as one of the efficient biomarker for COVID-19, thereby providing a new platform for therapeutic applications in the field of research.

Auto-PAP Titration Efficacy in Obstructive Sleep Apnea: A Single-Center Experience.

Introduction: Obstructive sleep apnea, often known as OSA, is a sleep-related breathing disease that, if not treated, can lead to serious disabilities or even death. Continuous positive airway pressure (CPAP) is the therapy technique that is suggested for treating severe and moderate OSA. An auto/manual CPAP titration study can be used to determine the appropriate pressure that must be maintained to treat this condition. The motive of this research is to appraise the effectiveness among OSA patients for the auto-PAP titrations. Methodology: A cross-sectional clinical prospective study was conducted at the tertiary care center. Subjects who underwent auto-PAP titration and had a diagnosis of moderate and sever OSA were included. They were evaluated for the efficacy of auto-PAP titration and other demographic features and their association with the titration efficacy. The values were compared for statistical significance. Results: The findings of the study showed that fifty percent of the cohort showed optimal titration, forty percent showed good titration, ten percent showed suitable titration, and none fell into the unacceptable group. Conclusion: According to the findings, using auto-PAP was associated with positive results in those with moderate and severe OSA. There is evidence to suggest that unattended auto-PAP titration is a very successful technique that might be regarded as a substitute for attended CPAP titrations. This would result in a reduction in the amount of labor required and the price.

Toripalimab, a therapeutic monoclonal anti-PD-1 antibody with high binding affinity to PD-1 and enhanced potency to activate human T cells.

Over the past decade, US Food and Drug Administration (FDA)-approved immune checkpoint inhibitors that target programmed death-1 (PD-1) have demonstrated significant clinical benefit particularly in patients with PD-L1 expressing tumors. Toripalimab is a humanized anti-PD-1 antibody, approved by FDA for first-line treatment of nasopharyngeal carcinoma in combination with chemotherapy. In a post hoc analysis of phase 3 studies, toripalimab in combination with chemotherapy improved overall survival irrespective of PD-L1 status in nasopharyngeal carcinoma (JUPITER-02), advanced non-small cell lung cancer (CHOICE-01) and advanced esophageal squamous cell carcinoma (JUPITER-06). On further characterization, we determined that toripalimab is molecularly and functionally differentiated from pembrolizumab, an anti-PD-1 mAb approved previously for treating a wide spectrum of tumors. Toripalimab, which binds the FG loop of PD-1, has 12-fold higher binding affinity to PD-1 than pembrolizumab and promotes significantly more Th1- and myeloid-derived inflammatory cytokine responses in healthy human PBMCs in vitro. In an ex vivo system employing dissociated tumor cells from treatment naïve non-small cell lung cancer patients, toripalimab induced several unique genes in IFN-γ and immune cell pathways, showed different kinetics of activation and significantly enhanced IFN-γ signature. Additionally, binding of toripalimab to PD-1 induced lower levels of SHP1 and SHP2 recruitment, the negative regulators of T cell activation, in Jurkat T cells ectopically expressing PD-1. Taken together, these data demonstrate that toripalimab is a potent anti-PD-1 antibody with high affinity PD-1 binding, strong functional attributes and demonstrated clinical activity that encourage its continued clinical investigation in several types of cancer.

A green one-pot synthetic protocol of hexahydropyrimido[4,5-d]pyrimidin-4(1H)-one derivatives: molecular docking, ADMET, anticancer and antimicrobial studies.

Ten hexahydropyrimido[4,5-d]pyrimidine derivatives have been synthesized by using a green and time-efficient microwave method. The synthesized motifs were evaluated for their anticancer activity, antimicrobial activity, molecular docking, drug likeliness and ADMET studies. Comparatively, the hetero-aromatic pyrazole substituted compound 4a exhibited the highest anticancer activity [Mean growth percent: 35.57], while EDG [-N(CH3)2] substituted compound 4i indicated very good activity [Mean growth percent: 60.92] against various cell lines. From the computational studies, Compound 4a passed the drug-likeness and ADME properties, fewer toxic properties, and potent inhibitory potential against the RIPK2 with significant binding affinity. In-silico molecular docking revealed that the compound 4a has significant binding energy (- 9.8 kcal/mol) and dissociation constant (0.54 µM) properties. Additionally, synthesized motifs were evaluated for antimicrobial activity by MIC referencing the standards. According to the SAR evaluations, the compounds 4f (4-NO2), 4g (3-NO2), and 4h (2-Cl) that include EWGs substituted aldehydes performed well as antimicrobials against selected bacterial and fungal strains. Thus, the synthesized pyrimido[4,5-d]pyrimidine with the heterocyclic and EWGs substituents could act as a potential candidate after further structural optimization for anticancer and antimicrobial drug discovery, respectively.

Unprecedented Multifunctionality in Novel Monophase Micro/Nanostructured Ti-Zn Alloy.

It is always challenging to integrate multiple functions into one material system. However, those materials/devices will address society's critical global challenges and technological demands if achieved with innovative design strategies and engineering. Here, one such material with a broader spectrum of desired properties appropriate for seven applications is identified and explored, and a glucose-sensing-triggered energy-storage mechanism is demonstrated. To date, the Titanium (Ti)-Zinc (Zn) binary alloys are investigated only as mixed phases and for a maximum of three applications. In contrast, the novel single phase of structurally stable 50 Ti-50 Zn (Ti0.5 Zn0.5 ) is synthesized and proven suitable for seven emerging applications. Interestingly, it is thermally stable up to 750 °C and possesses excellent mechanical, tribological properties and corrosion resistance. While exceptional biocompatibility is evident even up to a concentration of 500 µg mL-1 , the antibacterial activity against E. coli is also seen. Further, rapid detection and superior selectivity for glucose, along with supercabattery behavior, unambiguously demonstrate that this novel monophase is a remarkable multifunctional material than the existing mixed-phase Ti-Zn compounds. The coin-cell supercapacitor shows outstanding stability up to 30 000 cycles with >100% retention capacity. This allows us to prototype a glucose-sensing-triggered energy-storage-device system for wearable point-of-care diagnostic applications.

Rates and determinants of fast chronic kidney disease progression distinguished by nutritional status, and the impact of malnutrition on mortality - evidence from a clinical population.

BACKGROUND & AIMS: Malnutrition is a serious problem that influences morbidity, mortality, functional activity, and quality of life in patients with chronic kidney disease (CKD). However, there has not been much research done on how nutritional status appears to affect mortality in non-dialysis CKD patients. This study aimed to recognize the rates and predictors of fast CKD progression distinguished by nutritional status, and also sought to determine the impact of malnutrition on mortality in non-dialysis CKD patients. METHODS: This prospective cohort study (n = 360) involved non-dialysis CKD patients with index estimated glomerular filtration rate (eGFR) between the range of 15-89 ml/min/1.73 m2. Nutritional status was evaluated by using the "Pt-Global web tool/PG-SGA". A loss of eGFR >4 ml/min/1.73 m2 per year was considered to be a sign of fast CKD progression. Kaplan-Meier plots were used to evaluate the cumulative survival, and Cox-proportional hazard models were used to analyze the renal outcomes. RESULTS: Around 244 (67.8%) of patients have experienced a fast decline in kidney function. In the malnourished group, systolic blood pressure and hyperphosphatemia were observed to have increased hazards for fast CKD progression. The overall incidence of mortality and composite endpoints were found to be 13.9% & 37.6%, respectively. Death rates (11.6%) and composite endpoints (29.8%) were higher in the malnourished (severe & moderate) group. Cox regression hazard model reported 4 times increased hazards for death [HR 4.41 (1.99-9.77) 95% CI; P ≤ 0.005] and 3 times increased hazards for composite endpoints [HR 3.29 (2.10-5.16) 95% CI; P ≤ 0.005] for 'severely malnourished' category in reference to 'normal nutrition' category. CONCLUSIONS: Fast CKD progression was observed to be more common in malnourished patients. Systolic blood pressure and hyperphosphatemia were recognized as potential predictors of fast CKD progression. Moreover, malnutrition was found to be a significant predictor of mortality among non-dialysis CKD patients. The findings of this study advocate for early nutritional evaluation and timely dietary interventions to halt the progression of CKD.

Comparative evaluation of different debonding and reconditioning methods for orthodontic ceramic brackets regarding effectiveness for reuse : An in vitro study.

PURPOSE: To investigate the reusability of ceramic brackets in terms of shear bond strength, friction behavior, slot dimension, fracture strength, and color stability. METHODS: A total of 90 conventionally debonded and 30 by an Er:YAG laser debonded ceramic brackets were collected. All the used brackets were inspected under a stereomicroscope at 18 נmagnification and sorted according to their adhesive remnant index (ARI). Five groups were formed (n = 10): (1) new brackets as a control group, (2) flamed and sandblasted, (3) flamed and acid bathed, (4) laser-reconditioned, and (5) laser-debonded brackets. The bracket groups were tested regarding different properties such as shear bond strength, friction behavior, slot size, fracture strength, and color stability. Analysis of variance (ANOVA) and nonparametric Kruskal-Wallis tests were used for statistical analysis (significance level: p < 0.05). RESULTS: Shear bond strength values of the acid reconditioned brackets were significantly lower (8.0 ± 3.1 MPa) compared to the control group (12.9 ± 2.9 MPa). Laser-reconditioned (32.8 ± 2.7%) and laser-debonded (30.9 ± 2.4%) brackets showed the lowest force loss due to friction (control group 38.3 ± 3.0%). No significant differences were observed between groups regarding slot size and fracture strength. All groups had color differences of [Formula: see text]< 10. Scanning electron microscope images and ARI scores indicated that most of the residues on the bracket bases were removed. CONCLUSION: All reconditioning methods yielded adequate results regarding bracket properties. Yet, focusing on the need to protect the enamel and the bracket base, laser debonding seems to be the most suitable method for reconditioning ceramic brackets.

Rational synthesis, anticancer activity, and molecular docking studies of novel benzofuran liked thiazole hybrids.

A novel series of benzofuran bearing thiazole hybrids were synthesized by the multistep reaction approach. All synthesized molecules were selected by the National Cancer Institute, USA for one-dose anticancer activity against 60 various human cancer cell lines indicating nine types of cancer. Among thirteen compounds, two compounds showed higher lethality, so, it was selected for five-dose anticancer screening against all cancer cell lines. Compound 8g and 8h were displayed remarkable antiproliferative activity with GI50 values ranging from 0.295 to 4.15 µM and LC50 values ranging from 4.43 to > 100 µM. All data are compared with standard drugs fluorouracil and doxorubicin. Compound 8g showed higher potency as a cytotoxic molecule then fluorouracil. Furthermore, all new hybrids were studied for molecular docking into the active binding sites of 1HOV protein.

Quality of Life Postchronic Tonsillitis Treatments: An Original Research.

Introduction: The tonsillectomy is a common surgical procedure performed for the treatment of chronic tonsillitis (CT). In the present study, we aim to evaluate the quality of life (QOL) after CT. Materials and Methods: We conducted a retrospective study among 100 tonsillectomy patients whose data were collected from the department records. The QOL was evaluated using the "Glasgow Benefit Inventory." We assessed various parameters pre-and post-surgery. We deliberated P < 0.05 as significant when comparing the pre-and post-surgical QOL. Results: We observed that of the 100 subjected selected for the study, there was a significant improvement in the QOL and the disease severity variables. Conclusions: The tonsillectomy for the treatment of CT among adults has improved the QOL of the patients. Overall patients' health conditions and professional life improved after the procedure.

Evaluation of Efficiency of Dyes in Detection of Cancer Cells: An Original Research.

Introduction: The early detection of the cancer will dramatically improve the prognosis. There are many diagnostic aids that can be employed for screening. Hence, in our study, we aim to evaluate the efficiency of dyes in detection of cancer cells. Materials and Methods: We piloted a prospective clinical study among 30 subjects to detect the efficiency of two dyes-Lugol's iodine and toluidine blue. They were grouped equally for potentially malignant and malignant lesions. The areas were analyzed for the diagnostic accuracy of the dyes using the histopathological examination and compared using chi square test deliberating P < 0.05 as significant. Results: We observed that both the dyes showed a diagnostic accuracy of over 90% when used alone or in combination. Both the dyes had greater sensitivity while specificity was 20%. Conclusion: The combination of these two dyes can be used as an efficient screening aid for the identification of the cancer cells.

Improved photocatalytic activity of TiO2 nanoparticles through nitrogen and phosphorus co-doped carbon quantum dots: an experimental and theoretical study.

In this work, we develop a photocatalyst wherein nitrogen and phosphorus co-doped carbon quantum dots are scaffolded onto TiO2 nanoparticles (NPCQD/TiO2), denoted as NPCT hereafter. The developed NPCT photocatalyst exhibits an enhanced visible light photocatalytic hydrogen production of 533 µmol h-1 g-1 compared to nitrogen doped CQD/TiO2 (478 µmol h-1 g-1), phosphorus doped CQD/TiO2 (451 µmol h-1 g-1) and pure CQD/TiO2 (427 µmol h-1 g-1) photocatalysts. The enhanced photocatalytic activity of the NPCT photocatalyst is attributed to the excellent synergy between NPCQDs and TiO2 nanoparticles, which results in the creation of virtual energy levels, a decrease in work function and suppressed recombination rates, thereby increasing the lifetime of photogenerated electrons. A detailed mechanism is proposed for the enhancement in visible light hydrogen production by the NPCT photocatalyst from the experimental results, Mott-Schottky plots and ultraviolet photoelectron spectroscopy results. Further, first-principles density functional theory (DFT) simulations are carried out which predict the decrease in the work function and band gap, and the increase in the density of states of NPCT as the factors responsible for the observed enhancement in visible light photocatalytic hydrogen production.

Investigation of thermoluminescence and photoluminescence properties of Tb3+, Eu3+, and Dy3+ doped NaYF4 phosphors for dosimetric applications.

Hexagonal phase sodium yttrium fluoride activated with lanthanide ions; Tb3+, Eu3+ and Dy3+ doped NaYF4 phosphors were synthesized using a simplistic hydrothermal method. The photoluminescence studies demonstrated green, red and blue emission lines corresponding to 5D4 → 7FJ (J = 6, 5, 4, 3), 5D0 → 7FJ (J = 1, 2 and 4) and 4F9/2 to 6HJ (J = 15/2 and 13/2) transitions, which are characteristic of Tb3+, Eu3+ and Dy3+ ions, respectively. The as-synthesized samples were subjected to annealing at varying temperatures from 500 °C to 800 °C primarily for the optimization of the thermoluminescence glow curve. Meanwhile, we studied the influence of thermal annealing treatment on the crystal phase, morphological features, and photoluminescence properties of the phosphors. The spherical-like morphology of NaYF4:Tb3+ phosphor changed to micro block-like structures and the hexagonal phase of NaYF4 transforms into a cubic phase at a higher annealing temperature of ∼800 °C. The photoluminescence emission intensity also varied at different annealing temperatures. The systematic study using different dopants and annealing temperatures was carried out to accomplish efficient thermoluminescence (TL) properties. The most suitable TL dosimetric glow peak was attained for NaYF4:0.5%Tb3+ phosphor, which was annealed at a temperature of 800 °C, located at 194 °C. The NaYF4:Tb3+ phosphor exhibited TL response fairly linear in the dose range from 1 kGy to 25 kGy of gamma radiation. The phosphor showed TL response at higher doses, which stipulates that the NaYF4:Tb3+ is reasonably well suitable for high dose measurements and respective applications. The phosphor exhibited negligible fading and good reproducibility features. Trap-level analysis and experimental determination of activation energy were performed using the Tm-Tstop technique and initial rise method (IRM). The trapping parameters of the TL glow curve, such as activation energy (E), order of kinetics (b), and frequency factor (s) were estimated by Chen's glow peak shape (PS) method and glow curve deconvolution (GCD) method. The trapping parameters obtained using the IRM, PS and GCD methods are in good accordance with each other. Henceforth, along with efficient photoluminescence properties, the NaYF4:Tb3+ phosphor exhibited favorable thermoluminescence dosimetric properties. Consequently, this study provides new opportunities for utilizing these phosphors in the area of radiation dosimetry applications such as environmental and food monitoring, space dosimetry etc.

Activity measurement of mixed complex radionuclide like 152Eu with different methods.

152Eu has been standardized by three independent 4π ß-γ coincidence counting systems with beta detectors as proportional counter, plastic scintillator and liquid scintillator along with the CIEMAT/NIST method. The average activity concentration by primary methods was linked to key comparison reference value (KCRV) by comparing it with that of 4π γ ionization chamber (GIC) whose calibration factor was determined from the KCRV (BIPM.RI(II)-K1.Eu-152 and CCRI(II)-K2.Eu-152) and deviates from GIC by ± 0.16% indicating good agreement within standard uncertainties.

Predictors of outcome in diabetic patients undergoing infrapopliteal endovascular revascularization for chronic limb-threatening ischemia.

OBJECTIVE: The incidence of chronic limb-threatening ischemia in diabetic patients is increasing. The factors influencing outcome after infrapopliteal revascularization in these patients are largely unknown. Therefore, this study aims to identify the impact of perioperative glucose control on the long-term outcomes in this patient cohort, and furthermore to identify other factors independently associated with outcome. METHODS: Consecutive diabetic patients undergoing infrapopliteal endovascular revascularization for chronic limb-threatening ischemia were identified. Patients' demographics, procedural details, daily capillary blood glucose, and hemoglobin A1C levels were collected and analyzed against the study end points using Kaplan-Meier and Cox regression analysis. RESULTS: A total of 437 infrapopliteal target vessels were successfully crossed in 203 patients. Amputation-free survival by Kaplan-Meier (estimate (standard error)%) was 74 (3.3)% and 63 (3.7)%, primary patency was 61 (4.2)% and 50 (4.9)%, assisted primary patency was 69 (5.2)% and 55 (6.1)%, and secondary patency was 71 (3.8)% and 59 (4.1)% at 1 year and 2 years, respectively. Cox regression analysis showed high perioperative capillary blood glucose levels to be an independent predictor of binary restenosis (hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.31-1.1.78; P = .015). Postprocedural dual-antiplatelet therapy was found to be an independent predictor of amputation-free survival (HR, 1.69; 95% CI, 1.04-2.75; P = .033), and freedom from major adverse limb events (HR: 1.96; 95% CI, 1.16-3.27; P = .023) and baseline estimated glomerular filtration rate was significantly associated with better amputation-free survival (HR, 0.52; 95% CI, 0.31-0.87; P = .014). CONCLUSIONS: Poor perioperative glycemic control is associated with a higher incidence of restenosis after infrapopliteal revascularization in diabetic patients. Dual antiplatelet therapy is associated with better outcomes in this group.

South Indian zebu dwarf cattle show higher natural resistance to tick infestation compared to crossbreds: preliminary observations.

The present study aimed to evaluate the influence of various factors on the host resistance of cattle against tick infestation in Kerala State, South India. The number of naturally infested semi-engorged female ticks present on the cattle was counted on a sample cattle population across the four regions of Kerala. Then, the animals were grouped based on the tick count. The chi-square test and Fisher exact test were used to identify the effects of genetic and non-genetic factors on tick burden in cattle. It was found that the Holstein Friesian crossbred and Jersey crossbred cattle had a significantly higher level of tick infestation than the indigenous Vechur breed (Bos indicus). No tick infestation was observed in indigenous Kasaragod Dwarf cattle (B. indicus). Tick infestation was more in heifers and dry animals than lactating animals. However, the sex of the animal and the stage of lactation did not influence the tick load. Tick infestation was also influenced by parity, grazing, and region.

Covalent conjugation of single-walled carbon nanotube with CYP101 mutant for direct electrocatalysis.

Covalent linkage between the single-walled carbon nanotube (SWCNT) and CYP101 through a specific site of the enzyme can provide a novel method of designing efficient enzyme electrodes using this prototype cytochrome P450 enzyme. We have chemically modified the SWCNT with linker 4-carboxy phenyl maleimide (CPMI) containing maleimide functional groups. The enzyme was covalently attached on to the SWCNT through the maleimide group of the linker (CPMI) to the thiolate group of the surface exposed Cys 58 or Cys 136 of the CYP101 forming a covalently immobilized protein on the nanotube. Thin film of the modified SWCNT-CPMI-CYP101conjugate was made on a glassy carbon (GC) electrode. Direct electrochemistry of the substrate (camphor)-bound enzyme was studied using this immobilized enzyme electrode system and the redox potential was found to be -320mV vs Ag/AgCl (3 M KCl), which agrees with the redox potential of the substrate bound enzyme reported earlier. The electrochemically driven enzymatic mono-oxygenation of camphor by this immobilized enzyme electrode system was studied by measurement of the catalytic current at different concentrations of camphor. The catalytic current was found to increase with increasing concentration of camphor in presence of oxygen. The product formed during the catalysis was identified by mass-spectrometry as hydroxy-camphor.

Standardisation of 133Ba by efficiency extrapolation method and calibration of ionisation chamber.

133Ba has been standardised by direct measurements for the first time in the laboratory using two counting systems: (i) the 4πß (plastic scintillator) -γ coincidence, (ii) the 4πß (proportional counter) -γ coincidence. Furthermore, this standardisation experiment demonstrates the performance and applicability of the recently developed 4πß (plastic scintillator)-γ coincidence system for radionuclides decaying with complex decay schemes as well as for e, X-γ emitters. Additionally, 133Ba solution standards were prepared to calibrate the pressurized 4π γ ionisation chamber and determination of the calibration coefficient. The En score is a statistical indicator of the agreement between two independent estimations. Thus, the performance of the PS system was compared to the result obtained with the PC system using the En score as specified in the ISO13528:2015. The results of measurements are acceptable if En â‰¦ 1.0. An En score of 0.2 was obtained which indicates that, the 133Ba activity concentration obtained by the 4πß (plastic scintillator) -γ coincidence and 4πß (proportional counter) -γ coincidence systems are in agreement. This paper presents the standardisation procedure, the results obtained by the measurements and their comparison.

Outcomes of open and hybrid treatments in below the knee pathology for critical limb threatening ischemia.

INTRODUCTION: The optimal management of below the knee pathology remains one of the most challenging areas for revascularization in patients presenting with critical limb threatening ischemia. Patients commonly have multilevel lesions and have a high amputation rate and associated mortality. This review aimed to assess the outcomes of below the knee revascularization strategies. EVIDENCE ACQUISITION: An online literature search of medical databases for original articles or review articles was conducted using mesh terms. EVIDENCE SYNTHESIS: Bypass surgery remains the gold standard for revascularization with good long-term outcomes with regards to patency, limb salvage, and quality of life but is associated with a higher morbidity than the endovascular approach. Given the increasing frailty of our patients, endovascular treatments have become the preferred strategy with results that are now equal to bypass. Hybrid surgery is an increasingly popular option as it combines the benefits of both endovascular and open surgery and although the evidence base is small the outcomes are encouraging. CONCLUSIONS: Hybrid surgery offers promising results and could be considered in the treatment of multi-level lower limb arterial disease especially in high-risk patients or those who are not suitable for either open or endovascular techniques as a sole treatment modality.